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ZIGGYS DONUT SHOP - ESTABLISHMENTSuniversal oneTm www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA I Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: File Number: BHF -2004-000364 LOCATED AT: Kimberley Driscoll Mayor Ziggy's Donut 2 Essex Street Salem MA 01970 0002 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2011-0213 Jan 1, 2011 Dec 31, 2011 $140.00 ESTABLISHMENT TOBACCO VENDOR BHP -2011-0212 Jan 1, 2011 Dec 31, 2011 $135.00 Total Fees: $275.00 PERMIT EXPIRES December 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR DAVID GREENBAuM, RS ACTING HEALTH AGENT CITY Or SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4` FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 DGREP.NnAUM@SALL'M. CONI 2011 APPLICATION FOR PERMIT TO OPERATE ALFOOD ESTABLISHMENT NAME OF ESTABLISHMENT j / cit ✓?4 Soni,, DU'UA�TS TEL # Gl -73— f% qC/' qf 0� ADDRESS OF ESTABLISHMENT a SS ex s4T&,+ FAX # MAILING ADDRESS (if different) EMAIL - Business': OWNER'S Website: TEL ADDRESS -D S U rn M 1 + Siy rDi— Sd (P M MA 0161-70 STREET g CITYSTATE ZIP p �/ (�, 6 11.9 _ �J CERTIFIED FOOD MANAGER'SNAME(S) P�Gu � (`\Ql�li.5r\( CERTIFICATE#(S) 3 3 6Y� 1 (Required in an establishment where potentially hazardous food is prepared) p /� EMERGENCY RESPONSE PERSON_J f A KG� s 2-e ca5 k I HOME TEL # 9 � 0 _ q q __�j by HOURS OF OPERATION I Please write in time of day r9 // }} (For example Ilam -11 Pm) :6'31-3 1P'JQ-3 ! . 7 / ;x.30-3 '{p ,3o-7 IrO ;jU'� /� /� l,'Qti� '10 '3(t'�zrJ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 YES NO + 1tD 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------- ------------------------------------------------------------------------------------------------ RESTAURANT YES NO less than 25 seats ------ =$140 (Outdoor Stationary Food Cart $210) 25-99 seats more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO + 1tD 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. I 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. NA^, Q, 00 � (-,-W IO v y � - 8570 - 39.) Signature Revised 10/7/11 FOODAP201 Ladm Date Check# & Date a �ao��' Social Security or Federal Identification $ �S Commonwealth of Massachusetts c e City of Salem Board of Health 120 Washington Street, 4th Floor KlfTlb Mayor Driscoll or SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2012 ESTABLISHMENT NAME: Zig:gy's Donuts File Number: BHF-2004-000364 2 &sex Street - Salem MA 01970 LOCATED AT: 0002ESSEX STREET SALEM, MA 01970 Permit Type Permit No. PermitIssued . Permit Expires Fee Restrictions/ Notes' FOOD SERVICE BHP-2012-0288 Jan 1, 2012 Dec ;11,:2012 $140.00 ESTABLISHMENT TOBACCO VENDOR BHP-2012.0287 Jan 1, 2012 Dec ill, 2012 $135.00 .: Total Fees: $275.00 PERMIT EXPIRES IDecember 31, 2012 Board of. Health Po oo This. Permit isnot transferable-.and must be reissued upon change of ownership. or location. The permit must be.posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page t mm) KINIBERLEY DRISCOLL IN1;AYOR LARRY RAMDIN, RS/RI-:1 IS, CI {0, CI' -D'S I-lli.\1:1'11 AGIiNT CITY OF SALEM, NIASSACHUSI"'I"1:S BOARD OF HEALTH 120 WASHINGTON STREET, 4` FLOOR TEL (978) 741-1800 F_ -X (978) 745-0343 IramdmQc salem.com 201_ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT__ I gGV Qn Sons Dr,h_ l�S _?E.L# 0173`74q- G60S ADDRESS OF ESTABLISHMENT ✓ Q E S 5 P-yc 8+- 2e.+ FAX # MAILING ADDRESS (if different) EMAIL -Business': MMKFA(�M(b) cu ,COn') Website: OWNER'S NAME J66 P' AK(Ah, s?ew5ki TEL# 9785- 7y�--I-3SS0R ADDRESS Jr -b SLtrn r-) t } scileh-, MA 0 1 70 STREET CITY (� STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) I Q+6 GG A K (AYoUIS ki CERTIFICATE#(S) (0 (o f (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON H en W W, R cA+Ko03 k', p HOME TEL # DAY,$ OFOPERATION Monday j Tuesday,' ,-Wednesday a ihursdav --1 Fddaw. ' Saturday Sunday HOURS OF OPERATION W (D! 30 I (c.3o4M 10 Am 6:3G (o'3UGn 1 Please write i l lane d day. �;✓ OG m -ju I. {tu +7, (For examplellam-ttpm) 3Pn 3!00 n 3 o0�rv1 1 o0gM 1 3.00 PM C-1 If 12'ou Irx' TYPE OF ESTABLISHMENT 111� FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats140 -• 1 $ 25-9& seals =,'t� more than 99 seats =$420 MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES TOBACCO VENDOR no 4 r.0 ti� YES NO $13 ALL NON-PROFIT (such as church kitchens) YES ,( 10 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. 63 i— G a -r_5-73 Signature Date - Social Security or Federal Identification Number Updated 523/11 FOODAP201 Ladm Check# & Date IA9 1,4-666 i;-/3 0 J 5 t 0002 ESSEX STREET Telephone: 744-9605 Owner: John Akatyszewski PIC: Patty Rutkowski Inspector: Elizabeth Salandrea Date Inspected: Correct By: 18/29/2011 Risk Level: Permit Number: BHP -2011-0213 Status: SIGNED OFF 1# of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected i immediately or within 10 days)(Non-critical violations must be corrected immediately' or within 90 days) I Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils FAIL Non -Critical BLUE Comment: Label sink in back room "food prep only". Sanitizer concentration must be logged daily. Please forward invoice for current ventilation service to the Board of Health within one week. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2011 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2011 ) Page I oft w Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2011 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2011) Page 2 of k 19 tog. 1 " wUSkzr- vn ust 611e ih 49 Spot W/ 1 obi -ted 65h wzher b)&n in -For crr (voof a w� t ar V UO V)"i!� corr�d �y Ufi&i7 scehA'-z h rveur-/4d IFff- on rine i CITY_ OF 120 W KINMERLEY DRISCOLL MAYOR JAN C'; 'DIEHNNU' A<,,I'INC,i HU"AIa'hl AGL'',N'T t. Date: Friday, November To: Board Members From: Elizabeth Salandre RE: Ziggy's Donuts — ,...,k.�;y,,,. ;, -.Yf.. r:t,tz- , 1 � , Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 0 Floor' 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ( Dat _ O Tvoe of Ooeration(s) [�%F�pod Service ❑ Retail ❑ Residential Kitchen ❑ Mobile [I Cate erary ❑ Bed & Breakfast Permit No. Tvoe of Inspection �]c Rautine ❑ Re -inspection Previous Inspection Date: [IPre-operation ❑ Suspect Illness ❑ General Complaint HACCP ElO herr Address Ris * Level Telephone _ Owner /�` S HACCP YM Person in Charge (PIC) Time O /, OJ` Out: () t� InspectorEl Each violation checked ilequires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. R FOOD PROTECTION MANAGEMENT„,j',= ❑ 1 PIC Assigned/ Knowledgeable/ Duties EMPLOYEE HEALTH ' 7 74t,�'.��!,A,..'Sa;L.� ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3.. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE�`�'. i.'.�»`'aak„»a`.4,v7.„`a, ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans `PROTECTION FROM CONTAMINATION ?:�'"r -�"9 "• ❑ �8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Cvt 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) '26. Water, Plumbing and Waste (FC -5)(590.006) 27: Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s: SBDNSpBCIFomi 14,d. n ❑ 12. Prevention of Contamination from Hands ❑ 13 Handwash Facilities " PROTECTION FROM CHEMICALS_ a , 5 @ �'';�=i c"r'3 ,' �'��' ' t y y�.. _..e ❑ 14. Approved Food or Color Addltives ❑ 15. Toxic Chemicals TIMMEMPERATURE CONTROLS'(PotentlaltyHaYardous r=oods) LuW,3m€ 2❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control v If RED UIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATK)NS (HSP) ? ❑ 21. Food and Food Preparation for HSP I'CONSUMERADVISORY_`" 3, ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION-� VV n n Inspector's Signature: \ I Print: 3-560. PIC's Signature: Print: Page / ofZ Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) I Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590:003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-20113 Fluid Milk and Milk Products* applicants* Shell Eg s* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Char *e* 590.006(B) 590.003(G) in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions C 5 C C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Ford Code or 105 CNIR 590.000. 4 -- PROTECTION FROM CONTAMINATION S Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Foad in a Hermetically Scaled Container* 3-20113 Fluid Milk and Milk Products* 3-202.13 Shell Eg s* 3-202.14 E> s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* Washin Fruits and Ve. etables Sheltlish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish" 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatoty Authorit 3-202.18 Shellstock Identification Present` -590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 3-701.11 Receiving/Condition 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package bite it * 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstoek Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) labeling of Ingredients' Frequency of Sanitization of Utensils and Foul Contact Surfaces of E ui ment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Ford Code or 105 CNIR 590.000. 4 -- PROTECTION FROM CONTAMINATION S Cross -contamination 3-302.11(A)(1) Raw Animal Foods Separated from C(x)ked and RTE Foods* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-30215 Washin Fruits and Ve. etables 3-304.11. Food Contact with Equipment and Thensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning unsafe. F(x)d* 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* - 4-501.112 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4-501.114 Chemical Samfization- temp., pH, concentration and hardness. * 4-601-11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.1 t Frequency of Sanitization of Utensils and Foul Contact Surfaces of E ui ment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anes* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco` 2-401.12 Discharges From the Eyes, Nose and - Mouth* 3-301..12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* acities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 HandDrvingFrovision rt CITY OF SALEM BOARD OF HEALTH j Establishment Name: Z c.,.„ l��n ,� - Date: /i�� Page: of Item No. Code Reference C—Critical Item i R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION; - ' ,� PEASE PRINT CLEARLY ' VerMled / l �L � aa -)/,1,2 il�_!/ JQ f07QA691-OC1i1_r4 (, i A)oo n,rn _ i _ -. f F i i/L NI r f Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct allvolentary-Compliance violations before the next inspection, to observe all conditions as described, and to ” p comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines o twenty-five dollars or suspension/revocation of your food permit. ��{ _ " �i ""yu.LC.I�I t - Corrective Action Required: ❑ No `Yes` ❑ Employee Restriction / Exclusion O Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo El Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (litelins 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 16 Food or Color Additives 7—NI21-2— Additives" Fi-w 3-30114 Protest from Unapia oved Additives* LLI Mev,:s (vC:119; Poisonous or Toxic Substances Xiaw;&; 155 1 101.11 Identifying [rdiamation - Ori.ginal ,4i Wit1m) -, How!, Rime, filietn"d Nlt,IL, 1 U j5 Containers, 7-102,11 Common Nunn,-, - Workini, 0,.v,tm,-n,1 t I I S�pviiavievi storag�l' Pettiction preisi-ricvjvd L'cl 7-101 i 2 Coijdjum— of ihiel Tit, I —I 11 -Til"C—Containeri -- flrtillihi:wn", 20 204, sassilizers, Crit ria - clwiaicaW ; 2IJcl. 12�),, Chejlaiajs for Clitel a, 7-204A ss Urvimt Arecul. Crfteria it Int-i&,11[a] Voixi Contict, 1AINicaws": -4 llcicd t1sv peiicides� 0itelmm% 7-2,06.121 Roileni B%io Staiioa,,- 06 hiiekaig P,lvvdc(tont TIMEirrEMPERATURE CONTROLS 16 Proper CookiogTempetalures for Am)rding to Lam, Cooled to Fi-w Rows" Lttuxdi .. ... ..... Proper Cooling of PHFS Mev,:s (vC:119; Loni J�PviFtv Xiaw;&; 155 1 + J >;,el Road . L'7,f, loin, ,4i Wit1m) -, How!, Rime, filietn"d Nlt,IL, 1 U j5 1 -4 40 1 - I i (A)t 3) ? Wild („; 11, fMfft:d 1)[11"' `Dine ?haat a '. e t- 10j ( %4k COMIMM,ia;k, PI-IFt, Received at Temperatures Am)rding to Lam, Cooled to -- Rows" 41 °.F/45"F Within 4 Hours. Proper Cooling of PHFS j 501.14iA1 Loni J�PviFtv 14 7 + 17 t ,4i Wit1m) -, How!, 3501, 1401) A swadm�, I `Dine ?haat a '. e t- 10j ( %4k COMIMM,ia;k, PI-IFt, Received at Temperatures Am)rding to Lam, Cooled to -- Rows" 41 °.F/45"F Within 4 Hours. Proper Cooling of PHFS j 501.14iA1 Loni J�PviFtv 14 7 7o1l Within I {fours laid From 71jtT PHIF Hot and Cold Holding ,4i Wit1m) -, How!, 3501, 1401) Co(fi,it, miFl: %-tilde Front Ambient ronpaawre lnlrckiiitws io 41 B415 F 41"/450 1"' `Dine ?haat a '. e t- 10j ( %4k REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 o),ilteull/0'd Pry -pad aced Juices wid Ha tett tvith 801 111,13) i LS ul pa tell sd 1�, C,Y,)Kl,d Animal Fo(id avid - t,:, , s . . . 4 ; !,(xxl Packaec No _CONSUMER ADVISORY —-----, I — 7-- 22 3 4)0-: 11 Plr;tctj f vr (toliltumptioll 0" -In 1 Fi!t - 1whswuit- toi R;kv,, REQ,W-PEM Ell D) calo,(iF- .172 hili fvxxl, ittinporal v and rc1mdt,w A Llivichetl op;'natiori 'fle"Ild lie dcbii-ii and"I the appi-cm livo,` W,tli(aB ill::- Oil, lehuo to t,xJ t.;i k,OOD RETAIL IvRACD-C-E-S- VIHATidtvs REL (liesirs 23-30) clafc,& tag"I r, .r tl-lfca; i t i.r. ition'li do wn leilrc la 1h, frtr�rrbernc t:1 s, mtr(" t lw) emiro� fin f,lrc 1: r"Jalol 011 be "41 Coje aw; 10i Cio'R 2e_ 27. 3-501 14(1) PI-IFt, Received at Temperatures Am)rding to Lam, Cooled to -- — 41 °.F/45"F Within 4 Hours. 15 CoolingMethods �KfFs 14 7 PHIF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590 (-X)4(F) 41"/450 1"' 3-501,16(A) Hot PHIFz Maintained at or above 14WF 16(A) Pwists Held at or above 130,"F. 20 Time atia Public Health Control ; "itjj i) k-1 j -- 7 t)'110111-1) T'im,-a! a Public! Ieatlth Control?- - --d Vria-TL R sit REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 o),ilteull/0'd Pry -pad aced Juices wid Ha tett tvith 801 111,13) i LS ul pa tell sd 1�, C,Y,)Kl,d Animal Fo(id avid - t,:, , s . . . 4 ; !,(xxl Packaec No _CONSUMER ADVISORY —-----, I — 7-- 22 3 4)0-: 11 Plr;tctj f vr (toliltumptioll 0" -In 1 Fi!t - 1whswuit- toi R;kv,, REQ,W-PEM Ell D) calo,(iF- .172 hili fvxxl, ittinporal v and rc1mdt,w A Llivichetl op;'natiori 'fle"Ild lie dcbii-ii and"I the appi-cm livo,` W,tli(aB ill::- Oil, lehuo to t,xJ t.;i k,OOD RETAIL IvRACD-C-E-S- VIHATidtvs REL (liesirs 23-30) clafc,& tag"I r, .r tl-lfca; i t i.r. ition'li do wn leilrc la 1h, frtr�rrbernc t:1 s, mtr(" t lw) emiro� fin f,lrc 1: r"Jalol 011 be "41 Coje aw; 10i Cio'R 2e_ 27. V n, Commonwealth of Massachusetts s i City of Salem Board of Health Kimberley Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: File Number: BHF -2004-000364 Ziggy's Donuts 2 Essex Street Salem. MA 01970 LOCATED AT: 0002 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2010-0113 Jan 4, 2010 Dec 31, 2010 $140.00 ESTABLISHMENT TOBACCO VENDOR BHP -2010-0114 Jan 4, 2010 Dec 31, 2010 $135.00 Total Fees: $275.00 PERMIT EXPIRES (December 31.2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERI-EY DRISCOI-L MAYOR DAN71D GREENBAUM, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"r FLOOR TEL. (978) 741-1800 F X (978) 745-0343 - - DGREENBAUM&ALEM. COM 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 7166y AND SONS DONUTS TEL# 979-7tiy- 9(oog ADDRESS OF ESTABLISHMENT A ESSEX 5 T K EET FAX # MAILING ADDRESS (if different) EMAIL - Business': AOL. COM Website: OWNER'S NAME ;:I)41M P. A KA-rvs ZetOs KI TEL# gi-72f--744-25Oy ADDRESS 50 S U M M 17 ST12 E:ET 5A LE M /x/1/4 U I cl'70 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) PAT K I CI A A RUTK OUIISKI CERTIFICATE#(S) 13 3 6 ( L/ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON ALICE M HOME TEL # _ 97$-74 k1- O52L QAY.$ QF OP,ERgTIONi4 ', nday Tuesday%^ NednesdayyThursda Frida ri ":SalnNay" ' I Sunday ; HOURS OF OPERATION oAM!6"✓UAM Gt3o•aM_! &'3p/dM-i 6: 30" Please write in time of day. ANA i(v • 3 ' UO �.M 3 QM i P:41 C(,l)St1i ( NOo7�) Forexample11am-11 m m . ,9j I TYPE OF ESTABLISHMENT RETAIL STORE C NO RESTAURANT (Outdoor Stationary Food Cart $21 FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 less than 25 seats 25-99 seats more than 99 seats BED/BREAKFAST/ YES UNDO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS ----------------------------------------------------- .......--......... .----------------------------------------------------------------- •----------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE WNO $ 5 TOBACCO VENDOR YES $135 . ALL NON-PROFIT (such as church kitchens) S *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 retulns apd paid all stgte taxes required under the law. IS -o a3 I - 6o- s'S $rygnature Date Social Security or Federal Identification Ni --------------------------j,—.�--------- ��r -y�-/_ Revised 424/01 FOODAP2008.adm Check#&Date CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX (978) 745-0343 MAYOR DOWENBAUNa( ALFNECOM DnvID Gtr?ENBAUNI ACTING HFAI xi I AGENT' Memo Date: Tuesday, June 09, 2009 To: Board Members From: Elizabeth Salandrea RE: Ziggy's Donuts — Dishwasher This memo is to confirm that Ziggy's Donuts has installed a commercial dishwasher at their establishment. The dishwasher sanitizes with a high- temperature rinse cycle, and upon inspection today (June 9, 2009), the rinse cycle reaches 180°F as required to properly sanitize dishes and utensils. `i 0002 ESSEX STREET Telephone: 744-9605 Owner: John Akatyszewski PIC: Patty Rutkowski Inspector Elizabeth Salandrea Date Inspected: Correct By: 2/26/2009 Risk Level: Permit Number: BHP -2009-0249 Status: PARTIAL COMPLY '# of Critical Violations: ,3 'Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Ziggy's Donuts 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 LJ RED t�Comment: No sanitizing solution available in baking room. Sanitizer must be provided in all areas at all times. kanitizer log in baking room must be maintained daily if made at different time than sanitizer at front counter. A4anitizer bottles at front counter and in prep area were too strong. Provide sanitizer of proper concentration (200ppm) at all times. Handwash Facilities FAIL Critical ❑d RED Handwash sink in bathroom missing paper towels. Provide paper towels at all handwash sinks. Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE I/omment: Several sodas in the Coke fridge were expired, including Fanta, Sprite and pink lemonade. Owner to closely monitor all expiration dates. Physical Facility FAIL Non -Critical k4mment: One light in baking room is missing a cover. Provide protective cover for this light. Reinspection 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 BLUE GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2009 ) Page I 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® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2009 ) Page 2 oft 0002 ESSEX STREET Telephone: 744-9605 Owner: John Akatyszewski PIC: Patty Rutkowski Inspector: Elizabeth Salandrea Date Inspected: Correct By: 3/5/2009 Risk Level Permit Number: BHP -2009-0249 Status: SIGNED OFF '# of Critical Violations: 0 Time IN: .Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical Violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation All violations noted in the 2/26/09 inspection report have been corrected. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 Ziggy's Donuts Critical Urgency GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2009 ) Page I oft RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency E City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 05,2009 ) Page 2 oft Commonwealth of Massachusetts i tl City of Salem Board of Health Nmbedey Driscoll 120 Washington Street, 4th Floor Mayor SALEM, MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000364 Ziggy's Donuts 2 Essex Street Salem MA 01970 LOCATED AT: 0002 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2009-0249 Dec 29, 2008 Dec 31, 2009 $140.00 ESTABLISHMENT TOBACCO VENDOR BHP -2009-0250 Dec 29, 2008 Dec 31, 2009 $135.00 Total Fees: $275.00 PERMIT EXPIRES Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 KIMBERLEY DRISCOLL MAYOR ,JANET DIONNE, ACTING HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4m FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 IDIONNE&ALEM. COM ?� ' 9, lip" G��O.�` � •� y g0 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 16(oy L SOY)s 1)6)111-I2 �r T� ADDRESS OF ESTABLISHMENT a E SS 2)- S+r-?e.+ MAILING ADDRESS (if different``) EMAIL - Business': ( a U y P a g o a of ' G6 M Website: OWNER'S NAME Sohn P �KGiy$2WSK1 ADDRESS - 3tree+ So TEL# 928-7- q -y605 FAX # MA d Iq?v STREET Q .f� (CITY L STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) I A+� , AGI A ' I \IATKO1�.� furl CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL #, `;DAYS OF-0PERATION Monda '. ,` : -`eJuestla - 1 ''Wednesd ,. ,': ,Thursda ? 1-`:`Fdda d _ : Saturda 'j -.';.'Sunday' _' HOURS OF OPERATION Please wrdeintime ofday. !/ / 10.UUm.?iPYrl lDam -3pm (oGm-3 X104 3rm m 164ro _ 3 FA (For example llam-11pm) more than 10,000sq.ft. =$420 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES ONO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------ -----------------............................. --------------- RESTAURANT YES NO -------------------------............ less than 25 seats -------- -- $140 (Outdoor Stationary Food Cart $21 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------------------- ------- -------------------------------------------------------------------------------------------- BEDlBREAKFAST/ YES NO $100 CHILDCARESERVICES ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE $25 TOBACCO VENDOR ZES�S(iP 135ALL NON-PROFIT (such as church kitchens) NO $2 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, 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. Date t.Z - y - 0 8 Social Security or Revised 424/07 MODAP1008.adm Check# & Date r/l 6 0- 5 i �) i �A/ $ a%'J KIMBERLEY DRISCOLL MAYOR f ANI" I' DIONN 14; AC'T'ING HHAI.TI-I. AGL'NT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET. 41" FLOOR 'TEL. (978) 741-1800 FAR (978) 745-0343 JDIONNG a,SAL6M.COM Memo Date: Friday, November 14, 2008 To: Board Members From: Elizabeth Salandrea RE: Ziggy's Donuts — Certified Food Manager This memo is to confirm that Patricia Rutkowski, of Ziggy's Donuts, took and passed the ServSafe Food Protection Manager Certification Exam on October 4, 2008. A copy of the certificate has been added to our file, and the certificate is on the wall in the front of the establishment with their food permit. EXAM FORM NO. 4375 CERTIFICATE NO. 6133664 ServSafer Certification f M ACCREDITED IROGRA14 AMCll[an NaLonal SLindards In50Nte antl the Conlerencc ler Footl "rate �y National Restaurant Association EDUCATIONAL FOUNDATION for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe• Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)—Conference for Food Protection tCFPI. 10/4/2008 DATE OF EXAMINATION 10/4/2013 DATE OF EXPIRATION Local laws apply. Chad with your focal regulatory agency ler recertification requirements. Mary M. Adolf President & COO. Products and Services Division National Restaurant Association solutions VMNadond Restrainer, Mr iedon EducetenM tuundadon. All hgoo rtsei Sercsrle' and de Seri bao are registered mdowas d Ae Neaonet Restearn Assoaamn Edueedonal Fourdadon, aM wed unoer Ecave by Nedonal Romauram Aameieaon Solwme. LLC, a whMk owned euReidwnlal Ne Nafmiul Rmamam Aueoeaoe TMs document cennm be repiedi m ahered 0=701 a.0808 NATIONAL l RE TAUMNT ASSOCIATION s 0 L U T 1 0 N 5 T^' ' 0002 ESSEX STREET Ziggy's Donuts Telephone: 7449605 Owner: John Akatyszewski PIC: . Patty Rutkowski Inspector: Elizabeth Salandrea Date Inspected: Correct By: 111/612008 Risk Level: Permit Number: BHP -2008-0223 Status: SIGNED OFF 1# of Critical Violations: t0 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) r City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation i All violations noted in the inspection report of 10/30/08 have been corrected. i City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 Critical Urgency GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 06,2008 ) Page 1 oft Item '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 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 06,2008) Page 2 oft s -y 0002 ESSEX STREET Telephone: ,744-9605 Owner: John Akatyszewski PIC: Patty Rutkowski' Inspector: Elizabeth Salandrea Date Inspected: Correct By: ,10/30/2008 Risk Level Permit Number: 1211-113-2008-0223 (Status: Open I# 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 ilays)(Non-critical violations must be corrected immediately or within 90 days) Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOODSERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and �aod Protection FAIL Critical BLUE omment: 6 outdated sodas were removed from drink cooler. Owner to closely monitor all expiration dates. Equipmen and Utensils FAIL Non -Critical BLUE Z��//ogWment: Door tracks of donut case need general cleaning. mer needs general cleaning. 44acks between back and middle room need general cleaning. ocolate donut mix barrel needs general cleaning. ite & toasted coconut barrels on shelf in back room need general cleaning. Mo stored in bucket - store mop hanging to air dry. anitizer log in back room not up to date - ensure log is maintained on a daily basis. Physiirlm lity FAIL Non -Critical BLUE ment: Hot water handle on back prep sink is broken and the faucet drips. Repair handle and faucet to good working order. c�&el) rid rye a^ Lym�, ��,� + &-sc.r�u m,Q d1c.e K in Reinspection 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® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 30,2008 ) Page 1 of 2 Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) ._ Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 30,2008 ) Page 2 oft 10/10/2008 11:20 7813563960 EASTERMAS PAGE 01 • ServSafe Certification classes • Re -certifications • Consultations • Basic staff trainings on-site �r 70 Christina Drive Braintree, MA 02184 781-356-1467 Fax: 781-356-3960 c indy(,o,eastemmassfoodsafety. com To: S cdtvq � 6' -4 ` From: Cindy Rice Re: Foodhandler Certification Class Date: 16—to _OT This letter is to verify that �a}v; 6, Gl ")Sk ; -r 3 I a I qOQ is registered has taken the foodhandler certification class and examination scheduled for in _�Vl�t i- Results of the examination will be available in approximately 4 weeks from that date. If you have any questions, please feel free to call me at any time. Respectfully, Cindy A. Rice. RS, MSPH www.eastemmassfoodsafety.com BOARD OF HEALTH MINUTES OF MEETING May 13, 2008 The City of Salem Board of Health held its regular meeting at City Hall Annex, 120 Washington Street, 3rd floor conference room on Tuesday May 10, 2008 at 7:00 p.m. Present were Paulette Puleo, Chairwoman, Carol Rainville, Noreen Casey, Martin Fair, Barbara Poremba. Also present Joanne Scott, Health Agent, Tracy Giarla, Public Health Nurse. Excused Christina Harrington. Meeting called to order at p.m. 7:10 p.m. Minutes of Previous Meeting Carol made a motion to accept April minutes with changes, Barbara 2"d, all in favor motion passed. Public Health Nurse Report Tracy offered to students and teachers at a city school testing for TB. 119 students and 9 staff were tested. Out of the above students and teachers tested, two (2) positive PPD chest x-ray results were negative. TB testing was held six different dates in April. Meetings Tracy attended, North Shore Pulmonary, North Shore Cape Ann Emergency Preparedness, MAVEN (Massachusetts Virtual Epidemiologic Network) training for online disease investigation and reporting. Tracy reviewed the Communicable Diseases for April. Tracy and Joanne went to the Salem Mission on a report that a client of the shelter was sick and it spread to other clients. Joanne conducted an inspection of the shelter and closed the kitchen to the public for the weekend. The following week Tracy & Joanne returned to the shelter for a re -inspection. The personnel at the shelter replaced the bed linens and sanitized the shelter. When the re -inspection was completed with some recommendations so this would not happen again, the shelter was opened to the public. A discussion took place. NEW BUSINESS Old Salem Jail Ventures, LLC, 50 St. Peter Street/Old Salem Jail Site Plan Review as submitted. Pen Linsey and Dan Ricciarelli, Architect represented this project. Paulette told Mr. Linsey she has concerns that CO would get into the units from the garage. Mr. Ricciarelli said the parking area is open and there should not be any concerns. Mr. Ricciarelli said the parking garage plans were approved by the Building Inspector. Paulette asked are the fire alarms hard wired? Mr. Ricciarelli said the fire alarms and the CO are hard wired. Paulette asked about the placement of the trash. Mr. Linsey explained the new trash proposal and showed the location on the blue print. Joanne mentioned the three barrel per unit limit. Mr. Linsey said there will not be families in the units, professional people and some units will be occupied by one or two tenants. Paulette asked how many units will be rental and how many will be sold? Twenty Two will be rented for five years and the others sold. Paulette asked who will be the landlord? Mr. Linsey said they will have a company to oversee the property. Paulette and Barbara said there should be trash compactors in all units. Paulette reminded Mr. Linsey the new trash contract only allows three barrels per unit. Discussion continued about the trash compactors. Barbara made a motion to require trash compactors in each unit, Martin 2nd, four in favor one abstained, motion passed. Carol made a motion to approve the plans for this project with conditions, Martin 2"d, all in favor, motion passed. NEW BUSINESS cont. Ziggy's & Sons Donut Shop, 2 Essex Street John Akatyzewski and Patty Rutkowski, to discuss an order to install commercial dishwasher at the establishments. Patty said they use the residential dishwasher just for spoons, cups. Patty and her brother John would like a variance granted by the Board so they can continue using the same dishwasher. Martin asked why don't you use paper products? Patty said it would be too expensive to use paper products. Patty said the cups & spoons are sanitized when they take them out of the dishwasher. Patty said it would be very expensive to take the residential dishwasher out. Joanne said they also need a three bay sink. Patty said she thought the two bay sink would be grandfathered. Joanne asked if they make pies? Patty said yes around the holidays. Joanne said some of the problems go back to February 2006 and continue today. Joanne told the Board the code allows a variance to use a residential dishwasher. Patty said they would try this year to make changes. Joanne said they have to have a person Serve Safe at the establishment. Patty said she would take the course. Noreen made a motion to grant a variance for one year with the condition they have a Certified Food Manager by November 2008. Carol 2"d, all in favor, motion passed. NEW BUSINESS cont. K & C Auto Body, 17R Franklin Street, Kevin Foye to discuss a Board of Health odor complaint at his business. Attorney Tom Butler was with Mr. Foye as a friend not his Attorney. Joanne said this odor complaint goes back to the fall of 2005. A resident began to complain about an odor in the neighborhood. Joanne went to Franklin Street several times and she could not tell where the odor was coming from. Ms. Lemelin complained in April 2008 and Joanne went to Franklin Street, and at that time she did detect a chemical odor coming from K & C Auto Body. Mr. Foye said they have been in business for 38 years and never had a complaint. He said they added a stack and charcoal filters and they change the filters four times a year. Joanne got another complaint and that is when she issued the order. A discussion took place. Carol made a motion to modify the order for an additional six months and at that time if we don't have any more complaints the order would be withdrawn, Noreen 2"d all in favor, motion passed. TRANSFER STATION Joanne informed the Board that BETA states they will be filing an Environmental Notification form by either May 20`" or 215`. Joanne has a meeting with Beth Rennard. Carol also mention we have to make sure we have the best Engineer, Attorney and Air Quality personnel to advise the board. A discussion took place. Joanne said she completed all of the ICS Trainings. Board should take the 200 & 300 ICS trainings. Barbara made a motion to adjourn the meeting, Martin 2nd, all in favor, motion passed Meeting adjourned at 10:00 p.m. Respectfully submitted, Mary F. Page, Clerk of the Board d� W-" - 12 - 6L IV-D - - ---=MAY 0-6-2008- CITY-OF-SALEM 13QARD OF HEALTH ----�--- - - -- -- -- - --- - \ \ .. '•} � � ♦air T'Cl _y,^. _,�. r ,� .r I l \ '1 CITY OF SALEM , .. M/ AMM 11 UCAI TU .Fi �'Y s • -"F-- I> I Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3-20112 Additives*__ 3-302.14 Protection fro n Ti -11 roved Additives* 15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers" 7-102.11 Common Name - Working Containers* 7-201.11 Separation - Stotae" 7-202.11 Restriction - Presence and Use" 7-202.12 Conditions of Use, 7-203.1.1 Toxic Containers - Prohibitions* 7-204.11 Saoitizers,Criteria- Chemicals* 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Dtin r encs. Criteria* 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 1 Restricted Use Pesticides. Criteria* 7-206.12 Ralent Ban Stations, 7-206.13 Tracking Powders, Pest Control and Monitorinn* 16 17 TIMEITEMPERATURE CONTROLS 3-501.14(C) _ 3-501.15 Proper Cooking Temperatures for 19 PRFs 3-401.1 ] A(1)(2) Eggs- 1.55'F 15 Sec. 3-501.16(A) Eggs- Immediate Service 145'Fi5sw 3-401.11(A)(2) Comminuted Fish, Meats & Game 24 Animals- 155'F 15 sec. .k 3-401.11(,13)(1)(2) Pork and Beef Roast - 130'F 121 min* 3-401.1'1(A)(2) Ratites, Injected Meats- 155'F 15 _ Poisonous or Toxic Materials sec. 3-401.1 i(A)(3) Poultry, Wild Game, StuffedPHFs, .009 Stuffing Containing Fish, Meat, Poulh or Ratites -165°.5 15 see.. �` 3401.11(0)(3) Whole -muscle, Intact Beef Steaks 145'F ^ 3401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3401110k)(1)(h) All Other PHFs - 1.45'F 15 see, Reheatingfor Hot Holding 3-403.11(A)&(D) PHFs 165'F 15 sec. '0 3-403.11 (B) Microwave- 165' F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140'F* 3-103A UE) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs from 140'F to 70"F Within 2 Hours and From 70'F to 41.'F/45'F Within 4 Hours. 3-501.14(13) Coofing PRFs Made From Ambient Temperature Ingredients to 41'Fl45'F Within 4 Hours'n 3-501.14(C) _ 3-501.15 PHFs Received at Temperatures According= to L.aw Cooled to 41`'F({5"FWithin 4Hours. * Cooling Methods for PHFs 19 PHF Hot and Cold Holding 3-501. I6(B) 590.004(F) Cold PHFs Maintained at or below- elow590.004(F) 41°145° F* 3-501.16(A) Hot PHFs Maintained at or above 140°F.* 3-501.16(A) Roasts Held at or above 130'5. 24 Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004(H) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 21 3-501-11(A)) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-901.11(B) Use of Pasteurized ELLS* 3-$01.1 I (D) Raw or Partially Cooked Animal Food and Raw Seed S trouts Not' Served. 'n 3-80L 11(C) Uno sued Iccxxi Packa =e Not Re -served. CONSUMER ADVISORY 22 3-003.1 1 Consumer Advisory Posted for Consumption of 23. Marra ement and Personnel AnticA Foods That are Raw. Undercooked or 24. Food and Pond Protection Not Otherwise Processed to Eliminate 25.-_ 26. Equipment and Utensils _. Water, Plumbinq and Waste Pathogens.* shag d vozoor 2J. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 28. _ Poisonous or Toxic Materials -Eggs* ,-tAALHtUUIKt:MCIVi5 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering. mobile food, temporary mid residential kitchen operations should be debited under the appropriate sections above d related to foodborne illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. r1:71'iifNzN (items 23-30) Critical and non-critical violations, which do not relate to the foodiorne illness interventions and risk factors listen above, can be ,found in the following ,sections of the Food Code and 105 CMR 590.000. Item Good Retail Practices FC 590.000 23. Marra ement and Personnel FC - 2 .003 24. Food and Pond Protection FC -3 .004 25.-_ 26. Equipment and Utensils _. Water, Plumbinq and Waste -FC-4- .005 FC - 5 .006 2J. Ph steal Faciliy_ FC -6 .007 28. _ Poisonous or Toxic Materials FC -- 7 .008 29. 30. S ectal Re uiremonts other .009 ..5w)f-b,46-zd, '" Denotes i mucal item in the LAcral 1999 Food Code or 105 CMR 590 000. W lu/ lr�/n�//y��✓y/ 0 S J rs l-kxg.ktd4 _ vi _ �e r (94 -' cam \lN47 — —z�9 CITY OF SALEM RnARfl (1F HFAI TH Violations Related to Foodborne Illness Interventions and Risk Factors (110M 1-22) (Cont) w -=U= - - - - - - - - - - - - - Food or Color A, ETIUVA I . �wq 0 -1-6 20)2.12 3-302,14 protoction firtia ed Addinves" Poisonous or Toxic Substances 101,11 102,11 C 'ovit'alners Common Name - Workint, Coawifler,* 7-201-11 drilxon Stn, ape .. . .......... ... ...... .... i-26211 2 Restric6on -Prt,sence and Use* 7-202-12 Conditions of Use* —on `7.203.I1 Prol it In i i 7.2(A. I I 7.204. IT— Sannizers, Criteria - Che niiciIs* 71hcnncils for Ciuortal, -- �7, rvi A C ileria 7-2011 - widerual Food Cornim Lulnictuos,' 7-206.11 Restricted the Pe ticides', Catena* 206.12 Rodent Beit Stations* ,;-206 13 Tracking Powdem P,iJ Control and Sluffnit, Conf-dining Fish, h1eak, Mornhorin"4 ETIUVA I . �wq 0 -1-6 Proper Cooking Temperatures for PHFs 3- id I A(] )(-)I F.Mv- 155F 15 Sec. jjcsLLnuiwdi ate Service 145°'F]5sec, 7-40LIllA)(2,, Comminuted Fish, �,Meats & Chine Animals 155,171�sec.' 401.1 l.(B)(1)(2) Porl, and 15of Roam -IffF 121 min* 3-401 . 11 (A)(2) Ratites, !injected Meats -- 155"F-15 ---i 7 s�-, * --- I 401 11 (A)0; TPoultry, Wild Gianie, Sluffnit, Conf-dining Fish, h1eak, Foultry or Kaules- 165"T' lfimec. 3-40111 t Who]Q'�-tnoscle, Intact Beed' Steaks 145F4 F, 411171Y Raw Animal Foods C(xZ1, in a %ficiowav,� 165'F A AUT)(I)ob) tv! Other PHF;, -- 145'F 15 secs",_ L17_ Reheat ing for Hot Holding 3-463.1 I(A)&,fl)) ' I IHF, 165'T 15 sec, 3-403.11!8) Microwave. - 165° F2 Minute, Standing 1,1111C, 3-443.1 W- 140'F* -7-403-11 (E) Reniainfro, Roast"* 18Proper CEII, of PHFs 501 l4(A) Coaling Cooked PHF's from 144)'F to 70OF Within 2 Hours and From 70-F to 41 F745' Within 4 Houts, 3-501.14(13) Exiling PHFs Made Front Airiblent 'fernpaawre Ingredients to 4PF'/45'F IWithin 4 flours 'llenoCea ¢itScat kern i.a thztcAer¢i i 949 T'oort lode of 165 Ctvii2 S9{} 89U. 14(C) PHFs ke"�jwd at'remperatures According to Iain Cooled to 41"F145"FWithin -' Hors. + 13-501.15 Cociliw, VIctlaids for PHR, 119 PHF Hot and Cold Holding tornained at or lnAot Cold PETFq M 41V450 F 3 -SOT t6iA) I lot flffi:v Maintained at or above '3-,50%1-A6(A) �jwsts Held at or above 130017. * I Time as a Public Health Control 3 A0 1, l5i rift),,as a Public- Health control, 1).004(li) Variance Reouarcipent: REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPIJLATIONEt!SP� ----- t I(A) 11p„icurlzTd pre-packaged Juices and lleverates with Warning labels* Rno Seed sprotns hot saj +cd. 3-80 1 '1 1 (C i i Unonened Fix)d Packaite Not Re—served.. CONSUMER ADVISORY jF7 'j 7- n,a ... e, �%j, ltso, s osioj for Con',oraption of Aahoal 1 As that arc Raw. Undercxx)ked ci Not iw pr(,cssed to Eliminate -302.13 j Nasneoriz.txl Fgga Substitute for Raw §FPECIAL REQUIREMENTS — of S--ct—ion -5-0 4)XX)9(A)-(D)i n catering. molittic fowtd, teniporary and rcsicfetit 'al kitchen opecrationssliould be debited under the appropriate sections above if rohned to fix)dboriw illness Intel ventions and tisk faciorq. Other 51)0.009 violations relating to qo(A retail practices "'hould he debited under #29 - Special Requirements (Items 23-30) Oitww and non-crw,al vioIeaivto, which do tun reiare io the ftiodhorne diness interventions and rokficlors livied above, can be 1found in diefiMn,mg, senlions of in,! Food Code cold 10-5 CA4R '90Jys), 0002 ESSEX STREET Telephone: 744-9605 Owner: John Akatyszewski PIC: Patty Rutkowski Inspector: I Elizabeth Salandrea Date Inspected: Correct By: 14/1012008 j Risk Level: Permit Number: BHP -2008-0223 Status: SIGNED OFF of Critical Violations: 1# 0 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) I Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing PASS Critical LA RED Violations Related to Good Retail Practices (Blue Items) Equipment and Utensils PASS Non -Critical BLUE All violations noted in the 4/2/08 inspection report have been corrected. Commercial dishwasher not installed - dishes and utensils are washed in dishwasher, sanitized in sink and allowed to air dry. Owner to contact board of health when dishwasher is installed. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741.1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 14,2008 ) Page 1 of I - Item Status Violation Critical Urgency :RED: Violations Related to Foodborne Illness Interventions 'and Risk Factors (Require immediate corrective action) 64W � 4Ai�;k City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 14,2008) Page 2 of2 -A 0002 ESSEX STREET Telephone: 744-9605 Owner: Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Conta.4t Surfaces Cleaning and Sanitizing FAIL Cnbcai iment: Sanitizer was not available in back fryer room. Sanitizer must be available at all workstations at all times. Sanitizer was John Akatyszewski mut in back area at time of inspection. PIC: Violations Related to Good Retail Practices (Blue Items) _ Patty Rutkowski Inspector: Elizabeth Salandrea Date Inspected: Correct By: 4/2/2008 Risk Level Permit Number: BHP -2008-0223_ Status: PARTIAL COMPLY # of Critical Violations 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) Equipment and Utensils FAIL Non -Critical BLUE ent: Warmer across from fryolator has accumulation of food debris inside along racks and on the bottom. Thoroughly clean wee warmer. W tine fryolator area in back has accumulation of grease and food build-up, including sides of machine and shelves. Thoroughly clean entire fryolator area. �bglue barrel of dry ingredients in frying room rep ble and shelf underneath next to fryolator need general cleaning. 2el Ing above prep table in baking room needs general cleaning. oke cooler missing visible internal thermometer. Provide accurate, visible internal thermometer for this unit. Igidaire freezer and freezer/fridge unit need general cleaning along bottom of both units. tos between fryer room and baking room have accumulation of food build up -thoroughly clean the racks. /l'or tracks of display case need general cleaning. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. Commercial dishwasher not installed - dishes and utensils are washed in dishwasher, sanitized in sink and allowed to air dry. Owner to contact board of health when commercial dishwasher is installed. City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page I oft L 1 v RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Item Status Violation Critical Urgency Cityof Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMS® 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 oft r DATE PRINTED: Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street, 4th Floor SALEM, MA 01970 Food/Retail Establishment Permit 01/07/2008 ESTABLISHMENT NAME: File Number: BHF -2004-000364 LOCATED AT: Kimberley Driscoll Mayor Ziggy's Donuts 2 Essex Street Salem MA 01970 0002 ESSEX. STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2008-0223 Jan 4, 2008 Dec 31, 2008 $140.00 ESTABLISHMENT TOBACCO VENDOR BHP -2008-0227 Jan 4, 2008 Dec 31, 2008 $135:00 Total Fees: $275.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 4 of 4 KINMERLEY DRISOOLL MAYOR JOANNE SCOTT, HEALTH AGENT QTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4'ro FLOOR TEL. (978) 741-1800 ®® 7 r V ED FAX(978)745-0343 flEC..._:i�� ISOO (0)SALEM. COM DEC 19 2007 CITY OF SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT —Z O �V Gn c &a_3 'b6_W4T TEL # ADDRESS OF ESTABLISHMENT I a esse K s"Inu k_ FAX # MAILING ADDRESS(ifdifferent) EMAIL - Business':IJJohnand OWNER'S NAME J'06 ADDRESS Sl Website: TEL# �LiTLD STREET/CITY STATE ZIP CERTIFIED. FOOD MANAGER'SNAME(S) n� CERTIFICATE#(S) (Required in an establishment where potentially hazardous. food is prepared)... _ .. . . q EMERGENCY RESPONSE Please write in time of day. //GM'3 (Forexample Ilam QM _�-ttpm) fP p 6 TYPE OF ESTABLISHMENT RETAIL STORE NO ----------------- RESTAURANT Outdo Slaticnary Food Cart $2 BED/BREAKFAST/ YES NO CHILDCARE SERVICES----------------------- ADDITIONAL PERMITS _ TEL # m -3 pin Gam 3pM 64N-3pM L �J e� �OGM 12N MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) FEE (check only) less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 less than 25 seats =$140 25-99 scats =0460 more than 99 seats =$420 $100 YES (g) $25 YY ESD NO 135 7ff NO 'Please pay total with one check payable tothe 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. /.2—/ Date oya- 3SU— Social Security or Federal Identification --------------------------------------------------—--�� --,_-/-----_- -- -------SRevised 4/24/07 FOODAP2008.adm Chek& Dale --�ry--- �qr�7� ---------------- U,., „ ♦ R. i (,.N"M+IY4 :,iy_I H.fwYX Yf ",: �, ',i! .f,°� �uw�,'�l-^4� �Yi`..firo 'l 'Massachusetts Department of Public Health Salem Board of Health p 120 WashingtonStreet, 0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name -f t ] ( Dat ( Type of Operation(s) Type of Inspection -Food Service El Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ElBed &Breakfast Permit No. ❑•Routine [IRe-inspection Previous Inspection Date: ❑ Pre-operation ❑Suspect Illness ❑❑ HACCP General Complaint ElOther Address C Rik Level Telephone _ Owner' n HACCP Y/N Person in Charge (PIC) "1 Inspector � Time Out: ut:: tS 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. - .--`FOODPROTECTION MANA{�EMENT.�,,,„�� _.�-,.,� �.Mp,.�,„„�.m.m ❑ 1. PIC Assigned / Knowledgeable / Duties " EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC ❑ 3.. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION——— -7" ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 1-110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board "' of Health. C, ',N•, 23. Management and Personnel (FC -2)(590.003) 2�4. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.067)' 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other s:590M,p Fom 14.ex (-� ,.,� ' ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities []PROTE,CTiQN FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals ` TIMEREMPEFiATURE CONTROLS {Potenaaliy Hazardous koods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control r REQUIREMENTS FOR HIGHLY SVSOEPTIBLE Pd06WIONS (HSP) ❑ 21. Food and Food Preparation for HSP OONSUMER:ADyISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: ' Inspector's Signature: ` Print: PIC'sSignature: Print: Z)� 4 Page-- 1of %Pages n. u Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 596.003(A) Assignment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by foot( employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell Eggs* _ 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Iee Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003((1) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590,003(E) Removal of Exclusions and Restrictions 4 (® C C FOOD FROM APPROVED SOURCE " Denotes critical item in the federal 1999 Pool Code or 105 CMR 590.000. r i • * •i I,t 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.1.4 Eggs and Milk Products. Pasteurized* 3-202.16 Iee Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 220" Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Usual, Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* -590.004(C) Wild Mushrooms* 3-201.17 Came Animals* 3-701.11 Receiving/Condition 3-202.11 PIirs Received at Proper Temperatures* 3-202.15 Package htte it y* 3-101.11 Food Safe and Unadulterated Togs/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock Identification Maintained'" Tags/Records: Fish Products 3402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packagmg, criteria* 8-103.12 Conformance with Approved Ihocedures* " Denotes critical item in the federal 1999 Pool Code or 105 CMR 590.000. r i • * •i I,t 8 Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* Contamination from Raw Ingredients 3-302.1 I(A)(2) Raw Animal Foods Separated from Each Other" Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11. Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* F-9- Food Contact Surfaces 4-501..1.11 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing- Ilot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization- temp., pH, - concentration and hardness. * 4-601A [(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11. Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands mid Arms* 2-301.12 9SEu Prrxedrne* 2-301.14 When to Wash* 1.1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-30t.12 Preventing Contamination When'lasrin 12 Prevention of Contamination from Hands 590.004(Fs) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities;* 5-204.1.1. Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability L -L01 I 1_____L Hand Drvm Provision BOARD OF HEALTH Establishment Name: -,7L,3 Date: C, / 0-4 Pager of ltem'.; No. 'Codes e Reference C-Criticallterh4j R -Red ttem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Zf- f jr e i � PLrASEPRINT CLEARLY Date Verified VrOV f1c vc-crl )(A t'- (-(-C-Co 6,& II(A' i:. 17f rrCl 1 )Qi t , 0 riAiA/7 ktkei �Y-1.4-- Lr�' I'l 51i'a (Lad C,->/. 4- `3r)"r'f . j 4nAp 10 Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit.94 I 7��_l '1 Corrective Action Required: Lj No C3 Yes 1 Ll Voluntary Compliance El Employee Restriction Exclusion U Re -inspection Scheduled Lj Emergency Suspension Ej Embargo Lj Emergency Closure 0 Voluntary Disposal L3 Other: 'a, Violations Related to Foodborne illness Interventions and nisk Factors (lie?" I -W) (Cont) PROTECTION FROM CHEMICALS E L17 a- Pror �Cookmg�Temperatvrasfor 1 Food or Color Additives PHFs 3 401. IIA(],(2)' '(1dative'A* 3-10114 Protution firrtjuiiaa12Pro.ecf Add[hroes IS —,1 --ldenfifying Poisonous or Toxic Substances —Infosmation0tiginal -401.11(8)(1)(2) 101 3 3-4h) 1. 11 (A)(2) RatitesInjecled Merits 155'F 15 sec. * I 3401.1)(Ay3) Containers' 7-102,11 Common Name -- Workim, Cootailler", PAndery or katites-1 65`1 15 scc, At Wfwle-muscle,Intact Beef Steaks, 7-202.11 R"tric(Aon - Fo,staceatel Use* — Raw Animal P(Nxl,; Cooked in a 7-202.12 C'Ofeiilik)D� OfUse" 7-103.1I Toxic Contameir - Prohibvionit' Pffl-s 165'F 15 set:.. - 7-204.11 Sanitizers, Criteria - Chemicals* 7.204.12 Cerin Cats for Washer Produce, Ctiwtia Commercially Pavessed RIF Ftx+d - 7 - 204. 14 Dninl� Aitents. Criteria' . .... 3--1(E) 7-1-01A 1 Incidonal Folx�conta7�i]hfi—caltt Roasfs' 75.11 Restricted Use Pesticides. Criteatt, 1 -501.14(A) 7-206.12 Rodent Bin stations` 70``1- W thin 2 Hours and From 701' ;—'— 1 -206.13 17rackniPAA,,okci, lA,-s[ Control and 3-501.14(B) timing PHFs Made Nom Ambient E L17 a- *Denotes Critical Item ol the relleral 1909 Focal Ckxie or 105 ( NIR 599 000 19 PHFs According to Law Cooled to -,1'F#45`F Within A Batas. 3-501.16(B, Cold MIN Mi6mdried at or below Hfa 11HFq %lailoamed at or above 14)IF * 16i,4) 1 Roasts Held ai or arxAve 110'1-_ A Time as a 01 19 1 Time as a M 3-801.t1(A) i Unieneurizcd Pre-packaged hdccs wid Bewral,es with Warni �i-801 , 11 (B) UAe of' patttclaizl�d Ea—* — -1, , "' , 'A"I", 14� --"�-- 1-801 i I(D) R;iw or Partialiv Cmk-d Ammal Focid and _hLaa, ti4.(xLSj roaL� Not sict yvd. I I I j a om n ed f t(X Xi lane k aur. Not Reserved." 22 3-003-11 1 Poso�,d for Consoniption of Aninmi F-:K.Os net at(: Raw, Undercooked ca Not Othtm ise Prowessed fo Eliminate Pad3�Cris ms ^c for RAW Shell Viclawtuto Section 51)0,069(A) -(D) in caiering. fond, temporaiv and rcsidential kitchen operations should be Liebiled under the appropriate sections abuvc if related to RK)dbornc illness interventions and rise factors, 0d)CT 590.009 violations relating to,,00d retail practices should be debited under #29 - Special Requirements (items 23-30) Grillers/ ood non-,, ro;tal violations, whir -h do not relate to the 1'(4)dborne ifltun" info A-enfiore; and A-,4 jew tors licted abrorcan be sound in thcftWoweg SCA oom of Isic Food Code and J05 CUR ;1111V1 A'A I Pror �Cookmg�Temperatvrasfor PHFs 3 401. IIA(],(2)' F.gg,- 155F 154o�- -1 atlau ediale Serjcv 1/15,F)5sec, 7401.11(A)(2) Conaninuled Fish, Meats & Cams Animals -401.11(8)(1)(2) Poil, and Bvef'R(xist 1304 121 iam' 3 3-4h) 1. 11 (A)(2) RatitesInjecled Merits 155'F 15 sec. * I 3401.1)(Ay3) Poultry, V, ild Game, Striffed NiFs, StuffjjigConl�dwre, Fish, Meal, PAndery or katites-1 65`1 15 scc, At Wfwle-muscle,Intact Beef Steaks, 3-401.12 Raw Animal P(Nxl,; Cooked in a 3-401,11(A)(1)(b) Miciowave 165-F All Other Pffs - 145"F 15 sec. Reheating for Hot Holding 3-403.1I(A)&(D) Pffl-s 165'F 15 set:.. - l(B) Micotwavc- 1$5° F 2 Mo-ne StallFfill Time' 3-403.1110) Commercially Pavessed RIF Ftx+d - 140'F" 3--1(E) Remainin, Unsljced Pot nom of Reef Roasfs' Prot Cooling of PHFs 1 -501.14(A) Catling Cooked PFIB frna) 140'F to 70``1- W thin 2 Hours and From 701' to 14 1'F/45"F Within 4 Hours. I 3-501.14(B) timing PHFs Made Nom Ambient Tempcfature Ingredients 41-1-/45'F to Wahin4lfotatl *Denotes Critical Item ol the relleral 1909 Focal Ckxie or 105 ( NIR 599 000 19 PHFs According to Law Cooled to -,1'F#45`F Within A Batas. 3-501.16(B, Cold MIN Mi6mdried at or below Hfa 11HFq %lailoamed at or above 14)IF * 16i,4) 1 Roasts Held ai or arxAve 110'1-_ A Time as a 01 19 1 Time as a M 3-801.t1(A) i Unieneurizcd Pre-packaged hdccs wid Bewral,es with Warni �i-801 , 11 (B) UAe of' patttclaizl�d Ea—* — -1, , "' , 'A"I", 14� --"�-- 1-801 i I(D) R;iw or Partialiv Cmk-d Ammal Focid and _hLaa, ti4.(xLSj roaL� Not sict yvd. I I I j a om n ed f t(X Xi lane k aur. Not Reserved." 22 3-003-11 1 Poso�,d for Consoniption of Aninmi F-:K.Os net at(: Raw, Undercooked ca Not Othtm ise Prowessed fo Eliminate Pad3�Cris ms ^c for RAW Shell Viclawtuto Section 51)0,069(A) -(D) in caiering. fond, temporaiv and rcsidential kitchen operations should be Liebiled under the appropriate sections abuvc if related to RK)dbornc illness interventions and rise factors, 0d)CT 590.009 violations relating to,,00d retail practices should be debited under #29 - Special Requirements (items 23-30) Grillers/ ood non-,, ro;tal violations, whir -h do not relate to the 1'(4)dborne ifltun" info A-enfiore; and A-,4 jew tors licted abrorcan be sound in thcftWoweg SCA oom of Isic Food Code and J05 CUR ;1111V1 A'A I Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4t" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name ✓ Date Type of Operation(s) Type of Inspection I - _Z _U'Food Service Retail ElRoutine nFle-inspection Address c Risk V �I Telephone /] /° Leval ''y,.� El Residential Kitchen ❑ Mobile rrevious Inspection _ ?'/ Date:15771a 0� 7 Temporary ElOwner ElPre-operation ILIC HACCP Y/N ❑ Caterer ❑ Bed & Breakfast ❑ Suspect Illness ❑ General Complaint Person in Charge (PIC) Time In: Out: Permit No. ❑ HACCP ❑ Other Inspector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by°the Board of Health. "FOOD PROTECTION MANAGEMENT'._ ""'""' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH r"1 x3agaR;,wm�wo-+�`+a,' �I ,EI-2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE; -,,�?�i ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 13. Handwash Facilities +'PROTECTION FROM CHEMICALSam+e+ "�-'•"�°"`"""-'� ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMErrEMPERATURE CONTROLS (Potendally Hazardous Foods} s i [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling 1 El 19. Hot and Cold Holding —PROTECTION FROM CONTAMINAT101�t � � w .� 9 ❑ 8. Separation/ Segregation/ Protection ❑ 20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices - i Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) I 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) (/ 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S : 50bsInFon -14.ea � 13EOUIREMENTS FOR HIGHLY SUSCEPTIBLE PpPUI;ATIONS (HSP) as° ❑ 21. Food and Food Preparation for HSP "CONSUMER ADVISOR Y+'` ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions / l� and Risk Factors (Items 1-22): V Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector�c /12'1 ✓ Print: �lQ , / Q--_- PIC'sS` lure: _ Print: . ��' // 11 Pae ofO'Pa es L B B l� \j + U �l I . , Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assig ment of Responsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.1.2 require reporting by food employees and 3-201.13 Fluid Milk and Milk Products* applicants* Shell s* 590.003(F) Responsibility Of A Faxi Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 5901003(G) Reporting by Person in Charge* 3 1 590.003(D) Exclusions and Restrictions* 3-201.15 590.003(E) Removal of Exclusions and Restrictions 4 C C C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Rmd Code or I0i CMR 590,000. PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.1.2 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shell s* 3-202.14 ,g Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" Washing Fruits and Vegetables Shefllish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.1.7 Game Animals* 3-701.11 Receiving/Condition 3-202.1.1. PHFs Received at Proper Temperatures* 3-202,'15 Packa e Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records, Creation and Retention* 590.004(J) Labeling of Ingredients' Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures iHACCP Plans 3-502.11 S ecialized Proc 6s Methods* 3-502.1.2 Reduced ox gen acka 'ng, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Rmd Code or I0i CMR 590,000. PROTECTION FROM CONTAMINATION 8 Cross -contamination 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Fends* Contamination from Raw ingredients 3-302.110)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(H} Returned Food and Res^emce of Food'* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501,111 Manual Warewashing - Hot Water Sanitization Tem eratures* 4-501.11.2 Mechanical Warewashing- Hot Water Sanitization Temperatures* 4501.11.4 Chemical Sanitization- temp., pH, concentration and hardness. * 4-60 t.I I (A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - HotWaterand Chermcal* I(1 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Anes" 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* l l Good Hygienic Practices 2-401.11 Eating, Drinkin� or Using Tobacco* 2401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting* 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Suppled with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301..1.2 Hand Drying Provision I r. CITY OF SALEM BOARD OF HEALTH Establishment Name: 61 I _'>ynIi - �,1� Date: �-a�_�� Page: of Item No. Code Reference C - critical Item R — Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified /ns / o /h I.I`e r t YICi� ACl i/� i �z l / Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of -twenty-five dollars or suspension/revocation of your food permit. Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 4 Violations Related to Foodborne fitness Interventions and Risk Factors (Items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 16 17 18 TIMEITEMPERATURE CONTROLS Food or Color Additives 3-202.12 Additives" 3-302.14 Protection front Unapproved Additives* 3-501.15 Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers" 7-102.11 Common Name- Working Containers* 7-20'1.11 Se aration - Stora rc"` 7-202.11 Restriction - Presence and Use'k 7-202.12 Conditions of Use* 7203.1.1 Toxic Containers - Prohibitions* 7-204.11 Sanitizers,Criteria- Chemicals* 7-204.12 Chemicah for Washin Produce, Criteria* 7-204.14 Dr yin Agents. Criteria - 7 -205.11 Incidental Food Contact. Lubricants* 7-206.11. Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations4` 7-206.13 'Tracking Powders, ,Pest Control and bfonitorinn" TIMEITEMPERATURE CONTROLS 4 Denotes critical item in iho federal 1999 Food Code or 105 CMl3 590,000. 19 20 3-503.14(C) Proper Cooking Temperatures for Unpasteurized Pre-packaged Juices and 'Bevel ages with Warnin * Labels* PHFs 3-401.1 IA(i)(2) Eggs- 155`F 15 Sec. 3-501.15 Eggs- Immediate Service 1450F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3-501A6(B) Animals - 155'F 15 sec. ,k 3-401.11(13)(1)(2) Pork and Beef Roast - 130"F 121 mini° 3-401.11(A)(2) Ratites, Injected Meats - 155*F 1.5 27. see. * 3-401_1.1(A)(3) Poultry, Wild Game, Stuffed PHPs, 28. Stuffing Containing Fish, Meat, 3-501.'19 Poultr y or Ratites -165"F 15 sec.": 3-401.11(C)(3) Whole -muscle,' Intact Beef Steaks 145"F 3-401 12 Raw Aniuml Foods Crooked in a _. Microwave 165°F * 3-401,11(A)(1)(b) All Other PHFs-- 145'F 15 sec. Reheating for Hot Holding 3-40111(A)&(D) PHFs 165"F 15 sea 4' 3-403.11(6) Microwave- 165" F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Fail - 140'F* 3-403 11(E) Remaining thisliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501. W(A) Cooling Cooked PHFs from 140°F to 701' Within 2 Hours and From 70"F Lo 41'F/45'F Within 4 Hours. * 3-501.'14(13) Cooling PHFs Made From Ambient Temperature Ingredients to 41'F(45'F Within 4 Flours` 4 Denotes critical item in iho federal 1999 Food Code or 105 CMl3 590,000. 19 20 3-503.14(C) PHFs Received at'lemperatures Unpasteurized Pre-packaged Juices and 'Bevel ages with Warnin * Labels* According to taw Cooled to 3-801.11(Bi 41°F145°F Within 4Hours. 3-501.15 Cooling Methods for PHFs Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. PHF Hot and Cold Holding 3-501A6(B) Cold PHFs Maintained at or below 590.004(F) 41"145" F* 3-501.16(A) Mot PHFs Maintained at or above 27. 14WR * rT�503-501.16(Aj 1 �160)Time Roasts Held at or above 130°F. 28. as a Public Health Control 3-501.'19 Time as a Public Health Control" 590.0046-q Variance Redrurcurent i 2a 3-801.11(A) Unpasteurized Pre-packaged Juices and 'Bevel ages with Warnin * Labels* 590.000- .003 3-801.11(Bi _ Use of Pasteurized Eegs* FC -3 3-801A 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. _ E ui meat and Utensils 3-801.11(C) Una tined Focxi Pscka<>e Not Re -served. CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of 590.000- .003 24. Animal Foods'fhat are Raw. Undercooked or FC -3 .004 Not Otherwise Processed to Eliminate _ E ui meat and Utensils FC -4 Pathogens.* `rte"" ""0" 26 3-302.13 Pasteurized Eggs Substitute for Raw Shell .006 -- 27. F es* Violations of Section 590.009(A) -(D) in catering. mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under //29 - Special Requirements. (Reins 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and riskjac-tors listed above, can be found in the following ,sections of the Food Code and 165 CHAR 590-000. . Item 23. Good ROO Practices Manu om©nt and Personnel FC FC -2 590.000- .003 24. _-__-___ .-.--------- --_____. Food and Food Protection FC -3 .004 25. _ E ui meat and Utensils FC -4 1 .005 26 Water Plumbingand Waste FC .006 -- 27. PhysicalFacility-_ FC -6 .007 28. Poisonous or Toxic Materiais FC -7 .008 29- Special Requirements _009 3': _. $.SVp� niJu�kG2.ikic Massachusetts Department ofi,'Public.Health Division of Food and Drugs k FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4th Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name �� G (f s (� Date � �7a (i � Tvpa of Operations) 97"Food Service ❑ Retail ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. 7y ee of Inspection ❑Routine (❑ Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ❑ HACCP ❑ Other Address ( X,� T Telephone -� y / { Risk Lever Owner (1 /� 11 �I / 7 �6_L HACCP Y/N Person in Charge (PIC) Time In; Out: Inspector Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEEHEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans i PROTECTION FROM CONTAMINATIOW_____""a 1'''"`" ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing k ❑ 11. Good Hygienic Practices Violations Relat ed to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) ✓ 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) ✓ 27. Physical Facility (FC -6)(590.007)' 28. Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S ssansp tFom ,14.em N ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION, FROM CHEMICAi.S `�� "ii"�� - b ., -..,luiu El 1Z Approved Food or Color Additives ❑ 15. Toxic Chemicals 7IME2EMPERATURE CONTROLS (PotemlaIli Haxardpus Foods) 'T' -_ b'16. pau,�..n-` .r t ,A 16. Cooking Temperatures [117. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control ,REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) „``Id', ❑ 21. Food and Food Preparation for HSP .;',,.CONSUMER ADVISORY , g„', t..; r'. ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspect6Ps sigriatdrei l ; iNl /1� IVY LX Print: �p �� PIC's;Signature: i/ !\,t-lE+k'.P°t1kJ�1.l 1 blttle, Printo 1 �I IIUr� A, Ku Kmask) Page � of Pages Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) _ FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Res onsibility* 590.003(B) Demonstration of Knowledge* 2-103.11 Person in charge - duties EMPLOYEE HEALTH 2 590.003(0) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require repotting by food employees and 3-20'1.13 Fluid Milk and Milk Products* a plicants4' Shell Eggs* 590.003(F) Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water - ater*5-101..1.1 Applicant To Report To The Person In Drinking Water from an Approved System* 590.006(A) Char e* 590M06(B) 590.003(0) Reporting by Person in Charge* 3 590.003(D) Exclusions and Restrictions* 3-201-15 590.003(E) Removal of Exclusions and Restrictions In FB- I C FOOD FROM APPROVED SOURCE * Denotes critical item in the federal 1999 Foci Cade or 105 CMR 590.000. F8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 Food in a Hermetically Sealcd Container* 3-20'1.13 Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eg�s and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water - ater*5-101..1.1 5 -101 . I I Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* 590M06(B) Water Meets Standards in 310 CMR 22.0* Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-20114 Fish and Recreationally Caught Molluscan Shellfish* 3-201-15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by Regulatory Authonl 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 3-201.1.7 Game Animals* 3-701.1.1 Receiving/Condition 3-202.11 - PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.1.2 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destruction* 3-402.12 Records. Creation and Retention* 590.004(1) Labeling of Ingredients* Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen pttcka hg, criteria* 8-103.12 Conformance with Approved Procedures* * Denotes critical item in the federal 1999 Foci Cade or 105 CMR 590.000. F8 Cress -contamination 3-302.II(A)(]) - Raw Animal Foods Separated from Cooked and RTE Foals* Contamination from Raw Ingredients 3-302.11(A)(2) Raw Armad Foods Separated from Each Other* Contamination from the Environment 3-302.11(A) Food Protection* 3-302.1.5 Washing Fruits and Vegetables 3-304.11, Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.!4(A)(.BL Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.111. Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.11.2 Mechanical Warewashing- I-Iot Water Sanitization Teta eratures* 4-501.11.4 Chemical. Sanitization- temp., pH, concentration and hardness. * 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* - 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils* 4-70111 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* 1g Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* I1 Good Hygienic Practices 2-401.11 Eating, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-301.12 Preventing Contamination When Tasting" 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11. Numbers and Capacities* 5-204.11 Location and Placement* 5-205.11 Accessibility, Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Cleanser, Availabilit !.and 6-301.1.2 Hand D ing Provision CITY OF SALEM RnARD OF HEALTH Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 In TIMEITEMPERATURE CONTROLS 16 Food or Color Additives 3-202.12 Additives* 3-302.14 Protection front Una n roved Additives* 3 -501.16(A) Poisonous or Toxic Substances 7-101.11 Identifying Information - Original Containers„ 7-102-I1 Common Name. - Working gContainaO 7-201.11 Separation - Storage* 7-242.11 Restriction - Presence and Use" 7-202.12 Conditions of Usc� 7.203.11 'roxtc Containers Prohibitions* 7-204.11 Swttizem Criteria - Chemicals" 7-204-12 Chemicals for Washing Produce, Criteria"' 7-204.14 Dain .- ent-s. Criteria' 7-205.1.1 Incidental Food Contact. Lubricants* 7-206.1 l Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations - 7 -206.13 Tracking Powders, Pest Control and Monitoring* TIMEITEMPERATURE CONTROLS 16 PHFs Received at Temperatures According to Iaw Cooled to 41`F/45°F Within 4 flours. Coaling Methods for PHFs Proper Cooking Temperatures for PHF Hot and Cold Holding 3-501.16(B) 590.004(F) PHFs 3 -501.16(A) 3-401,11,%(l )(2) Eggs- 155`F 15 Sec. Roasts Held at or above 130°F. FC -- 3 E zes- Immediate Service 145gF15sce* 3-501,19 37101.11(A)(2) Comminuted Fish, Meats Bc Game Variance Requirement 26. Animals - 155°F 15 sec. * FC - 5 3-401.1 1(B)(1)(2) Pork and Beef Roast - 130'F 121 min* Physical Facility 3-401.1 t(A)(2) Ratites, Injected Meats- 155`F 15 28. Poisonous or Toxic Materials sec. * .008 _ 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, 1 .009 Stuffing Containing Fish, Meat, ---- Other Poultry or Ratites-I65°.F 15 sea. 3-101.11(C)(3) Whole muscle, Intact Beet Steaks 145°F* 3-401.12 _ Raw Animal Foods Cooked in a 165°P * 3-401, 1 l(A)(1)(b) _Microwave All Other PHFs --'145'F15see. 17 Reheating for Hot Holding 3-403.11(.x)&(I» PHFs 165°F 15 sec. 4' 3-403.11 (B) Microwave- 1.65`F2Minute Standing Time" 3-d03.11(C) Commercially Processed RTE Food - 140"F* 3-403.1](E) Remaining Unsliced Portions of Beef Roasts" 1ti Proper Cooling of PHFs 3-501. W(A) Cooling Cooked PHFs from 140°F to 700F Within 2 hours and From 70°F to 4I'F/=45°F Within 4 Hours. * 3-501_14(H) Cooling PFIFs Made From Ambient Temperature Ingredients to 41 017141°F] Within 4 hours°' * Denotes unucal item in the federal 1999 Food Code or 105 CMR 590.000. _1 N 20 3-56 1.14(C1) 3-501.15 v PHFs Received at Temperatures According to Iaw Cooled to 41`F/45°F Within 4 flours. Coaling Methods for PHFs Consumer Advisory Posted for Consumption of PHF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below -41`/45" F- 3 -501.16(A) Hol' PHFs Maintained at or above 140"F. 3-501. bii(A) Roasts Held at or above 130°F. FC -- 3 Time as a Public Health Control 3-501,19 Time as a Public Health Control* 590.004(li) Variance Requirement 21 3-801.II(A) Unpasteurized Pre-packaged Juices and - with Warning Iabels* Consumer Advisory Posted for Consumption of _Beverages 3-801.11(B) Use of Pasteurized Ears* 23. 3-801A 1(D) Raw or Partially Cooked Animal Foal and Raw Sced S rrout's Not Served. 'r FC - 2 3-801.11(C) Una enol Food Package Not Re -served. * 22L3-603-1 t Consumer Advisory Posted for Consumption of 590.000 1 23. Annual Faxls'rhat are Raw. Undercooked or 1 FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC -- 3 Pathogens.* 6"""- ""0" 25. _EJc 3-302.13 Pasteurized Eggs Substitute for Raw Shell .005 26. E>,s* ormr o`kG ncwurncrvr cn i a 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and tisk factors. Other 590.009 violations relating to good retail practices should be debited under JI29 - Special Requirements. (Items 23-30) Critical and non-critical violations, which do nor relate to tire foodborne illness interventions and risk f rctors listed above, can be found in the following seclions of the Food Code and 105 CMR .5.90.000. item Good Retail FC 590.000 1 23. _Practices _ Mang ement and Personnel FC - 2 .003 24. Food and Food Protection FC -- 3 .004 25. _EJc u�ment and Utensils FC -- 4 .005 26. Water. Plumbing and Waste FC - 5 _ .006 27. --� Physical Facility FC-6 _007 28. Poisonous or Toxic Materials FC -7 .008 29. Special R .uirements 1 .009 ------ 30. ---- Other 151)Orme.Ed,I&I i. is K: i I CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: (:Q-I-ko� Page: of Item No. Code Reference C -Critical ItemJQ R - Red Item I DESCRIPTION OF VIOLATION / PLAN OF CORR" V PLEASE PRINT CLEARLY j - /N I Date Verified I Id 7 A 1724 d66 42 ha i9P 1A C) Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars of, sus ' pension/revocation of your food permit.` I' Corrective Action Required: U No Lj Yes [I Voluntary Compliance Ll Employee Restriction/Exclusion Li Re -inspection Scheduled 0 Emergency Suspension 0 Embargo U Emergency Closure Iu voluntary Disposal U Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 16 18 3-202.12 Food or Color Additives Additives" 3-302.14 Protection froom L n roved Additives'= 3-40'1.11A(1)(2) Poisonous or Toxic Substances 7-101..1 I Identifying, Information - Original Containers* 7-102.11 Common Name -- Working- Containers* 7-201.11 Sa aration-Storaee* 7-202.1 I Restriction - Presence mud Use* 7-202.12 Conditions of Use* 7-20111 7-204.11 Toxic Containers -Prohibitions'` Sanitizers, Criteria --Chemicals' 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Dtyim Agent's. Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides- Criteria* 7-206-12 Rodent Bait Stations* 7-206,13'Cracking Powders, Pest Control and Monitoring* * Denotes critical item in the ccdend 1999 FoodCode or 105 CMR 590900. I Proper Cooking Temperatures for 19 PHFs 3-40'1.11A(1)(2) Fggs- 155`F 15 Sec. Mang eq ment and Personnel- -__- E *gs- inmrediute Service 145°I°15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 20 Animals - 1.55-F 15 sec. 's 3-401.11(B){1)(2) Pork and Beef Roast - 130'F 121 min* 3401.11(A)(2) Ratites, Injected Meats - 155°F 1.5 EllOpment and Utensils - Water, Plumbin* and Waste sec. * 3-401-11(A,)(3) Poultry, Wild Game, Stuffed PHFs, Ph sisal Facility Stuffing Containing Fish, Meal, -6 Poultry or Ratites -165'F I5 sec. 3-401.11(0(3) Whole -muscle, Intact Beef Steaks FC 145'F * 3-401.12 Raw Animal Foods Cooked in a Other Microwave 165'F * 3-401 11 (A)(1)(b) All Other PHFs-1.45'F15sec.* Reheating for Hot Holding 3-403.11(A)&(D) PHlis 165°.F 15 sec. " .3-403.11(B) Microwave- 165' P 2 Minute Standins Time* 3-403.11(C) Commercially Processed RTE Fowd - 140'F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501-14(A) Cooling Cooked PHFs from 140'F to 70'F Within 2 [lours and From 70'F to 41'F/45'F Within 4 Hours. 3-501.14(8) Cooling PHFs Made From Ambient Temperature Ingredients to 410F/45cF Within 4 flours* * Denotes critical item in the ccdend 1999 FoodCode or 105 CMR 590900. I 21 3-501.14(C)� PHFs Received at'Pemperatures According to Live Cooled to 41'F/45`F Within 4 Hours. 3-50:.15 Catlin,, Methods for PHFs 19 PHF Hot and Cold Holding 3-801.11(B) 3-501..16(8) Cold PHFs Maimaincd at or below 590.004(F) 41145° F* Mang eq ment and Personnel- -__- 3-5O.16(A) Hot PHFs Maintained at or above 140'F.* Raw or Partially Cooked Animal Food and Raw Seed S rmnt's Not Served. '# 3-501.16(A) Rousts Held at or above 130'F. 20 Time as a Public Health Control _ FC 3-5011.19 'Time as a Public Health Control* Pasteurized Eggs Sabstimte for Ray.' Shelf 590.004(H) Variance Re ul cement 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 8evetages with Warning labels^ 3-801.11(B) Use of Pasteurized Ee>s* Mang eq ment and Personnel- -__- 3-801.1I(D) Raw or Partially Cooked Animal Food and Raw Seed S rmnt's Not Served. '# .003 3-901.1 f (C) Unopened ,Foal Packa =e Not Re -served. • • • 22 3-fiO3.1 L Consumer Advisory Posted for Consumption of 590.000 Animal Foods'litat sire Raw, Undercooked or Mang eq ment and Personnel- -__- FC Not Otherwise Processed to Eliminate .003 24. Pathogens.* mean" _ FC 3-302.13 Pasteurized Eggs Sabstimte for Ray.' Shelf 25 26 EllOpment and Utensils - Water, Plumbin* and Waste E *s" 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. W4 0Z9i•I*z M7*XD ([tett; 23-30) Critical and non-critical violations, which no not relate io the foodborne illness iaterventlons and risk factors listed above, can be ,found in the following sections of the Food Code and 105 CMR 59[).000. Item Good Retail Practices FC 590.000 23. Mang eq ment and Personnel- -__- FC - 2 .003 24. Food and Food Protection _ FC - 3 .004 25 26 EllOpment and Utensils - Water, Plumbin* and Waste FC 4.005 - FC ., - .006 27. Ph sisal Facility FC -6 .007 28. _ 29. _ Poisonous or Toxic Materials S ecial Re uirements FC -- 7 .008 .009 30. Other I ,,, 6_2 J" 0002 ESSEX STREET Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency FOOD PROTECTION MANAGEMENT PIC Assigned / Knowledgeable / Duties PASS ❑J RED Non-compliance with: ' Anti -Choking PASS Tobacco PASS EMPLOYEE HEALTH Reporting of Diseases by Food Employee and PIC PASSd❑ RED Personnel with Infections Restricted/Excluded PASS RED FOOD FROM APPROVED SOURCE Food and Water from Approved Source PASS RED Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS EJI RED Conformance with Approved Procedures/HACCP Plans PASS ❑d RED 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 11,2006) Page 1 of Good Hygienic Practices Item Status Violation Critical Urgency RED: t'a`i x: "r... PROTECTION FROM CONTAMINATION RED Handwash Facilities PASS Violations Related to r Separation/ Segregation/ Protection PASS ❑d RED Foodborne Illness Interventions �I and Risk Factors (Require Food Contact Su ces Cleaning and Sanitizing FAIL Critical ❑d RED immediate corrective action) ' Y' ❑d RED mments: Sanitizer above proper ppm. Reading between 300.400 ppm. Sanitizer to be between 100-200ppm. Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities PASS ❑d RED Time As a Public Health Control PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures PASS CV RED Reheating PASS 0 RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASSRED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED 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 11,2006) Page 2 of s ro v Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE t�:amments: Child playing with coffee maker parts. Thoroughly clean and sanitize parts. Equipment and Utensils FAIL BLUE ,.-C pomeh'ts: Mop stored incorrectly. Mop to be stored by being hung to sllow, to air dry. Gene leaning of holding unit in back room required. .0 ront refrigerator requires general cleaning. /Front freezer has ice scoop stored incorrectly. Scoop to be stored so that handle is exposed or in designated labeled container. Utensil container beneath coffee maker requires general cleaning. Water, Plumbing and Waste PASS Physical Facility FAIL ,.-Comments: Behind counter area requires organization. rGeT�rel cleaning of back area required. .� iling in bathroom needs completion so that it is easily cleanable and made inpervious. BLUE BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes PASS BLUE GENERAL COMMENTS: 796: 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 11,2006) Page 3 of 0002 ESSEX STREET Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils Physical Facility GENERAL COMMENTS: 839:AII violations have been corrected. PASS BLUE PASS BLUE Expained to PIC that child is to be in designated area's only. Child is not to be in any food prep area nor touching any equipment. 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 19,2006) Page I of RED: 4';.,,t,. a " 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 v GeoTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 19,2006) Page 2 oft Salem fi'r ° f l * taf fi+�4 Board of Health Kimberley Dnscoll 120 Washington Street, 4th Floor_ #;, �� ` , _.4 ' .,Mayor, . , -,Fi' _ SALEM', MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: File Number: BHF -2004-000364 Ziggy's Donuts 2 Essex Street Salem MA 01970 LOCATED AT: 0002 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2007-0279 Jan 4, 2007 Dec 31, 2007 $100.00 ESTABLISHMENT TOBACCO VENDOR BHP -2007-0288 Jan 4, 2007 Dec 31, 2007 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 12 of 12 CITY OF $ALEMt MASSACHUSETTS o BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 'JAN - 3 2007 TEL. 978-741-1800 FAx 978-745-0343 CITY OF SALEM WWW.SALEM.COM BOARD OF HEALTH Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTz� aG `% � h S �0 h.�Lr'/STEL # % � �i f 6 �S ADDRESS OF ESTABLISHMENT o2 S S' i� / FAX # `,",AILING ADDRESS (if different) EMAIL -- Business':Own'er''s: G, p OWNER'S NAME—fT O t S zji�L C� TEL ADDRESS D �y M ) ` r ' I IVI STREET CITY STATE/�Jyy//� clr CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#j5y GG` .N (Required NUURSUFUPERATIUN a f36 .yy s, 3a)& Please write in time of Uau. 2 L, y_ �•�� -�y/ t� ,p p /�,_ //� lc-P��ygTYt� (for example11amniml TYPE OF I STABLIS T FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. _$ 5 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 - -- - - - - -- -- _ ' - - - - - - - -- less than 25 seats - $100 RESTAURANT YES NO 25-99 seats = 150 more than 99 seats =$200 BED/BREAKFAST ------------- ----- -------------------- YES 691--l' ------ --------------------- ----- ----- --- -- ----------- ------ ------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE TOBACCO VENDOR ALL NON-PROFIT (such as church kitchens) ----- - -- --- ------ ----- $100 -------------------------------------- YES Com/ $5 YES $50 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 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. Date Social rity or Federal Identification Number Revised 11/13/06 FOODAP2007.adm Check# & Date ? 6 G $ / 00 (vim (1) Explaining the relationship between FOOD safety and providing EQUIPMENT that is: (1) Sufficient in number and capacity, and (2) Properly designed, constructed, located, installed, operated, maintained, and cleaned; (J) Explaining correct procedures for cleaning and SANITIZING UTENSILS and FOOD -CONTACT SURFACES Of EQUIPMENT; (K) Identifying the source of water used and measures taken to ensure that it remains protected from contamination such as providing protection from backflow and precluding the creation of cross connections; (L) Identifying POISONOUS OR TOXIC MATERIALS In the FOOD ESTABLISHMENT and the procedures necessary to ensure that they are safely stored, dispensed, used, and disposed of according to LAw, (M) Identifying CRITICAL CONTROL POINTS in the operation from purchasing through sale or service that when not controlled may contribute to the transmission of foodborne illness and explaining steps taken to ensure that the points are controlled in accordance with the requirements of this Code; (N) Explaining the details of how the PERSON IN CHARGE and FOOD EMPLOYEES comply with the HACCP PLAN If a plan is required by the Law, this Code, or an agreement between the REGULATORY AUTHORITY and the establishment; and (0) Explaining the responsibilities, rights, and authorities assigned by this Code to the: (1) FOOD EMPLOYEE, (2) PERSON IN CHARGE, and (3) REGULATORY AUTHORITY. Duties 2-103.11 Person in Charge. The PERSON IN CHARGE shall ensure that: 21 (A) FOOD ESTABLISHMENT operations are not conducted in a private home or in a room used as living or sleeping quarters as specked under § 6-202.111; (B) PERSONS unnecessary to the FOOD ESTABLISHMENT. operation are not allowed in the FOOD preparation, FOOD storage, or WAREWASHING areas, except that brief visits and tours may be authorized by the PERSON IN CHARGE if steps are taken to ensure that exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE -SERVICE and SINGLE -USE ARTICLES are protected from contamination; (C) EMPLOYEES and Other PERSONS such as delivery and maintenance PERSONS and pesticide applicators entering the FOOD preparation, FOOD storage, and WAREWASHING areas comply with this Code; (D) EMPLOYEES are effectively cleaning their hands, by routinely monitoring the EMPLOYEES' handwashing; (E) EMPLOYEES are visibly observing FOODS as they are received to determine that they. are from APPROVED sources, delivered at the required temperatures, protected from contamination, unADULTERATED, and accurately presented, by routinely monitoring the EMPLOYEES' observations and periodically evaluating FOODS upon their receipt; (F) EMPLOYEES are properly cooking POTENTIALLY HAZARDOUS FOOD, being particularly careful in cooking those FOODS known to cause severe foodborne illness and death, such as eggs and COMMINUTED MEATS, through daily oversight Of the EMPLOYEES' routine monitoring of the cooking temperatures using appropriate temperature measuring devices properly scaled and calibrated as specified under § 4-203.11 and ¶ 4-502.11(B); (G) EMPLOYEES are using proper methods to rapidly cool , POTENTIALLY HAZARDOUS FOODS that are not held hot or are not for consumption within 4 hours, through daily oversight of the EMPLOYEES' routine monitoring of FOOD temperatures during cooling; (H) CONSUMERS who order raw Or partially cooked READY -TO -EAT FOODS of animal origin are informed as specified under § 3-603.11 that the FOOD is not cooked sufficiently to ensure its safety; 22 0002 ESSEX STREET Telephone: .744-9605 Owner. "John Akatyszewski PIC: Inspector: John Gehan Date Inspected: Correct By: 3/8/2006 Risk Level: Permit Number: BHP -2006-0293 Status: PARTIAL COMPLY # of Critical Violations: 0 Time IN: -' _ Time OUT: r 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) Ziggy's Donuts City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Physical Facility PASS BLUE Comments: Ceiling in bathroom being worked on to comply. Complete work by next routine inspection. vent in back room above sink to be repaired by next routine inspection. GENERAL COMMENTS: 531:Warewash machine to be Commercial 3 Stage dishwasher when installed. Owner to call Board of Health upon purchase of machine with plans. All violations cited on 3/8/06, unless noted, 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. Mar 15,2006 ) Page I oft J 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. Mar 15,2006 ) Page 2 oft 0002 ESSEX STREET Telephone: 744-9605 Owner: John Akatyszewski PIC: Inspector John Gehan Date Inspected: Correct By: 3/8/2006 3/15/2006 Risk Level:" Permit Number. ; BHP -2006-0293 Status: PARTIALCOMPLY # 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) City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation FOOD PROTECTION MANAGEMENT PIC Assigned / Knowledgeable / Duties PASS Non-compliance with: Anti -Choking PASS Tobacco PASS Ziggy's Donuts Critical Urgency RED EMPLOYEE HEALTH Reporting of Diseases by Food Employee and PIC Personnel with Infections Restricted/Excluded PASS PASS RED RED FOOD FROM APPROVED SOURCE Food and Water from Approved Source PASS RED Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED Conformance with Approved Procedures/HACCP Plans PASS RED City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeoTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 08,2006) Page I of Item RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/ Segregation/ Protection Foodborne Illness Interventions PASS and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing immediate corrective action) PASS Proper Adequate Handwashing Good Hygienic Practices Prevention of Contamination from Hands TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Handwash Facilities Status Violation PASS PASS PASS PASS PASS PASS Critical Urgency LJ RED D RED ❑� RED 0 RED D RED RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS Q RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures PASS 0 RED Reheating PASS 0 RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED 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. Mar 08,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE _--G`omments: Uncovered foods throughout back room. All foods being stored must be covered. ,,PIC,s son seen climbing in 2 -door refrigerator/freezer and coughing into the unit. PIC notified of potential problems. Equipment and Utensils FAIL BLUE 106mments: Double door refrigeratorlfreezer requires thorough cleaning. rigidaire Ultrafreezer requires general cleaning. Frigidaire Ultrafreezer had broken thermometer. Other thermometer not visible at time of inspection. Provide visible and accurate thermometer. Disgard broken thermometer properly. ont sink requires general cleaning. Back sink requires general cleaning. Lzvo`rage unit next to sink requires thorough cleaning. ,L,,Sanifizer must be readily available at all work stations. I—Mi rowave requires thorough cleaning. ,Aftd—nsils on back table had accumulation of food debris. Properly clean and sanitize utensils. L, o6art dough mixer requires general cleaning. Winter beneath coffee maker requires general cleaning. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE ✓60mments: Ceiling tiles in bathroom water stained. Find source of leak and repair. Replace tiles within two weeks of inspection. Repair or replace missing vent in back room above sink. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes PASS BLUE City of Salem Board of Health 120 Washington Street, 4th Floor SALEM MA 01970 (978) 741-1800 GeOTMS® 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 08,2006 ) Page 3 of Item Status Violation Critical Urgency q a 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. Mar 08,2006) Page 4 of 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 -2004-0364 LOCATED AT: Ziggy's Donuts 2 Essex Street Salem MA 01970 0002 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes FOOD SERVICE BHP -2006-0293 Jan 4, 2006 Dec 31, 2006 $100.00 ESTABLISHMENT TOBACCO VENDOR BHP -2006-0294 PERMIT EXPIRES Jan 4, 2006 Dec 31, 2006 Total Fees: 31.2006 Board of Health $50.00 $150.00 This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements, or equipment changes Are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 20 of 20 4"1 STANLEY J. USOVICZ, JR. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 Fax 978-745-0343 0 OFo O�?�/ic V� 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT711ty or)4 Sm lJc (k, TEL# g78-7YV-9Go6 VAI ADDRESS OF ESTABLISHMENT a Essex S -fir e e k MAILING ADDRESS (if different) OWNER'S NAME 70hn , AKO-j-ys2evJs1<1 TEL# g7FL-7V I-3508 ADDRESS so S u rY-1 rv-6-- Stv e e+ CITY So1eX, STATE MA ZIP t)IG'�() CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON r4A'vi 6 a A, HOURS OF OPERATION: Monk*_Tue. (0-3 We TYPE OF ESTABLISHMENT RETAIL STORE YES N gu+lcocvsJC1 HOME TEL# R%g"r7'1(_0tg8 Thu. (o-3) Fri. (0-3 Sat. QWfd Sun. 6 -ncvi) FEE (check only) less than 1000sq.ft. _$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - C-------N- --O- ------------------------- RESTAURANT YES ......................................... BED/BREAKFAST YES NO ------------------------------------------ - Iess than 25 seats = 100 25-99 seats =$150 more than 99 seats =$200 $100 ADDITIONAL PERMITS MAK (not -just Se ve) ICE CREIM, YOGURT, SOFT GERVE `arc �\ $c; TOBACCO VENDORa ^J �( YES N` ALL NON-PROFIT (such as church kitchens) 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 best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. -os Date Social Security or Federal Identification Number Revised 11/03/05 FOODAP2.adm Check# & +inn♦ • - _. , I n • 1 4 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name ZQC k/ Dat 1i Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) Assignment of Responsibility - 590 003(B) esponsibility`590.003(B) De_monshration of knowledge* _ 2-103.11 Person in charge -- duties EMPLOYEE HEALTH 2 590.003(0 Responsibility ofthe person in charge to with Food Iaw'r 3-20112 require reporting by fond etmpioyees and 3-201.13 Fluid MilkandMilk Products* a Jiiamts* Sliell Eggs* 590.003(F) Responsibility Of A Food. Employee Or An 3-202.16 Ice Made From Potable Drinking Water* Applicant To Report To The Person hn Drinkin Water from an A roved S stern* 590.006(A) Char 590.006(B) 590.003(01) Re r'tirrh Person in Chance* 3 590.003(D) E unions and Restrictions* 3-201.15 590.003(E) _ emoval of Exclusionsand Restrictions 10 E6 C I "Denotes critical item in the t'ederal 1999 Food Code or 105 CMit 590.000. Eff• • 1i 4 8 Food and Water From Regulated Sources 590.004(A -B) with Food Iaw'r 3-20112 _Compliance Food in a Hermetically Sealed Container* 3-201.13 Fluid MilkandMilk Products* 3-202.13 Sliell Eggs* 3202.14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-1.01.1.1 Drinkin Water from an A roved S stern* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0"` Contamination from the Environment Shellfish and Fish From an Approved Source 3-201.14 Fish and Reereational'ly Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources" Washin Fruits and Vegetables Carne and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Shellstock Identification Present* 590.004(0 Wild Mushrooms" 3-201.17 Game Animals* Receiving/Condition 3-20111 PHFs Received at Pin oer Tenn eratures* 3-202.15 Package htte it y* 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shellstock Identification Maintained'' Tags/Records: Fish Products 3-402.11. Parasite Destruction* 3-402.12 Records, Creation and Retention" 590.004(J) Labeling of Ingredients' ManutalWarewashim-, - HotWater Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen nacka ring. criteria* 8-103.12 Conformance with Approved Procedures* "Denotes critical item in the t'ederal 1999 Food Code or 105 CMit 590.000. Eff• • 1i 4 8 Cross -contamination 3-30211(A)(I) Raw Animal Foods Separated from Cooked and RTE Foods: _ Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each Other' Contamination from the Environment 3-30211(9) Food Protection* 3-302.15 Washin Fruits and Vegetables 3-304.11 , Ford Contact with Equipment and Utensils* Contamination from the Consumer 3-306A4(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding of Reconditioning Unsafe Food' 9 Food Contact Surfaces 4-501.111 ManutalWarewashim-, - HotWater Sanitization Tem eratures* 4-501.112 Mechanical Warewashing- Hot Water Sanitization Tem eratures* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensik* 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Iii Proper, Adequate Handwashing 2-301.11. Clean Condition - Hands and Arms 2-301.12 Cleanuna Procedure* 2-301.14 When to Wash* 1.I Good;Hygienic Practices 2-401 .11 -Ea-fin, Drinking or Using Tobacco* 2-401.12 Discharges From the Eyes, Nose and Mouth* 3-30112 Preventing Contamination Wlren TaA 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Em N� 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 5-20411 Location and Placement* 5-205.11 Accessibility,OnerafionandMaintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision 0002 ESSEX STREET HACCP: ❑ Telephone: 744-9605 Owner: John Akatyszewski PIC: 'Alice Akatyszewski*- t Inspector: David Greenbaum Date Inspected: Correct By: 3/15/2005 Risk Level: Permit Number: BHP -2005-0179 Status: SIGNED OFF # of Critical Violations: , Time IN: Time OUT: Ziggy's Donuts City of Salem RETAIL FOOD - Food Establishment Inspection Item Status Violation Critical Urgency Nature of problem or correction Non-compliance with: Not Done Anti -Choking PASS ❑ Tobacco PASS ❑ FOOD PROTECTION MANAGEMENT Not Done PIC Assigned / Knowledgeable / Duties PASS ❑J RED Urgency Description(s): Good Hygienic Practices PASS BLUE: Prevention of Contamination from Hands PASS Violations Related to Good 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. L,6 RED W RED d❑ 0 0 0 d❑ 0 0 RED RED RED RED RED RED RED RED RED RED ( Rev. Mar 16,2005 ) Page 1 oft EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASS Personnel with Infections Restricted/Excluded PASS FOOD FROM APPROVED SOURCE Not Done Food and Water from Approved Source PASS Receiving/Condition PASS Tags/Records/Accuracy of Ingredient Statements PASS Conformance with Approved Procedures/HACCP PASS Plans _. PROTECTION FROM CONTAMINATION Not Done Separation/ Segregation/ Protection PASS Food Contact Surfaces Cleaning and Sanitizing PASS Proper Adequate Handwashing PASS Urgency Description(s): Good Hygienic Practices PASS BLUE: Prevention of Contamination from Hands PASS Violations Related to Good 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. L,6 RED W RED d❑ 0 0 0 d❑ 0 0 RED RED RED RED RED RED RED RED RED RED ( Rev. Mar 16,2005 ) Page 1 oft 0002 ESSEX STREET must be corrected immediately or within 90 days) Aolations Related to =oodborne Illness Interventions and Risk Factors (Require mmediate corrective action) Ziggy's Donuts PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑J RED TIMEITEMPERATURE CONTROLS (Potentially Haz Not Done Cooking Temperatures PASS ❑J RED Reheating PASS ❑J RED Cooling PASS ❑J RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS W/ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done ❑ BLUE Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A ❑J RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Non -Critical ❑ BLUE Label dry ingredients in back baking area. Equipment and Utensils FAIL Non -Critical ❑ BLUE Dough machine needs a thorough cleaning. 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 GeoTMS® 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 16,2005 ) PaQe 2 oi2 r - w o STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745.0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Ziggy & Sons' Donuts Address of Establishment: 2 Essex Street Owner's Name: John Akatyszewski Restrictions: Application Date: 12/01/2004 Permit for Food Establishment 106-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 27-05 These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT STA CITY OF SALEM, MASSACHUSU'V4Q BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR NOV 3 0 2004 SALEM, MA 01 970 AYOR I HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Zt ar� Sans I7o n LA+S TEL #. ADDRESS OF ESTABLISHMENT a E sS ek S+ r e 2 -" MAILING ADDRESS (if different) q -79'- 7yy -q6 o5 OWNER'S NAME Tohn A1<01--VS2-e-OS�-t TEL# ADDRESS D Sur*,mtk Street CITY scdeSTATE MA ZIP 01q'7 O CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Alice-(AKQ X15 ZeLdsNl/ HOME TEL # HOURS OF OPERATION: Mon.`s 3Tue53'_3 Wed.S3�3Thu.s3J_ 3 Fri.53u'3Sat.00A Sun. -IZI`J TYPE OF ESTABLISHMENT RETAIL STORE YES NO RESTAURANT \YES NO D_� BED/BREAKFAST YES F(__O FEE check only less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 =$100 =$150 =$200 $100 less than 25 seats 25-99 seats more than 99 seats ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVENO $5 TOBACCO VENDOR '52j YE $50 ALL NON-PROFIT (such as church WiLchens) 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 beslhnowlep,dge aqd pelipf, have fled all state tax returns and paid all state taxes required under the law. nature Date Social Security or Federal Identification Number ------------------------------------------------- ---------------------- --- --------------------------------------- Revised 11/03/03 FOODAP2.adm Check# & Date rj 97; .11 . 'Jd r P P STANLEY J. USOVICZ, JR. MAYOR CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Ziggy & Sons' Donuts Address of Establishment: 2 Essex Street Owner's Name: John Akatyszewski Restrictions: Application Date: 12/15/2003 Permit for Food Establishment 206-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 48-04 These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. �V 3 S U J CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH Ilvj11' 120 WASHINGTON STREET, 4TH FLOOR y SALEM, MA 01970 DEC 15 2003 TEL. 978-74 1 - 1 800 FAX 978-745-0343 C11 CIF- SALEM TAN LE V SO CZ, R. JOANNE SCOTT, MPH, RS, CHO BOARD ©F HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT % I (pro / TEL # q7g - ') q 1-I -q(>0J ADDRESS OF ESTABLISHMENT d C S S Qk Si r e e+ MAILING ADDRESS (if different) OWNER'S NAME 1TU�r P, AY:�,Ub4S2 el+ TEL #. ADDRESS 50 Surnr''rii- 3ky-P—L% clFY Sc1IPrv) STATE MPS ZIP o 1 CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE (required in an establishment where potentially hazardous food is prepared.) 9?8--7vy -35v8 EMERGENCY RESPONSE PERSON John P- AKgeV:1s2-euu)4 HOME TEL #gia ��/�l 3Sa8 HOURS OF OPERATION: Mon. -530-3 Tue 530"3 Wed 530-3 Thu.S30 3 Fri. ee 3 Sat. L&W Sun. (OOM -TZ/00 `/ TYPE OF ESTABLISHMENT RETAIL STORE M -M NO /- 0 `. ()o U/ RESTAURANT YE NO BED/BREAKFAST YES NO FEE check onl 1000sq.ft. less than=$ 50 1000-10,000sq.ft. =$100 more than 10,000sq..ft. =$250 less than 25 seatsV =$100 25-99 seats =$150 more than 99 seats =$200 $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR yg% -0Y 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 be t k d and belief, have filed all state tax returns and paid all state taxes required under the law. �, i2- n-03 61{46 031-lv0- ?3 atur Date Social Security or Federal Identification Number Revised 11/03/03 FOODAP2.adm Check#&Date nfsi�^�/JZ ?I /,5v,— Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 41h Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name T- Si S V S De /IAT/ T of O eration s T e� Inspection Food Service ❑ Retail outine ❑ Re -inspection Address Risk Telephone , El Residential Kitchen Previous Inspection rZ IVY r �� MLevel ❑ Mobile Date: ElPre-operation Owner HACCP Y/N[_1Temporary K fZ SK/ ❑ Caterer El Bed & Breakfast ❑ Suspect Illness El General Complaint Person in Charge (PIC) Time xdtus A In: Out: Permit No. El HACCP El Other Inspector cacn vrvieuon cneckea requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH "- ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION' ❑ 8. Separation/ Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C, N 23. Management and Personnel (FC -2)(590.003) X124. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (Fc -7)(590.008) 29. Special Requirements (590.009) 30. Other 5:5901 Vs IFOm 14.do A [112. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY.. __„, El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signatu Print: PIC's Signature:�� O p Print: �iQ„hl ci A i"` ,r kOU.� ,� Page / ofPages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT I 590.003(A)Assi �tment of Responsibility"' 3-201.12 590.003(B) T)emonstrpion of Knowled e* 590.003(F) Responsibility Of A Food Employee Or An 210311 Person in charge-- duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to 590.004(, B) require reporting by food employees and 3-201.12 applicants* 3-20113 590.003(F) Responsibility Of A Food Employee Or An 3-202.13 Applicant To Report To The Person hr 3 202.1.4 Cha l,e* 3-202.16 590.003(G) Re orcin b Person in Char e* 3 1 590.003(D) Exclusions and Restrictions* 590.006(A) 590.0031h) Removal of Exclusions and Restrictions ll [0 - in in -' Denotes critical real in the rederal 1999 Pard Code or 105 CMR 590.000. y g Food and Water From Regulated Sources 590.004(, B) Compliance with F'iwd Law'" 3-201.12 Food in a Hermetically Sealed Container* 3-20113 Fluid Milk and MilkPralucts* 3-202.13 Shell EI, 3 202.1.4 Eggs and Milk Products. Pasteurized" 3-202.16 Ice Made Front Potable Drinking Water* 5-101.11 Drinking Water from an Approved Svstem* 590.006(A) 13ottded Drinking Water - 590.006(B) Water Meets Standards in 310 CMR 220' Washing Fruits and Vegetables Shellfish and Fish From an Approved Source 3-20L 14 Fish and Recreationally Caught Molluscan Shellfish* 3-201.15 Molluscan Shellfish from NSSP Listed Sources* Contamination from the Consumer Game and Wild Mushrooms Approved by RegulatoryAuthon 3-202.15 Shellstock Identification Present* 590004(C:) Wild Mushrooms* 3-201.17 Game Animals" 3-701.11 ReceivingfCondihon 3-202.11 PHFs Received at Proper Temperatures* 3-202.15 Package ante , it x` 3-101.11 Food Safe and Unadulterated Tags/Records: Shellstock 3-202.13 Shellstock identification * 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 3-402.11 Parasite Destructi(in* 3-402,12 Records. Creation and Retention* 590.004(7) Labeling of ingredients` Frequency of Sanitization of Utensils and Fad Contact Surfaces of Equipment* Conformance with Approved Procedures /HACCP Plans 3-502.11 S ecialized Pracessin Methods'" 3-502.12 Reduced nx en acka�ing, criteria* 8-103.12 Catformance with A p roved Procedures" -' Denotes critical real in the rederal 1999 Pard Code or 105 CMR 590.000. y g Cross-contaminatlon 3-303.1 1(A)(1) Raw Animal Foods Separated from Cooked and RTE Foods' Contamination from Raw Ingredients 3-302,11(A)(2) Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302A I(A) Food Protection 3-302.15 Washing Fruits and Vegetables 3-304-t1 Food Contact with Equipment and Utensils* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food" 9 Food Contact Surfaces 4-501.111 Manual Warewashing- [lotWater SanitizationTcm eratures* 4-501.112 Mechanical Warewashing- Hot Water Sartitization Tem eratures* 4-501.114 Chemical Sanitization- temp., pA, concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency ofEquipment Food - Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and Fad Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* to Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms"` 2-30112 Cleaning* Procedure's 2-301.14 When to Wash* [Ti Goad Hygienic Practices 2-401.11 F:atin , Drhtkin * or Usin * Tabacttr+' 2-401.12 Discharges Front the Eyes. Nose and Mouth* 3-301.12 Preventing Contamination When Tustin * 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Ent levees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities r 5-204.11. Location and Placement'* 5-205.11 Accessibility, O eration and Maintenance Supplied with Searle and Hand Drying Devices 6-301-I1 Handwashing Cleanser-AvaitabiliY 6-301.12 Eland Ervin, Pro%.ision CITY OF SALEM BOARD OF HEALTH Establishment Name: 71d:'GY +- sbN owu rf Date: /?o, Page: :L e7,— y Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION R — Red Item PLEASE PRINT CLEARLY - Date Verified 'S lid�6 ttt111A01KWF- 64~_", N 4z rASX�OS ttdwd✓ht/ !i >t Aro.,MtDr 1NIr-lB- fif-ecAi -_ u cfrr AfrPM �c 2; M I C**-) WtVC f s7 et. dA( rJ #9 Foe ate' e,�vJ .Lir( i uLr If Fr P1Ct6•t r u6 - Al e06 fl, ts r-r(r- 401 C& Ar lrd&#P S N� Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. �GJ pp z.d?.f.LLrLL Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure 0 Voluntary Disposal ❑ Other: Violations Related to Foodborne Illness Interventions and Risk Factors (items 1.22) (Cont.) PROTECTION FROM CHEMICALS 14 15 16 17 L� • Food or Color Additives 3-202.12 Additives" -- 3-302.14 Protection from Unapproved Additives* Poisonous or Toxic Substances 7-101..11 Identifying Information - Original Containers* 7-1.02-11 Common Name - NVorkim, Containers* 7-201.11 Separation - Storage'` 7-202.11 _ Restriction -Presence and Ilse* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers - Prohibitions* 7-204.11. Sanitizers, Criteria -Chemicals` 7-204.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Agents. Criteria* 20511 7ff2063 Incidental Food Contact, Lubricants* 3-401.12 Restricted Ilse Pesticides. Criteria* Rodent Bait Stations" 3401_l1(A)(1)(b) Tracking Powders, Pest Control and MonitarinR* • 4 Denotes craicaI item in the foleral 1999 Pood Code or 105 CNIR 590.000_ Proper Cooking Temperatures for PHFs Rcceived at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. Cootino Methods for PRF s PHFs 3-401.1 IA(1)(2) Eggs- 155'F 15 Sec. Eves- hnntediatc Service 145°Fl5sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game 3 -501.16(A) Animals - 155'F 15 sec. * 3-401.11.(B)(1)(2) Pork and Beef Roast -130'F 121 min* 3-401.11(A)(2) Ratites, Injected Meats -155'F 15 sec. * 3-401.11(A)(3)_ Poultry, Wild Game, Stuffed PHFs, Time as a Public Health Connol* Stuffing Containing Fish, Meat, 590.004()1) Poultry or Ratites -165".F 15 sec. 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145"17 s' 3-401.12 Raw Animal Foods Cooked in a Microwave 165'F * 3401_l1(A)(1)(b) All Other PHFs-145'F'15 see.* Reheating for Hot Holding 3-103.11(A)&(D) PHFs 165'F 15 sec. 3-403.11 (B) Microwave- 165' F2 Minnie Standing Time* 3-403.11(C) Commercially Processed RTE Food - 14WF* 3-4011.1(E) Remaining Unsliced Portions of Beef Rousts" Proper Cooling of PHFs 3-501_ 1.4(A) Cooling Cooked PHFs frotn 140'F to 70017 Within 2 Hours and From 70"F to 41'F/45'F Within 4 Hours. * 3-501.14(B) Cooling Mips Made Front Ambient Temperance Ingredients to 41'F/45'F Within 4 Hours* 4 Denotes craicaI item in the foleral 1999 Pood Code or 105 CNIR 590.000_ 21 3-501.14(C')� 3-501.15 PHFs Rcceived at Temperatures According to Law Cooled to 41'F/45'F Within 4 Hours. Cootino Methods for PRF s 19 3-801.11(B) PHF Hot and Cold Holding 3-501.16(B) 590.004(17) Coid PUPS Maintained at or below, 41'/45' F- 3 -501.16(A) lint PHFs Maintained at or above 140"F. " 3-501.16(A) Roasts Held at or above I30'F. 2 Time as a Public Health Control 3-501.19 Time as a Public Health Connol* 590.004()1) Variance Re uirement 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 3-801.11(B) Use of PasteurizedEes* 3-801.11(D) Raw or Partially Cooked Animal Food and Kaw Seed S groats Not Served.:ti 3-801.11(C) Uno ened Food Pucka *a NoC Re -served. "` CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods 51tat are Raw. Undercooked or Not Otherwise Processed to Eliminate Patho"ens.* �''e vrrzooi 3-302.13 Pasteurized Eggs Substitute for Raw Shell E es:` ZWrUAL MrUUIt1CMCIV t J 590.009(--(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited colder the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail Practices should be debited under #29 - Special Requirements. (Items 23-30) Critical and non-critical violations, n-hich do not relate to the ,foodborne iliness interventions and riskf`actors listed above, can be found in rhe following ,sections of the Food Code and 105 CMR 590.1100. SS11134, ibutG2.d,, Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT I k Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Z d v Date �i - 01/ T ' of Operation(s) T e of Inspection R�outine [PRe-inspection LY Food Service El Retail Address Risk Telephone Level ❑ Residential Kitchen ' Previous Inspection of _ 14as� ❑ Mobile [I Temporary Date: c;R3-0 ElPre-operation Owner HACCP YM n �{ ElCaterer ❑ Bed &Breakfast El Suspect Illness El General Complaint Person in Charge (PIC) Time rP Inspector /sf / _1Cl< Out: Permit No. ElO her �CUII vwiuuvn vneciteu requires an explanation on me narrative page(s) and a citation of specific provision(s) violated. A Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties ' EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ' ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection w n ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. C N 23. Management and Personnel (FC -2)(590.003) 24. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26. Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28. Poisonous or Toxic Materials (FC -7)(590.008) 29. Special Requirements (590.009) 30. Other S: 5.WIn5 aFom 14A. ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS El14. Approved Food.. or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods),' '. ❑ 16. Cooking Temperatures ❑ 17. Reheating [:118. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 21. Food and Food Preparation for HSP ` CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: `I s cto" Sig lure: 1Print:P. xOLUS)�l 4 PIC's Signature: Print: �, Page -L of_5ePages Violations Related to Foodborne Illness Interventions and Risk Factors (Items 1-22) _ FOOD PROTECTION MANAGEMENT '1 590.003(A) Assignment of Responsibility* 590.003($) _Demonstration of Knowledge* 2-103.11. Person in charge - duties EMPLOYEE HEALTH 2 590.003(C) Responsibility of the person in charge to Compliance with Food Law* 3-201.12 require reporting by food employees and 3-201.13 _Fool Fluid Milk and Milk Products* a )licants4` Shell Eggs* 590.003(F") _ Responsibility Of A Food Employee Or An 3-202.16 Ice Made From Potable Drinking Water"` Applicant To Report To The Person h7 Drinking Water from an Approved System* 590.006(A) Charge* 590.006(B) 590.003(0) Re)ortin �Charee* 3 590.003(D) Exclusions and Restrictions* 3-201.15 590003(F) _ Removal of Exclusions and Restrictions 6 i i Ih ^. • • • i E ' Denotes criocA item in the federal 1999 Food Code m 105 CMR 590.000. g Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Law* 3-201.12 in a Hermetically Sealed Container* 3-201.13 _Fool Fluid Milk and Milk Products* 3-202.13 Shell Eggs* 3-202.14 Eggs and Milk Ptuducts. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water"` 5-1.01.1.1 Drinking Water from an Approved System* 590.006(A) Bottled Drinkin Water* 590.006(B) Water Meets Standards in 310 CMR 22.01` Contamination from the Environment Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish" 3-201.15 Molluscan Shellfish from NSSF Ihsted Sources* Washing Fruits and Vegetables Game and Wild Mushrooms Approved by Regulatory Authartt 3-202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms - 3 -201.17 Game Animals* Receiving/Condition 3-202.11 PHFs Received at Proper Tcun eratures* 3-20215 Package Tnte it y 3-101.11. Food Safe and Unadulterated Tags/Records: Shellstock 3-202.18 Shellstock Identification * 3-203.12 Shelknick Identification Maintained* TagslRecords: Fish Products 3-402.11 Parasite Destruction* 3-402.12 _ Records. Creation and Retention* 590,0040) Labeling of Ingredients* Manual Warewashing - Hot Water Conformance with Approved Procedures /HACCP Plans 3-502.11 Specialized Processing Methods* 3-502,12 Reduced oxygen packaging, criteria* 8-103.12 Conformance with A. roved Procedures't ' Denotes criocA item in the federal 1999 Food Code m 105 CMR 590.000. g _ Grass -contamination 3-302-11 (A)(1) Raw Animal Fonts Separated from Cooked and RTE Foods* Contamination From Raw Ingredients 3-302,1.1(A)(2) Raw Animal Foals Separated from Each Other* Contamination from the Environment 3302.11(A) 'Food Protection'` 3-302.15 Washing Fruits and Vegetables 3=304.11 Food Contact with Equipment and Utensils" Contamination from the Consumer 3-306.14(A)(B) Returned Food and Resecvice of Food* Disposition of Adulterated or Contaminated Food 3-701.1.1 Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4-501.11 1 Manual Warewashing - Hot Water Saniuzation'reeleratures* 4-501.112 Mechanical Warewashim, Hot Water Sanitization Temperature'* 4-501.114 Chemical Sanitization- temp., pH, concentration and hardness. * 4-601.11(A) Equipment Fool Contact Surfaces and -760211 Utensils Clean* Cleating Frequency of Equipment Food - Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and Food Contact Surfaces of E ui ment* 4-703.11 Methods of Sanitization - Hot Water and Cheuncal* 10 Proper, Adequate Handwashing 2-301.11 Crean Condition - Hands and Annss` 7301.12 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401.J 1 Eahn , Drinking or Using Tobacco* 2-101.12 Discharges From the Eyes, Nose and Mouth' 3-301..12 Preventing Contamination When Tasting"` 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Ca tacities* 5-20411 Location and Placement* 5-205.11 Accessibility. Operation and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin Cleanser, Avttilabilit 6-301.12 hand Drying Provision CITY OF SALEM BOARD OF HEALTH Establishment Name:_�c�✓ 4tsa s _, /<fs Date: Page: 61 of Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION - - "" - -k PLEASE PRINT CLEARLY Date Verified 0 �le . i a -f7 > A/ 9ZE Zi646-- A_� U dill. `r / iJ U Discussion With Person in Charge: I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection, to observe all conditions as described, and toExclusion comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. �/� /j 1 1 �LeC£!,ECi[,t. ��t-l/t'CLLL1-ICAC Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / El Re -inspection Scheduled Ll Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness Interventions and Risk Factors (Items 4.22) (Cont.) PROTECTION FROM CHEMICALS X14 15 17 " Denona al9tical treat in the rederal Niel Pood Code or lot CMR 590.000. 3-501. t4(C,) Food or Color Additives 3-202. 12 Additives -4 302.14 Protection from Unapproved .Additives'% 3-SOI.li _ Poisonous or Toxic Substances 7-101.11 identif3migInformation -Original Containers* 7-102.11 Common Name - Working- Containers* 7-2()I.1 1 Separation - Stora el` 7-20111 Restriction -Presence and Used 7-202.12 Conditions of Use'" 7-203.11 'Toxic Containers - Prohibitions* 7-204.11 Sanitizem Criteria -Chemicals* 7-2(14.12 Chemicals for Washing Produce, Criteria* 7-204.14 Drying Ag-ents. Criteria" 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.1.2 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitarin * " Denona al9tical treat in the rederal Niel Pood Code or lot CMR 590.000. 3-501. t4(C,) Proper Cooking Temperatures for Unpasteurized Pre-packaged Juices and - Beverages with Warning-Umcls* PHFs 3-401.11A(1)(2) Eggs- 155`F 15 Sec, 3-SOI.li _ Eeg-s-Immediate Service 1450FL5sec* 3-401.11(A)(2) Comminuted Fish. Meats & Game 3-501.16(B) Animals - 155''F 15 sec. " 3-401.11(6)(1)(2) Pork and Beef Roast-130'Ft2l. min* 3-401.11(A)('2) Ratitcs, Injected Meats - 1.551F 15 E ui ment and Utensils sec. * 3-401.11(A)(3) Poultry, Wild Game. Stuffed PRFs, 20 Stuffing Containing Fish, Meat. 3-501.19 Poulh y or Ratites -165'F 15 sec. " 3-401.11(C)(3) Whole -muscle. Intact Beef Steaks Physical Facility 145''17 " 3-401.12 Raw Annual Foals Cooked in a 2S Microwave 165'F * 3-401.11(A)(1)(b) AlI_Other PHFs-- 1451, 15 sec. ,008 Reheating for Hot Holding 3-401.11(A)&(D) PHP,165'F 15 sec. * 3-4D311(B) Microwave- 165"F 2 Minute Standing ,_ Time* 3-403.1I(C) Commercially Processed RTE Fail - --,,. 140"F* 3403.11(E) Retraining Unsltced Portions of Beef Roasts' Proper Cooling of PHFs 3-501.14(A) Cooling Conked PHFs from 1461E to 70'F Within 2 Hours and From 70°F to 41'F/459F Within 4 Hours * 3-501.14(13) Cooling PHFs Made From Ambient Temperature ingredients to 41'F/45'F Within 4 Hours" " Denona al9tical treat in the rederal Niel Pood Code or lot CMR 590.000. 3-501. t4(C,) PHFs Received of Temperatures Unpasteurized Pre-packaged Juices and - Beverages with Warning-Umcls* According to Law Cooled to 3-801.11($) 41'P/45°F Within 4 Huurs. "` 3-SOI.li _ Coolitt Methods for PHFs 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41`Ai " F r50 L.16(A) Hot PHFs Maintained at or above E ui ment and Utensils 140"F * 3-50I.16(A) I Roasts Held at or above 1300F. 20 Time as a Public Health Control 3-501.19 Time as a Public Health Control" 590-004(H) Valiance Recufretnent • 21 3-801.II(A) Unpasteurized Pre-packaged Juices and - Beverages with Warning-Umcls* 3-801.11($) Use of Pasteurized E,g-,Is* Management and Personnel 3-801. I l(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. .003 3-801.11(C) Uno enedFand Packa>c NotRe-served. "` CONSUMER ADVISORY 22[3-3()'- (10.11 Consumer Advisory Posted for Consumption of 590.000 Animal Foods That are Raw. Undercooked or Management and Personnel FC- Not Otherwise Processed to Eliminate .003 24. Pathogens.'' enc "J"7oar FC .13 Pasteurized Eggs Substitute for Raw Shcll '.. 25. E ui ment and Utensils E1g-s" RVREPUTRIMMUMW 590.009(A) -(D) Violations of Section 590.009( -A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 1129 - Speeial Requirements. r ��itffur�rT r•tirrr,�y (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be found in thel'olloxing sections of.the It Code and 105 CMR 590.0!)0. � item Good Retail Practices '•.. FC 590.000 23. Management and Personnel FC- 2 .003 24. Food and Food Prot_ectio_n FC - 3 .004 '.. 25. E ui ment and Utensils ! FC -- 4 .005 26. Water. Pit! in and Waste FC 5 .006 7 27. Physical Facility .007_ 2S Poisonous or Toxic Materials FC - 7 ,008 29 IL30 5 ecial Reguiremenis .009 1 ,_ Other _..... --,,. 5'.+P.Nn�ok�r„a, "I tivw MassIachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Salem Board of Health 120 Washington Street, 4'" Floor Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 Name Z / 6G t Sc'�/ tJ h/V i Date �, -O 4/ T e of 0 eration s Tvpe of Inspection ood Service ❑ Retail °; ❑ Residential Kitchen ❑ Mobile ❑ Temporary ❑ Caterer ❑ Bed & Breakfast Permit No. outine El Re -inspection Previous Inspection Date: ❑ Pre-operation ❑ Suspect Illness ❑ General Complaint ElHACCP El Other Address Z L S3Lr_ $'f"' Risk Level Telephone 7ytf O S Owner V �j//r/ /? if/<rq T ySwf/ HACCP Y/N Person in Charge (PIC) Time In: Out: �e�f InspectorSj6,QppM�L,� v�'/n e6 %/s Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009( E) ❑ 590.009 (F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH _ ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/ Segregation/ Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. CQi _Nr' 23. Management and Personnel (FC -2)(590.003) ✓ 4. Food and Food Protection (FC -3)(590.004) 25. Equipment and Utensils (FC -4)(590.005) 26 Water, Plumbing and Waste (FC -5)(590.006) 27. Physical Facility (FC -6)(590.007) 28, Poisonous or Toxic Materials (FC -7)(590.006) 29. Special Requirements (590.009) 30. Other S 5901ns dFo, 14 MO W ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION'. FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) , ❑ 21. Food and Food Preparation for HSP .CONSUMER ADVISORY , ❑ 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions Z � and Risk Factors (Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations . cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: 's S• to e• --' Print: I0 PIC's Signature: „ 6, - - /' -- Print: ' ^ - :-0 Page / of � Pages Violations Related to Foodborne Illness Interventions and Risk Factors (items 1-22) FOOD PROTECTION MANAGEMENT 1 590.003(A) A.ssianmentof'Responsibihty* _ 590.003(B) Demonstration of Knowled e* 2-]03.11 Parson in ehare -- duties a 0 0 re I EMPLOYEE HEALTH 590.003(C) Responsibility of the person in charge to 590.004(A -B) require reporting by food enrplosees and 3=201.12 o >licants* 590.003(F) Responsibility Of A Food Employee Or An 3-202.13 Applicant To Report To The Person In 3-202.14 Charge* 590.003(G) Re [ortin by Person in Charge* 590.003(1)) Exchisionsand Restrictions* 590.003(E) Removal of Exclusions and Restrictions 11 Denotes critiud item in the tederal 1999 Food Code or 105 CMR 590-000_ PROTECTION FROM CONTAMINATION 8 Food and Water From Regulated Sources 590.004(A -B) Compliance with Food Iaw' 3=201.12 Food in a Hermetically Scaled Container* 3-201.13 Fluid Milk and Milk. Products* 3-202.13 Shell Eggs* 3-202.14 E< , and Milk Products. Pasteurized-" 3-202.16 Ice Made Front Potable Drinking Water* 5-101.11 Drinking Water from an Approved System'- stem*590.006(A) n90.000(A) Bottled Drinkine Water* 590.006(13) Water Meets Standards in 310 CMR 22.0* Shellfish and Fish From an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* 3-20115 Molluscan Shellfish from NSSP Listed Sources* Game and Wild Mushrooms Approved by Regulatory Authority 3-202.18 Sheltstock ldenutication Present* 590.004(0) Wild Mushrooms* 3-201.17 GameAnimais* F9- Receiving/Condition 3-202.11 PRFs Received at proper Temperatures* 3-202. t5 Package httegrft „' 3-101.11 Food Safe and Unadulterated Tags/Records: Sheilstock 3-202.18 Shellstok Identification * 3-203-12 ShellstockIdentification Maintained* Tags/Records: Fish Products 3-402.11 3-402.12 Parasite Destruction* Records- Creation and Retention" 590.004(1} Labeling of ingredients' 3-502.11 Conformance with Approved Procedures /HACCP Plans S ecializxdi Processinr+Methods* 3-502.12 Reduced oxygen packaging, criteria` 8-103.12 Conformance with A. roved Procedures* 11 Denotes critiud item in the tederal 1999 Food Code or 105 CMR 590-000_ PROTECTION FROM CONTAMINATION 8 Cross-comamaiason 3-302.11(A)W) Ravi .animal Foods Separated from Cooked and RTE Foods* �.. Contamination from Raw ingredients 3-302,11 (A)(2) Raw Animal Foals Separated from Each Other* Contamination from the Environment 3-302.41(A) Food protection 4 3-302.15 Washing Fruits and Vegetables 3-304.11 Food Contact with Equipment and Uren'Als* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food" Disposition of Aduiterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* F9- Food Contact surfaces 4-50 L 1 I 1 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501112 Mechanical Warewashing- HotWater Sanitizanon Tem eratmres* 4-501.114 Chemical Sanitization -temp., pH, concentration and hardness. 4-601.1 i (A) Equipment Food Contact Surfaces and Utensils Clean* 4 602.11 Cleaning Frequency of Equipment Food - Contact Surfaces and Utensils" 4-702.1 1 Frequency of Sanitization of Utensils and ,Food Contact Surfaces of E ui rnent* 4-703-i. i Methods of Sanitization - Hot Water and Chemical* 10 Proper, Adequate Handwashing 2-301.11 Clean Condition - Hands and Arms* 2-30112 Cleaning Procedure* 2-301.14 When to Wash* 11 Good Hygienic Practices 2-401._11 'Satinet, Drinking or Usin 'robed... 2-401.12 Discharges From the Eyes, Nose and Mouth" 3-301.12 Pieventin Contamination When Tasting* 12 Prevention of Contamination from Hands 54Q004(E) Preventing Contamination from Em rlovees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Nmnbcra and Ca racities* 5-204.11 Location and Placement* 5-205.11 Accessibilit v. O reration and Maintenance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashin Cleanser, Availability 6-301.12 Hand Drying Provision CITY OF.SALEM BOARD OF HEALTH Violations Related to Foodborne Illness interventions and Risk Factors (items 1-22) (Cont.) PROTECTION FROM CHEMICALS 14 t7 i Food or Color Additives 3-202.12 Addaives* 3-30214 _ Protection from Unapproved Additives* Poisonous or Toxic Substances 7-101. 11 Identifying Information - Original Containers" _ 7-102.11 Common Ntnne- Working Containers* 7-201 11 Separation - Stora>e" 7-202.11 Restriction - Prelurce and Use* 7-202.12 Conditions of Use" - 7-203.11 Toxic Containers - Prohibitions'* 7-204.11 Sanitizers. Criteria -Chemicals* 7-204.12 Chemicals for Washing Produce, Cr'iter'ia* 7-204.14 Drying Agents. Criteria* 7.205.11 Incidental ;Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-106 12 Rodent Bait Stations'` 7-20b.i3 Tracking Powders, Pest Control and Muni wrine* TIMEITEMPERATURE CONTROLS *Denote,, criiic:il i[em in the federal 1999 Food Code or 105 CMR 594.000. 3-507 14(C) Proper Cooking Temperatures for PHFs 3-401.11A(1)(2) Eggs- 155'F 15 Sec. _ 3-501.15 Eggs- m Tedi ate Service 145"F 15secc, 3-401 A I (A)(2) Comminuted Fish. Meats R Game 3-501.16(13) Animals - 155`''F 15 sea * 3-401.11(13)(1)(2) Pat kand Beef Roast -'130°F 121 True 3-40 )A I (A)(2) Ratites, hrjected Meats- 155'F 15 sec. s 3-401.11(A)(3) Poultry, Wild Game. Stuffed PRFs, �0 Stuffing Containing Fish, Meat, 3-501.19 Poultry or Ratites -165'1` 15 sec. 3-401.1 I (C)(3) Whole -muscle, intact Beef Steaks 145"F * 3-401.12 Raw Animal Foods Cooked in a Microwave 165*F * 3-401.11(A)(1)(b) All Other PHFs - 145'F 15 sec. Reheating for Hot Holding 3-403.11 (A)&(D) PHFs 165`F 15 see. It 3-403.11(13) Microwave- 1650 F 2 Minute Standing Time* 3-401.11(C) Commercially Processed RTE Food - 140'1' 340'.I I(E) Remaining Unsliced Portions of Beef Roasts* Proper Cooling of PHFs 3-501.14(A) Cooling Cooked PHFs Prom 140"F-- to 70'F Within 2 Hours and From 70'F to 41.^F/45"F Within 4 Hours- * 3-501.14(6) Cooling PHFs Made From Ambient 'Temperature Ingredients to 41'F145`F Within 4 Hours* *Denote,, criiic:il i[em in the federal 1999 Food Code or 105 CMR 594.000. 3-507 14(C) PHFs Recerred at Temperatures Acaxding to Law Cooled to 3-801.11(D) 1 4'F/45'F Within 4 Hours. _ 3-501.15 Cooline Methods for PRFs 19 P H F Not and Cold Holding 3-501.16(13) Cold Pi'1Fs Maintained at or below 590.004(F) 41°!45°F' 3-501.16(A) _ Hot PHFs' Maintained at ra above 140'F.* 3-501.16(A) Roasts Held at or above '130°F. �0 Time as a Public Health Control 3-501.19 Time as a Public Health Control'" 590.004(H) Variance Recuncrucnt REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. 3-801.11(A) _ -3-801.�11(13) Unpasteurized Pre-packaged Juices and Bevera+_>es with Warning Labels* Use of Pasteurized 1--s* 3-801.11(D) Raw or Pariiatly Cooked Animal 'Food and Raw Seed Sprouts Not Served. 3-801.11(C) Unopened Food Package Not' Re -served. 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'1'hat are Raw. Undercooked or Not Otherwise Processed to Eliminate 1J..e M..,.o.... is EY,ecoea v%:200 3-302.13 ( Pasteurized Eggs Substitute for Raw 5%009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food. temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under 4/29 - Special Requirements. f:N.iilAlMy 71rokIfTi1X9 (Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk {aclms listed above, can he found in the folloiving sections <f the Food Code and 105 CMR