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BOBS FAMOUS FRIED CLAMS - ESTABLISHMENTS (3) Bob's Famous Fried Clams �. 441 highland Avenue _}. .n n a 4 0 n u d �Nt+-T E«o-' reW» ?� Commonwealth of Massachusetts City of Salem ya Board of Health nT, 120 Washington Street,4th Floor SALEM,MA 01970 VIPFood/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Bob's Famous Fried Clams File Number:BHF-2005-0016 429 Highland Avenue Salem MA 01970 LOCATED AT: 0429 HIGHLAND AVENUE SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0028 Jan 2,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES IDecember3l, 2006 Board of Health "'sib •.�' This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 26 CITY OF SALEM, MASSACHUSETTS BOARD HEALTH S � f � 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 0 TEL. 978-741-1800 0 nnPP i STANLEY J. USOVICZ, JR. FAx 978-745-0343 u`�' Q MAYOR WWW.SALEM.COM Q/ OFC Z�05 JOANNE SCOTT, MPH, RS, CHO 8O ' lY'OF HEALTH AGENT qA0 Opal pil �CTy 2006 APPLICATION/FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT / 'V) NAME OF ESTABLISHMENT �77!/S �1X MOUS' ��/d/C,' ,,otea S TEL# 926 -' 711#4 3 ADDRESS OF ESTABLISHMENT % �7 M4 ', t1&e. MAILING ADDRESS (if different) / P /O q �! _ OWNER'S NAME {7r U1- Ueft /UiS TEL# ( 7f-770 ADDRESS ^ al °��e, CITY .fai D STATE ZIP (L/� CERTIFIED FOOD MANAGER'S NAME(S) U/ 1°/D dLt_'CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON Ar'-/hur Ve-10 t!S HOME TEL# 97t V7O 91`77 HOURS OF OPERATION: Mon.ki-f—TueJ/-P Wed./L_Thu.�Fri//—f Sat. Sun. / TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - -. .. ........ ........... RESTAURANT ES NO less than 25 seats 25-99 seatsP2O more than 99 seats ---------------------- -------------------------------------- ---------- 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 $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursunt to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kno dg nd 11f ,ave filed all state ttaxx returns and paid all state taxes required under the law. j Signatury Date Social Security or Federal Identification Number --------------------------------------------------------------- 1 Revised 11/03/05 FOODAP2.adm Check#&Date 3 A5-0 r 0429 Highland Avenue Bob's Famous Fried Clams City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-9366 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Arthur G. Velonis ' Tobacco PASS ❑ PIC -0- FOOD FOOD PROTECTION MANAGEMENT Done Arthur Velonl$ Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑d RED Janet Dionne 5. EMPLOYEE HEALTH Done Date Inspected: Correct By: E, Reporting of Diseases by Food Employee and PIC PASS ❑d RED 6/21/2005` Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: - - a ' - FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS Q RED BHP-2005-0387 w Receiving/Condition PASS ❑Q RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED Closed Conformance with Approved Procedures/HACCP PASS ❑J RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done ,Time IM = Time OUT _ Separation/Segregation/Protection PASSd❑ RED Notes:" Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 220. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑d RED BLUE ``_ - " Violations Related to'G1 Prevention of Contamination from Hands PASS ❑Q RED Retail Practices (Critical Handwash Facilities PASS ❑Q RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 22,2005 ) PaQe I oft 0429 Highland Avenue Bob's Famous Fried Clams must be Corrected Immediately PROTECTION FROM CHEMICALS Done or Within 90 days) Approved Food or Color Additives PASS 0 RED RED: Violations Related to Toxic chemicals PASS RED Foodborne Illness InterventionS TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action)' Reheating PASS ❑d RED Cooling PASS RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE all violations cited in the 6/9/05 report have been corrected.Thank you. 04A, � GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 22,2005 ) Page 2 oft 0429 Highland Avenue Bob's Famous Fried Clams City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-9366 Non-compliance with: Done Owner: - Anti-Choking PASS ❑ Arthur G. Velonis Tobacco PASS ❑ PIC: ?t - FOOD PROTECTION MANAGEMENT Done - " PIC Assigned/Knowledgeable/Duties PASS ❑J RED Inspector: Janet Dionne - EMPLOYEE HEALTH Done Date Inspected' Correct By: , Reporting of Diseases by Food Employee and PIC PASS 0 RED 6/9/2005 Personnel with Infections Restricted/Excluded PASS 0 RED Risk Level: - - - FOOD FROM APPROVED SOURCE Done Permit Number. Food and Water from Approved Source PASS ❑d RED BHP-2005-0387 - Receiving/Condition PASS Q RED [Status:,r Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED Open ,; Conformance with Approved Procedures/HACCP PASSd❑ RED #of Critical Violations: . Plans - PROTECTION FROM CONTAMINATION Done Time IN: _ Time OUT: Separation/Segregation/Protection PASS ./❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED 201: - Proper Adequate Handwashing PASS ❑J RED Urgency Description(s): Good Hygienic Practices PASS ❑d RED BLUE: .. Prevention of Contamination from Hands PASS ❑d RED Violations Related to Good- R@tail Practice's (Critical Handwash Facilities PASS ❑d RED a loyees restroom missing papertowels. violations must be corrected provide papertowels at all times. immediately or within-10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 1 of QL 0429 Highland Avenue Bob's Famous Fried Clams must be corrected immediately PROTECTION FROM CHEMICALS Done or Within 90 days) Approved Food or Color Additives PASS RED RED: Violations Related to Toxic chemicals PASS ❑D RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors(Require Cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS ❑d RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS ❑/ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS W RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 2 of 4 0429 Highland Avenue Bob's Famous Fried Clams Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE i Bersonal items stored with bread items. all personal items to be stored separately from all food items to prevent contamination. exfployees water bottle stored in back ice 4,/machine. nothing to be placed in ice.to prevent contamination. all dry ingredients not in original container must be labeled. odfatoes stored on floor. all food must be Kept at least 6-8 inches off floor. nt ice chest had some uncovered food. all food in storage must be covered. ibna freezer had some uncovered food. Yoo'd d must be covered. ests had some uncovered food. all �kapstorage must be covered. f flour stored on floor. all food to be toaat least 6-8 inches off floor. Equipment and Utensils FAIL Critical ❑ BLUEmyrowave needs general cleaning of food •V•_(ebris. machine had accumulation of growth and grime on tray panel.thoroughly clean and sanitize. erna freeer had temperature of 12'f freezer to be maintained at 0"f or below as mandated.service if needed. two chests and long white freezer sing thermometers. provide visible accurate thermometers maintained at proper temp as mandated. to g white freezer had accumulation of rime on top inner panel.clean unit. be pepsi fridge needs general cleaning ,food debris accumulation. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 3 of 0429 Highland Avenue Bob's Famous Fried Clams ont pepsi unit had a temp of 52°f. unit to be maintained at 41°f or below as mandated.service unit if needed. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUEswells in prep area had accumulation of V food splatter. clean walls of all food splatter and debris. kAQrooms vent not working at time of inspection. repair vents. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 4 of B & B PEST CONTROL P.O. Box 8077 LYNN, MASSACHUSETTS 01904 (781) 599.4317 IN '.UT- El UT❑r+R�.EEG�❑l 11-TIME El RES. ❑COMM. ❑ INDOOR El OUTDOOR NA I 0'a S 1--%?- ADDRESS I4, t>}tAtiO Au 4a— CITV.SMEjAw ,'ww PHONE :.SERMES PERFORM U TARGET FEST S7 `A0PLICATIONMETN00 ❑ INSPECTION TREATMENT ' ❑ CryEMICALS USED . �' AMOUNT: % .'.. EPA.NUMSER I DESCRIPTION I REMARKS AMOUNT`::. 1 MOnsTHL IZr'fG� 0V G NO. pL TOTAL cu, Me slcmnmRE SERVICE REPORT 4802 i 0429 Highland Avenue Bob's Famous Fried Clams City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-9366 r" Non-compliance with: Done .Owner: Anti-Choking PASS ❑ Arthur G. Velonis Tobacco PASS ❑ PIC: FOOD PROTECTION MANAGEMENT Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑d RED Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 16/9/2005 w Personnel with Infections Restricted/Excluded PASS RED - Risk Level:` FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS ❑d RED 9HP-2005 0387 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Open Conformance with Approved Procedures/HACCP PASS ❑d RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done Time IN: Time OUT: Separation/Segregation/Protection PASS ❑d RED Notes - Food Contact Surfaces Cleaning and Sanitizing PASS RED 201: _ _ - Proper Adequate Handwashing PASS ❑J RED Urgency Description(s) s Good Hygienic Practices PASS ❑d RED BLUE:, '` Prevention of Contamination from Hands PASS ❑d RED Violations Related to Good; Retail Practices (Critical " Handwash Facilities PASS ❑d RED employees restroom missing papertowels. violations must be Corrected provide papertowels at all times. immediately or within 10 days)(Non-critical violations GeOTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 09,2005 ) Page I of 0429 Highland Avenue Bob's Famous Fried Clams must be corrected immediately PROTECTION FROM CHEMICALS Done or Within 90 days); 4 Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic chemicals PASS ❑O RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS 0 RED immediate corrective action) Reheating PASS 0 RED Cooling PASS RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 09,2005 ) Page 2 of 0429 Highland Avenue Bob's Famous Fried Clams Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Personal items stored with bread items.all personal items to be stored separately from all food items to prevent contamination. employees water bottle stored in back ice machine, nothing to be placed in ice.to prevent contamination. all dry ingredients not in original container must be labeled. potatoes stored on Floor. all food must be kept at least 6-8 inches off Floor. front ice chest had some uncovered food. all food in storage must be covered. iberna freezer had some uncovered food. all food must be covered. ice chests had some uncovered food. all food in storage must be covered. bag of flour stored on floor.all food to be kept at least 6-8 inches off floor. Equipment and Utensils FAIL Critical ❑ BLUE microwave needs general cleaning of food debris. ice machine had accumulation of growth and grime on tray panel.thoroughly clean and sanitize. iberna freeer had temperature of 12°f freezer to be maintained at 0"f or below as mandated. service if needed. two ice chests and long white freezer missing thermometers. provide visible accurate thermometers maintained at proper temp as mandated. long white freezer had accumulation of grime on top inner panel. clean unit. back pepsi fridge needs general cleaning of food debris accumulation. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 09,2005 ) Poke 3 of 0429 Highland Avenue Bob's Famous Fried Clams front Pepsi unit had a temp of 52'f. unit to be maintained at 41'f or below as mandated. service unit if needed. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUE walls in prep area had accumulation of food splatter. clean walls of all food splatter and debris. restrooms vent not working at time of inspection. repair vents. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 09,2005 ) Page 4 of CITY OF SALEM9 MASSACHUSETTS . BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01970 TEL. 978-741-1800 _ FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Bob's Famous Fried Clams Address of Establishment: 429 Highland Avenue Owner's Name: Arthur G. Velonis Restrictions: Application Date: 1/10/2005 Permit for Food Establishment 259-05 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. VEALTH AGENT e� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 0 V (clgl v�O yt 120 WASHINGTON STREET, 4TH FLOOR III jg lf f o SALEM, MA 01970 �IVI TEL. 978-741-1800 DEC 3 0 2004 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR HEALTH AGENT 2005 APPLICATION �fFOR PERMIT TO OPERATE A FOOD ESTABLII�OF HEALTH F / NAME OF ESTABLISHMENT�7 // CJS /Pl�01�16 TEL# ADDRESS OF ESTABLISHMENT T�� I JIL&ll f kle MAILING ADDRESS (if different) / /� OWNER'S NAME /r/G/ W� E9 l ],6/� TEL# ADDRESS -6 �� a / It/G_ N� CITY AA1 46e7c zip / CERTIFIED FOOD MANAGER'S NAME(S)4 CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON &7 -7lAe G UeIOn/S HOME TEL# a HOURS OF OPERATION: Mon.[LLTue.,ILLWed.fL�LThu.//—,Fri. / Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 RESTAURANTES NO v V less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES N $5 TOBACCO VENDOR YES $50 ALL NOR1:PROFIT(such as church kitchens) YES &D $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bess�,knoyrJedge a6 beljeif�h�v II state tax returns and paid all state taxes required under the law. IVJA Signature Date Social Security or Federal Identification Number ------------------------------------------------ ----- Revised 'Ing}----- ---------- - ---Revised 11/03/03 FOODAP2.adm Check#&Date'10�'J ISLOV 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 Cit of Salem is hereby ranted to: Y Y9 Type of Establishment: FOOD SERVICE Name of Establishment: Bob's Famous Fried Clams Address of Establishment: 429 Highland Avenue Owner's Name: Arthur G. Velonis Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 183-04 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 i CITY OF SALEM, MASSACHUSETTS •� a BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &)J > y Fr�td (2-[(k 'STEL# ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) \ OWNER'S NAME TEL97'7 ADDRESS ; CITYftbV ave STATE Mt t ZIP. b /O CERTIFiED FOOD MANAGE^'S" iv114 M, (S) ✓C)6�A3 CERTIFICATE#(S)3fig5ffl rn�liRu C�vie �ZoZ9c13 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSOI\Ik_h r HOME TEL# HOURS OF OPERATION: Mon.//-�Tue.j�ed. Z KThu.//-" y Fri.JL__C_SaQL_?-Sun./4—E TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT / ES NO less than 25 seats _ 00 L/ 25-99 seats 15 more than 99 seats =$200 BED/BREAKFAST YES N $100 ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signatur D Social Security or Federaall1dentification Number ------------ ya b7-0�----------------� -aro S = Y ------------------ Revised 11/03/03 A0AP2.adm Check#&Date�37 Vo- a—6 3 qf/J�. str'''n+tiYtrti t r .. .. Massadhusetts Department of Public Health Salem Board S Health Department 120 Washington Street,4'" Floor Division of Food and Drugs r Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Nam J 1 Date a of O eration s Type of Inspection M ( a 26 S U ,?02 U Food Service ❑ Routine Address -Risk Retail 0 Re-inspection Level ❑ Residential Kitchen 'previous Inspection Telephone ry, x ❑ Mobile Date: /a�lc�(J0 Owner ri HACCP YiN F-1Temporary ElPre-o era ion S ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑General Complaint In: ❑HACCP Inspector Out: Permit No. ❑Other_Each violation hecked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Pion-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 .._. .S. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties d13. 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 Restrioted/Excluded ❑ 15.Toxic Chemicals . FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) r �: ❑ 4. Food and Water from Approved Source ❑ 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 1a) / 1 tvl 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 El11. Good Hygienic Practices CONSUMER ADVISORY �:z',.. a ❑22. Posting of Consumer Advisories . Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions ` immediatelyor within 10 days as determined b the Board y Y and Risk Factors(Items 1.22): of Health- Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below `'c N ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) 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 28. 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:SBUInspecrFnmrb-iJ.doc Is'p tor's f ' ' Print: IC's Signature* Print: /� �� 1/�` ,' .. Page ofPages Violations Related to Foodborne Illness r Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION _ FOOD PROTECTION MANAGEMENT S Cross-contamination I 590.003(A) Assignment o(Responsibilttyy 1 3-302.1 I(ANl) Raw Anmral oode Separated from 590-003(B) Demonstration of Knowledge* Cooked and RTE Foods* Person 2-103.11. Pen in rh erge-duties Cont m»Tion from Raw Ingredients 3-302.11(A)(2) Raw Animal Foals Separated brunt Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A) Food Protection* a plicants* 3-302.15 Wasbin Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer 590 003{G) Re orting b Pereon in Charee* 3-306.14(A)(B) Returned Food and Reservue of Foc&' 3 590.003(D) Exclusions arid 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 SOURCEFood* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.I I I Manual Wafewashing-Hot Water 3-201.12 _Food in a Hermetically Sealed ContaiueO Sanitimtion Tem eratures" 3-201,13 Fluid Milk and Milk Product's* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eges and Milk products.Pasteurized* 4-50t.114 Chemical Sarudzation-temp.,pH, 3-202.76 tee Made Frorn Potable Drinking Water"' - concentration and hardnees. 'r 5-101,11 Drinkin Water from an A. roved Svstem* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean" 590.006(A) Bottled Drinking Water 4-602.11 Cleaning Frequency ofEquipmentFood- 590 006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfacesand Utensils* and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensiisand 3-207.14 Fish and Recreationally Caught Molluscan _ Food Contact Surfaces of E ui nrent* Shellfish'" 4-703.11 Methods of Sanitization-Hot Water and 3-201.75 Molluscan Shellfish from NSSP Iasted Chemical* Sources* 1i1 Proper,Adequate Handwashing Regulatory Authority Game and Mushrooms Approvedby 2-301.11 Clean Condition-Hands and Arens* 3-202.18 Shellstock.Identification Present* 2-301.12 Cleaning Procedure` 590.004(0) Wild Mushrooms* 2-301.14 When to Wash- 3-201 17 ash-3-201.17 Game Animals* I'1 Good Hygienic Practices ;ti Receiving/Condition 2-401,11 Eating,Drinking or Using Tobacco* 3-202.11 PLiFs Received at Proper Temperatures* 2-401.1.2 Discharges,From the Eyes, Nose and 3-202.15 Packa e hate it y* Mouth* 3-101.11 Food Safe and Unadulterated r 3-301.12 Preventin>Contamination When Tasting* 6 Tags/Records:Shelistock 72 Prevention of Contamination from Hands 3-202.18 - Sliellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Sbellstock identification Maintained* Em tlovees* Handwash Facilities Tags/Records:Fish Products 13 Conveniently Located and Accessible 3-40111 Parasite Destruction* 3-402.12 Records,Creation and Retention' 5-203.11 Numbers and Captivate,* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 r Accessibility, Operation and Maintenance tHACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502,1,2 Reduced as 'gen ucka ring;criteria* 6-301.11. Handwashing Cleanser, Availability 8-103.12 Confanuance with Approved Procedures* 6-301.12 Hand D*drn,Provision Denote,critical item in tite federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: T )n 1S�rn�)1)S IP �/` YID Date: 1012010LJ Page: C of Item Code C=Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY Ih l Il n . — 1' 1/]. , • 6t' 10"F. V ec&r 47 1- rla�l ° s d 4-p ,141m l- . 7v ke Nalm-falhod a � 2 s h L � /7 6 & i Wla i cva�h slh K r i U >r'vR lsh C /I//)G� - 0SC /319..1 _v n i ` u�aSh, e s� . �e cz'/sG�s ussren/cuas)� si��K n l l( l a ods aY3 ' l°l i s )- a d� 4 �n' F :J r yFf Y p _ _ t Discussion With Person in Charge: _ Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the oppotf—uriity�`to ask questions and`agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ f violations before the next inspection, to observe all conditions as described, and to Exclusion .. P Ll Re-inspection Scheduled ❑ Emergency Suspension gdmply with all mandates of the Mass/Federal Food Code. I'understand that t noncompliance may result in daily fines of tw y-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure younfood permit. ` s 0 Voluntary Disposal ❑ Other: 3-501.14(E�, PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to taw Cooled to Factors(items 1-22) (Cont.) 4I'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 15 C5 Cool my Methods for Ps 13 Food or Color Additives 19 PHP Hot and Cold Holding 3501.16(B) Cold PFIFs Maintained at or below 3-202.12 Additives* 590.0040 41°/450 F' 3-302.14 Protection from Una o roved Additives" 3-501.16(A) 1{ot PHFs Maintained at or above 1g Poisonous or Toxic Substances 140'F. * 7-lOL l i I'dentitying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers'" 7-1.02.,11 Campton Name-Workinm Container.* 20 Time as a Public Health Control 7-1-01.11 Separation-Storage" 3-501.19 Time as a Public Health Comm&* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re uirentent 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Win-nine labels* Dr'in .A*ents,Criteria`" - 7-205.11 Incidental Food Contact,Lubricants* 3-g01.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S aroutr Not Served. 7-20(.12 Rodent Bait Stations" 3-801.11(C) Uno.ened Food Package Not Re-served. 7-206.13 Trackm„Powders,Pest Control and Monitodn')* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'Fhat are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate Patho em E`"""` ,ani 3-401.1lA(1)(2) 1 gbs- 155'F 1.5 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell E Ls-hnmedtateServtue145`F15sec* 3-401.11(A)(2) Comminuted Fish,Meats&Game E �s* Animals- 155°F 15 sec. * SPECIAL 3-401.11(B)(1)(2) Pork and Beef Roast- IXT 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 Came,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultt y m Ratites-165°F 15 sec. "' above if related to foodborne illness 3-401.1107)(3) Whole-muscle,hitact Beef Steaks Interventions and tisk factors. Other 145°F" 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'P* Special Requirements. 3401,11(A)(1)(b) All Other PHFs- 145°F15sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (1terns 23-30) 3-403.11(B) Microwave- 165°F 2 Minnie Standing Critical and non-critical violations, which do not relate to the Tune* ,foodborne illness interventions and iiskfdetors listed above, can be, 3-403.11(C) Commercially Processed RTE Food- .found in the follombtg sectians of the Food Code arm'10.5 CMR 140'F* 590.000. 3-403.11(E) Remainim,UnslicedPortions ofBeef stern Good Retail Practices _- FC 582000 ------ -lo Roasts* 23. Management and Personnel_ -FC-2 .003 1g Proper Cooling of PHFs 24. Foci 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 5 006 70°f Within 2 Hours and From 70"F 27. Physical FacilityFC-6 .007 to 41`F/45°F Within 4 Hpum * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ectal Re uirements i .009 Temperature Ingredients to 41 F/45'F 30_..----Other .. �_...__-- Within 414ours" *Denotes critical item in the fu{eral 1999 Food Code or 105 C Mft 590,000. 'a. ,.... .. „ .«r...' ay...:.-". .. ...w+:n;J`.«:N- ht+.r•.. �, ar.a3,..,.L�1:�.,.,-" ~`� - .Re...,,s..a r,� , .:.. . .�.. .. ., ... _ .. �tr.+eY' Massachuisetts Department of Public Health Salem Board Health S 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Date T e of 4 eration s T a of Inspection Nam f�(j)) 1 0 Food ServicIf e ® outine�^ AddressRik 11Retail ElRe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone j ❑ Mobile Date: Owner HACCP Y!N 171 Temporary [IPre-operation ❑ Caterer [I Suspect illness Person in'Charge(PIC) Time ❑ Bed&Breakfast El Complaint in: El HACCP Inspector b y) Out Permit No. ❑Other_ Each violat on 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. r FOOD PROTECTION MANAGEMENT r - ; 'n ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties x'13.Handwash Facilities EMPLOYEE HEALTH '- ,PROTECTION FROM CHEMICALS ' - ❑ 2. Reporting of Diseases by Food Employee and PIG ❑ 14, Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15,Toxic Chemicals FOOD FROM APPROVED SOURCE , . - -- - tiTIMEIrEMPERATURE CONTROLS(Potentially Haiardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 Holdingr`i) ElB. Separation/Segregation/Protection El 20,Time As a Public Health Control -. ©'9. Food Contact Surfaces Cleaning and Sanitizing "REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP ❑ 10. Proper Adequate HandwasMng _ -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. I - 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: S'ssorrace�rFumib-,�a.aoc I sp Act S• r': Print: d PIC19•Signai nr : i Print: �g, Page of + Pages Violations Related to Foodborne Illness r Interventions and Risk Factors(Items 1-22) `. PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 1 Cross-contamination I 590.003(A) Assrprnment of Responsrbiliry,* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstr tion of Knowledge'" Cooked and RIF Foods* 2-103.11 Person in charge--duties Contamination from Haw Ingredients 3-302,11.(A)(2) Raw Antral Foals Separated from Each EMPLOYEE HEALTH Other 2 590.003(0) 'Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-3011l(A) Food Protection"` applicants* 3-302-15 Washinit Fruits and Vegetables 590.003(9) Responsibility Of A Food Employee Or An 3-364.1.1 Food Contact,'with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Re rn'Cin�by Person in Char e 3-366.14(A)(B) Returned Fuad and Reservice of Pood* 3 590.003(D) Exclusions and Restrictions''" Disposition of Adulterated or Contaminated 590.003(L) Removal of Exclusions mid Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* L4 _ Food and Water From Regulated Sources 9 Food Contact Surfaces 590A64(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-[pot Water 3-201.12 Food in a Ilernteticail Sealed Container^ Sanitization arc er hin., `" uct 4-501. .12 Mechanical R arewashing-[lot Water 3-201.1.3 Fluid Milk and Milk Products* 3-202.13 Shell Eg.s* Sanitization Tem eratut�s' 3-202.14 Fees and Milk Products.Pasteurized 4-501.114 Chemical Sanitization-temp.,pf[, aincenhation and hardness-" 3-202.16 Ice Made Front Potable Drinking Water' 5-1,01-I l Drinking Water from an Approved Svstem* 4-61}1.1 l(A} Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 31.0 CMR 22.0'r Contact Surfaces and LJtensds* Shellfish and Fish From an Approved Source 4-702-I1. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E q of ment' Shellfish* 4-703.11 Methods of Sanitization -Hot Water and 3-201.15 Molluscan Shellfish front NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reaulatow Authori 2-301.11. Clean Condition-Hands and Annss` 3-202.1.8 Shellstock Identification Present" 2-301.12 Cleanmg Procedure* 590.004(C) Wild Mushtuolns 2-361.14 When to Washs` 3-201.17 Game Animals` 11 Good Hygienic Practices 5 Receiving/Condition 2-401-11 Eatin Drinkin or UsingTobaaxi� 3-202.11. PFIFs Received at Proper Temperatures* 2-461.12 Discharges From the Eyes.Nose and 3-20215 Package lnte it * Mouth* 3-101.1.1 Food Safe and Lnadulterated:% 3-301.12 Preventing Contamination When Tastin=" 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.1.8 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Em lavees* Tags/Records:Fish Products I3 Handwash Facilities Conveniently Located and Accessible 3-4(72.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-?03.11 Numbers and Ga acities'* 590.004(1) Labeling of Ingredients" 5-204.11 Location and Placements` 7 Conformance with Approved Procedures 5-205-11 Accessibility, 0 eratlgn and Maintenance /HACCP Plans Supplied with Soap and Hand Drying Methods* Devices 3-502.11. S ecializedProcessin 3-50212 1 Reduced oxv win packaging,criteria" 6-301.1.1 Hg andwashin Cleanser.Availability 8-103.12 Conformance with Approved Procedures" 6-301.12 Hand Drying Provision *Denotes.rtttctf item it)the Federal 1999 Food Cale or 105 C Nl R 590.006. }yyr t CITY OF SALEM BOARD OF HEALTH (f Establishment Name-T b S 1' 60S FYI Pd OO�'1'�S Date:JU �y/o Page: of 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified :PLEASE PRINT CLEARLY r o 7 & ,( - `� T C lir c, Gk- O Q Sd� 1 dw In /9 7 /',�2k;T n /) V s in k1A i 4 rQ C 6tle2k ma7rri t yQ hG d rc�-u u l a 7,-7 s - _ ark- q, /sem hG // o cCUI c- / /.&1. L J /�( Q L l tC �C k (_maI V f)t fA)ff9 h /s�PS an Y D l , i �- / . O ac / r� no oYl� 2 - DaIrICI S b hlv� as gra' 1la . 1P I )rrhps,l im �7- / jP ( h�� d I� mll d)i I -fin rld/-fa he Sta dtec��f� Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes f • 16ve read this report, have had the opportunity to ask questions and agree to correct all El Voluntary Compliance C1 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 /ood Code. I understand that r noncompliance may result in daily fines of a ty f ve doltdrs or uspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: r 3-501.14(C) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41''F/45".F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,168) Cold Pf IN Manatained at or below 3-2(Y1.,12 Addtnvcs* 590.004(F) 41V45'F* 3-302.14 Protection from Unapproved Additives* IS Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 40'F, r° 7-101.11 Identifying Information-(h:iginal 3-50L16(A) Roasts Held at or above13WF. Containers` -- 7-102,11 Common Name-Workin,Containers* 20 1 Time as a Public Health Control 7-201.11 Se aration-Storage"` 3-501.19 Time ae,a Public Health Control* 7-202.11 Restriction-Presence and Use* 59o.o04(I-i) Variance Re uirentent 7-202.12 Conditions of 1-201 ToxicCmuaineas-Prohibi ons* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sat»tizets,Criteria-Chemicals* POPULATIONS HSP 7-204J.2 Chemicals for Washing Produce,Criteria" 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying, ents.Criteria* Beverageswldl Watmng Labels^ ?-205.11 Incidental Food Contact,Lubricants' 3-801.11(B) Use of Pastennzed B *s* 7-206.11. Restricted Use Pesticides, Criteria* 3-801,11(D) Raw or Partially Cooked Animal Food and Raw Seed S bouts Not Served. 7-206.12 FraRodentBait Stations* 3-801.11(C) Lno erred Food Package Not Re-served. 7-206.13 Trackinit g Powder:,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 360331 Consumer Advisory Posted for Consumption of 16 Animal Faits"that are Raw.Undercooked or Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ "'°" '"' a.om 3-401.11A(1)(2) Eggs- 155F '15 Sec. Pathogens E>ts-humediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Suhstitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Eggs Animals- 1.55'F 15 sec. 3-401.11(B)(1)(2) Porkand Beef Roast - 130'F 121 titin* 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 -1-401.11(A)(3) Poultrv,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. a= above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 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'F15sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Steins 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing, Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, Can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140`F*' 590.000. 3-403.1.1(F) Remaining Unsliced Portions of Beef item Goad Retail Practices FC 590.000 Roasts* 23. Martaciernent and Personnel-------FC--3 FC-2 .003 IS Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 .004 _ Equipment and Utensils 3-501.14(A) Cooling Cooked PHFs from 25 FC 4 .005_140°F to 26 Water,Plumbin and Waste FC 5 .006 --- -P -- - 70"F Within 2 Hours and From 70'F 27. h steal FaciIi __ FG-6 .007 to 41"F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC77 ' .008 3-50L14(B) Cooling PFIFs Made From Ambient 29_ S ectal Re uirements _ _ . .009 Temperature'Ingredients to 41`F/45'F 30._ Other_ Within 4 Hours,., ss�or�,,,m.,aaaso. Denotes critical item in]he i'edexai 1999 Foot)Code or 105 CMR 590-000. Y CITY OF SALEM its / BOARD OF HEALTH Establishment Name: non' �/))1S �/�� C IQrns Date: l o //q l b y Page: Of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference -R—Red Item Verified PLEASE PRINT CLEARLY '{F ) 9 G ooral/sear oa-i Md s 07 58°f ' J(,bn its i / a� in o sdrm?. fi i I ;10/2Pv � ue 42�d a)? -ITP Baa/in / kl /a mam -&,SQL ama, m A / vhr f /hs /�f'11 eP �e zD a/, l o7dr law as mal? a 1Q&//" -ID 4_9P, la lPcl r'� LZQ L t'afgYzt� ur ren- ryi icrvwale area- l j�rc uncaveied. Ca,C d /r Sfo 1 k6uet�d 19 WR ItAl( had a S7' ; Rev-7-eQ /a be, c tma"d a F a- .den z..a d D° or _lo cis 4 - a,I1iT7 27i c, JDC ria/ ` ale-S -1 / a �D r3 rJ a - ,b 70 �G�I C r Ca a 7r z?77 r rfi U-sPef. /d ua >< girt/ 3lo/ch i vast /n /_� a s-�d N cCc a6ea ' q l �J 'ft r?C V� r7I^ 3alU77 J/ �z, D2 D� S rrf72�E'.P Xz/ Ori Uig n0 c� l D a l h!6Y? a .'_ s L Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes Mave read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance x ❑ 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 Fo d Code. I understand that noncompliance may result in daily fines of twe give dollars or suspen ocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: _ F 3-501.14(C) PHFs Received at Temperarares Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont) _ 41°FI451"F Within 4 Homs. PROTECTION FROM CHEMICALS i9 3-SU'i.15 C wtis_Methods, for PHFs 14 ,i Food or Calor Additives PHF Hot and Cold Holding 3-501.16(6) Cold PHFs Maintained at or below -T-202-12 Addidves't 590.004(F) 41°/45"F- 3-302.14 Protection fiarn Una roti°ed Attditives* 3-501,1 6(A) Hist PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'F. * 7-101.11 Identifying Information-Orin nal 3-501.16(A) Roasts Held at or above 130"F. " Containers` 7-102.11 Common Narne-Workin--Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stora e" 3-501.19 Time as a Public Health Control* 7-2011.1 Re�Criction-Presence and Use* 590.004(H) Variance Re uireinent 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions} REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smtitizers,Criteria-Chemicals" POPULATIONS{HSP) 7-:.04.12 Chemicals for Washing Produce,Criteria" 21 3-80L I I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dr •ins* eats.Criteria* Beverages with K rating Iabels* 7-205.11 Incidental Food Contact, Lubricants* 3-80L I I(B) Use of Pasteurized h°gs* 7-206.11. Restricted Use Pesticides. Criteria* 3-801.11(D) Raw or Partially Calked animal Food and Raw Seed Sprouts Not Served. r!!L Rodent Bait Stations* 3-801.11(C) Unopened Fri Packa�e Not Re-served. s' 'Pracking Powders,Pesl Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE 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 3401,11A(1)(2) FgPathogens gs- 155°F15Sec. Ergs-hnmediate Service 145°.Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game E gs't Animals- 155°F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155"F 15 59(1.009( 1)-(D) Violations of Section 590.009{A}-(ll)in sec. * catering, mobile food,temporary and 3-401..11(A)(3) Poultry, Wild Game,ShAfed,PFIFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited raider the appropriate sections Poultry or Ratites-165".F 15 sec. above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401..11(A)(1)(b) All Other PHFs- 145"F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. *, (Items 23-30) 3-403.11(B) Microwave- 165°F 2.Minute Standine Critical and non-critical violations, o-hich do not relate to the Time" foodborne illness interventions and risk factors Uged above, can be 3-403.1.1(C) Commercially Processed RTE Food- Mound in the following sections of the Food Code and 105 CMR 140"F* 590.000. 3-403.1.1(E) Remaining Unsticed Portions of Beef Item Good Retail Practices FC 580.000 ----- Roasts"' 23. Mann ement and Personnel FC-2 .003 1g Proper Cooling of PHFs 24 Food and Food Protection _ FC-3 .004 25 Equipment and Utensils _ FC 4 _ .005 3-5(It.1.4(A) Cooling Cooked PHFs from 140°F to 26 Water, Plumbin and Waste FC 5 .006 70°F Within 2 Flours and From 70".F 27. Ph sical Factli FC-6--,067--- t --- to 41°FI45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 I .008 3-501.14(B) Cooling PHFs Made Froin Ambient 29. S eeial Paqulremonts _ .009 Temperature Ingredients to 41°F/45"F Within Hours* or .r ss-zao� 4 Denotas critical item in the tcdernl 1999 Food Code or 105 CMR 590000. f CITY OF SALEM �/__ �. BOARD OF HEALTH '.� Establishment Name: 7 ��)b S T/�/)�DUS '�7)P/� ( IQ�YIS Date: °%y/6� Page:_ of Item Code C-.Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - "- Verified PLEASE PRINT CLEARLY 380F • j a) Q "rZ! QCZd 4fl'� J P w n (2 / "1"0131,041 'f arAjekzo L! dQ�el _t =� ce c a a »l Seo Led c a . , bn It =2 s� Z rrr� - o U o Pa fiAhs .t e 1- ;9/n K_ R 3 - n,11hlLl 2 Su1Lc�r _ , Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension x- comply with all mandates of the Mass/Federal/Cod Code. I understand that noncompliance may result in daily fines of tw 'y-fiv dollars or sysp�ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: F 3-501.14(C) 'PHFs Received at Temperartinxs Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(Items 1.22) ItCont.) 41'.F/45'F Within 44 Homs, PROTECTION FROM CHEMICALS 3-501.15 Conlin"Methods for PHFS 14 Food or Color Additives39 PHF Hot and Cold Holding 3-202.12 Additives, 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 41'/45'F* 3-302.14 Protection firma Unapproved Additives* 3-501.16(.4) /lot PHFs Maintained at or above 15 Poisonous or Toxic Substances 14{)'7. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Workina Containers* 20 Time as a Public Health Control 7201.11 1 Separation-Sos age* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizefs,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for lVashin Produce,Criteria' 801.11(A) Unpasteurized Pre-packaged Juices and Beveraaes with Warning labels* 7-204.]4 t)r Ing Agents,Criteria' 3-801.11(B) Use of Pasteurized Egp* 7-205.11 Incidental Food Contact. Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-80L11(D) Raw or Partially Cooked Animal Food and 7-206.12 1 Rodent Bait Stations' Raw Seed S trouts Not Served. 7-206.13 Tracking Powders,Pest Control and3-8ol.l (C) Uno encd Food Packs re Not12e-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Sfi Proper Cooking Temperatures for Animal Foods'Phat are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate Pathogens."011 fro r;;,zua, 1-401.11A(1)(2) Eggs- 155'F 15 Sec. E>es-hnmediatc Service 145`PlSsec* 3'30'2.13 Pasteurized Eggs Substitute for Raw Shell 3-401..(1(A)(2) Comminuted Fish,Meats&Came E s'" Animals-155'F 15 sec. * 3-401.1.1(13)(1.)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in SeC. * catering, mobile food,temporary mid 3-401.11(A)(3) Poultry, Wild Game, Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Barites-ib5'F 15 sec. * above if related to foodborne illness 3-401.11(,C)(3) Whole-muscle, Intact'Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Mierowave 165"F SpecialReguiientants. 3.401.11(A)(1)(b) All(hher 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°F2 Minute Standing Critical and non-critical violations, which do not relate to the Time" .foodborne illness interventions and risk factors listed above, can be, 3-403.11(C) Commercially Recessed RTE Food- .found in the fallowing sections of the Food Code and 105 CMR 14WF* 590.0000 3-403.1.1(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 59d.000 Roasts` 23. Mans ement and Personnel FC--2 .003 1g 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 Y40°F to 26 _Water,Plumbin and Waste FC 5 .006_ 70+Within 2 Hours and Front 70"F 27. Ph sicai-Facdhty FC-6 .007 to 41.'F145'F Within 4 Hours. * 28. Poisonous or Toxic Materials PC-7 .008 -T-50I 14031Cooling PI IFs Made From Ambient 20. 5 eels?Re uiremen s ------ --1009 Temperature Ingredients to 41'F/45'F 30. _Other _ Within 4 Hours'r ssmr,•,�„c:eaa.a« '*Demurs critical recant the(adexal 1999 Food Code or 105 CMR 590,000. 10 Sanitary Facilities and Pest Management General Guidelines for Chemical Sanitizers Chlorine Iodine Quaternary Ammonium Minimum Concentration o For Immersion 50 parts per million (PPM) 12 5-25-0 PPM 220 PPM o For Spray Cleaning 50 PPM 12.5-25.0 PPM 220 PPM Temperature of Solution Above 75`F(24`C) 75-F (29`C) Above 75T (24°C) Below 1157(46"C) Iodine will leave solution at 1207 (49°C) Contact Time o For Immersion 7 seconds 30 seconds 30 seconds--fead label; some products require longer o For Spray Cleaning Follow manufacturer's directions Follow manufacturer's directions contact time pH (detergent residue raises Must be below 8.0 Must be below 5.0 Most effective at 7.0, but varies pH,so rinse completely) with compound Corrosiveness Corrosive to some substances Noncorrosive Noncorrosive Reaction to Organic Quickly inactivated Made less effective Not easily affected Contaminants in Water Reaction to Hard Water 'Notaffected lvhx Not affected Some compounds inactivated— v ` tread label; hardness over 0-- P.-z 500 PPM is undesirable Indication of Test M required 4 . Amber color indicates presence.Use Test kit required; follow Proper Strength w ',r•test kit to determine concentration directions closely MACHINE WAREWASHINGr Most tableware, utensils, and even pots and pans can be cleaned and sanitized in warewashing machines. Most warewashino machines mnitize by using either hot water or a chemical-sanitizing solution. High-Temperature Machines These machines rely on hot water to clean aw,i The temperature of rhe final sanitizing rinse nu,1i be at least IbO'F (82'C)fror stationary-rack single-temperature madtinc>, the tempecuurr of the final smim/.int; rinse unist be ar least 16�'I (- i , Malec sure vour ward+usher has a built-in ilir:, 'onnurt to 111ra1urc clic temper:rrure of water ai rhe manifold, 1 iht i'II& i ServSafe Essentiak Scented or oxygen bicaches are not acceptable as sanitizers for food-comae surfaces- Household bicaches are acceptable only if the labels indicate they arc FTA rcgutcrcd. l Advantages and Disadvantages of Different sanitizers Types Advantages Disadvantages Chlorine Most commonly used sanitizer Less effective in LH ranges outside 6 to 7.5 Kills a wide range of microorganisms Did quickly inactivates these solutions Leaves no film on surfaces Corrosive to some metals such as stainless steel and t_east expensive aluminum when used improperly Effective in hard water Adversely affected by temperatures above 1157 (46"C) Iodine Effective at low concentrations Less effective than chlorine t Not as quicHy inactivated by dirt as chlorine 4 y r>. Less effective at pH levels above 5.0 Color indicates presence ; " Becomes corrosive to some metals at temperatures above y 120T(49 C) > - More expensive than chlorine 'f May stain surfaces Quaternary Not as tquic.- lnavc aleclb di a "o 'Leaves a film on surfaces ammonium fiema�ns acYSe fotoi e 4 e as - s Does not kill certain types of microorganisms compounds ...., r t t r; (quats) NonconosiVe y a K Hard water reduces effectiveness µ Nonimtatin #osian ` Wales in mos##emperature antltps��,�,„�� n r Factors Influencing the Effectiveness of Sanitizers Different factors influence the effectiveness of chemical sanitizers. The most critical include contact time, selectivity, temperature, and concentration. The table on the next page summarizes these factors. i«a A test kit designed for the specific sanitizer should be used to rest its concentration in the sanitizing solution. Test kits are usually available from the manufacturer or a restaurant supplier. Tic picture to the right shows one in use. A sanitizing solution muse be changed when it is visibly dirty, or Micit the concenrration of the sanicizer has dropped below the amount required. Sanitizer Test Kit Use the kit to test the concentration of a sanitizing solution. 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 (9 8) 745-0343 Name / Date L.' Tvygdoif 0 eration s of Ins ection S Liv✓hG c•S F P cP �LLU�� k'�/ T Food Service Routine Address ' / Risk ❑ Retail ❑ Re-inspection Telephone Ly Leve�1 El Residential Kitchen Previous Inspection Y ❑ Mobile Date://C W 03 Owner HACCP YM ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector / " vin6 / 49/10 77f k/S 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 ❑ Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties V. Handwash Facilities EMPLOYEE HEALTH J` C 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 ❑ 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 V/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) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY., ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions d e 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 ofHealth.Nth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other , DATE OF RE-INSPECTION: 5:5901nspecfPorm644 tloc ' s or's ig r : Print: I'PIC's Signa ure: Print: Pagea'_^-".gf o2.Pages �,, Cm Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 590-003(A) Assignrnent of Responsibility" 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowledge* Cooked and RTI:,Foods" 2-103.11 Person in char e-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH OthcO 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A 1(A) Food Protection* applicants* 3-302-15 Washing Fruits andVevetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To ReportTo The Person Tri Utensils* Chat-+e* Contamination from the Consumer 590M03(G} Re orting�Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition ofAdulterated orContaminated 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 liance with Fond Law* 4-501111 Manual Warewashing-FIot Water ;-201..12 Food in a Hermetically Sealed Container* Sanitization lcm eiatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 , Shell E__»s* Sanitization Temmeratures* 202.14 Ewes and Milk Products,Pasteurized* Chemical Sanitization-temp.,pH, concentration and hardness. " 3-202.16Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Fail Contact Surfaces and 5-191.11 Drinking Water from an Approved Sastem* Utensils Clean- 590.006(A) Bottled Drinking Water* 4-60211 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Iitcnsils* Shellfish and Fish From an Approved Source4-9(12.11 Frequency of Satutizatiort of Utensils and 3-201.14 Flsit and Recreationally Caught Molluscan Fond Contact Surfaces of Equi anent* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.I5 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reqrratory Authority 2301.11 CleanCondition Hands and Arms* 3-202.18 Shellstock Identification Present* 2301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash' 3-201.17 Garne Animals* -11 Good Hygienic Practices $ Receiving/Condition 2-401.11 Fatin ,Drinking or Using Tobacco* 3-202.11 PFIFs Received at Pro mer Tem eratures'r 2-301.1.2 Discharges Front the Eyes.Nose and 3-202.15 Packase httesrit * Mouth* 3-101.11 Food.Safe and Unadulterated* 3-301.12 Preventing Contamination When Tustin:* 6 Tags/Records:Shelistock L12 Prevention of Contamination from Hands 3-202.13 Shelistockl'dentifieation* 590.0(A(E) PrevendngContamination from 3-203.12 Shellsnrek Identification Maintained`" I IEnm to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.1.I Numbers and Capacities 590.004(1) Labeling of Ingredients' 5-204.11 Location mud Placement* 7 Conformance with Approved Procedures 5-205.11 AccessibiliC ,O errrtion and Maintenmtce /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methodsl' - Devices 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 1 Handwashing Cleanser.Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Band Divin>Provision Denote,critical Stem in the federal 1999 Fwd Code or 105 CKIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: ga& xi'mci/s Date: /3— d1;/ Page: a of Cz Item Code C-Critical Item. - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date No. Reference R—Red Item - Verified $ PLEASE PRINT CLEARLY � U ""`13 r v e. 7/el f r X7' 7-P FR ,ld//,C /fir d 7��7 a� 41 9 S-/57 aaG err b /°mss rGC�sdi r/s �i c�� /! 1,eVI F Q:s s��y ©� 7�rrr �,ed kers P - .�<./� Tivs 7�� - �i�✓q P S e � x , b 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- ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure Your food permit. ^g � ❑ Voluntary Disposal ❑ Other: t 3-501 J 4(C) PHFs Received at'1'eniperatnres Violations Related to Foodborne Illness Interventions and Risk Accardin��tq Iaw Cooled to Factors(items 1-22) (Cont) 41'F145FWitliin4Hours. * PROTECTION FROM CHEMICALS 3-501.15 Conlin« Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 35 ) 01.I6(B Cold PHFs Maintained at or below Additives' 3-302.14 Protection from Una i rmed Additives' 3-501 J4(F) lint P °F* Ig Poisonous or Toxic Substances 3-Sol.lb(A) }lot PHFs iYfaituluned at or above 40"F 7-101.11 Identifying Information-Ch'iginal 3-50 1. Roasts Held at or above 130°F. Containers" 7-1.02.1 I Comtn{»n Nanta-Working Containers* Time as a Public Health Control 7-201.11 Se oration-Stotnge.* 3-501.19 Time as a Public Health Control* 7-202.11 Rtwiction-Presence and Ilse* 590.004(H) Variance Ke uirement 7-202.12 Conditions ofUsc* 7-203.11 Toxic Containers-Prohibitions"` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 _Chemicals for Washing Produce.Criteria" 2T 3-801_11(A) Unpasteurized Pre-packaged Juices and 7-204.14 DryingAgerns,Criteria' Beverages with War mug I.Abels* 7-205.11 Incidental Food Contact.Lubricants* 3-h01..1I(B) Use of Past'eunzed Eggs* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.1 t(D) Raw or Partially Cooked Animal Food and Raw Seed S trouts Not Served. 'x 7-206.12 Rodent Bait Stations- 7-206. tations* 3-R01.11(C) Unopened Rood Packa=e Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.F 1 Consumes Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Aminal Hoods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.IIA(1)(2) Eggs- 155F IS Sec. Pathogens.* e"a`ma vvzoor E s-hwne.dratc Service 145°F15sec* 3-302.13 Pasteurized Eggs St&uarc.'for Raw Shell 3-401.11.(A)(2) Comminuted Fish, Meats Az Game Bas* Animals- 155°F 15 see. * 3-401.11(B)(1)(2) Pork and BectRoast- 130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)4D) Violations of Section 590.009(A)-(D)in sec, * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Scoffed PHI,s residential kitchen operations should be Stuffing Containing Fish,Meat, debited under die appropriate sections Poultr or Ratites-165°F 15 sea u, 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 Anieral Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-40 1.11(A)(1)(b) All Other PHFs- 145°F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(ll) PHFs 165'F 15 sec. 's (Itetm 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing (30ical and non-critical violationy, which do not relate to the Time* foodborne,illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTF Food- ,found in the following sections of the Food Code and 105 CMR 140°F" 590 000. 3-403-1.1(,F,) Remaining Uusl iced Portions of Beef item Good Retail Practices _ FC S90.DA0 Roasts* 23. Mona ement and Personnel FC__ FC -2 .003 Ig Proper Cooling of PHFs 24 Food and Food Protection FC-3 .004 _EquiRment and Utensils _ 3-501.14(A) Cooling Cooked PHFs from 140`F to 25 FC--4 .00526 Water.Plumbing and Waste FC-5 .006 70°F Within 2 Hour and From 70°F 2T Physical Facility__._ FC-6 .007 to 4 t°F(45°F Within 4 Hours. ` 28. Poisonous or Toric Materials FG-7 .008 3-501.14(B) Cooling PHFs Made From Ambien[ 29 _ Special Requiremanis 009 Temperature Ingredients to 41°Fl45`F 30. Within 4 Hours* Dcn(ribt critical neon in the tederd 1999 Food Code or 105 CNIR 590,000. l - ---- - ---- IF '—ani- - I -- -�— —�— - — ---_-- — — ..__. \ -- �la -- ---- -- - - ---- -- ------- IL i—'..%�T. r17 _ e-4— L)alR_ ce Iel esl / fly i I I I z : I I�- I r-�Cv' I F, r — •I I i II VIII iill I ii— _ IT u� I I I i— i +- at h --- �M�t^� ZVn��_ � ''1zImP � SSI �� ' �/9'il�uTAAa.S �-S'•S _ �-��'N�s I lN1n�IS.-- - i Pic --_ � I I � _ :� I �I� I I GYId�iL'�I' IL2 I i il„ I I �� i e✓[c1:IC �-.il I i I �� f"� __ —. --' — nX Tskl —} uclinl 3e .eu1—rJi un'dc�cn'vn�e z �I — Sur(r�.)ic4 Until I � �• —G�ost-Y I—I I � I �� _Au✓nr gyral° —5 � -- - '- -- — - �— I h i I ---_"� i qt "' I —_- 1 I I '�iZ2 Ci alJ. - - _ -fid - k iTt `VCM- �r'I ''t-F.��yS�-�s_�w��VV_�.�—�w�o� v�I J~_ •1�1 1. �I / �' j �'�"�I�•it/' Y Illy _ ry- -___ -- l2 � I I I _ 8 I I 5`�' y� A ~ xoroM CITY OF SALEM, MASSACHUSETTS "F BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM. MA 01970 'fes TEL. 978-741-1800 �P�fh N6 FAX 978-745-0343 SVANLEY 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 : Arthur G. Velonis Name of Establishment : Bob ' s Famous Fried Clams Address of Establishment : 429 Highland Avenue Type of Establishment : FOOD SERVICE Application Date : 01/02/2003 Restrictions : Permit for Food Establishment 203-03 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. r r HEALTH AGENT f Y CITY OF SALEM, MASSACHUSETTS 9 �s BOARD OF HEALTH 2 120 WASHINGTON STRFET, 47H FLOOR SALEM. MA 01970 ��s u` tfo �-� TFL. 978-7d 7- I BOiJ 9��M1INE Fax 978-745-0343 S'T'a I-EY USOVICZ. JR. JOAiJNE SCOTT. MPH. RS. CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERAT��sEA FOOD ESTABLISHMENT n7 NAME OF ESTABLISHMENT E,hJb> �' ye45 Cly Q19,w S TEL# ADDRESS OF ESTABLISHMENT A/C MAILING ADDRESS (if different) / OWNER'S NAME 4Q11Ue 67Vfv TEL X977 ADDRES ✓ /Z�Fffrn LI�J�� CITY STATE A�ff 7_IP_D/ 1Cj n40(p vel CERTIFIED FOOD MANAGER'S NAME(S)/htChR61 Corp CERTIFICATE#(s)2Z. 2.Y93 (required in an establishment where potentially hazardous food is prepared.) n EMERGENCY RESPONSE PERSON)k//A.J Ve-&,Ur3 HOME T E L#. 77 HOURS OF OPERATION: Monll-fl Tue.Il-l) Wed.I/ Thu.// Fri.10 Sat.//-`] Sun.!/ TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 O a-0 3 more than 10,000sq.ft. =$250 RESTAURANT E NO less than 25 seats =$100 (�' 25-99 seats =$150 more than 99 seats 200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YESN $5 TOBACCO VENDOR YES $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. Pur ant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my b s kn led a ndp�elief, have filed all tatg tax returns and paid all state taxes required under the law. 9 UZQa�+-�i i02 �q/OY d� S/ ,,� �� Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------ �_ Revised 11/25/02 FOODAP2.adm Check#&Date �� y.,-.. �... .. .....m.-.-..- �- �."•n-.�...+-.-�,e-.,-..�..n.�x�ts*+n*vY'+b�#�'.^"ti'+.f^'��.My'+v..My,.-wre+er---T^.`.,r...ao...r.='n,.avnv�'rb.F' THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name pp Date 7 fOperations) T f In i n Food Service Routine Address Risk ❑ Retail ❑ Re-inspection y Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP Y/N El Temporary E3Pre-operation .2 ,1 6. ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint 'S In: ❑ HACCP Inspector 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 "IL�J�� 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/ Excluded [1 14. Approved Food or Calor Additives ❑ 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 El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating EJ7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAM NINI ATI,ON 919. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El 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 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 oZ 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 f 27. Physical Facility (Fc-5)(550.007) 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 SignatureA I "1vt � % Print: PIC'sSignature: /// / °� Print: _ / //Q/ I� Page--Lof-c� Pages FORM 734A HOBBS&WARREN - BOSTON u� !� � J 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 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Char e-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting 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 SOURCEg 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* Hardness* P g€ Concentration and 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating, Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 ' Prevention of Contamination from Hands Tags/Records:Shellstock 590.004E v ( ) 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(J) 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. _ CITY OF SALEM BOARD OF HEALTH t. ` Jn Establishment Name: KBO B s Fdi✓YOdS Fie7(W (21a .c Date: /t/aa. 04- 03 Page: of oZ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY- - U c in - r? N vr7Ll/HEL P. S z f _ C m vti 7�5 17- ,un A P.P T L . * 7-Xe lv LXP O/ ,- Sty- till O _ _GL IJP /iriIJ 1-elaR L/'VI ' /!/P Vl';-ICLC1Li7//n/9 9 -`O6 N9 6; r l - PLPcJ e. �Sc� rir C T1f�v� eJ`so ie�� 'i. A*72� e /VC L L r". 4 II _ ., I/ /� 7rL 4 (� /3 r? iLe7` Ae).oYI9S 1v ey'd S eZ %7v �d�1/. PS "SX zu+-r .0 v e �; .¢,v aro 6 it 1 � f�IG Pd w P iP/+'7i f' VS Y�!�- r / NOsvo s/r7N— /1 / r 13w aJ / /✓h D acX T 7`_S S s e-r/ S/ <c d 4qe,,Y e6/ 17 7( AeeV,51A — LodeS 1W10P Al !' rs1N/SoP Re.'/ x, p GD P4 edS O.e /A/ C? !ld oQ " 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/ I ' ( violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in,daily fines of enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure { your food permit. % �J !!!///�v-L� Ll Voluntary Disposal ❑' Other: 4 4 3-501-14((') PHFs Received at Temperztures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4l'F/45'F Within 41-lours. PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFi Iy PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Addmves* 590.004(17) 41'/45'F* 3-302.14 Protection from Chtappnyed Additives" 3-501.16(A) Hot PHFs Maintained al of above LIS Poisonous or Toxic Substances 140°F.* 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 20 Time as a Public Health Control 7-201.I1 Common Name r Working Containers"' 3-501.19 Time as a Public Health Control'" 7-301.11 Separation-Storaee" 7-20111 Restriction-Presence and Use 590.004(H) Variance Recuirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 "Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Saniuzers.Criteria Chemicals 7-204.1.2 Chemicals for Was hin Prixlace U n'eriw. 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Diving- w'lints,Criteria* Beveraees with Wanting+1.ribels* 4-205.1.1 Incidental Food Contact, Lubricants* 3-801.11(8) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria` 3-801.11(D) Raw orPwtially cCooked Animal Food and Tra--cking Powders,Pest Control anti- -� it Stations* Raw Seed S routs Not Served. 7-206.13 Tracking 7-206.12 3-801.1Re-served. .1(C) Unopened Food Package BPC Monitoring` CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3503.11 Consumer Advisory Posted for Consumptionf o 16 Proper Cooking Temperatures for Animal Fouds That are Raw, Undercookcd or Not Otberwise Processed to Eliminate PHFs 0r 1 1 rr•nor 3-401.11 A(1)(2) Eggs- 155'F 15 Sec Pathoi,uts L ns-hnmedt lie Service 145°F 15sec* 3-302.13 Pasteurized Fa)s Substitute for Raw Shell 3-401-'11(A)(2) Comminuted Fish.Meats&Game Ego�s* Animals- 155'F 15 sec. " SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) Fork and Beef Roast- 130F121mm* 3-40111(A)(2) Ratites, Injected Meats- 1.55'F 15 590.009(A)-(,1)) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-40LI I(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Cooked in a practices should be debited under##29- Microwave 165'F* Special Requirements. 3-401.11.(.A)(1)(b) All Other PHF;-- 145'F 15 sec. :' I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403-I1(A)&(D) PHFs 165°F 15 sec. #` (Items 23-30) 1403.11(B) Microwave-165`F 2 Minute Standing Critical and nun-critical violations, which do not relate to the lune* Ioodborne iilness interventions and risk factors listed above, can be 3-403.1.1(C) Commercially Processed RTF Food- .found in the follon ing sections of the Food Code and 105 CUR 140'F* 590.000. 3-403-11(E) Remaining Unsliced Portions of Beef Item Gm Retail Practices ! FG 590.000 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 3-50114(A) Cooling Cooked PHFs from 140'F to 26. Water,Plumbin and Waste FC-5 .006 70"F Within 2 Hours and From 701, �- 27. I Ph sinal Facilit� FC-6 .007 to 41"F/45'F Within 4 Hoon * _28. ' Poisonous or Toxic,Materials I FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient Z9. S eclat Requirements .009 Temperature Fngredientstn4t'F/45°F 30, Other - -- Within 4 Hours* ermr�,mddr..a.m� 'Denote critical irern in the federal 1999 Food Codeor 101 C NIR 590.000. `IMPORT MT MESSAGE FOR [:)ATE //, TIME M OF PHONE AREA COOE NUMBER EXTENSION U FAX ❑ MOBILE AREA CODE NU BER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE.YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED FORM 400 Y�I �R MADE IN U.S. . NOTES ` IMPGRTAPJT MESSAGE ' FOR DATE �'� 3 TIME 5--//4w P.M. M OF J. /".Q/ 4 lye PHONE AREA CODE NUMBER EXTENSION O FAX D MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED �sFORM 9 MAGE IN A. NOTES `