Z CREPE CAFE LLC - ESTABLISHMENTSZ Crepe Cafe LLC '
180 Essex Street (mall walk)
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180 ESSEX STREET Z Crepe Cafe LLC
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical
Urgency
Telephone:
PROTECTION FROM CONTAMINATION
(978) 744-9904
Handwash Facilities PASS ❑d
RED
Owner:
Comments: Hand wash sink next to dish wash room missing hand wash only sign. Provide sign.
Tracy Thurdin
I Violations Related to Good Retail Practices (Blue Items)
PIC'
Food and Food Protection PASS
BLUE
Anders Thurdin
Inspector:
Comments: Shirt stored on glasses. Personal items to be stored in designated areas.
John Gehan
Equipment and Utensils PASS
BLUE
Date Inspected: Correct By:
12/4/2006
Comments: Sanitizing log not up to date. Log to be maintained daily.
Risk Level
Sanitizer not reading. Proper sanitizer to be used. Each work station to have sanitizer readily available with proper
concentration.
Permit Number:
1 Traulsen refrigerator requires thorough cleaning.
BHP -2006-0291
Same unit has no visible thermometer. Provide visible and accurate thermometer.
Status:
Leader refrigerator requires general cleaning.
SIGNED OFF
# of Critical Violations:
Shelves beneath crepe machines requires thorough cleaning.
0
Microwave requires general cleaning.
Time IN: Time OUT:
Dishwasher room counter requires general cleaning.
Urgency Description(s):
BLUE:
Soda refrigerator requires general cleaning.
Violations Related to Good
Retail Practices (Critical
GENERAL COMMENTS:
violations must be corrected
All violations from 12/04/06 have been corrected.
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 11,2006)
Page 1 oft
Item
RED: RED:
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
Status Violation Critical Urgency
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 11,2006) Page 2 oft
` 180 ESSEX STREET
N
Telephone:
(978) 744-9904
Owner:
Tracy Thurdin
PIC:
Anriars Thurdin
Inspector:
John Gehan
Date Inspected: Correct By:
12/4/2006
Risk Level:
Permit Number:
BHP -2006-0291
Status:
Open
# of Critical Violations:
1 I
Time IN:
Time OUT:
I
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item
PROTECTION FROM CONTAMINATION
Status Violation
Z Crepe Cafe LLC
Critical Urgency
Handwash Facilitieg— FAIL LJ RED
Hand wash sink next to dish wash room missing hand wash only sign. Provide sign.
Violations Related to Good Retail Practices (Blue Items)
Food and Food Protection FAIL BLUE
mment: Shirt stored on glasses. Personal items to be stored in designated areas.
Equipment and Utensils FAIL
--e6mSanitizing log not up to date. Log to be maintained daily.
BLUE
nitizer not reading. Proper sanitizer to be used. Each work station to have sanitizer readily available with proper concentration.
Yra/ulsen refrigerator requires thorough cleaning.
—85me unit has no visible thermometer. Provide visible and accurate thermometer.
L- �Leader refrigerator requires general cleaning.
v�es beneath crepe machines requires thorough cleaning.
t/
i 9 crow requires general cleaning.
�,s 5w;` sher.room counter requires general cleaning.
—19 fea irr gerator requires general cleaning.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 04,2006 ) Page 1 oft
RED:
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
Item
Status Violation Critical Urgency
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 04,2006 ) Page 2 oft
180 ESSEX STREET
Telephone: �1'
{9781744-9904
Owner: ;
Tracy Thurdin''
PIC:.
Anders Thurdin
Inspector.
David Greenbaum
Date Inspected:
Correct By:
9/7/2006---
Risk Level,
Permit Number:
BHP -2006-0291
Status:
SIGNED OFF
# of Critical Violations:
1
Time IN:
Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
Z Crepe Cafe LLC
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION _
Food Contact Surfaces Cleaning and Sanitizing
FAIL Critical
RED
Comment: The cutting boards are stained and scored. Resurface or replace the cutting boards. Owner has ordered a new cutting
board.
GENERAL COMMENTS:
784:All other violations cited in the 8131/06 inspection report have been corrected.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006) Page / of
RED „1,�k�
Violations Related to' '
Foodborne Illness Interventions
and Risk Factors (Require, :i,
immediate corrective action) 3
Item Status Violation Critical Urgency
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006) Page 2 oft
180 ESSEX STREET
Z Crepe Cafe LLC
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
PROTECTION FROM CONTAMINATION
Separation/ Segr gation/ Protection FAIL Critical ❑J RED
Co ant: The Leader reach in has potentially hazardous food stored above ready to eat food. Store all PHF below RTF to prevent
c as contamination.
Fo7�ntact S aces Cleaning and Sanitizing FAIL Critical d❑ RED
mment: Sanitizing solution found too strong. Sanitizing solution of proper concentration must be readily available at all work
stations at all times. Use proper test strips to check concentration and log on a sanitizing log. Log left at time of inspection.
4—The cutting boards are stained and scored. Resurface or replace the cutting boards.
Handwash Facilities FAIL Critical
Hot and Cold
d❑ RED
The kitchen hand wash sink is missing soap. Provide soap in the wall hung soap dispenser at all times.
FAIL Critical
RED
The Leader cooling unit had a temperature of 50'F. Repair unit to maintain a temperature of 41°F or below.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 31,2006) Page 1 oft
RED:. ..
ViolationsRelated t6
Foodbomeillness Interventions
and Risk Factors (Require, I `
immediate corrective action)
Item
Violations Related
(Blue Items)
Status Violation Critical Urgency
Food and Food rotection FAIL Critical ttLut
C ment: There are paper products stored directly on the floor. Store all paper products at least 6-8 inches off the floor.
Equi nt aje;n
ls
Coe Leader cooling unit has an accumulation of food debris.
Thegic Chef freezerneeds a thorough cleaning and defrosting.
-Th ulsen reach in needs a thorough cleaning inside and out.
he micro owave needs a thorough cleaning.
EEsstahment is in need of a general cleaning.
Physidef Facility
FAIL Non -Critical BLUE
Thoroughly clean this unit inside and out
FAIL Non -Critical BLUE
( Coommmen/oor in open position at the time of inspection. All openings to the outside must be sealed.
GENERAL COMMENTS:
771:Reinspection will be in one week. All violations to be corrected.
City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800
GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 31,2006) Page 2 oft
Commonwealth of Massachusetts
City of Salem
Board of Health
120 Washington Street, 4th Floor
SALEM, MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/04/2006
WHO'S PLACE OF BUSINESS IS:
File Number: BHF -2005-0036
LOCATED AT:
Z Crepe Cafe LLC
180 essex Street
SALEM MA 01970
180 ESSEX STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes
FOOD SERVICE BHP -2006-0291 Jan 4, 2006 Dec 31, 2006 $150.00
ESTABLISHMENT
Total Fees: $150.00
PERMIT EXPIRES Decetnber 31, 2006
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all
plans for such must be submitted to and approved by the Salem Board of Health. Page 19 of 20
w
STANLEY J. USOVICZ, JR.
MAYOR
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAx 978-745-0343
W W W.SALEM.COM
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
�o
c, QFC 091
@pK' P 0FS , .00S
pFtiq�F
44tM
�
2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT_ Z C'4-CVi,5 C.✓k-V'g TEL # I " -'`t`1 c(cto H
ADDRESS OF ESTABLISHMENT `( Z0 nSC?fS''12C'O�
MAILING ADDRESS (if different)
OWNER'S NAMETEL# l
CITY ys v STATE 'M"a ZIP
CERTIFIED FOOD MANAG R'S NAME(S) Awv�tL\ 7yyj\L a \.) CERT
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON HOME TEL # t'j-yY r1-- t NT(,"
HOURS OF OPERATION: Mon. � Tue._�C_Wed. ) Thu.Fri. k� Sat. Sun.
TYPE OF ESTABLISHMENT
RETAIL STORE YES NO
- ..............................................................................
RESTAURANT YES NO
7 61-0(�
.........-S : ........N.....O
BED/BREAKFAST YE
FEE (check only)
less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than I0,000sq.ft. =$250
less than seats C1500)25-99 seatsis
more than 99 seats
$100
.....................................................................................................
ADDITIONAL PER�4!TS
..
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO
$5
TOBACCO VENDOR YES NO
$50
ALL NON-PROFIT (such as church kitchens) YES NO
$25
*Please pay total with one check payable to the City of Salem .
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes
are made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best
knowledge and belief, have filed all state tax returns and paid all state taxes required under the law.
12IC Ifr
Signature Date Social Security or Federal Identification Number
Revised 11/03/05 FOODAP2.adm Check#&
$/5 /
180 ESSEX STREET Z Crepe Cafe LLC
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Telephone: Item Status Violation Critical Urgency Nature of problem or correction
(978) 744-9904 _ __ Non-compliance with: Done
Owner:
Tracy Thurdin *5
PIC: _
Anders Thurdin
Inspector:
David Greenbaum
late Inspected: ICorrect
By;; Reporting of Diseases by Food Employee and PIC PASS./❑ RED
Personnel with Infections Restricted/Excluded PASSd❑ RED
Risk -Level: � ' '°
Anti -Choking
PASS
❑
::Time IN:
Tobacco
PASS
❑
PASS
Notes: - — '`;,
FOOD PROTECTION MANAGEMENT
Done
PASS
Q
RED
PASS
❑J RED
Permit Number:
PIC Assigned / Knowledgeable / Duties
EMPLOYEE HEALTH
Done
BHP -2005-0463 '
By;; Reporting of Diseases by Food Employee and PIC PASS./❑ RED
Personnel with Infections Restricted/Excluded PASSd❑ RED
Risk -Level: � ' '°
PROTECTION FROM CONTAMINATION
Done
::Time IN:
.Time OUT
FOOD FROM APPROVED SOURCE
Done
PASS
Notes: - — '`;,
-- .�
Food Contact Surfaces Cleaning and Sanitizing
PASS
Q
RED
Proper Adequate Handwashing
Food and Water from Approved Source
Permit Number:
-
Urgency Description(s):
BHP -2005-0463 '
Receiving/Condition
PASS
0
RED
Status:
Tags/Records/Accuracy of Ingredient Statements
PASS
RED
SIGNED OFF'
Retail Practices(Critical`'-
Handwash Facilities
PASS
Conformance with Approved Procedures/HACCP
PASS
RED
# of Cfitical ViOlatiODS �.,
1, 4 -:
Plans
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc.
RED
RED
RED
RED
RED
RED
( Rev. Jun 15,2005 )
Page 1 of
PROTECTION FROM CONTAMINATION
Done
::Time IN:
.Time OUT
w
Separation/ Segregation/ Protection
PASS
Notes: - — '`;,
i#
Food Contact Surfaces Cleaning and Sanitizing
PASS
210
Proper Adequate Handwashing
PASS
t�
-
Urgency Description(s):
Good Hygienic Practices
PASS
BLUE ,, =
Violations Related to Good
Prevention of Contamination from Hands
PASS
Retail Practices(Critical`'-
Handwash Facilities
PASS
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc.
RED
RED
RED
RED
RED
RED
( Rev. Jun 15,2005 )
Page 1 of
180 ESSEX STREET
Done
Z Crepe Cafe LLC
must be Corrected Immediately
PROTECTION FROM CHEMICALS
Done
BLUE
or -within 90 days) s
Approved Food or Color Additives
PASS
❑J
RED
RED:
Violations Related to
Toxic chemicals
PASS
❑D
RED
Foodborne Illness Interventions
TIMEITEMPERATURE CONTROLS (Potentially Haz
Done
BLUE
and Risk Factors (Require
Cooking Temperatures
PASSd❑
BLUE
RED
immediate corrective action)
PASS
❑
BLUE
Special Requirements
Reheating
PASS
BLUE
RED
Other- See Notes
Cooling
PASS
0
RED
Hot and Cold Holding
PASS
RED
Time As a Public Health Control
PASS
Q
RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO
Done
establishment has met all requirements to
Food and Food Preparation for HSP
PASS
RED
CONSUMER ADVISORY
Done
Posting of Consumer Advisories
PASS
0
RED
Violations Related to Good Retail Practices (Blue
Done
Management and Personnel
PASS
❑
BLUE
Food and Food Protection
PASS
❑
BLUE
Equipment and Utensils
PASS
❑
BLUE
Water, Plumbing and Waste
PASS
❑
BLUE
Physical Facility
PASS
❑
BLUE
Poisonous or Toxic Materials
PASS
❑
BLUE
Special Requirements
PASS
❑
BLUE
Other- See Notes
PASS
❑
BLUE
Label all sinks.
In accordance with the Federal Food Code
and the State Sanitary Code this
establishment has met all requirements to
operate a food establishment.
GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 15,2005 ) PaQe 2 of
180 ESSEX STREET
Z Crepe Cafe LLC
GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 15,2005 ) PaQe 3 of 3
I Establishment
Item Code
No. Reference
i
C —Critical Item
R — Red Item
CITY OF SALEM
BOARD OF HEALTH
Ov- Date: 6- i a- 0 S- Page: f of I
DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date
Verified
4 I aed i l 1 547 /.¢✓
l � /Pis - 5 iu_ � � x cv�r -/�.• v C /�o °F h , �.-
►.vi%"Ir _0,1ojH /�S�S (still .5�i..0A i a 0,O
I WE
IIID � 11
v!
Discussion With Person in Charge: 17(yGd /�7
I have read this report, have had the opportunity to ask questions and agree to correct all
violations before the next inspection, to observe all conditions as described, and to
comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of
your foo perm!t. , lu f- 6W /0e�
hltrn X141
Corrective Action Required
❑ Voluntary Compliance
❑ Re -inspection Scheduled
❑ Embargo
❑ Voluntary Disposal
❑ No ) ❑ Yes
❑ Employee Restriction /
Exclusion
❑ Emergency Suspension
❑ Emergency Closure
❑ Other:
�j{ {yarrJC .C�(l/0-y{G l9e->'d UJOSh 5/�`J 4_
jziF_ry Ali ~tq h.Wf /hflilldr/ �fii.'��L� r(�i5 �f/°� r/ /OwPi i %✓CIZPv (70,c� ti,,
Violations Related to Foodborne Illness Interventions and Risk
Factors (items 1-22) (Cont.)
PROTECTION FROM CHEMICALS
la
15
16
17
I Denotes critical item in iha f simal 1999 Food Cody or 105 CMR 590.000.
3-501-14C)
Food or Color Additives
3-202.12
Additives"
3-302.14
_
Protection from Unapproved Additives*
3-501.15
Poisonous or Toxic Substances
7-101.11
Identifying information - Original
Containers*
7-102.11
Cotnuton Narne - Working Containers*
7-201.11
Separation - Slot a e*
7-202.1.1
Restriction - Presence and Use*
7-202.12
Conditions of Use,
7-203.11
Toxic Containers - Prohibitions'
7-204.11
Sanitizers. Criteria - Chennicals*
7-204.12
Chetnicals for Washing Produce, Criteria*
7-204.14
Di.in r ents. Criteria*
7-205.11
Incidental Food Contact, Lubricants*
7-206.11
Restricted Use Pesticides. Criteria*
7-206.12
Rodent Bait Stations*
7-206.13
Tracking Powders, Pest Control and
Monitoring*
I Denotes critical item in iha f simal 1999 Food Cody or 105 CMR 590.000.
3-501-14C)
Proper Cooking Temperatures for
3-801.11(B)
PHFs
3-401.1.1A(1)(2)
Eggs- 155'F 1.5 See -
ec.3-401.11(A)(2)
3-501.15
Cooling Methods for PHFs
3 -401.11 (A)(2)
Comminuted Fish, Meats e& Came
3501.16(3)
Animals- 155'F 15 sec. s
3-401.11(13)(1)(2)
Pork and Beef Roast - 130'F 121 min*
3-401.11.(A)(2)
Ratites, Injected Meats -155'F 1.5
Special Requirements
sec. *
3-401.11(A)(3)
Poultry, Wild Game, Stuffed PHFs,
20
Stuffing Containing Fish, Meat
3-501.19
Poultry or Ratites -165°17 I5 sec. a'
3-401 . I I (C)(3)
Whole-musele,Intact Beef Steaks
145°F *
3-401.12
,Raw Animal Foods Cooked in a
Microwave165'F w
3-401.11(A)(1)(b)
All Other PHFs- 145'F 15 sec.
Reheating for Hot Holding
3-403.11(A)&(D)
PHFs 165'F 15 sec. *
3-403.11(B)
Microwave- 165' F 2 Minute Standing
Tile*
3-403.11(C)
Commercially Processed RTE Food -
140'F*
3-403.11(E)
Remaining Unsliced Portions of Beef
Roasts*
Proper Cooling of PHFs
3-501.14(A)
Cooling Cooked PHFs from 140'F to
70`17 Within 2 hours and From 70'F
to 4PF145'F Within 4 Hours. *
3-50L14(B)
CoolingPHFs Made From Ambient
Temperature ingredients to 41 °FJ45°17
Within 4 Hours*
I Denotes critical item in iha f simal 1999 Food Cody or 105 CMR 590.000.
3-501-14C)
PRFs Received at'Temperamres
3-801.11(B)
According to taw Cooled to
3-80111(D)
4 F'17145°F Within 4 Hours.
3-501.15
Cooling Methods for PHFs
19
PHF Hot and Cold Holding
3501.16(3)
Cold PHFs Maintained at or below
590.004(F)
41%45° F*
3-501.16(A)
Hot PHFs Maintained at or above
Special Requirements
140°F - 'x
3-501.16(A)
Roasts Held at or above 130°F.
20
Time as a Public Health Control
3-501.19
Time as a Public Healon Conhni*
590.004(Hi
Variance Requirement
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS [HSP)
21 3-801.'11(A)
Unpasteurized Pre-packaged Juices and
Beverages with W amine Labels*
3-801.11(B)
Use of Pasteurized Eggs*
3-80111(D)
Raw or Partially Cooked Animal Fail and
Raw Seed S Croats Not Served. 't
3-801.11(0)
UnoenedFoaiPacka>eNotRe-served.*
2.2
3-603.7 I Consumer Advisory Posted for Consumption of
7�
Animal Foods That are Raw. Undercooked or
Food and Food Protection
Not Otherwise Processed to Eliminate
25,
Path(gens.* era.a,.e rn:e901
FC -4 _ .005
FC -5 ! _ 006
3-302.13 Pasteurized Eggs Substitute for Raw Shell
Ph sical Facili
E s*
SPECIAL REQUIREMENTS
590.0,RA)4D) Violations of Section 590.009(A)-(?) in
catering, mobile food, temporary and
residential kitchen operations should be
debited under the appropriate sections
above if related to foodborne illness
interventions and risk factors. Other
590.009 violations relating to good retail
practices should be debited under #29 -
Special Requirements.
IZ1 �Y�i�ifZSTi7�T3
(Metas 23-30)
Critical and non-critical violations, which do not relate to the
,foodborne, illness iurerverrrions and riskfortors listed above, can be;
found in the following sections of the Pood Code and 105 Cibflf
590.000.
Item
23.
Good Retail Practices
Mona ement and Personnel
FC 590.000
FC - 2 .003
24.
Food and Food Protection
FC- 3 - .004
25,
_ E9uipmeni and Utensils _
Water, Plumbin and Waste
FC -4 _ .005
FC -5 ! _ 006
27.
Ph sical Facili
FC -6 .007
28.
Polsonous or Toxic Materials
FC -7 .008
29_
Special Requirements
.009
30.
Other
_
rsa��mrn�:.v�r-zuo�
BOARD OF HEALTH xrF
" +':z • -, i 'M2'# e��.. .,y-'_a..t ...-....+.KasT +wn'xki. m�
r -
120 WASHINGTON STREET 4TH FLOOR
SALEM, MAO 1970
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: Z Crepe Cafe
Address of Establishment: 180 Essex Street
Owner's Name: Tracy Thurdin
Restrictions:
Application Date: 6/15/05
Permit for Food Establishment 305-05
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products
These Permits Expire December 31, 2005
This permit is not transferable and must be reissued upon change of
ownership or location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitted to and approved by the Salem Board of Health.
HEALTH AGENT
STANLEY J. USOVICZ, JR.
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343 -
JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT��Fe ) L C TEL # G -7F 4 -- y
9 v
ADDRESS OF ESTABLISHMENT lo'U E CSCic _ �'0'7 AA 01600
MAILING ADDRESS (if different)
OWNER'S NAME t t tnC4— k'r-JTEL
aIh
CITY ff C'%0K/ t
CERTIFIED FOOD MANAG
STATE MPI' ZIP 0tc tS
at/5'rf%rLdkti CERTIFICATE#(s)
(required in an establishment where potentially hazardous food is prepared.)
-91014
NSA y
EMERGENCY RESPONSE PERSON AAA crS Th A ii,\ HOME TEL i0q
HOURS OF OPERATION: Mon. T1 Tue.1'01 Wed.�Thu. 7'� Fri. 7'9 Sat.' g Sun.
TYPE OF ESTABLISHMENT
RETAIL STORE YES NO
RESTAURANT YE NO
BED/BREAKFAST YESo
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE
TOBACCO VENDOR
ALL NON-PROFIT (such as church kitchens)
FEE check only
less than 1000sq.ft.
=$ 50
1000-10,000sq.ft.
=$100
more than 10,000sq.ft.
=$250
less than 25 seats
=$100
25-99 seats
= 150
more than 99 seats
=$200
$100
YES O $5
YES O $50
YES O $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
befit kgwMedge arld belief, have filed all stqte tax returns and paid all state taxes required under the law.
Signature
Social Security or Federal Identification Number
------------ ---------------------------------------------------------------------------------------------
Revised11/03/03 FOODAP2.adm Check#&Date
_j/(/J `� lD'�� `�S•
CITY OF SALEM
BOARD OF HEALTH
Name of Establishment: Z Crepe Cafe
Address: 180 Essex Street
Owner(s): Tracy & Anders Thurdin
Phone: 978-921-4564
The owners of this proposed establishment presented a preliminary Floor Plan
and Menu for review in accordance with the State Food Code.
CERTIFICATION
Mr. Thurdin is a Certified Food Manager.
FLOOR PLAN
A Hand Sink must be located in each food prep and service area.
Therefore there must be a hand sink accessible to the crepe making machine
and the prep tables.
Hand sinks must have wall hung soap and paper towel dispensers. These
must be stocked at all times. Hand sinks must be used for hand washing only.
All floors, walls, and ceilings where food, utensils, paper products, etc, are
stored, prepared or served must be intact, impervious, and easily cleanable.
MENU/FOOD PREP
Any pre -made items must be purchased from a wholesaler licensed by the
State.
Fruits and vegetables must be washed prior to preparation unless the
packaging clearly states "pre -washed and ready to eat." The owners propose a
food prep sink in an adjacent small room. This sink must be sanitized before and
after washing.
All food must be held at 41 °F or lower, or 140°F or higher, at all times.
Therefore, all potentially hazardous ingredients for the crepes must be
maintained at these temperatures.
Food may not be added to containers in salad unit. Instead, a sanitized
container with new product may replace the existing container and the old
product may be placed on top of the new product.
There may be no bare hand contact of ready -to -eat foods. Gloves, tongs,
or tissues must be used when handling such food.
CERTIFICATION
There must be a Certified Food Manager working at this establishment full
time. i
teGGme-eertffnd.
When a CFM is not onsite there must be a Person -in -Charge (PIC) who is
fully trained in sanitation techniques and has a thorough understanding of the
operation.
UNDERCOOKED FOODS
If you plan not to sell undercooked foods, you menu must state this.
EXTERMINATION
Monthly services of a Licensed Pest Control Operator are required.
Please keep receipts for inspections.
SANITIZING
Sanitizing Solution must be accessible at each prep station and for the
patrons' tables.
Test strips corresponding to the kind of sanitizer, must be on hand to
check concentration of solution. Solution must be made daily, tested, and the
results recorded on a log sheet for examination by Board of Health inspectors.
Solution may be made in the food prep sink and spray bottles may be
filled there. Spray bottles with clean paper towels may be used, as well as
wiping pails with wiping clothes always held in the solution in the pail.
The owners plan to use an NSF approved dishwasher with a final rinse of
180 degrees.
Please check with the Building Department regarding restroom questions
and other building questions.. 978-745-9595 x 386
Please contact the Licensing Board to determine if a Common Victualler's
License is required because you have seating.
Outside area of premises, including the dumpster area, must be kept
clean and sanitary.
Please submit a final floor plan for review
Oanne Scott Date
Health Agent
Owner(s) Date
F
c� �
Z Crepe Cafe Menu
Crepes
Entree Crepes
Zalem
Smoked salmon, diced tomato, onion and cream cheese
Zippy
Turkey, tomato, cucumber, avocado, and cheese
ZigZag
Sliced ham, tomato, brie cheese and chopped nuts
Zoom
Turkey, tomato and feta
Zany
Turkey, onions, jalapeno, avocado and cheddar cheese
Zen
Tomato, garlic, red pepper, basil, mozzarella
Zinger
Sliced ham, pineapple, cheddar cheese
Sweet Crepes
Zummer
Strawberries, nutella and whipped cream
Zamaican
Banana, nutella and whipped cream
Z tropicana
Banana, kiwi and chocolate
Z special
Sliced apple, nutella and shaved coconut
Zummer mix
Strawberries, banana and chocolate
Custom Crepes
Meats
Cheese
"Veges
Fruits
other Good
Stuff
Ham
Brie
.Mushroom
Pine- Ce
Walnuts
Turkey
Provolone
Onion
A Ce
NuteCCa
SaCami
9vtozzareCCa
Tomato
Banana
Chocolate
Smoked
Salmon
Muenster
Asparagus
Strawberry
Shaved
Coconut
Roast Beef
Swiss
GarCLc
Grapes
Whipped
Cream
Feta
RedPepper
Avocado
alone
Cheddar
Lettuce
Xiwi
Cream
Cheese
Cucumber
Blueberry
Basil
5/3/2005
Page 1 of 3
Sandwiches
Salami & Brie Sliced salami with delicious brie in a baguette
Mozzarella & tomato Sliced tomato with fresh mozzarella
Roast Beef & Swiss Sliced roast beef with swiss cheese
muffins
Swedish chocolate balls
Cinnamon rolls
Croissants
Chocolate Cake
Chocolate Chip Cookies
Sweets/Snacks
Hot Drinks
Coffee Chai Tea Hot Chocolate
Cappuccino Herbal Teas
Cafe Mocha
Cafe Latte
Cafe Au Lait
Espresso
Espresso Macchiato
Espresso Con Panna
Cold Drinks
Iced Coffee Bottled juices
Iced Latte
Iced Tea
5/3/2005 Page 2 of 3
Smoothies (yogurt, fresh fruits)
Banana Strawberry
Banana Chocolate
Blueberry
Vanilla
5/3/2005 Page 3 of 3