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BELLA VERONA - ESTABLISHMENTS dtllu Vtfon,4 toi Ej�� Str�•t Lniversal one. www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA Commonwealth of Massachusetts ` F City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/13/2011 ESTABLISHMENT NAME: Bella Verona File Number:BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 . Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE- BHP-2012-0003 Jan 1, 2012 Dec 31,2012 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES ecember 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership,or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r-- CITY OF SALEM, MASSACHUSETTS '' BOARD OF HEALTH b ._ 120 WASHINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KINIBERLEY DRISC011 F_�x (978) 745-0343 M.'\YOR lramdina salem.com I,J�Itlt\'.ILAnrU1N,Rti�ILliI IS,CI I(1,CI'-I•l' HEArnI AGF:Nr 201_APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &It a V e-r 0 A/ ,+ TEL# ADDRESS OF ESTABLISHMENT_ lbFAx# MAILING ADDRESS(if different) ) EMAIL- Business': &,11a-,/ / #&Lqob cDlq Website: Ae//a 11e1-0,VA , CoM OWNER'S NAME G/ OPG in /440-nS0- TEL# ` ZX �S?-S �c/`IFJ ADDRESS M STRE T f CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) G/Dr 9/O J'� <{//274 A/A CERTIFICATE#(S) ld 1 9 z (Required in an establishment where potentially hazardous foo is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesda Thursda Friday Saturda Sunday HOURS OF OPERATION Please write in time of day, (For example 11 am-11 pm TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------- -- - ✓ RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$2YES 25-99 seats =$280 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 $135 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 mustbe 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. D Z/ 3S / Ssd I Signature dr Date 12 -11- 1 Social Security or Federal Identification.Number -------- ------ Updated 5/23/11 523/11 FOODAP201 Ladm Check#&Date 5 Commonwealth of Massachusetts ' �• City of Salem + Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Bella Verona File Number:BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0233 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 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 p CITY OF SALEM, MASSACHUSETTS ' C BOARD OF HEALTH ate, 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIINIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRr;ENtanu,Nl(@SALEnI.CONI DA\9D GREENBAuM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 6 e iI toy cro A)- TEL# 'T7 $ r$2s- I ADDRESS OF ESTABLISHMENT I h h &S e- x S+ FAX# MAILING ADCRcSS(.f di erppent) u EMAIL- Business': website: $Q I I Qy'2 f 0 IQ CC) OWNER'S NAME i D M aA2Q /\I-A TEL# 779- 1 7f--I 1 +y ADDRESS j I s L n1 bc_4 J e( S H -Pt_ b � R Z 3 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES)G I 0 r&I D H A"Al7 A_ "' " CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON l P 1 0 r- A A) HOME TEL# ;DAYS`OF OPERATION , � f4_Monday :_,: :.Tuesday' , ;rWednesda t v,Thursd - . I �Fnday' I ; ,Saturda K";is y Sunday%'., HOURS OF OPERATION Please write in time of day. For example Ilam-11m) -1 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - --- ------------------------------------***---------------------------------------------- RESTAURANT ES" NO ls than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 M more than 90 seats =$420 B---E--D--/--B--R--E--A---K--F--A---S--T--/---------------------YES------146------------------------------------- --------------------------------$-1-00------- CHILDCARE SERVICESINURSINGHOME........................................................ ..... .......... ................................ ............. - ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to 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 perjurythat I,to my best knowledge and belief,have filed all state tax retums and paid all state taxes required under the law. a,, 0. 12- Z_ 0y 3S1 g,�5_D Signature Date Social Security or Federal Identification Number ---------------- ------------------- D - ------------------------ Revised 10n1I I FOODAF201 Ladm Check#&Date § Q ' 2-5 �/' � !n'�".47-ri�..:e:°k'�s'ii1LV�`kr?•^K•i�F�°r':/14�l/tr4.�»a.� irr.a...:+.��+cP�,r' -�t Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Datevpe of Operation(s) Tvpe of in �n,1 ) 4Food Service ❑'Routine Address n' / v Risk El Retail ❑ Re-inspection / Level ❑ Residential Kitchen Previous Inspection Telephone /1 _ ❑ ❑Mobile Date: Owner /� Y Imo ^ HACCP Y/N ❑ Tem V porary Pre-operation m � ❑ Caterer ❑ Suspect Illness Person in Charge(PI Time ❑ Bed&Breakfast ❑ General Complaint i JU✓1 P� b1 < Q y'•`' ❑ HACCP In:� r� I Inspector Out: :,O ryy Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-ChokingTobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) /590 .009((/Ef action as determined by the Board of Health. -FOOD PROTECTION MANACEMENi .--4, ❑ 12. Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities 4 EMPLOYEE H€ACTH aA_„ ?i� F } ,"' G 6u= i 1pROTECTION FROM CHEMICALS �',F" 4 ®�°s1 Zu ❑-i-Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded & e :+ y r �,,: { ❑ 1$ Toxin Chemicals FOOD FROM APPROVED SOURCE,,2 „m,m �e,_,,,K- „•„„,�, „•,� K.:,3m -TIMEREMPERATURECON TROLS(Potentially Hazardous Fur}ds)r'`�r'1 ❑ 4. Food and Water from Approved Source a si ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. Cooling F PROTECTION FROCONTAMINATN" „r ` �� ❑ 19. Hot and Cold Holding M IO ` w 20.Time As a Public Health Control r❑ 8 Separation/Segregation/Protection ❑. , L,y 9. Food Contact Surfaces Cleaning and Sanitizing Y'-REQUIREMENTS FOR HIGHLY SUSCEPTIaLE PUPULATiONS(HSP) El21. Food and Food Preparation for HSP F-1 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices .CONSUMER IIOVISORy. r aw ,yr. u, =!m.�,..i"i�ru� a ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C " ! by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(550.005) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.00e) and submitted to the Board of Health at the above address 29. Special Requirements (590.009)\ within 10 days of receipt of this order. 30. Other I l DATE OF RE-INSPECTION: 11_ �G l �( t UIQ 1 CJtJ V 5:5901nspectFomi6-1C.tloc Clt /A� �� Inspector's Signature A C. ^ Print: f,�- ll t fir' a r IC's Signature: � l Print: /7 / -�� Page_L of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 596.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Focxis* 2-103.11 Person in charge-duties Contamination from Raw ingredients 3-302111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302-.1 I(A) Food Protection* applicants* 3-302.15 tiVashin Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* '-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(D) Exclusions and Re str ctions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3 701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hetmeticalb,Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashing-Hot Water 3-202.1.3 Shell EP-s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 ice Made From Potable Drinking Water* concentration and hardness.* 5-1.01.1.1 Drinking Water from an Approved System* 4-601_11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinkin Water* Utensils Clean* 590.006(B) Water Meets Standards in 31.0 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Frxxl- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source . 4702.1 L Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foot]Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1(1 Proper,Adequate Handwashing Regulatory Authority Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms` 3-202.18 Shellsta:k Identification Present* 2-301.12 Cleanim4 Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash* 3-201..1.7 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590 04(,E) Preventing Contamination from 3-20312 Shelistoek Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records,Creation and Retention; 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Special i:zed ProcessinMethods* Devices 3-502.12 Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanses,Availabilit 8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Drying Provision Denotes critical item in the federal 1999 Is"I Cate or 10.5 CMR 590.000. - CITY OF SALEM 130ARD OF HEALTH Establishment Name: LROPO. ).ej ,'� Date: I Page: of item' Code ft4V DESCRIPTION OF OF CORRECTION, '" & "' � ,)E Date a C7Criticalitem VIOLATION/PLAN I �V R-"Red Item �wto1p't W�l,W"�'rmt W,�r4 va, �'Or, "a �41 , - �q , " - 'tried P No." 11711"k-i-W,ml�) 0XII, 141, ;l?", w EASE PRINT CLEARLY' '41 ":�JI\A AOo ) houl, (�tJ2 q,7,01v 0 , �,M I LIPUA 1_1�/ A/1 'Pj� ::- -_ I - - __ M AA J V � 1'� k OPJ/-,, S�A r,''_I& / 44 )\,I 0 AP jh)A (j (/9 A mil rt _v R i A� V)i A/1, ),4-o A Ona k A2/ A^A I AA( A_t^ 719AA AA A , A,1AAI NI-A _j _A� N; L(4 -\A f- ro), 0 -0 A+ Corrective Action ec Sion With Person in Charge: _ -� � I have read this report, have had the opportunity to ask questions and agree to correct all C3 Voluntary Compliance 0 Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to LD Re-inspection Scheduled Ll Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five-dollars or suspension/revocation of Li Embargo Lj Emergency Closure your food permit. 0 Other: Ll Voluntary Disposal F' )-I(C" PlIFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk Accordific,to La'w Cooled at Factors(Items 1-22) (Cont) I`F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS SQ'- cwfito'Mcllm&for PHFK ------ Food,or Color Additives L—19- -PHF Hot and Cold Holding E - -— ,-501.16eti) Coid PHS Maintained at or below 3-202.12 Add;twc,I 590.0olff) 4 1a/45�`Fk 3-30214 Protection fomiLL jyroved Additws Poisonous of Toxic Substances 15t 1i flot PHF�, IMairtainedat or ab ave 140F. 7-i F)t I I identifying Into)mation -Orj�-Iinal a-501,16(A1 Roasts held at or above 130'F, Containers 11 0 Time as a Public Health Control 7 102,11 1 CommonName - Work m"Courxinen'* -3-SO; 19-- 'e,as a Public I lealth Control* — Vad 7262.1 I Resir—iction-Prc&Lnce and Use' r7-202ii Fowlj�o)n,",ot Use- rREQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-1-03,It --- Toxic w,Colluun - Prohibitions* POPULA IONS(HSP U-10 4 11 sanail.ers'Criteria --Chcmicils P7 20412 Chenacaic.far Wa�hn)E'Patcluce,cifterial --,4 --- L—� —.—I itcveraaes tvith�Llaj ronEl�tI)SIV F71 -J04 14 �4 Cfiteria' 4-801 of Pasteurized La 0�'I I hiculcmal Fx)d Contact,LohricanW 1 3-WT I l(D) Raw at C(x)),ed Allittial Food and I L ke,�iricled llw Peqioider',Crrtena" r, 11 3, Ra� -jirocoi Not Sri ROKICIa F3 at SMIIOTIS� 7-206.12 u1n),ened T;ix!q—Pack"'Le hot Re—sened I Nkc-i�' 6 8—LI, LI C I- Frzeking Pcmderi. Pf�sa Control and CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS C Arvin ii Fod,Thatawc Raw, Undeieooked ur 16 Proper Cooking Temperatures for sot Othtrwise Processed to Eliminate PHFs, 3-401.11 A(l Fgp'- 155'F 15 scc. ;-30'2.13 Comminutcd Fish,Meats tx(hint 1-401—110" — Aairoai�� - 1�117 15 sec- SPECIAL REQUIREMENTS -7;4iT)l.11 Pink nod Beef Roast (,^),)-F 121 inin` 1-40 1.I I(A)Q) 155FJT sst caienogmobil hxxJtemporary and 3.40i.lJ(A)(3,) Poultry.Wild Gajne,Stuffed PKF's, reeds tit al kitchen operations should lie slaffow Cowmiling Fish, Meat. 1 &I-ated ander the appropriate actions Poultry or knthes-165115 sea jAyove if ichned to fiKAborne Illness 3-401.I I f C)(3) Whole-rolls1e,Intact Beef Steaks and risk fiactom, Other 145'T 590,009 violatiow, rolalin,o to food retail 1-401 12 Raw Aminal FoidCooked In a pi acficec should he debited under#29 - Miciowaw 165'F * I Special 3-401,11(A)(1)(h) All Other PHTs 145'F 15 sec Reheating for Hot Holding V10LttTIDIUS RELATED TO GOOD RETAIL PRACTICES 3-403.1l(A)&,(D) Plif-, 165eF 15 sec. - (Items 23-30) e- 165'17 2 MmLia�,Standing- Critical and nort-,rin,:al whith do nor relate io the -7, 401 11(B) Mwrowav Time' 'foodhorne d1ness infei Vemkony md rivkJa4 ior�listed above, can bp 1(C.) Con'twavialiv Processed RTE Food /aUnd in the,k)[lowing 6ef fions ol the F'�od Code w44)(1-5 CMR 1(1-") Reamijang UnOc�ed Porti-- l PC 5 3-403, ons of lice, i (tam Gtel ----------- ------ Roast'* _23 Man Trent and Per onnt QFC 2 1 .003 Proie�,fion---- 4# 1 Food mr)d Food '3 66 Proper Cooling of PHF6 L12113—------4 FC -4 501,14A) C(x:,IiiigCooki,,itPHI:5fi(m ]4t)'Ft4, 26 1 "Nater,Pfuaibmayd IJ rte, F`FC'- ---5-'--T'-0-'(-)'6" 1001;Within 2 Hours and From 70'1' NT, Phv5ccca Fac lits FC-6 1 2& j Poisonous or Tccoc Materials L 008 4(B) Cooling t HFs Made Front Ambient 22mpraac hijaedients it,41'F/451 F 30 Other r5 6 1-1 --- - -------------- --- Within 4 IlourO Dc?V'Ws c'nii(al item m tht ledend to,),)VoM 0xie or 105 CNIR 590 00'6. 1 Commonwealth of Massachusetts 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: Bella Verona File Number:BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0053 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 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 CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOC�b TEL. (978) 741-1800 0 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM@SALEM.COM Ate DAVIDGREENBAUUt, (.• 009 ACTING HEALTH AGENT 2010 APPLICATION FOR` (PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT k Q,110. V 1 � O n) A TEL# l g7 g - b ADDRESS OF ESTABLISHMENT I D 9 - S S e>c FAX# MAILING ADDRESS(if different) D 7 S S L 5 � EMAIL-Business': &— Q— fQ L ,Website: cit C M OWNER'S NAME 1� I D C � l An 2a TEL# II ADDRESS f � Ireetcips �.ri b �cwe- cs H 0. . STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) G? l0 f g t o H CERTI FI CATE#(S) ° c1 -2- (Required (Requiired in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON I ° `\ / 1 a n a HOME TEL# 9 '1 - -7 -7 -t 14" o G DAYS' . J OPiiATIgN ,_ ontlay'y 1. . uesda'y y '„Wednesda'k i . Thursday a Fntla��' Satulday i `T�,Sun`diyv4 HOURS OF OPERATION , I Please write in time of day. 4-( - I y - ( L f 41— (For {— For example Ilam-11pm i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 -------------------- ----------------------------------------------------------- ------ RESTAURANT YES NO less than---- 25 seats $1 (Outdoor Stationary Food Cart$21 25-99 seats ( 77__ more than 99 seats =$420 BED/BREAKFAST( YES NO $100 CHILDCARESERVICES/NURSING HOM---------------------------------------------------------------------------------•-------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to 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 ret rns and paid all state taxes required under the law. 04 AJQJZW1vWe liec. 9 - 09 S'gnat a ---_-- Date —_——__ — —__—Social Security or Federal Identification Number. &vis 424/07 FOODAP2008.adm Check#&DateSR l`z- F� $ `� p Q , 0-?-) 4 01.07 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency 'Telephone: PROTECTION FROM CONTAMINATION 1825-9911 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED r"Owner: Comment:Sanitizer log not being maintained.Sanitizer concentration must be recorded daily on log sheet. ? Giorgio Manzana PIC: Giorgio 1 Giorgio Manzana 'Inspector: 1 Elizabeth Salandrea Date Inspected:Correct By: 14/3012009 j Risk Level: lPermit Number: 1 BHP-2009-0295 Status: SIGNED OFF #of Critical Violations: �1 Time IN: Time OUT: Urgency Description(s): BLUE: All other violations noted in the 4/23/09 have been corrected._ Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 04,2009 ) Page I oft .I• Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Cityof 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. May 04,2009 ) Page 2 oft 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency +'Telephone: - PROTECTION FROM CONTAMINATION i 825-9911 Separation/Segregation/Protection FAIL Critical ❑d RED `Owner: omment: Silver 2door fridge had shrimp stored above pasta.Organize fridge to properly separate potentially hazardous foods 1 Giorgio Manana from ready to eat items. PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑Q RED Carlos Bamaca v omment:Only one container of sanitizer was available in entire establishment,and was sitting on the floor next to the stove. _ - Sanitizer of proper concentration(50.100ppm)must be available at all workstations at all times. Inspector: Elizabeth Salandrea &,/nife with food debris on it observed in knife rack.All knives to be thoroughly washed,rinsed&sanitized prior to storage in rack. ;Date Inspected:Correct By: _11-16nitizer log not being maintaiged.Sanitizer concentration must be recorded daily on log sheet. A/23/200 Handwash Facilities pk'p�tr Ujol FAIL Critical ❑d RED Risk L6V21: gzomment: Handwash sink missing paper towels andsoa . Provide soap and paper owels at all handsinks at all times. i. Permit Number: Hot water recorded at 108.1°F at handwash sink,1072 men's room,and 1 .6 in women's room. Hot water for handwashing ' BHP-2009-0295 must be a minimum of 110°F.Turn hot water up immediately to reach 110o17 i1d.or higher. o f � � iStatus: boric stated that both the 2bay sink and the produce sink are sometimes used for handwashing.Sinks must be clearly labeled as to VIOLATION their intended use,and sinks used for produce or for washing equipment&utensils may not be used for handwashing. TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) �#of Critical Violations: CONTROLS and Cold Holding FAIL Critical RED 'S Jime IN: Time OUT: 4,__C ornment: Beverage air freezer recorded at 15°F.Repair or turn down to maintain temperature of OoF or below. ,Urgency Description(s): BLUE: ,Violations Related to Good Retail Practices (Critical 'violations must be corrected immediately or within 10 .immediately violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS@ 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 30,2009 ) Page 1 oft T ' Item Status Violation Critical Urgency RED: _ Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and od Protection FAIL Critical BLUE Foodborne Illness Interventions Comment: Container of breadcrumbs on shelf next to True fridge uncovered.Cover all food in storage to prevent cross and Risk Factors(Require contamination. immediate corrective action) j*Box of mushrooms being stored on floor under shelf next to True fridge.Store all food at least 6.8"off the floor. ;/rue fridge had uncovered container of gravy.Cover all food in storage to prevent cross contamination. Iver 2-door fridge had uncovered chicken.Coverall food in storage. (/Cooler of ice was being stored open next to handwash sink.Close cooler while not in use. �ry ingredients had cups without handles being used as scoops.Provide proper scoops and store in product with handle extending out. V4nife was being stored between beam and wall at waitstation.All utensils must be washed,rinsed&sanitized and stored in proper rack or container. Equipment and Utensils FAIL Non-Critical BLUE tokomment: Silver 2-door fridge has chipping paint and rust on racks.Repaint or seal racks in this fridge. kol6everage air freezer has chipping paint and rust on floor.Repaint or seal floor of this freezer. Right hand oven needs thorough cleaning&scouring. V4(rue fridge needs general cleaning in door tracks. A- ilver 2-door fridge needs general cleaning. Reinspection in one week, all violations to be corrected. VAease have February extermination receipt available at reinspection. 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. Apr 30,2009 ) Page 2 oft r Commonwealth of Massachusetts ` « City of Salem Board of Health Nmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: Bella Verona File Number:BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0295 Dec 30,2008 . Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2009 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 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,44"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAY(978)745-0343ECEIV Ib1AYOR 1DIONNE(@SAJ..EN(.COM - e 1 JANE'TDIONNE, DEC12008 ACTING HEALTH AGENT E'vF= C OF HEALTH 2009 APPLICATION FOR PERMIT TO OPERATE A FOODESTABLISHMENT NAME OF ESTABLISHMENT J 2// :�_ 7)e-ro/0-A TEL# ADDRESS OF ESTABLISHMENT /D 7 ESSeK sf FAX# MAILING ADDRESS(if different) � 3M� 0. �(( < <O`� D EMAIL- Business': /e /lay Website: /� Q /payP�ot! `} OWNER'S NAME 6166-3 "o Ma nl Za �/� TEL# / 7S'- 7-7V7/ L/ ADDRESS // 7 f(ff-DPs (_ A) -bA /1I J e C--S M xl D / `1 Z-3 STREET n �,/ CITY STATE ,f ZIP(,/ CERTIFIED FOOD MANAGER'S NAME(S) `� ) C°I J �-I a� 0"t CERTIFICATE#(S) O 9?'S 25 (Required in an establishment where potentially hazardous food' repared) EMERGENCY RESPONSE PERSON /a r9/ o .) 2-0. AJ A HOME TEL 7 -Ig -7 7 4 7 ( 4 d DAYS OF OPERATION ;' Monday , Tuesday Wednesda Thursday -'.i tTriday, Saturday Sunda HOURS OF OPERATION Please write in time of day. (/ y' _�/ .? — �� — y — / Ll (Forexample llam-llpm) TYPE OF ESTABLISHMENT FEE (check only) p RETAIL STORE YES NO less than 1000sq.ft. _$70 A oStau(. n 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------- ---- ---14 ---------------------------------------------- ------- - ---- ----------------_---------- RESTAURANT ES NO less than-- 2--5 seat- s (Outdoor Stationary Food Cart$210) 25-99 seats more than 99 seats = 420 BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YEShNO O $25 TOBACCO VENDOR YESO $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 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. , "O_ /4l .32. ? 46 - 95oS Signature Date /Z —,0(, —08 Social Security or Federal Identification Number -------------------------------------------------------------------------------------------- Revised 4/24/07 FOODAP2008.adm Check#&Dat.C222 z�o�/ s 2937, errs Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4"Floor 9 Salem, MA 01970-3523 4FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameDat / Tvne of Operation(s) T e of Inspection CA /d Food ServiceRoutine Address I - Rik Retail (,Ell]-Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone (9�-- El Mobile Date:((II//�o rr HACCP Y/N ElElv2 Owner Temporary Pre peration r ElCaterer [:1Suspect Illness ( Person in Charge(PI 4 Time ❑ Bed 8 Breakfast ElGeneral Complaint In: ❑ HACCP Inspector ou Permit No. ❑ Other Each violation checked re uires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. r,FOOD PROTEC110N MANAdEMENT,-",t;x ,. „,3„,: , ,„,'"'. ,.� El 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties r"i � � El 13. Handwash Facilities EMPLOYEE HEALTH a a �J „- PROTECTION FROM CHEMICALS"- aL ❑�2. Reporting of Diseases by Food Employee and PIC =w• ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals auw. i�..�w„s.4.$i.� �..ryi.R.`;�.wwuuw.w:{k'} .a FOO.FRAPPROVED SOURCE o OM �'` F TIME)tEMFERATURE CONTROLS(PRrtentlelly akaros FoHduods) �s� E] 4. Food and Water from Approvedd Source � � � � ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16.Cooling -PROTECTION FROM CONTAMINATION"" ""��` :' r tr " � m,19. Hot and Cold Holding .,. ,.».% ,_4 1 ❑ 6 Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing - r REOUIREMENTs FOR HIGHLY&d6dEPTIBLE P60ULAT10NS(HSP)ms w21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing �' a�CONSUMER ADVISORY,'., `�'F':: �t�, °1^"° ❑ 11. Good Hygienic Practices a �� \ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related G Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Co-+e. This report, when signed below s by a Board of Health megber or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations k' 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(550.005) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.00s) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: ff Q I + s:ssamm�r�o ia.000 Cy `�, OwL Inspector's Signature: Print: \ PIC's Signature: �""-� Print: ( ,�,�./� �� (, Paged ofd Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A. Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foix]Employee Or An 3-3(A.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004('A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetical) Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-lIot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 F g gs and Milk Products.Pasteurized* 4-501..114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.L1 DrinkingWater from an Approved System* 4-601.11(A) FAluipment'Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Fond- 590.006(B) Water Meets Standards in 310 CMR 22.0" Sheltlish and Fish Froman Approved Source Contact Surfaces and Utensils'4-702 11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* j Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authority hor" Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleanin Procedure* 590A04(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices g Receiving/Condition 2-401,11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes„Nose and 3-202.15 Pack-age Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 _freventing Contamination When Tasting* 6 TagstRacords:Shellstock Lt2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 Shelistoek Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.'11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records'.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1,2 Reduced ox gen packaging,criteria* 6-301.11 Hindwa.3hmR Cleanser, Availability 8-103.12 Conformance with Approved Procedures" 6-301.12 Hand Drying Provision ''Denotes critical item in the federal 1999. Pool Cale or 105 CMR 590.000. - 's CITY OF SALEM 1 BOARD OF HEALTH Establishment Name: 1--)P1�(A /nr ,/ic Date: l`1 f Page: of 3 Item ' ,Code C-Critical Item "DESCRIPTION OF„VIOLATION/ PLAN OF CORRECTION Date _: ,+ ;” r 5 � : - � No. Reference R-Red Item < r - � �' r, i` Verified` ymp_,+3�- �""_ '-"-�'* `�-�� "✓^ � � r PLEASE PRINT CLEARLY '' JJ - ..v_ _ .; / ��t SS,1i�r - Gear- d ,i ,r r, � K . It VY J! Al- r- 3-") I v _ tjJr, .nn,,j ��v/a� � .c � ,� i?]rJ nor moi)_ `n__) n // /J ��//_ I�✓n �_i d Awl J'7OM ' r�•( �\('rt) ,,: f. )/ I� °P "7 iA O C ,GttA IA CL- Te:J j )r P cn .� n + Cyt/D55 , C/C_> I Ar lir 1/).5, o )(? rI,n<I'Ar� z 1 4,<J +- -L, ir� _47.Z kJ. J- CA 0 )10orf ,r V ssr 7 / / . -7�J5t.,s,c�6 r�)c= On C'� �i,vttnP� �v h� crJ 6 �7'�gJ(,i 7, (7 J jam( /��- 4 Lc, l-1 Q' �,n. �, �) c�1�{�M: c a 3 r w/ , �, (A -//1.1 A/fGKJ rF )>/ r, j T I._rw.. �n/]�.f�/�1.."O i/� .. ? �iY i1 tGJ s� m t � '� Planl,l<s!/ 7 7 l,X✓r tJt4 C nr0"do(ecJ 0�7 t Cots 141 �z Tel FDiscussion With Person in CAarge: Corrective Action Required: ❑ No Yes r <. ad this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restrictions before the next inspection, to observe all conditions as described, and to ((_ Exclusion P ,t�� Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that i v noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your f5od permit. ❑ Voluntary Disposal ❑ Other: -0—1 —)4 �Pf[Fs Rec—eived ai'femperatures Violations Rotated to Foodborne Illness Interventions and Risk Acxx)rding to 1ae Cooled to Factors(item 1-22) (Cont.) 4 1 F/43`+Within 4 Hams. PROTECTION FROM CHEMICALS TJ— Footed.or Color Additives L_!9 PHF Hot and Cold Holding _,5( Cold PHFa Mainw tainerl at or belo - 202 12 Additives '59 1 16(B F- -36114 Protection from Unapproved �Wdifiyc,�' 4—aitamod at(if tdiov� 3 1 lot PHF�1\4sintaisiod at(it above 15 Poisonous or Toxic Substances F I 140'F� �)o I (It A) Hia PH 4b-I- 7-101.11 Iderl Infonnation -01i.-Inal 3-501,16(A) Roasls Held at of above 13(f`F� Roast. I a o' I 40"j, iaiats Held -- L20 Time as a Public Health Control 7-201.1 colinlilon Name--Wkak'fig Cowam� fealth Control, 1 70 t 19 1,OL Z 12 dicosholl �Jiaao on-Stouts:` iAit 7-202.11 Rest i iction-Presence and Uae* `7-202.12 Conditions of Use. I oxic Osntarinai�;-Pro5lamons' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE /-204.11 er�,Criteria-Cbemic�fs* POPULATIONS(HSP 7-2(4,12 Cheyinciq 'or Wlrsti�&E, -,_I l, I a 21 I-S01 I I(A) Unfameurized Ple-pay :aged Ances an(] 7 204.14 Bewlaves with l arca F,abds* 7-206.i I 1-801J]0)) Raw or Ra pall OR)kedkmmal F(x,,J :and —4 Regrided Use Paricides,Critet ia� Rau NkaStrvcd. 7-206112 Rodma Blit Statlkak�' Cant 7-206.1 I'lacking :wder;,P.,-S[Comrolaiid li8:(E-11-1-�C_ Monnnring CONSUMER ADVISORY 22 3�6 I I Cmanner Aavisoi% Posed hx Comairlption of TIMEITEMPERATURE CONTROLS ApilwA Rxi&'fllatarc Raw, Undmaollwd oi ProperCooldmg Temperatures for Not Othex Pr(x!essed to Flinanale PHFs 155'F 145ec- linitiediate Ser,,icv 145'Fl Ss C, TP—ilei irud Egg>SubsLitirle Ra Raw Shell 30 1,11(A)("l Conammilad Fish, .Meats&Ciallit Animals 17 F 1 sec 3-461.11(ft)(1)(T PoiR and fl of Roast - 1301` 121 n"* SPECIAL REQUIREMENTS 3-40 1.11(A)(2) R"altesAnjectedMcats 155F157ltitns—ofstetiOn 5()().(X)9(A)-(D)in sa catering. rnob&7 ftlod, temporary and Ts oefalvd under file appropriate sections Polifti V or Raines-165�1- LS s,�c. * above if related to plodborne ithiess 1 3 401.11(A)077J'oultD�Wild(Jamo.Stuffed1`4 re,!Ionlidl lilehen operations should be. 54111filliii Containing Fish, Meal, -401,11((-)„3j Whole-muscle; Intact Buof,Steaks interventions and risk tactorq, oflier 145OF590.009 vlolalions� relatinlo to tout retail F,1-41171112 Raw Amina[Foll(k Cooked Ill 11 be debited under R29 - --- Mio owave 165'F* spccial Requirements, 3-401 1f(A)(1)(b) All Other PHFa-- 145'217 15 sec, * Reheating for Hot Holding -VIOLATIONS RELATED TO GOOD RETAIL PRACTICES -,-s6Tff(A)&(5) PHF, 165)F 15 sec. (Items 23-30) 3-403.1,1(8) Nficiowave- Minute,Standing Ciati,al and noii-<rifiral va,lahons, wirwh do not reline,to the To-00 foodborne illness mli,?veriliolryand riA-fm lois haled-above, Ion be 1-40111(C) Commercially Pitxessed RIF Forx:l- � (nQ( J ol;le!Mid Coe and 10540+,� .1 Uwficed Portions ofllr4 eF Good Retail Practices3-401 1I(E) Rentainin --- 3� 1 Man-titsrf"nt and Personnel ------ Proper C��,—jnq�t-—pHFs -— 24� 1,-Fvind Food ProViction Sill, ant and uten"'Is C- 14(A) frons 140 1,- -25--LEg-opri- — Cooling C(x)kz,�d PHI Ind"Alasto FC � --26- ........ 701F Wallin 2 Hours and From 701'1 27, P FC=6 007 to 41�FAY F Within 4 Hlaw,,, I 1.29 FC -7 OOB Timc faster tis... 3-501A -oolbig Pitlas Made From Ambient 1 29 � ocia Ho tremens' 00,9 Tmporawrc Ingrediants to 41-F/45”F 1-20 LOther —--------- Within 4 flours" Z6,. 105(MR 59t10& CITY OF SALEM BOARD OF HEALTH 1 Establishment Name: G,I �r, ��n rrn-t.-. Date: 15—/C4 !', 0j Page:_ of 7 .Item°e Codexj;g`#- ;C-CritiCal Item„ = r. '.,.`',<t k ..,, f DESCRIPTION OF,VIOLATION/PLAN OF CORRECTION , Date Reference R-Red Item ,g + " `z:'�` . ,•' 'a`7< ' `' " ' ,k ( v a m.• � r,:. Verified PLEAS/E PRINT C�LEE RLY n7 1A -LO_ " /l_ P(ui 1, r.,i T h G,l�Qln/_Z iA.1 iA�i 3..t 1 .a A40A,, 'o.I-elf r -4- '71f. r /lam 4 4!J Y t �nl :�- C rr l� �✓,)�/ �- S.7( C� n'17s, nfi cwt— r�r.s . Nl.�}cc� n Coy^ n. l�o ( rP111 1�/' LA). )r7S b C "-A fi"f ttr �I ry s� r.O 17_lwnro� o f� .SI_iaT�,C/:.r �lf1l r�o e. .,✓t�li.r'1�-.✓ 1�i< Cl ti..t�.ol �-r-.t�«rt ..�'�/}.a n� t dT..�. '- . 3 [1have With Person in Charge: Corrective Action Required: '❑ No Yes this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee RestrictionExclusion efore the next inspection, to observe all conditions as described, and to OR_ e-inspection Scheduled ❑ Emergency Suspension h all mandates of the Mass/Federal Food Code. I understand that otnce may result in daily fines of twe�five dollars-orsuspension/revocation of ❑ Embargo ❑ Emergency Closure ermit. /f `_\'` >> ❑ Voluntary Disposal ❑ Other: F— I 14"c) PliFs. Received at Temperatures Violations Related to Foodborne fitness infor,,onnens and Risk ACCOTrfiag 10 Lar Cooled to 4' Factors(Iforns,I-V) (Cont) 41'F/45'F Withtiwl Hours, 3-SO 1,15 Coirfiw, k4dhods for PHFs' PROTECTION FROM CHEMICALS — 19 I Food or Color Additives , 50'1 16(13) Coed PHIs Maintained et rnbelow PH1F Hot and Cold Holding -�-201 1, Addiuves" 3-302.14 Protection front —una T�05`ir(��) Hot 111-11'�,%,(aiwrained at or above 1=5 Poisonous or Toxic Substances --7— 14WK 101 11 +o1e'--lw";;.Information 3-501,16(A) R(iasm Held at or above 130°F. I containers* -Timeasa Public Health Control 7,104,11 Common Name-- Working at I-iol'19 Tim,as a Public,T --------------- Health Control- 7-20L]1 _S�iLion-Sloa� 59'0.004fH) variarwe R r202.11 Reltriction -Prt,sciicc aud 11se* 7-202-IT Coridji7iomof Uso- 7203,11 Toxic Coirtamci,-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 11.204.11 incria-Cheinieals* POPULA I NS HSP Qheiiav ,-?(4.12 (".henneds for warh with -T�4 Di�in, 04 1 Aizew,Crjteria' �-801 ll(B) Uce of pa,winized ltsi"* Imidental F(Xid Contact.lAlbsicants' 7-205 11 tso'T'.ti MD) Rnwor Traitiall,,Ciok(�d Allimal Fixid And 7-206.11 I fiestrided Use PeNticides,Critelilli aw 7-206.12 R(X I Cn1-1;711T—st.stationR 7-206.13 Tracking Powder,,Pesi Control and - -7 Consumer ADVISORY——_ TIMEITEMPERATURE CONTROLS 12 -653,11 Consuer AdvisoryPosid forCouso ription of F(Krd�'fhai 16 Proper Cooking Temperatures for Not Oiherwis e Processed to Obinnate PHFs 3 155'F 155 c. 145"F15,ec, Rmcinizzd F99:;,Subs1jnsv for Raw Shell it 7 401JIW(2l Colinninuteipich, lkhi,�,& (�im 1- Anitnak 15's"1Ili,secSPECIAL REQUIREMENTS 7 461J I(fl)(1)(23 Pork and BQef Roast I 0T 121 ftA0 3-40 1 11(Ah-') Rains.bvieciedliAvats- 155'F 15tiF Seclion�90(WF()(AT, (7D D) in catering. niobilc,fo�.rd.temporary and ) in id 74(Ti I I fA)(T) poultry,Wild Game, $tuffed PHF's, rvmdetrti2l kitchen operations should be w� SwflContainint Fish, Meat, I klebitedl wider the appropriate sections _j-oultry or Ratios 165`1, 15 wc. * 7 1 above if rclwed to toodborric illness 401 11(C)(3) Whole-mu:cle, Innwt BeefStcA's inteivenhouqa;id risk factors Other (459; 590.009 violations refining trigood retail 9-401,12 Raw Animal F(xxh C(ioloctl fit a laactices 'hoold be debited toider 1129 - Microwave 165'F* Spce!ial Reqoirenievas, 3-401,11(Ai(l)(b) I An Othei PIIF. -- 145"F 15 sec. 17 -TReheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES PHF' 165'T , 15,sec. ; (items 23-30) 403,11 3-403.11(B) 25Minute, Standing liliithdoirrri relate loille 3 im0' fiwdleooeillness can be 3 d03. T Found n (All? I I—(C) Commzilatly oo� 140�F� T- 3-403]b(E) Remainin,UnFhced Pwions of Boef Ue!`-F�- Good Retail Practices FC - ........... - --------------- 23 Management and Pet sani al--777T-FE 2 003 FvA and F�ovd Prol�tior, K -3 004 Proper Cooling of PHTS -- ---- 3 50IA40k) C"A ing Cooksil PHF� from 140'F to 26, wattrJ FC-5 006 7(7°F Within 2 Hours and Frorn'701' 7, Physicaffa FC-6 1 C 4l'F/45'FWithin4Hants. 20 �i &sonwa or Traic faasiriais L_jFq -7 1 008 pecia '009 3-501.14(B) Cooluw PllFs Made Prom Ambient e qionn ----------- Within 4 11mrs critical Ireir in the loitinil 19139 F(w Code or 105 CNIk 590 000, DEC-15-2006 09 :46 AM t f-Of-� a:"yi.+t.. �, a.-a,.�, �,`_ .�, fie► tea. - �. ............rru«..nwr�nmm.wrr.+.Mrwwrl�.�•:....«....n.:..._...... ........ I f 4010 . Iaw.rwr wwwwono.a t3LIS* { Holl► I, Massachusetts Department of Public Health Salem Board of Health a 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel (978) 741-1800 Fax(978) 745-0343 Name ++ Date Type of Operation(s) Type of Inspection \1,0 ` Ii , ?d ❑=Food Service ❑ Routine Address Risk ❑ Retail 2-Re-inspection S Level ❑ Residential Kitchen lPrevious Inspection Telephone ci 1 1 1 e t El Mobile Date: �N JU Jl Owner TJ , 1 qHACCP V/ ❑ Temporary ❑ Pre-operation CJP orcr G A2C ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint Ina 27 [-] HACCP Inspector O Out: (�7 Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. �-� U��1 ;;FOQb PROTECTION MANAC,EMEHT,m,.�„,,1?,P, i@ir'". ,,,a.,�»i,'t '" ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH 'qd 1!7 i 'S€C'... ..e.•M,(W. y3E6a i m.` F PROTECTION FROM CHEMICALS "!ia + , i r. r l � ❑912.Reporting of Diseases by Food Employee and PIC sem_------ 1; w==»=-sf�• »» •••-- ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM,APPROVED SOURCE j _;,.. 1�u.Mm__I'rav:...,...,„�' - ❑ 4. Food and Water from Approved Source f TIMEITEMPERATURE CONTROLS(Potentially Hazardous Food") ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION �'m IF. -t, :,�.°"i` t r� ! .y "'� El 19. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)„-' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices I."CONSUMER ADVISORY,Nt ! ��.« %' 1 a.tm'. ..It ,�"�1`, ",'i [--122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C ' N> by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(5so.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:ssamscenw.ms-�a.aoo . Inspector's Signature: ` I Print: PIC'sSignature_ ---� `I' ;' Print: 7v i v Page4of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENTS _C_ross-contamination 1 590.003(A) Assignment of Responsibility" 3-302.11(A)(l.) Raw Animal Foods Separated from 590.003(B) Demonsn anion of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302.1.10)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 t(A) Food Protection* applicants* 3302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11, Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Raorting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food - - 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFoal"` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-HotWater 3-201.1.2 Food in a Heraneticall°Sealed Container* Sanitization'Fem eratures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* i l S i 114 Chemical antization-tem 3-202.14 Eggs and Milk Products.Pasteurized* 4-501. p•'FH, 3-202.16 Ice Made From Potable Drinking Water'" concentration and hardness. 5-101.1.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Fr Shellfish and Fish From an Approved Source Contact Surfaces and Utensils`" 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands lm and As* 3-20118 Sheltidock Identification Present* 2--301.12 Cleaning Procedure* 590,004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401.11 Farms,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-30112 Preventin Contamination When Tustin " 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040 Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 _Accessibility,Operation and Maintenance 1 HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with App roved Procedures* 6-301.(2 Hand Dry ng Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Bella Verona File Number:BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0294 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES O ecern er 31, 2008 Board of Health y� 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 2 of 11 CITY OF SALEM, MASSACHUSEM z tlf c BOARD OF HEALTH 120 WASHINGTON STREET,4'"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR TscoTraa SALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT l3,Ila ye,0 Al TEL tt y7 g- g a�;- 99 11 ADDRESS OF ESTABLISHMENT /10 7 F55ex -. ,S St-. /Y 4- • FAX# 979- ? a 7- '-P77 8 MAILING ADDRESS(ifdifferent) �� r/Y2 etoPS ),.j, -b a n o-e /-s, Ha . 0 19 z 3 EMAIL-Business': 'J&t/a 3H& Q R 0,i! • Co M Website: OWNER'S NAME 10 / q , o ani'zAn/�r'Slret /sF TEL# 97g - 77y- 7/ 1-0 ADDRESS lI Te2top5 �N. �4nJ2lS /� a . 0 / 523 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) &I n f_41 D MA/'J Za"I A CERTIFICATE#(S) l 0 If 9 Z S (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON G 1 o r'`)f o A a 1,J 2 G A/k HOME TEL# Z /7 y - 7/ `� o DAYS OF OPERATION Monda Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION ✓f I I y _ I( Y- I 1 H I 1 1q- It 14 - 11 1f Please write in time of day. For example 11 am-11 m TYPE OF ESTABLISHMENT FEE '(check only) = 7 YE NO less than 1000s ft. 0 RETAIL STORE S q 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT ES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats =$420 - -'---.-'.' -------------------YES ' BED/BREAKFAST( YES NO $100 CHILDCARE SERVICES -------------------------*--------------------- ------------------- --_..-------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to 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. - J.1f,RJCL- Q . .tPCL/K - /I-2- 9- 07 329- N `- 18aS' D D`13� /6- 6730 Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Checkft&Date 1,1�3 S 90 1 -11-D-7 S 2 S 0 06 I ` . Massa6usetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Mpgof O eration s Tvpe of Inspection t QIP r ( Food Service ❑ Routine AddressI� Risk L1Retail 2 Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: ?/a�(,(l Owner HACCP YIN El Temporary ElPre-operatiUn� ❑ Caterer ❑ Suspect Illness Person in Charge(PIIV) Time ❑ Bed&Breakfast ❑ General Complaint In: 3;/ ElHACCP Inspector Out: Permit No. El Other Each violation checked rdquires 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. ;`FOap PROTECTION MANAGEMENT.T _ p, !2111'71111 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities 'EMPLOYEE HEALTH k g _� . Gam} FPROTECTION FROM CHEMICALS ' �i *r ,r ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded r . ❑ 15.Toxic Chemicals FOOD FROMood APPROVED from Approved + ur ;1W ¢nME/TEMPERATURE CONTROLS(Potentially Haiarelous Foods), ❑ 4. Food and Water from Approved Source _ _ ( y ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATfON ;°,1, , +F ,t ,❑ 19. Hot and Cold Holding El8. Separation/Segregation/Protection E]20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing . 'F REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.,Good Hygienic Practices ,`-`CONSUMER..ADVISORY , ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical,(q) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(sso.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(s90. 0a4))o.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: �I J- ` 5:5901nspec(Fom,6f4.tlx \ 1 11J Inspector's Signature: -Print: PIC's Signature: I 1 Print: \ I Pageot,�Pages Violations Related to Foodborne Illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination , 1 1 596.003(A) Assignment of Responsibility* 3-30211(A)(1) Raw Animal Foods Separated from 590.003( Cooked and RTE Faxls* 2-103.11. Person in char e-duties Contamination from Raw ingredients 3-302.1l(A)(2) Raw Animal Foods Separated from Exch EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and - Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) ,Returned Food and Rescrvice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated - 590.003(F) Removal of Exclusions and Restrictions - Food 3-701.11 Discarding or Reconditioning Unsafe. FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.T 1 Manual Warewashing-Hot Water 3-201.1.2 Foal in a Hermeticall•Sealed Container* Sanitization Ten eratures* 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashim--Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 F as and Milk Products.Pasteurized* 4-501.11.4 Chemical Sanitization-temp_,pH, 3-202.16 fee Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* - 590.006(A) Bottled Drinking Water* 4-60211 Cleaning Frequency of Equipment Fo xl- 590.005(B) Water Meets Standards in 310 CMR 2201' Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4-702.11, Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods ofSanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arens* 3-202.18 ShellstockIdentification Present* 2-301.12 Cleanin Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.t Good Hygienic Practices Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1 t - PHFs Received at Proper Temperatures* 240112 Discharges From the Eyes, Nose and - 3-202.15 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tastin 6 1 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 -Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to ees* Tags/Records: Fish Products 13 Handwash Facilities 3-402,11. Parasite Destruction* Conveniently Located and Accessible 3-402 5-203.11 Numbers and Capacities* Labeling Creation and Retention* 5-204 11 Location and Placement* 590.004(1) Labeling of Ingredients' q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Suppled with Soap and Hand Drying 3-502.1.1 Specialized Methods* 6Devices 3-502.12 Reduced oxygen packa"req criteria* Handwa shi ng Cleanser, Availability 8-103.12 Conformance with A roved Procedures* b-301.12 Hand Drying Provision 'Denotes critical Item in the federal 1999 Foal Cate or 105 CMR 590.000. j CITY OF SALEM BOARD OF HEALTH f J i Establishment Name: '`� �/ n /'enc Date: to fc 4 -1 Page:__ of I ;Item-z 'Code rr C-Critical Item � .� � ; -,DESCRIPTION OF VIOLATION/PLAN OFCORRECTION .;ffi- A ;: -'� � ,y_ Verified No. Reference , R-Red Item ,: a. :,. � r,.�- s � - � -��.. � PLEASE PRINT CLEARLY r 41� 16 -6. -ems ,T- GJ� t i i { i r 4 f { s 1 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ ..Yes' ' I have read this report, have had the opportunity to ask questions and agree to correct all [H—Voluntary Compliance ❑ Employee Restriction/ ` Exclusion violations before the next inspection, to observe all conditions as described, and to l P U Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure yotix,food permit. V �� 0` ❑ \\ M Voluntary Disposal ❑ Other: V\v 1 - Violations Related to Foodborne fitness Interventions and Risk According to fav Cooled to Factors(Items 1-22) (Cont) 4FF/45'F Wiflan,! Hours,. 3-501,15 Coolin,,Methods for PHFs PROTECTION FROM CHEMICALS PHF Hot and Gold Holding L14 Food or Color Additives Ei;----202 12 Additives`1 -- 501 A VB) HF,Maintained at or below- 71 1 — 3 302 14 Protection frojajjaa�ed Additives" 590 004 - 3-501,16(A) Hot PHFv Niationioed at or aterve 5 Poisonous or Toxic Substances 140'1.. 1-1 7TCI,;,U iy,,g—Intot mat, 07, +TRa;4,�,t,.H�,djd at or ibove 130'F. 1, 307 4Y26 Time as a-Public Health Control 7-102.1'1 Common Name. - Workim,Coaiaimrs* It I i — 3-%!.19 oric�as!±�U� 71,ccm.,,::� 7-201-11 S�Ptaluon- I�il " 7-2,0111 -Restriction-Pi-rStaw and Usc* Ra.qT-1e2M-1-1t 7-20112— Condition 0fUiaiREQUIREMENTS FOR HIGHLY SUSCEPTIBLE F-T103 H Toxic Conwinei�� -Prolubidom"' POPULATIONS(HSP Sanitizers,Cnteria-Chemicals* - --- 204.12 Chvmuals for W tshmv Yrcxtncc C'ritori;"- 21 3-491 11(A) Unpasteurized Pre-pack aged bites and 7204.14-204,1 L BeveraLes with Warnh _Drrnw&,etw., k, ,ibdsl 3-80 1, of pateu 7-205.11 Inc -rital F��A("ont,7tt�Enin icants' iz�� id -=1-- p�--801 I I(D) Rawor Pintialiv Cmik .d Animal Food and 7-206.11 Restricled Use Pe nude..Criteria* Raw Sr d Sprants Voe Served. Rotlow Batt StiAi0Rs* _801 17-- 7-206.12 linotiened N Not veil, 7 206,13 Tiacking F,,,dei Yat Control and Monitoring* CONSUMER ADVISORY 36QI TIMEITEMPERATURE CONTROLS 01 Cloasuowr Pwed forCousumption of — uiinufl f(ssJs 11oll art: Raw. Underooriked to 16 Proper Cooking Temperatures for PHFs tior Othem ise Prcwesseal to Ew Pathalinaine 3.401.i 1 A(1)(2) Fgtt�- 155 'F 15 5,,c. 'ns ec, 302.F� zd Fgg;Substitute for Raw S157 �diate Service 145'F]5s -T40I,ll(A)(2) &Emit Animals- 155`1 15 sec 3 40 1 1 Ptak and Beef Roast 13WF 121 mm* SPECIAL REQUIREMENTS 3-401 11(A)Q) Rain.es, In ecied Mems-- 151�F 15sc Violation�oi-So.elion 590.009(A)-(D)j calering. mobile"xl.ternporai v and 3,401.11(A)(3) Poultry,Wild Garne, Stuffed Pffs, 1 rt,,siderhi'at kitchen operation should be I Sniff nc Conaming Fish,ht ,- klchiwd tinder the appropri ate aections Roultry 01 Kathe5-165`14 15,w-,c. 1; above if rida-ed to fioodborne illncss 401.1](C)(31 Whole-muscle.Intact BeJ Steaks intei ventjon.i aod Oakfactors Other 1450F 540.009 violations relating to good retail ,arae acts 0iould he debited under #-29 - 3-401.12 Raw Animal F(Nds Cooked ma Microwave 165°F* — 40 1,11 - Ali Other KlFs-- 145';F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,-103.1 iXT ;1 - -- VD) PHF� 1654T 15 sec. (items 23-30) 4 403.11�B) Microwave- 165°F 2 Minme. Standing Criii(wizaid nen-rrilwal violehom, which do not relate it)yhr Tithe"' Conitraircialtv in thejoflnmiioi sertions of I the Food Code ivid 105('111? 140'Fl W).000, 3-403-11(L) Remaj nin',, U nsliced Portions of Beel Roast,* 23 FG-�2 ---�0-03-------- Proper Cooling of PHFs 24, 1 Food and Food ProlffLtio,,_ Fc.�-3 004 pEt and tt,eals FC -4 005 ..........._=qu _n _ Eviing,Coolaid PHF�,from 144)-F to ------ �(Tf J4(A) vd Waste IFC-5 006 26, W FC— 7017 Within 2 Hours and From 701' 7- ly-$11 cal DRlity- 007 to 41'1/45`6 Within 4 Room s 008 xic hta�eriai _LPoisonrauit or Ti - - 3581.14{B)14013) Cooliog PHR�Made From Ambient Temperature latiredients lo 41'F/45"li 130_ I Other Within 4 llours lir the FoMnfl 191A Foal Cilie u 105 CMR 5911040. Massachusetts Department of Public Health Salem Board of Health Division of Food and Dru s 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Dto Type of Operation(s) Type of Inspection �Ic-, Food Service ❑-Routine Address Risk Retail ❑ Re-inspection u �+ Level ❑ Residential Kitchen Previous Inspection Telephone Cj '//' ❑ Mobile Date: / J7S �7R 1r 5-IG2 Owner HACCP YM r ❑ Temporary El Pre-operation �J/ i a 1 -k ❑ Caterer ❑ Suspect Illness Person in Charge(SIC) ' Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint Inspector l Ing :f�l, vCen p Out: ,a o Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. e FOOD PROTECTION MANAGEMENT k12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH _ 1 1 a i- n„...-, PROTECTION FROM CHEMICALS777-7- ❑ 2. Reporting of Diseases by Food Employee and PIC �� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ,-,'a` , ❑ 4. Food and Water from Approved Source TIMEiTEMPERATURE CONTROLS(Potentially Hazardous Foods) �? ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding _ ..a.,,a ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleanig nand Sanitizing REQUIREMENTS FOR HIGHLY suSGEPTIBLE POPULATIONS(HSP)m„I A.- ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwas1 - rCONSUMERAOVISORY: ,„.,«�«„R:c. . ,T�v�.a.� El 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related CVitical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below G by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of k`25. Equipment and Utensils (Fc-a)(ss0.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you a 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. DATE OF RE-INSPECTION: 30. Other - �I 601,�� S.5901nsWlFo m6-14.do /j\� Inspector's Signature: Print: _ ac r PIC's Signature: �,/ Print: Y Page of Pages Violations Related to Foodborne Illness + Interventions and Risk Factors(Mems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F 8 Crass-contamination 1 594.003(A) Assignment of Responsibility* 3-302.11(A)0) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.1 I. Person in charge-duties Contamination from Raw Ingredients - 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(,C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A Food Protection* applicants* 3-302.15 Washing Fruits and VeEetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food'* 131 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.t I 1 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Seated Container* Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Produces* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 lee Made From Potable Drinking Water* concentration and hardness. * 5401.11 Drinking Water front an Approved System* 4-601..11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* - 590.006(B) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Faod- Contact Surfaces and Utensils* Shetbish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 'Fish and Recreationally Caught Molluscan Fax!Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods ofSanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 - Clean Condition-Hands and Anus* 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.1.1. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 PreventinE Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590M04(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to,ees* Tags/Records: Fish Products 13 Handwash Facilities 340211 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients* 5-204.11 Location and Placement* q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.1.1 Specialized ProcessingMethods* Devices 3-502.12 Reduced oxygen paca 'ng,critera* 6-301.11 Handwashing Cleaner,Availability 8-103.12 Conformance with Apgroved Procedures* 6-301.12 Hand Drying Provision °Denotes enutud item in the federal 1999 rood Code or 105 CMR 590.000. CITY OF SALEM - BOARD OF HEALTH Establishment Name: Date: Page: — of � Item Code C-Crltical nem DESCRIPTION OF VIOLATION/PLAN O CORRECTION �''''" u r,,; Date w r No. + Reference R-Red Item 3, e 7 - Verified i. 1 X ,,✓ .;`b dfi,n iz, �"�, A r 4 84' =PLEASE PRINT CLEARLY /n b7h(/I OVI 5 (e/cvlv,! t n i 1� 74 ir/tr n` r�w,rl'�4r t—v1 o ti I 0 1 i q ' Y {i J I I1 C- i ��n•'x �Fnk�. n i_ I � �-� Discussion With Person in Charge: Corrective Action Required: Li"'ry No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that nc�ompliance may result in daily fines of twe toy five dollars or suspension/revocation of o Embargo ❑ Emergency Closure your food permit. ❑,�i Voluntary Disposal ❑ Other: 501 14(C)) PHF.,Reeeied femtperatuxes Violations Related to Foodborne Illness Interventions and Risk According to Lav, Cooled to Factors flienis 1-22) (Cont) I F/45'F Within.1 H4 an s, PROTECTION FROM CHEMICALS 3- PH 501,15 Coolin,Nlethiads for PHN F Hat and Cold"ding -- Food or Color Additives Ll -J--- - ZJ�t 3-50!16(B) Cold PRT Maintained at or boltov 1-202,12 590004(1-) 41'145"F 3-30114 Proteclion treat Unapproved Addifives" 1-50116(A) lint PHF� Maintained at or above Poisonous or Toxic Substances 101A, identifying Infonnation--Original 140'R Con(aiaers* '1-501.16(A) Resists Held at or above 130°F 7-10211 Coutmon Name - W�'oniaijiers* 1 Time as afnublat Health Control it a Public health th al in tr� -T01 to irric as t� S,�Pal alak)n stoi 7-2bl.jj a 7.20111 Rcqriction-Presence and Use* "'90.0041,H) ircmialt 7-202,E Conditions of I No- 7-203 it Toxic Container,--Pmribincirs� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE S POPULATIONS(HSP -204.IT Imit7ers, ri�t—Chcmicals* -L 21 3-801 11(A) Unpa,acurizod Pic-packaged Juices and 2-204.12 Chejnical.�lot '?�ashoditcc�Ciiteii;)!Ai� Llievenums with �A�2�1,ab,ds* 7-204.14 Dicjn,AlEnj� f riteria- -,-I 7-205,11 Incidental Food t,-Intact.1,iibricauts* Crater ia, 7-206.12 Rodent Boil Stations, Rav St,d SprootsNot Serycd, 'I iacking Powdvri',Pesi Control and L -` Lt 91 t 2f-Ir IIL- CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-6 03 11 f'iatsuryertaiv isorc Posted fort 16 Proper Cooking Temperatures for !,alilnil l,XsC'that are Raw, Undercoi)kCcl rn PHFs Not Others.ise Pe,wessed it)Flirmnive -73 1 A(I)(2 Nacilried Frt hell Se vier g,Subsowiv for Raw S 7401,11W(2) Curajoinuted Fkh, Meats & Game Arriwaths, 155F 15 sec l(s)(1)(2) Pork and li<cf Roast - 130'1- 121 nim* SPECIAL REQUIREMENTS 3401,1 I(A)(.)� Ralite�, hijectxi Mcwti,-- 155�F 15 590,W9(A)-(D) Viciafiona of Section 590.()09(A)-(D) in sec. * cateringmobili., hotel,temporary and 3-401,11(A)i3) Poultry,Wild(Jaino, Staffed lItTl7a, residentalkitchen operations should he Sniftig Cion aining Fish, Meal, debited under the appropriate geetimis Pouliot or Mantes 1654 15 sec. above if related to foodborne illness Tito I.I I—nol whole-mus de. hitact Beef Steaks iniciventions and risk factors. Other 590.009 violations relating to good retail 41.72 Raw Amoral IAA. s Corked in a practices Jiould be debited and Microwave 16,5'F* I Special 3-401,11(A)(I)(b) All(IThia PHF-s-- 145"F 1 5 Lec. ---—--- --------------------- ........... ... Reheating for Hot Holding N VIOLATIONS RELATED ID GOOD RETAIL PRACTICES 1(A)&(7) PHF, 1652 15 sec. - (Items 23-30) 3-403.11(hi) Nflciowavc- 165'F 2 Minute Stand Crifiw� and cion-criticalver solations,which do nrelare to the Tinic" Standing finwiliorne Moe."iwei veriaotty wid i isk jariors liwed above, (an be : 0�31 1(C. Commercially PirscesscTR7F 11ad fieltid in sectiorrtql the Food(ode,and Ilii CWR 140'F* 590.0w, I(F) R i�i n a i i i i a� G-I,�,-c�d-pe,l,—jo n F I j—"f -ffei� Goad-ha Practices 1 FC 590,000 --T403 -- -, -- --- I IS IFC -2 1 003 ge .... ... Pro�ar C,;o�Jlrrg of PHFS -d4TFood and rood Protection. -094--- 23 F C-4 :3-101,14(A) Cooling Cooked PKFS h cm 1401',to - 1. M5 70�F Within 2 1 ftws ral F-70" 2v Nater Pit FC-5 W6 27. Phy�i,4^ Facility FC-6 1 007 to 41'F145'F',)Vithin 4 Hours. Poisonous or Toxic Materials FC -7 OOB h-�-541.1406} (AxAin 001 Ambient- 009 g PHF�Made Fr Special P ituiriattents Temperatore Ingredients lo 41-F/45 ------- Within4 Hour.0 'j)at(,WS critical lital Milt',icdclal V)94Fo(X1CXleerr 105("AR591)000, ` 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 825-9911 Separation/Segregation/Protection FAIL Critical ❑d RED Owner: Comment:The Beverage air freezer has potentially hazardous foods all stored together. Organize unit to separate PHF to prevent Giorgio Manzana t—c ss contamination. PIC: ! T rue reach in has PHF stored above RTE food. Store all PHF below RTE food to prevent cross contamination. Food ontact Surfaces Cleaning and Sanitizing FAIL Critical d❑ RED Inspector: David Greenbaum ment:The cutting boards are stained and scored. Resurface or replace the cutting boards. Date Inspected:COrreCt By: Handwash Facilitips FAIL Critical 0 RED 3/1/2007 ' C ment:The kitchen hand wash sink missing paper towels. Provide disposable paper towels at this hand wash sink at all times. Risk Level: TIMEITE PERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding FAIL Critical ❑d RED Permit Number: BHP-2007-0217 ;ment,:Che Beverage air freezer had a temperature of 20'F. Repair unit to maintain a temperature of 0'F or below. Status: smalontinental unit had a temperature of 48'F. Repair unit to maintain a temperature of 41'F or below. VIOLATION Violations Related to Good Retail Practices (Blue Items) #of Critical Violations: Food and Foo rotection FAIL Critical BLUE 5 omme Time IN: Time OUT: nt:The Beverage air unit had uncovered food. All food in storage must be covered. �Th mall mental reach in had uncovered food. All food in storage must be covered. Urgency Description(s): BLUE: Th rent Beverage air unit has uncovered food. All food in storage must be covered. Violations Related to Good Equipment and Utensils FAIL Non-Critical BLUE Retail Practices (Critical violations must be corrected Com nt:The True reach in has an accumulation of food debris. Thoroughly clean this unit. immediately or within 10 he front Beverage air unit needs a thorough cleaning. days)(Non-critical violations must be corrected immediately Physical Facility FAIL Non-Critical BLUE or within 90 days) Co ent:The stair near the back door needs to be repainted to be easily cleanable and impervious. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 01,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to Reinspection in one week, all violations to be corrected. 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 01,2007 ) Page 2 oft % 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 825-9911 Separation/Segregation/Protection PASS Criticald❑ RED Owner: Comments:The Beverage air freezer has potentially hazardous foods all stored together. Organize unit to separate PHF to prevent Giorgio Manzana cross contamination. PIC: The True reach in has PHF stored above RTE food. Store all PHF below RTE food to prevent cross contamination. Giorgio Manzana Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑J RED Inspector: David Greenbaum Comments:The cutting boards are stained and scored. Resurface or replace the cutting boards. Date Inspected:Correct By: I Handwash Facilities PASS Critical ❑d RED 3/15/2007 Comments:The kitchen hand wash sink missing paper towels. Provide disposable paper towels at this hand wash sink at all times. Risk Level: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Hot and Cold Holding PASS Critical ❑d RED Permit Number: BHP-2007-1 Comments:The Beverage air freezer had a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. Status: The small Continental unit had a temperature of 48°F. Repair unit to maintain a temperature of 41°F or below. SIGNED OFF Violations Related to Good Retail Practices (Blue Items) # of Critical Violations: Food and Food Protection PASS Critical BLUE 0 Comments:The Beverage air unit had uncovered food. All food in storage must be covered. Time IN: Time OUT: The small Continental reach in had uncovered food. All food in storage must be covered. Urgency Description(s): BLUE: The front Beverage air unit has uncovered food. All food in storage must be covered. Violations Related to Good Equipment and Utensils PASS Non-Critical BLUE Retail Practices (Critical violations must be corrected Comments:The True reach in has an accumulation of food debris. Thoroughly clean this unit. immediately or within 10 The front Beverage air unit needs a thorough cleaning. days)(Non-critical violations must be corrected immediately Physical Facility PASS Non-Critical BLUE or within 90 days) Comments:The stair near the back door needs to be repainted to be easily cleanable and impervious. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 15,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to All violations cited in the 3/1/07 inspection report have been corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) L�� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 15,2007 ) Page 2 of FROM : _.._ FPV NO. : 9787778903 Oct. 06 2006 04.'22PM PI DENNIS THE MENNIS INVOICE PEST CONTROL 29 Locust Street LYNN, MASSACHUSETTS 01904 1.800.6449.3429 AceeunNng ��• 67 4 - ��.,g,Ci.ta,, ' FAX NO. 9767778903 Oct. 06 2006 04:22PM P2 o" FROM DENNIS THE MENNiS INVOICE PEST CONTROL 29 Locust Street. LYNN, MASSACHUSETTS 01904 2400.649.3028 Accounting illiMmlil r,. .. N3-o G 17 ?-.A3- �.4 cuow f p3 ()rt. 9 ria??? 3 DENNIS THE MENNIS INVOfk� PEST CONTROL !4 i.r '29 Locust Street LYNN, MASSACHUSETTS W-649a30?.8 01904 AccamUng T CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTtf """€ • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC 18 200& TEL. 978-741-1800 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll W W W.SALEM.COM 130ARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT A- U 'e r-0 A) A- TEL# ADDRESS OF ESTABLISHMENT D 7 t-S SC X S -V FAX# 1-79 - 9 Z,_1 - L( 7 7 MAILING ADDRESS (if different) EMAIL--Business': rJ,Qrnt I� t rhQ_ 0 ( •�.O 1u Owner's: OWNER'S NAME A N 2,0, n)-A TEL# 47-7 9 - 7 7 if -7i4 t) ADDRESS i/ Teef-ops if N GIAIoerS / l +9- 23 STREET 1, CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME (/S) `"'r 0 C� ( O N O CERTIFICATE#(S) ) O 19 2-5 9 (Required in an establishment where potentially hazardous food is A `prrepared) 919- � EMERGENCY RESPONSE PERSON U 10 r-J 1 ra r'7 CL N -CL tJ:�1 HOME TEL# f 1 9` SAYS OF OPERATION Monday Tuesday __Wednesday _Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (For example Ilam-Ilmol TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,0OOsq.ft. =$100 more than 10,000scIA. =$250 _.. -------- - ... .. .. -------------- --------- - --- -- ---- - --- _ - .... ... RESTAURANT YES NO less than 25 seats 25-99 seats => more than 99 seats =$200 .. b - ----- .... ---- --- . _. _ .....__................. - - ...._. _ ----- BEDIBREAKFAST YES NO $100 -------------....----._--_....._.. ... ___....._- _...__....._ - ------- ...._. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bestknowledge and belief, have file all state tax returns and paid all state taxes required under the law. Signature —� Date Social Security or Federal Identification Number — ---------- ----------------------------------- --------------- .-----------------_ ---- 'j-- ----- - -- ----------------- Revised 11/13/06 FOODAP2007.adm Check#&Date ny ,✓ wy z � c r SS, A,¢ c, a `w t � ^w-' ,." =- ,S+F�x"x�A � .# 'k.mA'V+F'.!"fSF . .. Commonwea�ltfhyo�f Maysssyachusetts iA�1c�t�le14I �,"atr ` r Ili" q}}e '"+^�r 4•* k r t Ctty of Salem.` ve '�` * "x�e ```. 9t ,�.;4�1 � • ' '$ � "f,,++y,'�'}ke' �"��^> "t i .rj A`''Z"'�y' rry r,�-,,��t�ah �:' i ,� . 9 a. ra Boa[a of Health �4 x.; x5:a � x ,:�mbedey Dnseoll x .t SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Bella Verona File Number.BHF-2004-000123 107 Essex Street Salem MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0217 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT 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 1 of 3 0 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 825-9911 Handwash Facilities FAIL ❑d RED Owner: Comment: Hand wash sink had no paper towels. Provide paper towels. Giorgio Manzana PIC: I Hand wash sink obstructed at time of inspection. Keep clear and accesible. Georgio Manzana Violations Related to Good Retail Practices (Blue Items) Inspector: Equipment and Utensils FAIL BLUE John Gehan Date Inspected:Correct By: Comment: Mop stored incorrectly. Mop to be hung up and stored so that it can air dry. 9/28/2006 Above thbe stove requires general cleaning. Risk Level No sanitizing log since 3/06. Log to be check and maintained daily. Permit Number: GENERAL COMMENTS: BHP-2006-0076 Status: 863:Owner to fax over past three month of extermination reports to BOH. Open #of Critical Violations: 1 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 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 28,2006 ) Page 1 oft rti 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 28,2006 ) Page 2 of IMPORTANT MESSAGE FOR A. DATE may -TIME� S .M. M OF PHONE AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU '.. RUSH . RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED CC FORM 09 M. MADE .S.A. NOTES _- , 'b M, •aAvs, w»m L3", t"`39'!S�? Yrt'' ".t :�/am�u. SP �`K�^iClHr �P# r� r a [ , „- s. 1 '4 .. e- } 3'-1.A �i^''fTF' Y r;:� ..vY $Y�.1•: x A h. ��! ..:i 'v Mh � 4.1 '� ' -pCommonwealth of Massachusetts': � ` ,r r1 ' �r "` y. . Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishmept Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Bella Verona File Number:BHF-2004-0123 107 Essex Street Salem. MA 01970 LOCATED AT: 0107 ESSEX STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0076 Jan 3,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health �yt� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 23 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH I 120 WASHINGTON STREET, 4TH FLOOR C rzn SALEM, MA 01970 � � - �nNe TEL. 978-741-1800 1-6) 14 FAx 978-745-0343 �n STANLEY J. USOVICZ, JR. yyyyyy,SALEM.COM 0 5 2005 ' MAYOR JOANNE SCOTT, MPH, RS, CHO 7� HEALTH AGENT 8pARp QF Heq TM 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 3L;Z� (/ ;2c,t)41 TEL# 9Ig `8.25 yq IL ADDRESS OF ESTABLISHMENT 104 Z ASF-k r,'7-. MAILING ADDRESS (if different) OWNER'S NAME S#�64 R I AIII),U4A- / TEL# q M - � 7 4 7 I t4 O ADDRESS I —tle te i I U P-S LN CITY A64 rk,& STATE zip/fCr(0 CERTIFI®TE#(s) 101 >t 1ST CERTIFIED FOOD MANAGER'S NAME(S)fr/7A:' �� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 4101? 1n glf}lV' ffil HOME TEL# �� ( � �l 0 HOURS OF OPERATION: Mon.-&_Tue.$.Wed.-&—Thu.�Fri. 2 Sat. R Sun. _ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 / more than I0,000sq.ft. =$250 RESTAURANT S NO -/ less than 25 seats $100 25-99 than =$150 more more than 99 seats =$200 ---------- - ---------- ------------------------------------------------------------------------------------ -- ----------------- BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS ----------------------------------------------------------------------------------------------------------------------------- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and,belief, have filed all state tax returns and paid all state taxes required under the law. 63Z — 7 & — 5-5- 7 Z Signature ,D,, Date Social Security or Federal Identification Number ------------ 4-`x `0--------- 1 .�L ---------------------------------------------------------- Revised 1 /031/ FOODAP2.adm Check#&Date .3 Z 7 �z— % 2 O i�5(' _ e 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 825-9911 _ Separation/Segregation/Protection FAIL Critical ❑d RED Owner: Comment:The Beverage air freezer has potentially hazardous foods stored above ready to eat foods. All RTF must stored above Giorgio Manzana PHF to prevent cross contamination. PIC: Handwash Facilities FAIL Critical ❑J RED Georgio Manzana Comment:The hot water at the handwash sinks had a temperature of about 105°F. A minimum hot water temperature of 110°F Inspector: must ne maintained. David Greenbaum The kitchen handwas sink found obstructed and missing paper towels. Keep handwash sink clear and accessible at all times and Date Inspected: Correct By: provide disposable paper towels at all times. 3/30/2006 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Risk Level: Hot and Cold Holding FAIL Critical RED Permit Number: Comment:The small Continental cooling unit had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. BHP-2006-0076 gViolations Related to Good Retail Practices (Blue Items) Status.` Equipment and Utensils FAIL Non-Critical BLUE PARTIAL COMPLY Comment:The canopener needs a thorough scouring. #of Critical Violations: Label all sinks with the designated purpose. Example"Food Prep Only" 3 Time IN: GENERAL COMMENTS: Time OUT 551:Owner will notify the Board oof Health within one week all violations have been corrected. Urgency Description(s): BLUE: _ : f�kLf )Cl �� 1 Violations (d to Good LA I 1 Retail Practicestires Critical � \ Z Q violations must be corrected L 1 immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2006 ) Page I oft 3 .� 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2006 ) Page 2 oft Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name '1 1 ( Date Tvpe of Operation(s) Type of Inspection (7+SNtG/1� '&I/(�t / /7 111410T_ �� / M'FoodService ❑ Routine Address Ire. t :1 jym / Risk' Ll Retail [0-Re-inspection ° ! Level ❑ Residential Kitchen Previous Inspection Telephone El Mobile Date: ElTemporary E] Pre-operation Owner ��./ C/c T ! el f ^ HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Chargei(PIC) Time ElBed&Breakfast ElGeneral Complaint r,%% El HACCP Inspector Out3' Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.00t9(F) ❑ action as determined by the Board of Health. �(��, ffiT co-po�cd �ytivt /f! ti �S FOOD PROTECTION MANAGEMENT .a ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties E] 13. Handwash Facilities EMPLOYEE HEALTH :" . 1 , _ . PROTECTION FROM CHEMICALS - ` ` •� ❑ 2. Reporting of Diseases by Food Employee and PIC - ❑ El 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE _" TROLS El 4. Food and Water from Approved Source" TIME/TEMPERATURE CONP s ( otentially HazardouaFoods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing f"REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (items 1-22): of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the BoaOfficial Order for Correction: Based on an inspection rd today, the items checked indicate violations of 105 CMR of c earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations. 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.5Mnsp cfFo,m 14.dx / 1 In A Inspector's Signature: / Print: PIC's Signature: A� t Print: J[Wage / of�Pages Violations Related to Foodborne Illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assi tmentoPResponsibility* 3-302.11(A)(1) Raw Anima Foods Separated from -� 590.003(B) Demonstration of Knowledge" _ Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302A I(A)(2) Raw AmUnAl FoWs Separated from.Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection" a tlicams* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Foci Contact with Equipment and Applicant To Report To The Person In Utensils* Char ge* - Contamination from the Consumer 590.003(G) Re rotting b Person in Charge* 3-306.14(A)(B) Returned Food and R service of Food* 3 590.003(D) I Exclusions and Restrictions* Dispositlon of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food _ 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" 4-501.111. Manual Warewashing-Hot Water 3-201.12 Food Ins Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products" 4-501.112 Mechanicat Warewashing-Hot Water 3-202.13 She]llnns* Sanitization Tem matures* 3-202.14 E<+gs and Milk Products. Pasteurized* 4-501.114 Chemical Sanitization-temp., pH, ' 3-202.16 Ice Made From Potable Drinking Water' concentration and hardness. * 5-1.01'.1.1 Drinking Water front an Approved System* 4-G01.11(A) Equipment Food Contact Surfaces and Utensils Clean` 590.006(A) Bottled Drinking Water 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and- 3-201A4 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-7(111 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Came and Wild Mushrooms Approved by Re utatoAuthor' 2-301.11 Clean Condition-Hands and Anns* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 _When to Was 3-201.17 Game Animals* Good Hygienic Practices y Receiving/Condition 2-401.11 Bating,Drinking or Using Tobacco* 3-202.17, PHFs Received at Proper Temperatures* 2-401.12 Discharges,From the Eyes, Nose and 3-202.1.5 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* - 3-301.12 Preventing Contamination When Tastiu b Tags/Records:Shellstock .12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em� Tags/Records: Fish Products 13 Handwash Facilities 3-402.71 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention" 5-203.11 Numbers and Capacities* 590.0040 Labeling of Ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility.O teralum and Maintenance /HACCP Plans Supplied wish Soap and Hand Drying Devices 3-502.11 S ecialize I Processing Methods* 3-502.12 Reduced oxygen packaging,criteria* 6-301.1 t Handwashin Cleanser, Availability 8-1(13.12 Conformance with Approved Procedures* 6-301.12 Hand Dr ing Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Ma556ch.n5ett5 Department of Public Health Salem Board of Health 120 Washington Street,4 1h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ` Date Type of 0 eration(s) Type of Inspection r4 / L4 Food Service [(J Routine Address Ri ❑ Retail Re-inspection Level ❑ Residential Kitchen Previous I spection Telephone , � ❑ Mobile Date: �{,// Owner / HACCP Y/N ❑ Temporary ❑ Pre- er'ation p 0 0 /1 Or, ❑ Caterer ❑ Suspect Illness Person in Charg ' IC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector 3 Permit No. E] O herr Q5E4 Ou , Each violation check d 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) [:1 590.009(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 ' .. - ❑ 13. Handwash Facilities PROTECTIONS FROM CHEMICALS E] 2. Reporting g of Diseases by Food Employee and PIC E],„. 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)' [:15. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating [1 7. Conformance with Approved Procedures/HACCP Plans ,(�] 18. Cooling PROTECTION FROM CONTAMINATION' - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashingr - ❑ 11. Good Hygienic Practices ® CONSUMER ADVISORY, ' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C Health. -- 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations y' 25. E ui Equipment and Utensils cited in this report may result in suspension or revocation of q p (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27.'Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: r- s:501nsp fFo, -14.nocn, �- Inspector's Signature: Print: PIC's Signature: l Q Print: /�.(1 i. .7 l� ' 1/ Page of_s� Pages Violations Related to Foodborne Illness .r Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION �-, FOOD PROTECTION MANAGEMENT S Cross-contamination I 1 790 003(A) Assignment of ResponubiHy" 3-302.11(A)(]) *tit R animal Foods Separated hum �90.003(Buafion) Demonsof Knowledac" _ Cookod and RIE Foods" L2 103 11 Person in charge-- duties Contamination from Raw ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other'° 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporti ng by food employees and 3-302-11(A) Food Protection' applicants* 3-302.15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Ford Employee Or An 3-304.11 Food Contact with Equipment and App]iatnt To Report To The Person In Utensils" Chm'ae' Contamination from the Consumer 590.003(G) Reporting by Person in Charge' 3-306.14(A)(B) Returned Food and Reset vice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701..11. Discarding or Reconditionini,Unsafe FOOD FROM APPROVED SOURCE Food` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111. blauual Warewashing-flot Water 3-201.12 Food in a Bet inctical ly Sealed Container* Sanitization Tem erattrres* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing- Hot Water 3-20113 Shell Eng,*s* Sanitization Temperatures 3-202.14 E>*s and Milk Products.Pastewized" 4-501,114 Chemical Sanitization-temp.,pH, 3-202,16 Ice Made From Potable DrinkingWater* Equip concentration F and hardness ' 5-101.11 Drinking Water from an A n-oved Svstem* 4-601..1 I(A) Equipment Fax1 Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning ure ccs all of E Utensils* rat Contact Surfaces acid Luttsils Shellfish and Fish From an Approved Source 4-70211 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equi ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Cie::m Condition-Hands and Arms" Re ulato Alimorit 3-202.18 Shellstock Identification Present"` f. 2-301-12 Cleanim,Procedure* 590.004(0) Wild Mushrooms* r 2-301.14 When to Wash"` 3.291..17 Game Animals* tl Good Hygienic Practices $ Receiving/Condition 2-401.11 t.atina, Drinkin or Using Tobacco" 3-202.11 PHFs Received at Pro rnr Tem reratures* 2-401.12 Discharges Front the Eyes.Nose and 3-202.15 PaekaeeIrate, it,* Mouth* 3-10111 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin�' 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3-202.18 Shel,lstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em kwees* Tags/Records:Fish Products 13 Conveniently Facilities 3-402.11 Parasite Destruction* Gonventently Located and Accessible 3-402.12 Records,Creation and Retention* 5-2031.1 Numbers and Capacities* 590.0(4(.1) Labeling of Ingredients' 5-204.11 Location and Placement' 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecializedProcessin L4ethWs* Devices 3-502.12 Reduced oxygen ackaging,tract ia`n 6-301.11 Hdndwashin Cleanser.Avaitabilit 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Diving;Provision *Denotes critical item in the federal 1999 Food Code ot 105 CM),590.000. T t CITY OF SALEM _ S�Srcn/e BOARD OF HEALTH ^c Establishment Name: Q�I Date: ✓, Page: of ? f Item Code C-Critical Item DESCRIPTION OF VIOLATION/'PLAN OF CORRECTION Date ,Z No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 01K or r IC, C2. � a Ct f I I Sax ul 1 r( ,I , !� 7 S n t W Y ^^ t a&l It 29 S V- ail" Wey'71'g )l c< S n/1 S r i razl, l v t,I/. �" J=6'01 r r € rl7 Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I hye read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance Cl Employee Restriction/ � Exclusion violations before the next inspection, to observe all conditions as described, and to -G Re-inspection Scheduled^ o Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ndncpmpliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo 13Emergency Closure your food permit. ii! AZ 0 A I'/Y/ln , � .�, ❑ Voluntary Disposal ❑ Other: 3-501.,i4(C)� PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to - Factors(items 1.22) (Cont.) 41'F145`F Within 4 Howl. PROTECTION FROM CHEMICALS 3-507.15 Lo Ln-Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501AWB) Cold PIMs Maintained at or below 3-202.12 Addtttves" 590.004(F) 41`745° F'` 3-302.14 Protection from Llnalrpmved Additives* 3-501 16(A) I1ot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40°F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 13WR Containers' 7-102.11 Common Name-Worki Q Containers* Time as a Public Health Control 7-201.11 Se.araLion-Storage* 3-501.19 Time Asa Public Health Control 7-202.11 Restriction-Preseneeaod Use 590.004(H) variance Re nirernent 7-202.12 Conditions of Use* 7-203.1.1 'toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets,Criteria-C'hemictds* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce, Criteria* 21 3-807.I1(A) Unpasteurized Pre-packaged Juices and _ Bewith Warnin 7-205-11 Incidental verages g Labels* 7-204.14 cid cuts.Criteria* 3-801.11(B) Use of Pasteurized Eyes' ental Food Contact. Lubricants* 3-801.1 f(D) Raw or Partially Cooked Animal Food and 7-206.11. Restricted Use Pesticides. Criteria* 7-206.12 Rodent Bait Stations' 3-801.11(C) Raw Raw SSeeeded S smuts NoC Served. "Ford Pucka e Not Re-served. a' 7-206.13 Tracking Powders,Pest Control and Monitorin'-* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLST1-30'2. .11 Consumer Advisory Posted for Consumption of Animal Foods`Pkat are Raw. Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate _ 3-40'LL1A(1)(2) � Eggs 155°F 15 Sec. Pathogens.*et'.1- nrzeoi E e,s-hmnediate Service 1450F15sec- 13 Pasteurized Eggs Substitute for Raw Shell 3-401.1].(A)(2) Comminuted Piste, Meats wZ Game Leas* Animals- 155'F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast- 13W17 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°13 15 sec.* above if related to foodborne illness 3-401.1.1(7)(3) Whole-muscle,intact Beef Steaks interventions and tisk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Cooked in a practices Should be debited tinder#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(h) All Other PHFs-- 145°F 15 sea 17 Reheating for Hot Holding 00LAT/ONS RELATED TO GOOD RETAIL PRACT/CES 3-403.11(A)&(D) PHFs 165'F 15 seo. * (Mentis 2.3-30) 34015(B) Microwave- 165' F2 Minute Standing Critical and non-critical violations, which do not relate to the Ti me* ,foodborne illness intervenYons and risk facto's listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the foltoe-ine sections of the Food Code and 105 CMR 1.40°F* 590.000. 3-403.11(E) Remauring Unslieed Portions of Beef Item Good Retail Practices FC 590.000 ' Roasts* 23. Mane pment and Personnel _ FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection _-_ _- FC---3 .004 _ 3-501.14(A) Caning Cooked PH0°F Fs from 14to 29 Euimenu and Utensils FC 4_ 26 Water. d Wasie Plumbin anFC 5 __ 005 __ __'_7.0_6___ 70'F Within 2 Hours and From 70'F 27. PhysicalFacility _ FC 6 1007 to 41"F(45'F Within 4 Hours. * 28. Poisonous or'Foxic Materials -F-C-7-1-.008 3-501.14(17) Cooling PHFs Made From Ambient 29_ S caul Re uiremants _ ( -009 Temperature Ingredients to 41°1/45°F _-, Other r Within 4 Hours'- - ssaor,,no. saax "Denotes critical item in the fo^deral 1999 Food Code or 105 CNIR 590.000. CITY OF SALEM � J 1 BOARD OF HEALTH t Establishment Name: ( o� (� Qn?Yt. Date: ! CJ� Pager_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item EA LV Verified -- PLEASE PB NT CL P , 1 - n P { ' f i i �r Discussion With Person in Charge: Corrective Action Required: ❑ No Yes r I hafe read this report, have had the opportunity to ask questions and agree to correct all ❑ vol ritary Compliance ❑ Employee Restriction/ ^' violations before the next ins ection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. .�� ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at'Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41`F/45`F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Coolore Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives 3-501.16(3) Cold KIN Maintained at or below 'k 590.004(F) 41745°F* 3-302.14 Protection from Unapproved Una roved Additives* 1.5 Poisonous or Toxic Substances 3-501.16(A) hint PHFs Maintained at or above - 140'F. * 7-IOLl l IdeContainers Information-Original 3-501.16(A) Roasts Held at or above 130'F."' Containers* 7-102-'11 Common Name-Workine Containers* 20 _ Time as a Public He411h Control _ 7-201.11 Separation-Storage^` 3-501.)`3-- Time as a Public Health Control* 7-202-'I1 Restriction-Presence and User -90.004(H) Variance Re uirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitions ` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizet's,Criteria-Chemicals* POPULATIONS(HSP 7-204.12 Chemicals for Wash iac Produce, Critoria'= 21 3-801.1 I(A) UnpasteurizedPre-packagedJuices and 7-204.74 Drying Agents.Criteria* Beverages with Warning labels* 7-205.11 Incidental Food Contact.Lubricants* 3-80111(B) Use of Pasteor9 zed Ee,es* 7-206.11 Restricted Use Pe4icides. Criteria* 3-80111.(D) Raw or Partially Cooked Animlil Food and Raw Seed Sprouts Not Served.,t 7-206.12 Rt efit Bait Stations* 7-206.13 'tracking Powders.Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. ' Monitoring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 7 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 1b Proper Cocking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1 IA(1)(2) Eggs- 155'F 15 Sec. 1'atho�x;ns."°cnera.e r,+,roai Eggs-'him kedrate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155'F 15 sec. * 3-401.1l(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in see, * catering, mobile food,temporary and 3-401-1.1(,,)(3) Poultry,Wild Game,Stuffed P,Hps, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,hitacr Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to scrod retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under//29- Microwave 165'F* Special Requirerneuts, 3-401.11(A)(1)(b) All Other PHFs-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 1650F 15 sec. * (Items 23-30) 3-403,11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and)iskfactors listed above, can be. ,-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code and 105 CMR 140"F' 590.000. _ 3-403.1.1 F Remaining Its Good Retail Practices _ (.) d Lnsliced Portions of Beef FC $80.000 Roasts* 23. Management and Personnel __ _ FC-2 .003 18 Proper Cooling of PHFS 24. Food and Food Protection_ FC-3 .004 _ 3-501.1.4(A) Carling Cooked PHFs from 140"F to 25._____26, _Water Plumbin and Was Equipment and Utensils FC 4 .005 FC -"5 _'0_06-006 70'F Within 2 Hours and From 70'F __Z7____ Physical Faeili FC6 .007 1'o 4l'F/45'F Within 4 Hours. `" 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Coo(in;PRFs Made From Other er Ambient 20. eial Requirements _ .009 Temperature Ingredients to 41'F/45'F _Oth Within 4llours,* ssoann,:m.,a.z.u« °'Denotes critical item in the federal 1999 Food Code or 105 CMIt 596.000. 0107 Essex Street Bella Verona City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: ; - Item Status Violation Critical Urgency Nature of problem or correction 825-9911 Non-compliance with: Not Done Owner: Y = Anti-Choking PASS ❑ ,Giorgio Manzana Tobacco PASS ❑ plc:b FOOD PROTECTION MANAGEMENT Not Done InspectoC PIC Assigned/Knowledgeable/Duties PASS Q RED i David Greenbaum ` EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 3/17/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑ RED BHP-2005-0063 Receiving/Condition PASS Q RED Status: " ' Tags/Records/Accuracy of Ingredient Statements PASS Q RED SIGNED OFF` #of Critical Violations' Conformance with Approved Procedures/HACCP PASS RED Plans Time IN: ,..Time OUT: - Notes:' 35:, . Urgency Description(s): . BLUE: m= Violations Related to Good Retail Practices (Critical violations must be corrected' immediately or within 10 days)(Non-critical violations::, GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Page I of ft 1 0107 Essex Street Bella Verona must be corrected immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) Separation/Segregation/Protection FAIL Critical ❑d RED Beverage air freezer has potentially RED: hazardous food stored above cooked or Violations Related t0 ready to eat food. Store all potentially Foodborne lilness Interventions hazardous food below cooked or ready to c eat foods to prevent cross contamination. and Risk Factors(Require Food Contact Surfaces Cleaning and Sanitizing PASS Q RED immediate corrective action) Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS Q RED Handwash Facilities FAIL Critical ❑Q RED Kitchen handwash sink has a pitcher in it and is missing paper towels. Keep handwash sink clear and accessible at all times. Provide disposable paper towels at all times. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑/ RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS ❑d RED Reheating PASS RED Cooling PASSd❑ REDi Hot and Cold Holding PASSd❑ RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED GeoTMS(D 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Page 2 of 0107 Essex Street Bella Verona Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Non-Critical ❑ BLUE _ Canopener needs a thorough scouring. Kirkland freezer in basement needs a visible, accurate thermometer. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Page 3 of z 1 ' v' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Bella Verona Address of Establishment: 107 Essex Street Owner's Name: Giorgio Manzana Restrictions: Application Date: 11/16/04 Permit for Food Establishment 009-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. C HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH . 120 WASHINGTON STREET, 4TH FLOOR �""'� "` u ♦� s / SALEM, MA 01970 TEL. 978-741-1800 NOV 12004 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO r MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT _'F HEALi H NAME OF ESTABLISHMENT Rt Stora mec Be IA Ver0ak�`TEL# 117$'9 ZS 71 11 B K J ADDRESS OF ESTABLISHMENT Iy QQri C SSS+ . a I e M , l�(�A b II r1o MAILING ADDRESS (if different) JCL M �O— OWNER'S NAME Gto (A 10 rJVVe-t;I-A M gnzgN{1 TEL# IIS - 7-7 4-x710 ADDRE S -freef6PS �A) CITY CA(1 J (-a STATE zip ( 2 CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) b I T 2-5 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON S I le A RAN Z6tN A- HOME TEL# 9 7 8 " r1 f14-7 146 HOURS OF OPERATION: Mon.1-1I Tuek"( Wed.1-11 Thu.H '/I Fri.q-/1 Sat. 1-ll Sun. `q"9 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO q v� less than 25 seats '-= 1 o 25-99 seats `-U-1D more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL ONLPROFfT(such as church kitchens; YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno I ge and belief have filed wall stateQax returns and paid state taxes required under the law. (,! 3s r $ s o q Signature Date Social Security or Federal Identification Number ------------------------------------------ --------------- ---------------- - - - - -- Revised 1 1/03/0 3 FOODAP2.adm Check#&Date I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 TEL. 978-741.1800 'nNe FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Bella Verona Address of Establishment: 107 Essex Street Owner's Name: Giorgio Manzana Restrictions: Application Date: 11/14/2003 Permit for Food Establishment 008-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT. t�rCin� d2 (dei"ONEL# `� 7S -6 paS9`t ADDRESS OF ESTABLISHMENT �q� " I S S e.)( 5r; Scy\ gen c hQ- MAILING ADDRESS (if different) Q.M OWNER'S NAME t tin C!?� t n 0.nZ c�1�� TEL# 9,%' -7 -7 '1 -7140 ADDRESS_ �1P-S Hc,— CITY STATE M n ZIP 0 2 CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) O-T 9 ZS ea n Z.cx c1C. U (required in an establishment where potentially hazardous food is prepared.) -7-7 Lf 1 1 `t EMERGENCY RESPONSE PERSON Ctitor3 10 q0L"'Zgfci HOME TEL# R 7g _g as 19 11 HOURS OF OPERATION: Mon NTue. �J)IWed �( Thu. -1` Frio-lt Sat.it-it Sun. q 'I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. 5_1 9 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 `, 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno I dge and beli9gf, have fled all state tax returns and paid all state taxes required under the law. ��Afl 1� 21a6A =n - 11-12-0 "3 3of9- qL. -% 8o-5 Signature U Date Social Security or Federal Identification Number -------------------------------------------------------- ------------------------------------------------------ Revised 11/03/03 FOODAP2.adm Check#&Date r ) --------- �� — __6_3 'i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of 0 eration s Type of Inspection � q 3� a Food Service ❑ Routine Address / .1sA.IV 3V Risk ❑ Retail �e-inspection Telephone Level El Residential Kitchen Previous Inspection Tele 4781 -8 f 99/ P # ElMobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation 6j 16 I oWA(k ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time EI Bed& Breakfast Ll General Complaint In: ❑ HACCP Inspector ReCA_ Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties E]- - 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded E] 14.Approved Food or Color Additives 'FOOD FROM APPROVED SOURCE 1 ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling "PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s)(sso.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.5901nsp aFom 14.tl c Inspector's Signature: " Print: i PIC's Si nature: c Print: O/1G 0 r//d- Page � of1- Pa e l Ir Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R Cross-contamination 1 `r90 003tA1 Assrgorient of Responsibility" � 3-30'_.I1(A)(1) f to Anitnal roods Separated fivm i90.003(B) Demonstr mon of Knowl4dge* Cooked and RTE foods.: 2-103,11 ftrson in charge-duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food cmployees and 3-302A I(A) Food Protection* applicants- 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee 01 An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char'T* Contamination from the Consumer 590.003(G) Re ortina b Person in Char e* 3-306.14(A)(B) Returned Food and Reseivice of Faxl* 3 590.003(0) Ewchtsions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removid of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 1 Food and Alater From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) I Com 1p ionee with Food Law* 4-501-111 Manual Warewashing,-Hot Water 3-20I J.2 Food in a liermetieally Seated Container* San iti zmtion Tem eraturess' 3-201.13 Fhnid Milk and Milk Products* 4-501.112 Mechanical Warewashing-]-lot Water 3-20213 Shell E os* Sanitization TemL)eratures* 3-202.14 Ee*s and M.iik Pro<htecs.Pasteurized`" 4-501-114 Chemical Sanitization-temp..pH, 3--202.1 Ci Ice Made From Potable Drinking Water" concentration and hardness * 5-101.11 Drinking Water from an Approved System'" 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* mg 4-602.11 CleanFrequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish" 4-703.11 Methods of Sanitization-'Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301,11 Clean Condition--Hands and Arms* Re Mato Authorit 3-202.18 Shellstock Identifiartion Present* 2-301.12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-301.1.4 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g ReceivingtCondition 2401.11 Eating,Drinking or Using Tobacco, 3-202J 1 PHR Received at Pro ter Tem !natures* 2-401.12 Discharges Front the Eyes,.Nose and 3-202.15 Package integrity* Month* 3-101.1.1 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin r* 6 TagsiRecords:Sheilstock LL2 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em loyees* TagsiRecords:Fish Products 13 Handwash Facilities 3-402.11 Parasite Deshvction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5.203.11 Numbers and Capacities" 590.004(7) Labeling of Ingredients' 5-204.11 Location mid Placement" g Conformance with Approved Procedures 5-205.11 Accesmbiht ,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 S eeializedPrttcessin Methods* Devices 3-502-12 Reduced ox gen acka«in ,criteria* 6-301.11 flandwashin Cleanser-Availabilit 8-103.12 Conformance with A roved Prncedutes* 6-301.12 F1and Drvin>Provision "Denotes conical itetn to ii}e Cederal 1999 Food Code or 105 CMR 596,000. CITY OF SALEM Q BOARD OF HEALTH Establishment Name: IMI-A V"Nk Date: 9�'3066y Page: � of ?/ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 9' /tm V W'rA C 7CW /1w~4— II 'F 4 f l Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspensionlrevocation of ❑ Embargo ❑ Emergency Closure your food permit. `n t ❑ Voluntary Disposal ❑ Other: I r � 3-501.14(C) PRFs Received at Toarlperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41"F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coaling Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50'Li6(B) Cold PHFs Maintained at or below 3-202.12 Protectionti�W 590.004(F) 41`/45° F* 3-302.14 Protection Prom Una t,roved Additives* 3-501.16(A) H;ot PHF,,Maintained at or above 15 Poisonous or Toxic Substances 140'F. * 7-1(11..11 Mentifyingtnformation-Original 3-501.16(A) Roasts Held atornbove130'F '" Containers* 7-102.11 Compton Name-Workin-Containers* 20 Time as a Public Health Control 7-201.11 -separation-St'orane" 3-501.19 Time as a Public Health Control* 7-20111 Restriction-Presence;and Use" 590.004(H) Variance Requirement 7-202.12 Conditions of Use- 7-203.1,1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1t Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7.204.12 C.".hemieals for Washing Produce,Criteria" 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 7E22 20414 Drtin�Agents,Criteria' Beverages with R' ,,nine L.abets* Incidental Food Contact.Lubricants* 3-801.17(B) Use of Pasteurized E CTS g,Restricted Use Pesticides. Criteria* 3-801,11(D) Raw or Partially CookedAnimal Food 2nd Raw Seed S routs Not Served. *Rodent Bait Stations* 3-801.11(0) Uno>enedFoodPacka>eNotRe-served.Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'rhat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1IA(i)(2) Figs- LSSF15 Sec. Pathogens.*erre=coe v zxn F tts-Irumediate Service 145"Fl5sec" 3-302.13 Pasteurimd F'ggs Substitute the Raw Shell 3-401.1_(A)(2) Comminuted Fish,Meats&Game Eggs Animals- 15.5'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast-130"F 121 min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites,Injected Meats-155'F 15 540.009(A)-(D) Violations of Section 590.009(A)-(ll)in sec. o- - catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuficd PNFs, residential kitchen operations shock) be Stuffing Containing Fish, Mear, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3 401.144)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Otlner 145"F* 590.009 violations relating to l;ood retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29-- Microwave 165°P* Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 1.7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 I(A)&Q)) PHF,, 165'F 15 sec. *' (items 23-30) 3-403.11.(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Tinte* foodborne illness interventions and risk factors listed above., can be 3-403.1 1(C) Commercially Processed RTE Food- found in the following sections q/the Food Code and 105 CMR 140'F" 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Ratati Practices_ FC 590.800 Roasts* 23. Management and PersonnelFC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC--3 .004 25. __ E ui ment and Utensils __FC 4 .005 3-501.WA) Cooling Cooked PRFs from 140`F to 26 Water, Plumbin and Waste FC-5 006 _ 70'F Within 2 flours and From 70,"F 27. Ph steal Faclllt FC-6 .007 to 41'F/45'F Within 4 Hours. . _ 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 'temperature Ingredients to 41"F/45`17 30._ _L.0ther L Within 4 Hours'` fiwor�n,e.�ea-zm, 1 Deputes critical item In the federal 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health M 720 Washington Street,41h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date UL TT��e df Operations T e-of Inspection Ra Nh / P-Tood sery r. 0 Routine Address Risk ❑ Retail ❑Re-inspection D7 JCrr'de Level ❑ Residential Kitchen Previous Inspection Telephone9,7 S^ 3 ❑ Mobile Date: Owner /� HAGGP YIN F-1Temporary ElPre-operation tT jb��t0 ►4 /CN/a ❑ Caterer 171 Suspect Illness Person in Charge(PIC) Time El Bed& Breakfast El General Complaint j)"&- In: ❑HACCP Inspector t4AAV Out: Permit No. ❑Other _ _Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compttanoe 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 Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED.SOURCE TIMEf{EMPERATURE CONTROLS(Potentially Hazardous Foods). ❑ 4. Food and Water from Approved Source it ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/ACcuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION ❑ 19.Hot and Cold Holding ❑ S. Separation/Segregation/Protection ❑20.Time As a Public Health Control "Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR.HIGHLY SUSCEPTIBLE.POPULATIONS(HSP) F9a; 9 ❑21. Food and Food Preparation for HSP [l',t 0.`Proper Adequate Handwashing 's ❑'11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C 'N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2}(ssa.003} order of the Board of Health. Failure to correct violations f 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of ?27, . Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food : Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. If aggrieved by this order, you Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing . Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Heaith at the above address . Special Requirements (590.009) within 10 days of receipt of this order. . Other DATE OF RE-INSPECTION: �1i+t/ 5 14 d. Inspector's Signatu rint: q PIC's Signature: r Print: HkPage of _ ges q r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Cross-contamination 1 590003(A) Assignment at Responsibility* 3-30111(A)(1) Raw Animal Foods Separated from 590.003(B) Dentonsh mon of h_nowledge' _ Cooked and RTE Foods* 2-103.11 Person in charge duties - Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection" a tlicams' 3-36215 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Fax(Contact with Equipment and Applicant To Report To The Person In Utensils* Charge,* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition at Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1 1 Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE r Food= 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(4-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food ins Hermetically Sealed Container* Saninzation Tem�erafiues* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing Hut Water 3-202.13 _Shell Sanmitization Teeratures* 3-202.14 F,,�s and Milk Products.Pasteurized* 450(.114 Chenecal temp., pH, 3-202.16 Ice Made From Potable Drin n Water* concenhation and hardness. * '!(4) Fqu-1 5-101.11 DrinkingWater from an Approved System* 4-601Utensils lill CClean* Food Contact Surfaces and 590.006(A) Bottled Drinking Water* 590.006(13) Water Meets Standards in 310 CMR 22.0"' 4-602.11 Cleaning Frequency of EquipmentFoal- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.1 2 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* :Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulatoAuthorit 2-301.11 Clean Condition-Hands acrd Arms"` 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-:401.14 When to Wash* 3-201.17 (lame Animals* ll Good Hygienic Practices g Receiving/Condition 2-401._11 Eatin .Drinking or Usha,Tobacco* 3-202.11 PHFs Received at Rn>er Tem eratures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package Integrity* Mouth- 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tastin * 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202 18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Ha Io ndwash Facilities Tags/Records:Fish Products 13 Co, nvenlenth/Located and Accessible 3402.11 Parasite Destruction* 3-402.12 Records,Creation and Retention* 5-203.1 l Numbers and Capacities': 590.004(7) Labeling of Ingredients* 5-204.t t I Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility. Operation and'Maintenance IHACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced as pen pEhana.criteria* 6-301.11 Hande,ashing Cleanser, Availability 8-103.12 Conformance with A> roved Procedures'' 6-301,12 Hand Drying Provision "'Denoles critical item in the tedertl 1999 Foot Cale or 105 CMR 590.000, CITY OF SALEM n BOARD OF HEALTH Establishment Name: /9,C!-LAygQy►JA-- Date: 9 lyele Page: 2 of . ^ Item Code C-Critical Item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified -PLEASE PRINT CLEARLY C 6C Pled 40 u4 J%'eNen if f4raAu46 arr 3 -P11% lAx t< rowsz r 10141 Vr 4 0"'rt4W*j* Rf�� Fb t.+l8s At4— C' vtft4' Met dA" 51111hi YfK0 A- vW J ddAg-0. e=6 �1 G 0 OP 1 Ir UWJ9 XJQU w I S ru le&a r t Ov,zo Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result irndaily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1 10 t �vL-�^, ❑ Voluntary Disposal ❑ Other: V tl 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-507.15 Carlin Methods for PRFs 19 14 Food or Color Additives PHF Hot and Cold Holding 3-202.12 Additives* 3-501AO(B) Cnld PHFs Maintained at or below 590.004(F) 41°/45`F` 3-302.14 Protection from Unta roved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40'F. * 7-101.11 Identifying Information-Original 3-501,16(x1) Roasts Held at or above containers*7-102.11. Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Sc aration-Stora> 3-501.19 Time as a Public Health Control* 7-2011.1 Restriction-Presence and Use* 590.0040-1) Variance Re� 7-202.12 Conditions of Use* 7-20111 'roxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satnuzes,Criteria-Chemicals* POPULATIONS(HSP). 7-204-12 Chemicals for WashinE Pi"oduce,Criteria* 21 3-8(d I1(A) Unpasteurized Pre-packaged Juices and evetaees with Warning Labels* 7-204.14 Dr in _ ants,Casteria* B3-801,11(B) Use of Pasteurized Legs- 7-206. es* 7-205.11 IncidenRestricted Fond Contact, .Criteria* 3-8011 i(D) Raw or Partially Cooked Animal Food and 7-206.11 RodenttedUse t Pestions des.Criteria" Raw Seed Sprouts Not Served. `" 7-206.12 Rodent Bait Stations* 3-801.1)(C) Ung anal Bcod Package Not Re-served. " 7-'_06.13 Tracking Powders,Pest Control and Monitoring° CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS22 3-603-1 I Consumer Advisory Posted for Consumption of I6 Proper Cooking Temperatures for Animal Faxls'That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 1.55°F 15 Sec. PothogenS 1e0 1,'a0e1 B�ate Servtec 145°F15sec* 3-302.13 Pasteurized Fggs Substitutc for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Came li 's" Animals- 155°F 15 sec. .r 3-40Lt1(B)(1)(2) Pork and Beef Roast- 130°F121min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites,Injected Meats- 155°F 1.5 590.009(A)-(D) Violations of Section 590.009(AF(D) in sec. * catering, mobile food,temporary and 3-401..11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°17 15 sec. s. above if related to foodhorne illness 3-401A 1(C)(3) Whole-muscle,Intact Beef Steaks interventions and tisk factors. Other 145°F* 590.009 violations relating to good retail 3-401.1.2 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401AI(A)(l)(b) All Other PHFs- 145°F"15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing Ci bit of and non-critical violations, which do not relate to the Time* foodborne illness interventions and risl-fiu'tors listed above. can be 3-403.11(C) Commercially Processed RTE Food- ,lound in the following sections of the Food Code and/05 CMR '140°F* 590.000. 3-403.11(1:) Remaining-Unsliced Portions of Beef item Good Retaf7 Practices FC 580 0100 Roasts* 23. Management anddF sonnei, _-_ FC-2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection_- - _ FC-3 .004 25.____ E ui meat and lJtensils FC _4 _ _.005 _ 3-501.14(A) Coolutg Cooked PHFs from 140°F to 26. Water,Plumbin and Waste FC-5 .006 70"P Within 2 Hours and From 70'E 21. Ph stool Facility__,____- PC-6 007 to 41.7/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29._ S ectal Re uirements .009 Temperature Ingredients to 4I°F/45`F 30 ____-Other--- ---- -;-----_-______ Within 4 Hours* rsvoro» �zax Denotes critical iiem in tha rederal 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e of 0 erasion s 7 of Inspection c€ 3-4(-04- Food Service Routine Address Risk ❑ Retail grFle-inspection c ysf Level ❑ Residential Kitchen Previous Inspection Teleph neXfwt _ 99�� El Mobile Date:oZ-aG-0 Owne HACCP YM ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Char4e(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Q [ In: ❑ HACCP Inspector -k i.h ec Out: Permit No. ❑ Other Each violation checked requires an 6xplanation 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: 't,' I It r ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties [:113. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 4 ❑ 2. Reporting of Diseases by Food Employee and PIC " [13. Personnel with Infections Restricted/Excluded El 14. Approved Food or Color Additives I'FOOD FROM APPROVED SOURCE` ' "" ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source s TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)-'i- I. ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ ❑ 17. Reheating 6. Tags/Records/Accuracy of Ingredient Statements 9 ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION "` `"" '"` "' ❑ 19. Hot and Cold Holding • .' ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE.POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER:ADVISORY,_. 'e ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions ((] immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC earth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (FC-a)(Sso.00s) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must$°e::,)nriviiting 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above;adclress 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S501nsMcfFom 14.Coc I s ctor's S na Print: PIC's Signature: j i Print: I� y C� / / Page of .2.Pages / C r ! 4 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assi nment of Res onsibilitf* 3-302.1.l(A)(t) Raw Anima) Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* LI-_103 11Person in char e-duties Contamination from Raw Ingredients - - 3-302.11(.4)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection'" a nlicants* 3-302.15 Washing Fruits and Ve stables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Re ort an b Person in Chau�e* 3-306.14(A)(B) Returned Food and Resctviee of Fund* 31590.00341)) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.11 t Manual Warewashing-Hot Water Sanitization Tem eratures* 3 201.12 Fluid in i Hermetically Scaled Container* 4-501.71.2 Mechanical Warewashim* Hot Water 3-201.13 Fluid Milk and Milk Products* 3-202.13 Shelt Eggs* _ Sainuzation Temperatures* _ 3-202.14 E >s and Milk Products,Pasteurized* 4-501.11.4 Chemical Sanitization-temp.:pH, concentration and hardness. * 3--202.16 Ice Made From Potable Drinking Water* 4-601.1I(A) Equipment Food Contact Surfaces and 5-101..11 - Drinking Water from an Approved System, Utensils Clean* 590.006(A) Bottled Drinkin WI . 4-60111 Cleaning Frequency of Egnilzment Fbod- 590.006(B) Water Meets Standards in 310 CMR 22.01 Contact Surfaces and Utensils's Shetffish and Fish From an Approved Source 4-702.1 1. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fuai Oontacf Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Mot Water and 3-207.15 MO(1nSCan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authori 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock.Identification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Came Animals* I7 Good Hygienic Practices Receiving/Condition 2-001.1'1 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package Integrity' . .. mouth* nce it y* .Mouth* Food Safe and Unadulterated* 3-301.12 Preventime Contamination When Tasting- 3-101.11 72 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 3-202.18 Shellstock identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained* Em lovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11n*Destruction* Conveniently Located and Accessible 503.11 Numbers and Ca 3-402.12 Records.Creation and Retention* 2mes* n 590k04(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen acka ring,criteria" Con r 6-301.1'i Hnndwashin Cleanser, Availability 8-103.12 ` formance with Approved Procedures" 6-301.1.2 Hand Drying Provision =Denotes critical item in the federal 1999 Food Cede or 105 Cb1R 590.090. E t CITY OF SALEM I'I BOARD OF HEALTH Establishment Name: GLa 1'rwowa' Date: 3- 41-0,V Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY L lt''I L4 /z�C77d_'-t- i IC,11 ; a162 (,7,4z /NSA,6t7e, sa/�or2r /y<ard� i u s 't A z Discussion With Person in Charge: Corrective Action Required: ❑ No ElYes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I_ J� e 1 B f� �\ �("J / � i{i(�L 2_�-�____ ❑ Voluntary Disposal ❑ Other: 3 / � t� 1 3-501.14(C) PRFs Received at'remperntures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cant.) 41.`F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coo]lna Methods for PH Fs I4 Food or Color Additives I9 PHF Hot and Cold Holding --- ------ 3-501.16(B) Cold P1iFs Maintained at or below 3-202.1? Additives 590.004(F) 41 '145=F ` 3-302.14 Protection from Unap.roved kddttii%es* 3-501.16(A) Hot PHFs Maintained at or above Ij Poisonous or Toxic Substances 140'F. " 7-101.11 Identifying Information-Original 3-50t.I6(A) Roasts Held at or above 13WF. Containers" 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7.201.11 Separation-Storage" 3-501.19 Time as a Public Health Control" 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of lice* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Cnieria-Chemicals* POPULATIONS(HSP) _ 7-204.12 Chemicals for Washing Produce Criteria* 21 3-801.11(A) Unpasteurized Fre-packaged Juices and Be er leges with Warning Labels* 7-204.14 llttimgAgauts.Cineraa* 3-801.11(B) Use ofPasteurized bggs* E7-2 Incidental Food Contact,Lubricants* Restricted Use Pesticides,Criteria* 3-801A I(D) Raw or Partially Caaked Animal Food and Raw Seed Sgrouts Not Served.Rodent'Bait Stations* 3-801.L1(C) Unu ened Food Packa=e Not Re-served. Tracking Powders, Is, Cont and Monitoring"` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatu.as for Animal Foods That are Raw, Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155`F IS Sec. Pathogens.": _'r ,o�e,raonr t s�s-Immediate Service 145'FI iwc:l 3-30213 Pasteurized F„gs Substitute for Raw Strait 3-401.7 1(A)(2) Comminuted Nish.Meals &Game Eg,s* Animals-155'F 15 sea SPECIAL REQUIREMENTS 3-401.17($ r )(1)(2) Pok and Beef Roast- 130F121mhr" 3401.11(A)(2) Ratites, Injected Meats- 1.55'F 15 590M09(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(.A)(3) Poultry,Wild Game.Stuffed PFIF's, residential kitchen operations should be Stuffine Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3 401.I I(C)(3) Whole-muscle,Intact Beef Steals interventions anis risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 4129- Miciowave 165'F* Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-145'F 15 sec. ` I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A l(AA0 Pf]Es 165'F 15 sec. x_ (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the 'Time" foodborne illness inlerventions and riskfactars listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and.105 CMR 14001,* 590.000. 3-403.1 1(E) Rum amine Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts' �23 __ Management and Personnel FC-2 .003 Ig Proper Cooling of PHFs ! 24. Food and Food Protection ._ FC-3 .004 -- - 25. E ui mend and Utensil _ FC 4 .005 3-501-14(A) Casing Conked PHFs from 140'F to 1...-.. . b 'i 26. Water. Plumber and Waste 1 FC-5 .006 70'F Within 2 Hours and From 70'F 27. Ph sical Facllit FC-6 .007 to 41'F145°F Within 4 Hours, * !1 28_ Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling P-1Ma . romAmbient 29. SLecaRe3wrement .009 1 Temperature Ingredients to 41'FI450FJ. 30. Other Within 4 Hours* *Denores critical item in thetederal 7999 Pood Code or 101'ChiR 590.000. � . r Salem Board of Health Massachusetts Department of Public Health 120 Washington Street,0Floor Division of Food and Drugs Salem,MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name Date` Tyne of Operation(s) TvDe of Inspection ® Food Service Er Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone [] jt ( ❑ Mobile Date;p_j2 7-d3 Owner10,79' HAGGP YJN 171 Temporary C] Pre-operation Lzi R as o_ ❑ Caterer ❑Suspect Illness Person in Charge(PIG Time 1771Bed&Breakfast El General Complaint sHACCP g d3 In: ❑ Inspector � e his Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Mon-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) ❑ 5so.eo9(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ..:-: ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - .PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC © 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE. - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ; ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition 1116.Cooking Temperatures ❑ 6. Tags/Records/ACcuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling t PROTECTION FROM CONTAMINATION' 0 19. Hot and Cold Holding El 20.Time As a Public Health Control 918. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations , 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you ✓�27, Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S SWMSPWFFb�-14do pi& ector s Signal re: i1 �_e_ Print: PIC's Signature: Print: \ {` _ c1 ` Q S Page f of Pages y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination_ 1 590.003(A) Assignment of Responsibility+' 3-;02.11(A)(1) Raw Animal Foods Separated hom 590.003(B) Demonstration of Knowledge* Caked and RTE Foods" 2-10111 ��Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2 Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other 2 59C1A03fC) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(4) Food Protection* applicants* 3-302.15 Washim Fruity and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person hr Utensils* Charge" Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Ford* 3 590.003(D) Exclusions and Restrictions" Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe, FOOD FROM APPROVED SOURCE Food* q 1 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law" 4-501.111 Manual Warewashing-Piot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization-tem eratures' 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical W arewashino llot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202-14 E es and Milk Products-Pasteurized* 4-501.114 Chemical Sanitization-temp.,piI, concentration and hardness-'^ 3-202.16 Ice Made Front Potable Drinking Water* 4-601.'11(A) Equipment Faxl Contact Surfaces and 5-1.01.11 Drinking Willer from an Approved Svstetn" 590.006(A) Bottled Drinking Water* Utensils Clean* 4-60111 590.006(.B) Water Meets Standards in 31.0 CMR 22.0* Cleaning Frequency of Equipment Food- 590.006(B) and Fish From an Approved Source Contact of fes and Utensils* 4-702.11 Frequenccyy of Sanitiz<2tion of Utensils and 3-20'1.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish'" 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources% Ip Proper,Adequate Handwashing Game and Wild Mushrooms Approved by * Reulato Authorit 301.11 Clean Condition-Hands and Anus 3-20118 Shellstock Identification Present' 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms` 2-301.14 When to Wash* 3-201_17 Game Animals* LLI Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinkin or Usin*Tobacco* 3-202.11 PFIFs Received at Proper Temperatures" 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Package]ate ity* Month 3-101.11 Food Safe and Unadulterated`" 3-301.12 Prevent.in g Contamination When Tasting* E6Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* r -EEI lovees* TagstRecords: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records-.Creationand Retention"' 5-203,11 Numbers and Ca acities'" 590.004(7) Labeling of Ingredients" 5-204.11 Lavation and Placement* 7 Conformance with Approved Procedures >-205.11 Accessibility, Operation and Maintenance lHACCP Plans Supplied with Soap and Hand Drying 3-502.11. S ecialized Proeessin=Methods" Devices 3-502.12 Reduced oxygen >uckagin ,criteria* 6-301.1.1 Handwashing Cleanser.Availability 8-103.1.2 Conformance witApproved zroved Procedures* 6-301.12 Iland Drying Provision I 0enotes criucal dein in the[edeia]1999 Pond Code or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH �t w Establishment Name: _I,nu.r Vla el,wl... Date: - a 6, -04/ Page o� of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified --PLEASE PRINT CLEARLY — /1 ¢ / o / 4,444-441"' P� / /t o v.IV o Z // N"i.t'P rYgC 1 ✓ / . / / rA • 2 / r� n ,m /o rL i l cYn r — n 0 C� �7 t - i.v A /tea / r f 4,&c...0 p p / s _ � rt 2 3Z62 W / �! / / \ AZ �< 4 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes f , r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five--dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. LlVoluntary Disposal LI Other: d t 3-501.14(C) PHFs Rece.ivedat Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cowled to Factors(Items 1-22) (Cont.) _ 41'F145"F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.11 C xiliuMethods Tor PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004ff`) 41°!45'Fl` 3-302.14 Protection frout Unapproved Additives* 3-50116(A) Hot PHFs Maintained at or above jj Poisonous or Toxic Substances 140°F. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above ]30�F. Containers"` 7-102.11 Common Name-Working Containers* 20 I Time as a Public Health Control 7-201.1.1 Separation-Stott e* 3-567.19 Tineas a Public Health Controlx 7-202.11 Rtriction-Presence and User 590.004(H) Variance Rcc mrEment 7-202.12 Conditions of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 9-2031.1 Toxic Cinuainers-Prohibitions* POPULATIONS(HSP) 7-204.11 SanitizemCriteria-Chemicals* -_ ---- 7-204.12 Chemicals for Washing Proxluee,Criteria* 21 3-801.1.1(A) Unp st.euriy-cd Pre packaged Juices and 7-204.14 Diving Agents.Criteria* Betemees with Warnim, 1.ahels* 3-801.11(B) Use of Pasteurized Eggs" 7-205.)1 Incidental;Food Contact,Lubricants" 3-801.11(D) Raw or PHtially Cooked Animal'Food and 7-206.11 Restricted Use Pesticides,Criteria* ff�71 Rodent Bait Stations* Raw Seed Sprouts Not Served. TruckingPowders, Peat Control and 3-8011.1(C) tJnor.enefl Food Pucka�e Not Ro-servecL"' Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Anirml Foods That are Raw. Undercooked or 16 Proper Cocking Temperatures for Not Otherwise Processed to Eliminate PHFs r,."r aunr 3-401.I1A(1)(2) Eeeti- 155'F In Sec. Patlnoy`tns EL,n-immediate Service 145'Fl9sec-s 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3-401.1 1(A)(2) Comminuted Fish.Meats&Game E998* Animals- 155'F 15 sea * 3-401.11(13)(1)(2) Pork and Beef Roast- 1.30°F 121.tnin` SPECIAL REQUIREMENTS 3-4011 t(A)(2) Ratites, Injected Meats-155°F 15 590.009(A)-(D) Violations of.Section 590.009(A)-(I))in sec_ * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Conlaining Fish,Meat, debited under the appropriate sections Poultr or Ratites-165'F 15 sec * abov-cif related to foodbarne illness 3-401.11(C)Q) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F 91 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Crooked in a practices should he debited under 1129- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) Ail Other PHFs--145'F 15 sec. LF 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-A01.11(A)&(D) PHFs 165'F 15 sec. " (Items 23-30) 3-403.11(B) Mia owave-165'F 2 Minute Standing Critical and tion-critical violations, which do not relate to the Time* foodborne illness bnerventions and risk factors lisreel above, can be 3-403A I(C) Commercially Processed RTE Food- found is the fottowing sections of the Food Code and IUs CAIR 140'F* 590.000. 3403A 1(E) Remaining Unsliced Portions of Beef + Item , Good Retail Practices FC 590.000� Roasts* 23. M_anagemant and Personnel FG-2 .003 lg Proper Cooling of PHFs 24 Food and Food Protention_- FC-3 .004 25l �tIs FC 4 .005. FC-5 006 ..3-50L14(A) CoolgCooes 14 ' . .Water inefand Waste 2loH and From 70'F 2Phsia1 Faciltv FC-6 .007 to 41'F/45'F Within 4 Hours. * 28 Poisonous or Toxic Materials FC-7 .008 3-50114(B) Cooling PHFs Matte From Ambient i 29 Special Requirements .008 Temperature Ingredients Co 11°Ei45`F �30 Other _ ____ -------- ----.-__- Within 4 Hours" s:=r�:o,oa.,ewz ax *Denotes critical irmi in the fc&rsl 1999 food Code or his CNIR 190.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: tllew"tr, Date: R r—<J Page rte _ Of OIL Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION � :' Date No. Reference R—Red Item , " Verified r -PLEASE PRINT CLEARLY - <f i 2 iti �d PS 7 15 �' 2 o Gn a/41 YK 4e.2 I CA212 1 -7- n, r �S Sz 1 24 s / a e s� ra PRO gil SAS w/ ,1 ',, lis PC l/ . .U, oif �✓� L d C� �L/ P /n/ r h db'aP Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I hive read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p 11 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five-dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: 3-70114(C) PH FsRover vedat'Cetnperatu-es Violations Related to Foodborne Illness Interventions and Risk Accordinv to C,aw Cooled to Factors(Items 1-22) (Cont.) _ 4I`F/a5'F_Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Col ne Methods for PHFs (4 Food or Color Additives 19 PHf Hot and Cold Holding 3-202.12 Addifne 3-501.16(B) Cold PHf. Vlaint'airred at or below 590.004(F) 41'/45°F'- 1-302.14 Protection from Unar roved Addwves'" q_gpt 16(,1) Hot PRFs Maintained at or above (j Poisonous or Toxic Substances 140`17 7-101.11 Identifying Information-Original Containers" ;-SOi.lfi(A) Roasts Held atarabove 130'F. * 7-102.11 Common Name-Working Containers" 20 Time as a Public Health Control 7?Ol.l l . eq aradon-Storage Thne as a Public Health Control 7-202.11 Restriction-Presence and Usc;'k 590.004(H) Variance Recuiroment 7-202.12 Conditions of Use* 7-203.11 Toxic containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sonit zers.Criteria-C'henricals* POPUL IONS(HSP) ?-204.13 Chemicals for Washing Produce,Criteria* 2( 3-801.11(A) Unpasteurized Pre-packaged Juices and Bee=emacs with Warman Labels* 7-204.14 Divine Agents.Criteria* 3-$01.1 l(B) Use of Pasteurized E3as* 7-205.11 Incidental Food Contact,Lubricants` 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1.1(D) Raw or Partially Cooked Animal Food and 7-M6.1.2 Rodent Bait Stations* Raw Seed Sprouts Not Served 3-80L11(C) Uno aened Food Paeka=e Not Reserved. "' 7-206.13 Tracking Powders,Pest Control and Moni torin>* CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or (6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155'F 15 Sec. Pathogens Legs-Immediate Service 145 FI5sec" .3-302.13 1 Pasteurized Fogs Substrate lot Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Animals- 155'F 15 sec. * 3-401.11(11)(1)(2) Pork and Beef Roast- 1.30'F 121 min* SPECIAL REQUIREMENTS 3-401.7 1(A)(2) Ratites, Injected Meats-1.51°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(I))in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'1715 sea * above if related to foodborne illness 3-401-11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145`'F* 590.009 violations relating to good retail 3=10112 Raw Animal Foals Cooked in a practices should be debited under##29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) Ali Other PHFs- 'l45'F15sec. * (7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,1.1(A)&(D) PHFs 165-F 15 see. " (Items 23-30) 3-403.11(3) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and risk fiactots listed abate, can be 3-403.11(C) Commercially Processed RTE Food- found in the folloning sec tono, of the Food Code.and 105 CMR 1400F' 590.000. 3 403.11(E) Remaining Unsliced Portions of Beef Item i Good Retail Practices FC 590.000 Roasts* _23 Management and Personnel FC -2 .003 (g Proper Cooling of PHFs 24. _ Food and Food Protection_ FC--3_ 004 25. 1E ui ment and 4 005 3-501.I4(A) Coaling Cooked PHFs from 140 17 to g F Utensils _ F.. _ 26. Water,Plumb�n and Wasfe IFC-5 -006 70"F Within 2 Hours and From 70°F 27. i Ph sica Faoilit ff-6 .007 to 41'F/45'I'Within 4 Hours. * _28. 1 Poisonous or Toxic Materials FC-7 .008 Y 3-501.14(11) Cooling PRFs Made From Ambient 29 + Sped al Requirements __ _ ._009 Temperature Ingredients to 41'F/45'F 30. Other Within 4 Hours* S *Denotes critical item in the tederal 1999 Foal Code or 1W CMR 590.000. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS. CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Giorgio Manzana Name of Establishment : Bella Verona Address of Establishment : 107 Essex Street Type of Establishment : FOOD SERVICE Application Date : 12/24/2002 Restrictions : Permit for Food Establishment 155-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT b; CITY OF SALEM, MASSACHUSETTS o}' BOARD OF HEALTH a a 120 WASHINGTON STREET, 4TH FLOpR SALEM, MA 01970 DEC 2V�y 2002 TEL, 978-741-1800 FAX 978-745-0343 BOARD '.,,�,J-,7,-L_iV{ STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BO/nRD Of HEA--LTH MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT b e l l ct V e 1'0 ,n/ A TEL it c! I ADDRESS OF ESTABLISHMENT t Q I SSS )C S-f aa.I� vi t�,ci MAILING ADDRESS (if different) OWNER'S NAME ' OC' rO S} tqon -z�t� c� TEL# r19 7-H -7I90 ADDRESS 11j ee- o P S ^) CITY A. L t STATE PIA ZIP OJ 1 2 CERTIFIED FOOD MANAGER'S NAME(S) r, IV ctn ncCERTIFICATE#(s) l `I 27:�l (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Pr )A " f c, A) 7"/JYS HOME TEL# q 7 7 7 I Y- N-1f y-/ '4-10 y-10 y-11 4NI HOURS OF OPERATION: Mon.—Tue. Wed._Thu.—Fri,—Sat.—Sun, �� _ TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO ! �'�'� less than 25 seats = ?0:> 25-99 seats =$ more than 99 seats BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bel rr}}ppwled o and belief, have filed all state tax returns and paid all state taxes required under t e law. �.[A t 1,Q9G 11r:_.1r� C-v-r� 12- _! q _0 ( qs 0 Z- _ (?1. 5-1 `; -G `f () �r Signature Date Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm �^Check#&Dateaib V 7- /a 0 vg�co CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ ® 120 WASHINGTON STREET. 4TH FLOOR to g' SALEM, MA 01970 ltd �` L TEL. 978-741-1800 FAX 978-745-0349 MAY 13 2003 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT Gil"'i OF SALEM BOARD OF HEALTH QUESTIQNAIRE - GREASE TRAPS (please complete and return to the Salem Health Department) 1. NAME OF ESTABLISHMENT: ----- L`- ------(Z6&Al d---------------------------- 2. ADDRESS OF ESTABLISHMENT: ---1-U -SSX-- D7. ------------------------------ 3. DOES YOUR ESTABLISHMENT HAVE A GRASE TRAP? ----------�� -- ---- —---------- ---------- 4. WHAT SIZE GREASE TRAP DOES YOUR /ESTABLISHMENT HAVE? -----—------------------------- CAPACITY IN GALLONS----A—-6---4AILGDN------------------------------------ 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? ----------------------------------------------------- =- -�1 �s -3 +? t �I hD v5 ' �-`-------�----------`------------ 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP?-------------- - ----T------------------------S--------t4-U- --------------------7-------------------- -------------------- 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? -----------—-------------—----------------------------—-------------—---------- -----------------------------------------------------------'- QT_-/AII.----------------------------------------- 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? ----------------- -------------------------------------------------------joT l/ (if not available,request that a copy be sent to the department within 7 days) CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR >¢ SALEM, MA 01970 TEL. 978-741-1800 FAX 978-.745-0343 STANLEY USOVICZ, JR. " JOANNE SCOTT, MPH RS,.CHO MAYORHEALTH-AGENT - - IIV)' MAY 13 2003 5�J CITY OF SALEM BOARD OF HEALTH April 30, 2003 Bella Verona C/o Giorgio Manana 107 Essex Street Salem, MA. 01970 Dear Mr. Manana: Please fill out the following questionnaire upon receipt and return it to the Board of Health as soon as possible. Also, please take some time to remind your employees the function of the grease trap and the reason it is used. Thank you for your time. If you have any questions please call me at (978) 741-1800. Sincerely, Jeff Vaughan Salem Board of Health 2 enclosures SOUTH ESSEX FACT SHEET SEWERAGE DISTRICT MARCH, 1997 RESTAURANT GREASE The South Essex Sewerage District(SESD)is responsible for collecting and treating wastewater from homes and businesses in Beverly,Danvers,Marblehead,Peabody and Salem. To do its job correctly,the District must regulate what goes into the sewer system not only to protect the environment, but also to keep the system's equipment working properly. The SESD Monitoring&Enforcement Division administers the District's Industrial Pretreatment Program that regulates the discharge of wastewater from the District's various businesses. Because grease is a major problem in parts of the sewerage system, the Monitoring and Enforcement Division has developed this fact sheet to explain how restaurants can help reduce the amount of grease that enters the sewers. $$ Thousands to Clean Grease $$ Every year communities in the South Essex Sewerage District spend thousands of dollars cleaning grease blockages from its sewer system. The cost is measured not only in dollars -- more than$1,000 per incident--but also in the threat to public health when sewage overflows occur. Grease causes sewer backups two ways:when grease builds up inside sewer lines,it restricts the flow of wastewater, and when grease binds with human waste, plastics or food it forms "grease balls" that can grow to the size of basketballs. They not only block pipes, but can harm other equipment in the sewer system such as pumps and valves. A Preventable Problem A significant amount of grease enters the sewer from restaurants. Restaurants spend thousands of dollars each year cleaning grease out of their own sewers,money that could be used to invest in preventive measures. Keeping grease out of the sewers can be done with equipment, regular cleaning, and good kitchen management practices. Equipment is Required The state building code, enforced by community plumbing inspectors, requires that grease traps be installed in restaurants on all plumbing fixtures where grease can enter the sewer and cause a blockage or hinder sewerage disposal. Traps collect the grease before it goes down the drain by using the basic principle of gravity. Since grease weighs less than water, it floats. Equipment is available in a range of sizes and costs. The proper size for a grease trap will depend on the rate of flow of water through it. The cost for a basic grease trap can be several hundred dollars while the cost of a more sophisticated grease trap can be several thousand dollars. r Cleaning is Required To do its job once a grease trap is installed, it must be cleaned regularly. Restaurant owners and/or managers are responsible for the cleaning of their traps. While cleaning a trap is not the most attractive job for a kitchen worker, the more often it is done,the easier it is. How often a trap is cleaned depends on the size and how much it is used. It could be daily or once every six months. The rule of thumb is to clean the trap if the grease layer is one inch or greater. Grease is easier to remove when'it is cold. It is suggested that traps be cleaned in the morning when the liquid in the trap is cool and grease separation is complete. When cleaning, solids --food scraps--that build up inside the trap must also be removed. If they are not,the grease will stick to the solids and be carried into the sewer. Some c\ampanies sell enzymes, bacteria,emulsifiers and other additives to "break down" grease in a trap. These additives typically reduce the size of grease particles making it harder to retain it in the trap. Therefore, they are not recommended as a substitute for physical cleaning of the trap. Grease Prevention Good kitchen management practices can prevent grease problems before they happen. The amount of grease in the drain can be reduced by doing the following: -scrape food scraps into a garbage can before plates are washed -allow hot liquids like broth to cool so grease will solidify; it can be removed and disposed of with other solid waste store grease and oils away from floor drains -train employees to prevent oil spills -allow fry baskets and filters to drain thoroughly over fryoiators before washing install permanent strainers on kitchen sinks to keep food out of drains *use garbage disposals only when absolutely necessary;garbage should be collected and disposed with other solid waste -do not clean pots,pans or other utensils in sinks without grease traps -collect used cooking oils and dispose of them properly-do not dispose in drains For more information on this topic, call one of the numbers listed below: South Essex Sewerage District Mark Allain(508) 744-4550,ext. 122 Salem Public Services Dept. -Michael Collins (508) 745-9595 Salem Plumbing Inspector-Dennis Ross(508) 745-9595,ext. 387 Salem Board of Health-Joanne Scott(508) 741-1800 ffle:enforcelgrease2 a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT April 30, 2003 Bella Verona C/o Giorgio Manana 107 Essex Street i Salem, MA. 01970 Dear Mr. Manzana: Please fill out the following questionnaire upon receipt and return it to the Board of Health as soon as possible.,Also, please take some time to,remind your employees the function of the grease trap and the reason it is used. Thank you for your time. If you have any questions please call me at(978) 741-1800. Sincerely, i Jeff Vaughan Salem Board of Health i L 2 enclosures 1 1 1 fTHE COMMONWEALTH OF MASSACHUSETTS OF 1-ki G/ fi Board of Health FOOD ESTABLISHMEN INSPECTION REPORT Tel. Name / Date Type of Operation(s) Type of Inspection /f �}� (/ El Food Service El Routine Address C �.-i-.., Risk ❑ Retail ElRe-inspection J Level ❑ Residential Kitchen Previous Inspection Telephone , (j� _ c/f f dr / / ❑ Mobile Date: Owner AC /` HCP Y/N El Temporary ElPre-operation l ( G' {VX1n ,/ 'Y-.� ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint f'" � � C In: ❑ HACCP InspectorI, ( ( Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURECONTBOLS(Potentially.Hazardous Foods) ❑ 4. Food and Water from Approved Source El 16. Cooking Temperatures ❑ 5. Receiving/Condition El 17. Reheating El6. Tags/Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. }( 30. Other DATE OF RE-INSPECTION: Inspector's Signature: PIC's Signature: _ \ Print: Page/of $ages FORM 734A(REV.7/2000) HOBBS&WARREN, INC -BOSTON This FormApproved by the Massachusetts DE]13nmCtll Of Pllb)IC Health Violations Related to Foodborne Illness . . 1 Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION ~ 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assi nment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.1.1 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE g Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.1.1 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 TagstRecords:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* r13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(]) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 washing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. BOARD OF HEALTH o- Establishment Name: �a /� (��/l'��`/ Date: G/ �� `—� Page: of i Item' Code C-Critical itemDESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—RedItem' _ a PLEASE PAINT CLEARLY' Verified i lav /�7�J/�c�r��'} �L,.,.--f ,��.✓/.�� .�- !C9�C.�5 r F _ I I /l(-� tri'1�z-�,•��zsh;r �I S� /?U-'l -7 h� 1�?C.�''C' �, �Gc" i _, � � R az I .17�U.?( ^iC-.- { -(1r,t^=�-/'��f.'1' .' fi � �� //� f15/r'9 ri _d`"f,� J-=.•�.�C. ''I CY�/�• // (JE >7 r-,Oecr-( cz,(,,'2 3 Discussion With Person in Charge:CZ c _ Corrective Action Required: ❑ No O Yes ❑ Voluntary Compliance ❑ Employee Restriction/ .0l L.. — C-.-^'� - _ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension r ❑ Embargo ❑ Emergency Closure )t \ Pt kql, it f to G",iv ��:.0-tom. � V -❑ Voluntary Disposal ❑ Other FORM 7348 (REV. 7/2000) HOBBS a WARREN, INC. - BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41*F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives LL9 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(6) Cold PHFs Maintained at or below 3-202.14 Protection from Una roved Additives* 590.004(F) 41*F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°E* Containers* 3-501.I6(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Critena* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(6) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EBectiv 111�2001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145*F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(6)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from I40°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Cooling PHFs Made From Ambient29. S ecial Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �„t,-•. �.: �:r+--.^��'4 .Y,-...h,w�s��ara1."'�.-s�`ti^,.,�e:N.'l�;+m�1`}.,.�..`n#..-,r9.amu' �y„b'P:,�v�,� stir,,?..A,;�nyYli•r ♦ ...?...�.a�hh,:�&-.� iiC1'assachusetts Department of Public Health 120 W Board S Health ashington 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name , Date Tvoe of Ooeration(s) Type of Inspection 1, (yVl Q` 1-14- 10 8 Food ServiceRoutine Address Risk EtRetail D Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ,� 2 /_ E] Mobile Date: Owner 7dLJ El Temporary ❑ Pre-operation HACCP YM P� ( ❑ Caterer ❑ Suspect Illness Person in Charge(PI CJ ( Time vV 4M E] Bed&Breakfast ❑❑ HACCP General Complaint In. Inspector ��ti� Out: Permit No. ❑Other Each violation checked requinits 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-Chokin9 Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 590.009(F) �I action as determined by the Board of Health. / FOOD PROTECTION MANAGEMENT;m '• �("� �[ ,'„ , ! � ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 4 r �13. Handwash Facilities EMPLOYEE HEALTH rPROTECTIONFROM CHEMICALS"" ❑2. Reporting of Diseases by Food Employee and PIC - »a _ -• »» - - • �- m�ti » ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [115.Toxic Chemicals 9m FOOD FROM APPROVED SOURCEE,�.„m„u"„„»„ ❑ 4. Food and Water from Approved Source �`.TIME/rEMPERATURE CONTROLS(Potemialiy Hazardous Foods) #'fl 6'» � .A.»..o ...a E] 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling g'PROTECTION FROM CONTAMINATION �;�, " "°` �`""`e El 19. Hot and Cold Holding » ' TI ��❑ 8. Separation/Segregation/Protection El 20.Time As a Public Health Control V. Food Contact Surfaces Cleaning and Sanitizing f REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)° � ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing 11. Good Hygienic Practices ;CONSUMER ADVISORY El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(500.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.00a4)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(5so.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.067) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(51,).,,6) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. n 30. Other (1 r 0 ' /1DA/TEE OF//R�� r E-INSPECTION:- „ �, 5:5901nspaclFo,m614 Cx �/'`^^ V VV\ � Inspector's Signator /�l D _ Print: ( ,-/ _C PIC's Signature: ® 0 r •t Print: rY Page of P'a _ 1 r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION _ FOOD PROTECTION MANAGEMENT S Cross-contamination 1 59(1-003(A) Assignment of Res onsibility* 4-302.11(A)M Raw Animal Foods Separated from 590.003(6) Demonstration of Knowled e"` - Cooked and RTE Foods* Z103.1'1 Person in char e-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Anirrutl Foetus Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Foci Protection* _ applicants* 3-302.15 Washin Fruits and Veetables 590.003(F) Responsibility Of A Foul Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Re ortin b Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanifization'rent eratures* 3-201.13 Fluid,Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 lee Made From Potable Drinking Water* concentration and hardness. * 5-101..1.1 Drinking Water from an Approved System* 4-60111(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(13) Water Meets Standards in 310 CMR 22.04, 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* SheiNish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Her Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Han dwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1.1 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Tem erahnes* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Ihte it y* Mundt* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* - 3-402. Records,Creation and Retention* 5-204.11 location and Placement* 590,004(4(1) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Pians Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Land Cleanser, Availability 8-103.12 Conformance with Approved Procedures* b-301.t2 Hand D 'n Provision -0 Denotes critical item in the federal 4999 Fond Code or 105 CMR 590.000. CITY OF SALEM _ BOARD OF HEALTH Establishment Name:P_AO i \ )� A ,,,n /;Q Dater -IU--Ir_ Gh` Pager of I Item Coca c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date; No. Reference R�Red Item _ Verifled� ; { PLEASE PRINT CLEARLY /0 _� .V'/� 1.7, 1.A' i A �i-X/ r� L! ,nn l• i. rr, nX a WIX X1 nil 1111�IJJ x^1.4, � Z, `.Y-YA.!. la: r r� �_ c_ n rte/ IL^_I 441 �\ 4� # A„0,0'/. X �ry�/ L��D ~`/_,� ( n�\ ,/_PON �//`n-.TI U./I ./1 Lt//Jl e,ti •-- ! I � Y1,I QV-Jw I\� r)V t� , v nn 3 O,,\M � SCA o n� n n _ 4A 0 ti I M(IIA.l n k/1 �I '77ie. i,4 , � '-fir Nei'�,1� �vl 11 f1�an,,,A ( 0 Ilc�.n'/Anl^ CInn "(2 —�oi .-1/1.-c--7 n -/�i_n.t.�v�/r�. - 1�a - ,YJt e /��U�)'�j /Jra AU� 1C> i v f{�' I/ / �'✓t4— r� 1)�u��lry _ OF'.nNI (_�O `` /p h } 1 l ,/R/ `I_%( ,/O s1hM ' q/\M rYin r.00/1� AA/n.. ln... _ /1 /� 10Q i CA<1 TA,L- t "..(. AA j /l--t r tl v Discussion With Person in Charge: Corrective Action Required: L3 No I have read this report, have had the opportunity to ask questions and agree to correct all �/I voluntary Compliance El Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion P comply with all mandates of the Mass/Federal Food Code. I understand that D Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ other: J a ♦ \ ?-S1i7.1A(C;} PHFs Received at Temperatures Violations Related to Foodborne iffness Interventions and Risk According to Law Cooled to Factors(1teMs 1.22) (Cont) I I°F/45"F Within 4 Hours_" PROTECTION FROM CHEMICALS 3-501.15 Coolin,,r Methods for PHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 4501.16(13} Coll PHFs Maintained at or below 3-20312 AdclitncO 590-004(F) 11 14S f 3-301 4 coon front Llnappro;�ed 0.dditives"- j - 'l 3-SS)1 16 Aj Ifni PHFs 4taintamed at or above I-S Poisonous or Toxic Substances 4UE '-LOI.I l ldenmttt lnfr,zinatn n--Ori ±o'u a' Contvners'� _� � � r Stil Ir' � Roasts Held at or :hove 130,'F. *_ r 1 ? 102 11 ' Common'Name 43 rkir,C w a + r.* I A � - + T+me as a Public Health Conttot }-- _� Lk;7�-=.,ii myucnSiFnt vRecuirt.nrcnrvia t�; v __C.omilli + of Us1 Fxi f o rt nner Pcolr hr.ions$ REOUIREratMENTS FOR HIGHLY SUSCEPTIBLE Satrivets Give tr Chc ncals POPULATIONS Zi7 t Snl ' i(A)— , - G! RtwY Pa aF akcd licev utdi 7-204,12 104.14 + es tatth %kanm i ti(riFeriaS ---j Y- rl(14 tip o t,taii ed + I t hrnt .ut ai 1 xx'( otr a Luh CrWs --- - — --.� P-wor a�n mliv Ctori,.dAunralFocxlaod ! t u Pc ,rrir C. +ft i + Ra St d groat, ti<F S,. vvd. i 7-)06.12 1 1,,x t b + S +Uaxn _ -� 1- r'_fJC>.7 . I„vn; .1,Pa,r;i a'-..r'.t,itr,' and „ ;1 r+rf �4r i cR f uad Pz_a� Ai<i R crv�cL '_.___1 ! ---._- --- � -n _.T._ ._ _- -----_ _-� CONSUMER ADVISORY _ TIMFU TEMPERATURE CONTROLS 2.,. 3 LJ F ( <orrsum i 1` ;sor4 P ,cd ka-Crnr mnptir+tt r-- ----- - - -- .+ ! vaalt and tht u< t„t , l6 F Proper Coak ng Temper rturEs ror 1 1 tics esv i :',, fn, 16! H 1(i Rant Slr't _ Ar m is ;» r r _ _� 401.1 TAO ryFot +rdl 4 Roit Cr t laimrn" . SwECIAI€�ct�trrRrPvtr'Pk+ S -_ __. .- - -t - -- - -- iVij,it; >u r, so",.i";t. :Si-(R, :ii,a F iJl.i ENE ., k. a injt" ,t tit ata - t iti - 1 3 �3 401_IIFA 0Z P,r; ,, lWd Gaie STU !111'1 s. I F .asiu^n +l }'tc(n"i �t t ntrtrs lr,snl.i ns `;,.,, nln ,Cor ,ilm, 10L�azl icbif- t. tiadcrthe 11.1arr,,a,p,rrt ¢ ins , .,. P, I? F Reltca'rng ter Prot r+ ! IM” V0LAPCJNSS RELA I'�_.. TO-00D FeF'Tf:R PRACIYOFS 11111 rG. `1 115 wu, i (llemf 23-301 1buw"av,- Its F 101au SFA r{Flt; C'+r r r.�i r r r--ni , n - ti rt r0 .a; r+ v, nc im _ , . -- . 7 r <rr.ra :?t t r F F+-r,rt n,. �,te�Fr,rlcu,i: <t�r�l ? ..C,It? Sr i(C) (on mereia,l. k'nn..,ed ,,f } sia- Frit....t r, n� IC 463.11(( i i Rc rajmn,;l n:Dred of is,rl 4_ttenF t Coed RotarPrn-trces FC { 530.000 a 1 1i raSK - , ttT i+lf? irtif di"2r on-,! i F,.: 003 Zino PruF 4VC t ri!Cooling 1ctuPHF u) t nFin r 225, E-ui s r iP incl t,2e s,a r C_ r t OP i 504 2rVA) C ixdtna Cfx+k d 11141's l-ow I 14)'l to , +- j U r f n 'ax F E rlC-7 00 U0f3 �_-i_ _JL 4rfii ( t oolira NiFk 1i.Ic Foiu Ambi, -. i 1 Ta.rnp.-+awre G.Ured.cwu rc l5 F I Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date- TVDe of Operation(s) TVDe of Inspection is � � Pn r� -4:- [l��od Service © Routine Address ` _ Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ro C3 Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation l rJP� fq2-ovi ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)J Time ❑ Bed& Breakfast ❑General Complaint In.t ❑HACCP Inspector nC G a Out: ✓ Permit No. ❑Other Each violation checked requires an expla ation on the narrative page(s)and a citation of specific provision(s)violated. Noncompliance 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) 0 action as determined by the Board of Health. ,' pwtm0 FOOD PROTECTION MANAG€MEN - El 12. Prevention of Contamination from Hands 1 PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH ,. ❑ 13. Handwash FBCIIItieS PROTECTION FROM CHEMICALS_. ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded _ El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE_ °_ � ____ _ ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION , ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATION$(HSP); El 21. Food and Food Preparation for HSP E] 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related El Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations.must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C "N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(e90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food �( 26. Water,,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing ° 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF o�RE-INSPECTION: S.5BOIns�FomK14.tloc 0 V U Inspector's Signature: X. Print: PIC's Signature: I ^in j( I` /'�.I / , �" /� _��r -Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.1](A)(]) Raw Animal Foods Separated from 1 590.003(A) AssDemonstratnmention ofResponsibility* of Knowle i -*� Conked and RTE Foods* 590.003(B) Demonstration of Knowledge" Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.1.1(A)(2) Raw Annual ponds Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(0) Responsibility of the person in charge to 3-302.11(A) Foal Protection* require reporting by food employees and 3-30215 Washina Fruits and Vegetables applicants* 3-304.1 t Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting y b Petson in Charee* Disposition of Adulterated or Contaminated 31 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.1.2 Food in a Hermetically Scaled Container* Sanifization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashmg-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water" concentration and hardness.* 5-101.1.1 DrinkingWater font an Approved System* 4-601_I1(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drmlcin Water* Utensils Clean* 590.006(.B) Water Meets Standards in 310 CMR 220* 4602.11 Cleaning Frequency of Equipment F od- Shellfish and Fish From an Approved Source Contact Surfaces and U'tensils't PPr 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-70311 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP tasted Chemical* Sources" ]0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 ReceivingfCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Lite,it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin ,. 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 1 590.0 M(E) Preventing Contamination from 3-203.12 Shelistock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-002.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* 7 I Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Pians Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved procedures* fi-301.1.2 Hand Dryin Provision *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. CITY'OF SALEM l BOARD OF HEALTH _ Establishment Name:L .� Date: l7 'I Page: C;� of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date NPLEASE o. Reference R-Red Item PRINT CLEARLY ��ivi� vermed 1 L OK- / �?/1/VI tJVt is CAS) (twd "'O/"A, P0 Cid Cir io n v i h �\ I I r � .'t l� Y .�e A"�, '_ ;�'ri 'a�✓w r!�.Pn-�r �JJ ,J pil �� T(4 �/1 Q t. ) 6E� r_A)o ,Z, v D //gy�p0 f - M „ - � zu .�A r Dn . ��,x elL / yY\ \ 7\r/G- �71 0 TU uiv� .P. ncrx� te,� . -Ain 1 L YU f�"" I ✓9i, Y DSI (11 �-,41�,0r� �G "�A Ul O. L l —rte t t)� n �'1 1 n:,,? Y 2 'Y,r,: Y' x, k C t, i� r: Discussion With Person in Charge: Correc a Action Required: ❑ No ,Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ VoluntaryCompliance El Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federal Food Code. I understand that 13 Re-inspection Scheduled L) Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. X' % 0 Voluntary Disposal ❑ Other: 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne 111ness Interventions and Risk According to Taw Cooled to Factors(Items 1-22) (Cont.) 41.°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 -Cocling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41°/45°F* 3-302.14 Protection from Unapproved Addiuves* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PRFs Maintained at or above 1400E* 7-10].11 Identifying Information-Orignal 3-50Ll6(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* Time as a Public Health Control 20 7-201.11 Separation-Stora e* 3-501.19 Time as a Public Health Control° 7-202.11 .Restriction-Presenc:eandUse* 590.004H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUiREMENTSFORH{GHLYSUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wannin Labels* 7-204.14 encs,Criteria* 3-801.11B) Use of Pasteurized E °s* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or PartiallyCooked Animal Food and 7-206.11 -Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served 7-206.12 - Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEtfEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooling Temperatures for Ani mat Foods That are Raw.Undercooked or. PHFs Not O ens.'sEProcessed to Eliminate 3-401.]IA(1)(2) Eggs- 155°F 15 See. Pathogens.* Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Pork and Beef Roast- 1.30°F 121 min* 590.009(A){D) Violations of Section 590.009(A) (D)in 3.401.11(A)(2) Ratites,Injected Meats-1550F 15 sec.* catering, mobile food,temporary and 3-401AI(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 340131(A)(1)(b) All Other PHFs- 145°F 15 see. 17 Retreating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.403AI(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(0) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000, 3-403.11(E) Remaining Unsliced Portions of Beef Nem I Good Retail Practices .FC 590.00o Roasts* 2i 3. anagement and PersonnelF� C-2 _ _003 ]g N Proper Cooling of PHFs 24. Food and Food Protection I FC-3 .004 25. Equipment and Utensils I-FC-4 _005 1-501-14(,A) Cooling Cooked PHFs from 140°F to 26. Water,Plumbirin and Waste FC-5 .006 70'F Within 2 Hours and From 70°F 27. Physical Facility FG-6 .007 to 41°F/45°F Within 4 Hours.* 26. Poisonous or Tonic Materials Fr 7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Mud Requirements .009 Temperature Ingredients to 41°F/450F 30, 1 Other Within 4 Homs* *Denotes critical imm in the federal 1999 Foal Cotte or 105 CMR 590.000.