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BISCOTTI CUCINA - ESTABLISHMENTS �.� Biscotti Cucina ��` �`� 231 Washington Street ii is o a !I u COURT OGCKET NO. CITATION NO. CITY OF SALEM A { p _ VIOLATION'NOTICE At Q AME(LAST,FIRST,INITIAL) tl t STREETADDRESS - CITYffOWN STATE_ ZIP G LCENSEN`O. ICitP:DATE' _ DME n OWNER' NAME(LAST FIRST,INITIAL) �- 2 r7 / �_ STREETADDRESS CITY/FO N STATE ZIP 3 REGISTRATt ION NO, STATE EXP,OA AK YPE .YEAR COLOR I DATE VIP TION TI ATE CITATION WRITTEN PERSONAL' A NJUR YEs NO LOC ION OF VIOLATION ENFORCING DEPT. i o�t��atnlw 41 OFFS E J CHAP, SECT. FINES A " U O Q cy B , C �d OFFICER ) I.D.NO. TOTAL 7 F= FINE _ DUE FFICER CERTI/F,IE��SGORY GIVEN TO VIOLATOR X A ry8YIN AND Imo} RYMALp0 NOT M -PAY ONLY BY POSTAL NOTE,MONEY rORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET - SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY�ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF f $—. CASE# .. SIGNATURE'. I SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO. CITATION NO. CITY OF SALEM a r VIOLATION NOTICE A18.98 i! AME(LAST,FIRST,INITIAL) STREETADDRESS�}� CITY/POWN STATE ZIP �`f C Jr_e, L tc `C `x'cf., 114 9A LICENSE NO. LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) A4 STREETADDRESS - CITYFrOWN ST TE ZIP REGISTRATION NO. STATE EXP DAT A' fE YEAR COLOR DATE OF VILATIV TIME DATE CITATION EN PERSONnL 4 INJURY A ❑YES P ❑NO LOCATION VI TION A5 `/ {rah ENFORCING DEPT OFFENSE f, / CHAP. SECT FINES A , B OFFICER I.D.NO. TOTAL FIN J E DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR / ❑ IN HAND � Imo. X BY MAIL DO NOT MAIE CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL rte, 0231 Washington Street Biscotti Cucina City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone. i lPigig. 0 a PROTECTION FROM CONTAMINATION 744-0950 " " " ` Handwash Facilities FAIL ❑d RED Owner: ,. Comment: Mens restroom soap dispenser is not dispensing soap. Repair and provide soap. Ann Delulis Violations Related to Good Retail Practices (Blue Items) PIC: giIF. Equipment and Utensils FAIL BLUE Ann Delulis f M Inspector: Comment: Microwave requires general cleaning. John Gehanl.` ,'F' Unit beneath Bunnomatic coffee maker requires general cleaning. Date Correct By: I Flour/sugar containers require general cleaning. Risk Level: r ' ,, Recycle containers require thorough ckeaning. Norlake refrigerator requires general cleaning. Permit Number: BHP-2006-0014 5 Front refrigeration unit missing thermometer. Provide visible and accurate thermometer. Status: True unit requires general cleaning. Open #of Critical Violations: GENERAL COMMENTS: 1 799: Time IN: Time OUT: r I> Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected 11 immediately or within 10 1 4 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 12,2006 ) Page I oft Item Status Violation Critical Urgency RED: ,,; L Violations Related to Foodborne Illness Interventions and Risk Factors(Require immediate corrective action)'; C� 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 12,2006 ) Page 2 oft 0231 Washington Street Biscotti Cucina City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION '744-0950 ^`' Handwash Facilities PASS ❑Q RED Owner. Violations Related to Good Retail Practices (Blue Items) 'Ann DeIUIIS PIC: Equipment and Utensils PASS BLUE Ann Delulis GENERAL COMMENTS: Inspector: 621:AII violations from 5/10/2006 have been corrected. John Gehan - - Date Inspected: Correct By: 3 Thank You. 5/18/2006 Risk Level: Permit Number. BHP-2006-0014 Status: FULL COMPLY #of Critical Violations. 0 . Time IN: Time OUT. " Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem 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. May 19,2006 ) Page I oft Item Status Violation Critical Urgency RED: i Violations Related to Foodborne Illness Interventions and Risk Factors (Require,z' immediate corrective action) 1; Cityof 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. May 19,2006 ) Page 2 oft V ~ C � U 0 CA Q o _ — — - - — ... : : . :: /L W V U � — , — . U o U W DOOR G -8 FUTURE TLET ROOMS OIa VJo ' Q � TZ CFO P 1 I I I o' O O � OFFICE/STORAGE I s � I , Q Q L] '= ----- - ------ 1 CONSULTANTS: 3'-O"X6'-8; _ :- DOORS NOTE: - ------#- _- 7 MAX. RISER NEW STAIRII" MIN. TREAD NO. OF RISERS => TO BE DETER- MINED IN FIELD ELEC. BUILD OUT EXISTING -- _ I WALL AS REQUIREDJ. H\ A—, No.5185 N' 3 eosr k y O F V " r:a _ i • ' I MEZ Z ANI NE PLAN 1 ^ \� ' I-HOUR NON BEARING SCALE: 1/4" = 1' WALL-UL DESIGN NO. d -- - U 999 == 1 P - -7 TO UNDERSIDE OF 1 ' 1 DECK W NOTE: i, ��;; r ;ii __= I ALL KITCHEN NOT IN CONTRAAT ll'a -- -- -J _ F- r- --- EMERGENCY = - LIGHT-TYP. W U) 1-- -- 0 1 17 { SWINGING DOL 2 5 UL DESIGN NO. U4CO 94 Z < Li l I-- - - ---- } . S Nonbehring Wall Rating - I HR NEW WALL-ALIGN W/ 3 9 STC 50 to 54 W EXIST. LALLY-COL. Nv b- Q 'U Q ` I � CD COUNTER UNIT 1 UNIT 2 U co o �fsl�sa� d uni7-9 his/0 lei y I. Floor and Ceiling Runners-hot shown- Channel-shaped runners, 2 1/2" wide by I" deep, fabricated from 25 MSG gale. steel. Attached to floor and ceiling w/ fasteners. REVISIONS: 2. Studs-Channel shaped, 2 1/2" wide bg 11/4 deep with 5/Ib"' folded back return. Fabricated from 25 MSG galy. steel Spced 24" o.c. Length'of studs to be I" less than assembly height. •DISCO l�fi C:u� /�cL 3. Batts and Blankets - Nom. 2 1/2" thick glass fiber batts supplied in 24" widths, installed to fill interior of stud cavities and friction held. 4. Ggpsum Board - 5/8" thick, 4 ft. wide, applied vertically, attached to steel studs and (N floor and telling runners w/ 0.121 un. dia. self drilling,' self tapping steel screws, 1 1/4" long, EXIT spaced 8" o.c. along edges of boards and 12" b.c. in the field of the boards. Joints centered b SIGN over studs and staggered on opposite sides of the assembly. S. Additional G sum Board-NOT required for U494 design - required for sound transmission. FIRE ALARM-COMBINATION 1/4" sim board applied to each tilde of studs w/ I" t e S drgwall screws 12" o.c. HORN/STROBE-MOUNT 80" A.F. 9yP PP gP y OR 6" BELOW CLG. WHICHEVER F F IS LOWEST. 6. Joint Tape and Compound - Vinyl based powder or premixed Joint compound, applied In 2 coats to Joints and screw heads; paper tape 2" wide, embedded in first layer ay compound FLOOR PLANS over all Joints. & DETAIL FIRE ALARM PULL _ �� "4 SCALE; AS NOTED STATION-48" A.F.F. DATE: 10/18/01 PROJECT No. 01019 F L_ O O R P L A N W A L L_ D E T A I L DRAWN CHECKED 'BY:PD,JG. SCALE: 1/4" = 1'-0' SCALE: 3'- = V-0- SHEET No, A - 1 IMPORTANT MESSAGE FOR AM DATE L"J /�-O,/ TIME ^a . M OFJ PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AC,AIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 14D/el---/- d� o SIGNED VTOPS. MADE IN U.S.A. FORM 4009 i j NOTES 0231 Washington Street Biscotti Cucina City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 744-0950 PIC Assigned/Knowledgeable/Duties PASS Q RED Owner: :. Non-compliance with: Ann Delulls PIC: Anti-Choking PASS .. Ann Delulis Tobacco PASS Inspector: John Gehan ' EMPLOYEE HEALTH Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 5/10/2006 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2006-0014 Receiving/Condition PASS RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations. N Conformance with Approved Procedures/HACCP Plans PASS RED 1 Time IN: _ TimeOUT: 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. May 11,2006 ) Page I of �r Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS Q RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS Q RED immediate corrective action) Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS 0 RED Handwash Fac�i"It'�es FAIL RED liComments: Handwash sink holding at 94°F. Water temperature to be held at 110°F-130°F.Check temperatures and maintain at appropriate temps. L_Wo em ns and mens restrooms sinks also holding below 110°F. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS Q RED Reheating PASS ❑Q RED Cooling PASS Q RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 11,2006 ) Page 2 of A� Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment andUtensilsFAIL BLUE j Cordments:Wet mop being stored incorrectly. Mop to be stored so that it can air dry to prevent growth of bacteria. orlakeunitt requires general cleaning. L.9, `5- nv e�reawre general cleaning. , b art unit requires general cleaning. Outside of dry goods containers require general cleaning. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 615: 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. May 11,2006 ) Page 3 of � a -+F ra ..,. �..- .R..r.,r., rcv�-.,�>.,.. ! 4 -+wg�••:E 'he, ��"'�j'w„'.. _ ++ i✓e+yrR�"'�- „,',�:� -.* #i^l "�'-�,�it. �� e'E. +x',+M t6E9W..tk,.i;:pA-Y -aFc°%'�+6�U�•�vM4N^a.:`*.+�''9'•'»w"<s47wN�t�4 �,'+��'^ '� '#'rn'_ ��+Tn7^��i t. Commonwealth of Massachusetts r +� City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2006 WHO'S PLACE OF BUSINESS IS: Biscotti Cucina File Number:BHF-2003-0010 231 Washington Street Salem MA 01970 LOCATED AT: 0231 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0014 Jan 1,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 11 of 18 CITY OF SALEM, MASSACHUSETTS u d. BOARD OF HEALTH �JN s) 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 .- STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR WWW.SALEM.COM �/ 9p JOANNE SCOTT, MPH, RS, CHO Og9�YO'cS HEALTH AGENT op tiFq�� 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT f C .l)GA �IC� �TEL#9-7S� ' I`9 ('I ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) I G q OWNER'S NAME f Yl Yl De L-0 ` ( S TEL# q�p 7LIS- �7� / ADDRES L � I ck e-s I il'd CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) S(c� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon. Tue.--N�Wed.s�Thu. Fri.<�5- Sat.,�Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. _ 1000-10,000sq.ft. - more than 10,000sq.ft. =$25 .... ......... ........... - --- -- - ------------- RESTAURANT YES NO / less than 25 seats $100 C. 4 25-99 seats = 150 Y X l more than 99 seats =$200 --------- - ---------O--------------------..........----------------......------------------------------- -0, .$10....------------- BED/BREAKFAST YES N0 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 Chap te C, Se tion 49A, I certify under the pains and penalties of perjury that I, to my best owle a and belief, ave filed a st ax returns and aid all state taxes required under the law. tig a u Date Social Security or Federal Identification Number ----------------------------------------------------------------------------------- ----- ------------------------------- ----------- Revised 11/03/05 FOODAP2.adm Check#&Dat Ao 0231 Washington Street Biscotti Cucina City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Non-compliance with: 744-0950 Anti-Choking PASS _Owner _ _ Tobacco PASS :Ann Delulis W PIC. .. FOOD PROTECTION MANAGEMENT - Ann Delulis PIC Assigned/Knowledgeable/Duties PASS ❑d RED Inspector: i +David Greenbaum EMPLOYEE HEALTH Date Inspected: Correct By:'- Reporting of Diseases by Food Employee and PIC PASS RED 11/1/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0305 Receiving/Condition PASS ❑/ RED Status:- , SIGNED OFF. . - _ Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations - t,� Conformance with Approved Procedures/HACCP Plans PASS ❑d RED 0 q: Time IN: Time�OUT� Urgency Description(s) BLUE. x Violations Related to Good , m 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors'(Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑J RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives - PASS RED Toxic Chemicals - PASSd❑ RED TIMEffEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS ❑J RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils FAIL Non-Critical BLUE Comments: Privode for the storage cooling unit in the kitchen. The microwave needs a thorough cleaning. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 365: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page 3 of 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- ,23 Dat Tvpe of Operations) Tvoe of Inspection J r 1 / .1 �_' I ) .� . "�� Food Service Routine Address I I^ 1 I_ Risk ❑ Retail ❑ Re-inspection Telephone ( I/ T Level y E-1ResidentialKitchen Previous Inspection ❑ Mobile Date: Ownern HACCP YM El Temporary ElPre-operation N 1 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) 6 Time ❑ Bed&Breakfast ❑ General Complaint Inspector In: El HACCP Ins P r b).on 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) [__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 ❑ 13. Handwash Facilities EMPLOYEE HEALTH E] 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS F] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices -CONSUMER ADVISORY., [: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 4Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board p of Health. today, the items checked indicate violations of 105 CMR C_! N. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an X 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations X 25. Equipment and Utensils cited in this report may result in suspension or revocation of / (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:saoo,spenFo,ms,u.ea 1 Inspect r's� i sty e• Print: U lil i PIC's,SiVnature:V Print: j 1��t)I + �+ Page) of Q�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 590,003(1, Assignment of Responsibility3-302.11(A)(]) Raw Animal Foals Separated from X590.003 B) Demonstration of Knowledge* Cooked and RTE Foods" L t_ 2101,11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Others, 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.1 t(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(2 Responsibility Of A Foott Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils'" Charge I Contamination from the Consumer 590.003(G) Re orting b Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Foal* 3 590,003(1)1 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) Com Bance withFoodLaw'* 4-50LIII 'ManualWarewashing-HotWater 3-20L t2 Food in a Hermetically Sealed Container* Sanitization Tem.eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.1.12 Mechanical Warawashing-Hot Water 3-202.13 Shell EggS* Sanitmation Tem eratures` 3-20214 I"s sand Milk Products.Pasteurized" 4-501-114 Chemical Sanitization-temp.,PH, concentration and hardness. * 3-202.1G Ice Made Froar Potable Drinking Water" 4-601 11(A) Equipment Food Contact Surfaces and -11 5-101Drmkim- Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinkinv,Water* 4-602.11 Cleaning Frequency ofEquipmentFood- 590.006(B) WaterMeets Standards in 31.0 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fisli and Recreationally Caught Molluscan Fax]Contact Surfaces of Er 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 Requiatory AuthoritV 2 30111 Clean Condition--Hands and Arms* 2-301.12 Cleaning Procedure` '3-202.16 Shellstock Identification Present* 590.004(0) Wild Mushrooms* 2-30'1.1,4 Wlnen to Wash* 3-201.17 Game Anunals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinkingor Using Tobace;o* 3-20111 PlIrs Received at Pro Per Temperatures`* 2-4(11.12 Mouthrges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101-11 Food Safe and Unadulterated 3-301.12 Preventing Contamination When� 6 Tags/Records:Shellstock L12 Prevention of Contamination from Hands 3-202.18 ShelktockIdentification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* ConvenienttyLocated and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca aeities* 590.00401) Labeling of Ingredients* 5-204.11 Location and Placement* J 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 oxy cn packaging,criteria* 6-301-11 Htmdwashin Cleanser.Availability 8-103.12 Conformance with Approved Procedures': 6-301.12 Hand Drying Pron7sion '"Denotes critics)item in IIIc federal 1999 Food Codc or 105 CMR 590.000- i CITY OF SALEM /� BOARD OF HEALTH n Establishment Name, Rf sG)ft ( a r C( n - Date: Page: C2 of •�+ Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' PLEASE PRINT CLE LY n� s fio d /no in � -A) / ' i C l� T� Je t / L) as— l �hbe 4w e cr'v. ! (,/p e 17 a� � z � 140 S 6PAar lua 'jo 62- -i ' '-sip o-A75 / rz // S /L n me Ab- U7e z G u V a gi? /7 O CLh odoe/Z ._�qC)e :2 to h�' 4 el 4 a im- a ni 1�14 VA �4ee�rx�f s "y s �h�, P)op e PP `l / i x--64 k r s l�/ar. � q� e7AO7 3 r anv,c enmemt� Fe 4 x S l c n • Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes i ❑ Voluntary Compliance ❑ Employee Restriction I have read this report, have had the opportunity to ask questions and agree to correction, to obseryall conditions as described, acorrect all / violations before the next ins e ditidibednd to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension it eomply with all mandates of the Mass/Federal Food Code. I understand tha t ripncompliance may result in daily fines of twee -five dollars or pens n revoc 'on of ❑ Embargo ❑ Emergency Closure yowr food permit. ❑ Voluntary Disposal ❑ Other: R'c 3-501.14(C) P1{Fs Received at'[emperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) 4l°F/45°'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Calor Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below, 3-202.12 Add�uie�1' - _ 590.004(F) 41"145° F" 3-302.'14 Protection from Una t.roeed Additives' 3-501.LCi(A) I{ot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'F. * 7-101.11 Identifying Information-original 3-501,16(A) Roasts Held at or above 130'F.'" Containers' 7-102.11 Common Nat -Working Canaainers'" 20 Tiontrol me as a Public Health C 7-201.11 Se oration-Stora>?e„` 3-501-19 Time as a Public Health Controls 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Ra uirement 7-202.12 Conditions of Use- 7-203.A]I se*7-203.11 Toxic L7ontainers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satnhters Criteria-Chemic7ls" POPULATIONS(HSP) 7-204.12 C...henticals for lhashius Produce Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Bever aces with Warning abels* 7-204.14 Drvm Agents.Criteria* - - 7-205.11 Incidental Food Contact.Lubricants* 3-801_11(B) Use of Pasteurized Ee,ass 7-206.11 Restricted Use Pesticides, Criteria* 3-801.11.(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.'s 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. " 7-206.'13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consun7 pour of 16 Proper Cooking Temperatures for Animal Faocts'll at are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate _ PathoRenS."En��ove rn,7oo� 3-401.11A(])(2) F mss- 155-F Ls Sac. E lL Immediate Service 145-Fi5secrl3-302.13 Pasteurized Eggs Substitute for Raw Shell ms 3-401.11(A)(2) Comminuted Fish, Me &Game Eggs* Anirnals- 155-T 15 sec. * 5-401.11(B)(i)(27 Pork attd Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, htiected Mcats- 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 Came,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratires-1.650F 15 sec. above if related to frodborne 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 Crooked in a practices should be debited under#29 - Microwave 165'F* Special Requirements. 3-401A ItA)(1)(b) All OtherPHFs-1.45°F 15 sec. "r 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,403.11(A)&(D) PHFs 165'F 15 sec. " (Iteuas 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 factors listed abot-e, can be 3-403.11(C) Commercially Processed RTF.Foal- ,/found in the fallowing sections of the Food Code and 105 C.MR 14WFt .590.000. 3-463.11(F) Retraining UrWiced Portions of Beef item Good Retail Practices FC 590.000 Roasts* 23. Management andPersonnel FC-2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 UII t�ment and Utensils FC 4 .0.05__ 3-501.14(A) Cooling Cooked PHFs from 140°F to 26 Water.Plumbing and Waste FG 5 .006 70"F Within 2 Hours and From 70'F27. Physical-Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic MaterialsFC-7 ' .008 3-501.14(13) Cooling PHFs Made Front Ambient ?0. Special Requirements Temperature Ingredients to 41'F/45°F 30, Other Within 4 Hours`r it e„rwz m� -"Denotes critical Hein in lht raid 1999 Food Code or 105 C61R 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name )s Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R Red item Verified PLEASE PRINT CLEARLY Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: �... .tie. ., �. _»._.; ^1.• :�...` ....w.Y_ ...i V!. ' a_ M y ^'-.r,.,y 1"' ti-...�v'. Y`yy 'V. n 'r Y , _ 3-501..14(C) _ PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41`F745°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-SOl.t5 Coolie-Methods for PHFs 19 14 Food or Color Additives PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below .590.004(F) 41'/45°P- 3-30114 Protection from Unapproved Additives* 3-501.16(A) Hat PHFs Maintained at or above 1$ Poisonous or Toxic Substances 40°F. * 7-101.11 Identifying InRxmation-Original 3-50I A6(A) Roasts Held at or above 130`R Containers" 7-10211 Common Name-Working-Containers* 2U Time as a Public Health Control 7-20'1.11 Separation-Storase" 3-501.19 Time as a Public Health Control* 7-202,11 Restriction-Presence and Use* 590.004(H) Variance Re uirement 7-202.12 Conditions of Use* 7.203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Smiitizers,Criteria-Chemicals* 7.204.12 Chemicals for Washine Produce,Criteria* 21 3-SOY_1 l(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Wanin_L.abels* Dr in A cuts,Criteria" 3-801_11(B) Use of Pasteurized zees 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(D) Raw or Pmtially l ti 7?06.11 Restricted Use Pesticides.Criteria* Raw Sr P S ally Cocked AnimaFood an Not Served. l 7-206.12 1 Rodent Bait Stations* 7-206.13 acking Powders,Pest Control and 3_gOl.11(C) Unopened Food Package Not Re-served. Tr Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foots That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-40 1.L l A(1)(2) F.ggs- 155''F 15 Sec. Padlogen0en ruF :zror Eggs-hmnechate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155'F 15 sec. * 3-40'1.11(B)(1)(2) Pork and Beef Roast-130'F121 min* SPECIAL REQUIREMENTS 3-401.1'1(A)(2) Ratites;Injected Meats-155'F 15 590.009(A){D) Violations o[Section .590.009(A){D)in sec.* catering, mobile food,temporary acrd 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited ander the appropriate sections Poultry or Ratites-165'F J5,sec. * above if related to foodborne illness 3-401.11(0(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 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. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11.(B) Microwave-165'F 2 1VGna1e Standing Critical and non-critical violations, which do not relate io the Time" foodborne illness interventions and risk factors listed above, can be. 3-403.11(C) Commercially Processed RTE Food- found in the following sections q1 the Food Code and 105 CMR 140°F" 590.000. _ 3-403-1.1(x) Remaining Unsliced Portions of Reef Item Good Retail Practices FC 590.000 Roasts` and Personnel FC-2 .003 ane emeni „nnel-_...__- _ Ig Proper Cooling of PHFs 24 Food and Food Protection FC-3 .004 -- 25 Em rnent and Utensils FC 4 1_005 3-501A,I(A) Cooling Cooked PHFs from 140'F to 26 Water,Plumbing and Waste FC 5 .0_06 70'F Within 2 Hours and From 70'F 27. Physical Facili FC-6 .007 to 41'Fl45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-50L14(B) Cooling PHFs Made From Ambient 29- S ecial R uirements _ _ .009 Temperature higredients to 41°r/45'F 30, - Within 4Floure* sswr,ron,d,:z*, "'Denotes critical item in the.f,dead 1999 Food Code or 105 CMR 590-000. CITY OF SALEM F. ( ` BOARD OF HEALTH { �` Establishment Name Date: Page: o`— of Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date II : No. Reference R-Red Item Verified .` PLEASE PRINT CLEARLY r G i i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of LiEmbargo ❑ Emergency closure your food permit. ,f ❑ Voluntary Disposal ❑ Other: 3- O1,14(C.) PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) _ 41'F745"F NGithin 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 y Cowling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintainer(at or below 3-202.12 Aotoctr e's 590.004(F) 41V45u F'" 3-302.14 'Poiso ou from xic roved Add(tives* 3-501.16(,A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-10L140'F11 Identifying Information-Original 3-501.16(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-Sttaaee„ %3j�0(1)_'19Time as a Public Health Control* 7-202.11 Restriction-Presence and Use" . 04(H) Variance Requirement 7-202.12 Conditions of Use* 7-20311 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP 7-204.12 Chemicals for Washin= Produce,Criteria" 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and Beveriges with WarnmeI.,bels* 7-204.14 Drying A eats,Listeria` 3-801.11(8) Use of Pasteurized El, 7-205.11 .Incidental Food Contact,Lubricants* 7-206.11 Restricted Use Pesticides,Criteria" 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rod as Bait Stations* 3-801.11(0) Uno tened Food Pucka=e No[Re-served. 7-206.13 Tracking Powder,,Pest Control and Monitoring* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-6G3.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Fords That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401-11A(1)(2) Eggs 75SF15Sec. 1'ath2ons rOeCnv mom E ss-hrmtedtate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell E gs* 3-401.11(9)(2) Comminuted Fish,Meats Fz Game Animals- 155'F 15 sec. * 3-401.11(8)(1)(2) Pork'and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(9)(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.I I(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Most, debited under the appropriate sections Poultr'or Ratites-165°F 1S sec. * above if related to foodborne illness 3 '10111(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw,Animal Foods Cooked in a practices should be debited under 7129- Microwave 165'F* Special Requirements. 3-401.11(A)(I)(b) All Otter PHFs-145"F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES }403.11(,4)&(D) PHFs 1650F 15 sec.a' (1teirts 23-30) 3-403.11(B) Microwave-165"F 2 Minute Standing, Critical and ruin-crith'al violations, uldch do not relate to the Time" ,foodborne illness interventions and risk jo(iors listed above, can he 3 403.11(C) Commercially Processed RTE Ford- fomtd in the following sections of the Food Cade and 105 C.MR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of8eef item GoodRetaiF Practices FC blt0.000 Ronsts* 23. Management and Personn_eI___ _ FC-2 .003 18Propar Coaling of PHFs 24. _ Food and Food Protection - __ FC-3_.004 25 _Equipment and Utensils FC 4 x005 _ 3-501.14(9) Cooling Calked PHFs from'140`F to _. 26 Water.Plumbing and Waste FC-5 .0_06 70'F Within 2 Hours and From 70+ 27. Ph sical Facility_ FC-6 .007 to 41'F145'F Within 4 Hours. -" 28. Poisonous or Toxic Materials FC-7 .008 3-50'1.14Q'3) Coolim,PHFs Made From Ambient 29_ _ S ecial Re ulrements 009 Temperature Ingredients to 41'F,45'17 30 __Other Within 4 Hours;' °Denotes critical item in aie Folend 1999 Food Code or 105 CMk 590 000. a,3-st}:ev�Ms `""e ``A '�"�p[r"ry'"uN�^'i"^rt. 'r.+.L�,�k�. �rx. •^w'�F-.�xus�. ,�a�•.-..o-?�, w+ew.seti. w. ', '�i w tr iw s. a -�c a- s � s t F c A ac a k ✓ u ' a w a.. ^..,�; w k,.-i..•.q.y�. "�'as*ti".. .,.tr,a-r^•,+i •�.>-. pMr Yw;.z.— .,.-..•m,� .,. .�.....v:. � i +.r,vr..�, ..-.S a 1HmXa'.•.,tr^«W rsY-wYaa**4... k..,e.. e v ,�, ,,, s r r'.;.:,t ... CITY OF SALEM MASSACHUSETTS ' � BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741.1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Biscotti Cucina Address of Establishment: 231 Washington Street Owner's Name: Ann Delulis Restrictions: Application Date: 12/7/2004 Permit for Food Establishment 197-05 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. H�AGENT CITY OF SALEM9 MASSACHUSETTS •" y �i BOARD OF HEALTH g' 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATIONFORPERMIT TO OPEER?ATE A FOOD ESTABLISHMENT q NAME OF ESTABLISHMENTy 15CQ �I (_ lX '1, TEL# I —O I SQ ADDRESS OF ESTABLISHMENT 3 CIS' \t'6 ��C _ MAILING ADDRESS (if different) OWNER'S NAME 11I r� S TEL# -7 L-1 Ll —�Z9SQ ADDRES I '-"I `1cde CITY _V\/\ CTA,IF ?IP CERTIFIED FOOD MANAGER'S NAME(S) h� E- CERTIFICATE#(s) � , S(� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon. Tue. Wed.�_Thu. Fri. �v- Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. -$ 50 1000-10,000sq.ft. 1 more than 10,000sq.ft. VP RESTAURANT YES NO ! less than 25 seats 25-99 seats 50 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 NCC-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 Chapte S ction 49A, I certify under the pains and penalties of perjury that I, to my st kn�"ledge and b ef, hav ile I state tax ret nstnd paid all state taxe required under the law. Signature Date Social Security or Federal Identification Number ------------------------- --- - - ------------------------------------------------------------- ----------------------------------- - - Revised 11/03/03 FOODAP2.adm Check#&Date CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH g{ 120 WASHINGTON STREET, 4TH FLOOR �a 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 I II, 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: Biscotti Cucina Address of Establishment: 231 Washington Street Owner's Name: Ann Delulis Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 182-04 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 CITY OF SALEM, MASSACHUSETTS � X ° o BOARD OF HEALTH r�",':.i W LZ . _ 120 WASHINGTON STREET, 4TH FLOOR tl// O ' a SALEM, MA 01970 ^^ TEL. 978-741-1800 DEC 10 2003 FAx 978-745-0343 STANLEY IJSOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR HEALTH AGENT BOARD OF HEALTH 2004 APPLICATION COC(yF�OR PERMIT TO OPERATE A FOOD ESTABLISHMENT 1� NAME OF ESTABLISHMENT f (nn00+ 0l TEL Q7 � 7 ADDRESS OF ESTABLISHMENT O� , Q S�l �)Ca MAILING ADDRESS (if different) — I OWNER'SNAME �ff\Yl TEL# ADDRESS_ I y Illrne.s C� rG �e, CITY `� ��Q/✓V� STATE ZIP CERTIFiEDFOODiAANAGErcSNAio-c(S) Iia I EP.TIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# gOIM— HOURS OF OPERATION:Mafi Tue. Wed. Thu. Fri. lopr>7 Sat. SuR. TL.es— 'c• t.X-5 TYPE OF ESTABLISHMENT ao 3o FEE check only RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. more than I0,000sq.ft. =$250 RESTAURANT (Y::E�> NO C �-� less than 25 seats =$1 25-99 seats 0 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. EestRkn2lce"geandbelii GL Chapt 2C, Sect' n A Ilcertify under the pains and penalties of perjury that I, to my f, v_ file al st tax returns and aid all state taxes required under the law. C2 V3,37R'05 Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/03 F00DAP2.adm Check#&Dateto • 1 �1T0—.3 / 16D 44 114-1. 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 Nam Date T of 0 erasion s Tvpe of Inspection o. 1111 nA3 D Food Service ❑ Routine Address � � Rik El Retail I Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone i1 l� _ -�� 1 6q 5 O ❑ Mobile Date: S/y 0q Owner I a r `Y HACCP Y/N ❑ Temporary ❑ Pre-operation u �( S ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: [_1HACCP Inspector Ip 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 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 El12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties .EMPLOYEE HEALTH - - El13. Handwash Facilities „. PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 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),,,,, [-] 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 (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): �G 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 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 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.501nVw Fom 14.do ' I s o a Print: / P C' Signature- Print: Zo Page!0f Pages 77Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S _ Cross-contamination 1 c90.003(A) AssiQnmentafResponsibihty` �� 3-30111(A)(1) Raw Animal Foals Separated from 590.003(B) I Demonstration of Knowledge? Cooked and RTE Foods'-* 2 103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Amaral Foals Separated from Each EMPLOYEE HEALTH Other- 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment r require reporting by food employees and 3-302.1](A) Food Protection* a tlicants* 3-302.15 Washin Fruits and Vc�etables 590.003(F) Responsibility Of A Food Employee Or Au 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Re orc�n in Claree* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.(N)3(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.OD3(E:) Removal of Exclusions and Restrictions Food 3-70).11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foci* q Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-50(.111. Manual Warewashing-Hot Water 3-201.12 Foci in_a Hermetically Scaled Container* S minration lem ieratnres* 3-201_13 Fluid Milk and Milk Products- 4-501.112 Mechanical warewashini,-Idot Water 3-202.13 Shell Eras* Sanitization Tem eratures* 3-202.14 Ii<>�s and Milk Products,Pasteurized'" 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 4-60 Ll I(A) Equipment Food Contact Surfaces and 5-1.01.11 Drinking Water from an Approved System, Utensils Clean* 590.006(8) BottledDrinkin Water* 4-602.11 Cleaning Frequency ofEquipmentFcxxi- 590.006(I3) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan , Foal Contact Surfaces of Equipment* Shellilsh* 4-703.11 Methods of Sanitization-I-lot 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"` 3-202.18 ShellstockIdentification Present" 2-301.12 Cleanim,Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Came Animals* Good Hygienic Practices 5 Receiving/Condition 1 2-401.11 Eating,Drinkinu or Usin Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-201-12 Discharges From the Eyes. Nose and 3-202.15 Package Inte cit,e Mouth* 3-101.11 Food Safe and Unadulterated* 3-30'1.12 Preventing Contamination When'rastin ,, 6 TagslRecorme 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 I3 Handwash Facilities Conveniently Located and Accessible 302.11 Parasite Destruction* - 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca iacities-, 590.004(1) I Labeling of Ingredients' 5-204.1.1. Location and Placement* 9 -Conformance with Approved Procedures 5-205.11 Accessibility.Operation and;Maintenance /HACCP Plans Supplied with Soap and Hand Drying 7502.11 Specialized Processirgt Methals* Devices 3-502.12 Reduced ox den acka ging,criteria* 6-301.11 ffandwashin Cleanser,Availability. 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dryim-,Provision *'Denotes critical item in the federal 1999 foal Code or 105 CNIR 590.000, CITY OF SALEM '' rr BOARD OF HEALTH ''// / Establishment Name: R) I sc"b'f0l C•U �'C lrl Date: g/7 /6`t Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference. R—Red Item - Verified PLEA PRINT CLEARLY / t 2_ r f r Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes r 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 o t five dollars o si u pe s'on/rev cation of ❑ Embargo 0 Emergency closure your food permit. � J_ ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFt.Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk .According to I.aw Cooled to Factors(items 1.22) (Cont.) 41'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-SO'L15 Cooline Methods for PHFs 13 Food or Color Additives 19 PHF Hot and Cold Holding 3-202._12 Adclitives" 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41°I45°Fs` 3-302.14 Protection front Unapproved Additives* 590000 ('F) Hat PHFs Maintained a[or above I5 Poisonous or Toxic Substances 14P'F. 7-101.11 Identifying Information-Oi9ginal 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Nat ne-�Vorkitr*Containers* 2t590.004(H) Time as a Public Health Control 7-201.11 Se aration-SYara e�' 501.19 'Time as a Public Health Control* 7-202.11 Restriction-Presence and Use" Variance Re uirentent 7-202.12 Conditions of Use- 7-203 '11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanitize",Criteria-Chemicals'^ ( POPULATIONS HSP) 7-204.12 Chemicals for W'ashins Produce,Criteria" S(}i.l 1(A) Unpasteurized Pre-packaged Juice*and Bevel a*es with W arni n a 126e1s`r' 7-204.14 Dam ants,Criteria' 3-801.-1 i(B) Use of Pasteurized Es* 7-205.1.1 Incidental Food Contact.Lubricants* 7-206.11 Restricted Use Pesticides.Criteria" 3-801.1 t(D) Raw or Partially Cooked Annual Ford and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11(C) Uno erred Food Package. Not'Re-served. 7-206.13 '1"tacking Pnwdars,Pest Control and Moniforin CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS TTI * umer Advisory Posted for Consumption of al FocKis That are Raw,Undercooked of I6 Proper Cooking Temperatures for Otherwise Processed to Eliminate PHFs 3-401.11A(1)(2) Eggs- 455'F 15 See. Pathogens... incur .2r�er Eggs-Inmredmte Service 145'F15sec* nrlaen Efgs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meals&Oame Annuls- 155°F 15 sec. a 3-401.11(13)(1)(2) Porkand Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.1'1(A)(2) Ratites, Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry In Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11.(0)(3) Whole-musele,Intact'Beef Steaks interventions and risk factors. Other 145°F'4, 590.009 violations relating to good retail. 3401.12 Raw Animal Foods Cooked in a practices should be debited under #29- Microwave. 165"F* Special Requirements. 3401.11(AI(1)(b) All Other PHFs- 145'F 't5sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 2.3-30) 3-403.1 I(B) Microwave- 165°F 2 Minute Standing Cri ical and non-critical ciokrtions, which do not relate to the Time" foodhorne illness interventions and risk factors listed above., can he 3-403.1 I(,C) Commercially Pnxessed RTE Food- ,found in the following sections of the Food Code and 105 CMR 140°F* 590160 3-403.11(F.) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 530.000 Roasts* 23. Maria anent and Personne__I__ _ FC-2 .003 I8 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 _ uiPment and Utensils FC . 3-501.1.4(A) Gaoling Cooked PHFs from 140°F to 25 E _4_ 005_26 WaterPLumbing and Waste FC 5 .006 70°F Within 2 Hours and From 70'F 27. Ph deal Facili _ FC-6 .007 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial Re uiremanis _ .009 Temperature Ingredients to 41'F/45°F 30. __.Other Within 4 Hours" ssoromexxs.+.w:: '*Denten critical item in 1110 federal 1999 Food Code or 105 CNIR 590,000. 'P^.^�_.:{�,;:. tE:�.,.:ATi:..., .+ .?..tea.. '•�....�...f e. - . . ,.. _ _ .... +`-"'� .y Massachusetts Department of Public Health Salem Board of Health Divis;6n of Food and Drugs 120 Washington Street, 4th Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e of 0 eration s T e of Ins ection d y d ood Service ©© outi e Address Ris ❑ Retail ❑ Re-inspection Telephone Level ElResidential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YM ❑ Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ElBed& Breakfast ElGeneral Complaint Inspector In: ❑ HACCP P 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 ' [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ' EMPLOYEEHEALTHGX3. Handwash Facilities (a� .. .. PROTECTION.FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE..-. ❑ 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 _ N49 Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY.SUSCEPTIBLE POPULATIONS(HSP)' El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices 'CONSUMER ADVISORY ' - E:1 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 n immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): l..r 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 CT Nlth. 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 )( cited in this report may result in suspension or revocation of (y (FC-a 590.005) the food establishment permit and cessation of food 6. 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: S5901nsppctPorm644 tloc I Ins c r• S' Print: y. PIC s Sig ature Print: n n `p / v Pagel of O Pages Violations Related to Foodborne Illness ' Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT_ S Gross-contamination 1 590.003(A) Assignment afRes onsibiiity* 3-302.11(A)(1) Raw Aniinid Foods Separated from 590.003(B) I Demonstration of Knowledge" j Cooked and RTE Foods* 2-1_03.11 Person in charae-duties � Contamination from Raw tngiedients 3-302A I(A)(2) liaw 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](A) I Food Protection a plicants�` __ 3-302.15 WasOin Fruits and Veretables 590.003(P) Responsibility Of A Food Employee Or An 3-304.11 Food Contact wi th figoipment and Applicant To Repw4'fo The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(2)(B) ,Returned Food and Reservice of Fund* 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 Fw�_ 4 Food and Water From Regulated Sources 4 Food Contact Surfaces 590.004(A-B) Compliance with Food Law 4-SOI.11 L Manual Wrarewashing-Hot Water 3-201.12 Food in a Hermeticaliv Sealed Container* Sanitization Tem eratmes* 3-201..13 Fluid Milk and Milk Product,;* 4-501.112 Mechanical Warewashing-IforWater 3-202.13 Shell I *M* Sanitization Tem statures* 1-202.14 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 tion an Approved System* 4-601.11(2) Equipincat Food Contact Surfaces and Utensils Clem' 590.006(A) Bottled Drinking Water" 4-602.11 Cleaning Frequency of Equipment Food- 530.006(B) Water Meets Standards in 3I0 CMR 22.0" Contact Surfaces �" c't Shellfish and Fish From an Approved Source and Utensil. 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ment* Shellfish* 4-103.11 Methods of Sanitization-Hot Water and 3-201.15 N'lo(luscan Shellfish from NSSP Listed Chemical* Sources" Ill Proper,Adequate Handwashing Reutato Authority Game and uMushrooms Approved by 2-301.11 Clean Condition-Hands and Aims* 3-202AS Shellstock.Identification Present* 2-301.12 Cleaning, Procedure" 590.004((7 Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Usino Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2401.12 Discharges,From the Eyes, Nose and 3-202.15 package'hne rit * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When'1'astinn* (> 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 Parasite Destruction* Conveniently Located and Accessible 3-40'2.11 1 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5204.11 Location and Placement* 7 Conformance with Approved Procedures 5-20-11 Accessibilit 0 Aeration and Maintenance ! tHACCP Pians Supplied with Soap and Hand Drying 3-502.11 Special 1'reiceesin>Medupds* Devices 3-502.12 Reduced ox gen packa ring, criteria* 6-301.11 Handwashin Cleanser, Availabilit &1{)3.12 Conformance with A roved Procedures* 6-301.12 Hand Drying Provision ''Uenotcs critical item in the Wesal 1999 Foix)Code or I M CMR 590.000. CITY OF SALEM 1 BOARD OF HEALTH Establishment Name: A/5(,07 7/ l�/ /?('( Date: S) Z/ Q Pager of a� Item Code C=Critical Item "" DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date No. Reference "R- Red Item - Verified PLEASE PRINT CLEARLY ` Lly G s k-ollit � S' l � l � n " i '• r C - :x < ( / v� ii'l b6icl f lir CUA h� o _ a ' a , r �ko'nfwh M1 MM4111S6121, A ✓ Discussion With Person in Charge: J Corrective Action Required: Ll - 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 C3Emergency Suspension c comply with all-mandates of the Mass/Fed'eral Food Code. I understand that noncompliance may result in daily fines wen y-five dollars o sur spen�io /revo tion of ❑ Embargo ❑ Emergency Closure youjfood permit. m ❑ Voluntary Disposal ❑ Other: w 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Acs:ording to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501-15 Cool inn Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PIIFs Maintained at or below 590.004(17) 41"14`°F* 3-302.14 Protection from Una r proved Additives* 3-501 16(A) Hot PRFs Maintained at or above IS Poisonous or Toxic Substances 40'1 7-I01.I1 Identifying Information-Original Containers* 3-501.16(.A) Roasts Field at or above 130°F. s 7-102.11 Common Name-Workln*Containers* 20 Time as a Public Health Control 7-201.11 Se aration-Storage+` 3-501-19 Timc as a Public Health Control* 7-202.11 Restriction-Presence:rod Use* 590.004(H) Varian ceRequirement 7-202.12 Conditions of Use- 7-203.J I se*7-203.'11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washin¢Produce,Criteria" 21 .Beverages with 3-801'11(A) Unpasteurized Pre-packaged Juices and Warning I�tbols* 7-204.14 Dryingguts,Criteria* -- � ?-20511 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized E)as' 7-206.11 Restricted Use Pesticides,Criteria* 3-301,11(D) Raw or Partially Cooked Animal Food and Raw Seed S rrouts Not Served * 7-206.12 Rodent Bait Stations* 3-801.1I(C) Una enedFood Packa>e,NotRe-served. 7-206.13 'Racking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 03.11 Consumer.Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'rhat are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155'F 15 Sec. Patho*ens Eggs-Immediate 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.' 3-401.11(B)(1)(2) Porkand Beef Roast - 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites,Injected Meats-155'F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec, * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PFIFs, 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 145'1* 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements, 3-401_11(A)(1)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-401.11(A)&(D) PHFs 165'1715 sec. x (Itetns 23-30) 3-403.11(8) Microwave-165°F 2 Minute Standing Critical and non-critical violation,., which do not relate to the Time* foodborne illness interventions and i isk factors listed above, can be 3-403.11(C) Commercially Processed WFE Food- found in the follou;iug seclions of the Food Code and 105 CM'R 1.40°F* 590.000. 3-403.1 IQ Remaining Unsliced Portions of Beef Item Good Retail Practices FC 538.000 Roasts* 23. Management and Personnel_- FC-2 .003 Ig Proper Cooling of PHFs 24 Food and Food Protection - FC-3 .004 25 _Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26 --- Water,Plumbin and Waste FC 5 .--00-6 70`17 Within 2 Hours and From 7U°F 27. Ph deal Fncilil _ FC-6 .007 to 41"F/45'F Within 4 Hours. 28. Poisonous or Toxic Mate "' * rials FC-7 .008 3-501..14(B) Cooling PHFs Made From Ambient 29. S ectal Re uirements __ .009 Temperature Ingredients to 41'F/,15'F -1 _ _ Other _ Within 4 Hours'x ss•oro,mxm.z *Denores critical item in tbo foderal 1999 Food Code or 105 CMR 590000. Massachusetts Department of Public Health Salem Board S Health f 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 TV of O eration7 s T of Inspection Sr / �. a. pF Food Service Routine Address Risk (Ui`Retail Re-inspection .03/ r/rn Sf Level ❑ Residential Kitchen Previous Inspection Telephone ? El Mobile Date:F-JgQ_� rF yN O 1S'O ❑ Temporary ❑ Pre-operation Owner HACCP Y!N ❑ Caterer ❑Suspect illness �/Al n/ . 7Je i L/S Person in Charge(PIC} Time ❑ Bed& Breakfast [I General Complaint In: ❑ HACCP Inspector Permit No. ❑Other lkPPrt11 . �`/I I It-- .jr�.�s-rx kJs out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT , , „_,_._„ . P ❑ 122..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 [3 5. Receiving/Condtion El 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP). .' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ,' :'� ❑ 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 0, 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 U2 5. 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:S90�nspeciFomw'a4.tla s e tor' -rg tore: Print: ?; 27;A7a ,t./ PIC's Signature: Print: � ��U//S PageL of Pages Violations Related to Foodborne fitness Interventions and Risk Factors(items 1.22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-corrtaminatian 1 591).003(A) Assignment dfRcS onsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B). Demonstration of knou4edge� Cooked and RTE Foods* 2-103.11 Person in charge--duties Contamination from Raw ingredients 3-302,11(A)(2) Raw AnirnalFoods Separated from Each EMPLOYEE HEALTH Other* r590.003(C) I Responsibility of the person in Chirac to -1 Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washht Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and App&cant To Report'Io The Person In Utensils* Charge" Contamination from the Consumer 590.003(6) Reporting by Person in Chane* 3-306.14(A)(B) Returned Food and Reservice ofFood, 3 590.003(D) Excitmons and Restrictions* Disposition of Adulterated or Contaminated 590.003(,E) Removal of Exclusions and Restrictions Food 3-70111 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food"' 4Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com rlian.,e with Food Law* 4-501.111 Manual Warewashing-Her Water 3-201.12 Food in a Hermeti(ially Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-507.112 Mechanical Warewashing-licit Water 3-202.13 Shell E* s* Sanitization car eratures* 3-20214 F,,as and Milk Products.Pasteurized* 4-501114 Chemical Sanitization-temp.,pH, concenbalion and hardness. 3-202.16 Ice MadeFrom Potable Drinking Water"` 4-601.11(A) Equipment Fond Contact Surfaces and 5-101.11 Drinkin Water from an A .roved S stem" Eis Clean" 590.006(A) Bottled DrinkingWater* Utens4-602.17 Utensil lecuency•oPF, uianest590.006( t) Water Meets Standards in 310 CMR 22.0"` g 1 Equipment Contact Surfaces and Utensils* Food- Shellfish a and Fish Froman Approaught cid Source 4-702.11 Frequency of Sanitization of Utensils;rod 3-201.74 Fish and kecreationalty Caught Molluscan Foal Contact Surfaces of Equipment* shellfish:* 4-703.11 Methods of Sanitization-I-lot Water and 3-20L15 Molluscan Shellfish from NSSP Listed Chemical* Source,0710 Re MatoAuthori Proper,Adequate Handwashing Came and uMushrooms Approved by 2-301.11. Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices LL Recely➢nglCondition 2-40111 Eatin ,Dr nkind or Usin Tobacco* 3-202.11. PHFs Received at Proper Tent eratures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package Integrity* Mouth* 3-101.11 Fond Safe and Unadulterated* 3-301..02 PreventinP Contamination When Pasting* F-6 --- TagsiRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(71) Preventing Contamination from 3-203.12 Shellstock7dentificationMaintalned* Em�lovees'" TagslRecords: Fish Products 13 Handwash Facilities 3-402-1 l 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 Lactation and Placement* 7 I Conformance with Approved Procedures 5-205.11 Accessihilit .O)oration and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Pracessin2 Methafs* Devices 3-502.13 Reducedox en ackarinv.criteria"= 6=301.17 8andwnshinKCleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dr sn� *Denotes critical item in the federal 1999 Food Code or 10i CMR 590-00o- L CITY OF SALEM BOARD OF HEALTH Establishment Name: J /.5</i7-Yi �:�/ V 4 Date: ':v-o?3-OPage: of � item Code C-critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY y NG GYJCa/�.c'i/C - /sKS,O C /Lb aG 'z !"OGGL°�"UI/✓I� n 3 l S/,L/ 5 U,'M ,S- J c(' e G!�'. /mac ✓(/C�Fr.�C l`/✓P.E'v;f f.. -J) /tP(f',DfcrCL-�' .F ,2 ��,�,chi m � ,/l,QeG �L(F/�" t$`✓d "f' �'rr/�CIG,YL�C t ✓ d L Xv P/y// avT e - � /✓P PdL v /Pm/ -9e , rr)91; -V 61,slS ✓ /�/ r/z/^✓�/ - � f4G/7 L/-C!/P/' LU 170' 7 S f - , 4G dol Y a -eM.7�- ,t a Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ r violations before the next inspection, to observe all conditions as described, and to Exclusion a comply with all mandates of the Mass/Federal Food Code. I understand that ❑ Re-inspection Scheduled ❑ Emergency Suspension ' noncompliance may result in daily fines of twe ty=fave dollarsor suspension/revocation of ❑ Embargo Ll Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: ,r %114(C) PHFs Received at Temperatures Violations Related to Foodmorne Illness Interventions and Risk According to Law Cooled to - Factors(Items 1.22) (Cont.) 41°T/45'1`Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs r jq Food or Calor Additives 19 PHF Hot and Cold Holding 3-202.12 Additives 3-501.16(B) Cold P1-1Fs Maintained at or below 590.004(F) 41°/45°F* _ 3-302.14 Protection front Una .ruled Additives" 3-501..16(A) Hot PtLFs Maintained at or above 1s Poisonous or Toxic Substances 40°F. * 7-101.11 ldenfifyiug Information-original 3-5O1.16(A) I2oaste Held at or above 130"F. Containers* in Time as a Public Health Control 7-102.11 Common Name-Wo riving Containers= 7-201.11 Separation-Stort�- 3-501.19 Time as a Public Health Control" 7-202.11 Restriction-Presence and Ilse" 5)0.004(1`1) Vw'iance Requirement 7-202.12 Conditions of Ilse" 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criterla-Chemicals* POPULATIONS(HSP) 7-204,12 Chemicals for Washing Produce, Criteria* 21 3-80 1.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Aoents.Crrima'` Beier ages with Warning Labels* 3-801.11(B) Use of Pasteurized Egg! 7-205.11 Incidental Food Cont act,Lubricants* 7-206.11 Restricted Use Pesticides,Crueria* 3-8(11.1I(D) Raw Seed Partially Cooked Animal Fcxxt and Raw Sced S gouts Not Served. :,: 7-206.12 �T,,ace odnt Baie Stations" 3-801.11(() Unopened Food Package Not Rc-served- 7-206.13 :ktag Powders, Pest Control and onitorine* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate Eggs175` l5 Sec.. Pathogens.* 3.302.1+ Pasteurized Fa g's Substitute for Raw Shell L e,,s-lmmedi ate Service 145'F]5sec* 3-401.11(A)(2) CtinnminutedFish.Meats&Game Animals- 155'F 15 sec. "` SPECIAL REQUIREMENTS 3-401.11(8)(1)(2) Pin kRad and BeefRoast MMB - 1- 15- 121.min* 590.009(A)-(I)) Violations of Section 590.009(A)-Q))in 3-401.11(A)(2) Radars,Injected Meats-155°F IS sec catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Staffed PHI-,,,, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°h 15 sec "` above if related to foodborne illness 3-401.11(C)(3) Whole-muscle. intact Beet Steaks interventions and risk factors. Other 45"F" __ 590.009 violations relating to good retail 3-401.12 Raw Anirnal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PITFs - 145''F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403-11(A)&(D) PHFs 165".F 15 sec. * (Items 23-30) 3-403.11(13) Microwave-165'F 2 Minute Standin<! Critical and non-critical violations, which do not relate to the Time* foodhorne illness interventions and risk factory listed above, can be 3-403.1.1('C) Commercially Processed RTE Food- 1Dund in the following sections of the Fond Code and 105 C.MR 1400F* 5,90.000. 3-403.1 I(E) Remaining Unsliced Portions of Beef Nem Gaud Retail Practices FC 590.000 Roasts* _234 Manaaeement and Personnel FC-2 .003 lg Proper Cooling of PHFs 24 Fend and Food Protection FC--3 .004 nslls FC 4 005 3-501.14(A) Conlin,,Cooked PT-fFs from 140 F to 25 E uq ipment and Ute _-_ _ t "" 26. Water.Rumbing and Waste FC-6 006 70'F Within 2 Homs and Front 70'F 27. 1 Physical Facility FC-6 067- to to 41°F/45°F Within 4 Hours. * _28._-i Poisonous or Toxic Materials FC-7 .008 1 3-501.14(B) Cool urgPHFs Made Hout Ambient 29 Speciat Requirements__ TemperatureIngredientsto 4l'F145"P30� her -- -- Within 4 Hours* *Denotes critical ilei in the tedcral 1999 Food Code or 105 CNIR 590.060. • 4f CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1 800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to : Owner ' s Name : Ann DeIulis Name of Establishment : Biscotti Cucina Address of Establishment : 231 Washington Street Type of Establishment : FOOD SERVICE Application Date : 01/02/2003 Restrictions: Permit for Food Establishment 184-03 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. q"44�,.,00� HEALTH AGENT i I r omlr CITY OF SALEM, MASSACHUSETTS �6 " o BOARD of HEALTH -� 120 WASHINGTON STREET, 4TH FLOOR a ,1 LCM. MA 01970 �rjMlrv@Cp� TEL 978 74I-1801:1 FAX 978-745-0343 ST4NLEY USOVICZ, Jr, JOANNE SCOTT. MPH, RS. CHO MAYOR HEALTH AGF,NT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �`FO} j� -Qy �'" �lG i n(-) TEL# t �9 SCS ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME )N��Q D ff TEL # It, S i` (' cc - I ADDRESS )o -n C `J I cc t6 CITY C�M - STATE--_ rD �_ ZIP OU 2/0 CERTIFIED FOOD MANAGER'S NAME(S) &nY1 `t) CTo11' S CERTIFICATE#(s) -lb2- 3510 (required in an establishment where potentially hazardous food is prepared.) r EMERGENCY RESPONSE PERSON , t HOME TEL#q7 -7y Q) / HOURS OF OPERATION: Mon, ue.� q Wed]—Thu 13U�3 = 4 Fri. ssatg'"?7 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 I- YES NO �t�T D less than 25 seats =$10 25-99 seats more than 99 seats =$200 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 Cha r 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my b owledge an elle , ave d all state to returns and paid all state taxes required under the law. 2V a chi nature Dat Social Security or Federal Identification Number - ------------------------ - -------------------------------- ------------------------------------------ Revised 11/25102 F000AP2.adm Check#&Date ./o21713- la? i 1 :M THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION RE ORT Tel: (978)741-1800 Fax: (978) 745-0343 NameDate Type of Operations) Type of Inspection _ - ❑ o0d Service ,LRoutine Address i5fk ) Retail ❑ Re-inspection Level / residential Kitchen Previous Inspection Telephone ( c''J1 (-,,, ❑ Mobile Date: OwnerJ lJ HACCP Y/N ElTemporary EJPre-operation t _ J .S ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector �- L 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 (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 ❑ 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 El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition ❑ El 6. Tags/ Records/Acc'tiracy of Ingredient Statements 17. Reheating ❑ L17. Conformance with Approved Procedures/ HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding 4 ❑ 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: ) Print:, PIC's Signature• e Print: PagV101 ofages FORM 734A HOBBS&WARREN -BOSTON - Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION -8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from W1 590.003(A) I Assignment of Res onsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302A 1(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and Applicants 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9'' Food Contact Surfaces 4` Food and Water From Regulated Sources 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water Sanitization Temperatures 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-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 r 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* I',I11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating, Drinking or Using Tobacco* S Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* -12" Prevention of Contamination from Hands «6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* F-13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 1 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: S%, 0 n Date: �� a3 Page:_ Z of Z Item Code e-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified — PLEASE PRINT CLEARLY Y E � l M r4 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p C1Re-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 C] Other: °. Y p. 3-50114(0 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 Hmu s. PROTECTION FROM CHEMICALS 3-501.15 Conhnu Methods for PIIFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-20112Additives'F 3-501.16(13) ColdPFfFs Mabrained at or below 590.004(F) 411!45°F- 3-302.14 Protection from Unan.rovedAdditives* 1=5 Poisonous or Toxic Substances 3-501.16(A) Hot PRFs Maintained at or above 14WE* 7-10 t.I I Identifying information-Original 3-501.16(A) Roasts Heid at or above 130"F Containers* 7-102.11 Common Name-Working Containers'~ 20 Time as a Public Health Control 7-201.1.1 Separation-Stooae* 3-501.19 Time as a Public Health Control" 7-202.11 Restriction-Presence mid Use* 590M04(H) Variance Recuirement 7-202.12 Conditions of Oise* 7-203.11 Toxic Containers-Prohibitions^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.1.2 Chemicals for Washin>Prciduce.Criteria* 21 3-80'1-I.1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* Bevetages with Warning Labels* 7.205.1.1 Incidental Food Contact,Lubricants* 3-801.1 l(B) Use of Pasteurized Eggs- 7-206.11 ons7-2(16.11 Restricted Use Pesticides, Criteria! 3-801.A I(D) Raw or Partially Cooked Aminal Food and Rav, Seed Sprouts Not Served. 7-206.1.2 Rodent Bait Stations* Uno>enetiFo�l Paeka>e Not R©-eery©d. "` 7-206.13 Tracking Powders, Pest Control and 3-801,11(C) Monitorin g CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate Patho;.xis F msr"`Ve' 001 3-4(ll.1lA(1)(2) Eggs-Tmmeduae Service 141°EiSsecx s- 15ned 15 Sec. 3-302 13 PasteunzedFa,gs Substitute for Raw Shell 3-40LI I(A)(2) Comminuted Fish.Meats&Gane Animals- 155''F 15 sec. 3-401.11(13)(1)(2) Pork and Beef Roast- 130"F t21 tninSPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 1.55'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sea. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401.11(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 Crooked in a practices should be debited under#29- Miciowave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs --145'F 15 sec- 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403-11(A)&(D) PHFs 165'F 15 sec. k` (Items 23-30) 3-403A I(B) Microwave- 165°F 2 Minute Standing Criiwal and non-critical violations, which do not relate to the Time* foodborne illness huerventions and risk factors listed above, can be 3 40311(0 Commercial ly Processed RTE Food- found in the fotlowing sections of the Food Code and 105 CbIR 1400F* 590.000, 3-40'A I(E) Remaining Lhnshced Portions or Beef Item I, Good Retail Practices I FC 590.000 Roasts* _23._ Management and Personnel 1 FC-2 .003 18 Proper Cooling of PHFs 24 Food Pand Food Protection ---- FC 3 004 25. - Utensil's FC-4 3-501.14(A) Cooling Cooked PHFs from.140"F to 26 Water, Plumbingtand Waste FC-5 006 70'F Within 2 Hours and From 70'F 27. Ph deal Facility FC-6 .007 to 41 OF/45'F Within 4 Hours. * 28. 1 Poisonous or Toxic Materials FC-7 ,008 3-501.14(13) Cooling PHFsMade From Ambient p. e __ t------ _-09 29 S acral R uirements 0 Temperature ingredients to 41'F145'F 30 Other Within 4 Hours* "Denote,Critical item in the noieral 1999 Pood Code a to-)-CMR590-000. -.,s:..-rrm w"'+v�`n+ ^.�..-.-.a' ,. .ry,,.7.;r--...r y,..v.-��-.,,v.•,�vr-+�-�..+a--+�.o-�w«r...,Y.^'^s.Wi+.«.+�.r�+•i+�w`wM+rv-++a*"Tew+ryir,�/'^-r.r+^.�.,.,.y„�,�,,,..`..�a.,wk'..,..... THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPOT Tel: (978) 741-1800 Fax: (978) 745-0343 Name - Dat r n Ty$e of Inspection J C(Jr� L. CL_S Food Service Routine Address Risk ❑ Retail IK Re-inspection Level/ ❑ Residential Kitchen Previous Inspection Telephone 9�f) /t( a 7� C_ ❑ Mobile Date: Owner Y ,, �J HACCP Y/N ❑ Temporary ❑ Pre-operation 14�/f T(/ (-3 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) ��`�C-- Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector A4ZC 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 (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 ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved Procedures/ HACCP Plans C] 18. Cooling ❑ 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 REINSPECTION: Inspector's Signature: Pr PIC'sSignature: til Print: Pag�O�ges i n FORM 734A HOBBS&WARREN -BOSTON - Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION L8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assi nment of Resp( * Cooked and RTE Foods* 590.003(6) Demonstration of Knowledge* Contamination from Raw ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment - 590.003(C)590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and Applicants 3.302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3- 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P"P 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 Waternd a 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* F-10 Proper,Adequate Handwashing Game and wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.(2 Cleaning 3.202.18 Shellstock Identification Present* Procedure*2.301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands ''G Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* " 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance ;7; Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 3� CITY OF SALEM ?' BOARD OF HEALTH Establishment Name: c/3'/� /-2C_�_J Date: 2. �/(::5 Page: of t item Code C=critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date 7 Nob iReference R-Red Item Verified�- - ` x Verified PLEASE PRINT CLEARLY ' i r F z a V,/ �s /vo pct 1C.- �/�^ 1, ✓J _ vim, AA, lAq- 5 1 y t t 1 r Discussion With Person in Charge: Corrective Action Required: " ❑ No ❑Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to comply Exclusion R ❑ Re-inspection Scheduled ❑ Emergency Suspension with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS &WARREN - BOSTON t Temperatures 14(C) PHFs Received a Violations Related to Foodborne Illness Interventions and Risk 3-501. . 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 .19PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/450F* a;15' Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F* Containers* 3-501.16(A) Roasts Held at or above 130°E* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21` 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 DrvinR A ents,Criteria* 7-205.11 Incidental Food Contact, Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.11 Resected Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1](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 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 11712001 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. 3-30213 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.1l(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food, temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165*F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 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 r'18'.: Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.