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VILLAS GROCERETTE - ESTABLISHMENTSm *do IJPC 90230 —No. H963 HASTINGS, MN Villa Grocerett:6ouui ail ?�jj (235 Lafayelta Str; et) r 1 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 -2004-0300 LOCATED AT Villa's Grocerette 235 Lafayette Street Salem MA 01970 0235 LAFAYETTE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes RETAIL FOOD BHP -2006-0262 Jan 3, 2006 Dec 31, 2006 $100.00 TOBACCO VENDOR BHP -2006-0263 Jan 3, 2006 Dec 31, 2006 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted'in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 7 r e;^"Rru „ STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM5 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT One 0 �0 ep '77 Q' X005 qAM opS14 tiF' y 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT # ql - JwO22-11 ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S TEL # CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) tVTft CCERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ... HOME TEL # 0 �6 HOURS OF OPERATION: Mon.$L�Tue.ctjf-Wed. Thu. - Fri._ff'I_Sat. 5= Sun. If - ,t� TYPE OF ESTABLISHM FEE (check only) RETAIL STORE YES NO � less than 1000sq.ft. 1000-10,000sq.ft. =$ 50 =$100 - more than 10,000sq.ft. =$250 -------------------------------------------- --- - -- ----------------------------------------- -.......-- RESTAURANT YES NO less than 25 seats _----------------------- $100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YER® $5 CTOBACCO VENDOR 33-+04 ES NO $50 ALL NON-PROFIT (such as church kitchens) Y S NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------ Revised 11/03/05 FOODAP2.adm Check# & Date (]I h I a.� 5-6� g%omaag. ofA- Zastfiy, Esqulzs 9fl McCarthy Low Offices 13 Sea View Avenue Tel. (617) 567 -0170 - East Boston, MA 02128 Fax (617) 569-1419 0235 Lafayette Street 744-4676_ Owner: Thomas Truoni PIC: * 4. Inspector: David Greent )ate Inspected 9/1/2005 HACCP: ❑ Nguyen; Villa's Grocerette City of Salem RETAIL FOOD - Food Establishment Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done PASS Anti -Choking PASS ❑ Tobacco PASS ❑ FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS 0 RED UM g,.: EMPLOYEE HEALTH Not Done Dorrect By Reporting of Diseases by Food Employee and PIC PASS RED '. Personnel with Infections Restricted/Excluded PASS ❑J RED Permit Number. BHP -2005-0089 Status " m SIGNED OFF s # of Critical Violations: Time IN: Time OUT: Dotes )GT - f•VVU rRV1VI HYrRVVCU JVURIiC rvoc vone PASS Food and Water from Approved Source Receiving/Condition PASS Tags/Records/Accuracy of Ingredient Statements PASS Conformance with Approved Procedures/HACCP PASS Plans PROTECTION FROM CONTAMINATION Separation/ Segregation/ Protection Food Contact Surfaces Cleaning and Sanitizing Proper Adequate Handwashing Urgency Description(s). Good Hygienic Practices BLUE: Violations Related to Good Prevention of Contamination from Hands Retail Practices (Critical' - Handwash Facilities violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMSO2005 Des Lauriers Municipal Solutions, Inc Not Done PASS PASS PASS PASS PASS PASS LL RED 0 RED ❑d RED ❑d RED RED RED RED RED RED RED ( Rev. Sep 01,2005 ) Page I oft 0235 Lafayette Street must be corrected immediately or within 90 days) RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require_ immediate corrective action) Villa's Grocerette PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASS PASS RED Reheating PASS ❑.] RED Cooling PASS Q RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑Q RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/Ad❑ RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL ❑ BLUE Ice cream freezer needs a visible, accurate thermometer. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other- See Notes PASS ❑ BLUE All other violations cited in 8/23/05 inspection report have been corrected. GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 01,2005) Paze 2 oft 0235 Lafayette Street Telephone: m 744-4676' Owner -Thomas:Tl PIC: City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Villa's Grocerette " Item Status Violation Critical Urgency Nature of problem or correction Not Done Non-compliance with: Not Done .8/23/2005 _ „ ^^ __4 7 Anti -Choking PASS ❑ ig Nguyen Tobacco PASS ❑ Personnel with Infections Restricted/Excluded ,r FOOD PROTECTION MANAGEMENT PIC Assigned / Knowledgeable / Duties David Greenbaum Not Done FAIL Critical IJ RED Onager did not have knowledge of PIC. A knowledgeable person in charge must be present in the absence of the owner. Date Inspected: Correct By: z EMPLOYEE HEALTH Not Done .8/23/2005 _ „ Reporting of Diseases by Food Employee and PIC PASS RED Risk Level: Personnel with Infections Restricted/Excluded PASS RED FOOD FROM APPROVED SOURCE Not Done Permit Number " .. ❑J RED Food and Water from Approved Source PASS BHP -2005-0089: Status' Receiving/Condition PASS ❑d RED VIOLATION ` Tags/Records/Accuracy of Ingredient Statements PASS ❑/ RED # of Critical Violations: Conformance with Approved Procedures/HACCP PASS ❑d RED 2 Plans Time IN: Time OUT: Notes: k � 6 249:Reinspection in 1 week, all tems to be corrected. Urgency Description(s): Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc ( Rev. Aug 23,2005 ) PaQe I o(3 0235 Lafayette Street days)(Non-critical violations. must be corrected immediately or,within 90 days) g. .x RED: Violations Related to Foodborne illness Interventions and Risk Factors (Requirep � _` immediate corrective action)# OTECTION FROM CONTAMINATION Separation/ Segregation/ Protection Food Contact Surfaces Cleaning and Sanitizing Proper Adequate Handwashing Good Hygienic Practices Prevention of Contamination from Hands Handwash Facilities Not Done Not Done PASS ❑D RED PASS ❑D RED PASS ❑Q RED PASS ❑D RED PASS ❑D RED FAIL Critical ❑d RED Villa's Grocerette The throom handwash sink has no paper V Is and no hot water. Provide isposable paper towels and hot water in bathroom all times. Bot andwash sinks found obstructed. ndwash sinks must be clear and accessible at all times. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIME/TEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures N/Ad❑ RED Reheating N/A RED Cooling N/A ❑Q RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control N/A ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP N/A ❑V RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A V RED GeOTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 23,2005) Page 2 of 0235 Lafayette Street Violations Related to Good Retail Practices (Blue Not Done Villa's Grocerette Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE covering expiration/sell by P/teDo 1.4 of obscure any expiration/sell by date . Equipment and Utensils FAIL Non -Critical ❑ BLUE Pr de a covered trash receptacle in the est room. J Ice cream freezer needs a visible, accurate thermometer. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non -Critical ❑ BLUE M y broken and missing floor tiles. epair or rep!iAce aLl missing/broken floor tiles. F ring throughout establishment needs a horough cleaning. Back st age room has an accumulation of old ris. Back room to be cleaned and ems not pertinent to business to be removed. T are many water stained ceiling tiles. eplace all damaged ceiling tiles. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other- See Notes FAIL Non -Critical Cl BLUE Ow r to provide extermination invoices to spectors at reinspection GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 23,2005) 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: RETAIL FOOD Name of Establishment: Villa's Grocerette Address of Establishment: 235 Lafayette Street Owner's Name: Thomas Truong Nguyen Restrictions: Application Date: 11/19/04 Permit for Food Establishment 32-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 009-05 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 i� STANLEY J. USOVICZ, JR. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM. MA 01 970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT . 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (6l ILIA C-Af)C Rf7 r� TEL # 97k _ 7�(/ _X67/ ADDRESS OF ESTABLISHMENT -�� FYf iE S % c !,61Ey /V(¢ d/ Gl7l] MAILING ADDRESS (if different) OWNER'S NAME T-tfOUA-S T- ALCZLYEAI TEL # 17,f�kOPG ADDRESS (0% 150SZON S� TCa��F r ,AIA O/9 CITY TO/��ri STATE IWA ZIP o/S CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATI (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL HOURS OF OPERATION: Mon.—Tue.—Wed.—Thu.—Fri.—Sat. Sun. TYPE OF ESTABLISHMENT RETAIL STORE YES NO 307 -0,5- RESTAURANT YES NO BED/BREAKFAST YES NO FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 $100 ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOQURT, SOFT SERVE YES NO TOBACCO VENDOR '�Io I- 00 ES NO $50 ALL NON-PROFIT (such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature -Z4�1l�uyq�Date//'� ,9 � Social Security or Federal Identification Number MW J/` fP -j-----9a--------------------- Revised 11/03/03 FOODAP2.adm/ Check# & Date /Jafy �[1L axed ) s �a 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: RETAIL FOOD Name of Establishment: Villa's Grocerette Address of Establishment: 235 Lafayette Street Owner's Name: Thomas Truong Nguyen Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 108-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 28-04 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. HEALTH AGENT aCITY OF SALEM, MASSACHUSETT BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR NOV 1 8 2063 SALEM, MA 01970 TEL. 978-741 - 1 800 FAX 978-745-0343 CITY OF SALEM STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATIONGT�'JCR fP,t.P_FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Vi la S TEtL # i7S - ]y 4X11 f�7Fi ADDRESS OF ESTABLISHMENTS & L"J a,��a S f Siem NA DIT%D MAILING ADDRESS (if different) OWNER'S NAME I Ta tory S T CERTIF (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON�`ENi<I IVI jVG L� 1� yl/ HOME TEL #°1%S�'�% HOURS OF OPERATION: Mon.7AY,Tue.7/L:+ _40ed.7A/u�A�Thu:7 H-6 ri2 u -a SatAA -e' un. clo TYPE OF ESTABLISHME RETAIL STORE YES NO RESTAURANT YES NO BED/BREAKFAST--NO' " ADDITIONAL PERMITS'— MAKE ERMITS'—MAKE (not just serve) ICE CREAM, YOGURT, SOFT. ERVE TOBACCO VENDOR 1 - ALL NON-PROFIT (such as church kitchens) FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. 0 more than 10,000sq.ft. =$250 less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 $100 _. Is Se> NO $5 YES NO 50 Y S NO $25 Please pay total with one check payable to the City of Salem This Permit is not•transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the.Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties'of perjury that I, to my best k owledge and belief, have filed all state tax returns and paid all state taxes required under the law. Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.ad.m Check#&Date %yq%— /I—f 1(/0? . - CITY OF SALE BOARD OF HEALTH n Establishment Name: VII(A- U;7'oCA/P� Date: /u _ /.,I -0y' rage: or r nem Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R — Red Item - - Verified PLEASE PRINT CLEARLY 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 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. ❑ Voluntary Disposal ❑ Other: Y•' Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 ON 18 " Denotes critical item in the faderil 1999 Food Code or 105 CKIR 590 000. 74 20 3-501.14(C) Food or Color Atlditives 5-202.12 Additives* 3-302.'14 Protection ProraUnapproved Additives* 3-50 L 16(B) 590-004(F) Poisonous or Toxic Substances 7-10t.Ii Identifying Informtion- Original Containers* 7-102-I't Common Name - Workin- Containers* 7-201.11 Se.aranion - Stora e* 7-202.11 Restriction- Presence and User 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions" 7-204.11 Sar» sizers. Criteria -Chemicals* 7-204.1.2 Chemicals for Washuw Produce, Cntorta" 7-204.14 Dr'in A cuts. Criteria" 7-205.11 Incidental Food Contact. Lubricants* .11 Restricted l.ise Pesticides. Criteria* -12 E Rodent Bait Stations" .13 Tracking Powders, Pest Control and MonitomL* " Denotes critical item in the faderil 1999 Food Code or 105 CKIR 590 000. 74 20 3-501.14(C) Proper Cooking Temperatures for 3-501.15 PHFs 3-401.11A(1)(2) Fags- 155'F IS Sec. 3-50 L 16(B) 590-004(F) E>es-Lnnredia[e Service t45°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats &. Game )Roasts Animals - 155°F 15 sec. 't 3-401.11(B)(1)(2) Pork and Beef Roast - 13WF 121 nint* 3-401.11(A)(2) Ratites; Injected Meats - 155`F 1.5 004(H) see. d 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, .009 Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. 3-40111(C)(3) Whole -muscle, Intact Beef Steaks 145°F * 3-401.1.2 Raw Animal Foods Cooked in a Microwave -165°F 3-401.11(A)(I)(,b) All Other PHFs - 145°F 15 sec. Reheating for Hot Holding 3-403.11(A)K(D) PHFs 16W 15 sec. * 3-403.11(B) Microwave- 165° F2 Minute Standing Timc* 3-403.11(C) CommerciadIvProcessed RTE Food - 140oF, 3-403.1I(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501..14(A) Cooling, Cooked PHFs from 140°F to 701- Within 2 Hours and From 70F to41°F/45°17 Within 4 Hours. " 3-501,14(B) Cooling PHFs Made Frout Ambient Temperature Ingredients to 41'F/45`F Within 4I°lours* " Denotes critical item in the faderil 1999 Food Code or 105 CKIR 590 000. 74 20 3-501.14(C) PHFs Received at Temperatures _ According to Law Cooled to 4PF1450F Within 4 Hours. * 3-501.15 Cooliun Methods for PHFs 3-801.17 (B) PHF Hot and Cold Holding 3-50 L 16(B) 590-004(F) Cold PTIFs Maintained at or below 41°145°F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. * )Roasts Held at or above I30°F. V,00� Time as a Public Health Control 19Time as a Public Health Control* 004(H) Variance Requirement REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONStHSP} 21 3-801.11(A) UnpasteurizedPre-packaged Juices artd Beverages with WHrn Labels* 23. Manu ement and Personnel 3-801.17 (B) Use of Pasteurized E gas* _ _ 24. Food and Food Protection 3-801A 1(D) Raw or Partially Cooked Animal Fond and Raw Seed S }routs Not Served. 25, _ Equi mensand UtensilsFC-4 - --. - - 26. Water, Plumbing and Waste 3-80111(C) UnoenedFaodPucka>eNotRe-served.* GZ�Ii'R . n s 22 3-603.11 Consumer Advisory Posted for Consumption of 23. Manu ement and Personnel FC -2 Aniutal Foods 'that are Raw. Undercooked or _ _ 24. Food and Food Protection FC -3 Not Otherwise Processed to Eliminate 25, _ Equi mensand UtensilsFC-4 - --. - - 26. Water, Plumbing and Waste FG FC - 5 Patho^ens.* crrllve r+aonr 27. Ph sica!Facility_____- 3-302.13 Pasteurized Eggs Substitute for Raw Shell 28. Poisonous or Toxic Materials FC - 7008 E *as* Qrc~nx� ncwUtnctvtcty i5 590.009(A -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should he 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. (111 23-30) Ctarcal and non-enttoal violations,which do not relate io tote .foodborne illness interventions and risk factors fisted above, can he found in the following sections of the Food Code and 105 CMR syo.000. Item Good Retail Practices FC 590.000 23. Manu ement and Personnel FC -2 .003 _ _ 24. Food and Food Protection FC -3 .004 25, _ Equi mensand UtensilsFC-4 - --. - - 26. Water, Plumbing and Waste FG FC - 5 j .005 ---6 .006 27. Ph sica!Facility_____- FC -6 .007__-- 28. Poisonous or Toxic Materials FC - 7008 29_ S ecial Re uiremeots .009 30. Other ? SALEM, MASSACHUSETTS LICENSING BOARD 120 Washington Street Salem, MA 01970 978-745-9595 ext. 421 HEATH DEPARTMENT NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed and returned with your application). NAME OF BUSINESS Corporate name: A177. G 5441,. J I 1 /vC . d/b/a: VII -L4 (�CoGtvl, F1'j LOCATION:�� s 5 / ✓-� `i 4� 1 r 5"'IV64 TELE. # TYPE OF LICENSE 13r/1.1L &V tNltiL APPLICANTS INFORMATION Name: C—PrsV S'�AG Home address: t), (lrTrti 5Tfl\% IMPORTANT MESSAGE FOR aL DATE Izo ;/ eg`/' TIME/�P Ma-4g � OF PHONE 0/ %� 74I- 90p0 AREA CODE NUMBER EXTENSION O FAX O MOBILE AREA COCE / NUMBER TIME TO CALL TELEPHONED .. PLEASE CALL CAME TO SEE YO L1 WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU ZA SIGNED I�a FORM 4009 MARE IN U.S.A. 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 VIL i' 6720 Cdof of i r'fr3 Date D � dN T of 0 eration(s) T etdf Inspection outine E:1Re-inspection Previ9s Inspection Dat re -operation ❑ Suspect Illness ❑ General Complaint El HACCP ❑ Other ❑ Food Service (Retail ❑ Residential Kitchen EI Mobile ElTemporary ❑ Caterer ❑ Bed & Breakfast Permit No. AddressRisk ids 1�r,e J Level M Telephone ,7 yy. 146 L OwnerHACCP i140WAS F WV yid YIN Person in Charge (PIC) (:)ar+1N tL N6ul/�r� Time In: Out: Inspector /fit1//� G�lFtFN� M Eacn vlolailon cnecxeo requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors 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 s PROTECTION FROM CONTAMINATION. ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing [111. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. CA 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) 2P. 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 tFoi 14. Doc FA ❑ 1 Prevention of Contamination from Hands Zt 13. Handwash Facilities PROTECTION FROM CHEMICALS - ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals 'TIME/rEMPERATURE 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) [121. Food and Food Preparation for HSP CONSUMER ADVISORY, N•_' ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions fG and Risk Factors (Items 1-22): I 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: �' y .-�\ / Page! of -Y Pages f Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 3 590.003(A) Assi>iment of Responsibility* i90.003(B) Demonsrr lion of Knowledge* 2 ]03.11 Person iocharge-duces EMPLOYEE HEALTH 2 590:003(0 Responsibility of the person in change to CompliancewithFood Law" 3-201_ 12 require, reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eg,, 590.003(1^) Responsibility OfAFood Employee -OrAn 3-202,16 lee Made From Potable Ddnkina Water" ApplicantTo Report To The Person In I�rinkins Water from an Approved Svstem* .-)90.006t A) Char ,,e* 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 C C R * Denotes critical item iu the federal 1999 Food Code or 105 CMR 590.UOo. PROTECTION FROM CONTAMINATION g Food and Water From Regulated Sources 590.004(A -B) CompliancewithFood Law" 3-201_ 12 Food in a Henneticul(y Sailed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eg,, 3-202.14 E s and Milk Products. pasteurized- asteurized-3'202.16 3-202,16 lee Made From Potable Ddnkina Water" 5-101.11 I�rinkins Water from an Approved Svstem* .-)90.006t A) I Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* WashmL Fruits and Ve,,etables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recrean onally 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.t8 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: Shelistock 3-202.18 Shelist'ock identification * 3-203.12 Shellstoek Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(.1) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of E u9 meat* Conformance with Approved Procedures 1HACCP Plans 3-502,11 Seciali ce.d Proeessm = Methods 3-502.12 Reduced oxygen packaging, criteria, 5-903.12 Conformance with Aoxovcd Procedures" * Denotes critical item iu the federal 1999 Food Code or 105 CMR 590.UOo. PROTECTION FROM CONTAMINATION g Cross -contamination 3-302.11(A)(1) Raw Animal Fowls Separated from Cooked and RPF Foods* Contamination from Raw ingredients 3-302.1I(A)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302A I(A) Fooxt Protection" 3-302.15 WashmL Fruits and Ve,,etables 3-304.11 Food Contact with Equipment and Utensiis" Contamination from the Consumer 3-306.14(A)(B) Returned Fond and Resei ce of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding of Reconditioning Unsafe. Food* 9 Food Contact Surfaces 4-501.111 Nilanual Wamwashine- Hot Water Sanitization `fens et:atures* 4-501.1.12 Mechanical Warewashing-Hot Waver Sanitization Tern teratures* 4-501-114 � Chemical Sanitization- temp.,pit, concentration and hardness. s` 4-601.'tI(A) Equipment Food. Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Fund - Contact Surfaces and Utensils' 4-702.(1 Frequency of Sanitization of Utensils and Food Contact Surfaces of E u9 meat* 4-703.11 Methods of Sanitization - Hot Water and Chemical* to Proper, Adequate Handwashing 2-301.11_ Clean Condition - Hands and Aran* 2-301.12 Cleaning Procedure` 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401-i1 Satin , Drinkin or Usin�*Tabacco* _ 2-401.12 _ Discharges Prom the Eyes. Nose and Month'* 3-301.12 Preventing Contamination When Tastin �` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from. Ero lovees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca genies* 5-204.11 location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied wild Soap and Hand Drying Devices 6-301.11 Hmdwashina Cleaner. Availability 6-301.12 Hand 1),yin-Prorrvon CITY OF SALEM BOARD OF HEALTH Establishment Name: ViLL. tj% (51kimAgii'Gc Date: /d B e'/ Page: 2 of 7 Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date R — Red item Verified PLEASE PRINT CLEARLY BAda'QoeH gt tPr /3+4CK0fe-OM irl /✓�C �jRG/�Qon�f c�+r[c-�-�' Ntf�ip V'�lo/�o,lb# G�g�ir�/b /tr�O /1t£PrrrrNrrs✓� 777 �✓ L' /jirt►f RoGaN FLaaR r/ V1X'C&/,h At . lo"rd. Goeit rN r'lmw/& w- ��} N �AiThtoaH NiZzOO 1c),t d4i GLS /N8496 /tAllpArNf /r -/G. SW A✓C 6A470e n L I61W rixtua& rq,sr,,.t6- Pin Medi Coe/��_ 112eW,�if A cgvvt FD,t- 774u L/ 2!i rl C WLee rj,' h2®ub,*eui*- rv0 Is orhty ewo 6ee"Y. AtO 1htx / I4/SrrtJ6r 67L6r. d ct-&,trr 4.a02 "O dr ^.t- "I-ri)N(r I%4.Otrrl.- "r, LOOM.. IS m" 00 OG l��G!"i� X&A-4GtiM4'rrl. " I-ri)ffef- 27 G GJ/! -L/[ 114 K-Lca A AWO 6v/a4 -r /JN /N l s 14w . f Loot G*u.s Mvsr 0440,c;w,au �sr� elf Pe r 6,1s,� ro-r► YKIC-A k /.r 4 1461.f 04 Ad PA it.- l� oe.e Pa�e.e Ftrr r srrr.�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 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-,ive dollars or suspension/revocation of your food permit. 4ona!=n � A � Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 11 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 [= 18 Elenotes critical item in the federal 1999 Food Code or 105 CMR 590000. Food or Color Additives 11 3-202.12 Additives'k 3-302.14 _ Protection front 'Una roved Additives* 3-8(It II(C Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers* 7-102.11 Common Name - Working Containers* 7-201.11 Se oration-St'oraee" 7-202.11 Restriction - &esence 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 W.Lhin, Produce, Criteria* 7-204.14 Drying.Agents. Criteria* 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 Restricted Use Pesticides. Criteria* Rodent Bait Stations* T Tracking Powders, Pest Control and Monitoring* Elenotes critical item in the federal 1999 Food Code or 105 CMR 590000. Proper Cooking Temperatures for 3-801.11(B) PHFs 4-401. 1IA(1 )(2) _ Eggs- 155'F 15 Sec. 3-8(It II(C E es- limnediate Service 145°FlSsec' 3-401.11(A)(2) Comminuted Fish, Meats & Game _ 3 Animals - 155'F 15 sec. * 3-401.1 l(B)(1)(2) Pork and Beef Roast - 130"F 121 me 3-401.1 l(A)(2) Ratites; Injected Meats -155'F iS 27. sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PIfFs, 28. Stuffing Containing Fish, Meat, FC - 7 Poultry or Ratites -165`P 15 sec. 3-407.11(7)(3) Whole -muscle, Inaict Beef Steaks 145°F 3-401.12 Raw Animal Foods Cooked in it Microwave 165`5 * 3-401.I1(A)(1)(b) Alt Oil.. PHF,- 145"F '15 see. * Reheating for Hot Holding 3-403.1 I (A)&([)) PHFs 165°F l5 sec. 3-403.11.(B) Microwave- 165° F 2 Minute Standing Time" 3-40111(C) Commercially Processed I2TE Food - WOOF* 3-403.1.1(E) Remaining Umliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHF., from 140"F to 70'F Within 2 Hours and From 70'F to4FF/45'F Within 4 Hours. * 3-501.'14(B) Cooling PHFs Made Front Ambient Temperature Ingredients to 41"F/45'F Within 4 hours* Elenotes critical item in the federal 1999 Food Code or 105 CMR 590000. sz z • 'I 2'1 3-80t.i1(A) 3-50 L N(C7) PHFs Received at Temperatures According to Iaw Cooled to 41`•F/45"F Within 4 Homs. " 3-801.11(B) 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-8(It II(C 3-501.16(B) Cold PflFs Maintained at or below 590.004(F) 41V45° F- Not Otherwise Processed to Eliminate 3-50i.16(A) Ant PHFs Maintained at or above 140°F. _ 3 3-501.16(A) Roasts Held at or above 130T 20 Time as a Public Health Control Pasteurized Eggs Substitute for Raw Shell 3-501.19 Time as a Public Health Control* 27. [:590 004(H)Variance Requirement sz z • 'I 2'1 3-80t.i1(A) Unpasteur:izeciPre-packaged7uicesand $cvefaees with Warri ne l...abels* 3-801.11(B) Use of Pasteurized Eaes* 3-801.1.1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 3-8(It II(C UnotenetsFood Packa.eNotRe-served." CONSUMER ADVISORY 22 3-603.11 Consmner Advisory Posted for Consumption of 580.000 23. Animal Foods That are Raw- Undercooked or FC - 2 _ .003 Not Otherwise Processed to Eliminate Food and Food Protection _ 3 Pathogens.* e"`rJe "I" 25. 26. 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 .006 27. Eger= 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 {129 - Special Requirements. rJr7 Fii�7MT39 (items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and rash fusions listed above, can be Mound in rhe following, sections of the Food Code and 105 CMR 590.000. Item Good Retail Practices FC 580.000 23. Mang ement and Personn_e_I FC - 2 _ .003 24. Food and Food Protection _ 3 .004 25. 26. ___FC- Equipment and Utensils Water. Plumbin and Waste FC - 4 FC - S .005 .006 27. Ph sisal Facility FC -6 .007 28. Poisonous o_ r Toxic Materia_Is FC - 7 .00II 29. S eclat R uirements .009 30. Other £SMrmnb,G'ti2 d,. CITY OF SALEM BOARD OF HEALTH ,t Establishment Name: V /1 L f� r 09094466 6 ra eDate: /o� 4`4 Page: � of `l Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date R - Red Item Verified PLEASE PRINT CLEARLY C 616 lJ 6ydWm4- Altos "ell Kha 111 -ate cJ4W-1 Al 0009- ArV Of' r'#C FlkMfr lloe<P of r_ - Arf 40a reKIOfX At.[._ pask-o rN or- drr i'tf:3F r.✓A{44L rar w�rN ?1J C 1Q&#04 A" 1`1116j9 44WfeAf1'i ark rYrsr.rof Gc£i4r✓!r. s. /q 148 9 ur*Slf svNK w5ri,46 _,;2W "a ?o&g-Fbarsrs 11409010k 5-44I *4'# OIJP *1W PrM6iL tN&Ls r WAIA— NvN6- O0'5"*.r14r'a9r Af ALL 17AUCS. '7JZ � � Lg7r�- r3�rhrr4 G��r��a< IS v ryNlsrdtFp. F�voa<- ruus�" rSef MrtOtl t I�taw '11/ Fit Accts -S r87 C_s..�Sg P�toA�" (tc;: PAt1C Oee.4s �r� SUSS R R"11 rU w9-rC14&R ?Jl rr AvL- IA uj r MrSo A 17dOrEou6141- G$hrfrr4- 00 /1SMIt"17944, atc M- rs s d' Gamw Beit t'o 1 F t sfv16L rdr f rul rr c �r�r[ru�•r' sf'1h1?,s nfcsn tb R6 Rti ?S( LIrkii 0 of 646& 4k&A rM1EtLp / *VA Altd*T of 0-8-W 4VO AW, AA- vhr 0A -M46 -C at Ik31Ptu- 0"00 C[Ir-rNA- 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 dollars or suspension/revocation of your food permit. r 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 16 17 18 m Denotes critical item in rile Inderal 1999 Food Code or 105 CMR 590-000, 3-501.td(C) Food or Color Additives 3-202.12 Additives'" 3-302.14 Protection from Una s. roved Additives'= 3-50t,16(B) 590.004(F) Poisonous or Toxic Substances 7-10t.1 1 Identifying Information - Original Containers* 7-IU2, I1 Common Name - Workine Containers* 7-201.11 Se.oration-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 DtyiitL, 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* m Denotes critical item in rile Inderal 1999 Food Code or 105 CMR 590-000, 3-501.td(C) Proper Cooking Temperatures for K3-501.15 PHFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-50t,16(B) 590.004(F) B gs-hnmediate Service 145°FlSsect 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501.16(A) Animals - 155'F 15 sec. * 3-401.11(11)(1)(2) Pork and Beef Roast -130'F 121 min - in*3-401.11(A)(2) 3 -40 1.11 (A)(2) Ratites, Injected Meats - 155'F 15 590.004(H sec. t 3-401.1.1(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165017 15 sec. rc4 3401.11.(C)(:3) Whole -muscle, Intact Beef Steaks 145'F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165"F* 3-401, 1 I(A)(1)(b) All Other PHFs- 145'F 15 sec. Reheating for Hot Holding 3-403.11(A)&(I)) PHFs 165'F 15 sec. s= 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(E) 3-403.11 (E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(1),) Cooling Cooked PHFs from 140'F to 70"F Within 2 Flours mid From 70'F to 41.'F/45'F Within 4 Horns. * 3-501.14(B) Cooling PHFs Made Front, Ambient Temperature 'Ingredients to 4l'F/450F Within 4 flourst m Denotes critical item in rile Inderal 1999 Food Code or 105 CMR 590-000, 3-501.td(C) PHFs Received at Temperatures According to Iaw Cooled to 41 `F/4YF Within 4 Hours. K3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-50t,16(B) 590.004(F) Cold PHFs Maintained at or below 41`145° F* 3-501.16(.4) I lot PHFs Maintained at or above 140'1`,* 3-501.16(A) Roasts Held at or above 130°F. 20 Timeas a Public Health Control 3-501.1.9 Time as it Public Health Control* 590.004(H Variance Re uirement 21 3-SO1.11(A) Unpasteurised Pre-packaged Juices mid Beverages with Warning Labels* -of 23. 24. 3-SO1..11(B) Use Pasteurized Bags* 25. 26. 3-801.11(D) Raw or Partially Cooked Animal Food and Kaw Seed S t,touts Not' Served. 's 27. 3-801.-II(C) Uno erred Food Packa >e No[ Re -served- a` f 22 3-fiO3. i 1 Consumer Advisory Posted for Consumption of 23. 24. Marra amen and Persona el Food and Feod Protection Animal Foods That arc Raw, Undercooked or 25. 26. _ _E-irement and Utensils _ Water, Plumbin and Waste - Not otherwise Processed to Eliminate 27. Phsical Facili __-- Path OaenS.t ERncoro� vvaom 28. 3-302.11Pasteurized Eggs Substitute for Raw Shell 29. S ecial R uiremants EE*s* orcv"A . ncaarnnervrenv r a -Section Violations of Section 590.009(A)-(7) 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. tib► 0X0riTT] (items 23-30) Critical mrd rein -critical violations, which do not relate to the foodborne illness interventions and risk jactars listed above, can be foend in the following sections of the Food Code and 105 CMR 590.000. item - Cood Retain Practioe_s FC -X90.000 23. 24. Marra amen and Persona el Food and Feod Protection FC - 2 .003 FC -3 .004 25. 26. _ _E-irement and Utensils _ Water, Plumbin and Waste - FC -4 -005 -005__ FC -5 27. Phsical Facili __-- 7C --6 .007 28. Poisonous or Toxic Materials_ FC -- 7 1 .008 29. S ecial R uiremants ; ,009 30- ---------------- Other �svor „��ma�.zaoc ITY OF SALEM 1 aBOARD OF HEALTH // Establishment Name: VILL-4 S /ZoCt� 6f If"g Date: 14OLebY Pager of V Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION "" PLEASE PRINT CLEARLY Date Verified 64CK 460LA f} smdw lAvir m4 icv #Astwr cv, rr Ag:;.; pw c61� u.,&NN oust' rv& 64" stem d mmif . 0a it r Nair NO;r' A KI NA Riff b 'kk', i e.ld UNff dffil V)-reOi.t£ oeoo-v4v f7tlaA frm 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 dollars or suspension/revocation of your food permit. h�n-yq�� r Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 15 18 ° Denotes critical item in Ilse foleral 7994 Food Code or 105 CPM 590.000. Food or Color Additives 3-202.12 Additives'" -- 3-302.14 Protection from Unapproved Additives* 19 Poisonous or Toxic Substances 7-10 L i I Identifying Information - Original Containers* 7-102-11 Common Name- Workin" Containers* 7-201.11 Se .oration -Stora *e* 7-202.11 Restriction -Presence and Use't 7-202.12 Conditions of Use, 7-203.1.1 Toxic Containers - Prohibitions* 7-204.11 Sanitizets,Criteria - Chemicals" 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying A eats. Criteria* 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 1 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitoring* ° Denotes critical item in Ilse foleral 7994 Food Code or 105 CPM 590.000. Proper Cooking Temperatures for PHFs Received at'Fcntperaturas According to Law Cooled to 41`F145°F Within 4 Hours. PHFs 3-40'1.IIA(1)(2) Eggs- 155°F 15 Sec. 19 E res-Itmuedrate Service 145"F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501,16(B) 590.004(F) Animals - 155"F 15 sec. "- 3-401.11.(B)(1)(2) Pork and Beef Roast - 130°F 121 into* 3-401.11.(A)(2) Ratites, Injected Meats- 1550F 15 3-501.16(A) sec. * 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Control Sniffing Containing Fish, Meal, 3-501.19 Poultry or Ratites -165°F 15 sec. 3-401.11(C)(3) IMimle-muscie,Intact Beef Steaks Variance Re uirement 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)8c(D) PHFs 165°F 15 sec. °' 3-403.11(B) Microwave- 165" F 2 Minute Standing Time* 3-403.1 1(C) Commercially ,Processed RTE; Fad - 140"F* 3-403.11(E) Remaining Unslieed Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) cling Cooked PHFs from 140°F to 70"F Within 2 Roars and From 70°F to 41°F145"F Within 4 Hours. * 3-501.14(B) Cooling PHFs Made Front Ambient Temperature Ingredients to 4V]7145°F Within 4 Hours* ° Denotes critical item in Ilse foleral 7994 Food Code or 105 CPM 590.000. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.11(A) 3-SQ1.I=I(C) PHFs Received at'Fcntperaturas According to Law Cooled to 41`F145°F Within 4 Hours. i3-501.15 3-801,11(D) Coolml� Merhods for PHFs 19 Uno cued Food Package Not Re -served. PHF Hot and Cold Holding 25 26. 27. 3-501,16(B) 590.004(F) Cold PHFs Maintained at or below 41`145"F* 28. 3-501,16(A) Hot PHFs Maintained at or above 140°F. * 29. 3-501.16(A) Roasts Held at or above I30"F. 20 Other Time as a Public Health Control 3-501.19 Time as aPubHcHealth Control* 590.004(H) Variance Re uirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 3-801.11(A) Unpasteurized Pre-packagcd Juices and Beverages with Warning Labels* 3-801.11(B) Use of Pasteurized'Eg,,s* 3-801,11(D) Raw or Partially Cooked Animal Foal and Raw Sccd S routs No[ Seuved. 3-801.11(C) Uno cued Food Package Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 23. _Practices Mona ement and Personnel Anitual Foods That are Raw. Undercooked or _24. Food and Food Protection Not Otherwise Processed to Eliminate 25 26. 27. Eqyjpment and Utensils _- Water, _P_Iumbing and Waste Physical Facility. _ Pathogens.* "" ""''o 28. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 29. S ectal R uirements - Ems* .1. t'MAAL KMUU1KtMM I S 590.0091A)) -(D) Violations of Section 590.009(A) -(ll) 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. 1I"U7ta (Items 23-30) Critical and non-erilieal violations, which do not relate to tire foodborne illness interventions and risk factors listed above., can be; foaind in the following .tec tions of the Food Code and 105 CMR 590.000. . to Good Retail FC 590.000 23. _Practices Mona ement and Personnel FC - 2 .003 _24. Food and Food Protection FC -3 .004 25 26. 27. Eqyjpment and Utensils _- Water, _P_Iumbing and Waste Physical Facility. _ . FC 4 .005 FC -5.006 FC--fi .007 28. Poisonous or Toxic Materials_ FC --7 .008 29. S ectal R uirements - .009 30. Other _! e;5trorom�bykfi-LJoc CITY OF SALECITATION NO. M /� VIOLATION NOTICE A 291 NAME (LAST, FIRST, INITIAL) , Villa's 6rocsrg4k, STREET ADDRESS CITY/TOWN STATE ZIP J1 5%i t JC C S% LICENSE NO. is LIC. EXP. DATE DATE OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) v� T u sr STREET�ADD ESS CITY/TOWN STAT ZIP �a -Sr,i;j)qa J REGISTRATION NO. SATE EXP DATE MAKE/TYPE YEAR COLOR DATE OF VII�OLATTI�O'N/I TIME y1 DATE CITATION WRIITTTTE/NN IN��SNONAL D,PIv1 I [-]ElYENO LOCATION OF VIOLATION ENFORCING � DEPT. ` bfi 35La - r sr l�e�rI � OFFE�NN-SSi'E�) CHAR SECT. FINES � A GY1 viz l.�t'17SA? p f 7 J` K •OSI B C OFFICER ID. NO. TOTAL FINE �%�, $ DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR 11 W}% j .j}y,4{f (/n� ❑ IN HAND X 1 f `d �il P 4N 0 ©l YMAIL DO'NOT`MAIL'6CASH - PAY ONCY'BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: t CITY CLERK �JJ CITY HALL 93 WASHINGTON STREET 01970 TEL. (508)) 7 745-95959 5 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE # SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL i s roce r ) 1) LICENSE NO. I I LIC. EXP. DATE DA E OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) NT STRE AD ESS CITV/TOWN STAT ZIP G e S, 4 s SATE EXP. DATE MAKE/TYPE YEAR COLOR co A4� PERSON L ' U'U`i I Lf) r m LOCATION OF VIOLATION ENFORCING , DEFT. ) i- �- :�41"ln oarz aM. .5( . aV OFFENSE I CHAP. SECT. FINES A rLuYz I 7� Q? 5 .o d 8 B it C OFFICER,_.._ I.D. NO. TOTAL `^ O7 ��-_ � FINE I DUE J 1 IS w Cc :yyI v !1 'o 0 o I WrI � N it ry .a o lym LuLu a i r C (] J fro & Wim LI?a Lo I�' �a� Ln NN 00 l , J I, O 1 m LNa E Yfw QO¢ aro 0 O F u COURT DOCKET NO.'... _ CITATION NO CITY OF SALEM A 29.11 VIOLATION NOTICE G NAME (LAST, FIRST, INITIAL) s roce r STREETADDRESSCITY/TOWN STATE ZIP LICENSE NO. I I LIC. EXP. DATE DA E OF BIRTH OWNER'S NAME (LAST, FIRST, INITIAL) V STRE AD ESS CITV/TOWN STAT ZIP G e S, 4 REGISTRATION NO. SATE EXP. DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATIONTIME DATE CITATION WRITTEN PERSON L ' U'U`i I NJURY ONO 07'b LOCATION OF VIOLATION ENFORCING , DEFT. ) i- �- :�41"ln oarz aM. .5( . aV OFFENSE I CHAP. SECT. FINES A rLuYz I 7� Q? 5 .o d 8 B C OFFICER,_.._ I.D. NO. TOTAL ��-_ � FINE $ L� DUE J OFFICER CERTIFIES COPY GIVEN TO VIOLATOR 1 ..�r IN HAND I r� u i � � ,! EJI MAIL DO �NOT*A(CCASH - PAY ONLY BY POSTAL NOTE, MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL / 93 WASHINGTON STREET SALEM, MA 01970 TEL. (508) 745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE, PEEL AND SEAL 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 `VR6 of Operation(s) Type of Inspection outine Re -inspection Previous Inspection Date: [ 7.01 ❑ Pre-operation ❑ Suspect Illness El General Complaint ElHACCP ❑ Other M Food Service (Retail El Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer E3 Bed &Breakfast Permit No. Address�F/%I1P 1 Telephone _ / 74/�(_ 416 76 Risk Level Owner A�-Md ,€wG2 C A/0 v 7 J P/✓I HACCP Y/N Person in Charge (PIC) JH Nt /+ ! (4 /, Time In; Out: Inspector J Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 1. PIC Assigned / Knowledgeable / Duties .EMPLOYEE HEALTH - --- ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded '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. 'C3 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 500/nsp�tFom 14doc ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS - ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑Z18. Doling 9. 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): G 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, ecto Imignati •e / Print: PIC's Signature: A( Print: / A f /Page of '�Yages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT L 590.003(A) IAsci g anent of of Knowledge 590.003(B) TJenlonsrr ruon of Knowledge" 2-103.11 Person m ch age - duties 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 Esggs* 590.003(1 Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking, Water* Applicant To ReportTone Person In Drinking Water from an Approved S_vstern" 590.006(A) Chm g,e k 590.006(B) 590.003(G) Re ortinn h Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C IN C * Denote, critical item in the fesltral 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION F8 Food and Water From Regulated Sources 540.004 A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealui Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Esggs* 3-202.1.4 E¢ s and Milk Products, Pasteurized" 3-202.16 Ice Made From Potable Drinking, Water* 5-101.11 Drinking Water from an Approved S_vstern" 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegztables Shellfish and Fish From an Approved Source 3-201.14 Fisit andRecreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory AuthontV 3-202.15 Shellstock Identification Present* 590.004(0) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11. Receiving/Condition 3-202.11. Pffs Received at Pro ger Tetn >eramres* 3-20215 package Integrity* 3-101.11 Food Safe and Unadulterated TagslRecords: Shellstock 3-20113 Shellstock Identification x 3-203.12 Shellstock Identification Maintained' Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(3) Labeling of Ingredients' Frequency of Sanitization of Utensils and Fmxl Contact Surfaces of Equi !E ffi Conformance with Approved Procedures 1HACCP Plans t3-5�502,11 S eci ati ud Processing Methods* .12 Reduced oxygen tacka�*InR, criteria^.12 Proper, Adequate Handwashing Conformance with Approved Prix edures* * Denote, critical item in the fesltral 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION F8 Cross -contamination v 3-302.7 I(A)(t) Raw -Ani-mat Foods Separated frrnn Cooked and RIF Foods" Contamination from Raw Ingredients 3-302A 1(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.75 Washing Fruits and Vegztables 3-304.11 Food Contact with Equipment and Utensils" Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposltlon of Adulterated or Contaminated Food 3-701.11. Discarding or Reconditioning unsafe Food* 9 Food Contact Surfaces 4-501.111 Manual Waiewashing- Hot Water Sanitization 'fe.m. eranues* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eral'ureS* 4-501-114 Chemical Sanitization- temp., pH, concentration and hardness. 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-60211 Cleaning Frequency of Equipment Food - Contact Surfaces and utensils* }-702.11 Frequency of Sanitization of Utensils and Fmxl Contact Surfaces of Equi !E ffi 4 7(Y3.11 Methods of Sanitization -Hot Water and Chemical* Ig Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anus" 2-301.12 Cleanintr Procedure* 2-301.14 Bruen to Wash* 11 Good Hygienic Practices 2401.11 Faring, Drinking or Using Tobacco" 2-401.12 Discharges Frorn the Eyes. Vose and Month* 3-301.12 Preventing Contamination When Tastin ;' L12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* I3 Handwash Facilities Conveniently Located and Accessible 5-203.1.1 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, O eration and ,Maintenance Supplied with Soap and Hand Drying Devices 6-301.I.I Handwashing Cleanser. Availability 6-30L12 Hard Diving Pro%ision CITY OF SALEM BOARD OF HEALTH Establishment Name: b6'pi''t. C V1'eP zV_ Date: /-/- /5 oN Page: -% of C9-- Item ZItem Code C - Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R — Red Item Verified n: PLEASE PRINT CLEARLY... 9 — e. GL Q o SGL E e cAle C11,57EX'g� 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 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 twent ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. LZ ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont) 16 17 a -r a Food or Color Additives 3-202.12 Additives *------- 3-302.14 ProtectionframUnar roved Additives* 3-501.16(A) Poisonous or Toxic Substances 7-101.11 -7-102 Identifying Information - Or i nal Containers" I1 CommonNarne-Workin Containers` 7-201.11 Separation - Slot ace* 7-202.11 Restriction - Presence- and User 7-202.12 Conditions of Use" 7-20311 Toxic Containers - Prohibitionsl, 7-204.11 Sanitizers, Criteria - Chemicals* 7-264.12 Chemicals for Washine Produce, Criteria* 7-204.14 Dr yin Aeents. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides. Criteria* Rodent Bait Stations" L!L 'Pracking Powders, Pest Control and Monitolmol a '* Denotes csirical item in the Ftteral 1999 Food Code or 105 CMR 590-000. r Proper Cooking Temperatures for 3-501.15 19 PHFs 3-401. I.IA(1)(2) Eggs- 1.55-F'15Sec. � 3-501.16(A) E >gs-7mmediate Service 145°Fl Ssec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Annuls - 155°F 15 sec. * 3-401.11.(B)(1)(2) Pork'. and Beef Roast - IM'F 721 min* 3-401.11.(A)(2) Ratites, Injected Meats -155°F 1.5 26, sec. * 3-401_1.I(A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, -LC FC -6 Poultry or Ratites -165°17 15 sec. 3-401.11tC)(3) Whole-mascle,Intact 'Beef Steaks FC - 7 145-17 3-401.12 Rata Animal Foods Cooked in a Microwave 165F 3-401.11(A)(1)(b) All Other PHFs- 145°F '15 sec. _ _ Reheating for Hot Holding 3-403. i 1(A)&(0) PHFs 165°F 15 sec. 3403.11 (B) Microwave- 165° F 2 Minute Standine Time* 3-403.11(C) Commercially Processed RTE Food - 140"F'" 3 103.11(E) Retnaiame Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501. t4(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. * 3-50'1 '14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45'17 Within 4 Hours'E '* Denotes csirical item in the Ftteral 1999 Food Code or 105 CMR 590-000. r 21 7801.11(1) PHFs Received at Temperatures .According to Law Cooled to 41°F/45'F Within 4 Hours. 3-501.15 19 Cooling= Methods for PHFs PNP Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 41V45° F" 3-501.16(A) Hof PHFs Maintained at or above 140R* 3-501.Ib(A) Roasts field at or above 130°F. 20 Time as a Public Health Control 3-50].1) Time as a Putz(ic Health Control* 590.004(H) Variance Re uirentent 21 7801.11(1) Unpasteurized Pre-packaged Juices and _Beverage$ Warmth! labels* 3-801.11(B) _with Use of Pasteurized &cgs* 3-&01.11(0) Raw orlsattiallyCookedAn(malFood and Raw Seed S }routs Not Served. 3-so1.11(C) Une. ened Food Package Not Re -served " • 22 3-ti(13.11 Consumer Advisory Posted for Consmnption of 590.000 23. Animal FrKids'Mat are Raw. Undercooked or FC -2 .003 Not Otherwise Processed to Eliminate _ _ Food and Food Protection FC - 3 Pathogens.* Efte"16 1/1"N'11 25 3-3112.13Pasteurized Eggs Substitute for Raw Shell 005 26, -EES!- 590.009(A) -(D) Violations of Section>90.009(A)-(D) in catering. mobile food, temporary and residential kitchen operations should be debited ander 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. M1KNZlIiI191 (Iterrrs 23-30) Critical and non-rrilicai viohaions, 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 10.5 CMR 590.000. Item Good Retail Practices FC 590.000 23. Mona sment and Personn_e_I_ FC -2 .003 24. _ _ Food and Food Protection FC - 3 .004 25 __ _Fquiprnent and Utensils __ FG -4 005 26, Water, Plumbin and Waste -S .006 27. Physical Facility -LC FC -6 - - -- 1 .007 28. Poisonous or Toxic Materials FC - 7 ! .008 29. S eclat Re ulrements .009 30. Other _ _ I"Of, 2.Mc Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name �i Print: "DateType % 0 of Operation(s) of Inspection ❑ od Service Er Retail ❑Q Routine ❑ Re -inspection LI / _ r w y- Address S Risk 3S J /m Level El Residential Kitchen Previous Inspection Telephone 7�t� 76 ❑ Mobile ❑ Temporary Date: ❑ Pre-operation Owner HACCP Y/N f %7 n< T a n o Vg222❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time ti/G H- NGL)V /✓ In: Out: Permit No. ❑HACCP ❑ Other Inspector w A7mv r yyt �S Each violation cneCKea requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. s. 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 SOURCEEl 4. 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 n ❑ 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. Cr N 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) 7. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S, 5MnVp tFom 14,dw ❑ 12. Prevention of Contamination from Hands M- 3. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives W ❑ 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. 1:122. Posting�of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 3G 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 % ctor' 'S' a e: Print: PIC's Sign tore: A Print: // . yam^ / Page of I, Pages /M Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) kV signment of Responsibility* 590.003(B) _Demonstration of Knowled.,c" 2-103.11 Person in charge -duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Food and Water From Regulated Sources require reporting by food employees and 590.004('A -B) a >lkamts* 596.603(F) Responsibility Of A Food Employee Or An Food in a Hernieticaliv Sealed Container* Applicant To Report To The Person In 3-20 L 13 Char o* 590.003(G) Ra or�n in Chaise 3 590.003(D) Exclusions and Restrictions* 3-202.14 590.003(E) Removal of EXOInSlolla and Restrictions 4 Cross-contaminafran Food and Water From Regulated Sources Raw Animal Foods Separated from 590.004('A -B) Cum riiance with Food Law* 3-201,12 Food in a Hernieticaliv Sealed Container* Raw Animal Foods Separated from Each 3-20 L 13 ,Fluid Milk and Milk Products* 3-202.13 Shell Ea'r's* Food Protection* 3-202.14 E�>s and Milk Products. Pasteurized'" 3-304.I 1. 3-202.16 Ice Made From Potable Drinking Water* ihensils* 5-101.11 Drinking Water from an Approved System - stem*590.006(A) 3-306.14(A)(B) 590.006(N) Bottled Drinkin^ Water* Disposition of Adulterated or Contaminated 590.006(B) Water Meets Standards in 310 CMR 21V 3-701.11 Discarding of Reconditioning Unsafe Shellfish and Fish From an Approved Source Food" 3-20114 Fish and Recreationally Caught Molluscan Shellfish" 4-501.111. 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Sanitization Tem teramres* 4-501.11.2 Gagne and Wild Mushrooms Approved by Re Mato Authorit 3-202.18 Shellstock Identification Present` Chemical Sanitization- temp.,pH, 590.004(C) 3-201.17 Wild Mushrooms* Game Animals* $ Equipment Food Contact Surfaces and Receiving/Condition Utensils Clean - 3-202.11 PHFs Received at Proper Tenr eratures* 3-20215 Package hrte it� Frequency of Sanitization of Utensils and 3-101.11 Food Safe and Unadulterated b Methods of Sanitization - [lot Water and Tags/Records: Shellstock Chemical:' 3-202.18 3-203.12 Shellstock Identification * Shellstock Identification Maintained'" 2-301,11Clean Condition -Hands and Arms* Tags/Records: Fish Products Cteanim, Procedure* 3-402.11 Parasite Destruction* 11 3-402.12 Records, Creation and Retention* Eating, Drinking or Using Tobacco* 590.004(J) Labeling of Ingredients' g Mouth^ Conformance with Approved Procedures /HACCP Pians Preventin t Contamination Fi9ten Tastinm" 3-502.11 S ecmlized Processin Methods* 590.004(8) 3-502.12 Reduced oxv en nacka>'n� - Em lovees* 8-103.12 Conformance with Approved Procedures* "Denotes cridad item in ttre federal 1999 Food Code or 105 C IR 590.000. V PROTECTION FROM CONTAMINATION S Cross-contaminafran 3-302.11(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other - Contamination from the Environment 3-302.11(A) Food Protection* 3-302. IS Washing Fruits and VeLetables 3-304.I 1. Food Contact with Equipment and _ ihensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Rcscry ice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding of Reconditioning Unsafe m Food" 9 Food Contact Surfaces 4-501.111. Manual N9arewashnie - Hot Water Sanitization Tem teramres* 4-501.11.2 Mechanical Warewashing-I-lot Water Sanitization Tem eratures* 4-501.119 Chemical Sanitization- temp.,pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean - 4602.11 Cleaning Frequency of Equipment Food - Contact SurfaceSand Utensils'r 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - [lot Water and Chemical:' ID Proper, Adequate Handwashing 2-301,11Clean Condition -Hands and Arms* 2-301.12 Cteanim, Procedure* 2-301.14 When to Washt 11 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.1.2 Discharges, From the Eyes, Nose and Mouth^ 3.301,12 Preventin t Contamination Fi9ten Tastinm" 12 Prevention of Contamination from Hands 590.004(8) Preventing Contamination from - Em lovees* 1; Handwash Facilities Conveniently Locatedand Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement.* 5-205.11 Accessilaht •, 0 vexation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashins Cleanser, Availabili y 6-301.12 Hand Divine Provision I �a CITY OF SALEM \ BOARD OF HEALTH Z Establishment Name: V/ bLCa S t-'rOac-ele9 e Date: Y- 7-O Li Page: a of Item No. Code4 Refer eece C -critical Item 15< Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION "' _ PLEASE PRINT CLEARLY Date Verified d U r✓ e P / L FSO r/S <77Drc 9/0)(e d v 011 Z — n �✓ 9 U r. YI7 O ct� S r�9 y i / e1?,r,,)R Iee.ZS rk,,ebU e r e Cr D C r- /t/S d , ZLf ro a ry ADO -� 4P �2DS PCUrc! /•oSA ` Y — d ciL�. S i s tim LLs z�dt�S s s ?iw s w,e C4,45 - C rni e S &/rL/ a de_ ved— 64wkw sadiLr>�! �c ci (c oLdes wee�Cy e%'P F 0'V cs A a2 4Q �ICr hi v9 i // /� zz S r e— /YD U SSYtIH 1N 4"lL--� 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 twen y" -five dollars or suspension/revocation of your food permit. � Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) 14 Proper Cooking Temperatures for Food or Color Additives PHFs 3-202.12 Additives* FC -2 3-302.14 Protection from Unapproved Additives* 15 20 Poisonous or Toxic Substances 3- 401.11(B)(1)(2) 7-10t.I t identifying,, Information -Original Containers* Ratites, injected Meats -155'F 15 7-102.11 Common Name - Workm- Containers* 3-401.11 (A)(3) 7-201.11 Searation- Storase` Stuffing Containing Fish, Meat, 7-202.11 Restriction -Presence and Ilse* 3-401A 1.(C)(3) 7-202.12 Conditions of Use" 145cF * 7-203.11 Toxic Containers - Prohibitions" _F_C_ 7-204.11 Sanitizers,Criteria- Chemicals* All Other PHRs- 145'F 15 see. 7-204.12 Chemicals for Washing Produce, Criteria' 3-403.11(A)&(D) 7-204.14 Diyin A eats.Criteria* Microwave- 165' F2 Minute Standing 7-205.11 Incidental Food Contact, Lubricants - 3-403.11(C) 7 -206.11 Restricted Use Pesticides, Criteria* 14WF* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitorim 'M 16 18 4 Denotes critical item in the [,doral 1999 Food Code or 105 CMR 590.000, F143-501. Proper Cooking Temperatures for Unpasteurized Pre-packaged Juices and Beverages with Wlnnm.- lzbets- PHFs 3-401.11All )(2) EMs- 155'F 15 Sec. FC -2 Eggs- linmediate Service 145°1715sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Animals - 155°F 15 sec. z' 3- 401.11(B)(1)(2) Pork. and Beef Roast - I10'F 121 min* 3-401.11(A)(2) Ratites, injected Meats -155'F 15 26. sec. * 3-401.11 (A)(3) Poultry, Wild Game, Stuffed PHFs, 27. Stuffing Containing Fish, Meat, FC -6 Poultry mRatites-165°17 15 sec. 3-401A 1.(C)(3) Whole muscle, Intact 'Beet Steaks - 7 145cF * 3-401.12 Raw Animal Foods Cooked in a _F_C_ Microwave 165'F s 3-40111(A)(1)(b) All Other PHRs- 145'F 15 see. Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec. * 3-403.11 (B) Microwave- 165' F2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 14WF* 3-403.11(E) Remaining Unsliced Portions of Bee 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 (0 41,'F/45'F Within 4 Hours. * 3-501.14(3) Cooling PHFs Made From Ambient Temperature htgredients to 41`P/45°F Within 4 Hours't 4 Denotes critical item in the [,doral 1999 Food Code or 105 CMR 590.000, F143-501. 3-501..14(0) PHFs Received at'remperatures I According to Lm Cooled to 4l".F/45"F Within 4 Hours. I5 Cooliiuy Methods for PHFs Unpasteurized Pre-packaged Juices and Beverages with Wlnnm.- lzbets- PHF Hot and Cold Holding 3-801.11(B} 3-501.16(B) Cold Pl1Fs Maintained at or below 590.004(F) 41145' F" FC -2 3-501.16(A) Hot PHFs Maintained at or above 14WK * Raw or Partially Cooked Aminal Food and Raw Seed S }routs Not Served. 3-501.16(A) Roasts Held at or above 130°F. 20 Time as a Public Health Control 25 3-50LI9 1 Time as a Public Health Control* Pasteurized Eggs Substrate for Raw Shell 590.004(H)I Variance Rc uiremeat 21 3-801,11(A) Unpasteurized Pre-packaged Juices and Beverages with Wlnnm.- lzbets- 590.000 3-801.11(B} Use of Pnstear u I Beus* FC -2 3-801.1 I (D) Raw or Partially Cooked Aminal Food and Raw Seed S }routs Not Served. Food and Food Protection 3-801.1 I (C) Unopened Pont Package Not Re -served. MTAHFA 22 3-60311 Consumer Advisory Posted for Consumption of 590.000 23. Animal Foods That are Raw. Undercooked or FC -2 _ .003 Otherwise Not Otherwise Processed to Eliminate Food and Food Protection FC --3 crr�m,a uveoo� 25 3-302.13 Pasteurized Eggs Substrate for Raw Shell .005 26. Eggs* CNIJ 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 foodborrte illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Speeiail Retinirements, (Itetns 23-30) Critical asd non-erilieal violations, Ivhich do trot r elate to the foodborne illness inteiventions and risk factors listed above, can be foarnd in the folhot;int sections of the Food Code and 105 CMR 590.000. It Good Retail Practices FC 590.000 23. Marracionient and Personnel _ -- --- FC -2 _ .003 24. Food and Food Protection FC --3 7004 25 Equipmem and Utensils FC - 4 .005 26. Water, Plumbing and Waste FC -5 .006________ 27. Physical Facility. _. FC -6 .007 28. Poisonous or Toxic Materials - 7 .008 29----S _ ecial R uiremenis __ _F_C_ .009 30 Other F. _-Y9rmm4�h6-2.d- STANLEY J. USOVICZ, JR. MAYOR March 22, 2004 Villa's 235 Lafayette Street Salem, MA 01970 Dear Owner, 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 On February 18, 2004 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17 -year-old female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Villa's is in violation of Section III(A) of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section, the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of ONE hundred dollars ($100) for the FIRST offense. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore, you are ordered to pay a tine of $100.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4t' floor, within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800. Sincerely yours,` -C-- oaf nne Scott Health Agent JS/bas Cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman GJ� N° 2148 City of Salem - Board of Health Violation Notice - Tobacco Sale to Minors This notice is to inform you that during a tobacco sales compliance check, your establishment violated the Salem Board of Health regulation # 24 prohibiting the sale of tobacco products to persons under 18 years of age. \/kIIG FEB 2 4 2004 1 Narrative report of incident and description of seller by adult supervisor who will testify at the Salem Board of Health meeting including a description of the seller: under the pains and f Adult that the above report is true to the best of my knowledge Adult supervisor (Prininame) G� VENDOR STA ENT: I acknowledge I received this Violation Notice on -2— -_, at _ t1 PM and I am being given a carbon copy of this notice. I also acknowledge that I have been told that a letter regarding Board of Health follow-up to this violation will be mailed to me at the above address. If vendor refuses this Notice or if Adult Supervisor feels unsafe in delivering it, an explanation must be written on a note attached hereto. Mailing of this Notice is thus required. For further information, contact the North Shore Tobacco Control Program at 978/741-5646. Board of Health-white/NSTCP-yellow/Establishment-pink