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BELLA LUNA NOW 62 ON WHARF - ESTABLISHMENTS Bella Luna 62 Wharf Street �i a 0 II i7 ie " IR 5 Commonwealth of Massachusetts 3 City of Salem Kimberley Driscoll M Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/06/2006 WHO'S PLACE OF BUSINESS IS: Bella Luna Cafe File Number:BHF-2003-0024 62 Wharf Street Salem MA 01970 LOCATED AT: 0062 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0391 Feb 6,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES IDecember3l, 2006 � Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the F,stablishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. nage 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ] j 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 �0 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION- FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I t� �`f�.��rU CC�1-C_ TEL# ADDRESS OF ESTABLISHMENT Ura- �hCt�� ��'k Sc c�QNy� (Y) O 7 0 MAILING ADDRESS (if different) OWNER'S NAME _:YCi\rnQ k_ \ Ll� '�VCjVCLOF-\inn TEL# ADDRESS 7JQ) ZJb(AL,C\— CITY STATE zip CERTIFIED FOOD MANAGER'S NAME(S)S6 ( a-tn o CERTIFICATE#(s) Keiir�s.ak• Pntzeh¢� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 1c, � rfQ_7\Ct VQ r'h h O HOME TEL# 5'2 'S Z�'3e1 U V HOURS OF OPERATION: Mon. Tue. Wed.�GThu. L.-'Fri. mat. Sun. ✓ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO less than 25 seats- 0 �5-99 seats =$150 more than 99 seats = - - ----------------------------------------------------------------------------------$100 0. - ---------...... BED/BREAKFAST YES NO $1 ADDITIONAL PERMITS ------------------------------------------------------------------------------------------......--------------------------- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES O $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES N $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. ature Date Social Security or Federal Identification Number --- -------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date lie Year Type Bill # Cost # Bill Name Ph I fjisfory l2a06 PP--R 92 25586, �BEAUTIFUL NOUN LNG Parcel ID T - 162 WHARF S ----- . _----01 _.. ..- ---.W__.. ._.. petal) Prop ID 503259 SALEM, MR 01970 Orifi BIII. Prop Luc i62 WHARF STREET E9enlSate . i 3" Special p Conditions/Notes � _C_. ons —Uiccan Int Dt Billed Abt/Adj Pmt/Crd Interest Unpaid bal specific Bill F t�08t02IU5 j 7-83 Do 1.�._ _. .00 1 57 8.40 W=Utility.Aect 2',11to2t05 J 63 00 00 z9 s.iz 3!o2ro2t6— j� 7.10 DD ._,.,, .aD .01 7.11 _ . $=Customer 4',05mim 7-10 .-- -00 ; ` .Do j 7.111 Y=Parcel Fees/Fen: .0o i .00 DO 00 00 =Name Totals:__{.. 29 A6 is87� _ 30.73 -" BBillDate s jJRH 1 owner- BEAUTIFUL Moom IMC 8®8® g4.6i; Ocuunt 'n¢ Due 02/06/2606 23.63 per Dir EXIT IDBA: BELLA LUNI CAFE JEO 062 6 Int,Pa*d / 80 Preferences CITY OF S LI PER CITY'OLLEC, a i Year Type Bill a Cust 0 Bill Hage_ Iii ,_ _. 2004 IFP--R- 89 BEAUTIFUL MOON IHC "-" - 255861st +t}+stoty ... - T 162162 WHAR� _ Parcel ID j P - etail _"- _� Prop ID 1503259 � SALEM,, 14A 91970 olig Bill Prop Loc (62 UXARF STREET I r Special ConditionslNotes LaentSate � _ Quick Scan Int Ot Billed Abt/Adj P®tfCrd interest Unpaid_hal .__.. 09 3 29 2 "; 12.64 �ecific Bill 1 [fl8l04/03 j 9.35 . '... -- �11/04/03. 9.34 i .U0 1...-.- 00 ._ 2.46 ( 12.3fl VN=Utility Acct 42-193/94 tl0 1.82 8.29. d 3102!03/04 1 b.47 J 00 �� 8.07 =CustBmer 4105/04/04 6_47 j .Oy fie© I 1.60 _„ .00 5.tl 1 e G .DO i 5.00 Y=Parcel Fees/Pen:i j 46.30 31.63 S.BO r- :90 9.67 Name Totals: -_- Lr= Discount I f�p �Dy 0210 /2006 46.30 ^' Bill Dates tiJAry j.tlwoer: BEAUTIFUL MOON INC Per Die - CITY C Fi rXIT iORA: BELL.A LOW CAFE CITY COLI Preferences PER 1 t +{ Year Type Bill A Cust 0 Bill Name Ph rienlSale ?005 �pP-ft 91 i 25586Parcel ID i62MHARF STREET Yrap ID ;503259SALEM, MA 01970 . r ____Prop Loc 62 uXARfSTREET 1 iSpecial Conditions/Notes Quick Scan int Dt Billed Aht/Adj Pmt/Crd Interest Unpaid bal specific Bill -- -__-..._----- 1188103/04 1 88/03/04 Bill 00 .90 1..71 9.82 ._..... _..._. .._.._ _.__ _.._._. .. .....:. _. �1=Utility Acct 2 11/02/04 0.19 DDI .B0 1.ea 9su X=Customer 3102/02/05 .,7.18 _ 00 _. .00 1.02 8.20 + OS/03/05 7.17 _00 .@0 i .77 7_94 Y=Parcel Fees/Pen 00 5 00 1 .00 5.00 _ Imo_ _ - _ - Z-Name Totals: 30.56 5 00 f� 4.94 40.50 Bill Dates - Discount 00' dAH 1 Owner: BEAUTIFUL MOUN tNCFEB ® Due 02!06/2086 Exit .. .. (' B Q 6 Ner Diem -"".Di" .. _. rOgfl: BELLA LUNA CAFE Ant Pai .00 Preferences CIIY Wi L + PER CITY Cold l 5eF6 f _ Salem licensing board, i I would like to inform you that The Bella Luna Cafe will be closed from February until mid April. I recently had a baby and I need to take some time off. My staff is not able to run the business without me. If you have any questions please feel free to contact me at (978)490-0569. f Thank you, e Tarantino APP 202006 C11-y OF SALEM DOARD OF HEALTH i a+:.nri^"aw*..� ad�.y...�+y. ..T.a .r_. ..wp .:b .. ' y P.",e•'U.S.,- n ,.� . . , . Massac�iusetts Department of Public Health Salem Board of Health M 120 Washington Street,4r' Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name D T e of Oosrationfsi Type of Inspection Qa Food Service El Routine AddressRisk C1 Retail 47 Re-inspection / Level El Residential Kitchen r Previous Inspection Telephone E] Mobile Date. j Owner ^ HACCP YIN 71 Temporary El Pry- para i n ❑ Caterer ❑ Suspect Illness Person in Charge(PIC Time ❑ Bed&Breakfast [I General Complaint r In: [IHACCP Inspector of on Permit No. [I Other Each violation Wiecked 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 �.. "'m ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties r.. „ _. . �..__., . . . ,,>�. ..� ❑ 13.Handwash Facilities EMPLOYEE HEALTH 'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employes and PIC -A I -- . ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ,A , 4. Food and Water from Approved Source " ` ' `TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ' F ❑ � w _ ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION �'°" m. ❑ 19. Hot and Cold Holding _ ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control NA. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) N ' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices CO UMER ADVISORY . 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): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below C by a Board of Health member or its agent constitutes an 23. Management and Personnel FC-3)(590.0 4)) order of the Board of Health. Failure to correct violations 130. 24. Food and Food Protection (FC-3){590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. if aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fca)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. Other DATE OF RE-INSPECTION:���,,,_'�-(({[n� S. ,nsPectFo,m6.14d. r"(J7',(}�t I 1 \I Inspector's Signature: Print: Q� PIC's Signature: J Print: i Page ofPages y Violations Related to Foodborne Illness ` Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590 003(A) Assignment of ResprnnibtPity" 3-302.11(A){I) Raw Animal hoods Separated from 590 003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2 103 1 t Person in char<,e--duties Contamination from Raw ingredients 3-302.1l(A)(2) Raw Animal Foals Separated from Fatah EMPLOYEE HEALTH Other* 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* a plicants* 3-302.15 Washing Fruits and Ve.aetables 590.003(F) Responsibility Of A End Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In _ Utensils* Chante* Contamination from the Consumer 590.003(0) __kporfing,by Person in Charge* 3-306.14(A)(B) ,Returned Food and Resevice of Food* 3190.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590M03(E) Removal of Exclusions and Restrictions Food 3-701.11 Discardingor Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food , 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Iaw* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food ma HertneticalN Sealed Container* Sanitization Teln peraolres* 3-201.13 Fluid Milk and MilkProduas* 4-501.112 Mechanical Warewashm. Hot Water 3-202.13 Shell[adds* Smutization Tem ezatxures* 3-202.14 Eu l imd R1ilk Products.Pasteurized'K 4-501..114 Chemical Sanitization-temp.,pH, concentration and hardness * 3-202.16 Ice Made From Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-1.01.11 DrinkingWater from an Approved S stent` Utensils Clean* 590.006(A) Bottled Drinkin Water" 4 602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equi stent* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-20IA5 Molluscan Shellfish from NSSP Listed i Chemical* Sources" t0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reouratory Authority 2-101.11 Clean Conditionn-Hands and Arens* 3-20218 Shdlstock Identification Present`" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ].1 Good Hygienic Practices Receiving/Condition 2-401.11 Fatin Drinkin,or Usm Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package Inte crit y* - .Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Sheiistock I2 Prevention of Contamination from Hands � 'on' 590.004(E) Preventing Contamination from 3-20.18 Shellstaktdentiticah. 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Em I)vaes�� Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* - 3-402.12 Records.Creation and Retention" 5-203.11 Numbers and Capacities* t of 5-204.11 [.)cation and Placement* Labeling o 5)0.0(11CJ) 9M . Conformance with A 5_205.011 Aceessibilit�,Operation and 7 Approved Procedures s lHACCP Pian Supplied with Soap and Hand Drying Devices 3-502.17 Specialized Processing Methtxls* 3-502.12 Reduced ox gen packaging,criteria* 6-301.11 Hand Drying n Cleanser,Availability 8-103.12 C'.onfortuance with A p roved Procedures" 6-30,1.12 Hand Dryim,Provision *Denotes,critical item in the federal 1999 food Code or 10i CNN 590,600. Y CITY OF SALEM f BOARD OF HEALTH ` Establishment Name: I�. �c n�� � / Date: a�JPage:_ of ' Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item - Verified s PLEASE PRINT CLEARLY �j.av AV, ,14 P T. I, r r,� P i l l J o ( 4S , nCIL-1)"I i l L o n 04 -�,J / , 5, .1 t i t f _ r i F { I I 9 . l J G — ;IAA9n i .z (e2 h coU C7 Discussion With Person in Charge: Corrective Action Required: Ll No Yes l I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion W iolations before the next inspection, to observe all conditions as described, and toRe-inspection Scheduled ❑ Emergency Suspension ek�x 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 'r your food permit. / �� ❑ Voluntary Disposal ❑ Other: r- 3-501.14(0 PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to law Cooled to Factors(items 1-22) (Cont.) 4l'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-001.15 Conlin-Methods for PiIFs 14 Food or Color Additives l9 PHF Hot and Cold Holding 3-501.16(6) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41145'F* 3-302.14 Protection tram Unapproved Additives, 3-501,16(A) lfat PHFs Maintained at or above 15 Poisonous or Toxic Substances 140°F, 7-101.11 Identifying Information-Original 3-501.16(?,) Roasts Held at or above 13017. Containers* 7-102,11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Use's 590.004(H) Variance Re-augment 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers Prohibitions* POPULATIONS(HSP) 7-2(k1.11. Saitutzers,Criter3a-Chemicals* 7.204.12 Chemicals for Washing Produce- Criteria^` 21 3-801,11(A) Unpastetnizcd Pre-packaged farces and 7-204.14 Drying Agents,Criteria* Beverages with W rrinia Labels* 7-205.11 Incidental Food Contact, Lobricants* 3-801 11(B) Ilse of Pasteurized Ries' 7-206.11 Restricted Use Pesticides.Criteria* 3-801 l i(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 's 7-206.12 Rodent Bait Stations"` 3-801.11(C) Unopened Food Package Not Re-served. 7-206.'I3 Tracking Powdcrz,Pest Control and . Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.'11 Consumer Advisory Posted for Consumption of 1fi Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.t1A(1)(2) Eggs- 155'F 1.5 Sec. Pathogens re"'' neo; Eggs-Iran ediate Service 145'F I5sec* 3-302.13 Pastennrr,d Eggs Substitute for Raw Shell- 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Amends- 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beet'Roast- 130'F 1.21 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590,009fA)-(D) Violations of Section 590.009(A)-(D)in sec * catering,mobile food, temporary and 3-401 J 1(A)(3) Poultry, Wild Game,Staffed Pills, residential kitchen operations should he Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-1650F 15 sec. * above if rehired to foodborne illness 3-40111(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145'1715 sec.' 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 se:. * (Reims 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions'ar+d rislafactors listed above, can be 3-403.t 1(C) Commercially Processed RTE Food- found bi the fallowing sections of the Food Code and 105 CMR 14WF* 590.000. _ 3-403.11(F) Remaining Unsliced Portions of Beefitem Good Retail Practices FC b90.000 Roasts* 23 Mana ement and Personnel ______ FC- 2 .003 24. Food and Food Protection 18 Proper Cooling of PHFs FC 3 AM 25 _Water,Equ�ment and Utensils _ FC 4 .005 3-501.14(A) Cutting Cooked PHFs from 140'F to 28 Plureta and Waste FG-5 .006 70°F Within 2llours and From 70'17 27. Phihps cal Fecili _ FG-6 .007 to 4 t'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .003 3-501.14(B) Cooling PHFs Made From Ambient 29. S ectal R- ulrements _ .009 Temperature Ingredients to 41°F/450F 30, -Other - Within 4 Hours* ss�or«ni,raa-m, Denote.,crricat ficin in the(Mend 1999 Food Code or 105 CMR 590 000, ".ry _.. . .. ✓r4A.^rYrA"rtY•%.e .vmFglM1vi'a��v.!'1+�- ayh.A..♦ .r �" /.. k-fiE a.r.>• .4"hJ'h� .•*,.,,,.w-'=nf+.... "-s,.-.,. i artment of Public Health saiem Board of"earth Massachusetts De p 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 Data TYpe of Ooeration(s) Tvne of Insinection ONA& J p2 J 'Food Service Routine AddressRik Retail Re-inspection Level ❑ Residential Kitchen Previous Ins ection Telephone 124if ❑ Mobile Date: `'J0 HACCP WNElTemporary ❑ Pre operation Owner Col HC' t ICJ ❑ Caterer ❑Suspect Illness Person in Charge{PIC) Time ❑ Bed&Breakfast ❑General Complaint Time Inf3 El HACCP Inspector g. Off. Permit No. ElOther_ 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. x FOOD PROTECTION MANAGEMENT _ „ . a _ { ❑ 12.Prevention of Contamination from Hands ( - ❑ 1. PIC Assigned!Knowledgeable/Duties 13.Handwash Facilities EMPLOYEE HEALTH ,. PROTECTION FROM CHEMICALS^ '�� - -- - ❑ 2. Reporting of Diseases by Foal Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals . ;',FOOD FROM APPROVED SOURCE "" TIMEfTEMPERATURECONTROLS(Potentially HazardausFoods) ❑ 4. Food and Water from Approved Source ❑ 5. Rec- iving/Condition ❑ 16.booking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance:with Approved Procedures/HACCP Plans ❑ 16. Cooling "PROTECTION FROM'CONTAMINATION -"- '' [119.Hot and Cold Holding ❑ 6. Separation!Segregation/Protection ❑20.Time As a Public Health Control M/9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �\ [:]21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing a_ UMER ADVISORY .. . (] 11.Good Hygienic Practices 2. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodbome Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1.22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003} order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of -25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:_ S:SBUInspeclFUnnb-f4tloc / Y Inspector's Signature: Print: PIC's Signature: - �1 �,,,,,/"- Print: ^ ! Page of�Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination I 590.003(4) AssignmenfofResponsthility'" 3-302.11(A)(1) Raw Animal EooclsSeparated trom 590 003(Bi�Demonstranon of Rnau ledge` - Cooked and RTE Frxtds* r< 103.t I Perw>n in charge-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Pools Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal ernployces and 3-302.1 1(A) Foal Protection* a 2licamts* 3-302.t5 Washing Fruitsand Vegetables 590.003(F) Responsibility Of A Foci Employee Or An 3-304.11 Food Cordaci with Equipment and Applicant To Report'ro The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Refsortmg by Pars)n in Charge* 3-306.14(A)(B) Returned Food and Resetvice of Food'" 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrict ons Food 3-MIA I Discarchng or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(4-B) Compliance with Food Law* 4-501.11 1 ManualWarewashing-Hot Water Sanitization'Teiu eratures* 3-201.13 Fluid Milk and Milk Products* b Hot Foci in il Hermetically cts Container* 4-501.11.2 Mechanical WarewashinR ot Water 3-202.13 Shell Eons* Sanitization Temperatures* 3-202 14 Eo gs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 lee Made From potable Drinking Water* concentration and hardness. ,w 5-101-11 Drinking in Water from an Approved System* 4-601.11(A) Equipment Foal Contact Surfaces and Utensils Clean" 590.006(A) Bottled Drinking Water* ` 4602.1 L Cleaning Frequency of Equipment Foal- 590.006(B) Witter Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4_702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact Surfaces±!E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed i Chemical" Sources* 10I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authori 2-301.11 Clean Condition-Hands and Arens" 3-202.18 Shellstock.Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms` 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401._1 l Eatin ,Drinking or Usin Tobacco* 3-20111. PHFs Received at Proper Temperatures" 2-401.1.2 Discharges.From the Eyes, Nose and 3-202.15 Package bite it-* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When'Tastintr* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em lovees* Tags/Records:Fish Products 13 Handwash Faciiities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibilit ..O reration and.Maintenance /HACCP Plans Supplied with Soap and Hand Drying p° 3-502.11 S ecialized Processing Medials'* Devices 3-502.1.2 Reduced nx • en racka ring. criteria* 6-301.11 Handwashht Clcauiser, Availability 8-103.12 Conformance wi.fh Ar roved Pra:edures'" 6-301-12 Hand Dr -m,provision N tlr "'Denotes critical item in the federal 1999 Food Code or 105 Ct14 R 590100. r CITY OF SALEM • BOARD OF HEALTH Establishment Name:al W�(r. ), .A/- ( ( Date: -lot / Page: of t item Code C—critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date '{ No. Reference R—Red Item -" - Verified - I^ ' - PLEASE.PRINT CLEARLY.. - -- OV CQ I>7 c (r9'!F F �gll n4 d �a C f 4 ' • l CJ .� Crn � ! � 1 AM i Aj j-/ JAI I e 1 r Discussion With Person in Charge: Corrective Action Required: ❑ No as I have read this report, have had the opportunity to ask questions and agree to correct allrRe-msp runtaryCompliance ❑ Employee Restrictionviolations before the next ins ection, to observe all conditions as described, and to Exclusion P ection Scheduled O" 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 ofbargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other.- y cY s 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk -According to Law Cooled to Factors(items 1.22) (Cont) 4I'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooiim� Methods for PHFs --- - 19 PHF Hot and Cold Holding lA Food iColor Additives _7501.16(B) Cold YHFs Maintained at or below 3-20212 Additives* 590.004(F) 31`145° F- 3-302.14 Protection front.Unat roved Additives* 3-501.1(((.4) Hot PHFs Maintained at or above 15 Poisonous or.Toxic Substances 7-10 t.I I Identifying Information-Original 140'F. Containers* 3-501.1.6(A) Roasts Held at or above 130'F. 7-102.11 Comrnon Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora*e* 3-501.19 Time as a Public Health Control* - 7-20111 Restriction-Presence and Uses 590,004(H) Variance Requirement 7-20212 Conditions of Use" 7 03.1.1 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sanitizets,Criteria-Chemicals,' 7-204.12 Chemicals for Washing Produce,Criteria"` 21 3-80Y_11(A) Unpasteurized Pre-packaged Juices and Bever-'mages with l nnnw Labels* 7-204.14 DcidenA eoo Criteria* 3-801.11(11) Use ofPasteurizedE ��s* 7-205.11 Incidental Food Contact. cide .Criteria* 3-80I A I(I)) Raw or Partially Cooked Animal Food and 7-206,11 Restricted Use Pesticides.Criteria* Raw Sced S trouts Not Served. ,r s 7-206.12 Rodent Bait Stations"` 3-801.11(C) Una ened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of l6 Proper Cooking Temperatures for Animal Foods,chat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(I)(2) Eggs- 1.55°F 15 Sec. Path -, Eracdver Eggs-Inimediate Service 145'Fl Ssec* 3-302.13 Pasteurized I ggs Substitute for Raw Shell Eggs* 3401.11(A)(2) Comminuted Fish,Meats&Game ,. Animals- 155'F 15 sec. ,t 3-401.11(B)(1)(2), Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-40;1.11(A)(2) Ratites, Injected Meats-155"F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food,temporary and 3-401.1I(A)(3) Poultry, Wild Game,Smfted PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see. * above if related to foodborne illness 340111(C)(3) Whole-muscle,Intact'Beef Steaks interventions and risk factors. Other 145'17* 590.009 violations relating to good retail. 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165"F Special Requirements. 3401_I1(A)(1)(b) All Other PHFs- 145'F-15 sec * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(I)) PHFs 165'F 15 sec. * (Items 23-30) 3-40111(B) Microwave-165'F2 Minute Standing Critical and non-(rilasd violations, which do not relate to the Time" foodborne illness interventions and i isk factors listed'above, (on be 3-403.11(C) Commercially Processed RTE Food- found in the foilowing sections of the Food Code and 10 CMR _ 1403F` 590.000. _ 3-403.11(E) Remaining Unsliced Portions of,Beef item Good Retail Practices FC 590.000 Roasts" 23. Management and Personnel FC-2 .003 ig Proper Cooling of PHFsFC 24. Food and Food Protection -3 _ .004 25 _ EE uiprnent and Utensils FC _ 4 .005 _ 3-501.14(A) Cooling Cooked PHFs from 140"F to 26. Water, Plumbing and Waste FC-5 _.006 70'F Within 2 Hours and Front 70"17 27. Ph sical Facility FC-6 .007 to 41'F/4511F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient _29. S ectal Re uiremants .009 Temperature hngredients to 41'F/45°F -.......Other -- Within 4 IIours' ssromr,ww-z,m� Denotes anucal item io the raderal 1999 Food Code or 105 CNIR 590.060. CITY OF SALEM FBOARD OF HEALTH T Establishment Name: �� i Date: 0 �e/u- Page: 3 of =� + — ' Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION. Date 4 No. Ref rence:x� R—Red Item - Verified PLEASE PRINT CLEARLY k.t l Sit .� C / r �!� t fn G r/� . P f , a e _ e cs� H J s r— r 00( l�L �Qn r 11 f/lS �GSrv� _ � kC O I 7 ro i Q cz � I 3. J Il i f Discussion With Person in Charge: Corrective Action Required: ❑ No k 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 t 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: IT ti 1.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 4l'F/451F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-541.16(3) Cold PHFs Maintained at or below 3-202.12 ProteAdcfictios'r 590.004(F) 4P/45°F' 3-302.14 Protection from lxic roved Additives* 3-501.16(A) Ifot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original '140°F * 3-501.16(A) Roasts Held at or above 1'30°F. " Containers"' 7-1.02.11 Common Narne-Working Containers` 20 Time as a Public Health Control 7-201.11 Separation-Storage 3 501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use` 590.004(H) Variance Requirement 7-202.12 Conditions of IJse's 7-203.1.1 Toxic Containers-Prohibitions" � REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saninzers,Criteria-Chemicals* POPULATIONS(HSP) 7-204-t2 Chemicals for Washing Produce,Criteria'` 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvin Agents.Criteria* Beverages with Warnin*Labels 7-205.11 Incidental Food Contact. Lubricants' 3-801.11(B) Use of Pasteurized Eggs- 7-206.11 Restricted Use Pesticides.Criteria* 3-801-11(D) Raw or Partially Cooked Animal Focal and Raw Seed Sprouts Not Served. ., 7-206.13 Tracking Powders,Pest Control and 7-206.12 cat Bait Stations"' 3-801.11(C) Unopened Food Package Not Re-served. Tracking Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'11 at are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155'C 1.5 Sec. e c. Path * as e'rxs•. ,rzani Eggs-Intmediate Service 145"F15sec* 3-302.13 Pasteurize(!Eggs Substitute for Raw Shell 3-401.1I(A)(2) Comminuted Fish, Meats&Game E s* Animals- 155°F 15 sec. '" 3-401.11(13)(1)(2) Pork and Beef Roast- IXT 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F t5 590.009(A)-(D) Violadous of Section 90.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and tisk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Amaral Foods Cooked in a practices should be debited under#29- Microwave 1650F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 14.5°F'15 see. It 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165'@ 15 sec. * (Items 23-30) 3.403.1 UB) Microwave-165°F2 Minute Standing Critical and non-Critical vialatto o, which do not relate io the Time* foodborne illness interventions and risk-factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- ,found at the Jbllnwing.sections of the Food Code and 105 Ch4R 140°F* 590.000. 3-4011.1(E) Remainim;Unslieed Portions of Beef CItem Good Retail Practices FC _ 580.000 Roasts" -__-- --_el FC-2 .003 23. Mona ement and Persona _ -. 18 Proper Cooling of PHFs 24. Food and Food Protection _ _FC-3 .004 25. _ Equi ment and Utensils --FC---4- _ .005 3-50L1.4(A) Cooling Cooked PHFs from 140°F to 26. Water,Plumbing and Waste FC 5 006 70`F Within 2 Boars and From 70'F 27. Physical FacilityFC -6 .007 -- to 4t°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials --FC--7 .008 3-501.14(,3) Cooling PRFs Made From Ambient _29. 5 ectal Re uiremants _ _ .009 Temperature'6igredients to 41°F/45"17 30 _ Other _ _( Within 4 Flours* '"Denotas critical item in tiro federal 1999 Food Code or 105 CMR 590.000. COURT DOCKET NO. Q CITY OF SALEM'III'CITATION NO. VIOLATION NOTICE PD 051..2 NAME(LAST,FIRST,INITIAL) STREET ADDRESS CITYITOWN STAT ZIP LICENSE NO. .. LIC.EXP. AT ATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS CITU WN STATE ZIP REGISTRATION NO. STATE EXP.DATE MAKID7YPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN a.SONu UFV i NO LOCATION OF VIOLATION ENFORCING DEPT._ Jjcrt st<- OFFENSE CHAP. SECT. FINES SYr D l?h'frJ/ )4- OFFICER I.D.NO.I TOTAL FINE �• /'./G'G;S>r�' /S DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR '2 ❑ IN HAND X if'j-�fr�f�E'r-t'.-� FT-s'Y MAIL DO NOT MAIL CASH-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 STATEDON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE H SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL CITY OF SALEM, MASSACHUSETTS + a BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL 978.741-1800 FAX 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, AS, CHO HEALTH AGENT January 26, 2006 Jamie & Sal Taratino Bella Luna Cafe 62 Wharf Street Salem, MA 01970 Dear Jamie & Sal Taratino: You are currently operating your Food Establishment, Bella Luna Cafe located at 62 Wharf Street, without a Food Permit. This is in violation of the State Food Code, 105 CMR 590.000, section 8-301.11. In order to receive a 2006 Food Permit, you must: • Pay outstanding tax bills, if any • Pay outstanding tickets from the Board of Health • Pay for your 2006 Permit • Submit a completed 2006 Food Permit Application You are hereby ordered to obtain a 2006 Food Establishment Permit forthwith. Failure to do so by Monday, February 6, 2006, will result in a Board of Health Order to cease all food operations at your establishment immediately. 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. An attorney may represent you. 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. Sincerely, Joanne Health Agent CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s e, _ 3I 120 WASHINGTON STREET, 4TH FLOOR �. SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR 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: Bella Luna Cafe Address of Establishment: 62 Wharf Street Owner's Name: Salvatore J. Tarantino, Jr. Restrictions: Application Date: 1/31/2005 Permit for Food Establishment 280-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 ThisP ermit 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 Jan 18 05 01 : 12p Joanne Scott Salem BOH 978 745 0 p. 2 ' CITY OF SALEM, MASSACHUSETTS LON ��(c .�. BOARD OF HEALTH 120 WASHINGTON STREET,4TM FLOOR CCT_ SALEM,MA 01970 eQgq QFS TEL. 978.741.1800 ,D FAX 978-745-0343 �A�Tjy STANLEY J. USOVIC Z, JR. JOANNE SCOTT, MPH, RS. CHO ^^II MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ �lllCt.U. nC,( 0 -fe TEL# q7 u. ..`AI-i.S��S ADDRESS OF ESl'ABLISHMENT_(0.1k,_L,. e't- S Y 2R f MAILING ADDRESS(if differenQ OWNER'SNAME 1 i,-Q_ VSC-A TEL O�V�� ADDRESS w\ cti(y 2Gu.A CITY-LL. t oui STATE I`Inr} zip 0(g 3U CEHIIHLUhUUUMANAULK'SNAME(S) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON CO2uru __...HOME TEL#, - 3zl00 HOURS OF OPERATION: Man. I Ue. Wed. b/ThU, L/Fri,�LS+L,,.t�. 3wi.✓, TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less Ulan 10005(im, _5 50 1000-10,000sy.fl. =$100 � more than 10,000sq `0 _ft. =$2 RESTAURANT YES NO �i0 Icss Man 25 scats :-$t00 25-99 seats =$150 noire than 09 s.,its =g20U 8170/131 YLS NO '6101) ADDI'I ZONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SFRVL- YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES NO $2b Please pay total with one, check payable to we City of Salem 1 his Permit is riot transferable and must be reissued upon chango of ownership. 1'he Permit must be posted irl a prominent loralion in the Establishment. - In accordance with lire Slate Sanitary Code, 1)0101vally ranovalions, improvements, or equipment changes are. mode, all plans for such must be submitted to and approved by the. Salem Board of Health. 19u:'.ie!r11 I., N(nl ('lr�ilUa G7l'.. ;icchui� .t9n. 1i.ui Illy umlrl IN: n, ;4b1;:,Ill pw luiy 111,111, hl Illy ho!"I I:nnwli!d(I�' :uul In�liel. h;wc Lh:d :111 I;C11c I:�s n;linn:; Jnll piud Al tiI;)W 1axos nRµNOd Untlel 111u low :ilgnaui !4G YM \ n,../� ll;u,� ��Q�:lul:r,d :i�:�lady Ili I cdc of Lli;nglic;Wun Nwnu.a _- CJ /I4 -tea-.143 Ib,er. i111p 10, I i n,11:J':'.nlui 1'.:n-t:::: blob. 4 9 COURT DOCKET NO. CHATfONNO. ., o ' CITY OF SALEM TD-0512 , -051 � a 4i _ VIOLATION NOTICE JJ GG { NAME(LAST,FIRST,INITIAL) /J STREET ADDRESS CmR STATE ZIP Ad xy err? o/9 w LICENSE NO. _LIC.EXP DATE DATE OF BIRTH S =AE�'!1�'' � Op Uz V OWNER'S NAME(LAST FIRST,INITIAL) T i STREET ADORES$ CITY/TOWN STATE 21P N_ a i � flEOiST i .GATE MAKE7fYPE YEAR COLOR rm DATE OF VIOLATION TIME DATE CITATgN WRRTEN ❑AM opm YES NO O M "i Cr.LOCATION OF VIOLATION ENF.ppCMG DEpToF LD 6 ;z46 /)Ia-.fir �ASdifLR� LD OFFENSE CHAP. 'SECT. FINES AiLue� w z a w w cc a a{,OO u<" i:%%U;'. V�Q h?✓/�'�. a .. C [_ l!1 1 I OFFICER i_D.NO. TOTAL G:C rrl�;/C'" "r'7 ' FINE DUE El OFFICER CERTIFIES COPY GIVEN TO VIOLATOR (J m 7 ❑ IAA,ND "+' 'G.G�t:'Ti.�'..L_. BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE T0: CITY CLERK wd CITY HALL WU. ux o ?r 93 WASHINGTON STREET SALEM,MA 01970 d. o a TEL.(500)7459595 X 251 06 p n En I I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON Ir Q z co r w REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE Zz m o r � �� D PAYMENT IN THE AMOUNT OF = 0: < Z < l FO Ott 0 Qf F a zN $ CASEa MI LQ L < 913 G o SIGNATURE _ SEE OTHER SIDE FOR FURTHER INFORMATION W < 3 H m I ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL �J `n z a 0. <O ue�st�czz+� Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 41h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Na Date Tvpe of 0 eration(s) Tvpe of Inspection Q a r] Food Service ❑ Routine Address Risk ElRetail ElRe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone _ ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)_ Time ❑ Bed&Breakfast ❑ General Complaint In: El Inspector Out: Permit No. ElO herr. 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) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS E] 3. Personnel with Infections Restricted/Excluded [114.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ' ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)'.. El 10. Proper Adequate Handwashing El21. Food and Food Preparation for NSP El 11. ADVISORY 11. Good Hygienic Practices - ❑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): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board of Health. today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below C N: p 9 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.005> cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5WInsp tFor 14.dx I p s i n tore: Print: / 's Signature: Print: Page / of Pages Violations Related to Foodborne Illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination Y 1 590.003(A) I Assi ninent of Res ponsibiluy'` 3-1,02.11(A)(]) Raw Animal Foods Separated from 591).003(6) I Demonstration of Knowledge* Cooked and RTE Foods" 2-103.1.1Person in charge--duties Contamination from Raw Ingredients 3-302A 1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by lood employees and 3-302.11(A) Food Protection* ar licants* 3-310215 Washhuz Fruits and VeEtables 590.003(() Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To ReportTo The Person ht Utensils" Chw,,,e" Contamination from the Consumer 590.003(G) Re ortinn by Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated at Contaminated 590.003(E)_11Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE IFood* 4 Food and Wafer From Regulated Sources L9 Food Contact Surfaces 590.004(A-B) Cam Bance with Food Law* 4-501.111 Manual Warewashing- Hot Water Sanitizatian`1'em erasures" 3-201.12 Food in a Hermetically Sealed Container" 4-501.1.12 Mechanical WarewashingHot Water 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shelf Eggs* Sannizatiott Temperatures* E ge and Milk Products.Pasteurized* 4-501-114 Chemical Sanitization-temp.,pH, 3-202.14 amcenhatian and hardness. 3-202.16 Ice Made From Potable Drinking,Water* 4-601-11(A) Equipment Food Contact Surfaces and 5-101.11 Drinkim,Water from an A n'ovad Svstetn* Utensils Clean'" 590.006(A) Bottled Drinking Water 4-602,11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of F q ui anent* Shellfish* 4-703.11 Methods of Sanitization---Hot Water and 3-201.15 Molluscan Shellfish from NSSP fisted Chemical'- sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2301.11 Clean Condition-Hands and Arms" Re Mato Authorif 3-202.15 Shellstock Identification Present* ?-30112 Ctemtim�Procedure` 590-004(C) Wild Mushrooms* 2-301.14 When to Wash'' 3-20117 Game Animals* LL1_ Good Hygienic Practices g Receiving/Condition 2-401.11 Eatin r, Drinkin or Usm,Tobacco" 3-202.11 PFIFs Received at Proper Tem�etatures'" 2-40'1,12 Discharges From the Eyes,Nose and 3-202.15 Package hne>rit " Mouth" • 0 3-101.11 Food Safe and Unadulterated'" 3-31.12 Preventing Contamination When Tasting': 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands * 590.004(E) Proven ng Contamination from 3-202.15 Shellstock Identification 3-203.12 Shellstock Identification Maintained* Ent loyees* Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3 402.11. Parasite Destruction* 3-402.12 Records.Creation and Retention" 5-203-I1 Numbers and Ca Placement* 590.00,10) Labeling of Ingredients' 5-204.11 Location and Flace 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized ProcessinE Methods* Devices 3-502.12 Reduccrl oxygen tackaging,criteria" 6-301..1.1 ffandwashin Cleanser_Ayailabilit 5-103.12 Conformance with A> xovcd Pra;ednres" 6-301.12 Hand Dr-yin,Provision Denotes critical item in the federal 1999 Food Cotte or 105 CMR 590,000, r g V^ Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Nam a Date Tvoe of 0 eration(s) Tvpe of inspection Ll Service ❑ Routine Address/C /� Risk El Retail ElRe-inspection(( t Level''�n ❑ Residential Kitchen Previous Inspection Telephone / L EI Mobile Date: Owner `1 HACCP Y/N El Temporary ElPre-operation 1.111FA al-n-iki ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint HACCP Inspector O Permit No. El. � I `� Out: ❑ Other 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 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition M ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION A ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [:110. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices 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): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board of Health. today, the items checked indicate violations of 105 CMR C N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-a)(sso.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:51n &For 6I4.do Inspect o s(Si nature: Print: PiC's Signature: Print: Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION_ FOOD PROTECTION MANAGEMENT A Cross-contaminafon 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Rau Aminal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTF Foods" 2-103.1.1 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated tient Each EMPLOYEE HEALTH Otter* 2 590.003(0 Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.1(A) Food protection* applicants* 3-302.15 Washing plans and Vc,,et ibles 590.003(F) Responsibility Of A Foal Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person lit Utensils* Chm�ge* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(D7 Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E,) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning ITnsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manuel Warewashing-HotWater 3-201.12 Food in a Hermetically Sealed Container* Sanitization I em eratures's 3-201.13 Fluid Milk and Milk Products* 4-501.1.12 Mechanical arewashing-Hot Water 3-202.13 Shell Eggs* 5(l Tem eratures* 3-202.14 Eggs and Milk.Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, '1-202,16 Ice Made From Potable Drink,imz Water* concentration and hardnes 5-101.11 Drinking Water from an A xoved Svshnn* 4-601_ll(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-(102.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 Ch1R 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-2.01.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* tment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ., Re ulato Authorit 301.11 Clean Condition--Hands and Arms* 3-202.15 Shellstock Identification Present* 2301.12 Cleanim*Procedure`" 590.004(0) Wild Mushroums* 2-301.14 When to Wash" 3-201.17 Oarne Animals"` .i l Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1 1 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes Nose and 3-202.15 Packa 4 e Integrity" Mouth* 3-101.11 Fatd Safe and Unadulterated 3-301.12 Preventing Contamination When Tastin L* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.0(4(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Ent)Ioyees* Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3--402.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Ca ac cutch 590.004.1) Labeling of Ingredients` 5-204.11 Location and Placement" 7 Conformance with Approved Procedures 5-205.11 Accessibilit O station anct Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.1 f Specialized Processing Methods* Devices 3-502.12 Reducer)oxygen packaging,criteria" 6-301..11 Handwaslr2j Cleanser. Ava9labilit A-103.12 Conformance with_AEEEaved Procedure "' 6-301.12 Hand Drvin Provision `�Denote,critical acid in the federal 1999 food Code or 105 CNIR 590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name _ )Vl (d Date: Page: of Item 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 a 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: 3-501.14(() PIFs Received at'Temperatures Violations Related to Foodborne illness interventions and Risk According to Lttw Cooled to Factors(items 1.22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PIFs - 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41V45° F 3-302.14 Protection from Unapproved Additives* 4.501,Lb(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140°F. * 7-101.11 Identifying Information-Original 3501.16(A) Roasts Held at or above 130°F. Containers* 7-10211 Common Name-Working*Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.'11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions" 7-204.11 Santtizets,Criteria-Chemicals* POPULATIONS(HSP) 7-204.L2 Chemicals for W ashiue produce,Criteria" 21 3-WJ.I I(A) Unpasteurized Pre-packaged Juices and Beverages with LLarmng I abels* 7-204.14 Drying eats.Criteria' 3-801.11(B) Use of Pasteurized E -s* 7-205.11 Incidental Food Contact.Lubricants* 3_501.11(D) Raw or Partially Calked Animal Fax!and 7-206.11 Restricted Use Pesticides. Criteria* Raw Seed S xon[s Not Served." 7-206.12 Rodent Bait Sections* 3-80'1.11(C) Uno cued Food Packa re Not'Re-served. " 7-206.'i 3 Tracking Powders,Pest Control and ltonitorim** CONSUMER ADVISORY _ TIMErfEMPERATURE CONTROLS 22 3 603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-407.11A(1)(2) Eggs- ISS'F 1.5 Sec. Pathogens Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(-A)(2) Comminnted Fish, Meats&Gante - Eggs* Animals- 155°F 15 sec. x 3-401.11(B)(I)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-]55°F 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food,temporary and 3-401.1.1(A)(3) Poultry,Wild Game, Stuffed PIFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited wider due appropriate sections Poultry or Ratites-165°F 15 sec. above if related to foodborne illness 3-401.11(C)(3) Whole-musele,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to gtxid retail 3-401.12 Raw Animas Foods Cooked in a practices should be debited under#29- Microwave 165"F* Special Requirements. 3-401,11(A)(1)(b) All Other PHFs- 145°F '15see. * 19 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(I)) PHFs 165'F 15 sec. " (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-rrificat violations, which do run relate to the Time* foodborne-illness inteiventions and risk factors listed above, can he 3-403.1.1(C) Commercially Processed RTE Food- ,found in the following.sections of the Food Code anal,105 CLLR 140°F* 590.000. 3-403.11(6) Remaining Unsliced Portions of Beef Item Good Retail Practices FC b80.A00 Roasts* 23. Mana ement and Personnel FC -2 .003 1gProper Cooling of PHFs 24._ Food and Food Protection _ _ TC-:_3__004 _25. Egu�ment and Utensils FC-4 .005 3-5(]1.14(A) Calling Cooked PIFs from 140°F to 26. Water, urn and Waste FC- 006_____ -Pl-- 70`F Within 2 Hours and From 70°F 27. Ph steal Facilii _ _ FC-6 .007 to 4t°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFe Made From Ambient 29. Special Requirements _ _ .009 Temperature Ingredients to 41`F/45°F 30 Other Within 4 flours'' 3 wmo ,,&,d6-2,aa< *Denotes critical item is the.1,slera1 1999 1ood Code or 105 CNIR 590.000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name I} (k l /1 Ub\ Ve— Date: Page: of Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item. - Verified PLEASE PRINT CLEARLY a Discussion With Person in Charge: Corrective Action Required: ❑ No U Yes 1 a " ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all 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: 3 750 I 114(C) THFs Receiveci,,Cr mperatures Violations Related to Foodborne Illness Interventions and Risk According to f,aw Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolinn Me hods for PRFs Food or Color Additives 1y PHF Hot and Cold Holding 1Q 3-501.16(1;) Cold PfrIFs,Maintained at or below 3-202.12 Additives* . . . 590.0(Y4(F) -11°I45°F` 3-302.14 Protech on fromom Unapproved Addrhveas 15 3-501,tb(A) ZIot PHFs Maintained at or shove Poisonous or Toxic Substances 14o°F. * 7-10t.I l identifying information-Original 3-501.1.6(A) Roasts Held at or above 1.30°F. Containers- 7-102,11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storaee�` 3-501.19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence mid Use* 590.004(H) Variance Re vire hent 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions"` pppULATIONS(HSP) _ 7-204.11. Smutizers, Criteria-Chemicals* 7-204.12 Chenticals for Washing Produce.Criteria"' 21 3-&0'1..11(A) Unpasteurized Pre-packaged truces and 7-204.14Bever Drying Agents.Criteria* tees with K trmn*Labels' 7-205.1.1 incidental Food Contact.Lubricants' 3-801 11(3) Use of Pasteunzed F ,�s* and 7-206.11 Restricted Use Pesticides.Criteria* 3-801A1(D) Raw or Pmtiall} Cooked Animal Foal Raw Seed S fronts Not Served. ,t 7-206-12 Rodent Salt Stationse 3-80'1.1](C) Unopened Food Package Not Re-served. 7206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Coil,umcr Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foals That are Raw-,Undercooked or PRFs Not Otherwise Processed to Eliminate 3-40'L11A('1)(2) Eggs- 1.55°F 15 Sec. Path tr ns1. tr...or roar Eggs-humediate Service 145°Fl5sec* 3-302.13 Pasteurized Fags Substitute for Raw Shell 3-401.11.(A)(2) Comminuted Fish, Meats&Game Eggs* Animals- 155°F 15 sec. 3401.11(B)(1)(2) Pork'.and Beef Roast - 130`F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats 155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A){D)in sec * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165"F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal,Foods Crooked in a practices should be debited under 7/29-- Microwave 165F* Special Requirements. _340 1.11 All Other PHFs-145°F'15sec . _17 Reheating for Hot Holding VIOLA r1OIVS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)Rt(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minato Standing Critical and non-criticat vralatians, which do eat relate to tire Time" foodborne illness interventions and risk, actors listed above, can be, 3-403.11(C) Commercially Processed RTF Food- found in the following sections of the Food Lade and 105 CMR t40'F* 590.000. :3-403.1.1(E) Remaining Unsliced Portions of Reef item Good Retail Practices FC 590.000 Roasts" _23. Mona emsnt and Personnel _ FC--2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _ _ FC-3 .004 25 _ Equipment and Utensils FC 4 1 ,005 3-SO1.14(A) Cooling Caked PHFs from 140`P to 26. WateyPlumbin and Write FC 5 .006 70'F Within 2 Hours mid From 70°F 27. Ph sical Facilites FC-6 .007 to 41."F/45nF Within 4 Hours. * 26. Poisonous or Toxic Materials 3-501.14(3) Cooling PHFs Made Frmn Ambient 29 S eciel R uiremems 009 'temperature ln&redients to 41°P/45`F 30,__ ,Other___ Within 4 Yours* orn,,es-aa,< °Denotes critical item in dre federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM r�� 1 BOARD OF HEALTH Establishment Name: I ��Q i Date: Page: of Item 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. 0 Voluntary Disposal ❑ Other: 3-501.14(0 PHFS Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law C(x)led to Factors(items 1-22) (Cont.) 41'F/45"F Within 4 Homs. " PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives t9 PHF Hot and Cold Holding 3-501.16(B) Cold PFIFs Maintained at or below 3-202.12 Additives* 590.004(F) 4P/45°F* 3-302.14 Protection from Unapproved Additives* 3-501.1.6(A) Hot PH,Fs Maintained at or above 15 Poisonous or Toxic Substances 140°F. * 7-101A l Identifying Information-Original 3-501.16(A) Roasts Held at or above 130"F. Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 1 Separation-Stora e" 3-X01.19 'rime as a Public Health Control* 7-20111 Restriction-Presence and Use 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals" POPULATIONS(HSP 7-204.1.2 Chemicals for Washing Produce,Criteria* 2I 3-801A 1(A) Unpasteurized Pre-packaged Juices mid 7-204.14 Drying ents.Criteria* Beverages with W nein g t.abcls* 3-801..11(,8) list,of Pastenuzed Eggs' 7-205.11 Incidental Food Contact. Lubricants* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 7-206.1 I Restricted Use Pesticides. Criteria* Raw Seed Sprouts Not Served.,a 7-206.12 Rodent Bait Stations"' 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 'Pricking Powders,Pest Control and Monitorin1* CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFS rrrcevc r ;wi 3-401.1.1A(l)(2) Eggs- 155°F 15 Sec. Pathogen Eggs-hmoediatc Service 145°F15see* 3-302.13 PsSteUriZed Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Fees* Animals- 155°F 15 sec. * 3-401.1 I(B)(1)(2) Pork:and Beef Roast-130°F 121 mint' SPECIAL REQUIREMENTS _ 3-401.1 1(A)(2) Ratites,Injected Meats- 155'F IS 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Sec * catering, mobile foal, temporary and 3-401_11(A)(:3) Poultry,Wild Game, Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165`F 15 sec. " alcove if related to foodborne illness 3-401.11(C)(3) Whole-muscle,'hitact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFS- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4)&(D) PHFS 165°.F 15 sec.* (Items 23-30) 1403.11(B) Microwave- 165°F2 Minute Standing* Critical and non-critical violations, which do nor relate to the Time" ,foodborne illness aiterventions and risk factors listed above, can be 3-403,11(C) Commercially Processed RTE Food- found inthe following sections of the Food Code and 10.5 CMR 14WF* 590.000. 3-403.1.1(F) Remaining Uusliced Portions of Beef item Good Retar}Practices FC 590.000 _._ Roasts" 23. Mana ement and Personnel FC_-2 .003 1g Proper Cooling of PHFS 24. Food and Food Protection _FC _25 _ Equipment and Utensils 3-501.W(A) Cooling Cooked PHFs from 1.40°F to 26 Wafer; mbing and W Pluaste FC 5 006 70'F Within 2 Flour,,and From 70°F 27. Physical Facility ___ _ FG-6 I .007 to 4FT/45°F Within 4 Hours. ` 28. Poisonous or Toxic MaterialsFC-7 I .008 --........ _- 3-501.14(13) Cooling PHFS Macre From -- Ambient 29. _ S ectal Re uiremsnts .009 Temperature Ingredients to4l°F/45°F 30 ..,_ _Other _ A.------_._Within 4 Hours" ssonr,m,.ma.a.a�o ''Denotes critical item in the federal 1999 Food Code or 105 CNllt 590.000. t CITY OF SALEM BOARD OF HEALTH Establishment Name: >G1 f1 �i'� f Date: Page: of Item 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 17havdread this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion Siolatibns 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: 3-501.14(0:) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41°F/45'F Within 4 Haus. PROTECTION FROM CHEMICALS 3-501.15 Coolinn Methods for Fi1'Fs Food or Color Additives 19 PHF Hot and Cold Holding 14 3-202.12 Additives* 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 41'!45°F* 3-302.14 Protection from Unapproved Additives* 3-50'1.16iA) Hot PH Fs'Maintained at or above 15 Poisonous or Toxic Substances 140°F. 7-101.11 Identifying Information-Original 3-50116(A) Roasts Held at or above 130°F. Containers,' 7-102.11 Common Name-Workin-Containers* 20 Time as a Public Health Control 7-1-01.11 Separation-Storage* 12 3-501.19 Time as a Public Health Control* 7-202..11 Restriction-Presence and Use* 590.004(2) Variance Reo airement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS{HSP) 7-204.11 Sanrtizers,Criteria--Chemicals^' ---- 7-204.12 Chemicals for W ashin y ProdUCc,Criteria' 21 3-801.11(0) Unpasteurized Pre-packaged Juices an Beverages with Waminy Labels^ 7-204.14 Drvin A ants,Criteria" 3-801.11(8) 1h of Pasteurized Fees* 7-205.11 Incidental Food Contact,Lobncants* 3-801,11(l)) Raw or Partially Cooked Annual Foal and 7-206,11 Restricted Use Pesticides.Criteria* Raw Seed Sp-m-Not S,- 7 -206,12 Rodent Bait Stations" 3-8t)1.l l(C) Unopened Foot)Parka=e Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 LO2 ConsumerAdvisory Posted for Consumptiarrof 16 Proper Cooking Temperatures for Arwmai Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Elitminate 3-401.110(1)(2) Fags- 155Fi5Sec. Patho ens Pasteurized Eggs Substitute for Raw Shell Eggs' 3-401.11(A)(2) Comminuted Fish,Meats&Came Animals- 155°F 15 sec. * 3-401.1 I(B('1)(2) Pork and Beef Roast- 130`F 121 nun' SPECIAL REQUIREMENTS _ 3-001.11(0)(2) Ratites,Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential'kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°.F 15 see. above if related to&xldborne illness 3-401.1.1(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Oilier 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Crooked in a practices should be debited under 7{29- Microwave. 165°F* Special Requirements. 3-401-II(A)(I)(b) All Other PHFs-145°F'15 sec * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 1650F 15 sec. "' (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute St'mttline Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercial ly Processed RTE Food- found in the fallowing sections of the Food Cade and 105 CMR '1.400F*- 590.000- ----- --------__ ----- .. . 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000_-_ Roasts* 23. Mona oment and Personnel FC-2 .003 __.-__--__-.-___--- 1g Proper Cooling of PHFs 24. Food and Food ProtectionFC-3__004 25. _Etc uipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to - --- -- 26 Water,Plumbing and Waste FC 5 �� .00_6__ 70°F Within 2 Hours and From 70°F 27. Ph stem Facile FG-6 1. .007 to 41.`F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PRFs Made From Ambient 29- S actor fte uiremenis _ __---------- .009 Temperature Ingredients to 41°F/45°F 30_ _ Other Within 4Hours" r rnxm-z.u« '"Denotes critical item in the icderal 1999 Food Code or 105 CN1R 590.000. f CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR 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: Bella Luna Cafe Address of Establishment: 62 Wharf Street Owner's Name: Salvatore J. Tarantino, Jr. Restrictions: Application Date: 12/2/2003 Permit for Food Establishment 81-04 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. HEALTH AGENT f 4 Y M u CITY OF SALEM, MASSACHUSETT • BOARD OF HEALTH 120 WASHINGTON STREET, 41 SALEM, ASHSALEM, MAR01970TH FLOOR VVV""" NOV L��� TEL. 978-74 1-1800 19 FAX 978-745-0343 CITY O STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RF SALEM S, CHO BOARD F HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT bell<- LUyA- �.s TEL# 938 74/ / S S S S ADDRESS OF ESTABLISHMENT Sfi MAILING ADDRESS (if different) OWNER'S NAME TEL# CY?$ 21W'/'L09"2 ADDRESS lI SC4UtG� RJZ CITY 64awaS y— STATE /✓/4 zip 0I9,3 O CERTIFIED FOOD MANAGER'S NAME(S) 5s/ te u CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON —s}�� Cu",I HOME TEL#9-�-Ff S2 S - 3f v O HOURS OF OPERATION: Mon.--K--Tue.,5::j Wed.//- 9 Thu. //-9 Fri.'/ /c)Sat. //-w Sun./0!30 - 9 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 RESTAURANTYES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS �y MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES O $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 Chapter 6,4, Section 49A, I certify under the pains and penalties of perjury that I, to my besyyyy� I ;age � ' ve filed all stat tax returns and paid all state taxes required under the law. 4y d Ilf/t,OJ d —y, — 34� Z Signature Date Social Security or Federal Identification Number ------------------------------------------ ----------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date 'SSG— ��� w Massachusetts Department of Public Health Salem Board S Health P' 120 Washington treat, 0 Floor Division of Food and Drugs Salem,MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DateT e of O eration s Type of Inspection l„ l y Alood Service ❑ Routine AddressSf- Ris ❑ Retail I]-Ffe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone7 M F1 Mobile Date: HACCP Y/N ElTemporary ElPre-operation Owner 5-4)N ra It hNnNd ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)r Time ❑ Bed&Breakfast General HACCP Complaint In: HACCP No. ❑Other Inspector A4 �Oitry✓o; Out: 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 Foodbome Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. "FOOD PROTECTION MANAGEMENT....,. _ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH. -- ' PROTECTION.FROM CHEMICALS " .. ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - - TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source _ ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION '' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) „ [121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑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 a immediately or within 10 days as determined by the Board and Risk Factors(items 11-22)• of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-s}(590,0 9o.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 28. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:59�Inspxffpmrt-14.G'ac ) - Kor'S" ig j 1 Print: A PIC's Signature: Print: \ , Page / of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination '1 590.003(A) Assignment of Resonsibility" 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Coc*ed and RTE Foods- 2-103.11 Persoe.n in char -duties Contamination from Raw ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A 1(A) Food Protection* applicants* 3-302.15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Foci Contact with Equipment and Applicant To Report To The Person In Utensils* Charr ge* Contamination tram the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Fond and Reservice of Food* 3 590.003(17) Exclusions and Restrictions* Disposition of Adulterated or Confaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Focal* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.0(4 A-B) Compliance with Food Law* 4-501.111 Manual Wa�ewashing-Hot Water 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* -" 4-501.'112 Mechanical Warewashi 3-201.13 Fluid Milk and Milk Products* n"- v Hot Water 3-202.13 Shell Eggs* S a ihzi tion Tem terarm'es* 3-203.14 Bees and Milk Prahtcts.Pasteurized' 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. * 3-202.16 Ice Made From Potable Drinking.Water' 4-601.1.1(A) Equipment Food.Contact Surfaces and 5-1.01.11 Drinking-Water from an Approved System" Utensils Clean' 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment F�d- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization --Hot Water and 3-201.15 Molluscan Shellfish froth NSSP Listed Chemical* SourceskLO Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ufatoAuthorit 2-301.11 Clean Condition--Hands and Arms" 3-202.18 Shellstock Identification Present"; 2-301.12 Cleaning*Procedure* 590.004(C) Wild rMushrooms" 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401-11 Eating. Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes.Now and 3-202.15 package Integrity* Month* 3-101.11 Food Safe and Unadulterated* 3501.12 Preverauut Contamination 4)fien Tastin 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contanination from 3-203.12 Shellstock Ident'if-nation'Maintained* Em levees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 5-20311 Numbers and 3-402.12 Records.Creation and Retention"` a asitias* 590.004(J) Labeling of Ingredients' 5-204.11. Location mid Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility, p ,ration atd Maintanaue MACCP Plans Supplied with Soap and Hand Drying 3-50211. Specialized Processing Methods' Devices <. 6-301.I1 Handwashow Cleats-ei.Availability 3-502.12 Reduced oxygen laeka ing,criteria* 8-103.12 Conformance with Approved Procedures* 6 301.12 [land Drtiine Provision '"Denote.,Critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY`'OF SALEM BOARD OF HEALTH Establishment Name: tg&u..& 4411 /- Date: 6/t/7 /(2y Page: 2 of Item Code C—Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified LEASE PRINT CLEARLY G O F i i I� Y ,j _5 t S A r t F Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ 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, to observe all conditions as described, and to Exclusion rP Ll Re-inspection Scheduled ❑ Emergency Suspension LLZoncompliance h all mandates of the Mass/Federal Food Code. I understand that may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure i permit. ❑ Voluntary Disposal ❑ Other: J\/ 3-501.14(0) PHFs Received at Tempeatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1.22) (Cont.) 41'F/451F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs 14 Food or Color Additives I9 PHF Hot and Cold Holding 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Additives* 590.004(F) 41%45'F* 3-302.14 Protection from Una roved Additives* '-501,16(A) Hor PHFs Maintained at or above IS Poisonous or Toxic Substances 140"F. * 7-101.11 Identifying Information-Original 3-50716(A) Roasts Held at or above 130°1'. Containers" 7-102.11 Common Narne-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage" -3-5,01,19 Time as a Public Health Control* 7-202.11 Restriction-Presence and User 590.004('H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions" POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* - 7-204.1.2 Chemicals for Washing Produce,Criteria" 2I 3-801.11(A) Unpasteurized Pm-packaged Juices and 7-204.14 Dr•ing cuts,Criteria" Beverages with Warning Labels* 7-205.tl Incidental Food Contact,Lulnicants* 3-801.11(B) Use.of Pasteurized bees^' 7-206.1 1 Restricted Use Pesticides. Criteria* 3-801.11(D) Raw or Partially Cooked Animal Focal and 7-206.12 Rodent Bait Stations* Raw Seed S rrouri Not Served. 7-206,13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. *' Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or 16 r PHFs Not Otherwise Processed to Eliminate 3-401.1 l A(1)(2) Eggs- 155"F 15 Sec. Pathogens.* re"""'0" roar Eggs-Immediate Service 145'1715sec* 3-302.13 1 Pasteurised Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eegs�r Animals- 155'F 15 sec. 3-401.1](B)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 1.5 540.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited trader die appropriate sections Poultr or Ratites-]65'F 15 sec. * above if related to foodborne illness 340L 1(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail. 3401.12 Raw Animal Foods Crooked in a practices should be debited under 1!29- Microwave 165'F* Special Requirements. 3-40 LI I(A)(1)(b) All Other PHFs-- 1,45'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD DETAIL PRACTICES 3-403.11(A)&(1)) PHFs 165'F 15 sec. ^' (Items 23-30) 3-403.11(B) Microwave 165°F2 Minute Standins Critical and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Fool- ,found in the following sections of the Fool Code and 105 CMR 14WF* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 5971.000 Roasts* 23. Mang ement and Personnel. _ FC-2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection _ _ _FC-3 .004 25. ..Equipment and Utensils FC 4 _ .005 3-501]4(A) Ca ling Cooked PHFs from 140'F to 26 Water,Plumblinq and Waste FC 5 .006 _ WE Within 2 Hours and From 70'F 27. Ph sica Facilit FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29 m _ 5 ectal Re uireents _ I .009 Temperature Ingredients to 41°F/45'F 30. _ -Other_ Within 4 Hours* ssvor�,�r.�.rr��: *Denotes cruical Stun in the fodend 1999 Food Code or 105 CMR 592000_ Massa6husetts Department of Public Health Salem Board of Health Division of rood and Drugs 120 Washington Street, 4th Floor W Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of 0 eration(s) T e of inspection UYl Z /9 ,D" [TF-ood service pp outi Address Risk El Retail E] Re-inspection n Y Telephone Level El Residential Kitchen Previous Inspection 5�L S El Mobile Date: OwnerHACCP Y/N ElTemporary ElPre-operation I PM El Caterer E] Suspect Illness Person in arge(PIC) Time ❑ Bed & Breakfast ❑ General Complaint InspectorIn. Permit No. [I HACCP Out: ❑ Other Each violation checked iniquires 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 revention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 13. Handwash Facilities PROTECTION FROM CHEMICALS '. El2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives F] 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE - ;, ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source ", TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) i ,r ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures i Ej 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 5�/g. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),` Ll 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices 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): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. E ui ment and Utensils cited in this report may result in suspension or revocation of q p (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s)(sso.00s> establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address FE29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.5MnsP ctFom -14.tl n�' c 'r' ignat8r, -Peint: p s j ature: ---C•- i Print: ( (A �..�,n� Page-/of )Pages Violations Related to Foodborne Illness 1` Interventions and Risk Factors(items 1-22) , PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Res onsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and I2TE Foods* 2-103,11 ( Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by'focxl employees and 3-302.11(A) Food protection* applicants- 3-302.15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char«e* Contamination from the Consumer 590.003(G) Re ortin- b Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11. Discarding orReconditioning Unsafe FOOD FROM APPROVED SOURCE Food" a Food and Water From Regulated Sources 9 Food Contact Surfaces _ _ 590.004(A-B) Compliance with Food Law* 4-501.111 ManualbVarewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures-* 3-201.13 Fluid Milk arid Milk Products* 4-501.112 Mechanical Warewashing-Hot'Water 3-202.13 Shell Eggs* Smuk¢aticm Tem eratunes' 3-202.14 1 sand Milk products,Pasteurized" 4-501,114 Chemical Sanitization-temp.,pH, concentration and hardness. * 3-202.16 Ice Made From Potable Drinking Water'r 5-1.01.11 Drinking Water from an Approved Svst'em* 4-b01_'11(A) Equipment Food Contact Surfaces and Utensils Clean, 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces mid I4ensils* Shellfish-and Fish From an Approved Source [4-7' 'i I. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of 73 ui ment* Shellfish* 03.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by P8001atory Authority 2301.11 Chan Condition--Hands and Arms" 3-202.15 Shellstock Identification Present* 2-301.12 C'lemunRPrcedure* 590.004(C) Wild Muslaroims* 2-301.14 When to Wash* 3-201.17 Game Animals"' 1.1 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking of Using Tobacco* 3-202.11 PHFs Received at Proper Tem>eraturesr 2-401.12 Discharg'es'Fiom the Eyes.Nose and Packaee Lite itv* Month* 3-101.11 Food Safe and Unadulterated* 3-301.,(2 Preventin ,Contamination When Tastin * 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.15 Shellstock Identification* 590.004(E) Preveeting Contmnination from 3-203.12 Shellstock Identification Maintained r Ent ilo ees* Handwash Facilities Tags/Records:Fish Products 13 Conveniently Located and Accessible 3-402.11 Parasite Destruction," 3-402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Ca acities* 590.0040) Labeling of Ingredients' 5-204.11 Location mid Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O ermon mid;Maintenance fHACCP Pians Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Me[hods* Devices 3-502.12 Kcduced ox en ackagine,criteria* G301.11 Handwashine Cleanser.Availability 8-103.12 Conformance with A roved Procedures"` 6-301.12 FImid Drying, Provisirm Denote«critical item in the federal 1999 Food Code or 105 Ch2R 590.000. 9 CITY OF SALEM BOARD OF HEALTH Establishment Name: '-e!L'7_ /uiva, e Date: fib ' Q Pager_ of 3 Item Code C=Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY /M od 0 4� — f r G o / k t zpllrolyi a a, 5atzh,�eJe_2 t ?� 'powdo J ( 4JOF Orh0_h&) _ G - _ 4 a U -nnizz t4� hZg x a - T `t 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 ❑ 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. Ll Disposal C3 Other: 3-,p01,14(C) PHFs Received at Tempera$ures Violations Related to Foodborne Illness Interventions and Risk According to Lau",Cooled to Factors(Items 1-22) (Cont.) 41'Fl45'F Within 4 Hours. a PROTECTION FROM CHEMICALS 3-501.15 Ctmhn M,effiodsfor PH'Fs Food or Color Additives 19 PHF Hot and Cold Holding l4 3-501.16(B) Cold PHFs Maintained it or below 3-202.12 Additives* 590.004(17) 41.'/45'F*- 3-30214 Protection from Unapproved Additives'n 3-501.1(i(A) Hot PHFs Maintained at or abuse 7 g Poisonous or Toxic Substances 140'17 7-101.I 1 ldentif}'ing Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers 20 Time as a Public Health Control 7-102.11 CommonName-WorkingContainers* 3-501.19 Time as aPublic Health Cantron" 7-201.11 Se amuon-Sotaee" 7-202,11 Restriction-Presence and Use" 590.004(H) Variance Ree uiremeut 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 T ' oxic Containers-Prohibitions* 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chenmcals for Wushin�Produce,Critoria* 27. 3-801.t 1(A) Beverages everUnpasages wit Pre-packaged Juices and Bevera yes with W'urninR Labe'1s* 7-204.14 Davin Aeeut.Cciteiia` 3-80L.11(B) Us'eofPasteurizedQggs* 7-20511 hncidental Food Contnct,'Lubricants* 7-206.11 Restricted Use Pesticides,Criteria* 3-30L't 1(D) Rum Seon d Partially Cooked rued,Airmail Foal and Raw Seed Sprouts Not Served. » 7.206.12 Rodent Bait Stations* 3-801.11(C) tlno.emodFotxl Packa>e Not Re-served. 7-206.13 Tracking Powders, Pest Control and Mouitoein>:` CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Eluninate YAChOc ens .� ^cE1/1 oai .3-401.11A(I)(2) EL,s- 155'F 15 Sec. E--s-Immediate Service 145'Fl.5sec, 3-302.13 Pasteurized F 4,s Substitute for Raw Shell 3-401.'1 l(A)(2) Comminuted Fish.Meats&Game F"a>,* Animals- 155 F 17 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pet kand Bee('Roast- 1.30'F121 mi n'" -- 3-401.11(A)(2) Ratites,Injected Meats- 1.55'17 15 590.009(4)-(f)) Violations of Section 590.009(A)-(I))in sec * catering, mobile foal, temporary and 3-401.11(A)(3) Poultry,Wild Game-Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, "' above if related to foodborne illness 3-401.1 l(C)(3) Whole-muscle,Intact Beef Steaks Interventions and risk'factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29 - Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs - '145'F 15 sec. * )7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(U) PHFs 165'F 15 sec. (Items 23-317) 3-403.1l(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the 'Pune" 16udborae illness intei,entions and risk{actors listed above, can be 3-403.1.1(C) Commercially Processed RTE Food- 'sound in the following sections of the Food Code and 105 CMR 14WF* 540.000. 3-403.'1I(E) Remaining tlnsliced Portions of Beef Item Good Retail Practices I FC 59o.000 f Roasts* 23 Management and Personnel FC-2 .003 tK Proper mg s 24. Food and Food Protection -i-F C-3 .0-0 4 2a Equipment and Utensils FC3-501.14(A) Cooling Cooked FP70F Within 2 flours and Front 70° I6WPllumb ng and Waste 5 006 i 2cat00 ---.-...- to 41''Fl45"F Within 4 Hours. * 28. Poisonous or Toxic Materials IFC-7 .008 28- 3-501.14(B) Cooling PHFs Made From Ambient 1 29, Special Requirements _ .009 _ Temperature.IngredientsF45'17 Other to 41 / 1 30 I Within 4 Hours* ------- Denotes critical item in the federal 1999 Food Com of los CMR 590.000. CITY OF SALEM F ^ `BOARD OF HEALTH Establishment Name: T 1Vk 9 {1 �Vl l /� FX Date: �D (b U� Page: of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r 4 E t \4 iz flm4 4m / \ V } n , P t 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 'cormply 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. `� 0 Voluntary Disposal ❑ Other: 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to I..aW Cooled to Factors(items 1-22) (Cont.) 41°F145°F Within 4 Hours- PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs Food or Color Additives I9 PHF Hot and Cold Holding 14 3-501_16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590X)4(F) 41`145° F* 3-302.14 Protection from Unapproved Additives'K 3-501,16(A) H pt PHFs Maintained at or above 15 Poisonous or Toxic Substances 140°F- 7-101..11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102,11 Common Narne-Working Containers* 20 1 Time as a Public Health Control 7?01.11 Separation-Storage* 3-501.i 9 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(1-1) Variance Requirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitions, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Samtizers,Criteria-Chcnticah' POPULATIONS(HSP) 7-20-1A2 Chemicals for Washing Produce, Criteria* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with R n'ningl.sbels* 3-801 I I(B) Use of Pasteurized)Jess* 7-205.11 Incidental Food Contact, Lubricants'- 3-801.11(D) Raw of Pittially(.coked Animal Food and 7-206.11. RcsirictcdUse Pesticides. Criteria* Raw Seed S gouts Not Set ced. 7-206.12 Rodent Bait Stations* 3-SO1.11(7) Unopened Foci Package Not Re-served. 7-206.13 'Prackmg Powders,Pest Control and Monitarinn* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603.17 Consumer Advisory Posted for Consumption of ;(6 Proper Cooking Temperatures for Animal Foods'lliat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Eggs- 155'F 1.5 Sec. Pathogens Er:�co�er:om Eggs-humediate Service 145°F15sce, 3-302.13 Pasteunitid Eggs Substitute for Raw Shell 3-401.11.(A)(2) Comminuted Fish,Meats&Game Eggs* Amends- 155'F 15 sec. * 3-401.1l(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) 'Ratites, injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see. * catering. mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, Tesidential kitchen operations should be Stuffing Containing Fish,Meat, debited raider the appropriate sections Poultr y or Ratites-165°.F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and tisk factors. Other 145oF* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements, 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. " (Items 23-30) 3-403.11(B) Microwave-165°F 2,Minute Standing Critical wid non-critical violations, which do not relate to the Time* foodborne illness into vention.s and risk foctorr listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in zhe following sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.1.1(&) Remaining Unsliced Portions of Beef Item Good Retail PracticesFC 590.006 Roasts` 23. Mans emantand Personnei � FC-2 .003 ig Proper Cooling of PHFs 24 Food and Food Protection FC-_3 .004 25.___ _Equipment and Utensils ___FC__-4_ .0_05 3-501.14(A) Cooling Cooked PHFs from 140°F to P6_ Water, Piumbin and Waste FC 5 -006 70'F Within 2 Hours and From 70"T 27 Physical Facility FC-6 .007 to 41°F)45°'.F Within 4 Homs. * 8 Poisonous or Topic Materials FC -7 .008 3-501.14(13) Cooling PHFs Made From Ambient 29. S solei Re uiremenis _ .009 Temperature Ingredients to 41°F/45°I' 30._ -- _Other Within 4Hours* r .mqa-z tut Denotes critical ilem in the,tMeral 1999 Food Coda or 105 CMR 590,000. `t Massachusetts Department of Public Health Salem Board S Health M 120 Washington Street,4`" Floor i Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name Dat of Ooerationts) M122 of inspection t L 1 T 9 0�] lo'od Service g3moutine Address Risk ❑ Retail ❑ Re-inspection r12- { - Level A 171 Residential Kitchen Previous Inspection Telephone }~�� s,p, t)�14g0uoSb9 ❑ Mobile Date: 5 ,--'� t 1 A4 (� HACCP Y/N ❑ Temporary ❑ Pre-operation Owner � ,- .� ❑ Caterer [I Suspect Illness Person in Charge(PIC) 54v4� �% Time ❑ Bed&Breakfast 0 HACCP General Complaint in: Inspector �r out: Permit No.CAO. ❑Other Each violation checked requires dn explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590,009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT_ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties Q­1-3CHandwash Facilities�,2� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE . TIMFITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - - ❑ 19. Hot and Gold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21, Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY [311. Good Hygienic Practices ,_... .. [122, 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): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C_ N' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 4. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of ✓ 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you ✓ 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:59UlnspeciFomr6-14.gx Inspector's Signatu e: Print: PIC's Signature:) --�" Print: "` - Page of Pages � t tl�� L Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility"`_ 3-302.1](A,)(.]) Raw Animal Foods Separated from 590.(103(8) Damanctration of Knowledge* Cooked and RIE.Fads" 2-103 11Perron in chtuge-duties Contamination from Raw Ingredients 3-302,11.(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibi liry of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A I(A) Food Protection* a) ticants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fad Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Repan To The Person In UtcnAls* Charge* Contamination from the Consumer 590.003(0) Re orring b Person in Char e" 3-306.14(A)(13) Returned Food and Reserviee of Food* 3 590.0030) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions J Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590,004(A,B) Compliance with Food Law* 4-501.111. Manual Watewashing-Hot Water 9x201_12 Food in a Hermetically Sealed Container* Sanitization [cin eratnreO 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem erat'ures* 3-202.14 E gs and Milk Products.Pasteurized* i 4-501.114 Chemical Sanitization-temp.,PN, concentration and hardness. * 3-202..10 Ice Made From Potable Drinking Water'" 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an A )roved Svstem* Utensils Clean* 590.006(A) 13ot0edDrinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils" Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces ofF qui meat^ Shellfish* 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical` sources* L0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1-301.11 Clean Condition- Hands and Aims* Regulatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Clemtin*1§Deeding* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash" 3-201.17 name Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 _Latin , Drinkm or Using Tobacco* 3-202.11 YHFs Received at Proper Temperatures 2-401.1.2 Discharges From the Eyes.Nose and 3-202.15Packa ge'Inteerit•* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tustin 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em In gees* Tags/Records:Fish Products 0 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.1'2 Records.Creation and Retention' 5-203.11 Numbers and Ca a� 5 Labeling of Ingredients* 5-204.11 Location and Placement* 90.004(7) g g F - Conformance with Approved Procedures 5-205-11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-50211. S ecialized Processin Methods" Devices 3-502.12 Reduced oxygen hackagin ,criteria* (�301.11 Itandw.tshin Cleanser.Acarlabil it 6-301-12 hand Drvin Prodrsion 8-103.12 Conformance with Approved Procedures* Denote_critical)lion m e e th [dual 1499 Foam Code or 105 Cb1R 590.060. '" CITY OF SALEM BOARD OF HEALTH }' Establishment Name: Date: / /�/`� Page: 2 of 2i item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R Red Item Verified 4 PLEASE PRINT CLEARLY L 2 S �G 1 t NF S�:-vt�.AL_ i Hr=a4�1¢r�Hr� �)td - Jnr c,� �C ✓�G- v,nr 1 �S �rCu„Dt✓ \1131QLLr 4C<_,71,_4 TLV- i `fak3 fir RLQ C 0 tiC , a/G_ uevfFr' -3 G fi rJ�fl i vyfri f Sl r✓K ° y�0 I/tom c�rKi`r�� /1 c �4 / r� r, aria v P �� 4 e Z C- 3 19�4 ` LAI-4C-H - fZ_usskE - SV?sv, JCI l3 t`f C- 7( S K- rOL-wiz Tv IA L Ujt � Z NC —/g7r�)di=f— U>< S F u�c i�/>'S rr i4 GvW�t•rs�fl��v C c S cS✓u. (_ 27 C ,�N) \ J21Nlr Su41(7QAf Afc)j - xt&.t i f,/�LL- . Sf}Jl�i (�ZlfUlj i S�L.�t 0,✓ tJ� f3 J,41 tdl�''G r� /�-ri' t4Lc_ i J sem( t e � IK Sf1 t.F/i� ✓ �1 !'uti k � �clt)N FJe�- Lit T Uri �X 4iLGLr •-.a,�I ��vr-JAS ' 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 t4 noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure '�' your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.1.4(C) . PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According,to haw Cooled to Factors(Items 1.22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-SOI-15 CatlhbRth<xls for PHFs _ Food or Color Additives 19 PHF Hot and Cold Holding 14 3-501.16(B) Cold PI-11's Maintained at or below 3-202.12 Addtrtverti 590.004(F) 41°145'F* 3-30114 Prott ctnon from Unapproved Additives'" 3-501.16(A) Hot PHFs Maintained at or above Ig Poisonous or Toxic Substances 140°F. 7-101.11 Identifying Information-Original 3-50 .16(A) Roasts Held at or above 130°F. _ Containers* 20 7-502.11 Common Name-Working Containers* Time as a Public Health Control 3-501.19 Time as aPublic Health Control 7-201.11 Separation-Stoner* - 7-202,11 Restriction-Presence said Use* 590.004(H) VarianceRecuiremenY 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions*' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* _ POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria* 21 3-80L1.1(A) Unpasteurized Pre-packaged,elsces and 7-204.14 Diving Aoents,Cnteria'" Beveras,eswith Warning t,abels* 3801.11(6) Use of PasteurizedE'-s* 7-205.11 Incidental Food Contac,Lubricants* 3-301.11(D) Raw on Partially Coked Animal Fond and 7-206.11 Restricted Use Pesticides,Criteria"` Raw Seed Sprouts Not Served. * 7-206.12 Rodent Hair Stations* 3-801.1 I(C) Ono erred Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitorin t CONSUMER ADVISORY TIME(CEMPERATURE CONTROLS 22 3-603.11, Consumer Advisory Posted for Consumption of Id Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate Pathos . unq r. cwsi -zoor 3-401.1LA(1)(2) Eggs- 155715See. E,,-s-Immediate Service 145'F15sec" 3-302.13 Pasteurized FgrI"sSubstieuteforRawSheit 3--401.t1(A)(2) Comminuted Fish.Meats&Game EW lnunals- 155 F 15 sec. . SPECIAL REQUIREMENTS - 3-401.11(11)(1)(2) Pork and Beet Roast- 130'F 121. min* 590.009(A)-(D) Violations of Section 590.QQ9(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats- 1.55'F 15 - sec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Scuffed PHFs, ressidenrialkitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec.* above if related to foodborne illness 3401.1.1(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Abimal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(Al(1)(b) All Other PHFs-- '145'F'15sec. * 17 Reheating for Hot Holding vIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(6) Microwave- 165'F 2Mhmte Standing Critical and iron-critical violations, which do not relate to the Time* foodborne illness intervenrions and risk factors listed above, can be 3-103.1.1(C) Commercially Processed RTE Food- fon ul in rhe following sections of the Food Cade and 105 C.MR WWFt 590.000. _ 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices `-FC 590.000 Roasts* 23 Mana emeni and Personnel FC 2 .003 Ig Proper Cooling of PHFs 24 Food and Food Protection FC 3 .004 25 Equipment and Utensils FC-4 ,005 3-501.14(A) Cooling Cooked PffFs front 140'F o - --- --- g 26. Water.Plumbing and Waste __ FC 5 .006 70'F Within 2 Hours and Front 70'F 27. Ph sical Factllt FG 6 007 -I to 41'F(45'F Within 4 Hours "' �28 Poisonous or Toxie Materials FC 7 008 3-501.74(6) Cooling PHFs Made From Ambient 29. Special Reguirements _ _ .009_ Temperature Ingredients to 4 FFl45017 30 Other - _ ---,_------- Within 4 ---__Within4 Hours` *Denotes critical iters in the federal 1999 Food code of 105 CMR 590.000. l MassacShusetts Department of Public Health Salem Board Health M 12a Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978)745-0343 Name jr Dat Type of Operationjsl T e of inspection / l 0 BWod Service LJ Routine Address (;--2- c Risk ❑ Retail ❑-RelAspection Lev I El Residential Kitchen Previous Inspection Telephone t �{ ❑ Mobile Date: ?y� � ) ❑ Temporary ❑ Pre-operation Owner 7/1' ijr- r- JI &ru HACCP Y/N ❑ Caterer ❑ Suspect illness ❑ Bed& Breakfast El General Complaint Person in Charge(PIC) �� Time r El HACCP In. Permit No. El Other Inspecto �'� F- � S , 2 Out - 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 590.00%E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT .. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ ❑ 13. Handwash Facilities EMPLOYEE HEALTH - ^ PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114, Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source .. --- - TIMEREMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [:118. Cooling PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP). .. ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY E]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): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below D N ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.o09) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 55901nspecrForm6d4.tloc V SI A ). Inspec is*n*Vr�.� Print: ' : '•. c? PIC's Signature: Print Page-of "Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 590.003(A) Assignment of Responsibility' 3-302-11(A)(1) Raw animal Foods Separatedtrorn 590.003($) Demonstration of Know ledge* Cooked and RTE Fo0ds* 2-103.11 Person in eharge-duties Contamination from Raw Ingredients 3-102.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 590.003(c) Responsibility of the person in charge to Contanttnation from the Environment require reporting by food employees and 3-302.1 1(A) Food Protection* applicants* 3-302.15 Wushin Frmts and Ve_etables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Foot Contact with Equipment and Applicant To Report To The Person In Utensils* Chat,e* Contamination from the Consumer 590.003(15) Re Cortin b 'Person in Charcc* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* 75lsposttsnn oAAdulterated or Contaminated 590.00'(,F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Fool in a Hermeticdly Sealed Container* - Sanitization 1 eraPeratures* 3-201.13 Fluid Milk and Milk Products" 4-501.112 MechamcalWarewashiri -HotWater 3-202.13 Shelf SattitizatIonTem eratures" 3-20114I?g-=s and Milk Products,Pasteurized' 4-501.114 t Chenneal Sanitization-temp., pH, concentration and hardness -" 3-202.16 Ice Made From Potable Drinking-Water* 4_601.11(A) Equipment Food Contact Surfaces and 5-1.01.11 Drinkin Water from an Approved System- Utensils Clean* 590.006(A) Bottled Drinkin Water+ 4-602.11 Cleaning Frequence of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils'' Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui stent* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Gamoand Wild Mushrooms Approved by Rr ulator Authcrit 2-301.71 Clean Cortdition-HandsandArms 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0 Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices F-_ Receiving/Condition 2-401.11 Eating,Drinking-or Using-Tobacco" 3-202.11 PIIFs Received at Patter Tem eranres* 2 901.I2 Discharges From the Byes,Nose and 3-202.1.5 Package hue rit y Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tasting-* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-20?18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" EmPlovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located end Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and C'a acities* 590.004(7) Labeling of Ingredients" J-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.O rerauion and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Proeessin", Methods* Devices 3-502.12 Reduced oxygen Packaging-.criteria* 6-301.11. HandwashinE Cleanser,Availability 5-103.12Conformance with AP roved Procedures* b-30].12 Hand D in«P,ravision Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM ,f BOARD OF HEALTH / i Establishment Name:��C L✓1 C .�lti�. Date: / ,f'r/i9Page: 2 of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. 'Reference R-Red Item - Verified :. _. PLEASE PRINT.CLEARLY OVVI NOW �rN / 9 l �Sp6: C vo'r .• XLDUft V L (I, 4E C-Nf CC1'YLrZC��{r .d h rY v 4 t yyr :7 i `i i. 9 .t 4 .h 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 Ll voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension Comply with all mandates of the Mass/Federal Food Code. I un r`d'that noncompliance may result in daily fines of tw y-five tl rs or su ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ' � � ❑ Voluntary Disposal ❑ Other: 's `Y 3-501,14(C) PHFs Received of Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41"F/49°F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.11 CoaIlne Methods for PHFs iq _� Food or Color Additives 19 PHF Hot and Cold Holding 3-202.1'2 Additives* 3-501.16(13) Cold PIIFs Maintained at or below ---- 590.004(F) 41'/45°F 3-302.1.4 Protection from Una roved Additives* 3-501.16(A) Itot P1 Fs Muntained al or above 15 Poisonous or Toxic Substances 40°F.* 7-101.11 CdenNtyinelnti>vnation-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7-102.11 Common Narne--Working Containers* 21531501,19 Time as a Public Health Control 7-201.11 Separation-Storage* Tune as a Public Health ConErol7-202.11 Restriction-Presence and Use" .004(H) Variance Recuiremenf 7-202.12 Conditions of Use* 7-20'.'I I Toxic Containers-P ohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanihzers.Criteria Chemicals* POPULLATIOATIO N NS(HSP) 7-204.12 Cheinicak for Washing Produce Criteria* 2J. 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with N arnin"Labels* 7-205.14 Inside tai Fooents-Conta t, 3-801.11(B) Use of pasteurizedFgns* 7-205.1.1 Incidental Food Contact,Lubricants" 7-206.11 I Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked AnimalFood and 7-206.12 Rodent Bait Stations" Raw Seed S n<uus Nbt Served. 3-801.1 I(C) Urr ened Food Package Not Re-served. ^` 7-206-13 Tracking Powders,Pest Control and Monitorinu* CONSUMER ADVISORY _ TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advi son Posted for Consumption of Animal Foods That are Raw,Undercooked or J.6 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.11A(I)(2) Egatsgs I35'F 15 Sec. PHFs Pathogens rr. o a .�.rooi 1 .,,,s Immediate Service 145'F15sec,k 3-302.13 Pasteurized Ebbs Substitute-for Raw Shell. 3-401.1 I(A)(2) Comminuted Fish.Meats&Game Fars* Animals- 155'F 15 sec. * SPECIAL REQUIREMENTS 3-40 ILII(B)(1)(2) Pork and Beef Roast- 13WF 121 min* - 3-401.11(A)(2) Rattles,Injected Meats- 155'17 15 590.009(A)-(I')) Violations of Section 590.009(A)-(I))in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165-F 15 sec. * above if related to foodborne illness 3401.1I(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F 4 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Crooked in a practices should be debited tinder#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F'15sec. * 17 1 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1.1(A)&(D) PHFs 165"F 15 sec. * (items 23-30) 3-403.11(13) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness internentlons and risk,factors listed above, can be 3-403.1,1(C) Commercially Processed RTE Food- found in the foltowingr sections cr)'the Fond Code and 105 CMR 14W F* 590.0010. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590000 Roasts* __23,_____x.Management and Personnel I FC-2 .003 18 Proper Cooling of PHFs 24 _Food and Food Protection ___ _ +FC -3 .004 1 25. Eqm meat and Utensils __ _i,FC 4 .005 3-501.14 A) Cooling Cooked PH,Fs from 140'F to r I R -- __- ( b 26. 1 Water.Plumbing and Waste FC-5 .006 70`F Within 2 Hours and From 70'F r27. 1 Ph sisal FacilityFC-6 .007 to 4VF/451F Within 4 Hours. * i_ 28..___ Poisonous or Toxic Materials FC-7 .008 -- __ 3-501.14(B) Cooling PHMadFromAmbient 30. Other q - eats Fs Made 29 S ectal Re uirements TemperatureIngredients to 41'F/45°F -her .......-._. Within 4 Hours* Drnr tea critical item 1n are'tedera]1999 Food Code or 105 CAgR X90.000. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �.' 120 WASHINGTON STREET, 4TH FLOOR e SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ. JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner ' s Name : Salvatore J. Tarantino, Jr. Name of Establishment : Bella Luna Cafe Address of Establishment : 62 Wharf Street Type of Establishment : FOOD SERVICE Application Date : 01/02/2003 Restrictions: Permit for Food Establishment 180-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT u CITY OF SALEM, MASSACHLtSETTS o Imo- = ry/I � I� BOARD OF HEALTH • > 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC 2 7 2002 TEL. 978-74 1-1 800 _ FAX 978-745-0343 Gi I ) t.-'I" bAL.EM STANLEY USOVICZ, JR. JOANNE SCOTT,'MPH, RS, CHO BOAR; OF HEALTH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE fA FOOD ESTABLISHMENT NAME OF ESTABLISHMENT _11. L'�e�,< L j q A- (ai TEL# `'ll-z!r - 7'1Y ADDRESS OF ESTABLISHMENT (y Z wh 4rf S4. lGleyr, ) IM k MAILING ADDRESS (if`different) OWNER'SNAME !erVAXOft 31 6y-av)bvlo Ji TEL#478- awl G4S8 ADDRESS I/ Sea\IIekJ 'Kz CITY (TlooCp Sir/ STATE ryj,t ZIP_U19,30 CERTIFIED FOOD MANAGER'S NAME(S) _&JuAk,,c ' _,,, k 1� CERTIFICATE#(s) as at26S32 mo kgwLO k Moberg U Z2 I77A (required in an establishment where potentially hazardous food prepared.) EMERGENCY RESPONSE PERSON KAP 1, wf-Wfy HOME TEL# O U HOURS OF OPERATION: Mon. Tue.`/ 9 Wed.//_9 Thu.I/- 9 Fri. //-/()Sat. 1/-/0 Sun.i0 - J/ TYPE - TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES N less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANTYES NO I less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES INO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $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 629, Section 49A, I certify under the pains and penalties of perjury that I, to my best led abelief, ave fil all-state tax returns and paid all state taxes required under the law. la/ /a oz Cz (��/- 348z Signature Date Social Security or Federal Identification Number --------------------------------------- ------------------ Revised 11/25/02 FOODAP2.adm Chedc#&Date &L— ZL-Z--2`a " l ,THE COMMONWEALTH OF MASSACHUSETTS CITY .OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Type of Operation(s) Type of Inspection Ti 0 El Food Service El Routine Address /' p Risk ❑ Retail ❑ Re-inspection ( 1-� Level El Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerHACCP Y/N El Temporary EJPre-operation 1 =�'-1 �t-y -L1 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) i �� Time El Bed 8 Breakfast El General Complaint - In: Ll HACCP Inspector V( c � Out: Permit No. ElOther Each violation checked requires Ian explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements E:1 17. Reheating [:17. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding E] 8. Separation/Segregation/ Protection El 20. Time as a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: A 2f PIC's Signature: Print Page of G.. Pages FORM 734A HO\S\d WA`REN ' BOSTON r Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-con6minatiotl FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1'Ir 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2< 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated ,3,, 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE ,9 Food Contact Surfaces 4., Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p.�p @g Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4.702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and e 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* +.:.10::' Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* --`.12: Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(!) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM �I BOARD OF HEALTH Establishment Name: �3�1 //7 �`J�� Date: �� v3 Page: of } Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY TZFZD - v � 2i � r. \ c�,l 0 S — 'F C � � ' C v� 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 ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion 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: .'y t. r .:g s 3501.1.4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk -According to L.9w Cooled to Factors(items 1.22) (Cont.) 41'F145'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolina Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Addmves" _ 3-501.16(13) Cold Plil s Maintained at or below 590.004(F) 41°745'F* - 302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 1.5 Poisonous or Toxic Substances 140''F. 7-101.t t Identif}ing Information-Original 3-501.16(A) Roasts Held at or above 130"F. Containers* 20 Time as a Public Health Control 7-102.11 Corrunon Name-Working Containers" 3-507.1.9 Time as a Public Health Control* 7.201.11 Separation-Stora e" 7-202.11 Restriction-Presence and Use" 590.00d(H) Variance Rec uiretnent _ 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 "Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanidzers. Criteria-Chemicals` 7-204-.1.2 Chemicals for Washing Produce,Criteria` 21 3-801Ll l(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvina Agents,Criteria* Bevel uie�s with W aroma Labels* 7-205,11 Incidental Food Contact,Lubricants* 3-801.11(B) Use ofPusteurired Erins* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) flaw of Partially Cooked Aminal Food and Raw Seed S grouts Not Served.. 7--20612 Rodent'Bait Stations* 3-801.11(C) Unopened Fwd Package Not Re-served. 7-2(16.13 Tracking Powders, Pest Control and Monitorine* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Fords'That are Raw, Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs n. nav pool 3-4(11.11A(1)(2) Eggs- 155'F In Sec. Pathogens.* F &s-immediate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-40111(A)(2) Comminuted Fish.Meats&Game EO t'* Animals- 155"F 15 sec. 3-401,11(B)(1)(2) Pea kand Beef Roast-'t30F121mill* SPECIAL REQUIREMENTS 3-401.1](A)(2) Ratites,Injected Meats- 155'17 15 590-009(A)7(D) Violations of Section 590.009(A)-('I))in ec ' catering mobile food, tempotarvand 3-401.11.(A)(3) Poultry,Wild Game.Stu fed PHFs, residential kitchen operations should be 5tutung t_ontaining Fish,Meat, -oder the Poultry or Ratites-165'F 1.5 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) Ail Other PHFs -- 145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sea * (Items 23-30) 340111(B) Microwave- 165'F 2 Minnie Standing - Critical and non-critical violations, which do not relate to the Time ,foodhorne illness irneri,entions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Fwd- found in the following sections of the Food Code and 105 CMR 14WF* 590.000. _ 3-403.1I(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 � Roasts* _23. Manngament and Personnel FC-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004__ nt 25 3-501 A,t(A) Cooling Calked PHFs from.140'F to 1 26 Water.Plumbic Utensils Waste FC-5 006 �I 7WF Within 2 Hours and From 70'F 1 27. Physical Facility FC-6 .007 to 41`F/45°F Within 4 Hours. " 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29 -Sial Requirements 009 Temperature Inge edients to 41'Fl45'F 30 Other Within 4 Hours* *Denotes critical item in the t'eder"d 1999 Food Code or 105 CMR 590.000. f 109 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON Sl'RE_ET. 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS. CHO MAYOR HEALTH AGENT" COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner ' s Name : Salvatore L Jaime Tarantino Name of Establishment : The Bella Luna Cafe Address of Establishment : 62 Wharf Street Type of Establishment : FOOD SERVICE Application Date : September 6, 2002 Restrictions : Permit for Food Establishment 320-02 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2002 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 5 o 1 . .` .,t,��* •Sw.r/ •�'S'Y"� '� h45s 'r R'sc,,rt3 �4 R'sa+ t i CITY OF SALEM, MASSACHUSETTS o n n iA �Norr IIU �• '� BOARD OF HEALTH. �� �� 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 OCT 1 1 ZOOZ TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. CITY OF SALEM JOANNE SCOTT, MPH, R8, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2002 APPLICATION FOR PERMIT TO OPERATE AFrO,OD ESTABLISHMENT NAME OF ESTABLISHMENT� 1_�4\hQ- LtsnQ I(CrCi2TEL# Q-7F3-`14q-c:�S'KS ADDRESS OF ESTABLISHMENT (p� (A) hn -F C-I-'Ir-PQ* i1:�(-,t arn mPrIq'l0 MAILING ADDRESS (if different) OWNER'S NAME �oI\1cLAPXC- 1 7&i mQ -T02kn)-1 0 TEL# G-]8' 7)2)I-G i Z ADDRESS I CITYGI, o 1Cos�P(- STATE 'Ml r zip C)930 _ CERTIFIED FOOD MANAGER'S NAME(S)Ga1yr.-Vnfe7 Tccoi)bry CERTIFICATE#r(ys) QS2.rJ��� -t=2. fir. � o^Js11l�S¢-R2 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON r 1Q�t(l� t QC�nnk C )HOME TEL# DAYS; HOURS OF OPERATION: Mon._Tue..�!LWed.__GThu. ✓Fri. ✓Sat. :/Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO ado $40 RESTAURANT YE NO $40 BED & BREAKFAST YES NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO NO CHARGE FOR NON-PROFIT(such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM 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 SapitaryCode, 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 ledge and belief, h ve filed all state tax returns and paid all state taxes required under the law. A Signature Dae Social Security or Federal Identification number ---------------------------------- ------------- --------------------- Revised 11/1/01 foodapladm Check#&Date /a7r3— /G - 3(ick THE COMMOf-.WEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name Date at of Operation(s) Type of Insoection // (� Food Service Routine Address w ^ C T_ Risk " �/1 LJ Retail Re-inspection f ' J Level y / ❑ Residential Kitchen Previous Inspection Telephone _ / ❑ Mobile Date: Owner-- __ \\ l HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Cl/7 Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector/- Out: Permit No. ❑ Other Each viola ton checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMETEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures [1 5. Receiving/Condition El6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El B. Separation/Segregation/ Protection El 20. Time as a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions O immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations \( 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 126. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing / 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF REINSPECTION: n Inspector's Signature: P-int: PIC's Signature: Print`- Pagfe�of Zpages FORM 734A HOBBS a WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1`171 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 1'2C> 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated u 3': 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces :44": Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p'P gg Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* IV Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authorit2-301.11 Clean Condition-Hands and Arms* y 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* "12" Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* ''"-13Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r, CITY OF SALEM BOARD OF HEALTH p —Establishment Name: v/J�I(/ Ly�� Date: � 2 Page: of Item Code g F C—Critical Item DESCRIPTIO NOFVIOLATION / PLAN OF CORRECTION is Date f No. ' `Reference': -R-Hed Item':p '' ' `� " Verified t _, -, s i PLEASE PRINT CLEARLY CXR a F v — ' S — v <Biscussion With Person in Charge: Corrective Action Required: " ❑ No L)Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LIEmployee Restriction / i violations before the next inspection, to observe all conditions as described, and to comply Exclusion t ❑ Re-inspection Scheduled Ll Emergency Suspension with all mandates of the Mass/Federal Food Code. I understand that noncompliance may S result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure z ❑ Voluntary Disposal ❑ Other S FORM 734B HOBBS a WARREN - BOSTON 14(C) PHFs Received'at Temperatures Violations Related to Foodborne Illness Interventions and Risk 3-501. According to Law Cooled to Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs LAAL Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 1400F.* Containers* 3-501.16(A) Roasts Held at or above 130°E* 7-102.11 Common Name-Working Containers* ' ,20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with blaming Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effect'-11112001 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals-155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17` Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and/05 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 ;18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41017/45017 Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Inspection of ` / V - l"//-�� / U�� Date Time ` Name Address Ownet S /17 / Tel. No. Type of Inspection 12/7° 7 12 ✓/ Inspectors. � - / V r`7 ( ' I Remarks and Violations are listed below: /�-Cxx Ccs /I- r L t� P� 1 \ -1ZyCk1prrl2r-\ CA _ �-1 r`•�+:5 Com' � . i— v 5 13 �a c t-'�- C, _ \ \-1(crl\k� Vu J � 0 Report Received by: flu. Inspection of Z / / ��/fl• e / G'� Time Name _ —T Address p 1 Ownea� �! _ / / / 7i )7J r,?� Tel. No. Type of Inspection �� �! �' v Inspector , ( ' ) Remarks and Violations are listed below: U V T`, . C✓z 1 C c -V�-- -,I �J��`7`-7�Y.aZ. rl(ir=1 GC'c • 1-\��� � ��lJ�/ ��"�5"-1`z_ J 4-t'"7 V C, r 1 , 1 r zC Eery::, cwt r � 1 Report Received by: ��. 7 A,. i /i I t ^ CITY OF SALEM, MASSACHUSETTS ` LICENSING BOARD 120 WASHINGTON STREET 978-745-9595 ext.421 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: JAIME AND SAL INC. d/b/a: The Bella Luna Restaurant LOCATION: 62 Wharf Street, Salem, MA 01970 TELE. # 978-744-5555 TYPE OF LICENSE Beer and Wine Year-Round APPLICANTS INFORMATION Name: Jaime A. Tarantino Home address: 11 Seaview Road City: Gloucester State: MA Zip: 01930 Home tele. # 978-281-6458 HEALTH AGENT/INSPECTOR'S COMMENTS: 47 -6),7 01 16Ldnl C i Rc(aA Agent notification form f ural CITY OF SALEM; MASSACHUSETTS ,• 4yQ BOARD OF HEALTH 3 '� 120 WASHINGTON STREET, 4TH FLOOR - ' SALEM, MA 01970 �,y� TEL. 978-741-1800 �'� FAX 978-745-0343 - STANLEY USOYICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94,- Section 305A and Chapter III, Section 5 of the General Laws, to operate aFdod Establishment in the City of Salem is hereby granted to: Owners Name: Julie Prosniewski/Nancy Parrillo Name of Establishment : Bella Luna Cafe Address of Establishment : 62 Wharf Street „Type of Establishment: FOOD SERVICE Application Date: 12/10/2001 '•'*' Restrictionse £ A Permit for Food Establishment 174-02 1' Frozen Desserts/Ice Cream Pe"rmit for the Sale of Tobacco Products ; .These Permits Expire December 31, 2002 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. Is accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. /� I ` CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ® • ! 120 WASHINGTON STREET, 4TH FLOOR D 1a3jr[j j� c � SALEM, MA 01 970 P p i TEL. 978-741-1800 llVll FAX 978-745-0343 EC O W1 STANLEY OVIcz, JR. JOANNE SCOTT, MPH, RS, CHO DEC lr 7 1 t; MAYOR HEALTH AGENT CITY OF SALEM HEt.LT-1 DEPT. 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT r41JJA �� TEL# 9 ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) can OWNER'S NAME G2 TEL# fit// - UO V(v ADDRES CITY'„ �, STATE .,.A",4 ZIP-0/976 _ CERTIFIED FOOD MANAGER'S NAME(S)- �) -CERTIFICATE#(s) 7) (required in an establishment where potentially hazardous food is prepared.) J EMERGENCY RESPONSE PERSONQLCL" (.L. OOAL fyl�llJS4 HOME TEL#9ik- N1-0016 DAYS/HOURS OF OPERATION: Mo.-Tue. L/Wed. hu. �Fri. at tun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO � $40 RESTAURANT I S NO �� 40 BED& BREAKFAST YES NO $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $10 NO CHARGE FOR NON-PROFIT(such as church kitchens)PLEASE INCLUDE COPY OF TAX EXEMPTFORM Please pay total with one check payable to the City of Salem i 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 an belief, have filed all state tax returns and paid all state taxes required under the law. 0t/6 55.7V gnatur Date Social Security or Federal Identification number Revised 11/1/01 foodap2.adm Check#&Date 134 0r�o 61 .-+.r,.-.-_....� «...w,+-r«.+�.+'7......y-.+.e�ww.+Ftc,.`-.';...,..'Y-�..�.,...-,,..„._. _..,....-..:+aw`w:...^m ...a''N(P+^:..e.-..-•imerr�._+;k.��';»-az1.:.'wrs.. i:r:,.:: _.. M1 THE COMMONWEALTH OF MASSACHUSETTS CITY OF� SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 740-9705 Name // Date Type of 0 eration(s) Type of Inspection MXlle, 241174 � 2 140"Food Service ❑ Routine Address9 n, n� J Jre / Ris ❑ Retail El Re-inspection /" i" Y T Level ❑ Residential Kitchen Previous Inspection Telephone Myy_ - A7.;l ❑ Mobile Date: ❑ Temporary ❑ Pre-operation Owner �Q HACCP Y/N ❑ Caterer ❑ Suspect Illness Tu/. e J/i e,rJ,s Person in Charge(PIC) /� /e Time ❑ Bed &Breakfast ❑ General Complaint ik1' T ❑ HACCP Inspector r--^ In: yVOther - -:7Aj e /!/Z' Out: Permit No. / e Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(sf violated. ^ Non-compliance with: RED Violations (1-22) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties U,1'3. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 88. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) LIi' 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations (23-30) Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 7 Immediately or within 10 days as determined by the Board and Risk Factors (RED Items 1-22): O` of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C N 590.000/Federal Food Code.This report,when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:59MnspecYFwmF10 tlac Inspector's Signature: Print: PIC's Signat *., _ Print: Page of Pages l Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT 8 Cross-contamination i_1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer _ 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* '.. 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensilsand Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by10 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* j 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 +.. Tags/Records:Shellstock =12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tans/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients` 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 1 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM F / BOARD OF HEALTH , Establishment Name: 7J2 �`r� ��i,L�i�i Date: • & /1"-7 10 Page: L of Item Code C—Critical It, tem9 i DESCRIPTION OF VIOLATION / PLAN OF CORRECTION m Date CLEARLY No. Reference R Red Item= PLEASE PRINT. 3 ;,? - Verified l ce nZZ,J r '< i P e L _41 a e C �� a t P Discussion With Person in Charge: Corrective Action Required:;` ❑ No; ❑Yes l I 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, to observe all conditions as described, and to comply Exclusion t with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension f result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ( ► ❑ Embargo ❑ Emergency Closure t ❑ Voluntary Disposal ❑ Other S FORM 7348 HOBBS &WARREN - BOSTON 1 Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at`Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14,;;, Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/450F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* "-21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 DrvinR A ents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY d 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Etlectl a 11v2001 3-401.11A(1)(2) Eggs- 155*F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.1 l(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17" Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and/05 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: 978 741-1800 Fax: (978) 740-9705 Name / \ D / T e of Operation(s) Type of Inspection l�V Ip Q' . Food Service ❑ Routine Address Ris ❑ Retail �Re-inspection Level e/ El Residential Kitchen Previous Inspection Telephone v L M' ❑ Mobile Date: El Temporary 11Pre-operation Owner (� 1el HACCP Y/N El Caterer 11 Suspect Illness YK +L � El &Breakfast 11 General Complaint Person in Charge(PIC) Time ❑ HACCP Inspectpr--C In: 71 Other v pc^^ Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: RED Violations (1-22) 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP [110. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations (23-30) 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(RED Items 1-22): of Health. Non-critical (N)violations must be corrected 7D immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C_ N 590.000/Federal Food Code.This report,when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-5)(550.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S,b9pMs IFwm Kd. Inspector's Signatu Print: / PIC'sSignature: Print: ` Page!of ages A Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT S Cross-contamination 1 590.003(A) I Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* ;-2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer _ 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE _ Food* F4 _ Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Seated Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensilsand Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by 110 Proper,Adequate Handwashing Regulatory Authority - 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* X11' Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Ta s/Records:Fish Products ('13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans '---- Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 1 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: L—�7� ��S 1� Date: 6- ; DZ Page: ,:'�_ of Item'' Codec C­Critical Item ` DESCRIP-TION OVIOLATION PLAN OF CORRECTION Date Rd ItemNo. Reference k-' Verified ied PLEASE. a ,. 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 / violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ^ ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) Accordingto Law Cooled to 41°F/45*F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 24.i Food or Color Additives 19 . PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41*F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°E* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* !r20:.. Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21< 3-801.1l(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for WashingProduce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1l(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY ' 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate ' - 1/1 2001 PHFs Pathogens.* Effect,. 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections - Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145*F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r.rL.-..,y�...yr;h'+m.t�,..H'�✓M�+�i-k'i-Iti:'..'.reLY�.--r��ir-^ri++/lfwi'w�-+iretit.V,'wY�. ..r�.-+r-ry-- .r.L-..i.r......... Y •^ ,THE COMMO,NVVEALTH OF MASSACHUSETTS CI`T'Y.,OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name / Date - r i n Tyoe of Insoection /l/v C��4� �AE `Q L Food Service Routine Address � Risk ❑ Retail ❑ Re-inspection . t Level ❑ Residential Kitchen Previous Inspection Telephone ^t17 _ I/� _ ❑ Mobile Date: Owner ./1� / �y. HACCP YIN El Temporary El Pre-operation N�r /J jlGrl//() tj L ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) `- Time El Bed&Breakfast El General Complaint In: ❑ HACCP Inspector Z, ^ VJ Out: Permit No. ElOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties 13. Handwash Facilities EMPLOYEE HEALTH [12. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) E] 16. Cooking Temperatures El 5. Receiving/Condition ❑ El 6. Tags/ Records/Accuracy of Ingredient Statements 17. Reheating -- ❑ 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding 1 iA 8. Separation/Segregation/ Protection 20. Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices X22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of X 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you ` 27. Physical Facility (FC-6)(596.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address { 29. Special Requirements (590.009) within 10 days of receipt'of this order. 30. Other DATE OF RE-INSPECTION: I` I Inspector's Signature: d Print: �14920 l� _( in/ f PIC's Signature• Print: Pages .i'1 r� r f 1 . ctn tn( i I. K e n 1>1 Page o O v FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 6 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3" 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces4`: Food and Water From Regulated Sources 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P'P g8 Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* it Good Hygienic Practices 3-20L17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* S Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* ,12-. Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* F-13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7> Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'r } CITY OF SALEM BOARD OF HEALTH } � LDate: Page:Name: of IteNom• Reference, R'.—Red Item verified ry DESCRIPTION OF VIOLATION /rPgAN OF CORRECTION Date Verified LY 27 l� �f S:n 6c 5 Ff b a IA.s - - - v\ t ll, -TE—cam w��t 5 s u C. Y �4 /l Z f —1- V) rE 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/ k violations before the next inspection, to observe all conditions as described, and to comply Exclusion tiA with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other a FORM 734B HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received A Temperatures Factors(Red Items 1.22) (ContAccording to Law Cooled to 41"F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs ,w.14. Food or Color Additives LiL PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15,a Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°E* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* ; 21.' 3-801.1](A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 DrvinR Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY ' 22- 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or -16" Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Eneclve 11112001 3-401.11A(1)(2) Eggs- 155*F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food, temporary and 3-401.1l(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should be 3-401.1 l(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23.30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18; Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41*F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM } BOARD OF HEALTH t Establishment Name: � ��`t �y�i� Date: -5-1361102- Page: of { Rem Code '" 'C-Critical Item s DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date= No..�,,, Reference R—Red Item 3 iq " z $• a�ensE PRINT CLEARLY .a a ^^» : Verified ' c)1_� vn l ur i� _N? sq� _t V f ` 65 i:)) 1 n G Z� S-&-'k-2 v3 J f �cDC�'Jl 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/ violations before the next inspection, to observe all conditions as described, and to comply Exclusion I'e ❑ Re-inspection Scheduled ❑ Emergency Suspension 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. ❑ Embargo ❑ Emergency Closure 1 s ❑ Voluntary Disposal ❑ 70ther S FORM 7348 HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures , Factors(Red Items 1.22) (Cont) According to Law Cooled to 41*F/45*F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14` Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15;+ Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se aration-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 2T 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* * - Beverages with Warning Labels g 7-204.14 _Dpi A ents,Criteria* 3-801.11(6) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or `16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 11112001 3-401.1IA(l)(2) -Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145*F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(I)(2) Pork and Beef Roast- 130*F 121 Min.* catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-40L11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 017,'. Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165*F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 1657 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial Re uirements .009 Temperature Ingredients to 41°F/45*F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.