BELLAS DOGGIE WASH - ESTABLISHMENTS Bell Cs Doggie-Wash
247 Jefferson Avenue "
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SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/30/2007
ESTABLISHMENT NAME: Bellas Doggie Wash
File Number:BHF-2007-000005 30 Cabot Street
SALEM MA 01970
LOCATED AT: 0247 JEFFERSON AVENUE IST FLOOR
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
RETAIL FOOD BHP-2007-0390 Jan 29,2007 Dec 31,2007 $50.00
Total Fees: $50.00
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 t
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH RECEIVED '
120 WASHINGTON:STREET,'4TH,FLOOR
SALEM, MA 01970 s +r JAN 2 4 2001 ` }
TEL 978-741.1804
FAx 978-745-0343 CITY OF S -EnA
Kimberley Driscoll www.SALEM.COM BOARD Cir HER1-T1!
Mayor JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT PJfl(i �,r4 f I JCL aV v TEL#-.Q7RR` 7qS S7�F57J
ADDRESS OF ESTABLISHMENT ar7 \�: Y1 - FAX#
MAILING ADDRESS(if
different)
EMAIL--Business'� a��Ysn(�4S hZ� Owner's:
OWNER'S NAME t7JLt)t!\ TEL#
ADDRESS 'ZD CA b0-I' &k Sfi G?AAA ILA A - Olq '-7(�
STREET CITY STATE ZIP
CE11 FIED FOOD MANAGER'S ME{S} C TIFiCATE#(S)_ —N�—
(Required in an stablishment where potenkial -hazardous food is prepared] \) /} \
EMERGENCY RESPONSE PERSON :kt ,in i� Qr-0t,0Y1 M( TEL# t �e �!
OATSOFOPERATION _ Monday Tuesday"' Wednesday Thursday Friday Saturday Sunday
HOUR$OfOPF-RATION !
Please write In time ofdall. /0/
�(�� � `T 5' - 10 - 7IQ— � 16 "" fQ
(for example llam-11nm1
TYPE OF ESTABLISHMENT FEE (check onl
RETAIL STORE E NO less than 1000sq.ft.
1000-10,000sq.ft. =$100
more than 10,000sq,ft. =$250
.................... .. ...... - -----N -- -- -------- ---------- ------- .._...... ... - - 5- - ,at-s ...... - - ...--
RESTAURANT YES NO less than 25 seats =$100
2.5-99 seats =$150
more than 99 seats =$200
- ..._..... E..S.. - .... -
- -_._..--- ---------$-100--..---------_ --- --------._--- -
BEDI6REAKFAST YNO
.. - - - - - ___..--...__.... - - ----- .... _ _ _
.. ........... ... . ..... -----------..... _.._.............. ....._.,...
ADDITIONAL- PERMITS -
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES N $50
ALL NON-PROFIT(such as church kitchens) YES 0 $25
*Please pay total with one check payable to the City of Salem. O_0
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 underthe pains and penalties of perjury that 1, to my best knowledge and belief,
have,filed all state tax returns and paid all state taxes required under the law. - - - -
b{ignature pate Social Security or Federal Identification Number
--------------------------- -----11------- --------------------------- ---- ------ - ------ - ------
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Massachusetts Departmentof Public Health Salem Board of Health
120 Washington Street,
Division of Food and Drugs Salem, MA 01970-35234"Floor
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343
Name�--� -,
Date Tvoe of Operations) Tvne of Inspection
P) a Y P ���>� 1 �_/&d ❑ Food Service ❑ Routine
Address n Risk ❑%Retail x❑. Re-inspection
Level ❑ Residential Kitchen Previous Inspection
Telephone �„/5_ El Mobile Date:, l-p'
Owner HACCP Y/N
El Temporary ElPre-operation
❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) Time ElBed&Breakfast ElGeneral Complaint
In: ❑ HACCP
Inspector Out: Permit No. ❑Other
Each violationrchecked 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 MAyQEINEN7�"Amro ;,„_„ ,�, �a „-� ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
❑ 13 Handwash Facilities
EMPLOYEE HEALTH" PROTECTION FROM CHEMICALS
❑ 2. Reporting of Diseases by Food Employee and PIC t.El 144..A• sa - •for
Approved Foodd or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals
&
FOOD FROM APPROVED SOURCE" ,em,;,�;,„ deTIMEIrEMPERATURE CONTROLS(Akefi ially Hazardous Foods) a->'
❑ 4. Food and Water from Approved Source _
d„
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Cohformance with Approved Procedures/HACCP Plans ❑ 18.Cooling
i'PRoTECT1 IN FROM CONTAMINATION " ''� '" �" , n�•� ❑ 19. Hot and Cold Holding
A,
❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing FREOUIREMENTS FOR HIGHLY SUSG PTIBLE PbOtiLATIONt(HSP);
❑21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
❑ 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
G ''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)(590.006) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
5:5901nspecfFomi614 da
Inspector's Signature. I �I ' Print:
PIC'sSignature: .. ,�� ���JYU/Y�- Print: l'��/)L!) PageLobcl?_ages
Violations Related to Foodborne Illness
Interventions and Risk Factors(Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 1; Cross-contamination ,
1 596.003(A) Asst tmenEofResponsibility* 3-302.11(A)QJ Raw Animal Foods Separated from
590.003(B) Demonstration of Knowledge* Cooked and RTE Faxls*
2-103.11. Person in charge-duties - Contamination from Raw Ingredients
3-302A I(A)(2) Raw Aninial Foods Separated from Each
EMPLOYEE HEALTH Other-
2 590:003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11(A) Food Protection*
applicants* 3-30215 Washing Fruits and Vegetables
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(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
3-201.12 Food in a Henneticall y Sealed Container* Sanitization Temperatures?' -
3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.1.3 Shell Eggs* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. *
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and
590.006(A) Bottled Drinking Watcr* Utensils Clean*
590,006(.B) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Food-
Shellfish and Fish From an Approved Source Contact Surfaces and Utensils*
4-702.11 Frequency of Sanitization of Utensils and
3-20.1.1,4 Fish and Recreationally Caught Molluscan Focal Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources*
Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing
-
Regulatory Authority 2-301.11 - Clean Condition-Hands and Arens*
3-202.18 Shellsto ck Identification Present* 2-301.1.2 Cleaning Procedure*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash*
3-201.1.7 Game Animals* 11 Good Hygienic Practices
5 Receiving/Condition 2-401.1 I 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 Pucka e kite it y* Mouth*
3-101.11 Food Safe and Unadulterated* 3-301.12 PreventingContamination When Tasting*
6 Togs/Records:Sheilstock 12 Prevention of Contamination from Hands
3-202.18 Shellstoek Identification* 590.004(E) Preventing Contamination from
3-203.1.2 Shellstoek 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) 1 Labeling of Ingredients' - 5-204.1.1 Location and Placement*
q Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502.11S ecialized Processing Methods* Devices
3-502.1.2 Reduced oxygen packaging,criteria*
6-301.11 Handwashin Cleanser,Availability
8-103.12
- Conformance with Approved Procedures* 6-301..12 Hand-Drying Provision -
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. -
t CITY OF SALEM
BOARD OF HEALTH
Establishment Name: I I S I Date: ' IID Page: of it-
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
y' No. Reference R-Red item Verified
PLEASE PRINT CLEARLY
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Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
is
YI 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 Ll Re-inspection Scheduled LI Emergency Suspension
s 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. ,� /
sig-u//,"i 11 ❑ Voluntary Disposal ❑ Other:
V
3-501.14(0) PHFs Received at'Yemperatures
Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to
Factors(Items 1-22) (Cont.) E 4t°F/45`F Within 4 Homs.
PROTECTION FROM CHEMICALS 3-501.15 Coolin-Methols for PHF,,
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', 'F'"
590.004(F) 41°/45
3-302.14 Protection from J.h ar roved Additives* 5-501 I6(A} Hot 45"' Maintained u[or above
I5 Poisonous or Toxic Substances
7-101_11 klentifying Information-Chi ginal
40°F.*
Containers*
3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers" 20 Time as a Public Health Control
7-201.11 Separation-Storage"`
3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) VarianceRe uirement
7-202.12 Conditions of Use`
7.203.11 Toxic Containers-Prohibitions, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizes,Criteria-Chemicals POPULATIONS(HSP)
7-204.12 Chemical for Washing Produce,Criteria" 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
Beverages withVWarning I.abels*
7-205.14 Drying Agents.Food
Criteria* 3-801..11(B) Use of PasteurizedEL,,s*
7-205.11 Incidental Food Contact.Lubricants'*
7-206.'11 Restricted Use Pesticides. Cri tcria* 3-801.1 1(D) Raw or Partially Cooked Animal Foot and
Raw Seed S routs Not'Served.
7-206.12 TrackiRodenng
gPow er',P" 3-901,1l(C) Uno eneriFoodPacka�eNotRe-served. *
7-206.13 Tracking Powders,Pest Control and
Monttotin-*
CONSUMER ADVISORY
T_I_ME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
Animal Foods That are Raw,Undercooked or
16 Proper Cooking Temperatures for
PHFs Not Otherwise Processed to Eliminate
_
3-40'1.11A(1)(2) Eggs- 155`I' ].SSec.
Pathogens.* E'te"""""I
Eggs-Inunediate Service 145°Fl5sec* 3-302.1;, Pasteurized Eggs Substitute for Raw Shell
3-401.11(A)(2) Comminuted Fish, Meats&Game b sr
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 Meat's-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 ander the appropriate sections
Pau�s-t65°P 15 sea * above if related to foodborne,illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other
145°17* 590.009 violations reladn.-toaood retail
3-401.12 Raw Anirmul Foods Corked in a practices should be debited under#29-
Microwave 165°F* Special Requirements.
3-401.11(A)(1)(b) All Other PHFs- 145°F '15see.
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403A 1(A)&(D) PHFs 165°F 15 sec. * ((teens 23-30)
3-403.11(B) Microwave- 165°F 2 Minute Standing Critical unci nun-criiicaf violations, ,rhich do not relate to the
Tune* .foodborne illness interventions and risk ftr(tars listed nbove., can be
3-403.11(C) Commercially Processed RTF Food- found in rhe following sections of the Food Code and 105 CMR
140'F` 590.000.
3-403.1.1(F) Remaining Unshced Portions of Beef Item Good Retail Practices FC 590.000
Roasts` ___ nel FC-2 .003
� ana ement and Personnel
13 Proper Cooling of PHFs 24.. Food and Food Protection _+_FC 3 .004
25. ___ Eggiprn r t and Utensils FC 4 .005
3-501.14(A) Coifing Cooked PHFs from 140cF to 26 Water, Plumbing and W aste FC 5 006
--
70°F Within 2 Hours and From 70°F 27. Ph steal Facility FC-6 1 .007 _
to 41°F/45"'.F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(B) Cooling PIiFs Made Front..Ambient 29 S ectal Re uiremenis -_ _ _ .000
Temperature Ingredients to 41°F/45°F 30 __ ..Other
Within 4 Hoursa
"Denotes criticai item it tiro torleral 1999 Food Code or 105 CMR 590.000.
L
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: VIAS q� If U JQ Date: A -q D Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
4 No. Reference R—Red Item ,.. Verified
PLEASE PRINT CLEARLY
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Discussion With Person in Charge: Corrective Action Required: a No Ll 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
-f P ❑ Re-inspection Scheduled Ll Emergency F 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:
A
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Ianw Cooled to
Factors(items 1-22) (Cont.) 41'F/45-F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-SOUS Conlin Methods for PHFs
14 Food or Color Additives 19 PHF Hot and Cold Holding
3-202.12 Additives:' 3-50tA6(B) Cold Pf1Fs Malntanied at or below
590.004(F) 41"'/45" F*
15 Poisonous or Toxic Substances
3-302.14- Pn roved Additives
Protection from Una 3-501.16(,A) Hot PHFs;Maintained at or above
40'F.*
7-101.11 Identifying Information-Original 3-501.1.6(A) Roasts Held at or above 130'F.
_Containers*
7-102.11 Common Name-Working Containers' 20 Time as s Public Health Contra)
ln
7-201.17 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"
7-203.11 Toxic Containers-ProhlbittorW REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.I1 Sanit9zxrs,Criteria-Chemicals`
POPULATIONS(HSP)
7-204.1.2 Chemicals for Washiue Produce,Criteria* 21 3-801.'11(A) Unpasteurized Pre-packaged Juices and
7-204.14 D7 'in ants.Criteria*
Beverages with Warning 1.ibels*
7-205.11 Incidental Food Contact, Lubricants* 3-801 ll(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides. Criteria* 3-801.1 I.(D) Raw or Partially Cooked Animal Foxl<md
Raw Seed Sprouts Not Served.'t
7-206.12 Rodent Bait Sfatiotts* 3-801.11(C) Unopened Fond Package Not Re-served.
7-21)6.13 Cracking Powders,Pest Control and
Monitoring,*
CONSUMER ADVISORY
TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted For Consumption of
a6 Proper Cooking Temperatures for
AniutA Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.11A(1)(2) fogs- 155-F 1.5 Ser;.
PathoEns* efkav r r100i
Firs-Iumredtue Service 145°F75see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
3-40LII(A)(2) Comminuted Fish, Mears,SrGame E s*
Anonals-ISYF 15 sec. *
3-401.11(8)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS
3-401.11(A)(2) Ratites, injected Meats-155'F 1.5 590.009(A)-(.D) Violations of Section 590.009(A)-(D) in
sec. * catering, mobile foot, 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
Poultr or Ratites-165°F IS sec. '° above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other
145°F" 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-
Microwave 165`F* Special Requirements.
3-40LlI(A)(1)(b) All Other PHFs- 145'F15 sec.
17 Reheating for Hot Holding VIOLATIONS RELATED TD GOOD RETAIL PRACTICES
3-403,11(A)Rt(D) PHFs 165'F 15.sec. * (Items 23-30)
3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to tine
Time' foodborne-illness interventions and risk fa(Inrs listed above, can be
3-403.11(C) Commercially Processed RTE Food- ,found in the following ser.tions of the F-oott Code and 105 CMR
'140°F* .590.000.
3-403.I.i(E) i Retraining Unshced Portions of Beef Item Good Retail Practices FC 580.A00
Roast, _.____._el Fc-2 .003
�* od nd Fo an Personn„__..____
1g Proper Cooling of PHFs 24. Footl and Foad Protection FC-_3 .004
25. E ment and Utensils FC-.4__.. ,005
3-501.14(A) Coultas Cooked PHFs from 1.40`17 to 26. Water Plumbic and Waste FC 5 .006--- ui - - ---
70"E Within 2 Hours and Front 70"F -2T Physical Facility_ 1 .007 _
to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(13) Cooling PHFs Made From Ambient 29, Special freuiremenis _ _ .009
Temperature Ingredients to 41`F/45°F 30._,- Other _--
Within 4I-lours"
°Denotes cr➢tical item In tile,federal 1999 Food Code or 105 CNIR 590000.