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VICTORIA STATION RESTAURANT - ESTABLISHMENTSv%,ddfiu tfodwwwwoJf JY�<•' Lniversal oneT www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 0197073523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Data �{ T e of Operation(s) Type of Ins tion Routine Re -inspection Previous Inspection Date: ElPre-operation ❑ Suspect Illness ❑ General Complaint El HACCP ❑ Other Food Service Retail. ❑ Residential Kitchen ❑ Mobile ElTemporary ❑ Caterer ❑ Bed & Breakfast Permit No. Address Risk Level TelephoneQW OwnerHACCP YM Person in Char (PIC) Time 0� 1VVI Inspector Each violation checked requires an e)(planation 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-Chokin Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) 590.009 (FJIZI action as determined by the Board of Health. j ((( FOOD PROTECTION MANAGEMENT_4 _ .w, . - 12. Prevention of ontaminatom Han s M 1 PIC Aecinnorl / Krin nnwloonhlo / Ilu}mc ❑ 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 Handwash Facilities ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIM EMPERATURE CONTROLS (Potentially Hazardous Foods)_:" ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating k ❑ 7. Conformance with Approved Procedures/HACCiP Plans ❑ 16. Cooling PROTECTION FROM CONTAMINATION [119. Hot and Cold Holding ❑ S. Separation/ Segregation/ Protection op 9. Food Contact Surfaces Cleaning and Sanitizing V ❑ 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 IT - 23. 23. Management and Personnel (FC -2)(590.003) JL 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) O" 27. Physical Facility (FC -6)(590.007) 28: Poisonous or.Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other 5:5901nspscfFormB-14.o I ) � j o_+ Vvi ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLEPOPULATI, POPULATIONS (HSP) ❑ 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 (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: Print: PIC's Signature: . Print: otlm N 7 �� Page � of__)Pfi es ��u.Prw���-� ��`���-G'� Q��1-,�,,d-,z� '��'cb1-P,vh��'�i✓1 f � i •- �„ '--'4.flvr�'l -1 �..n .... �_.7✓f.a� Lir r+.�.•..�,.....- _ -��. Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 1 2-103.11. 1 Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food law* 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 Fool Employee Or An 3-202.16 ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* tem* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 5 L C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 7a PAnTFrTir1N FRr1M r-nk Tamm ATinW 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* 3-202.1.4 Eggs and Milk Produces. Pasteurized* 3-202.16 ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* tem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 31.0 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 Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP lasted Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authort 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 ReceivingiCondition 3-202.11 PHFs Received at Proper Temperatures, 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* 12 Tags/Records:'Fish Products 3402.11 Parasite Destruction* 3=402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients' Handwash Facilities - Conformance with Approved Procedures /HACCP 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. 7a PAnTFrTir1N FRr1M r-nk Tamm ATinW 9 Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods-* 4-501.111 Contamination from Raw Ingredients 3-302.1 I (A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitizati2nTemeratures*-- Contamination from the Environment 3-302.11(A) Food Protection* - 3-302.15 WashinE Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* 4-602.1 t Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment*' Disposition of Adulterated or Contaminated Food 3-701..11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitizati2nTemeratures*-- 4-501.114 Chemical Sanitization- temp., pH; concentration and hardness. * 4-601.,11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.1 t Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils*, 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment*' 4-703.11 Methods of Sanitization -. Hot Water and . Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.1.2 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating. Drinking or Using Tobacco* 2401,12 Discharges From the Eyes, Nose and Mouth* .I . . 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination. front Employees* 13 Handwash Facilities - Conveniently Located and Accessible 5-203.11 . Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.1.2 Hand Drying Provision Establishment NameUL CITY OF SALEM BOARD OF HEALTH Date:_G.- I T_ '✓n Page: c_2 of _ '. �_ . i _.' '• .� �� 1 - �.�'R7.�_ ...1. �a'� AAftce. !. i I NO& s M ♦. /. 'r1L�S 1TTAS -R�— W WMW_ -w AMANYAUTAWASAW E'er .,���� . •UMV- ... ' ► ��_ SCh°h'��� MIFA M MM I. /� / 1 . 1�., ��♦ `� 'WAII � ,._ •. WAT c ��ae/ / 1 �1�'� Ii.. .I� L.II Rw � � RPM • • • 1. • :• • •• • • • • ■ .. •.� • ■ �. Violations Related to Foodborne illness Interventions and Risk Factors ptems 1-22) (Cont.) 15 im 18 TIME/TEMPERATURE CONTROLS Food or Color Additives 3-202.12_ 1 Additives* 3-302.14 Protection from Unapproved Additives'' !- FC- 2 Poisonous or Toxic Substances 7-101.11 Idetni*ing Information - Original Containers* 7-102.11, Common Name - Working Containers* 7-201.11 Separation - Stora e* - 7-202.11 .Restriction - PresenceandUse* 7-202.12 Conditions of Use* 7-20111 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 Lmhricants4 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 * Diaotes critical iwni in the fcdecal 1999 Feed Cale cr 1U5 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According to law Cooled to . 41'F/45*F Within 4 Hours. * Proper Cooking Temperatures for , 29 PHFs 3402.IIA(t)(2) Eggs- 155F 15 Sec- !- FC- 2 Eggs- Immediate Service 145'F[5sec- 3401.11(A)(2) Comminuted Fisb. Meats & Game 3-801AI(C) Animals -155°F 15 sec. * 3401.11(13)(1)(2) Pork and Beef Roast -130°F 121 min* 3-401.12(A)(2) Ratites, lnjeaed Meats - 155°F 15 ! 26. See. * 3401.11(A)(3) Poultry, Wild Game, Staffed 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 * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401 a i(A)(1)(b) All Other Prom's - 145'F 15 sec. Reheating for Hot Holding 340331(A)&(D) PHFs 16S'F 15 sec. * _ 3-403.11(B) Microwave -165` P 2 Minnie Standing Time* 3403.11(C) Commercially Processed RTE Food - 1400P 3-403AI(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* * Diaotes critical iwni in the fcdecal 1999 Feed Cale cr 1U5 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According to law Cooled to . 41'F/45*F Within 4 Hours. * 3-501.16(B) I Cold FIiF's Maintained at or below 3-501.16(A) I Hot PRFs Maintained at or above 20Tama ase Public Health Control 3-501.19 Titm as a Public Health Control* 590.004 fH Variance Reouirement - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 2 501..15Cool n Methods for PRFs 29 allot and Cold Holding 3-501.16(B) I Cold FIiF's Maintained at or below 3-501.16(A) I Hot PRFs Maintained at or above 20Tama ase Public Health Control 3-501.19 Titm as a Public Health Control* 590.004 fH Variance Reouirement - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 CONSUMER ADVISORY 22 3-801.11(A) Unpasteurized Pre-packaged Juices and .Beveraeeswith Warning Labels* $90.000 3-801.11(B) _ Use of Pasteurized EM* !- FC- 2 3-801.1 I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprains Not Served * Food and Food Protection 3-801AI(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of $90.000 23. Animal Foods That are Raw. Undercooked or !- FC- 2 0.03 Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Pathogens.' �""na t 1 25, 3-302.13. Pasteurized Eggs Substitute for Raw Shell '005 ! 26. 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 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 H29 - Special Requirements. (Items 23-30) Critical and non-critical violations, which do not relate to the fiwdborne illness interventions and risk,{actors listed above, can be found in the fallowing sections of the Food Code and 105 CMR 590.000. item I Good Retalt Practices I FC $90.000 23. 1 Management and Personnel !- FC- 2 0.03 24 Food and Food Protection FC -3 .004 1 25, Equipment and Utensils FG -4 '005 ! 26. Water. Plumbing and Waste f FG -5 .006 27. { Physical Facility i FC -6 .007 1 28. Poisonous or Tack Materials 1 FC- 7 .008 ~29. facia! R uiremsrns .009 ' 30 1 Other aW.".,�':+2&: ITY OF SALEM BOARD OF HEALTH Establishment Name: j le 4kA_ A I YA Q4Ak Date: I2�jl Page: ?; of - i4— R — Red Item EMEE CA EIN ME W / • I fflm ON NINEMOI- r .1�%Al111_Imam1�.7A..0 1L�P■c�I_� .._: 1��� 7SRNM : -�.�. i_ v. �if��'Ili'�1➢�if_ ME HE NO ME MENE ME MOMMEMEM MMMMMW!NN1FJWAWA.W4ff#H WIN ME --MEN ON = 5►1��'1MOAN AW-., W4. ®� ! IM ME1 ME WA OA MIMME IM r IN MIME ME IM ME■ your food permit. • ■ • • •• ■ • - Violations Related to Foodbarrte Illness Interventions and Risk Factors{tfems 1-22) (Cont) PROTECTION FROM CHEMICALS 1$ M 16 17 l 18 rtialtn:trI i Food or Gotw Additives 3-202_.12 ? Additives*' 3-302.14 Protection from Una roved Additives* Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11. Contracts Name - Working Containers* 7-201.11 Separation - Storae* 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Satntizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.1 I Incidental Food Contact. Lubricants* 7-206.11 - Restricted Use Pesticides; Criteria* 7-206.12 Relent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring*- rtialtn:trI i 1 ' Dirnxes critical i�em in the federal 1999 Focal Cale w' 105 CMR 90.000. I' w 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41"7'!45°F Within 4 Norim * Proper Cooking Temperatures for _ 19 PHFs 3-401.IIA(i)(2) Eggs- 155`F 15 Sec E-.brimediate Service 145°F15sec* 3401.11(A)(2) Comminuted Fish. Meats & Game 34801.11(C) Animals -155°F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast -130°F 121. mm* 3-401) I(A)(2) Ratites, injected Meats -155`F 15 sec. * 3401.1.I(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 3-401..11(C)(3) Whole -muscle, intact Beef Steaks 145°F 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-40LI I(A)(1)(b) All Other PHFs -145°F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PBFs 165-F 15 sec. 3-403.11(B) Microwave- 165` F 2 Minute Standing Time* 3401 O(C) Commercially Processed RTE Ford - 140'F* 3403.11(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of Phil's 3-501.14(A) Costing Cooked PHFs from 140°F to 70°F Within 2 Hours and From 70`F to 4VF14YF Within 4 Hours. * 3-501.14(8) Cooling PRFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Homs* 1 ' Dirnxes critical i�em in the federal 1999 Focal Cale w' 105 CMR 90.000. I' w 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41"7'!45°F Within 4 Norim * 3-501.16(B) ( Cold PIIFs Maintained at or below 3-50L16(A) Hot PRFs Maintained at or above 140°F. * I Wnnore "AA Wit -.E»- Ign-P Time Las, & a Public 3-501:19 _ Time ac a Public 21 3-501.15 Cooling Methods for PRFs 19 1 PHF Hot and Cold Holding 3-501.16(B) ( Cold PIIFs Maintained at or below 3-50L16(A) Hot PRFs Maintained at or above 140°F. * I Wnnore "AA Wit -.E»- Ign-P Time Las, & a Public 3-501:19 _ Time ac a Public 21 3-801.11(A) Unpasteurized Pre-packaged luices and Beverages with Wanting Labels* 3-$01.128) Use of Pasteurized Eggs* 3-801..11(D) _.-.-- Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served, * - 34801.11(C) Unopened Food Package Not Re=served. ° 22 3-603.21 Consumer Advisary Pasted for Consumption of Animal Foods That are Raw, Undercooked or Not Otherwise -Procenedto Eliminate PathU ns.*Es Nsrtr spot 3-302.13. PasteurizedEgl;s Substitute fwl2aw Shell E 590.009(A) -(D) Violations of Section 590.009(A) -(l7) 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 violationsrelating to gosrl retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical. wid non-critical violations, which do not relate to the foodborne illness interventfans and risk factors listed above., can be found in the following sections of the Food Code and 105 CMR CITY OF SALEM BOARD OF HEALTH Establishment NameiIA t��IM&AA L� r Date: Page:_ of nem No. Code Reference C—Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION ti PLEASE PRINT CLEARLY Date Verified pn l \. I l( ° 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 ditions as described, and to comply with all mandates of the Mass/Federal F d de. I understand that\W,.noncompliance may result in daily fines of twe y-fiv dollars pension/revocationof your food permit. Corrective Action Required: ❑ No Yes Voluntary Compliance ❑ Employee Restriction / Exclusion *Re-inspecf;'�n Sched led ❑ Emergency Suspension go ❑ Emergency Closure 0Voluntary Disposal ❑ Other: 11 Violations Related to Foodbonta fitness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or 116 18 ta_.11 a � Conor Rdditives 3-202.12 Additives*' 3-302.14 Protection from Unapproved Additives* -3-50L16(B) 590.004(M Poisonous or Toxic Substances 7-101,11 Identifying Information -Original Containers* 7-102,11, Common Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Satntizers. 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 Monitorin *_ ta_.11 a � ° Denotes crifical iwat in the federal 1999 Food Case 01 105 CMR 590.000. 3-501.14(C) Proper Cooking Temperatures for 3-501..15 PHFs _ 3.40i.11A(1)(2) Eggs- 155F 15 See. -3-50L16(B) 590.004(M Eggs- Immediate Service 145'F15sec* 3-441.11(A)(2) Comminuted Fish. Meats & Game 3 -SO l . f 6tA7 Animals -155'F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast =130'F'121 min* 3401.11(A)(2) Ratites, Injected Meats -15YF 15 St.004(H1 sec. * 3-401.1 I(A)(3) Poultry, Wild Game, stuffed PHFs, 27. Staffing Containing Fish, Meat, + FC - 6 Poultry or Ratites -165'F 1.5 sec. 3-401.11((N3) Whole -muscle, Intact Beef Steaks FC- 7 145'F r 3401.12 Raw Animal Foals Cooked in a Microwave 165'F * 3-401.11(A)(1)(b) All Other PRFs - 145'F 15 sec. I Reheating for Not Holding 3-403.11(A)&(D) PHFs 16_5-F 15 sec. * 3-403.11(13) Microwave- 165` F 2 Minute Standing Tine" 3-403.11(0) Commercially Processed RTE Fool - 140'F 3403.1 I(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Codling Cooked PHFs from 140`F to 70'F Within 2 Hours and From 70'F to 41'F/45017 Within 4 Hours. * 3-501.14(6) CcoHng'PHFs Made From Ambient Temperature Ingredients to 41'F/456F Within 4 Hours* ° Denotes crifical iwat in the federal 1999 Food Case 01 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. 3-501..15 CwlinF Methods for PHFs 3 801.11(6 PHF Hot and Cold Holding -3-50L16(B) 590.004(M Cold PHFs Maintained at or below 410145° F* 3-501.16(A) Hot PRFs Maintained at or above 140°P. * 3 -SO l . f 6tA7 Roasts Held at or above 130'F. 125. Time as a Public Health Control 3-501:!9 Time as a Public Health Control" St.004(H1 Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA11ONS (HSP) 21 3-801,11(A) Unpasteurized Pre-packaged luices and Beverages with War ting Ubels* _ 690.000i 3 801.11(6 Use of Pasteurized Eggs' i FC - 2 3-801.11(D) Raw or Partially Cooked Animal Foci and Raw Seed Sprouts Not Served * 1 Foal and Food Protection 3-501.11 C Unopened Food Packa Not Rc_served. CONSUMER ADVISORY 22 3-603.11 Cousumer Adiisory Posted for Consumption of 690.000i 1 23. Animal Foods That are Raw. Undercooked or i FC - 2 .003 Not OtherwiseProcessedto Eliminate 1 Foal and Food Protection FC -3 Pathogens.* 125. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. E 1 I-4 tu-ir eyi.�:n Violations of Section 590.009(A) -(D) in catering, mobile foots, 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) Criticaland non-critical violations, which do not relate to the foodborne illness interventions and risk facrors listed above, -can -be found in the following sections of the Food Code and 705 CMR 590.000. Item -- i Good Retail PracticesFC 690.000i 1 23. 1 Management and Personnel i FC - 2 .003 1 24. 1 Foal and Food Protection FC -3 .004 125. Equipment and Utensils l FC -4_ .005 26. 1 Water. Plumbing and Waste I FC -5 .006 27. 1 Physical Facifity + FC - 6 .007 28. 'Poisonous or Toxic Materials FC- 7 .008 r29. S ecial Requirements .009 30. i Other I Massachusetts Department of Public Health Division of Food and Drugs FOOb ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name _ S a A Date - .6 - I I Type of Operation(s) Food ServiceRoutine � Retail ❑ Residential Kitchen El Mobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Type of Inspection 1H Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness El General Complaint ❑HACCP ElOther Address A Risk Level Telephone Q /1 /1 U 1 I Ownerf n ! h �^ D HACCP YM Person in Charge (PIC) /i/.nn Inspector a Time Int : aO Out: Each violation checked requires Violations marked may pose an imminent he. action as determined by the Board of Health. 1. PIC Assigned / EMPLOYEE HEALTH n on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: rentions and Risk Factors Anti -Choking Tobacco hazard and require immediate corrective � 1 I9( E) ET, 590.009 (F) 0 El 12. Prevention of Contamination from Hands-�L���j ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 4. Food and Water from Approved ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM 8. Separation/ Segregation/ Protection I1 13. Handwash Facilities 17114. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding [120. Time As a Public Health Control ®' 9. Food Contact Surfaces Cleaning and in Sanitizing l,.U. _ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS_(HSP)! ?fin n.i c�2 �'U (�>P ��, �-J ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwash(bf ❑ 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. N` L -CAASl(s_ (j,_ (� C N (I `�VIC1�Pp 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) J 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)(590.001) 29. Special Requirements (590.009) 30. Other CONSUMER ADVISORY . - R -a+ O�W2. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions / and Risk Factors (Items 1-22): v� 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. 3- ag-� ) Inspector's Signature: Print: rr PIC's Signature Print ` C , .)� r- Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(0 Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Char ge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusit>ns and Restrict ons E 6 C FOOD FROM APPROVED SOURCE '" Denotes, critical item in the federal 1999 Food Cate or 10 CMR 590000. $ Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.1.2 Foci ma Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Products- Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5401.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinkin Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* 1 Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreadonaliy Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Lasted Sources* Contamination from the Consumer Game and Wild Mushrooms .4pproved by Regulatory Authority 3-202.18 Shellstock.Identification Present* 590.004(C) Wild Mushrooms* 3-201.1.7 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1 PHFs Received at Pro er Temperatures* 3-202.15 Package Ime,.it y* 3-101.11 Food Safe and Unadulterated Tags/Records: Shelistock 3-202.18 Shcllstoek Identification * 3-203.1.2 ShellstoekIdentification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients' - Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* Conformance with Approved Procedures iHACCP Plans 3-502.11. S ecialized Processin Methods* 3-502.12 Reduced ox gen acka 'ng, criteria* 8-103.12 Conformance with Approved Procedures* '" Denotes, critical item in the federal 1999 Food Cate or 10 CMR 590000. $ Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Fends* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.1.1(A) Food Protection* 3-302.15 1 Washing Fruits and Vegetables 3-304.11 Food Contac' 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..1.11. Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-60 L 11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11. - Clean Condition - Hands and Arms* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(F.) Preventing Contamination from Employees* 13 Handwash Facilities - Convenientty Located and Accessible 5-203.11 Numbers and Capacifies* 5-204.1.1 location and Placement* 5-205.11 Accessibility, 0 eration and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, .Availability 6-301,12 HandDryingProvision L�Establishment BOAR b OF HEALTH Name: U.t -+jr Al ,4- � c irn Date:?, -15 -1 1 J_a0 Page: a of _ Item Code " Reference C -Critical Rem R — Red Item- DESCRIPTION OF VIOLATION / PLAN OF CORRECTION bateNo. iii C..� "PLEAS PRINT CLEARLY _ . ' `''/'y�,• - Verified I1 0 k rt P. c n- 15 �� IYIyC%1 9 t� g A-lI MTM ink I w k<;)oi�lffjl_" ,K ;,� ;,:, 0 -pw, nn / k_ � _ /_ _ _ 6 hD, , R ( � )O ��O A A I ') - (� j .nAn� A T \Cj , i A4-7,,,,- 7 l OY J k�- — (% ,An C-�A nA ,6- p nrt — 1 ( M^ q,0n1 OAA / A. n � � 1 ! 1 i Dei o.rL /i ,�,,.fSi l'vivMA L( 0', j, ) p l� Pwi n- (D, �A ,R, Y a )i ��/.A "4,1 n'1r _A /I �" 1, _ �1 P P lto,7 14i - .ni, . i ' A _ Ni)2 - o _ J _ �w_r/ "" ra nA l.iiln A/ A <�FlA �0 !7 i9 B �/A C"' i Iscussion With Person in Charge. Corrective A.&iori Required. ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other I FORM 7348 (REV. 7/2000[ HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color 15 TIME/TEMPERATURE CONTROLS 16 Additives 3-202.12 Additives* 3-202.14 Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 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 16 PHFs Received at Temperatures According to Law Cooled to 41°F/45*F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(8) PHFs 3-501.16(B) 590.004(F) 3-401.11A(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(B)(1)(2) Pork and Beef Roast - 130*F 121 Min.* Physical Facility 3-401.11(A)(2) Ratites, Injected Meats - 155°F 15 Sec.* 28. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .008 29. Stuffing Containing Fish, Meat, .009 Poultry or Ratites - 165°F 15 Sec.* Other 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs - 145°F 15 Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave - 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - l40°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* tg 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 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45*F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(8) 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°F.* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(8) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Eff ofim 11112001 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (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. Special Requirements .009 30. Other Establishment Name: ""A_ ,. BOARD OF HEALTH Date; Page: of _ Item No. Code C—Critical Item _Reference R= Red Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION PLEASE' PRINT CLEARLY Date Verified - 1Y&�I Q. - r v, h JJA4 - )IfFw-A'A ./ t' <e"( �o nn so t 1 t r ' / U tl I .I FP,(�.Vllal WIZ C (r/1 .I A -0,4A CC �. �CA� �� J (1 \.i A _ '4 )F -1n nr AP A A /10 ti (n I,,, <_Jp i7 P An , 40 I >° 1 �ivAA 1. a 110 - A !A' it I �- V v`" O 1, vM TO -4-11 Discussion With Person iij)Charge: Col a five Action Required: ❑ No U Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure t ❑ Voluntary Disposal ❑ Other FORM 734B (REV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 15 Food or Color Additives 3-202.12 Additives* 3-202.14 Protection from Unapproved Additives* 3-501.16(6) 590.004(F) Poisonous or Toxic Substances 1-101.11 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 16 PHFs Received at Temperatures According to Law Cooled to 41°F/45*F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(6) 590.004(F) 3-401.11A(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* Physical Facility 3-401.1 I (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* 3-401.1l(A)(1)(b) All Other PHFs - 145°F 15 Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave - 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41°F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45*F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(6) 590.004(F) Cold PHFs Maintained at or below 41°F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°F.* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY -. 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Eft -1-"'12111 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL 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. Special Requirements .009 30. Other Establishment BOARD OF HEALTH Date: __-3 - / Page: 4 of � _ Item No. Code Reference C -Critical Rem., R- Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY - F - Date Verified G 1 Rat 0e. b c D I L ol\ L P-, ,eA.� I L1r J%,?�_ - .4- \�-1 V Q OA,--anaO 1/m, - 4 V 10 it) All i l _ _ n 1 70 "' —e,(,Mo \ nw _� ` 0'- r G a Discussion With Person in Charge: Corrective Action Required: ❑ No ❑Yes ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ ❑ ❑ ❑ Employee Restriction / Exclusion Emergency Suspension Emergency Closure Other ' . FORM 734B (REV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 15 PHFs Received at Temperatures According to Law Cooled to 41 "F/45'F Within 4 Hours.* Food or Color Additives 3-202.12 3-801.11(B) Additives* 3-202.14 Protection from Unapproved Additives* Eggs- 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* Poisonous or Toxic Substances 7-101.11 FC Identifying Information - Original Containers* 7-102.11 Time as a Public Health Control* Common Name - Working Containers* 7-201.11 - 4 Separation - Stora e* 7-202.11 Water, Plumbing and Waste Restriction - Presence and Use* 7-202.12 .006 Conditions of Use* 7-203.11 FC -6 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria- Chemicals* 7-204.12 Poultry or Ratites - 165°F 15 Sec.* Chemicals for Washing Produce, Criteria* 7-204.14 Whole -muscle, Intact Beef Steaks Drying Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 3-401.12 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 3-401.11(A)(1)(b) Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS 16 PHFs Received at Temperatures According to Law Cooled to 41 "F/45'F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(B) 590.004(F) 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145"F 15 Sec.* FC 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155*F Sec.* - 4 3-401.11(6)(1)(2) Pork and Beef Roast- 130°F 121 Min.* Water, Plumbing and Waste 3-401.11(A)(2) Ratites, Injected Meats - 1557 15 Sec.* .006 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, FC -6 .007 Stuffing Containing Fish, Meat, Poisonous or Toxic Materials FC Poultry or Ratites - 165°F 15 Sec.* .008 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 30. 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs -145"F15Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* F -To 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) 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 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41 "F/45'F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(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°F.* FC 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 3-801.1 l(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized Eggs* Management and Personnel 3-801. l 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* .003 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 Animal Foods that are Raw, Undercooked or Management and Personnel FC not Otherwise Processed to Eliminate .003 24. Pathogens.* Ellectiv 11112001 FC 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* 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 foodbome 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 foodbome 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. Special Requirements .009 30. TOther Commonwealth of Massachusetts QD�-'A City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/28/2011 ESTABLISHMENT NAME: File Number: BHF -2004-000228 Victoria Station Restaurant 86 Wharf Street SALEM MA 01970 LOCATED AT: 0086 WHARF STREET SALEM, MA 0070 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/ Notes FOOD SERVICE 6HP4012-0143 Jan 1, 2012 Dec 31, 2012 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES[December 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for; such must be submitted to and approved by the Salem Board of Health. Page 1 1� KINIBERLEY DRISCOLL MAYOR LARRY RAMIAN, RS/Rl?I IS, (:110, CP -1,s I-II:.\1:1'11 A(; h;NT CITY OF SALEM, MASSACHUSFTTS BOARD OF HEALTH 120 WASHINGTON STREET, 4... FIX)( )R TEL. (978) 741-1800 F_ -\x (978) 745-0343 Itatndin n salem.com 201_ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �L( � Iqs-- 400 NAME OF ESTABLISHMENT �� tr )r1� STG"CY oto TEL # ADDRESS OF ESTABLISHMENT -C39 FAX # J-11% MAILING ADDRESS (if different) EMAIL - Business`. Website: V;cLF-au,,4-r4 otn�c,(P:ytn. c% .w OWNER'S NAME Y-E0Ai Q- Val-sniAA7 TEL# 9-75A- --Lb-7?g1q0, ADDRESS '7S7- �'� c� �o} (Z6, A ,n 0-,r, 0 (g 8 "L STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(S) 136 4,n T -o (Required in an establishment where potentially hazardous food is prepared) ce �( �l� _ 74> — 3 S q`i EMERGENCY RESPONSE PERSON �Q A-A,,� Q - 15c� sL_.n� HOME TEL # LA —1-101 -N93 Please write in time of day. it OA vK (For exam de 11 am -1 I Dml I t'. nn An RETAIL RESTAURANT (Outdocr Stationary Focd Cart YES YES .I0: MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 less than 25 seats =$140 25-;i9 cents =$280 more than 99 seats =$420 $100 YES $25 YES $135 YES O $255 '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 ha er 62C, Section 49A, I certify under the pains and penalties of perjury that?, to my best knowledge and belief, have filed all state tax returns a paid all st axes required under the law. Date Updated 523/11 FOODAP201 Laden Check# & Date 11 -43170 Zo lecurity or Federal Identification Number 0 KIMBERLEY DRISCOLL • MAYOR LARRY RAMDIN, RS/RENS, CHO, CP -FS HEALTH AGENT 0 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 LRAMDIN(a),SALEM.COM /f,, 1 I COMPLAINT INTAKE FORM Date:Time: nit Received By: Complaint Number: 0294 Complainant 00—v �'hn'NA"o C -- Address: Investigated By: Property Owner/Occupant Name_ Date: Telephone #: Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Nam ! Date Type of Ooeration(s) TVDe of Inspection 7+. l a � : s A r n �( l �f ] Routine [] Re -inspection Food Service L Retail Ad ress Risk -rte_ a Level ❑ Residential Kitchen Previous Inspection Date: Telephone k r)(1ElMobile ❑ ❑ ❑ Temporary Caterer Bed & Breakfast ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint Owner HACCP YM Person in Charge (PIC) ��/ J Time CjP ,non -l� f,„o ff o,, K.a z �(,n �m Ind;(✓?�.� Out::.,& Permit No. ❑HACCP ❑ Other Inspector � i0 R .� ACJ Each violation checked requires an�planation 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) ❑i 590.009 (F), t action as determined by the Board of Health. n , -'F66D PROTECTION MANAGEMENT e.,„„ za � ❑ 12. Prevention of Contamination r fromHa ds ❑ 1 PIC Assigned / Knowledgeable / Duties ®' 13. Handwash Facilities EMPLOYEE HEALTH" .m..... <. a t °'.PROTECTION FROM CNEMIGALS El2. Reporting of Diseases by Food Employee and PIC �' ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [115. Toxic Chemicals .,a aj„ FOOD FROM APPROVED SOURCE,m.;`,�_.QA V TIMErrEMPERATURE CONTROLS (Potentiaily E]tiaxardous foods).-�,` `° 4. Food and Water from Approved Source _ ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans _- PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection W 9. Food Contact Surfaces Cleaning and Sanitizing ( [110. Proper Adequate Handwashing r 4 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 R immediately or within 90 days as determined by the Board' of Health. C 14 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) r� 27. Physical Facility (FC -6)(590.007) lJ 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s(A �/ ^ orme i� -,i�U "T'� (iii/ 7-d'✓��'W ' ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control LREOUIREMENts FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: " , Print: / PIC's Signature: �/' ' Print: - f h w�j2� J Page of W Pages t a „ V _. , I Ii r• •� Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT -590.003(A) Assie mentofResponsibility' 590.003(B) Demonstration of Knowledge" 2-103.11 i Person in charge- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law" 3-201.1.2 require reporting by food employees and 3-20113 ,Fluid Milk and Milk Products* applicants* Shell Eg s* 590.003(F) Responsibility 01'A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report'to The Person In DrinkingWater 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* 3-20,L',15 590.003(E) Removal of Exclusions and Restrictions 4 C 6 I * Denotes critical item in the federal 1999 Food Code or 105 CMR 596.000. i 'i u.. •l.itrI_ix 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law" 3-201.1.2 Food in a Hermetically Seated Container* 3-20113 ,Fluid Milk and Milk Products* 3-202.13 Shell Eg s* 3-202.14 E a s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-1.01.11 DrinkingWater from an Approved System* 590.006(A) Bottled Drinking Water* 590,006(B) Water Meets Standards in 310 CMR 22.0* WashingFruits and Ve etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-20,L',15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Reaulatory Authodt 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 - PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Sheiistock 3-202.18 Shellstock Identification * 3-203.12 Shellstoek Identification 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 E ui men[* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-50212 Reduced oxygen Eackaging, criteria* 8-103.12 Conformance with A. raved Procedures* * Denotes critical item in the federal 1999 Food Code or 105 CMR 596.000. i 'i u.. •l.itrI_ix 8 Cross -contamination 3-302.11(A)0) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-3021.1(A)(2) 'Raw Annual Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 WashingFruits and Ve etables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) ,Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501-111. Manual Warewashing - Hot Water Sanitization rem eratures'° - 4-501.112 Mechanical Warewashing- liot 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 F..quipment FcxA- Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui men[* 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* 1.1 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* 12 Prevention of Contamination from Hands 590.0(9(E) Preventing Contamination from Em to •eea* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availabilit, L.6-301 Hand Drying Provision f BOA D,OF HEALTH Establishment Name: ( )Oz Jn r E, _(::�A-774A Date: (,,>-i h Page: � of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Re re o R - Red Item ya-' �' ' '�� PLEASE PRINT CLEARLY r(} _ Verified n _yoc�x� �i i'` , I , L 0 /AA/_7 IV �)✓Vl -41 k C! Y AA C41 A tt 1 0 .l /° ^ Q c 111h UL4kP/� 2-)—c n" __ 11a �Q c rn Is— _ ___� __ nn X �'. u. .. _ t It v /.. _ �.� o A 9 n On V (--�• .` 1 LiTr/ 0Z � �/l to A! J04J04A P J4 - ,f R r . „.. D, iscussion With Person n Charge_: n (1 �� �S Corrective Action Requir ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / ❑ Re -inspection Scheduled ❑ Embargo Exclusion ❑ Emergency Suspension ❑ Emergency Closure . "`c / ❑ Voluntary Disposal ❑ Other // FORM 734B (REV.,7/2006j/HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health 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* 206.11 Restricted Use Pesticides, Criteria* 206.12 Rodent Bait Stations* r7-206.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS 16 PHFs Received at Temperatures According to Law Cooled to 41 'F/45"F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.1](B) PHFs 3-501.16(B) 590.004(F) 3-401.11A(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°E* 3-501.16(A) Eggs - Immediate Service 145`F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(B)(1)(2) Pork and Beef Roast - 130*F 121 Min.* Physical Facility 3-401.11(A)(2) Ratites, Injected Meats - 155°F 15 Sec.* 28. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .008 29. Stuffing Containing Fish, Meat, .009 Poultry or Ratites - 165°F 15 Sec.* Other 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs - 145*F 15 Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70*F to 41*F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41 'F/45"F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.1](B) 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°E* 3-501.16(A) Roasts Held at or above 130°F.* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.1](B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY f 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* EHectim 11112001 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) I Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome 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. Special Requirements .009 30. Other Sago/," BOARD OF HEALTH Establishment Name:d / r Bniu e. Date: Page: T of Item Code C - Critical Item' ' ; DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red item b ''• ,� PLEASE PRINT CLEARLY Verified T\ AlE K 1-1 - 0 -VIA{ / t _ li .. .n A lo vj O V 'D I �P An' ,Li( D � r _ ct n V GC lAAO . J14 / . -ro , h IJ)00 a 0 — — t n /YlAK /9-P /11 r. 6/ r /1X / Y w n 0 Discussion With Person in Charge: Corrective Action Required: ❑ No IJ Yes n �f J 11�� ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other T� r r FORM 734B (RE/200 HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 TIMEITEMPERATURE CONTROLS 16 Food or Color Additives 3-202.12 Additives* 3-202.14 Protection from Unapproved Additives* 3-501.16(6) 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 - Storae* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 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* TIMEITEMPERATURE CONTROLS 16 PHFs Received at Temperatures According to Law Cooled to 41*F/45°F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(6) 590.004(F) 3-401.11A(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.1l(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(8)(1)(2) Pork and Beef Roast -130°F121Min.* 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.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave - 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41 °F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45*F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41*F/45°F Within 4 Hours.* 3-50L15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(6) 590.004(F) Cold PHFs Maintained at or below 41°F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°F* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (NSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* EBect,o 111,200, 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and /05 CMR 590.00. Item Good Retail Practices FC 590.00 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils FC - 4 .005 26. Water, Plumbing and Waste FC - 5 .006 27. Physical Facility FC - 6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. Special Requirements .009 30. Other 'C' o ,," BOARD OF HEALTH Establishment Name: n $ A 0-4 , C' -6—+T oma. Date: —i 1 r Page: { of Rem No. Code Reference C - Critical item_ R – Red Item ., s ::; DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLSENT CLEARLY , - Date Verified �Jc _ ,v,�— 94 V' \ n A IIAN 1 4 rJ44 it q CU/1 1 – /J3 AAa lsa P n i APr. —'lA n ) _ �' '_Q_' Discussion With Person in Charge: Corrective Action Required: ❑ No ❑Yes ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ ❑ ❑ ❑ Employee Restriction / Exclusion Emergency Suspension Emergency Closure Other I — / I FORM 734B (BEV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health 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 16 PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(B) PHFs 3-501.16(8) 590.004(F) 3-401.11A(1)(2) Eggs - 155°F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155*F Sec.* FC - 5 3-401.11(6)(1)(2) Pork and Beef Roast- 130°F 121 Min.* Physical Facility 3-40IAl(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.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165*F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41°F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-501.16(8) 590.004(F) Cold PHFs Maintained at or below 41°F/450F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°F* 25. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(B) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Eftc, 111,2001 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) I Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under Jt29 - 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. Special Requirements .009 30. Other BOARD OF HEALTH Establishment Name: U.< d—A -A r ,rr - Zi_i 42 4. Date: ' —t —I ri Page: of Item No. Code C -Critical Rem Reference R - Red Item DESCRIPTIONOF VIOLATION /. PLAN OF CORRECTION H PLEASE PRINT cLEARw'' Date Verified /fes (1(T -t lb Ann 1Pi \/7 /Y1 1 D/ B A4 QeO _ 'PA 01 ) n,o A1 a /—,Ii$ _U i; - P. Q o / Anq A /p�-F�O LAA s � A A ' U�� V - - nAie _ _ I. _ .. _ `- �.. \J V90 lip- j— i0 A r-„ 0 M,1A f (-)An r7 r),4i),4 �nt� i to Discussion With Person in Charge: Corrective Action Require: ❑ No (�IffNes Voluntary Compliance ❑ EmployeeRestriction/ Exclusion Rhe -inspection Scheduled ❑ Emergency Suspension ❑ EmbargoC ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other ` FORM 7348 (REV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health” ` e e, Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 15 TIME/TEMPERATURE CONTROLS 16 Food or Color Additives 3-202.12 Additives* 3-202.14 _ Protection from Unapproved Additives* 3-501.16(6) 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 - 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 16 PHFs Received at Temperatures According to Law Cooled to 41*F/45*F Within 4 Hours.* Proper Cooking Temperatures for Cooling Methods for PHFs 3-801.11(6) PHFs 3-501.16(6) 590.004(F) 3-401.11A(1)(2) Eggs - 155*F 15 Sec. Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Eggs - Immediate Service 145*F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 Min.* Physical Facility 3-401.11(A)(2) Ratites, Injected Meats - 155°F 15 Sec.* 28. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .008 29. Stuffing Containing Fish, Meat, .009 Poultry or Ratites - 165°F 15 Sec.* Other 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F* 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs - 145°F 15 Sec.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41 °F/45°F Within 4 Hours.* 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 *F/45°F Within 4 Hours* * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 19 20 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41*F/45*F Within 4 Hours.* 3-501.15 Cooling Methods for PHFs 3-801.11(6) PHF Hot and Cold Holding 3-501.16(6) 590.004(F) Cold PHFs Maintained at or below 41°F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°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) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.00 3-801.11(6) Use of Pasteurized Eggs* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC -3 Pathogens.* EBecti a 11112001 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* SPECIAL REQUIREMENTS 590.009(A) -(D) I Violations of Section catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. 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. Special Requirements .009 30. Other BOARD OF HEALTH r - Establishment Name��p ��u m, ��O int.ri Date: n,(— I Page: Of Item Code, C=Critical item' �> DESCRIPTION OF VIOLATION / PLAN OF CORRECTION z I Date No. Reference R=RedItem - " '-' Verified ,� A PLEASE PRINT CLEARLY., 1 r_1 AP - _ — o i) — /1 _ MF�1r'�L1:►ri�''AAa -A Discussion With Person in Charge: FORM 7348 (REV. 7/2000) HOBBS & WARREN, -BOSTON This Form Approved by the Department of Public Health Corrective Action Required: ❑ No 'Voluntary Compliance ❑ Employee Restriction / Re -inspection Scheduled ❑ Exclusion Emergency Suspension oZ w eek_ ❑ Embargo ❑ Voluntary Disposal ❑ ❑ Emergency Closure Other This Form Approved by the Department of Public Health 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 16 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(6) 590.004(F) 3-401.11A(I)(2) Eggs- 155*F 15 Sec. Hot PHFs Maintained at or above 140°F* 3-501.16(A) Eggs - Immediate Service 145°F 15 Sec.* 25. 3-401.11(A)(2) Comminuted Fish, Meats & Game Time as a Public Health Control* 590.004(H) Animals - 155°F Sec.* FC - 5 3-401.11(6)(1)(2) Pork and Beef Roast- 130°F 121 Min.* Physical Facility 3-401.11(A)(2) Ratites, Ideered 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.* 17 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165*F 15 Sec.* 3-403.11(B) Microwave- 165°F 2 Minute Standing Time* 3-403.11 (C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and from 70°F to 41*F/45°F Within 4 Hours.* 3-501.14(8) 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 20 3-50L14(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(6) 590.004(F) Cold PHFs Maintained at or below 41*F/45°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F* 3-501.16(A) Roasts Held at or above 130°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 Beverages with Warning Labels* 3-801.11(B) 23. Use of Pasteurized Eggs* 3-801.11(D) .003 Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.* 3-801.11(C) FC - 3 Unopened Food Package Not Re -served.* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.00 23. Animal Foods that are Raw, Undercooked or FC - 2 .003 not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* Effective 1/112001 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* L�]IK9liL�ily�Dl IP 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 foodbome 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. Special Requirements .009 30. Other CITY OF SALEM/ �� on BOARD OF HE LTH Date: (I �� of Establishment Name: V (�; O'rl cr / AI Page: of Rem No. Code Reference C - Critical Rem R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date - Verified SP,c� SP6`n r r p LY'f _ ' i ie Jir-e I� ,tg v! S - IOC7 VI C( I` j? ! rx7rvo r were nn(-, e .s cr ( CveLM v- k-�inG C_iszp rif (tr(qd. 1t12_ A"Q_ n - e I ccr V'V�',t P Q I< T_" 5111"V H + P . , n M kyTIn (Y)fd k'P il .y Lux i n I () � P ut-- 4n , Lx ( )At 9 In. + Yl P _ ,x:14 hP r AI4lr (t{(X +^(oyi. ,n 41!� c rt.i . I r Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditionsas 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. / �G%C./��'�� Corrective Action Required: ❑ . No ❑: yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion El Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne liiness interventions and Risk Factors (8ems 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 18 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-50IA6(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 - Stora * 7-202.11 .Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 - Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS * Lhnotes critical item in the federal 1999 Feat Cade a 105 CMR 590.000. IN F2 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PRFs 3401.I1A(1)(2) Eggs- 155°F 15 Sec. 3-50IA6(B) 590.004(F) Eggs- Immediate Service 145'F15sec+ 3.401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(A) Animals - 155°F 15 sec. * 3401.11(B)(1)(2) Pork and Beef Roast - 130'F 12I min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 590.004 H) sec. * 3-401AI(A)(3) Poultry, Wild Gane, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, 1 FC -6 Poultry or Ratites -165'F 15 sec. 3.40LIl('C)(3) Whole -muscle, Intact Beef Steaks ! FC -7 145'F * 3401.12 Raw Animal Foods Cooked in a ; Microwave 165'F * 3401c11(A)(1)(b) All Other PHFs - 145'F 15 sec. -- Reheating for Hot Holding 3403A1(A)&(D) PHFs 165-F 15 sec. * 3403.11(B) Microwave- 165' F 2 Minute Standing Time* 3403.11(C) Commercially Processed .RTE Food - 140'F* 3403.11(H) 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* * Lhnotes critical item in the federal 1999 Feat Cade a 105 CMR 590.000. IN F2 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Hot and Cold Holding 3-50IA6(B) 590.004(F) Cold PHFs Maintained at or below 4101450 F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 3-501.16(A) Roasts Held at or above 130°F. 25. Time as a Public Health Control 3 -SOL 19 Time as a Public Health Control' 590.004 H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 2I 3-801.11(A) Unpasteur mil Pre-packaged Juices and Beverages with Warning Labels* 590.W�'0 3-801.11(B) _ Use of Pasteurized Eggs* ' FC -2003 3-801 A I (D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.W�'0 23. Animal Foods That are Raw. Undercooked or ' FC -2003 . Not Otherwise Processed to Eliminate Food and Food Protection FC - 3� pathogens,* e�'t'n0°' 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell _.004 A05 26. Eggs* Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical. and non-critical violations, which do we relate to the foodborne illness interventions and risk factors listed above, ran be found in the following sectionsofthe Food Code and 105 CMR 590.000. item I Good Retail Practices j .FC 590.W�'0 23. Manaciament and Personnel ' FC -2003 . 24. Food and Food Protection FC - 3� 25. Equipment and Utensils 4 _.004 A05 26. Water. Plumbing and Waste IFC -5 .006 27. Physical Facility 1 FC -6 .007 26. Poisonous or Toxic Materials ! FC -7 .008 29. Special Requirements ; .009 30. I Other - -- -- -_ &W2a Establishment Name: `I i(+giia -bli n CITY OF SALEM BOARD OF HEALTH Date: V/j( Pane: of 0 Item No. Code Reference C - Critical Item R - Red Rem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date - verified / —1 �j (_ �)-/ vn F:G I� - r - V i r y I(e , . t Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. / /v2e / �it t�& 11 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(@ems 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 18 TIME/TEMPERATURE CONTROLS Food or Color Additives 3-202.12 _ Additives* _ 3-302.14 _ Protection from Unapproved Additives" FC -2 Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-102.11. Common Name - Working Containers* 7201.11 Separation - Stora * 7-202.11 . Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toric Containers - Prohibitions* 7-204.11 Sanitizes. Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 1 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* TIME/TEMPERATURE CONTROLS * Lhnotes critical item in the federal 1999 Fwd Code or 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45°F Within 4 Hours, Proper Cooking Temperatures for 19 PHFs 3-401.11A(1)(2) Eggs- 455°F 15 Sec. FC -2 Eggs- Immediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-801.11(C) Animals - 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 26. sec. * 3-401.11(A)(3) Poultry, Wild OPame, Stuffed PHFs, 27. Stuffing Containing Fish, A4eat, FC -6 Poultry or Ratites -165°F 15 sec,* 3401.11(0)(3) Whole -muscle, Intact Beef Steaks ' FC - 7 145°F +' 3401.12 Raw Animal Foods Cooked in a - Microwave 165'F * 3-40LI I(A)(1)(b) All Other PHFs - 145°F 15 sec. Reheating for Hot Holding 3403.11(A)&(D) PHFs 165°F 15 sec. * 3403.11(B) Microwave- 165' F 2 Minute Standing Titre* 3-303.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(8) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) holing Cn)ked PHFs. from 140°F to 70'F Within 2 Hous 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" * Lhnotes critical item in the federal 1999 Fwd Code or 105 CMR 590.000. 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45°F Within 4 Hours, 3-501.16(B) Cold PRFs Maintained at or below 3-501.16(A) i Hot PHFs Maintained at or Roasts Held at or above Time as a Public Health REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.15 Cooling Methods for PHFs 19 PHF Not and Cold Holding 3-501.16(B) Cold PRFs Maintained at or below 3-501.16(A) i Hot PHFs Maintained at or Roasts Held at or above Time as a Public Health REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and Beverages with R'azning Labels* 590.000 3-801.11(8) * Use of Pasteurized Eggs* FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Na Served * Food and Food Protection 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603,11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw, Undercooked or FC -2 .003 Not Other -Arise Processed to Eliminate Food and Food Protection I FC - 3 pathogens.* E b e e i/v M1 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 raider 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, 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. Item I Good Retail Practices .FC 590.000 23. Managlement and Personnel FC -2 .003 24. Food and Food Protection I FC - 3 .004 25. Equipment and Utensils I FC -4 .005 26. Water, Plumbing and Waste I FC -5 .006 27. -Physical Facility FC -6 .007 28. Poisonous or Toxic Materials ' FC - 7 .008 29. - S ial R uirements - ,009 30. 1 Other s:s�ta„m+�tr a a 11. Victoria Statlon/Vic's Boathouse 86 Wharf Street / Salem MA. 01970 �,' 978-745-3400 1978-745-7460 1 victorlastationsalem.corn J, IH C U 0 Urgent 0 For Review 0 Please Comment 0 Please Reply Please Recycle Comments: [Your comments here] 4A� 1 aged 09bLSbLBL6 XHd 13Cd3SH3 dH Wd9C:G 1102 41 400 Invoice Service Pumping & Drain Co., Inc. 5 Hallberg Park North Reading, MA 01864 978.276.0217 www.sorvicepumping.com BIII To: Victoria Station 86 Wharf Street Deck View Management Co. LLC Salem, MA 01970 978.745.3400 .KEITH, OWNER June 10,20111 Summary: Invoice q: Tech: Due Date: Job Date: Job Name: Victoria Station 86 Wharf Street Per Keit JI Salem, MA 010 q 978.745.3400 Item Code Descrlption Hre/Qty Pump and dispose outside grease trap. 1000 gallons. Front, near bushes, on top. 2 month maintenance. No need to call first. Do first AM - 7:30 to 8:00 AM, as parking gets light in lot. Pump and dispose outside grease trap 1.00 Subtotal 250.00 All material Is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices, Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will beco ne an extra charge over and above ore estimate. All agreements contingent upon delays beyond our control. Purchaser agrees to pay all costs of collection, including attorneys fees. Terms: Net30 Visa, Mastercard, and American Express Accepted z aged 091,LS11PL8LG XH3 1317213SH-1 dH LL 0/2011 (2011 KEITH, OWNER I Amount EA 250.00 WdSErS 1102 bi 100 Invoice Pumping & Drain Co., Inc. rrg Park , Reading, MA 01864 4.276.0217 www.servicepumping.com Bill To: Victoria Station 86 Wharf Street Deck View Management Co, LLC Salem, MA 01970 978.745.3400 KEITH, OWNER Item Code Description Pump and dispose (1) inside grease trap. Quarterly maintenance. No need to call first. Do first AM - 7:30 to 8:00 AM, as parking gets tight in lot. Pump and dispose inside grease trap(s) $4 fuel surcharge for service with small pump truck July 19, 20 Summary:' Invoice #: Tech: Due Date: Job Date: Job Namel: Victoria Sta 86 W hart S Per Keith Salem, MA 978.745.3400 1.00 1.00 MAINTENANCE 197543 VM/JS 8/18/2011 7/1312011 KEITH, OWNER Amount 135.00 EA 4.00 POSTED 135.00 4.00 Subtotal Total 139.00 $139.00 All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs wlil be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon delays beyond our cwtral. Purchaser agrees to pay all costs of collection, including attorney's fees. Terms: Net 30 Visa, Mastercard, and American Express Accepted g aged 094LS1l LBLG XHd 131'd3SH-1 dH Wd96:9 TToa bT 100 _1 Invoice drvtce Pumping & Drain Co., Inc. Haliberg Park North Reading, MA 01864 978.276.0217 www.seryicepumping. co m August 16, 2011 Summary. Invoice #: Tech: Due Date: Job Date: MAINTENANCE 198341 A SANTOS W1512011 8/11/2011 Bill To: Job Name: Victoria Station Victoria Station 86 Wharf Street 66 Wharf Street Deck YPer Keith Management Co, LLC I Salem, MA 01970 Salem, MA 01 978.745.3400 KEITH, OWNER 978.745.3400 ! KEITH, OWNER Item Code Description Hrsioty pa Amount Pump and dispose outside grease trap. 1000 gallons. Front, near bushes, on top. 2 month maintenance. No need to call first,�I Do first AM - 7:30 to 8:00 AM, as parking gets tight in lot. Pump and dispose outside grease trap 1.00 2 10.00 EA 250.00 $5 fuel surcharge for every 1000 gallons pumped 1.00 1P.00 5.00 Subtotal 255.00 All material Is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any 311ier3dw or deviation iron above specifications Involving extra costs wilt be executed only upon written orders and will become an extra charge over and above the estimate. All agreemenis contingent upon delays beyond our eonbol. Purchaser agrees to pay all costs of collection, including altomey's fees. Terms: Net 30 Visa, Mastercard, and American Express Accepted I• y aged 091FLSi`L8LG XH3 13rd3SH3 dH WdSErS 110a bl 200 Commonwealth of Massachusetts s ` ° City of Salem Board of Health FGmberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: File Number: BHF -2004-000228 Victoria Station Restaurant 86 Wharf Street SALEM MA 01970 LOCATED AT: 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0105 Jan 4, 2010 Dec 31, 2010 $420.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $420.00 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 MEMO. X1'7 I• �'�.�� DAVID GREENBAum, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 DGREENUAU,MP—SALEM. CONI 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT VjC�O(�,�IA \1S1QN"""""TEL# ADDRESS OF ESTABLISHMENT 8G) � FAX MAILING ADDRESS (if different) (—� 5�� EMAIL- Business': I CTc)Qt1� S'stt)�i @�os�o�.� Website: wW�• V IQIAS*f4sn0a1C/,��, �pu� OWNER'S NAME L Sctacc�a TEL # ADDRESS G j 'EgiK 6 Lw M • 0 n3 STREET CITY( 49 jjJ T {TE ZIP �q CERTIFIED FOOD MANAGER'S NAMES) (�Vl ¢2(,343,p 1014)NJC i CERTIFICAQQTE#(S)T' '� 6 J (Required in an establishment where potentially ous food is prepared) ,�Q2 EMERGENCY RESPONSE PERSON PO L S W -ice HOME TEL # (�n 9I `�" " 09g� ®gYS(QF,OP,ERpT10N,?Mpnday ; TuesdaTw• Wed iesda , „' Thyrsda x„ Fgda .', ,SatSfday isSunday HOURS OF OPERATION Please wore in time of day. "1 Dile! 1163t1�-�Z pts>! j goo,-�Z For example 11 am -11 m TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. more than I0,000sq.ft. RESTAURANT (Outdoor Stationary Food Cart lace =$ 70 =$280 =$420 less than 25 seats =$140 25-99 seats 0 more than 99 seats =$420 ------------------------------------------------------------------------------------------------------------------...--------...... SED/BREAKFAST/ YES NO $100 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT (such as church kitchens) YES NO $25 *Please pay total with one check payable to he City of Salem. This Permit is ngi transf4able and must be r Issued -n c range of ownership. The Permit must be posted in a prominent location In acdb da ce 't thS to Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such mu UGLh tt t and approved by the Salem Board of Health. Pursuant tto 62 ,Section 49A, I d by and r l e pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax r t a equired under the law. Z.�o -q3zlo a? --o Signature Date Social Security or Federal Identification Number. Revised 424/07 OD FOAP20 8.adm Check# & Date IIIVaIf- Vrf C!•9IV ■ IYCGa�7NVG FOR L� r DATE 7A( G(TIMEI.�. A.M. M / li` OF VICt&C16 S"W/GN PHONE C,- -f 7S _ SaK ,3Xqj AREA CODE NUMBER EXTEN ION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL. CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED V%ps MAAOE IN U0O9 z 0 -� ;.. Establishment Name CITY OF SALEM I BOARD OF HEALTH II� Date: Ul Page: of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date - No. _ Reference R - Red Item:: �n 6p PLEASE PRINT CLEARLY /1Ai%i/-,r)&A7V_ AAAA I1,M A 0 0 1 A 11Y 11C C V\OV\k'_lh-64f 6 1`ji- A l vin /1 nf - Verified - Y ��I �n�\ g \tt n d f tiOtl llJ I f l(%V1 VNriC j i) /Y (10 - N(94k Wi OIV , _�trlA r�Gln.no(l V1 VUOa fiVOhG 01170L iA,A(; 0-A 9 0 /1) Q IA01 L� ,fit -IN 1 1,14 1-h J 1) fin/Ay e[ v6 61� i1 i'-. V47fli om I _. Coq+; 1 1 ('rlt�� I s rn nn�t ' �kw V4^j aaZ nc/c L( ro Y r,17 —//I c,�v� � � /�/i aV � c`f�� fig! � jrr ? J \f�Ut e ' � 7 fl ,(l �—L�/� /`Gell-�C•./i-Y(^fi� t l/� ( i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion inspection, to observe all conditions as described, and to violations before the next ins P ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors(/tents 1-22) (Cont) PROTEC71ON FROM CHEMICALS 14 Comlmnw,i F;eh kj,,mic Food or Color Additives FC 3 U 3-202.12 Ad(Jitivei* ii.1 I iA)t 3-302.14 Protection from Unapproved Additives' 15 40 1. 11 (AY t) Poisonous or Toxic Substances 19 _1 101.11klentifying infi�,i mation - Ommial RA, lj(B) Coot.ahlff,�' 7-102,11 ComnionNarce I Within =1 ll,vws' 7-20(.Il �Write 'n - Stina Q* 7-20111 and U,cl - ----- ---- Reheating lor)iot H'Aamg 7- 202.12 ("widi6oll, of 7-203 H Toxill ,ColltamcfRrohib;!�or101 11 V 2 %linwe stari'ling ,,-204.11 sanitizers. crwins - Cliculic'..'W 04.12 Owmicals for Washit ip hoihice.C iitoiw III 7-')04. 14 t7ntnh A rota Cnrt it (:orit� 41 -06.12 Rixioni Btsiao"TIN, 1ricking P,mder;. fl-,si Control ana 16 1 Proper Cooking Temperatures for I I F,-, '55 F 15 Sc�% -, : M 1! 3410 1 . I I (A)k") Comlmnw,i F;eh kj,,mic PHFs Received at �Temperatures FC 3 U [7,501 According to Lau' Cooled to ii.1 I iA)t Rowkwo,."d 4IeOqs 1 s Y- i'�, 41`P/45`F Witbin 4 Hours. aWerIE00ifing of PHF.-^_.�._ 40 1. 11 (AY t) 22.2.2 fld (7,ume, StOffico, P! Tii, 19 C-01iiiming 1-ish, PHF Hot and Gold Holdinig- RA, lj(B) i CiKJiv g MIR Mitilt Root Amhew I'Cirilwal'IT, ljl�rediellis Io Wi,45,F 4 I%Wo F* I Within =1 ll,vws' — 3 `01, WA) 1. 17 1 - ----- ---- Reheating lor)iot H'Aamg 103 1 iTA)K (I 5i i: -u- -'-f; --- — ----- - - i- i 15,iri_ 3 403. IJ (B) 11 V 2 %linwe stari'ling 3-403, 11 i (7) 1°,Kkl PHFs Received at �Temperatures FC 3 U [7,501 According to Lau' Cooled to W pil:TnUnq "V a, t --n, T - C K 41`P/45`F Witbin 4 Hours. aWerIE00ifing of PHF.-^_.�._ 501 li,N) '(h it im-, Cf�&�d PHI -'s Ilow I 41Y 1 � to 19 V1'uhrn 2 1 Iovrs wid Fro) if�01 j, PHF Hot and Gold Holdinig- RA, lj(B) i CiKJiv g MIR Mitilt Root Amhew I'Cirilwal'IT, ljl�rediellis Io Wi,45,F 4 I%Wo F* I Within =1 ll,vws' 1 21 1 ;-Sf) 1 ! I k Ni 1 Unpieui i nd Pic pack -aged Jiocee wid iii teza e. with Warainlel els' - Animal Food aid kiSd ;proul, \i,i.Serve t Packacv Not Re.-,,.erved 22 1.6,02 11 (limuma Aifisoty Ptwcd ],it Cmiskoopijon of A.,ki,al I x , 11tai ait taw. Underc"Avd o; Not Orhvt vise llrkx!tssd fi) N; Rtw Shelf I SPECIAL REQUIREMENTS "Oti"r �11 hik, food. tcinporaiY and , :inti. r110 kitcrien oper:tie rn* bold he 6"hic'd uildCt clic appropriate ice nows w "i 0;;, 16 0101 AriON'S ?FLA TCD TO GOOD RETAIL PF?A,,TfCEi (Item3-30.1 Uoi mf, aW4"'W'PS, "Ibich do Pw 1: 4�1 � "n'. Ou sk , rc li, led cl�ol'in ix' ,owli"f 11, il:;;1.,�," ;,' Pt, T, -Item I Good Retail Prarticos 1 Ft - fQ — PHFs Received at �Temperatures FC 3 U [7,501 According to Lau' Cooled to W pil:TnUnq "V a, t --n, T - C K 41`P/45`F Witbin 4 Hours. 3-5(11.15 Cwlion Methods for IIHFs- 19 1 PHF Hot and Gold Holdinig- 13 501.16(B) Cold PHFs Maintained at or belpw �590,0044(1`) 4 I%Wo F* — 3 `01, WA) I Iot PHI's Maintained at or above I)(I1) I Riiasls Held at or 3bote 130"17 20 1 Time as a Public Health Control N"'triar"ce. Rectorcumit 1 21 1 ;-Sf) 1 ! I k Ni 1 Unpieui i nd Pic pack -aged Jiocee wid iii teza e. with Warainlel els' - Animal Food aid kiSd ;proul, \i,i.Serve t Packacv Not Re.-,,.erved 22 1.6,02 11 (limuma Aifisoty Ptwcd ],it Cmiskoopijon of A.,ki,al I x , 11tai ait taw. Underc"Avd o; Not Orhvt vise llrkx!tssd fi) N; Rtw Shelf I SPECIAL REQUIREMENTS "Oti"r �11 hik, food. tcinporaiY and , :inti. r110 kitcrien oper:tie rn* bold he 6"hic'd uildCt clic appropriate ice nows w "i 0;;, 16 0101 AriON'S ?FLA TCD TO GOOD RETAIL PF?A,,TfCEi (Item3-30.1 Uoi mf, aW4"'W'PS, "Ibich do Pw 1: 4�1 � "n'. Ou sk , rc li, led cl�ol'in ix' ,owli"f 11, il:;;1.,�," ;,' Pt, T, -Item I Good Retail Prarticos 1 Ft - 24 F-o,)o �md F�.,id Prole�-!Clp. FC 3 U �inci utenm_l FC - 4 '0,.' W pil:TnUnq "V a, t --n, T - C K i -C 7 AC L ----- 4S_ CK 30 Omit, R. b CITY OF SALEM j- BOARD OF HEALTH / Establishment Name: \I C4L(( Cx <4ci I }, I if) Date: C6QG /ncl Page: of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red Item .Verified PLEASE PRINT CLEARLY f 1no ,,c ti° t U'`,"ISP /t y( ('I t K i H E n a ,Sir a t l2 A /n i Y -e %�RVtol t l }1 �Y1L f"11USi C kC(il� l IC(�'e(vd "hIculchuc75% 11 cztkl �nlv�, �,E ���cr� tCor ��nt;l�i.vClS��w�� 0)1Y- )/(-I )1xY—)/(-I to t I kfJ Pr. +zn Cl '94�\ I Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Ll Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fed eral_,Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit.) 1f� /� I ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors fillefts 1-22) (Cont) PROTECTION FROM CHEMICALS F-77- 14 Pou)wvi ;I! Grlpc. !J: pli�' Food or Color Additives 3-202,12 '(hbtivEs* 3-302,14 Protection from Unapproved Additives" 15 jtni,w&ltc fit'; vi Cc 15'T 1 :*tc- Poisonous or Toxic Substances 19 —i Identifying Info ination - 06"linal m:re:is >>> �� 4 scz. .' colitaillels, -- ------4 ns rwd 13.a Rost-.? -1 102,11 Common Name Workir.rj ", n--kj—!e StJndm"' t T MliJ T-2 7-210(.11 SVILKIII - St lz'fl! k,,ki 140'F, " I '40'F . ..... ic�vwtinll - Pr t's, rlc� "ird tl�"" .... . 7-202A2 Time as a Public Health Control '1 -10111 1 Toxi, Cunt amu -- Prob; - �i! on, -1 -204� . criirio - cl,11111c." WS '7-1r 4.12 4z '[winicak for wa,h -Lull 7 M5.1) (bu fd ntai f Xl coritao, ki"licaws' E617—L�ze'll wl�'t 1,'w i,ickinllo�tdof ;uiq 16 TiAeLriEMPERATURE CONTROLS Pou)wvi ;I! Grlpc. !J: pli�' Propel Cooking Towpol atufe; for I PHFs I J 3 fWAIA"l;' I I ^F/45'F Witbin 4 Hours, jtni,w&ltc fit'; vi Cc 15'T 1 :*tc- — m Cool��, Methods for PHF.q 19 PHF Hot and Cold Holding m:re:is >>> �� 4 scz. .' . :�i,1 13!', ns rwd 13.a Rost-.? Hit-, ibS F —1 _WS -7 -N-1-1 '11i'V 14 VIIAZI F P5 4N 1 �,A'i 3, Pou)wvi ;I! Grlpc. !J: pli�' PHFs Received at Terepetabires I J I I ^F/45'F Witbin 4 Hours, 3-5(11.15 -- — m Cool��, Methods for PHF.q 19 PHF Hot and Cold Holding 3-501.16(B) Rhealiltv tot Hot Hoidiro 0 -------- Hit-, ibS F —1 _WS -7 -N-1-1 1-1 n--kj—!e StJndm"' t T MliJ T-2 3-501, INA) I hri PHFI; Maintained at or above lz'fl! k,,ki 140'F, " I '40'F 3-063.)1(1) Rcnrawillg Port 'C! I Proper Cooling of PHi's 501,14(A) r',xtliiw C AE�d PHF; iiia 14''F is "i Willim, 7 Ifour, aid From 1JF Withm 4 fioll Cfofiit�, PHR Nhidc Front Ambiew f3iie6iwa- t(,411145'F qm� IES 01" iH 1: REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 11 3-Si)!Ai(A) I 1,*Tip,)tcutiedflre-lia,:!,,igcdltiiccswid 3-801 11(13) Uz-olPa�wliiizedEi,r,* or RIil i'lij" C' >)kk.d Artim"'ll RX)d alld Rg.j Nor Sot- v 14"X`I; %,)! Ro.-,.crvcd, 'c Ir Cowumption of f'ir Ras S1101 5-0.(0)i A"t 0: 'j��'iUi IN: Iv:.._ N 5 1OL4) iOAIS' 84,1A TED 10 300D RETAIL PRAcTfIr illefirs 23-30) 1 ("L'wl ':I;d fa� wwflh do ntn "e'Urr:', ,I,, CS3 'wce '10 10'- 1;;Ic'd aiIol r ,aII i OtL' .!I ;h' Food CoJea)."! 21'I -i Good Rftad Practices FC 530.000 n rind Perii Fc, > (10-- F-o,tion nl F(W Pro)ectior 0"vasle FC - r, 30 1 Om 4-501.14((`} PHFs Received at Terepetabires According to Lam Cooled to I I ^F/45'F Witbin 4 Hours, 3-5(11.15 -- — m Cool��, Methods for PHF.q 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590'0iP(F1 -12°/45`1 3-501, INA) I hri PHFI; Maintained at or above 140'F, " I Z -2(d kws'ts Held at or above 117,35T)IFT. Time as a Public Health Control rrw as a llubfiHealth "alftj Conjr')J_ REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 11 3-Si)!Ai(A) I 1,*Tip,)tcutiedflre-lia,:!,,igcdltiiccswid 3-801 11(13) Uz-olPa�wliiizedEi,r,* or RIil i'lij" C' >)kk.d Artim"'ll RX)d alld Rg.j Nor Sot- v 14"X`I; %,)! Ro.-,.crvcd, 'c Ir Cowumption of f'ir Ras S1101 5-0.(0)i A"t 0: 'j��'iUi IN: Iv:.._ N 5 1OL4) iOAIS' 84,1A TED 10 300D RETAIL PRAcTfIr illefirs 23-30) 1 ("L'wl ':I;d fa� wwflh do ntn "e'Urr:', ,I,, CS3 'wce '10 10'- 1;;Ic'd aiIol r ,aII i OtL' .!I ;h' Food CoJea)."! 21'I -i Good Rftad Practices FC 530.000 n rind Perii Fc, > (10-- F-o,tion nl F(W Pro)ectior 0"vasle FC - r, 30 1 Om Cajun Jumbo Wings 13 A heaping pound of jumbo wings served with grilled pineapple salsa Angus Beef Slider Trio 15 One each, caramelized onion & bleu cheese, grape tomato bruschetta & mozzarella, sharp cheddar & applewood smoked bacon with crisp shallot strings on pretzel rolls Shrimp & Bay Scallop filled Ravioli 17 Sauteed in roasted garlic butter with pancetta Oversized Lobster Roll 20 Giant chunks of lobster meat served on a toasted buttered top split roll with -Victoria "s Boston baked beans-�­-�, Grilled Salm Sandwich 16 o Atlantic salmon grilled and served onra whole grain ciabatta with meltedJontina. roasted asparagus, caramelized shallots and balsamic reduction with hoes made North-,&6re salt & pepper chips �Mozzare[[a Roulade 14 J/} Rotled fresh mouarella�stuffed with proscmtlo:roasted tom"yato. mixed greens and - ganccrplated on house basil%pesto with grilleli c�iia�batta cns�`s I Deep Fried Lbbste R ioii..1�6 IB �`-* >-�=(nth=a�roasted-corn=maple ippingsauce Vic's Fish &ChipS U S El Gourmet Steak & Cheese 17 Aged dry rubbed sirloin grilled and cut thin, served on a French baguette with crisp pancetta, sauteed shallots and roasted mushrooms finished with asiago cheese and seasoned fries Roasted Portobello Roll -Up 13 Portobello with roasted red peppers, roasted garlic goat cheese and baby spinach wrapped in a warm sun-dried tomato tortilla with sweet potato fries "Jamaican Mon" Chicken 16 Slow cooked jerk chicken served with jalapeno pineapple corn bread plated on piquant sauce and garnished with fresh time wedges Slow Roasted Prime Rib 16 An, 11oz portion of our signature slow roasted angus prime rib served with horseradish cream sauce, an jus and a kosher salted baked potato Add our famous "All You Can Eat" Salad Bar ...4 Featured Summer Drinks From The Blender Jose Cuervo Frozen Margaritas Classic. Strawberry Mango or Raspberry Pina Colada White Ram with pineapple & coconut Strawberry, Shortcake Amaretto, strawberries & ice cream Raspberry, Bellini On Tap Sam Summer Ale. Harpoon Summer Beer Seadog Blueberry Ale Stella Artois Blue Moon Bottled Twisted Tea ted --Half & Half Raspberries & champagne Ipswich Summer Frozen Sex oni e Beach peakO ganic Pate Ate Ketel One, rasp e� & mango Sam'Adams Irish WeddrT Frozen Bern ,,Umona�de Bud Light Lime i f t Sierra Nevada Pale Ate Ketel Omoocitroen, strawberries & if lemonade A// U S E Salem Sunset Stolt Razben Grand Marmer, pineapple juice & grenadine Lemonberry, Stolt Blueberi. Stott Razberi & Lemoncelto Boston Creme Pie - stoti Vanil. Dark Creme de Cacao & Godiva Caramel Bikini Tini Malibu Coconut Rum, Chambord & pineapple juice Pomegranate Pearl Pomegranate Vodka. Pomegranate .Schnapps & a splash of of French Cosmo Grey Goose L'Orange, Cointreau, cranberry & lime juice A La n <6 4�v/^Nl 4�* 403.6 404 554- 5,`: Sh M�]iiier,,t Of!�*9 House -la -0 lh� Vic , 'S - 1�0a - �- I 000000 0 0 0 0 0 0 0 0 Bar, 0 00 0 0 r lo�extl m Eil I I Z., 0 rTl TNNM, .0 0 14 rl �/ 0 V 0 0r^ V) M ~ Q N pO. 7 gt ..arn m I 4' • 211132" ".-u ur 2--6- 1 EQUIPMENT SCHEDULE Item No OtylModel Number Equipment Remarks 01 1 JIBA-24-CPIO SSR -24, CCD 02 1 ]JOS-t8 03 1 OBB-13 04 1 GT -24 -CW -208 05 1 IDBGR-24 07 1 IDHSB-12 08 1 IDWB-12 03000497 Slim Jim 09 1 DBGR-24 TO— I IBA-24-CPIO SSR -24, CCD 11— I DBSA-12 12 1 LOA -18S 14 1 ST72-SF C -6X4 -CO, BO/CC 16 1 8824-NI-XSN (L) C -4X4 -CO. SS -L, SS -R 2--6- 1 1 2'-6w 1 GLASTENDER, INC. UW IVIV 'A'­Cf(5RIA STATION 5400 NORTH MICHIGAN jw DEALER: SAGINAW, MI 48604-9780 1 B LC P.O.# 989.752.4275 U 8 BT ORDER # J HORTON IB10446000 FAX 989.752.4444 UW SHIP BY: 1/4" = 1' 14'/9 /09 14'/30/09JH M m mom loll 1111, 1 : mm m oo.s.l 1 2'-6w 1 GLASTENDER, INC. UW IVIV 'A'­Cf(5RIA STATION 5400 NORTH MICHIGAN jw DEALER: SAGINAW, MI 48604-9780 1 B LC P.O.# 989.752.4275 U 8 BT ORDER # J HORTON IB10446000 FAX 989.752.4444 UW SHIP BY: 1/4" = 1' 14'/9 /09 14'/30/09JH Please help us serve you better and rate our performance at www.glastender.com/customer_Survey.htm F-724010 Rev. c 1217-07 Quotation tQ ® ��.j� n ■ xpect more,, 267067 Glastender, Inc Justin Horton - ext 137 5400 North Michigan Road • Saginaw, MI 48604 jhorton@glastender.com 989.752.4275 " FAX 989.752.4444 " 800.748.0423 Date: 04-30-09 Expires: 07-31-09 Page: 1 Job: Victoria Station To: Viola Marketing Group Leadtime: 4 to 5 Weeks Rep 1: PO Box 1130 Freight: FOB Saginaw, MI 48604 Viola Marketing Group Madison CT 06443 Phone: 203-245-0711 X USA Fax: 203-245-8974 Rep 2: Attn: Rosina Boyd Email: rosina@violagroup.com Note: Please verify all information before ordering. Qty Item No. Model No. Item Description Wgt Net Price Extension 1 01 IBA-24-CP10 Ice bin, 24"w x 19"d with 10 pass cold 165 1,036.35 1,036.35 plate 1 01 SSR-24 Speed rail, single, 24" 7 69.30 69.30 1 01 CCD Condiment dispenser 5 56.70 56.70 Totals for item 01 177 1.162.35 1 02 IOS-18 Island Oasis stand, 18'w x 29"d 55 391.05 391.05 Totals for item 02 55 391.05 1 03 DBB-18 Drainboard, 18"w x 24"d 32 320.85 320.85 Totals for item 03 32 320.85 1 04 GT-24-CW-208 Glasswasher, 24" w, rotary, clockwise, 165 4,872.60 4,872.60 208V Switch, front, GT-24 Totals for item 04 165 4,872.60 1 05 DBGR-24 Drainboard glassrack, 24"w x 24"d, with 90 555.75 555.75 adjustable shelf Totals for item 05 90 555.75 1 07 DHSB-12 Hand sink, 12"w x 24"d, deluxe with 45 646.20 646.20 faucet, soap, and paper towel dispenser Totals for item 07 45 646.20 1 08 DWB-12 Dry waste chute, 12"w x 24"d, with 20 220.05 220.05 removable deck 1 08 03000497 Slim Jim trash receptacle 10 63.00 63.00 Totals for item 08 30 283.05 1 09 DBGR-24 Drainboard glassrack, 24"w x 24"d, with 90 555.75 555.75 adjustable shelf Totals for item 09 90 555.75 Please help us serve you better and rate our performance at www.glastender.com/customer_Survey.htm F-724010 Rev. c 1217-07 a Quotation .Q Expect more, 267067 Glastender, Inc Justin Horton - ext 137 5400 North Michigan Road " Saginaw, MI 48604 jhorton@glastender.com 989.752.4275 " FAX 989.752.4444 " 800.748.0423 Date: 04-30-09 Expires: 07-31-09 Page: 2 Job: Victoria Station To: Viola Marketing Group Leadtime: 4 to 5 Weeks Rep 1: PO Box 1130 Freight: FOB Saginaw, MI 48604 Viola Marketing Group Madison CT 06443 Phone: 203-245-0711 X USA Fax: 203-245-8974 Rep 2: Attn: Rosina Boyd Email: rosina@violagroup.com Note: Please verify all information before ordering. Qty Item No. Model No. Item Description Wgt Net Price Extension 1 10 IBA-24-CP10 Ice bin, 24"w x 19"d with 10 pass cold 165 1,036.35 1,036.35 plate 1 10 SSR -24 Speed rail, single, 24" 7 69.30 69.30 1 10 CCD Condiment dispenser 5 56.70 56.70 Totals for item 10 177 1,162.35 1 11 DBSA-12 Drainboard blender station, 12"w x 24"d 35 303.30 303.30 Totals for item 11 35 303.30 1 12 LDA -18S Liquor display, 18"w x 24"d 25 457.20 457.20 Totals for item 12 25 457.20 1 14 ST72-SF 72" Slide top cooler, stainless 350 2,172.60 2,172.60 interior, stainless exterior front & sides Caster, 3-3/4" h, set of six BO/CC, left side Totals for item 14 350 2,172.60 1 16 BB24-N BB24-N1-XSN (L) 24" Back Bar Cooler, 190 1,494.90 1,494.90 self contained Caster, 3-3/4" h, set of four Door, SS glass, L/hinge Cooler top, 24" finished, ss Side, exterior, left, s/s Side, exterior, right, s/s Totals for item 16 190 1.494.90 TOTAL WT 1,461 TOTAL (USD) 14,377.95 Please help us serve you better and rate our performance at www.glastender.com/customer_survey.htm VICTORIA STATION 86 W64 Skm Satem, Ata v997V 978-745-3400 — sax 978-745-7460 January 17, 2009 Re: Board of Health Inspection on 1-13-09 Mr. Joseph Roale Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 1-13-09. • Contacted Richard's HVAC to adjust 6 drawer line unit, which we found "Iced up" and to add refrigerant to the Victory 2 door salad refrigerator. Both were done while the inspection was being completed on 1-13-09 and are holding temp's, we continue to monitor daily • Reviewed proper thawing methods, under running cold water, with kitchen staff • Storage of dessert spoons with handles up reviewed with all wait staff and dishwashers • Reviewed procedures of knife handling with kitchen staff and where the proper placement should be, not put between prep tables • Cutting boards "bleach soaked" overnight, bad boards discarded and 3 new boards ordered • Reviewed with staff labeling of all squeeze bottles and containers up on line • Electrician contacted to replace Light fixture in exhaust hood • Lexan covers ordered to replace the cracked ones • Covering of all product in line freezer reviewed with the kitchen personal • On further inspection 8- #10 cans were discarded and one small can also discarded • Floors in both dry storage and pan storage organized and cleaned • Reviewed use of sanitation logs with kitchen staff for back of house and wait staff for the bus stands • Fan shield in Walk-in freezer removed and cleaned • Soda gun holders and guns them selves soaked over night and cleaned • Spoke with Richards HVAC about ordering the correct gaskets for the Walk-in door and other gaskets that need replacing, he is bring in the catalog so that we can order the correct ones • Soap and towels replenished in ALL dispensers and cleaning company alerted of the problem and need to stay on top of back on the house areas also • Aerator purchased and installed in ladies room employee bathroom • Cleaning behind Charbroiler and fryalators top and bottom done • Ordered 3 new metal filters for exhaust fan area • General review with kitchen staff on constant temping of product up on the line during the day and night shifts. If product is found to be in the "Critical" Zone it must be discarded • Lower container now used to keep the melons down in the ice more at salad bar • Floor re -grouting on the line shall take place while remolding is being done As discussed we will be going through a renovation of the restaurant in the next few months and I shall alert the Board of Health of these changes. Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer Owner, General Manager, Victoria Station /I Emequal- ti lllargeon Pest Control, Ince "Your Personal Pest Control Solution" COMMERCIAL Date _ Timein //""7 Time Out ',:1 r Service Technician-Roufe Number e�(O/ State License# Billing AddressService Name Na //// jpe�ftiCr�Ny.7�-tfS�s Address mr— Address Address r City State Zip City `yyy `�-� �' I "!!" � V State �`. /Wl Zip TelephoneTelephone / � ~'- � / rl 0 Weather Conditions Q Clear ,�; ❑Sunny ,:Q Windy ❑Rainy ❑Snow ❑Estimated Outside Temperature T ' WARRANTY METHOD, OF APPLICATION "' -''TYPE OF SERVICE " - TARGETPESTS ❑ Yes ❑ 30 days ❑ 90 days ❑ ❑ Ne ❑ 60 day❑"taon�thly�� 1:16 months ❑ Weekly _ y ❑ Quarterly New Stan -Up ❑ One Time Charge g I].8esidential ]•Commgrct2., ❑ i '� Rodent ❑Fleas ©-Cockroaches ❑ ❑ Ants ❑ ❑Bees - ❑ Pest Activity:>7 t f C •C' f i''{ C 1•esaa:.� - r=f.-r ywr� W6L'�b,+'r Kitchen: 9 l ' r Dining Areas: r �' ' 7 Bar/ Lounge: i I 6 !f`'a %� f- .P� G'T'�f.'.^v . y}S P ('E' ri=J✓�z�' /..-R-�`Pfi�(/��"' Or.0 h�JL- Storage Areas r', ?5 cG �r"� P -1 V o 4-r/i•s' r �r7Cy;�' "i- ;`t✓('r r'� f-� f% .`f1 �r ..� Basemenh.--- Structural Deficiencies: f qe J — / M Exterior Conditions IN MATERIALS USED EPA# .. - AMOUNT USED ---%---- -- SITE TREATED METHOD, OF APPLICATION .AREA -VOLUME TREATED TARGET PESTS. /20 p�F)f a�3'7 d Ifi S f W-' _� C?< �._Y�11 �/,r /rAaA� ;/)l:,{_ X- Customer Signature ,C,. y ACCOUNTNUMBER INVOICE NUMBER o c)/ S' ? 6 Please Remit Payment To: Baillargeon Pest Control, Inc. • P h Rnx 9314 AMOUNT'DUE.: Methuen, MA 01844-4417 Reorder Product # BAI101 from • CROW NMAX • 1-800-252-4011 Service Charge I SCJ Total Amount Due Q A A•1 Exterminators �/ /'� PLEASE REMIT PAYMENT TO: 183 SHEPARD STREET, LYNN, MA 01902-4597 IN �/ ®ICE P.O. Box 310, Lynn, MA 01903-0310 781-592-2731 1-800-525-4825 FAX 781-592-7641 [j. yj - ,'1 `r CURRENT 30 DAYS 60 DAYS I 90 DAYS Pest and Termite Control. Professionals I UAIL DAY TYPE DATE ' -1, f ` 1 ? f .. i]i`•I CONTROL FOR , COMMENTS =r tF4iI Irk qlt �Vlt�u l COMMERCIAL SANITATION REPORT MOUSE GL BD YES r. Floors— Clean ..................... .._....................................... ❑ ❑ Counter Surfaces — Clean ............................................ ❑ p COMMERCIAL SANITATION REPORT MOUSE GL BD YES NO Floors— Clean ..................... .._....................................... ❑ ❑ Counter Surfaces — Clean ............................................ ❑ p Drain Areas — Clean .... ... ...... ......................................... ❑ ❑ Rest Rooms — Clean .. ............................. :..................... ❑ ❑ Dining Areas — Clean ................ :...................... ..... ..... ❑ ID Employee Areas — Clean ..:.......... ... ............ .................. ❑ ❑ Locker Areas — Clean .................................................... ❑ ❑ Storage Areas — Organized ......... .. .... . .. . .... .... . . ❑ ❑ Comments ACCT N0.., SERVICE CHARGE NUMBER UNITPRICE AMOUNT UVVLLLINU IYHLWAHHANIY YES I NO I_l 1 Family. ❑ 3 Family ❑ 30 Days ❑ 60 Days ❑ 2 Family ❑ 6 Family ❑ 90 Days ❑ 6 Mos. L REASON FOR NO WARRANTY i • Partial service requested .................................. • Poor sanitation ............... .......................... POST APPLICATION REQUIREMENTS • Kitchen/bathroom cabinets not prepared ....... OCCUPIED AREAS MUST BE VACATED FOR HOURS. • Closets/furniture not prepared .......................... THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE o Rodent proofing needed .................................... REOCCUPIED. DO NOT ALLOW AQULTS, CHILDREN, OR PETS ON TREATED SURFACES U,NTIIJDRY. Other CONTRACTING ENTITIES HAVt RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD& AGRICULTURE'S PESTICIDE TIME IP BUREAU CONSUMER SREETS; WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO A,P,PLI,GATIONITWE. THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED. ws s -r -� CUSTOMER�SIGNATU,QEW LIC.# -;TECH: SEE REVERSE SIDE FOR PERTINENT INFORMATION r' •White —Office Copy Canary — ....... I ... I-- .................... ❑ ..................................... ❑ ..................................... ❑ ..................................... 1= ................................... 1. ❑ . '6,-%% r Pink - Remittapf e Copy MOUSE GL BD MULTI -01" TRAP / DATE r�/i/t�'+� PROTECTA PROTECTALP CHECK NO. RTU BAIT STA -_ ❑ MC ❑ VISA ❑ DISCOVER RAT GLUE RD ACCT # EXP DATE SALES TAX C.QD. ❑ CHc ❑ NIG ❑ TOTAL DUE ` TOTAL AMOUNT PD UVVLLLINU IYHLWAHHANIY YES I NO I_l 1 Family. ❑ 3 Family ❑ 30 Days ❑ 60 Days ❑ 2 Family ❑ 6 Family ❑ 90 Days ❑ 6 Mos. L REASON FOR NO WARRANTY i • Partial service requested .................................. • Poor sanitation ............... .......................... POST APPLICATION REQUIREMENTS • Kitchen/bathroom cabinets not prepared ....... OCCUPIED AREAS MUST BE VACATED FOR HOURS. • Closets/furniture not prepared .......................... THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE o Rodent proofing needed .................................... REOCCUPIED. DO NOT ALLOW AQULTS, CHILDREN, OR PETS ON TREATED SURFACES U,NTIIJDRY. Other CONTRACTING ENTITIES HAVt RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD& AGRICULTURE'S PESTICIDE TIME IP BUREAU CONSUMER SREETS; WRITTEN STATEMENTS, POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO A,P,PLI,GATIONITWE. THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED. ws s -r -� CUSTOMER�SIGNATU,QEW LIC.# -;TECH: SEE REVERSE SIDE FOR PERTINENT INFORMATION r' •White —Office Copy Canary — ....... I ... I-- .................... ❑ ..................................... ❑ ..................................... ❑ ..................................... 1= ................................... 1. ❑ . '6,-%% r Pink - Remittapf e Copy -/'I'1 -Exterminators PLEASE REMIT PAYMENT TO: I,NVOIC�E P.O. Boxs310, Lynn MA 01903.0310 �1� 183.SHEPARD.STREET„LYNN, MA01902-0597 ' 781.592-2731 1.800.525.4825- FAX 781-592-7641 # } Post and Termite Control Professionals tt 7040LV - CURRENT 30 DAYS.. I 60 DAYS - 90 DAYS y RT DATE DAY TYPE DATE -COD ACCT:NO:-1v7t); J-8 J?f9: E•3. /InlZl.i '-' 01.12 Mon 109 01 /,:1 /.C49 _.;.. „VICTORIA STATION CONTROL FOR _INTENSIVE CONTROL PR SERVICECHARGE :60.00 P I CKER I NG WHARF' -NUMBER UNITPRICE -AMOUNT SALEM MA 01970 MOUSE GL BD r 37f3--74•.`; .340lTJ 800AIYI -'' MULTI -CT TRAP DATE I 2- ) PROTECTA CHECK NO. 11-75 'PROTECTA LP COMMENTS RTU BAIT STA ❑ Mc ❑ VISA ❑' DISCOVER RAT GLUE BD ICP TARGET MICE/ROACHES KITCHEN ,'BAR/I}R/SALAD EAR/RR/ Accrn STORAGE'/EI_EC CLOSET/OFFICES DROI CEILING i FCC AS NEEDED INSTALL, 4( MULTI CATCH I CH TRAPS /GES/RTLJ & MONITORS IRE -AT' ALL AREAS & EQ0,IP FOR ROACHES T,vs j# IL,� r"u C �Y fS, e) , /.. rz/ Grp �,Tfj�..url.�.I, Is�L �7�p2 Floors Clean - ❑ :❑ ,.- Counter$udaces0-Clean - . ❑ „xr D m ms -_C lean ..... ....... _- ❑ ❑ R oClean .......................... ;............. ❑ ❑ Di eas —Clean ....:................................................ _.,-Other _ .. .. __ '...., n-.... ❑ ❑ Em Areas — Clean .............. ......... :............. ......... ❑ ❑ Loetke`Areas— Clean ......... ... ........... ...... ..... ❑ ❑ `"'.❑ Stor�)Areas— Organized . ............... ❑ POST APPLICATIONiREQUIREMENTS OCCUPIED AREAS MUST BE VACATED FOR HOURS, THOROUGHLY VENTILATE TREATED AREAS BEFORE.THEY.ARE EXP DATE - - - c d',g ❑ CHG D _ SALESPTAX N/C ❑ TOTAL DUE TOTAL AMOUNT PD- S'GO pia DWELLING TYPE WARRANTY YES ❑ NO ❑ 1 Family ❑ 3 Family ❑ 30 Days ❑ 60 Days ❑ 2Family ❑ 6 Family ❑ 90 Days ❑ 6 Mos. ❑ REASON FOR NO WARRANTY yT CEIVED�L MASSACHUSETTS DEPARTMENT OF FOOD.&AGRICULTURE'S PESTICIDE • Partial service requested............................:.......................I............................. ❑ •.Poor sanitation ......... .... ............................ :..................... ..... .:.............. I ... I ... I...... ❑ i'Kitcheri/bathroomCabinets' not prepared .....................................- DAYSP QR �rO APPL TIN • Closets/furniture not prepared.......................................................................... ❑ ; ::•,' Rodent,proofing needed;. ::.....:.......................................................❑ CUSTSMER 3 _.,-Other _ .. .. __ '...., n-.... 1 I I::A I CONTRAATING�ENTITIE AVE yT CEIVED�L MASSACHUSETTS DEPARTMENT OF FOOD.&AGRICULTURE'S PESTICIDE TIME IN -• :l} BUREAU ONSUMER SH TS, ITTEN EMENTS, POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYSP QR �rO APPL TIN IM yTHE OVESERVICE:HAS 'BEEN SATISFACTORILY COMPLETED. IyG�i �., ,ti• CUSTSMER 3 T4JRlf 1 I I::A " n-.,. -,P ;,•:,., 1 1;(0711 '` -)/-- SIGNATURE I; TECH NOS. 33 SEE REVERSE SIDE FOR PERTINE)NTiNFORMATION CAYbC/ White-officeCpp�i%IbRrCopy(�fink -ReminanceCopy _I PTS GORE STORAGE :3-93 492 NEED TO PASS DISHWASHER AREA PREP AREA'S LINE EQUIPMENTICOOK LINE MISC KITCHEN ITEMS LINE CHECK UNIT # DATE GENERAL MANAGER _ _.: TOTAL STORAGE 9-4-'°1. .-. DRYSTORAGE ALL FLOORS CLEAN AND IN GOOD REPAIR PTS SCORE 2 SHELVING CLEAN AND PAINTED 3 $ WALLS CLEAN AND IN GOOD REPAIR 2 OPEN BULK PRODUCTS IN CLEAN CONTAINERS LABELED WITH OPEN DATE 3 $ ALL LIGHTS WORKING WITH PROTECTIVE COVERS PRESENT 3 $ ALL PRODUCT AT LEAST 6" OFF THE GROUND 2 $ ALL PRODUCT FACED, PULLED FORWARD, ORGANIZED, DATED AND ROTATED 5 WALK-IN COOLER DOOR CLEAN AND IN GOOD REPAIR (INCLUDING GASKET) 3 FLOORS CLEAN, DRY AND IN GOOD REPAIR 3 WALLS AND CEILING CLEAN AND IN GOOD REPAIR 3 $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 4 EVAPORATOR FAN COVERS AND COILS CLEAN 2 $ INTERNAL THERMOMETER PRESENT, TEMPETURE AT 40 DEGREES OR LOWER 5 ALL LIGHT WEIGHT PRODUCT STORED ON UPPER SHELVES 3 ALL PRODUCT AT LEAST 6" OFF THE GROUND 3 $ BEEF OVER SEAFOOD; SEAFOOD OVER POULTRY (RAW), COOKED OVER RAW 5 ALL PRODUCTS FACED, PULLED FORWARD, ORGANIZED, DATED AND ROTATED 5 ALL SHELVING CLEAN AND IN GOOD REPAIR 3 FREEZER ALL PRODUCTS ROTATED NO AIR EXPOSED PRODUCTSISIGNS OF FREEZER BURN 1 ALL LIGHTWEIGHT PRODUCT STORED ON UPPER SHELVES 1 $ LOCKED WHEN NOT IN USE 5 DOOR CLEAN AND IN GOOD REPAIR (INCLUDING GASKET) 2 CLEAN FLOORS, NO ICE BUILD UP 2 INTERNAL THERMOMETER PRESENT, TEMPERATURE AT 0-10 DEGREES 5 WALLS AND CEILING CLEAN AND IN GOOD REPAIR 3 $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 5 EVAPORATOR FAN COVERS AND COILS CLEAN 2 $ ALL OPENED PRODUCT LABELED AND DATED 5 ALL RACKS CLEAN AND IN GOOD REPAIR 2 _ _.: TOTAL STORAGE 9-4-'°1. .-. U I AL. UISKVVAJFItK AKCAI ; 4.1 I d.m PREP AREA'S AND EMPLOYEE BATHROOMS PTS SCORE COMMENTS DISHWASHER AREA MACHINE CLEAN INSIDE AND OUT 5 $ PROPER CHEMICALS BEING USED, DISH MACHINE AND POT SINK 4 POTSINKS CLEAN AND IN GOOD REPAIR 2 PLATE STORAGE RACK CLEAN AND IN GOOD REPAIR 2 $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 4 $ FLOOR MATS CLEAN AND IN GOOD REPAIR 3 FLOORS CLEAN, DRY AND IN GOOD REPAIR 3 WALLS AND CEILING CLEAN AND IN GOOD REPAIR 2 PRE-SOAKING IN USE 2 CLEAN MOP HEAD AND BUCKET, BROOM, AND SWEEPER HOKEY READILY AVAILABLE FOR CLEAN UP AND USED 4 U I AL. UISKVVAJFItK AKCAI ; 4.1 I d.m PREP AREA'S AND EMPLOYEE BATHROOMS PTS SCORE COMMENTS ITEMS TO RF INCI I IDFD IN THE FIRST AID KIT $ BATHROOMS 1 $ ALL SUPPLIES STOCKED IN EMPLOYEE BATHROOMS 4 $ ALL FIXTURES WORKING PROPERLY AND CLEAN 5 $ DOORS CLEAN AND IN GOOD REPAIR IN BATHROOMS 2 $ ALL BATHROOMS LABELED AND NO SMOKING SIGNS IN PLACE 2 $ FLOORS, WALLS, AND CEILING CLEAN AND IN GOOD REPAIR IN BATHROOMS PREP AREA 4 $ SOAK TANK FULL, CLEAN AND IN GOOD REPAIR, AND COVERED 2 $ STAINLESS TABLE CLEAN AND IN GOOD REPAIR 2 $ ICE MACHINE'S: OUTSIDE CLEAN AND IN GOOD REPAIR, DOOR CLEAN, AND NO EVIDENCE OF LIME BUILD UP INSIDE 4 $ ICE SCOOP EVIDENT FOR ICE ONLY 1 $ ICE BUCKET EVIDENT FOR ICE ONLY 1 $ KNIFE RACK CLEAN AND IN GOOD REPAIR, INCLUDING KNIVES 3 $ SLICER CLEAN AND IN GOOD REPAIR 4 $ JACARD CLEAN AND IN GOOD REPAIR 1 FOOD PROCESSOR CLEAN AND IN GOOD REPAIR 1 FLOORS, WALLS, AND CEILING CLEAN AND IN GOOD REPAIR 3 $ LIGHTING TO SPECIFICATION (100 WATTS OR COOL WHITE FLORESANTS) 3 CUTTING BOARDS CLEAN, GOOD REPAIR, AND NOT STAINED SALAD PREP AREA ALL SINKS CLEAN AND IN GOOD REPAIR 3 2 $ HOT WATER IS WORKING 3 HOBART UNIT CLEAN AND IN GOOD REPAIR 4 STAND UP REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 ALL SHELVING CLEAN, AND FAN COVER CLEAN 3 ALL PRODUCT LABELED AND DATED 4 DESSERT REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 ALL SHELVING CLEAN, AND FAN COVER CLEAN 3 ALL PRODUCT LABELED AND DATED 4 ICE CREAM REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 $ NO FREEZER BURN ON PRODUCT 5 ICE CREAM DIP SINK WORKING, CLEAN AND IN GOOD REPAIR FIRST AID KIT 2 ITEMS TO RF INCI I IDFD IN THE FIRST AID KIT $ BAND-AIDS 1 $ ACE BANDAGE 1 $ BURN CREAM 1 $ BURN SPRAY 1 $ KNUCKLE BAND-AIDS 1 $ EYE SPRAY 1 $ EYE CUP 1 $ GAUZE BANDAGES 1 $ BLOOD CLOTTER 1 $ ANTISEPTIC SWABS 1 $ ANTISEPTIC SPRAY 1 $ STERILE PADS (3X3) 1 $ COLD COMPRESS 1 $ HYDROGEN PEROXIDE 1 MOP SINK WALLS CLEAN AND IN GOOD REPAIR 2 ALL EQUIPMENT HANGING 1 MOP BUCKET CLEAN AND IN GOOD REPAIR 2 HOT AND COLD WATER WORK 4 ALL CHEMICALS LABELED, FULL AND HOSE IN SINK 3 A TOTAL PREP AREA'5[ `1 3" I MAIN COOK LINE PAGE 1 SUB -TOTAL COOK LINE 757 POTATO DRAWERS OVENS PTS SCORE DOORS CLEAN AND IN GOOD REPAIR 3 RACKS CLEAN AND IN GOOD REPAIR 2 OUTSIDE OF UNIT CLEAN, NO DUST ON BACK OF UNIT 2 $ INTERNAL THERMOMETER PRESENT 5 $ OVEN GLOVES PRESENT AND IN GOOD REPAIR 5 LEGS AND CASTER CLEAN AND IN GOOD REPAIR 2 ALL DIALS PRESENT AND IN GOOD REPAIR 2 FRYERS ALL FRYERS CLEAN AND IN GOOD REPAIR 3 $ FRY FILTER MACHINE CLEAN AND IN GOOD REPAIR 5 $ FRY FILTERS PRESENT AND EVIDENCE OF USE 5 INSIDE UNIT CLEAN AND IN GOOD REPAIR 3 VENT AND SHIELD PRESENT, CLEAN AND IN GOOD REPAIR 3 $ CALIBRATED CORRECTLY 3 $ GRILL THERMOMETER PRESENT IN RESTAURANT 5 ALL GRATE CLEAN AND IN GOOD REPAIR 3 ALL RADIENTS CLEAN AND IN GOOD REPAIR 2 ALL KNOBS PRESENT 2 ALL SPLASHGUARDS PRESENT, CLEAN, AND IN GOOD REPAIR 2 UNDER TRAY CLEAN AND IN GOOD REPAIR 2 SLOW COOKERS OUTSIDE OF UNITS CLEAN, INCLUDING FAN GUARDS 3 GASKETS CLEAN AND IN GOOD REPAIR 3 DOORS CLEAN AND IN GOOD REPAIR 3 DRIP TRAY PRESENT, CLEAN AND IN GOOD REPAIR 3 ALL DIALS ARE PRESENT 3 $ ALL DIALS ARE SET TO PROPER READINGS 5 $ PRIME RIB COOKING CHART IS PRESENT 5 $ THERMOMETER PRESENT 5 LOW BOY UNDER DRAWERS CLEAN AND IN GOOD REPAIR 3 GASKETS CLEAN AND IN GOOD REPAIR 3 INSIDE UNIT CLEAN AND FREE OF DEBRIS 2 ALL RAILINGS CLEAN AND WORK PROPERLY 2 $ THERMOMETER PRESENT 5 SIX DRAWER UNIT DRAWERS CLEAN AND IN GOOD REPAIR 3 GASKETS CLEAN AND IN GOOD REPAIR 3 INSIDE UNIT CLEAN AND FREE OF DEBRIS, WITH NO ODOR 3 $ THERMOMETERS PRESENT ON EACH SIDE 5 CONDIMENT WELL CLEAN AND FREE OF DEBRIS 2 PLATE WELL CLEAN AND FREE OF DEBRIS 3 ALL RAILINGS CLEAN AND WORK PROPERLY 2 APPETIZER •' DOORS CLEAN AND IN GOOD REPAIR 3 GASKETS CLEAN AND IN GOOD REPAIR 3 SHELVING CLEAN AND IN GOOD REPAIR 3 $ THERMOMETERS PRESENT ON EACH SIDE 5 CARVING • CARVING BOARD CLEAN AND IN GOOD REPAIR 2 KNIFE RACK AND KNIVES CLEAN AND IN GOOD REPAIR 2 $ SANITIZER BUCKET PRESENT AND IN USE 5 ALL DRAINS WORK PROPERLY AND FREE OF DEBRIS 2 $ HOT SIDE IS HOT AND COLD SIDE IS COLD 5 UNDERNEATH STATION IS CLEAN AND IN GOOD REPAIR 2 WINDOW AREA CLEAN AND FREE OF DEBRIS 2 PAGE 1 SUB -TOTAL COOK LINE 757 POTATO DRAWERS . � 1V If1L.1�11VVLLLf\I� VV Iv i,�a..r •v. OLEAN AND IN GOOD REPAIR 3 RAILING ARE CLEAN AND FREE OF DEBRIS 2 HOLD TEMPRATURE AT 125 DEGREES 4 ALL KNOBS ARE PRESENT 2 POT SINK BOTH SINKS CLEAN AND IN GOOD REPAIR 4 $ IHOT WATER IS HOT AND COLD WATER IS COLD 5 ALL PLUMBING WORKING AND IN GOOD REPAIR 1 3 LOW BOY FREEZER DOORS CLEAN AND IN GOOD REPAIR 2 GASKETS CLEAN AND IN GOOD REPAIR 2 INSIDE UNIT CLEAN AND IN GOOD REPAIR 4 $ THERMOMETERS PRESENT IN UNIT 5 NO EVIDENCE OF FREEZER BURN 3 TOP OF UNIT CLEAN 2 ALL RAILS CLEAN AND FREE OF DEBRIS 2 . `.. ,TOTAL COOK'LINE =i $ MISCELLANEOUS ALL LIGHTING ON LINE TO SPECIFICATION AND COVERED 5 STAINLESS STEEL WALL CLEAN AND FREE OF GREASE 4 ALL CONDIMENT SHELVING CLEAN AND ORGANIZED 2 HEAT LAMPS HAVE PROPER BULBS 2 HEAT LAMP SHELF CLEAN AND FREE OF UN-USED EQUIPMENT 2 FLOOR MATS ARE CLEAN AND IN GOOD REPAIR 4 BUTCHER PAPER IS PRESENT UNDER MATS 2 FLOORS CLEAN AND IN GOOD REPAIR 3 $ JKNIFE RACK AND KNIVES CLEAN AND IN GOOD REPAIR 4 DESSERT WINDOW CLEAN AND IN GOOD REPAIR 2 HOT FUDGE MACHINE CLEAN AND IN GOOD REPAIR 2 HOBART MIXER CLEAN AND IN GOOD REPAIR 3 $ AT LEAST ONE MANAGER IF FOOD CERTIFIED 5 BACK DOOR IS CLEAN AND IN GOOD REPAIR 3 $ BACK DOOR ALARM WORKING AND LOCKED 5 ALL EXIT SIGNS IN KITCHEN WORKING AND IN GOOD REPAIR 4 HAND SINK IS STOCKED WITH PAPER, SOAP AND SANITIZE 4 ALL ELECTRICAL OUTLETS HAVE PROPER SHIELDS 2 FLOOR ON LINE CLEAN UNDER EQUIPMENT AND IN GENERAL 5 MICROWAVE CLEAN AND IN GOOD REPAIR 3 SHELVING CLEAN AND NEAT 3 PRINTER CLEAN AND ON A WOOD BOARD 2 PASS THRU LINE UPPERSHELF CLEAN AND NOT CLUTTERED 3 BEER BOTTLE EMPTIES AREA CLEAN AND ORGANIZED 4 $ BACK DOOR LOCKED AND IN GOOD REPAIR 5 WATER FILTERS CLEAN AND DATED 4 DUMPSTER AREA CLEAN AND ORGANIZED 4 DELIVERY DOCK CLEAN AND ORGANIZED 4 FLOORS IN BACK HALLWAY CLEAN AND IN GOOD REPAIR 3 BRL GREASE FROM EXHAUST CLEAN AND SECURED PROPERLY 4 ".r�rwl uI^^n l I AuCA110 VMUCM 17C1111C 1".4A) I . � 1V If1L.1�11VVLLLf\I� VV Iv i,�a..r •v. Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvoe of Ooeration(s) Tyne of Inspection Food Service n Retail ' Routine El Re -inspection VicL4 n l t i AddressRisk Level ❑ Residential Kitchen E]Mobile Previous Inspection Date: . Telephone�� Temporary [ITem ora ❑Pre-operation j Owner HACCP YM ❑ Caterer [:]Suspect Illness � / ❑ Bed & Breakfast ❑ General Complaint Person in Chaige (PIC) ' ' vt Time 1" In: Out: �! Permit No. El HACCP El Inspector ,- Each violation checked irequilres 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 ?i;;.;�;,.,� ❑ 1. PIC Assigned / Knowledgeable / Duties c EMPLOYEE HEALTH .'=,m_ --b.... .i., ...,:,.;a. i�sa.at•.S �i G:........a.' .ria ....:a ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOODFROMAPPR OVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 12. Prevention of Contamination from Hands �(N�13. Handwash Facilities e p PROTECTION FROMCHEMICALS i l_i 7 10 ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals f TIMErrEMPERATURE CONTROLS (PoteinlaflY Hazardous Foods) `7; �❑ 16. Cooking Temperatures ❑ 17. Reheating E] 7. 18. Cooling 7. Conformance with Approved Procedures/HACCP Plans F PROTECTION FROM CONTAMINATION" " _ z , 9• Hot and Cold Holding ❑ m8. Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 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) X26. Water, Plumbing and Waste (FC -5)(590.006) Physical Facility (FC -0)(590.007) s 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other REQUIREMENTS FOR HIGHLY SUS CEPTIaLE PQPULATIQNS (HSP}? ❑ 21. Food and Food Preparation for HSP i CONSUMER ADVISOIFIV [122. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): IZI 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: Z -:D (a jj5 Inspector's Signature: i l _ Print: \ ��� PIC's Signature \/ /� ' Print: t/ "CI -}1 't'�iy L- _ Page -L ol< Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT '1 590.003(A) AssipimmentofResponsibility* 590.003(B) Demonstration of Knowled e^` 2-103.1 ]. Person in charge -duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 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 A roved S .tem* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in CharE* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003{E) Removal of Exclusions and Restrictions im ra- 6 • :: • „ = • • :T•Fl�i�rlllcT•1 * Denotts critical item in the federal 1999 Fail Code or 105 CMIi 590.000. PROTECTION FROM CONTAMINATION F8- Food and Water From Regulated Sources 590.004('A -B) Compliance with Food Law* 3-201.1.2 Ford 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* 5-1.01..1.1 Drinking Water from an A roved S .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 Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatoryf2gulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition _ 3-202.11 PRFs Received at Proper Temperatures* 3-202.15 Package Integrity, 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records; Fish Products 3-402.11 Parasite Destruction* 3-402.1.2 1 Records, Creation and Retention* 590.004(7) Labeling of Ingredients` Frequency of, Sanitization of Utensils and Foal Contact Surfaces of E ui ment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with A. roved Procedures* * Denotts critical item in the federal 1999 Fail Code or 105 CMIi 590.000. PROTECTION FROM CONTAMINATION F8- Cross -contamination 3-302.11 (A)(]) Raw Animal Foods Separated from Coked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foals Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-30215 Washing Fruits and Vegetables 3-3(4.11. Foci Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and ReserviceofFood* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* y Food Contact Surfaces 4-501.111 Manual Warewashins - Hot Water Sanitization Ten eratures* 4-501.112 Mechanical Warewashin;-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 Foal Contact Surfaces of E ui ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.1 t Clean Condition - Hands and Awns* 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 Preventing Contamination When Tasting" 12 Prevention of Contamination from Hands 590.004(F;) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* 5-204.11 Lavation and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashi ng Cleanser, Availability 6-301.1.2 Hand Drying Provision I Establishment CITY OF SALEM BOARD OF HEALTH o � // on_l_Date: Paged of r: item Code No. Reference C - Critical Hem R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - ". RINT CLEARLY "' 'PLEASE " Date verified f L _ _AQAJ, n n iCoT 1.7/ . / Sift. *Jc rota v. _� pp f _� �. II f Sure P✓ A4Xi f+� rn, �v f 1 -i IIre,e ha1u, l fr�a- 1 V './ 1 e\hivwb,)-)j — /ecc' Ai_',54 d AWA -kl -' 7, X>1 -soa�oaCL_(2 GvY1 ,t _ Cdf� 01V o lon r= 64 /) -Q-W . ft"Lt ill='s L,u (4- ( 'ice cc✓! --/h k-A—Z u\ffhc /ice r yl� t' '1Q-� •`(./"ter! 1/� �..M./ Discussion With Person in Charge: I have read this report, have had the opportunity_ to ask questions an agree to correct all ,,� .., violations before the next inspection, to observe all conditions as described, and t0 comply with all mandates of the Mass/Federal Food Code. rpder e nd that noncompliance may result in daily fines. of twenty-five ollars or su ension/revocation of your food permit. Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension_ ,{ ❑ Embargo ❑ Emergency Closure C ❑ Voluntary Disposal 0 Other: Violations Related to Foodborne fitness interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 -Food 15 FM - 17 TIME/TEMPERATURE CONTROLS or Color Additives 3-202.12 Additives* I, 3-302.14 Protection from tJna> roved Additivcs* 3-501.16(A) Poisonous or Toxic Substances'. 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Natne - Working Containers* 7-201.11 Separation - Sint age* 7-202.11 Restriction -Presence and Use% 7-202.12 Conditions of Use, 7-203.1.1 Toxic Containers - Prohibitions* 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria'4 - 7-204.14 Dain ants, Criteria* 7-205. f 7 Incidental Food Contact. Lubricants* 7206.11. 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 ure Irdend 1999 Food Code or 105 CNIR 590900. 3-501..14(0) 3-501.15 Proper Cooking Temperatures for 19 PHFs 3-401.1.1A(1)(2) Eggs- 155°F 15 Sec. 3-501.16(A) E =as- Immediate Service 145°F t 5sec* 3-401.11(A)(2) Comminuted Fish, Meats r& Game 21) Animals - 155°F 15 sec. 3-401.1 I (B)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.i1(A)(2) Rarities, lnjectcdMcafs-155°F '15 FG 5 sec. r _ 3-401.11(A)(3) Poultry, Wild Game, Stuffed P1TB$, _ FC -'6 Stalling Containing Fish, Meat, 28. Poultr =or Ratites-l65`F 15 see. "= 3401.11 Whole -muscle, Intact Beef Steaks 29, 145`17'' 3401.12 Raw' Animal Foods Cooked in a 30. Microwave 165"F * 3401.11(A)(1)(b) All Other PHFs- 1,45°F 15 sec. Reheating for Hot Holding 3-403.11 (A)&(I)) mr,e 165°F 15 sec. * 3-4403.11(B) Microwave- 165° F 2 Minute Stand ina Time" 3-403.11(C) Commercially Processed RTE Food - 140°F% 3-403A 1(E) Remaining Unslieed Portions of Beef Roasts* Proper Cooling of PHFs 3-501J14(A) Cooling Cooked PHFs from 140°F to 70'17 Within 2 Hours and From 70°F to 41°F(45°F Within 4 Hours_ * 3-50L'14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41' F/45°F Within 4 Hours* : Denotes critical item in ure Irdend 1999 Food Code or 105 CNIR 590900. 3-501..14(0) 3-501.15 PHFs Received rt Temperatures Au ordi n , to Z aw Cooled to 4VT/45F Within 4 Hours. " Cooling Methods for PHFs 19 PHP Hot and Cold Holding 3-501.16fB) 590.004(F) Cold PHFs Maintained at or below 41°145°F* 3-501.16(A) Hot' PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130°F. 21) Time as a Public Health Control 3-501.19 Time as a Pubic Heal h Control* 590.0041H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 21 3-St)i.II(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* _3-801..11(6) tise of Pastemized Eggs* 3-801.11(D) Raw or Pmtially Cooked Aminal Food and Rew Seed Sprouts Not Served. 'r 3-801. l 1(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of Manu ement and Personnel FC - 2 Animal Foeds that are Raw. Undercooked or 24. Food and Food Protection Not Otherwise Processed to Eliminate .064 Pathogens." FC -4 3-302.13 Pnsteurized Eggs Substitute for flaw Shell Water, Plumbitat and Waste FG 5 E^ s* Jt'r'-IAL Kt:VUitfCMCIV 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. (Items 23-30) Critical and non-critical vio4gions, which do not relare to the ,foodborne illness inrervenliom and iiskfactors listed above, can be. ,found in the fallowing sections o{the Food Code and 105 CbtR 590.000. Item Good Retail Practices FC 590.000 23. Manu ement and Personnel FC - 2 .003 24. Food and Food Protection FC- 3 .064 E�grp niand Utensils FC -4 .005 26. Water, Plumbitat and Waste FG 5 .006 27. -_-Ph sica; Facility _ _ FC -'6 .007 --- 28. Poisonous or Toxic Mated as _ FC -7 .008 29, S eaiai Re uirements I .009 30. _ Other _... i C C -V. CITY OF SALEM � BOARD OF HEALTH ` Establishment Name: V r G i.7f i � ci 1( J-,cCd14:� Date:1/1 -5 /0' Page: of Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No.–Reference R – Red Item 11 ._. PLEASE PRINT CLEARLY Verified IV 1 i r L) ► . o. t /t co 2 r � J `.1C11, — t1 4 0� G � n f, Q I r 1 i , T r' /J Y Qit t St le I -2" S o -� Co t.,o �i r� �% G —^ V i� ( ` r ��_ 0Acl r Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the pportuni`y to ask questions and agree to correct all Ll Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all o � Itions as described, and to P q the Mass/Federal/Food Oo�e. I understand that Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of noncompliance may result in daily\fine`s,of-twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. W / ❑ Voluntary Disposal ❑ Other: J Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 16 17 18 * llenotes critical item in the fMeral 1999 Fooil Code or 105 CMR 590A00. 3-501,14(C) Food or Color Additives 3-20112 Additives 3-302.14 Protection front 'l'htat coved Additives* k3-501.15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers` 7-102,11 Common Name -Working C rsitarners* 7-201.17 Scarauon - Stora es` 7-20211 Restriction - Presence and Use'* 7-202.12 Conditions Of Use' - 7-2011.1 Toxic Containers -Prohibitions* 7-204.11. Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washing. Produce, Criteria* 7-204.14 Dr'ht * . ants. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.1 1. Restricted Uee Pesticides, Criteria's 7-206.12 Rodent Hart Stations"' 7-206.13 Tracking Powders, Pest Control and Monitoring* * llenotes critical item in the fMeral 1999 Fooil Code or 105 CMR 590A00. 3-501,14(C) Proper Cooking Temperatures for _ PHFs_ 3-401.11A(l)(2) Eggs- 155'F 1.5 Sec. k3-501.15 E=es-hnmediareService 145`FiSsec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(B) Animals - 155'F 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 -155°F 15 26__ sec. * 3-401.11(An3) Poultry, Wild Game, Stuffed PHFs, 20 Stuffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165'F 15 sec. 3401-1 i(C)(3) Wtrole-mrscla, Intact Beef Steaks FC -7 145`P * 3-401.12 Raw Animal Foods Cooked in a Microwave. 165`F 3-401_ i l (A)O(b) All Other PHFs-145'F 15 see. --_ Reheating for Hot Holding 3-403.11(A)&(D) PffFs 165'F 15 sec. 3-403.11(B) Microwave- 165' F 2 Minute St.andine TimC* 3-403.11(C) Commercially Processed RTE Fond - 140°F* 3-40311(E) Remaining Unsliced Portions of Beef Roasts" Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 1,40'F to 70`F Withht 2 Hottrs and From 70"F to 41'F(45'F Within 4 Homs. 3-501.14(B) Cooling PHFs Made Front Ambient - Ternperature Ltgredients to 41'F/45'F Within 4 Hours* * llenotes critical item in the fMeral 1999 Fooil Code or 105 CMR 590A00. 3-501,14(C) PI-IFs Received at Temperatures _ According toLaw Cooled to 3-801.11(D) 4FF145°F Within 4 Hours. k3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) Cold PFIFs Maintained at of below 590.004(F) 41°145`F* 3-50'1.16(A) Hot PHFs Maintained at or above 26__ 140'F. 3-501.16(A) Roa.gs Held at or above 130°F. 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590 00 49(H) Variance Requirement 21 3-80LII(A) UnpastewizedPre-packaged Juices and Bevemaes with Warmine Iabel s* 3-501.11(B) Use of Pasteurized E 7 ,,s' 3-801.11(D) Raw or Pattialiv Cooked Animal Foal and Raw Seed Sprouts Not Served. 'x 3-801.11(C) Uno etted Food Package Not Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000___ 23. Animal Foods That are Raw. Undercooked m FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC- 3 Pathogens.* 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26__ Eggs -- 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 tisk 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 file ,foodborne illness interventions and risk factors listed above, can be ,found in the following sections of the Food Code and 10.5 CMC{ 590 000. Item GoodRetail Practices FC 590.000___ 23. en Ma_ement 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. Phsical Facility_----_. FC -6 .007 28. ____ Poisonous or Toxic Materials FC -7 .008 29. S ectal Requirements '�, .009 .30. _ Other - --_ 11110o- b,A' I d,, IMP CITY OF SALEM �/ BOARD OF HEALTH ' Establishment Name: � r l iP f� riyt ICS ✓r Date: O Page: of ,Rem Code C Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Zr r' 'W" ' Date Verified No �.�'.b� Reference R — Red Item w ti ,a.. r .,zrx.. g�: a� ;�,: >:..,rr m a ,'��. 8 .wd ire. 4+''/f �� �"i; 6�YfiZ <PLE'ASE PRINT CLEARLY ,adypz+ a...a o t f, �.cs. oR2 ,. .nti. Ic�.� CII n !� L 1, /ate / J J JL111 a Ir 1 f -)eu l , . �! L� i// Won J _ ��� o a� acv 4-- w, r ElA o J to LA 0 , -)J -'�'� n �. Z ` r A I I i� ,-a- l j,,b 4 1, 1 . r � C -t V C/ (YIgJ t In Cc17 7'LuP-L 9 �3 J% n �- f-6 r /S AA cJ/1 L Q I D'/'�p r 04!p I 1 1 J L /-_1 , n t,)Q1).1 "Discussion With Person in Charge: Corrective Action Required: ❑ No �`, ❑ `Yes I have read this report, have had the opportunity tt ask question§ 'and agree to correct all ❑ Voluntary Compliance U Employee Restriction / Exclusion described, and to violations before the next inspection, to observe all conditi ns as � Food Code.�llunderstand that inspection Scheduled U Emergency Suspension comply with all mandates of the Mass/Federal noncompliance may result in daily fines<f twe ty---five doll rs or uspension/revocation of l a Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal 0 Other: Violations Related to Foodborne fitness lnterventtons and Risk Factors ((tions 1-22) (Cont) 14 1 ( Food or IS �' Po#sonous or Toxic Substances �'-103.tf i 3clentit}tng tnfb,enut�on ..-()t't ina� 7.102-1_€C_ovenon Naas 1V+.rLRa g f :ructi �? 20€.'11 S s urn -Storm 3 7-20117 I Restriction - Prc "."ce and Lae* Eo 7-203.11 ToxaG Containnt— ProlnhttionS* r.304.11 sattnerers, Criteria t.hnoic is __ TTOLINA)(2) collu inuted 1 Sil Meats h Uaane '7-204. 12 Chomc etc for 1 rs� Vr<xince (ntceias' 204.14 ti3'{i74 A Cn .(merit' r 565. ) 1 ineide'-wal FsNXt Contact. Lib cart ` 7-206.12Rrxlent Britt st�tuoms _ 7-205.73 l Tricking Powders, Pest Control and K I JJ Ai l l(2} 1.555 r 15 S e. kms lrrsu<drat. 5e,rviea 145,F) 5sc __ TTOLINA)(2) collu inuted 1 Sil Meats h Uaane __ 's IIIA Anisnais - 155T l5 sec. - -40111(B t Ij(2)F'erri; and Beef Ratst - I_r6°F 121 in =401.11(A)t2) FKauas laieved Scats 155 F 75 st ' _ -3—Z 1€(A),4? _ Poeitr FVilihante.'Autrel1; Fa j Stuffing Conlonant. €'iso bleat 7 Pon h ).or Ran es I 65'F 15 sec " T40171 (C),3i Whole-tnuscle, hitactBe f Steaks 45 € s' TO ___. R ew 3tc9r�u( Fckxis (;txikrd an nm Microwave !WF * __ 3-40111{A)(1)(b) { All Other PHls-145`€ 15ste-x 3-4011 €(A)&(J)) PHI-, 165'F 15 eu >403.11(B) Mictowive 165 F2WnantStand*,, 403.11(`') t anunercratl} Puarsset# R I i-, VLM - 140 L i- 40 F" _ 3-4{)3-It{G) j Remat tirtgl LnsicedPomonsctCBaee 3-501,14A) CtxlingCooked PHFsfront l WI --to 0"'F 4YSihin 2 }fours aux€ Froin 7WT __ 's todl'i7-15`F'S4itldn=lHvtus.s -50i. Will Cooling PHFsiftxia Hour Ambient ITemperature ing,,Miients to 411445`F Within_4 (loins.'' ' Denotes critical r ctt .a thr to Seri CN Poa3 £'vi;c or l ii5 C:M118 5Ri3 fX30- 5fs7.ia(C, S PSiFsReceived art ;efnNratrrres According to Law Cooiod to a 1 41 °Pf45`F Within 4 Howl- x 51;1.15 Cox+liir. hofor PHFs PHF Not and Gold Molding s-501 „bili} Cold FHFe Maintained at or li tka 590,d(W5) _ 4€`45°F- -3-56'171 0-'(—A',, '3-5p11la(Ai 1 iPHFsMaintained atorabove 140'F. * 3-501.t6.A) [toasts Held at or above 130'F. * Trrrre as a Pub€lc Health Control Vaiianco REQUIREMENTS FOR HIGHLY SUSCEPTIBLE _ _ POPULATIONS {HSS if -T SQ2.11fAj ttnpaste nzxiPrey>xckagcdiuicaswrd 3-801.1 E ffr) k Raw or Partiatla Ct�)k d Aviard Food and _ Raw Sc(d S7rant4 hetServcn 3 8(, . €1(Ct 1 Gr, tocnecl Foixi Pau:au Nia ice -se cd, CONSUMER ADVISORY_ 22_ 3 6W, I I Cot»oirex Arfoisory Punted for coasomption , !, vaien al F,KxP That are Ren. Under ewked in Ij tion Othemr iso Po,,res, d it) Vhtntnaw 3-102.13 1 € tae ri2ud Fqg. Substitute foi Raw Shen SPEC€ALREQU€REMENTS 590,009(A)-07 VinlauotlsofSectior550d009(A)-(D)in 1 entering. mobile. tool, temporary and resident at kitchen operations should he debited under the appropriate sections above if rotated to foodborne illness inlet vel tions and risk factors. Other 5Q0.009 violations relating to good retail j practices should he debited under #29 - Special Rerluirenidnts. vroa,ArlonrS Arr*,zrEo TO Boors REraac PR,acrrcEs (Items 23.2(1) C�iwrland nnnrnlircu ti tJbns,whichdowcretatctnthe "foodborne rein r< into v<ntions Bind riA jactors Z,sud above. (an be . 1'Uirn<f in the frtLnurng sertt its o7 rhe Food Code and 105 Oillf SSni,",d (-M- Establishment Name: Item Code C - Critical Iten No. Reference R - Red Item e H i -' Discussion With Person in Charge: I have read this report, have had the violations before the next inspection, comply with all mandates of the Mas noncompliance may result in dail fir your food permit. CITY OF SALEM �5_VOARD OF HEALTH jc j Date: / Page: S of DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date - Verified I 1 , G ( ca/. Corrective Action Required: ❑ No ❑ s ty to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / e all conditions as described, and to Exclusion Re -inspection Scheduled ❑ Emergency Suspension Fopd/`ode. I understand that aty-fi��or suspension/revocation of ❑ Embargo ❑ Emergency Closure _r j I ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 -.___ Food or Color Additives 3-202.12 Additives' 3-302.14 _ Protection from Unapproved Additives* 19 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers' 7-1.02.11 Comtrton Name - Working Containers* 7-201.11 Separation - Storage* 7-202.11 Restriction -Presence and Use* 7-20212 Conditions of Use, . 7-203.1.1 Toxic Containers -Prohibitions' 7-204.11 Smtitizer's, Criteria -Chemicals* 7-2(,1.12 Chemicals for Washing 11 educe, Criteria'' 7-204.14 Dritt A eats. Criteria" 7-205.11 Incidental Food Contact- Lubricturs* 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stationer` 7-206.'13 'tracking Powders, Pest Control and Monitoring* *' I3enotas critical item in the (1alcsml 7999 Fooel Code or 105 CNilt 5l(1D00. r� Proper Cooking Temperatures for PHFs Received at Temperatures According to Law Cooled to 41'F/4.5'F Within 4 Hours.'` PHFs 3-401.11A(1)(2) Eggs- 155'17 1.5 Sec. 19 EygS-htmtediate Service 145°F15sec* 3-401.1l(A)(2) Comminuted Fish, Meafs&Oame 3-501.16(B) 590.004(F) Animals - 155°F 15 sea 3-401.11(13)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.11(A)W Ratites, Injected Meats - 155°F 1.5 3-501.1.6(A) see. 3-401,11(A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control Stuffing Containing Fish, Meat, 3-50L,19 Poultry or `Ratites -165'F 15 sec. 3-401.1 ((,C)(3) Whole -muscle, Intact Beef Steaks Variance Requirement 145°F 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3401.11(A)(1)(b) All Other PHFs - 1.45°F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec. * ' 3-403.11(8) Microwave- 165° F 2 Minute Standing Tune* 3-403.11(C) g Commercially Processed RTE Food - 140°F" 3-40111(E) Remaining UnslicedPortions,ofBeef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Coked PHFs from 140`F to 70°F Within 2 Hours and From 70'F to 41'F/45°F Within 4 Hours. * 3-501.14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45'F Within 4 Ilours* *' I3enotas critical item in the (1alcsml 7999 Fooel Code or 105 CNilt 5l(1D00. r� REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.14(Q PHFs Received at Temperatures According to Law Cooled to 41'F/4.5'F Within 4 Hours.'` 23. 3-501.15 Cooling Methods for PRFs 19 3-801J 1(D) PHF Hot and Cold Holding 25 26. 3-501.16(B) 590.004(F) Gold PHFs Maintained at or below 41145° F- 27. 3 -501.16(A) Hot PHFs Maintained at or above 140'R * 28. 3-501.1.6(A) Roasts Held at or above 130'F. 20 S ecial R uirements Time as a Public Health Control 30. 3-50L,19 Time as a Public Health Control* 59ZW04(H) Variance Requirement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages rv9dt Warning,t.abels* 23. 3-801.11(13) Use of Pasteurized 24. 3-801J 1(D) Raw or Partially Cooked Animal Food and Raw Seed S monis Not Served. 25 26. 3-801,11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consutner Advisory Posted for Consumption of 23. Manaoament and Personnel FC - 2 Animal Foods That are Raw. Undercooked or 24. _ Food and Food Protection PC -- 3 Not Otherwise Processed to Eliminate 25 26. _ Equipment and Utensils Water, Plumbin and Waste FC -5 Pathogens.* E"'°e•,a 11i"2011, 27. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 28. _ Poisonous of Toxic Materials FC -7 E cgs" 590.009(A) -(D) Violations of Section 590.009(A) -(I)) 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. pra6ces should be debited under #!29 - Speeial Requirements. Wzlf l (Items 23-30) Critical and non-critical vio alions, which do not relate to the foodborne illness into ventiom and risk factors listed above, can be ,found in thef'ollowatg sections o(the Food Cotte and 105 CMR 590.000, Item Good Retail Practices FC 590.000 23. Manaoament and Personnel FC - 2 .003 24. _ Food and Food Protection PC -- 3 .004 25 26. _ Equipment and Utensils Water, Plumbin and Waste FC -5 .006____ 27. _ Ph sical Facility_. FC -6 .007 28. _ Poisonous of Toxic Materials FC -7 .008 29. S ecial R uirements .009 30. Other vswnvvm„w-z.a.,� 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 NameI ( I S TZWfe% I _ D to Type of Operation(s) Type of Insoection ®; Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑ Routine 9 Re -inspection Previous I spection Date: I (-3 /,1 ❑ Pre-operation ❑ Suspect Illness ❑❑ General HACCP Complaint ❑ Other Address J ( Risk I Level Telephone�S _ J4 Q J Owner '/ Y��it) L 5��6 / HACCP Y/N Person in Charge (PIC) „ Time In:� �j Out: Inspector Each violation checkedlrequires an explanation on the narrative p ge(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 ;`,''i6 i ,,§,� , a ,. �. j LJ -a_ ❑ 1. PIC Assigned / Knowledgeable / Duties t EMPLOYEE HEALTH",`•'y"* rat _P 9 "4.as®e�m{Ew ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded ;FOOD FROM APPROVED30URCE,. a;�u:.,�-�,.,"�, ❑ 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 ❑ 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. S.L Nt 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 (590.009) 30. Other S, 5011 OFoi -14,m ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS RQ `" 3 fig" �.s�,�m,,,� El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals "•;'TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) "gtm - xm A ❑ 16. Cooking Tempatures ,. ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and.Cold Holding ❑ 20. Time As a Public Health Control � REO'IIIREMENTS FOR,N!GNlY SU9GEPTIBLP POPULp,TtONS {MSPj ❑ 21. Food and Food Preparation for HSP -it ONSUMEA ADVIS0RYa;.. ,.w` 2,j�.=7.�v, ❑ 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: 3V,a�v�j Inspector's Sigriature:� \ Print: PIC'sSignature 1 Print: ���_(%L SC(_)�-i';..- Pageof�ages, Violations Violations Related to Foodborne Illness Interventions and Risk Factors (Hems 1-22) FOOD PROTECTION MANAGEMENT 1 596.003(A) I Assignment ofResponsibifity* 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 Com Nance 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(Cl) Reporting by Person in Charge* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions: Restrictions C M 6 C 13�Z�7►7y;ITiLRJ� T�PI��I:Ya1tl:iiilti * Denotes, critical item in the Ceder, 1999 R"I Code or 105 CMR 590,000. PROTECTION FROM CONTAMINATION $ Food and Water From Regulated Sources 590.004(A B) Com Nance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.'13 Fluid Milk and Milk Products* 3-202.1.3 Shell Eggs* 3-202. t4 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5 -' fill. II Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.01' Washing Fruit's and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authors 3-202. IS Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PIif s Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(J) Labeling of Ingredients* Frequency of Sanitization of Utensils and F<wd Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 S ecialized Processin Methods* 3-502.12 Reduced oxygen packaging. criteria* 8-103.12 Conformance with r1. roved Procedures" * Denotes, critical item in the Ceder, 1999 R"I Code or 105 CMR 590,000. PROTECTION FROM CONTAMINATION $ Cross -contamination 3-302.11(A)(1) Raw Animal Fcwds Separated from Coked and RTE Frxnds* 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) Food Protection* 3-302.15 Washing Fruit's and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Rescrvice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe. Food* 9 Food Contact Surfaces 4-501..111 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-60 Ll l (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 F<wd Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.1.2 Cleaning* Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Ddnkina or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 PreventinE Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conventently located and Accessible 5-203.11 Numbers and Capacifies* 5-204.11 Location and Placernent* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-361.11. Hindwashing Cleanser, Availability 6-301.1.2 Hand,Dnvin,Provision Establishment CITY OF SALEM BOARD OF HEALTH 4 Date: 1I��1g Page: 2 of ;nem No. 10 Code Reference �,. C-. Critical Item ;R=Red Item y„ ^.a. ' $DESCRIPTION OF VIOLATION / PLAN OF CORRECTION,'` yr. t ” �%_^' t `,g $r, i c �, °.. ;1 ✓ In �i PLEASE PRINT OLEARLV � i ;.✓s n ,a..-3r5�;.aw sw� ,1 ?.AX" � �,.,ri.. . " 1;xl`` ,„ ,rv':",„� ., m ,r �,�,ax.. _�r.n, �.,,s,. >r> g/. ' Date Verified N llnrol b� w 7( i,.,./ �) -I-n LAA rl A ti r D C, in _. - I /1 V 7(cn � l od 111 C11, 4 t 4-J( r o h Ike -)r-.00,t0d - o e (.; hrnuP., 169 a r- Y,,n! ,- _ l ,� IPr 6-1 Vrnl -IL- O�S --)--D '��l —1L P (Z N't— rAl V nr •A� ae— lir IkJ di U/), 4 , (o r vt n Ar P f J✓�T Y7�, M l� i n Discussion With Person in Charge: I have read this report, have had the opportunity to ask question and agree to correct all violations before the next inspection, to observe -all conditions as described, and to p / r comply with all mandates of the Mass/Federal Food Code. Ilunderstand that ( noncompliance may result in daily fines of twenty,fiveAdoliars,orsus/pension/revocation of your food permit. �\C/, ` // ��YY Corrective Action Required: ❑ No J —yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion -&--Re-inspection Scheduled ❑ Emergency Suspension / ❑ Embargo ❑ Emergency Closure LiVoluntary Disposal LJ Other: j 1-501. # 4(0) PHFs Receiwt d at Temperatures Violations Related to Foodborne fitness Interventions and Risk i _ ci cording* to #.rain Cooled to Factors (/tents t-tomd fCont,)_ I I T/4�5 F Within -t Hou);. i PROTECTION FROM CHEMICALS 3 St;1 l 5 C xl ps ifi hods for PRFs _ ..._. _._.._._.._ T9 PHF Hot and Wit Holding 14 oatlarCa#arAdd€tives� 50! 36(B) Cold PHFaNIvintivadatorbalow 1 ? 241a.t2 Atfcitdvea' _.�.. 590IX14(f 4I�F4.g F" 3-30114 Protection front t''na}>pxoaad Ad 3nives*- � � 101 16(A) Not PFTs =s Maintained at or mt+ove � 1 S ' Poisonous or Toxic Substances 101A 1 t Idernify ng lnfli; iiou Ors mal _ 3 �t'.i-x6{.>) Roasts Held at or above 130'F, s Time as m Public "'s Control �. -1-102 t_t GwnmorrNtme WorkineConr incr," I -- _ 1 T�'sm�asi PvbhaIRa- h"niroI'..._ r-202.1'. heat coon Pri sclice, and U,�w._ tascc R nircntent _--..- 7 2011 � condmono of USc, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 Toxic O ntamo Prohtbt it)nv' POPULAT#OhiS (HS 7-2-04.17 -SamC,=i Cr ; to Clie Wric IS 7204,12 Chemicals for thashi Ptndnc�e tritcriar_ 'fl ?-Hit' IILI Uttpxteuriwhined irr�la]A-lxvcd cesand� 7 204,14 i7;�an #. c.nts. C rite t t .-_.. ._ Hetiet r es vuh Wart tui ]A -lx" _ 2l)5 -I# InceicntatlaxiContact, lnbrrcuilsr —. "-sot LI (S) Lx a Pas'ttaitrtcd — 3-80 1. i I (DI Raw or i'artiall Cwk ct Aiumal Pooh and 1 7 X06.2 t Reetridea Use Pe Weidel_ E tena 7 2{}b.#2 ?talurt f3 ut S¢nueris i R lu Sctd Sprout. Not Sln'y'A --3-R01 t i C)Unct eneti P'atr! Parka *r i�at I2<, cervetl. iravktnti Prnsdc I'�st t antroi and —"-- ------ 4toaatorin- CONSUMER ADVISORY _ TIMEITEMPERATURECONTROLS ; 22 3-(,,0,AI CCursmncrA&isotvPtnte.I'forConstimpponol 16 Proper Cooking Temper acarus tar ' xninol te'atd<Ihat re R -w. Cndercookcd cr PHFs I Not Oflw iSe Pre* c std to FArrontite 3'ithP'csis ` °� r m -401.I14fE)(tt Eggs 155'F 15 Sec. ----�- 1 S iinn: di ttc. Servic I-,5` T15sec i{361 3 t # Sre trtn,d t-ggc Sabaotnte fcr Raw S#tel C9h� Cv*ntnuwt d FM' Mesh & Ctanx -x — ___ Anun tis I 117 se: SPECIAL REQUIREMENTS I-461.I1(BC#}t2} Pwf and Boat Roast -1St E i2#nun" S 5-4Ql.l i(A)t2j � Rellic., Baja a kleats 15 [' 75 � � �� )` � 1ie x catering mobilc foaxi ternporaty and 1-401.11(A)0: Pocdrrv, Wild Gaint Stuffed IIFs, � rasid ut r[�kitch4n operations Sltc+ttfd be Slidfrna C"atmtunt Fish Meat, debited cinder the appropriate ,ecttans Pataltfv or kaWte s 165=1 5 ice. �. - alx e if related w fxlber cxnL illness �34Q111rC)f3? Sihrth nnrL#r..Lrt.u.i.'(3uP;,ir~iks a Intelvennonsandnskhictors {hirer i #45 k' _ ,9(i Ofl9 rolaiion, re#atin. to ")(A ictal! 3aDi.l27 Animal I calls Corked ill a t Iaractices, should be debited under #29 - I 1liuoxave 105,14 * Speal k ciegnircnrcnts. 3-401,iiiA1(litto AI.CRIrerplS#, #45"F"i 15sec.^ 17 _ _ Renee ling for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-#0iO3,lIfA)<@(B) pHt. 16§1' 15 set;. (Wors23-30) 403,II fB) Yt c to aw 165 F I Miura slandim, Criora? a , -f niwal ioleliapia, which d© nal Male to ihr I title _ fnaonr rnt t'I ,err uuc ry<nt ung ,end ri Jaczarr 1 sic -rt c+bone. can be. 3-403.11 (C) 1 C omrnertially Pia essed RTF l Foot - f Land get rFu te1t>n4o,% s t frons of the Food forte and 105 C'MR 3-463.11(E) ' I Remannng Unsliced Portions of Pecs 1Proper -Siftl4(A) Cooling at PHF-s ctioline cooked PHSs him, 140-- to ?u°F 4Vithan 2li0117s and From 701, 3-5 Ll4(B) _ t0 41 Ft54h Within 4 Hi tats. Cnohne; PHFs Made From Ambient i F nrperarnre hrexedieatS l0 411=145`F € Within 4lhiur ` - Defi"Ie3 critical itom ill !ht f e4xnt 1990 Pe00.clxfe "r l OS CMit 590 606. ,"V'" a,. maisichusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT r I I Salem Board of Health 120 Washington Street, 41h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name D e Type of 0 eration s Tyoe of Inspection I/ C !i A v 3 Food Service Retail ❑Routine ®-Re-inspection AddressG% Water, Plumbing and Waste isk 27. Physical Facility Level ❑ Residential Kitchen ❑ Mobile Previous-Insp ction Date://Zof�q Telephones 29. Special Requirements C] Temporary ❑ Caterer F-1Bed& Breakfast ❑ Pr -operation ❑ Suspect Illness El General Complaint Owner 1� L n c ( HACCP Y/N Person in Charge (PIC) Timef In �� El HACCIP Inspector \ y Out:O Permit No. ElO herr Each violation cltecked'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. r FOOD PROTECTION MANAGEMEM%'-"'',`;w„„,,��1R`„, ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH,`,n ❑ YFQorting of Diseases by Food Employee and PIC ❑ 3.. Personnel with Infections Restricted/Excluded 3 FOOD FROM APPROVED SOURCE;^„��, „ ,�,„ ^„, 1 �, W. ❑ 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 FiOM CONTAMINAOtJ g : n 8. SeparatioN Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 34 -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 (590.009) 30. Other S, 5901ns IFom 14.tl r Y / /7 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities P'PROTECTION FROM CHEMICALS "-- F,'4;j,7j.FVM'N1i ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals zY TIMENEMPERATURE C64TR60 (Potenttallp Hazardous Foods) ❑ 16. Cooking Temperature,$ ❑ 17. Reheating ❑ 18. Cooling ' ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control r.i1EQUIREMENTS-060 ---'---§(HSP);"`�_�, ❑ 21. Food and Food Preparation for HSP jC0NSUytEt3 ADYISORY„ ; .5 ?t'uV�.a4 ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature: \ - Print: / j - pf7ds -PagePIC'sSignature: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment ofResponsibility* 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 fool employees and 3-201.:13 Fluid Milk and Milk Products* a r rlicants* 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 1 Drinking Water from an Approved System* tem* 590.006(A) Charge* 590.006(B) 590.003(G) Reporting by Person in Charge` 3 1 590.003(D) - Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 in C C FOOD FROM APPROVED SOURCE * Denoas critical item in fie -federal 1999 rood Code or 105 C,NIR 590.000. PROTECTION FROM CONTAMINATION Food and Water From Regulated Sources 590.004(A B) Compliance with Food Law* 3-201.12 Food in a Hermeticall • Sealed Container* 3-201.:13 Fluid Milk and Milk Products* 3-202.1.3 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 1 Drinking Water from an Approved System* tem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.Q* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by . Regulatory Authority 3-202.18 Shellstoek Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.1.1 Receiving/Condition 3-202.1.1. PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-203.12 ShellstockIdentification Maintained* Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxy gen tacka ing. criteria* 8-103.12 Conformance with Approved Procedures* * Denoas critical item in fie -federal 1999 rood Code or 105 C,NIR 590.000. PROTECTION FROM CONTAMINATION Gross -contamination 3-302-tl(A)(1) - Raw Animal Foods Separated from Cooked and RTE Forms* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foals Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. Foal 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 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501..11'I Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- Hof 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 E ui ment* 4-703-11 Methods of Sanitization -Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 1 Clean Condition - Hands and Arens"` 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.11 Eating, Drinkin or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Prevemin Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees, 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placernent* 5-205.11 Accessibility, O oration and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hanalwashing Cleanser, Availability 6-301.1.2 Hand Drying Provision ITY OF SALEM BOARD OF HEALTH Establishment Name: Vc-;z_�Al nl Date: t / -3,-)/0 Cy Page: _0 of 1 Item . Code, C - Critical Item UA DESCRIPTION OF VIOLATION! PLAN OF CORRECTION " 6 Date No 04 Reference R - Red Item EVerified PRINT CLEARLY 11A.Pe r = 9 I I f -j- I l _ L I I _ I l I l'_ / '11, ,J - n. ri 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 r�6ncompliance may result in daily fines of twenty-five dollars or suspension/revocation of yur food permit. r Corrective Action Required ❑ Voluntary Compliance ❑ Re -inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ No 'Put u f Yes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: Violations Rotated to Foodborne fitness fntervontrons and Risk Factors (hears 1-22) (Cont) 26 ?-Ss?3. i d(t7) �.� Pk[b`s Rc a,, ascii at T�rrperatures ACordia in T=aw Cooled til .I x745 F Within 4 H rhs. � ..� f -r4 - 155 F 15 sec. I9 PHF Hot and Cod Holding Fps hnnmdr lte S en-ic t45'ivi5sec'- Food or Color Additives � - Annuals - 155'F is sec. —.— — �Ad&,,cV 4-StIi.16(9' Cold PRFs Maintt;ined at or below 3-24 12.11 __.. ,, 7907-f#S}4tFi -11`745° F 3-302.14 prolextitin from lrtat roveda 3-50 1INA) IIut IFN* s Maintained at or 6te Poultry, or Ratites -165"T l5 wc. " Poisonous or Toxic SubstanAes Shale -mu ls, intim Be.f Shiites 40T'. 71 01.11 -CAignal 3-501, WA) -1 Roasts Reid at or above t3O°kr- s' %1ioowave 165 Cnitt'rrt e,e � 20 I Time as a Public Health Control 102.1 t COren7On N1 iW- R or[un- t mt tin rs* r'-- — ---- Ytuiowaec 165 P 2 Rtmute Standing -- 3-5O1 [ts ime us e Puhlii. Health Conn•ot' 7 201.111 ( Se a ttion Stir apnc_____:LT 9U.f){kllH}��> - ^' mance Rs.rvntenr 7-20111 Reu action Pn sena, and t sc _ 7-20112 coaditiorei of Uso, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 '>C74 Ii 1 9z, t^ „v",nm _Prnhihirr -204..1 i Sannifet_s, C�ritct.i i chemicals* _ 7-204.12 Chctmclais for W t hinv> Prod cc Criteria°" /-205,11 lecid mai Fa J t c riaat. Litt teams 7-206. Fl Iia iuc d cfse Pr uc.ahts. 0itei is" 13 j Tracking Pouder>. Pesr (Amnof and 3-401.11A(l ('j f -r4 - 155 F 15 sec. Fps hnnmdr lte S en-ic t45'ivi5sec'- Gonuni nntesi Fish %teats d flame - Annuals - 155'F is sec. 3-4G 1.1 (FI)i f }(21 Pork tmd fi cf 12ilast - 1 it) P' 121 min* 3-4OIAI A)(2) i we" lln6ct a btc,ts 155'F 15 uc _ _ 3.4{)LIVA0}� Pauitry,b4itd(,ame,Stu ffe.dPfff"S� Stu fi ig Contain fn Foo Meat, Poultry, or Ratites -165"T l5 wc. " j 3-101 INCi(3t Shale -mu ls, intim Be.f Shiites I 1451,'*Ar _ 3-401.12� RawwSoimatColxksCo,rkcafitva 'F %1ioowave 165 E 3-4OLtI.{r%}Cl}{hj � All00mv I lHFz 14 'i'V 15 sec. Reheating for Hot Holding 3243,11i�}R(L)F 3 903.11(13] Ytuiowaec 165 P 2 Rtmute Standing Time, -�in3. i 1(Cj Commercially Pro essed RTF: Korth - 3-403-11(E) 1 Remaining unsliced Portions (if Beef 3-501.144Aj Cooling Caked PHFs Prim; 1.4}`F d) VT within 2 Flours and From 70`F a i er<re¢r c w;ir,;., a u,.... r 3-501.14413)j Cootog PRFs Made Itroat Ambient !1 Temperature Ineredierit= to 4ThMS'F "llenotes.7iti:xti stem in the f xte,od 1999 Food Cede or 105 (, %,IR 591)0010. 21 ! i-501.1 1(A3 Pre pled regcd juices and -.� F3rvetavec with chatsnts�labuls* I iw of Pa*teunrcd Eq R w or Partial Cook-(] timznal Food and ftit S d h'ProntS °tioi Scr�va _ LlnoC,t,ired Foi+d Packs Le Nor Re -served, CONSUMER ADVISORY _ 213 Consatner 5c t irot v P ost t d for Co .unrption o1 .animal Foods That ire Raw_ LTrideruwked ar Not OdetnA iv< Prua sse.d to l.lrnnn w P tthtIon 3.302.0 t V stem ur d FMt: Subst;te tc fci flaw Shell Viol ti tai, of St tion 590.(k)9(A)-(D) in catering, n -i taxi temporarsand resiui ut d kitchen operations should be debited, under lbc appropriate sections alwvc if related to foodhornc illness interventions rind risk £actors Other 5190.009 violations relating to hood retril practices should be debi,tecf under 4129 - Speclal Require tents. (Items 23-30) Croicai and nim-cripral sius:Worrx voimh do ?eni sedate to the f iodhorne Woes, s, inlervcntunc and roA factors I itcd above, call be faand in the fall ,wing sw trnro of the Food Code at d 103 CMR 86 WHARF STREET 668-09 GIS #: X14591 ----- -I------------- COMMONWEALTH OF MASSACHUSETTS lock: Pemrit # 665-09 Project# JS20 -09-001271 Est. Cost: $3,000.00 . e Due: Class: s Gained: s Lost: Safe #: ISSUED ON: 06 -Apr -2009 CITY OF SALEM BUILDING PERMIT PERMISSION IS HEREBY GRANTED TO: Contractor: License: Expires KEVIN HOYL Owner: ria Station Applic /t: KEVIN HOYLE AT: 8 WHARF STREET AMEN D ON: EXPIRES ON: 06 -Sep -2009 TO PERFORM THE FOLLOWING W� DEMO PARTIAL RESTAURANT (INTERIOR ONLY) jhb POST THIS CARD SO 1T IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: underground: Excavation: Service. Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Metcr: Oil: Final: House# Smoke Water: Alarm: Treasury: Assessor Sewcr. Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEMUPO OLATION OF ANY OF ITS RULES AND REGULATIONS. I A . A ft Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2009-001445 06 -Apr -09 2958 $35.00 QHTJ t1; An inspection is SEQUIRED tpon wirmpieiion o;work, plqm call 74&%03 Fid. M GeoTMS© 2009 Des Lauriera Municipal Solutions, Inc. 0 Commonwealth of Massachusetts City of Salem 6 Board of Health 120 Washington Street, 4th Floor Kimberley Driscoll Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000228 LOCATED AT: Victoria Station Restaurant 86 Wharf Street SALEM MA 01970 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0214 Dec 23, 2008 Dec 31, 2009 $420.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $420.00 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 ICIMBERLEY DRISCOLL MAYOR JANET DIONNE, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 IDIONNL9SALEM. COM 2009 APPLICATION FORPERMITTO OPERATE A FOOD ESTABLISHMENT ` NAME OF ESTABLISHMENT V IC71�Ig�C7�Y�EL# ADDRESS OF ESTABLISHMENT 9G w �` ST, ,%APFAX# I%�� /TJ- ✓ ' �/ MAILING ADDRESS (if different) In EMAIL -Business': vIC7��1�61�3�(J� Qrn,I T,Nat� Website:y IcwaI�ST��Icp�✓ eCo01 OWNER'S NAME avL C ' '2 TEL# q9g-�g3 OQRZ- ADDRESS .�itK Pi/C� Gwwa—sa-�, P4 0 030 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �t�V CERTIFICATE#(S) ©LTA-'-rW(,g 1601 (Required in an establishment where potentially ous food u( ' repared)....�^ �y EMERGENCY RESPONSE PERSON / L ��° ` HOME TEL #� DAYSQFaOPERATION. Mond -" .: ,Tuesd Wednesd '- "i Thursda r`: ' ';; Frida'-SatuMa . . ' " ', Sunda : HOURS OF OPERATION 11:30p"—! 11:30 PC-, ; I j' *Jd rwn j )1:30 r1 I I I ;'10 6?4r% 11 t 30 PJb Please write in time of day. (For example Ilam-11pm i))�a0p� i1'iias� 11 -�0� I1 :0 11',00'pq, II:00 117r.1'ifx�, TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ff. =$280 more than 10,000sq.ft. =$420 NO (Outdoor Stationary Food Cart BED/BREAKFAST/ MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) less than 25 seats =$140 25-99 seats more than 99 seats =$420 $100 YES $25 YES $135 YES $25 'Please pay total with one check payable to t City o6D0;n;c'hz al This Permit is not transferable and must be reissue ngeof ownership. The Permit must be posted in a prominent location in the Establishment. IQacco�d�aci with St t Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for suu m e t d approved by the Salem Board of Health. Phapt r 2 , ection 49A, I certify underthe ains and penalties of perjury that I, to my best knowledge and belief, have fled all state tax s e es uired under the law. I I I� ^� r 70 Z Signature J Date Social Security or Federal Identification Number -----------------�—(�-------------------ii-%%��- ��, Revised 424/07 FOODAP2008.adm Check# & Date'7(�i4�) 11 /) g�� $ IV Dec 2S 08 09:57a Victoria Station 19787457460 P.1 i TO: I FAX # RE: a. 86 wfia%t sl4ed Sa&m, Ata 01970 978-745-3400 - 5ax 978-7454460 FROMq. /-% 4 :6f--+t/( DATE: [a �A(l URGENT j FOR REVIEW PLEASE COMMENT PLEASE REPLY Comments- 17�l - � e(404 t[- LIM 4- A,01, acL Piz Pffi( 'RQTtym- poslig-vvc�,,, q%-9*5�y4o C-9 Beverly Cooperative B B 161.09 BEVERLY CGOVERATIVE BANK DECK VIEW MANAGEMENT CO., LLC BEVERLY. MA 01915 4204 VICTORIA STATION 86 WHARF STREET 53-72M2113 SALEM, MA 01970 12/23/2008 - PAY TO THE ' ORDER OF City of Salem 161.09 E One Hundred Sixty -One and 091100•••**...•••` •• , , , •• • • • •• , «.,.......,, ,.. ,«... .«.. ' DOLLARS City, of Salem MEMO 4oti �. 11'00420411' 1:211372&451: 0630&54998' DECK VIEW MANAGEMENT CO., LLC VICTORIA STATION 4204 City of Salem 12/23/2008 Date Type Reference Original Amt. Balance Due Discount Payment 6/30/2008 Bill 511 79.15 79.15 79.15 10/1/2008 Bill 511 81.94 81.94 81.94 Check Amount ��GZ Spn o�' 161.09 Beverly Cooperative B B 161.09 26 08 08:57a Victoria Station 19787457460 My `File Edit Tools Help %0" x Eb V2 Detail C=omtt File 'e, Payment Nbcale Payment) Apply �-P-9-e-t ail into . Eff diva Dale Property CO&: 5O0726 Effective Date 2 %fV213/2008 Year Cal 94 MSC Ong Billed AcCvrly Unpaid Rai Due Now Payment Amount 2009 Pp, R 511 MAS. 328.47, 164.31 7' 2008 PPR 893. Ej'304.66; .2k 61 7276 1276, 12.76 2007 PP -R gm Lj -06 0,00 2004 PPR 950❑ 64133 -641.33: 06 .00 aao� 20115 PP -R 942. 0 380.50 -390.50, Do: .00 000 -2606 PPR 426 - Mill -Mll '001 - 00 000 2002 PP -la 1039 ❑ 761.29 -761,29 .00: '00 0.00 200 PP R 571 800, 52; 5211— .00. W 0.00 2001 PPR 154 08 --BM . 154.08. Oft '00 O'CO 20b PP -A 1027; Q 164.58, --- ------- ---- -- ---- ---- -- -164.58 Du .00 0.00, PAID Totalpaymen Total due now Total wpad L �Iv� LI LI 17TO IMPORTA..N�}T MESSAGE `�Lo_ FOR __... _.. A.M. DATE %f— ^ Q d/ TIME P -kr r f- M �wrQ - L Ci/_6-9.L ism J /7—�I.LCJ+y OF PHONE" AREA CODE NUMBER EXTENSION O FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED L4 PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU SIGNED FORM 4009 Y�� �• MACE IN U.S.A. •�1Jun 30 08 07:37a Victoria Station 19787457460 86 Wfiia4 Shed Sa&m, Ata 09970 97S-745-3400 - lax 978-745-7460 Fax Cover Sheet Fax Date: / -20/ D2 Time: 7 1 (0) '" Pages: oC Fax Number: Fax Name: �I2 Fax From: �UL SCi������� GA. av-NWz VOL) Pljvt :,/Jun 30 08 07:37a June 30, 2008 Victoria Station ld ICTORIA 86 Whaq Stwd Sa&m, .MCL 01970 19787457460 978-745-3400 — 5ax 978-745-7460 Re: Board of Health Inspection on 6-24-08 Ms. Liz Salandrea p.2 To follow-up with are meeting of last week here, is what we have accomplished on your list of recommendations: • 4 New cutting boards have been ordered thru Hallsmith-Sysco and should be in service no latter that Wednesday of this week • Reviewed procedures with kitchen staff to keep all food containers covered at all times in all refrigerators. • Hose at service bar area has been secured up high by Coca-Cola to keep it out of the drink ice. • Slicer has been thoroughly cleaned and procedure for cleaning has been reviewed with the kitchen prep staff • Thermometer has been placed in the True unit • Rear delivery door has a new sweep plate installed and the sidepiece has been re- attached to close in all gaps • All florescent light fixtures now have plastic covers over the bulbs to protect them from & in the case of breakage. • I have spoken to "Dick the Welder", he has contacted the Salem Fire Department about the Tig welding that needs to be done and has scheduled us into the 2nd week in July. • 2 New trash containers have been ordered with "Flip" tops for the bathrooms and should be in service by Wednesday of this week. Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer General Manager/Owner 86 `dJ" Stwd Satem, .MCL C197C 978-745-34CC - sax 978-745-7460 June 15, 2008 Re: Board of Health Inspection on 6-12-08 Ms. Liz Salandrea Action Plan Following are the actions that we have taken to correct violations / recommendations from your inspection on 6- 12-08. Food Contact Surfaces: • Cutting Boards all cleaned of stains • Ice scoops purchased • Sanitizer log re established and staff made aware of procedures • Hand Wash Facilities: • Soap refilled where necessary • All handwash sinks labeled "handwashing only" • Hot and Cold Holding: • Fridge in waitstation emptied and theres a call in for service. • Food and Food protection • Addressed with staff on keeping storage containers covered at all times. • Also addressed all food to be covered at all times. • Call in to Coca Cola to shorten line so not hitting ice. • Reviewed thawing procedures with Kitchen and prep cooks • Equipment and utensils • Dry storage area and bins all cleaned • Cover ordered for trash can • Can opener scrubbed and new one ordered. • Thermometers purchased and replaced where necessary • All walkins cleaned • Physical Facility: • Have an appointment to have floor and door re -done in trash area. • Theres a call in for the floor tiles to be replaced in a couple weeks. • Protective cover ordered for light in wait station • Plumber will be in next week to fix leak in dish area. • Snaked urinal in bathroom, now working fine. Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer, General Manager, Victoria Station JUN -21-2008 11:36 PM DICK 7M$I� 147 SUMWIIT HUlIDII�i(i 3A PRAA11m. MA 0198MI01 Phar• M%93148" P.01 =I0 t3f 1'o Pham VblMifniter(S�irY) 86 ~WAlt 97�716d10D t3f 1'o Pham VblMifniter(S�irY) 86 ~WAlt 97�716d10D 11L7M�7MID 10 g51-twa% 7g5:Qo 0086 WHARF STREET Victoria Station Restaurant Telephone: 745-3400 Owner: M. Management Corp PIC: Ryan McCarthy Inspector: Elizabeth Salandrea Date Inspected: Correct By: 6/12/2008 Risk Level: Permit Number: BHP -2008-0215 Status: VIOLATION # of Critical Violations: 4 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) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Co ment: White cutting bat ell sqnit in kitchen is stained and scored. Resurface or replace cutting board. will Cras. Ord.zr�d ce scoop missing at ice machine in wait station. Provide ice scoop stored either in the ice with handle extending out, or in a clean samti d container designated for the ice scoop only. anitizer log not being kept. Sanitizer log must be maintained daily. Handwash F cilities FAIL Critical E/1 RED omment: Handwash sink in wait station missing soap. Provide soap at all handsinks at all times. sink had food debris in it. Handwash sinks to be used only for handwashing. nk must be labelled'handwash sink only'. sink across from 3bay sink must be labelled'handwash sink TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical RED ktellm,ment: Small fridge in wait station that is not in use reading at 50°F. PIC stated nothing should be in there and that all items would be discarded. Fridge may not be used until repaired to maintain temperature of 41oF or below. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 17,2008 ) Page I of :Ian Violations Related to Foodborne Illness Interventions; and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and F d Protection FAIL Critical BLUE omment: Dry ingredients barrels left open. All food containers must be closed or covered to prevent cross contamination. Deli unit across from single fryolator in kitchen had some uncovered foods in it. Cover all food in storage to prevent cross contamination. - Hose to soda gun in the bar r9 sting on the icethe ice machine. Provide a shorter hose so that it does not touch the ice. ict colC �Z �ew, Ca(lxd — Shrimp thawing in a bay of the 3bay sink in bucket of cold water. Thaw potentially hazardous items under running water. Equipmenta Utensils - FAIL Non -Critical - BLUE omment: Dry ingredients barrels need cleaning. storage area had food debris on the floor. Clean/sweep this room. Emplo as mens room needs cover for trash recepticle. e trash room needs a thorough cleaning of floors and equipment. -ontinental fridge has water accumulation at bottom. Investigate for leaks and remove water. Van opener needs a thorough cleaning/scouring. 1ream freezer in back needs general cleaning inside and on the top. loor of the walk-in fridge needs general clean inglsweeping. Slicer needs general cleaning, including undersides of all components. to r of the beer walk-in needs sweeping. e unit missing thermometer. Provide visible, accurate internal thermometer for this unit. ������ oo/�oor of the walk-in freezer needs general cleaning/sweeping. e unit has accumulations of grime/dust on the wire shelving. Thoroughly clean shelving. mall ice cream freezer in kitchen missing thermometer. Provide visible, accurate internal thermometer for this unit. des of equipment next to the fryolators have some grease build-up. Clean and de -grease any such areas. Tru freezer in kitchen had broken thermometer. Provide visible, accurate internal thermometer for this unit. + mall beverage air fridge at end of kitchen needs general cleaning. loors throughout establishment are in need of a thorough cleaning. Physical Facility FAIL Non -Critical BLUE .Comment: Back door next to trash room has gap at right bottom corner. Seal gap to prevent entrance of pests into establishment. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 17,2008 ) Page 2 of Item Status Violation Critical Urgency Cement floor in trash room is worn out and pitted. Resurface the floor. 0q Floor tiles in disrepair in storage room next to arctic walk-in. Repair floor to ensure good and safe condition. SOyI �Q aFottom of victory fridge in disrepair; pans are being laid over the bottom to store items on. Repair floor to be intact, impervious and easily cleanable. .One light in wait station missing protective cover. Provide protective cover for this light.8lt-1"'✓t'$"tr9'i5 DY Lra,rf d 'There is a pipe leaking under the sink at the dishwasher and a broken, overflowing plastic container catching the leaking ater. nays Hire services of a licensed plumber to r pair to ensure good working order and free from leaks. -PI UihV (sC,(7, '�+ V(.� workor t(Y Water, FlurnlSing and Waste U'(=1 FAIL Non -Critical f BLUE omment: Small urinal in patron men's room not flushing properly. Hire services of a licensed plumber to repair to good working order. Reinspection in one week (thursday 6/19), all violations to be corrected. /ease have last 3 months of extermination receipts available at reinspection. Cityof Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 17,2008 ) Page 3 of IMPORTANT MESSAGE L -) �_ [gs- ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU SIGNED �J Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000228 LOCATED AT: 10mberiey Driscoll Mayor Victoria Station Restaurant 760 Summer Street Stamford CT 06901 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -200&0215 Jan 4, 2008 Dec 31, 2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 24 of 24 l >s KIMBERLEY DRISCOLL MAYOR JOANNE SCOTT, HEALTH AGENT QTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4a" FLOOR TSL. (978) 741-1800 FAX (978) 745-0343 )sooTTCa?sALEM. GOM 2008 APPLICATION FOR PERMIT TO OPERATE AA FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Y l C%r0 (-,—I, j A �tH I t�O�l(ASC ` 0- 2 TEL # ADDRESS OF ESTABLISHMENT 86 L��lY7U J FAX # 14yf —kyr �yl'd MAILING ADDRESS (if different) EMAIL - Business': !u G e GO r'yt OWNER'S NAME /��J// ��/�/�/ C��rY / ��" �T/EL# 9�%�lS'S 600/ ADDRESS /d SOJ 1 /Dunt 6 � XI / X10 /�y ADv STREET W,' (� l � ASCITY STATE /% ZIP Zk1Je& P / (g'J �n lr ,e3c� iso/ ` r +oz CERTIFIED FOOD MANAGER'S NAME(S) /y9 cc / �L W Tt�}�altN /r ��l� /RTIFICATE#(S) -3570.50 f (Required in an establishment where potentially hazardous food is prepared) q�7 EMERGENCY RESPONSE PERSON /Apt / �G(� q-� HOME TEL # / /� IW3 — W2 HOURS OF OPE Please write in time M TYPE OF ESTABLISHMENT RETAIL STORE YES ------------------------- (Outdoor -----------------(Outdoor Stationary Food Cart $210) ......................... ----- - ------------------- BED/BREAKFAST/ YES NO - - CHILDCARE SERVICES_---.-..-_--------------- ---------.. ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 less than 25 seats =$140 25-99 seats -$280 more than 99 seats =$420 $100 YES $25 YES $135 YES O $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Ch pter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fled all state tax 1ret paid all tet es required under the law. A f . 0��. P_.� i�/.%eve/-9137071 Date Social Security or Federal Identification Number — --- -- --- — -- - -- - -- -9 Sc --------- - ---- - - - - -- ------ ---- Revised 4/24/07 FOODAP2008.adm Check8 8- Date –"/� /� / Q, $ M. Management Corp. c/o Munir Saltoun 888 Park Avenue New York, N.Y. 10021 917-455-0001 212-249-1114 fax December 1, 2007 Ms. Joanne Scott City of Salem Board of Health 120 Washington Street Salem, Ma 01970 Re: 2007 Food Establishment License Renewal Dear Ms. Scott, Enclosed is the 2008 Food Permit Application with payment of $420.00 for Victoria Station Restaurant. Thank you, Munir Saltoun President ITY OF SALE BOARD OF HEALTH Establishment Name: Vl t ) oRt,N 'Si Mr 1 (3w Date: ) 2- 1A1 .a 1 Page: 1 of Item No. Code .'f Reference v. C - Critical Item R – Red Item 0' /� DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION �"` " z - , � PLEASE PRINT CLEARLY ` Date kaz Verified owfl`t� 7 �j CA07T\c V,avgi )aNS �S n�US-crvc'i IS �iXPeV{c.n (� CWSh Yv 6 \ca -o JhsJlraL L- V W\ 1, i \^ i 7'J1 �� �aa�Yao 1�4 c 7� <:5 VV C•\'v i / V i i Discussion With Person in Charge: I have read this report, have had the opportunity to ask questtior epd agree to correct all violations before the next inspection, to observe -all conVitions as described, and to P � I I comply with all mandates of the Mass/Federal Food\Code.11 understand that noncompliance may result in daily fines o ft twenty-five o suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes j Voluntary Compliance LJEmployee 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 r 7—Food orColorAdditives Protection front Additives^` Poisonous or Toxic Substances i 102,11 1 CommonNam, - 7-202.12 Conditions of tjw 7-203 11 Toxic COulailleTc - PrOlub, 10110 7-204.11 Sauitlzerti,Criteria - Chemicals* r -214,E (7fictilic"6 for Wash U11, 7-204,14 Drvirw Aecri 7-206.11 Rostricled Use Petivides, critelia, 7-1106.12 Rodent Bet Stations' 7-208.'13 Tracking Powdem Pt -s[ C.untrol and -T6 Proper Cooking Temperatures for PHFs V6l I I Aft r('} E;qp; - 155"F 15 5 -,., c 1-401 Comminuted FishNUius & Gallic Annuals- 15,5"F 15 sec. 3-401.1 llorband Beef Poitsi - 130'-F 121 ruin* 3-401.11(A){ 2) Rrotes, tnjcctcc. Meats 155 F 15 3-401-lliA)`3) Poulrrg, Wild Clame, Studied NfFs, Poultry of Ratites -1615°1 t see. 3-ff)Tjl(C)(3i Whole -mush bucci Beef Si aks I 1451; ° 3-401.72 Rax Annual Fo)yJs C(x)ked in a Microwave 165`F7 471, 11 (A)(1)(b) All Other fflf:s - 145'F 15 �,m [j7 Reheating- for Hot Holding PI -IN 165t�F 15 sec, 3-40111 (8) -%Aicrmave- 165' F2 Minute, Standing Time, Commercially 14011F* — —Bmf Remaijfirig Unsficed Portions of Roasls* �18 Proper Cooling �1-501,14(A) coiilitly cooked PHI -',s from Hfff to 7VF Within 2 Hours and From 1017 e) 41 °F145°F Within 4 hours. � 3 501 1 B) Citoliv a PRFs Made From Ambient Temperature Ingredients to 41°F'145 Within 4 *tJenot�s critical item is the I'deral 3999 Fond C,Aj2or 105 C's 590000. 21 1 1 —4 Reserapes with Warain --- P !�&As' rj80111 f13l -11 S e of Pas _iroi I I lj_) Raw or Pailialtv Cook -,A Annual Fix)d and Ro, av,, Se S#rrotns ;Vat Served _ H-901. I li`C) i Un }coned Food Pack jte Not Re eerier,(. 22 3- )0-,A I Coirsumor Auvisory Posted fur Consumption of Lnimal f,xi<ls thatarcRaw, Undercooked ci Not Oflrem il;e Prss!essed to 1,liminae Paste rrvt,d Fire. SubsuitutV fen, Raw Shelf 301 11 1 Violations of Section 590A)9(A)-(D) in cidcriug, motulo, fcxxl, temporluy and residmtlal kitchen operatioris should be dehieu raider the appropriate sections Axwe if related to foodbortic iciness inter ventions and risk factors, Other 1 590.009 Violations relating to food retail practices .should be debited under #29 - Speem] Requirements - (,Items 23-30) Critical arid non rme:al vk taliolis, which do roi relare io rhe ftrodborne dincss mwvorlions ond rokia(lors Rued ahmse can be found in the filflost hi, setans m of,he Food Code and 105 CAIR 500004 SI I)r iA-, rough service worklight 75 luz de traba " refer alda protective coating helps contain glass fragments ifbroken Con rewitmiento protector que, on caso de j J rotura, condone los Oagmentos de vidrio. for ra indoor/outdoor use A pause werioni leaenmes rugged filament withstands rough 21 handling and shock at lilamenro /unite resist, to manipulation indica Y los bruits 0 rough service worklight 75 protective coating helps contain glass fragments if broken for indoor/outdoor use rugged filament withstands rough handling and shock , A 21 light output: energy used: rrendfm!entoluminoso: 740lumens energlauti6zada wattr I75va light output., energy used: 1umenes os fon '' 740 lumens 175 watts life: vida util: contains: contiene : life: contains: 1000 hears he.. 116om6i11as1A21) �/� 1000 hours I I bulb (A21) 0 • Specialtybulbs hour GE offer innovative solutions fora variety of lighting needs • Saf-T-Gard shatter-resudantbulbs from GEareperfect for homes and businesses with hard floor surfaces • Designed with a heavy-duty, all-weather construction, Saf-T-Gardproduces against shattering, rain breakage and - slide oar from oil lubricants and welding materials. • Los bombillas especkdois de GEo6ecen soluciones innovadoras para one variedad de necesidades de iluminacibn. • Los bombillas resistentes at astillado Sal -T -Gard its GEson locales para hogares y empresas con poses dum r, • Orsenado con one constmccion resehente, para todo upo de clime, Saf-T-Gardprotege contra el astillado, at resquebralamiento producide por Is guide ylas salpicaduras de scene, lubricantes y materiales its soldonda. A WARNING Risk of fire. Keep combustible materials away from lamp. Will operate in any burning position, but fixed -socket usage other Nan base up or continuous burning in any position in ambient temperatures above 1501 RVC1, may result in some loss of protective coating, Reflectors and accesories may raise bulb temperature and cause some lass of protective coating. A ATTENTION ! Riesgo de incendio. Mantenga los materiales combustibles alejados de la lampara. iuncena an cualquier posicifin, polo si se mill on to portalemparas him can Is base hada code o at este encendide an forma conn rma an cualquier posicifin an ambiames con temperature superior a 150 'F R66 °C6 as cards founder parte del revesurniento protector. Los reflectores y Ins accesorios podrian eleven la temperature de Is bombilla y producir In perdida percial del revesdmiento protector AT V II II I III II V II II I III II E l� Massachusetts Department of Public: Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 0 Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name ( PIC's Signature: /�' _ Print:-��%✓Ah 1 y 1yr �.t 7- I'�! Date ,� a of Ooeration(s) Tvoe Inspection I )nAl-'I. ?l . LCo !G �1i' rid Food Service ❑ Retail ut ❑Routine Q°Re-inspection Address Vi� Risk t 1 1Ar r� _ 1- Level El Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone El Temporary ❑ Caterer E]Pre-operation ❑ Suspect Illness Owner J ( �`f Co HACCP Y/N ❑ Bed & Breakfast El General Complaint Person in Charge (PIC)-~$ Time ^� In: pu{ )� Permit No. El HACCP El Other Inspector ��� Each violation checked requires an explanation on the narrativerpage(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. . FOOb PROTECTION MANAGEMENT;„,; ❑ 1. PIC Assigned/ Knowledgeable/ Duties EMPLOYEE HEALTH .;' T ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 7 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 CONTAMtNATK)N r. ❑ 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 ryHealth. ilii. .YY is i� 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (Fc -7)(590.008) 29. Special Requirements (590.009) 30. Other S: Mnsp IFOm IdC ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities "'PROTECTION FROM CHEMICALS �"ay , 3:,�A8c.«- h++, 4a�s.�.m,dE{uv.v�avxunv xrm., 3,.�, &w.•mmww«.G�.� a4f'a..,.,,:,$ ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals L TIMEITEMPERATURE CONTROLS (Poten(lally Hazardous Foods) ❑ 16. Cooking Temperatures ti r ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control (; REQUIREMINTS 060'HIGHLY SUSCEPTIBLE POPULATIONS (HSP).,,'; ❑ 21. Food and Food Preparation for HSP ? CO NSUMERAOVISOF(y� 3r ""11 ' ❑ 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: �a r�Fcc D (1f_ yQ64 1121b"-5L4Vf\ 'r5 Grp (: f66 j. ��7, Inspector's Signature: I Print: '- PIC's Signature: /�' _ Print:-��%✓Ah 1 y 1yr �.t 7- I'�! Paged of .Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) � FOOD PROTECTION MANAGEMENT I 1 590.003(A) Assignment of Responsibility* 590.003(6) Demnstrat9onofKnovlege* 2-103.11 Person in charge- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food .Iaw* 3-201.12 require reporting by food employees and 3-201.13 Fluid .Milk and Milk Products* applicants': Shell Eg s* 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) 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 Restrictions C FN C C #sa •.•.. -.• # # * Denotes critical iteni in the Federal 1999 FoM Code no 105 CMR 590.0(16. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food .Iaw* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid .Milk and Milk Products* 3-202.13 Shell Eg s* 3-202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5401.1.1 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* WashingFruits and Ve etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Sbelistock 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 fintei[ * 3-101.11, Food Safe and Unadulterated Tags/Records: Shellstock 3-20118 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction - 3 -402.12 Records. Creation and Retentions` 590.004(7) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* Conformance with Approved Procedures /HACCP Pians 3-502.11 Specialized Processing Methods* 3-502.1.2 Reduced oxygen pack 'ng. criteria* 8-103.12 Conformance with A roved Procedures* * Denotes critical iteni in the Federal 1999 FoM Code no 105 CMR 590.0(16. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(1) Raw Annual 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 3-302.11(A) Food Protection* 3-302.15 WashingFruits and Ve etables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Resenice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe. Food* 9 Food Contact Surfaces 4-501.11'1 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501,112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chetnioai Sanitization- temp., pH, concentration and hardness. '" 4-001.A I(A) Equipment Food Contact Surfaces and Utensils Clean* - 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* 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* it Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventing Contamination When Tastin 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from E111)l0Yees* 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 Hindwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: col Page:,.Q of -7> ftem, C ode C - Critical Item �v "DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION K,u!X, Date Verified 1� No. Reference R - Red Item i , r - PLEASE PRINT CLEARLY in A41, ry 16 e�^ _Ar�r)' j r vAJ 1�p k,n,o k, __Aj_j r I f II r- ? Aer nn or -def A -Z)", r 1, nI 10 1A �,l ti vi/ -"j) t I VlAr IV*\ ctcw, P_ f -i -,M 6-Liad 4--1 hz re 0e, =(P J tjx�- ,I- �4!/)f V el� 141 x6J cIr,,,.,% 4 a, 4L loqge (PJAC/�O­ T� I r0).I I V_Qa,' r Ill __-T6 I)L-.e'-, 4Al-) c;4L Discussion With Person in Charge: Corrective Action Required: ❑ No Yes 1 have read this report, have had the opportunity to ask questions and agree to correct all U Voluntary Compliance U Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, -and to that Lj Re -inspection Scheduled U Emergency Suspension comply with all mandates of the Mass/Federal Food Code--Iu erstand noncompliance may result in daily fines of twenty five dollars or suspension/revocation of 0 Embargo 0 Emergency Closure your food permit. o Voluntary Disposal Lj Other: ra jk,- Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) (CorR) PROTECTION FROM CHEMICALS 14Food or Color Additives---- 3-202,12 Addinivas r 3562,14 protuctionfroultin IS Poisonous or Toxic Substances 11 Identifying mfo; oration-- Original 7-102,11 Comrra)n Nauw - Workint, Cocoa 7-20 1. !Se aradon - Snya e 7.202.11 �jj Re,�n iction - Prestnce and U�e*— 7-202,12 Conditions of Use* 7-203.11 profiibitior;* 7-2(W.12 7-204,14 1-1-265 11 ?-2W I I 7:25iiTi 7-.'.06.7? L -- TIMET TEM PrIPs Recerv�d a! natures djljj ' to Law Cooled to Within 'l Rows- coo fins methrKls for PHF4 A-50!.16(13) Cold PHFt; Maintained at or below 590,0(WF,� 41'/�Vt` 3 5f) ----T� Ifu �Fffl-s Maintained at or alxlve 1,110W N Reacts Hold at or above 130°F. as a Public Health Control 4i)7 1`'s Tito,, as a Public Ifealth ComroV Var;nnce Peaturentenr REQUIREMENTS FOR HIGHLY SUSCEPTIBLE aiN Cook,,d Animal Hiatt and ue�litades. Cruel ta TRiw R .. ! "" Ste"I S Raw Seed SrTotte, No Served. Tiacking Powcfers. Pest Control and MomloritiO Proper Cooking Temperatures for PHFS Eg', is'5 145'F)5! Cutinninuted Ptah, Meats T-GT1uC timires, bucocti Mchns 155 F 15 Sec. 1'oiflt,5, V5d Gain, $tutfeFPITF,, Stuffint, Continuing Fish, Motu, Poultry or Rafitei-165"I i5 scc. Whole -nus 7c Intact 13u Steaks (45"'F * Raw Ammat FoKk Cooked in a Microwave 165°F 3-103'1 pl-IF's I 5sec. " T4-63. i i(B) —T-47—icm�—,a,-,, ioi�, Ninnue shawtin., lime, 3.11 in Commercially PrrxsNed RTE hutri - 3-403,1 l(Fj Remaining,, Unshed Portions of [fref Roast,* Proper Cooling of PHFs :3-$01.1.4(A) Cixiiag Cooked PHF's It act 140'F t" 70 P Within 2 Hours and From 701' Lo41^F/45F Within 4 Hraus. r 3-501, i4{Iij Cooking PKFs Made Front Ambient Tevnfaorarure Ingredients to 41"F/45`It I 1)cn'rea critical hele is the fe;lrral 7949 Fttmi('Ae or 105 59)0 (9)U. 22 3 -(,0', 11 1 CDnsuruef Advisory Posted 1")r Coususipticur of ink u,il F,:A<'Ilattarc Raw, tjnder"xaked ci Uot oflamwise rroeessed to rliruanatc pathopens" 4 Leo,, -302.13 1 llasteurifxd Elegs Substitute for Raw Shell SPECIAL REOUIREMEWS T Vioknfion,, of'Su-tton 590.(X)9(A)-(D) in catering. inobile Rxid, temporisfy and reeiden't'tal kitchen operations should be debited under the appropriatesections alx)vc if related to ftx)dl-K)rnc j1hicss nleihen8onc and kick fack)rs, Other 590.(W violations relating to loctod retail practices should he debited under #29 - Speeial Requirements, Ro—LA'ric-Fiv-s—RELA'rw TO G000 RETAIL PRACTICES (Items 23-30) Ctairaland rhai-t rental vio,tdums, wiuch do teal relate m the ftwdhorrte illpess muteentiotuand rLkja(tors hqed ab,>ve, ran be found in i& toll ,nongsertiorrs r/,he Food Code and 105 (AIR SS'K",d'ie �," Massachusetts Depdrjrrer t of, R,ubjic�lealth Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name / Date Tvoe of Operation(s) Type of Inspection DI'Pood Service ❑ Retail ❑ Routine Q Re -inspection 1 C j4 al c Address ) Risk / 2f�r - Level El Residential Kitchen ❑ Mobile Previous Inspection Date: /) /( 1 d2 Telephone [ITemporary ❑ Caterer ❑ Bed & Breakfast ElPre-operation ❑ Suspect Illness General Complaint ❑❑ Owner11 ,, _ Cit % HACCP Y/N Person in Charge (PIC) �� ( G Time r/C ��( In: 19: Permit No. HACCP ❑ Inspector Out: Other Each violation checked 'requires an €xplanation 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.__"„ , E]1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH" w ....�..",....- L .m .�.. .. ... v.=a....... to a. .. ...-..r.W wm....A.m.. .w. u e a ❑ 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"` •$��- � "�'-t` ❑ 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. -7C 'N 23. Management and Personnel (FC -2)(590.003) 24. Food and •Food Protection (FC -3)(590.004) 25. Equipment: and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5901ns fFom 14, x F), ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities I'PROTECTION FROM CHEMICALS` " ` '"•" E "" ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErTEMPERATURE CONTROLS (Potentially Hazardous Foods) ,--' ❑ 16. Cooking Temperatures ❑ 17. Reheating girl8. Cooling e ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ;tt REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 1:121. F\d and Food Preparation for HSP a K ,"CONSUMER�ADVISORY, E122. 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 des of receipt of this order. DATE OF;RE-INSPECTION: # T".� M " •1 A ) Inspector's Signature:` / Print:. )06 PIC's Signature: Print: _ Y I 1ANC 2f�r - Pagel ofPages Violations Related to Foodborne illness interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Respimsibility* 590.003(13) Demonstration of Knowledge* 2-103.11. Person in charge --.duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3 -201 . 13 Fluid Milk and Milk Products* plicants* 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 tem* Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(0) Reporting by Person in Charge* 3 590.013(D) Exclusions and Restrictions* 3-20L15 590.003(F.) Removal of Exclusions and Restrictions 4 6 FOOD FROM APPROVED SOURCE w Denotes critical item in the federal 1999 Fwd Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.1.2 Food in a Hermetically Sealed Container - ontainer*3-201.13 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..1. I tem* Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.04` Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shell isM 3-20L15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authodt 3-202.18 Shellstock Identification Present* -590.004(C) Wild Mushrooms* 3-201_17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202. t5 Package htte it * 3-101.11 Fcwd Safe and Unadulterated Togs/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* - Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans - 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen acka ging. criteria* 8-103.12 Conformance with. Approved Procedures* w Denotes critical item in the federal 1999 Fwd Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION 8 Crass -contamination 3-302.1l(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](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` UL Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eramres* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. 10 4-601_11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.1.1 Cleaning Frequencyof 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 2-301.1.1. Clean Condition - Hands and Anus* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401_ 1 t Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and - Mouth* 3-30112 Preventing Contamination Witen Tasting* 12 - Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacifies* 5-204.1.1. Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices L6-301.11 Handwashing Cleanser, Availability 6401.1.2 Hand Drying Provision EM j �"� //BOARD OF HEALTH Establishment Name: `/ V Ir4cr4 �rf1 vt r�ogz&4 &C 4 Date:Io7I-7 Page: of Item a Code C - Critical Item - �H�} er DESCRIPTION OF VIOLATION /PLAN OF CORRECTION �. - �''"'� 'Date Verified No. Reference R Red Item z, &' _ // . A, PLEASE PRINT, CLEARLY / - Q.Pcr r0 - ?) C ecI c ter" -fit -�� ,� Tln��a r l/J rd-- I /A Cha i:?t— 1 )r n r > (6, j LA _ (4, P UP f ha Ave do 1 v + O ( c_(C jo) f - _. i to c IIi /Z WVII)C, Irl Yrc )�Y✓ % i.� A I v U/1. 1�A1 -1 /1 CJiCr/ 1V eP f ro 411 (V / ( ivy- Ck/,^/- �� G� 4%, 6 _ � I l loci r Y>)c5 moi— ) Y/C GcSn jyFil r(l�i�%�J Discussion With Person in Charge: Corrective Action Required: ❑ No U Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to P Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ' ` noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: � v {J J N Violations Related to Foodborne fitness Interventions and Risk Factors (Itants 1-22) (Cont) 14 Food or Color Additives 202 12 Additme, 102 14 Proud ;()n front Eta1>pro ed 4ddttLvss:--- 7 -tot -11 Poisonous or Toxic Substances woja'ia' Int"I., -401.1 I (H)( 13(2} 1 Containers, 1—ComiconNarce - Workinu Ritites, bijwrxil Meals 155 3F IS -STi�la—uon- 41 145` F t-A�l ll(A)0 7-202 12 condjtions of Uw' 7-?03.11— -f"'ic, co,uaineo, - proit—lbriom, t 7-2-04 1 —1cls- --- 204 M�104 —12 rotor for Wadiine Proditee, Ciinnial TF M i 205 i 1 Inculcrital Foixil Contact. Lubricicils 7-206 11 Pe,�,ncled U�� Pent ides- Criteria_* 7-206.12 1 Rodent Bait Stn Iom* 9-206.13 Traking powder . P Control and TIMErrEMPEAATURE CONTROLS 3 401A IA(l)(2) fgg,,- 155`F M5 Accordiag to Lac, CwIW to 3-40IJI(A)(2) Comoinaved Fish, Meats Ganic Anirnals - 135"F 15 sec -401.1 I (H)( 13(2} ISY4, and beef RtxIsi - 1304-121 MITI �-41) 1. 11 (A)Q) Ritites, bijwrxil Meals 155 3F IS 41 145` F t-A�l ll(A)0 Rocuvry, Stu{ted P F I sitiffinn Containing Firb, Meat, 3-501 (1 A) 1 P*ulty w, katites- 165'F IS svc. --- 204 fie"t -Raw —T-111Ck T4o —112— sIrtnal clo,'k-1xi In a Actowave 16-5'F * 3-451A1(A)(1)iIo All Other PlIFs -- 141"F 15 sec -T Reheating for Not Holding 63A I (A)&(I)) I'llf, 165"F 15 sec. 3-403.11(B) Microwave- 165' F Minute. Standing firer, 37;63-1 I —(c) connuencially Processed RTE Food 140°F* 3,403.1 1(E) Rernaining Utes iced Portions of licef poasl"� -750� Proper Cooling at PHIFS 14(A) Coobfg Cook. ,,d Ptil-s froru 1401- to 70OF Within 21 -fours and From WPP <,,d4-T,/4;'P 2440,;n A t4—... * 3-501,148) Cociiug IIJIFs Mpde Front .Ambient Tempe rawre Ingredients Io 41 '1,/45'1`r _LVithin 4 Dcn0W"r11W31 Iron in thr Iodcl"! 1749 Fo(s! (Ae (if 105 Coro 59'1644. I 3-501 )4(Q pl-IF's Receivedntl'ovnporatures Accordiag to Lac, CwIW to 4 I`F/45'F Widiin J Hows, Coolin, kledtods for 1`11FK Hot and Gold Holding ,5Cr,.,6(S 3-5' Cold PHFs Minntairied at or below 41 145` F F-5`-)1 Jet A) I lot I'HF..s Mainquaf-A at or above I NWE 3-501 (1 A) Roasts Held at in above 1300F. --- 204 Time as a Public Health Control I Bewrj"es with Warniroz Labels Rav, Se. SonjuLs No,, Served. 3-801 A J(C? 1 Unopened Flax! Pachi.,e iNol Ra -served. —CONSUMER ADVISORY F2 3 Zj-�� � T Cormisiror A&isox v Post�,d 1or Cormunption of Anialal I cs* That arc Raw, undelaxtked ("n Not Other wi.w Poxssed to Eliontiarc PaLint-eTus v 3-303.13 )j13 1 flasteuiizA Fgg> Subsintrue for Raw Slidl A)-(Dt sliolafioeN of Section 590.0)9(A) -(D) in caterin -1, mobile focrdt teyaporai v and rcm&w4al kitQheri operations should be debited ander the appropriate sections Axwe if related to foodfx)rrie Illness interventions and HA factors, Odwr 590.009 violations relator.c, to good retail pactices., q1rould be debited under #29 - Special Reifoirenjords. (items 23-30) Cfiti,(21? and non,,ruical vW1,71wn,s, which do ?m reirve in the f(wdhorne ilhw" ;nu'r voll'olvand risk factors lotvd above, c,m Irr found in the kdtoww, d 1 05 (141? j �vetrons qf,'he Food Co c aw Establishment Name: CITY OF SALEM I J BOARD OF HEALTH Date: /h�Page: of G� item r -Code .�^ C -Critical Item �^� ' ...� ' ' ^"' ';�% ;,, � �DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION �:" � , Date's.. No. Reference R - Red Item - S, PLEASE PRINT CLEARLY / Verified ��o '�-l:�S ./ �� 0, /'.-f- I�p/✓� �7i !�_ �'w S� n� 'i,D �' /r/I/e C n I y f r — ^ 1 u .I+ S n`I A W / ���a J, 14-N I nS/�pp7r.. ie -I 0CS7%( tY !a/OUl // AJr k,+ cod c P r )' ct z . h u el A 74;t „� 5IY? C, n ��A oc-AS c.,;x- - rf- fr k Y, r' S ��P �f' G L./ .1•, nn '1 OfJ �- s- L� 1, // A)v9t.A A.17. _ ., • 1 T4:1--sD( ' , ( o �p�rf �.do2'/- f��t Discussion With Person in Charge: Corrective Action Required: ❑ No Ye I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ( :6 ZA /t , � /1 ❑ Voluntary Disposal ❑ Other: [J PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According. to Law Cooled it Factors (ftehia, 1-22) (Cont) WF/45"FWithin 4Homs. v 3-5t t.15 1,11Fs PROTECTION FROM CHEMICALS �P F �Hc'lt and �Lld� 14 Food or Color Additives Lj-9- C"'id PHf 3-202,E Adlnwf 590.0041-1 414/450 F� 3-30214 an Hot [II'lFs Nlainlauled at of show Prot et t?L 15 Poisonous or Toxic Substances 1,10T 10'1 .11 lderaji'yine Intonnation - on-inal PoastsHc1datorabfa,e1300F,* -4 102.11 Common Name- WorUn- Coocaimns* L20 3 fol, i9 Time as a Public Health Control 7-201.11 S�tna a6on=�'!L)ra�e'� --- Tina, —" a —Public —1101 -ad, clono —T- -T 119().rK)4tH) I virianx and Us,�* 7-20112 Conditions of Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Contaircts - arollibinons, —1 its POPULA IONS (HSP Unpaiteuriecd Ilte-pacl%�&cd Joices wid Thetnicalf, for ��aCij 1, ce, ciitoli Aa. 12 C' i,DT4�1 I r1tcric a 21 t -s frF i I tAj Bevvmms 7-204,14 ia;, 2v —it 11, ik a 11 1 11-vt --a IiIL U� of Pa�,teorized 7245,1i Incidental F�M)d Cvntact, IAIbi lctuT,111 rat 4;10 [ " "I"') Taw or Pam ill,, T,,kcd Amoruii 7-206.11 Rogriciad Uw Peiicides art -na' aw se cd 7-206.12 R(Affil Bait slationf, 7-206, 11 rla kI 1'oI afc s Yeni C1,111,11, and 'I'lonilorin", CONSUMER ADVISORY ruption of TIMEfTEMPERATURE CONTROLS ten aril Foods licit ate Raw, UndercuxAcd C": 16 Proper Cooking Temperatures for F"ic"do'll—I'll 7W F posoal for Consal Not Otliere. iw Processed to I-lifalfrate PHFs Eggs - 155'F 15 &,,c. 130113 Suhsuoji� ka R�kw Shell ZILS11 l - e, ,dP�teorpod Fq�, 1, L Sep, e i? 5 1: 1 Ise 1-40 1 11 (A)(2) Comminwed FishMeats & Game ArornaL,. - 051 I5 sec. 40 i. 1 ](13)(1)(2) Poih and Bed Roast -13U 'U 121 uriO SPECIAL REQUIREMENTS 3-401.14(A3(21 590A)1)(Af-(f)) Violaw3rls of SVction �'00,009(A)-(D) in RArc, , injeclod bleats 155�F 15 *catenug. mobtic Rxxi. temporary and 1 3-401.11(A)l31 4Wild Gaine, Stuffed Plff`s; icsiiRml;al kitchen operations sliouid be Solffilig Containing, Fish, hien, 60,haed under the appropriate SeUtotls )I L� (i �, llc�-1651` 15 sec. al -awe if rclaied to foodborne illness -4,), ,i(,)r3-2L . Whde-nfoscle3 Intact fief Steaks interventions and risk foctorsOther 590.009 violatioi)q relating to IWO(J retail 3-401,12 Ra w Aninual Fka4s Cooked i vpeunderractkshould be debited under #29 - Miooe6 ava 1 -*'F1 ----f:1 Spetaal Requirements, 3-401,1 I(A)(I)(b) Alt Othei llilFs - 145'1 15 se T7Reheating for Hot HoIFn-9 VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4-03.111 -P-I I F 1 -65'T 15 ser,..( — (Items 23-30) 3,403.1](B) Microwave- ]6-1' F 2 klioule, Standing, Cfi,,iPal and najn-crifical viol0o,ws, whichdo wn rehne ;o ihe 'Fifoe, foodborne illness rlwtven6ow sand ri,skjccrors livcdabove, con b", 3-403.11 (C) Cotranercially Processed RTL Food - found in zhojollowing swfionxof the Food Code road 105 3403A I Wi I 3-50L14A) I 70`17 Within 2 llours and From 79'T to 41 'F/4�i'!` Within 4 I-ifem. e �3 5 (0) 1. 1 �(V) Cooling PHFe Madc From Ambient Te raperawre lngrediaias to 4VF/45'17 the tora', IYa) Food ( rule u 165 (AR 594) 000f ITY OF SALE _"BOARD OF HEALTH I 'e'e jfc/ ✓! Date: I Page: ­4� of Item NO: Code p Reference J�R7Reclltem C - Critical Item �'DESCRIPTION OF, VIOLATION/ PLAN OF CORRECTION F 4 PLEASE PRINT CLEARLY I A Date Verified 0 - Ca r� '9 __i7-al� C_23--�,44 1))00d,-f—Sr) r c,, &4 T 4 A -1 L. _� A.) eo j, ClIel, A) e-,_ F;� L a A fj,�. f Y-ee :ze z_ WA4 k�_- _�,r rN ;)a LA 'V� U—P C 19C'117r'� Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: Lj No --U- U as Q Voluntary Compliance 0 Employee Restriction Exclusion _t -re inspection Scheduled Q Emergency Suspension u Embargo 0 Emergency Closure 0 Voluntary Disposal Ll Other: (1/ 4/ Violations Related to Foodborne illness Interventions and Risk Factors fftoms 1.22) (Cont) M M w Food or CC i2 Adt6tives* Additnesu` 7_205. 11 ' Incidental Food C oniact. istbroamts' `7 vp6� 11 es.,ncti a t to Pe ncides. C "te"a- 7 206.12 R(xlen 13 it SeiuonS 7- 206,13 I Tracking Poi %der,. P. si Cuntrut and 3-401 IIA(])(') I F'jg,, I55`F15Sac Poisonous or Toxic substances 7-IOt.IF ; ktentil}tnglnfonnatioa--Origin,! _ Containers" 7-102.11 1 Catovion Name -- Workine Contin 7-2(}1.I I � ation -Stora ' 202.11 Re€triction Pre is nce and Use* 7-202.12 Condiuons of Use* 7-20117 Toxic Container Prohibition,{ 1-204.1 �Sa�rtiu7e,7, Crim i Chen3ic++i�s* 7-204.12 i Chemical& for Wshn v Prcxh,ice, 7_205. 11 ' Incidental Food C oniact. istbroamts' `7 vp6� 11 es.,ncti a t to Pe ncides. C "te"a- 7 206.12 R(xlen 13 it SeiuonS 7- 206,13 I Tracking Poi %der,. P. si Cuntrut and 3-401 IIA(])(') I F'jg,, I55`F15Sac 3-401. 12 Raw Animal i uiid Ccmked in a _ sliciowave 16"F * t40i.I fA)(10)) All Cather PliI7 145'T 15 Sec. _ _ Reheating for Hot Holding �-103,f 1f.4)&Q)} Pftl s Ifi5 i I r se �_ �� 3-403.11 (S) 'uficrowava 10, F 2 Minute, Stand'utn 3-403.11 tC} (omme..rcially Processed RTF Ftiod - 14(i t '-403.1 1(F3) Remaining I nonce d Portions of i3eef _ Roasts* tg__ Prager Cooling of PHFs _ l.i-Sf}L1=lAj Cool tngCookidPRFsfro nild0`Pto 70OF Within 2 flows and From 701' to 41'T/45' F7kithin 4 Hours. C _ 3-50 t. t 3(B) Cooking PHI s Made From Ambient Temperature lin; redients to 4PF745"F W-ithm 4 ihiurS ' Venotet cadent hem m thi- teftend 1919 Fotxi Co1C or 105 CM %) 000, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 !-Sol I I (A4 U l% tem izcd i tc nael aged ltu rs acid -_ Hi vet i eS viih Vvarmn t Labels" ' -SQ 1, 11 B) i�t31 i 1 fIl) Raw or P2rtiali r Coos d Abnn s1 hrxxl and k to Sc dirt urs tact Berton 3 ({'l Uno n ned F msi Pat's 'tiit Reserved * , _ CONSUMER ADVISORY __ 22. 3fiG:.l�(;ousu rner ' evisO Pnsted frig ('attsusnpdvn a1 void al I xui That ire Rain. ilrchow ,ked ca Not Othvvwiscnr(xtssrd.oEliminate In ons v r•a , o Pati _ 3-311' 13 St.�ate(rv+d Fpz= S ibstinwe foi Rau• Shell Violation m'Sectuon .590.009(A) -(r)) in catering rnobilr food temporary acid residential kitchen operations AVelld be debited under the appropriate s ction,s above if i.la€ed to foodborsic illness interventions and risk factors. Other 590,009 violations relating to g0cid retail practice. should ire debited under i#29 - Spceidl Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Ci airai and twn-crkPcal violafwns, srhkh do Ira' relate io the foodborne diness hued t owinns and risk factors listed ahww,, an be fund in the folloni-ing sertion.ti of the Font! Cods and 105 C.411? 59f,0U) 1' mmcd tic Secvict 145"T '155ec, 340I.II(Ali 2) Cvnenini to d t i>h Xfea'> k Game Animzils - 1 �'i F _ _ 340I.11(Sh 1)('T (rrh and t3 of koaisa 13U"F )21 minx ..._ 3d01.iT(e�(2) tt--------ki its -S, hi(Cl( f1 j4(Bh%S 1ti5 F 1.J 3-4 1-111AA)(3) Poaltrp, N°iid'Iarne, Stutfe YHFs> Stnifiric Cont iii , Fish Meat. _ Foultry orkathos 165"T 15 scc. * T-4_0 1-11 t C) (3 1 Whde-muedoe nacz F3eef Sleaks 3-401. 12 Raw Animal i uiid Ccmked in a _ sliciowave 16"F * t40i.I fA)(10)) All Cather PliI7 145'T 15 Sec. _ _ Reheating for Hot Holding �-103,f 1f.4)&Q)} Pftl s Ifi5 i I r se �_ �� 3-403.11 (S) 'uficrowava 10, F 2 Minute, Stand'utn 3-403.11 tC} (omme..rcially Processed RTF Ftiod - 14(i t '-403.1 1(F3) Remaining I nonce d Portions of i3eef _ Roasts* tg__ Prager Cooling of PHFs _ l.i-Sf}L1=lAj Cool tngCookidPRFsfro nild0`Pto 70OF Within 2 flows and From 701' to 41'T/45' F7kithin 4 Hours. C _ 3-50 t. t 3(B) Cooking PHI s Made From Ambient Temperature lin; redients to 4PF745"F W-ithm 4 ihiurS ' Venotet cadent hem m thi- teftend 1919 Fotxi Co1C or 105 CM %) 000, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 !-Sol I I (A4 U l% tem izcd i tc nael aged ltu rs acid -_ Hi vet i eS viih Vvarmn t Labels" ' -SQ 1, 11 B) i�t31 i 1 fIl) Raw or P2rtiali r Coos d Abnn s1 hrxxl and k to Sc dirt urs tact Berton 3 ({'l Uno n ned F msi Pat's 'tiit Reserved * , _ CONSUMER ADVISORY __ 22. 3fiG:.l�(;ousu rner ' evisO Pnsted frig ('attsusnpdvn a1 void al I xui That ire Rain. ilrchow ,ked ca Not Othvvwiscnr(xtssrd.oEliminate In ons v r•a , o Pati _ 3-311' 13 St.�ate(rv+d Fpz= S ibstinwe foi Rau• Shell Violation m'Sectuon .590.009(A) -(r)) in catering rnobilr food temporary acid residential kitchen operations AVelld be debited under the appropriate s ction,s above if i.la€ed to foodborsic illness interventions and risk factors. Other 590,009 violations relating to g0cid retail practice. should ire debited under i#29 - Spceidl Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Ci airai and twn-crkPcal violafwns, srhkh do Ira' relate io the foodborne diness hued t owinns and risk factors listed ahww,, an be fund in the folloni-ing sertion.ti of the Font! Cods and 105 C.411? 59f,0U) r "k f2f ` 0086 WHARF STREET Telephone: 745-3400 Owner: M. Management Corp PIC: Paul Schafer Inspector: Elizabeth Salandrea Date Inspected: Correct By: 6/12/2008 Risk Level Permit Number: BHP -2008-0215 Status: SIGNED OFF # 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) Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Comment: White cutting board at deli unit in kitchen is stained and scored. Resurface or replace cutting board. Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical RED BLUE Comment: Deli unit across from single fryolator in kitchen had some uncovered foods in it. Cover all food in storage to prevent cross contamination. Hose to soda gun in the bar resting on the ice in the ice machine. Provide a shorter hose so that it does not touch the ice. Owner states a call has been made to Coke to fix hose so it does not rest in the ice. Equipment and Utensils FAIL Non -Critical BLUE Comment: Employees mens room needs cover for trash recepticle. Slicer needs general cleaning, including undersides of all components. True freezer in kitchen had broken thermometer. Provide visible, accurate internal thermometer for this unit. Physical Facility FAIL Non -Critical BLUE Comment: Back door next to trash room has gap at right bottom corner. Seal gap to prevent entrance of pests into establishment. Cement floor in trash room is worn out and pitted. Resurface the floor. Owner states this is scheduled to be done in September 2008 or January 2009. Floor tiles in disrepair in storage room next to arctic walk-in. Repair floor to ensure good and safe condition. Owner states this is also scheduled to be done in January 2009 when renovations take place. One light in wait station missing protective cover. Provide protective cover for this light. Owner states cover has been ordered. There is a pipe leaking under the sink at the dishwasher. Hire services of a licensed plumber to repair to ensure good working order and free from leaks. Work has been scheduled - copy of work order from welder taken. All other violations noted in the 6/12/08 inspection report have been corrected. Please notify the Board of Health within one week that remaining violations have been corrected (excluding welding, re -flooring and already planned repairs). City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2008 ) Page I oj2 t' Violations Related to Foodborne Illness Interventions, and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2008 ) Page 2 oft 86 2064 SWd Saeean, Ata 01970 978-745-34CC - sax 978-745-7460 December 6, 2007 Re: Board of Health Inspection on 12-01-07 Mr Joseph Reale Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 12-01-07. • Hand Sink, Towel & Soap dispenser are operational per order Joanne Scott • Ordered Gaskets for 3 refrigerators, 5 arrived and installed, others back ordered • Sweep installed on rear door to dumpster area • Welder contacted " Dick the Welder" to fix sink in dish area, will come ASAP • Cooling Log used for large batch cooling • Back Flow device installed on outside faucet • Exhaust vent in ladies room cleaned • New cleanable panel and hooks installed above prep area for hanging utensils • Ordered replacement gasket for walk-in door, on back order • HVAC technician cleaned and service 2 ice machines • Management Reviewed with kitchen & Management the following: Food Storage containers kept closed at all times, and labeled to same Use of cooling log • Fan shield in Walk-in and door/floor cleaned • Spoke with contractor about floor in Dumpster area, to be repaired when we shut down in Jan • Installation of splash boards out by dumpster area in progress, will continue with this type of board thru-out kitchen Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer, General Manager, Victoria Station Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat / Type of Operation(sl Tvpe of Inspection Print: ,�r/Ahl /� /(l / ) AT Food Service ❑ Retail M Routine ❑ Re -inspection Address Ris ' AM 9 Level ❑ Residential Kitchen ❑ Mobile Previous Inspection Date: Telephone ❑ Temporary ❑ Pre-operation Owner HACCP Y/N ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) ^ 1 Time ❑ HACCP Inspector OutR " 4= Permit No. El Other Each violation checked requir s 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 ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH ..,a. ".. .....:�...m.J�. ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED;g,„, a.m'� ❑ 4. Food and Water from Approved Source _V-5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans y PROTECTION FROM CONTAMINATION 4"a ❑ 8.. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing D'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. _N3 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) -25. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S: 59014PWFSm 144a , /,?� ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities V:PROTECTION FRO@" CHEMICALS'€ ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals IMEa.T.�E.wM.a,PEaR..A- TiRs Er.,C:a.r.d.o, uLsid Foods) ,j oods)eTtzz ❑16. 1 Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ;;.REQUIREMENTSPORHIGHLY SUSCEPTIBLE PgPUt,ATtONS (HSP) i , El 21. Food and Food Preparation for HSP CON.b`umER ADVISORY,,, y -, .w a k m -IT -; a " "e SSRI ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: �� Inspector's Signature: / Print: \ PIC's Signature: f/� Print: ,�r/Ahl /� /(l / Page_(of� Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Hems 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 Drioldng Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.03(0) Reporting by Person in Charge' 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.03(F) Removal of Exclusions and Restrictions C C FOOD FROM APPROVED SOURCE Denoles critical Item in the Federal 1999.Foix) Code or 105 C.MR 590.000. PROTECTION FROM CONTAMINATION 8 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* 5-10111 Drioldng Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Sheltfrsh 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 Regulatoty Authority 3-202.18 Shellstock Identification Present* 590.004(0) Wild Mushrooms* 3-201.17 Game Animals* 3-701.1.1 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Lite it * 3-101.11. Food Safe and Unadulterated Togs/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock Identification Maintained* TagstRecords: Fish Products 3402.11 Parasite Destruction* - 3-402.12 Records, Creation and Retention* 590.004(J) Labeling of Ingredients` - Conformance with Approved Procedures 1HACCP Plans 3-502.11. Specialized processingMethods* 3-502.12 Reduced oxygen packaging. criteria* 8-103.12 Conformance with Approved Procedures* Denoles critical Item in the Federal 1999.Foix) Code or 105 C.MR 590.000. PROTECTION FROM CONTAMINATION 8 Cross -contamination - 3-302.1.1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foals* 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 Resemee of Food* Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501..1.11. Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.11.2 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitifation- temp., pH, concentration and hardness. * 4-601-11(A) Equipment Food Contact Surfaces and Utensils Clean" 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* Il Good Hygienic Practices 2401.11 Eating, Drinking or Using Tobacco* 2-401.1.2 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 5-203.11 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 6-30112 Hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name: VLCZQ./L Date: Page: of Item Code C - Critical Item -A DESCRIPTION OF VIOLATION/ PI_Ai�6 CORRECTION , , I " Date" Verified No. Reference' R -Red Item $TIP PLEASE PRINT CLEARLY Dt 4;RC(-\4, n4 1,A) t 1 5r �� A,)1?0d -L) L= L r, L�2 of :5�� '(erlr,(-c A— 41) r '1-1r�, 4— eq,-) J Ker ­h, :jDf Y-) -I) k-1 I, ha- 10 j;e 0 Lf f -r, 6 1 C e U, n, n rl )-Ac, wo J f r1J O. A-ZA !UL JD e Asx f %L o cj,2 P1 r 0 Q.2"Ae o, ff7P�o <Q& A , 4-) --,12— 4— 6 r l (I "(I,— Pr go fn) Lr Ve✓r Discussion With Person in Charge: Corrective Action Required: Li No Yes I have read this report, have had the opportunity to ask questions and agree to correct all cD Voluntary Compliance o Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to inspection Scheduled Lj Emergency Suspension comply with all mandates of the Mass/Federal Food Code -.)I understand -that I � j " / , ,- . ensign/revocation noncompliance may result in daily fines of twenty-five do r n7revocation of �7 0 Embargo U Emergency Closure your food permit. ?; Lj Voluntary Disposal El Other: rr(7' fA CX ') Lel Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont) 14 IN m 3-2U2.12 3-3 02A --Food or Color Adclinves ltlit % T4(T � TF7,k) F)) l Poisonous or Toxic Substances 7-101,11 1 klerlifying Into Illation - Original I Containers' 3-303.11(C') Contmemally Prcesied RTI-.' foKid - L-20 140'F" 140 F" 7-202.11 Restriction -- pj,'",ertoe rajd trst* 7-201E ClaididonV of Use' 7-203,11 Toxic Containers- Prollibition,4 1-204.IT Sanitizers, caiteris-chemicals" 7-214.12 Chelaicak for Wachine Produce, cliten 7-205.11_ - Incidental Food Coraim Lubricantsmo 7-206. IT cd Usc, lle,ticider. critell'I't '-- T� kil—ll I 7-'06.12 R(Xlk'Ot Bot Srltillat,' -206.13 fnwking Powdery_ Pest Control and 3-401.11 Af1)(23 E -1m, 153'F 15 F, S- Inall diate Set Vic, 145',Fl5s 3-401JIt02) i Cepa ianuted Fish, Meals & Game \nl[lal is - 155"F I7 sec. 3-401-t 1(13)(1I(2) 1 Poll. and Bert Roast - 130'F I23_n 3-401.11(A)t1) Ratite, , lniected Meati, '1.,5'F 15 "c 401 —11 (ATf Poultry, Wild Game, Stuffed 111-fFs StliffillgContallung Fis'll, Meta, Poultry or Raines-] 65"F 15 3-403.11W;(3) Whole -made. Intact Bect' SteaKIS, 14,501; t 3-41;1.12 Raw Anarml I'Valt, ca)kcd in a IC -11-1— "C'1" * 3 -40 1. 11 (A l(I )(b) I A,[ 1 Other PI IFs - 145"F 15 see —&,,- Reheating for Hot Holding T4(T � TF7,k) F)) PFIF, 165°F 13 3-403.11(1) Microwave- 165' F 2 Mirali, Standing Time, 3-303.11(C') Contmemally Prcesied RTI-.' foKid - 140'F" 140 F" 3-401 11, E) Remailarq, UnFlieed Piviems, of Heef ,)ast,* --i,--R Proper Cooling of PHFs 70'1; Within 2 Iflaaq and From 70 1` Io 41T/4i`F Within 4 lloucs, i'301 14(B) Cooling PHF,, Made From Ambient Terapeotikae ingredients o,410FM5`F ' Denotes craical Alan to lthr ledecd 1999 V(a, l Gie oe 105 CM12 590 O(Xl. 21 1 3,801,114A) UnpaNceurizcd Pre-padlmgcd ruices and Bewrjces with Warai —Wal a l!ILI Raw or Pailialiv Oiked Animal Fut ,d -rad Raw sed sproati No Served. l'—,—A P—i 22 1 3-60, 11 1 Aahcal FtN}J, That ate Raw Undercooked ci dot (ah raise Prwessed to Oinallate 3 1 taste lmd Fa, StkIlsi.ilule Ra Raw SPECIAL REQUIREMENTS ,i tf7l ViofatitJtis of, Section clotering, mobile food. temporary and rcmdcntA kitchen olm taiorts vhould be defaled under Ole appruprietc sections abuvc, if related to IlKxiborne illness inteiventionqand risk factors Other 530009 violations relating to l000d retail piacum, ihouid be debited under #29- Special 29-Special Requirements, (Items 23.30) Clitte al cerci pan-(nlecal vivledwnj, which do no; rebore to fitc filociliorne Hotess iwervewiUm,oid rW-ja(lors can be found in ilwceihtumg seclimm of the Food Code mid 105 CUR tv. ITY OF SALE BOARD OF HEALTH Establishment Name: (;4y,4 ' _ Date: Page: � of V Item Code '4 C-Criticaj Item ' DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION t Date f No., R R -Red Item I 1, 4 tft� ��I_6ASIi'PRINT`CLEAR�Y'� 4 }VerTed 0 A 1 41 Ij- 41D )_6 r�' i 'A i eA L70 fis V /'Yo ce � V <__ ell, iqE gbin79, kh IV6 AzJli Orf! AO)c 'Ce -4r4- =6 [A JL. A 4 lcz: C'G V,1 Ile 16212-- Ccz2 ;20� sm t: T Discussion With Person in Charge: Corrective Action Required:] 'Yes I have read this report, have had the opportunity to ask questions and agree to correct all Lj Voluntary Compliance ZI Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to )a/1"Re-inspection Scheduled Q Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I undbrstand that noncompliance may result in daily lines of twentyzfive dollars or duspen'dion/revoGation of 0 Embargo Lj Emergency Closure your food permit.,, 0 Voluntary Disposal U Other: Violations Related to Foodborne fitness liderrventlone and R13k Factors (items 1-22) {Cont.} -5- LL Addtiives 3-202,12 j Addiri%es,* 3-30214 rProtection from 3-501.1 S Poisonous or Toxic Substances Iden 151 it Information - Original 3-401.17(§)(2} I Cojltafijldrsx /-loll](ourmonName - Ydork'a�- 7-201.11 Se ararion -I toi a e* 7-202.11 ReArictio.in - and 7-202,12 Conditions of Uu.* �0111 'Foxic Confainel" - Prollifirtions'a 7-204.11 Samtizets, Criieria -- Chemiuls"' 7-204. 12 Chenkicak for wasbnwjlnijitce, clitetial, 7204,14 DrIjitit! is. Criteria, 7-205,11 Incidental Food Contact, Ijibi.aauvtsx 77-206,11 Rvslriciad Use PeAcidei,, Critem* 7-206A2 Rodent Bait StallOM" 7-206,13 Tracking Pfmdcm Control and HUT* -f Food or Color I I)eii(ae, critical Item is the fealfrai N09 Fop(i ("'gle or 105 CNIR YM 000 3-501.14(0" -3-a2-01-t iA( I i(2) 1-40LII(A)(2) Proper Cooking Temperatures for PHFs Fgy- 155`F155 F7,,a,- howediate Scrvica, 145'fil 5fev Camacnitted Fi�h, Meats & Garne Annuals 1�11-' 15 sec. AC,Wrdi ng to Lav, Cooled to ,l-4 )I�,f2� Park and B eci Roast in 130" F 121 nan 3-501.1 S Uxdjm,MUxatls for PHFs PHF Hot and Cold Holding 3-401.17(§)(2} I Ratites, lrijcined klcats - 155 T 15 ,590 k(g(Fl 41745° F' 1 [fill IIHFs Ntriml armid at or above sec. 3 461, 11 (fk)t3) Poultry, Wild Game, Stuffed PHFs, SniffingConlainina Fish, Meat. Poultry firkaftitoa-16YF 15 sec. -,-1n7- 7-V-hT7a.01r, Rej Steaks N if e ni 145"F -401,12 Raw Anintal F(",Is Cooked in a Aclowave 165P , 3-401 II(Ar(l)(b) All Other Plif-s -- 1451� 15 sec, L!7 Reheating for Hot Holding T 10 3711 M libs 165'F Ii 3403.11B) Microwave- 165' 1,- 2 Minute Standing 3-403.11(C) Time" 011uummally Processed RIEFvod - 14Q'Ft 1(t) I Remaining Unsheed Portions of Bmf Roalt" 28 Proper Cooling of PHFs 73SZT 740�) Cool] ing Cook�,d PHFs from 14W F to 70"T Within 2 Hours and From 791' to 41 F/45,F'W,.Ihm 4 Houm 3 MI . I 4(b) Co.oling PHFs Made Front Ambient Inisredients to 410P/45`F 1Vltbin4 HouO I I)eii(ae, critical Item is the fealfrai N09 Fop(i ("'gle or 105 CNIR YM 000 3-501.14(0" PHFs Rto6wrlatTemperatures AC,Wrdi ng to Lav, Cooled to I1 `F/45"1 Within 4 Hours. 3-501.1 S Uxdjm,MUxatls for PHFs PHF Hot and Cold Holding �-T(Y 16 (B) CAd PHFs Maintained at or belvw ,590 k(g(Fl 41745° F' 3 t01,MA) [fill IIHFs Ntriml armid at or above IAIOaw * 3- 501. 16(A) Roasts Held at ix above 130°F. Time as a Public Health Control — ----------------- I-� — 3-501 .19 1 Time as Public Ilea.1da Control' 21 1 1-801,11(A) I Unpliqlcurizcd Pre-packaged Juices and 22 3-60 I I COIDAcom Arivisory Posted for Coivarnaption "la'Imal Fond That are Raw, Llrader")kcd tar Not 011wrw ise Prowossed to Eliminate I'ladmaens.. SPECIAL REQUIREMENTS 590 009(A3 -M) Violatjow; of Section %900 O(A)-(D) in catering , mobile food, lemporary and residenal kitchen operations should be 6clolied under the appropriate sections above if related to Rx)(11borric illness interventions and risk faclors Other 5,9 {X39 violations relatint, to flood retail practices should be debited under fi29 - Spovial Reqtikcinents. (items 23-30) Criewalaoid wai-,,roiral vif,fafions, i4dch do trot rebate to the fiiodborne illness uttcrveretfnnr rztid riskjactors livied abovv, (fill be. found in ihefifiloil 'lig Yel-tiorts *J,,hc Faud Code and 105 CUR I I I 11lz z,, Establishment .`JIG'S Jri/ (;jUj C�Jc en Our?, � CITY OF SALEM BOARD OF HEALTH .,I/— Date: 1417-131-_ Page: 19' of Item Code IC- Critical Item R-'Redltem,,,, DESCRIPTION OF VIOLATION / PLAN OF CORRECTION A, INT CLEARLY' PLEASE PR DatesReferen�ce: 0 W 0 J, D./— 0/7, Ln AJS�, J fe – 471-1 1 bN 17(l i�(-/ re -�10.,XWo ,e -qc C.H1 1 4- /V r i7o- rn✓zl Pe -ab dv-ulna;- fe--S, dd 0 Cz bkCeob� 6"iG -L he cj- C,90[C�1--OU49 V V fe d C 5 ZFF k 3Xe we4y r:0P(.)-/ b-sf� (cf& 1-2- Oa�— Affn),od Oj ALo) vu� iyl) da4 5),jcce .e/L)P,,Cd:j 4 )w.-5 Discussion With Person in Charge: 'Corrective Action Required: I have read this report, have had the opportunity to ask questions and agree to correct all u Voluntary Compliance L:l Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to Re -inspection Scheduled ❑U Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars - suspension/revocation of o Embargo ci Emergency Closure your food permit. U Voluntary Disposal LI Other: -e).- Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont) PROTECTION FROM CHEMICALS hf Food or Color Add941ves 3 -20TE I AddAivc,, x 351hZ14 4 1 �F/4-5",F Wiflvin,t Rvans, 35 -�_Poisonous or Toxic Substances 101.11 idelaitying lidb; Inaiiiin Original Tsm cmajhers� 1 7-1U2 11 g7tciuuner, 7-201.11 seas 'atlion -- St r 1-2)! 11 Rett,,ic6ort - Presence and Use* 7-201.12 Condilions of UISO* 7-303.11 Toxic Cssnairiars - F `7 -704. Vl F-, -204 112 Santo lets erre to --- clteloics' Chemicak for Wash�wcj Ciiteri 204� 14 Drynij, Aeent�, Crne�jja�, -205A3 lachh"total fsods ant a I-All-ai'ants " '0G.1 ) I Use PeAcIdes , critedn' 1 7-2406.12 RO h i 13111 -Stiullnl- I I? ?206 1 -, liacknks4 Pooklvc,;. A,Isi Control and TIMErrEMPERATURE CONTROLS 16 Proper Cooking Temperatures for PHFS 3-401 A iAiih(2) 1 El,,P155 c' 15 S Lmtt�-er icv 145"'Fl5sec, ----- 7 401 Comouni0ad HNla, ffeats & Giumv Animals 1,isF 15 see -401 11 B)a ly2) 1 roti and BetoRoa�o - 130" F 121 urine I I I (A)f 2) i Reines, Agit ut� Mckitt, - 1 55"F 15 — ---- I 8,00. 3-40tJ 1 (A)0) PooPi , Wild Game, Sinfird PHFsi', SIuffimlz Cont imqoFish, Isleat, Poultry or kavtcs-165"'F 15ycc. Whole-musde, in arca leu JSicak�, 3 401.62 R7m Animal F( )& Cooked to a Nlicrowaw 16 F }�b) rM! Otliet PHF< 145'F 15 qec, 17 Reheating for Hot Holding - -- —D) _PF1, - TV6-5-171-51se —cl- T403 11(13) Nfico)wavc- 10, F2 Nlowi,Stutrdint, 3-463.1 I Coatmervi ally PiwesssdRTEKiod 3-4f)3.1 1 (F) Remun., Upsheed Portions of ficer Roast;t 18 Proper cooling of PHFS TiluI l 14(A) �Uoxding Cooked PHFr [rsnri 14WF to 70'F7 Within 2 ffour< and From 70F u) 4:'T'145'F Wninu 4 Houis, 3501 1 M(B) Coofiikg PHFs Nlit& Front Ambien! 'fa parware liontedienta to 411,145`F Within 4 fl,mrs-s 19')9 Forx9 C,Kle,r 705 t:MV, 5415 000 16(A) Citrtsts—Held It, or ibove 130"F. 1 Time as a Public Health Control 33-501.19 I riaw a, a Public, Health Control' REOUIREMEWI 9 FOR HIGHLY SUSCEPTIBLE 21 1 3-8MAI(A) I 3-801 1(D) R ry )r Palliallv CwKcd Aniiiial r(ax! awl Raw S,,,,d S, outstseYsclvted. 3-8(;j llsc� 11nonened Kxxf Pirckaiw No tie -served. 22 33 -ti(? 11 14rColisump uf M 011 Armpol RKiti, Pisa are Raw, Undercookcd c,; Not Gitlwm i�e Pr(xe.qs&,d tai ildtona(v -;0113 l Paste tinfA Flgga Subsuluot R)i Hem, Shell 590 (t)9(A)-(T)) I Viokincvs ofSee0on 5()0,00%A).(D) in I Catering, mobilo fosid, temporaiv and. tillsideal5al kitchen opelations should the debited under the appropriate sections alkive if related o) ftes)(11home illness Intel ve"Idnell and fist. factors. Other 590,009 violarioim relarink to good rcI0 paiwitces should be debited under 1#29 - Sp,,,.ehd Requirervients V10KX 151VSRELATEDT5Gcg:HgqETAxpRAmcEs -S (Items 23-30) Crit "Iiaild violapomy' whh:h do na; r,("hne "o the foodborne tint ss inwi vewiowund n4joszorc listed above, s,m If: found in the - fijiloit4og . er.,tions of ih, Food Code wid,105 CAIR I W'if "e,_ According to Law Cooled to 4 1 �F/4-5",F Wiflvin,t Rvans, 3-501.15 coolota Nlednids for IFit —16(B PHF Not and Cold Holding 'Toid —Pflf—1vb11-1,1v Tsm mwnk,—,,,Zat 590,00A(F) 410/4e" I" 3-5(11,16(A) flol 111f0l" * 16(A) Citrtsts—Held It, or ibove 130"F. 1 Time as a Public Health Control 33-501.19 I riaw a, a Public, Health Control' REOUIREMEWI 9 FOR HIGHLY SUSCEPTIBLE 21 1 3-8MAI(A) I 3-801 1(D) R ry )r Palliallv CwKcd Aniiiial r(ax! awl Raw S,,,,d S, outstseYsclvted. 3-8(;j llsc� 11nonened Kxxf Pirckaiw No tie -served. 22 33 -ti(? 11 14rColisump uf M 011 Armpol RKiti, Pisa are Raw, Undercookcd c,; Not Gitlwm i�e Pr(xe.qs&,d tai ildtona(v -;0113 l Paste tinfA Flgga Subsuluot R)i Hem, Shell 590 (t)9(A)-(T)) I Viokincvs ofSee0on 5()0,00%A).(D) in I Catering, mobilo fosid, temporaiv and. tillsideal5al kitchen opelations should the debited under the appropriate sections alkive if related o) ftes)(11home illness Intel ve"Idnell and fist. factors. Other 590,009 violarioim relarink to good rcI0 paiwitces should be debited under 1#29 - Sp,,,.ehd Requirervients V10KX 151VSRELATEDT5Gcg:HgqETAxpRAmcEs -S (Items 23-30) Crit "Iiaild violapomy' whh:h do na; r,("hne "o the foodborne tint ss inwi vewiowund n4joszorc listed above, s,m If: found in the - fijiloit4og . er.,tions of ih, Food Code wid,105 CAIR I W'if "e,_ .4 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code I understand that noncompliance may result in daily fines of twenty-fivedoll rslor/suspension/revocation of your food permit. �� U Corrective Action Required. ❑ Voluntary Compliance ❑�Re-inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ No I giYes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: CITY OF SALEM BOARD OF HEALTH /I Establishment Name: Vcr In /I Sfin�=n�� y�L� Date: lh IL-11- 116) --1- Page_ of ( 1 Q Item Code. ,a ;c -Critical item ,;,� i ; �;, ,� .,r- , DESCRIPTION OF,;VIOLATION /PLAN OF CORRECTION. '2,4,F� " t- Date: - No. !Reference ,R - RedItem ,,, ' ` - - •74 - -. A a9r � �.- o.PLEASE CLEARLY a �. `' +''*°'^ ` .. <= � 25� Verified,. 1Nn k�-'"Y+�.� )PRINT I .4 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code I understand that noncompliance may result in daily fines of twenty-fivedoll rslor/suspension/revocation of your food permit. �� U Corrective Action Required. ❑ Voluntary Compliance ❑�Re-inspection Scheduled ❑ Embargo ❑ Voluntary Disposal ❑ No I giYes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (Items 1-22) (Cont) 101#11441M.7104MUMMUNEM 1=4 — Food or Color Additives Connairined Fih, - 4cius & Ckruiv 3-20)112 AddhivcO 3-461.11(H)(1)(2) 3-301 14 il:E—Acet � —1m, protection front Us 1 J!211 L LS_ 7-101.11 _Nn Poisonous or Toxic Substances I Identify .. gintonwtuon Ongural 590,0041"l_ Fisb, klvat' 3.50L14(B) — Poultry or Ratites 105"' 15 sec. lk 7162.11 1 Common Name - Workitu, Container,* TR�rw 7-1-01.11 7.202.11 �lursoon - She it e* Restriction -- pres"irct, will Use' Amrvst 1-11"I'Ll clooked In a 7-202,12 Conditions of Use" 3 46 1, 1 7-20111 rr''-204.11 Toxic Connameo - Prolkibitiorvtl Sanitimrq, crueri;l - chclniclils' Reheating for Hot Holding 7-204.12 Chemicals for Wivrhit~ Yroth ceclitelial 1 (B) 7-204,14 Dr 11T 'IAXLCMs' Criterm" — — ---- 7-201TI Ui-1 Incidental FIIXF'olt7lti. 1Tir11 Mi. 7-206-11 Rogricled Use PeNticides, critel nt", 7-406.12 Rctleril 13�lit siationO 7 206-1't j Ira. -king Powd rs. Pesti Control and Monilmiln­ 0 E9rg - 155'F 15 Se, 1 3- 403,1 J (C) i Commelcialiv provessed RTE Kiltid T2,_�)kl Connairined Fih, - 4cius & Ckruiv Amunals - 155F 15 sec. 3-461.11(H)(1)(2) Pott. rind Seef Roast - IRTF 121 lrlm= 3-461.11(A)(2} OxAing Cookr,,d PRFs friall 1407T, 3-401 I i(A)(3) Poultrg, Wild GansL, Sturfed PKFs, 590,0041"l_ Fisb, klvat' 3.50L14(B) — Poultry or Ratites 105"' 15 sec. lk T-401 11 (C)(3)'M sc I e. Intact fleof S teoks TR�rw IL45"F 12 Amrvst 1-11"I'Ll clooked In a Micill,;Navc 165F * 3 46 1, 1 ,Ml Other l'IfFs - 145"F 15 sec, Reheating for Hot Holding 3-10+1 i(A)&1B1 PHI-, 16511' 15 sec. 1 (B) Microwave- 105" F 2 MqnaSumzly 3- 403,1 J (C) i Commelcialiv provessed RTE Kiltid 3 -403 11 (H i Remaining Unsheed Portions of beet Kooits* 3-501,15CtxIm- Proper Cooling of PMFs :f -50L 14(A) OxAing Cookr,,d PRFs friall 1407T, 1-50! 16(B) 70'f: Within 2 Hours and From 70'1' 590,0041"l_ ill 41 �1`145'F Within 4 Hours. e 3.50L14(B) — Cooling PHFs Made From Ambient Temperature Ingredients to 4111745T * Dcri"te, critical tielli is the fi-fler'd NIN Food ClAe or 165 CNfR 590 900, -501.14(2 PJIFs Received at feomerauures According to Law Cooled it) 3-501,15CtxIm- Methods for Mills PHF Hat and Clain Holding 1-50! 16(B) Cold PIfFs Maintaringi at or behrit, 590,0041"l_ 31745` F-__ I I N A) [fill pflFq Maintained at or above i At, !V Ro;ists Held ai or above 1301, Time as a Public Hwfth Control 3-501,1 I Tialt, as a Politic Health Control REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 3-80111(33) UsroftlastelnzM_f 3-801.1l(1)) R�iwkxPaitiailiCooked Animal F(xyJaid ir7 7I nRnaA r; .. j P { -S ..... . s ­ j in marl r 22 360' 11 !U)illi�lj F'_Kld< 'j_hln are Raw, Urelciall)ked ill Not Othef wise Proce.qsed to Fliminate 301. 13 Pulte urlzWd Egg, Substilmie far Raw Shell SPECIAL REQUIREMENTS Vilelllalions of Sectiipcia 5911NMA)- (D),in carn, mobi1c. hxrd, temporaiv and _�91 -""T g - residential kitchen opei aflimis should he defined under the appropriate seeficiiis nhuvc if r0wed to fiXAN)rfle ilhrcss iriiLet've,fitioiisand risk facit)rSL other 5,91f009 violations relating to gold retail p;actices should be debited under #29 - Special Requireflizlits- VIOLA TIONS RELATED TO GOOD RETAIL PRACTICES (Ftems 23-30) C,riiv'21 aild tion-livicia vw1alemi, tAlfich do ian relate in the "friodhorm: fllge." 'w"'i verniorvand rokjal sors 1;vied above, (on be. found in olf lhe Fuad Code and 105 CAM ','u , ; , L , a . , e Sd.: CITY OF SALEM BOARD OF HEALTH / /^ ((! �J4Page: �r of Establishment Name: If f c�r" 6f' � �,h I�it �c.�� Date: I -Item Code C - Critical Item 9 DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - z < Date. Verifled'� No ..®.. s Reference R=Red item ; � . •� a �.�t o & -�+ x +_ �'^- ^� -i.x ^z e �^ ` _ _. 7 4" ry=r�.,.t 'k =`-w3'f �� c 'rte �"'� `��`'� '� � PLEASE PRINT CLEARLY f �L ac Sa�� - �� . = /-i- 0, / k - , , - � r I JA Oa,lC6CP hi-ov—/I L» it L «, 0 2 ef C a^5.V1 1 93 Jl. 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 dgg�����p'ension/revocation of our food permit. 0 Corrective Action Required: ( ❑ ❑ Voluntary Gompliance Re -inspection Scheduled Embargo ❑ Voluntary Disposal Yes ❑ Employee Restriction / Exclusion ❑ Emergency Suspension ❑ Emergency Closure ❑ Other: Violations Rotated to Foodborne tltness Interventions and Risk Factors(lietns 1-22) (Cont) 25 m Food or Color Additives 12 i Additiees* Additives* Poisonous or l oxic Substances 7-(01.11 ! idem'ifynzgSni2innation-0riginal __ ! Ccnitaluers'" __ — -r I 02.11_ Common Name - A orkin& C-2at__ t_iim 7-201.1 1 S.a . ars.ticrn - 5t<rrageT` _ 1-2011 Restriction- Presence and tile* 7-102.12 Conditions of 6so" �- 7-2(-.11 Toxic Containers._ Piohibinom* S:mieizets.Ctite;i:�-_ChcnucAs*_ J2 Chemicals for tn'echan 'uc , G_ 71-204 14 Dnnn eat raerir 205, i 1 Iniad, alai t xxl C ort ct Lu1v antic' 7 20&.1 ( fZesuuted t5e Pe nudes- Catetza* 7-206.12 _ 1 Rodent Bait Statists 7- Q6.73 I nicknt Posvders, Pvst Contras and im 3 401.IIA(I)(2) i.ggs- 155"F 1.5 S -e. "-C-iotnmtnmed 1. i <_Inuuudt tri. Servicz 145 F1.5sec, 3-401.II(A)(2) 1 tSh SSeatc t. Ceallle Animals . } zY'F 15 sec 3 401 1?(A;(1}!2} Pot and l3c'ef (toast - fzQ 1 123_min* � 3-401.11(A)t2) Ranter, laject€xl bleats 155"F 1.5 _sec, T461.I1(A)0) Poultry. wlid Game_ Stnited PtiFs, CniRrngContaining Nish Meat : Poult�' Itaote$-165'1` 15 sec. .3-901.I! (C), 3) Whole -mi sole, Intaca Beef Steaks 145°F * _ s-401.12 kis Aninrae} }euxis Cooked in a bliemwave 165'1' * _ 3-46TA16A!(11(b)� Atl Qthes PHlrs-- 145`F 15 sec. Reheating for Hot Holding — 3-�k03.21(A)&,(D) PEiFs I65'T M sec. • 3-403.1,18) ;uficsowave- 165' T72 Maine Standing 1-40111(C) CominexcialiyPioceciedRT'ERaid l4i}„f;.x 3-203.t!(E) � Remaining;Cans}icedPortions oi'13eei' Proper Cooling of 3-5 (1. fdlA) �Cooling Caked 1`111's from t4t)`Ftr 701L Within 2llcw s and Fn'ons 7C} 1= _ tn4P1•I45`FATf33n4Honr. * 3-501.14B) Cooling i?HFsMade From Ambient Temperature Incredienta to 414,145�F ^ Desv te. critic 1 Hem In lf-� 1011en'! 1999 Ft 1 C d � cr 105 CMR 590 (9)0. REOUIREFMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3-801.11(A) ItinpasteuTized Pre-pn<:}:aged Juices and i-801 1)fB} `1 i;�t ut Pa zazinrcd t,. �s.'� _ (i h'�ev, our Pan ti all Cue�n } Anurias F<x asci o, Sc d v ,Touts Net Serw d ' i -Blit I S (C; L,rnne ned Pox} PPackase salol Re -served. ” 22 3-60,,A I ConsuntUr At;viso c Pt to fist trntsatnittion anim IIix,& f1w art Raw. Undercooked et Not ()drelwseRnscasl oi:Imt3nate -302 11 1 P &stem i zil t-i.k':: 5 ibsdunu for Raw Shelf SPECIAL REQUIREMENTS _ U)vTiiahzns m &S cion 90.003(.A) -Qi) in catering, mobile Rxxt, temporary and resident ai kitchen op xatic$is should be debi ed under the apprupt9 rte sections alxise if reialed to f(xxltx)rne tltness nterr'enttons anti risk' factors_ Other 5905}09 violations relating to good retail p acticas should be delated under #29- Spu tat Rquirccn mts. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (items 23.30) Criu(-al and non-croh:at viourtimo, which rlo ,no; redare to the foodborne illness ituerventions and ricd-foelors listed above, can be found in theJoihea-mg wroions of fne Food Code and Jos C.111? Temperature Incredienta to 414,145�F ^ Desv te. critic 1 Hem In lf-� 1011en'! 1999 Ft 1 C d � cr 105 CMR 590 (9)0. REOUIREFMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3-801.11(A) ItinpasteuTized Pre-pn<:}:aged Juices and i-801 1)fB} `1 i;�t ut Pa zazinrcd t,. �s.'� _ (i h'�ev, our Pan ti all Cue�n } Anurias F<x asci o, Sc d v ,Touts Net Serw d ' i -Blit I S (C; L,rnne ned Pox} PPackase salol Re -served. ” 22 3-60,,A I ConsuntUr At;viso c Pt to fist trntsatnittion anim IIix,& f1w art Raw. Undercooked et Not ()drelwseRnscasl oi:Imt3nate -302 11 1 P &stem i zil t-i.k':: 5 ibsdunu for Raw Shelf SPECIAL REQUIREMENTS _ U)vTiiahzns m &S cion 90.003(.A) -Qi) in catering, mobile Rxxt, temporary and resident ai kitchen op xatic$is should be debi ed under the apprupt9 rte sections alxise if reialed to f(xxltx)rne tltness nterr'enttons anti risk' factors_ Other 5905}09 violations relating to good retail p acticas should be delated under #29- Spu tat Rquirccn mts. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (items 23.30) Criu(-al and non-croh:at viourtimo, which rlo ,no; redare to the foodborne illness ituerventions and ricd-foelors listed above, can be found in theJoihea-mg wroions of fne Food Code and Jos C.111? 86 `0164 Shed Sa6em, .MQ 01970 978-745-3400 — 9ax 978-745-7460 November 27, 2007 Re: Board of Health Inspection on 11-17-07 To Whom It May Concern: Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 11-17-07. • Prior to inspection plumber was contacted about toilet in employees bathroom and sink drain in dish area, also installation of hand sink in prep area ordered per Joanne Scott • New thermostats installed in refrigerators that needed them • Ordered Gaskets for 3 refrigerators • Floor, Walls & Ceiling cleaning with degreaser and fresh water done the week of November 26 • Drain line replaces for ice scoop drip sink • Ordered replacement gasket for walk-in door • Investigating purchase of plastic (PVC) peg board for installation ASAP • HVAC technician called to clean and service 2 ice machines • HVAC technician to clean and replace all filters and in line filters for H2O lines • 2 Sanitation logs re -instituted for dish machine and the sani-buckets and knives • Pot sink area cleaned and staff instructed on use of log for sani-solution • HVAC contacted about new bin for ice machine or repair • Shatter proof light bulbs installed at salad bar • Repair of interior of ice machine bin completed • Have spoken to contractor about sneeze guard at end of salad bar being installed ASAP • Back side of Convection ovens cleaned and painted • Exposed pipes above prep area cleaned, sanded and painted per Joanne Scott 9 Installation of new soap and towel dispensers behind bar • Walk-in cleaned, shelves removed and cleaned fans removed and cleaned • Hired contractor for entire kitchen painting to be done mid Jan 08 • Re -grouting of floor areas started week of Nov 26 • Management Reviewed with kitchen & Management the following: Food Storage containers kept closed at all times, and labeled to same Silverware storage reviewed with front of house staff Use of sanitation log Procedure for when a can or container is found dented or damaged Proper hand washing technique used and washing of hands after changing of gloves Proper storage of clean utensils Wiping cloths and sanitation solution usage Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer General Manager Weekly Kitchen Cleaning Monday • Salad and dessert remove all shelving from refrigerators and clean interior Tuesday • Clean all walls on the main line and prep area including 3 bay sinks Wednesday • Organize Walk-in, dry storage, freezer. Thursday • Clean inside and out of salad and dessert reach-in's and sink in salad area 11 Friday • Clean all soup pans with scrubby( inc other pans that need it) Saturday • Clean in and out of ovens, and slow cooker Sunday • Clean all hood filters and back wall behind grill and top of the oven. Closin Kitchen Checklist Complete closing count and submit to MOD Drain and properly ice all seafood condense and wrap all food items, fill pans if necessary Organize and check temp of the reach in slow cooker cleaned with soapy water inside and out. Change over all steam table pans ( hot and cold) Drain, clean and dry steam table and counter top Remove all debris from ovens and scrub bottom Clean fronts and tops of ovens, check for loose paper and towels Brush both sides of the broiler and the back Clean and replace broiler pans Clean and replace all hood units. Strain and clean fryolators. All ovens off, check to make sure pilots are still lit. All fryers off Broiler off. Clean all walls behind broiler, carve area, spice shelf, etc.. Clean Microwave inside and out. Scrub stainless behind stovetop with soapy water Clean and replace pan under stovetop Clean and replace all saute pans Clean and wipe spice shelf and return all unnecessary items to dry storage Clean prep sink and prep table make sure all faucets are completely off. Clean and sanitize all knives Clean all pull out drawers and remove any debris from under and tracks Remove mats to the Mop sink area. Remove all garbage to dumpster. Shut off exhaust fans ( red button above prep area) Date: Manager signature Cleaning and Maintenance List 11-10-2007 Back of house: Base Tile by dish machine missing and fix hole in wall. Base tile missing by carving station. Paint ceiling and walls in kitchen. Replace tiles on floor by the grill. Replace gaskets in drawer units and fridge units Clean and paint sundae glass rack by dessert area Walk-in door gasket needs to be replaced Salad cooler needs new racks and floor needs to be replaced or something Clean all shelves including back prep area( under slicer) Floor by beer cooler and freezer coming up needs to be replaced. Victor is cleaning walkin and freezer. Store extra pans we are not using for the winter out back in train room. Check and order replacement thermometers for all freezers and walk/reach ins that need them. Grease unit on back prep area leaking. Both Salad and line ice cream freezers cleaned Fan guard on salad upright unit next to 2nd ice machine needed to be cleaned Ice machines cleaned thoroughly Clean and paint all shelves in dry storage Remove ALL non-food items from dry storage including bleach, rock salt etc. Toilet needs to be secured in Men's room Both employee bathrooms to be cleaned out thoroughly Mop sink area cleaned and painted Organized electrical room remove umbrellas ( back train possibly). Steam table drains need to be fixed, pans covered at all times Broiler condiments need to be moved ( onions, mush, BBQ and Teriyaki) Bacon to be kept at 135 degrees. Rice and Potato warmer at 135• Sanitation solution changed every 2 hours and PH log done consistently Spice racks and all shelved cleaned nightly Hole in Pantry ceiling needs to be repaired. Check Duct tape repair job in pantry area Under range top needs to be cleaned Kale and Cabbage needs to be kept cold ( iced poss) Potato rack needs cleaning. Slicer needs to be updated to a 3 sec blade stop. Front of house: Re -organize to -go area clean shelves & get rid of anything that doesn't go there. Organize liquor room again still lots of junk back there. Wooden stand up beer cooler behind bar needs to be cleaned thoroughly. PH strips need to be used for sanitized water behind bar and recorded in a log. Speed rack behind bar to be cleaned (front and inside) Ice bins cleaned thoroughly Re -organize area under soap dispenser in the busstand ( no food product under soap) Organize & clean all shelves in bus stand. LIS bus stand shelves cleaned and all condiments brought to early side to get used. All S & P shakers cleaned All sugar caddies cleaned. Temp check for front and back of house (FOH including salad bar, soup warmer, etc.) _ 2l as �-eea�iliivz o-�nzeeLih� tiie/z,�a�ed9aaiza����ar�2e2��-ov cevG�aaCior� 1ea9 re R1--"-eI PAUL E. SCHAA' ER ✓W� r%9i�a4wl?, CERTIFIED PROFESSI®NAI, FOOD MANAGER TM b Exam 1501 Recognized By Conference For Food Protection uraCiz a��v.1, �aiwrl are%u-ia���v ^ t�ies^ecurta a/yaer-Gauzeir�. 1 Douglas F. Campbell, CFSP Certificate lssued:10/10/01 _______________--___�--------- ----------- Experior Assessments Congratulations! You have passed the National Score Report Certified Professional Food Manager examination. Your name has been added to the National Registry 6 of Food Managers. Congratulations! You passed the National Certified li Professional Food Manager examination. Enclosed j I, is your wallet certification card. PAUL E. SCHAPRR C Your Score is as follows: Score Status Exam Date 85 PASS 10/10/111 This is to cer_tc/y that EAUL' �r`SC�IAF'ER O r has met the-necessaufi ments for Food Ylalc er Cerizfleation j .0 ij Ezam 1501 2ecnY�ginzcd By Conference for Pond Protection SSN #x)15 42-1Q6111118 ExaI Ate: 10/10/01 Experior Assessments' (800) 624-2736 600 Cleveland Street, Suite 900 (800) 624-2736 Clearwater, Fl- 33755 Fax: (727) 461-1974 EXAMMAMN FbkM NO: _.:. 2019 ......................_... _. ........_............_. _.......... .........._........._................._......__......... .....__.__...... .....-. .. ... _. ... _............... ..._: TO RYAN MCCARTHY far successfWy completing the standards set forth by the National Restaurant Associalien Educational Foundation tar the SefvS" Food Protection Manager Certification Examination, which is recognized by the Conference Sar Food Protection (CFP). Presented fife the National HestaurantAswcialion Educationai Foundation 12/17/2003 DATE OF EXAMINATION 12/17/2008 DATE OF EXPIRATION Cho" wM yutx IoGccaW heeaaakhh 00ParOwnl for Their 3Pec9lc mgvmmeMa MARY M. ADOLF PRESIDENT AND CHIEF OPERATING OFFICER NA710MAL RESTAURANT ASSOCLATION EDUCATIONAL FOUNDATION am DIWaolarurdfBsllenlAr.B,rA Fan� 0�9]m i0.m1P L National Restaurant Association EDUCATIONAL FOUNDATION < ,k ew.nracf Urk r "/aillargeon Pest Control, Inc.w RESIDENTIAL COMMERCIAL "Your Personal Pest Control Solution" Date 9 / _ Time In *" o ' ..- Time Out t Service Technician Route Nurnbei 001 Stale License # ❑ Yes ❑ Na " ❑ One Time Charge ..- t ❑ 60 da y Billing Address ❑.Residenti@tM} . "' Service Address - Name ❑ 90 days Name 1/1",d e' J C G -t• ^9. ';'y �'S^t,�.' ''C[]jCommercial ,i r E] Ants ❑ - ❑ Address ❑ New Start -Up _.❑l......x..�.,.�:«... ❑ Bees ❑ AddressrI- ` ell -/e Y ~=/-''"� L City State Zip City State ✓r.%'f°JJ Zip '1,.' ^ • ir"a..'rr - ".,. ..... �,=�,;.r.'. - /k'i'rt.("'.d.-+.%roc - r. r r �, i /, �Jr `>S'i��,=�_ %=t .r. (-%;.v-a'�l �I�?,!)Ctl`/= Please Remit Payment To: Baillargeon Pest Control, Inc. P.O. BOX 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 SERVICE REPORT / INVOICE/ %" pa Telephone Service Charge Telephone - Weather Condifions�EfClear ❑ Sunny ❑ Windy ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature WARRAMY - TYPE OF SERVICE- METHOD OF APPLICATION TARGET PESTS ❑ Yes ❑ Na ❑ Weekly_ ❑ One Time Charge n. �.•'[`�ARofien(" ❑ Fleas' ❑ 30 days ❑ 60 da y ✓•°"xc+'❑'Month) y >v-,•�" ❑.Residenti@tM} „]Cockroaches ❑ ❑ 90 days ❑ 6 months ❑Quarterly ''C[]jCommercial ,i r E] Ants ❑ - ❑ r ❑ New Start -Up _.❑l......x..�.,.�:«... ❑ Bees ❑ Pest Activity: ell -/e X- Customer Signature f°'_�-- 97 Kitchen: '1,.' ^ • ir"a..'rr - ".,. ..... �,=�,;.r.'. - /k'i'rt.("'.d.-+.%roc - r. r r �, i /, �Jr `>S'i��,=�_ %=t .r. (-%;.v-a'�l �I�?,!)Ctl`/= Please Remit Payment To: Baillargeon Pest Control, Inc. P.O. BOX 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 SERVICE REPORT / INVOICE/ %" pa r .rr;. .;. �•./ Service Charge GO - Dining Areasrd a r a v - `�l Bar Lounge: Storage Areas r �:%•� fj Be ement: r m-- < j'� f" ''� i'✓ t! % - - SITE TREATED METHOD OF APPLICATION ! xJ .a TARGET PESTS - r11��'r cTl- .,;, r= f, ..� ' , Ga .�e"(+` �' < r "r F -'J'': f ✓�r ,r,-'" � , . ,�:., i ,� - ^�t'' T7l}. ['c,,.. ^d— a7..T;> p-f!<'�� Av 1 e � f"l J G.1 w /i'"�l�! ,li...e. Be ement: r m-- < j'� f" ''� i'✓ t! % - - SITE TREATED METHOD OF APPLICATION ! xJ .a TARGET PESTS - r11��'r cTl- .,;, r= f, ..� ' , Ga .�e"(+` �' < r "r F -'J'': f ✓�r ,r,-'" � , . ,�:., i ,� - ^�t'' T7l}. ['c,,.. 'S' C $1F, '../. a7..T;> p-f!<'�� .. Structural Deficiencies: ^ % j { ✓�+ 1 �' �' 7r<VI r firs Exterior Conditions: MATERIALS USED EPA# AMOUNT USED % - - SITE TREATED METHOD OF APPLICATION AREA -VOLUME TREATED TARGET PESTS ,.%E(r��f•°=3+i rrx� � 7U` % �:,%1 �! y� ^�t'' T7l}. ['c,,.. 'S' C $1F, '../. a7..T;> p-f!<'�� ti firs X- Customer Signature f°'_�-- 97 ACCOUNTNUMBERINVOICE NUMBER ) ? j r t' '' � �� 1 1 1 Q Please Remit Payment To: Baillargeon Pest Control, Inc. P.O. BOX 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 SERVICE REPORT / INVOICE/ %" pa AMOUNT DUE Service Charge GO Added Service Sales Tax Total Amount Due _;) COMMERCIAL r� Uilo f r. Tinto In r _-- Time Out Weather Conditions ❑ Clear ❑ Sunny ❑ Windy WARRANTY - ':Tyl ❑ Yes ❑ No ❑ Weekly.... ❑ 30 days ❑ 60 day. ' ✓ ❑ Monthlyy i ❑ 90 days ❑ 6 months - ❑f Quarterly ❑ ❑ New Stan -Up r. Pest Activity: -,[j Rainy ❑ Snow ❑ Estimated Outside Temperatures •°`' FSERVICE - TARGETPESTS ❑ One Time Charge 'ElRodent ❑ Flcns _❑aResldentia I '❑Cockroaches �'Q;Gpmmercialp. ❑ Ants ❑ ❑ ❑ Bees ❑ J ° " EPA #. AMOUNTUSED% r t .. ServiceTechnician -Route Number - Sl tle License !/ D StrUCtUral Deficiencies: ,.; .. _ i{rC ... �) aJ�':`- ( •x:77 /+ i,k.,_,1rG' r[ :t 1 , Billing Address 1 + Service Address /. /�i . ; �_ t ;� �;rt.� � / � r s +�r � Name f S j...Tf P' 'It/a Name tr Address Address Address City State Zip City 7k.F �' State J,fr°„ Zlp ,.. 'e /L ` INVOICE NUMBER q.•�� 1099 Telephone Telephone ; To �w Baillargeon Pest Control, ontr®I Inc. Weather Conditions ❑ Clear ❑ Sunny ❑ Windy WARRANTY - ':Tyl ❑ Yes ❑ No ❑ Weekly.... ❑ 30 days ❑ 60 day. ' ✓ ❑ Monthlyy i ❑ 90 days ❑ 6 months - ❑f Quarterly ❑ ❑ New Stan -Up r. Pest Activity: -,[j Rainy ❑ Snow ❑ Estimated Outside Temperatures •°`' FSERVICE - TARGETPESTS ❑ One Time Charge 'ElRodent ❑ Flcns _❑aResldentia I '❑Cockroaches �'Q;Gpmmercialp. ❑ Ants ❑ ❑ ❑ Bees ❑ J ° " MATEflIALS USED EPA #. AMOUNTUSED% r t -: _S7 TflFATED.: OF METHOD' OF APPLICATION :AREA -VOLUME TREATED I D StrUCtUral Deficiencies: .. f�i+ �I• i{rC ... �) aJ�':`- ( •x:77 /+ i,k.,_,1rG' r[ :t 1 , 1 1 /. /�i . ; �_ t ;� �;rt.� � / � r s +�r � ,C`.. �� ; X13 l• �✓vc MATEflIALS USED EPA #. AMOUNTUSED% r t -: _S7 TflFATED.: OF METHOD' OF APPLICATION :AREA -VOLUME TREATED I TARGET PESTS StrUCtUral Deficiencies: ��. iC �!'}�� yfi n', rPY TJ °'e F -i//(_" ... ,/2'P !'%.�-• 1,.' ryf�(� �%is> <,L.t r[ MATEflIALS USED EPA #. AMOUNTUSED% -: _S7 TflFATED.: OF METHOD' OF APPLICATION :AREA -VOLUME TREATED I TARGET PESTS u. )(-Customer Slgnanlre r ACCOUNT .NUMBER ` INVOICE NUMBER q.•�� 1099 Please Remit Payment Within 30 Days d' ; To �w Baillargeon Pest Control, ontr®I Inc. AMOUNT DUE P.O. Box 2314 Service Charge Methuen, MA 01844-4417 Added Service Sales Tax Office 978-683-5541 o Fax 978-989-9228 SiERVucE REPORT / INVOICE 7l 6_0 RESIDENTIAL COMMERCIAL i7 1 I DileJ -. Tlmo In q '.1 Time Out ,e" ✓ �YJ chnician- Route;Number Slate iERVICE - („r �,,.! / S TARGET PESTS l- _. ✓ C.::I{ l]cense l/ Billing Address ❑ I -leas "'' '-`"'"" J r%�.' Name ❑ r / Service Address ❑ Ants Please Remit Payment !Within 30 Days .r Name C 7 i Elr Address Baillarrgeon Pest Control, Inc. Address. -- { -City Service Charge State State Zip City f....,; . J J p {f -TZ.+._, State p, Zip Off Ice 978-683-5541 a Fax 978-989-9228 Added Service Sales Tax Telephone P+ mduma animi• SERVICE REPORT / INVOICE ,. ry / .. OGG� Total Amount Due WeatherConditionsCond—itions .:+ Clear ❑ Sunny El L- wNRRANTY ❑ yes ElNo ElWeekly ❑30 days El 60 day te+°❑,Monthly F190 days El months ❑ ew Star Pest Activity: 1 � Sanitation: r d �F Structural Deficiencies: F Storage. Conditions: ,_ MATERIALS USE iT EPA# -. ✓ �YJ ❑ Rain Y ID ❑Estimated Outside Temperature Y_7 T iERVICE - AREA -VOLUME TREATED TARGET PESTS l- TARGETPESTS ❑ One Time Charge k:O-Rodent ❑ I -leas Residential ❑Cockroaches ❑ 1❑ ❑Commercial ACOOUNTNUMBER ❑ Ants Please Remit Payment !Within 30 Days .r To Elr Storage. Conditions: ,_ MATERIALS USE iT EPA# -. ✓ �YJ ft: FxiJ :''s .i r METHOD OF APPLICATION c -f- `-,,-7- AREA -VOLUME TREATED TARGET PESTS l- .7 Storage. Conditions: ,_ MATERIALS USE iT EPA# -. -AMOUNT USED'. % SITE TREATED METHOD OF APPLICATION c -f- `-,,-7- AREA -VOLUME TREATED TARGET PESTS l- .7 X- Customer Signature ACOOUNTNUMBER INVOICE NUMBER Please Remit Payment !Within 30 Days a 'f ' To Baillarrgeon Pest Control, Inc. AMOUNT DUE P.O. Box 2314 Service Charge Methuen, MA 01844-4417 Off Ice 978-683-5541 a Fax 978-989-9228 Added Service Sales Tax P+ mduma animi• SERVICE REPORT / INVOICE ,. ry / .. OGG� Total Amount Due tic-f�a�e-; ��uv� Cleaning and Maintenance List 11-10-2007 Back of house: Base Tile by dish machine missing and fix hole in wall. Base tile missing by carving station. Paint ceiling and walls in kitchen. Replace tiles on floor by the grill. Replace gaskets in drawer units and fridge units Clean and paint sundae glass rack by dessert area Walk-in door gasket needs to be replaced Salad cooler needs new racks and floor needs to be replaced or something Clean all shelves including back prep area( under slicer) Floor by beer cooler and freezer coming up needs to be replaced. f Victor is cleaning walkin and freezer. Store extra pans we are not using for the winter out back in train room. ✓Check and order replacement thermometers for all freezers and walk/reach ins that need them. Grease unit on back prep area leaking. Both Salad and line ice cream freezers cleaned Fan guard on salad upright unit next to 2nd ice machine needed to be cleaned Ice machines cleaned thoroughly Clean and paint all shelves in dry storage ✓Remove ALL non-food items from dry storage including bleach, rock salt etc. Toilet needs to be secured in Men's room Both employee bathrooms to be cleaned out thoroughly Mop sink area cleaned and painted Organized electrical room remove umbrellas ( back train possibly). Steam table drains need to be fixed, pans covered at all times Broiler condiments need to be moved ( onions, mush, BBQ and Teriyaki) Bacon to be kept at 135 degrees. Rice and Potato warmer at 135• Sanitation solution changed every 2 hours and PH log done consistently Spice racks and all shelved cleaned nightly Hole in Pantry ceiling needs to be repaired. Check Duct tape repair job in pantry area Under range top needs to be cleaned Kale and Cabbage needs to be kept cold ( iced poss) Potato rack needs cleaning. Slicer needs to be updated to a 3 sec blade stop. Front of house: /Re -organize to -go area clean shelves & get rid of anything that doesn't go there. ✓Organize liquor room again still lots ofjunk back there. Wooden stand up beer cooler behind bar needs to be cleaned thoroughly. PH strips need to be used for sanitized water behind bar and recorded in a log. Speed rack behind bar to be cleaned (front and inside) ,Ice bins cleaned thoroughly e -organize area under soap dispenser in the busstand ( no food product under soap) ,Organize & clean all shelves in bus stand. P✓L/S bus stand shelves cleaned and all condiments brought to early side to get used. All S & P shakers cleaned All sugar caddies cleaned. Temp check for front and back of house (FOH including salad bar, soup warmer, etc.) Remove all clutter above service bar area. Remove clutter under TV by the 2 micros. VICTORIA STAMN 86 2[Jh4 Shed Saeem, .Ma C197C 97S-745-34UU — sax 978-745-7460 10-29-06 Re: Board of Health Inspection Mr. David Greenbaum Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 10-26-06. Steam cleaning of walls, ceilings and floor in the kitchen cooking area and prep areas, Main walk-in, pan storage room, Victory Refrig, Scan Frost Fridg, Continental Refrig, Ice cream freezer,Micro-wave and can opener Scheduled repaint entire kitchen in January. Management Reviewed with kitchen & FOH Staff personnel the following: Proper cleaning of knives and storage Food Storage containers kept closed at all times, and labeled to same Silverware storage reviewed with front of house staff • Ordered or called the following people: New cutting boards measured and ordered thra Sysco Electrician Called to replace plate cover Plumber called to re attach toilet and align Lowboy shelving ordered Ordering closed containers for staff to use as drinking • Paper product moved off the floor • New paper dispenser installed in server bus stand • Checked both Ladies & Men's room hand wash temps, 112 & 114 respectively • Installed thermometer in salad unit on line & Silver King in servers area Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer General Manager E7(AMINAibN FbkM NO. 2019 . _. _.:...mWqW....-1..rre-.ems..-wrs...��u...--iu�nen• m c N TD RYAN MCCARTHY for successfully completing the standards set forth try the National Restaurant Association Educational Foundation for the ServSafe Food Protection Manager Certification Examination, which is recognized by the Conference for Foal Protection (CFP). Prnsenaed by the National Restaurm tArsocr'ation Educational Foundation 12/17/2003 DATE OF EXAWNATIoN 12117/2006 DATE OF EXF:;RATION Ohm wih yell! Wei heeAh oeprawnl ler t4ir spit C tBG1imma-.i11 MARY M. ADOLF PRESIDENT AND CHIEF OPERATING OFFICER NATIONAL RESTAURANT ASSOCIATION EDUCATIONAL FOUNDATION 0m K401 MezmaL(dwalbn[Axod ftitkn 32117m Tom National Restaurant Association A EDUCATIONAL FOUNDATION %mW.nraer.org °�ze2 reaa�ziliaiz a�irze�Cciz� Cie/e�a�edJia2tz�i��zzis�orz2CJ�� cevt�ic'¢Ciaia Acu1 ca2r��t�rz�zoiz )a PAUL E. SCHAFER CERTIFIED PROFESSIONAL FOOD MANAGER TM a Exam 1501 Recognized By Conference For Food protection caiC1adll�ylCa 4146-1 u✓u%z�aae��e� r� � � D C�'ierecuaCa cyyzevCauuiz�. Douglas F. Campbell, CFSP Certificate lssued:10/10/01 --,_________ ---____ _________--JSatWiS- U31591-_---______- f Experior Assessments Congratulations! You have passed the National Score Report Certified Professional Food Manager examination. Your name has been added to the National Registry h Cof Food Managers. Congratulations! You passed the National Certified I; Professional Food Manager examination. Enclosed j Ii I I, is your wallet certification card. Your Score is as follows: li Score Status Exam Date 85 PASS 10/10/01 I li II II I'. I! U II II I� I'. PAUL E. SCHAFER I' Ij b I' 600 Cleveland Street, Suite 900 (800) 624-2736 j�, Clearwater, FL 33755 Fax (727) 461-1974 1M jzpaillargeon Pest •' r.r "YourRESIDENTIAL 9 •nal Pest Control Solution" COMMERCIAL Date ^7 / �-� Time In Time Out -- Service Technici Route Number OCG / State LicenseR Billing Address -'Service Address ' Name {�% Name LJ j}.(�-`�"fJ �li%� jy.�-i-/'0�/...�, cB'Rhdent ❑ Fleas [:130 days El 60 day, Address Address °'Q'Cockroaches City State Zip City" f State ,rr7 Zip Q Quarterly > ❑ Ants Telephone Telephone i1J7"rJ Weather Conditions ❑ Clear ❑ Sunnys EI e�''"�Raihy Snow ��- El Outside Temperature WARRANTY ' TYPEOFSERVICE '--- - TARGETPESTS ❑ Yes ❑ No Weekly ❑ One Time Charge cB'Rhdent ❑ Fleas [:130 days El 60 day, ❑+..Mynthly� ❑„(;ies'14put`ial °'Q'Cockroaches ❑ ❑ 90 days ❑ 6 months Q Quarterly CO.QttJomemi ❑ Ants ❑ ❑ i1J7"rJ ❑ New Stan -Up ❑ ❑ Bees ❑ Pest Activity: 9, J( /a Sanitation: CJ'-' I l y of e- /i9! __ Lf, /-1 ( i ./Jz fir �(TA f1 f /V?y 5' ri1 Structural Deficiencies: ��( f' .}' q- �i 1 /�"�`' < / �C�<j 6-1d rPrC MATERIALS USED EPA# AMOUNT USED % SITE TREATED METHOD- OFAPPLICATION .AREA -VOLUME TREATED TARGET. PESTS G7 �,r-; ij4 tiyS� j`/,tJ)( -r7 Fc,r'r cmc (; �f"i/`h)t f3 i1J7"rJ fi Q .. /IGS X -Customer Signature ��°( ACCOUNT/NUMBER`.-INVOICE NUMBER. C r 1099 Please Remit Payment Within 30 Days To Baillargeon Pest Control, Inc. P.O. Box 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 SERVICE REPORT / INVOICE %l 'LlMj AMOUNT DUE Service Charge Added Service Sales Tax Total Amount Due YfOd WIN 6Au Ul • HeOmer tram GHUW N UHAFHILb, INU. • 1-NUU-252AUI I i RESIDENTIAL aillargeon Pest Control, Inc. "Your Personal Pest Control Solution" COMMERCIAL eR1i /�2 ate Time Ing Time Out Service Technicia -Route• umder�Q� Stale License# TYPE OF SERVICE- AREA -VOLUME TREATED TARGET PESTS ❑ Yes ❑ No ❑ Weekly Billing Address / ✓_ ServlgE'Address ' 'JCC firGiC Name Name •C %Yr'7� _77A Address Address �i�t rf— /fc A-p,/f-.. ` (. iv/77- City State Zip I City State �' jam{ Zip 119 �11 Telephone Telephone CJ IF .. / `/ - ,„?� Weather Conditions s0 Cear ,_1 1 � ivC i�f�CF >cr�r= .S'm �'c Surveys�a2 ? rc ❑ Sunny El y ❑Rain y ❑ Snow ❑ Estimated Outside Temperature 7 WARRANTY TYPE OF SERVICE- AREA -VOLUME TREATED TARGET PESTS ❑ Yes ❑ No ❑ Weekly ❑ One Time Charge <0•Rodent ❑ Fleas ❑ 30 days ❑ 60 day Cc "❑••Myn'�••^thly ❑ Residential 'fl•Cockroaches ❑ ❑ 90 days ❑ 6 monthsCommercials D ❑ Ants ❑ El sg _� Stan -Up ❑ `' f`r'E � ❑ Bees ❑ Pest Activity: )t C. ( es' ri'' rx/����9GOGi�I-k)t gAc�.`�ife�F�Q. r 'fC/R�iC. c'pr J Sanitation: s 1_4 //T 4- 1,A 4- q1 b.,di',A<�-Ff X77_ DfJ t Structural Deficiencies: 1... �f7PS ,C�o7 ce.!"it' q`"I'c�Gvu7 Storage Conditions: `-=�Fc fiC-• �UCi !+-�©! MATERIALS USED - EPA# -. AMOUNT USED .% ` SITE TREATED - . METHOD OF APPLICATION AREA -VOLUME TREATED TARGET PESTS 7�`�� ��� I/ctuet,=> F IIT�1 �o_ sg _� � * e z `' f`r'E � '�` 12 ? F X- Customer Signature/ ACCOUNT: -NUMBER. `.INVOICE NUMBER /IN Oft 1®87 Please Remit Payment Within 30 Days To Raillargeon Pest Control, Inc. P.O. BOX 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 / _ / Q SERVICE REPORT / INVOICE %l 'i" ° / AMOUNT DUE Service Charge 051-5 C7. --0L Added Service Sales Tax Total Amount Due Product#RAI 101• Reorder from CROWN G RAPHICS, IN .•1-800-25&4011 RESIDENTIAL aillargeon Pest Control, Inc. "Your Personal Pest Control Solution" COMMERCIAL Da Time In Time Out -'TYPEOF.SERVICE Service Technician Route Number t'} r r State License k I//;1 Billing Address�f Name J Service Address Name % �ryr-�,_�r .!'4- �f.+�l %}��-�/�/✓t,--;' Address Address ;Red nt El Fleas City State Zip City / "1 State J�� 019 Telephone Telephone(` ,Zip Weather Conditions,,.•VZkd-- ❑ Sunny ❑ Windy ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature T7 -2 WARRANTY -'TYPEOF.SERVICE - SITE TREATED TARGET PESTS ❑ Yes ❑ No ❑ Weekly^., ElOne Time Charge 7;�t(-ySL ;Red nt El Fleas El30 days ❑ 60 day /Z8 Mo0 thty,,,,,+ ❑ Residential ❑" Cockroaches ❑ ❑ 90 days ❑ 6 months ❑ Quarterly UayS EI Ants El ❑ ❑ New Start-up ❑ ❑ Bees ❑ + Pest Activity tette I= �`EC'%✓lC /�`�-r'GG?7 �`iJ .,t /%'ii .5 fi /'�C��'ra1 t?? s� (A I C Sanitation: ; /C . ( r e� l'!l.- U T._N tTt''001 q Dx?4("(/ e`/ L1;�-1C( 1f)f�"!�}« � r /✓r J{7 /dl�lC�/�t-��_ Dac�2 Structural Deficiencies: �((!+ %"f f)'1 Lk'../'tl�f t�r�� �1 G^-�f`? � Ivi F ��i CJI 7 C ��l�'� 'f �e ra Storage Conditions: CJ -MATERIALS USED EPA# AMOUNT USED % s - SITE TREATED METHOD OF"APPLICATION AREA -VOLUME TREATED TARGET PESTS , t�r�sr 7;�t(-ySL s-,tiFlt4z4� 1144r ° UayS hYL�I r (It iT�F7C_Q(ox l2 1S ")e /C) c e ao5 r`rq�:p I fi FttT3l )fY0 fc�P X- Customer SignatureL` ACCOUNT NUMBER INVOICENUMBER" 0018- 6� NOW 1071 ®79 Please Remit Payment Within 30 Days To Baillargeon Pest Control, Inc. P.O. 60x2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 ry� SERVICE REPORT / INVOICE /�uu1 Ocd� AMOUNT DUE Service Charge QJQ a�� Added Service Sales Tax Total Amount Dm) YI d(ICI# HAI so • ne0uer rrom UMuwN i,rnrnics, ANG. • I e00 -z52-41.11 I Icry J•'•j Name Weather Con ❑ yes ❑ 30 days ❑ e0 days ❑ — Pest Activity: Sanitation: I F 17 17 t,�/ ( t"ic C1't I' Z7 CWit= r` fI��IS�t aillargeon Pest Control Inc. �'� �' "�/�k; "A2, Control, -7vF����7 COMMERCIAL' "Your Personal Pest Control Solution" OTime Out / Servic�echnici n/- Route Number �,Cy/ St)ate License #AM— State Cle` - ❑ Sunny ❑ Windy T ❑ No ❑ Weekly ,. - ❑60day ®,(u1o�ntFly ❑ 6 months ❑ quarterly (_ ❑ New Stan -Up 77 me (/LC �Gl/t'C! STA -1116 � Address 1 Cp2f1C5 Cs '111a/ J city p�tysC% 7 c State i`l!%l zip p )U Telephone ! 9 % y.p :3060 ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature SERVICE>. 'TARGET PESTS. ❑One Time Charge El ❑Fleas ❑ Residential CQ ddkroaches ❑ mQa6ommarq'sl "� ❑ Ants ❑ ❑ ❑ Bees ❑ �4 /3la'1c ti` t's 7 S f'!� G 4 vti '� 1r4V1 /3v/C Ar2 loch _� IJ��n"!� f v� ��� ,�/,�; rr�tl� Sys r' Z- C\f4 �^����} T f'�� /�` 7— � t� l✓�'Lr cNe / /� 2141`x- 121 �iy�i!/� %LC ficrvr � S 1`G'Q»n Iii St12 /ff9�E' !', fCJ ��� { &-Irk Structural Deficiencies:f,.� 61 i�✓'�% i �.Zi %cam( V�7"%">'/i� j '' A47-- Q? j" DfT0,( � F-%C� l 2 CJ fl /',7 AQP. ('A -J S+op;A, `%c . f I�fCGi� iirnei L() r 7`c/7-7 fcr' ` C llfA-41'2,(,4 S. Storage Conditions: S -to 12 Ade C� L) a/2e C dl n _� 7 �G-/�txP To c A;it MATERIALS USED EPA# '- `�Z AMDUNT USED 11" %. ' SITE TREATED `FPMETH0fD:0F MC APPLICATION �����p.�L # .� - L i�(e AREA -VOLUME TREATEDQ}_/0 ilC ^p eii X- Customer Signature .'D67 15 .ACCOUNT NUMBER. INVOICE NUMBER Please Remit Payment Within 30 Days To Baillargeon Pest Control, Inc. 0 �? 6 ® ® 5 AMOUNT DUE P.O. Box 2314 Service Charge JI a u Methuen, MA 01844-44171 Office 978-683-5541 *Fax 978-989-9228 SERVICE REPORT / INVOICE r0duct#BAI101-Reordermm CRnWNrROPNIrC mir .o,,.,,, ..,.. SP/t i!P r� /44"//I/m/ Added Se vice �l p < e Sales Tax Total Amount Due ..d 7 Co CITY OF SALEM BOARD OF HEALTH Name of Establishment: Victoria Station Address: 86 Wharf Street Owner: Paul Schafer Phone: 978-745-7460 Date: Novemebr 14, 2007 The proposed owner of this establishment who is also the current manager, Paul Schafer, presented a Floor Plan for review in accordance with the State Food Code. FLOOR PLAN A hand sink must be located to serve the front cook area and the rear prep area. Mr. Schafer will call to discuss the possible location the required new hand sink. Hand sinks are for hand washing only. There must be wall hung soap and paper towel dispensers at each hand sink. Employees are required to wash their hands when changing gloves because of contamination. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. All food must be held at 41'F or lower, or 140°F or higher, at all times. Salad display items, such as vegetables, must be cold prior to being held cold in the salad unit. Food may not be added to containers in salad unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready -to -eat foods. Gloves, tongs, or tissues must be used when handling such food. The preparation of a chicken dish was reviewed. Glassware used to prepare mixed drinks with dairy products must be washed, rinsed and sanitized at least once each hour. There may be no bare -hand -contact of ready -to -eat foods. CERTIFICATION The owner and Ryan McCarthy are the Certified Food Managers. Two additional employess may also be certified. When a CFM is not onsite there must be a Person -in -Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. There must be a person on site at all times trained in choke saving. UNDERCOOKED FOODS Undercooked foods will be served. There is an existing warning on the menu. The latest required warning and the brochure were given to the owner. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3 -bay sink and spray bottles and/or wiping pails may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Spray bottles and wiping pails must be clearly marked "sanitizer". Outside area of premises, including the dumpster area, must be kept clean and sanitary.0/� &it d� An application will be mailed within two weeks to the establishment4n opening inspectiorkis_sch� EXAMINATION PbkM NO • 2619 ..,,.,; .... _,..•:<- 0 co m C9 0 m m 0 an ......... .. ...... ...._._._... _....._... _.. _ ........_... _....._ ......_... ro RYAN MCCARTHY for successfully completing the standards set forth by the Nafunal Restaurant Association Educational Foundation for the ServSafe Food Protection Manager Certification Exsrnination, which is recognized by the Conference for Food Protection (CFP). Presented by the Mdonal Restaran'MtAssociatwn Eduratonal Foandatrbn 12/17/2003 DATE OF EXAMINATION 12/17/2008 DAT E OF EXPrRAI IVN Cheer wth your Iocel heath 0spahnant tm their speciric mgwmmeNs. X* MARY M. ADOLF PRESIDENT AND CHIEF OPERATIN.O OFFICER NATIONAL RESTAURANT ASSOCIATION EDUCATIONAL FOUNDATION 0 = mfi ad FmW Om7m ion National Restaurant Association ,\— EDUCATIONAL -EDUCATIONAL FOUNDATION t wu-w.nraef.org °l�za2 �ca�aatib% a��reeetii� t%e�eac�JJio2�re�t�iseirreertfi,9�v cevt�ctat�ai� ' - ?.Cl.� cpit�er�etiuJwi� 1 0 PAUL Ee SCHAFER �ie �ed��ndtia2 CERTIFIED PROFESSIONAL FOOD MANAGER TM Exam 1501 Recognized By Conference For Food Protection Accat�i a�w�%Gt$a %eaiea�l-Arztl/u'aire��e9 t�iere�utta a�ytevtainue�. Douglas F. Campbell, CFSP Certificate Issued:10/10/01 __._____—_—__ ____--___._� __-----__—TUtCQk-Qi431541—_--__-- 1 R Congratulations! Experior Assessmentsations! You have passed the National �� Score Report Certified Professional Food Manager examination. Your name has been added to the National Registry li of Food Managers. Congratulations! You passed the National Certified p Professional Food Manager examination. Enclosed j I! is your wallet certification card. PAUL. E. SCHAFER Your Score is as follows: li Score Status j' 85 PASS Exam Date 10/10/01 This is to certa/y that PA[1�%��SC�IAFER O E has met th4� eces�ary requerements for Poud laltttger`Ce�tcfruati it of LRxmu 1501 RecugnizedIIy sCaiifatence t'oi' Pond Protection SE"xpWeri)r N #1 am'�iite: 111/10/01 Assessments (80 0) 624-2736 1' 600 Cleveland Street, Suite 900 (800) 624-2736 �� Clearwater, Fl- 33755 Fax: (727) 461-1974 14 Cleaning and Maintenance List 11-10-2007 Back of house: Base Tile by dish machine missing and fix hole in wall. Base tile missing by carving station. Paint ceiling and walls in kitchen. Replace tiles on floor by the grill. Replace gaskets in drawer units and fridge units Clean and paint sundae glass rack by dessert area Walk-in door gasket needs to be replaced Salad cooler needs new racks and floor needs to be replaced or something Clean all shelves including back prep area( under slicer) Floor by beer cooler and freezer coming up needs to be replaced. Victor is cleaning walkin and freezer. Store extra pans we are not using for the winter out back in train room. Check and order replacement thermometers for all freezers and walk/reach ins that need them. Grease unit on back prep area leaking. Both Salad and line ice cream freezers cleaned Fan guard on salad upright unit next to 2nd ice machine needed to be cleaned Ice machines cleaned thoroughly Clean and paint all shelves in dry storage Remove ALL non-food items from dry storage including bleach, rock salt etc. Toilet needs to be secured in Men's room Both employee bathrooms to be cleaned out thoroughly Mop sink area cleaned and painted Organized electrical room remove umbrellas ( back train possibly). Steam table drains need to be fixed, pans covered at all times Broiler condiments need to be moved ( onions, mush, BBQ and Teriyaki) Bacon to be kept at 135 degrees. Rice and Potato warmer at 135• Sanitation solution changed every 2 hours and PH log done consistently Spice racks and all shelved cleaned nightly Hole in Pantry ceiling needs to be repaired. Check Duct tape repair job in pantry area Under range top needs to be cleaned Kale and Cabbage needs to be kept cold ( iced poss) Potato rack needs cleaning. Slicer needs to be updated to a 3 sec blade stop. Front of house: ,/Re -organize to -go area clean shelves & get rid of anything that doesn't go there. ° rGe S. Organize liquor room again still lots of junk back there. Wooden stand up beer cooler behind bar needs to be cleaned thoroughly. PH strips need to be used for sanitized water behind bar and recorded in a log. Speed rack behind bar to be cleaned (front and inside) -+-we s . rvio rw ng s w -e �u.-c�.j �� b0 s Ice bins cleaned thoroughly — mo j - nnofhiocis wee.t_ty Re -organize area under soap dispenser in the busstand ( no food product under soap) Organize & clean all shelves in bus stand. -Oo Ke 1 117 LIS bus stand shelves cleaned and all condiments brought to early side to get used. All S & P shakers cleaned All sugar caddies cleaned. Temp check for front and back of house (FOH including salad bar, soup warmer, etc.) Remove all clutter above service bar area. Remove clutter under TV by the 2 micros. ROCKETTMANAGEMENT OF SALEM, INC. 23 CONGRESS STREET SALEM, MA 01970 TEL. (978) 740-6990 FAX ( 9 7 8 ) 740-6728 FACSIMILE TRANSMITTAL SHEET To FROM: David Greenbaum KathyMcLauOhlio OOMPANY: DATE: 9/10/07 FAX NUMBRE TOTAL NO. OF PAGES INCLLOING COVER 978-745-0343 5 PHONE NUMER: SENDER'S REFERENCE NUMBER: RE: YOUAREFERENa NUMBER: Victoria Station Grease raps O URGENT OFORREVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE NOTES/OOMMENTS: Auached are copies ot letters sent to Victoria Station at Pickering Wharf in Salem ngatdirg theirgrease trap. RECEIVED 'SEP 10 2001 CITY o -:j\4 BOARD OF HEALTH J -d 0026 13r83SHl dH WUFV:0I LOOP'g2 9nd E 09,07/2007 FRI 15:11 FAX 1 781 699 2290 ROCKErr REALTY ,+, Salea OYf1Ce 00017002 , THOMAS K. EGAD! COUNSELOR AT LAW 190 PLEACMI STREET MARBLEWAD, MA 01965 781 6394212 FAX 781 630.2290 September 7, 2007 VIA HAND DELIVERY Deckview Management C imparry, LLC Individually, Paul Schafer and Keith Barsanti dlbla Victoria Station Sale n, Inc. Pickering Wharf 90 Wharf Street Unit 2F Salem, MA 01970 RE: Grease traps Dear Messrs. Schafer and arsanti: Thank you for Pau 's September 7, 2007 telephone call updating me on resolution of the existing roof grease traps. Paul provided the following information: 1. The original ne w grease gauge ordered was incorrect and had to be returned. 2. A new greaseauge was received and installed. 3. A stainless S I pan to complete correction of the grease trap leak is being fabricated and 71 be received and installed next week. 4. Once the com;lete new grease trap system is in place after installation of the stainless steel an, Victoria Station will re -roof the damaged area as the tenant admits the (Lan iage repair is his obligation. To stress that time is of the essence regarding this repair, I enclose pan of an article in today's Globe stating the recent fatal West Roxbury restaurant fire was caused by a defective roof grease trap Very truly yours, Pickering Wharf Realty Trust, by its attorney, ��Thomas K. Egan, Esq. TKE: kd cc: Richard P. Rockett i Z -d OOZE 13C83SUl dH WU20:01 L002 92 2nU V 09/07/2007 FR1 12:69 FAR 1 7911039 2290 ROCKEIT REALTY --- Salem Office ®002/002 August 13, 2007 Deckview Management Cc mpany, LLC Individually, Paul Schafer and Keith Barsanti D/b/a Victoria Station Sale , Inc. Pickering Wharf 90 Wharf Street Unit 2F Salem, MA 01970 RE: Grease Traps Dear Mssrs. Schafer and Barsanti Please correct the leaking grease traps on the roof of Victoria Station by performing the following actions at once: 1. Remove the grease gauge currently on the roof, which is, obviously full. 2. Install a new reass gauge. You can purchase one for $500.00. 3. Steam clean the grease gauge and the area of the roof damaged by the grease. 4. Forward me pies of the invoices documenting removal of the grease gauge, instal ation of the new grease gauge and steam cleaning of the roof. Thank you. Very truly yours, Richard R ettfor Picks in rt Re Ity Tr st Richard P. Rock I 190 PLEASANT STREET • MARBLEHEAD. MA 01945 • 781-631-3070 • FAX 781-639-2290 S'd 0026 13C83SHl dH WHZb:Or L002 82 2ny 09/07/2007 FRI 12:59 FAX 1 7811839 2290 ROC)aWf REALTY » Saler Office THOMAS K. EGAN COUNSE_OR AT LAW 19D PLEASANT STREET MARBLEHEAD. MA 01948 781 689+1212 FAX 781 659-2290 August 13, 2007 VIA HAND DELIVERY Deckview Management ( Individually, Paul Schafe d/b/a Victoria Station Sal Pickering Wharf 90 Wharf Street Unit 2F Salem, MA 01970 ItE; Grease trans ompany, LLC and Keith Barsanti ML Inc. Dear Messrs. Schafer ane) Barsanti On Au t i3, 2 7, you received the enclosed August 13, 2007, letter from Richard P. Rockett after i 3y telephone conversation with Paul, wherein Paul assured me the four (4) requests rep ding (bang the grease trap would be completed by the end of the week (August 18, 20( 7). It is now three (3) weeks later, and the leaking grease trap issue has still not been rectified. Please rectify the situation at once and confirm completion of the four (4 promised repair actions. Victoria Station will be held one hundred (100%) percent liable for any costs and damages caused by the ongoing delinquency regarding the leaking grease haps on the restaurant's roof, pursue t to Sections 12,03 and 21.02 of its lease. Furthermore, ongoing disregard of the leaking grease trap is an actionable breach of the lease. Giv(n the events of September 6, 2007, at Salem District Court, the Trust does not wish to b forced to institute another breach of lease action but will do so if given no choice. ®001/002 Please respond al once. Thank you. Very tnt1Y yours, Pickering Wharf Realty Tnist, by its attorney, Thomas K. Bgan, TKE:sloc cc: Richard P. Rockett I b'd OOZE i3r83SH1 dH WHZbrOi Looz t3Z 2nH CEty (E B O STo�N GLO'B'E YRID Fire S le q Receipt indicates vent State fit exhaust pipe not eli� cleared of greaseI res, respousib . right. BxDoriwatt Slack Fire Cl •ewatann 81feAR hG The owner of TW He Mandarin and Can etawl,Mat toneselle+taarantba96ivenat901ftda6arg' Aug. 29a ceipt indicating that a company hired to re- . anbourbe move kitchen greaepoat the wast Roxbury z" liraysb eatary in June did no't elean tha l itchen fg. speetWn.& t pause nirre. Firefiehtem beve said gr€ase I re.wnO [Ieatting saysiu.srart workad is the kitaren' reataur?uiBt below and climbed ontotheroof above: to i; "a1 regulator dean an cxhauftfah. Bttt itdoes botsaY?1 Y'. !n7dassullu cleaned thetrucial clew in betviaw -where " a result;' mai fire officials say the bidden grease was leak= grease only 1 iug. .. hanathoods, 1heM is no indication op the lune 21 re 'This iq I ,eipt.thst the cleaners oven examined the _. �. B +► �, Deaths Ey14 i 4on Lo__" '. Nameel B6 e 86 weather D20 E MR%, 2007 i.. nursed ' _ Illn ulUrrUuw unr rx unx nuunmrgt mru nn...... nn u1,lu,llnrinirt011, Tai "..Mandarin and Cantonese ftestaurant bad tyro ceilings. date wdartaIy inapecand - enpi4naustskstems.and theMA ombumed of detect it or.more than an hour. and y buildup f nlid the codes customers did net detect i[ for;more than an hour. : owners with the nitirpate QGfeatefrom the—fdnayst�MiQe;. r making sure it is done Grusetfooe eccumnileted{n a yin MacQtrtaln has Said erra.holapatfaaav9. exhaust pipe o6zed Into a both ro0ings. s a coding .where"itClgnited ted undetecbed for at react © Wera efighter£allivecl.. fdeFphters t.+, ' tfeet :ialnsasay athorough in- arrived, the - oingtwomen" before the fimsmolderee -� 'ravealed.iny buildup or and anilled' iuot&.m flammable pnibfein: National stand- gases. Ito d'tbe deanttig of on, ate weak and wrote and to ©Thaw gas ea Vesseeteaningcompanies and toxin emptedine "fiberbie. i§Virura,W nonexistent As . flash", WM cw1ing Tipanics inspect and clean down the eeff". ' visible areas — stoves, ex- vslis,forexampla aerebaxmibbuaaan;w.amwnanatoumc M�^A a^n1e �r"n"'°'�' . e most par, a orr"vtwo• 50.pGE9: aoclen fasewMnN, aerlaxlnwniarri 5e^'uraepMeunl Wma7 i°'°m oaworunarAawcscet rnrr 'R[grAVRANT.9age 85 w x 0086 WHARF STREET Telephone: 745-3400 Owner: M. Management Corp PIC: Jodi Biancardi Inspector: David Greenbaum Date Inspected: Correct By: 5/8/2007 Risk Level: Permit Number: BHP -2007-0342 Status: SIGNED OFF # of Critical Violations: 1 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) Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Status Violation FAIL Critical Critical Urgency :7091 Comment: The meat slicer in back has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: The racks in the walk in have an accumulation of grime. Thoroughly clean all racks. The shelves in the dry storage area have food spills and splatter. Thoroughly clean all shelves. GENERAL COMMENTS: All other violations cited in the 4/24/07 inspection report have been corrected. 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. May 08,2007 ) Page 1 oft s RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency 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. May 08,2007 ) Page 2 oft 1 0086 WHARF STREET Telephone: 745-3400 Owner: M. Management Corp PIC: Paul Schafer Inspector: David Greenbaum Date Inspected: Correct By: 4/24/200' Risk Level: Permit Number: BHP -2007-0342 Status: VIOLATION # of Critical Violations: 3 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) Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Co ment: Dirty knives found in all knife racks throughout the kitchen. All knives must be properly cleaned and sanitized prior to orage. T interior panel of the front ice machine has an accumulation of grime. Thoroughly clean and sanitize the inside panel. ,The meat slicer in back has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Th a was no sanitizing solution in the cook line. Sanitizing solution of proper concentration must be readily available at all work 'tions at all times. Handwash Facilities FAIL Critical ❑r' RED C ment: The hand wash sink in the wait station has no hot water. Restore hot water at this hand wash sink immediately. 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 24,2007 ) Page I of RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Violations Related to Good Retail Practices (Blue Items) Food and Fond Protection Status Violation Critical Urgency FAIL Critical BLUE . 6omment: The True freezer in the cook line has some uncovered food. All food in storage must be covered. �/he walk in has some uncovered food. All food in storage must be covered. Equ ment/anndd Utensils FAIL Non -Critical BLUE C6mment: The walls behind the back prep table hav an accumulation of food spills and splatter. Thoroughly clean these walls. V. hack rep tables need a thorough cleaning. Th to ge area flooring needs a thorough cleaning, including under all racks. T ice c m freezer at the end of the cook line has an accumulation of food spills. Thoroughly clean this freezer. Th walls at the desertlsalad area in the cook line need a thorough cleaning. Th raw refrigerated unit needs a visible, accurate thermometer. . T Blodgett oven needs a general cleaning. .ri TheBeverage air reach in at the end of the cook line needs a visible, accurate thermometer. he V' ory salad reach in has an accumulation of grime and food debris. Thoroughly clean this unit. I walls m the produce prep area have an accumulation of food spills and splatter. Thoroughly clean all walls in this area. he Frost freezer in the produce area has abroken door. Replace the door. �T a same unit needs a thorough cleaning. ",Q� The racks in the walk in have an accumulation of grime. Thoroughly clean all racks. The shelves in the dry storage area have food spills and splatter. Thoroughly clean all shelves. Physical Facilit FAIL Non -Critical mment: The toilet in the employees men's room is loose. Resecure the toilet to the floor. GENERAL COMMENTS: Reinspection in two week, all violations to be corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 BLUE GeoTMS® 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 24,2007 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS@ 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 24,2007 ) Page 3 of 86 W64 Stud Satem., .Ma C197C 978-745-34VO — sax 978-745-7460 04-30-07 Re: Board of Health Inspection Mr. David Greenbaum Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 04-24-07. Steam cleaning of walls, ceilings and floor in the kitchen, salad area and prep areas Food walk-in floor and shelving cleaned and sanitized Both Ice cream freezers cleaned Salad refrigerator base pans removed and cleaned, gaskets and doors cleaned Build up on panel in the # 1 ice machine cleaned Storage area floor (opposite freezer) cleaned thoroughly Cleaned dry storage shelving, walls and floor Management Reviewed w/ kitchen & FOH Staff management the following: Proper cleaning of knives before placing in storage racks Sanitation solution available on line and in prep areas Cleaning of the slicing machine after each use and sanitize Covering of all pans in freezer and walk-in that contain food • Called the following: Plumber called to reattach toilet in employees mens room Repair hot water in bus stand Scan Frost freezer doors on order (may be in by reinspection) A • Checked both Ladies & Men's room hand wash temps, 112 & 114 respectively • Installed thermometer in salad unit ( Bev -air) on line Line fish storage refrigerator unit Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards Paul Schafer General Manager r Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2007 ESTABLISHMENT NAME: File Number: BHF -2004-000228 Victoria Station Restaurant 760 Summer Street Stamford CT 06901 LOCATED AT: 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0342 Jan 5, 2007 Dec 31, 2007 $200.00 ESTABLISHMENT PERMIT EXPIRES Total Fees: $200.00 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 1 of t Jan 05 07 10:35a Munir Saltoun 212-249-1114 p.2 Jan OS^r97 ll:S2a Joanne Scott Salem 80H 970 745 0343 p.l CITY OF SALEM, MASSACHUSETTS BOARD OP HEALTH 120 WASMINVON STRE97T, 4YM FLOOR A SALCY, MA 01970 TEL. 978-741-1800 FAx 978745.0343 *0W.SALEM.e0m Kimberley Driscoll JEMMMr' SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATIOlaFOR P€RMLT TO-GPERATEA.FQOR ESTAB-USNMENT N4Mt= AP ESTABLISHMENT _V( tt? .t I�` I t11LV_. y� r` >t--<=r�/ -- —vU ADDRESS O>• ESTABUSHMENi l 7� �'-J �c'�' r- FAX #_ it MAILING AOORE55 (if (ffm'an) �_J..._._._._.__. pMA1L-dusnTesx•��/CoA S�S>/ �rV, r( LO M`p !s �U.LLD o�//♦J O .T O ��% �`-�/.lr.o�VT ve OWNER'S NAME -Z-12214: /L ftiv-r p TEL rl,1'��J�/ ADDRESS -��Q S/! -'(To b00 �� (rsuru. N /V / 1007-1 _.._ rlTv STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S), ?'1 " ! Se. A a- %R CER11FICATElf(5) ,,.-- 3. O.SU/ 25.99 scilla „na.�LCM "'0.0 than u9 mats = 20( 1 (RegwlM m Bn GSIa0fiS0�tlenl'MINC poleA14a0y h�nra/a.9 rase /s urepa.eo) .7 EME"RGkNCv RESPONSE PCRSDN_ 3b ROME TEi p_ HOME /" 550 $]5 11WS8f sfE8iilsY ._ MtI1paY Ssesttay WedsesOaY - lnsesUaY . ietdaY, ._..: Saturdaj _...._.. SUnRay __ w88Sif8NtN11011 vuauwrnswumcier. q _ p/y� p !02 .J�----�. RA? Ilef eonefe ttmr•llumt .L✓M.. „IE1�/?1 .-.._/Q�/Y� TYPE QLL.UTABLISHM!NTFEE check OM b0 RETAIL STORE YES O Itr dear, 1000or Q, 1000-10.0001;04 ft. =% =$100 more thein 10,000sq.It. =$750 • •Ilia RESTAUFANT ES NO than 75 SMAS =$100 25.99 scilla =5150 "'0.0 than u9 mats = 20( 1 ... .. ... ._....... ... . .. . ...._......8100 BF.O/BREAKFAST v[S VO AODITtONAL PERMITS MAKr (not prsl 5ervr,) IGF CREAM, YOGUR I. SOFT SENVE YES 3b TODACCO VLNVOR YFS YES 550 $]5 ALL NON PROFfT (such as church kilchensl 'PICase pay total with one check payable to the City Of S310M. This Peanut is not tyansforable and must be reissued upon +,hangs of ownership. The Permit +nust be pvbtcd in A prominent location it file Establishment. I.1 accordance with the State Sminary COde.hefolO any-re+rovations, unproveolents, or equipment changes arc made, all plans for such must De Subinilted to and approved by the Salem 8u.v0 of heann. Vars.pn 10 MLA Ch-wie. 021:.:-I.:IRl4 49A, rcrrbfy t^1M.tMie t>;m`> ��� Ptl44bw .,ul patlwytn.lL 1. 1-1 qty bFa Aralwlvtl9e :✓1ry ln,lil!1. ha 311 slate •tri. ns 1011 Oa 1 II a91a�10/11W: reUW 1'n t J . n O 0- ^ 7/ j aNar / Dale oOL. N SzNnty Or F...... ldenbLY,:etiop NumbCr 1 IF:rn.pl l t l CM 4: 1 CK0AV/007 111' 0•'[k/61 al 7�I1%m S g� �rrvt :2'pp�.ta(ic2 iar>rrh, l��ux�Jlo2al'.'c�ttc,'rntarrGl�wc'e�/t�ircLrivi p r PAUL E. SCHAFER CERTIFIED PROFESSIONAL FOOT) MANAGER TM Exam 1501 Recognized By Conference For Food Protection miCii a�wt��J, irortoiN aiul/evsh �1'e�e.i C%reustto tyy�er•Catituzry Douglas F. Campbrll, CFSP Certificate Issued: 10/10/01 �_---__--- __— _---— _--JaitcQkL62,WQ3L501_----_----_. I I V Experior Assessments Congratulations! You have passed the National I 11 Score Report Certified Professional Food Manager examination. p Your name has been added to the National Registry li of Food Managers. Congratulations! You passed the National Certified l; Professional Food Manager examination. Enclosed is your wallet certification card. j I Your Score is as follows: I, 6 Score Status Exam Date 85 PASS 10/10/01 I ji This 1s to certify that 1, � PAUL E: SCRAPER I { has met thernecess'a, rggW ments for t' a FooWdtfWe° tc�tion Ezmn 1501 Ref.�j s' nze ate o Food Protection i l , , rAUL E. SCHACER SSN #n15-42-1068 a a - ate: 10/10/Ol I, Experior Assessmeri_ (800) 624-2736 f. I' 600 Cleveland Street, Suite 900 (800) 624-2736 p Clearwater, FL 33755 Fax: (727) 461-1974 N d W a b EUNItNAMN F0 04 NO. 2019:. .............. TO RYAN MCCARTHY for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafem Food Protection Manager Certification Examination, which is recognized by the Conference for Food Protection (CFP). Premted by the National Restaurant Association Educational Foundation 12/17/2003 DATE OF EXARIINATION 12/17/2006 DATE OF EXFIRATfGN Check wM yclu tical health tdBPW4Wnl fm Dwir spealic regwrements. MARY M. AOOLF PRESIDENT AND CHIEF OPERATIN.O OFFICER NATIONAL RESTAURANT ASSOCIATION EDUCATIONAL FOUNDATION 0 F$IIm110d Ak{JI]Ir:®CiNA(� latmkn 3WM IL" National Restaurant Association ;1 EDUCATIONAL FOUNDATION %m-wrtrael.org r 0086 WHARF STREET Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-3400 Physical Facility FAIL Non -Critical BLUE Owner: Comment: The toilet in the employee men's room is loose. Repair and resecure the toilet. M. Management Corp PIC: There is a broken electric plate cover in th cookline. Replace the electric plate cover. Paul Schafer GENERAL COMMENTS: Inspector: 971:AII other violations cited in the 10/26/06 inspection report have been corrected. David Greenbaum Date Inspected: Correct By: 11/9/2006 Risk Level: Permit Number: BHP -2006-0261 Status: SIGNED OFF # of Critical Violations: 0 Time IN: I 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) 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. Nov 09,2006 ) Page 1 oft r� RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation ( b L City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 Critical Urgency GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2006 ) Page 2 of 0086 WHARF STREET Telephone: 745-3400 Owner: M. Management Corp PIC: Ryan McCarthy Inspector: David Greenbaum Date Inspected: Correct By: 10/26/2006 Risk Level: Permit Number: BHP -2006-0261 Status: VIOLATION # of Critical Violations: 4 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) Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Syffaces Cleaning and Sanitizing FAIL Critical RED Dirty knives found in knife racks. All knives to be properly cleaned and sanitized prior to storage in the knife rack. Pvide sanitizing solution of proper concentration at all work stations at all times. Tre ares me cutting boards athat are stained and scored. Resurface or replace all cutting boards. si r found stored handle side down. Store silver ware facing one direction handle side up. Good Hygienic Practices FAIL Critical W RED Com t: Employees drinks observed in the kitchen. Emplyees must eat and drink in a designated employee area or in the dining ro to prevent cross contamination. Handwash Facilit FAIL Criticald❑ RED mme he wait station hand wash sink missing paper towels. Provide paper towels at this hand wash sink at all times. L .es room hot water had a temperature of 108°F. Restore hot water at a minimum temperature of 110°F in the ladies room. 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. Oct 27,2006 ) Page 1 of rZ* Item RED: Violations F Violations Related to Food and Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) r )d Retail Practices Status Violation Critical Urgency FAIL Critical BLUE Paper products stored directly on the floor of the paper room. Store all paper products at least 6.8 inches off the floor. found uncovered. Keep all food in storage covered. directly on the floor of the walk in freezer. Store all food at least 6-8 inches off the floor. inienif anndd IJIt�-nsils FAIL Non -Critical BLUE r Co�fiment�he room near the beer walk in needs a general cleaning, including under all racks. V/ The main walk in needs a general cleaning including under all racks. Vmkw7a�dwalls s and hand wash sink in the salad prep area have an accumulation of food debris, spills and splatter. Thoroughly clean the T in this area. The cano ener in the salad prep area has an accumulation of food debris and grime. Thoroughly clean the canopener and holder. T Scan Frost freezer in the salad prep area needs a thorough cleaning. Tt1c'm reach in in the salad prep area needs a general cleaning. Tental reach in near the salad prep area needs a general cleaning. T re is "accumulation of food debris, spills and splatter in dry storage. Thoroughly clean the dry storage area. T dry ingredient containers need a thorough cleaning. T ace cream freezer in the cook line has an accumulation of food spills and splatter. Thoroughly clean this freezer. T e saladynit in the cook line needs a visible, accurate thermometer. needs a general cleaning. King reach in in the wait station needs a thorough cleaning. Phe same unit needs a visible, accurate thermometer. Facility FAIL Non -Critical r -ax., Comment: The toilet in the employee men's room is loose. Repair and resecure the toilet. There is a broken electric plate cover in th cookline. Replace the electric plate cover. GENERAL COMMENTS: 933:Reinspection in one week, all violations to be corrected. BLUE 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. Oct 27,2006) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 27,2006 ) Page 3 of DATE PRINTED: 02/10/2006 WHO'S PLACE OF BUSINESS IS: File Number: BHF -2004-0228 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Victoria Station Restaurant 760 Summer Street Stamford CT 06901 LOCATED AT: 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes TEMPORARY FOOD BHP -2006-0413 Feb 10, 2006 Feb 11, 2006 $0.00 / TO BE SERVED: Chocolate Mousse Total Fees: $0.00 PERMIT EXPIRES February 11, 2006 Board of Health Page 9 of 9 01/31/2000 17:34 FAX 2039974003 A.S.-MGT.CORP. Jul 11 OS 11129e Joanne .Scc: L Salem HCH 'CI [a 01 Ve 745 0343 p.T1 CITY OF SALEM, MASSACHUSETTS 9CARD OF HMALTM I:U aTn jLOOF AIA 01970 TEL. 979-741.1900 FAX 57C'7a:•O3a3 MPH, Rb. Cu0 M Fnirn AF.T-XT ? 1cs-Se kr(l cok- Gr)6 APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT �p Ne,::PE for Sclitm Salz;ti�C�u ether Cf Cca�n�:rc r' FEc: 1-3 DAYS= ° SGl e M foaU,�. S j,�� e-}- 4-7 DAYS = s3DD g1 Si; li'SSis Sa1e1n, Sr- SL�ce t MowF T MAN 7 DAYS 5 0. [NE[Jr aArABIE ia'lYE [�:Y,1r iAv`M YO Ii`.SI'1 NAME OF EvE,vr �`C`�i�` q l l)i!4 TnSti�t� lecA,oF ^ref curl f , I �I ( a 'r1 �� �j L'ERTIFItU.''90D MANAGERS NAVE go ✓c _ 4� t'�`TtF1CA71(itd[ �2Y 9�7+J �Nu,�j=O 4?LAN CF THE E-TABUSHMEM IS: �_ DRAWN ON YNE BACK, OTMEP TYFE Of SEFNIGEPATION" _''•AS —�—TLE ORY IL't ME7MOC FGF COOKINr(HOT'icwR1G: �'?= �OTHeR METNOC FOR SANITIZING. G1,Te1,R0,L SOURCE OF F000. NAME.`.- .� FOODu J.+��c%IVc: IZti::'D.G ^10rE 'tF.: —'JC�S!ETrIT �nRFPARATKJN' V i PAVE READ t'HE .3' -ARO Llr' 06 hE.�LTI', ..�kQU:FF.�18'vTS "OF .'MPCRANv FGOU ESTAFUSHMENTS." I K. VE r;AD T.tit 'JPP:,R' .;INITY c. nl)NS F.E�NG 7:-10-E B= UIRES:'EN'8. I 'JNCEkS7P.NU Yr!2M; A:}Nt:' -U @IDE a'r TNE'.! ANC UNDFArTAND. THA- c -C :ALw?c C;��;:iGY.9LL nt$ULT'NRCV0C:.TI0NiY:,4--.eA1POFARY Fot)U CjTABUSPMENT?EHA'IT 3E'- YvI tiuGc ^✓J0 BgI.iEP. FERSJANTTG MEL CS_C. PAVE -dSO��E TAI, SIcw' uRE LI` I CE3TIF'r UNC'::. TrE rY:NP.Li:E•S 9F PC•^.JUFY trot• I. .. . AND r=410 A{,1.: qTE __`�-� SOCIAL sEcukir! lip, F' -uEFAL ID;; 19M 'A T 86 M4 Sued Seem, Ata C997C 978-745-34CC — 9ax 978-745-7460 09-13-06 Re: Board of Health Inspection Action Plan Following are the actions that we have taken to correct an violations / recommendations from our inspection on 09-08-06. • Steam cleaning of walls, ceilings and floor in the kitchen cooking area and prep areas, scheduled repaint entire kitchen in January. • Electrician installed new "Covered" fixture above the Cooking line- Expo • Refrigeration company re -calibrated small "Sandwich Unit" and added "Freon" and getting pricing on replacing compressor or entire sandwich unit with -in 10 days. Didn't hold temp... REPLACED WITH NEW UNIT ON 09-12-06. • Checked all refrigeration on the property to make sure it was running properly and holding temperature. • Two line units, Freezer & Low Boy, were serviced and the coil and radiators acid cleaned. • Refrigeration installed fan guard on the 2"d salad unit • Both Ice machines drained and cleaned inside and out • Shelving sanded and painted for the "Salad" refrigerator, • Proper use of utensils, storage there of and cleaning procedures reviewed with all managers and kitchen personnel. • Hallmark called and re -calibrated soap & sanitize, reviewed all test stripe procedures with managers and kitchen personnel. Dish machine needed new parts to work properly, installed and machine working to standard. L? • Re -instructed kitchen staff on the importance of the "Test Stripe Log Book" for both dish machine and pot sink. • Handling of Dressing on "Cold" station improved by the use of ice under product, holding temps. • Baillargeon Pest control did 2nd full fly and pest control, fly strip usage in back area started again. • Bacon made 3 times a day now in smaller quantities and held under refrigeration after cooling. • Use of lids at slow period on both Hot & Cold stations up on line implemented to help with holding of temperatures. • Desert station Swiss Cheese moved to the cooler. • Re- addressed labeling of all "Oil" & spray products up on the line, looking into Pre -Labeled bottles for different products. • Fans at the bar area beer cooler dissembled and cleaned. • Use of a holding pan in bus stand for ice scoop implemented. • Cleaned walls ceiling & shelving in beer-kegcooler. • Walk-in striped and cleaned, shelving washed and stock check for dates. • Ice Cream Freezers, Defrosted and cleaned (2). • Bus stands refri eg rator (2), emptied, cleaned and re -calibrated. • Cleaning of F arY lator interior, sides and behind. • Hood company cleaned interior, exterior and to roof, fan removed and the blades and shroud cleaned. Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. ( I ega Paul Schafer General Manager Capitol Cooling & Heatin Heating Refrigeration Air-conditioning 3 Forms Way Middleton MA, 01949 1-781-233-0355 1-978-7624448 Fax 1-978-750-8155 September 12, 2006 Dear Paul, RE: Replacement Refrigerator The following quotation is for a replacement reach -in cooler on the main line. As per our conversation, the existing 27 inch Beverage Air single door cooler has an inefficient compressor. This job can be completed for approximately $500.00. An exact replacement will be $1580.00 This price shall include pick up, delivery, and proper disposal of the old machine if needed. The new machine shall have a one year parts and labor warranty, with five years parts only on the compressor. During our conversation we spoke of a machine with a refrigerated top rail. We found two brands that make this style of machine. however the shortest width is 44", too wide to fit in existing area. Please feel free to contact me with questions regarding this quotation. My direct cell phone number is 1-617-828-66541 will be available to answer questions. Regards, Mark Yeanacopolis .a--. osv.iv True e'vc.Tewrsa.Tnaer Iares�a CE RT IF KATE. OF COMPLETION M FOR PUBLIC NOTICE TO LET IT BE KNOWNr THAT. THESE PREMISES HAVE UNDERGONE HOT HIGH PRESSURE STEAM CLEANING TO THE* EXTENT AS FOLLOWS: [,, � VENTILATING HOO[)F_XHA � � US-T DUC;i'S ACCESSIBLE EJANS. AND/OR BLOWERS y FGtUIPM4ElUi': ®FLOORS WALLS ❑ []CEILING'S .[ErOTHER .,, 114 THAT THESE PREMISES, NAMELY [.ocarEt? AT ON THIS bATI HAVE BEEN CLEANED IN-COUPLIA NCE -WITH-HEALTH ARID ERRE SAFETY. 90PES OF THE COMMONWEALTH n OF-HASSACHUSETTSr McGUA1REjRiCF1 CO. �� - i+ighPressure steam Cleaning R►16THORI ED SIGNATURE P.O,Box 4064 ��® SEAL TEItBODY, MA 01961 NEXT CLEANING DATE: 978-535-7609 MONTH __ S YEARZW ty � i McGuire/'Ridz Co. P.O. Box 4064 Peabody, APIA 01961 978-535-7609 I SOLD BY DATE % f NAME+ ADDRESS + CITY Ll CASH' , ❑ -CHARGE ` ` ❑ MERCHANDISE RETURNED - ❑: C.O.D 't• t ❑PAIDOUT, " ,.;❑ PAID6NACCOUNT QTY. DESCRIPTION AMOUNT I 1 s ,a to J ry 4 Ile I I I I i II � I I RECEIVED BY fr. TOTAL ....w 0897 THANK YOU (r RESIDENTIAL Service Call ❑ Reported Problem: 013 aillargeon Pest Control, Ince (9 "Your Personal Pest Control Solution" Re/Clean Out n udle Account Name 1 (R C1 )'?! �i `tel r'j fil dilAddress City ( dlr States /r 1 Zip Code Telephone# Weather Conditions: Sunny ❑ Windy ❑ Snow ❑ --Cloudy ❑ Estimated Outside Temperature: Was pest activity found at this service: Ye No ❑ 1 found pest activity - Location - Be specific: fr � r /A105 PI2PO Summary & Recommendations r COMMERCIAL Retreatment El ,2A -:T age State License # Hairy L_j uiez A fc -�I t/ cnl �;fx-f5 �t uturr p oc '�— X150 C'Ak,,J'e .!5— tsi✓5 F- z t( kyo4 ?�, "-t7 1041'f' (-I 57 sc .Eked?� rc �` cc,a'jqrvn( oel,(r`/LS- Customer Sig ature X yk e Target Pest: Rodents ❑ Cockroaches FlieF Ants[--] E] Insecticides used E.P.A. # (%) Amount Rodenticides used E.P.A. # Amount Business Phone 978-683-5541 P.O. Box 2314 Fax Number 978-989-9228 (BAT) Methuen, MA G� Ir 01844 J "You Get What You Pay For' R - 0612 `! WWW.BAiLLARGEONPESTCONTROL.COM REASON FOR THIS CALL: PREVENTIVE Ej EMERGENCY MAINTENANCE SERVICE DISHMACHINE "q LAUNDRY TEMPERATURES: PREWASH Hallmark P.O. BOX 468 SALEM, MA 01971 Service: (978) 744-0880 Fax: (978) 745-3808 CUSTOMER SERVICE REPORT N'01 41-824 DISHMACHINE SERVICE-* ACCOUNT NUMBER J iMlEmiE j Ej'�CUSTOMER REQUEST r7 ARVIM PERFORMED BY NEW ACCOUNT E] NEW ACCOUNT, SURVEY INSTALLATION DETERGENT CONC. MACHINE IN USE? FILL VALVES 1/,' jy 11 ESE 1:1 NO MODELDETERGENT 0. % FINAL RINSE P.S.I. NO. ,t/` CONCENTRATION PRESSURE RES. CHLORINE OF -y OF POWER OF FINAL OF WASH FRESH WATER FEEDBACK RINSE RINSE BRIGHTNESS DISHMACHINE SERVICE-* "'�XNEMW - : a =e SEE CRECK)IMOCE1 REPION, DETERGENT CONC. FILL VALVES 1/,' CUPS Ll WASH/RINSE ARMS V RINSE ADD. CONC. GLASSES iX DRAINS/SCREENS V, SANITIZER CONC. ,t/` CONVEYOR RES. CHLORINE FLATWARE CURTAINS/RACKS FORMULAS SOFTNESS FRESH WATER FEEDBACK PH BRIGHTNESS "ADDITIONAL COMMENTS ON C SERVICE OR OPERATION. t p c' ,A CHEMICAL PRODUCT INVENTORY/ORDERACCOUNTAIIILE ITEMS USED OR DELIVERED TYPE/Pamucy aT xuo piii io., 'f MECHANICAL W/W 4 " i�" RINSE ADDITIVE J A MANUAL WM SANITIZER PRESOAK L GEN, PURPOSE CLEANER z 00 I I ?") 'It U OVER CLEANER ,PRS. SERVICE @ $ rl ) r , 1 1, LIT TOTAL THIS SERVICE WAS ACKNOWLEDGED BY: THANK YOU FOR 1- YOUR PATRONAGE! XDATE I I A CUSTOMER SIGNATURE I Hallmark ORIGINAL COPY 7 STORAGE DISHWASHER AREA3L" PREP AREA'S LINE EQUIPMENT/COOK LINE MISC KITCHEN ITEMS LINE CHECK 93�, 492 NEED TO PASS �? SCORE 113 a 9 200 102. 75 - .. " TOTALSTORAGEI 93 1 V .I . DRYSTORAGE ALL FLOORS CLEAN AND IN GOOD REPAIR PTS 2 SCORE ' SHELVING CLEAN AND PAINTED 3 - i)s -pA/Ar $ WALLS CLEAN AND IN GOOD REPAIR 2 V64 l/T2 ,iICG OPEN BULK.PRODUCTS IN CLEAN CONTAINERS LABELED WITH OPEN DATE 3 J $ ALL LIGHTS WORKING WITH PROTECTIVE COVERS PRESENT 3 • $ ALL PRODUCT AT LEAST 6" OFF THE GROUND 2 / /3 O Xc4jr -9 &1 L $ ALL PRODUCT FACED, PULLED FORWARD, ORGANIZED, DATED AND ROTATED 5 3 6cGD S,Up,�� WALK-IN COOLER DOOR CLEAN AND IN GOOD REPAIR (INCLUDING GASKET) 3 j FLOORS CLEAN, DRY AND IN GOOD REPAIR 3 pZ TI[ S 6UL44 WALLS AND CEILING CLEAN AND IN GOOD REPAIR 3 $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 4 qS v T "&I EVAPORATOR FAN COVERS AND COILS CLEAN 2 a $ INTERNAL THERMOMETER PRESENT, TEMPETURE AT 40 DEGREES OR LOWER 5 ALL LIGHT WEIGHT PRODUCT STORED ON UPPER SHELVES 3 ALL PRODUCT AT LEAST 6" OFF THE GROUND 3 $ BEEF OVER SEAFOOD; SEAFOOD OVER POULTRY (RAW), COOKED OVER RAW 5 lJ/)( ALL PRODUCTS FACED, PULLED FORWARD, ORGANIZED, DATED AND ROTATED 5 ALL SHELVING CLEAN AND IN GOOD REPAIR FREEZER ALL PRODUCTS ROTATED 3 1 NO AIR EXPOSED PRODUCTS/SIGNS OF FREEZER BURN 1 ALL LIGHT WEIGHT PRODUCT STORED ON UPPER SHELVES 1 % $ LOCKED WHEN NOT IN USE 5 J T- of 4// Dpi DOOR CLEAN AND IN GOOD REPAIR (INCLUDING GASKET) 2 72 CLEAN FLOORS, NO ICE BUILD UP 2 / Sf r/L 0' INTERNAL THERMOMETER PRESENT, TEMPERATURE AT 0-10 DEGREES 5 ° WALLS AND CEILING CLEAN AND IN GOOD REPAIR 3 $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 5 S EVAPORATOR FAN COVERS AND COILS CLEAN 2 / •c/ -t7 CO✓NfS $ ALL OPENED PRODUCT LABELED AND DATED 5 ALL RACKS CLEAN AND IN GOOD REPAIR 2 eZ - .. " TOTALSTORAGEI 93 1 V .I . TOTAL TOTAL DISHWA5HER AREAI _ 31 I d5 7 - DISHWASHER AREA MACHINE CLEAN INSIDE AND OUT 53 ovr:51hpD, $ PROPER CHEMICALS BEING USED, DISH MACHINE AND POT SINK 4 POTSINKS CLEAN AND IN GOOD REPAIR 2 02 PLATE STORAGE RACK CLEAN AND IN GOOD REPAIR 2 • $ ALL LIGHTING WORKING AND TO SPECIFICATION (100 WATTS) AND COVERED 4 $ FLOOR MATS CLEAN AND IN GOOD REPAIR 3 3 FLOORS CLEAN, DRY AND IN GOOD REPAIR 3 j WALLS AND CEILING CLEAN AND IN GOOD REPAIR 2 pZ PRE-SOAKING IN USE 2dF CLEAN MOP HEAD AND BUCKET, BROOM, AND SWEEPER HOKEY READILY AVAILABLE FOR CLEAN UP AND USED 4 qS v TV /JA/V6 rvd/ /A/ TOTAL TOTAL DISHWA5HER AREAI _ 31 I d5 7 - ITFMS TO RF INCLUDED IN THE FIRST AID KIT $ AEIP AREA'S AND EMPLOYEE BATHROOMS BATHROOMS 1� .- ' $ ALL SUPPLIES STOCKED IN EMPLOYEE BATHROOMS 4 $ ALL FIXTURES WORKING PROPERLY AND CLEAN 5 $ DOORS CLEAN AND IN GOOD REPAIR IN BATHROOMS 2 $ ALL BATHROOMS LABELED AND NO SMOKING SIGNS IN PLACE 2 $ FLOORS, WALLS, AND CEILING CLEAN AND IN GOOD REPAIR IN BATHROOMS PREP AREA SOAK TANK FULL, CLEAN AND IN GOOD REPAIR, AND COVERED 4 2 / 41600 00KA4 $ STAINLESS TABLE CLEAN AND IN GOOD REPAIR 2 $ ICE MACHINE'S: OUTSIDE CLEAN AND IN GOOD REPAIR, DOOR CLEAN, AND NO EVIDENCE OF LIME BUILD UP INSIDE 4 $ ICE SCOOP EVIDENT FOR ICE ONLY 1� $ ICE BUCKET EVIDENT FOR ICE ONLY 1 $ KNIFE RACK CLEAN AND IN GOOD REPAIR, INCLUDING KNIVES 3 $ SLICER CLEAN AND IN GOOD REPAIR 4 3 NC S 6"6ulal $ JACARD CLEAN AND IN GOOD REPAIR 1 $I FOOD PROCESSOR CLEAN AND IN GOOD REPAIR 1 FLOORS, WALLS, AND CEILING CLEAN AND IN GOOD REPAIR 3 1 /q/ 4/i9 "(CS $ LIGHTING TO SPECIFICATION (100 WATTS OR COOL WHITE FLORESANTS) 3 02 / (Jr/ 1-0 3,-X CUTTING BOARDS CLEAN, GOOD REPAIR, AND NOT STAINED SALAD PREP AREA ALL SINKS CLEAN AND IN GOOD REPAIR L 3 2 3 6A& $ HOT WATER IS WORKING 3 HOBART UNIT CLEAN AND IN GOOD REPAIR 4 yy�� &Ktd 5 Akt-W STAND UP REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 ALL SHELVING CLEAN, AND FAN COVER CLEAN 3/�t ^V � 46eC ALL PRODUCT LABELED AND DATED 4 N NU"✓C DESSERT REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 S ALL SHELVING CLEAN, AND FAN COVER CLEAN 3 ALL PRODUCT LABELED AND DATED 4 A N6 p'Q1 bOT:5 ICE CREAM REFRIGERATOR CLEAN AND IN GOOD REPAIR 5 $ NO FREEZER BURN ON PRODUCT 5 S ICE CREAM DIP SINK WORKING, CLEAN AND IN GOOD REPAIR FIRST AID KIT 2 ,2 IS ITFMS TO RF INCLUDED IN THE FIRST AID KIT $ BAND-AIDS 1� $ ACE BANDAGE 1 $ BURN CREAM 1 $ BURN SPRAY 1 $ KNUCKLE BAND-AIDS 1 $ EYE SPRAY 1 i $ EYE CUP 1 $ GAUZEBANDAGES 1 $ BLOOD CLOTTER 1 $ ANTISEPTIC SWABS 1 $ ANTISEPTIC SPRAY 1 $ STERILE PADS (3X3) 1 $ COLD COMPRESS 1 $I HYDROGEN PEROXIDE 1 •• SINK WALLS CLEAN AND IN GOOD REPAIR 2 1 /q/ 4/i9 "(CS ALL EQUIPMENT HANGING 1 MOP BUCKET CLEAN AND IN GOOD REPAIR 2 6A& HOT AND COLD WATER WORK 4 ALL CHEMICALS LABELED, FULL AND HOSE IN SINK 3 TOTAL PREP AREA'S .113 "° MAIN COOK LINE PAGE 1 SUBTOTAL COOK LINE 157 OVENS DOORS CLEAN AND IN GOOD REPAIR PTS 3 SCORE RACKS CLEAN AND IN GOOD REPAIR 2 OUTSIDE OF UNIT CLEAN, NO DUST ON BACK OF UNIT 2 $ INTERNAL THERMOMETER PRESENT 5 $ OVEN GLOVES PRESENT AND IN GOOD REPAIR h&kl 6rvo LEGS AND CASTER CLEAN AND IN GOOD REPAIR 2 ALL DIALS PRESENT AND IN GOOD REPAIR 2 FRYERS ALL FRYERS CLEAN AND IN GOOD REPAIR 3 $ FRY FILTER MACHINE CLEAN AND IN GOOD REPAIR 5 $ FRY FILTERS PRESENT AND EVIDENCE OF USE 5 INSIDE UNIT CLEAN AND IN GOOD REPAIR 3 VENT AND SHIELD PRESENT, CLEAN AND IN GOOD REPAIR 3 3 $ CALIBRATED CORRECTLY 3 $ GRILL THERMOMETER PRESENT IN RESTAURANT 5 -5- ALL GRATE CLEAN AND IN GOOD REPAIR ALL 3 J ALL RADIENTS CLEAN AND IN GOOD REPAIR 2 ALL KNOBS PRESENT 2 ALL SPLASHGUARDS PRESENT, CLEAN, AND IN GOOD REPAIR 2 UNDER TRAY CLEAN AND IN GOOD REPAIR 2 SLOW COOKERS OUTSIDE OF UNITS CLEAN, INCLUDING FAN GUARDS —T -fl CLEAN AND IN GOOD REPAIR 3 DOORS CLEAN AND IN GOOD REPAIR 3 3 DRIP TRAY PRESENT, CLEAN AND IN GOOD REPAIR 3 ALL DIALS ARE PRESENT 3 3 $ ALL DIALS ARE SET TO PROPER READINGS 5 S $ PRIME RIB COOKING CHART IS PRESENT 5 .Q� CSD Un/ $ THERMOMETER PRESENT 5 LOW BOY UNDER GRILL DRAWERS CLEAN AND IN GOOD REPAIR 3 3 GASKETS CLEAN AND IN GOOD REPAIR 3 ^' AA) (ie/ Ald INSIDE UNIT CLEAN AND FREE OF DEBRIS 2 ALL RAILINGS CLEAN AND WORK PROPERLY 2 e:9,— $ ITHERMOMETER PRESENT 5 /✓ %i%liLYIGo1:�FF✓ SIX DRAWER UNIT DRAWERS CLEAN AND IN GOOD REPAIR 3 3 GASKETS CLEAN AND IN GOOD REPAIR 3 INSIDE UNIT CLEAN AND FREE OF DEBRIS, WITH NO ODOR 3 3 $ THERMOMETERS PRESENT ON EACH SIDE 5 Y/✓CCYlnl O CONDIMENT WELL CLEAN AND FREE OF DEBRIS 2 PLATE WELL CLEAN AND FREE OF DEBRIS 3 /N� CEO01/ ALL RAILINGS CLEAN AND WORK PROPERLY 2 oT REFRIGERATORAPPETIZER DOORS CLEAN AND IN GOOD REPAIR 3 GASKETS CLEAN AND IN GOOD REPAIR 1 3 1 0 1 ye/ ilv SHELVING CLEAN AND IN GOOD REPAIR 1 3 $ THERMOMETERS PRESENT ON EACH SIDE L 5 1J STATIONCARVING CARVING BOARD CLEAN AND IN GOOD REPAIR 2 DEe- KNIFE RACK AND KNIVES CLEAN AND IN GOOD REPAIR 2 .2- Z$ $ SANITIZER BUCKET PRESENT AND IN USE 5 ALL DRAINS WORK PROPERLY AND FREE OF DEBRIS 2 $ HOT SIDE IS HOT AND COLD SIDE IS COLD 5 UNDERNEATH STATION IS CLEAN AND IN GOOD REPAIR 2 WINDOW AREA CLEAN AND FREE OF DEBRIS 2 PAGE 1 SUBTOTAL COOK LINE 157 ;POTATO DR. CLEAN AND IN GOOD REPAIR 3 RAILING ARE CLEAN AND FREE OF DEBRIS 2 HOLD TEMPRATURE AT 125 DEGREES 4 ALL KNOBS ARE PRESENT 2 POT SINK BOTH SINKS CLEAN AND IN GOOD REPAIR 4 $ IHOT WATER IS HOT AND COLD WATER IS COLD 5 ALL PLUMBING WORKING AND IN GOOD REPAIR LOW BOY FREEZER DOORS CLEAN AND IN GOOD REPAIR 3 2 / )./d 1JQdJ e GASKETS CLEAN AND IN GOOD REPAIR 2 INSIDE UNIT CLEAN AND IN GOOD REPAIR 4 $ THERMOMETERS PRESENT IN UNIT 5 NO EVIDENCE OF FREEZER BURN 3 TOP OF UNIT CLEAN 2 ALL RAILS CLEAN AND FREE OF DEBRIS 2 ... TOTAL COOK LINE I 200 I $ MISCELLANEOUS JALL LIGHTING ON LINE TO SPECIFICATION AND COVERED 5 S STAINLESS STEEL WALL CLEAN AND FREE OF GREASE 4 ALL CONDIMENT SHELVING CLEAN AND ORGANIZED 2 HEAT LAMPS HAVE PROPER BULBS 2 HEAT LAMP SHELF CLEAN AND FREE OF UN -USED EQUIPMENT 2 a2 FLOOR MATS ARE CLEAN AND IN GOOD REPAIR 4 BUTCHER PAPER IS PRESENT UNDER MATS 2 FLOORS CLEAN AND IN GOOD REPAIR 3 / SOd/ ( S U $ KNIFE RACK AND KNIVES CLEAN AND IN GOOD REPAIR 4 DESSERT WINDOW CLEAN AND IN GOOD REPAIR 2 HOT FUDGE MACHINE CLEAN AND IN GOOD REPAIR 2 oQ- HOBART MIXER CLEAN AND IN GOOD REPAIR 3 3 $ AT LEAST ONE MANAGER IF FOOD CERTIFIED 5 -S- BACK DOOR IS CLEAN AND IN GOOD REPAIR 3 $ BACK DOOR ALARM WORKING AND LOCKED 5 q NG vuje✓r' ALL EXIT SIGNS IN KITCHEN WORKING AND IN GOOD REPAIR 4`% HAND SINK IS STOCKED WITH PAPER, SOAP AND SANITIZE 4 S/ ALL ELECTRICAL OUTLETS HAVE PROPER SHIELDS 2 FLOOR ON LINE CLEAN UNDER EQUIPMENT AND IN GENERAL 5 MICROWAVE CLEAN AND IN GOOD REPAIR 3 SHELVING CLEAN AND NEAT 3 p PRINTER CLEAN AND ON A WOOD BOARD 2 C PASS THRU LINE UPPERSHELF CLEAN AND NOT CLUTTERED 3 BEER BOTTLE EMPTIES AREA CLEAN AND ORGANIZED 4 $ BACK DOOR LOCKED AND IN GOOD REPAIR 5 .4 L%%% -C / WATER FILTERS CLEAN AND DATED 4 /VG I DUMPSTER AREA CLEAN AND ORGANIZED 4 DELIVERY DOCK CLEAN AND ORGANIZED 4 FLOORS IN BACK HALLWAY CLEAN AND IN GOOD REPAIR 3 ,3 BRL IGREASE FROM EXHAUST CLEAN AND SECURED PROPERLY 4 TOTAL MISCELLANEOUS KITCHEN ITEMS1 102,1,y/ al -6 Massachusetts Department:.of, Public Health" Salem Board of Health 120 Washington Street, 4Floor Division of, ood and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name IL ry r �crin D to ci T e of O erasion s Food Service LJ Retail ❑ Residential Kitchen El Mobile ❑ Temporary ❑ Caterer El Bed 8 Breakfast Permit No. Tvoe of Inspection Routine ElRe-inspection Previous I spection Date: fJ�i���s- ElPre-operation ❑ Suspect Illness El General Complaint ❑ HACCP ❑ Other AddresstL �a Risk Level Telephone _ f,l� F 3 1 J Owner A^h ��t PAA HACCP YIN Person in Charge (PIC) Time In: Q 441 Outer Inspector r O Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking „Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ t 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ,,,,.E., ¢' •„„, , „� ,,y, , A ❑ 12. Prevention of Contamination from Hands ' ❑ 1 PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities '-'EMPLOYEEHEALTH�' ,m,.,m`PROTECTION FROM CHEMICALS' -::c El 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE„"'�'"�' ❑ 4. Food and Water from Approved Source V5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans a•PROTECTION FROM CONTAMINATION = U ❑ s8. 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. rC' N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007)' 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S:590Mn,OFom 14,tl q Xr /'1 ❑ 15. Toxic Chemicals =TIMEREMPERATURECONTROLS (PolenUalty Hazardous Foods)41 ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling Af19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ":REQUIREMENTS FOR HIGHLY,SUOS CEPTISLE POPULATIONS (HSP) u' ❑ 21. Food and Food Preparation for HSP EC , ®tw.Cw 1 .rNt® :w� a` ,..Las..... t ❑ 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 It 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: Yl"'1 ' Print: PIC's Signature: ` Print: T Y c_w L Page -( or i Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT CI 596.003(A) Assi nment of Responsibility* 590.003(M Demonstration of Knowledge* F-2-10311 .. Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Com (Hance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a licamts* 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(x) Charge* 590.0(16(B) 590.003(G) Reporting by Person in Char e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C C C - Denotes cmical item in the federal 1999 Food Code or 105 CMIZ 590x00. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A B) Com (Hance 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* 5401.11 Drinking Water from an Approved System* 590.006(x) Bottled Drinking Water* 590.0(16(B) Water Meets Standards in 310 CMR 22.0* -Washing Fruits and Ve etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Rer ulafory Authority 3-202.18 _ Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Ince it-* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification 3-20112 Shellstock Identification Maintained* TagstRecords: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590,004([) Labeling of Ingredients` Frequency of Sanitization of Utensils and Food Contact Surfaces of ui ment* Conformance with Approved Procedures IHACCP Plans 3-502.11 Specialized Processing Methods* 3-502.1.2 Reduced oxygen acka hg- criteria* 8-103.12 Conformance with A roved Procedures* - Denotes cmical item in the federal 1999 Food Code or 105 CMIZ 590x00. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)0) Raw Animal Foods Separated from Cooked and RTE F(x)ds* Contamination from Raw Ingredients 3-302.11(,x)(2) Raw Animal Foods Separated from Each Other - Contamination from the Environment 3-302.11(A) Food Protection - 3 -302.15 -Washing Fruits and Ve etables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food" 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization 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 Foo d - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of ui ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-30111 Clean Condition - Hands and Anes* 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 Preventing Contamination When Tastin 12 - Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.1.1 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashi ng Cleanser, Availability 6-301.12 Hand Drying Provision 1�" '3 F r Establishment Name: CITY OF SALEM l BOAR/DD OF HEALTH C i vt n R/fc.M'f Date:q/2/'0 o f Pager of — Item Code No. Reference C - Critical Item R - Red Item - DESCRIPTION OF VIOLATION / PL F CORRECTION L PL ASE PRINT. CLEARLY Date Verified \, h _ L -07 1 f�CJ J t n � . h I -Q j 4 13.) {i Vj 011e S G .... .. < c.� (T , 9 - tv ur Q c - TO2 �C (`e&jt chasat n AA Gc� IZfrv�/ c� C rn c oal. U,- I-7iijo CJS S3 f = c t t (Ce C c A, rl e, Discussion With Person in Charge: uestio s a d agree to correctall I have read this report, have had the opport9tIo Violation's before the next in ection, to obsias d s ribed, and to PRe-inspection co'mplH with all mandates of the Mass/Fedee. I nder to d that noncompliance may result in daily fines of t11 s or slu p nsion/revocation of yo& -food permit.❑ J �J Corrective Action Required: ❑ No ❑ -Yes ❑ Voluntary Compliance ❑ Employee Restriction / � // : M Exclusion Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont) 14 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Natne - Workin,. Containers* 7-201.1 1 Separation - St'oraee* 7-20'2-1 1 Restriction - Presence and Use* 7-202.12 Conditions ofUse'r 7-203.11 'toxic Containers - Prohibitions* 7-204.11 Samnzers, Criteria Chemicals* 7-204.12 Chemicals for W tshm Produce, Cnteria* 7-204.14 Dt m ents, Crttena". 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait SwlionO 7-206.13 Tracking Powders, Pest Control and Monitodnn* 16 18 TiMMEMPERATURE CONTROLS * Deaotes Cat iCal Mu) in i.he federal 1999 Food Code or 105 CMR 590.000. P3-501.15 Proper Cooking Temperatures for �PHFs Received at Tempera ares According to law Cooled to 4FF/45'F Within 4 Hours. Cooline Meda�ds for PHF's PHFs _ 4-401.1 I A(1)(2) Eggs- 155"17 15 Sec. 3-801_ 11(C) E ees-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(B)(1)(2) Pork tied Beef Roast - 130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 1550F 15 26. sec. * 3-401.11(5)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control* Stuffing Containing Fish, Meat, 590.004(1-1) E Poultry in Ratites -165'F 15 see. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks FC - 7 145'F #, 3-401.12 Raw Animal Fords Cooked in a � Microwave 165'F=" 3-40 1.11 (A)(1)(b) All Other PHI s - 145'F 15 see _ Reheating for Hot Holding 3-403.11(A)&(D) PHFs, 1650F 15 sec. * 3-403.11(B) Microwave - 165' F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 14WI' 3-461 tI(E) Remaining Unslieed Portions of Beef Roasts* Proper Cooling of PHFs 3-561.14(A) Cooling Cooked PHFe from.140`F to 70°F Within 2 flours and From 7WT to 41'F/45'F Within 4 Hours. * 3-501.14(B) Cooling PF1Fs Made From Ambient Temperature Ingredients to 41'F/45'F Within 4 Hours* * Deaotes Cat iCal Mu) in i.he federal 1999 Food Code or 105 CMR 590.000. P3-501.15 3-501.14((-,) �PHFs Received at Tempera ares According to law Cooled to 4FF/45'F Within 4 Hours. Cooline Meda�ds for PHF's 14 3-801.1 t(D) PHF Hot and Cold Holding 3-801_ 11(C) 3-501.16(B) 590.004(F) Cold PRFs Maintained at or below 41'/45" F* Food and Food Protection 3-501_ 16(A) Hot PHFs Maintained at or above 140°F. * 25. 3-501.16(A) Roasts Held at or above 130`P. 20 26. Time as a Public Health Control FC -5 3-501-19 Time as a Public Health Control* Physical Facillty 590.004(1-1) E I Variance Re ulrement 9 3-801.11(A) Unpasteurized Prc packaged Juices and Bever saes with W nninE I. tbels* 3-501.11(B) _ Use of Pasteurized Eggs* 3-801.1 t(D) Raw or Partially Cooked Animal Food and Raw Seed S rrouts Not Served. * 3-801_ 11(C) Uno ened Food Packa ,e Not Re -served. 22 3-603-11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods'fhat are Raw. Undercooked or ! FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC- 3 Pathogens.* 25. 3-302.13 Pasteurized"Eggs Substitute for Raw Shell .005 26. E gs* bFLUAL Kt-UUlKhM1=N 11.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 tate 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 /129 - Special Requirements. sZ4l/A (items 23-30) Critical and non-critical violations, which do not relate to the foodborne il(nes.s interventions and risk factors listed above- can he, found in the following sections of the Food Code and ,105 CMI? 590.000. Item Good Retail Practices ( FC 590.000 23. Mang ement and Personnel ! FC - 2 .003 24. Food and Food Protection FC- 3 .004 25. Eguipmeoi and Utensils FC -- 4 .005 26. _ Water. Plumbing and Waste FC -5 _ X008 27. Physical Facillty --- FC -6 i .007 28. Poisonous or Toxic Materials FC - 7 .008 29. S eciai Re uiremonts � A0g 30_ _ _ _ Other _ S:511-ffc ibnW 1 dx r CITY OF SALEM 1 / + I BOARD OF HEALTH _ Establishment Name: Yi c loo a Date: Page:_— of Item Code C=Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R - Red Item - - Verified ' PLEASE PRINT CLEARLY. SU . I 1mv, a bLw a6. 4 1 -/" (cc piss n `f a L L) s. I 6wv q�r -- � - RC1( Irl✓ F-- �� H��/� %Q9u r ff d c I n n I' n r Q 0 Eger (.,Y--PiYt, f'07Have- C IeRkAce c, . S) r ed fit= WI IF --� —� ` / } / 2fft*fe CIA Pte( 4 ( i M t ,J� OF -t P P LXI yr e - i n QD cL I .. 2 Cu d. o�,IS (I s Discussion With Person in Charge: Corrective Action Required: ❑ No lik Yes I have read this report, have had the opportunity to ask ues 'Ons and agree to correct all o Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all co ditio s asJdescribed, and to P Re -inspection Scheduled ❑ Emergency Suspension =' comply,with,all mandates of the Mass/5ederal FsQQ dei I understand that in daily fines twenty- I a olla s or uspension/revocation of ❑ Embargo ❑ Emergency Closure noncompliance may result of your food permit. ❑ Voluntary Disposal ❑ Other: \ cet -4S' Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) (Cont.) 17 18 s • Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-801.11(0) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11. ConunonName- Workin- Containers" 7-201.1 1 Separation - Stora e" 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 Dr °ins r eats. Criteria* 7-2(75.11 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* • i Denotes critical item in the iMirral 1999 Foot[ (:ode or 105 (`biR 590,000. Proper Cooking Temperatures for PHFs Received at'l'emperatures PHFs s -401.11A(1)(2) Eggs- 155'F 15 Sec. 3-801.11(0) E es-Lrmiediate Service 145°F15sec* 3-401.11(A)(2) - Comminuted Fish, Meats & Game 3-501.15 Animals- 155815 sec. *" 7T4 .1 Pork'. and Beef Roast - 130`*F 121 min* 3-401.11(A)(2) Ratites, Injected Meats - 155°F 13 3-50'1.16(B) sec. 3-40L11(A)(3) Poultry, Wild Game, StuffedPHFs, 41'145° F* Stuffing Containing Fish, Meat, 3-501.16(A) or Ratites -165°.F 15 see. t` -Poultry 3-401A 1(C)(3) Whole -muscle, Intact Beef Steak's 140'R* 145'17 s 3-401.12 Raw Animal Foods Cooked in a 20 Microwave 165'F * 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. 3-501.19 Reheating for Hot Holding 3-403.1 I (A)&(D) PHFs 165'F 15 sec. 3-403.11(B) Microwave- 165' F 2 Minute Standing, Z 1mC* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11(4+) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501_ W(A) Cooling Cooked PHFs from 1.40`F to 70'F Within 2 Flours and From 7U'F to 41'F/45'F Within 4 Hours. * 3-501..131(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F745'F Within 4 Hours* i Denotes critical item in the iMirral 1999 Foot[ (:ode or 105 (`biR 590,000. 21 3-801.'11(A) 3-501.14(0) PHFs Received at'l'emperatures Ilse of Pasteurized Ee�s* 3-Ml,1.1(D) According to Lov Cooled to "< 3-801.11(0) Unopened Food package Not Re -served. " 41`F145� F Within 4 Hours. 25. 3-501.15 Coolin , Methods for PHFs lg 3-302.13 PHF Hot and Cold Holding 27 3-50'1.16(B) Cold PFlFs ,Maintained at or below 28. 590.004(F) 41'145° F* 29 3-501.16(A) Hot PHFs Maintained at or above _ 30 _ Other 140'R* 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* 590.004H) variance Rc uirement 21 3-801.'11(A) Unpasteurized Pre-packaged Juices and Beverages with Watnine laibels* 3-801.17 (B) Ilse of Pasteurized Ee�s* 3-Ml,1.1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprints Not Served. * 3-801.11(0) Unopened Food package Not Re -served. " CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 23. Mona emend and Personnel Aniural Foods That are Raw. Undercooked or 24. -_-- Food and Food Protection_ Not Otherwise Processed to Eliminate 25. Equipment and Utensils Pathogens.' E'er`"'a rnaoor 26 3-302.13 Pasteurized Eggs Substitute for Raw Shell 27 Ph sical FaciiltY_ E as* 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. Viragw-4 rULTAI (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness entervenleom and risk factors listed above can be, found in the following sections of the Food Code and 105 CMR 590.000. lrem Good Retafl Practices FC 590.000_ 23. Mona emend and Personnel F� C -- 2 .003 24. -_-- Food and Food Protection_ -- FC -3 .004 25. Equipment and Utensils FC - 4 .005 26 Water Plumbin and Waste FC -5 27 Ph sical FaciiltY_ .006 FC -6 �, .007 ----- 28. Poisonous or i oxic Materials FC - 7 .008 29 S ectal Re uirements t on _ 30 _ Other �,_-- WE0- MW WIN _Alaffi�MAYI 1 AU`I'. =!r 4o ad- /M eAo i q26n&n Lc4rc "c/ 260F. /%,L��n ,.Gl✓/l.�- —<�i I Discussion With Person in Charge: 11Corrective Action Required: ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, toAF, itions as described, and to Exclusion P ❑ Re -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/ e. I understand that noncompliance may result in daily fin s liars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: - Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 0 17 IS Food or Color Additives 3-202.12 Additiveg� _ 3-302.14 Protection front Unapproved Additives* Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers" 7-102.11 Common Name -WozkinnCanainers* 7-201.11 Separation - Shni ' e aration-Stora e* 7-202-11 Restriction -Presence and Use* 7-202.12 Conditions of. Use* 7-203.11 Toxic Containers -Prohibitions" 7-204.11 Sanidzers, Criteria - Chemicals* 7-204.1.2 Chemicals for Washine Produce, Criteria"` 7-204.14 Dr lin.- A eats. Criteria"` 7-205.11 Incidental Food Contact. Lubricants - 7 -206,11 Restricted Use Pesticides, Criteria* 7-206.12 Raritan Bait Stations" 7-206.13 Tracking Powders, Pest Control and Monitorina* Proper Cooking Temperatures for PHFs 3-40'L11A(1)(2) Eggs- 155°F 15 Sec. E > >s- hnmediate Service 145°FI Ssec* 3-401.11(A)(2) Comminuted Fish, Meats & Game Animals - 155°F 15 sec. 3-401.1 1(B)(I)(2) Pork and Beef Roast - 130�F 121 min* 3-401.11.(A)(2) Ratites, Injected Meats- 155°F 15 see 3-401.11(A)(3) Poultry, Wild Game, StaffedPHPs, Stuffing Containing Fish, Meat, Poultry or Ratites -1650F 15 sec. 3.401.11(C)(3) Whole -muscle, Intact Beef Steaks 145'17 * 3401.12 Raw Annual Foods Cooked in a Microwave 165'F * 3401_1l(A)(1)(b) All Other PHFs -145°F15sec. * Reheating for Hot Holding 3-403.11(A)&(D) PHFs I W'F 15 sec. * 3-403.11(B) Microwave -16.5° F 2 Minute Standine Time* 3-403.11(C) Commercially Processed RTE Foal - 140°Et 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 Hans and From 70°F to 41'F/45'F Within 4 Hours. 3-501.14(B) Cooling PHFs Made Front Ambient Temperature ingredients to 41°F/45`17 Within 4 Hours* Denoaes critical item nt the federal 1999 Food Code or 105 0,110 90000, 3-SOL14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45" F Within 4 Hours. 3-501.15 Canino, Methods for PHFs 19 PHF Hot and Cold Holding 3-501..16(B) Cold PHFs Maintained at or below 590.n4(F) 41145° F* 3-501.16(A) I{ot PHFs Maintained at or above 140°F.* 3-501.1.6(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 Re uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.11(A) Unpasteurized Pre-packaged Juices and Beverases with Worming I;abels 3-80LII(B) UseofPasteurizedEacs' 3-801.11(D) Raw or Pulially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-801.11(C) Una erred Ftxx1 Pacl:a >e 1V'ot fte-served * 22 3-603.1 I Consumer .Advisory Posted for Consuniption of Animal Foods IStat are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* ..... rxr 3-302.13 Pasteurized Eggs Substitute for Raw Shell E as" 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, Proper Cooking Temperatures for PHFs 3-40'L11A(1)(2) Eggs- 155°F 15 Sec. E > >s- hnmediate Service 145°FI Ssec* 3-401.11(A)(2) Comminuted Fish, Meats & Game Animals - 155°F 15 sec. 3-401.1 1(B)(I)(2) Pork and Beef Roast - 130�F 121 min* 3-401.11.(A)(2) Ratites, Injected Meats- 155°F 15 see 3-401.11(A)(3) Poultry, Wild Game, StaffedPHPs, Stuffing Containing Fish, Meat, Poultry or Ratites -1650F 15 sec. 3.401.11(C)(3) Whole -muscle, Intact Beef Steaks 145'17 * 3401.12 Raw Annual Foods Cooked in a Microwave 165'F * 3401_1l(A)(1)(b) All Other PHFs -145°F15sec. * Reheating for Hot Holding 3-403.11(A)&(D) PHFs I W'F 15 sec. * 3-403.11(B) Microwave -16.5° F 2 Minute Standine Time* 3-403.11(C) Commercially Processed RTE Foal - 140°Et 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 Hans and From 70°F to 41'F/45'F Within 4 Hours. 3-501.14(B) Cooling PHFs Made Front Ambient Temperature ingredients to 41°F/45`17 Within 4 Hours* Denoaes critical item nt the federal 1999 Food Code or 105 0,110 90000, 3-SOL14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45" F Within 4 Hours. 3-501.15 Canino, Methods for PHFs 19 PHF Hot and Cold Holding 3-501..16(B) Cold PHFs Maintained at or below 590.n4(F) 41145° F* 3-501.16(A) I{ot PHFs Maintained at or above 140°F.* 3-501.1.6(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 Re uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.11(A) Unpasteurized Pre-packaged Juices and Beverases with Worming I;abels 3-80LII(B) UseofPasteurizedEacs' 3-801.11(D) Raw or Pulially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-801.11(C) Una erred Ftxx1 Pacl:a >e 1V'ot fte-served * 22 3-603.1 I Consumer .Advisory Posted for Consuniption of Animal Foods IStat are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* ..... rxr 3-302.13 Pasteurized Eggs Substitute for Raw Shell E as" 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, Denoaes critical item nt the federal 1999 Food Code or 105 0,110 90000, 3-SOL14(C) PHFs Received at Temperatures According to Law Cooled to 41'F/45" F Within 4 Hours. 3-501.15 Canino, Methods for PHFs 19 PHF Hot and Cold Holding 3-501..16(B) Cold PHFs Maintained at or below 590.n4(F) 41145° F* 3-501.16(A) I{ot PHFs Maintained at or above 140°F.* 3-501.1.6(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 Re uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.11(A) Unpasteurized Pre-packaged Juices and Beverases with Worming I;abels 3-80LII(B) UseofPasteurizedEacs' 3-801.11(D) Raw or Pulially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-801.11(C) Una erred Ftxx1 Pacl:a >e 1V'ot fte-served * 22 3-603.1 I Consumer .Advisory Posted for Consuniption of Animal Foods IStat are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* ..... rxr 3-302.13 Pasteurized Eggs Substitute for Raw Shell E as" 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-501.11(A) Unpasteurized Pre-packaged Juices and Beverases with Worming I;abels 3-80LII(B) UseofPasteurizedEacs' 3-801.11(D) Raw or Pulially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-801.11(C) Una erred Ftxx1 Pacl:a >e 1V'ot fte-served * 22 3-603.1 I Consumer .Advisory Posted for Consuniption of Animal Foods IStat are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* ..... rxr 3-302.13 Pasteurized Eggs Substitute for Raw Shell E as" 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, 22 3-603.1 I Consumer .Advisory Posted for Consuniption of Animal Foods IStat are Raw. Undercooked or Not Otherwise Processed to Eliminate Pathogens.* ..... rxr 3-302.13 Pasteurized Eggs Substitute for Raw Shell E as" 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, 590.009(A) -(D) Violations of Section 590.00(A) -(D) in entering, mobile food, temporary and residential kitchen operations ,should be debited under eine 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 -- I Special Requirements. rd;#fT1 (Items 23-30) Clinical and non-critical violations, which do not relate to the firodborne illness interventions and risk f icttrrs listed above., can be found in the following sertions of the Food Code and 105 CMR 590-000. Item Good Retail Practices j FC 580.000 ----------- 23. Marra ement and-Personn_eiFC -- 2 .003 24. Food and Food Protection _ QFC - 3 .004 25 Equi ment and Utensils FC 4 _ _ 005 26. Water, Pluarbinst and Waste FC -5 '..006 - --- 27. Physical FaciliTyFC- Q ._-_-- 28. Poisonous or Toxic Materials FC - 7 .008 29ecii Requirements 009 _ 30 Other SSYOrmmbatl.AZA,, SSYOrmmbatl.AZA,, 1 t Establishment Name: fY OF SALEK BOARD OF HEALTH .ey� Date: qk- /O 6 Pager_ of Item No. Code Reference c - Critical Item R - Red Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION RINT CLEARLY -- PL SE P. Date „,Verified e"I p f -Cr r I v I n U Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all vio6ations before the next inspection, to observe WI condi jl ns adescribed, and to comply with all mandates of the Mass/Federal Foo�o e. I un er�tand that noncompliance may result in daily fines of twenty-fiv tl ,Ila 'or tsuspension/revocation of your food permit. � Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion 4--We-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 F-14 15 '* Denol2r critical item in the federal 1999 Food Co& or 105 CMR 596,000. 3-501,14(C) 3-501.15 Food -Or Color Additives 3-2!}2.12 Additives" 3 02.14 Protection from 'Unapproved Additives'r 7-101.11 Poisonous or Toxic Substances ldentitying Information - Original Containers* 7-302.11 Common Name - Workim, Containers* 7-201.11 Separation - Storage" 7-202.11 Restriction - Presence mud Use* 7-202.12 7-203.11 Conditions an Use* 'Toxic Containers - Prohibitions" 7-204.11 Satutizers. Criteria - Chemicals* 7-20-112 Chemicals for W ashine Produce, Criteria* 7-204.14 Dr •Ina,,ent's. Criteria" 7-205.11 Incidental Food Contact. Lubricants - ubricants*7-206.11 7 -206 11 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations - 206.13 'tYacking Powders, Pest Control and Monitoring* '* Denol2r critical item in the federal 1999 Food Co& or 105 CMR 596,000. 3-501,14(C) 3-501.15 Proper Cooking Temperatures for 14 PHFs 3-401.1. I A(1)(2) Eggs- 155'F 15 Sec. _ 3-501.16(A) Sees -honed SerSer,iec 1450F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Animas - 155F 15 sec. 'r 3-40 Ll l (B)(1)(2) Pork and Beef Roast - 130'F 121 nun* 3-401.11(8)(2) Ratites, Injected Meats- 155'F 1.5 26 sec. a' 3-401.11(A}(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC-6 Poultry or Ratites -165'17 15 sec. 3-401.11(C)(3) Whole -muscle, finact Beet Steaks FC - 7 145`17;. 3401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401.11(A)(1)(b) All Other PHFs - 145°F 15 sec. 17 Reheating for Hot Holding 3-4011 l(A)&(D) PHFs 165'F 15 scc. * 3-403.11(B) Microwave- 165° F 2 Minute Standim, Time" 3-403.11(C) Commercially Processed RTE Food - 14WF* 3-403.11(E) Remaining Unsliced Portions of Reef Roasts* 18 Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 700F Within 2 Hours and From 70'F to 41`F145'F Within 4 Hours. 3-501.14(B) Cooling PHFs Made From Ambient Temperature htgredients to 41'F145'F Within 4 Hours" '* Denol2r critical item in the federal 1999 Food Co& or 105 CMR 596,000. 3-501,14(C) 3-501.15 PHFs Recen ed i t Temme r tut.vs According to Low Cooled to 41 17145 F W ahi n 4 Hour t Conlin,* Methods for PHFs 14 PHP Hot and Cold Holding 3-501,16(B) 590.004(F) Cold PHFs Maintained at or below 41`/45°F* _ 3-501.16(A) Hot PHFs Maintained at or above 14017 * 3-501.16(A) RosenHeld at or above 130'F.* 20 Time as a Public Health Control 3-507-39 Time as a Public Health Control" 590.004(H) variance Re uirement 21 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) . 3-801.11(A) I:npntwnzedPre-packaged Juices and Beverte�es with Warnine "bels* 3-801.11(B) Use of Pasteurized Egleq,* 3-80L l I(D) Raw or Partially Cooked Animal Food and Raw Seed S xouts Not Served. 3-801. I1(C) Uno rened Fo[x{ Package Not Re -served. * 22 3-603.1 t Consumer Advisory Posted for Consumption of FC Animal Foods That are Raw. Undercooked or 23. Not Otherwise Processed to Etuninate FC - 2 PathaRens.* re«to:-d ,nzxi 24. 3-302.13 Pasteurized Eggs Substinde for Raw Shell FC -- 3 g, s* ZWMAHt_ Kt:UUIHtMl=N i`5 590.009(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 gond retail practices should be debited under /629 - Special Requirements. l (Means 23-30) Critical and non-critical violeriions, which do not relate to tiro _foodborne illness aatse venlion,s' and risk fiuwrs listed above, can be .fo and in the fWooving sections of the Food Cade and 105 CMR 590.000. Item -----------...__-------- Good Retail Practices FC 590.000 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC -- 3 I .004 25. Equipment and Utensils FC -4 26 Water Plumbin and Waste FC_5 _7005 ..006 27. Ph sical Facility FC-6 _ .007 28. Poisonous or Toxic Materials FC - 7 .008 20. _ S ecial Re uiremants i .009 30, other Massahusetts Department of Public Health Division bf Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name I Datg' T e of 0 eration s Tvoe of Inspection Food Service ❑ Retail i A ♦. I, R -jz_ a Cil/S 0 ❑Routine ,gLRe-inspection Address Rik / Level ❑ Residential Kitchen EIMobile Previous Inspec ion Date: GI�� Telephone �� � 0 El Temporary Caterer ❑ Bed & Breakfast El Pre-operation ❑ Suspect Illness ❑ General Complaint Owner s e n 1T HACCP WIN❑ Person in Charge (PIC) / Time Ino; 0❑ HACCP Inspector Out,? _ Permit No. ❑ Other Each violation checked re uires 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. 7 FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties f` EMPLOYEE i;€€. ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION f ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals .,FOOD FROM APPROVED SOURCE„'„ r-17 �?yMPOR"!=, n'• t f 71MEREMPERATURE CONTROLS (PotentlallyHazardaus Foods)A . % E] 4. Food and Water from Approved Source r ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION" ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C I N' 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007)' 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other 5: 5901nspectFanKr l4.tla ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control j;;RE0U1gEMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (NSP) ;J ❑ 21. Food and Food Preparation for HSP ;„CONSUME R. ADVISORY,, °�v -',,°}`'"si�v m 3�a�.,J '_'. a- -a` ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. ✓ DATE OF RE -INSPECTION: / ) /^ Inspector's Signature: , Print: I // PIC's Signature: \_ ,\ Print: `/ �lXil'L G Paged of-rPages -m Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-}03.11 Person in charge - ttuties -----� ; EMPLOYEE HEALTH 2 590.003(C) ,Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reportingby 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 Drinicing Water from an Approved System* 590.006(A) Char e* 590.006(B) 590.003(0) Re ord ng by Person in Char+e* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(F) Removal of Exclusions and Res tic ions 4 In 6 in FOOD FROM APPROVED SOURCE *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. '.• '.•O TOTT F907.7fTt Y e, $ 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* 3-20214 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.1.1 Drinicing Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatcvy Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 ReceivinglCondition 3-202.1.1. - PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated - TagsfRecords: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* TagstRecords: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.0040) Labeling of ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.1.2 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. '.• '.•O TOTT F907.7fTt Y e, $ Cross -contamination . 3-302.1](A)0) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anirnal Foods Separated from Each Other* Contamination from the Environment 3-302.1.1(A) Food Protection - 3 -30115 Washing Fruits and Vegetables 3-30411 Foci 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* F-9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Saui6zation'rent ratures` - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temper tures* 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* 4-70311 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* 1.1 Good Hygienic Practices 2401.11. Eating, Drinking or Using Tobacco* 2.401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Contamination When Tasting* 12 -Preventing Prevention of Contamination from Hands 590.004(F) Preventing Contamination from Em Flo ees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Hindwashing Cleanser, Availability 6-301.12 Hand Drying Provision r CITY OF SALEM BOARD OF HEALTH n Establishment Name:V"I'/aDate: 7 Pager_ of No Item Code C - Critical item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R— Red Item - - Verified Employee Restriction / described, and to.Exclusion - PLEASE PRINT CLEARLY ❑ Emergency Suspension rstand that uspension/revocation of G0 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: _ Gn �— Q c f__>-- Discussion With Person in Charge: r'. 1 have read this report, have had the opportunity to ask q violations before the next inspection, to observe all condj �&mply with all mandates of the Mass/Fe ral Food C dl ` Noncompliance may result in daily fines ftVenty)iveko M+� .t t; 'your'food permit. :F ro Corrective Action Required: ❑ No Yes and agree to correct all Voluntary Compliance ❑ Employee Restriction / described, and to.Exclusion 13 Re -inspection Scheduled ❑ Emergency Suspension rstand that uspension/revocation of ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 17 18 3-202. _12 Additives'r Additives 3-302.14 Protection from Unapproved Additives* Poisonous or Toxic Substances 7-10I. i I Identifying Information - Original Containers - 7 10-2 11 ontainers*7-102.11 Common Naaw - Worklna Containers* 7-201.11 Se.aration- Storage* 7-202.11 Restriction -Presence and User 7-202.12 Conditions of Use- 7-203.11 se*7-203.1t Toxic Containers - Prohibitions* 7-204.11. Saintizers.Criteria - Chemicals* 7-204.1.2 Chemicals for Washin> Produce, Criteriaa' 7-204.14 Drvino AEents. 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 Monitorinn* Food or Color 3-801.1 I(B) PHFs_ 3-401.11-4(1)(2) _ Eggs- 1.55' F 1.5 Sec. 3-801,11(C) E >es- hmnediatc Sen -ice 145°FI Ssec* 3-401.11(A)(2) Comminuted Fish, Mears <? Game FC- 3 Animals - 155°F 15 sec. * 3-401.1 I(B)(1)(2) Pork and Beef Roast - 130"F 121 nam* 3-401.1 I(A)(2) Ratites, Injected Meats - 155'F 15 27. sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 28. Stuffing Containing Fish, Meat, FC -7 Pouiu� or Ratites -165°P 15 sec. * 3-401.11(C1(3) Whole -muscle, Intact Beef Steaks - 145°F 3-401.1.2 Raw Animal Foods Cooked in a Microwave 165'F * 3401A I(A)(1)(b) All Other PHFs- 145°F 15 sec. * Denows critical ite n in ihe. tedend 1999 Food Code or 105 CMR 590-000. 3-501.14(C) PFIFs Received at Temperatures According 1'o Law Cooled to `' _ _41.Ft45`�F Within 4 Hours. 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41 F'745° 3-501.16(A) I-lat PHFs Maintained at or above t4WI-,as 3-501.16(A) Rots 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 N REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3-801_11(-4) Proper Cooking Temperatures for 3-801.1 I(B) PHFs_ 3-401.11-4(1)(2) _ Eggs- 1.55' F 1.5 Sec. 3-801,11(C) E >es- hmnediatc Sen -ice 145°FI Ssec* 3-401.11(A)(2) Comminuted Fish, Mears <? Game FC- 3 Animals - 155°F 15 sec. * 3-401.1 I(B)(1)(2) Pork and Beef Roast - 130"F 121 nam* 3-401.1 I(A)(2) Ratites, Injected Meats - 155'F 15 27. sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 28. Stuffing Containing Fish, Meat, FC -7 Pouiu� or Ratites -165°P 15 sec. * 3-401.11(C1(3) Whole -muscle, Intact Beef Steaks - 145°F 3-401.1.2 Raw Animal Foods Cooked in a Microwave 165'F * 3401A I(A)(1)(b) All Other PHFs- 145°F 15 sec. Reheating for Hot Holding 3-40111(A)&(D) PHF6 165°F 15 sec. f 3-403.11(B) Microwave- 165° F 2 Minute Standing Timer 3-403.11(C) CommerciatlyProcessedRTEFood- 140'Fr _ 3-403.11(E) Remaining Unsliced Portions or Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°P 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'r * Denows critical ite n in ihe. tedend 1999 Food Code or 105 CMR 590-000. 3-501.14(C) PFIFs Received at Temperatures According 1'o Law Cooled to `' _ _41.Ft45`�F Within 4 Hours. 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41 F'745° 3-501.16(A) I-lat PHFs Maintained at or above t4WI-,as 3-501.16(A) Rots 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 N REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3-801_11(-4) Unpnt uri zed Pre-packaged Juices and with Warning Labels* 3-801.1 I(B) _Beverages Use of Pasteurized Eggs* 3-801A 1(D) Raw or Partially Cooked Animal Foal and Raw Seed Sprouts Not Served, s 3-801,11(C) Unopened Food Package Not Re -served. Not Otherwise Processed to Eliminate ---R)od and Food Prctection FC- 3 Pathogens.* 20 26 3-302.13 Pasteurized Eggs Snbstoute'for Raw Shell _:005 .006 27. Eggs* FC -6 .007 28. Poisonous or Toxic Materials FC -7 .008 N REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3-801_11(-4) Unpnt uri zed Pre-packaged Juices and with Warning Labels* 3-801.1 I(B) _Beverages Use of Pasteurized Eggs* 3-801A 1(D) Raw or Partially Cooked Animal Foal and Raw Seed Sprouts Not Served, s 3-801,11(C) Unopened Food Package Not Re -served. s 22 3-1103.11 Consumer Advisory Posted for Consumption of 590.000 23. Anunal Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate ---R)od and Food Prctection FC- 3 Pathogens.* 20 26 3-302.13 Pasteurized Eggs Snbstoute'for Raw Shell _:005 .006 27. Eggs* 5`n)Ah (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 {129 - Special Requirements, F.*7.7T (Iteur s 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and riskfactors hoed above, can be ,found in the following sections of the Food Code and 105 CMR 590.000. Item Good Retail Practices FC 590.000 23. Management and Personnel FC - 2 .003 24. ---R)od and Food Prctection FC- 3 .004 20 26 _ _ Equipment and Utensils Water, Plumbin and Waste FC -4 FC 5 _:005 .006 27. Physical Facility FC -6 .007 28. Poisonous or Toxic Materials FC -7 .008 29 30 S ecial Re uiremenis Other - I .009 45op(crni+.�d6.>.Uoc ,00ac�oq>o� SUE SILVA Manager Pickering Wharf Salem, Ma: 01970 (978) 745-3400 Fax (978) 745-7460 1 Please Complete and Send or Fax to., (2neS(IOrIS7 Cad: ND Date: �I I� MDPH Food Protaction Program Food Protection Program: (617) 9836712 305 South Street, Jamaica Plain, MA 02130 Division of Epidemiology. (617) 9636800 M Fax (617) 9836770 Enterics Laboratory: (617) 983-6609 ron Completing Information C�r 74 k da ,p Name: %7 - Affiliation: ❑ Local befi (town): ❑ State DPH (division): ❑ Other. I IReport�r/Complainant Name: _— /' 1W: ( ) r Affiliation: XConsumer 1&6L ❑ Laboratory division, ❑ Local BOH facility, ❑ Medical Provider address, ❑ State DPH town, etc. ❑ Other Illness Information # Persons ill:® Symptoms: (mark if reported for an one : ❑ Diarrhea VomitingNausea ❑ Abdominal cramps ❑Bloody Headache Muscle aches ❑ Fever stool Chills Loss of appetite ❑ Fatigue ❑ Dizziness ❑ Burning in mouth ❑ Other symptoms: ...................... . Lab Time: f AM ❑PM Onset: > Earliest Date: / / Latest (if > 2 ill) Date: / / Time AM ❑PM ................................................................................................................ Duration: ❑ Less than 24 Hours8 Hours ❑ More than 48 Hours ❑ Ongoing ❑ Unknown Ill Persons: Age Name Addressrrown(yrs) Occupation Med. Provider/ 9 i same as reporter (above) r , 3 N v 4 Medical attention received (by anyone)? ❑ Yes ❑ Unknown If Yes, specify above: T ` /No Stool specimens submitted (byanlronel? ❑ Yes No ❑ Unknown > To SLI'? ❑ Yes ❑ No ❑ Unknown \ Medical diagnosis reported? AJO/ Food History - Obtain history back 72 hours prior to symptoms, or, if organism identified, bin min and max incubation periods (see p.2) — If > 2 ill, follow above time frame for common meals, (foods) only # Restaurant 1 store where Date & Time2 Ex ' Foods consumed urchased name, town P ce consumed IU Q ry-� 1 �/7I r�yt�//,' same (as -it) ❑Home �� rj cj C' atn:5 r On j ❑Other (specify): )� I A° 2 6 f11 MDPH Foodborne Illness Complaint Worksheet Page 2 of 2 Food History (continued) # Restaurant / store where Date & Time= Ex J Foods consumed urchased name, town Place consumed 1 1 ❑ B �f O Same (as leM D Home ❑Other (specify): ❑ D d LJ}.- ❑ B�\) lyl f�'/,l ❑ Same (as left) ❑ Home ❑Other (specify): I ❑ D ' I v - ❑ B - 0 Same (as left) ❑ Home O L ❑ Other (specify): 0 ❑ B ❑ Same(asleft) ❑ Home O L ❑ Other (specify): 0 B ❑ Same (as Left) ❑ Home 0 L ❑ Other (specify): ❑O Notes \/ Food Testing Food(s) available for testing? El Yes J�7 No ❑ Unknown > Sent to SLI'? O Yes ❑ No El Unknown If Yes, specify food(s) & sources / \1 Product and Manufacturer Information for Commercially-Processed Food(s) Product name: Code/lot # Expiration date. / /_ Package sizeftype: Manufacturer: Address: Incubation Periods for Selected Organisms Min Max Min Max Min Max B. cereus (short) 1 hr 6 his E. coli 0157 H7 3 days 8 days Staph. aureus Shigella 30 min 8 his 12 hrs 96 hrs B. cereus (long) 6 hrs 24 hrs Hepatitis A 15 days 50 days Campylobacter - 1 day 10 days --da ----- Salmonella (non typhi) 6 hrs 7"2 his -- - - —--- 1-wk— 3 wks S a-mlonella typhi-_ yphi Vibrio cholerae few his 5 days 4 ys-- - Cyclospora 1 day 1da C - - - - - Viral GI 12 hrs 48 hrs-- _. C. perfringens 6 firs 24 hrs - Shellfish poisoning minutes few hrs Yersinia 3 days 7 days �. ti'.@:' + Y .:7'�`-£",T't✓!.yt' �y�"R.�, "e+gr'.. rw« R'F` 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 -2004-0228 Victoria Station Restaurant 760 Summer Street Stamford CT 06901 LOCATED AT: 0086 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0261 Jan 3, 2006 Dec 31, 2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 7 STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT DEC 0 8 2005 0, CITY BOARD OF HE,q HEALTH 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAM CERTIFIED FOOD (required in an establishment where potentially EMERGENCY RESPONSE HOURS OF OPERATION: TEL # ao3 / '1003 r/�yy food is prepared.) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 --------- .......... RESTAURANT Y NO / 7J ��[3� less than 25 seats 2-5---9-9--seats =$100 more than 99 seats= 200 - ---------------------------------------------- ------------------- -00 ----- BED/BREAKFAST YES O co) $1- $1 P.DD:TIONAL PERtAIrc MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVEO TOBACCO VENDOR ES N $50 ALL NON-PROFIT (such as church kitchens) YES O $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL'9hapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno e a�d lief have filed all state tax returns and paid all state taxes required under the law. 4`%-�3i3 `7a 7/ i nature Date Social Security or Federal Identification Number ------------------------------------------------------------------�----r--------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check# & Date 9?4 ?9 L x205- 3 x00. `yJ Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4t" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpa of Operations) Type of Inspection L Inti [k Food Service ❑ Retail ❑ Routine qRe-inspection Address Ris Level El Residential Kitchen P evious Inspection Telephone 9 ❑ Mobile ❑ Date: ElPre-operation Owner HACCP YIN ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness [I ❑ GeneraFC,omplaint Person in Charge (PIC) Time In:_ El HACCP Inspector i Out11 J, Permit No. ❑ Other tacn violation cnecKeo requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT " ❑ 1. PIC Assigned / Knowledgeable / Duties "EMPLOYEE HEALTH'- i ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded "FOOD FROM APPROVED SOURCE' _ ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s=�,=ce«Fe ,a F � ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives " ❑ 15. Toxic Chemicals TIMElTEMPERATURE 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 (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 r1 n Inspector's Signature: Print: P PIC's Signature: Print: �> I Pagel oi� Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) 1 590.003(A). Assignment otrstbilrty* 590.003(8_)_ Dernanstrationof'Knowledge"` 2-103.1 T Person in charge -duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law" 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 590,003(F) _ Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System 590.006(A) Charge* 590.006(B) 590.003(co Re ortin )y Person in Charge* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Res rictions 91 Denotes critical item in flit federal 1999 Foal Code or 105 CYIR 590.000- PROTECTION FROM CONTAMINATION 8 Food andWaterFrom Regulated Sources 590.004(A -B) Compliance with Food Law" 3-201.12 Fond in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 E<s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-1.01.1.1 Drinking Water from an Approved System 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" Food Contact with Equipment and Utensils* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Lasted Sources* Returned Food and Rescrvice of Food* Game and Wild Mushrooms Approved by Re ulato Authorii 3-202.18 Shellstock Identification Present* 590.004(0) Wild Mushrooms* 3-201.17 Grano Aninif 4-501.111 ReceivinglCondition 3-202.11. PHFs, Received at Proper Temperatures* 3-202.1.5 Package Integrity* 3-101.11. Food Safe and Unadulterated Tags/Records: Shelistock 3-202.18 Shellstoek Identification * 3-203.12 Shelklock Identification Maintained? Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(7) Labeling of Ingredients` Cleaning Procedure* Conformance with Approved Procedures 1HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen pEL2ring. criteria* 9-103.12 Conformance with Approved Procedures'" Denotes critical item in flit federal 1999 Foal Code or 105 CYIR 590.000- PROTECTION FROM CONTAMINATION 8 cross -contamination 3-302A I (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) 3-302.15 Food Protection" 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 Rescrvice of Food* Dispasitlon of Adulterated or Contaminated Food 9 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures' 4-501.114 Chemical Sanitization -temp., pH, concentration and hardness. * 4-601.1 [(A) Equipment Food Contact Surfaces and Utensils Clean - 4 -602.11 Cleaning Frequency of EquipmentFood- Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* 4-703.11 I{) Methods of Sanitization - Hot Water and Chemical* Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arens* 2-301..1.2 Cleaning Procedure* 2-301.14 When to Wash* 1 ( Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobaccos` 2-401.12 Discharges From the Eyes. Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.0dctt(E) Preventing Contamination from Employees' I Handwash Facilities Convententiy Located and Accessible 5-203.11. 5-204.11 Numbers and Ca aeities* Location and Placement* 5-205.1.1 Accessibility. O oration and ,Maintenance Supplied with Soap and Nand Drying Devices 6-301.11Handwashiit Cleanser, Availability Hand Drying Provision C z t. CITY OF SALEM' � BOARD OF HEALTH Establishment Name: �,`K,n ��AN Date: �r�' I`1 /(l� Pager_ of �- Item No. Code Reference C — Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified t 6T \ Y" i S �a C� Y 07-L G/ �t 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 comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollarsr suspension/revocation of your food permit. Corrective Action Required: ❑ No es voluntary compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: ZX Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 km I6 17 18 *Denotes critical item In the Funeral 1999 Food ('Ode or 105 CNIP 590,000. 3-501.14(C) Food or Color Additives 3-202.12 Additives'k 3-302.14 Protection from Ilia i roved Additives* 3-501.168) 590.004(F) Poisonous or Toxic Substances 7-101.11 7-102.11 7-201.11 Identifying Information -Original Containers* Common Name- Workim* Containers` Separation - Stoiae* 7-20111 Restriction - Presence and Use'' 7-202.12 Conditions of Cine* 7-20311 Toxic Containers - Prohibitions"' 7-204.11 Sanitizers, Criteria - Chemicals* 7-204.12 _ C:hemicalsfor Washing Produce, Criteria* 7-204.14 Di in : +gents. Criteria* 7-205.11 7-206.11 Incidental Food Contact, Lubricants" Restricted use Pe-Stieide5. Criteria* 7-206.12 7-206.13 Rodent Bait Stations* Tracking Powders, Pest Control and Monitorine* *Denotes critical item In the Funeral 1999 Food ('Ode or 105 CNIP 590,000. 3-501.14(C) Proper Cooking Temperatures for 3-501-15 PHFs 3-40'1,11A(l)(2) Eggs- 155'F 1.5 Sec. 3-501.168) 590.004(F) E =c - Iutmediate Service 145°P15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals - 155°F 15 sec. 1% 3-401.118)(1)(2) Pork and Beef Roast - 13WF 121 nein* 3-401.11(A)(2) Ratites, Injected Meats- 155'F 1.5 590004(H) sec. ' 3-401.11(A)(3) Poultry, Wild Game, StuffedPlffs, 26. __ Stuffing Contaitlinz� Fish, Most, FC 1!2ah�Rmitcs-165"1' 15 sec " 3-001.11(0)(3) Whole -muscle, Intact Beef Steaks Ph sical Facility 145 F :_ 3-401.12 Raw Animal Foods Cooked in a 28. Microwave 165"F 3401,11(A)(1)(b) All Other PHFs-145'F15see. .008 Reheating for Hot Holding 3-403.11(A)&ff)) PHFs 165'1715 sec. * 3-403.11(13) Microwave- 165" F 2 Minute „Standing 30. Time" 3-403.11(C) Commercially Processed RTE Food - 140'F 3-403.11(17) Retminml; Unslieed 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 4I-F/45'F Within 4 Homs. 3-501.14(3) Cooling PCIFs Made From Ambient Temperature Ingredients to 41 °FI45"F Within 4 Hours* *Denotes critical item In the Funeral 1999 Food ('Ode or 105 CNIP 590,000. 3-501.14(C) PH17s Received at Temperatures According to Law Cooled to 4 FI45"F Within 4 Hours. 3-501-15 Contra Methods for PHFs 19 PHF Hot and Cold Holding 3-501.168) 590.004(F) Cold PFIFs Maintained at or below 41°145° F* 3-501.16(A) Idol PHFs Maintained at or above t40°P. * 3-501.16(A) Roasts Held at or above 13WR 20 Time as a Public Health Control 3-501.19 Time as a Public Health Conlon* 590004(H) Variance Requirement RI • 21 3-801A 1(A) Unpasteurized Pre-packaged Juices and Beverages with Winning Labels* 3-801.11(B) Use of Paetemized 'Ees* Mann ement and Personnel 3-801.11(D) Ravi or Partially Cooked Armed Ford and Raw Seed S gouts Not Served. .003 3-80 1.11 (C) Unopened Food package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 Animal Funds That are Raw. Undercooked or Mann ement and Personnel FG Not Otherwise Processed to Eliminate .003 24. Pathogens.* eoccay.; vrnooI FC 3-302.13 Pasteurized Eggs Substitute for Raw Shell 25. Equipment and Utensils Eggs* ;I'!=UTAL Kt:UUIMCMt:N 15 590.009(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 N29 - Special Requirements. 7AIM (Items 23-30) Critical and non-critical viotauons, which do not relate to the foodborne illness interventions and risk factors fisted above, can he found is the following sections df the Food Code and 105 CMR 590.000. !tent Good Retail Practices RC 590.000 23. Mann ement and Personnel FG -2 .003 24. _ __ _ Food and Food Protection FC - 3 .004 25. Equipment and Utensils _ _ FG -4 .005 26. __ Water, Plumbing and Waste FC - S .006 27. Ph sical Facility FC -6 .007 28. _ Poisonous or i oxic Materials FC - 7 .008 29. S ecial Re uirements-__-___--- - .009 30. her _ _ _-s�o[oemesk62aae cw, i .. _ •v.�n,..:-sSk"a"l.0+',. •.KK.T"'*nra^t'.+sw Yr+h.. .cw'n �.. r -.... . ... .. _ ... .._ 4 V I Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name UL< Dat *T '� e of 0 eration s ❑ )Food Service Retail ❑ Residential Kitchen ❑ Mobile El Temporary ❑ Caterer ❑ Bed ,& Breakfast Permit No. Type of Inspection Routine Re -inspection Previous Inspection Date:, ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑ Other Address / Telephone _ Risk Level Owner HACCP Y/N Person in Charge (PIC) Time Out i;, O�„ Inspector odcn v1U1duvn cnecKea requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: e 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 -�'92. Prevention of Contamination from Hands El 1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ t3t. Personnel with Infections Restricted/Excluded FOOb FROM APPROVED SOURCE El4�.-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 Handwash'ng.=.. ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practice 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. 3. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 6. Water, Plumbing and Waste (FC -5)(590.006) 7. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. WlnspwlFopm -14. PROTECTION FROM CHEMICALS "` - ---- [:114. _--❑14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling tR�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 (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: /�j (�Ccyn _a Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(.A) I Assignment of Responsibility* 590.003(B) Demonstr tuoa ofKnowe edge" 2-103.11 1 Pei son in Charge duties EMPLOYEE HEALTH 2 590.003(C) Responsibilitycifthepersoninchargeto Raw Animal Foods Separated from 590.004(A -B) require reporting by food employees and 3-201.12 a ilicants* Raw Anima! Foods Separated from Each 590.003T) _ Responsibility Of A Faxi Employee Or An 3-202.13 Applicant To Report To The Person In Food Protection* 3-202.1.4 Charge* 3-304.11. 590.003(G) Reporting by Person in Chauae* 3 1 590.003(D) Exclusions and Restrictions* 3-306A,t(A)(B) 590.003(E) Removal of Exclusions and Restrictions q Cross -contamination Food and Water From Regulated Sources Raw Animal Foods Separated from 590.004(A -B) Com fiance with Food Law's 3-201.12 Food in a Hermetically Sealed Container" Raw Anima! Foods Separated from Each 3-201..13 Fluid Milk and Mick Products* 3-202.13 Shell Eggs* Food Protection* 3-202.1.4 _ Eggs and Milk Pmdncls. Pasteurized* 3-304.11. 3-202.16 Ice Made From Potable Drinking Water` 5-101.11 Drinkin Wate in an A rovedSysteru* 3-306A,t(A)(B) 590.006(.A) Bottled Drinking Water* Disposition of Adulterafedor Contaminated 590.006(3) Water Meets Standards in 310 CMR 22.0* 3-701.11 Discarding or Reconditioning Unsafe Shellfish and Fish From an Approved Source Foody_ 3-201.14 Fish and Recreationally Caught Molluscan 6hclI{Wi* 4-501.111 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Sanitization 'L em eratures* 4-501.112 Carne and Wild Mushrooms Approved by Reculatory Authorit 3-202.18 SheiNtock Identification Present* Chemical Sanitization- temp., pH, 590.004(0) Wild Mushrooms* 4-001.11(A) 3-201.17 Game Animals* g 4-602.11 Receiving(Condition 3-202.11. PRFs Received at Proher Tem eratures* Frequency of Sanitization of Utensils and 6-202.15 Package hue hit 4-703.11 3-101.11. Food Safe and Unadulterated'' (. 10 Tagr/Records: ShOlstock Proper, Adequate Handwashing 3-202.18 Shellstock Identification Clean C.orrdinon - Hands and Anus" 3-203.12 Shellstoek Identification Maintained` Cleanim, Procedure* Tags/Records; Fish Products When to Wash* 3-402.11 Parasite Destruction* Good Hygienic Practices 3-402.12 Records. Creation and Retention" Eating, Drinking or Using Tobacco 590.004(J) Labeling of Ingredients" Discharges ..From the Eyes, Nose and Conformance with Approved Procedures IHACCP Pians Mouth" - t3-502 .11S ecialized Processin Methods* Preventing Contamination When Tasting* .12 Reduced ax gen hacka 'ng: criteria* Prevention of Contamination from Hands .12 Conformance with Approved Procedures* P Dcnoles critical iter in the federal 1999 Food Code or I Oi (7,y9R 590.000. g Cross -contamination 3-302.1.1(A)(]) Raw Animal Foods Separated from _ Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Anima! Foods Separated from Each Other" Contamination from the Environment _ 3-302.11(A) Food Protection* 3-302.15 Washi ag Fruits and Vegetables 3-304.11. Food Contact with Equipmentand Contamination from the Consumer 3-306A,t(A)(B) Returned Food and Reservicc of Food* Disposition of Adulterafedor Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Foody_ BEFood Contact Surfaces 4-501.111 Marmd Waiewashing - Hot Water Sanitization 'L em eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. s 4-001.11(A) Equipment Food Contact Surfaces and Utensils Clean" 4-602.11 Cleaning Frequency of EquipmentFood- 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 C.orrdinon - Hands and Anus" 1301,12 Cleanim, 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" - 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Enh lovecs* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca aeities* 5-204. ] 1 ,Location and Placement* 5-205.11 Aecessibiiit . O eration and Maintenance Supplied will,, Soap and Hand Drying Devioes 6-301.11. Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF SALEM �1 _ ] BOARD OF HEALTH Establishment Name: V, til �/ Date: 101 '9/'.5- I Page: Ll— of Item No. Code Reference C -Critical item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified 7 / P n ✓/t7 • { 1 O U C/tG.� A. 0 O 0QAJ9 VA �J F IJ w n hod r �%aG &/` e/ fl �Jc� n fij r tt�a /L1 I \ q' e I' V V ( ' r;17 � / S6t 41h,-7 \ X/ _ 1 Discussion With Person in Charge: t 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 in/revocation of noncompliance may result in daily fines of twMW�� 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 F 6 1S * Denotes ung car item in We federal 1999 Foal Code 01 105 CNIR 590-000. 3-501.14(0 Food or Color Additives 3-202.12 Addhives* 3-302.'14 _ Protection from Unapproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information - Ch�iginal Coniidners` 7-1.02,11. Common Name - Working Containers* 7-201.11 Separation-Sfontge"' 7-202.11 Restriction - Presence and User 7-202.12 7-203.11 7-204.11 Conditions of Use- Toxic Cot tainers -- Prohibitions* Sanitizers,Criteria- Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204_14 Drvina Agent's. Criteria'" 7-205.11 Incidental Food Contact, Lubricants - 7 -206,11 Restricted Use Pesticides, Criteria* 7-2{}(x,12 7'206,13 1 Rodent Bait' Stations" 1 Tracking Powders. Pest Controland MonitorinR' * Denotes ung car item in We federal 1999 Foal Code 01 105 CNIR 590-000. 3-501.14(0 Proper Cooking Temperatures for 3-501.15 PHFs 3-401,11A(1)(2) Eggs- 155°F 1.5 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 145°Fl5sec* 3-401.11(A)(2) Cormninuted Fish, Meats & Game 3-501.16(A) Animals - 155°F 15 sec. * 3-401.1l(B)(1)(2) Pork and Beer Roast - 130°F 121 ram* 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 590.004(1-t) sec;. 3-401. I I (A)(3) Poultry, Wild Game, Stuffed PHFs, .009 Stuffing Containing Fish, Meat, Other--- - Poultry or Ratites -165.F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F h 3-401.1.2 Raw Animal Foods Cooked in a 165"F. 3-401,11(A)(1)(b) _Microwave All Other PHFs- 145715 sec. * Reheating for Hot Holding 3 -403.11(A)& -(I)) PHFs 105'F 15 set. * 3-403.11(B) Microwave -165° F 2 Minute Standing Time* 3-403.1.1(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts` Proper Cooling of PHFs 3-50114(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 7lours and From 70'F to 41 °F1450F Within 4 Hours. 3-501.'14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41 "F745°F Within 4 Hours * Denotes ung car item in We federal 1999 Foal Code 01 105 CNIR 590-000. 3-501.14(0 PHFs Received at Temperanu-es According to Law Cooled to 4FF/45°FWithin 4 Hours. + 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold P111 -s Maintained at or below 41 %45° F� 3-501,16(A) Hol' PHFs 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(1-t) Variance R uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning I abels* Consumer Advisory Posted for Consumption of 3-801.11(8) Use of Pasteurized Eggs* Mana ement and Personnel 3-801,11(1)) Raw or Partially Cooked Animal Foal and Raw Seed Sprouts Not Served. 24, 3-801.11 (C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 23, Mana ement and Personnel Animal Foods That are Raw. Undercooked or 24, Food and Food Protection Not Otherwise Processed to Eliminate 25._ 26. EguiPment and Utensils Water, Plumbing and Waste Pathogens..* E1h16bB v+;zoo. 27. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 28. Poisonous or Toxic Materials E gs" ar C41HL neLluirSelV1 CIV 13 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, 4eibporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under /129 - Special Requirements. 174XVtA1 f+3 (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can he found in the following sections of the Food Code and 105 CMR 5.90.000. Item Good Retail Practices FC 590.660- 23, Mana ement and Personnel FC - 2 1 .003 24, Food and Food Protection FC -- 3 .044 25._ 26. EguiPment and Utensils Water, Plumbing and Waste FC - 4 .005 _ FC -5 .006 27. Phsicat Facility 28. Poisonous or Toxic Materials FC - 7 .008 29. S ectal R uiremants .009 90.------ Other--- - _ ----_____--- SaY9f nda�M-2tloc CITY OF SALEM. - BOARD OF HEALTH' Establishment Name:y'�I Date: Pager of.,? Item No. Code Reference C - Critical Rem R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION -.: PLEASE PRINT CLEARLY Date Verified {off ( a ( r n2, i., o71 0C a 1,41 1 ✓ M V `o .h ` n 'J vt. i C`. I. Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and toExclusion comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty ive dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction / 111� 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 l6 Food or Calor Additives 3-202.12 Additives` 3-302.14 Protection froui Unapproved Additives* 7-10t.11 Poisonous or Toxic Substances Identifying Informati on - O111.nal Containers - 102.11 Common Name -Woram, ontamers'" 7-202.17 Se anuioa - Storage" 7-202.1.1 7-202.12 Restriction -Presence and Use* Conditions of Use - se*7-03.1.1 7 ­203.11 Toxic Containers- Prohibitions'` 7-204.11 Sanitizers, Criteria - Chemicals* 7-2(1-1.1.2 7-204-74 Chemicals for Washin v Prodaa:, Giterta* Drvin A eats. Criteria - 7 -205.11 Incidental Food Contact. Lain icants* 7-20611 Restricted Use Pesticides. Criteria" 6.12 r-206.13 Rodent Bait Stations* Tracking Powders, Pest Control and Monitoring-* l6 Proper Cooking Temperatures for PHFs Received at Temperatures According to Law Cooled to 41^F/45°F Within 4 Hours. PHFs 3-50]15 3-40'1.1.IA(1)(2) Eggs- 155°F 15 Sec. 19 Eggs- hmnediate Service 145"F15sec* PHF Hot and Cold Holding 3-40L11.(A)(2) Comminuted Fish, Meats & Game 3-501,16(6) 590.004(F) Animals - 155'F 15 sec. * 25. 3-401.11(6)(1)(2) Pork and Beef Roast -130'F 121 min" Ilot PHFs Maintained at or above 14WR * 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 3-501.16(A) sec. * 2g 3-401.11(A.)(3) Poultry, Wild Game, Stuffed PRFs, Time as a Public Health Control Staffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165'F 15 we. 29._ 3-401.11(C)(3) Whole -muscle, intact Beef Steaks Variance Requirement I45OF * 30 _ 3-401.12 Raw Animal Foods Cooked in a Microwave 165F * 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec, 17 Reheating for Hot Holding 3-403.11 (A)&(L)) PHFs 165'F 15 sec. 3-403.11(B) Microwave- 165'F2Mining Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-403.11{E) Remaining Unsliced Portions ofBeef Roasts* (* Proper Cooling of PHFs 3-501,14(A) Cooling Cooked PHFc from 140'F to 70"F Within 2 Hours and From 7WF to 41"F/45°F Within 4 Hours. 3-501.14(B) Cooling PHFt, Made From Ambient Temperature ingredients to 41 °17/45°F Within 4 Hours'' DeMdes critical itern in thr. federal 1999 Foocl Code or 105 CMR 590.000. 1.1 ] (A) 3-501.14((') PHFs Received at Temperatures According to Law Cooled to 41^F/45°F Within 4 Hours. I-] f Pateurized Egg* 3-50]15 Cooling- Methods forPHFs 19 Una coed Food Package NotRe-se vel. PHF Hot and Cold Holding Food and Food Protection 3-501,16(6) 590.004(F) Cold PI-IFs Maintained at or below 41`/45°F* 25. 3-501.16(A) Ilot PHFs Maintained at or above 14WR * .005 3-501.16(A) Roasts Held at or above 130°F. 2g .006 Time as a Public Health Control Phsical Facility Poisonous or Toxic Materials 3-501.19 Time as a Public Health Control* 29._ 590.004(H) Variance Requirement 1.1 ] (A) Unpasteurized Pre-packaged Juices and Beverages with Warning Libels* 1.11(B) I-] f Pateurized Egg* 1.11(D) E Raw or Partially Cooked Anunal Food and Raw Seed S rzoats NServed. L11(C) Una coed Food Package NotRe-se vel. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.0_0.0_ ' 23. Aninial Foods'IRat are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Pathogens.* E/M"""' 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 _ 26, 1 E es'" 115i�aywl�L a9V1 Ka El 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 1129 - Special Requirements. VIOLATIONS (Itelres 23-30) Critical and non-critical violations, which do not relate tothe foodborne illness interventions and risk j'a( tors listed above, can be found in the following sections of the Food Code and 105 CMR 590.00 Item Good Retail Practices FC 590.0_0.0_ ' 23. Mena emeny t and Personnel_..... FC - 2 .003 24. Food and Food Protection FC -3 .004 25. _ E ui ment and Utensils u FC - 4 .005 _ 26, Water, Plumbin and Waste _ FC -5 .006 27. 28. Phsical Facility Poisonous or Toxic Materials FC -6 FC - 7 .007 .008 29._ S ecial Requirements l ,o09 30 _ Other _(______ S )d" a c STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA O 1970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO 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: Type of Establishment: FOOD SERVICE Name of Establishment: Victoria Station Address of Establishment: 86 Wharf Street Owner's Name: Munir Saltoun Restrictions: Application Date: 11/23/2004 Permit for Food Establishment 61-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 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. HEALTH AGENT CITY OF SALEM., MASSACHUSET m BOARD OF HEALTH 120 WASHINGTON4TH FLOOR SALEM, MAD 1970 TEL. 978-741-1800 ruv 22 u4 ' FAX 978-745-0343 CITY OF STANLEY J. US VICZ, JR. - JOANNE SCOTT, AGENT RS, CHO BOARD OFAEEM 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT g>� fi NAME OF ESTABLISHMENT Vi 0+0e -I FF- �`f /�/-idA) TEL # g!d /iJ'rJ'7DB ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAPA ADDI CITY CERTIFIED FOOD MANAGER'S (required in an establishment where 70 #-.;2o3 — A6 7-11,96 -3 EMERGENCY RESPONSE PERSON ROk&I POU)eP-4 HOME TEL#'7Bf'X639-79AI jf:augi+/ H: 3r. Mr/ /tt)a+R+'1 //: So M'1 //.'3o A-✓ry 22�io9+�l //: �bH�7 HOURS OF OPERATION: Mon./v1r/7Tue. /oymWed./iPm Thu.11,Pr4 Fri./ yo�bj, at. /,?m/. io r+i TYPE OF ESTABLISHMENT RETAIL STORE YES O RESTAURANT YES NO BED/BREAKFAST YES 0 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 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROriT (such as church kiichens) YES 0 ` $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 MGt Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b w.ed //an ef, hav,� filed a state to ret rns and paid all state taxes required under the law. � g l�K�` /111c_ D�� 3/3 ?y7/ _ Si ature`'-Date Social Security or Federal Identification Number ------------------------------------- - -- - -G 2----------------------- ---- Revised 11/03/03 FOODAP2.adm Check#&Date f36bl 11//' 16 1 0086 WHARF STREET HACCP: ❑ Telephone: 745-3400 Owner: M. mauOUVI I Icua vVl P z. PIC. Inspector. David Greenbaum Date Inspected: Correct By: ;: 9/7/2005 Risk Level: Permit Number: , BHP -2005-0133' x Status: VIOLATION ,r # of Critical Violations: 2 Time IN: - `-: S:Time OUT: Votes »7 - Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done a Anti -Choking PASS ❑ Tobacco PASS ❑ FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS ❑? RED EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASS Q RED Personnel with Infections Restricted/Excluded PASS ❑J RED FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASSd❑ RED Receiving/Condition PASS 0 RED Tags/Records/Accuracy of Ingredient Statements PASS RED Conformance with Approved Procedures/HACCP PASS RED Plans GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc ( Rev. Sep 07,2005 ) Page I of 0086 WHARF STREET must be corrected immediately or within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require' immediate corrective action) Victoria Station Restaurant PROTECTION FROM CONTAMINATION Not Done Separation/ Segregation/ Protection PASS ❑d RED Food Contact Surfaces Cleaning and Sanitizing PASS RED Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑Q RED Prevention of Contamination from Hands PASSd❑ RED Handwash Facilities FAIL Critical ❑d RED TjhAadies room and the wait station Vendwash sinks did not have hot water. store hot to these hand wash sinks immediately. T women's employees restroom was %ssing paper towels. Provide disposable paper towels in the women's room at all es. 4ti e wait station hand wash sink is missing oap. Provide soap at the hand wash sink at all times. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑J RED TIMEITEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASS�/❑ RED Reheating PASSd❑ RED Cooling _ PASS ❑d RED Hot and Cold Holding FAIL Critical ❑d REDS. The French Onion soup was held at a temperature of 130°F. Hold soup at a temperature of 140°F or above. he True freezer in the cookline had a emperature of 107. Repair unit to maintain a temperature of 0°F or below. e Victory produce refrigerator had a Vemperature of 48°F. Repair unit to maintain a temperature of 41'F or below. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS Q RED GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 07,2005 ) Page 2 Of 0086 WHARF STREET Victoria Station Restaurant CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUETh nterior panel of the ice mahcine has accumulation of grime. Thoroughly clean and sanitize the ice machine. '"e Victory produce cooling unit has Ne uncovered food. All food in storage must be covered. Ter�ere is a Continental cooling unit near dry k rage that has uncovered food. All food in s orage must be covered. Equipment and Utensils FAIL Non -Critical ❑ BLUE IiQTAe canopener needs a thorough cleaning. The drawer cooling unit in the cookline needs a visible, accurate thermometer. T ice cream freezer in the kitchen needs v ible, accurate thermometer. e True cooling unit in the wait station a visible, accurate thermometer. Teo T produce prep area has an ccumulation of food debris. Thoroughly cle n floor. To Continental cooling unit near dry orage has an accumulation of food spills. oughly clean unit. %TFTh e shelves in dry storage need a )yrough cleaning. ),the flooring in the walk in needs a horough cleaning. Water, Plumbing and Waste FAIL Non -Critical ❑ BLUE a toilet in the men's employee restroom 'rs coming off the floor. Repair and grsecure the toilet. Physical Facility FAIL Non -Critical ❑ BLUE Nhe mop room needs to be organized. T trash room needs a thorough cleaning. T re is chipping/peeling paint in the liquor om. Scrape and repaint all hipping/peeling paint. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS - ❑ BLUE Other- See Notes PASS ❑ BLUE GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 07,2005 ) Page 3 of 4 0086 WHARF STREET GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. Victoria Station Restaurant ( Rev. Sep 07,2005 ) Pate 4 of 4 0086 WHARF STREET HACCP: ❑ Victoria Station Restaurant City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection Telephone: m Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Done 745-3400 M`°" Owner: s Anti -Choking PASS Ll M. Management Corp Tobacco PASS ❑ PIC ; FOOD PROTECTION MANAGEMENT Done Robert Powers PIC Assigned / Knowledgeable / Duties PASS ❑d RED Inspector: Mri EMPLOYEE HEALTH Done etDavid Greenbaum Date Inspected: ICorrebt By:, Reporting of Diseases by Food Employee and PIC PASS RED 9/16/2005 ,fir Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level: FOOD FROM APPROVED SOURCE Done _ .;;,.. ,,. Food and Water from Approved Source PASS ❑ RED Permit Number: BHP -2005-0133 Receiving/Condition Tags/Records/Accuracy of Ingredient Statements PASS PASS ❑d RED RED Status:.: ;� �; SIGNED OFFS Conformance with Approved Procedures/HACCP Plans PASS ❑Q RED # of Critical, Violations: µ - 1 I PROTECTION FROM CONTAMINATION Done Time IN Time OUT: Separation/ Segregation/ Protection PASS RED Food Contact Surfaces Cleaning and Sanitizing PASS RED Notes: i - 302: .. _. Proper Adequate Handwashing PASS RED Urgency Descrlptlon(S): Good Hygienic Practices PASS RED BLUE: ,. Violations Related to Good Prevention of Contamination from Hands PASS ❑d RED Retail Practices (Critical Handwash Facilities PASS ❑J RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005) Page I o{3 0086 WHARF STREET Victoria Station Restaurant must be corrected immediately or within 90 days) RED: Violations Related to r Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) PROTECTION FROM CHEMICALS Done Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS (Potentially Haz Done RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Cooking Temperatures PASS ❑d RED Reheating PASSd❑ Done RED Cooling PASSJ❑ ❑V RED RED Hot and Cold Holding FAIL Critical ❑J RED Soup held at a temperature of 134°F. Hold Water, Plumbing and Waste PASS ❑ soup at a temperature of 140'F or above. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Management and Personnel Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Done PASS Posting of Consumer Advisories PASS ❑V RED Violations Related to Good Retail Practices (Blue Done ❑ BLUE Special Requirements Management and Personnel PASS ❑ BLUE PASS Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non -Critical ❑ BLUE Liquor storage room has chipping/peeling paint. Scrape and repaint all chipping/peeling paint by the next routine inspection. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other- See Notes PASS ❑ BLUE All other violations cited in the 9/7/05 inspection report have been corrected. GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005) Page 2 of 0086 WHARF STREET Victoria Station Restaurant F ;L GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 16,2005) Page 3 of 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 JOANNE SCOTT, MPH, RS, CHO 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: Type of Establishment: FOOD SERVICE Name of Establishment: Victoria Station Address of Establishment: 86 Wharf Street Owner's Name: Munir Saltoun Restrictions: Application Date: 11/26/2003 Permit for Food Establishment 42-04 Frozen Desserts/Ice Cream 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. 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. U HEALTH AGENT CITY OF SALEM, MASSACHUSETTj�9 L� 4D, �11BOARD OF HEALTHb�120 WASHINGTON STREET, 4TH FLOOR NOV 2 4 2003 SALEM, MA 01970 - TEL.978-741-1800 k-,l":;�,LEM FAX 978-745-0343 BOARD OF HEALTHSTANLEY JSOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATIONS �IFOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT V;C i -Ott R c1� �1a nJ TEL # ,G�//i0 L / 3'io-0 ADDRESS OF ESTABLISHMENT S/� MAILING ADDRESS (ififferent) ?60 OWNER'S NAME Al/'/ /rl i� is. =.a TEL # -?° 3 ADDRESS 760 Swh''1 e� cSy CITY 4-0 STATE ZIP 06901 CERTIFIED FOOD MANAGER'S NAME(S) ZabeA t QoUJ4-' d' CERTIFICATE#(s) /-2QQJ93 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 1&ar e -Pt -T !Li elS p—HOME TEL # HOURS OF OPERATION: Mon. � - Tue. Wed.//-'I"Thu ".*10'Fri �"""O"S t.//:5""Sun. if;30 � TOPS /iom A091 //.'3°P" M -0 4;4f /a IPA TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO C�A less than 25 seats =$100 25-99 seats =$150 more than 99 seats �2 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NO.N :PROF,'T (such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b owled a belief, have fled all stat tax returns and paid all state taxes required under the law. p ature Date Social Security or Federal Identification Number ------------------------------------------------------ -------------------------------------- ---- - ---- 6�r-���� 'l� c Revised 11/03/03 FOODAP2.adm Check# & Date � ve 0?60-- 4 Massachusetts Department of Public Health Division of Food and brugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name DateType of Ooeration(sl Tvoe of Inspection Z` D�Food Service ❑ Retail ❑Routine [IRe-inspection Address S1 , Risk IY Level ElResidential Kitchen Previous Inspection Telephone _ 5 _ 00 El Mobile El Temporary Date: //- 61- O� ElPre-operation Owner HACCP Y/N ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time t: In Ou Permit No. El ❑ O herr- Inspector �OU11 V IU1aLwn cnecReu requires an expianaiion on me narranve page(s) ana 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. j FOOD PROTECTION MANAGEMENT '' a ❑ 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,. n= El4. Food and Water from Approved Source N ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection 0/6. 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(a) (FC -3)(590.004) 5. 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 (Fca)(590.008) 29. Special Requirements (590.009) 30. Other S, SWIreceaForms.14, o Print: ❑ 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 Hazardpu§ Foods) [116. 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 (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: Pagel of L>Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Asst-nment of Responsibility* 590.003(B) DemonsnttionofKnow led e" 2-103.11 Person in thane-- duties EMPLOYEE HEALTH Fm IN C I Food and Victor From Regulated Sources Responsibility of the person in charge to r590.003(C) 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Erns* _ 590.003(F) Responsibility Of A Food Employee Or An 3-282.16 Ice Made From Potable Drinktnr Water - Applicam ro Report To The Person In Drinking Water from an ARproved System* 590.006(A) Chaise' 590.006(B) 590.003(0) Re rortin b Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions Fm IN C I Denotes critical item in the fivietal 1999 foal Code or 105 CMR 590.060. PROTECTION FROM CONTAMINATION DEGross Food and Victor From Regulated Sources 590.004(A -B) Crnn pliance with Foud Law" 3-201.12 Food in a Hermetically Seated Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Erns* _ 3-202.14 Er =s and Milk Products. Pasteurized* 3-282.16 Ice Made From Potable Drinktnr Water - 5 -101.1,1 Drinking Water from an ARproved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contamination from the Environment She itish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish" 3-201.15 Molluscan Shellfish from NSSP Listed Sourees" Washi ng Fruits and Vegetables Came and Wild Mushrooms Approved by Peculato Authorlt 3=202.18 Shellstock identification Present'* 590.004(0) Wild Mushrooms* 3-201.17 Came Animals* Receiving/Condition 3-202.11. PH Fs Received at Proper Tem eratures" 3-202.15 Package Integrity! 3-101.11 Foot Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * _ 3-203.12 Shellstock Identification Maintained" Tags/Records: Fish Products 3-462.'11 Parasite Destruction* 3-402.12 Records. Creation and Retention" 590.004(7) Labeling of Ingredients' Manual Warewashing- Hot Water Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Meihods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with A roved Procedures' Denotes critical item in the fivietal 1999 foal Code or 105 CMR 590.060. PROTECTION FROM CONTAMINATION DEGross -contamination v 3-302.1 [(A)(1) Rat 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 1302.1 i(A) Food Protection* 3-30215 Washi ng Fruits and Vegetables 3-304.11 Food Contact with &Iuipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Retained Food and Resemoe of Fcx)d* 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* 4-501.11.2 Mechanical Warewashim- Hot Water Sanitization Temperatures* 4-501.11.4 Chemical Sanitization- tetnp., pH, concentration and hardness. * 4-60 1 A I (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.1 1. Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 1p Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms" 2-301.12 Cleanim5 Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401_11 �Eatina, Drinking or Using Tobacco"` 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tastin * 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em Iovees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca _aeities* 5-204.1.1. Location and Placement.* 5205,11 Aecessibihty.Operation and Maintenance Soppked with Soap and Nand Drying Devices 6301.11 Handwashing Cleanser, Availability 6-301.12 Hand Dryinr Provision Establishment CITY OF SALEM BOARD OF HEALTH Date:��' �j- nq Page: C� of RM Item No. Code Reference C -Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - .. PLEASE PRINT CLEARLY --- Date Verified -- a� /„ Kmrpl f)afL� am -� i ' ad" cy .41 d ( s (' hQ 'L( ( ) Use t -o -Y d A/) „ \ ,m 016yas _ lS— a SOLI d 6 h/ `/V ' l r / tc h / `' - ��2fJS/ Cords_v off lago-sen F vn v_ -h olxet ren L�OW,Qed. >441 REP lil s L k� Y/ �a� r i /r(in -wmd7kld! a -0 bpr1A Q ! 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 co Itio s as described, and to p comply with all mandates of the Mass/Federal F de. I understand that noncompliance may result in daily fines ohtw dollar or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension LlEmbargo ❑ Emergency Closure ElVoluntary Disposal 0 Other: 9R. Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 55 17 .^ Denotes critical item in th,c (' cral 1999 Food Code or 105 CMR 590,000. Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* FC - 2 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers', 7-102,11 Common Name - Working Containers* 7-201.11 Separation - Stoi afic* 7-202,11 Restriction - Presence and Use* 7-202.12 Conditions of Ilse* 7-203.11 ToxicContainers- Prohibitions` 7-204.11. Sanitizers, Criteria - Chemicals* 7-20412 Chemicals for Washine Produce, Criteria, 7-204.14 Davin A*euts,Criteria' 7-205-11 .Incidental Food Contact. Lubnrtcants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206-12 1 Rodent Bait Stations* 7-206,13 Tracking Powders, Pest Control and Monitoring* .^ Denotes critical item in th,c (' cral 1999 Food Code or 105 CMR 590,000. Proper Cooking Temperatures for E3-501.15 PHFs 3-401.11A(1)(2) Eggs- 155gF 15 Sec. FC - 2 Eggs- hnmediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-80'1.1 l (C) Animals - 155'F 15 sec. * 3-401.11(,6)(1)(2) Pork'. and Beef Roast - 130"F 121 min* 3-401.11(A)(2) Ratites, Injected Meats- 155°F 1.5 27. sec. * 3401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 28. Stuffing Containing Fish, Meat, F_C - 7 Poultr , or Ratites -165".F l5 sea * 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145"F * 3-401.12 Raw Animal Foods Cooked in a - Microwave 165"F * 3-401.1 1(A)(t)(b) All Other PFIFs - 145"F 15 sec. Reheating for Hot Holding 3-403.11.(A)&(D) PHFs 165"F 15 sec. *_ 3-403.11(B) Microwave- 1658 F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTL Food - 140°F* 3-403,11(E) Remaining Unslieed I'or6ans of Beef Roasts* Proper Cooling of PHFs 3-501..14(A) Cooling Cooked PHFs from 140`F to 7WF Within 2 flours and From 70°F to 41°F/45°F Within 4 Hours. * 3-501.14(11) Cooling PHFs Made From Ambient Temperature Ingredients to 41 °F/45'F Within 4 llours* .^ Denotes critical item in th,c (' cral 1999 Food Code or 105 CMR 590,000. 4 ♦ - 2'I 3-501.14(C) PHFs Received at Temperatures According to law Cooled to 41'F/45',F Within 4 Homs. E3-501.15 Cooling Methods for PRFs 19 PHF Hot and Cold Holding FC - 2 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41145° F* Raw or Partially Cooked Animal Food and Raw Seed S xouts Not Served, 'r 3-501.16(A) ]-tot PHFs Maintained at or above 14WR * 3-80'1.1 l (C) 3-501-16(A) Roasts Held at or above 130°F, 20 Time as a Public Health Control Pasteurized Eggs Substitute for Raw Shelf 3-501,19 Time as a Public Heafth Control* 27. 590.004(H) Variance Re uiremcne 4 ♦ - 2'I 3-801.11(4) Unpasteurized Pre-packaged Juices ander Beverages with NkamineLabels* 590.000 3-801..11(B) Use of Pasteurized Segs* FC - 2 3-80,1,11(D) Raw or Partially Cooked Animal Food and Raw Seed S xouts Not Served, 'r - Food and Food Protection 3-80'1.1 l (C) Uno. cued Food Packa*e Not Re-servecL CONSUMER ADVISORY 22 3-603-1 1 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.* erra�s vaaenr 25. 26. 3-302.13 Pasteurized Eggs Substitute for Raw Shelf ._o0_5 27. Eees* +� ♦ l 590.009(A) -(D) Violations of'Section590.009(A)-(D),in catering, mobile tood, 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. 17ZlIfim (Items 23-30) Critical and nun -critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, con be found in the following sections of the Food Code and 105 CMR 590.0100. item Good Retail Practices FC 590.000 23. Management and Personnel FC - 2 .003 24. - Food and Food Protection FC -- 3 .004 25. 26. _ Equiprnant and Utensils Water,Plumbin FC - 4 ._o0_5 27. Physical Facility_ FC -6 .007 28. Poisonous or Toxic Matemi s F_C - 7 .00II 29. --30, S ectal Re uiremetnts ''i .009 Other __-- - rr 1,.Tb, 6a.,� Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4`" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name A Date / /' ' �y T e of O eration s Type of Ins ection Food Service ❑ Retail L� outine ❑ Re -inspection Address + Risk Level ❑ Residential Kitchen Previous Inspection Telephone El 15. Toxic Chemicals I f I ❑ Mobile ❑ Temporary Date: ❑ Pre-operation Owner HACCP Y/N /1 /64w"4 e. ❑ 6. Tags/Records/Accuracy ofIngredient Statements tyr ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time 2'19. Hot and Cold Holding (3) In'. Out: Permit No. [3HACCP ❑ Other Inspector(I i1 , A � i' [110. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices.40i CONSUMER. ADVISORY aacn vrvmuon cnecKeu 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 - - i ❑ 1. PIC Assigned i ❑ 12. Prevention of Contamination from Hands / Knowledgeable / Duties []413. Handwash Facilities EMPLOYEE HEALTH Pagel-of-5Pages ❑ 2. Reporting of Diseases by Food Employee and PIC _.PROTECTION FROM CHEMICALS-� ❑ 14. Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded El 15. Toxic Chemicals .FOOD FROM APPROVED SOURCE -- _ _ ❑ 4. Food and Water from Approved Source (Potential) Hazardous Foods TIM EMPERATURE CONTROLS y ) ❑ 5. Receiving/Condition L � i ` Q 16. Cooking Temperatures e. ❑ 6. Tags/Records/Accuracy ofIngredient Statements tyr "E] 17. Reheating El 7. Conformance with Approved Procedures/HACCP Plans ` [118. Cooling PROTECTION FROM CONTAMINATION *k'�* _ ''' 2'19. Hot and Cold Holding (3) V8. Separation/ Segregation/ Protection E] 20. Time As a Public Health Control W9. Food Contact Surfaces Cleaning and Sanitizing (a) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP),,-.' A � i' [110. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices.40i CONSUMER. ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations`marked must be corrected To Foodborne Illnesses Interventions immediately'or within 10 days as determined by the Board and Risk Factors (Items 1-22): OC of Health.fion-critical (N) violations must be corrected mme'diately"or within 90 days as determined by the Board Official Order for Correction: Based on an inspection t d th 't h k Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 5. 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'50lns tFor i<.tloc n o ay, e ems c ec ed 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 ns '%Tn tore: Print: PI(i1' $'fgnatere• Print: Pagel-of-5Pages Violations Related to Foodborne illness Interventions and Risk Factors (items 1-22) 0 590,003(A) Assi tment of Responsibility", 590.003(H) Demonsbat'ion of Knowledge* 2-103.1.1 _Personincharge --duties IgAwal sfl-waft1Sl 2 590.003(0) Responsibility of the person in ch nge to Com liance with Food Law 3-201.12 require reporting by tood empiowes and 1 -201,13 Fluid Milk and Milk Products* applicants* Shell Eicgs* 590.003(F) Responsibility Of A Mood Employee Or An 3-202.16 he Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(F3) 590.003((") Re ortin, b , Person in Char e* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 5 C C •a '•* 'I Denote, critical item in the federal 1999 Food Civic or 105 CNIR 590,000. $ Food and Water From Regulated Sources 590.004(-4-B) Com liance with Food Law 3-201.12 Food in a Hermetically Sealed Container - 1 -201,13 Fluid Milk and Milk Products* 3-202.13 Shell Eicgs* 3-203.1.4 Eggs and Mi k Pro eels. Pastewizud 3-202.16 he Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) 13ottledlirinkingWater* 590.006(F3) Water Meets Standards in 310 CMR 220* Waslinw. Fruits mid Vegetables Shellfish and Fish From an Approved Source 3-201.14 - Fish and Recreationally Caught' Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Re Mato Authorit 3-202.19 Shellstock Identification Present* 590.004{0) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11. PRFs Received at Proper Tem 2212res* 3-202.15 Package lnteinity* 3-101.11 Food Safe and Unadulterated " Tags/Records: Shellstock 3-202.13 Shellstock ldentification 3-203.12 Shellstock Identification Maintained" Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 _ Records. Creation and Retention* 590.0040) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E�t* Conformance with Approved Procedures /HACCP Plans 3-502.11. Seciah cal Peocessin = Methods* 3-502.12 Reduced oxy en aackaaht , criteria` 8-103.12 Conformance with Approved Procedures* 'I Denote, critical item in the federal 1999 Food Civic or 105 CNIR 590,000. $ Cross -contamination 3-302.11(-4)(1) Rats, Animal FooA Separated 'fiY7m Cooked and RTE Foods" Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302A I(A) Food Protection` 3-302.15 Waslinw. Fruits mid Vegetables 3-304.1.1 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-30(i.14(A)(B) Returned Food and Reser vice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces -1-501.111 Manual Warewashing - [lot Water Sanitization"rem eratures* 4-501_1.12 Mechanical Warowashing-,Her Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., p11, concentration and hardness. * 4-601.1 ] (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Iftensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of E�t* 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 Cleanim* Procedure* 2-301.14 Mien to Wash' II Good Hygienic Practices 2-si01.11 E -acing, Drinking or'Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Month* 3-301.12 Preventing Contamination When Tastin t^` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 33 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca a jLs* 5-204.11. Location acid Placement - 5 -205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301-11 1 kindwashing Cleanser. Availability G-301.12 (land Drvin,, Prmgsion CITY OF SALEM I BOARD OF HEALTH Establishment Name:\X (4290 Q 'S -_ 1)n Date: Li -+o4 Page: 10L of Item Code No. Reference C - Critical Item R — Red Item - DESCRIPTION OF VIOLATION /PLAN OF CORRECTION PLEASE PRINT CLEARLY... Date Verified 1h Y� 1i I UWI` 1 v i fto ,� Q D(' (Am_In ,+ 1 t i ur `1a nf o i 3vrmova G (a c - YIwD WDA up yjAJA +atm to 4 rhe 'Vt i 1 Issi nc, o rn S Q nind 63ncs, a 'C'D r - t/ + VtA cul kev oro- A ,Inn U n- Nick -00 d AzweiIe rAianffhkS usl t i rr o vv1� o vtees n Izrlv�o - 612 .3 YIC� 6 em -0( roar HYD s aA Ylb ScnP .0 r % b ISh V_V"+ 1v s� of P -1 n r-bA t 411 has"L a L' s. nIS : "b uYl d (A)S Ki 1, rzloe haA n I 1 - o1cl d de60S. o uah + _ -ze . s . G (' r �� o j - IQ e:;)� I V "a V1�C 1i7� VII IVl P C 1Q �( . d r r, & U n C -;in j u s� btJ(huerc& Discussion With Person in Charge: 0 U 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- n rs 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: M Ate) Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 16 (7 18 '° Denotes critical item in Iho federal 1999 Food Code or 105 CMR 590-000. Food or Color Additives 3-202.12 Additives" 3-902.14 Protection from Una p proved Additives* FC -- 2 Poisonous or Toxic Substances 7-10t.1 I Identifying information - Original Containers - _102 1, Common Name - Working Containers* 7-201.11 Se.aracion- Storages 7-202.1.1 Restriction - Prc sena' and Use't 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 Drin*. ents.Criteria* 7-20511 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 t '° Denotes critical item in Iho federal 1999 Food Code or 105 CMR 590-000. Proper Cooking Temperatures for Unpasteurized Pre-packaged Juices mid Beverac!es with Waadne l-3bels* PHFs 3-401.11A(1)(2) Eggs- 1.55'F 1.5 Sec. FC -- 2 Eggs- Inmtediate Service 145'F15sec* 3.401.11(A)(2) Comminuted Fish, Meats & Game 3-801.1](C) I Animals - 155'F 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`17 1.5 26. 27. sec. 3-401. t [(11)(3) Poultry, Wild Game, Stuffed Kips, 20 Stuffing Containing Fish, Meat, FC -7 Poultr, , or Ratites -165°F 15 sec. 3-401.11(C)(3) Whole muscle, 'IinactReef Steaks 145'F * 3-401.12 Raw Animal Foods Cooked in a _ Microwave 165'F * 3-401.II(A)(1)(b) All Other PHFs -145°F15sec, Reheating for Hot Holding 3-403.11(A)&(D) PHF, 165'F 15 sec.' 3-403.11(B) Microwave- 165" F 2 Minute Standia Time* 3-403.11(C) Commercially Processed RTE Food - 1.40°F* 3-403.1.1(5) Remaining Unshced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 70"F Whitiit 2 Flours and From 70'F to 41"F/45'F Within 4 Hours. 3-501.14(6) Cooling PHFs Made From Ambient Temperature Ingredient's to 41"17145'F Within 4 Hours' '° Denotes critical item in Iho federal 1999 Food Code or 105 CMR 590-000. 21 - T--- 3-SOY.Id(C)I (PHFs Received at Tenppermures Unpasteurized Pre-packaged Juices mid Beverac!es with Waadne l-3bels* According to l2w Cooled it) 3-$0 L 11(B) r 4FF145'F Within 4 Hours. FC -- 2 3-501,15 CoolimgMethods for PHF's 19 PHF Hot and Cold Holding 3-801.1](C) I 3-50'1.16(B) Cold PHFs Maintained at or below 25. 590.004(F) 41°145° F- 1 Pasteurized Fggs Substitute for Raw Shell 3 -501,16(A) Ihx PHFs Maintained at or above 26. 27. 14WK * FC -5 FC -6 3-501.16(A) Roasts Held at or above I' 0"R 20 Time as a Public Health Control FC -7 3-501.19 Time as a Public Health Control* 29. _ 590.004(H) Variance Requirement 21 3-501A I(A) Unpasteurized Pre-packaged Juices mid Beverac!es with Waadne l-3bels* 590-000 3-$0 L 11(B) ITse of Pasteurized )✓ens* FC -- 2 3-801.11(0) Raw or Partially Cooked Animal Focal and Raw Seed S routs Not Served. ,r _ Food and Food Protection 3-801.1](C) I Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590-000 23. Animal prods That are Raw. Undercooked or FC -- 2 .003 Not Otherwise Processed to Eliminate _ Food and Food Protection FC -3 Pathogens.* `necnva tnizoor 25. 3-302.13 1 Pasteurized Fggs Substitute for Raw Shell .005 26. 27. E Vis* .'WMAAL Kl=UUIKt:MtNlS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitehcn operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 1129 -- Special Requirements. r;zrrstirrrz�; (Items; 23-30) Critical acrd non-critical viciatione, which do nor relate to the foodborne illness oneiventions and risk fcu ions listed obove- can he ,found in the folloiring sections of the Food Code and 105 CMR 590.000. Item Good Retail Practices FC 590-000 23. Mang eq ment and Personnel_ FC -- 2 .003 24. _ Food and Food Protection FC -3 .004 25. Equipment and Utensils FC - 4 .005 26. 27. Water, Plum bin and Waste Physical Facility-__ FC -5 FC -6 006 ' .007 28. _ Poisonous or Toxic Materials FC -7 .008 29. _ Special Requirements .009 30. _ Other _ sz�m„m..ceo-za,_ LEM \ / I �� y BOARD OF HEALTH 5 Establishment Name: V 1 CTo 121 Ci- JVi�" 6 n Date: `- q Page: of Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R - Red Item ... PLEASE PRINT CLEARLY Date Verified Li a a 5 ern v S i -Cd:jz s47 Q Y 1 of s p a -- if n 0 z /x,kh P vP e V er2i ITCQ _6 C7,11y - acc my r O C► i S1 In t � a i -rrr, i ow Ln I v I b 09 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No l7 Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 77 •V Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 18 * Denotva critical item In the Ccderal 1999 Foal Code or 105 CNIR 590.1100. Food or Color Additives 3-202.12 Additives` 3-302.14 Protection from Unat roved Additives`` 24. Food and Food Protection Poisonous or Toxic Substances 7-101.11 Minititying Information - Original Containers, 7-102.1 t. Common Name -Forking Containers` 7-201.11 Se araban - Storage* 7-202.11 Restriction -Presence and Uge" 7-202.12 Conditions of Use, 7-203.11 Toxic Containers - Prohibitions/` 7-204.11. Sanitizers, Criteria - Chemicals* 7-204.12 Chemicals for Washine Produce, Criteria* 7-204.14 Diving A ends. Criteria - 7 -205.11 .Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides. Criteria` 7-206.12 Rodent Bait Stations* 7-206.'13'Cracking Powders, Pest Control and Monitoring* * Denotva critical item In the Ccderal 1999 Foal Code or 105 CNIR 590.1100. Proper Cooking Temperatures for P3-501.'15 PHFs 3-401.11A(1)(2) _ Fggs- 1.55'F 15 Sec. 24. Food and Food Protection Eggs -immediate Service 145'Fl5sec+ i -401.11(A)(2) Comminuted Fish, Meats <? Game FC74 FC 5 FC -6 Animals - 155'F 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 sec. * 3-401.11(A)(3) Poultry, Wild Game, Stu@edPHFs, Stuffing Containing Fish, Meat, Poultr or Ratites -165".F IS sec. 3-401A 1 (C)(3) Whole-musele,Intact Beef Steaks 145'F * 3-401.12 Raw Anitual Foods Cooked in a Microwave 165°F * 3-401,11(A)(I)(b) All Other PHFs -145'F't5see, Reheating for Hot Holding 3-403.11(A)&([)) PHFs 165'F 15 sec. ;it 3-403.11(B) Microwave- 165' F 2 Minnie Snmdine Time* 3-403.11 (C) Cominercialty Processed RTE Food - 140'F 3-403.11(B) Remaining Unsbced Portions of Beef Roasts* Proper Cooling of PHFs 3-501..1.4(A) Cooling Cooked PHFs from 140'F to 70`F Within 2 flours 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 fFIours* * Denotva critical item In the Ccderal 1999 Foal Code or 105 CNIR 590.1100. 21 3-501.14(C) PHFs Received at Temperatures According to 1,aw Cooled to 41°F/45'F Within 4 Homs. P3-501.'15 Cooling Methods for PHFs 14 PHF Hot and Cold Holding 24. Food and Food Protection 3-501.16(1?) Cold PFIFs Maintained at or below 590.004(F) 41'/45' F` Not Otherwise Processed to Eliminate 3-501.16(A) Hot PHFs Maintained at or above 140"F. * FC74 FC 5 FC -6 3-501.16(A) Roasts Held at or above 130'F. 24 Time as a Public Health Control Pasteurized Eggs Substitute for Raw Shell 3-501.19 Time as a Public Health Controls` 590.004(11) Variance Re uiretnent 21 3-801_1 l (A) Unpasteurized Pre-packaged Juices and Beverages with Warningi;abels* Consumer Advisory Posted for Consumption of 3-801.11(}3] Use of Pasteocized Bess* FC-2 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed S xonts Not Served. 24. Food and Food Protection 3-801.1 i (C) Unopened rood Packa re Not Re -served, • 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 tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. 1�:�rrrrra�l (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, eon be found in rhe following sections of the Food Cade and 105 CMC( 590.000. Item Good Retail Practices FC Consumer Advisory Posted for Consumption of 76��7 FC-2 Artanal FocAs Tliat are Raw. Undercooked or 24. Food and Food Protection FC - 3 Not Otherwise Processed to Eliminate 25. Equilarrent and Utensils 2S.__ _ Water, Plumpki and Waste 27. -Ph sical Facili FC74 FC 5 FC -6 Pathogens:* E're�:,a vvsooi 26. Poisonous or Toxic Materials 3-302.13 Pasteurized Eggs Substitute for Raw Shell 29. S acini Re uirements B gs` 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 tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. 1�:�rrrrra�l (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, eon be found in rhe following sections of the Food Cade and 105 CMC( 590.000. Item Good Retail Practices FC 590.000 23. Mann ement and Personnel FC-2 _ .003 24. Food and Food Protection FC - 3 .004 25. Equilarrent and Utensils 2S.__ _ Water, Plumpki and Waste 27. -Ph sical Facili FC74 FC 5 FC -6 .005 .006__ .007 26. Poisonous or Toxic Materials FC - 7 '..008 29. S acini Re uirements .009 30 Other - �- 3:SMIcm11A,d ' CITY OF SALEM / BOARD OF HEALTH 11 Establishment Name: V i &6210. S h (jY) Date:—b -G% " -1 Page: of 5 nem No. Code Reference C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY bate Verified. f Al 1 n S Y4 9C c�s� ✓a - lit . S ;lto�-Li l r o'I zJ'-,f � �Yi v� hS Teo A 1�u Uru} r)Sl S CLJO t L4 ,01 �SVIA I. G" I VIC4 z Q- I�VDv .li iS Lk- v " t -M C S. E ap a o° L as K. abti , ,[ 4z r1.y in w y o CA o n N1 , of Nov, N 1 ss)V1 p a c cov:°vi n I Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty- d , lar_ or suspension/revocation of your food permit. /�j Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo LI Closure ❑ Voluntary Disposal ❑ Other: r -- U/ IN i Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 15 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection frorrtUnaproved Additives* 3-501.16(B) 590.004(F) Poisonous or Toxic Substances 7-101.11 Identifying Information -Original Containers'" 7-102.11 Common Name- Workin" Containers* 7-201.11 Searaban - Storage* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use" 7-203.11 Toxic Containerrs- Prohibitions* 7-204.11 Sanitizers, Criteria Chemicals^ 7-204.12 Chemicals for Washing Produce., Criteria"` 7-204.14 Drina Agents. Criteria - 7 -205.11 Incidental Food Contact. Lubricants* 7.206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* _T206 13 Tracking Powders, Pest Control and Monitorinn* 15 PHFs Received ,it Temperatures According to Law Cooled to 41 °F/45"F Within 4 Hours. Proper Cooking Temperatures for COOED" Mei 10(h for PHFS 14 PHFs 3-501.16(B) 590.004(F) 3-401.11A(U(2) E.ggS- 195"F 15 See. Hot PHFs Maintained at or above 14WF. 3-501.16(A) Eggs- Immediate Service 1450F15scc* 20 3-401.11(A)(2) Comminuted Fish, Meats & Game I Time as a Public Health Control* 590.004(H) Animals - 155"F 15 sec. 30, 3-401.1l(B)(1)(2) Pork and Beef Roast - 130"F 121 nun* 3-401.1 l(A)(2) Ratites, Injected Meats -155°F 1.5 sec. * 3-401.1_1(A)(3) Poultry, Wild Game, Stuffed P1117s, Scoffing Containing Fish, Meat, , Poultry or Ratites -165"F 15 sec. #` 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 1.45°F 4' 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 I7 Reheating for Hot Holding 3-403,11(A)&(D) PHFs 165"F 15 sec. 3-403.11(B) Microwave- 165" F 2 Atmore Standing Time* 3-403.11(C) Commercially Processed RTE Food - 14W17- 4W173-403.L1(E) 3-403.11(E) Remaining Unslieed Portions of Beef Roasts* lg Proper Cooling of PHFs 3-501.14(A) Cowling Cooked PHFs from 140°F to 70:F Within 2 Flours and From 70°F to 41"F/45°F Within 4 Hours. * 3-501.14(13) Cooling PHFs Made Front Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours'i s Denotes unuceI item in the Federal 1999 Foal Code or 105 CMR 590000. 3-50114(C) PHFs Received ,it Temperatures According to Law Cooled to 41 °F/45"F Within 4 Hours. 3-501. I5 COOED" Mei 10(h for PHFS 14 PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41`745°F* 3-501.16(A) Hot PHFs Maintained at or above 14WF. 3-501.16(A) Roasts Held at or above 130°F. 20 Time as a Public Health Control 3-iM A 9 I Time as a Public Health Control* 590.004(H) I Varianw uirement 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with W'am..i, labels* 3-801..11(B) _Use of Pasteurized Eees* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Sced S routs Not Served. 'P 3-801.11(C) Unopened Food Package Not Re -served, CONSUMER ADVISORY 22 3-603.1 I Consumer Advisory Posted 'for Consumption of 7 Mona ement and Personnel FC -- 2 Food and Food Protection FC -3 Animal Fads `That are Raw, Undercooked or 25.- _ _ Eguipment and Utensils FC - 4 Not Otherwise Processed to Eliminate 26. 27. Water, Plum bin and Waste FC -5 Physical Facility FC -6 Pathogens_': era1« e eveoor 28. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 20. S ecial Requirements E gs* Violations of Section 590.009(A) -(D) in catering. mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical and nrin-critical violations, which do not relate to the foodborne illness interventions and risk fiirtors listed above, can be found in the followintg sections of the Food Code and 105 CMR 5.90.000. Item Good Retail Prac_ tices FC 590.000 23. 24. Mona ement and Personnel FC -- 2 Food and Food Protection FC -3 .003 004 25.- _ _ Eguipment and Utensils FC - 4 .005 26. 27. Water, Plum bin and Waste FC -5 Physical Facility FC -6 .006 .007 28. Poisonous or Toxic Materials FC -7 .008 20. S ecial Requirements .009 30, ether r ti99nm�baMd-2.tluc CITY OF SALEM / �J BOARD OF HEALTH C Establishment Name: V 1 C�,`(o_ S�h im - Date: u - q " U Page: 5 of J Item No. ' Code Reference C - Critical item DESCRIPTIONOF VIOLATION / PLAN OF CORRECTION R — Red item - PLEASE PRINT CLEARLY Date Verified r 9 c stnq Vyd --en aC o° i C1( `y, P CtJ- OGDe, I6 M, j -KI & -m a.c ri 4-o N PM F ro:ln -IP un°F o>' aw IS ah,a d l Y y S No VuAar I A S f bD -off' ngWo nu n q S o r res4-no s 6i2u n— V e Ca ' te a �t V lam r t (s 1( P I 1l td l m rncf S - O\-_0UQ r vi 41 — F06XA nj=_V S Discussion With Person in Charge: this report, have had the opportunity to ask questions and agree to correct all efore the next inspection, to observe all conditions as described, and to p Comply all mandates of the Mass/Federal Food Code. I understand that Loncompliance may result in daily fines of twenty-five dollars uspension/revocation of ermit. i Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: r +` Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 I5 16 17 18 r Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Una ironed Additives* FC -2 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102-11 Common Name -Workin- Containers' 7-201.11 Separation - Storage - 7 -20111 Restriction -Presence and User 7-202.12 Conditions of 11se* 7-203.11 Toxic Containers - Prohibitions'' 7-204.11 Sari Criteria - Chemicals -" 7-104.J.2 Chemicals for Washin Product; Criteria* 7-204.14 DryingAgents. 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 r I Denoias critical nein in the toderal 1999 Food Codc or 105 <`ML 5)D.000 E3-501. Proper Cooking Temperatures for PHFs Received at Temperatures According to Law Cooled to 41'F/45`F Within 4 Hours. Cooltna Methods for PHFs PHFs 3-401.11A(1)(2) Eggs- 155°F '15 Sec. FC -2 E eeliateService 145°Fl5sec*. 3-401.11(A)(2) Comminuted Fish, Mears & Game 3-501.16(A) Animals - 155°F 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 11 sec. 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 -165°.F 15 sec. 3-401.1.1(C)(3) Whole -muscle,' Intact Beef Steaks FC -- 7 145°F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3-401-1I(A)(1)(b) All Other PHFs- 145'F'15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 sec. * 3-403A I (B) Microwave -165' 1F 2 Minute Standing Tunc* 3-403.11(C) Commercial lylarocessed RTE Food - 140'Ft 3-40311(F) Retraining Unsliced portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140°F to - 709F 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 4I-iours" I Denoias critical nein in the toderal 1999 Food Codc or 105 <`ML 5)D.000 E3-501. 3-501.14(C) I5 PHFs Received at Temperatures According to Law Cooled to 41'F/45`F Within 4 Hours. Cooltna Methods for PHFs 19 3-801.11(B) PHF Hot and Cold Holding FC -2 3-501.16(B) 590 004(F) Cold PHF,, Maintained at or below 41%45' F* Food and Food Protection 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 25. 3-501.16(A) Roasts Held at or above 130°1,. 20 11 Time as a Public Health Control FC 5 3-501.19 Time as a Public Health Control* Phsical Facility..- - 590.004(H) Variance Re uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.'1I(A) Unpasteurized Pre-packaged Juices and Beverages rjith Warning Iabels* 530.000 3-801.11(B) Use of Pasteurized Es,�,s* FC -2 3-801.11tD) Raw or Partially Cooked Animal Fund and Raw Seed Surtax Not Setved. Food and Food Protection 3-801.11(C) Un�Pucka �e Not Re -served. " w 22 3-61)3.11. Consumer Advisory Posted for Consumption of 530.000 23. Animal Foods lbat are Raw. Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -3 Patho-*ens.* ErvIll., 11van0I 25. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell .005 26. Eggs!, 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 wader the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should tie debited under #29 - Special Requirements. WeTlriilttmy.�I (Items 23-30) Crldeal and non-critical violations, which do nor relate to the foodborne illness interventions and risk factors listed above, can be found in the folionfng sections of the Food Cate and 105 CMR 590.000. Item Good Retail Prat._ rices FC 530.000 23. Management and Personnel FC -2 .003 24. Food and Food Protection FC -3 .004 25. Egaiprnent and Utensils FC - 4. .005 26. Water, Plumbing and Waste FC 5 .006 27. Phsical Facility..- - FC -6 1 .007 26. Poisonous or Toxic Materials FC -- 7 I .008 29. S ecial Re ulremonts .009 30. Other s CITY OF SALEM '— BOARD OF HEALTH Establishment Name: V I � 1Z DC7 ��'//iY) Date: & '.39 Page: of Item No. " Code Reference C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY _L.e Date Verified a r /acrr ferg/;49ossl 904,-s OhSe i rc , � Y s hn�ce J tP Q cc nze Y1�c .a o f is _1_07bac 6 U Ca /2S P,u r s he /njav-o ( G Ce. 1 U %[ _M lr _ '� D Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all inspection, to observe all conditions as described, and to violations before the next ins P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines o twenty-five dollars or suspension/revocation of your food permit. ` Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion El 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 a I8 I flit fait aimC1 •\. C•'. Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unimproved Additives'" �^ Poisonous or Toxic Substances 7-101.11 Identifying information - Original Containers'' 7-102.11 Common Name- Working Containers* 1-201.1.1 Separation - Stora e* 7-202.11 7-202.12 _ Restriction - Presence and Use* Conditions of Use' 7-203.11 Toxic Container, - Prohibitions* 7-204.11 Sanitizers.Criteria- Chemicds* 7-204-12 Chemicals for Washing Produce. Criteria* 7-204.14 Drying A 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 Monitoring' I flit fait aimC1 •\. C•'. * Denotes crltical item in the federsl 1999 Food Code or 101 CMR 590.000. 19 2n 21 3-501.14((") - 3-501.75 Proper Cooking Temperatures for Consumer Advisory Posted for Consumption of PHFs 3-401AIA(1)(2) Eggs- 1557 15 Sec, 3-501.16(A) Egmss- Immediate Service 145`Fi Ssec, 3-401-1 I (A)(2) Comminuted Fish. Meats & Oame FC 3 Animals - 155`F 15 see. '4 3-40(.11(13)(1)(2) Pork and Beet Roast -130'F I'll al 3-401.1l(A)(2) Ratites, Injected Meats- 1.55'F 15 26. sec. * 3-401.11(A)(3) Poultry, Wild Game. Stuffed PHFs, 27 Stuffing Containing Fish, Meat, FC -6 Poultry or Ratites -165°F 15 sec. 3-401.1 l(C)(3) Whole -muscle, Intact Beef Steaks FC - 7 145'F * 3-401.12 Raw Animal Foods Crooked in a Microwave 165`F 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3-403,11(A)&(D) PHFs 165'F 15 sec. * 3-403..1(B) Microwave- 165' F 2 Minute Standing Tithe* 3-403,1.1(C) Commercially ProcessedRTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beet Roasts'' Proper Cooling of PHFs 3 -SOL 14(A) Coaling Cooked PffFs from 140`F to 70'F Within 2 Hours and From 70'F to 4I F145°F Within 4 Hours. * 3-501.14(B) ComingPHFs Made From Ambient Temperature Ingoedients to 41'FI45" F Within 4 Hours* * Denotes crltical item in the federsl 1999 Food Code or 101 CMR 590.000. 19 2n 21 3-501.14((") - 3-501.75 PHFs Received at Temperatures According to Law Cooled to 4 t'F/45''F Within 4 Homs, Cooling tMeflwds for PRFs _ Consumer Advisory Posted for Consumption of PHF Hot and Cold Holding 3-501.16(}3) 590.004(F) Cold PHFs Maintained at or below 4l'(45' F* 3-501.16(A) HOtPHFS Maintained at or above 140'F. * 3-501.16(A) Roasts Held at or above 130'F. FC 3 Time as a Public Health Control 3-50119 Time as aPublic Health ControF` 590.004(Ji) Variance Retuireiucra t 3-801.11(A)( Unpasteurized Pre-packaged Juices and Beneraces with W armna, Labels* 3-801.11(B) I Use of Pasteurized Encs* 3-301.11(D) Raw or Partially Cooked Annual Fail Raw Seed Surout's Not Served. * 3-801. W&UM f 4WIFITIWAff 22 3-603.11 Consumer Advisory Posted for Consumption of 590,000 1. 23.Mnn4a Animal Foods lhat are Raw. Undercooked or FC -2 .0031 Not Otherwise Processed to Eliminate _.__... _. Food Protection FC 3 Pathogens.* "'ie`ore ?5. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 005 26. E „s* or'c4rAt- rrMVUU (c1Y1c1Y i o 590.009(A) -O 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 Tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Speeial Requirements. IeT�rNilEJ17 Fii�tAX� (Items 23-30) Critical and non-crilieal violations, which do not relate to the foodborne illness interventions and risk factors:listed above, canbe found in the follon inrg sections cf the Fond Code and.105 01R 590.000. item i Good Retail Practices '.. FC 590,000 1. 23.Mnn4a ement and Personnel FC -2 .0031 ,.....-.__._.._. 25 _.__... _. Food Protection FC 3 004 ?5. pandMe E ui meat and Utensils FC 4 005 26. - Water Plumbing and Waste FC -5 006 I 27 Ph sinal Facile FC -6 .007 '. 28. Poisonous or Toxic Materials FC - 7 ..008 29. Se rial Hegmrements .009 LM 30 ',_ Other _.. ysnrynnlll! 2111.z IMPORTANT MESSAGE FOR DATE 1�1rP JIF i PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU SIGNED ��.sFORM 4009 ���III��r MARE IN IJ. S. A. z 0 i cn �wFORM 4009 MADE IN U.S.A. IMPORTANT MESSAGE FOR DATE \^3o e �- TIME �' 3� P.M. 7 M J OCCivv�q/��� -- fu cpR OF IA-x PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED. PLEASE CALL WILL FAX TO YOU CAME TO SEE YOU WILL CALL AGAIN: WANTS TO SEE. YOU RUSH RETURNED YOUR MESSA! /GE/� /ij Circ J / l-c-r � X C /.r lGi� _ % DjLe — SIGNED �wFORM 4009 MADE IN U.S.A. CALL WILL FAX TO YOU �wFORM 4009 MADE IN U.S.A. i o ` 'I I{ I I III I i 1 Baillargeon Pest Control, Inc. RESIDENTIAL COMMERCIAL "Your Personal Pest Control Solution" Service Call /Re/Clean Out F -I J Retreatment wl Reported Problem:-- lyC �G�� - ` -kL 14 � Date S - M - T W - CT - F - S Time In Time Out Service Iechnicia antra Hout/e# (— state License fr Account Name % (� f d �r A-/ri f< G/` Address City (' f G' w i State IA Zip Code Telephone# Was pest activity found at this service Y No El , SCS<zrir��,�1 p,ci��; S I found pest activity -Location - Be specific: � Summary & Recommendations f A ry Cc. A4 r ? <( AP Customer Signature X Target Pest: Rodents Cockroaches Flies E] Ants ❑ It, 4iniP/'/�;S Insecticides used E.P.A. # (%) Amount Rodenticides used E.P.A. # _ Amount Pity 3 r7S 5C— i Business Phone 978-683-5541 24 Tudor Street Methuen, MA 01844 Established in the Year 2000 W W W.BAILLARGEONPESTCONTROL.COM Fax Number 978-989-9228 (BAT) Y 2 RESIDENTIAL Service Cali Reported Problem:_ Balllargeon Pest Control, Inc. "Your Personal Pest Control Solution" Re/Clean Out ❑ COMMERCIAL Retreatment Account Name (,I('C rtoV2 I'' ::>/ fi ► (C A ---I Address t c City �%� L total/ State � i f Zip Code Telephone # Was pest activity found at this service Ye' `-No ❑ I found pest activity - Location - Be specific: Summary & Recommendations r U Sl v J U2 PSI­e7f214-7/E> c' f -C rC- F-,PS"t`- Corr" S— 4 1,:5:A,511�Cc�7v Target Pest: Rodents ❑ Insecticides used I E.P.A. # Flies ❑ c Tfl� r !-;9/1 C Ants ❑ # Amount 1 PG1I G20 u- / 1 5-- o G, ° L_ Business Phone 978-683-5541 24 Tudor Street Fax Number 978-989-9228 Methuen, MA 01844 (BAT) Established in the Year 2000 II WWW.BAILLARGEONPESTCONTROL.COM i IMPORTANT MESSAGE FOR �.L1 DATE Tit a A. tFi O PHONE; Ll �RJEpA�CIOQD�E NUMBER �GpEMENBIDN AREA C E NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH. RETURNED YOUR C LL WILL FAX TO YOU MESSAGE SIGNED bmMOCRMNU.SA CITY OF SALEM BOARD OF HEALTH Establishment Name: d/GTadIII4 4"y-leiJ Date: -6-z"Aff Page: / of / Item No. Code Reference C - Critical nem R—Red Item DESCRIPTIONOF VIOLATION / PLAN OF CORRECTION Date Verified PLEASE PRINT CLEARLY C10e C . 6e USS /.i CTvaN INiQ C u eslJ /N fft *I7r 14J OT$: t c - P1s0V Pt i9 N S J)7 Uea a 10C S M - SAC t S'a < o : / # u r&..s r t/r G LA rr • rJ2 f4 of / S 04Gn u c cfN J Rc?i.1XIA0 13411- W*" 'IfWIAJ fl"CAknr W A-, S_,W84110 Bef PU10 Alf QICM , a '4 6R fit_ 1r/ Ates C© dr off 10D 641t, 6 S is cm HuL& cv �d Q 6 eL' C6 Mfrs f rnCA.- s v Nor-' /ss 2fsF/ LGd _ Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. dorrective 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) - 1119*41111401112* u' 15 18 ' Denotes critical item in tau fMeral 1999 Food Code or 105 CMR 590.000. E3-501.15 Pool or Color Additives 3-202.12 Additiv..-.......- cS k 3-302,14 Protection from ilna t roved Additives* Flane s ment and Personnel Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-102,11 CommonName- WorkingContainers* 7-201.11 Separation - Straace* 7-202.11 1 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 Dr ino E cuts. Criteria" 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 Restricted Use Pesticides. Criteria* 7-206.72 Rodent Bait' 9tatiatts" 7-206.13 'Cracking Powders. Pest Control and Monitorinn* ' Denotes critical item in tau fMeral 1999 Food Code or 105 CMR 590.000. E3-501.15 Proper Cooking Temperatures for 19 PHFs 3-401.11A(])(2) Eggs- 1.55'F'15Sec. Flane s ment and Personnel E cgs- "am nm ed"ne Service 145'Pl Ssec* 31101.11(11)(2) Comminuted Fish, Meats t Game 20 Animals - 155°F 17 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130"F 121 min* 3-401.11.(A)(2) Ratites, Injected Meats - 15S`F 15 Etc uipnrent and Utensils and Waste sec. 3-401.1.1(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FG Poultry or Ratites -165'F 15 sea. ' 3-401_11(C)(3) Whole -muscle, 'Intact Beef Steaks Poisonous or Toxic Materials 14TT * 3-=401.12 Raw Animal Foods Cooked in a 29. Microwave 165'F * 3-401,11(A)(1)(b) All Other PHFs- 145'F 15 sec. .009 Reheating for Hot Holding '3-403.11(A)&('D) PHFs 165'F 15 sea 3-403.11(B) Microwave- 1.65° F 2 Minute Standing Time* 3-403.11(0) Commercially Processed RTE Food - 140°F* 3-403.1.1(E) Remaining Unslieed Portions of Beaf Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140`F to 'WF Within 2 Hours and From 70'F to 41°F/45°F Within 4 Hours.'" 3-50114(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41`F/45'F Within 4 Hours" ' Denotes critical item in tau fMeral 1999 Food Code or 105 CMR 590.000. E3-501.15 3-501, 14(C) 'PHFs Received A Temperatures According to Law Cooled to 41(F145'FWithin 4'Houcs. Coolan, Methods for PHFs 19 PHF Hot and Cold Holding 590.000 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41'145' F* Flane s ment and Personnel 3-501,16(A) Hot PHFs 'Maimainedatorabove 14WF. * Not Otherwise Processed to Eliminate 3-501.16(A) Roosts Held at or above 130'1,. 20 Time as a Public Health Control FG 3-501.19 Time as a Public Health Control* Pasteurized Eggs Substitute for Raw Shell 590,004(8) Variance Requirement 21 3-801,11(A) Unpasteurized Pre-packaged Juices and _Beverages with Warnioe labels* Consumer Advisory Posted for Consumption of 3-80111(B) Use of Pasteurized Eees* 590.000 3-801.11(D) Raw or Pml'ialty Cooked Animal Foal and Raw Seed Sprouts Not Served. Flane s ment and Personnel 3-80 1. l l (C) Uno erred Food Pucka >e Not Re -served. "` CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 Animal Foods 'Phat are Raw. Undercooked or Flane s ment and Personnel FC Not Otherwise Processed to Eliminate .003 -24. Patlto�ens."` Erre.rc:-e nnaooi FG 3-302.13 Pasteurized Eggs Substitute for Raw Shell 25. 26. _Vla_ter.Plumhi�nc Etc uipnrent and Utensils and Waste Fees* Violations of Section 590.009(A) -(D) in catering. mobile food, temporary and residential kitchen operations shouldd 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. r 7 7,TWjfAj zLq (Stems 23-30) Cynical and non-critical violations, ahieh do not relare to the foodborne illness inrerventions and riskjaciors listed above, can be ftnnrd inthe following sections of rhe Food Code and 105 CMR .590.000. Item- Good Retail_ Practices_ FC 590.000 23. Flane s ment and Personnel FC - 2 .003 -24. Food and Food Protection FG -3- .004 25. 26. _Vla_ter.Plumhi�nc Etc uipnrent and Utensils and Waste FC PC - 4 -5 .005 !.006 27. Ph sical Facility _ FG -6 007 28, Poisonous or Toxic Materials FC -- 7 .008 29. S eoial R uirements .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 L arl Date ./ S 417 Tvpe of Operations) Type of Inspection WFood Service El Retail El Residential Kitchen El Mobile [ITemporary ❑ Caterer ❑ Bed & Breakfast Permit No. ®-Routine ElRe-inspection Previous In sp ction Date:/Z/ja; ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address NA�J4 Risk Leve Telephone 97s- S, 3yod Owner A"m N r cb4ty_ HACCP Y/N Person in Charge (PIC) /4 Time In: Out: Inspector LFAitA M "S /e,r Each vioiatlon cr iteQ requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned/ Knowledgeable/ Duties - EMPLOYEE HEALTH' ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded 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 Plan PROTECTION FROM CONTAMINATION' " El8/Separation/ Segregation/ Protection ® 9. Food Contact Surfaces Cleaning and Sanitizing (g") ❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices v 1�. Prevention of Contamination from Hands L-� 113. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives El 15. Toxic Chemicals TIME/rEMPERATURE CONTROLS (Potentially. Hazardous Foods) E]16. Cooking Temperatures El 17. Reheating Plans F❑, 118. Cooling IL�f t 9. Hot and Cold Holdingt'L) ❑ 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 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. 3. Management and Personnel (FC -2)(590.003) / 24. Food and Food Protection (FC -3)(590.004) ✓ 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 5s M$s rFOm 14.do 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: n ect Y Si t Print: PIC's Signature: Print: Page / of Pages \- Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 'I 590.003(A) Assignment of Resporimbility" 590.003(B) Demonstration of Knowled e* LL- 1031t Personincharge- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Feld Law" 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a licants* _ Shell Ee,*s' 590.003(F) Responsibility Of A Fuad Employee Or An 3-202.16 Ice Made From Potable Drinking Water" Applicant To Report To The Person In Drinking Water from an Approved Svstern* 590.006(,A) Charge 590.006(B) 590.003(G) Re orti fig by Person in Char *e* 3 590.003(1)) Exclusions and Restrictions" 3-201.15 590.003tE) Removal of Exclusions and Restrigjc C In M C _ Food and Water From Regulated Sources 590.004(A -B) Compliance with Feld Law" 3-201.12 Food in a Hennetiwlly Sealed Container" 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Ee,*s' 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 Svstern* 590.006(,A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Ve,,etables ShetBish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Sheiihsh* 3-201.15 Molluscan Shellfish front NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(0) WildMashroojns* 3-201.17 Game Animals* 3-701.11. Receiving/Condition 3-202.11. PI Fs Received at Pro rer Tem teratures'* 3-202.15 Packagelntegity" 3-101.11 Food Safe and Unadulterated Tags/Records: Sheilstock 3-202.13 Shellstock Identification * 3-203.12 Shellstock Identification Maintained" Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3402.12 Records. Creation and Retention* 59U04(1) Labeling of Ingredients` Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment., Conformance with Approved Procedures iHACCP Plans 3-502.11 S ecialized Proccssin� Methods* 3-502.12 Reduced oxy mr; aekwnrr , criteria* 8-103.12 ConfrarnaneewithAi)rovedProcedures* .r Denotes critical item in the federal 1999 Food Code of 105 CMR 590.000. g Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and I2TE Foods" Coniamination 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 Ve,,etables 3-304.11 Food Contact with Equipment and Utensils" Contamination from the Consumer 3-306.14(A)(13) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11. Discarding or Reconditioning Iinsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Tem eramres* 4-501.1.12 Mechanical Warewashing- Hot Water Sanitization Tem erafurts* 4-507.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.1](A) Equipment Food Contact Surfaces and Litensik Clean' 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment., 4-703.11 Methods of Sanitization --Hot Water and Chemical* to Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms'` 2-301.12 Cleaning Procedurc* 2-301.14 When to Wash* if Good Hygienic Practices 2-401.11 1=alit , Drinkin or Ilsin*Tobacco* 2-401.12 Discharges From the Eyes. Nose and Month* 3-301.12 1 Preventing Contamination When Tasting* 12 I Prevention of Contamination from Hands 590.004(E) Preventing Contvninatiorr from Em Io ees* 13 Handwash Facilities Conveniently Located and Accessibte 5-203.1.1 Numbers and Ca acities* 5-204.11 Location and Placement' 5-205.11 -kcassibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.1] Handwashin Cleanaer. Availabilit 6-307.12 I-Iand Drying Provision ITY OF SALEM BOARD OF HEALTH r Establishment Name: VIC rol IA 51-47-1 oil Date: c"i Page: Z of Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item - PLEASE PRINT CLEARLY. Date Verified G / & CI B Q/rl�wraT ttt,�lt OVA IO rMW 5eekIll' W4 r0 . X/1N10- 24- c�vi /�t/lcir 1nIS,O� tc� ,�c,d�N� N c� rtO�ur' c,C tf✓ R Siaa, Zan omc'/ - LA!3t.-s-460 t' SSCOc?Ir d r '7� /« oYf�,aM Ftt6�Yeit� MtJStN� f�d�fwleM�i�tt-. PR[Jve9Lf; t9lB� sic � �llt�./t+WtMfSa'at:�� �! Lo t46-dL6r 4Fe}N$/t RL C( (Ytnf4; 2S .gtv,f-,z,NF LvG- rttrr t«.Af' v? so f�A� . 5+4rr0-)mtn/ too- F•d Sts c Pta�� n tt . 19 C [3 viErTAs--W A to c u ufrt(' 13` 49� c 26X(iPt& 10')i0 A CAAW Jf n ntsa K- a -a M►4 MAI rTB+tp OF ql,fwt- 6&6 . 2S wSlt- i 6. fr ,*, Qr4XA4rrtm' UV Ill' AIM" (41 � c viAf7s �It i��0 � 2f7 �iWtllo� C'ev6.053 6AU H&A6:1 t.I fS 0 V 0- —x1140 1.4140MOF 20' 0:�'. A 4.Tv rr vu fa p Afrf+if rNfQ c)+r ©a dfz de-l'o f. 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 do ornsion/revocation of your food permit. v � Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: pF Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) L14 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 7-101.11 kientit5>ing Information -Original Containers* 7-102.11 Common Natne - Wcr k Containers* 7-201.11 Separation - Stora =cr 7-202.11 Restriction - Presence and Use* 7-20112 Conditions of Use" 7-203.1.1 Toxic Container - Prohibitions"` 7-204.11 Satiitizers, Criteria -Chemicals* 7-204.12 Chenncals for Washin Produce, Criteria"' 7-204.14 Drvin�riteria" 7-205.11 Incidental Food Contact. Lubricants* 7-206.71 Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bart Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* 16 17 18 • I Denotes critical item in ihd f •deral 1999 Food Code or 105 CNIR 590.000. Proper Cooking Temperatures for P3-501.15 PHFs 3-401.11A(1)(2) F-ggs- 155°F 15 Sec. 24. E>qs- lnunediate Seraice 145`P15sec* 3-401.11(A)(2) Comtninuted Fish, Meats &. Game 3-801.11(C) Animals - 155'F 15 sec. s 3-401.11(6)(1)(2) Pork and Beef Roast - 130°F 121 nun* 3-401.1 I(A)(2) Ratites, Injected Meats -155°F 15 Poisonous o' "toxic Materials S ecialR uirements sec. 1, 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, _' Stuffing Containing. Fish, Meat, Poultry or Ratites -165'F 15 sec. 3-401 A I (C)(3) Whole -muscle, Intact Beef Steaks 145`F * 3=401.1.2 Raw Animal Foods Cooked in a I65`F 3-401-1i(A)(1)(b) _Microwave All Other PHFs-145'F'15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 1650F 15 set. 3-403.11.(B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F 3-4t)3.11(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(450F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F(45°F Within 4 Hours* I Denotes critical item in ihd f •deral 1999 Food Code or 105 CNIR 590.000. 2'1 :,-501.14(C) PHFs Reaavefl at Temperatures Accordin to Law Cooled to 41'F/45`F Within 4 Hours. P3-501.15 Coolin, Methods for PHFs 19 PHF Hot and Cold Holding 24. 3-501.16(B) Cold MIN Maintained at or below 590.004(F) 41`145'F- *3-501.16(A) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-501 16(A)Hot PHFs Maintained at or above 140'F. 3-801.11(C) 3-501.16(A) Roasts Held at or above 130'F. 20 Time as a Public Health Control _.005 FC -5 .000______ FC -6 .007 3-501-19 Time as a Public Health Control* Poisonous o' "toxic Materials S ecialR uirements 590.004(H) Variance Re uirement 2'1 3-A01.11(A) Unpasteurized Pre-packaged Juices and Beverages with Winning Labels* Animal Foods 'that are Raw, Undercooked or 3-801.11(B) Use_oi Pasteurized F,egs* 24. 3-801.:( 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-801.11(C) Uno aged Food Packa<=e Not Re -served. + !. 22 3-603-11 Consumer Advisory Posted for Consumption of -- - FC 590.00000 Animal Foods 'that are Raw, Undercooked or Maga emeni and Personnel Not Otherwise Processed to Elinunate 24. Pathogens.* Ene "vvaom FC -3 A04 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eguipmznt and Utensils Eggs* 590 -009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should he debited wider the appropriate sections above if related to foodborne illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 -- Special Requirements. (Rents 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 ,seclions ol'the Food Code and 105 CMR 590.000. Item - f Good Retail Practices -- - FC 590.00000 23. Maga emeni and Personnel FC - 2 .003 24. Food and Food Protection FC -3 A04 25. _. Eguipmznt and Utensils FC -4 26. 27. _ Water, Plumbin and Waste Physical Facile _.005 FC -5 .000______ FC -6 .007 28. 29� Poisonous o' "toxic Materials S ecialR uirements FC - 7 .008 .009 30. _ Other _' CITY OF SALEM BOARD OF HEALTH Establishment Name: V 1 L6 0A A Tf aP i oAf Date: 'd!C/VL/ Page: 3 of V Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item --- -. PLEASE PRINT CLEARLY ---- Date Verified q C7 Cd w G arN ANm jIAS Atd ACctJrtv44rj*N T7�OLVV dlr/ CLA&i AMD SAPrefa-S' "ilt ,r9vSA— ANO f%d'ncV—. �11OAJea Sr K " 1040aLAca cnNL_' i C_ Gat�E+v cc,rs„sG (3OpAO TC&C&III &60 014,15o. F6_3Ue,-Act >'4Lsa fJA3 td L!; rr+ rs LL .TLS L. 1VOCif _ 'W �L ,�c�- On �NG�O�c� �' � � iN m�1Gsr�AL CGAtiNQ• `L% 61` f (f/p t s f ArlDt� L tG CnN6:t ltSt I�rr . V1 Q6 Gear- (nt3(” K-- 2 G -t �N1 (. r►Qt6 ski N e►ri PL✓f Cts r-051tber ,I6fo KN V IE s f N atilt. (JI rGW)oN NA rtOs 27 NtF rs r (�! P►�ls�A'1,/B' tGe1f cet,6 UVLIJrs ao�l�cil ✓(� /9 Psv ' 6t_ TftffW0- tN6 r W NK Ki�tr P v1°E1Lt �e l$10A19� t r�rrs Ku L t�f(�R�fn't atoms, ZS rCt^s sG�O� r,1`tS10aAwot& 51 06 up. Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions,as described, and to comply with all mandates of the Mass/Federal Food Code."I understand that noncompliance may result in daily fines of twenty-fjve` 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 interventlons and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 l7 '^ Detotts critical item in tit [°feral 1999 Food Code or 105 Cl IR 540-000- E3-501.15 Food or Color Additives 3-20212 Adtfitke,* 3-302.14 Protection from Una roved Addltives'� FC -2 Poisonous or Toxic Substances 7-101.11 Identifying lntormation - Original Containers* 7-102.11 Common Natne - Working Containers* 7-201.11 Separation - Stora e* 7-202.11 Restriction - Presence and Use* 7-202.12 Conditions of Use - 7 -203,11 Toxic Containers -Prohibitions* 7-204.11. Sanitizem Criteria -Chemicals* 7-20412 Chemicals for Washing Produce, Cistern I` 7-204.14 Drvina A eats. Criteria* 7-205.11 Incidental Food Contact. Lubricants - ubricants*7-206.11 7 -2K 11 1 Restricted Use Pesticides. -Criteria- 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* '^ Detotts critical item in tit [°feral 1999 Food Code or 105 Cl IR 540-000- E3-501.15 Proper Cooking Temperatures for 19 PRFs 3-40'1.1.1A(1)(2) Eggs- 1,55'F 15 Sec. FC -2 E s- humediate Service 145°Fl Ssec* 3-401.11(A)(2) Comminuted Fish, Meats & Came 20 Animals- 155'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130'F 121 nun* 3-401.11(A)(2) Ratites, Injected Meats- 155°17 1.5 26. sec. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Sniffing Containing Fish, Meat, Fc -6 Poultry or Ratites -165".F 15 sea 3-401-1l (C)(3) Whole -muscle, hntact Beef Steaks FC - 7 145`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. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165F 15 sec. * 3403.11 (B) Microwave- 165' F2 Minute Standing Time,. 3-403.11(C) Commercially Processed RTE Food - 140'F'r 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.1.4(A) Cooling Cooked PHFs from 140'F to 70`17 Within 2llonrs and From 70'F to 4t'F/45'F Within 4 Hours. 3-501.14(3) CoolingPHFMade From Ambient Temperature Ingredients to 41'F/45`'F Within 4 Hours* '^ Detotts critical item in tit [°feral 1999 Food Code or 105 Cl IR 540-000- E3-501.15 3-501-14(0) PRFs Received at'lemperatures According to Iaw Cooled to 41'F/45'F Within 4'Hours. Cootlna Methods for PHFs 19 PHF Hot and Cold Holding 3-80L11(R) 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 41V45° F* FC -2 3-50116(A) Hot PHFs Maintained at or above 14WF. * Raw or Pailially.Ctroked Animal Food and Raw Seed S rzouts Not Served. 3-501.16(A) Roasts Held at or above I'O'F, 20 Time ass Public Health Control 25. 3-501.19 Time as a Public Health Control* Pasteurized Eggs Substitute. for Raw Shell 590,004(H) Variance Re airement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.1)(A) Unpasteurized Pre-packaged Juices and Beverages with Warnin,IAbets* ---......... 590.00-0 3-80L11(R) Use of PasteurizedEees* FC -2 3-801.11(1)) Raw or Pailially.Ctroked Animal Food and Raw Seed S rzouts Not Served. Food and Foal Protection 3-801.11(07} Una ened Food Packa c Not Re -served. CONSUMER ADVISORY 22 3-603-1 I Consumer Advisory Posted for Consumption of ---......... 590.00-0 23. Animal Foods 'That are Raw, Underaoked or FC -2 _ .003 Not Otherwise Processed to Eliminate Food and Foal Protection FC --3 Pathogens-" e"v`"°` wrzogi 25. 3-302.13 Pasteurized Eggs Substitute. for Raw Shell .005 26. E >as* Jr'CLIAL t1rUUlHtMtiV[S 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. 171UMV90M (items 23-30) Cnarcal mud non-critical violations, which donor relate to the foodborne illness interventions and riskftalors listed above- can be found in the fot7omntg sections of the Food Code and 105 CMR 590.000. ---- Item - Good Retail Practices FC ---......... 590.00-0 23. Mona ement and Personnel FC -2 _ .003 24. Food and Foal Protection FC --3 .004 25. Equipment and Utensils FC -4 .005 26. Water,PlUm_bing and Waste FC -5 1 .006 27. Physical Facility _ Fc -6 .007 28. Poisonous or Toxic Materials FC - 7 .008 29. S ectal Re uirements 1 oo9 30 Other 35M(an-.b,k6 2A- �M nc�M.Nen■ IJ . - ITY OF SALEM BOARD OF HEALTH no*.• Donn• of Item No. code Reference C - Critical Item R – Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Z G tea Ac .L- n id /Cd 6-04 13Ac ,, uf AN ICE 3r.6)s C& ZVO940 1rf leKT Id PrtAtnr cRe c lit-A�.l cN �o /3 G 1 '40 N S' i'S IF- 430Mr M - 0C W leN AN 0A1j"--- \/'NQUroar T4 I"30'r— IMA T1 c..s fF"Fo#-e91r04#r- 14A c s SAMt t „r cs onR 0 VIkAr E-04 Ado cof±:j its'u d K c 1�sF>ts S• Distcussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code._I`understand that noncompliance may result in daily fines of twenty-five dollars o,rsuspension/revocation of your food permit. �Z Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion D Re -inspection ScheduledEmergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Hems 1-22) (Cont.) 14 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Una _ roved Additives'' IS Poisonous or Toxic Substances 7-101.11 Idcntifying information -Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Stora e"' 7-202.11 Restriction - Presence and Use* 7-702.12 Conditions at Use* 7-203.'11 Toxic Containers - Prohibitions^` 7-204.11 Sanitizers. Criteria - Chemicals* 7-204.12 Chemicals for Washin g Produce, Criteria'^ 7-204.14 Drying Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-306-12 Rodent Bait Staticros* 7-206.13 Trucking Powders, Pest Control and Monitoring* 17 129 • x Denotes critical item in thetederul 1999 Kicd Co& or tOj CNIR 390.000. 19 20 21 3-501-14(C) Proper Cooking Temperatures for 3-50t.15 PRFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec, 3-501,16(B) 590.004(F) Ergs -Immediate Service 1450Flssec, 3-401-1 I (A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Mitrals - 155'F 15 sec. * 3-40t. I I (B)(1)(2) Poi 'kandBeef Roast-130"Ft2lmin * 3-401.11(A)(2) Ratitcs, Injected Meats - 155'F 15 590.004(H) see. '* 3-401.11(A)(3) Poultry, Wild Game. Stuffed PHFs, 1 26.26. Water. Plumbing and Waste Stuffing Containing Fish, Meat, C FC 5 Poultry or Ratites -165"F 15 sec. 3-401 A I(C)(3) Whole -muscle, Intact Beet Steaks FC - 6 145'F " 3-401.12 Raw Animal Foals Crooked in a FC - 7 Microwave 165'F * 3-401.11(A)(1)(b) All Other PHFs -- 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165T 15 sec. 3` 3-4011.1(B) Microwave -165' F 2 Minute Standing Time* 3-403.1.1(0:) Commercially Processed I2TE Food - l40'F* 3-403.1.1(E) Remaining Unsllced Portions of Beef Roasts" Proper Cooling of PHFs 3-50IA4(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 41T/45`F Witten 4 Hours* x Denotes critical item in thetederul 1999 Kicd Co& or tOj CNIR 390.000. 19 20 21 3-501-14(C) PRFs Received at Tetnperatures According to Law Cooled to 41° AsT Within 4 Hours. 3-50t.15 Cooling Methods for PHFs 3-801.11(D) PHF Hot and Cold Holding 3-501,16(B) 590.004(F) Cold PHFs Maintained at or below 41°745° F* 3-501.,16(_A) Hot PHFs Moiatamed at orabove 14WK * 3-501.16(A) Roasts Held at or above 130'F. 124. i Food and Food Protection Time as a Public Health Control 3-507.19 Time as a Public Health ControP" 590.004(H) Variance Rec uh'emenY ffffilm��� 3-801.11(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 Raw Seed Sprouts Not Served. * 3-801.11(C) Unopened Foal Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 Animal Foods That are Raw, Undercooked or Not Otherwise Processed to Eliminate FC - 2 Pathogens.* neco.� V" -01I 124. i Food and Food Protection 3-302.13 Pasteurized Eggs Substitute for Raw Shell .004 25. r Egwpment and Utensils 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 ilhtess interventions and risk factors. Other 590.009 violations relating to -()oil retail practices should be debited under #29 - Special Requirements. (Items 23-30) Critical and non-critical violations, which da not relate to the foodborne ilhtess interventions and risk factors listed above, can he found in the,fallowing sections of the Food Code and 105 CMR 590.000. Item _' Good Retail Practices FC 590.000 23. _Management and Personnel FC - 2 .003 124. i Food and Food Protection FC - 3 .004 25. r Egwpment and Utensils .005 1 26.26. Water. Plumbing and Waste C FC 5 .006 27. Ph sical Facilit FC - 6 .007, 282_8 Poisonous or Toxic Materials FC - 7 .008 _ r29. Special Requirements_ 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 VI C�O�+/� Sf �!► SON Date 'ri �a T e of O eration s Type of Inspection [I pod Service Retail ❑ Routine ©Re nspection Address86 W Sr Risk Telephone 97,r., 7&/ 6/00 Level N4 ElResidential El ❑ ❑ ElBed Kitchen Mobile Temporary Caterer & Breakfast Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ElGeneral Complaint Owner M. !46oTMlTMr C y°. HACCP Y/N Person in Charge (PIC)Time iwv✓r2R-S• Uii In: Out: Permit No. ❑ HACCP ❑ Other Inspector J0AVr 04&a v 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 Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH - ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S 590/nS UFOr i 14 d ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS - ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMENEMPERATURE 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 Q 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: In actor' Sig ure:'- ' Print: _ PIC's Signature:. -., \ I Print:�IA�� [� "� Page of 9 -Pages] Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) a 590003(A) A.ssignmentofResponsibilky, 590.003(B) Demonstration of Knowledge* _ 2-103. 11 1 Person to charge -duties EMPLOYEE HEALTH 4 a C M alt - Kesponsibility of the person in chmge torequire Compliance with Fond Law* 3-201.12 reporting by food employees and 3-201.13 Fluid Milk and Milk Products* a ticants* Shell Eggs* 003(F) Responsibility Of A Food Employee Or An 3-202.16 159�0).003i,C) Applicant To Report To The Person ht Drinking Water from an A roved Svstem* 590.006(A) Charge* 590.006(B) 003(G) Re ortin -b y Person in Charge"003(D) Shellfish and Fish From an Approved Source 3-201.14 Exclusionsand Restrictions'' 3-201.13 003(E) Removal of Exclusions and Restrictions 4 a C M alt - Food and Wafer From Regulated Sources 590.004(.A -B) Compliance with Fond Law* 3-201.12 Food in a Hermeticallyy.Sea led Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk ProductsPasteurizcd 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an A roved Svstem* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 220* Washing Fruits and Ve,,etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish', 3-201.13 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Reoularory Authority 3-202.18 Shellstock Identification Present* 590.004(0) Wild Mustunoms* 3-201.17 Game Animals„ 3-701.11 Receiving/Condition 3-202.11 PIIFs Received at Pro ger Tem �eraturee" _ 3-202.15 Package lute 3-10'1.1.1 _i.ty* 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* 3-40112 Records. Creation and Retention* 590.004(,1) Labeling of Ingredients" Frequency of Sanitization of Utensils and Fad Contact Surfaces of Equipment* Conformance with Approved Procedures 1HACCP Plans 3502.11 S ecialiaed Processin = MethoW 3-502.12 Reduced oxvgen aeka�ing, criteria" 8-103.12 Conforinanee with A t roved fin_... .. ess` * Denotes critical item in the federal 1999 Food Code or 105 C69R 596.000. H Cross -contamination 3-;02.11(A)i 1) Raw Animal Foods Separated from Cooked and RTE Foods` Contamination from Raw Ingredients 3-30211(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302A I(A) Food Protection' 3-302.13 Washing Fruits and Ve,,etables 3-304.1.1 Ford Contact with Equipment and Utensils` Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Faxt* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food" <) Food Contact Surfaces 4-501.111 Manual WarawasMne - Hot Water Sanitization Tent erasures* 4-501.112 Mechanical Warewashing- Hot Water Satutization Temperatures* 4-501.114 _ Chemical Sanitization- temp., pH, concentration and hardness. * 4-601, t I (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils' 4-702.11 Frequency of Sanitization of Utensils and Fad Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2301.11 Clean Condition -Hands and Arms* 2-301.12 Cleamhn, Procedure' 2-30114 When to Wash" 11 Good Hygienic Practices 2-401.17 Eatitt , Drinkin * or Using Tobacco* 2-401.12 Discharges Froin the Eyes, ,Nose and Month* 3-301.12 Preventing Contamination When Tastin,,Az 12 Prevention of Contamination from Hands 590-004(E) Preventing Contvninahou from Employees, 13 Handwash Facilities Conveniently Located and Accessible 5.2011.1 Numbers and Ca acities* 5-204.11. Location and Placement: 5-205.1.1 Aecessibifrt y, Operation and Maintenance Supplied with Soap and Mand Drying Devices 6-301.LI HxndwashingCleanser.Availability 6-301.12 Band Drvinv Provision ITY OF SALEM BOARD OF HEALTH Establishment Name: V I Cert, 4 SV -4 i'rn ff Date: Jam- / Z/ - D e/ Page: 0-- of Item No. Code Reference C - Critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified / _ Up mi -//rrL C zt-rie lJYY' tjlG o c i� tC r a — Se pera v C h - -D Y i 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 LlVoluntary Disposal 0 Other: Violations Related to Foodborne Inness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 3-202.12 Food or Color Additives Additives* 3-302.14 Protection fromt ulna roved Additives" Poisonous or Toxic Substances 1-101.11 Identifying Information - Original Containers' 7-102.11 7-201.11 Common Name -Working Containers" Se. araban - Storage" 7-202.11 Restriction -Presence and Use 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions` 7-204.11 7-204.12 SaTizers. Criteria - Chemicals-` Chemicals for Gyashint, Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11. 7-206.12 Restricted Use Pesticides. Criteria* Rodent Bait Stations'. 7-206.13 Tracking Powders, Pest Control and Monitoring' 1(i ;PHFs Received of Temperatures According to taw Cooled to 4I °F/45°F Within 4 Howl. Proper Caakmg Temperatures for Coohna Methods for PHFs 19 PHFs 3-50'1.16(B) 590.004(F) 3-401.1 JA( 1)(2) Eggs- 1.55"F 15 Sec. Hot PHFs Maintained at or above 14WF. * 3-501.1.6(A) -1 E gs-hrmrediateService145°F15sec* 7_216 -Time 3-401.11(A)(2,) Comminuted Fish, Meats & Game Time as a Public Health Control* 5EE90.004(H) Animals - 155°F 15 sec. FC -6 3-401.11(B)(1)(2) Pork and Beef Roast - 130°F 121 min* Poisonous or Toxic Materials 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 29. _ S ectal R uirements sec. * : .009 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry of Ratites -165°F 15 sec. 3-401.11.(C)(3) Whole -muscle, Intact 'Beef Steaks 145°F ;. 3401.12 Raw Animal Foods Cooked in a Microwave 165°F -* 3-401.1 I(A)(1)(b) _ All Other PHFs- 145°F 15 sec. 11 Reheating for Hot Holding 3-403.11(A)&Q7) PHFs 165`F 15 sec. * 3-403.11.(B) Microwave- 165° F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F- 40'F*3-403.11(2) 3-403 li(E) Remaining Unsliced Portions of Beef Roasts" IH Proper Cooling of PHFs 3-501.1.4(A) Cooling Cooked PHFs from 140'F to 70`F Within 2 flours 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* * Dtnotes tial item in aha loderu 1999 Food Code or 105 (IM12 590.600, 3-501.14(C) ;PHFs Received of Temperatures According to taw Cooled to 4I °F/45°F Within 4 Howl. F3-501.15 Coohna Methods for PHFs 19 PHF Hot and Cold Holding 3-50'1.16(B) 590.004(F) Cold PHFs Maintained at or below 41V4511 F* 3-501.16(A) Hot PHFs Maintained at or above 14WF. * 3-501.1.6(A) -1 Roasts Held at or above 130'F. y 7_216 -Time as a Public Health Control 3-501.19 Time as a Public Health Control* 5EE90.004(H) Variancc Requirement 3-801 II(A) Unpasteurized Pic. packaged Juices and Hever tees with Rarning Labels^ 3-801.11(B) Use of Pasteurized Eees* 3-80,111 (D) Raw or Partially Cooked Animal Fexxl and Raw Seed Sprouts Not Served. 'r 3-801.11(C) Unopened Food Package Not Re -served. 4T 22 3-60i'I I Consumer Advisory Posted for Consumption of 580.00t1 23. Animal Foods That are Raw. Undercooked or FC- 2 .003 Not Otherwise Processed to Eliminate _ Food and Food Protection FC- 3 Pathogens. * Eihxova 1111"2oo 25 26 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 -.006 27 Eggs" ZWMAAL KrUUIKt:Mt:N 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 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 - Speeial Requirements. tt�3Y•Zs3r7�1.3��;i�Li (Items 23-30) Critical and non-critical violations, Which do not relate to the foodborne illness interventions and risAtaetons listed above, can be found in the following sections of the Food Code and 105 CMR 590.000 - Item Good Retail Practices FC 580.00t1 23. Management and Personnel FC- 2 .003 24. _ Food and Food Protection FC- 3 .004 25 26 Equipment and Utensils Water Plumbin and Waste FC 4 FC 5 .005 -.006 27 Ph sical Facility _ FC -6 .007 28. Poisonous or Toxic Materials FC 777-T.008 .008 29. _ S ectal R uirements : .009 30. Other s:pror�mwr zaeu Massachusetts Department of Public Health Division of Food and Drugs K; FOOD ESTABLISHMENT INSPECTION REPORT t w h Salem Board of Health :f 120 Washington Street, 4t" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name $a J L7 T e of O eration s Type of Inspection Food Service Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑ Routine ©,Re -inspection Previous I splection Date:// �, El Pre 4 ec atio ❑ Suspect Illness ❑ General Complaint ❑ HACCP El Other Address Equipment and Utensils Risk I Level Telephone /� O % Owner HACCP YM Person in Charge (PIC) InspectorO Time In: ('r'✓' Out:) Each violation checked equires 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 PROTECTIONMANAOEMENT,� , - ,""",- a,," U � ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH _ # T„c `PROTECTION FROM CHEMICALS E ale' i' "711" ❑ �2. Reporting of Diseases by Food Employee and PIC m ❑ 14. Approved FoodorColor Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals [,,FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEREMPERATURE CONTROLS (potentially Hazardous Foods) ' [1 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION.w.' _ 3 verve E]8. Separation/ Segregation/ ProtectionA ❑ 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 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water; Plumbing and Waste (FC -5)(590.006) 27 -Physical Facility (FC -6)(590.007) 28.'Poisonous or Toxic Materials (FC -7)(590.008) N. Special Requirements (590.009) 30. Other ,moi ❑ 17. Reheating ❑ 18. Cooling 1-119. Hot and Cold Holding [120. Time As a Public Health Control T_'REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP)1,1 ❑ 21. Food and Food Preparation for HSP f CONSUMER ADVISORYh-,,..Fr-ir' ssi . , ❑ 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 abo4address within 10 days of receipt of this orde DATE OF RE -INSPECTION:, Inspector's Signature: y1 PrinfE-- J ' PIC's Signature: Print:-"J6Q �� P R Pagel or(1Pages tom, Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) in FOOD PROTECTION MANAGEMENT 590.003(A) Assignment of Responsibility_ 590.003(B) DemonstationofRrowledge* 2-103.11 Person in charge -duties EMPLOYEE HEALTH 2 59O003(C) Responsibility of the person in charge to Compliance with Food Luw* - 3-201.13 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* 59(r003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinkin-- Water* Applicant To Report'Po The Person In .Drinking Water from an Approved System* 590006 A0 Charge* 59O006(B) 590.003(G) Re oxtin b Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions [1! C N * Denotes critical item in the federal 1999 foal Code or 105 CMR 590000. • K ♦ ITU( • '' 11 A ] • A 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Luw* - 3-201.13 Food in a Hermeticall • Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.1.3 Shell Eggs* 3-202.14 Eggs and Milk Products, Pasteurized' 3-202.16 Ice Made From Potable Drinkin-- Water* 5-101.11 .Drinking Water from an Approved System* 590006 A0 Bottled Drinking Water* 59O006(B) Water Meets Standards in 310 CMR 22.0" Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Requilatoty Authorit 3-20118 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.1.1 ReceivingtCondition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package Lite it * 3-101.11 Food Safe and Unadulterated TagstRecords: Shelistock 3-20118 Shellstuck Identification * 3-203.12 Shelistock Identification Maintained* Togs/Records: Fish Products 3-402.1 I. Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures tHACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packa ng, criteria* 8-10312 Conformance with A roved Procedures* * Denotes critical item in the federal 1999 foal Code or 105 CMR 590000. • K ♦ ITU( • '' 11 A ] • A 8 Cross -contamination 3-302.1.1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other' Contamination from the Environment 3-302.11(A) Food Protection* 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 Foot and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111. Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- Hot Water Staff tization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 41601_1 [(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* 1Q Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms"` 2-301..12 Cleanin Procedure* 2-301.14 1 When to Wash* 1.1 Good Hygienic Practices 2401.11 Eatin , Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tastin 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Convenienty 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. Harulwashing Cleanser, Availabilit 6-301.12 Hand Drying Provision t Establishment Name: Vic Item Co;,e C — Critical Item No. Reierence R — Red Item K CITY OF SALEM % BOARD OF HEALTH n�� i a✓ Date: P,/('— o ,e DESCRIPTION OF VIOLATION / PLAN OF Page: oZ of '- Date `*. , Verified Discussion With Person in Charge: Corrective Action Required: ❑ No _JJ—/es i I have read this report, have had the opportunity to ask questions and agree to correct all voluntary Compliance o Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re- inspection. Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines o/��ty-fijce dollars r suspension/revocation of a Embargo ❑ Emergency Closure your food permit. ' --- ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (How 1-22) (Cont) PROTECTION FROM CHEMICALS 14 Food or Color Additives & 3-202,12 Addifi%c,`+ 3-302.14 Protection from UnappnIved fkdditivcs� _Fi,i ard 13pl kwsf 1 t 121 mii) Poisonous or Toxic Substances 41 'F145*17 Within 4 Hours. ,0,,11Iflellfifying Into lmotion-On winal 3-501.15 1 Com aineW Sac. 'A VVild t al iC, StlIffed PFFi, lot H (ommoTIN"IDI: workill.'Coniall"Irl- C,qlil in Fish. Nlca�, Cold PHFf; Maintained at or below kjQs 16i L 3 7 S _Pat aufm - SL IA ll. 1. 131."C! IVI fti aks 7 )f 02 Rc,16I_fiojl -- fIrf"sencCalld L'c ol, I it PHI INLIawntaillmdat far above - 1401'. 7-202J2 C.ondlu f aof fs�l fi 1 Roasts Held all or atwvc 136°F. Tuxic Cnlairfcl -- ------ -- - sallid-zels, Crite rle - ClIeI!I;CAN1 9,S Cfwjtufdf, hodiice ,(jitezia' T" Tima, a Public fleald) Control, Comimn"Wh 131(e ,,e:d R'll, [,Ni 7 Imi&(it,il f fx)d Cf,111tU1, lAtb6ca3iW: ---, [I , Prz,*icidee cnwl) imica s L OL` 7-_06.1< R(XI'mI ftt STOut'a"- I 72-66 I i;i..kmt, Po Ide-f. 1",\s" Copilot and 16 3-403 i l(h) liS til "i & 1 F tiuhi 2 jlou-v wid From _Fi,i ard 13pl kwsf 1 t 121 mii) '4; F W"dnn -1 How!,, 41 'F145*17 Within 4 Hours. PRF Mi0v From Aml�ellt 3-501.15 ToFllpl.lwiere lfllTcdicnts io W1 /t5F Sac. 'A VVild t al iC, StlIffed PFFi, C,qlil in Fish. Nlca�, Cold PHFf; Maintained at or below kjQs 16i 590 WWFF IA ll. 1. 131."C! IVI fti aks ol, I it PHI INLIawntaillmdat far above - 1401'. fi 1 Roasts Held all or atwvc 136°F. "3 -- ------ -- - Time as a Public Health Control 9,S J- T" Tima, a Public fleald) Control, Comimn"Wh 131(e ,,e:d R'll, [,Ni 3-403 i l(h) liS jRcillamirk" UI,Siired I Proper Cooling of PHFs I it! 1, 1 I(A; 1 F tiuhi 2 jlou-v wid From '4; F W"dnn -1 How!,, 41 'F145*17 Within 4 Hours. PRF Mi0v From Aml�ellt 3-501.15 ToFllpl.lwiere lfllTcdicnts io W1 /t5F 19 PHF Hot and Cold Holding 3-5W.16(B) Cold PHFf; Maintained at or below REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I—POPULATIONS (HSP I — 21 Unpl cut izcd h e-lfachagcd Juices wid HeV('d2ee With V, umI :-j-801114B) ItDI of lfafl�all', 'Arlitnil Ftkd and j inroul, N Iq Screw ` 'IT"nencd 1,;fIA llftd.:we Not CONSUMER 22 1 3-00 11 I f:oI-,wTf,,t AoIif,cct P,j,d !)xCcfwwtIpdf,n skJN I hv art, to r_ UnJcTwffkcd cr nnb� wf- ioi Raw Slwll i. SPEC'AL REQUIRF&IENTS v infAlik, kxId. t�IvI)raly and, tolal.'MLA 1:4ctletl slicAdd be L, ,hff:,d Linde; 0w 1p VIOLATIONS REL A �0 Z=SIUDRETAIL P4ACT;CES ?,,,r,:h do w); iezeftI, :,, 111:� f9 `e M, 11NCi I(I)Iz J 5.if"d 7';"A idf!or, b" I 1- - ifw,fy !'Ood a .! fl)i C�.jl!f FC 53 0 '0 go Item 00 Vta;i):,raC ices ------- --- If I�L! ,of K' 003 F,1)(1 ;'rd F,>od PC 5 004 qUtppncnt "ine FG - 4 10S iprj w; S4; FC - I X111I Vz, efIjs PC - 7 003 Omer F:_5()1 14( PflFs Received at Temperatures Acwrding, to Lau Cooled to 41 'F145*17 Within 4 Hours. 3-501.15 Ccofiri� Method, s for PHRs 19 PHF Hot and Cold Holding 3-5W.16(B) Cold PHFf; Maintained at or below 590 WWFF 41 "/45` F" 1-50 1, 161A) I it PHI INLIawntaillmdat far above - 1401'. fi 1 Roasts Held all or atwvc 136°F. 20 Time as a Public Health Control J- T" Tima, a Public fleald) Control, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I—POPULATIONS (HSP I — 21 Unpl cut izcd h e-lfachagcd Juices wid HeV('d2ee With V, umI :-j-801114B) ItDI of lfafl�all', 'Arlitnil Ftkd and j inroul, N Iq Screw ` 'IT"nencd 1,;fIA llftd.:we Not CONSUMER 22 1 3-00 11 I f:oI-,wTf,,t AoIif,cct P,j,d !)xCcfwwtIpdf,n skJN I hv art, to r_ UnJcTwffkcd cr nnb� wf- ioi Raw Slwll i. SPEC'AL REQUIRF&IENTS v infAlik, kxId. t�IvI)raly and, tolal.'MLA 1:4ctletl slicAdd be L, ,hff:,d Linde; 0w 1p VIOLATIONS REL A �0 Z=SIUDRETAIL P4ACT;CES ?,,,r,:h do w); iezeftI, :,, 111:� f9 `e M, 11NCi I(I)Iz J 5.if"d 7';"A idf!or, b" I 1- - ifw,fy !'Ood a .! fl)i C�.jl!f FC 53 0 '0 go Item 00 Vta;i):,raC ices ------- --- If I�L! ,of K' 003 F,1)(1 ;'rd F,>od PC 5 004 qUtppncnt "ine FG - 4 10S iprj w; S4; FC - I X111I Vz, efIjs PC - 7 003 Omer .,..: ,:.. .,. -ziFh"`-+t:n. .._, ,� tldW. +l"`:+��':bM1. i'h4.:Mc�'�"+"i �'Sd r":t /.:r "'zk w. P i�.',: a:.F�✓w,7�'11�r°FI'r y h^ �S'f'�b .1�`�� Massachusetts Department of Public Health Salem Board of Health Division of Food and Dru 5 120 Washington Street, 4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT �INSPECTION REPORTk°r Tel. (978) 741-1800 Fax (978) 745-0343 Name l� C �Il-e A J uJ Dat Q�f T e of O eration s Type of Inspection Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile F-1Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. ❑ Routine W] Re -inspection Previous Inspection Date: V31.1 ElPre-operation ❑ Suspect Illness ❑ General Complaint ❑Other Address Risk Level Telephone Owner J14 r_ G HACCP YIN Person in Charge (PIC) Time In:[IHACCP Outs/ Inspector Each violation checked aequi�es an explanation on the narrative page(s) and a citation of specific provision(s) violated. I. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. 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 t FOOD FROM APP ROVED SOURCE,„",""xw�;. ❑ 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 v " ,1,1` 0 r ❑ 8. Separation/ SegregatioN Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing 4 [111. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S 5ZInSp &Fpm 44.dx ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities 'PROTECTION FROM CWEMICAL6 ' I k G n r" f' i" ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals )tTIIJIE/rEMPERATURt CONTROLS (Poternlally Haterdous Foods) , l"rg, ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control [REQUIREMENTS FOR HIGHLY SUSGEPTIBLE_POPULATION$ (HSP)_l El21. Food and Food Preparation for HSP r CONSUMEPADVISORY.a° ,a "" """�T" NAIM El 22. Posting of Consumer Advisories :1 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 1 O5;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: I / Print: PIC's Signature: \ <./ Print: r�(lL , �'C,(,Ty'� Page_oV of ZPages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT 1 596.003(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 fool employees and 3-20113 Fluid Milk and Milk Products* a licams* Shell Eggs* 590.003(P) Responsibility Of A Food Employee Or An 3-202.16 Tee Made From Potable Drinkin. 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 CharE* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(1?) Removal of Exclusions and Restrictions 4 L5- L6 C I *Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000. EME'.fr1 ♦,:.o ra.. 0 $ Food and Water From Regulated Sources 590.004(A B) Compliance with Food Law" 3-201.12 Food in a Hermetically Seated Container* 3-20113 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eos and Milk Products, Pasteurized* 3-202.16 Tee Made From Potable Drinkin. Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 31.0 CMR 22.0* Washin Fruits and Veetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201..17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 PackaLe'hue it y 3-101.11 Food Safe and Unadulterated Tagr/Records: Shelistock 3-202.18 Shellstock Identification * 3-203.12 ShellstoekIdentification Maintained* Tags/Records: Fish Products 3-40111 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 ax en acka h«, ceiteria* 8-103.12 Conformance with A roved I rocedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000. EME'.fr1 ♦,:.o ra.. 0 $ Cross -contamination 3-302.1.1(A)(]) Raw Animal Foots Separated from Cooked and RTE Fo(ds* Contamination from Raw Ingredients 7302,110)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.1)(A) Food Protection* 3-302.15 Washin Fruits and Veetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservtce of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe. Food* 9 Food Contact Surfaces 4-501.1.11. Manual Warewashing - Hot Water Sanitization Tent eratures" - 4-501.112 Mechanical Warewashing- I-lotWater Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.1 i (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703-11 Methods of Sanitization - Hot Water and Chemical* 10 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 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" 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em to ees's 13 Handwash Facilities Convenfentfy 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 DrvinaProvision , - CITY OF SALEM I D_.� BOARD OF HEALTH 1, Establishment Name: `�1�� /1 Date: OS Pageel- of Item No. Code Reference C - Critical Item R - Red item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - Date , Verified " PLEASE PRINT CLEARLY n I r (� G ��n� G J d� tC l�� + ri,4 s if Dr <, _"'t4o'- S 0/7- r ^ 011 II .1 -J a Lee, . kiJ & G -1" 17L_ 1 / (' . J/1 - �1. �L.2 c� H2O C7 l ✓1f ?lam _NI J c( /A `�` LtP (nY cG? �s Ir f a ,n U n� u���� I = trI ✓p- — 1c -W ' r Vn. "a d' X11 41A 1 P ti /. hzl� r, mc t Pd 2 6 L4 C OV( xvjI StAti(rs N_w-/- On,/ 4 Discussion With Person in Charge: I have read this report, have had the opportunity to ask grestions and agree to correct all violations before the next inspection, to observe all con.ditionls as described, and to / tinspection comply with all mandates of the Mass/Federal �ood�Code. I understand that noncompliance may result in daily fines of twee dolllars or suspension/revocation of your food permit. � Corrective Action Required: ❑ No '5�<es ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Scheduled LD Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: l-� ?vrrc 1w Violations Related to Foodborne Illness Interventions and Risk Firefors (items 1-22) (Cont) PROTECTION FROM CHEMICALS 14 Plo'er,l'J Food or Color Additives_ Comillot tk, Fkch. Meas & C'nol: 3-202,12 lditivc�'lk 01. l P B (I l2) 3-302.14 PRUCti(A) front Ll!eppro-.ed Additivca"__ 15 50lA4lAt Poisonous or Toxic Substances 19 7-101.11. khmlifying, infoi ination - Onplial t 114. 14 fl art liolw" 3_5 I Cojitainersx 3 I i02,11 Common Nanw, - Workilic Cont,wm!r,," T_ Sepaiabon -Sisnagc" 20211 7-202.12 p "'Itt-ici loll - 11wScricellid Ulc' LL"i'dilion., if '/-�03 11 TlzxiCAmillorieu -- Prollibrion" L j-204.11 sallili7cu Crilerie - cllco)icJil� Mmul" sillild;lk, 7-204.12 Chmill~ for lkkl'ashlk4� Clilelial 7-204,14 Di-mig, iter Cria' ,7- L hind cnial FlxXj Ck'nirlio. Lulllicklws: "T Pe wizic Critep:i' C,-206.12 11k)(IM 13,10 S1:160TIS- i,?06 13 Tzickim, P.Mdi­ 4, Cojail�! aid TIMMEMPERATURE CONTROLS 1.16 Proper Cooking Temperatures for 55 p 1 mucal li-ir q the 11 it' ,)') 1: '!"� 1 (. icor I, I S i �1 ll I Iii I N ik". Plo'er,l'J PRFs Received kit Temperatures Comillot tk, Fkch. Meas & C'nol: 41113 I I(F) 1, -bei. 01. l P B (I l2) Pki[ [:.unci 13,,,,4 Ro;i�l I -,0't 1 1 min'. 41`F/45`F Within 4 Hours. ------------ low'%"d N'1.'r.t'> S F ft 50lA4lAt Ckh,hn?kr C,,x&',d PHFs from 14 YT lo 19 Pk)Ll!qty, Will (410ile, Stu =e 1 11k, PHF Hot and Cold Holding t 114. 14 fl art liolw" 3_5 rte f'RE, N1 etc From Ambient 3 - ------ - ------ --- -------- - ------ -- ljw',l Bf.m 41°/4)° �" F' T_ Hot PHF,, Maintained at or above W01'. * 3-501, J ti A)_ p ,,,tjng to!, }jot 14.01,fing L 1(33 F 1" w I Time as a Public Health Control Mmul" sillild;lk, mucal li-ir q the 11 it' ,)') 1: '!"� 1 (. icor I, I S i �1 ll I Iii I N ik". Plo'er,l'J PRFs Received kit Temperatures 41113 I I(F) Rcrqawin, UnNi ped Portionil ofli(tc i 41`F/45`F Within 4 Hours. Proper Cooling of PHFs 50lA4lAt Ckh,hn?kr C,,x&',d PHFs from 14 YT lo 19 2;1; Within 2 Hours r•!id Frogn 791' PHF Hot and Cold Holding t 114. 14 fl art liolw" 3_5 rte f'RE, N1 etc From Ambient TcFnp,, rai kite fill;redlellis to 41°/4)° �" F' mucal li-ir q the 11 it' ,)') 1: '!"� 1 (. icor I, I S i �1 ll I Iii I N ik". REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 -,-S0111iA) j line om euri zed Pr& pzkk:1:ligcd Jon es wi(l Boverkkes with 11th nuts, lali1s° fSd 11(i3l Pli,leunzed F IlD)I R�iw orl"ailiali% Chow Animal Foi.-d end kr ste(I �onlats Not Se,wd. ft 1, 11 fci LCn �'ned R.Xlii Packae, Nol ki, served, CONSUMER ADVISORY sic tel.! ioi Cme�tonpuigi of "'v�iolzi 1 ,t'd-hat ln: Rww' ulldexAed cl :'<,it 0fliorv, iw llrk,,�ellsd ii) Hloomau-. �-3ki2- J13 :i 1',,reliruA Fs„for Kliw S101 inobih• tollid- telliporai vand op "lations 'Alould he uj"(1cl 011"'T -I'lid VIOLA DONS PELA TF -D iO GOODRETAk PRACTICES (Items 23.301 C'w4i!_wd rizi, al i'l, 'A=Oil do z"); e'!Urc 1n 11:: ;a4(77( rm IiI,wS, Fli;'� I i" 31 Jn5 find "kja( ro, c 17 krt�d ll{'t ... (" c (in b" F,tt< Food Co -le and J'ii C"VR at Ind Per so"Ir"?l i FG FC11- and kjteosi's "Ijater. pil'aliz,c 'iik bIj 1a. 3-501.14(0 PRFs Received kit Temperatures According to Law Cooled to 41`F/45`F Within 4 Hours. 3-501.15 Cookfinu klahfi& for PHFx: 19 PHF Hot and Cold Holding 1-501.161'13) Cold PH17l; Maintained at or beff)—w' 590.004(F) —5() 41°/4)° �" F' T_ Hot PHF,, Maintained at or above W01'. * 3-501, J ti A)_ - 4 R(K�st., Held at or adiokc 130"F, L I Time as a Public Health Control 70A4trk i_. ti leer Rec;uIreintill REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 -,-S0111iA) j line om euri zed Pr& pzkk:1:ligcd Jon es wi(l Boverkkes with 11th nuts, lali1s° fSd 11(i3l Pli,leunzed F IlD)I R�iw orl"ailiali% Chow Animal Foi.-d end kr ste(I �onlats Not Se,wd. ft 1, 11 fci LCn �'ned R.Xlii Packae, Nol ki, served, CONSUMER ADVISORY sic tel.! ioi Cme�tonpuigi of "'v�iolzi 1 ,t'd-hat ln: Rww' ulldexAed cl :'<,it 0fliorv, iw llrk,,�ellsd ii) Hloomau-. �-3ki2- J13 :i 1',,reliruA Fs„for Kliw S101 inobih• tollid- telliporai vand op "lations 'Alould he uj"(1cl 011"'T -I'lid VIOLA DONS PELA TF -D iO GOODRETAk PRACTICES (Items 23.301 C'w4i!_wd rizi, al i'l, 'A=Oil do z"); e'!Urc 1n 11:: ;a4(77( rm IiI,wS, Fli;'� I i" 31 Jn5 find "kja( ro, c 17 krt�d ll{'t ... (" c (in b" F,tt< Food Co -le and J'ii C"VR at Ind Per so"Ir"?l i FG FC11- and kjteosi's "Ijater. pil'aliz,c 'iik bIj 1a. is' Massachusetts Department of Public Health t Division of Food and Drugs SFOOD ESTABLISHMENT INSPECTION REPORT, fe'' r r F 11 w Salem Board of Health 120 Washington Street, 4" Floor Salem, MA 01970-3523 Tel. (978) 741-1000 Fax (978) 745-0343 Name % 1 0 G wrunI Dae d � `a.- a of 0 eration s Lme of Inspection [�]c"Routine ❑ Re -inspection Previous Inspection Date: E] Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other . `Food Service ❑ Retail ❑ Residential Kitchen EIMobile El Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. Address Lp PIC's Signature: Risk Level Telephone Owner " I2 5 �G '` HACCP YM I Person in Cha ge (PIC) Time In: O�� Inspector Each violation checked requires an explanation on the narrative page(§) aid a citation of specific provision(s) violated. Non-compliance with: Anti -choking Tobacco Violations Related to Foodborne Illness Interventions.and Risk Factors 7 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. p Assigned / Knowledgeable / Duties 2. Reporting of Diseases by,Food Employee and PIC Personnel with Infections Restricted/Excluded =` F006 FROM'APPROVED SOLR E k_T= 313, ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 8. Separation/ Segregation/ Protection �j 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. E11 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) ,C 27. Physical Facility (FC -6)(590.o07) l 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S. 501n�Tom 14,m n ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM 01EMIcAL67rr r a try of yMR ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEREMPERATURE CONTROLS (Potentlally Hazardous Foods) _) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control j ;REQUIREMENTS FOR Hfl3HLY SUSCEPTIBLE POPULATIONS (H§P) ❑ 21. Food and Food Preparation for HSP I;CONSUMER :ADVISOR,Y�`� �*�,�,=a'�.�.,,,,,,�x-„"„,� ��',�"N�� ❑ 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 A, and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: fa - Inspector's Signature: ` Prjr•nf: " .1. � PIC's Signature: % ` /1 1,2 -'Print: rA,h ti PGL ✓jC.-e lam' Page of l Pages t Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(,X) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge" 2-103.11. Person in charge -duties A;rt moyl*l:Igi itIa 2 590:003(C) Responsibility of the person in charge to Compliance with Food Law* _ 3-201.12 require repotting by food employees and 3-201.13 Fluid Milk and Milk Products* ' applicants* Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Iee Made From Potable Drinking Water - Applicant To Report To The Person In - Drinking Water from an Approved System* 590.006(A) Char =e* 590.006(B) 590.003(6) Re orcin b Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions im FOOD FROM APPROVED SOURCE - Denotes critical item in the federal 1999 Proal Code or 105 CLMR 590000. $ 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* 3-20214 E> =s and Milk Products, Pasteurized* 3-202.16 Iee 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* Washin Plaits and Ve etables ShelBish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C} Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 eceivingfCondition 4 HFs Received at Proper Temperatures* Food Contact Surfaces ackage Lite t * WIFood Safe and Unadulterated agstRecords: Sheilstock Mechanical Warewashino Hot Water Sanitization Temperatures* hellstock Identification 4-501..114 helhaoek Identification Maintained* TagefRecords: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures IHACCP Plans 3-502.11 S ecialized Proeessin Methods* 3-502.1.2 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* - Denotes critical item in the federal 1999 Proal Code or 105 CLMR 590000. $ Cross -contamination 3-302.1 I(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Funds Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washin Plaits and Ve etables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(,X)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 4 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashino Hot Water Sanitization Temperatures* 4-501..114 Chemical Sanitization- temp., pH, concentration and hardness. 4-601.I1(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 - IIot Water and Chemical* Ill Proper, Adequate Handwashing 2-301.11 Clean Condition -Hands and Arms" 2-301-12 Cleaning Procedure* 2-30114 When to Wasb* L1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2401.12 . Discharges From the Eyes, Nose and Mouth* 3-301.12 PreventinZ 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* acities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Nand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision J (` ` �� �/ /BOARD OF HEALTH f Establishment Name: GI�J ,.4 S�Mi ,. 1�3tu c rti �f Dater/ S�/� % Page: of Rem I nReference Code C - Critical Item R - Red Item DESCRIPTION OF VIOLATION ( PLAN OF CORRECTION- _ <' PLEASE PRINT CLEARLY Date . Verified Lv �t6 a4 V -et lc." 2-J .4_,,,r h,d�l A- 317 /r* J'C ,,, 5 Gulp — 0 C e4- ,r , 1 (_' A J (o -I a4 (nG J'�4V 13e score cl L./ -f-A CJr1CIYri9 �I SUI, fZ l LjJ 1lcua?-./_ tief) vo c G(n o- loi �e clCpil W , ! ni Lf LIa-C —� I �7Y/ Ua G 1l n, ire i m F C , c A 4ralr.-J. / 1 r- ,�. 0+- Grp („ -c. 4(0-E). A LL- R4 E5 (,j k1� /o LI _Q n L I oM 1 C1 r'1=._jro.. / 1 crtll^. 7r S�� I jbl, iJnA v oL IA /) _ 17 41- �D i . 4 tZ4 h r ,e _A Z' w 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 twenty-five dollars or suspension/revocation of your food permit. �j/�/�� /t' � (/ le Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure Voluntary Disposal LlOther: Violations Rol~ to Foodborne Illness interventions and Risk Factors (fterm 1-22) (Cont) PROTECTION FROM CHEMICALS F-14: 16 Food c r Color Additives 202 12 Addifivc,`t 32 �14 41 T�/45"F Within 4 Haw's. s. 15 3-501.75 Poisonous or Toxic Substanctis co,il!mmile d Vc,h, IdentifairigAnfonnalion -Cm-mai Poic at,,' I j,;t!! Contaniew = --------- ---- 7 102,11 CO3Mn11a1N'ante - W,401 013, D"T, j0LihAj;3,,,, t;vw,, Wild (;apfc, slwfcti svpai aaon - S1 1-1-202,11 Rcitricl�oa - Nrlstncc "lid utf, 7-202.12 Condniop> of Use to 7 703._€1 D'Xic Ca,tajnn, Poill:laii(Ri" 3_5t,P, F, I sanni/efs� Crocria - ChcloicLiW 7 --MA, 12, Chojw�aj, fofWafnni, Vi() �,Ecc, G P7 2-104.14 j DVARi. INrW. Criwita; it[ [I,, t0 F 15 i(15,1 i lucid raal 1`4Nxl Cvnoict, Jahn ... c.—vt 106 1 T— c.d 1 w Pc,iu[de,, 1.1till, Pot dcrz, ll.si Coat 1 ;wd TIM_ rfcMPEFIATURE CONTROLS 16 Prop— Cooking Temperatures tot PHFs According to Lam Cooled to 41 T�/45"F Within 4 Haw's. s. 3-501.75 34(i 1. 1 IiA)t, — co,il!mmile d Vc,h, Amomk I Poic at,,' I j,;t!! FT _-i. t. _D = --------- ---- 590 WA011 41`145` 1," j0LihAj;3,,,, t;vw,, Wild (;apfc, slwfcti f lot PHFMaintained at or above ------------ 44WF :Z_501 16(t\) Koasts Held atorabove 130,'F to Time as a Public Heafth Control 3_5t,P, F, lim"is a public Health Cont,ol, P7 7 Rahoating for Hot Hqlaing .:103.11 %)&tD) it[ [I,, t0 F 15 4P4 ,,1per Cooling of PHFs 501 1 VA) 7 at I Within 2 1 fou1nd I -roj n Widion fiomt. H Cool in g PI IF: Nl.kd, Foam tin hicia Fi inpoiature tVi w a t 11 i ; 13 1" f 1 1: 1 1, LA I I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 ;-,S01 11(A) Oifm cu; czed Pre- oad.aced Juice% and Here a es with Wariiii), I ab, -As` of lla%tteiavtA E� j and R,•,7l.a: S11MMI, NVI .v, if yCrYtlii, 72 'i4@4131 11 Not Odtree f s r;o ,--Io? :,,u fiaw SPEC 'ALRFOUIREMENTS 1 0 litto'l. ttinp)r""I'v aod i,c :Ax_l it i (t'd to fity!l'o'lit ;Pn (Ilems 2,11-30) C,ipal, a; iA jar -tors sn 1h, f ood Itam I Goca riecaupf-acnces FC' 590 'D on F,- 00,-' 24Fe"d qd Fx PC - 3 1 004 2e Eqopmcnt and ule,,151is --- - ----- --- 4'1afC( 2 7 FC,_f i 007 T_ FC- _71 ?-501,14( i PHF< Received at Ternparaturcit, According to Lam Cooled to 41 T�/45"F Within 4 Haw's. s. 3-501.75 Coaling) Me,,Lhods for PHF,9_ 19 PHF Hot and Cold Holding — 3-501.16(B) Cold PHF. Maintained at m below 590 WA011 41`145` 1," I -5!)1,16(A) f lot PHFMaintained at or above 1 44WF :Z_501 16(t\) Koasts Held atorabove 130,'F `2t; Time as a Public Heafth Control 3_5t,P, F, lim"is a public Health Cont,ol, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 ;-,S01 11(A) Oifm cu; czed Pre- oad.aced Juice% and Here a es with Wariiii), I ab, -As` of lla%tteiavtA E� j and R,•,7l.a: S11MMI, NVI .v, if yCrYtlii, 72 'i4@4131 11 Not Odtree f s r;o ,--Io? :,,u fiaw SPEC 'ALRFOUIREMENTS 1 0 litto'l. ttinp)r""I'v aod i,c :Ax_l it i (t'd to fity!l'o'lit ;Pn (Ilems 2,11-30) C,ipal, a; iA jar -tors sn 1h, f ood Itam I Goca riecaupf-acnces FC' 590 'D on F,- 00,-' 24Fe"d qd Fx PC - 3 1 004 2e Eqopmcnt and ule,,151is --- - ----- --- 4'1afC( 2 7 FC,_f i 007 T_ FC- _71 CITY OF SALEM RnARn nG WPAI Tu Violations Related to Foodborne Illness Interventions and Risk Factors (Itehfs 1.22) (Cont.) - PROTECTION FROM CHEMICALS 14 3-501.1d(CI Food or Color Additives Prapec Conking 7empnlakr,s r„Y-�� 3-202.12 Adcbnves'� -_—}—_ 3-302.14 Poisonous Protection from Unapproved Addnives'_� 15 f 3-501.15 or Toxic Substances 1.9 7101.11 IdentifFinglnfotmation— ()Baal j 3-501 16B) Cold PHF. Maintained at or balow ' E ufl, �ni [I Cj f .h t`_I+ t i 102.1 I ' C_utntnnll Nionw W rk t" [ mt t 4 7-101 1 t +Sf!Pa u.turt�Stu - — u t r 3 !r it Kt ' irn' _.. _. 1-501, 7 1 F(_ll Rest u:on- I'r-u.ncc-and !,e 20 j i-3fiu.l� f�1331dii1pn>Ot �'SC' ��_-� „i } t j 'i-203 (1 Toxic C o ainet Proh Suion • " ! 204.17 � Ssnnverti C'titen+ lhunu I. ,i St:PPh-Cnt ll1n;1i:1l, Fiecv. i 12 _� (..he nv al+ tot R tsnik k x11 1 e ;'' �L2QjI Di mr, Atenca.0 iwria .-ms, (, ..:.?i: 7,205,11 hrnc raa f 'A t "wao I.ub1 u'ts i `/-206. i I{c.*I,i f d •sr Pc.ur+de•;. U torr: _� 7--'06. 1 Rod(n Bio Stati n• y " REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPL_ __ 21 3401 It +.j� linp� �c.ari�:d Fr�pae(:aged iaicac ;utti Bever e• with 1i„ tum i.al ht' 801 1101) !'t 0 Pu to i ,7d F .� -S�t ilU)) ri,, orP'lumt1: t? C Establishment Na CITY OF SALEM BOARD OF HEALTH Date: Page:_ of / Item No. Code Reference C - Critical Item R – Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION ,.,".. PLV E PRINT CLEARLY Data - , Verified L NL _t- haterle�_, r�.v ✓n_II r 7 'Ins GLv� C��7,k" �tr.ef 4�5✓iC � ri �9!' ,�.. �" f. ._ S --h CCS — �J�lll.0 ( c� ,� l N� �s�- r e_ t zsr / 41,(1Z1#g6S= S I �— fQ _v.tt C . /n 54DDjoj;nom C&71 ., a Poar – 57JI, lL Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all inspection, to observe all conditions as described, and to violations before the next ins P comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. �,. f(�� 61 Corrective Action Required: ❑ No /Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion (�Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 11 2,1 Violations Related to Foodborne fitness Interventions and Risk Factors (ilettrs 1-22) (Cont) - PROTECTION FROM CHEMICALS 14 Proper Cooling of PHFS Footl or Cotor Additives °ail"oe Cai4 d PF{i - imai l 4ir F ti's 3-202.12 YT 41+ithfi 2 1 fours slid i rom9—F 3-302.14 Protection from Unapproved Additives' 35 j Poisonous or Toxic Substances -I tol.11 identifying Info;inonon- Ori mal =-1111Xi.B)1 n; ( omain w i 102.11 ' Common Naaw Works Cceu. tin r� 20t.l1 5oa uon Soaager I i-19211 kest`icunn Pr .nuc an 1 —}! 7.702.i I �7''4311 Condition of i;se — ---. �G� �_��7ime ftxunei Profibi!iot _Toxic r 204A janitVCfh Criteria cliclai it -204. 12 Chl,mi tts for Aeashu 1 idit" Crtteda _2-101.14 2iyII Aveiw (riterta _ t)5 it Incrd atti F'xX o, i -_)i1. 11 ItC�li it iAi 3t hC ILtd(k. (.�itU , i ] ,00 19 Roti ni 11 iii St:ltinn<^ c.h z 1; ickms Pom%d. 11%,sL +xntr t and t04t1 t llt ' i 1"114" TEMPERATURE CONTROLS 16 ' Prapar Coalang Tonspetetu es tar _ i PtfFS _ }! I 1 L� Inmidtt¢ Sc, c E,� i is -:eco I _ i f i _1)(. - .. C rai;mitic" 4 i%h' , Oxn: w _._. !f' I!13)i! Ii i Putt "'fidIe R'm t I-' nuns I -?vt.1 f(Aliti_ r� 1 i —r s 3, Pot; try l0u fri. .. S't I t i'i4;S, ' . S P,�tr,no.t n ti ni=.b, dinar. ? i R hest rg for hot l mg i .... ..... (Il M i wfaz it F Nl ru i silmd.nfi I live, 13>03.IJiC} Cm, nercia ii Yi rx,<i;..'f" 1.r i-� 3� 403, 1 1(E) 1 Re arcing Lriliwco Pot k ¢s of iiccf 1g Proper Cooling of PHFS + 501. l.dtA} °ail"oe Cai4 d PF{i - imai l 4ir F ti's YT 41+ithfi 2 1 fours slid i rom9—F to #,^F-1-15 F Within d Hnut_. ` t 3 5x71. PHF 'vi do i r,,m lmhent j r ml _iituire ht rt iEem to 11 tv,15`F -I Within in 4lkpu: . PHF Hot and Cold Holding =-1111Xi.B)1 n; Jill' iiir I:-'•+;'.`.< REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS It � -S`i2 itAj � L'np,ctcurized Pr hack aged 1uS'es at:d-� i hU: Ilii3 Ul <I P"-temi 3I ..` Ir +)i k,iv or Pttimil" G(x;d and RaiSccd oorDat 'vot Served. ` CONSWER ADVISORY 22 1 1. J' f , rn�u.i v -.soa r'ost i ;1,r r oa,.nn p., ,va ei _ se.i � ;d. fha arc R5m_ C�naerdxih e! ,u I Not to 1Ch3 itnL:u". Z: -.S a 3. uia for °:-PEC AL FF.` UIREMENiS _ CMI"'rl Ax tl. t np ,r r3 = wid. ups r:.,lOz s .,t_rttd. ke j Ili t .iOIL i0 =tetbi; JO,x A716�. fi`L.A rEL11 U GO rJ 4iE AW cF? tF{`l S (lhrrl4 23-10i C t u'mi, fit n it s, wifichdo i +1 t arll k te:'. +'l" r [< :!)t Y l)u II pwi it, , id ri A iu wo n lti f { at. i rop, b 00r1 I Orin ar.a I:o Cltlt ltsrrt GooAf#stait practices PC --- ---06 1 FC -6 � p+, Rai 'en�r�+i 6Gi3 3-501.14Ki) PHFc Reu ived at I m1peratures According to Lain Cooled to ' 41°Ff45`F Within 4 Homs_ * . 3-501.15 Conlin i A4cthods for PHFs 19 PHF Hot and Cold Holding 3-501.16(13t) Cold Pli Maintained at or below 590.0040-i 41 145,i 13- I -50 i 3 -50i 16,A) Hot VHF Maintained at or above 1400'. 7 5(il 15=ei) { Ra sts Held ut or above t30°F. + �G� �_��7ime as a Publtc Health Cantrof 3_50i i , iii is t Pubht t,tea(h Conttotr--'--�'j _f f`s 3t7 ,9pdi H} .._ i 5 aet�t�7�u�ttttct lent —. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS It � -S`i2 itAj � L'np,ctcurized Pr hack aged 1uS'es at:d-� i hU: Ilii3 Ul <I P"-temi 3I ..` Ir +)i k,iv or Pttimil" G(x;d and RaiSccd oorDat 'vot Served. ` CONSWER ADVISORY 22 1 1. J' f , rn�u.i v -.soa r'ost i ;1,r r oa,.nn p., ,va ei _ se.i � ;d. fha arc R5m_ C�naerdxih e! ,u I Not to 1Ch3 itnL:u". Z: -.S a 3. uia for °:-PEC AL FF.` UIREMENiS _ CMI"'rl Ax tl. t np ,r r3 = wid. ups r:.,lOz s .,t_rttd. ke j Ili t .iOIL i0 =tetbi; JO,x A716�. fi`L.A rEL11 U GO rJ 4iE AW cF? tF{`l S (lhrrl4 23-10i C t u'mi, fit n it s, wifichdo i +1 t arll k te:'. +'l" r [< :!)t Y l)u II pwi it, , id ri A iu wo n lti f { at. i rop, b 00r1 I Orin ar.a I:o Cltlt ltsrrt GooAf#stait practices PC --- ---06 1 FC -6 � p+, Rai 'en�r�+i 6Gi3 ar CITY OF SALEM I / BOARD OF HEALTH �^— Establishment Name: Vic Lw' /-I .S�S�htN . Date: � S O Page: L'� of Item No. Code Reference C - Critical nem R - Red Ite DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY `�•^'�--'i; Date Verified =_- J-) Z S h4- n ok rt iL_ bD (P , .I.- mor- 4-1,L 141 41 U ea -A do +�e r) cu bt%o Yo, ^,(u oJ01,v1 rn V /eN rn)JA 4L. �r)3 1S /C^) WWf)I On -147— Agn� Puy, 4typokAk At ill -T IR—', Jtj 11Y s t vs ev can Y Gy4- a Ct 7A GWI�. �ILQ ✓1-6 4 S "ate is CJ Floar Qurp Lz- .,a AU •/14 JO-tcX G9 re Cis U• (ytCC.21ve st- K_f- ASO AA. I-Orl tJi / Q (e v ! CJb L �e �rrf Discussion With Person in Charge: SJNf g v Pe^4 t I have read this report, have had the opportunity to ask questioris^awid�ag�elkl correct all . r�iii� violations before the next inspection, to observe all conditions as described"d�4b comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. I �yj�( / /i (17 1&_(_4 Corrective Action Required: ❑ No -liS— Yes ❑ Voluntary Compliance ❑ Employee Restriction / n�.w Exclusion � Re -inspection Scheduled ❑ Emergency Suspension 13 Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (!tents 1-22) (Cont) . PROTECTION FROM CHEMICALS 14 -401.i 1(13),1 _2) Food or Color Additives '':Li..!(/.1 3-262-12 PHF Hot and Cold Holding Adiiuves'° Hnt PHFs Maintained at or above 3-302.14 _ Protection froin Una) nr ed Additives'_ 15 -}- Poisonous or Toxic Substances '-101.1? I Time as a Public Health Control ( idtliu;Niiig?nfonnation- Orilimal Containers` _ �7-102.11 .�C'omnn»ttiame 7 20t.11 �)3.FI(i)` 01 It �a raun-Si,, 7-20111 3.403,1 i (b) ! l:estno ion - Yr s, nCi Will _ 7-202,12 Crmdi t>n. of Use I tc) x'03.11 T'uxi<Conlainet Pobibitium` I � 463.! 1(Fl --��� s t-^.04.]1 I Saivu tis Cfit_en, Cha mit In 7-204.12 �{� _ I Cho) tip toiVi 1vh7 v 1- vet C n - j fi 204,14 t�Oi Inr, 4i ntc, Criwria Ltcin nttl t xrlirrtto, Luhl wants' -.t - R� Dl set L se -('e ❑.,de,.=_Cit lIt ......-._.___..� �7_66.1� Ral I F 4,tim i r 56b.1t Its ia,'txc9u .l.s, ont„l,,nd I Mhrnonsl' 16 IE,,mwlfim; s r <i,„ -^,fe_ ` Casnt rli to „ 1 -401.i 1(13),1 _2) P,,zt ;q)d ['s _., fts. 3 - 1 .) 1 t1, Vp'..j '':Li..!(/.1 1Ue,:!2t7 �Ni: cit` PHF Hot and Cold Holding Hnt PHFs Maintained at or above 140'E ?_StsI.IH{A)Roasts Held at or above 130°F e I Time as a Public Health Control a i f �)3.FI(i)` 01 Nllaaf6.I 3.403,1 i (b) hs r Wlt%r It'r'('2 mmu., S andsu;l j 1 nt i I tc) (31L YIGtt'tally 1'1 {,�. 'yl,? .ill ? rskl I � 463.! 1(Fl ! Rtn1ll lllli, 1,�1P{�(;-L I � Fi�dctlk I 118 I 1 Propet Cooling of PHFs I 501.1,4A) i Crwlinc C.x>ked PHFs A>a. i.1°fto � Wi'- Within 2 Iltlurc:;ml From m 3-501.1+4ih i-j4_�.-s>< Vie 2; PHE t Midi: 6roi v tut cit 9 nh nature. la.red,.ut=ti I 1i -15'F I Within A IIll leat re-. ..it7n.' 'OUa ( 'xle or 101 i � r,01.1A(C) PHRaceived at To 'prAca'ding to Faw Cool1476ledto - 41'7145`F Within 4. In4i, t - pg-5GF 15 Caroling Metbods for PHFs 19 41°145` F' PHF Hot and Cold Holding -w..lhf I3) COICI PHt, Mam[amW at or below 590 O(WF) 41°145` F' 3 5-'31.76{Aj Hnt PHFs Maintained at or above 140'E ?_StsI.IH{A)Roasts Held at or above 130°F e I Time as a Public Health Control inlas a Public Ileaith vamm t 4euuircmenf REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 I +S0111(A) lint .teariccd Fr I.aci,ged Jauec and c � lirverr�csavith 1Sarnn�_b is"' -ho' 11 (1;, 1'. ofPa tuicdt ,�,- - 5„i lit`)t�Ba at lati,all. C, k>1�d ,4a u7�n?Pocu azsd 3 -AOi s t 7 (load Pac ea, CONSUMER At3diSORY _ 7, t ,n7 F :=1=tc xc ti .iso;t Inn,! i�,, f r t!tutlfiOP t7f, .._, 1 � va'�il-hl�i lT�,aa cc k:, w�C=.j �lcd,7 s ! :�r+t isr as.• 1''rc Sc ;:.(E.l:tnttc z ...L 4 Fs S 7 s te, V;t iL vv S1,41'_ _-- i , a` I �. 4l REQUIREMENTS 110?ail: 1`,x .,. t:r,vpo,ar , snd I i Or L''I'r1ec, W1d:.i the 1ilfln Triitr , t'I I "i i J T i `)fi �� eVi&7if tcl.+ltl o *?IC(h. YIOLAi ON's RELATED TO, 43000 RETAk P)4A1-TK,'E5i C r , -r 'r n rtzt r tt n. xr rrh do uar v+� ix r) s rr r e +) „td re t Jut rrlr; cd e„a5 ,� r,tn lr »Q(lou Retai r Practicc s ---I FC. 53tt.ft`3tt._ itlnkr P„ nrGftCyk .ru vd as'e 1 ;=C -5 FG -6 CITY OF SALE BOARD OF HEALTH Establishment Name: 6t"--) V^ Date: C3 6E6 q Pager, of 190 Item Code C - critical Item DESCRIPTION OFVIOLATION /,PLAN OF CORRECTION Date No. Reference, R - Red Item A� Verified ,,a. PLEASE PRINT CLEARLY /,7 C t7 Z4, -11 4 Discussion With Person in Charge: Corrective Action Required: u No Yes __I-�Ll I have read this report, have had the opportunity to ask questions and agree to correct all Ej voluntary Compliance U Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to Re -inspection Scheduled Ll Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 4�p noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of 0 Embargo Lj Emergency Closure your food permit. cl Voluntary Disposal LI Other: Violations Related to Foodborne illness Interventions, and Risk Factors (Itords, 1-22) {Cont) 14i Food or Color Additives 3 _202,12 1 :additives* 3-302,14 Protection L I Poisonous or Toxic qubstances -!S— klentitying Information -- Original PHF Hot and Cold Holding Containers- rs`_ 102 11 '0 -i-Contact _ Common Mime - Workifig Cklotaurnr," 7'0_L11 'Sirraomon -- Sto -20111 Restrictlfsi - prescrice mid (,se* 7-20112 Conditions of Use' x;411 Toxic Container., - FlTolubuions* 204.I1 Samuzeis, terni - Chellficals* 1-204.12 7 77tw—lwcals for CiitciW 1204-14 1 '-205, Incidental Fix)d Con�, a warits*7 ,�L� 7-206.11 kc;.oic!ed !.Ttv Pe,6cides, Crucror -7-206. 12 Rodiurt 13"il SattionN, 7-206 11 Fra "king f) "wd Pest Control and TIMF/TEMPERATURE CONTROLS 16 ! I Proper Cooking Temperatures#or 3- 401.Ihlk(1)'21 Fg4� - 155'F r5 Sec. 3-401.1.1.4.1}(2; Comminuted Fofe Meaev & Game Animals- t55"F 15 sec. 3- 401.11(g)(1)(2) Pork mal ftect R( xist - 1'101j 121 ff TZ 1. 1 17A)f,) Raiiie,, hiieciod k4ciar - 155"F 15 3-461 . I I (Ay 3) 110kifur), W�ld(Jautc Sitittec 11iff's, Sniffing C(lationim, Fish, Islem, Poulu v or Ratites 165'F 15 sec. -401.11.(C){3) WhOe-muscle, linau Beef Steaks IIli Raw Animal FKk Cooked in a Nflcwwave 163'F * — TZI, I I (A t( 1)4 b) A 11 Orhei Pf IF c -- 14 `i" I t I 5 sec I 3?03.114.4)&(C3} PRFs 1651F 15 sec -, 3-403-11(13) Microwave- 165°P 2 Muni,, standing ':+ r.1.1(C) conuncriciativ Processed RTF. Food - 10) 1 Remaining UnFliced Portions of Beef Proper Cooling of PRFs 3-5-() T i-4(,\) cohnp, cookct Pift-'s farm —140-F to 70'17 Within 2 flours and From 701' to 41 1745' F Within 4 Homt ° 5(f.14(D) Cooling PHF* Madli From Ambient Temperature ln�� 'redients to 41'P'145'F Within 4 flotirO -Dm,tes crib:ai live ill the [,,te3c0 199v Foix] coaor 105 (`,11{590 006, 1 3-501.}4(Q PHFl, Received m Temperatures According to lav Cooled to -41 4l1V4.5FWiThm,1fiow:s * PHF Hot and Cold Holding 3 501.1601) Cold Pfff's Marmailled at or below 540004W, -Y) 1. 16(A) Hot IIHFc Maintained at of above �lNitirfleld at or above 13WF, ""s' fleld 4 r 20 T,me ai�s �a�Pub�lloc �Haafth — 03.19 _�R Timm, as a Public Health Control" —5-- 90.904(fi) --I'Variance Recivarement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 21 1 3-801.11(A} 1, Unpiisteurierd Pie-pacl',aged Juices and 1 I t>3) ! ,Rau; or Partially C.txtked Aminal Foal and _Rar Seedimmuts got &arvc tt r` I NC,, 1 Unoriened Fixxi frackaLe Not Re -served. - CONSUMER ADVISORY 12 1 Comulyl�r A(Jrisory Atinum That ,ire Raw. Undereooked ci 'Not trmtr, ise Processed to Eliminate F&Clz; S"AbS6NAlf for RAM' Shelf REOUIREMENTS Violalior)s of Section 590,(XMA)-(D) in catering. mobile lesxl, temporary and residential kitchen operations should be debited under the appropriate sections above if related it, foodborric illness inrervemirms, son risk factors. Ofliff 590.009 violations relarurg to 'good retail practices should be debited under #29 - Special Re'quirculents (Iteurs; 23.30) Cfive,aiatid tion -critical vivlanoiis, ivideh do ironn relate to the 1/tw(lbortir illness interverai,ms too riskjmiors livteoiaiiiwe. ran be hound in the toil owing serfions r}fthe Food Carte curd 105 CMR .590,000, S � Mat -L" O 1 1*1 r —-..t't"'J'e. V u c v-- 1+ ..e 1'� k r vtx.... d' .!"'vc c .— } JJ LI GG./Y /• +J r t l Upq�� $aillargeon Pest Control, Inc. rl �3 > ,�j� Graz, RESIDENTIAL COMMERCIAL �Y "Your Personal Pest Control Solution" �- Date��C"/ Fr- Time In /� rime Out ervice�,hgGhnicia 1Route Number per .- , '�i' State Lic�sed BillingAddress Name f%I f Na e ( 1f , bervice Address 7 l� Address Address QCsC- >•j •! �/,g�['i""' Cit State Zip City /4-(j'a�ff State %✓�f�Zi Telephone Telephone Pest Activity: Weather ConditipDOETElear EPA# ❑ Sunny ❑ Windy ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature 17— WMARBAMY METHOD OF APPLICATION AREA -VOLUME TREATED TYPEOFS RVICE TARGETPOM ^� ❑ Yes ❑ 30 days ❑ 90 days ❑ ❑ W ❑ 60 day ❑ 6 months ❑_ Weekly ❑ One Time Charge mioll iCy�' .r- ❑.Resrctenfial-,ti ❑ Ouaneny r`. &C<tmmmiciaj/ ❑ Nev., Slan-Up❑�— t t f rP E)' net �'❑-� "cockroaches ❑ Ants ❑Bees ❑ Fleas ❑ ❑ ❑f Pest Activity: / �"t Ile C ij l• .J,cF016 L{jl'p' Z..C.ytr�?, 1 { jJ Cx /!-j '11�� y' / t P [ t Kitchen: r���%? aV17l''fllst/rn re'Jt", 14N L/V-ip Dining Areas: 5f) j i fa!? t !� ��` 5 f Axn t?Attz !3flYi9 X F �j t %FFI�_rn /npt* j ,(,A( 4 SI A Bar/ Lounge: A It�e C�/3f1t 4tT Sf {`!. p <'t' FD E P Grf F`1��C7c '. A/L/ 18,41, a,P(( -S SPA ' •Pf�lt,tc-ts Y }i2 A)I �5�(1q/vn7 AC17P,-�.-.5'�1� Storage Areas k1pe C %�l( �k/L 1, L)lyC1 A � 0�- /-) s� t 9 f t fJIV Basem'en`t%f iFl0IT1� 7 e '9 pt S 1?CJGist .s7 }! f c,r l?Gi art Structural Deficiencies:. P6 oil r li"e;S lk',, 1,41r"t, A -k ycq j - Exterior Conditions: '3x MATMALS USED EPA# AMOUNT % SITE TREATED METHOD OF APPLICATION AREA -VOLUME TREATED TA,«R-GE PEST. ^� 0;-7 t t f rP X- Customer SignatureL f ACCOUNT NUMBER I INVOICE NUMBER l Please Remit Payment To:'"jj Baillargeon Pest Control, Ina P.O. Box 2314 Methuen, MA 01844-4417 Office 978-683-5541 -Fax 978-989-9228/fitc,c SERVICE REPORT / INVOICE 7" 1 pa / AMOUNT DUE i. Service Charge a -- Added Service (` Sales Tax Total Amount Due jQt1 STATION 86 W64 SUM Saeem, Ata 09970 978-745-3400 — 9ax 978-745-7460 August 6, 2009 Re: Board of Health Inspection on 8-06-09 Mr. Joseph Roale Action Plan Following are the actions that we have taken to correct violations / recommendations from our inspection on 8-06-09. • Glass shield for light on line is ordered and is scheduled to arrive Monday; light was removed until fixture is in. • Began implementing a line temperature check log to ensure proper rotation and handling of P.H.F's • Cleaned Ice Cream Chest • Hooks were installed to hang mops and brooms • Installed new weather shield strips on rear door • Paper good storage floor was cleaned and sanitized • Hot water temperature in the bathroom was adjusted to 110 degrees • Thermometers were calibrated and placed in all refrigerator and freezer units • Discussed options to repair both salad two door units and make adjustments to the salad unit on line, Mark from central cooling has ordered the necessary parts and will be completing work when parts arrive. (See attached paperwork) • Reviewed proper thawing methods, under running cold water, with kitchen staff • Reviewed with staff labeling of all generic bottles and containers on line • Lexan covers ordered to replace the cracked ones • Reviewed use of sanitizer concentration log with kitchen staff and dishwashers • General review with kitchen staff on constant temping and more consistent rotation of product up on the line during the day and night shifts. If product is -found to be in the "Critical" Zone it must be discarded Thank you again for your input and I hope that these actions that we have taken address your concerns and recommendations. Regards John Andrews Executive Chef, Victoria Station CITYWIDE COOLING & HEATING, INC. 134 Highland Avenue Salem, NIA 01970 Tall Free: 1.877-792-9931 Tei 978.741.1134 BILL TO rf(� L I HVAC SERVICE ORDER INVOICE ME ❑ C.O.D. ❑ CHARGE ❑ NO CHARGE MAK r MAKE MO MODEL SERIAL NUMBER SERIAL NUMBER SfNEEi _ DATE a- Si A (, 7 6k? ENVIRONMENTAL CHECK LIST RECOMMENDATIONS - l CITY PROMISED WORK PERFORMED OTY. TYPEOISPOSITION s Atcn— PHONE CALL BEFORE[IRECOVERED 7/ ry [IA.M. � T4 -- 'p �' / ' � ❑ P. M. ❑ RECYCLED TECHNICIAN r q(rl'HgRIZED BY RECLAIMED AAACU, WORK TO BE PERFORMED ❑ RETURNED t. G({„S,��Q,/�j �'01% ❑ DISPOSAL so. > ❑ DISMANTLED TOTAL S ❑ CHANGED OUT)REPLACEO OTY. MATERIALS & SERVICES UNIT PRICE„ .AMOUNTr�R DESCRIPTION OF WORK PERFORMED . .. :r ,.. ...,. REFRIGERANT R- UBS,i j (I et"� �n AWGn ////'����` �/�['� •' /�'fe x C0 1feci L1'%%Gf4 Cc6C - oI CNG GAwd U_,rLL RLl AM) L-o-,1All tI l ��lit\ ► Y _ •` QO r i ci7 t�S� A S✓� l�S, i T,z,.� G — 0 tCD�.ts1� /fit.-� .! . FR�� nn�,�-�F�c_t �- • s�t�.�PC�-•- -�-�1 P�ivS l Vzclxy lvpti V7' IR, UmL I [(r 4AC(d XA-z FILTERS % Xll AA44) PO LLAJ it ,.. f FILTERS % X BELTS TOTAL MATERIALS i L,,,,O/tiPR.EiSSUIL- &,-0 CAC To" _ — NRS. 'LABOR " RATE rt�> "AMOUNTWQ.C,all f"!i�J- i l I i TOTAL LABOR LIMITED WARRANTY: All materials, parts and .off ���x �;,; 'j - 'TERMS : -?je rte Equipment are warranted by the manufacturers or ""S' TOTAL SUMMARY `' N TERMS suppliers' written warranty only. All labor performed • - - by the above named company is warranted for 30 TOTAL days or as otherwise indicated in writing. The above MATERIALS � named company makes no other warranties. TOTAL LABOR express or implied and its agents or technicians aro • 1 have a IMI to order Ne work rLdineJ some which has been satisiaC.orily completed. I agree that not authorized to make any such warranties on Seller talons Hilo to aqutpmenCmelerlals Worml ed uab} final payment he made. It payment is not made diseasd Seller ran remove sato esoipmenlimaleriaB at Sell expense. Airy damage resulting from behalf of above named company. •F. cyd remo re be the sponse y of Seller. s ,,, ❑ REGULAR ❑ WARRANTY d . .._ D SERVICE CONTRACT TAX DATE - �'cusrquT onyn yRE <r. r gw TOTAL 5r•rvS,af�-� EXAM FORM NO. 4440 CERTIFICATE NO. 6322390 111111111 oi Fill : $ervSafe Cf�i tific��atic•�i� #0655 TO H for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). 2/20/2009 DATE OF EXAMINATION 2/20/2014 DATE OF EXPIRATION Local laws apply. Check with your local regulatory agency for recertification requirements. National Restaurant Association David Gilbert Executive Vice President, Products and Services Group EDUCATIONAL FOUNDATION National Restaurant Association Solutions 02008 National Restaurant Association Educational Foundation. All rights reserved. ServSafe* and the ServSafe logo are registered trademarks of the National Restaurant Association Educational Foundation, and used under license by National Restaurant Association Solutions, LLC, a wholly owned subsidiary of the National Restaurant Association. This document cannot be reproduced or altered, 08121102 v.0812 NATIONAL C RESTAURANT ASSOCIATION S 0 L U T 1 0 N S" �ServSafe� �m EXAM FORM NO. 4460 CERTIFICATE NO. 6425710 ServSafeo Certification TO JOHN ANDREWS for successfully completing the standards set forth for the ServSafe' Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI) -Conference for Food Protection (CFP). 4/23/2009 DATE OF EXAMINATION 4/23/2014 DATE OF EXPIRATION Local laws apply. Check with your local regulatory agency for recertification requirements. ^ 9.0 r NATIONAL c7 — — — _ — -- RESTAURANT ® Daoid Gilbert ASSOCIATION c, Chief Operating Officer, National Restaurant Association 80655 Executive Director, National Restaurant Association Solutions RJ2099 National Restaurant Association scat a tienal Fe and than. All rights reserved. ServSafe' and the ServSafe logo are registered tratlem arks of the National Be statuenl Association Ed ue ational Feundaie n, .ad used ends, license by National Restaurant Association Solutions, LEC, a wholly owned subsidiary of the National Restaurant Associatio, anis eocument cannot be reoroeocee or turner. S�-•r uS,.+f+-. EXAM FORM NO. 4440 CERTIFICATE NO. 6322386 ServS�fe° �E-�rtifi���.�ti�•�r� #0655 for successfully completing the. standards set forth by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection (CFP). 2/20/2009 DATE OF EXAMINATION 2/20/2014 DATE OF EXPIRATION Local laws apply. Check with your local regulatory agency for recertification requirements. National Restaurant Association David Gilbert Executive Vice President, Products and Services Group EDUCATIONAL FOUNDATION % National Restaurant Association solutions ®2000 National Restaurant Association Educational Foundation. All rights reserved. ServSafe" and the ServSafe logo are registered trademarks of Ne National Restaurant Association Educational Foundation. and used under license by National Restaurant Association Solutions, LLC, a Molly owned subsidiary of the National Restaurant Association. This document cannot be reproduced or altered. 00121102 v.0012 NATIONAL RESTAURANT ASSOCIATION S 0 L U T 1 0 N S TM r P«Izci+pi.rt'tltRaS� f c �joiXus U 0�u 5 S�caAC �a� sYCx�(�sr` >� r�� t'r�e ST$aPGargeon Pest Contr I, Inc. f.>U n2oti:- 0oz- RESIDENTIAL COMMERCIAL �.J .. "Your Personal rest Cogtrol Solution" 241, Weather Conditions .09bear ❑ Sunny ❑ Windy ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature ` 0 Q a Q ❑ yes ❑ 30 days ❑ 90 days Pest Activity: Kitchen: Dining Areas: E r ` Bar/ Lounge: Storage Areas ❑ No Weekly, ❑ 60 day � ,Mont V ❑ 6 months ❑ Quarterly ❑ NeW Start -Up ❑ One Time Charge ❑Residential U ti t' -/- les At 4eti ,ZF'Q-Frderit ,0:�O-Cockroaches ❑ Ants ❑ Bees ?.&p% - L4 Q C' -f CA_j I C—r!Pc-yl?e- ' yo! .atl /—elG4:li 4 n1c'A. (3Atz t S '�i� f Pp2r'r�5 r��c'PS y�l2Gc j pci` /dry^ Ac Q L ( S 0 �A ,i- /'�/I ( (,A -,e til /1Q 0 Z/ =�CI4702 fr —Basement N /7'C C.' rJ /i1 Y -fe (_ l '1r� C7 rte �- cOc%r- (�j �r --_ f 1._ A s c 440,0 .- X74CC 42 b �y tit '9h I/ ey - 7 AI-Zr 4---A9-7, Structural Deficiencies:�$-e ,e C0 r 7` C) . r'&5 (Jc`S 4-C14 r`rv£� f Exterior Conditions: %7 /,/� S �'-�� / A p��. r-< L c� MATERIALS USED Time In 0-33 (% Time Out [""?� J J ,� 'ce Terihnican-.�?AGNtynbeerr�� ; ;9 (�L(f'I � State License 9,(19, 7 , Billing Address/ Name Nave Service ddress C C 1�0 t'14 S-?Pj 4 O t<J Address Address IC City State Zip Cit 5 0A0_l� State i Telephone Telephone % )/ t—)67t—)67`` /` (1 3 % e d Weather Conditions .09bear ❑ Sunny ❑ Windy ❑ Rainy ❑ Snow ❑ Estimated Outside Temperature ` 0 Q a Q ❑ yes ❑ 30 days ❑ 90 days Pest Activity: Kitchen: Dining Areas: E r ` Bar/ Lounge: Storage Areas ❑ No Weekly, ❑ 60 day � ,Mont V ❑ 6 months ❑ Quarterly ❑ NeW Start -Up ❑ One Time Charge ❑Residential U ti t' -/- les At 4eti ,ZF'Q-Frderit ,0:�O-Cockroaches ❑ Ants ❑ Bees ?.&p% - L4 Q C' -f CA_j I C—r!Pc-yl?e- ' yo! .atl /—elG4:li 4 n1c'A. (3Atz t S '�i� f Pp2r'r�5 r��c'PS y�l2Gc j pci` /dry^ Ac Q L ( S 0 �A ,i- /'�/I ( (,A -,e til /1Q 0 Z/ =�CI4702 fr —Basement N /7'C C.' rJ /i1 Y -fe (_ l '1r� C7 rte �- cOc%r- (�j �r --_ f 1._ A s c 440,0 .- X74CC 42 b �y tit '9h I/ ey - 7 AI-Zr 4---A9-7, Structural Deficiencies:�$-e ,e C0 r 7` C) . r'&5 (Jc`S 4-C14 r`rv£� f Exterior Conditions: %7 /,/� S �'-�� / A p��. r-< L c� MATERIALS USED EPA# AMOUNT USED % SITE TREATED METHOD OF APPLICATION AREA -VOLUME TREATED TARGET PESTS bills) 16t l/Slo j aG.r7 /, b �cr'fr. 7; -it ti cP� c'pS X - Customer Signature e1-:7t1"r a ACCOUNT NUMBER INVOICE NUMBER 00/&- '-1325 Ple se RemitPayment To: Baillargeon Pest Control, Inc. P.O. Box 2314 Methuen, MA 01844-4417 Office 978-683-5541 • Fax 978-989-9228 SERVICE REPORT / INVOICESales �i[cGttt¢ �flU! AMOUNT DUE k „j Service Charge p7 `arra. AF -e Added Service Tax Total Amount Due � —"- Massachusetts Department of Public Health Division of Food and Drugs City/Town of S M tw 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 Address:: ry Tel. ql -7`U I �-o0 Nam Print Typ fOperation(s) Ty p Inspection Print:. ^ ood Service ❑Retail outine Re inspection Address 7Risk ❑Residential Kitchen Previous Inspection Tele hone P � ❑ Mobile ❑ Temporary Date: ❑ Pre-operation Owner ❑ Caterer ❑ Bed 8 Breakfast ❑ Suspect Illness E] General Complaint Person -in -Charge (PIC) Tim In:ElHACCP Out: Permit No. ❑.Other ------------ Inspectorvp 643 Each violation checked requires an x IInation 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. r _ _ „I'DO4PROTECTIONMANAGEMENT ❑ 1. PIC Assigned/Knowledgeable/Duties 'EMPt:OYEE 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�J 5. Receiving/Condition CCA Y. -4a+ dr� 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. 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 -4x590.005) 26. Water, Plumbing and Waste (Fcsx59o.ow) 27. Physical Facility (Fc -6x590.007) 28. Poisonous or Toxic Materials (FC -7x590.008) 29. Special Requirements (590.009) 30. Other S fartw w\ Anti -Choking 590,009(E) ❑ Tobacco 590.009(F)❑ Allergen Awareness 590.009 (G) dl ❑ 12. Prevention of Contamination from Hands (�U13. Handwash Facilities , -. -- - -. --M PROTECT -ION FROM'CHEICALS_- ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE.CONTROLS (Potentlally Hazardous F.(Tods) ; ❑ 16. Cooking Temperatures ❑ 17. Reheating [118. Cooling ❑ 19. Hot and Cold Holding ❑ 20 Time as a Public Health Control REQUIREMENTS FOR HIGHLY4USCEPTIBLE-POP6LA-i ONSt(N8P)' ❑ 21. Food and Food Preparation for HSP CONSUMERADVISORY _ I ❑ 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 Pis order. DATE OF RE -INSPECTION. Inspector's Signature: Print PICS Signature: Print:. ^ Page ofiPages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge" 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants-' Shell E ++s* 590.003(F) Responsibility Of A Fad Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To ReportTo The Person in Drinking Water front an Approved System* 590.006(A) Charge* 590.006(B) 590.003 G Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C 10- 11-0 11-0 C FOOD FROM APPROVED SOURCE * Denotes critical ;tent in. the Weral 1999 rood Cade or IU5 CMR 590.001). PROTFr:TInN FRnFA rnKMAU1MA'nnM Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in o Hermetically .Scaled Container' 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell E ++s* 3-202.14 .E +=s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water front 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 Fad Contact Surfaces of Equipment* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caup„ht Molluscan Shellfish* 3-201.15 { Molluscan Shellfish from NSSF Listed Sources* Proper, Adequate Handwashing Game and Wild Mushrooms Approved by Pe ulato Authorit 3-202.18 Shellstack identification Present' 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 2-301.14 Receiving/Condition 3-2011.1: PHFs Received at Proper Tcmperamres* 3-202.1.5 Package Ince it y* 3-10;.11 Food Safe and Unadulterated* Tags/Rerords: Shelistock 3-202.18 Shellstock Identification * 3-20312 Shellstak Identification Maintained* 12 Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(1) Labeling o1 Ingredients' Handwash Facilities Conformance with Approved Procedures lHACCP Plans 3-502.11 Specialized ProcessingMethods* 3-502:1.2 Reduced Oxygen packaging, criteria* 8-103.!2 Conformance with App roved Procedures` * Denotes critical ;tent in. the Weral 1999 rood Cade or IU5 CMR 590.001). PROTFr:TInN FRnFA rnKMAU1MA'nnM 9 Cross -contamination 3-302.11(A)(i) Raw Animal Foals Separated from Cooked and RTE Foods* 4-501.111 Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each Other* Mechanical Warewashing- Hot Water Sanitization Temperatures*. Contamination from the Environment :i 302.11(A) Food Protection* 3 302. t5 Washin Fruits and Vegetables 3-304.11 FoodContactwith 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 Fad Contact Surfaces of Equipment* Disposition of Adulterated or Contaminated Food 3101..11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures*. 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4702.11. Frequency of Sanitization of Utensils and Fad Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization -Hot Water and Chemical* 1{i Proper, Adequate Handwashing 2-301-11 Clean Condition - Hands and Arms* 2-301..12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 - Good Hygienic Practices 2-401..11. Eating, Dt lnkin or Using Tobacco* 2401.1.2 Discharges. From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* . 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 . Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 - Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices - 6-301.11 Handwashing Cleanser,Availability - 6-301..12 Hand Drying Provision CITY OF SALEM ) �,�n ` ,Q BOARD OF HEALTH e:L sk` Establishment Nam&Lc� `Ulia ' �6�in o Date: 5 �—� (� Pager of K�[ C —Critical item • . . . • Now; 101� --M` 1 11..%�' I Imo'=moi 'r_ ��.1 • �•�• .. 1.... 11 ♦ _ � M WTI, �= 'N�L tII.� / /I� a /'_. IC.' A'_/./ r, ��.• _ ..�. MW IIIWA MIAMISSMIMMUM too of your food permit. Violations Related to Foodborne illness. Interventions and Risk Factors (hems 1-22) (Cont. PROTECTION FROM CHEMICALS 14 - Food or Calor Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Addiuves* 15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers" 7-102.11 Common Name - Working Containers* 7 ?01.11 Separation - Stora * 7-202.11 . Restriction - Presence and Use 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11. Sanitizers.Criteria- Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lnbiicants* 7-206.11 Restricted Use Pesticides Criteria* 7-206.1.2 Rodent Bait Stauuns* 7-206.13 Tracking Powders, Pest Control and Monitoring* IN 117 is 71MEITEMPERATURE CONTROLS * Nnotes critical ism in the federal 1999 Fiord Cade or 105 CMR 590.(H)O. SMr 3-501.14(C) Proper Cooking Temperatures for - 3-501.15 PHFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-501.16(B) 590.004(F) 'E w Immediate Service 145°F15sec* 3401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(.9) Animals -155'F 15 sec. * 3.401.11(B)(I)(2) Pok and Beef Roast - I309F 121 min* 3-40131(A)(2) Ratites, Injected Meats - 155°F 15 590.004(H) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, : FC -6 Poultry or Ratites -165°F 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 1650F * 3-401.11(.A)(1)(b) All Other PHFs - 145°F 15 sec. ° Reheating for Hot Holding 3.403AI(AWD) PHFs 165°F 15 sec. * 31103.11(8) Microwave - 165' F 2 Minute Standing Time' 3-403.11(C) Commercially Recessed RTE Foo) - 1400F 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs _ 3-50114(A) Cooling Cooked PHFs from 140°F to 700F Within 2 Hours and Front 70'F to 4I°F/45'F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambien Temperature Ingredients to 4103(45°F Within 4 Hours* * Nnotes critical ism in the federal 1999 Fiord Cade or 105 CMR 590.(H)O. SMr 3-501.14(C) PRFs Received at Temperatures According to Law Cooled to 41.'F/45°F Within 4 Hours. 3-501.15 Conlin Methodic for PHFs 3-801.11(B) PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 4101450 F* 3-501.16(A) Hot PRFs Maintained at or above 140`F. * 3-501.16(.9) Roasts Held at or above 130°F. X25. 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(.4) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590��r.000 3-801.11(B) Use of Pasteurized Eggs FC -2 3-801.11(D) Raw or Partially Cooked Aninml Food and Raw Seed Sprouts Not Served. * Food and Food Protection 3-801.1) (C) Unopened Food Pack a Not Re -served. CONSUMER ADVISORY 22 3-603.11. Consumer Advisory Posted for Consumption of 590��r.000 23, Animal Foods That are Raw. Undercooked or FC -2 MryI Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.' X25. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 i r26. E 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate Sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (hellos 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 Cade acrd 105 CMR 590.000. t Item I Good Retail Practices .FC 590��r.000 23, 1 Management and Personnel - FC -2 MryI 24.. Food and Food Protection FC - 3 .004 X25. L Equipment and Utensils FC=4 .005 i r26. 1 Water, Plumbinq and Waste I FC -5 .006 27. Physical Facli f : FC -6 .007 28. Pois�ous a Toth; Materials ! FC -7 .008 29. S carat R irements .009 30. 1 Other --�-- ru CITY OF SALEM r BOARD OF HEALTH Establishment Name:J".'6 W cL �Z-� I i QA n Date: 5—qt::I Page:of _ IF ���AL�� •..LLi�.. � WR alb EA� 0_� �� � � � � Vii, _ .. _-_-WI� MT101,M !• I I _ ._ PON Wire.- =��� r ` Discussion Wi.th Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all . ... Employee .. Violations Related to Foodborne Illness Interventions and Risk Factors (Nemsr-22) (Cont.) PROTECTION FROM CHEMICALS 14 Color AdditIla ives 0 17 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* Poisonous or Toxic Substance ' 7-101.11 Identifying Information,- Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 Separation - Sto 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 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* Food or 3-501.15 PHFs 3-401.IIA(1)(2) Eggs- f55'F 15 Sec. 3-501.16(B) 590.004(17) Eggs- immediate Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(.9) Animals -155°F 15 sec. * 3.401.11(3)(1)(2) Pork and Beef Roast - 130°F 121 mitt* 3.401.11(A)(2) Ratites, Injected Meats -155°F 15 590.U04(H) sec. * 3A01.11(A)(3) Poultry, Wild Game, Stu$'ed PM, .27. Stuffing Containing Fish, Meat, FC - 6 Poultry or Ratites -165°F 1.5 sec. 3-401..11(C)(3) Whole -muscle, Intact Beef Steaks FC _ 7 145PP " 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401.11(A)(1)(b) Ali Other PHFs -145°1715 sec. * skates critical item in the federal 1999 Foal Code or 105 CMR 590.otx). ON 3-i01.14(C) Proper Cooling Temperatures for 3-501.15 PHFs 3-401.IIA(1)(2) Eggs- f55'F 15 Sec. 3-501.16(B) 590.004(17) Eggs- immediate Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(.9) Animals -155°F 15 sec. * 3.401.11(3)(1)(2) Pork and Beef Roast - 130°F 121 mitt* 3.401.11(A)(2) Ratites, Injected Meats -155°F 15 590.U04(H) sec. * 3A01.11(A)(3) Poultry, Wild Game, Stu$'ed PM, .27. Stuffing Containing Fish, Meat, FC - 6 Poultry or Ratites -165°F 1.5 sec. 3-401..11(C)(3) Whole -muscle, Intact Beef Steaks FC _ 7 145PP " 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401.11(A)(1)(b) Ali Other PHFs -145°1715 sec. Reh�ting for Hot Holding 3-403.11(A)&(D) PRFs 165°F 15 sec. * 3-403.1.1(B) Microwave --I65° F 2 Minute Standing Time* 3-403AI(C) Commercia]ly Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsticed Porti ns of Beef Roasts* Proper Cooling of PRFs 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Within 2 Hours and Front 70°F to 41*F/45 F Witten 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Tn„redienLa to 41°F/45°F Within 4 Hours* * skates critical item in the federal 1999 Foal Code or 105 CMR 590.otx). ON 3-i01.14(C) PHFs Received at Temperatures According to Law Cooled to 417/45°17 Within 4 Hours. 3-501.15 CoolmE Methods for PHFs 3-801.11(B) PHF Not and Cold Holding 3-501.16(B) 590.004(17) Cold PHFs Maintained at or below 410/450 P* 3-501.16(A) -Hot PHFs Maintained at or above 140°17. * 3-501.16(.9) Roasts Held at or above 130°F. 25. - Time as a Public Health Control 3-5Dl.l9 Time as a Public Health Control* 590.U04(H) Variance Requirement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPS 21 3-801.11(A) . Unpasteurized Pre-packaged luice.s and Beverages with Warning labels* 590.0w 3-801.11(B) Use of Pasteurized E °s* FC - 2 3-801.11(D) Raw or Partially Cooked Animal Food and . Raw Seed Sprouts Not Served. * Food and Food Protection 3-801.11(C) Unapeneci Food Package Not Re -served. Ct ]MIME AnvIS6RY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.0w 23. Animal Foods That are Raw. Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Pathogens.* 25. - 3-302.13. Pasteurized Eggs Substitute for Raw Shell Los i 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 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 23.3.0) .Critical. and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in she folloa4ng sections of the Food Corte mrd 105 CMR 590.000. p` Nem 1 Gaod Retail Practices _-_ - .FC -. 590.0w 23. I Manaosment and Personnel, FC - 2 .003 24.. Food and Food Protection FC - 3 .004 25. - ' Equipment and Utensils I FC -4 Los i 26. 1 Water. Plumbing and Waste 'I FC -5 .006 1 .27. Physical Facility FC - 6 .007 28. - Pdsonous a Toxic Materials FC _ 7 .008 29. S pial R uiremants � .009 I 30. 1 Other s:rxkbnmmrkGz Oc CITY OF SALEM �1— BOARD OF HEALTH Establishment Name:( k0:l, LreV� Date: Page: L_71� of _ Rem No. Code Reference C —Critical Item R -Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY ' Date Veritled 1 A / v r AAA kA Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct alloluntary 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 finesof twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: o 13 Yes compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness tnterventlons and Risk Factors, (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 - Food or Gator 15 16 117 is F#T19199-1797.4-: ha ' Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* - Poisonous or Toxic Substances 7-101.11 Identifying information - Original Containers* 7-102.11. Common Name - Working Containers* 7-201.11 - Separation - Stoa - 7-202.11 .Restriction - Presenceand Use* 7-202.12 Conditions of Use*' 7-203.11 Toxic Containers - Prohibitions*. 7-204.11 Sanitizers. Criteria - Chemicals'* 7-204.12 Chenucals for Washing. Produce, Criteria* 7-204.14 - Drying Agents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.1.1 Restricted Use Pesticides; Criteria* 7-206.12 Rodent Bait Stations° 7-206.13 Tracking Powders, Pest Control and ii Monitoring* F#T19199-1797.4-: ha ' * IX -notes critical item in the federal 1999 Foci Code w 103 CMR 590.000. U 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PRFs 3-401.IIA(1)(2) Eggs- f55"F 15 Sec. 3-501.16(B) 590.004(F) Eggs- Immediate Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish. Meats & frame 3-501.16(A) Animals -155°F 15 sec. * 3.401.11(B)(I)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155°F 15 590.004(H) sec. 3.401.1 t(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC - 6 Poultry or Ratites -165°F 15 sec. 3401..11(0)(3) Whole -muscle, Intact Beef Steaks FC = 7 145°F " 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401.11(A)(1)(b) All Other PRFs -145°F 15 sec. Reheating for tot Holding 3-403.41(A)&(D) ' PHFs 165-F15 sec. * 3-403.1.1(B) Microwave -'165° F 2 Minute Standing Tithe* 3.403. t 1(C) Commercially Promssed RTE Food - 140°F* 3-403,11(E) Remaining Unsiicui Porticros 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/4FF Within 4 Hours. * 3-501.14(B) Cooling PHFs Made From Ambient Temperntuie ingredients to 41°F/35°F Within 4 Hours* * IX -notes critical item in the federal 1999 Foci Code w 103 CMR 590.000. U 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41.°F145°F Within 4 Hours. 3-501.15 Cooling Methods for PHFs 3-801.11(B) PHF Not and Cold Holding 3-501.16(B) 590.004(F) Cold PIFs Maintained at or below 41.°145° F* - 3-501.16(A) -Hot PRFs Maintained at or above 140°F. * 3-501.16(A) Roasts Held at or above 1307. 25. Time as Public Health Control 3-501.19 Time as a Public Health ControP 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-801.11 (.A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 590.000 3-801.11(B) Use of Pasteurized Eggs* FC -2 3-801.11(D) Raw or Partially Cooked Animal Food and . Raw Seed Sprouts Not Served. * and FSI ProtectionFCS-' 3-801.11(C) Unopened Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw. Undercooked or FC -2 ( .003 j Not Otherwise Processed to Eliminate and FSI ProtectionFCS-' Pathogens.' 25. 3-302.13 Pasteurized Eggs Substitute for Raw Shen .005 r- Eggs * 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 sectians above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Items 23-30) Griticat,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 Cade mrd 105 CMR 590.000. t item I Good Retail Practices .FC 590.000 23. I Managament arni PorsaateA FC -2 ( .003 j 24. and FSI ProtectionFCS-' 25. Equiprnent and Utensils FC -4 .005 r- Water, Plumbing and Waste - FC -5 .006 27. Physical Facility FC - 6 .007 28. Poisonous or Toric Materials FC = 7 .008 29. Special Requirements � .009 i 30. I Other