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THE GREENHOUSE SCHOOL - ESTABLISHMENTSi THE GREENHOUSE SCHOOL 145 LORING AVENUE '4I � ll a 3 u •. f .wn� .ri.r..r. y»ywniw .l.w.enre?�ia �. •n y. ....Ya ..."� a� �µ ... r. _ RA; T ei ..YiF F S I! ij i a 0 to Q „ it w r Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of FOOD ESTABLISHMENT INSPECTION REPORT Address: Tel Name //� � � 110- PLS Zo D e Pagel age of Pages T pe of Operation(s) food Service ❑ Retail Type of Inspection ❑ Routine Re -inspection Address Jr_ Risk Telephone l _ Level ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. reviouto;, pl s Ion Date: (L ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑Other Owner .I HACCP YIN Person -in -Charge (PIC) Time In: In . Inspector Each violation checked rer{uires an explanation on the narrative pages) and a citation of specific provision(s) violated. + Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) AMI -Choking 590.009 (E) ❑ Violations marked may pose an imminent health hazard and require Imm dlate Tobacco 590.009 (F) ❑ y p q Alle�gn Awareness 590.009 (G) ❑ corrective action as determined by the Board of Health. �1�5 I /a�'�trp FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Reoords/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices- (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003)' 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FCa)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEREMPERATURE CONTROLS (Potentially Hazardous Foods) [:116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLYSUSCEPrIBLE.POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for' Correction: Based on an in ection 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: Pagel age of Pages PICS Signature: Print: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT I 590.003(A) Asim irient of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590 006(A) Charge* 590.006(B) 590.003(0) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C 6 C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CAtR 590.000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A-13) 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 Drinkim, Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recrcalionally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Musluooms* 3-20L17 Game Animals* Receiving/Condition 3-202.11 PI-IFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* 11 Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590 004(J) Labeling of Ingredients* 12 Conformance with Approved Procedures I ACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CAtR 590.000. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302. I I (A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food'Protection* 3-30215 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-30614(A)(13) Resumed Food and Reser-vice 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 Smtilim ion Temperatures* 4-501.112 Mechanical Warewashing- Her Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness.* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food- - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of l-bmsils 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 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 prevenline Contamination When Timing* 12 Prevention of Contamination from Hands 590.004(F-) Preventing, Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203,11 Numbers and Capacities* 5-204.11 Local ion and Placement* 5-205.11 Accessibility, Operation mid Maintenance Supplied with Soap and Hand Drying Devices 6-301.11. Handwashiiv, Cleanser, Avai lobi lit 6-301.12 Hand Drying Provision Massachusetts Department of ;Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4"' Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of FOOD ESTARI ISHMFNT INSPFC inN RFPART Address: Tnl NameD e Type of Operation(s) Ty, a of Inspection - I Ir'� od Service 'LJ Retail utine Re -inspection �� Address K� 'sk r Level El Residential Kitchen ❑ Mobile ElTemporary Previous Inspection Date: ElPre-operationt Telephone P _ C OwnerHACCP ( YIN e ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑General Complaint Person -in -Charge (PIC) Time In:ElHACCP Inspector Out�23 Permit No. ❑.Other macn violation CneCxea requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Norrcomjoliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned/Knowledgeable/Duties .+ 'EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel Wth Infections Restricted/Excluded FOOD 'FROM APPROVED SOURCE- ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition 11 ❑ 6. Tags/Records/Accuracy. of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION - ❑ 8. Separation/Segregation/Protection . Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing - ❑ 11. Good Hygienic Practices - Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)[590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment.and Utensils (FC -4x590.005) 26. Water, Plumbing and Waste (FC5)(590.006) 27. Physical Facility (FC -6x590.007) 28. Poisonous or Toxic Materials, (FC -7x590.008) 29. Special Requirements (590.009) 30. Other 3: b". �7 1 Anti -Choking 590.009 (E) ❑ Tobacco. 590.009 (F) ❑ Allergen Awareness 590.009 (G) ❑ ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROWCHEMICALS- ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals - JTIMEREMPERATURE"CONTROLS (Potaatlalty Mazartlous,F.00ds)�, 'm-. ]. [116. Cooking Temperatures ❑ 17. Reheating [118. Cooling X19. Hot and Cold Holding [120. Time as a Public Health Control REQUIREMENTS FOR HIGHLY4USCEPTIBLE-POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Oficial Order for Connection: 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 older. DATE OF RE -INSPECTION: S�sr`S, l(a �1 Inspector's Signature: Print: - PICsSignature:Print: - Page of ages I/ Uv ✓ v �- i I , 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 KnowledLCL_ __ 2-103.1.1 Person in char e -duties MIDI nVFF 14FAI TH 2 C 6 C __590 003(C) Responsibility of the person in charge to Compliance w;ihrood. Law'' - 3-201-12 require reporting by food employees and 3-20 1. 13 Fluid Milk and Milk Products* a zlicants* _ Shell E s" 590.003(F) Responsibility Of A Pont 3tnployee Or An 3-202.16 lee Made From Potable Drinking Water* Applicant To Report To The Person In D inkin Water from un A roved System* 590.006(A) Chare* 590.006(B) 590.(N)3(G) Re rrt n b Person in Clharee* 3 590.003(D) Exclusions and Restrictions* --T201. 15 590.003(3) Removal of Pxciusions and Restrictions C 6 C -Denotes critical item in Lire federal 1999 Poon Code, or 105 CMR 590.0(H). I PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B7 Compliance w;ihrood. Law'' - 3-201-12 Focal in a Herneticall Sealed Container* 3-20 1. 13 Fluid Milk and Milk Products* 3-202..13 Shell E s" 3-202.14 F, as and Milk Products. Pasteurized* 3-202.16 lee Made From Potable Drinking Water* 5-1011.1 D inkin Water from un A roved System* 590.006(A) Bottled Drinkin Watez'r 590.006(B) Water Meets Standards in 310 CMR 22.0* Washitt Fmits and Va xtables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* --T201. 15 Molluscan .Shdifishfrom NSSPListed Sources* _ Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock MentifieationPresent* 590.004(0) Wild Mushrooms* 3-201.17 Game Animals* _ 3-701.11 Receiving/Condition 3-202.11 - PHFs Received at Proper Temperatures* 3-202.1.5 Package huecrit * 3-iftl I Food We and Unadulterated TagsfRecords: Shelistock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation arid Retention* 590.004(7) Labeling of Ingredients' Cleaning Frequency ol'Equipment Food - Contact Surfaces and Utensils* Conformance with Approved Procedures '.. 1HACCP Plans _3-502 11 S eeiaFized Proeessin Methods* 3-502.12 Reduced oxygen packaLqing, arteria* 8-103.12 Conformance with A. loved Procedures* -Denotes critical item in Lire federal 1999 Poon Code, or 105 CMR 590.0(H). I PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(l.I Raw Animal Foods Separated from C(x)ked and RTE Foods* Contamination from Raw Ingredients 3-302-11(A)(2) Raw Animal Foods Separated from Each Other* - Contamination from the Environment 3-302.1l(A) Food Protection* 3-302-15 Washitt Fmits and Va xtables 3-304.11 - Food Contact with Equipment and Utensils* Contamination from the Consumer 3-30614(A)(13) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food-_ -._- 9 Food Contact Surfaces 4501.111 Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- HotWater Sanitization Temperatures* _ 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. 4-60t. Il (A) - .Equipment Food Contact. Surfaces and Utensils Clean" 4-602.1 t Cleaning Frequency ol'Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Folli Contact Surfaces of Equipment* 4-703..11 Methods of Sanitization- Hot Water a'nd. Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Amus" 2-301.12 Cleanin , Procedure* 2-301.14 When to Waslr* it Good Hygienic Practices 2-401-11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-'_03.11. Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-30111 Handwashing Cleanser, Availabilit 6-301.12 Hand D - *Provision Establishment CITY OF SALEM BOARD OF HEALTH Date::�Gl�/(z Page: _-r of �— nem Code No. Reference C -Critical Rem R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date verified PLEASE PRINT CLEARLY _ r s " n/ T 14 i 'V23" E r Q; C o DY: U G� rt f n rr -- �I t!r 1 7 Nl�a n t I r- wiz , aU - - i e �.tir a 170°F 77°C Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of tty-fie d liars r s nsion/revocation of your food permit. wen Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion pection scheduled (3 Emergency Suspension j 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 TIMElrEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-801,11(C) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Co mason 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 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 Monitonn * TIMElrEMPERATURE CONTROLS * Denotes mlical item in the federal 1999 Food Code m 105 CMR 590.000. Proper Cooking Temperatures for Cooling Methods for PHFs PHFs 3-401.11A(I)(2) Eggs- 155'F 15 Sec. 3-801,11(C) Eggs- Immediate Service 1450F15sec* 3-401.1 I(A)(2) Comminuted Fish, Meals & Game 3-501.16(A) Animals - 1550F 15 sec. * 3-401.1 l(B)(1)(2) Pork and Beef Roast -130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 15501' 15 sec. 26. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, 590.004(H) Poultry or Ratites -1650F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FC - 7 1450F * 3-401.12 Raw Animal Foods Cooked in a Microwave 1650F 3-401.11(A)(1)(1)) All Other PHFs- 14501' 15 sec. Reheating for Hot Holding 3-403.11(A)&(I)) PRFs 1650F 15 see * 3-403.11(13) Microwave- 1650 F 2 Minute Standing Time* 3-403.11(0) Commercially Processed RTE Food - 1400F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PRFs from 1400F to 7001,'Within 2 Hours and From 700F to 410F/450F Within 4 Hours. * 3-501.14(B) Cooling PHI's Made From Ambient Temperature Ingredients to 4101"/4501' Within 4 1 -lours* 3-501.14(C) PI-IFs Received at Temperatures Accoidine to Law Cooled to 410F/450F Within 4 Hours. * * Denotes mlical item in the federal 1999 Food Code m 105 CMR 590.000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSPI 3-801.11(A) 3-501.15 Cooling Methods for PHFs 19 3-801,11(D) PHF Hot and Cold Holding 3-801,11(C) 3-501.16(13) 590.004(1-) Cold PHFs Maintained at or below 410/450 F* Food and Food Protection 3-501.16(A) Hut PHFs Maintained at or above 1400F.* 25. 3-501.16(A) Roasts Held at or above 130'F. 20 26. Time as a Public Health Control FC - 5 3-501.19 Time as a Public Health Control* Physical Facility 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSPI 3-801.11(A) Unpasteurized Pre-packaged.luicesand Beverages with Warning Labels* 3-801.11 B Use of Pasteurized I- s* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801,11(C) Unopened Food Package Not Re -served. 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 FC - 3 pathogens.* e"0 h" 11120°1 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* AYCI IAL KCtAU1KCIYICN 1 J 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 429 - Special Requirements. TO GOOD RETAIL PRACTICES (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk facmrs listed above, can be ,found in the following sections of the Food Code and 105 CMN 590-000- . Item Good Retail Practices FC 590.000 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. Special Requirements .009 30. Other S 5%f-b:rc±aa I r OF SALEM )ARD OF HEALTH f Date: 6 Pager of e7`"1 C M 61:M RZCI�te DESCRIPTION OF VIOLATION i PLAN OF CORRECTION PLEASE PRINT CLEARLY r�lli_t�I�i� as rlT'� • . riT�Tii.►�7.:V�/SWAM � 17 F1811 NIM =I �ta,`� _.-- -- 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 twent five 4ollars or suspension/revocation of your ... 77L3 Corrective. ction Required: ComplianceDiscussion C3 Voluntary .. Exclusion �s�pection Scheduled [3 Emergency Suspension 0 Embargo a Emergency Closure Voluntary Disposal e7`"1 I Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS F1 _4 15 16 17 18 TIME/TEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-801.11(C) Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-102.11 Cominon 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 A gents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-2(16.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Proper Cooking Temperatures for Cooling Methods for PHFs PHFs 3-401.11A(l)(2) Eggs- 155"F 15 Sec, 3-801.11(C) E s- Immediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game -3-501.16(A) Animals - 155°F 15.sec-* 3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 sec. 26. R 3-401.11(A)(3) Poultry, Wild Game, Stuffed PRFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, 590.004(H) Poultry or Ratites -165°F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FC - 7 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * r 3-401 A I(A)(1)(b) All Other PHFs -145"1715sec. * Reheating for Hot Holding 3-403.11(A)&(U) PHFs 165°F 15 sec. * 3-403.11(13) Microwave- 165° F 2 Minute Standing "I inle* 3-403.1 I (C) Commercially Processed RTE Food - 140°F• 3-403.1](E) Remaining Unsliced Portions of Beef Roasts* • Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PRFs from 1407 to 70°F Within 2 Hours and From 70°F to 41 °F/45°F Within 4 Hours. * - 3-501.14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F/45°F Within 4 Hours* 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Bouts. * * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 21 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSPI 3-801.11(A) 3-501.15 Cooling Methods for PHFs 19 3-801.11(l)) PHF Hot and Cold Holding 3-801.11(C) 3-501.16(13) 590.004(17) Cold PHYs Maintained at or below 410/45017* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*_ -3-501.16(A) Hot PHFs Maintained at or above 140cR * 25. 3-501.16(A) Roasts Held at or above 1307. 20 26. Time as a Public Health Control FC - 5 3-501.19 Time as a Public Health Control* Physical Facility 590.004(H) Variance Requirement 21 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSPI 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wanting Labcls* 3-801.11(B) Use of Pasteurized Eggs* 3-801.11(l)) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Food Package Not Re -served CONSt1MFR ADVISORY 22 3-601,11 Consumer Advisory Posted for Consumption of FC Animal Foods That are Raw, Undercooked or 23. Not Otherwise Processed to Eliminate FC - 2 Pathogens.* frtuc61" "' 24. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*_ arCuIAL KCUU1KC1V1CN 10 590.009(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 429 - Special Requirements. (Items 23-30) Critical and non-crincal violations, which do not relate to the ,foodborne dlness intetmentions and risk./actors listed above, can he ,found in thefollowing sections of the Food Code and 105 CMI? 590.000. Item Good Retail Practices FC 590.000 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 26. Poisonous or Toxic Materials FC - 7 .006 I 29. Special Requirements .009 30. Other S 5ormo.k1' e d Kimberley Driscoll Mayor City of Salem, Massachusetts - Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 PublicHealth; health@salem.com Trevent. promote: Proieer., Larry Ramdin, MPH, RENS, CHO Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2017 Permit Number: FM -16-659 Permit Type: Food Establishment < 25 seats Goods & Services: Food Service: Non -Profit Name of License Holder: Corporation Greenhouse School Name of Food Establishment The Greenhouse School, Inca Address of Food Establishment 145 Loring Avenue Salem MA 01970 Restrictions: This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2017 unless sooner suspended or revoked. Permit Fee: $0.00 G. Effective: 12/21/2016 Larry Ramdin, MPH, REHS, CHO Health Agent r CITY OF SALEM, MASSACHUSETTS BOARD OF HEMA'14 120 WASHINGTON S1RF.,E'P, 4"' FLOOR KIMBERLEY DRISCOLL TF.L. (978) 741-1800 FAX (978) 745-0343 MAYOR health@salem.com LARRY RAMDIN, RS/RENS, CHO, CP -FS HEALTH AGENT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: 2) Establishment Address:-r-p'AVC 3) Establishment Mailing Address (if different): S C� 4) Establishment Telephone No: 5) Applicant Name & Title: cvi e., W 1✓t �°iG 6) Applicant Address: 7) Applicant Telephone No: 24 Hour Emergency No: S�1-IEimail: CV p& 'k to LeiD- 6) Owner Name & Title (if different from applicant): 9) Owner Address (if different from applicant): S G- 10) Establishment Owned by: An association iCt x3 A corporation V— An individual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Titre' Home Address \ N 12 Person Directly Res onsible For Daily OperationsPerson in Charge, Supervisor, M a er, etc. Name & Title: Owner, W dC,(A 0i Ij Vt; Address: Telephone No: �j � R n S-` < q[ Fax: ga VV -e--. Email: Ste• �� VtQ, Emergency Telephone No: srli/�v.e. 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check #:�661 Date: /�� / /� Amount: �� Food Establishment Information Offers RTE PHF in Bulk Quantities To be completed by the Board o(Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I, the undersigned, attest to the accuracy of the information provided in 590.000 and he Federal F o0d Code.complwith 105 CMR 590.00 and all °the/5pplicable(tr 1 have/eery 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of Have filed all state tax returns and paid state taxeyequ` e l 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: application. and I affirm that the food establishment operation will acted by the Board of Health on how to obtain copies of 105 CMR that I, to my best knowledge and belief, 14) Water Source: 15) Sewage Disposals DEP Public Water Supply No: ( if applicable) G( 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( if 25 seats or more): VeYes No 20) Location: 22) Establishment Type (check all that apply) (check one) 13 Retail ( Sq. Ft) 10 , O Caterer Permanent Structu& 0 Food Service - ( Seats)) O Frozen Dessert Manufacturer Mobile C3 Food Service - Takeout O Residential Kitchen for Retail Sale 0 Food Service — Institution 0 Residential Kitchen for Bed and ( Meals/Day) SC/�I Breakfast Home O Food Delivery O Residential Kitchen for Bed and —Breakfast Establishments -----•--•------------ 21) Length Of Permit: (check one) RETAIL STORE S RESTAURANT VAnnual 13 Less than I000sq.ft. $ 70 17 Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,OOOsq.ft. $280 ❑ Residential Kitchens $140 O More than 10,OOOsq.ft. $420 ❑ 25.99 seats $280 ❑ More than 99 seats $420 - ---- ----------•-- - ----------•---------------- ----------- --------------------------------------------------------------- .......- ❑ Bed 8 BreakfasUChildcare Services /Nursing Home $100 Temporary/DatesMme: ----- ------------------------------------------ -......... ADDITIONAL PERMITS ---------------------------- •-----••-• •------------------- ❑ MAKE ICE CREAM, YOGURTISOFT SERVE $25 O ASTURIZATION $25 ALL NON-PROFIT' $25 cludin , church kitchens, state funded childcare & private club 23) Food Operations: Definitions: PHF- potentially hazardous food (timeAemperature controls required) Non-PHFs - non -potentially hazardous food (no timeRempersture controls required) (check all that apply): RTE- read -to -eat foods Ex. son dwi s, salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs r� In {lt for More Than a Single Meal Service Sale of Commercially Preparation of PHFs Pbr Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self -Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative, time as public health control. Customer Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHF Juice Manufactured and Packaged for Prepares FoodlSingle Meals for Catered Retail Sale I Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board o(Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I, the undersigned, attest to the accuracy of the information provided in 590.000 and he Federal F o0d Code.complwith 105 CMR 590.00 and all °the/5pplicable(tr 1 have/eery 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of Have filed all state tax returns and paid state taxeyequ` e l 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: application. and I affirm that the food establishment operation will acted by the Board of Health on how to obtain copies of 105 CMR that I, to my best knowledge and belief, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' • Compensation Insurance Affidavit: General Businesses Business/Organization Name: T,,* I`Ct.K Phone #: Are you an employer? Check the appropriate box: Business Type (required): 1. [,I am a employer with S employees (full and/ 5. ❑ Retail orpart-time).* rQ( 6. ElRestaurant/Bar/Eating Establishment 2. ❑ I am a sole proprietors arts ship and1hle tk U 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. . [No workers' comp. insurance required] a _ g• [KNon-profit 3. R We are a corporation and its officers have exe eiised j 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have 10. ❑ Manufacturing no employees. [No workers' comp. insurance required]* 11.❑ Health Care 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] I 12.❑ Other *Any applicant that checks box #1 must also fill out the section below showing thew workers' compensation policy information. * *If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #1. ' , I am an employer that isproviding workers' compensatio i surance for myem loyees. Below is the [icy information. ( i ( Insurance Company Name: _ �` d� �,;w <] r a K� to -e-jit-L N Insurer's Address: �KcGr City/State/Zip: �'(Y t S rO �q �-- V o Policy # or Self -ins. Lic. # �I ECAA-e 1) 1. - �U ` Expiration Date: t n�iu:1 1 Attach a copy of the workers' compensation policy declaration page (showing the policy number and exiliration date . Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pain enalties of perjury that the information provided above is true and correct. Simature: V b Date: Phone #: Official use only. Do not write in this area, to be completed by city or town offeciaL City or Town: Issuing Authority (circle one): 1. Board of Health 2. Budding Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: City of Salem, Massachusetts lu Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 PubliCHealth Prevent, Promote. Protect. Iramdin@salem.com Kimberley Driscoll Larry Ramdin, MPH, RENS, CHO Mayor Health Agent FOOD ESTABLISHMENT PERMIT (must be posted on the Premises of the Food Establishment) 2016 Permit Number: FM -16-191 Permit Type: Food Establishment < 25 seats Goods & Services: Food Service: Non -Profit Name of License Holder: Corporation Greenhouse School Name of Food Establishment The Greenhouse School, Inc. Address of Food Establishment 145 Loring Avenue Salem MA 01970 Restrictions: This License is granted in conformity with the statutes, Regulations and ordinances relating thereto,and expires on 12/31/2016 unless sooner suspended or revoked. Permit Fee: $25.00 Effective: 1/1/2016 f CITY OF SALEM, 10 MASSACHUSETTS PublicHealth BOARD Ole Hi!AIA'11 o11.111,�- 120 WASrnNc'rON S'IRPEl', 4111 FLOOR KIMBERLEY DRISCOLL T[:L. (978) 741-1800 FAX (978) 745-0343 LARRY R NID1N, RS/7tEI IS, Ch10, CV -PS MAYOR 1ramdinQsa1em.com Hi3AL'n-i ACENf Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: ie, SatrlU 1� A. -n 2) Establishment Address: � ,/fv'(, 3) Establishment Mailing Address (if different): �S 4) Establishment Telephone No: 611 5) Applicant Name & Title: 6) Applicant Address: S� 7) Applicant Telephone No: /�y� 24 Hour Emergency No: -i ra )�-jm1a_il: 8) Owner Name & Title (if different from applicant): 1'c .e 4V-1- - -�c 1( 9) Owner Address (if different from applicant): 4044"� 10) Establishment Owned by: An association PoAn-rnMVi ua A partnership Other legal entity I 11) If a corporation or partnership, give name, title and home address of officers or partner. Name ( Title p--�j �Home Address r� " �`" 12 Person Directly Res onsible For Daily O erations Owne(r,/Pe/frson in Charge, Supervisor, Manager, etc.) Name & Title: INt/ W Ci Address: Telephone No: Fax: 5U 1/�` e— Email: Nf"" Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check #: Date: I n 1 O Amount: J Food Establishment Information 9 � v 14) Water Source: ��lU.w�' 15) Sewage Disposal: ! .'4 T o DEP Public Water Supply No: (if applicable) !,, �T �w `��) A#^. 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: -i(', C � t Jw( Required as of 10/1/2001 in accordance with 105 CMR 590.003(A) o ,rt, of6u ceir-l"T - 19) Person Trained in Anti -Choking Procedures ( if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) wG4- (check one) ❑ Retail ( Sq. Ft) O Caterer Permanent Structure ❑ Food Service - ( Seats) 17 Frozen Dessert Manufacturer Mobile ❑ Food Service - Takeout 0 Residential Kitchen for Retail Sale ❑ Food Service - Institution 17 Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ... ❑ Residential Kitchen for Bed and _Breakfast Establishments---------------------- .................... 21) Length Of Permit: (che k one) RETAIL STORE RESTAURANT Annual t� ❑ Less than 1000sq.ft. $ 70 ❑ Less than 25 seats $140 Seasonal/Dates: ❑ 10 00-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 ❑ 25.99 seats $280 ❑ More than 99 seats $420 ---------------------------------------------------------------- ------------------- ----............. - - --------- ❑ Bed & Breakfast/Childcare Services /Nursing Home $100 Temporary/DatesMme: ------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ALL NON-PROFIT' $25 * ncludin , church kitchens, state funded childcare & private club 23) Food Operations: Definitions: PHF- potentially hazardous food (time/temperature controls required) ' Non-PHFs - non -potentially hazardous food (no time(temperature controls required) (check all that apply): RTE - read -to-eat ds Ex. sandwiches, salads, muffins which need no furtherrocessing Sale of Commercially PHIF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self -Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative, time as public health control. Customer Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Ori_ain Perishable Foods Only Preparation of Non-PHFs 1/ Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service V" y BU 5 S�i5 Offers RTE PHF in Bulk Quantities - c l To be completed by the Board of Health Tui W 0175 / ff�� •• Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I, the undersigned, attest to the accuracy of the information provided in comply with 105 CMR 590.000 and all other applicableI I have beep' 590.000 and the Federal Food Code. \ 24) Signature of Applicant: application and I affirm that the food establishment operation will ucted by the Board of Health on how to obtain copies of 105 CMR i Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: , V `t )_ S-0 (14(a_'� 26) Signature of Individual or Corporate Name: 3) Kimberley Driscoll Mayor City'of Salem, Massachusetts Board of Health ' lu 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 PublicHealth .Prevent: Promote. Protect.. Iramdin@salem.com Larry Ramdin RS/REHS, CHO, CP -FS Health Agent FOOD ESTABLISHMENT PERMIT • (must be posted on the Premises of the Food Establishment) 4 2015 Permit Number: FM -15-184 Permit Type: Food Establishment nonprofit Goods & Services: Food Service: Non -Profit Name of License Holder: Corporation Greenhouse School Name of Food Establishment The Greenhouse School, Inc. Address of Food Establishment 145 Loring Avenue Salem MA 01970 Restrictions: This License is granted in conformitywiththe statutes, Regulations and ordinances relating thereto,and expires on 12/31/2015 unless sooner suspended or revoked. Permit Fee: $25.00 r Issued: 1/1/2015 KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD oh HL'm TH 120 WASI'lIN(iTON STRRE'r, 4111 FLOOR Tel.. (978) 741-1800 F,\x (978) 745-0343 Immdin@salem.com LARRY RAMDIN, RS/REHS, C4I0, CP -FS, HEAL. 'm Aca-WT Food Establishment. Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: 2) Establishment Address: 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: t -jV -ilk C 14 %--ZA 0\ 5) Applicant Name & Title:%�yt G7°�� t ✓'e 6) Applicant Address: 7) Applicant Telephone No: SWC- 24 Hour Emergency No: 8) Owner Name & Title (if different from applicant): 't 9) Owner Address (if different from applicant): V` 10) Establishment Owned by: An ion c ndlvidual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address (Ck D r4if- l k3 AvcwA� �l t 12) Person Directly Res onsible For Daily Operations Owner, Person in Charge, Supervisor, Manager, etc. Name & Title: t Address: Telephone No: Fax: S Email: W hH u Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check#:gypdO— Dater Amount:,) CUrA Food Establishment Information X14) Water Source: 7a Bl / ltGl 15) Sewage Disposal: G Ct DEP I Water Supply No: ( if applicable) 16) Days and Hours of Operation: 1 �„� • �3(7 Ya/ u 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti -Choking Procedures ( if seats or mor es No 20) Location: 22) . EstablishmenfTypelcffeck all that apply) (check one) 13 Retail ( Sq. Ft) ❑ Caterer Permanent Structure 13 Food Service - ( Seats) 0 Frozen Dessert Manufacturer Mobile ❑ Food Service - Takeout ❑ Residential Kitchen for Retail Sale O Food Service - Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery .......................Breakfast ❑ Residential Kitchen for Bed and Establishments ..-... 21) Length Of Permit: (c eAi%ne) RETAIL STORE '$70 RESTAURANT Annual V ❑Less than 1000sq.ft. O Less than 25 seats $140 Seasonal/Dates: 01000-10,000sq.ft. $280 0 Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 O 25-99 seats $280 O More than 99 seats $420 ----------------'--------------------------------- ------------------------------------------------ ----------------........... ❑ Bed & Breakfast/Childcare Services /Nursing Home $100 Temporary/Dates/Time: ........................................................ ---_---- --------- ADDITIONAL PERMITS ----------------------------------- ----------------------- ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 0 PASTURIZATION $25 LL NON-PROFIT' $25 `Including, church kitchens, state funded childcare 8 private club 23), Food Operations: Definitions: PHF- -potentially hazardous food timekem erature controls p y ( p required) that Non-PHFs - non -potentially hazardous food (no timeltemperaturo controls required) .(check all apply): RTE - read -to -eat foods Ex. sandwiches, salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Nan-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self -Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative, time as public health control. Customer Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service uner5 KI t rnr In tsulK 4tuamnies To be be completed by the Board ofHealthby the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I, the undersigned, attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other appligpble law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: v Pursuant to MGL Ch: 62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: O If_�- 26) Signature of Individual or Corporate Name�� Massachusetts Department of Public Health Division of Food and Drugs City/Town of �QQ,,W FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, a Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Address: nn -- TA I Nameto E]12. Prevention of Contamination from Hands [1 1. PIC Assigned/Knowledgeable/Duties Type Opemdonfsj Type of Inspection .`-- 'pROTECTIONFROM'CH_EMICAtS ❑ 2 Reporting of Diseases by Food Employee and PIC El 14 Approved Food or Color Additives L4 -Food Service ❑ Retail ne ❑ Re -inspection -Address I -Risk ❑ 4. Food and Water from Approved Source Level ❑ Residential Kitchen Previous Inspection Telephone ❑ 17. Reheating ❑ Mobile Date: --- - - - - `) PROTECTION FROM CONTAMINATION �"� 19 Hot and Cold Holding ❑ 9 [ITemporary ❑ Pre-operation own HACCP YIN - ❑ 21: Food and Food Preparation for HSP ❑ Caterer ❑ Bed 8 Breakfast ❑ Suspect Illness ❑ General Complaint Per on- uirge (PI Ti e . - In ❑ HACCP Inspector Out: Permit No. El. Other tacn violation cnecxe0 requires an expTaaalion on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Antistroking 590.909 (E) ElItems) Tobacco 590.009 (F) ❑ , Violations marked may pose an imminent health hazard and require immediate Allergen Awareness 590.009 (c) ❑ corrective action as determined by the Board of Health. rFOOG_PROTECTION MANAGEMENT' � _--1 E]12. Prevention of Contamination from Hands [1 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities - [EMP4QYEEHEALTH .`-- 'pROTECTIONFROM'CH_EMICAtS ❑ 2 Reporting of Diseases by Food Employee and PIC El 14 Approved Food or Color Additives [-]3. Personnel with Infections Restricted/Excluded e_ - - ❑ 15. Toxic Chemicals FOOD FROMPROVEDSOURCE APE ,_.�, _- ❑ 4. Food and Water from Approved Source , ro, � j�TIMEREMPEiC TURE'CONTROLS (Pae-ntiaffy Harardous Food9)� ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6.- Tags/Records/Accuracy. of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans - ❑ 18. Cooling _ --- - - - - `) PROTECTION FROM CONTAMINATION �"� 19 Hot and Cold Holding ❑ 9 Separation/Segregation/Protection ❑ 20. Time as a Public Health Control 9. Food,Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUSCEP.TBLE_POPULATIONS'{HSP): - ❑ 21: Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY„^- . - ❑ 22. Posting of Consumer Advisories - Violations Related to Good Retail Practices- (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Noncritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2x590.003) 24. Food and Food Protection (FC -3x590.004) 25. Equipment and Utensils (Fc -4x590.005) 26. Water, Plumbing and Waste (FC-5)(59o.00s) 27. Physical Facility (FC -6x590.007) 28. Poisonous or Toxic Materials (Fc -7x590.008) 29. Special Requirements (590.009) 30. Other Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22); Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: 6-3o-4 q Inspector's Signature: Print: PICS Signature: Print: Page Pages u ,�,....�.,+`..v'b.+^-.=v'+"'�.-�+.'r--w-•._.-+r-...�.--...v-�+-..+.+.r.+..,-.i'*.""'r`.-4'rY�_ _-r..,.rs-'��-�v.''�„"'....� �`..1+...'^-T.�.uw x..rr'^si"C� Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Responsibility* 590.003(6) Demonstration of I;nowled e" F-2-103.1 1. Person in charge - duties EMPLOYEE HEALTH 2 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 F1uid.Milkand Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable DrinkEag Water* Applicant To Report To The Person In Drinking Water from an Approved System* tem'* 590.006(A) Charge* 590.006(B) 590,003(G) by Person in Charge* 3 590.003(1)) _RS2ovring Eielusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C L C 1- FOOD FROM APPROVED SOURCE ' Denotes critical item inthe federal 1999 Fcod Code or 105 0MR 590.000. g 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 F1uid.Milkand Milk Products* 3-202.13 Shell Eggs* 3-202.14 .Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable DrinkEag Water* 5-101.1.1 Drinking Water from an Approved System* tem'* 590.006(A) Bottled Drinking Water* - 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfisb* 3-201.15 Molluscan Shellfish fromm NSSP fisted Sources* Contamination from the Consumer Game and Wild A&shrooms Approved by Regulatory Authority 3-202.15 Shellstock Identification Present" 590.004(C) Wild Mushrooms* 3-201.17 Game. Animals* 3-701_11. Receiving/Condition 3-202.11" PHFs.Received at Proper Tem erasures* 3-202.15 Package hite it * 3-10,L11. 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(.) Labeling of Ingredients' Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* Conformance with Approved Procedures - /HACCP Plans 3-502.11. Specialized Processing Methods* 3-502:1.2 Reduced oxygen packaging, critera* 8-103.12 1 Conformance with Approved Procedures* ' Denotes critical item inthe federal 1999 Fcod Code or 105 0MR 590.000. g Cross -contamination 3-302.11(A)(l.) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Fool Protection* 3302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer - 3-306.14(A)O3 Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701_11. Discarding or Reconditioning Unsafe Ford* 9 Food Contact Surfaces - 4-501.111 Manual Warewashing - Hot Water - Sanitization Tem eraiures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures*. 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and - Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* to Proper, Adequate Handwashing 2-301..11 - - Clean Condition - Hands and Arms* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* Il - Good Hygienic Practices 2401.11. Eating, Drinking or Using Tobacco* 2401.12 Discharges. From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 - Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* - 13 Handwash Facilities . Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* - 5-204.11 Location and Placement* 5-205.11. - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 7301.1.2 HandDryingProvision CITY OF SALEM I C� BOARD OF HEALTH Establishment Name•, ?AQP ,a �,,A.,nl Date: -�1-C� Page: f of MAA *! F Or A ■ • .. ■ • Viotilaons Related to Foodborne illness Interventions and Risk Factors (Items 1-221 (Cant.) 16 M - - - Food or Gator Additives 3-202.12 Additives 3-302.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying lnfonnation - Original Containers* 7-102.11, Common Name -Working Containers+ - 1201.11 Separation - St * . 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 Focal Contact, Lubricants* 7-206.11. _ Restricted Use Pesticides, Criteria° 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* _ M - - - Proper Cooking Temperatures for 3-501.15 PHFs 3-401.I1A(1)(2) Eggs- 155"1715 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(.A) Animals -1.55F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast -130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 S90.004(H) sec. * 3-40L I I(A)(3) Poultry, Wild Game, StuffedPHF9, r27 Stuftmg Containing Fish, Meat, `. FC -6 Pouitry or Ratites -1650F 1.5 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks ! FC - 7 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165F * 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. * 3-403.11(B) Microwave- 165' F 2 Minute Standing Tiuxe* 3403.11(2 Commercially Processed RTE Food - 140'F'* 3-403.I I(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFS 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 Hours and From 70'F to 41°F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F145'F Within 4 Hours* * ihnotes critical item in the federal 1999 FL ed Code or 105 CMR 590.000. IMN 3-501.14(C) PRFs Received at Temperatures According to Law Cooled to 41'17'/45'F Within 4 Hours. ' 3-501.15 Cooling Methods for PHFs 3-8O1.11(B) PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41'145° F* 3-501.16(A) Hot PRFs Maintained at or above 14WR 3-501.16(.A) Roasts Held at or above 130'F. 25. Tirrre a3 a Public Health CaMrot 3-501.!9 Titles as a Public Health Control* S90.004(H) 1 Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS {HSP) 21 3-801.11(.4) Unpasteurized Pre-packaged Juices and Beverages with Warnina Labels* 590.000 3-8O1.11(B) Use of Pasteurized Eggs* FG -2 3-801.11(0) Raw or Partially Conked Animal Food and Raw Seed S s Not Served. * 1 Food and Fred Protection 3-801.11(C) Unopened Food Packa a Not Re -served. CONSUMER ADVISORY 22 3-603.11. Consamer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw, Undercooked or FG -2 .003 i Not Otherwise Processed to Eliminate 1 Food and Fred Protection Patho ens.■ ee rn/e00t 25. 3-302.13. Pasteurized Eggs Substitute for Raw Shell 005 26. Eggs* 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. Cather 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-310) Critical, mid non-critical violations, which do not relate to the foodborne illness imenention.s and risk factors listed above, can be found in the following sectiones of the Food Cade and 105 CMR 590.000. t Hem Goad Reta1J Prestices (.FC 590.000 23. 1 Management and Por "l - FG -2 .003 i 24 1 Food and Fred Protection 25. E uarmarit and Utensils FC - 4 005 26. 1 Water Plumbing and Waste ( FC -5 .006 i r27 Physical Facility `. FC -6 .007 X28. Pds nous or Toxic Materials ! FC - 7 .008 j �� Special Requirements 1 .009 _ 30. ( Other_-- 4LEM ALTH Date: L�C Page: J of . CR ItiZim I/Ii IWi. 1 1 �fil�%i % 1 177.�i F� �91 I Vie � <l1� 1 .A RMA _W4Mal ,j � _ � ..I � v' � a�T_� I / ' � •1 / 1 � ILS ` ��r wWNiia� . / W' 1 1� IF1". TIN 7711 WMEN&I your .... / / -Compliance.. Exclusion Embar o El Emergency Closure A&b r?0c U Voluntary Disposal 0 Other: ..'.-.-� ...�'. r.. ..-..... ... -.v �..'+_+i .'. -.-.-:r l.ya��.lYFa 4+.•��'��µ � V.ti ... : - .-Y'_..r^'-", .ev }'-f.^� , J� ,� .: r..�0 Violations Related to Foodborne Itinesa Interventions and Risk Factors (Nems 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color 16 * Dena, critical hat in the federal 1999 Frrod Cade or 105 CMR 590.000. IN 3-501.14(C) Additives 3-202.12 Additives* 3-302.14 Protection from napproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-10-7,11 1 Common.Name -Working Conminers* 7 201AI Separation - Stoe* 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: encs. Criteria* 7-205.11 Incidental Food Contact,Lubricants* 7-206.11 - Restricted Use Pesticides, Criteria* 7.206.12 Rodent Bait Stations". 7-206.13 Tracking Powders, Pest Control and Monitorin * * Dena, critical hat in the federal 1999 Frrod Cade or 105 CMR 590.000. IN 3-501.14(C) Proper Coo -king Temperatures for 3-501.15 PHFS 3-401.I1A(l)(2) Eggs- 155T 15 Sec. 3-501.16(B) 590.004(F) 'E gs- immediate Service 145'F15sec* 3-401.11(A)(2) - Comminuted Fish. Meats & Game -501.16(.9) Animals -1.55°F 15 sec. * 3-40LI1(B)(1)(2) Pork and Beef Roast -130°F121 min* 3-441.11(A)(2) Ratites, Injected Meals -155*F 15 90.004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC - 6 Poultry or Ratites -1650F 1.5 sec. 3-901.11(0)(3) Whole -muscle, Intact Beef Steaks FC'- 7 145OF " 3-401.12 Raw Animal Foods Cooked in a - Microwave 165°F * 340131(A)(1)(b) All Other PHFs -145gF 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) ` PHFs 165-F 15 sec. * 3-403.11(B) Microwave -165° F 2 Minute Standing Time* 3403A I(C) Commercially Processed RTE Food - 140*F* 3403.11(E) Remaining Unsliced Portions of Beef .Roasts* Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PHFs fmm 140'F to 70OF Within Hours and Front 70"F to 41°F/45T A ithin 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 410F/45°F Within 4 Hours* * Dena, critical hat in the federal 1999 Frrod Cade or 105 CMR 590.000. IN 3-501.14(C) PHFs Received at Temperatures According to law Cooled to 41T/45gF Within 4 Hours. 3-501.15 Cooling Methods for PHFs 3-801.11(D) PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PHFa Maintained at or below 410145' F* 3-501.16(A) Hot PHFs Maintained at or above WOR * -501.16(.9) Roasrs Held at or above 1300F. r3-501.19 Time as a Public Health Control Pasteurized Eggs Substitute for Raw Shell Time as a Public Health Control* 90.004(H) Variance Requirement U REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801A I (A) Unpasteurized Pre-packaged Juices and .Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized Eggs* - 3-801.11(D) Raw or Partially Cooked Animal Food and II Raw Seed Sprouts Not Served. * 3-801.11(C) unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted far Consumption of J 590.0w 1 23. Animal Foods That are Raw, Undercooked or I FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 .004 25.- 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. E * Violations of Station 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 tinder #29 - Special Requirements. (helms 23-30) ,Critical, mrd non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sectionsof the Food Code mid IOS Cb1R 590.000. p Nam Goad RataN Practices I .FC J 590.0w 1 23. 1 Management and Persona I FC -2 .003 24. Food and Food Protection FC - 3 .004 25.- E vioment and Utensils 1 FC -4 .005 26. I Water, Plumbirto and Waste i FC -5 ..006 ! 27. 1 Physical Facil FC - 6 .007 28. Poisonous or Toxic Materials FC'- 7 .008 j 29. Special Requirements i .009 30. 1 Other 5]3C.£pnri 1F2C+c \e�ep,'rounys foo/ never slop teaming May 4, 2014 Bobbi Cody Salem Health Department 120 Washington Street Salem, MA 01970 Dear Ms. Cody, the greenhouse school patricia jennings-welch, executive director in memoriam daniel patrick welch & julia nambalirwa-lugudde, directors 145 loving avenue ❖ salem, massachusetts 01970 tel. 978-745-4549 f,V 0820;" CIN OF SALEP�I BOARD OF HEAL;; i Pursuant to your visit yesterday, I wanted to forward documentation on some of the items you mentioned. Signs are posted and thermometers are in place (the one in the fridge was actually already there, just behind some items). The washer needed another cycle, but came up to temp just after you left. Here are also three months' service slips from pest control. While we understand you will need to reinspect after the 13'h, we wanted to assure you that we are diligent as always in addressing the Department's concerns. Sincer ly, Waniel. Welch, Hdhool t v I 0 3f ff fff L-J®°Lk Le°rj Lod LSObl00110°k=FA°g:::l°m1-O°c LO°e *03vlLLZ—G°Lk L90vj Lod Le°blAo r - `p < j rE ' J M } • 4 �l f t `Q ~il 3'i 4 rti: 'r SS f k s f } Y A t« RM a r � 1 r - `p < j rE ' J M } • 4 �l f t `Q ~il 3'i 4 rti: SS f k Y f } t« RM a k- `p < j rE ' J M } • 4 �l f t `Q ~il 3'i 4 rti: A-1 Exterminators P.O. Box 310 L,vmn, MA 01903.0310 800-525-4825 Bill -To: (1765700] GREENHOUSE SCHOOL INC 145 LORING AVE SALEM, MA 01970 04/12/14 09:30 AM Service Slip / Invoice INVOICE: 977852 DATE: 04/12/14 - - ORDER: 977852 Work [1765700] 978-745.4549 Location: GREENHOUSE SCHOOL INC 145 LORING AVE, SALEM, MA 01970 ....�•o.+.:.us Y..o:r.�AESd4il'!�5+�1u 5S..;tfy�'ilf •,�.k�+�v.Y^s�.0 t�-.•�J4y �•.,?,^„a 005 Donald Gardner 9S win D5 D5 Lic.*:29642 �.F.".•�" 4sN-»5Y'�n�f..�"ir:., l e,.$".��&:'��lhr �rTS�'e��,Eriv�a"nv hr4•''f'„��µ 1��"'��• F y ,.- �4'`� P•+. f.r wf n'��'.. 'uTM"' f.� s?� 7 ..a41M:$.iw w�k��'� r�� h'id�.A�.�✓x`�i �stP "��'S"x,*a"�k�Jed�crM1 , 101 . REGULAR PEST CO :TROL SER'JICE $51.00 TODDLER KIICHEN/RW. ^AJF KEYS!!!!. ,i SUBTOTAL Inspect all art+s.outside_for burrows -Replace .any wet.or_oltl rotlent.bait, Olean batt $51.00 .� .. _ TAX .. $0.00 TOTAL $51.00 AMT. PAID $0.00 BALANCE '. $51.00 I r ' 'Charges outstandm9 over 80 days from the date of service are Subject to 717%the de CHARGE PER MONTH or annual percentage rate of 18% Customer agree. 'o pay accrued cost of servkces asdspec fled above. satisfactory completion of all services tendered, and agree to pay the expenses in the event of collection. X w CusroMER SIGNATURE PLEASE PAY FROM THIS INVOICE f #?L�3i�3i�3i�Ti�?W■C/aoo-l°o�T�oT::�oWC^�Xo�TTo-T4o�lpol��o®-Ix'Io®X�4�� ■p■s�z■ ■ A-1 Exterminators P.O. Box 310 Lynn, MA 01903-0310 800-525-4825 Bill -To: 117657001 GREENHOUSE SCHOOL INC 145 LORING AVE SALEM, MA 01970 Service Slip /- Invoice INVOICE: 965454 DATE: 02/08/14 ORDER: 965454_ Work [1765700] 978-745-4549 Location: GREENHOUSE SCHOOL INC 145 LORING AVE, SALEM, MA 01970 7 ..1. enon• � � sig n at 02/08/14 09 rr D5 101 REGULAR PEST CONTROL SERVICE Inspect areas Outside for burrows-Tlnside-replace old or wet rodent bait in. backrot Il storage area. Treated preventatively for roaches boiler room, storage area and laundry- No roach activity noticetl l $51.00 SUBTOTAL $51,00 TAX $0.00 TOTAL $51.00 TECHNICIAN___ SIGNATURE Charges outstanding over 30 days from the date of service are subje pt to a 114% FINANCE 1 hereby acknowledge the satisfactory completion of all services rendered, and agree to pay the • CHARGE PER MONTH or annual percentage rate of 18%. Customer agrees to pay accrued cost of services as specified above. 1 , expenses in the event of collection. PLEASE PAY FROM THIS INVOICE `t'11��' C''��✓ CUSTOMER SIGNATURE f. ueuzeiy e42d#TAXIo6Z *¶@QSo-,?E.Aa ' A-1 Exterminators P.O. Bax 310 Lynn, MA 01903=0310 800-525-4825 Service Slip /,Invoice INVOICE: 959937 DATE: 01/11/14 ORDER: 959937 _ Bill -To: (17657001 Work [1765700] 978-745-4549 GREENHOUSE SCHOOL INC Location: GREENHOUSE SCHOOL INC 145 LORING AVE 145 LORING AVE, SALEM, MA 01970 SALEM, MA 01970 Work Date Time Target Pest Technician 01/11/14 09:26 AM 005 �:; rC's3c J'Ccr 7c;: c _ziei Se7.Vtp Niap Cnd • �pt/11/14"—1 D5 $CNICe 101 Description REGULAR PEST CONTROL SERVICE TODDLER KI'fCiiEN/RR HAV@ KEY$!II! «--- — 7 Inspect all areas inside. replace old or wet rodent bait laundry and boiler room, New roach ball treat storage oack room area.noroachactivity noticed. 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 Time In lime Jul Amount $51.00 SUBTOTAL $51.00 TAX $0.00 TOTAL $51.00 AMT. PAID $0.00 BALANCE $51.00 TECHNICIAN SIGNATURE . .. _ percentage rate of t8%. er F _. ... _ .. acknowledge ren _ Charges outstanding over 30 days from tho date of service are subject to a 1'h % FINANCE I hereby acknowletlge the satisfactory complotio of all services rendered, and jgrec to pay the CHARGE PER MONTH or annual g Customer agrees to pay accrued cost of services as specified above. //� �.I1s expenses in the event of collection. - �r\ v,.! �c,�t�„ rt, PLEASE PAY FROM THIS INVOICE 1 �V 1 vvv fff CUSTOMER SIGNATURE £1►°LkFrLMassHealth) 0' 1u0%""0%MR0)° Z&ILR�®°LkFrLStarted°� LL-L-!!%-!!%0oiaILI$>_®°Lkr�► 200 $BiL°Sbau'+8LkF�,between training providers who train direct °kL,-L,%%!!/%%%!!!!-%%%@ OBI L°Sbau'+1LkFr-L,care workers for jobs just higher up on the i4OLkF�Leanne O�LLMM)Z&I B4OLkFr-LWinchester °�R-B%"%%"!!%-°»LaLLo CITY OF SALEM, Ip MASSACHUSETTS RECEIVE® BOARD OI' HEALTH n 130 WA$EIINGTON SIRE LT, 4'O1 FIAOR KIMBERLEY DRISCOLL NOV 2 4 ?O 1 3TF:L. (978) 741-1800 FAX (978) 745-0343 MAYOR Irarnn(a�salemcom CITY OF SALEM BOARD OF HEALTH V PubliclHeatth LARRY RAMDIN, RS/R1 GIS, CHO, CP -ES HEAI.LH AGENT Food Establishment Permit Application (Application.must be submitted at least 30 days before the planned opening date) 1) Establishment Name: J�, cp SC.I�L dU 2) Establishment Address: I—oyvt 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: S t E 5) Applicant Name & Title: Sad44- e- 6) Applicant Address: rr 7) Applicant Telephone No: QA4-Q 24 Hour Emergency No: 6) Owner Name & Title (if different from applicant):er' 9) Owner Address (if different from applicant): 10) Establishment Owned by: An association crpor ual A partnership Other legal entity 11) If a corporation or partnership, give name, title and home address of officers or partner. Name Title Home Address / -L t4oe4 T 12 Person Directly Res onsible For Daily Operations Owner, Person in Charge, Supervisor, Manager, etc. Name &Title: j/l 0`r J Cti Zon , Address: Telephone No: Fax: R all: 0 Emergency Telephone No: 13) District or Regional Supervisor (if applicable) Name & Title: Address: Telephone No: Fax: Email: Check#: ,%&v Date: �� U J Amount: �� Food Establishment Information C 14) Water Source: 15) Sewage Disposal: YIEP Public Water Supply No: ( if ap cable) J � ��)) �N 16) Days and Hours of Operation: 97) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Amy J ( Required as of 101112001 in accordance with 105 CMR 590.003(A) (N C. L491 N 19) Person Trained in Anti -Choking Procedures (if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type (check all that apply) (check one) / ❑ Retail ( Sq. Ft) ❑ Caterer Permanent Structu?A-� ❑ Food Service - ( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service - Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service - Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ......----•---------------•-------...-.........-RESTAURANT....................................--... ❑ Residential Kitchen for Bed and -Breakfast Establishments 21) Length Of Permit: (k one) RETAIL STORE Annual ❑ Less than 1000sq.ft. $ 70 ❑ Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,000sq.fL $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 ❑ 25-99 seats $280 ❑ More than 99 seats $420 .......... ----------- --------------------------------------------------------------------------------------------------- ❑ Bed & Breakfast/Childcare Services /Nursing Home $100 Temporary/Datesrnme: - - ----- -------- - - --- --- ADDITIONAL PERMITS - r, , ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 uV ❑ P&WURIZATION $25 ttvL Sacj. 6 LL NON-PROFIT* 1 $25 CFG *Including, church kitchens, state funded childcare & private club 23) Food Operations: Definitions: PHF-potentially hazardous food (time/temperature controls required Non-PHFs - non -potentially hazardous food (no fime/temperature controls required (check all that apply): RTE -rea to -eat foods Ex. sandwiches, salad; muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self -Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service thin 4 hours contact alternative, time as public health St} s 'rG r control. Cusforner Self -Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Nan-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage, Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1, the undersigned, attest to the accuracy of the information provided in this application and 1 affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I hove been instructed by the Board of Health on how to obtain copies of 105 CMR 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A,1 certify under the penalties of perjury that I, to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: d l� a"qrvl Lf& 3 26) Signature of Individual or Corporate Name: i Vkp, a r,,,&A &e_ �� Commonwealth of Massachusetts • s r City of Salem Board of Health 120 Washington Street, 4th Floor Kimberley Driscoll SALEM, MA 01970 Mayor Food/Retail Establishment Permit DATE PRINTED: 01/03/2012 ESTABLISHMENT NAME: The Greenhouse School, Inc. File Number: BHF -2005-000026 145 Loring Avenue Salem MA 01970 KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/REHS, CHO, CP -FS HF AL PI -I AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4:m FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 Iramdin&salcm.COm 2011 APPLICATION FOR PERMIT TO OPERATE�A /FOQD ESTABLISHMENT NAME OF ESTABLISHMENT 1h6 e. 6 Pf evt (1t,du� �1 rcifEL # ADDRESS OF ESTABLISHMENT SLar-,'eI4 At -e - FAX # MAILING ADDRESS (if different) SClli EMA ,,Buussi�ine�sss': �-"'vt'Ifn Lite: Qa AME aa 8 $ C�yLt (A TEL ADDRESS d v,� a d( Ct STREET pctlq weu-k CITYnn,, S ATE �S(p`AV CERTIFIED FOOD MANAGER'S NAME(S) '114,&L' PAAA&Ufu (.A-Ltia," CERTIFICATE#(S) Y3 IS 6011 "�yP 791gNtb (Required in an establishment where potentiallyy hazardous food is prepared) /q ter. EMERGENCY RESPONSE PERSON �✓aVI-iw cr�( JLt (el HOME TEL HOURS OF OPERATION Please write in time of da. (}yam (For example itam-11pm) TYPE OF ESTABLISHMENT RETAIL STORE. YES NO FEE (check only) less than1000sq.ft. =$ 70 C QQ �3I(3 1000-10,000sq.ft. more than 10,000sq.ft. =$280 =$420 -- - - --- -----------------------------.....-----------------------------------------------------------1 --- --........-- --------------- ----------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart $210) 25-99 seats =$280 - -- ------------------------------------------- more than 99 seats =$420 �D ; BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSLNG HOME----------------------------------------------.....----------------........-----------------------------`��- AA 11 ADDITIONAL PERMITS �,�-�� MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR 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 SanitaryCode, 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 Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and p id II st t as equired under the law. I a-1 r�)— / u 6� ` ��c�� -2, Signature Date I Social Security or ----_____------------ Updated 5/23/11 FOODAP2011.adm Check#- & Date ____ q _ $ I1r,,,6 1 Vl7 w/ Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35230 Floor 190-35234 °Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800, Fax (978) 745-0343 Name //� 11 __ l9FPo �' 19J S - Datet (( a/ T of Operations) TVoe of Inspection ❑Routine Z Re -inspection Previous Inspection Date: ElPre-operation El Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Food Service LJ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary E] Caterer ❑ Bed & Breakfast Permit No. Address �. ^ R s Level Telephone �j r4 Owner - /( u C. HACCP Y/N Person in Charge (PIC) Time In: (; ¢s' Out: Inspector 00 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Print: 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) O 590.009 (F) ❑ action as determined by the f Board of Health hJ5 1� V (�tNV'ec� v /-�/G4 ( / FOOD PROTECTION MAryRGEMENT , _ :", m`-` - „r - ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned / Knowledgeable / Duties ❑ 13 Handwash Facilities r EMPLOYEE HEALTH i}.- *" '. 5 �'" x e °i ' i j, y i a r �a a iy it .4huMt�e ,.5.,..,„sw,,....n.,. , v, mow m r _s aY w ,mc q PROTECTION FROM CHEMICAkS ,,,� yy , k a is t c w a ai! ❑ 2. Reporting of Diseases by Food Employee and PIC L R- h am, 11 "- Z a -_ �-,� - _� � �_A r= _a =a ❑ 14. Approved Food or Color Additives, ❑ 3 Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals it FOOD FROhf*F?FROVEDSOURCE,_ ,,,,.a ,�;;X,w�, R0r rev..m,; ,ci E]4. Food and Water from Approved Source tnME TEMP£i1A7URE CONTROLS (Potentially He ardour Foorta) a ` °d'-3a�R-nals.dWikl4�wavitW,gs�Flp. ❑ 5. Receiving/Condition �n.ar'�'e�smrv��`.� �rvil��.v.x$�Ptw"�`3}.�`7I+4�sm5'.��txrr®�e:&'a ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION _311 El 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)(590.006) 29. Special Requirements (596.009) 30. Other " s:50nsp�re�14. ❑ 17. Reheating 1B. Cooling ❑ 19. Hot and Cold Holding ,r +' ❑ 20. Time As a Public Health Control ;RE4UIREMENTS OR HIGHLY SUSQEPTINL£ POPULATIONS=(HSP);F ❑ 21. Food and Food Preparation for HSP Eft - El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days Of receipt of this order DATE OF RE -INSPECTION: i Inspector's Signature: J Print: i PIC's Signature: rI / Print: r W e r Page r of Pages V i L/ 0 C v - _ Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) AssignmentofResponsibthty* 590.003($) Demonstration of Knowledge" 2-103.1 I Person in charge - duties EMPLOYEE HEALTH 2 590:003(0) Responsibility of the person in charge to C )or Iiance with Food Law* 3-201.12 require repotting by food employees and 3-20'1.13 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* 590.0M(B) 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Rtstrictions* 3-201.15 590.003(F) Removal of Exclusions and Restrictions In * Denotes critical hens in the federal 1999 Foci Code or 105 CMR 590.000. g Food and Water From Regulated Sources 590.004(A -B) C )or Iiance with Food Law* 3-201.12 Food in a Hermetically- Scaled Container* 3-20'1.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-20114 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* 590.0M(B) Water Meets Standards in 310 CMR 220* Washin Fruits and Ve etables Shellfish and Fish From an Approved Source 3-201.1.4 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Re uiato Author" 3-202.18 ShellstockIdentification Present'r 590.004(0) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Tem reratures* 3-202.15 Package Inte ity* 3-101.11. _ Food Safe and Unadulterated Togs/Records: Shelistock 3-202.18 Shellstock Identification * 3-203.12 Shelistock ldentification Maintained* Tags/Records: Fish Products 3-40211 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 ox en packaging, criteria* 8-103.12 Conformance with A. roved Procedures* * Denotes critical hens in the federal 1999 Foci Code or 105 CMR 590.000. g Cross -contamination . 3-302.1-1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each Other' Contamination from the Environment 3-302.1.1.(A) Food Protection - 3 -302.15 Washin Fruits and Ve etables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-30b.14(A)(B) Returned Food olid Reservice of Food* Disposition ofAdulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Fee& 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tent eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 1g Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arens* 2-301.-1.2 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventin ,Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to ces* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwaslung Cleanser, Availability fi-301.12 Hand Drying Provision Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 NameC �acn Date - /CA Type of Operation(s) Tyne of Insoection Food Service ❑ Retail ❑'Routine ❑-Re-inspection vck -^1 Address Risk X22 v Level ❑ Residential Kitchen ❑ Mobile TemporaryCaterer Previous Inspection Date: ElPre-operation Telephone Owner HACCP Y/N ,, ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) n Time In: I SZ ❑ HACCP Inspector n Out: )- Permit No. ❑ Other Each violation checked 'requirestan 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. !' FO0D t?»OTECTI©N MANAGEMENT' µ,'; E : ` , m�: §1` ,� `,,,=,�,a a2_1 ❑ 1. PIC Assigned/ Knowledgeable/ Duties {F 3kWL44YP'}:I -R"+1 E If^8WI @{�'i 6 Pf5^�i EMPLOYEEff HFAiTH°On F «�v C�nU �«66a ,.M, w.u�I ai:idde..a ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded F00D FROh1 APPROVED SOURCE 4. Food and Water from Approved Source [1.5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM COt:TRMINATION ' 3, F I`" s I=r : t ''T r wi-sifr�3�:-!� ,s dz.`s .E."s'i�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) Z25. Equipment and Utensils (FC -4)(590.005) ` 26. Water, Plumbing and Waste (Fc -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 50MSa CfFo,-14.eoc ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities "' PROTECTK$N FROM CHEMICALS ELM, -pr :: vlAiil .34tam anl..:,:. Yin emNdtla y'wE k'VEb a bE Edi m181E' ..0 w�'�=-GwuRa,.sa6;u3 ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals ITIME/rEMPERATURE CONTROLS {Potemle8y Hazardous Foods) ;, f;"" moi m ate.®�. r:,g. ❑ 16. Cooking Temperatures ❑ 17. Reheating I] 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control 4 REQUIREMENT$ FOR FIIGHLY SUSCEPTIBLE POPULATIONS',(HSB) ❑ 21. Food and Food Preparation for HSP ii C.CN$(1MEii ADYI.SC,RY iva' 'ska�„i ""'i "�'F®'`'.' wrEa' "tut- "'g5'`' [122. 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 ofrreceipt of this order. . DATE OF RE -INSPECTION: J �Me 10. X,)=y Inspector's Signature:\ Print:� PIC's Signature:/ -^1 Print: /P U k �ZEd Page of ages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1I 590.003(A) I Assignment of Responsibility* 590.003(B) I Demonstration of Knokiedge* 2-103.11. Person m charge - dupes 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* appPicants* _ Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System 590.006(A) Char *e* 590.(K)6(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 * Denotes critical iteot in the federal 1999 Food Code or 105 CbtR 590.000. r PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Ea =s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System 590.006(A) Bottled Drinkin Water* 590.(K)6(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Sheiflish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Re uiafo Authord 3-202.18 Shelismck Identification Present* -590.004(C) Wild Mushrooms - 3 -201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11. Food Safe and Unadulterated TagslRecords: Sholistock 3-202.18 Shellstock Identification * 3-20312 Shellstoek Identification Maintained* Tags/Records: Fish Products 3-402.11. Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004()) Labeling of Ingredients* . Conformance with Approved Procedures /HACCP Plans - 3-502.11. Specialized Processing Methods* 3-502.1.2 Reduced oxygen packagin.g, criteria* $-10312 Conformance with Approved Procedures* * Denotes critical iteot in the federal 1999 Food Code or 105 CbtR 590.000. r PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients - ` 3-302.4 I(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A}{B} Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sam tization"Pen eratures* - 4-501.112 :Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.11.4 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 Samuzation- Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11, Clean Condition - Hands and Anes* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventin , Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Ent to `ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Hindwashing Cleanwr,.Availability 6-301..1.2 Hand Drying Provision CITY OF SALEM -� BOARD OF HEALTH / Establishment Name: !hn t�.►&.,h,=. o &1211 Date: Pager_ of o� Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red Item.. Verified PLEASE PRINT CLEARLY 1 4—to C ('J'6':.4 �.I Vt A40 jr, 0 _(w A I 0 A A _^^ _ 14 12/1424e _ —DAL(, lot 1 r -iQ 7..10 d4�' _ Lz�Jj I u Discussion With Person in Charge: Corrective Action Required: ❑ No as I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / inspection, to observe all conditions as described, and to violations before the next ins P Exclusion Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five d tars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. f _`\�� /\ 0 Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont) PROTECTION FROM CHEMICALS 1-4 Food or Color AdditivesE PHFs Remiwd atTernperaturcs —9-20212 i 3-30114 Protection from Unapproved Additives) L15— --- Poisonous or Toxic Substances I I "F/45'1` Within 4 Hoots_ * _ ows- Identifying [nfoi ination Orig nal 7 101AIi ( 3-501.15 3-501.15 Cont users , i 31-4,0!.DIA}00 1 7-102 It 1 Common Nilow -- Working Coarain�n,' PHF Hot and Cold Holding sgai tion ary-LIC, and Fe 3 501 . 1 6,B) 7-201A2 Condi ort of !"S,i 'j i )?03.11 Toxit: 6jiltamel, - 410/45` F* 1 1-204.11 sallilizets Criteria - ClIculic.1W I 501,16(A) Clot pl'IFtl %fairita iued at or atx)Ve 1--- , 7-2-04. 12 Ch.wlcak for WashinghodilceCli 140'F, --- 7-204,14Dning Crit�ria�� 1711;]w I, ImidLltal I'Ix,d Contact. I Time aso Public Health Control I`bt 00.1^ P(XiOtlll 13,61 Slilil'M' -DO1t "J;l at RequirClIletit A� !;I 1 74. i5? F 15 le , '7 F- -1-)oIA4(() PHFs Remiwd atTernperaturcs - ------- ---- I I "F/45'1` Within 4 Hoots_ * _ ows- K;mle" biwocd Nfi.A� I ( 3-501.15 3-501.15 Cooling,Wtbod.s for PHFs i 31-4,0!.DIA}00 kN od lilulfed 11IT-, PHF Hot and Cold Holding 3 501 . 1 6,B) Cold PHFs Maintained at or below 'j i W (X)4(F) 410/45` F* t% v3. It i tz 4+:4.... I 501,16(A) Clot pl'IFtl %fairita iued at or atx)Ve 140'F, q�,, Held at ill libove Ll()7,-� 14, T I Time aso Public Health Control I`bt MicllwttV"- In NlIsluTc S"Indirl' R,pllalnill"' L"Shwed R la'r I 1 Proper CL>oIInq of PHFS 42%) PHI`F imm 1d(l` Ft,, "'lihill 2 1 Tour, and From to 'J'F/ji'F Witilin A How" I 50IA4(B) i Clt(Auio, P1 IF Wdc FIL)m AmIlioit Tmp,.taws e I,, 4. WFIli'l, !L REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I I (B)1 - of PuSwt :lprow, NSeri t M?1 Not Rc-wn Litl, lo 1 lill ilaw kill V .'l'zl"!TM I1101lik, izin trai v and It :az t:nitdl�rtft )rcpriafc dotogs i, l u Lilt, I') '-oo't iv JAl"Cd I itenis 23-30) -,t,Jho,?t, i'Il:,o im,i ",la ons f,?,d r mtiors V,ttl c r=nrt "IN I ;11 !11, of 1h, Food odcand 1 ("lfl? Pirtni I Gao(IR6fallPrartices re 5�qo' Ono _Iq a ltd Pm r So n n 1? 1 JOS - 24 F-il)(1 pd POCKI prlll<>rllcl, PC I (k,4 EquiRmCnI and (j!epsi!s FC - 5 DO' F Y� FC - W1 !" cal r FC 6 - 7 XP -- -------- ------- -- F- -1-)oIA4(() PHFs Remiwd atTernperaturcs According to Lau Cowled to I I "F/45'1` Within 4 Hoots_ * _ ows- ( 3-501.15 3-501.15 Cooling,Wtbod.s for PHFs 19 PHF Hot and Cold Holding 3 501 . 1 6,B) Cold PHFs Maintained at or below W (X)4(F) 410/45` F* I 501,16(A) Clot pl'IFtl %fairita iued at or atx)Ve 140'F, q�,, Held at ill libove Ll()7,-� 14, T I Time aso Public Health Control Iuhlie 11"Ith t:om'ol- RequirClIletit REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I I (B)1 - of PuSwt :lprow, NSeri t M?1 Not Rc-wn Litl, lo 1 lill ilaw kill V .'l'zl"!TM I1101lik, izin trai v and It :az t:nitdl�rtft )rcpriafc dotogs i, l u Lilt, I') '-oo't iv JAl"Cd I itenis 23-30) -,t,Jho,?t, i'Il:,o im,i ",la ons f,?,d r mtiors V,ttl c r=nrt "IN I ;11 !11, of 1h, Food odcand 1 ("lfl? Pirtni I Gao(IR6fallPrartices re 5�qo' Ono _Iq a ltd Pm r So n n 1? 1 JOS - 24 F-il)(1 pd POCKI prlll<>rllcl, PC I (k,4 EquiRmCnI and (j!epsi!s FC - 5 DO' F Y� FC - W1 !" cal r FC 6 - 7 XP -- -------- ------- -- C M wn,,7 ommon V IV 3 4�, we , 14 6 j�'City of S idem Q�, 41A, 19171beil Y.,Board of Health eDrlicoll'� -' 120 Washington Street,4thFloor 'F = Mayor SALEM, MA 01970 Food/Retaff Establishment Permit; DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: The Greenhotise School, Inc. File Number: BHF -2005-000026 -145 Loring Avenue Salem MA 01970 LOCATED AT: 0145 LORING AVENUE"' SALEM, MA 01970 Permit Type Permit No. Permit.Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP -2008-0136 Jan 3,2008:. -Dec 3l,2068 125.00--_ ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES Board of Health 91 This Permit is not transferable and must be reissued upon change. of.ownership orlocation. -The.permit must.be posted, in c: - a prominent location in the Establishment ; - : ' In stablish nt...��.-_ In accordance with the State SanitaryCode, beofre.any. revonations, improvements, or equipment -changes are made, all - plans for such must be submitted to and approved by the Salem -Board of Health. Page34607 KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 ISCOTMSALEM. COM 2008 APPLICATION �FOR PERMIT TO OPE'RiATTE. FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 11� `� reWt� �CVVTEL # / Fi I'r Sj c1 ADDRESS OF ESTABLISHMENT FAX # Si fM �Q MAILING ADDRESS (if different) 5(NlM Q A J3kk, ' TEL# ADDRESS I Lt"'ykg'-(lv� e>WV�y-L STREET \—, r t f 'L CITY STATE CERTIFIED FOOD,MANAGER'S.NAME($) _ItAL\ Iv7nntn+orit(Ir B uv(�{ CERTIFICATE#(S) 31 (Required in an establishment where potentially haza _ Qp(r¢�p �)G EMERGENCY RESPONSE PERSON GL>ti (X HOME TEL # I �� nwno yr yr w,r Please write in timee of of day. 11-44-1 TYPE OF ESTABLISHMENT RETAIL STORE YES NO - -. -...W-------------------------------------`---------------------------------------- RESTAURANT YES NO (Outdoor Stationary Food Cart $210)- -----------' ------------------' --' -' ----:....... Y -E--........ -' --------------------------- BED/BREAKFASTI S NO CHILDCARE SEPERMITS RVICES----------------------------------- MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check onl less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------------------------- less than 25 seats =$140 25-99 seats =$280 more than 99 seats =$420 [, f f YES NO $25 YES NO YES NO $2 '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 t e pains'and penalties of perjury that I, to my best knowledge and belief, have fled all state tax returns and paid all to tauir� under the law. %L vxe �, l/ _11�J 1q ate► Signature Date Social Security or Federal Identification Number --------------------- --------- �5T-----'-- -- ---------______------------------'--- Revised 4/24/07 FOODAP2008.adm Check# & Dale, 7 4 'j 4 $ Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Physical Facility FAIL BLUE COMMENTS: Faculty restroom wall under sink has water damage and in disrepair. Find source of water leak and repair wall. wall to be sealed and make non-absorbent and impervious. At time of inspection wall has been repaired. non-absorbant panel on hand and to be secured to wall. ce V�-�� - -q, �-6bo bf (�Lc-Q-(;a act� K rl na arena are 9 Fax: (978) 745-0343 0145 Loring Avenue The Greenhouse School, Inc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Handwash Status Violation Critical Urgency FAIL Critical RED ant: Provide soap and paper towels in proper dispensers at all handwash sinks throughout establishment. Soap and paper to be readily available at all times. Fpculty restroom- hot water handle for hand sink not in working order at time of inspection. Repair and provide handle in good orking order. repeat violstion. Chi rens restrooms missing paper towels in dispenser. Provide paper towels at all times. oys re froom missing soap. Provide soap at boys restroom sink at all times. Th a was little to no hot water at handsinks at time of inspection through establishment. a dress to provide sufficent hot water to all sinks. han mk m kitchen draining slowly. check to ensure draining properly. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 This is a repeat violation and must be GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 26,2007 ) Page I of Item Violations Related to Good Retail Practices (Blue Items) Status Violation Critical Urgency Equipment and Utensils FAIL Critical BLUE Comment: Through discussion with Health Agent, Establishment is ordered to replace and provide commercial dishwasher within next 6 months. Before next routine food inspection. icrowave needs general cleaning. ab4lelcaed inet under two bay sink in disrepair. repair cabinet under sink. hen has many miscellaneous items throughout. kitchen to be cleaned and organized and all itmes that are not food/ food prep to be removed from prep areas. as to not be a source of contamination. ., WI0to GE Freezer unit missing handle. Provide handle for this unit. ame unit needs thorough cleaning. ^, own GE unit (large unit) freezer needs general cleaning. es in kitchen had bare wood in some areas. All wood to be sealed to be made impervious and easily cleanable. elves to be thoroughly cleaned and sanitized to remove dust and grime buildup. r Ide toilet paper in toilet paper dispensers in all restroom at all times. S II brown GE fridge missing thermometer. Provide visible accurate thermometer maintained at 41 degrees or below as ndated. TT�Ygre were dishes being dried on towels. Dishes and utensils to be washed rinsed and sanitized and set to air dry on a clean and sanitized surface. hand towels or towels not to be used to dry utensils or dishes as to help prevent contamination. \j*nsils to be strored handleside up to prevent contamihstion from hands. Provi covered trash receptacles in all restrooms. white fridge 10 degrees F. service to ensure kept at zero degrees or below as mandated. Physical -Facility - FAIL BLUE Comment: Provide door sweeps on door near counters and side entrance door to prevent entrance of rodents and insects. sall closet used for laundry has peeling and chipping paint on ceiling. Scrape and repaint. Faculty restroom wall under sink has water damage and in disrepair. Find source of water leak and repair wall. wall to be sealed and make non-absorbant and impervious. �ame restroom there are areas along baseboard with gaps and holes. Provide baseboard and seal all holes. ,_�oys restroom missing light cover. Provide light cover. yZaundry room ceiling had peeling and chipping paint. Scrape and repaint. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 26,2007 ) Page 2 of Item Other- See Notes Status Violation Critical Urgency FAIL Critical BLUE e )p,Comment: upon inspection an odor in faculty restroom was observed. Owner Mr. Welch is aware of odor and has had exterminator S N,V into "and locate what they believe is a deceased animal. Please provide copies of extermination invoices for last three months. Exterminator to be hired to treat and remove cause of odor. stored incorrectly. Mop to be stored mop head up to air dry. , 1-4fa'undry room to be organized. All repeat violations will subject to a monetary fine of $25 for each repeat violation. ant observed in kitchen on counter. Exterminator to check. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 26,2007 ) Page 3 of Rpr 24 07 07:32p Gbds 6177316057 p.1 0y taundsr never stop le ruing April 23, 2007 Janet Dionne Salem Board of Health 120 Washington Street Salem, MA 01970 Dear Ms. Dionne: the greenhouse school patricia ,jennin�S-welch, executive director 145 luring avenue solem, massachusefis 01970 tel. 978.745-4549 I wanted to keep you abreast of our progress in addressing the issues you brought tofightom - Thursday. As noted in the enclosed, the items marked °X" were already completed when you left on Thursday. I understand you wanted to include them irryourreportbecause you saw them, and I am sorry you caught us on an off day; however, we also wanted it noted how many of the items were immediately addressed_ We continue to make progress on the other items. Freezer has been serviced, defrosted and cleaned and is currently below zero. Wom edges of shelves have been coated; board below kitchen sink has been replaced. Left handle on faculty sink has been fixed again and is not leaking; we have begun patching wall behind, and hope to be done by Thursday or Friday. Exterminator came Friday, investigated for the odor and treated for ants. He says that moisture may exacerbate both, but says he treated appropriately. You can call him (Dan Gardner) if necessary. We are still working on the water temperature: I hope you understand that it is not so much a repeat violation, but an intermittent problem that is difficult to identify and correct, as two different plumbers have confirmed. The difference is that one implies that we are not serious about the problem, as you said during your visit. The truth, however, is that we are eager to comply and have tried numerous times to correct the problem. As I mentioned, we had a plumber in between your visits on Thursday, and the water was up to temperature—then when you came back, it was cold again. Very frustrating. A second plumber came today and will try yet another fx tomorrow by changing out a valve to see if that does the trick. We want you to know that we are not ignoring any problems and are doing our best to work things out. On top of everything, your report comes in the last week of our month, when money is at its tightest. This is not your problem, of course, but again we hope you understand we are doing the absolute best we can. Thank you for your understanding. Sincerely, Daniel P. W Adminisbati Director Visit us online or t�.greenhoweschool.oig Please lurk to us if you have a website Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION ' Violations Related to Separation/ Segregation/ Protection PASS J RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS u' RED immediate corrective action) "- Proper Adequate Handwashing PASS J RED Good Hygienic Practices PASS .�. RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL Critical 7Y011 RED Comments: Provide soap and paper towels In proper dispensers at all handwash sinks throu hout estabrshmegqt. Soap and,paper towels to be readily available at all times. ,iyi4I2. LtsZ Hu�Piu kd 4't ye q, V`Grtlr��le. aF a�l Stw1C5 G4" tAlffr hS Faculty restroom- hot water handle for hand sink not irIworki,99 order at time of hispection. Repair and provide 7andle In good/ working order. repeat violytlon. { yt S %L'c jarY (L pCu't 4T LC ':�y� 1.1 ll v�n1 llctu is l G�re�t p;-�vtvks I a C-vtrC fdJ-t d u.�t` (as,{f y t,(,S Chiltlrens restfooms missinglpaper tovGe s n dispenser. Provide paper towels tall J..jj1..(��ll {�' p ,,` ` , Boys restroom misslifg soap. Provide soap at boys restroom sink at all times. �(3 \ 4`'1 y�•1 � tat There was little to no hot water at handslnks a e of inspection through establishment. This is a repeat violation and mtist betr / V\ address to provide sufficent hot water to all sinks. f f ,f �,,,.�r / t t�,vey' ( 25 4'IiLtlrwrrY.0 S SI�IKC 1 !' k v=(fJ�R1y�� hand sink in kitchen draining slowly. check to ensure draining properly,;�.r+,�Lt,�',g( Y t-t.L(,tt,� § r k �111n PROTECTION FROM CHEMICALS - .1--.1•" W, Approved Food or Color Atlditiyes PASS J RED Toxic Chemicals PASS RED TIMElTEMPERATURE CQNTROI.S (Potentially Hazardous Foods Cooking Temperatures' PASS OV RED Reheating - PASS - yr] RED Cooling PASS iL RED Hot and Cold Holding PASS C: RED Time As a Public Health Control PASS :/1 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS City of Salem Board of Health 12DWashington Street, 4th Floor SALEM MA D1970 (978) 741.1800 GegTMS(A) 2007 Des Lauriers Municipal Solutions, Inc. Common) ealjh of massachusetts ( Rev. Apr 19007 j JPagu 2 of Item Violations Related to Good Retail and Status violation Critical Urgency PASS BLUE Equipment and Utensils FAIL Critical BLUE Comments: Through discussion with Health Agent. Establishment is ordered to replace and provide commercial dishwasher within next 6 months. Before next routine food inspection. microwave needs general cleaning. cabinet under two bay sink in disrepair. repair cabinet under sink. X kitchen has many miscellaneous Items throughout. kitchen to be cleaned and organized and all times that are not food/ food prep related to be removed from prep areas, as to not be a source of contamination. • White GE Freezer unit missing handle. Provide handle for this unit. ASame unit needs thorough cleaning. .. !' Brown GE unit (large unit) freezer needs general cleaning. WISI— ftfl�C�— Gtsle •� C��tLl�fotesS �C Shelves in kitchen had bare wood in same areas. All wood to be sealed to be made impervious and easily cleanable. X All shelves to be thoroughly cleaned and sanitized to remove dust and grime buildup. Provide toilet paper In toilet paper dispensers in all restroom at all times, Small brown GE fridge missing thermometer. Provide visible accurate thermometer maintained at 41 degrees or below as �( mandated. t X There were dishes being dried on towels. Dishes and utensils to be washed rinsed and sanitized and set to air dry on a clean and sanitized surface. hand towel or t eignottatiougadtod s or dishes as So help prevent contamination. ,y utensils to be strored handleside u to prevent contaminstion_1from hantes. Provide covered trash receptacles in all restrooms. iCa 1St t'iR i^�-1 vu1 CmS� /�dfl Y &WIZv' GE white fridge 10 degrees F. service to ensure kept at zero degrees or below as mandated. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE Comments: Provide door sweeps on door near counters and side entrance door to prevent entrance of rodents and Insects. Faculty restroom wall under sink has water damage and in disrepair. Find source of wate%k and repair wall. wall to besealed and make non-absorbanl and impervious. jy�"-- c n �'✓z�`�S5 City of Salem Board of Health 120 Washington Streaq 4th Floor SALEM MA 01970 (978) 741.1800 1t GeoTMSO 2007 Des Lauriers Municipal �oluligns, Inc. Page 4 of 5 2007 Des Item Status Violation Critical Urgency In same restroom there are areas along baseboard with gaps and holes. Provide baseboard and seal all holes. - $Lip("r3yc, yr- C� t r Boys restroom missing light cover. Provide light cover. Laundry room ceiling had peeling and chipping paint Scrape and repaint. Management and Personnel PASS BLUE / Poisonous. or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes FAIL Critical BLUE Comments: upon Inspection an odor in faculty restroom was observed. Owner Mr. Welch is aware of odor and has had '� extermijwtor In to try and locate what they believe is a deceasetl animal Please provide copies of extermination invoices for last t e�ths. Exterminator%6e TiiT�at end remove cause of odor XMop stored incorrectly. Mop to be stored mop head up to air dry. Laundry room to be organized. All repeat violalions will subject to a monetary fine of $25 for each repeat violation. ant observed in kitchen an counter. Exterminator to check. - A i/ r /p A/` i City of Salem Board of Health 120 Washington Street, 41h Floor SALEM MA Sojution)s, Inc. Commonwealth of Massachusetts (978) 741.1800 Apr t Page 5 oj5 04/19/2007 17:47 7815927641' AIEXTERMI I RATORS PAGE 1 02/03 m Dale acv 145 WRING AVE, SALEM 978-745-41349 oi I COMMENTS (5) OUTSIDE i Mo. wn liykv—w� � IYC I 1V 4 03/10/07 INC PUMOLM buftirlt. k01)dNT CONTR yFovrrsrwan-33.02 /07 8-8:15 AM Oki - NUMBER UNIT PAM. MOUNT d MOUSE GL BD DATE 3.2y, 02 kwun-a TRAP -j 0 MTVOTA LP CHECK NO. ... .1 . ... 0 RTU BAIT STA 0 MC; 0 VISA 0 DISCOVER I FIAT GLUE DO ACCT. 0 CUFlRE3D DAYS go DAYS EXP DATE glonalli; ......... 3. gd I 9A. I 13 47. —3.9 •:VT � IYC I 1V 4 03/10/07 INC PUMOLM buftirlt. k01)dNT CONTR yFovrrsrwan-33.02 /07 8-8:15 AM Oki - DIRECTIONS ADOMONAL COMMENTS -PD NUMBER UNIT PAM. MOUNT YES MOUSE GL BD DATE 3.2y, 02 kwun-a TRAP -j 0 MTVOTA LP CHECK NO. ... .1 . ... 0 RTU BAIT STA 0 MC; 0 VISA 0 DISCOVER I FIAT GLUE DO ACCT. 0 0 EXP DATE SALES TAX ......... X 1) Dining Areas — Clean ...... . . ........ 0 TOTAL WE 0 Employee Arm — Clean ..... .............. TOTAL AMOUNT PD n DIRECTIONS ADOMONAL COMMENTS -PD 417�A CONTRACTING BUREAU CONS DWELLING TYPE WARRANTY YES NO Floors — Clean ..... ..... ....... . 0 0 Counter Surfaces — Clean ... .1 . ... 0 r-1 DrainAraas—Clcan 0 0 Rest Rooms — Clean ......... ......... .... 0 1) Dining Areas — Clean ...... . . ........ 13 0 Employee Arm — Clean ..... .............. [I n Locker Areas — Clean ........ j .............. 0 L) Storage Areas — Organized . .J ! — ........... 0 C3 Comments I 417�A CONTRACTING BUREAU CONS DWELLING TYPE WARRANTY YESU NOU IFamily 11 3 Family 0 30 Days CJ 80 Days 0 2 Family F3 6 Family 0 90 Days 0 6 Mos. VJ REASON FOR 140 WARRANifY -partial service mquested ..... , ................. ......................... * ...................... 0 -Poor sanitation ..................... i ......................................... - -- ...................... rj vilitchenibathroom cants bot prepared ...................................................[J -Closet3ffwniture not preparid ........................................... I .... . ............. ... El -Rodent proofing needeU ...... i .......................... ..................... ..................... .0"r or FOOD It AORCULTURE'S P&TICIVE TOM IN 32-7d wft�i 1 7-00 cl 5l I At� I AT9 V13 Q= DP%"CW- S1110, MR iLA6awt wbm"mom v"e—offmodoxv Canary —OL;.d=W Copy ft*—RQftdft*M"C0[ 5 oG2. fz Cu a 04/19/2007 17:47 7815927641 ar -r OpIE MY 005 "" Sat , qffEENHousE SCHG 145 LORING AVE, 978 745 �'i549 01 COMMENTS TODDLER KITND KEYS!''' AlEXTERMINATORS PAGE 03/03 CU Fl R'i* 4 ct ikc P�01anaLm— REGULAR PE9jr 'CONTRQL 01970 DATE PPZMCTALP CHECK NO. RTU RAFT STA 0 MC 0 VlSA 0 ClSCOVER' RAT OWE ED PAPOOL HAVE ACCT. 0 EXP DATE SALES TAX OLH wua6 c.o.tro x Won TOTAL DUE Floors — Clean ..... Counter Surfaces — Clean Draln Areas — Clean . - - - ReV Rooms — Clean ...... Olning Areas — GleSn ..... Employee Areas — Clean Lobkw ArM — Clean .... Storage Areas — Or9w1z6d Comments TDIAL AMOUNT PD DIRECTIONS ADDITIONAL COMMENTS DWEWNG TYPE WARRANTY YES [I NO 0 1 Family 0 3 Family 0 30 Days 0 60 Days 0 2 F=4 0 6 Ponq 0 1 90 Days 0 6 Moss. 0 REASON FOR mo WARRANTY I — -Partial SarAce requested ............. ... ... ......... .... ............... . .. -11 .......... Q .... L1 .pow sanitation........_ ................. * . . ......................... I ... I ............... -Kitcheh/Uthf mcabinel3trot prapared ...................................................El -rA�Wsflvrnll� not p-phed ..................................................... ............. _0 .Rodent proofing needed ...... P .......... 0 .............. d ...... I ................................ -Other & AGRICULTURE'S nE7wk I tETOS27 oa *My CWPLEVEh wsai I UC: a �� — — I . . opy —CMm,rcapy Pb* — Parnitutn" I SEP FtEvEnce A"EN;INFORMATION Wme—d"'. c cwwy w"k"`v sg {+.y {+ &('i NmO@ney Un$coll ;ii:. 120 W aShmn Street,_4th FIOOCrk,.-* x, , Y yM1.i'*xz Mayor% L°, 't,4v SALEM, MA 01970 DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: File Number: BHF -2004-000200 The Greenhouse School Pool 145 Loring Avenue - Salem MA 01970 LOCATED AT: 0145 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee .Restrictions / Notes SWIMMING POOL - BHP -2007-0299 Jan 4, 2007 Dec 31, 2007 $40.00 ANNUAL Total Fees: $40.00 PERMIT EXPIRES December 31, 2007 Board of Health Page 4 of 4 Kimberley Driscoll Mayor CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745.0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL LOCATION OF POOL NAME OF APPLICANT �'� / ` TEL # 6tTg MAILING ADDRESS Name: D PO�QL OpPERATOg � g� Name: !� k \ t . f.�� (/t,� Cert #: 4)3EL # SMVIA DATES OF OPERATION (if not annuap:__��"� DAYS & HOURS OF OPERA TYPE OF POOL Public' .. ,.. ..- _. .. .. .... Semi -Public " Special Purpose FEE: $200.00 for year round poufs $100.00 for seasona$40.00 Non -Profit (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. 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 63C, Section 49a, 1 certify under the pains and penalties of perjury that 1, to my best knowledge td belief, have file a I state tax returns and paid all state taxes required under the law. ' Date SS# or Federal Identification Number iR6%,Isctl7/1/2004 poolapp.wpd pennit THE GREENHOUSE SCHOOL, INC. /�PATRICIAJENNINGSMELCH, PRES. 3492 V, City of Salem 12/8/06 40.00 VA 41 —M q—g F S� 'Its -4",z P am, Viv n, N", pennit SALEM,MA U197U Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: File Number: BHF -2005-000026 LOCATED AT: The Greenhouse School, Inc. 145 Loring Avenue - Salem MA 01970 0145 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0120 Dec 20, 2006 Dec 31, 2007 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES !December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 22 of 23 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH r 1/20 WASHINGTOHSTREET, 4TH FLOOR RECEIVED SALEM, MA 01970 TEL 978-741-1800 DEC 14 2006 FAx 978-745-0343 r L-`�''tr9' WWW.SALEM.COM CITY r'.- SALE vl Kimberley Driscoll s I ,,.. L,,,ARD OF HEALTH r:� �R JOANNE SCOTT; MPH, RS,.CHO Mayor :. HEALTH AGENT{yy 1r. 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT LO rL5 4,,e FAX # _,a u/tt�a� MAILING ADDRESS (if different) EMAIL ADDRESS TEL ST ZIP CERTIFIED FOOD MANAGER'S NAME(S) JK�O�rwo- Gf � CERTIFICATE#(S) IA qtt l `' J• Soft-W�e (Required in an establishment where potentially hazardous food,, is prepared) S'� � K 9�r ply" 1 �tO EMERGENCY RESPONSE PERSON �g/tw /� V LrA H1OME TEL # OAySOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. - (For example Ilam lloml 7 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than I000sq-ft. =$ 50 4fp,) 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - - - - ----------------------------------- -- ---------------------------------------- RESTAURANT YES ------ less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 - -------- ------ ---- -------- ------- - ------------- --- - -- BED/BREAKFAST YES N $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR IYES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MQL Chapter 52C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all MrnV paid all state t xes required under the law. Signature Revised 11/13/06 FOODAP2007.adm Check# & Date Social Security or Federal Identification Number $_n5,o6 l / � `;_•,, a'ri�. ` f wyi WWF_ p u�s THE GRFENHOUSE SCHOOL, INC. /PATRICIA JENNINGS-WELCH, ?RES. '612ity of Salem 12/8/06 MM 25.00 A p �e 0o T,' d, 'r v r" 'F -IN v K RS H^o.t ".Z V vv � I , p ".' i - .' s wt'�, L FROM : FRX NO. : Jun. 28 2006 11:54RM P1 10und the greenhouse school patricia jenninQs-welch, executive director los Ioring Ovenue Il sok m, mossachuseth 01970 tel. 978-745-M49 never sMp learn7ng June 27, 2006 David Greenbaum Salem Board of Health 120 Washington Street Salem, MA 01970 Hi Dave: Just an update on the pool situation: the replacement pump isonorder and will be in late this week or early next. However, 1 also wanted to keep you abreast of our progress on the other concerns you noted. The-mutme maintenance-tssues(cleaning: defrosting: etc}have- been -resolved. We havealsa., replaced roll towels and filled all dispensers. The cabinet floor under the kitchen sink has been shored up. The leakin thestaff-bathroom.isa. bit .more -problematic. We have patchecIftseem in the roof above, but will have to wait for a soaking rain to see if it takes before painting. The reftigerator is down to temperature after a bit oftinkering, but vie are still Warned about the hottest. days and will keep an eye on it—it may be on its last legs. The freezer simply won't budge from 15- 20 degrees; for the time being we will remove any PHF products and I have feelers out for a new freezer and parent labor to pick one up. Mohan and hand sink water is hot: however, I am a bit wary about the kids' sinks being too hot as we discussed. We are working to find a solution that can split the temperatures appropriately. I will let you know as soon as the pool pump is ready; in any event we will be dosed for the long weekend, so I'm hoping it will be up to speed when we get back. Have a happy Fourth and IT touch base soon: Thanks: Sin7ely, Daniell P.WeW Administrative Director Vint us oxliae ar w gmg4hvuseschoof.org Plra link wwff'wwkovevwebrire-- ��/tlscr� a K4 -n - J 0145 Loring Avenue The Greenhouse School, Inc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I PROTECTION FROM CONTAMINATION 745 4549 Handwash Facilities FAIL Critical 0 RED Owner. Comment: There is only warm water at all hand wash sinks. Provide hot water at all hand wash sinks to a minimum temperature of Corporation Greenhouse Sc 110°F � PIC: Dan Welch Inspector: David Greenbaum Date Inspected: Correct By: 6/19/2006 Risk Level: I Permit Number: BHP -2006-0242 Status: 'PARTIAL COMPLY # of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): 'BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Provide wall hung paper towel dispensers at all hand wash sinks. _ TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical ❑J RED Comment: The GE refrigerator has a temperature of 50"F. Repair unit to maintain a temperature of 417 or below. The GE freezer had a temperature of 18°F. Repair unit to maintain a temperature of 0°F or below. Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The GE refrigerator/freezer needs a thorough cleaning. The GE freezer needs a thorough cleaning. The microwave needs a thorough cleaning. Repair or replace the handle on the GE freezer. Physical Facility Comment: Repair the hot water handle in the faculty restroom. The sink cabinet is in disrepair. Repair or replace the sink cabinet. FAIL Non -Critical BLUE The counter tope has exposed wood on rhe end. Seal the end of the counter. There is water damage on the ceiling of the faculty restroom. Investigate the source of the IeK and repair. Repair the ceiling. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 19,2006 ) Page I of 2 :r INZIG Item GENERAL COMMENTS: Status Violation Critical Urgency Violations Related to 667:Please notify the Board of Health when the pool is repaired and working. Reinspection will be done at the Foodborne Illness time of the pool inspection. Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 19,2006 ) Page 2 oft Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2005-0026 LOCATED AT: The Greenhouse School, Inc. 145 Loring Avenue Salem MA 01970 0145 LORING AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0242 Jan 3, 2006 Dec 31, 2006 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES Iecember 31', 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted, in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revocations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 11 of 13 STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT FESTABLISHMENTP ION FO TO OPERATE A ,OD ESTABLISHMENT NAME O J ADDRESS OF ESTABLISHMENT ILI ss MAILING ADDRESS (if different) --�' rt (y'__Q OWNER'S NAME �l ,.QwWd` ,�-nC � TEL# Sl"' ADDRESS t`� - CITY STATE ZIP We, ?L4 FOOD MANAGER'S NAME(S) hti2C CERTI`FI`CATE#(s) ZJ° �%Q,rj tl` e, L4e: prq ,ra In Ow f rtG a2� � r I� (required in an establishment where potentially ha25&t�fo�r ” err ed.) t EMERGENCY RESPONSE HOURS OF OPERATION: I TYPE OF ESTABLISHMENT RETAIL STORE YES ,4- HOME TEL # -t�F 4(, � 7 Th u.Fri.Sat.--S u n.�� FEE (check only) less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -------------------------------------------------------- RESTAURANT YES N V W less than v seats =$100 25-99 seats =$150 more than 99 seats =$200 YES. .----------------------------------------------------------------------- --------..............----------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR NO $50 ALL NON-PROFIT (such as church kitchens) nE NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must.be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. � 7 �QryvlKa p It - a-6146 3 1Cs��p�l�� Signature (, Date j t� Social Security or Federal Identification Number cVgv � end Revised 11/03/05 FOODAP2.adm ChebL# & Date 2C7 ` INTERNAL REVENUE S RvICE I D PA`viyUE!7 OF 1HL. TREASURY DISTRICT DIRECTOR G.P.O. BOX lbs0 BRO(,)KLyN. NY 11203 Employer identification Number: 04-2SO1463 Dat JAN 61995 Case Number: 11432-01? -IHF- GRFLN-liOLSL SCITCIOL- INC. Contact Pson 145 LOPING AVE. FRANCES E. ilCKEN A SALEM. On 01970 Contact Telephone Number: ( 7 15) 438-2318, Accounting Period Ending: December 3J Form 940 Required: Yes Addendum Applies: Ya Dear applicant: Basest oil information supplied anis assuming your operations ill be as stated in your application for recognition of exemption. we gave dettermined ,you -arc" e:*.empt'f oiiFederal income tai, under section 50 (1) f the Interna l Revenue Cole as an organization described in section 501(c)(3) We have further .determined that you are not a-privaate foundation within the meaning of section 509(x) of the Code, because you are an er9:3niz.,tiOn described in sections 509(ai(l) and 170(b)(1)(A)KH . If -:r sources•of support, -or your purposes, character. of method of .- operation change, please let us know so we -can consider the affect of the - change onyour exelf t status'and.foundatron status. In the cage of an amend went to your organizational document. or hylaWs please send us a copy of the amended Cd! Qr.bylgws;. Also. You should- .inform us.ob all 4t ;nzes in your Name or-addaess.. As of ianuary 1. I.9S4. you ate liable for taxes -under the --Pede rat insurance Contributions Act (social security taxes) on remuneration of `l0`) or more you pay to each of your Employees during a calendar year. You are not liable for the ta:: rmpo-act under the.Federal-Unemp,lovmen( Ta,. act (1-tTA),', Since you are not a p.liyate foun;latton, you are not_subjeet to the expise. taxes uudet i'hapter 42 of the Code. However. you are not automatically exempt from other Federal excise taxes If you have any questions aoout'eNcise. employment.. or other Federal tares. pleasee let us knot':. Grantors and contributors n��_ . rely On this determinat A unless the �av - publishes notice to the contrary. however. if you. - al Revenue Service publr._he Bern o a not rely lose your section 509(al(1) status. a grantor or contributor ��i on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no lonzer.be classified as a section 509(a)(1) organization. Donors may deduct contributions to you as provided in section 170 of the Letter .947 IDO/CG) THE GREE\N()il.SL SCH/)JL., INC. Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meets: the applicable provisions of Code'sections 2055. 2106, and 2522. Contribution deductions�vre allowable to donors only to the entent that their contributions are gifts; with no consideration received. Ticket pur- chases and similar payments ip-_conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246. pubJ ished in Cuim lative Bulletin i9b: ?. on page 104. which sets forth guidelines re_•ardins, the deductibility. as Chari-, table contributions.. of payments made by taxpayers for admission to or other participation in fundraising activities for charity. In the heading of this letter we have. indicated whether you must file Form 990. Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only if your gross receipts each year are normally more than ;25.000. However, if you receive a Form 990 Cacl:nse in the mail. pease file the return even if you do not exceed the gross receipt.5 testa if you ore not required to file, simply attach the label provided. check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less. and sign the return. If a return is required., it must be filed by the 15th day of the fifth month after.the end of your annual accounting. period. A penalty of $10 a day is charged when a return is -filed late,"unless there is reasonable causefor the delay. However, -the maximum penalty charged .camnot exceed $5.000: or 5 per. cc;nt of your xros9 receipts for the year whichever is less! This penalty may °also be ch lt.ged.�f.a rECUFYI is not r_ompletG tiO please.li@ suraTour return it - conipl to before you,:file. it. You are not required to : f i 1 e federal income tax returns unless you are subject to.the'tax on unrelated business income under section �tl of the Code. I1 you are subject ao-this tax. iou must file an income tax return on Form 9907T, Fxempt Organization-Business.incomaiTax Return. In this letter we are not deteiminine wheKey any -cif your Resent gr,p,roposed activities are unre-' lated trade or basiness as defined,in section 313 of the Code. You need an employer identification number even if you have no employees. if an employer identification number was not entered on your application. a number will be assigned to you and you will be advised oi'it. Please use that number on all returns you file and in all correspondence with the internal Revenue Service. Revenue Procedure 5-50. published in Cumulative Bulletin 1975-2 on page 50. sets forth guidelines and recordkeeping requirements_ for determining whether private schools have racially nondiscriminatory policies as to students. you must comply with this revenue procedure to maintain your tax-exempt status. In accordance with section 508(a) of the Code., the effective date of this Letter 947 (DO/CG) THE GREENHOUSE SCHOOL. INC. determination letter is August 30, 1953. This determination is based on evidence that your funds are dedicated to the purposes listed in section 501(c)(3) of the Code. To assure your continued exemption, you should maintain records to show that funds are expended only for those purposes. If you distribute funds to other. organizations. your records shoulcl sh= whether they are exempt under section 501(c)(3). In cases where the recipient organization is not exempt under section 501(c)(3). there should be evidence that the funds >\ill remain dedicated to the required purposes and that they will be used for rhos purposes be the recipient. If distributions are made to individuals. case histories regarding the recipients should be kept .showing names, addresses, purposes of awards. manner of selection. relationship (if any) to members. officers, trustees or donors of funds to you, so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service. (Revenue Ruling 56-304. C.P.. 19-56-2. page 306.) Q we have indicated in the'heading of this letter that in a d•:ndum apl)ies. the enclosed addendum is an integral part of this letter. Because this letter could help resolve any qUeSLiOnn grout tvur CXCMX status and foundation status;: you snOuld keep it in your permanent records. l.f VOtI have any gtles doffs. please yconlact.the person whose name, aid telephone number are shown in the heading of this letter.. _ SincerelyV ours 7 if r . , lit °; , 6 � Herbert -J Huff p'istrict Virectoi Enclosurets): ' Addendum Letter 947 (pO/CG) ` -4- TfIL GREENHOUSE SCHOOL. INC. Since you have not indicated that you intend to Finance your activities with the proceeds of tar exempt bond financing. in this letter we have not determined the effect of such financing on your tax. exempt status. i . t Letter 947 (DO/CG) FROM FAX NO. Dec. 12 2005 10:12PM Pi --DATE t1-1,? jo' FAX NUMBER PAGE TOTAL the preenhouse school nj 1 145 oring avenue - salem, ma 01970 1118) 7454549 fox: H78) 744-3598 K'S It4� 46 Cr CITY OF SALEM i BOARD OF HEALTH Establishment Name:-10_eL_X �6 0') Date: Page -.L41 dT/ Item Code No. Reference c - critical nem R - Red Item DESCRIPTION OF VIOLATION / PLAN Of CORRECTION Date -. - - Vermed PLEASE PRI T CLE RLY c Sal. i e t lC-W Nru" "'j, Jj�) t a� . t l( 55- 5b! I t tN(e �L (/ Discussion With Person in Charge: 1 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 inly fines of twwen f' dolls r sus a ion/revocation of your food permit. GdYi e t' tom`( Corrective Action Required: ❑ No es . ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Q J Violations Related to Foodborne illness interventions and Risk Factors flterm;1-22) (Cont.) I im Foal or Color Additives 3-202.12_ Additives* _ 3-302.14 Protectionfrom Lluapproved.Addiisives,r Protecti- 3-501.16(B) 590.W4(F) Poisonous or Toxic Substances I-101.11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201. 11 Separation - St * - 7-202.11 . Restriction - Presence and Use4 7-202.12 1 Conditions of Use* 7-203.11 Toxic Cotimmers - Prohibitions* 7-204.11 Samtizers. Criteria - Chemicals* 7-204.12 Chemicals ftirWashing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 incidental Food Contam Lubricants* 7-206.11 Restricted Use Pesticides; Criteria* 7-206.12 Rodent Bait Stations* 7-206.73 Tracking Powders, Pest Control and Monitoring* I im Foal or Color ' 0.nMce critical irt'm in the federal i 999 Fbcd Cneie a' IDS C�t2 590.OtI0. 20 3-501,1.4(C) Proper Cooking Temperatures tar .. 3-501.75 PHFs 3401.IIA(1)(2) Eggs- 155`F 15 Sec. 3-501.16(B) 590.W4(F) Eees- Immediate Service 145'F15sec* 3-401.11(A)(2) . Comminuted Fish. Meats & Game 3-501.I6(A) Animals -155'F 15 sec. * 3.401.11(8)(1)(2) Port; and Beef Roast -130'F 121 min* 3 4(}l.l Illi){2) Ratites, Injected Meats -155`F 15 590.004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 2T 1 Stuffing Containing Fish, Meat, ' FC -o Poultry or Ratites -765'F 15 see, 3-401_11(C)(3) Whole -muscle, Intact Beef Steals i FC -7 145°F * 3-401.12 Raw Animal Famis Cooked in a Microwave 165`F * 3-401.11(A)(1)(b) All Other PHFs -145'F 15 sec, Reheating for Not Holding 3403.11(A)&(D) PHFs 165'T 15 sec. * 3403.11(B) Microwave- 165' F 2 Minute Standing Time* 3-403.1I(C) Commercially Processed RTF. Food - 1400F* 3-40311(E) Remaining Unsticed Portions of Beef Roasts* Proper Cooling of PHFs 3-501'.14(A) Cooling Cooked PHFs from 140`F to 70'F Within 2 Hours and From 70'F to 41`F/45'F Within 4 Hours.* 3-501.14(8) Cooking PHFs Made From Ambient Temperature ingredients to 41'F/45'F Within 4 Hours* ' 0.nMce critical irt'm in the federal i 999 Fbcd Cneie a' IDS C�t2 590.OtI0. 20 3-501,1.4(C) PHFs Received at Temperatures According to Iaw Cooled to 417/45°F Within 4 Hours. 3-501.75 C olitl2 Methods for PHFs 3-801.11(D) PHF Hot and Cold Holding 3-501.16(B) 590.W4(F) Cold PHFs Maintained at or below 41'745° F* . 3-50116(A) Hot PHFs Maintained at or above 140'F. * 3-501.I6(A) Roasts Held at or above 130'F. " 25. Time as a Public Health Control 3-501: i9 iirne as a Public I$ealtia Cmntrol* 590.004(H) Variance Requirement IN REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.11(A) Unpasteurized Pre-packaged Juices and .Bevem *es with Warning Labels*_ 3 801.11(B) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served * 3-801. i L(C) Unopened Foul Package Not Ro served. CONSUMER ADVISORY 22 3-603.11 ConsumerAdvisory Posted for Consumption of 590.00 i i 23 Animal Foods That are Raw. Undercooked or 1 FG -2 .003 Not Otherwise Processed to Eliminate Fcod and Food Protection I FC -- 3 Pathogens.' t ` n2ra 1 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 005 ! 26. E 590.009(A) -(D) Violations of Section .590.009(A) -(D) in catering,, mobile food, temporary and residential kitchen operations should be debited udder 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-criticat violations, which do not relate to the foodborne illness interventions and risk_factors listed above, can be }'bund in the fallowing sections of the Food Code and 145 CMR 590.000. 1 Item % Good Retail Practices 1,17C 590.00 i i 23 Management and Personnel 1 FG -2 .003 1 24. Fcod and Food Protection I FC -- 3 004 j 25. Equipment and Utensils FC -4 005 ! 26. 1 Water. Plumb>ina and Waste _� i FC -5 006 2T 1 Physical Facility ' FC -o 007 28. ' Poisonous or Toxic Materials i FC -7 .008 i 29. Spatia( Requirements 009 30 1 Other ssurrama7::E-z c: i) J V CITY OF SALEM BOARD OF HEALTH Establishment Name: (-M Vt^P¢ 0.1�r9.�5G�i .�c� Dater Pager of item Code No. Reference C - Critical Item R - Red item DESCRIPTION OF VIOLATION / PLAN OFf CORRECTION - Dete Verified` PLEASE PtUNT CLEARLY vim_ I� r Oc d n LJ/7 AJ Aqloj2d d�— Afl�'Cx- o,"- c lryfjQB tU Sfi t6,i 5 '4z'(, r 't/ e �'.n11 v ra Link nl r .e) N 4,o U AA,4 a P(J-,AWjck,,V r C b I , t _ ? ` C-� TiI V �, r _ &tjo� 'h- L vIA bA 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 i dally fines of twen�y-ft doll f or suspension/revocation your food permit. � t/t%�� ' 6�/ IIJJ Corrective Action Required: ❑ No o: Yes ❑ voluntary Compliance ❑ Employee Restriction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo a Emergency Closure Voluntary Disposal a Other: �s L Violations Related to Faodberne ltiness fntervenflons and Risk Factors (Hems 1-22) (Cant.) �• s _R... 15 16 W t, til u • *ii. `• Food or Color Additives 3_202.12 .. .-,. 3-302.14 _Additives Protection from Una coved .Additives"' 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.1 i Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Storage- tora e*7-202.11 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitize". Criteria - Chemicals* 7-204.12 Chemicals for Washing Produtx, Criteria* 7-204.14 Drying Agnim Criteria= 7-205.11 i»cide11 Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Momtorm * t, til u • *ii. `• * Denotes critical nzai in the federji 1999 Food Case a' 10� C:.MR X90.000. M 3-501.14(0 - Proper Cooking Temperatures for 7501..15 PRFs 3-40i.IIA(1)(2) Eggs- 155`F 15 Sec. 3-501.16(B) 590.004(F) LEE: Immediate Service 145'FI5su+ 3401.11(A)(2) Comminuted Fish. Meats & Game 3.501.16(A) Animals -155°F 15 sec. * 3.40LI1(B)(I)(2) Pork and Beef Roast - 130°F 121 min* 3-401.1 I(A)(2) Rattles, Injected Meats -155°F 15 590.004(H) see. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Staffing Containing Fish, Meat, Poultry or Ratites -765°F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 1450F * 3-001.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401:11(A)(1)(b) A1) Other PSiFs - 145'F 15 sec. * Reheating for Hot Holding 3- 03-.41(9.)&(D) PlIFs I65*F 15 sec. * 3-403.11(B) Microwave --I65` F 2 Minute Standing Time* 3403.11(0 CommercialIy Processed RTE Food - 140'F 3-403.11(E) Remaining Unsiiced Portions of Beef Roasts* Proper Cooling of PRFs 3-501.14(A) Cooling Cooked P1117s from 240'F to 70'F Within 2 Hours and From 70'F to 4I'F/45'F Within 4 Hours. * 3-501.14(B) Cooling PRFs Made From Ambient Temperature ingredients to 41'F/450F Within 4 Hours` * Denotes critical nzai in the federji 1999 Food Case a' 10� C:.MR X90.000. M 3-501.14(0 - PHFs Reocived at Temperatures According to Law Cooled to 41T/45*F Within 4 Haus.'* 7501..15 Cooling Methods for PHFs 3-801.11(D) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PRFs Maintained at or below 4101450 F* 3-50L I6(A) Hot PHFs Maintained at or above - 140'F. 3.501.16(A) Roasts Held at or above 130'F. Titre as a Public Health Control 3-501.19 - Time as a Public Health Cont14* 590.004(H) Variance Requirement 3-801.11(A) Unpasteurized Pre-packaged Juices and :Beveratres with Warning labels* . 3-801.11(8) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Food Package Not Re -served. " 22 3-603.1I Consumer Adiisary Posted for Consumption of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate 1 Pathogens.* °1+2mr 3-302.13 Pasteurized Eggs Substitute for Raw Shell 1 E 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to goad retail practices should be debited under #29 - Special Requirements. (items 23-30) Critical, mrd non-critical violations, which do nor rehrte to the foodborne illness interventions and risk,factors listed above, can be found in the following sections of the Food Code and 105 CMR syuer, �::6x e:: V e - CITY /j / ) BOARD OF HEALTH Establishment Name: f �Is2 l'r 4 �l��S� � Date Page: CD- of LI Item Code No. Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLANJOF CORRECTION ' - PLEASE PRINT C RLY Verified s w.' In��3c 5 cr c vL _f. NJL m I 0 493 17 100 n kA Discussion With Person in harge: 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 fines of twenty-filye dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ . No Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion e -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure . ❑ Voluntary Disposal ❑ Other: MA Violations Related to Foodborne Illness Interventions and Risk Factors fltems 1-22) (Cant.) _ Food "or Color Additives 3-202.12 Additives* 3-302.14 Protection from Un roved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers" 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Stns 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* 7-2041 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 Bair Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* Im tl � ' Demos ctifical item in the E -dent] 1999 Fo A Cale o' 10 C4iR 590.000. 20 3-501, I.4(C) Proper Cooking Temperatures for 3-50(.15 PHFs 3-401.11A(t)(2) Egggs- 155F 15 Sec. 3-501.16(B) 590.004(F) 'H as- Immediate Service 145'F15sec* 3A01.11(A)(2) Comminuted Fish. Meats & Game 3-501. f 6(A7 .Animals -155'F 15 see. * 3-401.11(11)(1)(2) Pork and Beef Roast -130'F 121 min* 3-401.1I(A)(2) Ratites, Injected Meats - 155°F 15 ! 26. sec. * 3101.1 t(A)(3) Poultry, Wild Game, Stuffed PHFs, 27 Stuffing Containing Fish, Meat, i FC -6 Poultry or Ratites -165'F 15 sec 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 1 FC -7 145'F 4' 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-40LI I(A)(1)(b) All Other PHFs - 145'F 15 see. Reheating for Not Holding 3-403:11(.4)&(D) PHFs 165°F 15 sec. * 3-103.11(B) Microwave --165` F 2 Minute Standing Tithe* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(E) Remaining Unsliced Pardons of Beef Rmsts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 70T Within 2 Hours and From 70`F to 4I`F145'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* ' Demos ctifical item in the E -dent] 1999 Fo A Cale o' 10 C4iR 590.000. 20 3-501, I.4(C) PHFs Received at Temperatures According to law Cooled to 4171457 Within 4 Boom 3-50(.15 CoolmE Methods fur PHFs 3-801-II(D) PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41°!d5' F* - 3-501.16(A) Hot PHFs Maintained at or above 1407. * 3-501. f 6(A7 Roasts Heid at or above 130'F. 125. Time as a Public Health Control 3-501.19 Time as a Public Health Control* ! 26. Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS FISP 3-801.11(A) Unpasteurized Pre-packaged Juices and .flevenges with Warning labels* 3-801.11(B) Use of Pasteurized Eggs* 3-801-II(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served * 3-801.1I(C) Unopened Food Package Notlie-served. e. M. . 11. y1 22 3-603.11 Consumer Advisory Posted for Consumption of 540.000 1 23. Annual Foods That are Raw, Undercooked or 1- FC - 2 .003 NotOtherwiseProcessedtoEliminate- i Food and Food Protection i FC - 3, Patho ns.*�`"fr 125. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 I ! 26. Egirsr SPECIAL. REQUIREMENTS 590"009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.004 violations relating to good retail practices should be debited under #29 - Speeiai Requirements. (Items 23-30) Critical mrd non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the fallowing sections -of the Food Code and 105 CUR 590.000. j item Retell Practices � FC 540.000 1 23. _j]_God i Management and Personnel 1- FC - 2 .003 --� 124. i Food and Food Protection i FC - 3, .004 i 125. 1 Equipment and Utensils _ i FC -4 .005 I ! 26. Water. Plumbing and Waste t FC -5 .006 27 Physical Facility i FC -6 .007 28. 'Poisonous or Toxic Materials 1 FC -7 .008 X29. special R uiremants Ap9 j 30. I Othor �,L g4NiloriMa[�i. L•C r Massachusetts Department of Public Health Division of Food and Drugs City/Town of FOOD ESTABLISHMFNT INSPFCTlnN RFPnRT Salem Board of Health 120 Washington Street, 0 Floor . Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Address: Name -0ate Type ofOperalion(s) Type of Inspection lfv�.1 Pag�_ oll- Pages tg�1, Food Service I_J Retail Routine jRe-inspection Address Ri Telephone Level El Residential Kitchen Previous Inspection ' r El Mobile ❑ Temporary Date: - ElPre-operation Owner C HACCP YIN Q� ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person -in -Charge (PIC) I( u i Time In: [I HACCP Inspector OUP Permit No. ❑ Other_ tea..a V W avn eu<..neu reyunes an eAPsananvn on ine narrative pagets) ana a Citation Of specific provision(s) violated. _ Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) - - Anti -Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009 (F) ❑ Allergen Awareness 590.009 (G) ❑ - corrective action as determined by the Board of Health. V6 PROTECTION MANAGEMENT_ 7 [112. Prevention of Contamination from Hands 1. PIC Assigned/Knowledgeable/Duties . HEALTH _ '-' �- ,� .❑ 13. Handwash Facilities CEMPLOYEE- ❑ 2. Reporting of Diseases by Food Employee and PIC IPROTECTION FROM'CHEMICALS' [114. Approved Food or Color Additives ❑ 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 CPROTEC710N FROM CONTAMINATION -'moi ❑ 8. Separation/Segregation/Protection- X4 3. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing , ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Noncritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (Fc -2X590.003) 24. Food and Food Protection (FC -3X590.004) 25. Equipment and Utensils (Fc -4)(590.005) 26. Water, Plumbing and Waste (FcsX590.006) SZ 27. Physical Facility (Fc -6X590.007) 28. Poisonous or Toxic Materials (FC -7X590.008) 29. Special Requirements (590.009) 30 30. Other 15. Toxic Chemicals JTIMEREMPERATURE:'CONTROLS (l?ot'eMially Flazerdous F_oou I ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling Z449. Hot and Cold Holding ❑ 20. Time as a Public Health Control [REQUIREMENTS. FOR' HIGHLYSUSCEPTIBLE=PO_ PULATION$(HSP),, ❑ 21: Food and Food Preparation for HSP rCONSUMERADVISORY__e ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions � and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address . within 10 days of receipt of this order. DATE OF RE-INSPECTION:f g � t M Inspector's Signature: Pri , PICS Signature: Print: f - we(CIA Pag�_ oll- Pages Gp (rr-C(_-,r % as "tea (d Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of R esonsibilit * 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food law* 3-201.12 require reporting by foal employees and 3201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* - 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 lee Made From Potable Drinking Water - Applicant To Report To The Person In Drinking Water from an Approved System." 590.006(A) Charge* 590.006(B) 590.003G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C I I FOOD FROM APPROVED SOURCE * Denotes c?itic€d item !n.the federal 1999 Fntrtl Cone or 105 CMR 590.000. C PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A-8) Compliance with Food law* 3-201.12 Food in a Hermeticail, Seated Container* 3201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* - 3-202.14 Eggs and ?Milk Producis. Pasteurized* 3-202.16 lee 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*: Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Shellfish and Fist? From an Approved Source 3-201.14 Fish and Recreadonaliy Can& Molluscan Shellfish* 3-201.15 Molluscan Shellfish from :NSSP Listed Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Pe ulatory Authority 3-20218 Shellm."ck identification Present* 590.004(C) Wild Mushrooms* 3-20).0 Game. Animals*. 2-301.14 Rece!ving/Condition 3-202.11 PHFs Received at Proper Tem eratures* 3-202.15 Package Integrity' 3-!01.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 SirelistockldentiGcationM-aintainctp" 12 Tags/Records: Fish Products 3.402.11 Parasite Dk.strncc or.* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures 1HACCP Plans 3-502.11 Specialized Processing Methods* 3-502:12 Reduced Oxygen acka "ng, criteria* 8 103.!2 Conformance with Approved Procedures* * Denotes c?itic€d item !n.the federal 1999 Fntrtl Cone or 105 CMR 590.000. C PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from , Cooked and RTE Fads* - Contamination from Raw Ingredients 3-30211(A)(2) Raw Animal Foods Separated from Each Othcr* Mechanical Warewashing- Hot Water Sanitization Tem ratures* - Contamination from the Environment 3-302.11(_A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and - Utensils* 4-602.11 Contamination from the Consume? 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 70I.TF Discarding or Reconditioning Unsafe Food* 9 -Food Contact Surfaces 4-501.1.1 l Manual Warewashing - Hot Water Sanitization Temperatures* _ 4-501.112 - Mechanical Warewashing- Hot Water Sanitization Tem ratures* - 4-501.11.4 - 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 Arens* 230t.12Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2401. t2. Discharges. From the Eyes, Nose and Mouth* 3-30t.12 Preventhn2 Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(F) Preventing Contamination from - Employees* - 13 Handwash Facilities Conveniently Located and Accessible - 5-203.11 . Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying - Devices -6-301.11 Handwashin Cleanser,.Availabilit 6-301.1.2 Hand-Dn Pruvision SALEM HEALTH Date: Page:_ of �L_ item No. Code Reference C - Critical item R - Red ItemVermed DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date PLEASE PW CLEARLY _tl ( o f✓ `� a ^L. CL f M/ t-1 _ O Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five liars or ension/revocation of your food permit. Corrective Action Required: ❑ . No es ❑ Voluntary Compliance ❑ Employee R striction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo o Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (ftemsY-22) (cant.) 15 - Foal w Calor Additives,.,, �Additives* 3-202.12 PHFS 3-302.14 Protection from Unapproved Additives* 3-801.11(C) Poisonous or Toxic Substances 7-101,11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.II Separation - Stora 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* - 7-205.11 hicidental Food Contact, Lubricants* 7-206.11 - Restricted Use Pesticides, Criteria* 7-206.12 - - Rodent Bait Stations* 7-206.73 Tracking Powders, Pest Control and Momtorin * Fu Im C TIMEITEMPERATURE CONTROLS " Denotes critical iu.m in the L-deral 1999 Fond Cate a 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures - According to Law Cooled to 41M- 45`F Within 4 Hoars. * Proper Cooking Temperatures fat 19 PHFS 3-401.11A(l)(2) Eggs- 155F 15 Sec. 3-801.11(C) Eggs- immediate. Service 145'Ft5sec* 3-401 A I(A)(2) Ccxrm inmed Fish. Meats & Game FC - 3 Animals.- 1550F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast - 130-F 121 min* 3-401.11(A)(2) Ratites, injected Meats -155`F 15 26. SPC. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, - Poultry or Ratites -165'F 15 sec 3-401.11(C)(3) Whole -muscle, intact Beef Steaks y FC -7 145'F * 3-401.12 Raw Animal Foods Cooked in a - Microwave 165`F * 3-401:1 f(A)(1)(b) All Other PfI s -145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165-F 15 sec. * 3-403.11(B) - Microwave- I65` P 2 Minnie Standing Tiaae* 3403A i(C) Commercially Processed RTE Food - 140°F* 3403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHF9 3-501.14(A) Cooling Cooked PRFs from 140`F to 70`F Within 2 flours and From 70`F to 41`F/45°F Within 4 Homs. * 3-501.14((3) Cooling PHFs Made From Ambient Temperature ingredients to 41*F/45'F Within 4 Hours* " Denotes critical iu.m in the L-deral 1999 Fond Cate a 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures - According to Law Cooled to 41M- 45`F Within 4 Hoars. * 21 3-501.16(6) 1 Cold PIFs Maintained at or below 3-501,16(A) I Hot PHFs Maintained at or above 3-501 3-501,19 3-801.1](A) 3-501.15 Conlin Methods for PHFs 19 1 PHF Not and Cold Holding 21 3-501.16(6) 1 Cold PIFs Maintained at or below 3-501,16(A) I Hot PHFs Maintained at or above 3-501 3-501,19 3-801.1](A) Unpasteurized Pre-packaged Suices and .Bewrazes with Warning Labels* . 3-801.11(6) Use of Pasteurized Eggs* _ 3-801.11(D) Raw or Partially Coked Animal Food and Raw Seed Sprouts Not Served. s 3-801.11(C) Unopened Food Package Not Re -served. 7077MUMN-Tvirx =I; 22 3-603.11 Consumer Advisory Posted for Consumption of 1.5.90.000 �- 23. Animal FoodsThat are Raw. Undercooked or •, FC - 2 .003 Not Otherwise Processed to Eliminate TFood and Food Prot lion FC - 3 Pathorens.* FNe "Y/c2IX r 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. Emt 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. (Rents 23-30) Critical mid 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. '- tram ! Good Retail Practices Fc 1.5.90.000 �- 23. I AAanacement and Personnel •, FC - 2 .003 24. TFood and Food Prot lion FC - 3 .NA 25. E ui menu and utensils FC -4 .005 26. Water. Plumbing and Waste l FC -5 .006 27. 1 Pti sisal Facia 1 FC -8 ! .007 i i 28= Poisonous or Toxic Materials y FC -7 .008 C29. Special R uiremarrts - .009 I 30. j Other Massachusetts Department of Public Health Division of Food and Drugs City/Town of FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 40' Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Address: TAI Name Da Type of Operation(s) Food Service Type of Inspection ❑ Routine Address �� r �i Rik Level Retail ❑Residential Kitchen Mobile - :®Re -inspection p"revious a wn Date: Telephone _ _ qyy c,❑ -❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑Pre-rativ ❑ Suspect Illness ❑ General Complaint ElHACCP ❑.Other Owner t\J U0 1,6- HACCP YIN Person -in -Charge (PIC) v - Inspector Time 145 O3� eacn violation cneCxeo requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Violations marked may.pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. t FOOD PROTECTION MANAGEMENT' ❑ 1. PIC Assigned/Knowledgeable/Duties) [EMPLOYEE HEALTH__ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded r- ,- -.. _ - ---.. FOO D'FROM _APPROVED SOURCE _ ��. ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy. of IngredientlStatements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing - ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2X590.003) 24. Food and Food Protection (FC -3X590.004) 25. Equipment and Utensils (FC -4X590.005) 26. Water, Plumbing and Waste (FC -5X590.006) 27. Physical Facility (FC -6X590.007) 28. Poisonous or Toxic Materials (FC -7X590.008) 29. Special Requirements (590.009) 30. Other .EHd,. o� Anti -Choking • - 590.009 (E) ❑ Tobacco 590.009 (F) ❑ Allergen Awareness 590.009 (G) ❑ ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities ��ti PROTECTION FRRM'CHEMICACS' ,_ ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals -�TIMFITEMFERATURECONTROLS(l?otentlallyHazardousFgods) [116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling [119. Hot and Cold Holding - ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLYSUSCEPTIBLE=P_OPULATIONS_(NSP):� ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY-,.,_� ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22)t 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 REINSPECTION: Inspector's Signature:Print: PICS Signature: Print:- f (00A Pag o�ages Violations Related to Foodborne Illness Interventions and Risk Factors (Hems 1-22) i FOOD PROTECTION MANAGEMENT 1 590.003(A) Assi tment of Res tonsibilit * 590.003(B) Demonstration of Knowledge 2-1.03.11. Person inchaze-duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* - 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 14e Made From PotableDrinkingWater* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) CharE* 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 Restdetions 4 i® I C FOOD FROM APPROVED SOURCE Denotes critical iter in the fiWeral 1999 Ford Code or 105 CMR 59010). C PAnTFfT1nN FROM r1]NTAMINATUVJ Food and Water From Regulated Sources 590.0(M(A-B) Compliance with Food Law* 3-201.12 Food to ;t Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* - 3-202.14 Eggs olid Milk Produces. Pasteurizzd* 3-202.16 14e Made From PotableDrinkingWater* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 31.0 CMl? 22.0* Frequency of Sanitization of Utensils and - Food Contact Surfaces of Equipment* Shelffish and Fish From an Approved Source 3-201.14 Fish and Recreationally CaaghY ?vfollusuan Slicllflsh' 3-201.15 - Molluscan Shellfish from NSSP Listed Sources* Proper; Adequate Handwashing Game and Wild Mushrooms Approved by Re ulato Authont 3-202.18 Shelistock identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game. Animals* 2-301.14 ReceivingrCondition 3-202.11 PRFs Received at Proper Tem raiures* 3-202.15 Package integrity* 3'-101.11. Food Safe and Unadulterated .-Tog-Accords: 5helistock 3-202.18 Shellstock Identification * 3-203.1.2 Shelistock identification Maintained" 12 _ Tags/Records: Fish Products 3=402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) Labeling of Ingredients' Handwash Facilities Conformance with Approved Procedures /HACCP Plans 3-502.11 S' cialized Processir. Methcxls* 3-502.12 Reduced 6x en acka .ng, criteria* 8-103.12 Confo mance with An roved Procedures* Denotes critical iter in the fiWeral 1999 Ford Code or 105 CMR 59010). C PAnTFfT1nN FROM r1]NTAMINATUVJ 9 Cross -contamination 3-302.11 (AN 1.) Raw Animal Foods Separated from Cooked and RTE Foods* 4-501.. Ll L Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water . Sanitization Temperatures* em eratures*4-501.114 Contamination from the Environment 3-302.11(A) - Food Protection* 3-302,15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* 4-602.1.1 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reserviee of Food* Frequency of Sanitization of Utensils and - Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3 --?01-i1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.. Ll L Manual Warewashing - Hot Water Sanitization Temperatures* _ 4-501.1 f2 Mechanical Warewashing- Hot Water . Sanitization Temperatures* em eratures*4-501.114 4-501.114- Chemical Sanitization- temp., pH, concentration and hardness. * _ 4-601.. 1'1(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.1.1 Cleaning Frequency of Equipment Food - Contact Surfaces acid Utensils* 4-702.11. Frequency of Sanitization of Utensils and - Food Contact Surfaces of Equipment* 4703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper; Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301..12 Cleaning Prmedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges. From the Eyes, Nose and Mouth* . 3-30L12 Preventin ContatninationWhen 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* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6301..12 Hand Drying Provision Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of FOOD ESTABLISHMENT INSPECTION REPORT Address: Tnl Name -ype ks, Print: of Operations) Type of Inspection Page -[of Pages 0 Food Service ❑ Retail - ❑ Routine DgRe-inspection Address R,&-- Telephone Level ❑ Residential Kitchen ❑ Mobile Previour I sp c ion Dater 11 Temporary ` ❑Pre perabon Owner - HACCP YIN ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person -in -Charge (PIC) Time ^� ` ln:�r,t-J ElHACCP Ins ector p Out:) ca.,,,� Permit No. ❑.Other c cavil vrurauun cnecReu requires an explanation on ine narrative pages) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors -(Red Items) Anti -Choking 590.009 (E) ❑ Violations marked may Tobacco 590.009 (F) ❑ y pose an imminent health hazard and require immediate ) ale en A areness 530.009 (GElcorrective action as determined by the Board of Health. 3) � le F006PR6TE¢TION_MANAGEMENT_ ❑ 1. PIC Assigned/Knowledgeable/Duties' --� 'EMPLOYF� HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded LFWUFROMAPPROVED SOURCE _ d ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition _ ❑ 6. Tags/Records/Accuracy.of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans 'L PROTECTION FROM CONTAMINATION 7 ❑ 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices -(Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Noncritical (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 -3X590.004) 25. Equipment and Utensils (FC -4X590.005) 26. Water, Plumbing and Waste (FC -5X590.006) 27. Physical Facility (Fc -6X590.007) 28. Poisonous or Toxic Materials (FC -7X590.008) 29. Special Requirements (590.009) Other 30. n ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities fPROTECTIONFROM"CHEMICALS '„ _ _ _ ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals i*OM EMPERATURE CONTROLS j0,R9 Ualty_Hazardous Foods) -1 [116. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and ColdHolding ❑ 20. Time as a Public Health Control -p REQUIREMENTS FOR; NIGHLY4U$CEPTBLE=POPULATIONS"(HSP) C]21. Food and Food Preparation for HSP (CONSUMERADVISORY--- ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22); Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: (/jL Inspector's Signature: Print: PICsSignature: I Print: 14 Idl P WAI� ---] - Page -[of Pages V ll/ V \1 - Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 7 590.003(A) Assigttment of Res nsibility* 590.003(6) Demonstration of Knowledge" _ 2-103.11. Person in charge. -duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3201,13 Fluid Milk and Mitk.Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-20116 Ice Made From Potable Drinking Water* Applicant To Report To'Phe Person In Drinking Water fmm an Approved S stem" 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 B 6 FOOD FROM APPROVED SOURCE '* Denotes critical ;wra in .(be federal 1999 Food Code or 105 CMR 590.0(N). C PROTECTION FROM CONTAMINATION Food and WaterFrom Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Rxod in a. Hermetically Sealed Container" 3201,13 Fluid Milk and Mitk.Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Mill: Products. Pasteurized* 3-20116 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water fmm an Approved S stem" 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* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Mol,iuscan ShelLl3h* _ 3-201.15 _ Molluscan Shellfish from NSSF i.isted Sources* Proper, Adequate Handwashing Game and Wild PAushrooms Approved by Regulatory Authority 3-202.18 Shellstock identification Present* 590.004(C) Wild Mushrooms*� 3-201.17 Game Animals* .. 2-301.14 Receiving/Condition 3-202.11 PRFs Received at Proper Temperatures* 3-202.15 Package lntegritt* 3-10,L! I --�y-� , Food Safe and Unadulterated Tags/Records: Shelistock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock Identification Maintained* 12 Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retemiun-4 590.004(f) Labeling of Ingredients' Handwash Facilities - - Conformance with Approved Procedures 1HACCP Plans 3-502.11 Specialized ProcessingMethods* 3-502x2 Reduced oxygen packaging, criteria* 8-103.!2 I Conformance wilhApproved Procedures* '* Denotes critical ;wra in .(be federal 1999 Food Code or 105 CMR 590.0(N). C PROTECTION FROM CONTAMINATION 9 Cross -contamination 3-302.11(A)(l.) Raw Animal Foods Separated from Cooked and RTE Foods* 4-501.. t 11 Contamination from Raw Ingredients 3-302.11(A)(2) Raw Antill Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Temperatures* Contamination from the Environment 3-302.1.1(A) Food Protection* 3-302.15 I Washing Fruits and Vegetables 3-304.11. Food Contact with Equipment and Utensils* 4-602.11 Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3--701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.. t 11 _ Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.1 12 - Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.11.4 - Chemical Sanitisation- 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* 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 C'leam Procedure* 2-301.14 When to Wash* 11 - Good Hygienic Practices - 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Moutb* 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* 5-2041.1. Location and Placement* 5-205.11 - Accessibility, Operation and Maintenance Suppled with Soap and Hand Drying - - Devices -6-301.11 Handwashing Cleanser, Availability 6-301..1.2 Hand Drying Provision h Ir20M N FLia\Ar !,L6 \1 t '"F1''f G.P.O. BOX t530 i1R(K)Ai.VN. N; 1,1232 nate- JAN 6 1995 THE GRF:ENIHOUSS KHOO'- INC. 1.45 LORIN, AVE. SALEM, MA 01170 Bear applicant: Based cn information s stated in your application you are exempt from Federal Fevepue 'Code as an or=aniza FAX NO. : Dec. 12 2005 10:12PM P2 Gnlploy'er ;ric11'Il.if l,�at tUil Number: 04-2$01463 Case Numbe..-: 11432-D)2 Contact Person: FkANCES 13 A4C IT-NNA Contact Telephone Number: (4IS' 458-2318 Accounting Period Fnding: December 31 Form 940 Required: Yes Addendum Appl i.es: Y"ei: plied. and assuming your operations will, be as r recoKnition of exemption, we have determined ncome tax under section 501(a) of the Internal on described :n section 501(c)( ;. We have further octermi�ned that you. arc not a private founda:icn w�i.thi,n the meaninA of section 509(x!1 of the Codc, because you are an organisation described in Sections _09(a)(11 and '170(15)(1)(A)(ii). i if yccr sources of support. or..your purposes, character, or method of operation, change. please let us k•tow so ac can consiaer the effect o'f the cilan?e on your exempt status and foundation status. in the case of at: amend - sent to your oreaniZational document or bylaws. please send us a copy of tic amcrided document or bylaws. iAlso. .you should inform us of ail changes in your :lame or address. As .: January 1, 1954, 4ou are. iiabl for faces under the Feder)) Insurance Contributions Act (social security taxes) on remuneration ?f $100 or more you pay to each of your employees during a Calendar year. Yau .are riot liabie for the ta:; imposed under the Federai Onemployment Tax Acr (PCTFA.i- I Since you are net private g'aundation; you a.re not Sub}ect to the excise ttaxes under Chapter 42 o of the Code. Ho`N_+ver, ,you are not ac;omatically exempt from other rederal excise taxes: - If you nave any questions about excise, employment, or other Federai taxes. piease ict us ):now. I Grantors and contribOLU_T'S may rei,y or, this determination unloss the internal Revenue service Trabi'�ishes notice to the contrary. Hpwever•iif yO11 los your section ,09(a);1j sitatt:s, a grantor pr contributor may notirc!y on this determination if hu or she was in part responsible for, or `As awareof, the act or failure to acts. or the su'Usianrial or m„tet sal. chanye:Cn ti;e part of the or,anizati.on that resulted in vou,r loss of sues) status, Sir if he of she acquired ltnov;ledue that the Internal Revenue Service sad. Bitter, notice that you cmui<i no ionper he classij ie:i'as-a ,Section 'i0?(,y)il) ergani:7atioil. i Donis may deduct contributions to you as provided ir, section 0 1-ei Letter 94? lrr,`/CG; FP.OM FAX NO. : - Dec. 12 2005 10:13PM 'P3 7HE GitEEN<1QrSE SCH<.x)1„ IN' Code. Bequests. ice, i.I q es, transfers, or vi,ts to you or ,`cr your use arc deductible for Yederal testate and gift tax nu1'poses if they meet the applicable provisions of Coide sections 20.5, ?106,. and 2522. i Contribution deductions are allowable to donors oniy to the c -stent that their contributions arC gifit S. with no consideration received. '[icket pur- chases and similar payments in con;iurction Faith fundf;;isle events may not nec'cG:az'ily quality as deductible contributions de ending on the circum- stances. See Revenue Hulin. 67-246, published .iat Cwnulative lju:ictin 19 7-2. - on. page 204, which sets fbrih wideiincs reg:rr<iir:., the deductibility, as cha i- tab?.e contributions, of payments made by t",M11yers .for.addltissi.on to 0'r nthe-r nztrticinacion in fundraising activities for c*,amity in the heading of this letter we have indicated whether you must 1'iie Perm 990..Return of Organization lExempt Prom Income Tax. if yas is indicated, you are required to file Form 990 only if your gross receipts each year are no.rmz.11y more than S25,000.I However, if you receive a N, e 990 package in the matt, please file the return even if you do not exceed tlic gross receipts test• If you are not required to fi)e, simply attach the iabel provided, chec3, the box in the heading to indicate that your annual press receipts are normal;v 525,000 or less. and sign thic return. If a return is requiredla it muse be filed by the 15th clay of the filth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return is filed Iate, unless there is reasorabie ,.^wase for the delay. However. the maximum penalty charred cannot ex<.eed $5.000 Or J' per- cent of your roS= receipts for the year, whichever)CSS. This penalty may also be charged if a return is not complete, so pleese be sui:r e your retuo is. complete before you fila it.I- You are not required tolyou fi.le Federal income tax returns unless are subject to the. tax, on unrelated business incoms under section 511 of the code. If you are subject to this tax. you rause file an income tax return on ]'orm 990-T, Excirpt Organization Business income Tar, Return. in this letter we are not determining whether any-Qf your present or p:'opo,scri a.ctiv'itias are unre- lated trade or business as de�fined in section 513 of the Code. You need an employer identification number even i` you have no.employaes. If an emnhryer identificationl numbcr was not entered en y011r application, a number wilt be assrgneci to youand you sill he r:dviser. oi' it. Please use that number on e11 returns vca fi1rr F and in ail cucres-ridence with the Internal Revenue service. I Revenue Procedure 75-50. publishc_: in C.:tmul alive Dul.letin 19?5-2 on pa„e 536, sets �crtlr guidelines and recerakeeping !'egniremerts for de.terraining Whether private schools have racially nondiscilannatory policies as to students- Yoo must comply wi6! this 1-c-VEnUe procedure _tc Maintain vol -r tax-exempt status.. 1 to accordance with section 508(al of the ccAe, the effective date of chis Letter 94' i, IK`,/w) FROM FAX NO. Dec. 12 2005 10:14PM P4 Ti.IF (:,REL•%7i0USE SO1100L, iNC. determination letter is august 30, 19S;. This determination is based on evidence that your fends are 6ed.icated to the pu;-poscs listed in section 501(c)(3) of the Code. ro assure your continued exemption, you should :maintain records to slim that funds are expended only for those purposes. f'you distribute funds to Ctl1C'Y or.ganizat ions, your records should show whether they are exempt under section 50l(c)(3). In cases, where the recipient organization is nut exempt under section 501(c)(3),. thele should be evidence teat tN: funds a•j11 remain dedicated To the fP.gUlred eL`YpOSL'S and that i.t1eV will be used i0i' those purposes by the recipient. If distributions are made to individuals. case histories rel,ardine tLe recipients should be kept showing names. addresses, purposc�z of awards. m'ianner of selection. reiationship fif any) to :,tembers, officers, trustees or donors <.f funds to you., so that any and all distributicnls made to individuals can ue substantiated upon request by the Internal Revenue Service. (Revenue eui:ing 56-3r,4, C.B. 19-56-21 page 306.) 1 if we have indicated inithe heading of this letter that an addendum applies, the enciosed addendum is an integral cart of thi 'otter. DEeaUSC Lhi:: letter could help reso.fve any questions about your exempt status grid foundation status, you should keep it in your permanent recons, If you have any questions. please contact the parson .hose name and telephone number are shown i. the heading of this letter. Enclosurc(s): Addendum - -� incerely'yOU.T'S, "} r.� rl �6 �fP 5 � Herbert J. Huff District Directoi Lettor 9-,.7 I t' CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH e s, 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 _ STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR l HEALTH AGENT , a ,TH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: (School Name of Establishment: The Greenhouse School, Inc. Address of Establishment: 145 Loring Avenue Owner's Name: Corporation Greenhouse School Restrictions: Application Date: 1 Permit for Food Establis Frozen Desserts/Ice Permit for the Sale of T These Permits Expire This permit is not tran ownership or location in the Establishment, 254-05 Products 31, 2005 ferable and must be reissued upon change of The permit must be posted in a prominent location In accordance with thelState Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT e CITY OF SALEM, MASSACHUSE BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR t SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 DEC 3 U 2004 JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM STANLEY J. USOVICZ, JR. MAYOR HEALTH AGENT BOARD OF HEALTH 2005 APPLICATION FOR ,PER/M" IT TO `OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I ty rieaiytv�yZ.tV !EQ CnTEL # cT IZ �f ADDRESS OF ESTABLISHMENIT ��5 L�UI�R 1rt 111iU i cR, MAILING -ADDRESS (if different')I' n�n�ni�'� NAME I ADDRESS U�-3- CITY L,G U-1AA- CERTIFIED FOOD -MANAGER'S NAME(S) b, ZIP TEL# TE#(s) a4Jdi (required in an establishment where potentially hazardous Food food is prepared.) EMERGENCY RESPONSE PERSON (A (ue(4 HOME TEL # q -N -14c( � ( HOURS OF OPERATION: Mon.-t--Tue. JC . Wed.�ThLy(-- Fri._ Sat. dun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 RESTAURANT YES I O/Lf less than 25 seats =$100 J ll 25-99 seats =$150 V more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR IYES NO $50 ALL NON-PROFIT (such as church kitchens) 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 `'-change`s are made; all plans for'Isuch must be submitted to and approved by the Salem Board of Health ;I I :t+{ t � A ei r:. ^:. m •..,.. ^,..a:t �s ,ry r.u..., � m x. v�. bN�v. �s �.'�i s. Y ="�., -`-.. :.,4� �-. i •' a `• 'Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my, . besbknowledge and belief, have filed all state tax returns and paid all state taxes required under 'the'law. Signature ►�)// -' Date 113 clif Social Security or Federal Identification Number ----------------�---------------- 1 t Revised 11/03/03 FOODAP2.adm Check# & Dateim Y i . CITY I OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM,.MA 01970 TEL. 978-741-1800 FAX 978-745-.0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS; CHO MAYOR I' HEALTH AGENT i COMMONWEALTH OF MASSACHUSETTS 'j PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: School I , Name of Establishment: The Greenhouse School, Inc. Address of Establishment: 145 Loring Avenue Owner's Name: Corpoation. Greenhouse School Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 176-04 Frozen Desserts/Ice Cream u Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. IThe 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. •I HEALTH AGENT e CITY OF SALEM, MASSACHUSETTyIC;z, l IBOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR L IIVI SALEM, MA 01970e ryry�nry • "'" It 5 TEL. 978-741:1800 PEC'5 4UUJ - - --- FAx 978-745 0343--r _ STANLEY LSOVICZ, JR MI 1 C,117 yr 1L� MAYOR JOANNE sco T, MPH, RS; C'Ho HEALTH AGENT I90ARD OF HI ALTH 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTLr>))ADDRESS OF OF ESTABLISHMENT R' S- L -Ont /} trP MAILING ADDRESS (if different) -&/Lvv 0 - ' OWNER'S NAME , C€lr J/t�a ��vs TEL# ADDRESS �� .� avta 1`'�C.. CITY _ I STATE ZIP CERTIFIED FOOD MANAGER'S.NAME(S) 1 w V_40 -I RTIFICATE#(s) y u§Jfor.dis `d.) (required in an establishment where potentially hazardou ' ood is prepared.) EMERGENCY RESPONSE PERSON JtA� ar- +�ett�l' HOME TEL HOURS.OF'OPERATION' Mon. Tue. )r , Wed')(— Thu. C. Fri.,K_Sat. r' Sun: I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO Jess than 11000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST- t- YES NO $100 ADDITIONAL PERM ITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR 0 YES NO $50 ALL NON-PROFIT (such as church kittc�h�ens)) / CD 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 forsuchmust 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 1, to my best knowledandAeV, havol pj7eed SII state tax returns and paid all state taxes required under the law. r Signature n, Date 'T 3 Social Security or ___________ Revised FOODAP2.adm iCheck#&Date -� 8i5 •&3 `Y , I - Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name %r15 GlLdE6 Na vs� S K/ L Dats � , 3 Tvoe of Oueration(s) Type of Inspection ❑Food Service ❑ Retail El Residential Kitchen ❑ Mobile ElTemporary ElCaterer El /Bed & Breakfast Permit No. ❑ Routine ©Re inspection Previous Inspection Date: f: / 00y ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑HACCP ❑Other Address 1y S L Al lr-11- Risk Level /_/ Telephone P 7 ` -1: `i3 9 OwnerHACCP o Payt,4ne)W 6;y(h),K14e.,VrCt/�� Y/N Person in Charge (PIC) ff)bL Wit LI If Time In: Out: -&/PAyGr9rcer IGlti nspectorQd� eum m ylw vrr.( ,, - oid/vr8 cacn vidiaudn 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. u,FOOD PROTECTION MANAGEMENT �- ❑ 1. PIC Assigned / Knowledgeable / Duties "EMPLOYEE HEALTH "`" ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded .I 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/IHACCP Plans PROTECTION FROM CONTAMINATION' 'f ' ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and SaniI tizing [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C'N" 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (Fc -3)(590.004) 25. Equipment and Utensils (C-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 @5WInVw For S-14,Wc ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities f PROTECTION FROM CHEMICALS . �❑ 14. Approved Food or Color Additives ri s ❑ 15. Toxic Chemicals P TIMENEMPERATURE CONTROLS (Potentially Haiardoi s Foods) ❑ 16.Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)'_ ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY,- ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 4.J 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: V i 41ie 1'g Il e' O duo a,F� -Rr�t: PI C's Signature: Print I / G Page of Zpages Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) U 790003(A) Assigmnent of Responerbiltty* 590.003(B) Dwrionsuatnon of Knowledge" 2104.11 Personin charge --duties EMPLOYEE HEALTH 2 590.003(C-) Responsibility of the person in change to Compliance with Food Law" 3-201.12 require reporting by food employees and 3-201-13 Fluid Milk and Milk Products* a Aicants* Shell Eegs 590.003(F) Responsibility Of AFood Employee Or An i--202.16 lee blade From Potable Drinking Water" Applicant To Report To The Person In prinking Water Prom an A snved Svstem* 590.006(A) Charoe* 590.006(fl) 590.003(G) Re outing b Personin Char *e* 3 590.003(D) Exclusions and Restrictions 3-201.15 590.003(E) Removal of Ezchrsions aid Restrictions 4 5 M C FOOD FROM APPROVED SOURCE '1 Denorzs critical item iia dw luderal 1999 Fwd Code or 1115 CMit 590.000. PROTECTION FROM CONTAMINATION g Food and Water From Regulated Sources 590.004(A B) Compliance with Food Law" 3-201.12 Food in a IlihaefiCa11V Sealed Contamer- 3-201-13 Fluid Milk and Milk Products* 3-202.13 Shell Eegs 3-202.1.4 Segs and Milk Products, ,Pasteurized` i--202.16 lee blade From Potable Drinking Water" 5-1.01.11 prinking Water Prom an A snved Svstem* 590.006(A) Bottled Drinking Water* 590.006(fl) Water Meets Standards in 310 CA1R 229* Washin Petits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Campint Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Reoulatom Authofitv 3-202.f9 Shellstock Identification Present* 590.064(C) Wild Mushrooms" 3-201.17 Carne Animals" 3-701. I I Receiving/Condition 3-202.1.1 Pl-tFs Received at Proper Temper atures 3-202.15 Paekaee Integrity* 3-101.11 Food Safe and Unadulterated TagsfRecords: Shellstock 3-202.18 Shellstock Identification* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Patasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients" Conformance with Approved Procedures 1HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxy en scfiagin ,criteria" 8-103.12 Conformance with A roved Procedures* '1 Denorzs critical item iia dw luderal 1999 Fwd Code or 1115 CMit 590.000. PROTECTION FROM CONTAMINATION g _.. Cross -contamination 7702.11 Raw Animal Foods Separated from Cooked and RTE E Foods` Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each Others` Contamination from the Environment 3-302A I(A) Food Protection* 3-302.15 Washin Petits and Vegetables 3-301.1.1 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. I I Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Wamwashing- HotWater Sanitization temperatures* 4-501.1.12 Mechanical Wanewashing- Hot Water Sanitization Tem teratures* 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 mrd Utensils' 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization -- Hot Waterand Chemical* 1() Proper, Adequate Handwashing 2-301.11. Clean Condition -Hands and Arms* 2-301.12 ' Cleating Procedure* 2-301.14 When to Wash" 11 Good Hygienic Practices 2-401.11 tiating,DrinkinorUsingTabacco^ 2-401.1.2 Discharges From the Eyes. Nose and Mouth* 3-301.12 Preventine Contamination When Tastin gs` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to gees 7.3 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca aciLies* 5-20411 Location and Placement* 5--205.11 Accessibility, Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 flandwashing Cleanser. Availability 6-301-12 Hand Drying Provision ITY OF SALEM BOARD OF HEALTH Establishment Name: Date: ;S //� /oY Page: 2 of Item No. Code Reference c=Critical item R --Red Item _-.PLEASE DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PRINT CLE A LY.. Date Verified' --- 4 v LVir /Y 0 _ u (_ P ung G nt rYfLR is D fl� w w r i5c s; cra I rA C_ 0 (7836 /+v 4 Gld ^N s J�!?G-- Discussion With Person in Charge: have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to at comply with all mandates of the Mass/Federal Food Code. I understand tt/hha�eV noncompliance may result in daily fines of twenty-fiv ollar oror si!( 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) (Card) * i' t 14 Food or Color Additives FC 590.000 FC -2 .003 3-202.12 Additives'" 3-80111(B) 3-302.14 Protection front Unaimmed Additives* 15 Poisonous or Toxic Substances 19 7-101.11 Identifying Information - Original ;-501 IN Containers* 590.004(F) 7-1.02.11 Common Name -- Workinn Containers* 3-501,16(A) 7-201-11 Se ataflon- Sto]axe* -_ _ Other 7-202.11 Restriction - Presence and Use I 3-501.16(A) 7-202.12 Conditions of Use - 20 7 -203.11 Toxic Containers - Prohibitions* 3-501.19 7-204.11 Sannizers, Criteria - Chemicals* 590.004(H) 7-^04.12 Chenticais for Wushin> Produce- Criterion' 7-204.14 Di'in g A ents. Criteria* 7-205.11 Incidental Food Contam Lubricants* 7206.11 Restricted Use Pesticides. Criteria" 7-206.12 Rodent Bait Stations 1 17 7-206.13 Tracking Powders, Pest Control and Monitoring" 1g Proper Cooking Temperatures for FC 590.000 FC -2 .003 PHFs_ 3-80111(B) 3-40111A(l)(2) Egg, 155`P15Sec. 3-501.15 E `>s-hnmediate Service 145°F15sec* 19 3-401.11(A)(2) Comminuted Fish, Meats & Game ;-501 IN Animals - 1.55'F 15 sec. 590.004(F) 3-401.11(B)(1)(2) Pork'. and Beef Roast - 130"F 121 min* 3-501,16(A) 3-401.11(A)(2) Rantitas, Injected Meats -155"F 15 -_ _ Other sec. 1 3-501.16(A) 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHF,, 20 Stuffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165".3 15 sec. 590.004(H) 3-40L1 t(C)(3) Whole -muscle„ Intact Beef Steaks 145°F * 3-401.12 Raw A-nimat 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 see.' 3-403.11(B) Microwave- 165° F 2 Minute Standing Tune* 3-403.11(C) Commercially Processed RTE Food - 14WF 3-403-11(P) Remaining Unslieed Portions of Bee[ Roasts" 18 Proper Cooling of PHFs 3-501,14(A) Cooling Cooked PHFs from 140`F to 7W'F Within 2 Hours and From 70"F to 41.°17(45"F Within 4 Hours. * 3-501,14(B) Cootiny PHFs Made From Ambient Temperature Ingredients to 41 °F/45°F Within 4 Hours* "Denotce critical ilea in the trderal 1999 1ood Code or 105 CMR 5900(10. 3-501 I d(Cl) PHFs Recurved of Temperatures ' FC 590.000 FC -2 .003 According to Iaw Cooled to 3-80111(B) 41 `P145".F Within 4 Hours. 3-501.15 Coolie, Methods for PHFs 19 PHF Hot and Cold Holding ;-501 IN Cold PHFs Maintained at or below 590.004(F) 41"/45" F* 3-501,16(A) Hot PHFs Maintained at or above -_ _ Other 140'F. '* 3-501.16(A) Roasts Held at or above 130`F. 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement a- 21 3-801 11(A) unpasteurized Pre-packaged Juices and FC 590.000 FC -2 .003 Beverases with Warning Labels* 3-80111(B) _ Use of Pasteurized hies* 3-801.1 i(D) Raw or Partially Cooked Animal Food and 3-302.13 Raw Seed Sprouts routs Not Served. * 1_Rrti i VC`i nlo.........1 r -.i P -r-, N.a RdoP -A +� 22 3-603.11 Consumer Advisory Posted for Consumption of FC 590.000 FC -2 .003 Animal Foods That are Raw, Undercooked or Fand Food Protection Not Otherwise Processed to Eliminate 25. _-__---- 26 27. Pathogens.* et"`""n vnaoor 3-302.13 Pasteurized Eggs Substitute for Raw Shell Poisonous or Toxic Materials 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. Otter 590.009 violations relating to good retail practices should be debited under #29 - Special Ruclahernents. (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness batt venhons mrd riskfiictors listed above, can be (nand in the folloOng sections of the Food Code and 105 CMR 590.(X)0. item 23. Good Retail Practices anagement and. Personnel -- Mood FC 590.000 FC -2 .003 24. Fand Food Protection FC -3 .004 25. _-__---- 26 27. Equpment and Utensils Water. Plumbin and Waste Physical Facility., _ .005 FC - 4 .005 FG -5 .006 FC -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. _ Special Requirements _ .009 30. -_ _ Other _ Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name v Date S TYDeOeion(sl T e of Inspection ❑ Retail Routine ❑ Re -inspection Address Risk 41 Telephone Level ❑ Residential Kitchen Previous Inspection El ❑ Temporary Date�l-ds-�'3 ❑ Pre-operation Owner HACCP YA QOomi El Caterer Bed & Breakfast El Suspect Illness ElGeneral Complaint Person iri Charge (PIC)/ Time i i141r X In: Out: e- Permit No. ❑ HACCP ❑ Other Inspector Ai acs Each violation 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' ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties , # EMPLOYEE HEALTH [1 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded �13. Handwash Facilities t PROTECTION FROM CHEMICALS t. 5- ❑ 14. Apprcvea Food or Color Additives m FOOD FROM APPROVED SOURCE o ❑ 15 Toxic Chemicals .. ter „ { TIMENEMPERATURE CONTROLS - a-za _- ❑ 4. Food and Water from Approved-So pproved Source (Potentially Hazardous Foods) ---- 4 ❑--^J- 5. Receiving/Condition M❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Sta(lements ❑ 7. Conformance with Approved Procedures/ HACCP Plans t'PROTECTION FROM CONTAMINATION - I" ""y` ❑ m8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C :N 23. Management and Personnel (Fc -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) _IZ 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (F6-5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements 1 (590.009) 30. Other S 501n50 Form 14 tloc ❑ 17. Reheating El 18. Cooling 6Q 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control g REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)., _. ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY,- 'I- , ` .� - • .. , -. ❑ 22. Pasting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions J7 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: s/ 1/O I ector' Si re: !_ �... Print: IC's S aur : "'- _---' Print: (P - Page / of o2 Pages CV I UT �1� Violations Related to Foodborne illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 I 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 21.03.1.1 Person in ihirpe -- duties ,.. EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in chv�ffe to Food and Water From Regulated Sources require reporting by Food employees and 590.004(A -B) applicants' 590.003(F) Responsibility Of A Pond Employee Or An Food in a tlenn_eticulk, Sealed Container* Applicant To Report To The Person In 3-201.13 Charge* 590.003(Cl) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions'' 590.003(E) Removal of Exclusions and Restrictions 4 Food and Water From Regulated Sources 590.004(A -B) Compliance with Fouet Iaw' 3201.12 Food in a tlenn_eticulk, Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Egps 3-202.1.4 Eggs and Milk Products, Pasteurized* 3-'_02.16 Ice Made From Potable Drinking Water* 5-1.01.11 Drinking Water from an A xoved System" 590.006(A) Bottled Drinking Water* 590.006(B) Water Meecs Standards in 310 CMR 229* Shellfish and Fish From an Approved Source 30.21)1. I4 Fi�eh and Recreation:dly Caught Molluscan Shellfish* L9 3-201.15 :Molluscan Shellfish from NSSP Listed Sources* 4-501.111 Game and Wild Mushrooms Approved by Re uYafo Authorlt 3-202.15 SheiNtock Identification Present" 590'NA(C) WildMusln�ootns' 3-201.17 Cart Animals* 5 4-602.11 Receiving/Condition 3-202.11 PI-tFs Received at Proper Tem )ei amres" 3-202, t5 Package htfegrit ,x= 1Q 3-101.11 Food Safe and unadulterated 2301.11 Tags/Records: Sheilstock - 3-202.13 Shelktockldentification' 3-203.12 Shellstock Identification Maintained' LLj- TagsiRecords: Fish Products 3-402.11. Parasite Destruction* 3-402.12 Records. Creation and Retention" 590.U04(.i) Labeling of ingredients* 7 Conformance with Approved Procedures /HACCP Plans 3-50211. Specialized Processing Methods* 13 3-502.12 Rednceil oxygen acrkxgin ,criteria" 8-103.12 Confiirmance with A )roved Procedares4' 'k Denotes critical item in the federal 1999 Food Cbd:. or 105 C61R 590.000. PROTECTION FROM CONTAMINATION F8- Cross-contamfnation 3-302.11(Ah _l) Raw Animal Foods Separated from Cooked and RPL Foods* Contamination from Raw ingredients 3302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302_1I(A) Ford Piotection' 3-302.15 Washing Fruit mud Vegetables 3-304.1.1 Food Contrica 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 Reccmditioning unsafe Food* L9 Food Contact Surfaces 4-501.111 Manual Warewashine- Hot Water Sanitization Tear eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Find 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 Er ui itnent* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 1Q Proper, Adequate Handwashing 2301.11 Clean Condition - Hands and Arms* - 2-301-12 Cleaning Procedure* 2-301.14 When to Wash' LLj- Good Hygienic Practices 2-401.11 Eating, Drinkmj4 or Using Tobacco' 2-401.12 Discharges From the Eyes, Noseand Mouth* 3-901.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590-004(E) Preventing Contamination from Entiloyees* 13 Han dwash Facilities Conveniently Located and Accessible 5-303.11 Numbers and Capacities * 5-2tMA I Lavation and Placement* 5-205AI Aeeessibilit , O eration and Maintenance Supplied with Soap and Nand Drying Devices 6-3011.1 I3andwashing Cleanser. Avaitabilit 6-301.12 Hand Drvin =Provision CITY OF BOARD OF HEALTH Establishment Name: Date: -3- Page:—a of Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION /,PLAN OF CORRECTION R — Red Item - : ':" 's - PLEASE PRINT CLEARLY' Date Verified A,/Nri C c of a 1 Sa ' Z -r 6f /iiio7�C. a. a - r e S/�70LL o �� T� . l3 P E r� 42 __eel - t o e Pin 7- r4/17` e.r° auGty q�e� po AP-rde G 7 - / r1� Pt �O ' C3G7 i w Oa/e �Sln/X k4 /3 — F% cu/ e e cs gLe eLs, Not Dde�p�A.S e , e 7 G� LPA / Y c1 `/7Z7✓/S�27 t e - p v S Stat ti a 74- e�< lialr� r. .4&417 -- -- ---- - -- --- ----em14,a-7" - AI Ism Lzr — rrc/ 7QS A r Zi vii Discussion With Person in Charge 1 t // C�,, /� Y ( I have read this report, have had the opportunity to ask q e/s(tio�ns and agree td corr ct all violations before the next inspection, to observe all conditions as described, and 1( comply with all mandates of the Mass/Federal Food Code. I understand that S noncompliance may result in daily fines of tw nt fi oll or sus sion/rev/pc�tpr} o� your food permit. TI CSI Corrective Action Required: El No El Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension rombargo ❑ Emergency Closure I� ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 lm 1{r Food or Color Additives 3-202.12 Additives' 3-302.14 Protection horn unap vui..1ctditives'" Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers* 7-102.11 -Common Name - Working Containers" 7-201, 11 Separation - Stogy'_ 7-202.11 Restriction -Presence and Use* _ 7-202.12 Conditions of I)se* 7-203.11 'Toxic Containers - Prohibitions 7-204.11 1 Sanitizcm Criteria -Chemicals* 7-204.12 Chuuicals for Washing Ptoduce, Criteria- riteria-7-204.14 7- 104 14 Drying A eats. Ca'Lteria* 7-205. t 1 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-20b.12 Rodent Bait Stations" 7-206.13 Tracking Powders, Pest Control and Monitorine` 1{r 3-501.14(0) PHFs Received at Temperatures Proper Cooking Temperatures for According to Law Cooled to PHFs 3-401.11A(1)(2) Fees- I55`F 15 Sec. PHF Hot and Cold Holding FL -s- Immediate Service 145'Fl5secc` 3-401.1 I (A)(2) Comminuted Fish, Meats & Gamc 3-50L16(A) Hot Pffs Maintained at or above Animals - 155`F 15 see. " 3-401.11(8)(1)(2) Pork andBeef Roast - 130°F 121 min'h Time as a Public Health Control 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 590.004(H) Variance Requirement sec. x. 3-401.14 (A)(3) Pouttrv,Wild Game. Stuffed PHI,"' Stuffing, Containing Fish, Meat Poultry or Ratites -16517 15 sec. 3-401.11(0(3) Whole -muscle- Intact Beef Steaks 145'F * 3-401.12 Raw Ani nal Foods Crooked in a Microwave 165°F * 3-401.1 t(A)(1)(b) All Other PHFs - 145'F 15 .sec. 1'7 Reheating for Hot Holding 340311(4)&(D) PIIFS 165'F 15 sec. s` 3-103.11(I3) Microwave- 165' P 2 M[nute Standing Time* 3-403.1.1(C) Commercially Pto essed RIFE Food - 140-F 3-403.1.1(E) Remaining Undiced Portions of Beef Roasts,^ 18 Proper Cooling of PHFs 3-50).14(A) Cooling Cooked PHFs from 140°F to 70'F Within 2 Hours and From 70'F to 41'F145'F Within 4 Hours. 3-SOL14(B) Coo]htgPFiFsMade from Ambient 'temperature Ingredients to 41'F145°F WiCtYin 4 Hours* * D now: eritical item in the fuiei.d 1999 Food Code or 105 COR 590.400. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels'% 5-501.11(B) Use of Pas ten¢ized E�,n 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S souls Not Served.* 3-801.I1(C) Unooened Food Packaac Not Re-scrocd. 22 3-66,11 Consumer Advisory Posted for Consumption of .Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate 1 3-302.13 ( Pasteurized Eggs Substitute for Raw Shell Violations of Section 590.009(,A) -(T)) 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 illuess interventions and riskfaclors listed above, can be found in the following sextons of the Food Code and 105 CMR 3-501.14(0) PHFs Received at Temperatures According to Law Cooled to _41.71457 Within 4 Hours. '^ 3 -SOUS Cooling Methocts for PHFs 19 PHF Hot and Cold Holding 3-501.16(8) Cold PHi's rMaimained at or below 590.004CF) 41°t45'F,' 3-50L16(A) Hot Pffs Maintained at or above 140°F_ 3-501.16(A) Roasts Held at or above 130`F. 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels'% 5-501.11(B) Use of Pas ten¢ized E�,n 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S souls Not Served.* 3-801.I1(C) Unooened Food Packaac Not Re-scrocd. 22 3-66,11 Consumer Advisory Posted for Consumption of .Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate 1 3-302.13 ( Pasteurized Eggs Substitute for Raw Shell Violations of Section 590.009(,A) -(T)) 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 illuess interventions and riskfaclors listed above, can be found in the following sextons of the Food Code and 105 CMR ••,• - `�r,n ,w. rray. tlb MU4 UI: 14111 /•1 a the greenhouse school, inc. Patricia jennings-welch, mte utiw Arrector 145 brig avenue sdem. MMCMuseds oivyo id.9HW454549 neva. stop kmnina May 6, 2004 Donald Weston, Fire inspector Salem Fite Department 29 Fort Avenue Salem, MA 01970 Dear Inspector Weston Pursuant to your visit earlier today, 1 Warted to tet you know as soon as possible that the suggested temediestavealreadybeenimpiern med.'AMlamm&tefiQcidsi"hetaduomr,have been switched into the metal container per our discussion. Thanks again for your prolessioriaGsm in attitude anti ctmduet dwhIgUie iaspeetiOn--it mIktsVdngs s11100dw aftthewaywound. Si Y, Daniel Patrick Ich` Administrative, irector Wpdam+y Qaol.00m Far more information about the greenlmas whool, web match `Ilx Greenhouse School" y i "OdA Wdzz:r roz-90—S . S G d "OdA Wdzz:r roz-90—S v Z 'd city n p of =Sa.&n4 �aiia.chulzttl. t 4= fafayette,�eet t �arcm, m'yafmc�iufc!!f J�Q10.3��$ �Od-'/4J-239 n♦'DcC `h ie/ `�u• 3o8 -las -4646 �uicau RECORD OF COMPLgTNT DATE:4�z�� RECEIVED BY: SUBJECT: 5'%eK�%4J u� fWL,0WwxctJ ify tijy7iF/say LOCATION: Gar /5ivr gov*wno-.4�j t - i COMPLAINT BY; ADDRESS: NARRATIVE: SITE INSPECTED BY:� DATE: a -/[/e COMMENTS :%a�cq O.+Kkx 7D 147-/4%�iJ« s//�� F" /R/ �f} Ma�sX � CstB. r!✓/�a le�rNtpe7' D�✓ .yam'//3d REFERRED TO: r f Farm #SB (revised 3/90) SIGNED: G� wodd WdIZ'9 roz-90—S S-06-204 4:21PM FROM FAX a to: VIK yNrlv /%9at,5-/73K/:Y i from- date: subject: /7'S �Kv, 5ut Pa=ts: NOTES_ 'n:s ljc.:mde contarns pnvrlegod and c6o'.* dio� information intended -only for the use n/ the mdly dual or entity to waom it is addressed. ,If the,reader of the facsimile is not lhB nlendt�i reclp,ew cr the employee rH agent responsible for delivering it to the intended r ec,plenl you are hefeby noh,ied that any Communicah'on, bansmrssion, dissemination or reprM urban vi lois racsimlie x Its Coiftenfs rs suicoy pfoh,Ddtti, UYJu have receiver/ irmefPlLf LN : ` Oy'.efeph'one 3n; retum th.^. _rfgln=i !acarrnrc to �. at 1ne obove a'1drrs- via too- V S po•115J serwce Think You. P. 1 . FROM =:- FAX N0. May. 10 2004 0G:24PM P1 F relent Younysry�i the greenhouse school, inc. patricia jennings-welch, executive director 145 bring avenue, Salem, mossadwsens 01970. Id. 978-7454549 never stop learning May 9, 2004 D. Greenbaum & V, Moustakis, Inspectors Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Dear Inspectors Greenbaum & Moustakis: Pursuant to your visit theotherday. I wanted to let you know as soon as possible that the noted non-complianpes-havebeen corrected: Allhadbeen corrected at-the-timE.ofyotrrsecond visit, as . I noted in our discussion of the report, except for those we were unaware, of the tube guard for the flourescetifiigbt abovethe counter, -the door sweep, covered wastebasket in -adult restroom and the GFI outlet you mention. Enclosed receipts will confirm purchase.of the former items, with respect tjrthe latter, our electrician came and inspected; a IM breaker is instatied at -the panel level. covering the entire circuit, so ground fault protection is in place for all the outlets on_ the north wall, ofthe'kitchen. Thank you for your attention -to -these items. Si re y, Daniel Patnck Welch Administrative Director Wpdanny @aol.com For more information about the greenhouse school, web search `[he Greenhouse School' I� 0 1 i ft . l 10ml ::J ll'1bril.S. 'WAY THE HOME OEPOT 268(-.1 - ' sN EM. Mil Cl's1)- 50 TRADERS WAY SALEM, MA 01970 15)81141-7293 $ALE AM . 2686 00057 26773 Oti/10.0.t SALE 14 SCO157 09:'17 PM 6537 � I kN. -I LID DWI' S Gu '� 821 l<!3J 1171 ? hf+i JJE1t' 1 B/ T 4' 4u�,e.T, -. L�� , x 784233021477�cr jjN� 1.93 - 8010S�60Ua1 a MSXY NRN - �Nr-- �i•- , SALES TAX 0.10 j 07169128035;4 5.97 V4-9� ' Z TOTAL $2.68 ' ` 31.11• - o CASH 2.25 ; - SALES IAK 1.59 CHANGE DUE 0.17 _ T01 PL $3:1.35 i I I III! I NII III Ij I NNpI{ I Y,XXXXXXXXXXY2397 DE8I/ 53.35 ��I�II I�III�IIII�III�III IIfI�II��11I W111 AUTH CODE 260505 AT�WWW.II SSS(MEDE22666P777OTOPOOOI666MOIIIONCOMPLETE SURVEY COMAND999777NIkRt �2I6865Ei�ll ?BIND619�53I TO WIN A-$5.000 HOME DEPOT GIFT CARD! - - YOUR OPINICN COUNTS! COMPLETE A SURVEY - AT WWW.HON�DEPOTOPINION-.COM AND ENTER. - TO WIN A $5,000 HONE DEPOT VIFI CARDI, - �3 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner's Name: Corporation Greenhouse School Name of Establishment: The Greenhouse School, Inc Address of Establishment: 145 Loring Avenue Type of Establishment: Application Date: 12/10/2002 Restrictions: Permit for Food Establishment 37-03 Frozen Desserts/Ice:Cream I Permit for the Sale'of Tobacco Products These Permits Expire December 31, 2003 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 t' CITY OF SALEM, MASSACHUSETTS or equipment changes are made, all plans for such must be BOARD OF HEALTH • e 120 WASHINGTON STREET, 4TH FLOOR .,. SALEM, MA 01970 o I TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE Scorr, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner's Name: Corporation Greenhouse School Name of Establishment: The Greenhouse School, Inc Address of Establishment: 145 Loring Avenue Type of Establishment: Application Date: 12/10/2002 Restrictions: Permit for Food Establishment 37-03 Frozen Desserts/Ice:Cream I Permit for the Sale'of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. I HEALTH AGENT Y. is �0 I CITY OF SALEM, MASSACHUSETTS 6�coNniry BOARD OF HEALTH 120 WASHINGTON SiREEI'. ATH FLOOR DEC 0 2002 SALEM, MA 01970 TEL. 978-7:11 - 1 600 U-1 Y L;r aALENI FAQ 976-7 5-0343 BOARD OF HEALTH S'14.J LEY USOVICL, JR. JOANNE'SCOTI. MPH., RS. C H 0 MAVORHEALTH AGEi"I „t + 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL # 1 9t thevieenhousesc oo , 6. ADDRESS OF ESTABLISHMENT 145loring avenue sa em, ma 01970 MAILING ADDRESS (if different) � Q OWNER'S NAME GOY �(N7ti`KA^ �t °2u Ct r/U r uL�, TEL # ADDRESS S" CITY STATE 71P CERTIFIED FOOD MANAGER'S NAME(S).11AW2 ,rwu-Lu/�d ERTIFICATE#(s) Vall� (required in an establishment where potentiallhazardot�sf, d)spr red.) 4� t> If�CLI �1' pa EMERGENCY RESPONSE PERSON ,u 1 (u (>cra HOME TEL # y�� } HOURS OF OPERATION; Mon Sat. Sun. TYPE OF ESTABLISHMENT — RETAIL STORE YES NO RESTAURANT YES NO BED/BREAKFAST�Q YES NO ccGG�itiUv `- AD[7fifONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO TOBACCO VENDOR YES NO ALL NON-PROFIT (such as church kitchens) `(2) NO FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 $100 $5 $50 $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. SignatureDate u a �-- Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm Check# & Date '�ZoZO'A THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Type -9t Operation(s) Type of Inspection Print: Page/of�Pages Food Service ❑ Retail © Routine Re -inspection Address ' Risk C Level J ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone r ^ C/ ❑ Temporary ❑ Pre-operation Owner , ,-// - HACCP Y/N ❑ Caterer ElBed & Breakfast ❑ Suspect Illness [I General Complaint Person in Charge (PIC),-l� Time (�� In: Out: Permit No. ❑ HACCP ❑ Other Inspector i Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted / Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving / Condition ❑ 6. Tags / Records / Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures / HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation / Segregation / Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils 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)(590.008) 29. Special Requirements (590.009) 30. Other V12. Prevention of Contamination from Hands 13, Handwash Facilities t% PROTECTION FROM CHEMICALS ❑ 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 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions / and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Sinature: ' Print:--i- PIC'sSignatue: Print: Page/of�Pages \ FORM 734A HOSES & WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT .. 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in Charge - Duties EMPLOYEE HEALTH 2 ; 590.003(C) Responsibility of the Person in Charge to Compliance with Food Law* 3-201.12 require reporting by Food Employees and 3-201.13 Fluid Milk and Milk Products* Applicants* Shell Eggs* 590.003(F) Responsibility of a Food Employee or an 3-202.16 Ice Made from Potable Drinking Water* Applicant to Report to the Person in Drinking Water from an Approved System* 590.006(A) Charge* 590.006(8) 590.003(G) Reporting by Person in Charge* 3 ` 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 10 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made from Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(8) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3.201.14 Fish and Recreationally caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 Tags/Records:Shellstock 3-202.18 Shellstock Identification* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(]) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 8 9 10 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization - temp., pH, Concentration and Hardness* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH % Establishment Name: i1�6 / Date: /SSI U� Page: of `- Item No. Code Reference C-Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - . -. y _. .. _- .. ,_ _ : PLEASE POINT CLEARLY - Date - Verified L d 73 Pt 4f ,471I -0M1 S U 7 Discussion With Person in Charge: have. read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 1.6 Food or Color Additives 3-202.12 _ Ald_itkes 3-302.14 Protection from LinaTm oved Additives* _ 24 ,r Poisonous or Toxic Substances 7-10111 identtiyine Information - Original _ Containers' 7-102.11 Common Name- - Warkino Containers" 7201.11 Sa arniion-Stora e* -- 7-202.11 Restriction- Preserme and Ilse'" 7-20212 Conditions of Use` 7-203.11 Toxic.Containers-Prohibitions* 7-204.11 Sauitizers. Criteria - Chemicals' 7-204.1.2 Chemicals for Washing Produce. Criteria* 7-204.14 DrJinp Aocuts, Criteria"' 7.205.1.1 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 3-4011.](A)&(I)) Monimring" 1.6 Proper Cooking Temperatures for PHFs Received at Temperatures PHFs 3-401.1 1A(1)(2) Eggs- lis"F 15 Sec. _ 24 Leos- immediate Seiwice 14S1715soc" 3-401.1 I (A)(2) Comminuted Fish. Meats & Game _ Animals - 155'F 15 sec. * 3-401.1 1(3)(1)(2) and Beef Roast - 130'F 121 min" 3-401.11(A)(2) _Pork Ratites, Injected Meats- 1.55'F 15 3-501.16(B) sec. " 3-401.11(A)(3) Poultry, Wild Game. Stuffed PHFs, 41'/45' F* Stuffing, Containing Fish. Meat, 3-501.16(A)� Poultr - or Ratites -165`1- 15 see. 3-401.11(C)(3) While -muscle, Intact Beef Steaks 140"F.' 145"F 3-001.12 Raw Animal Foods Cooked in a 20 Microwave 16YF * 3-401.11(A)(1)(b) All Other PHFs - 145'1-15 sec. L17 Reheating for Hot Holding 3-4011.](A)&(I)) PHFs 165'F.15 sec. * 3-403.11(13) Miciowave- 165' F 2 Minute Standing Time" 3=t03.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts" 18 Proper Coating of PHFs 3-501,14(,A) Cooling Cooked Mips from 140`Fto 70'F Within 2 Hours and From 70'F to 4I'F145"1. Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature tngrodients to 41'Fl45'F Within 4 Hours* * Dan(Ac, citicat item in the federsl 1999 Food Code or 105 CMR 90.000. POPULATIONS HSP 21 1 3-801.1I(A) I tJnpanteurizcd Pre-packaged Juices and 3-601.11(13) Use of Pasteurized Eggs* 3-301.11(D) Raw or Parhafly Cooled Animal Food and CONSUMER ADVISORY__ 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathos ens.* 3-302-13 1 Pasteurized Eggs Substitute for Raw Shell Fo ,,' Fx7�3t1F31t�Ix�lilF:3y s1�. Y.i 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under tire appropriate sections above if'related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #1-29 - Special Requirements. (Items 23-30) Critical and rmn-critical violations, which do not relate to the foodborne illness onernentions and risk,factors listed above, can be found in thefollowing seetiomr of the Food Code and 105 0111? 590.000. Item Good Retail Practices FC 3-501,14(C) PHFs Received at Temperatures Management and Personnei FC - 2 Accordin; to Law Cowled to _ 24 Food and Rood Protection 41.'1-'t45'F Within 4 Hours. 004 25 26 Cooling Methods toot PHFs E3-501.15 19 005 006 J PHF Hot and Cold Holding Physical Facility 3-501.16(B) Cold PRFs Maintained at or below 28. 590.004(F) 41'/45' F* .008 3-501.16(A)� Hot PHFs Maintained at or above _ .009 _ 140"F.' 3-501.16(A) Roasts Held at or above 130'F. 20 rime as a Public Health Control 3-5Ol.l4 Tinge as a Public Health Control* 59Q004(H) variance Requirement ' _ POPULATIONS HSP 21 1 3-801.1I(A) I tJnpanteurizcd Pre-packaged Juices and 3-601.11(13) Use of Pasteurized Eggs* 3-301.11(D) Raw or Parhafly Cooled Animal Food and CONSUMER ADVISORY__ 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathos ens.* 3-302-13 1 Pasteurized Eggs Substitute for Raw Shell Fo ,,' Fx7�3t1F31t�Ix�lilF:3y s1�. Y.i 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under tire appropriate sections above if'related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #1-29 - Special Requirements. (Items 23-30) Critical and rmn-critical violations, which do not relate to the foodborne illness onernentions and risk,factors listed above, can be found in thefollowing seetiomr of the Food Code and 105 0111? 590.000. Item Good Retail Practices FC 590.000 23 Management and Personnei FC - 2 .003 _ 24 Food and Rood Protection FC 3 004 25 26 Equipment and Utensils Water Plumbmq and Waste FC 4 FC -5 005 006 J 27 Physical Facility FC -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 4 29 130 Special Requirement ___. __.. other _ .009 _ '.o ti 3a STANLEY USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR I SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT CITY OF SALEM HEALTH DEPT. 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL # ADDRESS OF ESTABLISHMENT the greenhouse school, Ino. 145 orng avenue MAILING ADDRESS (if different) salem, ma 01970 OWNER'S NAME ITEL CITY — STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) A UAv ERTIFICATE#(s) al ZF 1sli:.lktw�balvw-1-�d, S �lr (required in an establishment where potentially hazardous food is prepared. WI L - EMERGENCY RESPONSE PERSON HOME TEL # DAYS / HOURS OF OPERATION: Mon.— Tue.-Wed.-Thu.-Fri.-Sat.-Sun.-TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO �� $40 RESTAURANT , YES NO ` $40 BED & BREAKFAST YES NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO 10 NO CHARGE FOR FIT (such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPT FOR �� fi 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. Signature ( Date tt pt Social Security or Federal Identification Revised 11/1/01 foodap2.adm Check#& ':,THE COMMONWEALTH OF MASSACHUSETTS CITY OF ,SALEM BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tek(978) 741-1800 Fax: (978) 745-0343 Name r+ // T�j� `prC'��/fIp(J.52 JCIiCJd� D,at/e / 'Y ,r'v/�.Z.. Type of Operation(s) IjKFoodService ❑ Retail El Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Tvoe of Ins ection Routine ❑ Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address /5/�- / Or/N �� h Risk Level /W c� Telephone ��- 5/f Y / Owner G/ r/ / C /G/ Te''C� HACCP Y/N Person in Charge (PIC) , Time In: Out: Inspector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted / Excluded FOOD FROM APPROVED SOURCE i ❑ 4. Food and Water from Approved Source ❑ 5. Receiving / Condition ❑ 6. Tags / Records / Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures / HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation / Segregation / Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) ✓ , 24. Food and Food Protection (FC -3)(590.004) e/ 25. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility I (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other M ❑ 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number ofViolated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: Print: PIC's Signature: Print: Page) -of- Pages FORM 734A HOBBS & WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) FOOD PROTECTION MANAGEMENT 4; 590.003(A) 1 Asmonf Res onsibilit * Demo5900003I() ofKnowledge* 2-13.1 Person in Charge - Duties EMPLOYEE HEALTH !: 590.003(C) Responsibility of the Person in Charge to r 3-201.12 require reporting by Food Employees and 3-201.13 Fluid Milk and Milk Products* Applicants* Shell Eggs* 590.003(F) Responsibility of a Food Employee or an 3-202.16 Ice Made from Potable Drinking Water* Applicant to Report to the Person in Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3, 590.003(D)Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions A4' 5 C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. C 9 12 13 PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made from Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3.201.14 Fish and Recreationally caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* 4-501.111 Game and Wild Mushrooms Approved by Regulatory Authority 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 4-602.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* 2-301.11 Tags/Records: Shellstock 3-202.18 Shellstock Identification* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(7) Labeling of Ingredients* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging, Criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. C 9 12 13 PROTECTION FROM CONTAMINATION Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 1 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization - temp., pH, Concentration and Hardness* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Good Hygienic Practices 2-401.11 Eating Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible .5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision 9 CITY OF SALEM BOARD OF HEALTH Establishment Name: i Date: V/// tel — Page: of DESCRIPTION OF VIOLATION OF CORRECTION Item Code. C —Critical llernO) Date No. Fiefii4rtce 4 Red Item PUASEPRW CLEARLY e Verified 7,) � r e- ;7 r, 4v -" , a //& 13 C /lall'ir/f amz 4 ;(:rza Llgx g,2 9_4Wye,� 7' &_/_6 1427le-Ad -4 )II/1-z- e i2 e-r-cl Discussion With Person in Charge: Correclive"'Action Required: Q No ❑Yes r. I have read this report, have had the opportunity to ask questions and agree to correct all Q Voluntary Compliance ❑Q Employee Restriction violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may C) Re -inspection Scheduled U Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. U Embargo L11 Emergency Closure Ll Voluntary Disposal Q Other FORM 7348 HOBBS&WARREN - BOSTON 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 Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19' 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 23. PHFs 3-501.16(B) 590.004(F) 3-401.i1A(1)(2) Eggs -155°F15Sec. Hot PHFs Maintained at or above 140°F* 3-501.16(A) Eggs - Immediate Service 145"F 15 Sec.* 25. 3-401.1 l(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. 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.* 17s. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(8) Microwave - 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 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 41°F/45°F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 23. PHF Hot and Cold Holding 3-501.16(B) 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°E* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) :§21,3-801.11(A) 3-603.11 Unpasteurized Pre-packaged Juices and ^[!ELL 23. Beverages with Warning Labels* FC - 2 3-801.11(B) Use of Pasteurized Eggs* " 3-801.11(D) Raw or Partially Cooked Animal Food and 25. 3-302.13 Raw Seed Sprouts Not Served.* .005 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 " FC - 3 Pathogens.* E9ecft a 1/1/2001 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* 'WrWAL KrUUIKr MrN I J 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - 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 105 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. Sp ecial Requirements .009 30. Other Commonwealth of Massachusetts City of Salem Board of Health Nmberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2009 ESTABLISHMENT NAME: File Number: BHF -2005-000026 LOCATED AT The Greenhouse School, Inc. 145 Loring Avenue . Salem MA 01970 i V14J LViC11V V'HVtS1V VL' SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0343 Jan 2, 2009 Dec 31, 2009 $25.00 ESTABLISHMENT Total Fees: $25.00 PERMIT EXPIRES Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, an plans for such must be submitted to and approved by the Salem Board of Health. Page t 0 ti CITY OF SALEM, MASSACHUSETTS v' BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR g a TEL. (978) 741-1800 K MBERLEY DRISCOLL FAx (978) 745-0343 I r �n MAYOR ` ' IDIONNE SALEM. COM ,, N L ��09 JANET DIONNE, " CAO," rtlH ACTING HEALTH AGENT 13OARp 0'- i 2009 AP�P7LLIICATIOON FOR /P�E`"RM�IpT TO OPERATE A FOOD ESTABLISHMENT -"NAME OFESTABLISHMENT - 1 ke, l'Jr�e�llybt.a�c.5�01 TEL # GI j 3j ADDRESS OF ESTABLISHMENT - _L±. LO riles FAX # MAILING ADDRESS (if different) �1 EMAIL - Business: j�VV1�06)-OWNER'S NAME lwvt,vP ' (Ali G a / TEL# 5'a"A-e— ADDRESS * I' t �(o rp C1VL� ill ( (Jm STREET w G ITY STATE p r�� op- 3v/��t CERTIFIED FOOD MANAGER'S NAME(S) aGt�t , a R`i'Z�li �'^ ! O CERTIFICATE#(S) R O I �3 ` b (Required in an establishment where potentially hazardous food' its prre�oarredd) / _. - . PERSON EMERGENCY RESPONSE �Cc-�-( �� 1p;& t( `� x HOME TEL# - q -a nuures ur uPtltAllul� �., Tx I Please write in lime of day. (For example llam-11 pm) - ! \ 1 TYPE OF ESTABLISHMENT -FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 —............... RESTAURAiJT YES NO less than 25 seats ....... =$140 (Outdoor Stationary Food Cart $210) 25-99 seats =$280 r r more than 99 seats =$420 BED/BREAKFAST/ YES, NO $100 CHILDCARE SERVICES ADDITIONAL PERMITS ------------------------------------ MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR �f§� 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. .r .- - - 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 a aid a to taxes a fired under the law. ?110/0 3 - Signature Date! - v Social Security or Federal Identification Number ------------------- -- --- ---- --- ---- Revised 424/07 FOODAP2008.adm Check# & Dated