The URL can be used to link to this page

BOSTON HOTDOG CO - ESTABLISHMENTS Boston Hotdog Co. 60 Washington Street u �I li M d n h ;i u a F Yf 9 t{ C i Ii U 1 u - � o n V c _ .-4'� cx.. —�. 0 `�-'S3L'^r - c -� - LS?�G�.-- 6 -*�-+��a.- Yk 1 ___ _ _ __ __ _ _ .� r _ _ _ _ _ _ _ ____ _____ _ _ __�.. _ .. v i 9 I >O 1 _ _ � �..._ .. .�...-. m 4 �� J_-_----- . _.P._ _.....� ___ .. � _ _._. � rLcT��J�� .. � t' .. �' F- r! r `�i {E} f I f{: �� , , i �`� fi �(i f: �� t' 'k �4 l� -� 1� �� i� _ �I �� I l� - - � - � _ - � - f �� v W. 4 5� CUfuulunwcultli of Massachusettis U 7. 4ADf -r citfof-Salem, g, Al SIA 1�1 *w 1K, -W Boar d of Health A MbO- d NNR07M��'- � � 120Vasb� OWISNP M 4 -T ."5. _ . k 4.-JA-�F_Ar VIM, SALEM, Ai V: Ar, - Obod/RetailMita MiY W21-% __1 V6. D:- 1 01/09/ DATE klr4iiE A;A Aw. S. A "�'Bostowlfotddg`U.A NAME - ESTABLISHMENT' A- VA M File NumbaSHF-2064-600265 WWtghifiktan'Sfrebt W Ok i Salem -TEDfT ' LOCA A :; w6WASHINGTON-STREET W SALEM 0197 i W 'u A -'I.,_Al- zxernutNo.-Az� Permit FOOD SERVICE 8HP-2014-0344- -Jan I 2014 ,, ,Dec 3l,,2014,9A$140UO ESTABLISHMENT Z", -a- A't Ak Total A� -00- & g:i!x Q K 'A. �4Z 1 r4 V, z Ru4e- 41 A 4�k I k A PA t5A'!t?- _Ok, a 9t M N, �4N, 41, EXPIRES C_-`% PERMIT E lbir-11" 201, A N S '4Z W� A4�4� u 57_7.14� ' 61 1 yY TT % 7Y, 4 X —A" Aw- X _jhis Permit is not transferable and mustbereissued upon changeofownership orW atl6i.The oermit—mu-s' t Wposted, . i IH Zx� in-a prominent location in the Egfiblislinefitr' g tz inyievOnatibusi'tim- proy-em--- In keordante With theStste:Sajiltar ents;,or,equipment changes y�COde;biofre allplansfor,such Must bi:submitted to and-k -approied by the Salem aoikvdkal& ... .... ..... _J 1W ~-V- .. ....... . A k CITY OF SALEM, MASSACHUSETTS P BOARD OF HEALTH 120 WASHINGTON STREET,4TM FLOOR KIMBERLEY DRISCOLL TEL.(978)741-1800 FAX(978)745-0343 MAYOR lydmdin(a]salem cnm LARRY RAMDIN>RS/REHS,CHO,CP-FS HEALTH AGENT Food Establishment Permit Application (Application.must be submitted at least 30 days before the planned opening date) 1) Establishment Name: � � � 2) Establishment Address:v�_ 0 3) Establishment Mailing Address(if differegt): 66 4) Establishment Telephone No: 6 1 -� u l '-7 I �� IS Applicant �T � � U — ' APP cant Name&title: /� q c�A� �t1J 0✓ �� 8) Applicant Address 7) Applicant Telephone No:ler) ��1f( O�14 Hour Emergency No: 8) Owner Name&Title(if different from applicant):191 1 Owner Address(if different from applicant): 1111 18) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. " An association Name Title Home Address A corporation An Individual A partnership Other legalentlty 12) Person Directly Responsible For Daliia v Operations(Owner,Person in Charge,Supervisor,Manager,et .) p^ ,�^ Name&Title: 9 Q A- �j J �( � V).� Address: � 6 s I✓�� Ljty (6 �r A Telephone No: (R I, ! �/ �_ x; .J Email: Emergency Telephone No: -] `'6 I oLq, CVJy`'I[1 13) District or Regional Supervisor(if applicable) Name B Title: Address: Telephone No: Fax: Email: j Check#: Date: I gA,Wnt: _ 1� r%Ael rooa estanusnment Information 14) Water Source: 15) Sewage Disposal: i `I DEP Public Water Supply No: (If applicable} � J0 _ J 16) Days and Hours of Operation:) {� 1 'l a 17) No,of Food Employees: my 18) Name of Person in Charge CePNfied fo Food Protection Management: Required as of 101112001 In accordance with 105 CA9R 590.003(A) �{�t✓I c�p (j ct J 1 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) O etail( Sq. Ft) 0 Caterer Permanent Structure fl�Food Service-( Seats) O Frozen Dessert Manufacturer Mobile Food Service-Takeout l7 Residential 10tchen for Retail Sale Food Service-Institution O Residential Kitchen for Bed and ( Meals/Day) Breakfast Home E3 Food Delivery E3 Residential Itchen for Bed and 21)/Length Of Permit: .Breakfast F,stabllshmerRs..................... (check one) RETAIL STORE RESTAURANT - Annual 17 Less than 1000sq.fL $70 E,kess than 25 seats $140 Seasonal/Dates: O 1000-10,OOOsq.fL $280 IN Residential Kitchens $140 13 More than 10,000sq.ft.$420 O 2549 seats• $280 O More than 99 seats $420 Temporary/Datesmme: - ------------------•-------------------------------•-$5--------- Betl&-�eakfastlChildcare Services/Nursing Home $100 --- -•-•--- - ------------------------..-.-...-....-...-.--.......---...------- ADDITIONAL PERMITS ..................••-----.-......-------• ❑MAKE ICE CREAM,YOGURT/SOFT SERVE $25 O PASTURIZATION $25 O ALL NON-PROFIP $25 'Including,church kitchen;state funded childcare 8 arlvate club 23) Food Operations: I Definitions: PHF-potentially hazardous food(timeBemperature controls required) Non-PNFs-non-potendally hazardous food(no timeltempendure controls required) (check all that apply): RTE-resdrto-eat foods(Ex.sandwkhes salad;muffins which needno furtherprocessinp - Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs I for More Than a Single Meal Service Sale of Commercially I Preparation of PRFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFsI Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for I and/or HACCP Pian(including bare hand Service Within 4 hours contact alternative,time as public health' control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares FoodISIngle Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board afHealth Retail Sale of Salvage,Out of Date. or Reconditioned Food I Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided In this application and I a Irm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been Instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Cade. 24) Signature of Applicant: /c Pursuant to MGL Ch.62C,sea 49A,I certify unde the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or federal ID: 26) Signature of Individual or Corporate Name: I R CITY OF SALEM, MASSACHUSETTS BOARD OF HE ixi-i IV 120 WASHINGTON STREET 4"'FLOOR PublicIieatth > Yre.em.Prcmom.Promo TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEY DRISCOLL lramdinnsalem.com - LARRY It,\nm1N,1tS/Rru Is,G u),(J)-F'S' MAYOR HI?.AI;1'I-1 AG Ii:N'I' January 6, 2014 Strates Frangules, Owner Boston Hot Dog Company 60 Washington Street Salem, MA 01970 Dear Mr. Fangules: In November the Salem Board of Health sent you an application for your 2014 Food Permit. Included in that mailing was a cover letter stating that you were required to return the application by December 16, 2013. To date we have not received your application or application fee. You are operating your establishment without a permit in violation of the State Sanitary Code Chapter X: Minimum Sanitation Standards for Food Establishments, 105 CMR 590.000, Section 8- 301.11. Therefore. you are ordered to close vour establishment on Wednesday. January 6. 2014 if the aoolication, reauired oe'rmit fee and the late fee $100.00 are not received by 4:00PM on Tuesday. January 7. 2014. Sincerely yours, Z' Larry Ramdin Health Agent Hand delivered by Inspector CITY OF SALEM, MASSACHUSE'rTS V9 BOARD OF HF-M,"M PnbheF[ealth 120 WASHINGTON STREET,4"'FLOOR v....m.rr mmc.Promo. TEL. (978)741-1800 FAx(978)745-0343 KIM13ERLEY DRISCOLL 1lamdinasalcm.com LARRY RAMAN,RSJRF.i IS,CI Ht,t:P-I S MAYOR FII::v;PN AcI1;NT January 6, 2014 Strates Frangules, Owner Boston Hot Dog Company 60 Washington Street Salem, MA 01970 Dear Mr. Fangules: In November the Salem Board of Health sent you an application for your 2014 Food Permit. Included in that mailing was a cover letter stating that you were required to return the application by December 16, 2013. To date we have not received your application or application fee. You are operating your establishment without a permit in violation of the State Sanitary Code Chapter X: Minimum Sanitation Standards for Food Establishments, 105 CMR 590.000, Section 8- 301.11. Therefore, you are ordered to close vour establishment on, Wednesday. January 6. 2014 if the aoalication, required permit fee and the, late fee $100.00 are not received by 4:00PM on Tuesday. January 7. 2014. Sincerely yours, Larry Ramdin Health Agent Hand delivered by Inspector Miissachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 `` Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of SoJowV1 Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel.v1 y� Name Type of Operation(s) Type of Inspection ❑ Food Service ❑Routine Address r O t C� e . Risk ❑ Retail ❑Re-inspection 1 D ! l Level ❑ Residential Kitchen Previous Inspection Telephone (� d �/� ❑ Mobile Date: ,� z [I Temporary [I Pre-operation Owner 'C 1_„ I �A1 G`:�„� 1)per' HACCP YIN I ❑ Caterer ❑Suspect Illness Person-in-CChhargei((PI7CC) i-r F r / S 17 TI yn^nn E] Bed&Breakfast [I General Complaint //1i1 /� �l / I 'I ,{/( ❑ HACCP Inspector ` l� �(�1 0 Out: Permit No. E],Other Each violation checked requires planation 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 590.009(E) ❑ ❑ A/� ,�, Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) Awareness sss.00s(G) corrective action as determined by the Board of Health. DOPROTECTION MANAGEMENT' ] [112. Prevention of Contamination from Hands W 1. PIC Assigned/Knowledgeable/Duties L MPLO_YEE HEALTH__ -� ❑13. Handwash Facilities ❑ 2. Reporting of Diseases by Food Employee and PIC iPROTECTION FROM'CHEMICALS ] ❑ 14.Toxic Chemicals Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded di[,F000FROM 15.APPROVED SOURCE __F14. Food and Water from Approved Source , EITEMPERATURECONTROLS_(Pot_an_tlally Ha_x_erdou__s F_gods)" ❑ 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,HIGHLNSUSCE__PTIBLE_pOPULATIONS'_(H---- ❑21.Food and Food Preparation for HSP ❑10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices [CONSUMER ADVISORY ) �v'7"' 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 ins ction 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-2X590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3X590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FcsX590.006) establishment operations. If aggrieved by this order,you /A 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing (� 28. Poisonous or Toxic Materials (Fc-7X590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: [aspector's Sigaatal.: JdIJ YA�.C/l� Print: h(eo �,yy7 PICS Signature A Print: �� _ N(� , Page-Lofr Pages i Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I 1 Cross-contamination j 3-302.11(A)(]) I Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I 1 Contamination from Raw Ingredients 12-103.11 1 Person in charge-duties 3-302.1 I(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTHOther* J 2 590.003(C) Responsibility of the person in charge to I 1 r I Contamination from the Environment I : 302 tl(A) I Food Protection 1 require reporting by food employees and 3-302.15 1 Washing Fruits and Vegetables 1 applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* JI Applicant To Report To The Person In Contamination from the Consumer Charge* 13-306.14(A)(B) Returned Food and Reservice of Food* f 590.003(G) Reporting by Person in Charge* I i DsposdionotAduReratedorContaminated I3 590.003(D) Exclusions and Restrictions* I JI Food 590.003(E) Removal of Exclusions and Restrictions I 3-701.)1 Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I Food* J 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law* I 4-501.11 I Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I ( 4-501.1 12I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pmteurimd* I 14-501.t 14 ( Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinking Nater* I concentration and hardness. ° 5-101.11 I Drinking Water from an Approved System* ( 14-601,11(A) Equipment Food Contact Surfaces and 590,006(A) I Bottled Drinking Water' I Utensils Clean* ,� r I 14-602.11 Cleaning Frequency of Equipment Food- 590.i)06(B) I Water Meets Standards in ppr Ced Sour e Contact Surfaces and Utensils* ShetBish and Fish From, an Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recrea!irmaliy C:ao�t Molluscan I Foal Contact Surfaces of Equipment* Slielhish' ( 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP fisted I Chemical* J Sources* 10 I 1 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( I RegulatoryAuthor#V 12-301.11 Clean Condition-Hands and Arms* f 13-202.18 Shellstock identification Presem` 12-301.12 Cleaning Procedure* 1590.004(C) ( Wild Mushrooms* I 12-301.14 When to Wash* 3-201.17 I Game Animals* ( 111 + I Good Hygienic Practices ) 5 + Receiving/Condition I 12-401.11 I Eating,Drinking or Using Tobacco* 1 3-202.11 I PHFs Received at Proper Temperatures* I ( 2=101.12 I Discharges From the Eyes,Nose and 13-202.15 I Package huegriw I Mouth* 3.12 i.l l I Food Safe and Unadulterated* 13-301.12 Preventing Contamination When Tasting* 1 6 1 I Tags/Records:Shellstock 112 I Prevention of Contamination from Hands 13-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 13-203.12 I Shellstock Identification Maintained* I Employees* Tags/Records;Fish Products I 113 , Handwesh Facilities 3-402.11 Parasite Destruction' I I ConvenienW Located and Accessible 13-402.12 Records.Creation and Retention* I 15-203.11 I Numbers and Capacities* I 1590.004(1) Labeling of Ingredients' 15-204.11 I Location and Placement* 7 I Conformance with Approved Procedures 5-20511 1 I Accessibility_Operation and Maintenance IHACCP Pians I I I Supplied with Soap and Hand Drying 13-502.11 I Specialized Processing Methods* I Devices 13-502.12 I Reduced oxygen packaging,criteria* I 16-301.1 t Handwashing Cleanser,.Availability 1 1 8-103.12 ( Conformance with Approved Procedures* I ( 6 301.12 I Hand Drying Provision •Dentes critical item in the federal 1999 rood Code or 105 CMR 590-000. CITY OF SALEM BOARD OF HEALTH n Establi ment Name: {� Date:�� Page: hof (U w E r Item Coda C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Da<e. No. Reference R—Red Item Verified PLEASE PRINT CLEAR.Y - �_ 0 lei I 47J hiOD61 dr I i i� 1 ) Iia + A@J 1)PA _ n aiv /1�L 1 n oa n 1/r1 0 -.,j2,P/1�lirn/�a6 Q npl - u nck- cx�4 - CJ ® _ Y\,a4 i1 On10,e ,/fit A/V S�Ze n n aq 1� �i A. @2, \ rn Q t$lu SZ J5+ e o I n� U0 a Discussion With Person in Charge: Corrective Action Required: ❑ No I tY Yes I have read this report, have had the opportunity to ask questions and agree to correct all ntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to ;/Reluinspection Exclusion P 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 r suspension/revocation of ❑ Embargo ❑ Emergency Closure - your food permit. �� 0 Voluntary Disposal ❑ Other: 't 4 I I 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne/fines Interventions and Risk According to Law Cooled h I Factors(Mems 1-22) (Cont.) 41'F145'F Within 4 Hairs, PROTECTION FROM CHEMICALS ( 3-501.15 Cooline Methods for PHFs { 19 PHF Hot and Cold Holding 14 ( Food or Calor Additives ( 1 3-202.12 Additives o { 3-501.15(B) Cold PHFs Maintained at or below ' 3-302.14 Protection from Unapproved Additives* 3-50 Y 6( Hot41 P 'F* { 15 Poisonous or Toxic Substances 3-S01.1fi(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140 . Containers* 3-501,16(A) Roasts Held at or above 130'F, I 20 Time as a Public Health Control { 17-102.11 Common Name-Working Containers* I 3_501.19 Time as a Public Health Control* { 7-101.11 Separation-Storages' { 590,004(H) Variance Requiremem 17-202.11 Restriction-Presence and Use* I e 7-202.12 I Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.£1 Toxic Containers-Prohibitions* f I POPULATIONS(HSP) ! 7-204.11 ChemicalsSanitizers.Criteria-Chemicals* { 21 3-801.II(A) Unpasteurized Pre-packaged luices and 17-204.12 Chemicals for Washing Produce,Criteria* I _Beverages with Warning Labels* ! ( 7-204.14 Drying Agents.Criteria* 3-801.11(8) Use of Pasteurized Eggs* I ( 7-205.11 Incidental Food Contact,Lubricants* 13-801.1 I(D) Raw or Partially Cooked Animal Food and 17-206.11 Restricted Use Pesticides,Cnteda* I Raw Seed Sprouts Na Served. y 17-2()6.12 Rodent Bait Stations* r 13-801.11(C) ( Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and i Monitoring* CONSUMER ADVISORY TIMEIPEMPERATURE CONTROLS 22 3-60.3.11 Consumer Advisory Posted for Consumption of ( 116 Proper Cooling Temperatures for Animal Foods That are Raw.Undercooked or f PHFs Na Otherwise-Processed to Eliminate Pathogens.*e"ec0 "`3-40£.IIA(I)(2) Eggs- 1557 15 Sec. Eggs-Immediate Service 145'F£5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS 13.401.11(B)(1)(2) Pork and Beef Roast-130'F 121 mW* y 590.004(A 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 }(D) Violations of Section 590,009(A)-(D) in I sec. * � catering, motile toad,temporary and E 3401.1 I(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be g Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-I0I.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F 9' 590.009 violations relating to good retail 3-101.12 Raw Animal Foals Cooked in a practices should be debited under#29- ! Microwave 165F* Special Requirements. 3-301AIW(1)(b) All Other PHFs-145'F 15 sec.* 1 19 Reheating for Hot Holding I VIOLATIONS R LATER TO GOOD RETAIL PRACTICES ? 3-103A 1(A)&(D) PHFs 165F 15 sec. (Items 23-30) .� 3.403.11(B) Microwave- 165'F 2 Minute Standing Critical mrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors luted above, can be 3-103.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code mrd 105 CARR 1400F* 590.000. 1 3-403.£1(E) Remaining Unsliced Portions of Beef Item , Good Retail Practlees 1 FC 590.000 j Roasts* 23, 1 Management and Personnel i FC-2 .003 j 118 Proper Cooling of PHFs 1 1 24. Foal and Food Pictection i FC-3 .004 1 ! i 25. 1 Equipment and Utensils ( FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26, Water.Plumbinq mid Waste 1 FC-5 006 700F Within 2 Hours and From 70'F ( 27. i Physical Facility FC-6 .007 1 to 41'F/45'F Within 4 Hours.* i 26. Poisonous or Taxic Materials FC-7 1 .008 t 3-501.14(8) Cooling PHFs Made From Ambient � i 29. I Spacial Requirements � .009 1 ( 'rearperamre Ingredients to 41'F/45'F I Other t, i Within 4 Hours* t 'anc+ma critical hem in the feral 1999 Fuod Cade or 105 C.41R 590.000. 4 I t CITY OF SALEM � ( BOARD OF HEALTH 'n Establishment Name: d;_byt _ Date: Q —�O —t Page: of W Item Code C-Critical Item _ DESCRPLEASE PRI�CIEARIV IPTION OF VIOLATION/PLAN OF CORRECTION Date, No. Reference R-Red turnVerified }�J.�� lL (0- - .- .` �� ` 1/ 7,0 =l. — `t LC 1�P�. - l� 4n Geo r10„/\/, ,-, A-& <;LI I:-)P L /�1'ry eFt ens. V \Oe f v I 6 V- rA, -WA p_ cnm .N1QGr liy\ -� �nn,� _nA QPOal A - � n (-i�iD,#��i &kQ h�PAaoA ai /1 A, 2 A 0 u �D.A _1 .f2 DisCl_ssion With Person in Charge: I Corrective Action Required: I es I have read this report, have had the opportunity to ask questions and agree to correct all g/Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P LY 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 twen -five dollars or suspension/r vocation of ElEmbargo ❑ Emergency Closure your food permit. \ /) � 0 Voluntary Disposal ❑ Other: 3.501.14(C) PHFs Received at Temperatures Violations Related to Foadborne Illness interventions and Risk According to Law Cooled to Factors{Items 1-22) (Cont.) 41'F/45°F Within 4 Horn's. f PROTECTION FROM CHEMICALS 3-501.15 Cooling Mekhods for PHF5 14 O Food or Gator Additives ( 1 19 PHF Not and Cold Holding 501,16(B) Cold PIIFs k1u ntamed at or below 3-202.12 Additives* � 590.004(F) 41°145°F* 3-302.14 Protection from Unav_proved Additives* 3-501.16(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substences 1 140°F. 7-10Ll l Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* " J 20 Time as a Public Health 7-102,11 Common Name-Working Containers* 3-501.19 Control Control* rol J 7-201.11 Separation-Storage" 3-501.19 Time as a Public He } 7-202.11 Restriction-Presence and Use* 590.004{H} Variance Requirement 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.t 1 Toxic Containers-Prohibitions* 7-204.11 Sar Criteria-Chemals"icPOPULATIONS(HSP) itiurs. f 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Jltving Agents.Criteria= ( .Beverages with Warning Labels* 7-204.14 + . 3-801-11(6) Use of Pasteurized Eggs* 7-205-11 Incidental Food Contact,Lubricants* ( 7-206.11 Restricted Use Pesticides;Criteria* 3-801.11(D) Raw or Partially Cooked Annual Food and t Raw,Seed Sprouts Not Served i 7-206.12 (rodent Bait Stations' t I 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Y ivfon t xing CONSUMER ADVISORY t Y 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS S 16 Proper Cooldng Temperatures for Animal Foods That are Raw.Undercooked or PIFs , Not Otherwise Processed to Eliminate Pathogens.'401.11A(I)(2) Eggs- 155`F 15 Sec. " Eggs-Immediate Service 145°F15sec" , ( 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-441.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155°F 15 sec. IREMENTS 3-401.11(B)(Ik2) Pork and Beef Roost- 130°F 121 min* t SPD) REQUnsofSeti 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.009{A}-(D) Violations of Section .490.fX}9(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 t5 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 I practices should be debited under#29- Microwave 165F* ! Special Requirements. 3401.11(A)(1)(b) All Other PHR-145°F 15 sec. f 17 Reheating for Hot Holding VIOLATIONS R 7.ATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 16S F 15 sec. * (Itetac 23 30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Crilical and non-critical violations, which do not relate to the Time* foodborne illness inter entions and risk,facrors listed above, can be 3-403,11(C) Commercially Processed RTE Foal- found in thefollowing sections of the Food Code and 105 Cb,R 140°F* 590.000, 3403.11(E) Remaining Unsliced Portions of Beef 1 Item 1 Good Retail Practices 1 FC 590.000 I ti Roastsr' 1 23. i Management and Personnel FC-2 .003 1 I 18 Proper Cooling of PHFs + 124. 1 Food and Food Protection i FC-3 .004 1 25. Equipment and Utensils 1 FC-4 005 I 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26. Water,Plumbing and Waste ; FC-6 .006 700F Within 2 Hours and From 70`F ( 27, Physical Facility i FC-6 .007 to 41`F/45'F Within 4 Hours.* 28. Poisonous or Tozsc Materials ? FC=7 .008 3-501.14(6) Cooling PHR Made From Ambient 29. Special Requirements •009 } Temperature Ingredients to 41°F/45°F 3 Other 1 Within 4 Hours`" ' *D.notrs critical ism in the federal 1'399 Foal Cade w 105 C-MR 590.000, 7 ) t CITY OF SALEM BOARD OF HEALTH - - Establishment Name: GYZ t � Data: Page: L. of I nem I Code I R-Redite Hem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I II NIMI(11 RelereRce (III R-Red Item verified�3, I PLEASE PRINT CLEARLY CaL --fin �saao a� i I - per y,-�-e ; {'" "�...t.1�G? DD rvAA - L � rZ-7 , \4\ h As I I s I I Ipit/V. � Ip(lv) { tT/iz Discussion With Person in Charge:----- Corrective Action Required: ❑ No 1 Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Vluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federat Food Code. 1 understand that Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of twee -fivor sus nsian/revocation of a Embargo C1 Emergency Closure your food permit. ^tjlfl U Voluntary Disposal 0 Other: 3-501.WC) PHFs[deceived at Temperatures Violations Related to Foodborne lltness,interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'7!45*F Within 4 Hoods, R PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs { ( 14 I Food or Color Additives { 119 PHF Piot and Cold Holding i 3-501.16($) Cold PHFs bfaintarned at or below 13-202.12 Additives* ( 590,004(F) 41*1450F* 3-302.14 Protection from Unaecrorved Additives" 3-501.16(X) Hot PHFs Maintained at or above { 15 Poisonous or Toxic Substances { 140`7• 7-10111 ldenti6ing Information-Original 3-501.16(X) Roasts Held at or above 130'7. Containers* 120 Time as a Public Health Control { 7-101.1 I CommoSeparation Name-Working Containers* { 3-501,19 Time as a Public Health Control* -20111 Separation-Sterane* ( 590.004(H) Variance Requirement 7-202.11 ,Restriction-Presence and Use* ( ( 7-202.12 1 Conditions of Use* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE r { 7-203.11 ( Toxic Containers-Prohibitions* POPULATIONS(HSP) L { 7-204.11 ( Satirizes.Criteria-Chemicals* 21 3-801.1](A) Unpasteurized Pre-packaged Juices and 17-204.12 Chemicals for Washing Produce,Criteria* { Beverages with Warning labels* i 7-204.14 Drying Agents,Criteria* 7-205.11 Incidental Food Contact Lubricants* ( 3 801.11(8) Use of Pasteurized Eggs* t 13-801 A I(D) Raw or Partially Cooked Animal Food and ( 7-206.11 Restricted Use Pesticides;Criteria* 1 Rao Seed Sprouts Not Served.* y ( 7-206.12 Rodent Bait Stations* { i 3-801.11(C) Unopened Ford Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of i 16 Proper'Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs No Otherwise Processed to Eliminate Pathogens."Fx ` 1 3-401.IIA(1)(2) Eggs- OFF 15 See. rn¢w Shell Pasteurized Eggs Substitute for Raw She Eggs-immediate Senicc 145'Fl5see* 314W A I(A)(2) Comminuted Fish.Meats&Game Ear Animals-155'F IS sec." ( 3-401.11(11)(1)(2) 1 Port:and Beef Roast-13TF 121 grin* { SPECIAL REQUIREMENTS and sec. * 590.009(X)-(D) Violations of Section 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 temporary in focatering, mobile Rind,temparan'and 31401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stalling Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-765*F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks � interventions and risk factors. Other 145OF* 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under X29- Microwave 165'F* Special Requirements. i 3140111(A)(1)(b) { All Other PHFs- 1450F 15 sec,# { { 17 Reheating for Not Holding { VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165'F l5 sec.* (Items 23-30) 34,113.11(B) Microwave-165'F 2 Minute Standing � Critical and non-critical violations, which do not relate to the. Thpc* foodborne illness interventions and riskfactors listed above, cam be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Gtde and 105 CMR 140*F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef i Item 1 Good Retail Practlees I FC 590.600 1 Roasts* 1 i 21 Management and Personnel 1 FC-2 .003 i { 18 { Proper Cooling of PHFs ( i 24, i Food and Foes]Protection I FC-3 .004 25. 1 Eguipmet and Utensils FG-4 ,005 i 3-501.14(A) Cowling Cooked PHFs from 14(YF to P6, Water.Pitimbino and waste i FC-5 '006 ' 70'F Within 2 Hours and From 70'F 27. 1 Phvsicai Facility ; FC-6 .007 I to 41°F(450F Within 4 Hours.* 128. Poisonous or Toicc Materials ; FC-7 ,008 3-501.14(8) Cooling'PHFs Made From Ambient ! 129. Special Requirements '009 i TernpeviturcIngredients to41*F/45'F ill 30' 1 Other Within 4 Hous* 'Demarco critical it.m in the federal 1999 Food Cmie w 105 C..MR 590.000. 1 ) Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41h Floor Division of Food and Drugs Salem, MA 01970-3523 In Tel. (978)741-1800 Fax (978) 745-0343 City/Town of j� Address: FOOD ESTABLISHMEN"§PECTION REPORT Tel. ley._ Type of Operation(s) Type of Inspection Name ] / D -I I" 7 El-nod Service ❑ Routine Address Risk ❑ Retail EPRe^iinspection Telephone 1 1 Level El Residential Kitchen Previous�I s action ❑ Mobile OwnerHACCP YM [I El ❑Pre-operation I , 1„ _ �, ❑ Caterer ❑Suspect Illness Person-in-Cha e(PI ) Tim ❑ Bed I Irp„akfast El HAeneral CCP Complaint Uf ElInspector ) 7 Out S;VI Pit Nin o./l � E]Other Each violation Oise ed requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance Wily Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) ,FOOD PROTECTION MANAGEMENT' j [112, Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ _ _ _ ❑ 13. Handwash Facilities 'EMPLOYEE HEALTH PROTECTION FROWCHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded E] 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - ❑ 4. Food and Water from Approved Source TIMEIrbAPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116. 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 ❑ REMENS FOR HIGHLY.-SUSCEPTIBLE=_POPULATIONS 9. Food Contact Surfaces Cleaning and Sanitizing REQUIT (NSP) + E] 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ,CONSUMER''ADMSORY _ El22. 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. Noncritical (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-2x590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3xsso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4x590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCSx590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590 007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. /lV 30. Other `` _ I,� ,, DATE OF RE-►IySPL3C�N: o-,.ia I"V.r`✓1 (/ g, l/;,�,-•, _ r Inspector's Signa I Print: i� L ( (O PICS Signature: l - Prinn--` P n{{�`9 V/VVG//'��'w Page of_]Pages III Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) ,PROTECTION FROM CONTAMINATION g Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.110)(1) Raw Animal Foods Separated from 1 1 590.0031 A) Assignment of Responsibility* � � Cooked and RTE Foods* 590DW(B) Demonstration of I(now!edge' j Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302 t I(A)i 2) Raw Animal Foods Separated from Each } Other* f EMPLOYEE HEALTH Contamination born the Environment 2 590.003(C) I"Responsibility of the Person in charge to 3-302.11(A) Food Protection* require reporting by food emptogees and ( 3 302 IS Washing Fruits and Vegetables applicants* 3-3(,.1.1 t. Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An ( Utensils* Applicant To Report'lo The Person In I Contamination from the Consumer ] Charge* p1 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* I Disposition of Adulterated orContarninated 1 3 590.003(D) Exclusions and Restrictions* j Food 590.003(E) Removal of Exclusions and Restrictions 3-710).11 Discarding or Reconditioning Uns afe Food* FOOD FROM APPROVED SOURCE 14 Food and Water From Regulated SOUrW5 9 Food Contact Surfaces ` 4-501.111 Manual Warewashing-Hot Water 590.0041,-B) Compliance wirb Food law* i, Sanitization Tenweratares* 3-201.12 Food in a Hermeticall)v Scaled Container* 4.501.112 Mechanical W'arewashing-Hot Water I 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-50!.114 Chemical Sanitization-to H, 3-202.14 Eggs and Milk Products.Pasteurised* �"p + concentration and hardness. 202.16 ice Made From Potable Dr We,;(!;vt ater* 14-(,01.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Ware from an Aporoved System" Utensils Clean* 590.()06(.A) Bottied Drinking Water* 3 4-502.11 Cleaning Frequency of Equipment Food 5qo)()o6(B) Water Meets Standards is 310 CMR 22.0* Contact Surfaces and Utensils' Sholffish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Mcllu�csa Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-1-01-15 Molluscan Shclitisb from NSSF Li>tul Chemical* Sources* tg Proper,Adequate Handwashing ) Game and W&I Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority ' 2-301.12 Cleaning Procedure* 3-202.13 Shellstock identification Prescm' , 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* Game Animals* tt Good Hygienic Practices 3-20!.17 Ga eivin Animals* 2401.11 Eating.Drinking or Using Tobacco* Re 3-202.11 PHF's Received at Proper Temperatures* I 2-101,12 Discharges From the Eyes,Nose and 7 3-:02.15 ( Package hitegrity` j Mautb* 1 3-!;!1.1 i Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* - Prevention of Contamination from Hands 6 TaysiRenords:Stpelistoek 1 I!I! 3-202.18 Shell rock identification* 59U.004(E) Preventing Contamination from Employees* 3-203.12 She!lstock identification Maintained" ' 13 Handwash Facilities TagsiRecor3s:Fish ProductsConveniently Located and Accessible 3-402.11 Parasite Ik:structiou* 1 � 5-2Q3.11 Numbers and Capacities*3-4Q2.12 Records.Creation and Retentivn* nts' 5-204.11 i.ocatian and Placement* 590.004(!) Labeling of Ingredie Conformance with Approved Procedures ( 5?O5.t 1 'Accessibility. ae and and Maintenance 1 71 ! MACCP Plans Supplied with and Soap Hand Drying i � � Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen nackagin;i,cnteria* 1 6-301.12 Hand Drying Provision 8-103.!111 Conformance with Approved Procedures* Denotes cliff 0 ivin in the fedtral 19'341'0.3{'ode or twi CMR 590.(WI, Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of Address: FOOD ESTABLISHM I SPECTION REPORT TeL Name (I ) Da Type f operation(s) Type of Inspection _ ood Service M.RdMine Address ( Ris Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner { � HACCP YIN [I Temporary [IPre-operation I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC �C.i� %r Ti #aej ❑ Bed 8 Breakfast st ❑General Complaint r:12/Tii) ❑ HACCP Inspector y OuPermit Ney E]Other Each violation chi a requires an explanation on the narrativs)and a citation of speci is provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Tobacco 590.009(F) ❑ y pose an imminent health hazard and require immediate Allergen Awareness _590,009(G) � Violations marked may corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT'> ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties • _ _ - [113. Handwash Facilities EMPLOYEE HEALTH PROTECTIONFROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14 Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded •, I ❑ 15 Toxic Chemicals „FOOD FROM APPROVED SOURCE , .___ _ _ ❑ 4. Food and Water from Approved Source^ TIMErrEMP.ERATURE CONTROLS(Potentlalt9 Hazardous_Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18 Cooling PROTECTION FROM CONTAMINATION _ _ - ❑19. Hot and Cold Holding ❑ 8 eparation/Segregation/Protection ❑20. Time as a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY-it (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_(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. Noncritical(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-2X590.003) order of the Board of Health. Failure to correct violations 2 ood and Food Protection (Fc-sXsso.00a) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4x590.005) the food establishment permit and cessation of food .Water, Plumbing and Waste (Fc5X590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this Qrder. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: I Print-VJ�'1l L If L� P[Cs Signature: xAq 1'� Ami Prin[ \/� elal '�"�„�; I Page of ages .r`��.Jy^- i n I+`•ti' ri-� • -..-.T_ .f1_ �Y�.- � ..��.- --�� .. +� . iM. ^'^v6- 4yrv� -M1`7- „ ��s y :y . .�`- i .i Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S I Cross-contamination 3-302.11(A)t 1) ( Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* I I Cooked and RTE Foods* 590.003(B) ( Demonstration of Knowledge" I ( Contamination from Raw ingredients 2-103.11 Person in charge-duties I 13-302.1 I(A)(2) I Raw Animal Foods Separated from Each I EMPLOYEE HEALTH Other* J Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to I ' I 3-30_1 UA) ( Food Protection require reporting by food employees:md ( 3-302.1 IS I Washing Fruits and Vegetables J applicants* 3-3W.I1 Food Contact with Equipment and 590.003(F) Responsibility Of A Foul Employee Or An I I I Utensils* Applicant To Report To The Person In Charge* I I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 13-306.14(A)(B) I Returned Food and Reservice of Food* J 131 590.003(D) Exclusions and Restrictions* I ( I Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3- 01,1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I I Food* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law* ( 4-501.111 Manual Warewasbing-Hot Water ( 3-201.12 I Food in a Hermetically Seated Comamer* I Sanitization Temperatures* 3-201.13 I Fluid Milk and T%-silk Products* ( ( 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 I Shell Eggs* I Sanitization Temperatures* 3-202.14 I Eggs and Milk Products.Pasteurized* __ ( 14-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 ice blade From Fotahle Drinking G1'ater" I concentration and hardness. 15-101.11 Drinking Water from an Approved System* ( 14-601.1 i(A} I Equipment Food Contact Surfaces and � Utensils Clean* 590.006(A) Bottled Drinking Water` 590.006(B} Water Meets Standards:n 310 CMR 22.0* __ 14-60_'.11 Cleaning Frequency of Equipment Food- ( Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.i4 Fish and Recreationaiiy Caught [vloliaeran I ( Shellfish' I Food Contact Surfaces of Equipment* 4-7033.11 ( Methods of Sanitization-Hot Water and 3-201.15 I Molluscan Shellfish from NSSF Listed ( Chemical* Sources* Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Regulatory Authority 2-301.11 I Clean Condition-Hands and Arms* I 13-202.18 Sheilstca k identification Present" 12-301.12 Cleaning Procedure* ] 590.004(C) Wild Mushrooms* 12-301.14 ( When to Wash* 3-201.17 Game Animals* I it I I Good Hygienic Practices ( 3 I Receiving/Condition ( 12401.11 Eating,Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures* ( 12-401.12 I Discharges From the Eyes,Nose and 3-20.1.15 Package lnteprity" I Mouth. 3-10i.11 I Food Safe and Unadulterated* ( 13-301.12 I Preventing Contamination When Tasting* f 16 I Tags/Records:Shelistock I 112 I Prevention of Contamination from Hands 3-202.18 Shellstoek Identification* ( 1590.004(E) Preventing Contamination from 3-203.I2 Shellstock Identification Maintained* ( I Employees* ( Tags/Records;Fish Products I 113 I Handwash Facilities 1 ( Conveniently Located and Accessible 3-402.11 �Parasite Destruction' __ _ _ _ ( I 13-402.12 I Records,Creation and Retention" I 15-203.11 Numbers and Capacities* I 590.004(.)) I Labeling of Ingredients' _( 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility.Operation and Maintenance f fHACCP Plans I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* ( Devices 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 + Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 i Hand Drying Provision 4 Denotes cdtical iwai in the weral 1999 Pa'd Code or 105 CMR 590.0(A). CITY OF SALEM f,� r BOARD OF HEALTH Establishment Name: ! bY>" n• Date: �'l h (� Page:_ of (i Item Code C-Critical ItelR DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red ItemVerified PLEASE PRINT CLE RL 1A 11 . itr� � per► I nt Ilor ti� i�l DI2 'u�-, 1l_61-- -�-' fo(�I 1,1 CiL ] kLXA,( 0,-,) '44 iy . I1 �f carer&�' I ` I I l .1- I u ' L 2e r v .x t-� �t�„� (Ph5 Ih-,�it�, �f �0 rt-) (��xi� >'- r Iqjl (04a1 I!� ��e�,� C�n,�vt~l ra - tray �- lP v> W4-i-) h6--19ArzOkIC- = Pl r,"U W �V&0) Discussion With*Person in Charge: , I Corrective Action Required: Li No I m�'esi 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 eEmersion R -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in cAily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _- ❑ Voluntary Disposal ❑ Other: 3-501,14(0 PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to n Factors{Hems 1-22) (Cont.) 41'7145°F Within 4 Homs. " i PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs Additives. PHF Not and Cold"ding 14 Food or Color Addit ! f 401.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* ! 590.004(F) 4101450 F* t 3-302.14 Protection from Unapproved Addpives'k ! ! ! 13-541.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140`7 7-101.11 ldentif}ing I dormation-Original T 3-541.16(A) Roasts Held at or above 130'F. Containers* 20 Time as a Public Health Control 7-102.11 Common Na -Working Computers* I ! New C ! 3-501.14 Time as a Public Health Control* 7-201.11 Separation-Storage"' 540.004{H1 Variance I 7-202.11 .Restriction-Presence and Use* ( e Repuiremeitt I 7-202.12 Conditions of Use* + REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ! 7-203-11 'Toxic Containers-Prohibitions* I POPULATIONS(HSP) 7-204.31 Sanitizers.Criteria-Chemicals* ! 7-204.12 Chemicals for Washing Produce,Criteria* I 21 3-541.i1(A) BevUnperages wit Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* 1 Beverages w th Warning Labels* 7-245-11 Incidental Food Contact,Lubricants* ! 3-801.11(B) Use of Pasteurized Eggs* ! ! 7-206.11 Restricted Use Pesticides,Criteria* I ( 3-801,11('D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served ! 7-206.12 Rodent Bait Sta tions# ` 3-801.11(C) Unopened rood Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* i CONSUMER ADVISORY TIMET 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 Patbogens.* 1401.3IA(1)(2) Eggs- 155°F 35 Sec. Egg-Immediate Service 145°Fi5sec" I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game 1 Eggs* Animals- 155'F 15 sec. 13-401.11(8)(1)(21 Port:and Beef Roast-130-F 121 min' I SPECIAL REQUIREMENTS ! 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590.049(A))-(D).(D) Violations of Section .590.009(A)-(D)in sec.' catering, mobile food,temporary and 3401.11(A)(3) Poultry,Wild Game.Stiffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections j Poultry or Ratites-165'F 15 sec, above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steals I interventions and risk factors. Other 145°F* 590.009 violations relating to goodl retail f , 3401.12 Raw Animal Ftxx3s 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.° ! j 17 Reheating for Hot Holding VIOLA710AIS R=LATER TO GOOD RETAIL PRACTICES 3-443.11(.A)&(D) PHFs 165T 15 sec." I (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the r Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR t "140°F* 590.000. r 3403.11(E) Remaining Unsiiced Portions of Beef % item l Good Ref211 Practices 1. FC 690.00o Roasts* 23. l Management and Personnel FC-2 .003 r ! 18 Proper Coaling of PHFs { 124. I Food and Food Protection ( FC-3 .004 25. I Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 126. Water.Piumbinq and Waste l FC-5 .006 74°F Within 2 Hours and From 70'F 27. ( Physical Facility FC-6 .007 to 41`F1450F Within 4 Hours. * 128. Poisonous or Toxic Materials ? FC-7 .008 3-541.33(@) Cooling PHFs Made From Ambient 124. Special Requirements I .003 1 Temperature Ingredients to 41°Fi45°F l 30. 1 Other Within 4 Hours* s��nsmG i genote.uinra:hem in the federal 1999 Fwd Code a ins CMR i9O.00O. t 1 f r Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,40'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHM INSPECTION REPORT Tel. Name Dat �TType9�1'Operation(s) Typ Inspection Il-rood Service LLTRoutine Addres vn � Risk ❑ Retail ElRe-inspection Telephone ' Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑Pre-operation I ro�) ( ❑ Caterer ❑Suspect Illness Person-in-Charg (PIC) /{ Times' ❑ Bed&Breakfast ❑General Complaint [IHACCP Inspector + , Out: r Permit No. 0,Other Each violation ec a requi s exp anatton on the narrative page( )and a citatiolrof Ispecific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ IViolations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT. _ - - • Y 1 El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ^ _ _ ❑ 13. Handwash Facilities rEMPLOYEEHEALTH PROTECTION FROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded -� �FOOD�FROMAPPROVEDSOURCE El 15.Toxic Chemicals _ _ 1714. Food and Water from Approved Source _ T)MErrEMPERATURkCONTROLS(Poieritia_IIyH_a¢_ardousFoods),s ] ❑ 5. Receiving/Condition ❑ 16 Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling 4 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:SU$CEPTBLE=POPULATIONS'.(NS6 ] [110. Proper Adequate Handwashing E]21.Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER'ADVISORY_ _�_T _ • �, _ _ ,- ,__�1 ❑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 anin ction immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. C N 590.000/federal Food Code.This report,when signed below 23. Management and Personnel (FC-2X590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4X590 005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCSX590.om) establishment operations. If aggrieved by this order,you 27. Physical Facility (Fc-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) 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 A! , �ATE OFRE-INSPECTION: Inspector's SigntGre: Print:, ��/��. � r_v PICsSigaature: ` I Print.-. (��t�KK CCC---<... '-(� '/l�Page4of1Pages II • R ry .� vr- e. ,�. - tiryr n -•+.. „ • . .v ...r 1 . r - -. -- . v• -. ` A _ v - Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination 3-302.11(A)(]) I Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.00Demonstration of Knowledge" Contamination from Raw ingredients 2-103.1111 Person in charge-duties I 3-302.1 l(A)(2) Raw Animetl Foods Separated from Each �.. �.. `��t1�� I ll- EMPLOYEE HEALTH Other*, t 2 590.003(0) Responsibility of the -1 o Protection*from the Environment p y person in charge to 13-3U2.71(A) � '!,Food protection* 1 require reporting by food employees and I 1 3-302 15 1 t- 1 Washing Fruits and Vegetables applicants Fwd Contact with Equipment and 13-304.11 1 590.003(F) Responsibility Of A Food Employee Or An C 1 ' , Applicant To Report To The Person In ! Utensils*- Charge* ' i'. 1 ul, I �.,! Contamination from the Consumer 590.003(G) Reporting by Person in Charge*1 I.t t I 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* I I - ' I Disposition of Adulterated or Contaminated Food 590.OU3(F,) I Removal of Exclusions and Restrictions I 13.701.; ! I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fwd* 14 Food and Water From Regulated Sources ' 19 ( Food Contact Surfaces ( 590.004(A-B) CompliancewithFood Law* ( 4-501111 Manual Warewashing-HotWater 3-201.12 Food inn Hermetically Scaled Container* 1 I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.1 L I Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 I Eggs and Milk Products. Pasteurized* ( ( 4-501.114 I Chemical Sanitization-temp.,pH, 13-203.16ice Made From Potable Prinking Water* I concentration and hardness. * 4-601.1.11(A) I Equipment Fwd Contact Surfaces and 15-I01.I l Drinking Rater from an Approved System* Utensils Clean* _590.006(A) _ _ _Bottled Drinkma Water` I 4-602.11 CleaningFrequency ofEquippment Food- ' S90.0U6tL'1 I Water Meets Standard,in 310 C'b1R^_2.0 q n l Shellfish and Fish From an Approved Source I I Contact Surfaces and Utensils" j 4-702.1 I Frequency of Sanitization of Utensils and a 3-201.14 Fish and Reeationafiy Caught[vloliusc:rn I I Food Contact Surfaces of Equipment* l SItelLish` 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish- from NSSF Listed � Chemical* Sources* Game and Wild AAcshrooms Approved by I to I Proper,Adequate Handwashing Regulatory Authority 2-301.11 1 Clean Condition-Hands and Anes* J 3-202.18 Sheiloock identification Present' I 2-301.12 1 Cleaning Procedure* 1590.004(C) I Wild Mushrooms* I 12-301.14 When to Wash* 13-201 1; I Gam;Animals* 111 I Good Hygienic Practices 1 $ ( Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* 1 12-401,12 Discharges From the Eyes,Nose and 3-202.15 Package integrity" I Mouth* 3-!OL ll I Foal Safe and Unadulterated* I 13-301.12 Preventing Contamination When Tasting* I 6 Tags/Records:ahelgstock I 112 I Prevention of Contamination from Hands -I,3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 3-203.12" Shellstock Identification Maintained* Employees* Tags/Records:Fish Products i 113 Handwash Facilities 13402.11 Parasite Destruction* I Conveniently Located and Accassibe 13-402.12 Records.Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(.) Labeling of Ingredients* _I 15-204.11 1 location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility.(I)eration and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 I Handwashmg Cleanser,Availability f 18-103.12 I Conformance with Approved Procedures* I 16-301.12 I Hand Drying Provision ` ! *Denotes edtiad;tem in the federal 1999 Pard Code or 105 CMR 59000(). ^. r._ �• r . ' 1`r >•'!, � -t' a r L \ L r Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name fY I Data/ /�1 Type of Ooeration(Il T��1wwwpppe of Insoection Food Service ® Routine Address Risk ' I ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone /I� �I/ �O El Mobile Date: Ownert� HACCP Y/N [3Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector �1v�kl � �� 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. LFOOD PROTECTION MANAGEMENT_ 2. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties- ,--, EMPLOYEE HEALTH 'j L�is• Handwash Facilities - --' I. 4 I PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded y Toxic Chemicals LFOQD FROM APPROVED [1 4. Food and Watery fomApproved Source ITIMEfEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116.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 Food CSurfaceCleaning and Sanitizing tContact Segregation/ s Protection ❑20.Time As a Public Health Control nitizing IREOUIREMENTS FOR HIGHLY SUSCEPTIBLE_POPULATIONS(HSP) [:121. Food and Food Preparation for HSP C] 10. Proper Adequate Handwashing , ❑ 11. Good Hygienic Practices ICONSUMER ADVISORY r_ - 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 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or-within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-s)(590.0so.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 erials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requireme s (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5 5901r5pecfFomb-14 tlx / I n Inspector's Signature: Print: ) PIC's Signature: Print: 1 1n I4471,�h_6 IPage of-�ages ... '„ -n- ..f--..., -,�w.ws.�+ri.e....r,g,��y1iT•Fa»v...`.�Y^• '�."„�,oJ'.^�r»F��s o-r'`rh.>n r.yy'. .a.. t . Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 18 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.1](,A)(]) Ra'w Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foals* J 590.003(B) Demonstration of Knowledge* I i I Contamination from Raw Ingredients 2-103.11 Person in charge-duties I I 3-902 11(A_ )(..) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH I I Contamination from the Environment I 2 590.003(C) Responsibility of the person in charge to 13-302.1 l(A) Food Protection* f require reporting by food employees and applicants* 13-302.15 Washing Fruits and Vegetables I ` 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An I Utensils* Applicant To Report To The Person In I Contamination from the Consumer Charge* 13-306.14(A)(B) I Returned Foal and Reservice of Food* 590.003(G) Reporting by Person in Charge* I 131 590.003(D) Exclusions and Restrictions* I I Disposition oiAduterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I I Food* J 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law* I 4-501.111 Manual Warewasbing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures* l 3-202.14 Eggs and Milk Products,Pasteurized*' 14-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* ( concentration and hardness. * , J , 5-101:11 Drinking Water from an Approved System" ( 14-601.1 1(A) I Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* l 590.006(B) Water Meets Standards in 310 CMR 220* I ( 4-602.11 Cleaning Frequency of Equipment Food-' 'I ShePfish and Fish From an Approved Source I Contact Surfaces and Utensils* 1 J 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 ( Frequency of Sanitization of Utensils and Fad Contact Surfaces of Eirunimici Shellfish* 14-703.11 I Methods of Sanitization-Hot Water and I. 3-201.15 Molluscan Shellfish from NSSP lasted I Chemical* Sources* 110 I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 I Clean Condition-Hands and Arms* .I 13-202.18 I Sliellstock Identification Present* I � 2-301.12 Cleaning Procedure* 1590.004(C) ( Wild Mushrooms* ( ( 2-301.14 I When to Wash* 3-201.17 I Game Animals* I 111 ( I Good Hygienic Practices I . 15 I Receiving/Condition ( 12401.11 Eating,Drinidng or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* ( 12-401,12 I Discharges From the Eyes,Nose and 13-202.15 I Package Integrity* I Mould* 3-101.11 I Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* I 6Tags/Records:Shelistock ( 112 _ Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) I Preventing Contamination from 13-203.12 Shells[ock Identification Maintained'" I Employees* TagsMecords:Fish Products I 113 Handwash Facilities I3-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 15-203.11 I Numbers and Capacities* 590.004(7) I Labeling of Ingredients* I 5-204.11 I Location and Placement* ibili 11 205 A - . I Accessibility.Operation and Maintenance g Conformance with Approved Procedures 5 Y I /HACCP Plans ( I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria" 6-301.11 I Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 I Hand Drying Provision *Denotes critical nem in the federal 1999 Food Cade or l05 CMR 590.000. CITY OF SALEM �� 1 _ V". n BOARD OF HEALTH Establishment Name: �_/�V 7fY�(l I P� Date: l I I1U II� Page: /_/ Of Item CodeC—Critical Item J DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference ( /R-Red Item I PLEAS PRINT CLEARLY 1 I Verified 414-)raAk -14 �J ;�rA) --kc-fa �A�r C' r>i h r I nil i 0,\ IVA � � IL 14 U - 5, as r II _Wt I AQ a r4 1 'j If to �. 1rr`E - I9 . CAC),) Discussion WitYi a son 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 I ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion O Re-inspection Scheduled Cl Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines oftwenty-fivedollars or suspension/revocation of ❑ Embargo El Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: •..•,.� �. .� n �...-'..�. � �J i." "•Wa�KTJF'�''fv.'Y+RY�'!,�.:.�{.Y'�.�5'w..v .9i#^ _�"�^' .N•y,�I`�iT,w/'w}.�V�w'S!�^^'�., __ F- r 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk _ According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 14 � Food or Color Additives I 1 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives*' I 5W004(F) 41°/45°F* 3-302.14 Protection from Unapproved Additives" i 15 Poisonous or Toxic Substances 13-501.16(A) Hot PHFs Maintained at or above + 140°F. * 7-101.111 Identifying Information-Original � 3 501.16(A) I Roasrc Held at or above 130°F. Containers* * 17-102.11 Common Name-Working Containers* I I I Time as a Public Health Control 17 01.11 Separation-Storage* ) 13-501.19 Time as a Public Health Control* 17-202.11 Restriction-Presence,andUse* I 1590.004ft I Variance Requirement 7-202.12 Conditions of Use* i 7-203.11 Toxic Containers-Prohibitions* - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 17-204.12 Chemicals for Washing Produce,Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning lab 17-204.14 Drying Agents.Criteria" els* 3-801.11(8) Use of Pasteurized 7-205.11 Incidental Food Contact,Lub3-801.11(D) Raw or Partially ricants* I ially Cooked Animal Food and l Eggs* 7-206.11 Restricted Use Pesticides,Criteria" 17-206.12 Rodent Bait Stations" j Raw Seed Sprouts Na Served. I 3-801-II(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMETIEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 1 16 Proper Cooking Temperatures,for Animal Foods That are Raw.Undercooked or I PRFs I Not Otherwise Processed to Eliminate 3-401.11A(I)(2) Eggs- 155°F 15 Sec. Pathogens.*E"°..rnrmr Eggs-immediate Service 145°Fi5sec" 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-1550F 15 sec. " 3401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 thin* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food,temporary and 3110LI1(A)(3) Poultry,Wild Game,Sniffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec.* above if related to foodborne illness 3-401.11('C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should Ise debited tinder#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec." I 117 Reheating for Hot Holding I VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(D) PHFs 165°F 15 sec. * talc 23-30) 3.403.11(B) Microwave- 165'F 2 Minute Standing talcal,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) Commercial ly Processed RTE Food- found in the following sections of the Food Code mid 105 CAM 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef i Item I Good Retail Practices .FC 590.0m i Roasts* i 23. I Managetnentand Personnel FC-2 .003 I 18 I Proper Cooling of PHFs I i 24. ( Food and Food Protection FC-3 .004 i 1 25. Equipment and Utensils FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140'F to ( 1 26, 1 Water.Plumbinq and Waste FC-5 .006 70°F Within 2 Hours and From 70'F 1 27, 1 Physical Facllity FC-6 .007 to 41°F/45'F Within 4 Hours.* 128. 1 Poisonous or Tome Materials FC-7 .008 s 3-501.14(B) Cooling PRFs Made From Ambient ( 129. Special Requirements 009 1 Temperature Ingredients to 41°F/45'F I '`A. 1 Other Within 4 Hours* "Nnows critical item in the federal 1999 Food Code cr 105 CMR 590.000. r . CITY OF SALEM —�'��^ n1I ��yy BOARD OF HEALTH Establishment Name: �? � fo��I . Date: Page: of Item Code C-Critical item U DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R—Red Item Verified PLEAS PRINT CLEARLY , 4D ,(M )\rY^ _gin "U� h l%t�� n _ r� , rnpl _ fr _WCivn lit' a I I :(110 f A, o rArr q 1 IfYY� i ICf1M�11.( 1 ln1 (A rA ri -12 I �f�l�nr o, If6L,tarAil r (t111f _, (i�Pl�lr�f� �Ir , pfd Form I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes i 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-fiv<<e dollars dr suspension/revocation of ❑ Embargo Li Emergency Closure - your food permit. �� ❑ Voluntary Disposal ❑ Other: r 3-501.t4(C) PHFs Received at Temperatures i Violations Related to Foodborne fitness interventions and Risk According to taw Cooled to I Factors{Items r-P2) (Cant.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS { 3-501.15 Cooling Methods for PRFs I Food or CoA Additives j 19 PHF Hot and Cold Holding { { 14 { 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives' 590.004(F) 41`!45°F* 3-302.14 Protection from Unapproved Additives* i { 1 15 Poisonous or Toxic Substances { 3-501.16{A) Hot PHFs Maintained at or above 1400F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F. Containers* j 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* { 3-501.19 Time as a Public Health Control* { 7-201.11 Separation-Storage* { 590,004(H) Variance Requirement { 7-202.11 .Restriction-Presence and Use° ( - { 7-202.12 Conditions of Use* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7-203.1.1 'Toxic Containers-Prohibitions* 1 POPULATIONS(HSP) { 7-204.11 Sanidzers.Criteria-Chemicals' 21 3-801.11(A) Unpasteurized Pre-packaged Juices and { 7-204.12 Chemicals for Washing Produce,Criteria* { .Beverazes with Warning labels* t { 7-204.14 Drying Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* { { 7-205.I I Incidental Food Ce>ntacY.Lubricants* { 3.801.11(D) Raw or Partially Cooked Animal Food and ' { 7-206.11 Restricted Use Pesticides,Criteria* { Raw Seed Sprouts Not Served.* ` { 7-206.12 [rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and Monitoring` CONSUMER ADVISORY i TIMET TEMPERATURE CONTROLS 22 3603.11 Consumer o d That Pasted for Consumption of 16 Proper Cooking Temperatures for Not eFoods Ms That are Raw.Undercooked or ` Not Otherwise Processed to Eliminate PHFs `itrrvar 3-401.11A(i)(2) Eggs- 155'F 15 Sec. Pa .*t Eggs-Immediate Service 145`Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Sheri 3.401.1 I(A)(2) Comminuted Fish.Meats&Game Ex Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 340111(13)(1)(2) Pork and Beef Roast-130°F 121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D).in sec.* catering, mobile food,temporary and 31401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,A3eut, I debited under the appropriate sections Poultry or Ratites-165'F t5 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 Faxh;Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 31401.11(A)(1)(b) All Other PHFs-145`F 15 sec.* { j 19 Reheating for Hot Holding { WOLA77ONS R i1A7ED TO GOOD RETAIL PR4C77CES 3-403A I(A)&(D) PHFs 165-F 15 sm. * (Items 23-31) 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 he 3403,11(C) Commercially Processed RTE Food- . found in the following sections of the Food Code and 105 CMR 140°F* 1 590.000. 3-403.1I(E) Remaining Unsliced Pordmis of Beef 1, Item i Good Retail Practices I FC 1 590,000 i Roasts* 1 23. 1 Management and Personnel FC-2 .00.3 1 Proper Cooling of PHFs 1 24. 1 Food and Food Protection ( FC-3 .004 1 25. Eouipmern and Utensils FC-4 ( .005 3-S0I.14(A) Coaling Cooked FHFs from 140`F to Mater.Plumbing and waste 1 FC-5 i .006 70`F Within 2 Hours and From 70'F 127. I Physical Facility FC-6 007 to 41`F/45'F Within 4 Hours. ° ( 28. 1 Pasonous or Toxic Materials FC-7 !! .008 3-501.14(6) Cooling PHFs Made From.Ambient 129. Special Requirements 1 .009 I ' Temperature Ingredients to 41`F/45'F 1 30� 1 Other ! Within 4 Hours* ` s19�r"�'"'d"�: 'Denotes csitleal itecnr in the federal 1999 Fc ,J Cody.w 105 CA1R 390.000. 1 - CITY OF SALEM BOARD OF HEALTH Establishment Name: ' _Ifi J� vB�• Date: � Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date. No. Reference R-Red Item �rym�� CPfV� 1" b ' PLEASE PRINT CLEAFkLY VedflBd 'alt 69,31 1 I 1 ,Y;,� IZI1 �,�� II I 5 - i I I I I I ��I rani) r�QA rQ /- If`A,Mn T r� 7Ahi�' r ( a urs,. Discussion With Person in Charge: I Corrective Action Required: I ❑ No ❑ Yes I 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 LlRe-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: �''"r ' - ...v-�.-�.- -�.,.�� r-...'��.,'• :.. - - .r{,,..:.(�i��v9'*$'W,�IY�.,gyr.."`'7ir..,/y..-- . .�-"wi.J:..wetl'r..l%.e,5. +: - =r; 3-501.14(C) PHFs Received at Temperatures 4 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 PHFs 14 Food or Color Additives 19 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 from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140 7-101.11 Identifying Information-Original ( 3-501.16(A) Roastssts Held at or above 130°F. Containers* 7-102.11 Common Name-' 'orking Containers* 20 Time as a Public Health Control 7-201.11 Separation-Smrage* 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 i 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce.Criteria° 121 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria" .Beverages with Warning Labels* 3-801.11(8) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 1 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw Seed Sprouts Na Served.* or Partially Cooked Animal Food and " 7-206.12 Rodent Bait Stations* i I Raw S I - 3-801.11(C) Unopened Food Package Not Re-sensed. 7-206.13 Tracking Powders,Pest Control and Monitoring' CONSUMER ADVISORY t 22 3-603.11 Consumer Advisory Posted for Consumption of TIME(TEMPERATURE CONTROLS 16 Proper Cooking Temperatures for I Animal Foods That are Raw.Undercooked or PHFs - Not Otherwise Processed to Eliminate pathogens.*E'NcpvO 3-401.11A(I)(2) Eggs- 155F 15 Sec. 3-302.L3 Pasteurized IEggs Substitute for Raw Shell b1 Eggs-Immediate Service 145'F15sec* 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals'-155F 15 sec.* SPECIAL REQUIREMENTS 3 40LI1(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 1 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 I 590.009(A}-(D) Violations of Section temporary and in sec. * 1 catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Sniffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat, I debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11('C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- - Microwave 165'F* Special Requirements. 3-401.11(A)(1)(6) All Other PHFs-145°F IS sec. 17 Reheating for trot Holding VIOLA77ONS R LATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165°F 15 sec.* (!teats 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critic's,acrd 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- I found in rhe following sections of the Food Code and 105 CMR ! 1400F'* 590.0OO. 3-403.11(E) Remaining Unsliced Portions of Beef I 1 Rem I Good Retail Practices I .FC 590.000I.I Roasts* 123. Management and Personnel I FC-2 .oM 18 Proper Cooling of PHFs 24. Food and Food Protection' FC-3 .004 i 25. Equipment and Utensils ( FG-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 26,_ I Water.Plumbing and Waste 1 FC-5 A06 I 70'F Within 2 Hours and From 70°F 1 27. Physical Facltity j FC-6 I .W7 to 41'F/45'F Within 4 Hours. * 128. I Poisonous or Toxic Materials FC-7 1 .008 1 3-501.14(B) Cooling PHFs Made From Ambient 1 29. I Special Requirements I 009 I Temperature Ingredients[041°F/45°F 130. I Other ! I Within 4 Hours* 'Denotes critical item in the federal 1999 Fuod Cale a105 CMR 590.000. CITY OF SALEM I� I/�_1 \ - /� BOARD OF HEALTH Establishment Name: b J�"[JI 1 -t 11 12� 1_ '). Date: 11621 I Page: 15- of lU Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Vermed PLEASE PRINT CLEARLY i I rA.Irxn 6al iMt°� . nl'\ A ka ff- - L ry I I ;ry k �J 'Sl Qt-o/- icy I :a 1 I Z5 U oy:� f Discussion With Person in Charge: Corrective Action Required: I ❑ .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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I �� 0 Voluntary Disposal ❑ Other: .�.f�r _ -.,� �.. .....Ji ..,.,-....1 '� - .. _.�ee,-.;,v�."ttgw:`�xW... l,.''ti" L.....e"r`'�i. ..�... �';.+..r.,..-.• _mat....:-,a'" 3,-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Gond.) I 41°F/45°F Within 4 Hours. * _ PROTECTION FROM CHEMICALS I 1 3-501.15 CoolinazMethods for PHFs I 1 14 1 - ( Food or Color Additives I 119 PHF Hot and Cold Holding I 3-202.12 I Additives* 1 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 1 590'004(F) 4101450 F* 115 Poisonous or Toxic Substances 1 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original I 140°F.* 3501.16(A) i Roasts Held at or above 130°F. Containers* i 7-102.11 I Common Name-Working Containers* 1 20 i Time as a Public Health Control i 1 7-201.11 Separation-Storage* 3-501.19 I Time as a Public Health Control* 1 7-202.11 Restriction-Presence and Use* 1 1 590.004(H) I Variance Requirement 1 i 7-202.12 Conditions of lisp* 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-203.11 Toxic Containers-Prohibitions* 1 POPULATIONS(HSP) 17-204.11 Sanitizers.Criteria-Chemicals* I 1 7-204.12 Chemicals for Washing Produce,Criteria* 1 ( 21 13-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Wanting labels* 7-204.14 1 Drying Agents.Criteria* 1 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 I Incidental Foal Contact,Lubricants* 1 1 7-206.11 i Restricted Use Pesticides,Criteria* I ( 3-801.11(D} Raw or d Sprouts Cooked Animal Food and i 7-206.12 + Rodent Bait Stations* 1 + Raw Seed prams Not Served I i 3-801.t 1(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. I Pathogens.*eAe 1.1/1r 1 Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 nun* 1 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 1 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Scoffed PHFs, residential kitchen operations should be Stuffing Containing Fish,A4eat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-40L11('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#29- Microwave 165°F* Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-145°F 15 sec.* 1 1 17 Reheating for Hot Holding VIOLATIONS R:LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 165°F 15 sec.* (Items 23-30) 3403.11(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 3-403.110 Commercially Processed RTE Food- found in the following sections of the Food Code mrd 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef 1 Hem I Good Retail Practices I .FC 590.000 I Roasts* m 1 23. 1 ManNeent and Personnel I FC-2 .003 I 1 18 1 Proper Cooling of PHIes 1 24. Foal and Food Protection ` FC-3 .004 I 25, Eauipmemand Utensils FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to I 1 26. ( Water.Plumbinq and Waste FC-5 .006 70°F Within 2 Hours and From 70°F 1 27, Physical Facility FC-6 I .007 1 to 41°F/45'F Within 4 Hours. * 1 28. Poisonous or Toxic Materials I FC-7 I .008 i 3-501.14(B) Cooling PRFs Made From Ambient 129. Special Requirements ; 009 I - Temperature Ingredients to 41°F/45°F 130. 1 Other I I Within 4 Hours* s.suo;ommsc6z ex. *Wtiotes critical neat in the federal 1999 Food Code or 105 CMR 590.000. G CITY OF SALEM BOARD OF HEALTH Establishment Name: 1(1_ I_ (7 Date: _ Page: lU of Item Code c-Critical ttem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date., No. Reference R-Red ttemVerMled LEASE PRINT CLEARLY I I hG�C : n In I I %�l i� G��fDlni"Y� l rel 1 .1 Ile i I I � I I _ I Discussion With Person in Charge: I 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 ❑ 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: 1^+1_�_--••.rri�.^'-"'^ l/-•yam �,..•-,,,.....y,n s�ar�C:.-...•r�..tf'.T`°. /'`ny*"nw"' ....,.+'P+.-.-.'.SPi4`...,'.st"`r..rwe-r++eY' r� .n r 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodbomo Illness.Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41°F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 19 PHF Not and Cold Holding 114 I Food or Color Additives I ({ 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives o 590'00 3-302.14 Protection from Unapproved Additives* 16( 41°145°F* { is Poisonous or Toxic substances 1-501.16(A) Hot PHFs Maintained at or above 140 7-101.11 Identifying Information-Original I . * I' Containers* � 3-501.16(A) I RoastsHeld at or above 130°F. 17-102.11 Common Name-Working Containers* I I Time as a Public Health Control 1 7-201.11 Separation-Storage* I 3-501.19 I Time as a Public Health Control* 1 7-202.11 Restriction-Presence and Use* I 1590.004(11) Variance Requirement I 17-202.12 Conditions of Use* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-203.11 Toxic Containers-Prohibitions* I POPULATIONS(HSP) 17-204.11 Sanitizers.Criteria-Chemicals* 17-204.12 Chemicals for Washing Produce,Criteria* I 121 13-801.11(A) Unpasteurized Pre-packaged Juices and 17-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 17-205.11 Incidental Food Contact,Lubricants* I 3-801.118) Use or Pasteurized C Eggs* I 13-801.11(D) Raw or Faunsnaally Cooked Animal Food and; 17-206.11 Restricted Use Pesticides,Criteria* { Raw Seed Sprouts Not Served* 17-206.12 Rodent Bait Stations* 13-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEREMPERATURE 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 3-401.11A(1)(2) Eggs- 155F 15 Sec. Pathogens.*E1M1"0v°""f Eggs-Immediate Service 145°F15sec* I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game j E=* Animals-155°F 15 sec.* I SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 thin* I 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering,mobile food, fcmporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, I 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 745°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3.401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* I i 17 Reheating for Hot Holding I VIOLATIONS R=LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23.30) 3403.11(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. 3-403.11(E) Remaining Uns[iced Portions of Beef Hem Good Retail Practices .FC 1 590.000 I Roasts" 1 23. Manaqement and Personnel FC-2 1 .003 i { IS ( Proper Cooling of PHFs { 24. Food and Food Protection FC-3 1 .004 25. Equipment and Utensils FC-4 1 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 26. 1 Water.Piumbinq and Waste FC-5 .006 I 70°F Within 2 Hours and From 70°F 1 27. Physical Facility FC-6 .007 to 4I'F/45'F Within 4 Hours. * 128. I Poisonous or Toxic Materials ! FC-7 .008 I 3-501.14(B) Cooling PHFs Made From Ambient 129. I Special Requirements 009 1 Temperature Ingredients to 410F(45°17 I 130. I Other ! I I Within 4 Hours* sm mac.x ax. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DateN I Type o eration s TyQe of Insoection I ood Service ❑ Routine Address Risk ❑ Retail -inspection Level [3Residential Kitchen Previous Inspection Telephone '7 rt ❑ Mobile Date: OwnerHACCP YM ElTemporary ❑ Pre-operation I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint > In: ❑ HACCP Inspector \> � / (n Out: Permit No. ❑Other Each viola t' checked requires a explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. [FOOD PROTECTION MANAGEMENT 1 ❑ 12. Prevention of Contamination from Hands EMPLOYEE HEALTH d eable/Duties es es 9 of Diseas ❑ 2. Reporting 1. PI ssi9 ne Howe I PROTEC ION FROM CHEMICALS by Food Employee and PIC - ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 4;415.Toxic Chemicals [ FROM APPROVED SOURCE �El 4. Food and ) TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods)_j 4. Water from Approved Source ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding eparation/Segregation/Protection El 20.Time As a Public Health Control Food Contact Surfaces Cleaning and Sanitizing FREOUIREMEN7s_FOR HIGHLY_SUSCEPTIBLE POPULATIONS(HSP)' El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices LCONSUMER ADVISORY I ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C_ x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-z)(s90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Re uirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5900speclFw 14 eoc p Inspector's Signature: cy-' Print: ) 1 PIC's Signature: PrirlE: ,,,(T4-C� � K Page L of ages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 3-302.1](A)(]) Raw Animal Foods Separated from' I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Fails* 590.003(B) I Demonstration of Knowledge': ( Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3302.1 I(A)(2) Raw Animal Foods Separated from Each Other EMPLOYEE HEALTH Contamination from the Environment I 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by ford employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Foal Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* - Applicant To Report To The Person in I 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 I3 590.003(,D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions I 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 141 Food and Water From Regulated Sources 19 ( Food Contact Surfaces ' 1590.004(A-B) Cumpliance with Food law* I 14-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* I- 3-201.13 Fluid Milk and Milk Products* I 4-501.112I Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* I 4-5171.114 I Chemical Sanitization-temp.,pH, 3-202.16 lee Made From Potable Drinking Water° I concentration and hardness. *, 15-101 A I Drinking Water from an Approved System- I 14-601'11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 14-602.11 Cleaning Frequency of Equipment Food- I . 590.006(B) Water Meets Standards in 310 CMR 2... '0* I Contact Surfaces and Utensils* . Shetl/ish and Fish From an Approved Source I 4-702.11 ( Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish" I ( 4-703.11 I Methods of Saintization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed I Chemical* I r_ Sources* Game and Wild Mushrooms Approved by I 110 I I Proper,Adequate Hantlwashing Requlatory Authority 2-301.11 Clean Condition-Hands and Arms* - 13-202.18 Shellstock identification Present* 12-301.12 Cleaning Procedure* 590.004(C) I Wild Mushrooms- 2-301.14 When to Wash* I 13-201.17 Game Animals* I if Good Hygienic Practices 5 1 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202:11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and - 13-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*' I 6 Tags/Records;Shelistock 112 Prevention of Contamination from Hands 3-202.18 Shelistock Identification 590.004(F,) Preventing Contamination from 3-203.12 Shells[oci:Identification Maintained* I Employees* I Tags/Records:Fish Products I 113 Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 13-402.12 Records,Creation and Retention* I 15-203.11 ( Numbers and Capacities* 590.004(1) Labeling of Ingredients* I 15-204.11 I Location and Placement* 7 Conformance with Approved ProceduresI 15-205.11 I Accessibility,Operation and Maintenance I /HACCP Plans Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* Devices 13-502.1_ I Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 ( Conformance with Approved Procedures* 16-301.1-2 Hand Drying Provision *Denotes critiwl item in the federal 1999 Food Code or t OS CNI R 590.000. ' Larry Ramdin From: MSHCGRACE@aol.com Sent: Friday, August 10, 2012 10:58 AM To: Larry Ramdin Subject: Boston Hot Dog Company Dear Mr Ramdin, My name is Grace Martins RN and Food Safety Instructor from Martins Training Center, LLC in Peabody.) would like you to know that I have been hired by Boston Hot Dog's owner to assist him with his most recent inspection results.Would you kindly forward this email to his inspector as I do not see her name on the web site. 'I conducted a site visit on 8-9-12 and provided a training for him and his staff. Meanwhile I am working on a plan of " correction for all his deficiencies. He has already correct the critical violations but still has more to be done. I will be returning to his site on 8-11-12. c...•r.. Please feel free to have his inspector contact me should she have any other questions or concerns. Thank you for your assistance Grace Martins RN 978-977-0717 , 1 COURT DOCKET NO CITATION NO. CITY SALEM PD 6 4 6 4 VIOLATION N NOTICE NAME(LAST,FIRST,INITIAL) ?x2,ssr®N 14671)csu STREETADDRESS CN'Y/TOWN STATE ZIP Lis wacul,i"w 'w- 9AALU-� av'% LICENSE NO LIC EXP DATE I DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETA -sib I sl1�'Q� �V CITY/TOWN I fvlk V9 , - I REGISTRATION NO STATE EXP DATE MAKE/IIPE YEAR 1COLORI DATE OF VIOLATION TIME El AM DATE CITATION WRITTEN ae Uw `IfJ�'I`- fLJ 1 n IPEl y '`1.41��-L 1— �PM �" AO�' ` ONO LOCATION OF VIOLATION ENFORC�IN DEPT. IFAS(a ItJI�1 1� OFFENSE ,CHAP SECT FINES ' A b 'k=1 IS C OFFICER y. FINE % ID NO. TOTAL t* DUE OFFICER CFFftIFIES COPY GIVEN TO VIOLATOR *IN HAND XZV ❑ BY MAIL DO NO-LAAIL 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)765-9595 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 R SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO CITATION NO. CITY OF SALEM PD C `6`F+ A VIOLATION NOTICE [7 NAME(LAST,FIRST,INITIAL) 1STR�EETADDRESS CITY?OWN STATE ZIP LICENSE NO. - LIC EXP DATE I DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREETADDRESS CITY/TOWN STATE ZIP ((p WtaS1a la+u i-T-" S1 SpkLv t-, t,%% 1614'r- REGISTRATION NO STATE EXP DATE MAKE/TYPE YEAR (COLOR DATE�OF VIOLATION TIME DATE CITATION WRITTEN PERsoNAI S iluuRY �7��D1 11 GYM IP. ❑VE �O [-I NO LOCATION OF VIOLATION Eh(F RCING DEPT tom;,L,�sas q aa1>'k+� � � OFFENSE CHAP SECT I FINES A &w:4 8 ,��.: ic OFFICER ��1 LD NO T DUE LI �p OFFICER CERTIFIES COPY GIVEN TO VIOLATOV X d� -.;n IN HAND ❑ BY MAIL DO NO AIL 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 IN THIS ENVELOPE,PEEL AND SEAL Commonwealth of Massachusetts * 3 'rt. } _.� ' - ' City of Salem S - 4 _ - °- a r _ J - - " Board of Health K mberley DnStoil--, v - - 120 Washington Street,4th Floor Mayor r _ a SALEM MA 01970 s 3 b' & Food/Retail Establishment Permit ,a (DATE PRINTED: 01/03/2013' ESTABLISHMENT NAME: _ - . Boston Hotdog Co. -. ,. +File Number:BHF-2004-000268 . 'S `60 Washington Street _' Salem ' 7,, MA 01970: LOCATED AT: 0060 WASHINGTON STREET - ' SALEM,-MA-01970 _ . Permit Type 1PernutNo. a Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2013-0298 = Jan 1,2013 Dec 31,2013 - $140.06A '• _ v �, A ` ''+ ESTABLISHMENT r Total Fees: 3'$140.00 Y r' ' '• f a� Al PERMIT EXPIRES December 3112013 a k µBoard of Health n- - S � f 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,' A plans for such must be submitted to and approved by the Salem Board of Health: " page 1-, _ CITY OF SALEM, ` 106 MASSACHUSETTS p„ u, BOARDoi�HEM.Tli `." 120 WASTI,NGroN S'IRIiI::I',4O1 F,,oOR KIMBERLEY DRISCOLL Ti;,%(978)741-1800 FAN(978)745-0343 LARRY RANDIN,ILS/RHI-IS,(11 10,CP-FS MAYOR Iramdin(u�saletn.com HUM;I'I-I A(i l':N'I' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) n a 11 Establishment Name: ® / � 2) Establishment Address: e® WASR>41,\._,v 3) Establishment Mailing Address(if different): / 4) Establishment Telephone No: 5) Applicant Name&Title: ��t 1 Cl LAS 6) Applicant Address: � 1I ^ A V (A/4 6*-4- t � �C 7) Applicant Telephone No: / 0 our Emergency No: Email: 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporation An individual A partnership Other legal entity 12) Person Directly Responsible For Daily Operations(Owner_, Person in Charge, Supervisor,Manager,etc.) Name&Title: Address: 6 �,t,VA /\I l Telephone No: 7z5-1 ,-5 Irk, 9 Email: Emergency Telephone No: 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Date: / 2 Amount: l r Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) t 16) Days and Hours of Operation: c 17) No.of Food Employees: 18) Name of Person in Charge Certified In Food Protection Management: Required as of 101112001 in accordance with 105 CA9R 590.003(A) A IMI 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): Yes No 0 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ etail( Ftj ❑ Caterer Permanent Structure [fl Food Service-( 4. T'*Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: ...................................Breakfast Esta_blishments (check one) RETAIL STORE RESTAURANT Annual V5 Less than I000sq.ft. $70 ❑ Less than 25 seats $140 Seasonal/Dates: (71000-10,000sq.ft. $280 ❑Residential Kitchens $140 ❑ More than 10,000scift $420 ❑ 25-99 seats $280 , ❑More than 99 seats $420 Temporary/Dates/Time: - - ... - - - - -- -- --- -------------------------- ❑Bed&BreakfastlChiidcare Services)Nursing Home ---$100-'- --- ------- --------------------------------------- -------------------------- ---------------------------------- ------------------------------ -------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM,YOGURTISOFT SERVE $25 ❑PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF—potentially hazardous food(timeltemperature controls required) Non-PHFs—non-potentially hazardous food(no timeltemperature controls required) (check all that apply): RTE—ready-to-eat foods(Fat.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Gooled or Hot Held I Pre-packaged Non-PHFs for More Than a Single Meal Service li Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly 1 Pre-packaged PHFs Cold Holding for Single Meal,,Service Susceptible Population Facility r Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities I To be completed by the Board ofHealth Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and i affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. ,,., 24) Signature of Applicant--i 4 !"/q/�x / r Pursuant to MGL Ch.62C, sec.49A,I certify under the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law.. 25) Social Security Number or Federal ID: nf 0 26) Signature of Individual or Corporate Name: L l� J � +� Commonwealth of Massachusetts City of Salem Board of Health -_ _ - ---_-.-- - - — — - - --—IGmberleyDriscoil - ----- - 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2009 ESTABLISHMENT NAME: Boston Hotdog Co. File Number.BHF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0357 Jan 9,2009 Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2009 t � Board of Health 24Z Y" This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4r"FLOOR TEL. (978) 741-1800 KIMBERL.EY DRISCOL.L FAx(978)745-0343 MAYOR IDIONNE(a�SALEM.CONI JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT � / � �d63 COr,pQr1J 4A6 TEL# R'7Y- 7Y11%2326 ADDRESS OF ESTABLISHMENT CD 4,454 FAX# 979-?W-a 32 y MAILING ADDRESS(if different) EMAIL-Business': �OS7oh// mS�®�� ` Website: OWNER'SNAME S ' S F6vvq-,/PS TEL# 731 ADDRESS J/h c/4 IVti STREET // CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 3�f qks CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON JjQ,kS P'Ptr. arules HOME TEL# J&/ '6`BI' 6 I iDAYS OF OPERATION; I . Monday Tuesday I Wednesday. 1. . Thursday i s : Friday r I Saturday i Sunday HOURS OF OPERATION Please write in time of day. 9d n "�� `l 77 9RM /� cl" -//,V":! 9 //p Y4ht " /�/ q.7,& (For example 1lam-ttpm) $m �i TYPE OF ESTABLISHMENT FEE (check onlvt RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$260 more than 10,000sq.ft. =$420 ---------- ------ ------ ------ -------------------------- .................. -- s-- ---40---- (Outdoor ---- YES' NO less than 25 seats $140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 BED/BREAKA .-------------------YES------NO--------------------- ----- ------------------------------------------------------$-1--0-0------- CHILDCARE SERVICES ADDITIONAL PERMITS MAKE(notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returnss and paid all state taxes required under th/e I �s Sign 'afure ] te 7 / Social Security or Federal Identification Number _? Revised 484/07 FOODAP2008.adm Check#&Date `,Ce UO` I W� $ f - - , . � �,. ��. 5� � r�� . �� CITY OF SALEM BOARD OF HEALTH 2 Establishment Name:_ �1n f Date: Page: of IJ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ' Date No. Reference R-Red nem Vernled PLEASE PRINT CLE LY 1tn;nDCL2bDt0 _ �� ► e fL 06t::�� q I f �J r(X4WA � � g I _ o C4,, }�� A 4 s �- 1^^�3 111:0 I I , v MV4 6- 60A Discussion With Person in Charge: Corrective Action Required: I Li ¢Y No I Ves 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 undderstand that noncompliance may result in daily fines of twenty-five dollars spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 3 / �l n ❑ Voluntary Disposal ❑ Other: f 3-501.14(C) PHFs Received at Temperatures .t Violations Related to Foodborne,Illness interventions and Risk According to Law Cooled to Factors(Ifetns 1-22) (Cont.) 41'F145 F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooline Methods for PHFs 7 ( 14 ( Food or Caton Additives - 19 'PHF Not and Cold Holding 3-501.16(B) Cold PLIPs Maintained at or below ( 3-202.12 Additives* ( 590.004(F) 410145"F* 3-302.14 Protection from Unapproved Additives' 3-50L16(A) Hot PHFs Maintained at or above J 15 Poisonous or Toxic Substances 7-101.11 identifying Information-Original ( 3-501.16(A) Roasts Held at or above 130'F. Conmiaers* ( 20 Tome as a Public Health Control 7-102.11 Common Name-Working Conminem* J 7=201.11 Separation-Storage" 3-501.4( Timeaca Requirement irLIent Control* J 7-202.11 .Restriction-Presence and Use* 1 590.004(H) Variance Requirement 7-202.12 ( Conditions of Use* 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ,t 7-203.11 1 'Toxic Containers-Prohibitions* J POPULATIONS(HSP) J 7-204.11 1 Samtizers.Criteria-Chemicals' 1 r J ` 27 3-801.17(A) Unpasteurized Pre-packaged Juices and 7-204.1 { Chemicals for Washing Produce,Criteria � Bevznges with Warning Labels" ,r J 7-204.14 Diving Agents.Criteria* - ( 3-801.11(B) Use of Pasteurized Eggs* 1 7-205.11 Incidental Food Contact,Labticants* 13-801.11(D) Raw or Partially Cooked Animal Foci and 1 J 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served f 7-206.12 -Rodent Bait Stations* 3-801.11(C) unopened Food Package No Re-served. ,r 7-206.13 Tracking Powders, Pest Control and s Mpnitcring• CONSUMER ADVISORY r 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEtTEMPER4TURE CONTROLS 16 Proper Cooking Temperatures for Not Otherwise Foods That are Raw,EliminatUndercoe or r PHFs , Na Otherwise Processed to Eliminate _ Patlto�'eILS-*�xoee+a�nrzce!r ( 3401.1IA(1)(2) Egg- 155F 15 See. J, I Eggs-immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell t 3-401.11(A)(2) Comminuted Fish.Meats&Game 1 Egvs* Animals-155°F 15 sec.* I r J 3-401.21(13)(1)(2) Pork and Beef Roast-130°F121mio* J SPECIAL REQUIREMENTS 14 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in y sec.* , ( catering,mobile fwd,temporary and i residential kitchen operations should be 3-401.11(A)(3} Poultry,Wild Game,Stuffed PHFs, � Stuffing Containing Fish,Meat, debited under the appropriate sections l Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 1 13-401.11(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.* 2 1 17 Reheating for Hot Holding VIOLA77ONS R_LATER TO GOOD RETAIL PRACTICES 'i 3-403A I(A)&(D) PHFs 165'F 15 sec.* ( (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical mid non-critical violations, which do not relaw.to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- faand in the folinwing sections of the Food Code and 105 CMR 140°F* 590.000. 3403.1l(E) Remaining Unsticed Portrtms of Beef I Item I Good Retail Practices I FC 540.000 I Roasts* ( 123. Managernentand Personnel I FC-2 .003 r 1 24. i Food and Food Protection FC -3 .004 18 1 Proper Cooling of PHFs � 125. i Equipment and Utensils' i FC-4 ,005 i 3-501.14(A) Cooling Cooked PHFs from 140`F to ( 26, Water.Piumbinq and Waste ! FC-5 .om 70'F Within 2 Hours and From 70'F ( 27. Physical Facility i FC-6 .007 to 4 FF/45'F Within 4 Hours.* 28. ' Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient ! 29. I Special Requirement, .009 1 Temperature ingredients to 41'F/45'F III 30. e Within 4 Hours* 'Denotes critical ism in the feder_t I�)7 Foal Cale w i0i C,YtR:90.000. t { - - CITY OF SALEM Establishment Name: �'I 1 BOARD OF HEAD Date:LTH 'O1 11 dU & Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Pb. Reference R-Red Item Verified PLEASE PRI C EARLY ✓� �� I D�1 •owil 4z I I I I I I I I I I I I I I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No 9� re I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars suspension/revocation of Ll Embargo C] Emergency Closure your food permit. / !_ ! ❑ Voluntary Disposal ❑ Other: 4. 3.501.14(C) PHFs Reozived at Temperatures f ti ialations Related to Foodborne Illness Interventions and Risk According to Law Cooled to 1$ Factors(trams 1-22) (Cont,) 41'F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methtxis fir PHFs I ( 14 Food or Calor Additives 19 PHF Not and Cold Holding ( 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives' 3-302.14 Protection from Un proved Additives* ( 3-501,k1{F) Hot P 'F* ( 15 Poisonous or Toxic Substances ( i-SUI.tfi{A} Hot PHFs Maintained at or above 140°F. 7-101.11 Identifying Information-Original ( !4 3-501.16(A) Roasts Held at or above 130'F. Containers* " i 7-142.11 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 7-243.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) ( 7-204.11 Sanitizers.Criteria-Chemicals* t 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasterriwd Pre-packaged Juices and ( ( .Bevernees with Wanting labels*7-204.14 Drying Agents,Criteria' 1 _ ( 3-x01.118) Use of Pas 7-205-11 hicidemal Food Contact.Lubricants* ( bultl Eggs* ly 3-801.11(D) Raw or Partially Cooked Animal Food and ( 7-206.11 Restricted Use Pesticides,Craeria* ( Raw Seed Sprouts Not Served. ( 7-206.12 (talent Bait Stations* ( 3-801.11(C) Unopened Food Package Not Re-served. ° 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMErTEMPERATURE CONTROLS 22 3-603.11 Cousumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate i Pathogens.*etc>. r 3-401.11A(Ix2) Eggs- 155°F 15 Sec. 1 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs Animals-155'F 15 sec:.* SPECIAL REQUIREMENTS 7 3401.11(6)(1)t2) Pork and Beef Roast-130°F121 min* i 590.009(,0)-(D) Violations of Section .590.004(A)-(IJ)in f 3-001.11(,0)(2) Ratites,Injected Meats-155°F 15 sec.* catering, mobile rood,temporary and 3-401.1 t(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3-401.11(0)(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#29- Microwave 165°F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * ( 17 Reheating for Hot Holding ( WOLA77ONS R LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165LT 15 sec. * 1 Ream 23-30) 3403.11(B) Microwave- 1650 P 2 Minute Standing Crcal and non-critical violations,which do not relate to the Tine* foodborne illness interventions and risk factors listed above, can be 1 3-403,t 1(C) Commercially Processed RTE Food- found in the following seriians of the Food Code and 105 CMR 140°F*.' 590.000. 3403.11(E) Remaining Unsliced Portions of Beef f Item ! Goad Retail Practices FC 590.000 i Roasts* i 23. i Management and Personnel FC-2 .003 I 1 24. Far!and Food Protection 1 FC-3 .004 I 4 ( 123 Proper Coaling of PHFs 125. i Equipment and Utensils FC-4 .005 3-541.14(,0) Cooling Cooked PHFs from 140°F to � 26. 1 Water.Ptumbinq and Waste FC-5 .006 i 74'F Within 2 Hours and From 70`F ; 27. I Physical Facility i FC-6 .007 to 41`F145017 Within 4 Hours.* 1 26. 1 Poisonous or Toxic fUlamnals FC-7 .008 i 3-501,74(6) Cooling PHFs Made From Ambient 129. ( Special Requirements .009 1 Temperature Ingredients to 41°F145°F Other1 1 Within 4 Hems* r 'Drnoies critical aura in the federal 1'I99 Fuai Code w 105 C;NR 590.000, r Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name �, ff �__ -- �t to TYoe of Operationlsl. Tyge of Insoectlon Y1 1-tiJ1 \ di`� ��-Qr Food Service Routine Address P Risk Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection ❑ Telephone r�(i I� �n ' IlS I Mobile Date: Owner �"�� HACCP Y/N ❑ Temporary ❑ Pre-operation , nP� t� MV`16 A O, J ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)/. ��n Time ❑ Bed&Breakfast ❑General Complaint / 1 In: ❑ HACCP Inspector �� (-mc I Out: Permit No. ❑Other Each violation checked require ar explanation on the narrative page(s)and a citation of specific provision(s) violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 0'590.009(Fy-j] action as determined by the Board of Health. tand fv r, OOD-PROTECTION MANAGEMENT _ - t ❑ 12. Prevention of Contamination 1. PIC Assigned/Knowledgeable/Duties �3. Handwash Facilities k,EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC "` [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals EFOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATUR_E CONTROLS(Putentlally Hazardous Foods), ❑ 5. Receiving/Condition [:116.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 CREOUIREMENTS FOR HIGHLY SUSCEPTIBLE_POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices I CONSUMER ADVISORY I ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x 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)(5cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(590.00 )o.0o5) 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 JLZ 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.00s) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: RE-INSPEC�TI(O/^NS: S m ,. x � _ � yTCUGQiVAS ecir'sSgnuPrint: Print: OCC / Pg)e�IF»1 Xaa�gr `a f -1 of2 es .i - . '. **:�./+w-+�. 'i'. Y`J-"'r ._. . . :ter. '��tF .._....... 4'.r)v'w.,�-• -.�-w.....".Y' i ri+`"-`� , � �..ti,�, Violations Related to Foodborne Illness Interventions and Risk Factors(Nems 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT I 3-302.11(A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I; I I Contamination from Raw ingredients 2-103.11 Person in charge -duties l 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH I Contamination from the Environment 2 590.003(C) Responsibility of the person to charge to 13-302.11(A) Food Protection* require reporting by food employees and 13-302.15 Washing Fruits and Vegetables � applicants* 590.003(F) Responsibility Of A Food Employee Or An Utensils13-304.11 Food Contact with Equipment and Applicant To Report To The Person In Contamination Charge* I I Contamination from the Consumer I 590.003(6) Reporting by Person in Charge* 13-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(F,) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food" 4Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law' 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in it Hermetically Sealed Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing-Hot Water 13-202.73 Shell Eggs* I Sanitization Temperatures* 13-20214 Eggs and Milk Products,Pasteurized* I 14-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. 13-202.16 Ice Made From Potable Drinking Water' I 5-101.11 Drinking Water from an Approved System" ( 14-601.1 I(A) I Equipment Food Contact Surfaces and i 590.006(A) Bottled Drinking Water* I eClean* J 590.0(k(B) Water Meets Standards in 310 CMR 22.0* I 4-602.1 I Cleaning ing Frequency of Equipment Food" SheiHish and Fish From an Approved Source I Contact Surfaces and Utensils*. 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I _ Food Contact Surfaces of Equipment* ' Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* f 10 I Proper,Adequate Handwashing I Game and Wild Mushrooms Approved by Regulatory Authority I 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 12-301.12 I Cleaning Procedure* 590.004(C) Wild Mushrooms* I 12-301.14 ( When to Wash` 3-201.17 Game Animals* I I1 I Good Hygienic Practices, r 5 Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 IDischarbes From the Eyes,Nose and I ' 3.302.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* I 13-30 L 12 Preventing Contamination When Tasting* I 6 I Tags/Records:Shellstock ( 112 Prevention of Contamination from Hands 13-202.18 Shellstock Identification* ( 1590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I ( Employees* Tags/Records:'Fish Products I 113 Handwash Facilities 13-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention" 15-203.11 Numbers and Capacities* 590.004(J) I Labeling of Ingredients' 15-204.11 Location and Placement* 5-205.11 Accessibili ,Operation and Maintenance I 9 Conformance with Approved Procedures � ?Y IHACCP Pians ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 I Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleanser, Availability 8-103.12 I Conformance with Approved Procedures* I 16-301.1.2 Hand Drying Provision *Denotes critical item in the federal 1999 Food Cade or 10 CMR 590.000. iU W t v - -e-0 0'A L ce caw, 0 Fo&�� La CITY OF SALEM fq�q0 BOARD OF HEALTH Establishment Date: Page: of nem Code C-Critical Item `DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Rem --�� ) Verified PLEASE PROAT CLEARLY - '-PMq_ Z t.A LAO /a QPOA �, I I � r, 6 /��II L I V� T �� ] - l{ I,'.�nre�\ 000 51e .(Q .�n A AA.91 � XA7�.� IM, � t )JAPek((��/� 1 01y>Lll I�� n�drilll _ Acd �lU s Vw' Al '- -- A, A,. ISG m��'4 f UQ�Pn a� II /L . ... .-'1n2� -Q AA - �J – 1 .11 W,&_C .A M nU .t — �VO.A+ A411V Q'17 OL Of 0AA-a-� l 0Dom( \ M( O _v S/1.+..� ��QG� _ �d7il� e F/f �i�(2�A_^ 't�X?�i/�no .fl— G4� n(�✓Y, C� Discussion With Person in Charge: I Corrective Action Required: I ❑ No I pi r®s 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 Emergen Re-in ctian Schedul ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food-Code. I understand that 04AV noncompliance may result in daily fines of twe ty-five dollars or suspension/revocation of ov Embargo – l ❑ Emergency Closure f your food permit. ❑ Voluntary Disposal ❑ Other: V 37501.14(C) PHFs Received at Temperatures ' Violations Related to Foodborne fitness lnmr✓enfions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) - 4£°F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS { 3-541..15 Cooling Methods for PHFs { ( 14 Food or Color Additives , ( 19 PHF Not and Cold Holding i 3-50L16(B) Cold PRFs Maintained at or below 3-202.12 ProteAdditctionvee { 590.044(F) 41'145°F* 1-342.14 Protection from i?naoproved Additives f ( _ ( 15 Poisonous or Toxic Substances ( 501.!6(A) Hot PHFs Maintained at or above 144 7-101.11 Identifying Information-Original Roasts ' Containers* � 33-501.16(A) Roassts Held at or above 130'F, ( j 20 Time as a Public Health Control 7-102.11 C rtamon Name-Working Containers* { ( j ( 3-501.19 Time as a Public health Contra!' 7-201.11 Separation-Storage* 590.404(H) Varian j 7-202.11 .Restriction-Presence and Use* Variance Requirement j 7-202.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* f ( 7-204.11 Samtizers,Criteria-Chemicals* POPULATIONS(NSP) ( 7-204.12 Chemicals for Washing Produce.Criteria* 21 3-80L I l(A) Unpasteurized Pre-packaged iuices and 1 .Beverages with Wanting Labels* ( 7-204.14 Drying Agents,Criteria* ( 7-245-11 Incidental Food Contact,Lubricants* j ( 3-801.1 i(B) Use of Pasteurized E„,'s° 17-206.11 Restricted Use Pesticides,Criteria* f 13-801.11(D) Raw or Partially Cooked Animal Food and ( Raw Seed Spnuns Not Served.* ( 7-206.12 Rodent Bait Stati insfi { 7-206.13 Tracking Powders,Pest Control and ( 3-$41.11(0) Unopened Fc1 Package Not Rt:-served. Momtoring'r CONSUMER ADVISORY TIMEtFEMPERATURE CONTROLS 22 3-603.11 Consumer:advisory Pasted fou Consumption of 16 f Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or i PHPs Not Otherwise Processed to Elimmate 3401.11A(I)(2) Eggs- 155°F 15 Sec. Pathogens'* x>re v,zmr Eggs-Immediate Service 145°Fl5su* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Came1 Eggs* Animals-155°F 15 sec. " ( SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590.009(A}-(D) Violations of Section 590.009(A)-(D)in sec.* entering, mobile ftod,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHF's, 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(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F v 590.009 violations relating to good retail 1-441.12 Raw Animal Fuodc Cooked in a practices should be debited under#29- Microwave 165°FSpecial Requirements. 3-40L11(A)(1)(b) All Other PHFs- 145'F 15 sec. j i7 ( Reheating for Not Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACT7CES ( 3-403.11(A)&(D) PHFs 165°F 15 sec.* � (Items 1st-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(0) Commercially Processed RTE Food- faund in the folloit ing sections of the Food Code and 105 CMR 140°F* 590.000, 3-403.1l(E) Retraining Unsliced Portions of Beef tram i Good Rem:7Practices 1 FC 590.0m j Roasts* 23. 1 Management and Personnel 1 FC-2 .003 i 18 Proper Cooling of PHFs 1 24. 1 Foal and Food Protection i FC.-3 .004 1 f 25. ( Equiomerd and utensils i FC-4 .005 j { 3-541.14{A} Cooling Cooked PHFs from 140`F to ' 2g, Water.Plumbing and waste FG-5 .0o8 70°F Within 2 Hours and From 70'F 1 27. I Physical Facility FC-6 .407 to 41`F/45'F Within 4 Hours. * 1 1 28. ; Poisonous w Toxic Materials ' FC-7 .008 ( 3-501.14(8) Cooling PHFs Made From Ambient 29. I Special Requirements .009 l Temperature Ingredients to 41°F/45°F Other Within 4 Hous* 'Denore critical mm in the federal 1799 Food Cate or 103 C:vt1i X90.000. Preventative Drain Services 338 Grapevine Road Date: /A-Ica 161 2- Wenham,MA 01984 978-468-9001 Time: \/ CUSTOMER SERVICE REPORT Technician: System Owner: ZFI,s/, ✓ Job Site/Contact: Address: � �!n SL ✓ S f— Address: Phone: Phone: Machine used One hour Additional Minimum Hours J It is agreed Preventative Drain Cleaning ❑High pressure water jetter $115/hr- Shall not be responsible for any additional ❑High pressure Interior water jetter $95/hr conditions known or unforeseen, including, ❑Large mechanical drum machine $95/hr__ ____ but not limited to broken pipes,water ❑Midsized mechanical drum machine $95/hr _ damage,utility damage and or any other 119mall mechanical drum machine /y/zf- $95/hr _ unforeseen condition. All work will be ❑Sewer line video inspection camera $95/hr guaranteed for 30 days,unless otherwise ❑Wi onde Pipe locator $125/hi stated by technician. DRAIN SERVICES PERFORMED f QTY. DESCRIPTION PRICE AMOUNT f I II I I TOTAL �k/ZS= - Payment amt received 1 $ ❑ Cash ❑ Check#: Bal: (- THANK YOU For office use only please. El Invoice entered 11 Payment El Payment lied Days E ❑7 7 DDays ❑30 Days Void Date: Date: ❑Other Massachusetts Department of Public'Health Salem Board of Health ' �, 120 Washington Street,4'"Floor a Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343. Name y \ Date Type of Ooeration(s) Tvpe of Inspection (01 Food Service CoRoutine Address � , O i ( c 1-� Risk Retail {] Re-inspection �J( VYL1 t n[7 �T Telephone Level Residential Kitchen Previous Inspection n '' ,' n � �o (,) ❑ Mobile Date: Owner �1 p / HACCP YIN El Temporary ElPre-operation l 11 A Q(1 FM / 0A X p/) ) I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) 7 Time ❑ Bed&Breakfast El General Complaint In .-40 ❑ HACCP inspector / rn n { Permit No. I �� - '. � Ou : C3 Other Each violation checked requires a,h xplanation on the narrative page(s)and a citation of specific provision(s)violated. U 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) Ly' 590.009(F) 0�, action as determined by the Board of Health. �'�l�Je l l Cj( CODPROTECTION MANAGEMENT_� ( ,; ❑ 12. Prevention of Contamination from Hands 7ole 1. PIC Assigned/Knowledgeable Duties ! fel'13. Handwash Facilities 4EMPLOYEE HEALTH " " _ % ; --- ,. - ------ I PROTECTION FROM CHEMICALS I ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded " cals LFOOD_FROM APPROVED SOURCE FJTEPERATUR15.Toxic IE CONTROLS(PoteMlaliy Hazardou E3.4.4. Food and Water from Approved Source Ma Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures x El.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 1 ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing t REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) // 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing O / ❑ 11. Good Hygienic Practices yCONSUMER ADVISORY.-_-_'' - ' '.g,�;,; OW22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number'of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C_ x p g 23. Management and'Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of"Health. Failure to correct violations 5. Equipment and Utensils (Fc-4)(590.005) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.005) 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 i 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: f1 0 I 6 C� Inspectors Sign ture: Print: I (� C�� 60hh16:11 I PIC'-s�Sign-a-t�ure: Print:70SP a/J � CG/ Pagelhe�o oUfa-Pages I V TG McKS is 1 Violations Related to Foodborne Illness , Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 1 ( 3-302.11(A)(1) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* ( Calked and RTE Fads* 590.003(B) Demonstration of Knowledge* ( Contamination from Raw Ingredients 2-103.11 Person in charge-duties ( 3-302.1 UA)(2) Raw Animal Foods Separated from Each I Other* EMPLOYEE HEALTH I I Contamination from the Environment I 2 590.003(C) Responsibility of the person in charge to 1 3-302.1 UA) Food Protection* require reporting by fad employees and 3-302.15 I Washing Fruits and Vegetablesapplicants* 590.003(F) Responsibility Of A Food Employee Or An 304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils Contamination from the Consumer { Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* 13 590.003(D) Exclusions and Restrictions* Food Disposition od 590.003(E) I Removal of Exclusions and Restrictions 3-76r.i 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces I 590.004(A-B) Compliance with Food Caw* 4-501.111 Manual W rewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Contamer* { Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* { 3-202 14 Eggs and Milk Products, Pasteurized* I 4-501.114I Chemical Sanitization-temp.,pH, 3-202.16 ( Ice Made From Potable Drinking Watt,* I concentration and hardness.* 4" 15-101.11 Drinking Water from an Approved System* ( ('01,17(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean" J 590.006(B) Water Meets Standards in 310 CMR 22.0* I 4-602.11 Cleaning Frequency of Equipment Fail- Shellfish and Fish Four an Approved Source ( Contact cy of Sanitization and tionUteoflUt 4-702.11 Frequency of Sanitization of Utensils and 3-207.14 Fish and Recreationally Caught Molluscan Shellfish" ( Food Contact Surfaces of E ui mer 14-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed ( Chemical* Sources* t0 I I Proper,Adequate Handwashing Game and Witd Mushrooms Approved by I Regulatory Authority 12.301 11 Clean Condition-Hands and Alms* 1 3-202.18 I Shellstock Identification Present" 2-301.12 Cleaning Prwedure* 590.004(0) Wild Mushrooms- � 2-301.14 When to Wash* { 3-201.17 Game Animals* I I if Good Hygienic Practices 1 5 Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PRFs Received at Proper Temperatures* 12-401.12 I Discharges From the Eyes,Nose and 3-302.15 Package Integrity'" Mouth* 3-101.11 Food Safe and Unaduller.ited* I 3-301.12 Preventing Contamination When Tasting" 6 Tags/Records;Sheilstack ( 112 Prevention of Contamination from Hands { 3-202.18 Shellstock Identification` ( 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identificition Maintained* I I Employees* I Tags/Records:Fish Products 13 Handwash Facilities I 3-402.11 Parasite Destruction* I I Conveniently Located and Accessible 1 3-402.12 Records,Creation and Retention* I i 5-203.11 I Numbers and Capacities* 1 590.0040) Labeling of Ingredients' 1 5-204.11 I Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance I /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12Reduced oxygen packa4ing,criteria' 1 6-301.11 I Handwashing Cleanser, Availability I { 8-103.12 Conformance with Approved Procedures* 16-301.12 I Hand Drying Provision 'Denotes critical item in the tedend 1999 Fond Cale or 105 CMR 591.0006 CITY OF SALEM BOARD OF HEALTH Establishment Name: �,- M �� Date: 9-) - AG—/( I age: .�, of 'Q _ Item Code C-Critical Item > furn��rf DESCRIPTION OF VIOLATION/PLAN OF CORRECTION bete No. Reference I R-Red Item � �7T, \ �^n^ n J VI'/ r� (I'll � �' PLEASE PRINT CLEARLY ,r� (� Verified O'I� '�r; rX"� �WT I�n-��,ry�1�I , e 0. �(Y—,�nrSC.-- I.111 r,�Al - 0/ S_nI .(11 O, 1 � ��l � / _�� lmn.,L/ an /, v 'fin . ,., 40 U A nn I. ., 1•YW'N.1 , I !x o .-,n. LI-1° t V-D -�,-0 r 7 A 1,�-141l,�(✓��-� 4, \,_ I f >r,K/�., (S�t Ynn AA,�/L /1 G�(n- `�X-� n.pn<N Inr,,.(\. Yn AA l�i: Y t, .'�' Jn9K y I( •� /1 1 P, 1� �'1 klv!/Ll. /- fl�0 �A n�_ k \�n, o�ntnnl �� 'ClG✓ Ny Il I � --I" �, •Pn,h l� nlnn\ — l ��.:,,... t�v_ -r� \r�rT7//1 ,I,.L� VIII iYi Ann /j �R.�, A Illy I A 0,Z rIA tn„ � 4I—f w S, 1�A� w. Yl J'1rar�r(n�ril IOA5rV *' AaAn - Al IRJI1)f(� . r)t1 . OU r/trp rl !\ Slalrut l,r/1V1�RIOk 0 nnllOnin ntot� o IVl rr,nn y/ `�- 1W11 �_ 0\tPAA I �f/✓� (nno I1/ nl t1 v in 11\ AA,-r ,r A Discussion With Person in Charge: I Corrective36tion Required: I ❑ No I O'' Yes I have read this report, have had the opportunity to ask questions and agree to correct all 1Z Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and toExclusion +Pf Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 1 W-e e'v' noncompliance may result in daily fines of twe(r/y-five dollars o .uspension/revocation of ❑ Embargo ❑ Emergency Closure •I �/OUr food permit. -- �( / r .l ❑ Voluntary Disposal ❑ Other: �J n 11 3-501.14(0) PHFs Received at Temperatures + Violations Related to Foodborne Illness.Interventions and RiskI According to Law Cooled to Factors(Items 1-92) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 1 1 3-501.15 1 Cooling Methods for PHFs 1 1 14 Food or Color Additives 1 19 1 PHF Hot and Cold Holding j 3-202.12 Additives* I 3-501.16(B) Cold PHFs Maintained at or below 590.004((? 4i°145°F* 3-302.14 Protection from Unapproved Additives* 1 1 15 Poisonous or Toxic Substances 1 13-501.16(0) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original J 1st Containers* 13501.16(0) Roast,Held at or above 130'(. 7-102.11 Common Name-Working Containers* 1 1 20 1 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 1 1 11 1 f 7-202.11 Restriction-Presence and Use* 1 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-203.11 Toxic Containers-Prohibitions* 1 POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 1 7-204.12 Chemicals for Washing Produce.Criteria* 121 3-801.11(0) Unpasteurized Pre-packaged Juices and 1 7-204.14 Drying Agents.Criteria* 1 Beverages with Wanting labels* j 7-205.11 Incidental Food Contact,Lubricants* 1 3-801.118) Use of Pasteurized Eggs* j 1 1 13-801.11(D) ( Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served * 7-206.13 Tracking Powders,Pest Control and ( 1 3-801,11(C) 1 Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.110(1)(2) Eggs- I55°F IS Sec. Pathogens.*Et"vr° Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Egzsx Animals-155°F 15 sec. * SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast- 130°(121 min* 1 3-401.11(0)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat, I debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * 1 j 17 Reheating for Hot Holding 1 VIOLATIONS ReLATED TO GOOD RETAIL PRACTICES 3.403.11(A)&(D) PHFs 165°(15 sec.* 1 (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness imementions and risk factors listed above, can be 3403.11(0) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Hem I Good Retail Practices I ,FC 590.000 i Roast's* ( 23. 1 Mannpetent and Personnel FC-2 .003 I 1 lg Proper Cooling of PHFs ( i 24. Food and Food Protection I FC-3 .004 j 125. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26, W ater.Piumbinq and Waste I FC-5 .006 70°F Within 2 Hours and From 70°F 127. Phvs cal Facitiiv FC-6 007 to 41'F/45'17 Aithin 4 Hours.* 28. Poisonous or Toxic Materials i FC-7 .008 3-501.14(13) Cooling PHFs Made From Ambient 1 29. Special Requirements 1009 Temperature Ingredients to 41°F/45°F I 1 30. 1 Other 1 Within 4 Hazels* s:,orr°m.ar x ex. 'Denotes critical item in the federal 1999 Food Code a 105 CMR 590.000. � � 'X+ .n ., i,-'T+n•ti°F'1.12��,MSM.�n"'tlad'.Ma..'lr<;,Nw�'itt- ..!<„�t,•J7. _ w�.K't^r�^`Tylyjti?w'��r+tt3l�yl.., ;�Fd{.- ��./R's'^'*�"�'r+Ar�'(°.�•":. A �P,iissachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Salem, MA 01970-3523 4th Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name(J ' ` 1 Date 7 Tyge of Ooeration(s) Type of Insoection qq a()1 11 I Food Service RRoutine Address L,,C) � ARisk Retail Re-inspection J Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner _ HACCP YM I ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint OG/M p1L InO Q/Vh ❑ HACCP Inspector � �() (�b Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. UNon-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)/6 A action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 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,,, „ ❑ 4. Food and Water from Approved Source . TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)' ' ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures Q 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)_ N ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ��22. Po�ansumer Advisories �-<y Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(5 23. Management and Personnel (FC-2) 90.004) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-a)(ss0.00s) I the food establishment permit and cessation of food V 26. Water, Plumbing and Waste (FC-5)(590.006) establishmentoperations. If aggrieved by this order, you 0 k �✓ 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 DAQTE..OF RE -INSPEC TION: � -3 _(�\ S sJio�rFoc.ia tL l�-Vw V Inss1,p1ectt-oor�'s Signature: �f p /J 0 U Print: � �h PIC's Signature:� X - Print:'(�5,e IO C �r Page of Zi ges vie, Sc� GQGQ �;d I Violations Related to Foodborne Illness . �. Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 5 Cross-contamination 1 590.003(A) Assignment of Responsibility* I 3-302.11(A)0) Rain Animal Fonds Separated from 590.003(B) Demonstration of Knowledge,' I j Cooked and RTE Foods* 2-103.11 I Person in charge- duties I I Contamination from Raw ingredients 3 302L1(A)(2) Raw Am mal Foods Separated from Each EMPLOYEE HEALTH I Othcr° 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 13-302A I(A) Food Protection" applicants* ( 3-302.15 Washing Fruits and Vegetables 590 003(F) Responsibility Or A Forxl Employee Or An ( 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* l Charge` ( Contamination from the Consumer 1590.003({•) Reporting by Person in Charge" I 13-306.141A)(B) ( Returned Food and Reservice of Food* 3 590.003(D) Exclusinns and Rcstrictions' i I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-70i.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources I 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* j 4-501.111 Manual Warewiching-Hot Water 3-201 12 Food in a Hermetically Scaled Container* Temperatures"ner* 4-501.1 12 Mechanical W"arewas hanical hin� Hot Water 3-201,13 Fluid Milk and Milk Products* ( ( n 13-202.13 Shell Eggs* I Samdzation Temncratures* 1 3-202.14 I Fggs and Milk Products.Pasteurizes* ( 1-501.1 I,} Chemical Saniti.atiun-temp.,pH, concentration and hardness. 3-202.76 ]ce Made From Potable Drinking Water" I I 5-101.11 Drinking Water from an Approved System* j 4-60 Ll 7{AI UtenEqusils Food Contact Surfaces and Clean' I 590.006(A) Bottled Drinking Want-* Clean 4-602.11 Cleaning Frequency of Equipment Fexxl- 590.006(B) Water Meets Standards in 310 CMR 220* j Contact Surfaces and Utensils" SheYNish and Fish Froni an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Mulluseatr Fax[Contact Surfaces of Equipment* Shellfish* i I .4-703.11 Methods of Saarization-F[or Water and 3-201.15 Molluscan Shellfish from NSSP listed C'hem:calr Sources* I to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2_301.11 I Clean Condition-Hands and Anus* j � 3-202.18 Shcl(sh2-301.12 Cleaning Procedure*Kk Identification Present" � I 590.OU4(C) Wild Mushrooms* j 12-301.14 ( When to Wash* 3-201.17 Game Animals* 17 t Good Hygienic Practices I g Receiving/Condition I 2-401.11 I Eating,Drinking or Using Tobaccol` 13-202.11 PHFs Received at Proper Temperatures* 2-401.12 I Discharges From the Eyes,Nose and 13-202(5 Packagelntegxity' j Mouth* 3-101.11 Food Safe and Unadulterated* ( 3-301 12 I Preaentutg Contamination When Tasting* 16 Tags/Records;Shellstock I 112 1 I Prevention of Contamination from Hands 3-202.18 Shellstock Identification' i 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" j ( Employees° Tags/Records:Fish Products I 113 I Handwash Facilities 3-402.11 Parasite Destruction' I ( Conveniently Located and Accessible 3-402.12 ( Records.Creation and Retemion* ( 15-203.11 Numbers and Capacities' 590.004(.1) Labeling of Ingredients* 15-204.11 I,ocation and Placement* 7 Conformance with Approved Procedures ( 5-205.11 Accessibility.Operation and Maintenance I IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 ( Reduced oxygen packaging.cnteria'; ( j 6-301.1 t Handwashing Cleanser,Availability 8-103.12 I Conformance with Approved Procedures* ( 6-301.12 Hand Drying Prosision 'Denotes.crinud item in the federal 19ri9 Fond Cede a 105 CkIR 590,000, ,z BOARD OF HEALTH Establishment Name: �5�n, —\ ��nir l� Date: _ ,�- 1d -1 Page: C_) . of 7 Item Code C-Critical Item L DESCRIPTION OF VIOLATION / PLAN OF CORRECTION v Date No. Reference R-Red Item PLEASE PRINT CLEARLY `"I,�,� . Verified U _ 1 Gn = A/.�n_ 17, mein n .n.n �- ✓ � � � - -� J r I /� JI I� (`-t_ •a�'li� ��i'\�-+yTn LA .:�7rY)i �/C� � t✓� _J��\Inn /IP ��ilyn-._nnA.n... , nen_ , l�nv. n_., � e € I ' ✓ AA F'-n/ N/./ n/ I�+yn ✓IPir . (1� 't rh`(_IAAn -h 00 .fFIT11A7J.l1 1) k P ,-t- n`iM 0A AM 61\_111\-a 11,9,lM ( X ". A_n -., : ( \//L�A{ '�g ter✓-1 '9 �_ Nr.. iYn NI_:'��nnJiy\t�_ (In /f�i�l�/ 1.0 o.A\� nnn�A,_ �'.?/.`q�P, 07, anOA ,o I � I�- "'i1�1� Ih_ �I-.� � l.,i,�✓ /O n n n n i IN<, /Y n. Ai - �n D� QOn _M =t-A „t✓ <1,1,an� - /0 n, .�,, , 9� ' JRt OL Q1nA ( ) /110 r�.r �7�( t "i(A�� li/A,(_� �,_ Art .ij �_. d_Q_r n_3. 1 �e. _ A Il0 / J\ 7 ��A� Cwt/Pn <:�l-rni O r� � �J 00o.�s/J+..... ni .Q_ \_0 ��e,r_�� ,Ira_,v� . _ C_. Dnn iii o _0A, _,� 011 o_.,r-� (),I m, i Ij ^ t ctt 1 LF'lrrna, l Aoo I ki C )(`'t/Y�, f _�0u�a?kl n �-fi / 0nl�l�0 /n.. i f 1 A ny-�s_,_ir_ i>,.nl,.+_IA `A ..'f� -- - Lr 4 Discussion With Person in Charge: / �� Corrective Action Required: I ❑ No 1$6es �- � r Voluntary Compliance ` ❑ Employee Restriction /. IC�n t i11I (7� 9,11, 1 mon M u /i AAS � Q 1, n f_, � Exclusion ` r `nU �f nAAA ❑ Re-inspection Scheduled L) Emergency Suspension r nA JlJ ❑ Embargo ❑ Emergency Closure ( r /tJ L) Voluntary Disposal ❑ Other FO!!.W 734B (REV 7/2000H OBBS &WARREN, - BOSTON This FOmI Approved by the Department 0f Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to4I"F/45'F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(6) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Addiives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140'F* Containers* JI 3-501 16(A) Roasts Held at or above 130°E* 7-102.11 Common Name-Working Containers* 201 Time as a Public Health Control 3-501.19 7-201.11 Separation-Storage* 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 Drying Agents,Criteria* - 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(6) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Anima]Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Batt Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* enrecnve 11112111 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401 1413)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering, mobile food,temporary and 3-40L11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.*I 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 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and riskfactors listed above, can be Time* found in the following sections of the Fond Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 _ 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 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. =( ,� Commonwealth of Massachusetts s i City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/03/2012 ESTABLISHMENT NAME: Boston Hotdog Co. File Number:BNF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes .FOOD SERVICE BHP-2012-0253 Jan 1,2012 Dec 31,2012 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES _ December 31,2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r � • •� CITY OF, SALEM, MASSACHUSETTS BC).\RD OF HE3iLTH \ 120 WASH INC PON STR):,F.T,4." Fi O tOR TF,I.. (978) 741-1800 K11SfBFRLEY DRISCOLL FAX (978) 745-0343 MAYOR lramdm�salem.com LARRY RA NIDIN,1(S/RN IS,CI R),CI'-FS Hli,\!;I'll AGIiNI' 201_APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT J �j NAME OF ESTABLISHMENT_ &,f� �� _ o h / TEL# D ADDRESS OF ESTABLISHMENT + a , �(Apsc r(`I ' ' '::W - FAX# MAILING ADDRESS(if different) 6o EMAIL- Business': ll Website: OWNER'S NAME--6+ �Y Sii v1L;U (E p' TEL# ADDRESS 6 ,knllk kA'vt)F-" �J 1�-Pu4,ft. STREET �}�-- - � CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)"-t�-�rtt_eaC-�l �Ytif� CERTIFICATE#(S' (Required in an establishment where potentially hazardous food-iseprepar d F' / � ` EMERGENCY RESPONSE PERSON 1 O SS ( qtr 1��l9(J`�S HOME TEL# 7S' v I DAYS OF OPERATION ��- j Monday 1 "Tuesday Wednesday I - Thursday 1 Friday 1 Saturday 1 Sunday HOURS OF OPERATION Please write in time of day. i (For example 11 am-11 pm) ; � ' l �t �� '' l_ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------------------------------------------------------------------------------------------------------------seat-------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationa:y Food Car,$2101 25-9C a, a =$2R0 more than 99 seats =$420 BED/BREAKFAST/------------- YES NO ------------------------------------------------------------------------------$100 ----- CHILDCARE SERVICES/NURSING HOME---------------- ---------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS - MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Boar:. 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. Signature Date Social Security or Federal Identification Number Updated 523/11 FOODAP2011.adm Check#&Date I Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Boston Hotdog Co. File Number:BHF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0175 Jan 1,2011 Dec 31,2011 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31, 2011 Board of Health 7 ` This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS � - BOARD OF HEALTH »ra 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 NL1YOR DGREENIIAUNIOSALEM.COM DAVID GREENBAUNI,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT? p NAME OF ESTABLISHMENT�� TEL# 7Sz5 L �G(� ADDRESS OF ESTABLISHMENT Df4, A 1, FAX MAILING ADDRESS,if direre:") EMAIL- Business': P Website: OWNER'S NAME \� �1 Website: OWNER'S TEL# Zg� � KD n v ADDRESS {, z04- 11.� /t//�7 ¢4t, (}� —VREE ��CIF STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)`am-bnc CERTIFICATE#(S) (Required in an establishment where potentially-'hazardous food is prep ed) L �j EMERGENCY RESPONSE PERSON \' IIWC L//moi HOME TEL#T DAYS OFOPERAT,IO,N Monday' .'I;= esday ":�':Hednesday;�;l `.,Thursday.>_'!:'' :;Friday, ' ' ; r;SatuMay -=_.IK°' :Suntlay ;� HOURS OF OPERATION I Please write in time of day. I (Forexamplellam-llpm) I •�,- TYPE OF ESTABLISHMENT FEE (check only) kJ -- RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------------------------------------- ----------------------------------------•- ---• ------------------------------------ RESTAURANT YES NO less than 25 seats =-$-,1'4'"O'.... (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSINGHOME________•-•___________________________________________ ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and enalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and ppid all state faze equi ad under the law. Signature Date / Social Security or Federal Identification Number Revised ionli I FOODAP201 Ladm Check#&Date tl- L�.3�// $ t 14Ia3i4 220,L) 0 Citp of *alrm, Alagorbuatw Office of the Citp Counril Citp ?fall COUNCILLORS-AT-LARGE ROBERT K.MCCARTHY WARD COUNCILLORS PRESIDENT 2010 2010 THOMAS H.FUREY CHERYL A.LAPOINTE ROBERT K.MCCARTHY JOAN B.LOVELY CITY CLERK MICHAEL SOSNOWSKI STEVEN A.PINTO JEAN M.PELLETIER ARTHUR C.SARGENT Al! JERRY L.RYAN JOHN H RONAN PAUL C PREVEY JOSEPH A O'KEEFE, SR January 21, 2010 Mr. Strates Frangules Boston Hot Dog Company 60 Washington Street Salem, MA 01970 Dear Mr. Frangules: At a regular meeting of the City Council held in the Council Chamber on Thursday,January 14, 2010,the City Council voted to grant permission to Boston Hot Dog Company located at 60 Washington Street to operate during the hours of 11:00 P.M. to 2:00 A.M. on Thursday, Friday and Saturday with the fallowing conditions: 1.) This will be a six (6) month trial and: 2.) If the company is sold or changes ownership then the extended hours that were granted will become null and void. Before your six month trial period expires you should submit a letter to the City Council asking for these extended hours to become permanent. This action was approved by the Acting Mayor, Robert K. McCarthy, on January 20, 2010. Very truly yours, - — x"!a�e'� JAN 2 12010 CH YL A. LAPOINTE CITY CLERK Cc: Police Chief HOAHL)OF HEALTH Solicitor Building Inspector Board of Health SALEM CITY HALL•93 WASHINGTON STREET• SALEM, MA 01970-3592•WWW.SALEM.COM • '* ',.+s+,^^`_-y; a .,,«^. ,"',w .a.•..�fm.-mtLT.�rNri".�.il"wrc'. . F Ird.a1✓.�.. .,a..i" Y'-°�•"4's, eirse...*"'r.'! g4ksa-•`L�.. lY.. .W '�...•a.� �.e�-.✓ 4 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'" Floor 9 t Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION,REPORT, mel. (978) 741-1800 Fax(978) 745-0343 ( Name Dt TYoe of Ooeration(st, TYQe of Inspection l 7C�0% Food Service ®Routine Address // t Risk ❑ Retail i❑ Re-inspection l �n 400kAq IILYYYfff t r Level El Residential Kitchen Previous Inspection Telephone Q �11 Xll z � ❑ Mobile Date: Owner1 f�J `_II ��f / ❑HACCP YIN ❑ Temporary ElPre-operation ?A koc o(¢o Caterer El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint �� HACCP rnnE V_� /�> In:3 ❑ Inspector � ) �-�-� rt7 k KPAO Out% or- Permit No. ❑Other Each violation checked requires an'explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT,:," � ,_,. ,__;, � ,. ., � ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities i 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 . , .�'�'„ ._ :..: ' TIMFITEMPERATURE CONTROLS(Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source Y ) ,. ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION .. - X,9. Hot and Cold Holding E38. Separation/Segregation/Protection ❑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 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): 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, r by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)590.0 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-s)(sso.00a) cited in this report may result in suspension or revocation of X'25. Equipment and Utensils (FC-4)(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: �1 . S 501, Foy-14 eoo 'V '"JE) Inspector's Signature: Print: I �h 7 PIC's Signature: �1�/„j Print:S�� 4Z 'i 0c, l P 'Z„ Page I of_01[irages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ' Cross-contamination I 1 59O.003(A) Assignment of Responitbility, 3-302.11(A)0) Raw Annual Foals Separated from 590.003(B) Demonstration of Knowledge" Coked and RTE Foods* 1 2-103.11 Person in charge -duties Contamination from Rat,ingredients 3-302,11(A)(2) Raw Aninml Foods Separated from Each EMPLOYEE HEALTH I OthcrT 2 590.003(C) Responsibility of the person in charge to ( Contamination from the Environment require reporting by food employee;and ( 3-302.1 If A) Food Protection° applicants* 1 3-302 15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A F*al Employee Or An 3-304.11 j Foal Contact with Equipment and __---- Applicant To Report To The Person In Uten,ils" Charge* j Contamination from the Consumer 590 003(6) Reporting by Person in Charge* I 3-306.14(A)(A) Returned Food and Resen ice of Food* f 1 3 590.003(D) Exclusions and Rcstrictiom* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions I i Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE F'(x)d* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces - 590.0(Al(A-B) Compliance with Food Law* 4-501.111 Manual Warewashmg- Hot Water 3-201.12 I Food in a Hermetically Sealed Container* I Sanitization Temperatures, I3-201.13 Fluid Milk and MilkPnxlucts* I 4-501.112 Mechanical Warewashing-HotWater I 3-202.13 Shell Eggs* concentration a)titizationTemperatures' 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 hemical Samtiration-temp.,pH, hatch 3-202.16 ice Made From Potablc Drinking Water* and ontacess. 'p 5-101.11 Drinking Water from an Approved System"` 14-601.11(A! Utensils Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* 590.006(B) Water Meet;.Standards in 310 CMR 22.0" I 14602.11 Cleaning Frequency of Equipment Food- 590.006(B) and Utensils l Shellfish and Fish From an Approved Source 14-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces oi'Equipment* Shellfish* ^ 703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* t0 I I Game and AWild nthority Mushrooms Approved by I 2-301.11 Proper,Adequate Handwashing Repulafory AutClean Condition-Hands and Arms* I 1 3-202 IS Shellshn:kIdentification Present* I 12-301.12 Cleaning Procedure" 1590.004(C) I Wild Mushrooms* I 12-301.14 When to Wash` I 3-201.17 Game Animals* I I it I Good Hygienic Practices I 5 Receiving/Condition I 12-401 11 EatntK. Drinking or Using Tobacco* 3-202.11 PHFs Received at Propel Teutperttures* I 12-401.12 Discharges From the Eyes, Nose and 3-202 15 Package Integrity' I Mouth* 3-30i.12 Preventing Contamination When Tastine* 3-101.11 I Food Safe and Unadulterated* 1 6 TagsfRecords:Sheilstock I i 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * I 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" ( Employees* Tags/Records:Fish Products I 113 Handwash Facilities 3-402.11 Parasite Destruction" I Convenientty Located and Accessible 3-402.I2 Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 1 590.004(1) Labeling of Ingredients' I 5-204.11 I Location and Placement* 7 Conformance with Approved Procedures I 15-205.11 Accessibility.Operation and Maintenance I lHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices _ ____11 Handwashing Cleanser,Availability ___ 3-50...12 I Reduced oxygen packaging,criteria* , 6-301. - _ 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision 'Denotes critical item in the Wmil 1099 Pond Code or 105 CNIR 500.000. i CITY OF SALEM !� BOARD OF HEALTH �, Establishment Name: t S�,n F/i '))o Date: labo/o / Page: t;� of I item Code C-Critical item " DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R–Red Item Verified f i PLEASE PRINT CLEARLY Ci 5ll(_I(fA QL�=AAnavr r �, , � , c1 � ti, �c� Ltl�tD Gfv�1'�c( W, 'i 145_)o��ln { o11„lie c �fC�i''� �� un�r .rn fa'� I� o� fC4.Urec�ll_� rfC� �, �,/� �I� Anosa� I� rIM-X04 }f44 �� G� �G/ICo 1/� tJc7�L�Si�tbwA 17�!�� -l_ k�_un,nc J -lijpj Ao3c iA ,4—/vu �4 u1/ "i(o � C/ ,07_/y0 (_)5 C J Af- Ga,l,Cl A)644cg sArei Z)L`7 6-nu- I f+ ,,,it `kf- ay -� 4JQpoLi r)rcr–/J.Z1 IN f V*' jV Ir I I �n r I Ja , -4 , I I I ✓ dzn jnslcc� -i-pJ-4 to,,, . CJ/-Li c, ��_ � /2-0� d 4. baeoKJ k 1l `f�M oac, fe,I rL4c� r. J-- 4ibc,7,m, r-1Qs4---iWyf`4-v I ✓ Cor �r . ?.it �7F7 ri I— IYnS_i.✓V.r A,-.P_1 I Discussion With Person in Charge: Corrective Action Required: -I ❑ No 110—'Ves I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure Y your food permit. C�l ❑ Voluntary Disposal ❑ Other: i � ..;t€t.i4tC:i Pk?F�ct2t;a'itvt'd a='I'wtitx:r;,rturos t c RIPPSE±n r�rs�a*nPians end ArsR i •�: 'a, , Violations Aa aged to andktarne t es., t. ncxar 1111 g to...s C led t s C Factors(items 1--V) (Cent) IFIF44"T Within 4 Hours = j { 3-301.15 Ctxdin'I\lethnd3 for I'HF, PROTECTION FROM CHEMICALS 19 PHF Not and Cold Holding tq Farad or Gator Arst3,t,ves E i 3 Sitt.lbfl?`, t:o1;f Yk€P":YtaiMa,ncu at orhrf:,w 3-2112 1? Aakhtivc: "F :;-30114 Prowcli,m trans I I iappnncd A,id:t,+�r � IS PoEsenatrseri'ox'sc`~uastnncer E x50i 1t4:A) €haP}-1tattuint;;insdnturabovo ! i 140 F ! 101.1E I<t:ntitxsu.c €ntcaFl:;,,:r'n - fAt,nc,t; Ruastr Rod at or;!hove 130, ° 20 T€me as a Puhi+c Hcatth Cunirnl ! 710 11 rinx•a,a t'iabzic: ttealsl2 t'o;,tsv}r 1-2U i.€I S,-pat:tsitm-.Sn:a a}.�" } s-, "7tr 7t?..:I{} tiariance R.eauirensetN 7-2t)2.11 t ci�t:on -1'rrurcC ind i,:e^ } 7-202-12 i"otahtior+.of(Eva' 7 '.03 11 €l,+=c Co;u:a,ur,--u:ob:bt::t , - i REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 1;trsi,ir;r,.Ctttern-(trf-'Oa:is' i POPULATIONS(HSP} 2t ":.�,t!.l i!f•.t ! t:np:�';•Curse'd Pre pad:a€tcd Jomca aur€ I 7.1U4,id Che},titals fou %a:,Ni i�nti:rcc,{:ire,:.s' � � I 7-.1.04.14 Di ian Aventl grit:r,:t' . _. ! R•';rt,s.e<with 1i'arinflL 1.a1'z10 ; 72{45'19 ln'id"rnv'€ F•uxti't,n;a,t.i:tl2�scantm' ; 8s;1.1164; L;,('I pwtewwdk: '.-.�.i)I,f It!)} 'et.rW Or FtRKI nn'. 7-�06,i t ke:.tn•_,,:a l'ar Ye,ti.:,tf•', 1'nrerta" liar:Sr:d �ipmut,Nvt Set veu. ' ?.}.Ui.k IrCs 1'1„nened Ftxxi Pack au.e No k•' scr:c,l C'.a,trol vvi j I- CONSUMER ADVISORY ZF 1 ;s.,0;; 11 C:ensumor Nil.,ivory P:,,,A 1;,r t'rntrninU:i„n o? ! TlktEtTEMPERATURE CONTROLS vrtn,,,l t•xxf' that are: Kau". Undelt'kxli c C-1! 16 Prop"CoaAtng Tom,,^.arntures Pnr } PHFa } 1lVt Otlis'n,ise Il rtxesset,.e l ?irun:ua.' { .i •901 €t.it t,(: i-f;b. 155'F' s 3 f 1'a;,atcsurr,rd F.gp' St,hS?itvir tl}r ELav: F.£:Yl' {a2,Bt li:2tL S:`[:•i'C 1-4;Y r'1.1>Ct' � f 3-401.!1(:)Q., Com'I'.."w"ttLGja,r , Fg2" ! t - SPECIAL REQUIREMENTS 401.1 l(H)(I tial ( t} .,n; ii,ti4 K'+.tSf i::P:4_.1'�r,1iTv r ,,, t 221'._1 ^ _. S,),fN,11:.1-,1)! { Viu.atinn )2 Sechcm 5r1€).(W(A)_(D) ;n , . ; lit., 173H:,", b,icJCti 91eai, is^ F' €,`: : fcatering. rilobilc ttr;d tt'+ripura and 3-401.11fA)s-i', t2nt:ih.,,11€ld t,:,n,e, ?,h;it• 'i III 11;". ri:a2d:'8ira1 i:itt;lit'n uperaflon� €ould 17;; S:,,il'mc Conlan-Ing i ty,,;tits;;, dctnt,xi under Phr apprunrMtt:ttCOWn< i i':,uitr. l,r)sartty.-it5 s••c ; aKwe if r.:l.t€ed us fixylborTIV i1bo's= 3.404.{i((701 vt:r€c'-a2u,i'k;, Lv's4t 1S'":f c,,a'sr. I inict'ven;ions and t'ist: factt,rz, I.tj'i• .: i 5f!()1}(211 vidatum•t're"ilt m to t*ood Pt;ta11 1 3-4r)€,12 Raw Aninra3 i'„a?"t'.arl:i'tr•a E praciiu s should iv det,itod u,sder 11«11 - s 111.ru,L av' if:9'r f Spi:t:iRI Requireitiutltt } 1,401A I(A}(i)thf :fit tht:rt pill-,-- 1-.5..a' 1 r ce•' It E 17 Reheating tot Hot Holding VIOLATIONS RF_LATEP TO GOOD RETAIL PRACTICES 3401.1 I(At d)+ ;'l l} 10T- 1) .C•. =. —... - __ �_1 (Itelds 21_34) i--.Ila)irli) ~111,1,«.,:..:- tb`• F: t<.€:nu,e tt.antliaE. � C;'ttir«'•md n,.n-, +'ttn tet ri,r!nft•,na, x'irn.h donm rtFq.'r•:n ri;,� 'llsue s (irur(hurnr:(tnss nrr•r:•cniiora,r,uuJ ri:kJau,>re i,uad af.ove wn b, {:0001,c*CIA11v rtx:;,,'e3 :Yii:t•laui 1)k 5<,p.CrxJ. ..._.._.. rtem Good Retail "i-i{1� l 1112+ �esn:tssfnt�,','nsls:•r:f Po^ir'•ts,>f Slec; I i oPractices ! 3r•Aanage1.W mcnt and Pernnel FC - 2 ! txU^ If; proper Cool€rig of PHP& j 24 pond and Favi Proitrtw_n FG 3 .004 a 2,;i, Equ;pn,ent and Utensi!a FC-4 ; '.-56P.14t Aj C7tir1x`F•lin'>Ve.iCsh'.t+n>l.:caltt,+w2H:l:'t_t,r:m€Pr,r,lnui t'1;.i1"t1t'> -._ii;-_-"_- i 065 Vatc, {umtlnq:UsdtJu;te FC- 0F _ _ � hyS _ —-- _..- 27 F ,C<`Fdr:lt,� F{; _ i �_g ) III-4i"F/dJF Within 11 Finw*.s ' �_28_1Poaona;ss or Twc•, tJate_r,_ds � FC -7Ti itG� 3-sUi.iti:k.Y nLF' Mack,:r•,ns.�inhsur � _79......_.,._Sna._cssas R�:gu:tesnes2ts , 4fs5 I'.mpaanttc30. Other s ` _ . ivtthrn.t{i.+i:,° ' .•,�u.:a. aII,at::<m c,!t, 141:0101•+1'nn,t,",u1-•., :ni 4 S92t 9'1(t n'r„ r I r t ti CITY OF SALEM �] BOARD OF HEALTH Establishment Name: Date: I� I..v °/().%A Page: 7 of - 1 Item Code C-Critical Item _ DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date �'� No. Reference R-Red Item . I „1- ' t Pt,eeVerified _sF varNr c�ena�� _ - � r` �� IOr7i�7 Ir� I�l<7��r kll' .. eWa"rAI IUIJ.k /_: k" � l .t�_ p , �i• 1✓l Sl%r��ntl� n !` r?5g - l 'V� l 1 q.)h+rl, . , � Ar_ ("K49s, w00e n/� ��C�/A7✓tr [, ! �11.2�,�! /IJ fr� ' I � ''i 3-7�i, �lt-.h � N/•��I 1 � G v��nr_it r� � . � �.'7'r Olr �, � moi'. n f'" I\�lLyrt—r� ��/.Jn k q_, A N -It t if c , 7/.. . a J r/� �>� O11s f r� L�n l f,(r�(� A .-, -17n <.I• ,{.,.,,� (�r..,v/_S _T.•_� �/ II'�5 c`); 1 .�v1/!� J `. . j�'Y�J n[= V 1�n Oi�tJ -, G�� J 1 ,svj , 7n vr�l /'r,r, �r1 T,>Z 7)-� 4 4 f4 JV�r�L ��sr -lam A.nC.0 (IAq_SY'- Al rlr TI_JJ t _l.!/'l.rf" '4;'7 YA1!/ 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 O Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that r noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ' ❑ Embargo ❑ Emergency Closure i your food permit. ('7�� CC"S__Q�C� x ❑ Voluntary Disposal ❑ Other: t - t Violxiona Ratawd to FoorAnortiv fftnesv Wit Accolditig is LaN, ClxkA;o Factors(items 1,22.) (CoA) s 4IT-/4Y'F Widvin,l Hlqq,, PROTECTION FROM CHEMICALS cliolikl,-t for phr-Z tQ Food or Color AddW,va6119 j PHF Hot and Cold Holding 3-202 12 Additn�,, 3 N01 I(,''it) Cont PHFX lviamuned alw be-l't"i, 3-3(1114 pmtxilon I iQ i,1(11 A) I lot PHFx Mainmined at f)r abow is Poisonous or To,,,,Ic Sub,4onc.r 7-101.11 ulfinlw,l!"n- ;', "*' (,iA) %,ms ficid at or above 130'F 102,11 CuminoTi�,ante. - Work,j,�i Time as Public Health Control T 1-2f;L 11 1 1 -1 .�w I 'I tq,,c ax a Public Health Control, 7-202,12 Conklmom 4 RZOUTREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS{HSP) 7-204,11 !J, 3-80IJ IiA) 11iipoileurwd Pm roc! f fieniic-k f ai4cd Juice::and Rlvlves with Warlmi,- 7-204.14 t DrNin, ekt:ewc,Criwti�" hlcl&wal I'lzyj Raw or Rininh,, Cookcd vmiml and Raw Syed�vrouj,;Not icirvol. 7-106.1 Plukw Ioa, ,.,s !,(:f 206.13 wi C'ONSUMER ADVISORY `' -a'_- ' `'' (ou,umili Ail,,t,,ovv P,,m,�d lor TIMEITEMPERATURE CONTROLS Aimiwl 1-cuk 11m.ire k,lw Unjer,,x,iivd os Proper CoohiiA Telnpctilltvres for it otlwm isc flrmosf�,A u)EHIAMWO PHF,'c for Rilw sh,'ll F." -ox I 1Y F i il t. g� "Cf I 0IJ I(H)t 1 SPECIAL REOUIREMENT S 4 Poll, ,,,,d R,,T,�sk 11"O't' !2 1 rain'- 5a0(0)(A)- D of t i D) in kxid. winporary and f 146 1.11(A i:k.s P,�Qikrl, 1k jJ4 i,if I t f- I u i,. (Cmllcnl�;d Ofchin sIiokJd hC sl-1, debited undo"the appr(�,pnwe se,-itoas llol,!I;t or Kaw , 16:; F 0.w, Aiwa if rcIwrd to lkxxdbornc illncN,: 3-40!.l I(Ci,3i Wfl.�-, niil,-3r It-,I micyve.mim:and ri,k liiciors Otlic-, '90.W9 ViOlilliOnq 17011611111 14-'*, 3-401,12 in A r1;1('IjCCs'hould 1:,c&bitLs.! U,)&r#29 - 3-4(JA IiA)t'fb) 11, Oin"Ptlk- 0 ic,. 17 Reheating for hot Politiq j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.1),A'1,lPt [,it, : jt,:.r'F II (heals 23-3(S) 3.403AI(B) T' 7 Cna,zd and nfM-,r.'P,W llwhifum„ whie:hdo ow p,me nilk RTI Frliuj 3-403,i 1 fF) Rcm;jnkm,, L-iwiwed Pi,r unns ill*11;el I FC r23 FC 2--!� C vlariageritc-ot and Pet�onnrfl 18 2-4------- --Ffv,)d:)nd Food Prckctilirf FC -3 W4 Proper Cooling of"-Fs, -25, Eq. nLanqy!ensits-- FC,-4 00�1 3 5til.14!Ai C(N.Iul'Goki"[PlWf flool u, qf� --- ------ Water,Plombinq and Waste Fr 00,t, 7WF 7 lfomr:i aod rrorn 70`I' FC 307 4 Howz, 2b potSonl)Us ef.ais FC ;YJB 3 -30).i'li B) Made l.,-,l�q Ambiew spilcial Rr:owtr remen 009 7 '1;:,18:9= ........ Within 4 11�41r, CITY OF SALEM BOARD OF HEALTH I / Establishment Name: Date: 1 r� /�6 �r7�1 Page: of !� Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- l No. Reference R-Red Item - I Verified " PLEASE PRINT CLEARLY (bz r �� r, u � �� Clea h��l�� ,�.t�✓�� G-,� o (tiv hh�,i�� , I � i h 0 -�O 6 47 1 I Ihls�oG{�r5 � �iu,�r� cre__l� _ ,! .u,�„y✓1,, s,upp- :_il- 1/ bel=3 Or J, 1"ed I Jl l r14-4-71-e c�c� n/R��I� s V,t 1 ,. (7 r r 1 i on, �-,�s G� (5.� d ri n div -I�,� k- ✓�.�J> ��J -�.vr ✓ Az v I " - - SAn , ��,t t�� ,,,f- 7AA.. r�wro .1,P f, 1 �� 1r--1a< «,.'� - - Y , , e/F—( u I r.� elr,, 1.",p MS.,V nloti-4 p.�.� .�. ro ��-�i.-o m AM,7� 1 �# � hh � _ 1 i 11 U-�Pl)i✓rc. .1 ♦�tiP �,t. 11 M.'"P n - �✓��'�K D;A r�2 — 7 tic�cP Ott'" a4( Q7;1 n� J✓1 Y--1,i1.� I(L�i �ICr;1v15,A 17 (Lt-`,4i(ie�� , N ss,>~ aJ5( }� lP� 1x24 $ ,a�- (l�� ^� ►�(��,� �h�l�c //c h--hocX klogzerchgofi ~,4clac�,9t,4< f Discussion With Person in Charge:' l/ Corrective Action Required: I ❑ No ,. have read this report, have had the opportunity to ask questions and agree to correct all ❑ Volun ary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to Exclusion P >1 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. �) C1=} C7 hAe ❑ Voluntary Disposal 0 Other: y. ;:J(( piivs Rec;6wd lit fdupevlojw¢ Violations Related to Fordbomr,(I intmontlons and R.'sp f Atxwdiaa 10 Lzv, 'Cor)t',d W Factors(hp-ans! (Court) 41'1145`'F WOWn 1 tuul"' PROTEC'1& j-501.1', ("IXIIII)Ir Wtltorj�for PHF< ON FROM. CHEMICALS 14 Fuad u,Cater Aldnives PHF Hat and Card Holding 1"'iR) Cold PHFm"imakilk.-I at'a tI'At'w 4 k',4�" I,- 3-X11 14 ai Jr-wa 1 5(11.1 '') Hol f" HF: crabove Poisonous orr Toxic Suernanoest; Z_rtj Lklmqs Hdd aq III IIb,ve I 2G I Time as a PuMic Hcallh Conuroi 7-102 If Corrunon'Nmy,e-- W"rk'me I,t'vtmn"W II inir ,a.,a hjbltt 110,1110) 7,2(y 1.11 Svre'law"It- 7-202,11 K"�trict;oll -Pwu'rcc and C"C" 7-102A2 I CoAdloon,of U;k�- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7_10,11 11 T,,x;c CGnosir� t> POPULATIONS(HISP) a.te t. 1:z04 11 S.n1ro'Ci:,('flIC111 I I(A) I '()4.!I Ch,:%oii,ait tut W1v,hik.e h oo,Irc.Ct iwz;s 7-20 14 Dnme At,tmts,1'rq,�r ia" Wanling)zb�A:;' 11,B, I Ute at pa'wmiz'A Dtt"I,' Inciec:-ut'd F'NA Uorrf'rl I.tonmuas' Rw.,, "r?;d1jally Cmik,:d Amm'o F'K�j '11A r7T7) Raw Sc,d:+pro uia Not acivcd. 7 21116.12 RIkI,.`i„ 13 SUIIIIO't" 3,8v' 1 1(0 I Unopricd Tror4i Palta;_,c Not Rot- ^06 13 lr.WKim5 901,%&1, 3'-5[L_'0o!TvI UIJ CONSUMER ADVISORY 22 3 ,O,, !t 1�)r TIME7EMPERATURE CONTROLS Proper Cooking Tersop,atufos ter Pnwesq,�d to Fltnsiu,vc P H Fs. 'I,",'..,:'.TGC 3 401 11 A(!I(,*, 15 S,,, Sri.1'.v -"f" SPECIAL REQUIREMENTS ir A;'u h_"n k,),IFI - i SFr 1' 7-" MITI, -40 F I I tK)r Roto.'< bowor'4 Nlceoz'� 1c` F 15 W)00'11A'-ti)� violdlvv�el section �)90'00)tA! (D'; In cuu,,rw-, mobitIr, toI%!,o,ntpor:uy and icmd,.,11d.al Htchctl op�tjaflnnz,,%4(,,,Ii1d t¢'4o I 211.'`.}:3,, Po:ijlr', i1a Swllcd ol IF", Moor d,!Imwd to'Act,the appri,11muc. F• :5 11""' if relai'A to IiIIAh(rIw Iilncl� ijIT'I':r BQJ'Swak' ulike velmol,�and 6"1' radom Citi,ff 90.000 viotraolloq to 'ooil rlwl NI&bitoi untkr 1,9 - sp'!cial Roqtnrenh:(Wa' -1-401 i)(Arrh4b) 1110:hIm 17 RcherI for Hot holding VIOLATIONS R_1A TED TO GOOD RETAIL PRACTICES 3-103.11(A, 0 1 i'llk to5'F 1j cc': i (Hews 23-30) (B) Miol'IInc lt'` r- 2 Momil'.Swn'img i anoi rio,al nolovoim, uhich do wn sdap'1'c 111.' Tint,'' 'oodh S �vr""0o" I qlw,V:wimo and ri,%A-fiutora b;' 3-41)3 1;r', ('Imzow'Ialiv l- Foi fuund in of dw Food Cook and)0 'Un'iwed P-�:pb"n,t(it 11.�Cl FC 5,R0.000 poast"' 23, - Per,onne- --------i FC proper Cooling of PHFs �ird Fenn Prolcrtw FL 3 CK'4 I FC- wr7 15, EwiproxIt and Utensils ('o"jing Cmk�A'P11I.-r iron; 141'i if, z I. Water.Flurnismand Wt" 2C ,to FG Whron 2 llous?�:n I Engn�Iof_' I 27, PrIg,,,�;pj Fat;011'j f^-C= 007 to J!'1145'V' _n!iin A jjoko:, � I r _T_T_� 7 1 o03 1 �13 Pox,-ulnas or Tex.,r:M:itenala Ril'wtitl Cooiin;,T'HF, *vtiA� 1,mal Aiobl�jt V"4_':r Tuition iRxrr:' II)St IMPOR ANT MESSAGE 5 FOR ,, '//�^��'�� DATE �lA/ /��,�TIME . J.� M Nnn f if,vr.ri/S OF ' PHONE AREA CODE NUMBER EXTENSION O FAX O MOEIII G AREA CODE NUMBER TIME TO CALL TELEPHONED ��) PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU (I RUSH I RETURNED YOUR CALL I�WILL FAX TOO YOU MESSAGE !ILJ O� r� )G 12a11-3 1D�S nn G ' wl.,,l.lQ_ �r�'�nr�✓ � d , ( ��Blw, �,�✓ InO. ids aper, -4)y&,C2,� SIGNED NEEDD '� / Y 0_ps FORM 4009 ' ■■��/// MAGE IN U.S.A. vS, P �a _�J Commonwealth of Massachusetts City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Boston Hotdog Co. File Number:BHF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0232 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2008 Board of Health V �� 3 •J\ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 25 QTY OF SALEM, MASSACHUSEM BOARD OF HEALTH t 120 WASHINGTON STREET,4" FLOOR TSL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR TsCom&sALEM.COM JOANNE SOOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT -7 NAME OF ESTABLISHMENTnpp `(�� Nom( ,TEL#_ /� �/ �y r 13 ADDRESS OF ESTABLISHMENT 77 hO W \il� )l� J 1 FAX# �� / MAILING ADDRESS(if different) \J EMAIL-Business': e 1 Website: OWNER'S NAME C ) 1 � \ Qwwk S TEL# [ �ADDRESSI kIOA I^Al& STREET CITY ! STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �t JI��ERTIFICATE#(S) w 7 O�� (Required in an establishment where potentially}hazardous foo is prepareedd) /vim. EMERGENCY RESPONSE PERSON \ �P 2 O U S 1�Jlc� HOME TEL# 7�l DAYS OF OPERATION Monday Tuesday Wednesday slay Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (For example I lam-11pm) - TYPE OF ESTABLISHMENT FEE (check onlv), RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 ------ - �-----------. ------------------------------------------------- -- ------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES --------------------------------------- .. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. 03( 3S Signature Date I S ial Security or Federal Identification Number ------ ------------------ -- ------- - - --- - — -- ------------------- Revised 4/24/07 FOODAP2008.adm Cheel &Datc �"t V r Qa Massachusetts Department of Public Health. Salem Board of Health Division of Food and Drugs 120 Washington Street,4"' Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name /'� II ' / Date Type of Operationtsl, Tyge of Insoection if ®'Food Service ❑ Routine Address � J. Risk El Retail ® Re-inspection (1-1) 1A//!/Ylr Ac /�Av� Level ElResidential Kitchen Previous Inspection Telephone -4 d _ 'a,Z; El Mobile Date: H 1-1 Temporary El Pre-operation Owner j CT G '� ))G�V'A HACCP YM ❑ Caterer ❑ Suspect Illness Person in Lharge(PIC) L ` t Time ❑ Bed&Breakfast ❑❑ General HACCP Complaint Insinspector In-� �� Permit No. El Other p /7�{2nL1 \ r 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 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH • PROTECTION FROM CHEMICALS 71^2. 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 Potential) Hazardous Foods ' E] 4. Food and Water from Approved Source ( y ) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM 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): 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) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0so.004) cited in this report may result in suspension or revocation of 1 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 5sbi tFom 14m. n Inspector's Signator PIC'sSignature; l _ - I I - _ Print: r l^�� I I �� ! ��. Page_(of��- •Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination . I I I 1590.003(A) Assignment of Responsibility* I 3-302.1 I(A)(1) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge--duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Aninutl Foods Separated from Each EMPLOYEE HEALTH I I Other" 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by foal employees and 13-302.1 I(A) Food Protection- applicants` ( 3-302.15 Washing Fruits and Vegetables 590.003(17) Responsibility Of A Foot Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* J Charge* I Contamination from the Consumer 590.003(0) Reporting by Person in Charge* ( 3-306.14(A)(B) ( Returned Food and Reservice of Food* 3 590.(H)3(D) Exclusions and Restrictions* I ( i Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food _ 3-701.11 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 141 I Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law* 4-501111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.1 t2 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures* 1 o * 4-501.114 Chemical Sanitization-temp.,pH,3- 02.14 I Eggs and Milk Products.Pasteurized* I concentration and hardness. * 3-202.16 ( Ice Made From Potable Drinking Water' I _ � 5-101.11 Drinking Water from an Approved System" I 4-601.1 l(A) Equipment Foal Contac[Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* 4-602.11 I Cleaning Frequency of Equipment Food- ( 590.006(B) Water Meets Standards in CMR 22Utensils** Food- Shellfish and Fish From an Approved oved Sourccee Contact Surfaces and Utensils* I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( I Food Contact Surfaces of Equipment* Shellfish* 14-703.11 I Methods of Sanitimtion-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemical* Sources* Game and Wild Mushrooms Approved by 110 ( Proper,Adequate Handwashing I pp 30111 Clean Condition-Hands and Arms* Regulatory Authority _ I 3-202.18 Shellsto:k Identification Present* 12-301.12 Cleaning Procedure* 1590.004(C) Wild Mushrooms* 2-301 14 When to Wash* 3-201.17 Game Animals* I 111 Good Hygienic Practices ( g Receiving/Condition ( 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* I 1 3-101.1111 Food Safe and Unadulterated F 2-401.12 Discharges From the Eyes, Nose and 3-202. I Package Integrity* ( 3-301.12 Preventing Contamination When Tasting"' I * I 6 ( Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* ( Employees* TagstRecords:Fish Products ( 113 Handwash Facilities i 3402.11 Parasite Destruction* I I Conveniently Located and Accessible- 3-402.12 ccessible3-402.12 ( Records,Creation and Retention* I ( 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 590.004(J) I Labeling of Ingredients' 1 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance lHACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging.criteria* 16-301.11 Handwashing Clean ser,Availability I 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denotes critical nein in the federal 1999 Fond Cale OT 105 C.MR 590.000. i t CITY OF SALEM BOARD OF HEALTH Establishment Name: t _D 1N f I o'T �L� c. .Date: /� �f �n � --- Page: � of ' ^� r Item Code C-Critical Item r bESCRIPTION OF VIOLATION/PLAN OF CORRECTION,. Date - - No. Reference R-Red ItemI Verified NT CLEARLY f PLEASE PR r ),/, T4 PA.)511- -f 7 f I � j . - j I I I � 1 { Dis sisuc on With Person in Charge: Corre ive Action Required: ❑ No �f❑�`!e's r t I Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all t . 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 Fold Code. I understand that noncompliance may result in daily fine of twenty- ive d liar r s\�sp`ven ion/re_voDcation of ❑ Embargo LJ Emergency Closure your food permit. ,— � �1 .❑ Voluntary Disposal ❑ Other: L' Variations Related to Foodborne Illness Interverillona and Wall, to iatI. Gvied to Factors(Iferms 1-22) {Cont.} j $1 F/-F Within I HoutI,, Ct x,!:0 Ix Ili fl PROTECTION FROM CHEMICALS 1 PHF Not and Cold Holding 14 Food or Color Additives lVBI Cold ppj-�NUinuimco ati-w hcb)w -262,12 3-;242.14 Prtxrcb()n troll, Mdiij;�e0 1 3-,0 1.W A) iiiI im FRI,,t%honfaived it,Ir ab,,k-,i% I5 Poisonous or Toxic Substances iF 101.11 I&,ntitykils In"blillaIlon orizinal 3A01.1f"I""i Rwio H004or,tbv,e I3(FP,* Colllaiuers' Time as a Public Health Control Common NNaruc-Wxlting,Coutlunitr,.' svpw awn- Sunag.-." 1!i Tirm.,,,a llc;uth ct)ravol 1-201 Re:tricrou- Prt',�ncc zurd U\e" 5,11,1,04flit Var;Iuwe koclurclll,�u( 7'-20 2. Coadillon".'It Us,,' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Criteriv POPULATIONS(HSP) ;-"t,1,1 ti"', Z,id wid fii,l`rceee Will, Warailn"IAI,:l� 7 21A 14 DruwAvws.Cnw:ia' 2(1�,11 ln,:idt!ul�d F-fIxi• Contact, ub6cams" 1-20-6.11- (xltvIls, 0,')11:II Allifflal FiKlj 011d 7-20li.12ltt�t-, St,d Sclvcd. - Rixlitil ft:m Siatww,' I fiticking ora CONSOMEP ADVISORY 22 3 1; Coilsnsn,t 'aw,nnildiat of TIMEITEMPERATURE CONTROLS An ikkin I I I;-Jc Thai .in-R,lw, urckrox,],ed till 16 Proper Cooking Tempil,atures for I "ot PHFa 101 1 15 5", _.--iii'.!? 1?-�d I: c:;tubsolul,: f,�, �Liw Stiell YTJ 5se l-ii,h. Mc;v,;&(cain, Aidm 's 1-15"T' 0 wc. ' 3-401.1 HB)t IV21 VIlki, aitnd 13),W RoiIst 130"F221 n�411 SPECIAL REQUIREMENTS wwri,iE,. iriohiik, loo6, tctitporai-y wid Prialir,,,Nkild(;ante. SlulTed IIITFa, re>,dmti,A I:i!k,hcm olwnitimi:; %hould he S w ) altiming.,Fish, Meat 6chll-:d udder thc ;W1011i poilltrk "I.kiiwct:105"F t5 aec, .1la"ve it' it,fiNd"orlic illness 3-401.1 l(C)(3l WhOe tntao [1--f Si,!ak� imci-lcw:oit;ai,d risk focwr-:. Odwr 145-12' 590.0 j,} vwlatiun,,remal- v)gokd retail 3--201.12 Raw twitnal Foli.Cwtked in a prmlic,!I, xIionld 1%c debited urlt'tk•r #'9 - %Ilctowaw 165 1- , 1 3-401,11(Aillltbi All Otho PIIF�- 149'T 15 5ec I 17 Reheating for Not Holding I VIOLATIONS FiELATED TO 000D RIF rAlf, PRACTICES 3-t!)3.1 1(AI&ID) Pf[1;, 165'F I I uiuia 23,301 3-403,11(B) \11croIlaN e- 1('+'F 2 Nitow'.stjndm�,, GWrfd .zmr It",)-,rim:a, which dt,;uc claw III the I rare frodb,"14 I,,t folfo,s lial',Iarww "m be 3-403.11 Wi I comirwrClailv prmcsa,,d KTF Irood III:hl:1rt4!,)ui,kv se,'t;OnT In Ihe Food Codeand Ilii :AIR 3-40111(E) Remajilin'I ull,jwed 11olditm of 11CO i Plan? ,ocdRv10 Practices FC 590,000 2,4 Proper Cooling of PHFS I L24 Food,)Pti Fow--FlAlt,,t;��n 'b 'FC-I, 'ttc," 3-501,14(A) C(xIlinii Oxked rHF, Mau 1�4)'Fw sstf i FC -5 _,—4-- - 70,F� wabln 2 11,Iur,;i4rd FTolll 7,0 Z7 PtIVS(cal�aLIW FC S 007 to 41 J745'F W,thm-1 fi,,iwt ° mc -7 nt 3 501.14(02) Crxttiut3 111-IFIt Made Float Anibi rnt -7— Tvnipc[aWre !„.i!”FilS F Within 4 ll,Iur� III C.:j"It"w, 11"I'l liod("We or 10'IN)" L ,l t,swy. h- b' t`Tvtl.ifm,n Lh+fb-r a.�'bw ... ,. +.mqa ,r:.+... _.ykL?tt,'.r#y.+'FFrt%'(•.,��f,.h. ; M .�Y. � a.Y~ a i.. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of,Foord and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Tvpe of Ooeration(s), Type of Insnection !'S>S�y i�� I ( )4 /// - I fai Food Service ❑ Routine Address Cn n /fir y'L) /J l_ _O 1 Riskt E] Retail �J Re-inspection tv vl --3I)1r1 r7 Level ❑ Residential Kitchen Previous Inspection Telephone f ' -' ��J ❑ Mobile Date: lllldlV� Owner II / 7 f HACCP YM ❑ Temporary El Pre-operation ,nA ! �lon,J r HN2 7Lw/K �i_ I El Caterer ElSuspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast El Complaint / In: / ❑ HACCP Inspector �� h�� OE s 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 ' _._... ' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH " " [:] 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded - El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ' " _.,_- " El 4. Food and Water from Approved Source TIMErrEMPERATURE 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 I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) " ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions I immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-s)(sso.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007)' have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5001no fFor 14d Signature: Inspector's Si InsP g I Print: \ _A-��immm ( � PIC's Signature: ^I-(� �n I Print P ` (� 1 (/t Page ofoages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) r PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ( Cross-contamination I 1 590.003(A) Assignment of Responsibility" i 3-302.11(A)(1) Raw Animal Foods Separated from 590.003($) Demonstration of Knowledgex ( Coked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other* 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by feed employees and 3-302.11(A) Foci Protection" I applic,mts* ( 3-302.15 Washing Fruits and Vegetables f 590.003(F) Responsibility Of A Fail Employee Or An ( 3-304.11 Food Contact with Equipment and Applicant To Report-ro The Person In Utensils* Charge* I I Contamination from the Consumer 590 003(6) Reporting by Person in Charge* I ( 3-306.14(A)(6) ( Returned Food and Resendce of Food* 13 590.003(D) Exclusions and Restrictions` I I I 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 Ftp* ( 4 I Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Caw* I 4-501.11 I Manual Warewashine-Hut Water 3-201.12 Food in a Henneticail i Sealed Contvner� I Sanitization Tentperaturea" 1 3-201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashing-Hot Water I 3-202.13 I Shell Eggs* I Sanitization Temperatures* 3'_'02 14 Eggs and Milk Products,Pasteurized" 4-501.114 I Chemical Sanifi.ation-temp., pH, 1ardn 3-202.16 I Ice Made From Potable Drinking Water" I concentration and Contact S 5-i 01.11 I Drinking Water f,our an Approved System' ( i 4-601.1 ((A) Equipment Yard Comtact Surfaces and ( 590.006(A) I Bottled Drinking Water* ( Utensils Clean" 590.0'6(6) Water Meets Standards in 310 CMR 22.01 4-602.1 t Cleaning Frequency of Equipment Food- , I Shellirsh and Fish From an Approved Source I Contact Surfaces and Utensils* J 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ,Shellfish* Food Contact Surfaces of Equipment* 1-703.1 I Methods of Sauinzation-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources"' Game and Wild r•.-ns Approved by 10 .I Proper.Adequate Handwashing Regulatory Authority ( Clean Condition-Hands end Arms" ry L-3t(1,I! 3-202.18 I Shellstock Identification Present* I 12-301.i 2 Cleaning Prtvedure* 590.00.4(C) I Wild Mushrooms- ( 12-301.1.1 When to Wash* � 3-201.17 ( Game Animals* I 111 I Good Hygienic Practices ISI I Receiving/Condition I 12--101.11 Eating,Drinking or Using Tobacco* 3-202.1 t I PHFs Received at Proper Temperatures* I I 2-401.12 Discharges From the Eyes, Nose and 3-202 15 Package Integrity" Mouth` 3-101.11 I Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellsnxk Identification * ( 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I andw aash I Tags/Records:Fish Products I 113 HandwesFacilities 3--402.11 Parasite Destruction" Conveniently Located and Accessible 1 3-402.12 ( Records.Creation and Retention* I I 203.11 I Nmnbers and Capacities* 590.004(1) Labeling of Ingredlente I 5-204.11 I Location and Placement* 7 Conformance with Approved Procedures I 15_05.11 I Accessibility,Operation and Nlaintenance IHACCP Plans I Supplied with Soap and Nand Drying Devices 3-502.11 Specialized Processing;Methods* 6,-301.11 Handwashin :Cleanser,Availability 13-502.12 Reduced oxygen packagin„criteria* j ---_ 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denote:critical nem in the federal 1999 Foal Code of 105 CMR 590 000. 1 CITY OF SALEM BOARD OF HEALTH r Establishment Name: Date: l(l/ 1/ 3 Page: of ?71- item Code- c-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ( No. Reference R-Red Item Verified PLEAS' PRII�NT CLEARLY 1' S"/t ✓( \f �''L?�1/ � �r W1vl /✓1 S17C��'(J�t"I CJ�nl(/ ,V //o °� ��G11,✓ oc� I�rcr�c. I� t r �. —<-Air/ d 4,) IIG q-V1, z;>»r- *2v" �,'� r7�1J4,-AAI n- (�" 1,�"tip � � ,��_\3�;- �1 fair' , r,��/� ��i��G P Ir12v"A49IP/ - Jixt/� — tr )-✓I/ /r �, ,44?'nL,, C7\SS�t��4cl l �� IG , d4 i I C�� ) � Shr (�--.a b�✓c 1,.I�,.� G �- /ter � ;--, �-I: v,2e-rte�,.� �nan�-,I.,,. f�jA-) c-,)I i t c �,��! f ��I� d - i 1 I Discussion With Person in Charge: Corrective Action Required: ❑ No es I hayp. read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LaEmployee Restriction / Exclusion i violations before the next inspection, to observe all conditions as described, and to , � Re llnspection Scheduled ❑ Emergency Suspension comph�with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of-twe ty-five ollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal 0 Other: T ;_5i,€ flit- j PHIcR,°(.:iseEk.it'I oi!xt+nures, { Viniattone TatrF.rted to Foodborne tldness Interventions and Atsdt i .liccl=!dirty it f_m f,,x>€ of ill\ (f Factors(items 1-22) (Cont) 141''/4<:'£• Vr ni;in a Ft„ua;. PROTECTION FROM CHEMICALS I (:, €,0 flet:.t,tx tIF, I r ` ' Food or Color Additives j f`} i Pill:Hot and Cold Floiding j 's 14 I j ; cr}i jf,tl;l C0ii 13ifFs hlamtained at or t+ I"W 1 3-302 t4 Pt'onctionfromUn I1x,!:'ed Addit,.e,' 3-S')i.Itrl.\; Hot i)3-il'i: Main,ainedx:tic ab,,ve f Poisonous or Toxic Substances I t lt;i if i,tettt:fvanintir.u,attrrn-- tlaay;nat „ 1 16£.11 Rw,,':.Heid at,rt.,t,uv 13001k, j CEanainer::" C_cynntun N.,tme- Vt',)rl;nc i''m)uutaT•,+ ! 2ft Time as n Pnhht.Hearth Conti of f ,-�(}1.11 S.j'Utata(in--SStltal:.:� 1 • k^ktsiclion -Prt'u:nce wild Cke” 5«lLtatN'r}}} j t';:ria; r Reywiri:nteuf ( 7-202.1Tc i'et:oftier' (t1 Toxic REWREMENTS FOR HIGHLY SUSCEPTIBLE j '3-503. f;untai.nor:.- Prohcbtttc+mt" {" 1 7.204.11 �Sannt7er,,.Criteria -Chetnic:iW POPULATIONS(NSP) 21 : 5,'1.1?(A? 1 l'n .at[cklrwkI Pre-nikcl,;igcd jt,iEt.4nd i 7-'rl&.3' ('nruti,.aii lot iN:s,hn' �k'rrxlttCc.C't i:rE.7'" � .. 1 ! i E :s,.T:ra_e..ilttE, .1 aat,a,tg,at„is” _7 }Gd.ld I7T)'�ur Ae;en[<.Cntc:ia' : 7 "..4)5.17 htcide.mal F:xxl Cklnt'rM i.uhric:allW, i ',-h+ll.i 103) t::t•i,#'Yn,[r:a,�zrd Ez,?: AnnnaiF,a:do,id YC'iicidcC Gitetia' }{,t.t ;ic.tl:ilii,ytt•,'N" lct t."3. ' i 7-2+16.12 Raidow B.+ii Jtsttc'ti," ( j gr•i } (Ci I {;;t<,n. ,•t ?ti ;? 'i racktaeg A)wdero, t'i t,t(,u` onot alit Lluni:i,ring I! CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 :.t i { ( on,unx., §dti,o r i'<,:t•d to,< ;n :ttnp u+n nt r'v,aitu! ' # 96 Prager Cooking Temperatures tar that:aL Raw, tln&r"x)kvd,, i j �ati8;.rte;tse?Tax:e`s:x`,tit)laiL,trtare i PNFs i,gp.- i 55,F' 15 tit.. t-�t)?.k 3 k f°P¢tw,tdz�ti I{v±g.yuharttsrc f+)i €taix She2E 1>i'gc-Itniu.ili.tic S:r'u,r t t5"Fl:r:.ec I 1 ,_401,11 t`,h;:t CUmillnuit"d Fi'b' \four.& Cia)rx: i Ailineak- 135 F 15 ccc• # SPECIAL REQUIREMENTS i"401,1](H?tI ti2i Pot1, and beef Roa,t - 130'3 1" m#n` ,._...__.._...� I". __.. 59i)Jt i'-)t A),0" � L'tE, u—n,ts;.`inion `'*('4)9(Ai-(L') to ti,l)t11 Rant"- 3tticutA klt.lb - I'l5 3. Is ' j c a[c`rtng. ;n:htic t=xu1. [eniptirary and 3 437£.11,,"AlO; Pouirn,Wild f'r'olic. S'Wetl PHI S' j rt,:.sr3�nt.:;l tats€tcn opk:iario;[s,horrid he Giui)nt¢C'onrtincnr:t i.h M1iea:, 6eh:icd vn(le; 1110 aiti roputac atti't it oar; Poultry or Mantes 165`(' 15 Sec. * ehuvc it r,:Iawd to ftx(K Morar ilhwk,, 1 j,40l.iliCi=1i '+Vitol -mil'Ov. Itttacrf3,:efSte.:':., j level volgiorl 'Midrict IJcti)r�. 011ICT I 145"1- Vitt 3StUnG YE:i:tltnt. 1(e Uud ft-£ai1 ?-40I•i'2 Raw Animal F„xi,C(x&aJ iiia gra:;it�a;huttld t-,C(irbi£erl Uodrr tl29 -- � lfiCt(.r:air ir,^°t- ”` °enc+.t,rl Itt'tf,tart')IiCtif.,. ;_401.11(Alti}tb) All Or4er PIIt>-- 145"1 15cec i 1p Reheating for Hof Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.403.11(.A),.,t 0) 041.) 1651715 lc.:. a ( {Items 23.301 � 3-403.11(13) Microwave- 165°F 2 Niinui,.Standingi Crut,:t':-tilt rillx-, ti,ir.al :;',haat'" wilfj,dr,n<n rc'irne:n Mr I Itw, 1 1.h:dh,:rite i.'(n. (, r:,tartt:n!. ,rz, ,rid r::.t]it, 1:'!"d iii (On br. '..4:}3.11(("7 C omir,:a,ialty Prcr.':astd RTt:1-i'td, f(';w'i ill:h:io11':r.::,,.,',Minn,r,J:hi Fiat,'t ode iar,tr t(r,4 Cc;R ` t v:tflci ftE'tbtt PtactiCt=s FC ' S9Q.tNJ0 I � 3-4f,"',1 i(P, Rem.unmg Lnsli;�ed Rettan,+,f'tleei � .rsrsr ._; .. -_I 23. ' td-1,a,en,5n[ane Pet same; FC - 2 ! 00_ Ft:,asn� _-.a..'- . _ � � .� I� Proper Cooling of PHFs F'2_41 ` FryA kind=axf Prol<.rtka, FC. -3 r1C4 ` ii k ___.._ -_-1 (f3 . j��-:y1'rk C=Jt+GtnUc'Ne_`^r-,rJ-.�Rln% .0n ture'ctamem�nntv;;l,t -- FF_rf: - U4pC6S s-5i1.34tAt C'rxru�C )ketPF 't #ront=fI'i ) .rt., dJ3?er,pii.^btn4 U,G Vi3't' 70'1,Within 2 Iir,and F } 2 � Cr iOnbe76 u, 81'F; S' 1lithnu 4 H urk,. 2? 1iS .apr a Y,t 4l'; -- _ 4 ----- �il 413} PHF: Made Float Trmt,rrawren1c 41 1'/45'F —`_ --'-- I,1 i ')Vithtn4Iblar,° Pcm•tc CrIlWA ucn,in Ih, ro oak: 1S')9 Fond 1Ct5 t MLt 5q+i r"lU I Massachusetts Department of ,Public,Hdalth Salem Board of Health Division of food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOO;{ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type of Ooeration(sl Tyge of Insoection 10..n i. ,! Food Service \E] Routine Address �rr Risk ` Retail ❑ Re-inspection r� Ii.a jN. J-1 Z � Level ❑ Residential Kitchen Previous Inspection Telephone % j„ ;,_ ❑ Mobile Date: 7 t _ (1 ElTem ora Owner-�- � /� 1 HACCP YM Temporary El Konge Lit,�,A /�A�1 ElCaterer ElSuspect Illness Person i Char (PIC) J Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector �sOln PX I Out::-)` � Permit No. ElOther Each violation checked requires an explanation on the narrative page s and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. _..._ , '-FOOD PROTECTION MANAGEMENT , -„ ". � -� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ❑ 2. Reporting of Diseases by Food Employee and PIC I 1 "1 ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ��✓✓✓ 5.Toxic Chemicals FOOD FROM APPROVED SOURCE - -_TI\MEITEMPERATURE CONTROLS Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source (Potentially ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating E] 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ." " ' ` 9. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection 20.Time As a Public Health Control I ❑ 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 7[122. 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 InterventionsFA immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): i' 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 es0.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(c-3)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: \7 1( n S 580M5 IFo� IC do 1� I b( 1'v� Inspector's Signature: Print: /,I PIC'sSignature: rA_J011k J � Lwwll'c Print: �� , I Page�of Pages 1 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.t1(A)(1) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge" ( Cooked and RTE Foexls* 2-103.11 Perron in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-3(A.1 I Food Contact with Equipment and Applicant To Report To The Person In Utensils* _ Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 13 590.003(D) Exclusions and Restrictions* Disposition ofAdulterated or Contaminated 590.003(F.) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fes* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food taw* 4-501.11 I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures" - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical W arewashing-Not Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 14-501.114 ( Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 4-601.1 I(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System" Utensils Clean` 590.006(.4) Bottled Drinking Water* 590 006(B) Water Meets Standards in 3 t0 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shei ish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equinment* Shellfish* 4-703.11 McthodsofSantization-I-IotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by ( ( to Proper,Adequate Handwashing - - Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* I 3-202.18 Sbellshxk Identification Present' ) 2-301.12 Cleaning Procedure* - 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* if Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1 t PHFs Received at Proper Temperatures* I 2-401.12 Discharges From the Eyes, Nose and Mouth" 3-101.111 Food Safe and Unadulterated 3--202 I Package Integrity' * ( 3-301.12 Preventing Contamination When Tasting" � 6 ( Tags/Records:Shelistock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 1 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 IHandwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities" 590.004(J) Labeling of Ingredients" 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 15-205.11 ( Accessibility,Operation and Maintenance tHACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 I Reduced oxygen packaging,criteria* ( 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures' 6-301.12 Hand Drying Provision fienotes critical nem in the federal 1999 Paas Code of 105 CMR 590.000. i CITY OF SALEM t` BOARD OF HEALTH ii I Establishment Name: _> �. ! _ , H Date: ( I II "w Page: _� of Item Code C-Critical Item ° DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date f No. Reference R-Red Item - ' - Verified b t PLEASE PRINT CLEARLY t f f)4- �nlitP/ )Ontn n l�u I `�,✓It rJa_�!rA, w- J -h:;, � GJ/ �c-- 1 I (✓�S�� XC 'f +1sx -1 iL1r/l tr✓a S�nn�c,i Ho ►Q�tlt/ e r� /`C , LP r r N)4of1,t,n,.4 .1 Flog I4#,t,,f ( /71talc A obrou4k , -- --ko, c )n. l _ Q7,i -71L&A L�,r ✓1 In Df'Y lC < ��/'9G. G�- �.�•t-r .�-t'- ,I In L�,�9-c�`'`�/±9't _ � 1- 50rin� r (�\S hr 4-)Atn 1_af P-A.Ar , Iv riff ( �r4j - • / !A!A0J,,1(a rn4 r, - c-Li/ � b�L`7 <-�- .,� r �,�-•. 71-1a2d- tJQnrVn CumOvJ r-Ulb/7i r u��,<,� : �u 0+11 L"4h/11) t�L l fr , �1_nI Al III 1 12-77 5- �. 41, n _ ! KeJ*Ira/I:l l n I rT L �r c c Discussion With Person in Charge: Cor— r c eAction Required: I ❑ No Yes 1 ❑ 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 1GRe-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollar's or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. - V � ❑ Voluntary Disposal ❑ Other: t r J li -5,1 auto I PHI, Rtceiy,d:i; WaUfforis Alitlabid to Foodborne IfIriess Interventions and Risk Factors(items 1,22) .(Cont.) PROTECTION FROM CHEMICALS PHF� 1 Food or Color Additives 19 PHF Ifol and Cold Holding 14 15MA00i =1 PHF,Minollitiow at or 3-?U212 AdLIhivcs,* 591"tstlff- 4[-t4s-,3.302 tit Priltuiion ficne l-jnak)rrl1,,edAddhjvc�- 3:0( 16,A) 101 I'lli., at i's above Poisonous or Toxic Substances 7 10131 Idmijim;lodurvi onyind -501.146 Al,mab Kid at in ;hove KWOR 4 Containers' 'lime as a Punto:Health Control 740111 Cersoon Came- `Aorking Soul Q E Linin as j Fohio-l lvauh TT)LJ I Sipm noxi Slot agn' walnut I D t V:Ircriee RroDieormi 7---02.11 f Reitrict;ori lifeEtnuainj 7-202.12 Condition,of us-., i 7-203 H Toxi�Conujyrwi� -Prolubrion,!t RFOUIstEMENTS FOR HIGHLY SUSCEPTISLE 7-244.1 i POPULATIONS(HSP) 21 1001 1 UA, Unymenn,ed Flolatkain nd Juates wid 7-..0-} !2 Chetnim0l,for Ww hing Paxhwe (-iiiezij, 7 204,1) Dilhoi Aretoi,Crinerk' �-()!i I I fu-idolal FaY(AWO lXhrV*m0 AS) 0"T pownism Eqn 3 bMA 101 0r,or ImuA!l 0,;Ked Ammid FXQ Md 7,206 i! 7-200.12 0106 13 i Tnicking Pildu,. P-�m(Amtm.1 and C !"(xxi pa"Jedrl: Not k.:-,wrier CONSUMER ACIASORY TIMEn'EMPERATURE CONTROLS 22 34A? i i Qrxmo�r,`lar,iroi vi`os,ed lor i'oaanovuant of An It, Proper Cooking Temperatures tot NiAl hw+!bit im FUv% Underoluked a Oilwir,%iso fr,ce,scd al,!Jiinan.T PHFs Egpw 153,17 loviledtate Ser,rlc t 15'Fl 5rc& vul!3 Knonmind 11W :%hpirme AX Ran Ehdl 34MINAID C farin himired I bly Moo i A thns; Ion' bibuds 1010 1"wo , 3401.11(hinIgh 10a mid beef R.oam - DMF 121 ink' SPECIAL REWREMENTS A Aq A RAI 4 Rohm. "emd M&AN 155 F 15 390 SV�Jjejj in cu. ' rnleriog, zekbilk, fixill. maporny and -401.1 IiAl:3) Poithr), Wild Ganc, SIuefrJ IIHF , ri'aillul'al i.ltcon opoattions Afkaild he smillmati(Ini Klo mea, idloed iiiat;:f tile ;CC;vXw I'Vitiltry or NatiteniblF 0 sec. ak�ac d• to fokAborlo: Miles, 3401A DC)PI Whdiraitirde, Ituxt Bol:iwaks Peel ai'd fi"f. fjchors lkletr 10-0 t "Q(�f,ftt) vqjotp'ol;relating to ,s;erld rotoj! 34WA2 Raw,aminal Yoxis 0x ked i;,A jnm,.mc� hoold be d0oled under #29 - MOmwivy 161F 2-WWI HAIiab; V I Otho PHE: - 145 1 15 qcc 17 Reheating for Hot Holding VIOLA 171ONS RELATED TO 0000 RETAX PRACTICES 3=1 UAKLU 1111% 1 hF F 13 sec. ' # 4 1 tems 23-30,, 3 4(I3.11(H) MjC,,jWNr._ Ital J,'2 I'doeor SUMMns C/1!o zi :rd nza. , 1!1.ol rw!ap.;e i, lvnich dr)no: re;we to!hr I nee' jwn%me .=aij I I !Mn"w'-wO r"'A la,sort 1,w4 d abol" (an be 3-113.1 Itic) Coneouciall) NwesM RIV had 1,afad is:h,f;,Jjfle Jfjf4 sero,), q: b,p,,d i*odc roil 1 ('1111? 1-40 1P , i-40; I I(Ii i Rmoonin'j, liaxi llertion,fir hio�l item rT r 590,000 214, 1 Msqatofry pill:vn!Pcntx:rel FC 130-1- -s 25 i Proper Coo!lng of PHFs i 24 taxi and �milreic�i�or PC -3 004 3 901,14(At Cooling Uflokcif PlIhs from ITY h, VC wat,�.,r. ci GG-5.- 006 XF Whbin 2 1 burs ord Fianfi191' 17 11 FC 007 28, paigqoo,;it Too! i'louf'o!l; FC - 008 3 Swiss, Cooling PriFskladie Fioni Arihe�nt __44 -�L '009 Tjtqx�rfuory 1( 41,i•i-ls L46 -00,; j •Uri am into low lVAIWIDWO CITY OF SALEM BOARD OF HEALTH (( ,Q Establishment Name: �s ,. t 17M��, c r, Date: ( /�� Page: 2' of { Item " Code C—Critical Item' ,, , ,U DESCRIPTION-OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item t /N Verified PL€ASE PRINT CLEARLV� � P" r"'\ / �t/V�) NterM��t�. i n�W -�.� ,�en�i (^�,/-1�^/s Lid �G� e t ✓ l 7499, , IN6 ,telo sri— k IFIT � un , i �� c� ` [Ce (� (� /J�'I�. , N1 C*1 JVbL�L � IN'r i—��rY <; Ar_ r/1 S�iA� 4/CG t�h]s L �)raj\. Un C_(-),� ej CG Cofv —1 I I L� c / � �- --z � ce — �� ' �- � �Ch::/ t U� � � tro. " � I 6— �(Vjv f" 4, )4-- k.)�t `(�1.�'�( � r/ AL- � U3 W� ) Y.I. 11�. +form Ci v/ rr _1 C�`c,L c t-, -h AAc 0-4 ,,.p I(� f ��/- la Itr+D. �3eor� � n(-I.wt �l�c�- 777�i= z�Jk Un Ir t�. 9 Discussion With Person in Charge:j � Q in a� LJJ� ��M�� JGr Corrective Action Required: ❑ No i q Yes t7l— * Ior^ —w� !'t r C ❑ Voluntary Compliance U 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 q comply with all mandates of the Mass/Federal Food Code. 1 understand that -� I ' noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure j your foQdpermit. f ❑ Voluntary Disposal ❑ Other: J Racejved zu Teuiperallrc': Violations Related to Foodborne fitness Interventions and Risk to L, v Cooled w Factors(llenrif 1-22) ;Cont.) Wifinn't ROWS !ethods "ol PHF,. PROTECTION FROM CHEMICALS 19 PHF irot and Gold Holding 14 Food or Color Additives r'ok!11ik MrtPu3nkx1 a!rn b::tine 4i'1'4f: F- 3-31)2.14 - 1 1-302,14 Prowelmn from I fjlappro�ed Adddo 16,A) lic,*, Pf&,:,tamilmood ator above 1; Poisonous or Toxic itubstences Womilyinu,Infollmi-Im - Oilgifl;d Ro,��110,1 at or +mvc !,',00F, Time-,as a Pulthie Health Conti of 20 7 162,11 (,omnwriNanie Ww*i<,M,I,foafam:r�' Iirr"a�, I Public I lealih A:oatrol, 1-201,11 S,-oarmixi ShI a�,c fl) Rr"ihitt)on Pfes� 7-20111 000acid tr,,� 7-202,12 Condition,ot fjwv REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Tw.ic Cowamieo; -Proh:bi:ions* 204.11 POPULATIONS(HSP) sarlitt/:t(s, ch'low;ds' '7-2(j4.12 Ch-onicais for Vvd,fimr llroduee�clileo.), i'sid llry and 5i iii, Warnive Uj.ls 7-204,14 DiJm Agcnta.Crheria'' Incidental f4iixi Cuptact,Lkih6eaiiis, 3 rP ,v,ir 26 ! iCCorol Awmal I-txd oid I . R",Iiocd Uw j�,iicie" '� ) R;ii,, ipn�'u� Nkll ',�CI Ned. 7 205.12 flMow f"ot Siailoc!,, 1,om Psc!act Nor Re-served mo 12 '[T.1"khig CONSUMER AWSORY TIMErrEMPERATURE CONTROLS 22 4-io, I Po"I"'d IiIi Ccaznmptim of vs PHFs 16 Proper Cooking Temperatures far ,,d Chm,jrc Ra,..-, Undcroo];�iJ !o'Himmaw Rmfio-,m, 101 1 IA(l I(,I Egg- I�,S'F 15 Scc. "u"2.)3 llmrw I 174n,; fur Kim Shot Eg'2�. hiuw�di:ae Seric� I 3-401JIIA)(21 -C',mininoted Fish, Nlcazs&Caw, Animak- I Wfl 15 sc<. 3 40 1.i I(B V 11(21 NO and beel kiew i,�O t' l2 i moO SPECIAL REQUIREMENTS 5qo f)) -(D) in -40 1.1 Ph Rohte�, Iniemd%'Itat, 15S F Iyy cji,,riiiF, mokil,,ltx)d, wmporary atid ro.,vi, 1, lloultr}, Vild Gaw�,, Souiftd PHF�, \ifi-11crt op,,,N�tion,�l 'tild be Commi,rig Fish. !11,1:9 Pouftry or kaotes 16.",'F 15 sec.. I elx)v,� !t r,4;IiVd To fxAlXwm� ilhos� Whl'le bit"cl lieef iut,ovqctlol,:wid ii�k fictom 01hor 6,)Iat�kiil¢ relating,to Pood reNIA ?-401,12 Raw Anitrul FO KI,CiVkCd ns. cm,,s;hooid be d&,ited wi&r #29 NllctimiIve 16s1 f 3-Zi t](A)(t)ib) All Other PIJF<-- 14T,F 15 ito 17 Reheating for Hot Holding VIOLA TIOAS RELATED TO GOOD RETAIL PRACTICES 340311 iA)&,t f`I PHF: t65'F 15<ci, i (Items 23-30) 1 ('01.1P zi;�Vhl row-,rowul �0,, ,,�4011,j if b) MICI"iWaNC- 16'1"F 'MiniAle StdndinjZ "dack do wn re;a1c I,,th, wrIbe 3-103.11(C) comfneicimhP,tv,,seii R,rF 4� tai 340I!'Fi Roplainak", U1101cce Pomt nsof fi(ct ± fiWi TonoIJN01aw-Practives 1-5wmq 23, �.il aLplikqi,end d Ff, --.2 p"nst", 3,1 -f�4-, ro-'X-1 and P K - 'i (AN 18 Proper Cooling of PHIFS C 5o1,3.4(A) cooling C,X)L,d PHI-4 (roll) 14"F h, s oric, 6, Wator,phan .bLrl '7ij"F Withm 2 flour,;and Groin 101' 1 27, Fa,111,4 FC—6 1 W7 Withm 4 Hou,:. kl- - ��— -- -, Opp___ i to 41"Fi43 F Pc�srinous or T�!yic M&ze,4-� -301A4(L) Coolivv 1111Hs Mado From Ambient 29 Special R-qu&emws joto Within,l,lbw� 1,15( olj<59lt(Xo, i CUSTOMER INFORMATION BOSTON I'1NG) Il N 1'(:1 TERM/N/X r:>i7 I,IAr:>I-I z Nc;;'rLli� s:,r AI...ri.N ,HA 0:1.1?70 Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation. Interior Areas Pests Conditions Food Areas 7Pests Conditions ❑ Offices ❑ Dining Area ❑ Lobby/Public Areas - EI.Stove/Oven Line ❑ Entryways D'Food Storeroom •-Et Rest/Locker Rooms ❑ Dishwashing Area ❑ Janitor Closets ❑ Deli/Bakery ❑ Laundry ' Processing Area �- ❑ Boiler/Furnace Room TT nn ❑ Packaging Area El Storage Utility ❑ ProduceArea ❑ Warehouse ❑ Meat/Seafood Shap ❑ Basement Exterior Areas , ❑ Patient Rooms O Exterior Walls-North _ ❑ ICU ❑ Exterior Walls-South O Linen Storage Rooms ❑ Exterior Walls-East' 0 Kitchenettes ❑ Exterior Walls-West ❑ Nurses Stations ❑ Loading Dock ❑ Guest Rooms O Dumpster O Banquet/Meeting Rooms ❑ Exterior Storage Rooms ❑ Display Aisles# ..v t � ❑ Roof ..; �. ,� O Other ❑ Other ❑ Other ❑ Other 1.. German Cockroaches ' 6 Pharaoh Ants 11. Occasional Invadersats 2. American Cockroaches 7.Pavement Ants 12. Hunting Spiders 17 ice 3 Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9 Argentine Ants 14 Brown Recluse Spiders 19, Other 5 Silverfish 10 Yom` Ants. 15 Black Widow Spiders 20. Other z A Drain Clogged/Dirty I. Paper/Litter Q Poor Storage Practices Y. Move Dumpster Away From Bldg. B. Food Debris Under Table J Water leak R Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned C. Food Debris On Shelf K Mops Improperly Stored S. Seal Exterior Cracks/Holes AA Mercury Vapor Lights Outside D. Food Debris Under Appliance L Trash Containers Need Cleaning T Trim Back Tree/Shrub Branches BB.Keep Doors Closed E. Wet Organic Matter in Cracks M.Heavy Dust/Dirt Deposits U Remove Piles of Debris ,gC.Repair Door/Screen F Grease Deposits on Floor N Numerous Cobwebs Present V Cut Tall Grass/Weeds DO Replace DoorWeatherstripping G. Grease Deposits on Equipment O. epair Floor/Tiles/Wall/Ceiling W.Improve Outside Drainage, Poor Outdoor Storage Practices H Soiled Dishes Left Over Night _P al Holes/Cracks in Walls X. Install Gravel Foundation Barrier FR Other Comments o (t.¢��q(Si Lv4G��+n SCr'F'�rtic, M h�.c� c1Ja0 a 6LaAn W�—�' INI� '11n� 4J�a' H(A.()(1v,G0.1� OVlO �PqujpA Y)t, o PQ%A o alb S(�ru sa¢ c{F �)oor 4oSl �roM �t��ofokC QP•-errs Cust/r�er's Signature - Service Professional's Signatua // Data / �J>w V" Wy( CUSTOMER'S COPY SA:11: 69642`5.9 Da-tc--, W0# 652/4:1.40:1.4 ❑ INITIAL SERVICE REGULAR SERVICE Ll EXTRA SERVICE AIRMINIX Re'-i BRANCH ACCOUNT IRT7. TELEPHONE GRID S.DAY jai FT T PRODUCTION TIME=INTIME OUT ;H t L I C 7 9 017 6 2: 0 1A 2:1. 07 -7, 90 7 1 p It' 7,c,c, I If L7 R R It.-, -.IJ I ' PROPERTY AT BRANCH DsTl HITT 006 CO 50 1'30 RUN-i ROAD; SU.Ii 1.1.3; :;AI EAJIA 0111"M NI:::WT0I4 ,l 02466 ir Al 7�-9A900'1P IOPERATOR NAME&CERTIFICATION NUMBER SUPERVISOR NAME&CERTIFICATION NUMBER 1JOHN F* SI-Ii-Eil :17625 1: .1 3 1. -. R , A IRTI-4t.)R F-I r :1.:5';8 Target 3 GurnmenCockiduchas J PassmartAnde ❑ Rat U Occasional Invaders Materials Local Pests U Armaxsed 0.ckmcrheP J Ar,rubmiksta U Stored Precaut Parts 1 450 insiders 6' WIND-UP TRAPS C1 oreastrui3eclacrems, LI Pet J Silverfish LI Door 400 Insect Vectors 0 TIN CATS D OtherGodismadhes CI Other Ants LI Has, U other 410 Pheromone Traps :5 Rat Bait Stations — Glue Traps 640 Vedas Bait Station. Pest Control Materials Used EPA Reg.# T/C E/C Amount 1 630 Snar,Trade ESE Liound Bait Stations 293 Advance Granular Ant Bait(Abamectin 81)0011% 3 49 Areas Inspected and/or Treated 295 Advance Dual Choice Ant Bait(Abannectin Bl)0011% 1 49 Dust Control materade counjameatted by Poess from list at left 315 Aftemind Fire Ant Bait(Abandectin Bl)0 011% 1 499-370N od Areas 309 Aven Roach Bau2tations(Alearrectim)0.05% 499-467 -1 an 365 Advance 388B Ant Gel Bait(Be..)5 41/. 499-492 \Ing Areas 100 Bond Dust(Orthopedic acid)99% 1 9444-129 1 U Office. 15 Demand CS(Lancludar-cyinalothrin) L10015% L1003r)a 0006% 1 100-1066 1 J Pmelm Areas 210 Dettal G(Deltamethi 005% 1 432-936 1 1 1 �Rsa,LddksrH.ma 168 TnDia Bulk Dust(Silica Gel 40°%(Pyrethrins)1 0% 1 499-429 1 1 1 J De,ge,Areas 41 Grantrol PC(Hydrolodene)0.06% 1 2724-351 1 1 1 0-mmm,A3sler He= .540 Generation Mu,Blocks Bait(Difethialone)00025% 1 7173-218 Orators,.eautility 541 Generation Blue Max Blocks Bait(Difethialoart 09025% 7173'236 439 Intice Granular Bait(Ortholooric Acid)5.0% 73079-2 U Processed,Areas 43 Kicker EC(Pyrethrins) 0005% C1014 002% 4 432-1145 Patient Boards 550 I-quil 11 Bait(Ducal Salt of Dintracel 0.106% 1 12455-61 m Guest Record 352 Ma<force PC Roach Bait Stations(Fipronfl)0 05% 432-1257 1 1 1 314 Mareforce,FC Art Bait Stations(Ppronil)0 01 at 432-1256 1 1 1 D Basement 357 Mierforce FC Ant Gel Bait(Filphout)0 001% 1 432-1264 1 1 J Perot 354 Mromme FC Select Roach Bait Gel(Fipronil)0 01% 432-1259 1 1 J Em,nor Perimeter 355 Maoiforce,F3 Insect Bait(Hydramedyinch)10% 432-1262 1 1 J L.dB.,.Anne, 46 NylarEG(Fryriproxyfen) 00015% 00.02% 11715-307-57076 1 1 1 0 Loading onsidournpater 151 PT Cy-Kick Aerosol Cyfludinnim 01% 499-470 1 1 1 00ther If r 70 PT Cy-Kick CS(Cyfluthnn)0 0 0075% 0 0.025% LI 0 05% U 0 1% 499-304 312 PT Avert Gel Bait(Abarrectin Bl)0 05% 499-410 Precautions 69 PT 565 Plus XLO Aerosol(Pyrethrins)0.5% 499-290 Zy"out of reach of childrarand sets carse eye,a.,throvd.or'skin rtmerms 159 PT TriDie Aerosol(Silica Asti 48%(Pyrethrins)0 6% 499-385 1 1 1 Avoid breathing vapors case,or dusts Harmful if swallowed 81 Tempo Ultra WP(Cyfluthrin) U0025% U005% U01% 432-1304 1 1 1 Dampen grandider,to activate I ct Warner vand amended.sameness a 83 Tempo SC Ultra(Cyfluthrin) ZI 0 025% 0 0 05% J 0 1% 432-1363 wor, ot refund to mom until after ventilation 91 ULD So 100 JLV Pynctini 10% 499-452/11540-9 1 1 1 De,and touch treated added sur dr, 92 ULD BP 300 ULV(Pyrethnns)3.0% 499-450/11540-1 1 1 1 For fee treatments.remain off treated area for a minimum of four hours or until dry 591 Weatherblok XT Bait Bardifacount 0005% 100-1055 TheatermatCodd C=GdockifGavice 'V-Vad IS-Graftemal S-Spot BT=Bmt DC=D1mdadGPrtacA B-TRand SP-Space IN-Inspection Equipment Code(l CS-Dome Air Sprayer T-Trip Bait Station HD-Hand Duster A=Arearsol Gun PT=Pa.,Treatment F-ULV CCYA bt�� (F�)k Ili 14 y")S) tt -A I service Sticker? J yes Q No fain it& CawI,,-"0-tr,7"4 ,4 '? -i t Supervisor's Comments: 4 -ewv--> P Y,i o Y, B a.l.a 11 c e, 00 SPECIAL SERVICE INSTRUCTIONS I a x C h c11•9 e + -AMOUNT PAID ToLSI'I. [Wel 11 . 1 i 41 . 00 CASH UNRESOLVED PROBLEMS? DAT o I i CHECK CALL 1-800-TERMINIX(1-800-837-6464) r CUSTOMER'S COPY IMPORTAN_ MESSAGE FOR DATE TIME /10 M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED V LEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE zvl .�„�,.v,.. i I� + SIGNED `ir'T7 FORM 4009 .�V MAOE IN U.S.A I v r NOTES K a i i i i :i i �i i i �! I �; . . �, �� a�_wl o ��. �.�, �� --- n i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT y��}��y NAME OF ESTABLISHMENT. hT(7C7C TEL# ADDRESS OF ESTABLISHMENT 60 WCSF}!/�Ny ✓1 3T FAX#!� LAY MAILING ADDRESS(if different) EMAIL--Business': Owner's: OWNER'S OWNER'S NAME ` Ai m `li;-i4n l,1 [15'7 TEL# 7 2r/ 0513 ADDRESS_C kto-64 6bv ;s AAU&.rtt -_ 14A- (?)t STREET Ciff STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S3 ~S Vjjo Awa r)te-S CERTIFICATE#(S) (Required in an establishment where potentially hazardous rood is prepared) sJ EMERGENCY RESPONSE PERSON HOME TEL# 1 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION IPlease rexampeintimeolaay. 1 ` t lr I,` ! iFor example tram-llnml 1 ` l � � "' ( l � �( TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES NO less than 1000sq.ft =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft =$250 RESTAUR----- --- - -- ---- ----.-- --- --- . ............_. ._....-- ... _.. ... ANT NO less than 25 seats $100 25-99 seats more than 99 seats =$200 ..... .....W-0 -... - .-.... _.-.. _..... BED/BREAKFAST YES NO --- .. - --- -- ... -... - ------------- ------- -------- --- ... .... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOf F 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 Bled all state tax returns and paid all s'.ale taxes required under the law Signature Date Social Security or Federal Identification Number ---------- ------ ------ — - ---------/------------------- ---------- --------- --------- -------------------------- - -------------- Revised 11/13106 FOODAP2007 adm Check#&Date -I ) L 4�A, walmotmassmichyse ki *-� J, Ot �W' lam ne ."Dirl' '-'-V"120 Washing ton-Stieet,4th'Flo SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Boston Hotdog Co. File Number:BHF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2007-0150 Dec 20,2006 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 16 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-744-2320 Food and Food Protection FAIL BLUE Owner: Comment: 9 yogurts were discarded for being outdated. Joseph Garuti & Strates Fra I PIC: Ice scoop in front stored incorrectly. Scoop to be designated tabled container or with handle exposed from ice. StratesFrangules Equipment and Utensils FAIL BLUE Inspector: Comment: Microwave requires general cleaning. John Gehan Date Inspected:Correct By: Right true unit requires general cleaning. 4/4/2007 Front true unit requires general cleaning. Risk Level: Permit Number: BHP-2007-0150 Status: SIGNED OFF #of Critical Violations: j 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page I oft s-� Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 2 oft 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-744-2320 Food and Food Protection FAIL BLUE Owner: Comment: Personal items stored meat slicer. All items ro be stored in designated areas. Joseph Garuti & Strates Fra j PIC: i Medical supplies being stored in refrigerator. All supplies to be stored in proper designated areas. Strates FrangulesEquipment and Utensils FAIL BLUE i Inspector: Comment: Sanitizing log not being kept up. Log to be maintained daily. John Gehan tWhite freezer requires thermometer. Date Inspeced:Correct By: 10/11/2006 GENERAL COMMENTS: Risk Level: 882: Permit Number: BHP-2006-0016 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem 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. Oct 11,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2006 ) Page 2 oft 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-744-2320 Handwash Facilities PASS 0 RED Owner: Violations Related to Good Retail Practices (Blue Items) Joseph Garuti & Strates Fra Equipment and Utensils PASS BLUE PIC: Strates Frangules Physical Facility FAIL BLUE Inspector: _ - Comments: Back restroom needs to be repaired by next routine inspection. John Gehan GENERAL COMMENTS: Date Inspected: Correct By: 5/9/2006 620:AII violations from 5/9/06 have been corrected unless noted. Risk Level: Permit Number. BHP-2006-0016 Status: Open #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 17,2006 ) Page I oft w Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 17,2006 ) Page 2 oft 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-744-2320 PIC Assigned/Knowledgeable/Duties PASS ❑d RED Owner: Non-compliance with: Joseph Garuti & Strates Fra Anti-Choking PASS PIC: Strates Frangules Tobacco PASS Inspector: EMPLOYEE HEALTH John Gehan Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑J RED 5/9/2006 Personnel with Infections Restricted/Excluded PASS ❑Q RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS ❑d RED BHP-2006-0016 Receiving/Condition PASS RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS RED 1 Time IN Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev. May 09,2006 ) Page 1 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 Q RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑ RED Handwash Facihb s FAIL ❑ RED �ts: Paper towel dispenser at hand wash sink in back room missing paper towels. Provide papertowels in dispenser. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASSd❑ RED Cooling PASS ❑Q RED Hot and Cold Holding PASS ❑Q RED Time As a Public Health Control PASS ❑J 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 09,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils FAIL Non-Critical BLUE ments:Can opener has accumulation of food and grime. Clean and sanitize can opener. ue unit had missing thermometer. Owner provided thermometer at time of inspection. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE ments: Ceiling tile wet to touch with water stain by back door. Find source of leak and repair. Replace tile(s). roken ceiling tiles by back door. Replace or repair tiles. Back restroom has leak. Floor wet at time of inspection. Properly clean floor and repair any leak. Management and Personnel PASS _ BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 612: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Laurlers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 09,2006 ) Page 3 of i - 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-744-2320 PIC Assigned/Knowledgeable/Duties FAIL Critical ❑d RED Owner: como ment: No PIC or servsafe certified pension working at time of inspection. In the absence of servsafe or PIC person,a I ra LZ knowledgeable Garuti & Strates Fknowledgeable employee must be present. PIC: PROTECTION FROM CONTAMINATION .. Handwash Facilities FAIL Critical 0 RED Inspector:,Y _ t.Cerifirnerit: Hot water should between 110°-130°f. check water temps to insure proper temperatures. John Gehan Date Inspected: Correct By: ndwash sink in rear should be accessible at all times. Relocate any buckets,soda or other items beneath sink. 1/3/2006 Violations Related to Good Retail Practices (Blue Items) Risk Level: Food and Food Protection FAIL Critical BLUE i `/Comment:All food being stored must be 6-8 inches off of the floor to prevent cross contamination or rodent problems. Permit Number: Equipment and Utensils FAIL Non-Critical BLUE BHP-2006-0016 . I Status. L -cb-mmen :GE freezer thermometer missing or not visible. Replace or relocate to a visible position. PARTIAL COMPLY crowave in back requires general cleaning. #of Critical Violations' 3 . . eral cleaning required on both True refrigerators. Time IN: Time OUT. y I Physical�Fa/cilityy ' FAIL Non-Critical BLUE Urgency Description(s): L- of rmrment: ceiling tiles outside employee bathroom in disarray. replace or repair tiles. BLUE:. ,. GENERAL COMMENTS: Violations Related to Good Retail Practices (Critical . 408: violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Y ) 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. Jan 05,2006 ) Page 1 oft s Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 05,2006 ) Page 2 oft t<--t.. i ': e��,s-?'(*sya�yaS�w�,sk:ic.s#i:�;s�.`M=:.�, Commonwealth of Massachusetts . 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: Boston Hotdog Co. File Number:BHF-2004-0268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0016 Jan 1,2006 Dec 31,2006 $100.00 ESTABLISHMENT FROZEN DESSERTS BHP-2006-0017 Jan 1,2006 Dec 31,2006 $5.00 Total Fees: $105.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 13 of 18 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMITTO 'OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT OS�h 4c4etc 6 �y� EL# ADDRESS OF ESTABLISHMENT b)&91oNPfM Jf. s MAILING ADDRESS ((if different) OWNER'S NAME,:16P [n (li4vai ' r c � c,�J ci TEL# 7E/-$t 3"6 Y'lI3 ADDRESS oC -1( CITY--F-,&L)-t'y STATE S ZIP-jo9/ CERTIFIED FOZSD MANAGVR'S NAME(S) / 6 ✓. • CERTIFICATE#(s),Jg7)A62 yu?oo44 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON &6V)(sGh�izyl�S HOME TEL# 7$/ J-9I 09/3 HOURS OF OPERATION: Mon.q—7Tue. 9 7 Wed. 9-' Thu. 4- 7 Fri.Q -7Sat.//-7 Sun./2- r TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 ----------------- RESTAURANT S NO / /l lesshan tseats $100 -�V/►�-., 25-99 seatsis =$150 more than 99 seats =$200 .........YES ..... ..N - BED/BREAKFAST YES O $-10-0- .... ........ 100.... ......... - ........ - _.-............-. L _ADDITIONAL PERMITS 60i l MAKE (not just serve) ICE CREAM;-YOGURT;SOFT_SERVE j�CD 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 owledge and belief, have filed all state tax returns and paid all state taxes required under the law. gat /ZA105- S7-//S69 Si ature I Date Social Security or Federal Identification Number - -- --------------------------- dm-------- Chec #---Date ------- n-,-//--------------- sed 11/03105 FOODAP2.adm Check#-&-Date o2 a S/ �IT --------------------------------------------- co 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-744-2320 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Joseph Garuti & Strates Fra Tobacco PASS ❑ PIC: Joseph GdrUti FOOD PROTECTION MANAGEMENT Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑ RED David Greenbaum EMPLOYEE HEALTH Done Date Inspected:I Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 6/16/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level. ' FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS ❑d RED BHP-2005-0077 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED FULL COMPLY Conformance with Approved Procedures/HACCP PASS ❑d RED At 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 214. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑J RED BLUE: Prevention of Contamination from Hands PASS ❑d RED Violations Related to Good 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 16,2005 ) Page 1 oft _ c 0060 WASHINGTON STREET Boston Hotdog Co. must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASSd❑ RED RED: Violations Related to Toxic Chemicals PASS RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS RED Cooling PASS 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 ❑d RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS 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 inspection report have been corrected. 9"- � GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Page 2 o{2 0060 WASHINGTON STREET Boston Hotdog Co. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-744-2320 Non-compliance with: Not Done Owner: A Anti-Choking PASS ❑ Joseph Garuti & Strates Fra Tobacco PASS ❑ PIC:' Joseph Garuti FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected' Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 6/9/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number. Food and Water from Approved Source PASS ❑d RED BHP-2005-0077 Receiving/Condition PASS ❑d RED Status' - Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED VIOLATION Conformance with Approved Procedures/HACCP PASS d❑ RED #of Critical Violations: Plans 2 Time IN: I Time OUT: Notes: 203. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 1 o!3 0060 WASHINGTON STREET Boston Hotdog Co. must be corrected immediately PROTECTION FROM CONTAMINATION Not Done Or within 90 days) _ Separation/Segregation/Protection PASS RED RED: Violations Related to Food Contact Surfaces Cleaning and Sanitizing PASS 0 RED Foodborne Illness Interventions Proper Adequate Handwashing PASS ❑O RED and Risk Factors (Require immediate corrective action) Good Hygienic Practices PASS ❑O RED Prevention of Contamination from Hands FAIL Critical 0 RED Emplo /drinkstored in cooling units. oyee drinks must not be stored with customer food to prevent cross contamination. Handwash Facilities FAIL Critical 0 RED /s, dwash sink found with a bag of n of Lysol and rags stored in dwash sink rust be kept clear ble at all times and used for g only. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS Q RED Toxic Chemicals PASS Q RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS ❑d RED Reheating PASS 0 RED Coaling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Paze 2 of 0060 WASHINGTON STREET Boston Hotdog Co. Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Critical ❑ BLUE At ooi g unit and freezers missing ermometers. Provide visible,accurate internal th rmometers in all cooling units and f yLezers. e GE freezer eds a thorough !sanitizin aning. the time nspection there was no olution in the front food prep e unitizing solution of proper ncentration MUST be readily available at all work stations at all times. 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 4 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 10,2005 ) Page 3 of .. `�. t r�.. .e. ��rf.;:.,. $�+w-r_.,tv---«. ....». .rr•M.rs...a4+i.yrs+�•em_-.•riasees::.-+la.-:..,ggwx+. . .. ..._=w*, 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. 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: Boston Hotdog Co. Address of Establishment: 60 Washington Street Owner's Name: Joseph Garuti & Strates Frangules Restrictions: Application Date: 11/18/04 Permit for Food Establishment 25-05 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. MEALTM AGENT • 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 2005 APPLICATION 2FOR � P)ERMIIT/T'O/OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT +s�QYI�tf) _(/1pG l/d[� 9,i VTEL# I N'-74lY'� ADDRESS OF ESTABLISHMENT �D g77 MAILING ADDRESS ((if different) ` / 1 /� OWNER'S NAME , I(SSC', h r-)avali TELt16J-ffi 33 wyIfS ADDRESS CITY STATE I4'/ zip F/rfGz CERTIFIED FOOD/MANAGER'S NAME(S) ;T[1sFpdt C3av✓t`,' CERTIFICATE#(s)AR?7A49, skf.-aYJ►h4dddh (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON S4,-O-I&S HOME TEL# HOURS OF OPERATION: Mon.3=2Tue.J:::1Wed.9—'? Thu.4'7 Fri. q 7Sat./I- Sun.L(—S 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 ES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pu suant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my b t knowled a elief, have filed all state/tax/r�turns and paid all state taxes required under the law. �P, _I I_��1 5-7-"4 9,i 6'- S' ature Date Social Secunty or rederal Identification Number --- --------------------- ----------------------------------- - e ised 11/03/03 FOODAP2.adm Check#&Date 1(a a2 V '`� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • , 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 •�,qMr� 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: Boston Hotdog Co. Address of Establishment: 60 Washington Street Owner's Name: Joseph Garuti & Strates Frangules Restrictions: Application Date: 5/18/2004 Permit for Food Establishment 304-04 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 Bo r�t HEALTH AGENT ca CITY OF SALEM, MASSACHUSETTS `- BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 "• +" FAX 978-745-0343 STANLEY U--SOVIQ,JR. JOANNE SCOTT, MPH, RS, CHO MAYOR t ^HEALTH AGENT 2004 APPLICATION FOR PERMITTO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT B0. Aii ''rt}}Wclo_5 �'�j. TEL# `) -,7Vr/-o2 3,76 ADDRESS OF ESTABLISHMENT 40 u[/QS l� lviq�Yw, 5� MAILING ADDRESS (if different)) J OWNER'S NAME 2W-411 /A4Cknoy J. TEL# 97$',�YV-.23ZO u ADDRESS S'eeY",e.-k S/eC2 CITY STATE ZIP CERTIFIED FOOD MANAGER'SNAME(S)�psev* FC-qt-%41- CERTIFICATE#(s)a1?22,9,E;;( (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON J6SGI74 F G4vvY 1 HOME TEL# ;V 173 -6Yg3 HOURS OF OPERATION: Mon.`l=l t Tue, '1( Wed._J,11 Thu.-9-/ Fri.-71/ Sat. I'/) Sun. 9 /! TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 J„6 more than 10,000sq.ft. =$250 RESTAURANT YES NO C36r7 than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $1p0 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES N $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 1, to my st knowledge a d belief, have filed all sta)e to returns and paid all state taxes required under the law. gnat re Date Social Security or Federal Identification Number - 's---------------O ---- ------------------------------------------------------------------------------------------------------- evised 11/03/03 FOODA P2.adm Check#&Date r 1 � f / / f �� t �l�2 l�/ � (> f��nG7r4 f-,4f1,-&,, s �ynh yt'1a otq �a. �a�an� ��' dt�Y�4" 7�'t s`�3 dyY3 Mgr • �'g/- C3g'l3 _y I CITY OF SALEM /I /1 ' I BOARD OF HEALTH Establishment Name: 1305-t 1 b� Date: D Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I OfIIAD/ . )0S1-,Ph 4a I S�1/3-..E/vrr1� � /?�C.(, .tel'' h� l�/wr,+P� C�rQf�s Fra�rgv/mss.• �h 1214 3 I �'hn ✓rte,/ i6,.�r YrOo�n� -1r � CLvai /a�LP -�a �'�»�.�.�s . I � T/ti o� ��.aar� �'Ia 5 S v�J�-l(•(t_c/ PvI�-r�� . �D �'��vrt�za so dW rA70-r /?%SS n s rrrc 9,0 5l�.ev 1 � P�-tya� � ,�P.��:��• y-yii� yam.-v�-,�t I .Gi�iJ� T�iv � �i�P� -bra vn ho//u�c. -/a ✓�(voa'�r, qui i/ A _61slf/I.VPr4. Pie Pa, of , I Jam" G� IOdBS r7n �ai� �'lrerrd C',o- 40r5j,4 O-F Y-lae,(N - - as f( -(o-sWS I Discwvion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violaions before the next inspection, to observe all conditions as described, and to Exclusion t • P Ll Re-inspection Scheduled 13Emergency 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. \� Q c—X Q `1n1Q9JlJh C) ) \ ❑ Voluntary Disposal ❑ Other: 3-3W. 4,C+ :'RFs Rzcoly�d n'reZnerrtunrs Violations Related to Foodborne Illness Interventions and Risk ' sordiug to�ti,G:uled to Factors(items 1.22) (Cont.) ' -4!' taj'F within 4 Hour::. * PROTECTION FROM CHEMICALS I S 50",15 1 C:,ulitg Pdednd} i: � - - �� y �� r � o ��i c �-� ;� 4 ' � i ,� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH + 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Boston Hotdog Co. LLC Address of Establishment: 60 Washington Street Owner's Name: Lawrence Scaglione/Joseph Ganti Restrictions: Application Date: 11/13/2003 Permit for Food Establishment 007-04 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 BOARD OF HEALTH i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. -JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TOL OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT AOSFOY� 6'1A Ln U-C TEL# 97�- 71N -x310 ADDRESS OF ESTABLISHMENT Go W H.IVIeI 6 r) )4 mm: )V;PA 6rM77d MAILING ADDRESS (ifdifferent) OWNER'S NAMEM/A p� Z,&e G2r2� TEL ADDRESS_2L /� uGr of 2/ /�h�/� S/- 114 CITY STATE �+ 1 / ZIP CERTIFIED FOOD MANAGER'S NAME(S)�nh C-rarL)h ' CERTIFICATE#(s) (aZ. (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# JELI� /-Q40 f- HOURS OF OPERATION: Mon.1-1—Tue. Wed. cLL1 Thu. _Fri. Sat.12- Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO / less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $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. Furs kGChapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my be o I dgeli f, have filed all st tet x returns and paid all state taxes required rider the law. ?- 1 8� 9 k � Signatur V Date Social Security or Federal Identification Number -------- - --- ------------------------------------------------------1------------------ - - ------------------------------------- --- ---- 11 /03 FOODAP2.adm Check#&Date l `I f i` f! 0� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ g 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741.1800 ' FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, R5, 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: Boston Hotdog Co. LLC Address of Establishment: 60 Washington Street Owner's Name: Lawrence Scaglione/Joseph Ganti Restrictions: Application Date: 10/22/2003 Permit for Food Establishment 326-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • e 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 e TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �7 7 NAME OF ESTABLISHMENT RC& 11 I'�JaW CCS L. - C tt TEL#17/1p' FI (7 >-901 ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) 11�� (S I� (� ►UG rl�p.+lr /�4� OWNER'S NAME P ' S6-c- �h G6,1411 TEL# IV'$3(o-96/� ADDRESS 1 M n r5I C U CITY_hjn1ti(1v. t_ STATE VYI A- zip 61 K'6e CERTIFIED FOOD MANAGER'S NAME(S) o�h CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ltrlilLeo HOMETEL# HOURS OF OPERATION: Mon. Tue._Wed._Thu. Fri. Sat. Sun. TYPE OF ESTABLISHMENT � — I FEE check only RETAIL STOREES ' NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 a (' more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats -$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE <ZED NO 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. Pursu to M Ch ter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bes wled ee n lief, rive filed all st to t x returns and paid II state taxes re uired under the law. ,u, ( / acv 770- 4 �.Z 37�Oy ignature Date Social Security or Federal Identification Number Revised 11/ / FOODAP2.adm Check#&Date /31/p/— P. 7-0-3 V LAWRENCE J. SCAGLIONE III 53-7129/2113 1568 SUSAN M. SCAGLIONE PH. 781-581-0009 71 MAOLIS RD. DATE e NAHANT, MA Q1908PAYTOTHE i a ORDER O^ �� DOLLARS Ll s ✓7 NQUHSH REM LOCJ /1PPwbody,MAA' � 0�19660 7 1: 2113712981: 8006 i4 6 9' r S CITY OF SALEM g BOARD OF HEALTH r Establishment Name: gasyv-n 'Z4., 4A0 t �i /./t Date: /G-,2 "q Page: / of / 'i Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R-Red Item PLEASE PRINT CLEARLY Verified I I I fA�`E'�-OOPiYlir7i/0 /,v^.�C/fl�r�J / /i7Uf� /�P� / Ji7i17L / �7nJh//,Q n.n/_e- Citi» 11-210 to I C it�7/v iY.O�,ii//!` 1.1-a?. C f�L/C IXpP./I i I j 1 t I I ' I 1 i Discussion With Person in Charge: y Corrective Action Required: I ❑ No I ❑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 comply Exclusion fidr n ❑ Re-inspection Scheduled Emergency Suspension with all mandates of the Mass/Federal Food Code./uefand that/noncompliance may L11 result in daily fines of twenty-five dollars or suspension/(revoca nn of your food permit. ❑ Embargo L) Emergency Closure \7f/ Thr s ❑ Voluntary Disposal ❑ Other t , i FORM 7348 HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures y Factors(Red Items 1-22) (Cont.) According to Law Cooled to1°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF 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/45°F* 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°F* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-80L11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Critena* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3.801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* ERecbve 11112111 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* I 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.*I catering,mobile food,temporary and 3-401.1 l(A)(2) Ratites,Injected Meats-155°F 15 Sec.*I 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 3-401.1l(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 4 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Cade and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 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(8) 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. CITY OF SALEM nn 1 / BOARD OF HEALTH Establishment Name: 9-�n_S-, n 4-14 ci C//�� L LCD Date: / 0 -1-7- 03 Page: 1 of / t Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red ItemVerified PLEASE PRINT CLEARLY/ / /P IfMI,� asp 1✓/5j��n.� irr,, O + fNIS V T/ i' I.Vrr ` �PCI'YI�/r�l� /vl �( ��'✓Ci /.L✓1 L'4_i ( /J /`Y-Gl kQ � I:.✓ �� • (�C-X . .2� n.�_ � a-� f 3 nom, I Ir A I 4-&A4 i�5�� ,_ n ✓�.� s�.l��s Asa - /✓1 /a�1ti1(�. GTS 5lht ! /7�Lcl • �J� r6>v-5 �v// /e,r /9,6 i �Jo7��Jr�i� /f-M )J0i,.P�a a �i0', i in -3 �ilrs-c.. !� F 5!-I/ LL J/ l22 ✓0/' JOSdfd_ I ✓ +Al/ ✓P �( q.��ale..� /iuwl�-� �1cc.rJo- /�k� rTQ1 ��,zcs I = ;L0 UPIcc „ orte/ ece. 04 AMJ- -41--ke, - -mak.. X6.1 o ( -Fly/ea /.w 4- Discussion Discussion With Person in Charge: Corrective Action Required: ❑No I ❑Yes i I have read this report, have had the opportunity to ask questions and agree to correct all :1 voluntary Compliance L11 Employee Restriction / c Violations before the next inspection, to obser a all�eonditions as described, and to comply Exclusion 1 1 ❑ Re-inspection Scheduled ❑ Emergency Suspension with all mandates of the Mass/Federal Food lode. I��nderstand that noncompliance may result in daily fines of twenty-five dollars or suspen�sio�evoc tiontion of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS a WARREN - BOSTON \` t V J Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures n 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 I I Food or Color Additives 19 I I PHF Hot and Cold Holding 1 3-202.12 I Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 I 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°F.* 7-102.11 Common Name-Working Containers* 120 I 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 I Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.1](A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1l(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801 11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Ebecnve 11112001 3-401.1IA(1)(2) Eggs- 1557 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish.Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(6)(1)(2) Pork and Beef Roast- 130°F 121 Min.*I catering,mobile food, temporary and 3-401.11(A)(2) Ratites,Injected Meats- 1557 15 Sec.*I residential kitchen operations should be 3-401.1 l(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 17 I 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* farad 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. Manaqement and Personnel FC-2 .003 f Roasts* 24. Food and Food Protection FC-3 .004 f 18 I Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 J 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbinq 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 CITY OF SALEM � � BOARD OF HEALTH / Establishment Name: ,� 1C��1�U1 f7�/CEJ ZiL<L'_ Date: i__12X�3 Page: / of Item Code C-Critical item a, ,DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified " PLEASE PRINT CLEARLY I I � - {��u1� nGtz)cccs Cw---) I U I _ I I I ! ' 1 i Discussion With Person in Charge: / / Corrective Action Required: I ❑ No I ❑ 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 comply with all mandates of the Mass/Federal Food Code. I understand that P ❑ Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-501.14W) PIPs Rurrvrd at'i'en,perattrres Viol.slots Related to Foodborne Illness Interventions and Risk Accnrdi.nL,to Lvx Cool"eo to Factors(Items 1-22) (Cont.) .I I 'FIdS'F Widtin Y Planta PROTECTION FROM CHEMICALS 501.15 Cohn, Meths:ls f6r PHFS 1q Food or Color Additives 14 PHF Hot and Cold Holding 3-SULIEi(tit C'(,]itPI-iFsMrird.,:neuatuibelow 3-202.12 Additivesk ( 590.004("1-", 41-i4J" F;: 3-302.14 Protection from Unappivied Add iLives* If 3-5('1.16(:1; Hot P117s Minatauter at or above 15 Poisonous or Toxic Substances i 1409' ` 7-101.11 Idennfyinzlnfornetion-Original ' Stii.!h( `,) Roa:,,:HzldatOtaUo,el30F' Conta ncrc" 7-102.11 Common Name-Working Container," ( it 21) I Time as a Pabiic Health Control 1 7-'01.11 Separation-Storage' 3-50:.19 'trax its a Publi Ie al t:Cons rot" 1 202.11 Reetrichun-Preseuce and Use" 500,0-04,1i) 'yams,ace Regw cotilt 7=202.12 Conditions of Use' ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 II toxic Containers-Ptoldbitions 7-204.11 Samtizeis.Criteria - Chemicals* ( POPULATI npa(HSP) 7 204 12 Chenucals lot Waalauc Produce. Criteria, 2f 3,4110 1.11 A) Unpasteurized Pre-pac.katt:al fuioes and 7-204.14 Dryinc Agents.Crttena* � I Be,erage`, With 1Parnin1,, LAci.,,. 7 '_OS I 1 Incidental Food Contact,Lubrtrants„ ( 3-301.1 UP te of Paste.;:;zed Eggs" U 3-301 11(D) Ra,a or Partially Cooked Animal Fv(xt and 7-200.11 Restricted Use Pesticides,Criteria" RasSeed S}wont:;Nc Scrvtd. * 7-206.12 Rodent Bait SladunO 3-80!.11!17) Unopened Food Package N.�t Re-srrned. 7-206.13 -Cracking Powders, Pest Control and - Monitunng' CONSUMER ADWSWi TIME(TEMPERATURE CONTROLS 22 3-60311 Consl<toer.Advisoiv PoLsted for Con,umpt toll of 16 I Proper Cooking Temperatures for ( Animal Fcxdf Flut: arz Raw. Undereoukrd or PHFs ;Not Othet Wier Prrvres,cd to Elinutale e-4H)1.I IA(I)QI Ep^,s- 155"F 15 Sec, 3-30^ 1; Pasteu tzcl F,-;Substitute for R:aw Shell E_•_s-Immediate Scrvi:e 145E 15sec" i-401.1 I(A)(2) Cunanini ted Ptah. Meats& Game Animals- 155^F 15 sic. * SPECIAL REOt1tREMENTS 3-401.1 I(H)(I)(2) Pork and Beef Roast - 130"F 121 mm" SPECIAL Violations of Section 500 009(A)-ill) in 3-401.1 I(A)(2) Rahtce,Itjected Meat.- 155"P l5 caret ink, mah;!e ttx)d; lemptn nry nod 3-401.11(A)(3) P011 tty,Wild Game.Stuffed PHFs, residential kitchen operations should be Staffing Containing Fi:dt. "+lrut debited ander t€1r_ippropriatc sections PonhrS or Ratites-165'F 15 acc. "' above ifre;ated to foodborne illness 3-,1U1.11(C)(3) Whole-muscle, intact Reef Sroak< iinterventions anti risk fagot's. tether 145`F* 590009 violations relating to imod retail 3-401.12 Raw Amucd Foods Cooked in a practices should he dchued under#t29- Microwave 165`F Special Requucm)ents. 3-401.1 WAl(1)(b) All Other PHFs-- 145'F 15 sec. ' t7 Reheating for Hot Holding ( VIOLATIONS R.FLA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF., 165'F 15 sec. * ( (;terns 23-30') 3- 403.1103) Microeavv- 165"F 2 ivlinute Standing Ctii,ai and nen-c id;Lat i4ola ions. it,hichdo not relate to the Titne* foorlbn(rne illness b,/errcntions and rill hee(un listed above" em+be 3-403.1 1(C) Conr=rcial ly Processed RTE Food- found in th,t Jl,n,ins;Scc non.,,f !7!, Feud Code and NLS CivIR 140"F' 5(;0.000. 3-403.1 I(E) Remamim_,Umlieed Portions of Beef item I Good Retail Practices FC 590.000 Roasts: 23 i Manadsment and Perscnnel ( FC-2 .003 is Proper Cooling of PHFs '2'4 Food and Food Protection FC--3 .004 25 �mpruf i and Utensils IFC-4 .005 35OLbftA) Coolie`,G.K1ked PlfFs from I-kff to - - - - -- ------ o ( 126. i Water.Picmbina and Waste: FC-5 .006 7(f'F\4ithin 2 Hums and From 70''F 27, Physical Fac i iiy FC-6 007 to 41°F(45'F Within 4 HOun. * ( ! 2A Poisonous or?otic UateriaL. FC-' .008 3-101.14([3) Coo!ina PHFs Made From Ambient I 24. 1 Soec:al Hegmiernents .009 Temperature Ingredients m 41'F/.45 F 30 p Othe( i Within 4 Hours" >. 'Denote,int:cal arm in the leder-d 1999 7L..d Code of 105(,Slit 50010110. August 7, 2003 Re: Boston Hotdog Co. 60 Washington Street Salem, MA To Whom It May Concern: Enclosed is the blueprint for our proposed establishment at 60 Washington Street, Salem, Massachusetts. It is the Boston Hotdog Company and will be styled to blend with old-time Salem. Please let me know what I need to do to proceed. I can be reached on my cell phone at 978-836-9017 or at home at 781-581-0009. Thank you for your time. Sincer , e,w Lawre . Scaglione Welcome to The Boston Hot Dog Company Specialty Hot Dogs Sides Choice@of kosher beef Hot dogs or natural casing Boston Baked Beans $1.95 The Hot dog with a snap! Steamed or Grilled Homemade Cole Slaw $1.9 Arizona Dog- with Western Roast Toppings...$2.85 Bag of Chips $.95 Roasted Peppers, Chopped red onion &jalapeno peppers. Can of Soda $1.0, Chicago Dog- Chopped tomato, green pepper, celery, Bottle of Soda Pop $125 Onion, shredded lettuce, sliced cukes , relish and Grey Poupon Dijon mustard....................................$2.85 Toppings and Sauces New York City Dog- Grey iloupon, sweet relish, Chopped onion, sauerkraut and celery salt..............$2.25 Heinz Ketchup, Frenches Texas Dog- Chili, cheese sauce, chopped onion, bacon, Mustard, B.B.Q. Sauce And Jalapeno peppers....................................$2.85 Gulden's Mustard, Grey California Dog- with Garden Toppings.............$2.50 Poupon Dijon Mustard, Diced fresh tomato, cukes, radish, sliced green onions Hot Sauce, Sweet Relish, And Ranch dressing. Sweet red pepper relish, Taco Dog- Cheese sauce, shredded lettuce, fresh salsa No Charge for above topping: Crushed tortia chips.......................................$2.50 25cents for each toppin B.L.T. Dog- Real bacon bits, diced tomato, shredded Shredded Swiss, Cheese Lettuce.....................................................$2.50 Sauce, Shredded Cheese, Baco Slaw Dog- Coney Island Favorite..............$2.25 Cole Slaw, sauerkraut, Sautee Topped with our own homemade cole slaw and mustard. Onions, Fresh Salsa, Chili, Thai Dog- Topped with our secret peanut sauce.$2.50 Any two fresh Veggies. And sauteed onions. Ruben Dog- Topped with sauerkraut, shredded Swiss Cheese and Russian Dressing...........................$2.50 Frank Sinatra- That's right you do it your way....$3.25 As many toppings it doesn't matter we do it your way. All specialty Hot dons Served on a Grilled buttered roll unless specified II. Bostons other Hot Dogs Steamed or Grilled Hot Dog..................$1.85 Chili Dog........Plain.$2.25.with cheese....$2.50 Veggie Dog-Meatless Hot dog topped with veggies..$2.50 Puppy Meal-Skinless Hot dog, chips and a soda....$2.50 Old Fashion Root-Beer Float Real draft Root-Beer with a scoop of super premium vanilla ice cream.....$1.95 ,4!',6;.' rP.":' 'AG f+ .�Z�a- !. i��.2.-j.7,i*k','s•YadF.a'trd�e+a�4'If f+f`/f+S!- '�x.i��.�..�"`/'� ,.1#`, t r: �4'd,:.,r.l,'�tt.4("4'v�(•f�.+'',�., :,�-•2 -.k. Mastachusetts Department of Public Health Salem Board of Health 120 Washington Street,41h Floor Division of Food and Drugs Salem, MA-401970-3523 FOOD ESTABLISHMENT INSPECTION REPORT h Tel. (978) 741-1800 Fax (978) 745-0343 Name ,yyl� D, / Type of Operation(§) Tyle of Insoection ( ,o 6/,;K/0Ci I�ood Service ❑,Routine Address l Risk ` Retail -Re-inspection �_^��( h✓_ 1'v 5 �✓� ` 00 Level ❑ Residential Kitchen Previous inspection Telephone ❑ Mobile Date: .,_� / Q-7 �'-aJ HACCP YM ❑ Temporary ❑ PrA(p r Owner 1Y`A�� S �(�n Jlr� ❑ Caterer ❑ Suspect Illness Person in Charge( C L In:* Time / J El Bed& Breakfast 0 HGeneral ACCP Complaint Inspector ) ��41 1�✓ro � 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_, ,,, ❑ 12. Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Fac�ties 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 El 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): 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 cf Health. 590.000/federal Food Code.This report, when signed below + C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-s)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 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 5001nsps Fom 14E c I I Inspector's Signature: _ '//-� PIC'sSignature: /- Print � 1 (/b a ' r��9 '?`�C Page ages S. ^. V rte- ` l �:.. , Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ( Cross-contamination 1 590.003(A) Assignment of Respon.ibility* 3-302.11(A)(1) Raw-Animal Foots Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge -duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Othcr` J 2 590.603(C) Responsibility of lite person in charge to I Contamination from the Environment require reporting by food employee::and 3-302.1](A) Food Protection- appticants* 1 3-302.15 Washing Frits and Vegetables __ f 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* ( z.31)6 14(A)(B I Returned Food and Resea•rce of Food* 3 590.003(D) Exclusions and Restrictions` Disposition of Adulterated or Contaminated 590.003M) Removal of Exclusions and Restrictions I I Food rDiscarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 1 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Fond law* 4-501.11 I Manual Warewashmg-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures" _ 3-20 L 13 Fluid Milk and Milk Products* ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shelf Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products. Pasteurized* ( 4-50L114 ( Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water' concentration and hardness. 5-L01.1 l Drinking Wulerltum an Approved System" 14-601.11(A) Equipment Fool Contact Surfaces and 590.006(A) Bottled Drink,,ng Water* Utensils Clean" J i -602.1 L 590 OOO(P,) Water Meets Standards in 310 CMR 22.0* Contact I Clearing es and Utensils* Frequency of Equipment Fond- Shellfish and Fish From an Approved Source 4-702.11 ( Frequency of Sanitization of Utensils and Molluscan Food Con 3-201.14 Fish and Recreationally Caueht tact Surfaces of Equipment' Shellfish* 14.703.11 ( Methoik of Sanitization-Hot Water and f 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ! Game and Wild Mushrooms Approved by to Proper,Adequate Handwashing Regulatory Authority 12-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms" 2-301.14 When to Wash* --� 3-201.17 Came Animals* i 1 i Good Hygienic Practices I g Receiving/Condition 2-40LII Eating.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper TeniperatureO I( '-401.12 Discharges From the Eyes, Nose and 3-202.15 Package httesnity* I L Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-1-03.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Dication and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packagingj ;enteric* ( 6-301.11 Haudwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures` ( 6-301.12 Hand Drying Provision i Denotes critical nem in the fedeiA 1999 Font Cale ni 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: ��' /0�`r��6— Date: /"15C/ Page: of I nem Code c-critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ference R-Red Item - _ ' PLEASE PRINT CLEARLY ( Red No. ReVeri �/,)4,4J 1,1RVOriyD .�/ fn.� �1j� , vlV+ /T,I I C � I �Il ./t, 1 �C)�..I�nn 1�Lfi ✓ r l?cf �, �/1�.�/ � I /ii. �7/l )/}7/111--/-1 f1 I I 1 I � 1 _I 1 I I f Ic Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes j 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 ode. I understand that noncompliance may result in daily fines o wenty-fie dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. l (IL ❑ Voluntary Disposal ❑ Other: Ai � I Violations RalaW to Foodborne Illness Interventions cod Risk PI 1,3v C)'34ed to Factors(Items 1-22) (Cont) A` "FWW.in I Hialis 15 PROTECTION FROM CHEMICALS ior pffl`�� 14 1 Food at Color Additives 19 PHF Red and Cold Holding i :' im Itii'tIl Colt;Ffflas Memzained at kT 6,4ow 1 004(li-) 41V4<- 1- I 3-302 14 Poatoi,ai lrojaUnavioru,rd Additives' i 1N Ai I�:'i PI-IF'i Mahv„hged it or abow i Poisonous or Toxic Substances tO F 101.11 Womfifinnt triforinittion -Original -%1'i Holl'a i'l ��bo,,c I:iWF, cotaai'v-ra` I i 20 Time as a Poialm Health Conti of m2 It Ckimmoit Nari,e- W,irkirn;Cotwiin'.r"k 7 2ot J� S�:Pal won-swaigc` in,a t`nblic Hoalth Civrv& K:rancc Retanfiivlcns 7.2U2.11 R eeu ici,on -Pres,.ncc and L,k!' 7-20212 Condition.,of I I Toxic Conlainerz,-Prnlnbrwu,. I RE-QUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Bursitides s,crittxia-chikmic'ls^ I POPULATIONS(HSP) '_6A.!2 Chemicab,ior'A"whing hokliate.Oiteiia- ;-sm 114,1,' Llzllvireljk tzt:d fin, pa,t' and It'vetilaes with S'4arlvng 7-20S 14 Ditking A L-tic,Criteria -1, 213,1'11 1116&filal F,x,d Coriao.Luba wants' 7 20(3.11 med t:se Critei 1�)' z. t: ihDl "r flatliall'. ('*',*(-k1 AntinA Fouil dnd Rat, 5,.'d Fproalfi Is".1 7--'06.12 Rkifical B"It staw'w I,!it ipen^.i I Pak k.4's: Not RO-S'rved '06 1 Tracknig PoNtdc'ro' Control and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 123 J,!; i t :oe;unvj "kIk 1e"!v iiw,i] !',r( tmSnbnv6.1n of I to Proof,. Cooking Tempel atures for( ( pHFs ftltwgwisc f'v,ce%!kM to jt�rnqlate 1-401 11 MI)(-,I 151'F 13 114:."ziNti!uIv Ito) Rax'Shell 0,inwlriw^.j f7k,h- Mcjl,;& Gainc SPECIAL REQUIREMENTS 13.401.1 1(6fi(I 11 2) Ptak and li,vi Po;ia - 130Y 121 min' ill -Setlion in 3-4-0 1.)1((4)(21 lime,, Inject-,d Mcat, 1`5'F I.,, thlerinti, molsil:, kvd, lciopira(,, and 44111 t I(A j0) Pklnlrry' Wild Qwl!: !k1utri'd PI-Irs, I re'Md'.inw! t:401k'l op'latton", %liQk I ILA IV Sinifilw t-iiatawilci t'lsll. hiedi, i1 0'Aloctill undcr ilm 8J1); UPI lata q_'10[kills Ponlitik"or Raotcs-165'F 0 s,v. aii xwe •r,-I ii I ed to fkxxilit ir'n I: Innes ww risk Factors. 0[lit-r- 1'40.009 -ioLitiow; r0a6m, j(1 711kd rk;tail Ui.l2 Raw An4raal N,,KJs to a ynn:IfLeihoold I)c debited under #29 - -4o 1A I(A J(1)(1)) All Oniti PHI i 1.1i'(• 15 kc, 77 Reheating for Hot Holding VIOLA TIONS RELATED TO GOOD RETAIL PRACTICES 3-41,11.1 ItA)&ffo jrk5r14, 15 sec. ^ I (11vnis 23-At)) iG .1IeHNwl ith do in; rekre;o ifirtrt Time, 1;W(dCd'.ovr ('m in, 1-401 lhri ('Onnnetk Tally I'roi:e,k,d RTF: funnd in (4:he i'a"d L f'de und P)i("fIR 140 1, W) Rcinamin',, Unshoed Potions of Bi•ei from l Good Retail Pructires FC 69II01W.- "'3ManfiqPiannt and FG 1_063 Proper Cooling of PHFs -24--..-' �:Ikld P;Ofiec�w' !-t. 3 1 -004------ 15, 1 Fw�pr.L-nt and ut-naita :4 �AOI I RA� Cooling coola�d PHFg I'mrn I-vii F it) 6, Vvotfif,Plumbinq kind'Na;te K-5 1 006 701, Withni 2 dour:.and F 71 1, Ph J, FC-5 007 t,i 41'1-/45'F Wiflini 4 Houki,. 2r� Is rc. - 006 3 501 148) Couliul;PHFn IvIidt Frkli.i AwNein I "I '-' i= Temperature litzge,ficin s i, 4 lF/45'F gO Otl Within 4 jikm�" 1)on, es.:rtii: l stent iii iht t,acral 19°9 Foul Cook,"r In'('sla 5YiNK", iF,4 --r b3 Massachusetts Department of Public Health Salem Board ofHealth f 120 Washington Street,4t"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT , Tel. (978) 7414800 Fax (978) 745-0343 Name ^" ( DaW / Type of Operation(s), Type of Inspection -aCd 0 i Z-Food Service D_Ioutine Address �nv �, / J n 5 Risk _3 Retail El Re-inspection r vvwu' f _ Level ❑ Residential Kitchen Previous Inspection � Telephone El Mobile Date:GI'1� Owner HACCP Y/N [_1 Temporary ® Pre-operation �j ��^p/,��I(/) I ❑ Caterer [] Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In:, Z-. [3HACCP Inspector I �/� Ouf:g�-;- Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. `FOOD PROTECTION MANAGEMENT '"�' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 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 El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ' ❑ 4. Food and Water from Approved Source TIMEtrEMPERATURE 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) } El 21. Food and Food Preparation for HSP El 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): 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 uf'Health. 590.000/federal Food Code. This report, when signed below C- N by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) ) 23. Management and Personnel (FC-2)(990.0 order of the Board of Health. Failure to correct violations I 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)(5so.00s) 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 501ns10Fom-14eac /r'T ' Gj Ir Inspector's Signature: Print: �\ PIC's Signature: ,(r_ �� Print:( " �\t t Ct , �'� I Page of ges I p. R Violations Related to Foodborme Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S j Cross-contamination ' i 590.003(A) Assignment(if Responsibility* ( 3-302.11(Aul) Ram Animal Foods Separated from ------� 590.003(B) Demonstration of Knowledge" I Cooked and RTE Foods* 2-103.1[ Person in charge-duties j ( Contamination frorn Raw Ingredients 3-302.11(;1)(2) Raw Animal Fads Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by foot employees and 3-102.11tA) Food Protection* applicants* 1 3-=02 15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Fool Employee Or An 3-304,11 Food Contact with Equipmem and Applicant To ReportTo The Person In j utensils* Charge* j Contamination from the Consumer 590.003(6) Reporting by Person in Charge* j 3-306.14(Ml Fl) Returned Food and Reservice of Fucd� .1 590.003(D) Exclusions and Restricilons* j Disposition of Adulterated or Contaminated 590.003(3) Removal of Exclusions and Restrictions j I Food f 3-701.11 I Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE Food'-' 11 4 Food and Water From Regulated Sources E 9 Food Contact Surfaces 59U.004tA-B) Compliance with Food Law* 14-50 L.i 11 Manual Warewashing-Hot Water 3-201.12 I Food in a Henueticall}Sealed Container* j Saniti ation'rentperature.0 ! 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized'* j 4-501,114 Chent cal Sanitization-temp.,pH, 3-202.16 Tee Made From Potable Drinking Water` concentration and hardness. 'r l 5-101.11 Drinking Water from an Approved System* 4-601.11('4) Equipment Font Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 1 4-602.11 Cleaning Frequency of Equipment Fool- 590.006(B) Water Meets Standards in 310 CMR 22.0* ( Contact Surfaces and Utensils" Shellfish and Fish From an Approved Source 3-,^.-07.11 Nish and Rec�ea[ionally Caught Molluscan 4-702'11 I Frequency of Sanitization of Utensils and I Food Contact Surfaces of Equipment" Shellfish* ! 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 I Molluscan Shellfish from NSSP Listed ( ( ( Chemical* Sources* ( 10 I j Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.1 j Clean Condition-Hands and Arms" Regulatory Authority 3-202.18 Shellshsk Identification Present" j 2-3O1.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* j 2-301.11 When,to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition j . 2401.11 Eatine. Drinking or Using Tobacco'' J 3-202.11 PHIFs Received at Proper Temperatures* j 2-407.12 I Discharges From the Eyes, Nose and 3-202.15 Package integrity' j Mouth* 3-101.11 Food Safe and Unadulterated* j 3-301.12 j Preventing Contamination When Tasting" 6 Togs/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Emplovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 ( Records,Creation and Retention* j 5-203.11 ( Numbers and Capacities* 590.0040) ( Labeling of Ingredients' j 5-204.11 j Location and Placement* j 7 Conformance with Approved Procedures i 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying I 3-502.11 Specialized Processingh4ethods' Devices J j 3-502.12 Reduced oxygen packa;.>ing.criteria* j 6-301.11 Handwashing Cleanser, Availability 8-103.12 j Conformance with Approved Procedures" 6-301.12 1 Hand Drying Provision 'Denotes critical item in the federal 1999 Pool Code a lW C:MR 590.000. t � 'M CITY OF SALEM BOARD OF HEALTH / 2 1 Establishment Name: �—�5 �(�f !/�1 Date: �O/��i/�i Page: ra- of 7 4 Item Code C-Critical Item d DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ' ' Date No. Reference R-Red Item Verified t PLEASE PRINT CLEARLY I�� d-G�.c� 1—a,. G 1 i�r�✓t�- G��n 12,C n, *V C)s�I �,2� c�sd�rr ��He� ✓ r IIr2 r�)-cca�:r� �F �t�t GoMa�v�f �Qvc Un, I- c Fn�f1�- l ��il N. cboa A( I/ 7 )w L*"u t-:�?v. A/ ✓n , _� �.ri, ri - zn life r. 6Dd-t J os[S 11- 4z" TA'b cLsr url 1 f - CA-kc b <n I C'&MUh {{ .sot- Ci3 50�� /� n J IUY •140 CUV Pictd' [J 6-- 4y _Q i Iv Discussion With Person in Charge: - Corrective Action Required: ❑ No 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 � e-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 I your food permit.` (1 n Q�C� ❑ Voluntary Disposal ❑ Other: +-50!.14((:) PfIFs Reurved at Temperatures -� Violations Related to Foodborne Illness Interventions end Risk According to Lau Cooled to Factors(Ilehfs 1-22) (Cont) 41`F/45`F W'itbin-1 Hours,_z PROTECTION FROM CHEMICALS ( 3-501.15 Catling Method,,for PHFs 19 PHF Hot and Gofd Holding a-23-202,1212 Arldun 14 f Food icc'r r Color Additives 3-501.16(B) Cold PHF.,Mammmmi at or below 590 001(T-1 41"G}5`1•` i 3-302.14 Protection front tlnapPro',ed Addrures" i 1-51)1 INA) Hot PHP:%taintaint:d at or above 1,5 Poisonous or Toxic Substances Jde.mifvinfoimmion - Original i 14() F l 16!A) j Rwt tt Held,tt or abocc 1301, f Cont<tincrs` 1 --- 'rg 1 Time as a Public Health Control 7 102,11 I C omninu\�;mie� N�:,rkuic{'nni.unar+"_ : '-= —---._---- ' sU n ` � � ' Vtt.rr,�nna.e Public"I,f.eea nt h Cunvol' nn'-201.11 Sepatauon-Sona);c" 7 - < _ :cC,X02.1! Ttct; Pn:Yna mid - I I {:enduion•nf Use" i 12.1)3 11 I 'F,;ir C'ontamcr: -.Proltih:!:oti, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I 7-204.11 baniuzetY,C'hens-Chcuiic,it' �'; — , _ POPULATIONS(HSP) � 7-](}1.12 r'h�.n:ical:.ftn 11'a>fin'P;rn.6tec,iiita,:a'_-� 1 ='i 1ni lir,l) l:npa<tcu:t�edF'm } dlut.ec;,wui I + 204,14 D1 mw Areutt.Cntr:ia' ! f Rereraces with 11",a'mn;:tah:k'. ---� ._ St;:.l CII'„ 1 L t•f Fmta•u:9zCd la±r:,' i7-1 5 1 I _ ht�idrniai },wxl Cunrat!, l.nhriaun!�----'- I .'.;rL i !tftl �2<._�•. or P.w1at1', is v}c<! Auirnal Fiii.J at',d 12.106.!! R:>:n<!eti l:sc l'r..nwlr�.Cnreua ADVISORY i :.>� i•i' -r s�, dF.xri Pn,:'.,:r " ?t•'__.n:r.vl TIMET MPER'ATU RE CONTROLS22 ;:J ti:+ .:.., a .i, t a.. x=:y i',.a d Gtr s>,,,, , ..,.e ' ,__..- .___m.-._.___. __-_ _"'- _ ....._.-.�-_. --_ _.. u. :1 I••t ni' !'stat..a' 3i,r. ;'n.ic:,.:.ia: ' I � j(, ;�i'"'vgrr C-t.+oh,og Tempe(al4+eY t<;r + ,.<•c'-I'tn ,� ; � ii;. � -. ,,..� d i':`a: .a1i,.2`x Shea itC'',:a::n,a:•d h'h. ate, E: t,,.•n, � 7-7 I .};:; n); N'::n �j",-; .aa 1;t',to •f. ,7 - - � ,. ,. ! i 3Ln�ty,(?i2:U:-a `1{,(q}:.:.�\l�t!i; L, i ' ' :. •\ : ..,<:"ta a,. R i+Ii� I:x,u.tai;z'. t3 t'- Ft, ::e:!Q ,'.t!:, 1' .r:i. ti 1 n; at ,:t:nrr :,}'::;.. ,.is 3n:n,u bt t' a1i:1:' .�ant at pf r,.. FL'S'. n..,.. ' 1 t ....�t•,i CC, (i n,'.'r 37a'v('i,t1 g;1't.0 t. -,.< ..� 1 a t { 1 2 F ' ' .j ! i?:•}:_,in;, h:; Hof i{.e,r,:r::. __. .P,.-.-_TEL) '-'C } 3 d +7D'.>,tt. r;$ .,.:; .1 :_L 'r G' C:i_;..-, liEiT.ert. ; ^C.:':'. 1-03.tIiA), tt,t ;'iii'. Inv 1_I". .ct: -- Oteni,i W.'4A If H) I V m*ot� tvt- le't-' ? 11tat :�'SI rdin;: C:+u,•'a t+:,'. „<t= .. .. nowt. .'n. wl-:k de rro; .rk:r. : 'rt: 11ii• , .b.,.. .; rR: , :.n' .: ,,, .. :,, raf 1, t:o<< itwilw Ptt' - ,,4 WIV I,.,it jt=rn.'.. .. . +, nc : ?. :.d Ct`rc L, tit. ; p:: ".1;f{ + em E;ootf Mora:'Prarfices ._.._- - t:_C_ __'-_,_ _ ,_4ft3_}I(t'i i?crtivmu.;L'ntiit�i:o K! i<:nY,:!'!},rt Itr : _ _ �,100tP_ :a 1 c --- jg I Proper Coning of PHFs i <i F_ox+:trd;-':at ot,>;t:o,- rC s ;01 i4(A) tlatiineC•xt}.cdPHPFii) 1:1" i }'- .. - - --'--- - _ -- - ' - -i i ,U"F tbnlun Z Lour.,r.d Froin"'i E' ; ,> p-,;,<,,::r„ l,t FC-R _.u^i i i t,;.7i t-/'.5"F 4t';tl;in ; }{nw i 2(tuon.:ny:is `'+•: i 5;)I.i-1(H) I i-r(Allu•PHK Nktdc lat•m.'\m!':ent - jfrmpacawre Inercdlew, a,};';-i.!< 1: •Pte:o.r._um:.a i:•.rv, .ti,=:, .-;:' .':.:+itUt.:;,<.le\•l o`l tih'.o.•...�r r" CITY OF SALEM BOARD OF HEALTH ' Establishment Name: g NA /n;'r7-o /_: , Date: ��oZl�n Page: 3 of _ } nem Code ' ' c-Critical Item DESCRIPTION OF VIOLATION/ PL`AN OF CORRECTIONDate No. Reference R-Red nem - ;, � Verified 1 Y - PLEASE PRINT CLEARLY i ;� I QrarI S -C' `jV,0i% Gcb�, y� I [� q- ) NJ'i ✓- 1/.� n<l C /l� 17;)CC !"k.)1 n - 1't i AA L,1I f X77 s�'. -]-1 J � /�7 'Tl.� T I/;Y.!)IAQ, l r " v ' !A 4L - I I I 1 1 t � l Discussion With Person in Charge: ,Corrective Action Required: ❑ No of Yes I have read this report, have had the opportunity 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 f P L�F' nspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that Q noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (�) � � 1 — '~--•. t ❑ Voluntary Disposal ❑ Other: Violations Fiala"to Forid6orne fitness In fervent.lorill and Risk [,az' to Factors(Ifilhas 1-22) {Cont.) 1 4 1"F/4,"F Within I How s. PROTECTION FROM CHEMICALS :',.flint rig llliFs I , I) PHF Hat and Cold Holding t4 Food or Color Additives I X01 16(9, Cold pi-fkMail) dimki at fr How 3 301,14 Prk,teoion fromt!naU until Additivcs W Al 1 int PHFs Poisonous or Toxic Substances IWA I IdwilltymIt trltomiaiiorl -Original Colltaille[N 0 Time as a Public Heatrki Conti at 7-1,12,11 Cwastion Narn,- Workin, T,;mv �s a Putfic 11�.dth 7-20(A 1 S'Pamlwrt-Sit)!hgo- -, I, Rt:qHcoon -prtiu rict,md 1,1";, Condition.,,fliv., REOUIREMENTS FOR HIGHLY SUSCEPTIBLE I Toxic Coltialm" P Ul ATIONS!,PPCF) 204.11 Saniliz%r,.cmtt�rlv -Ch,lnic:,W -0-P Pre-J!nk1,,,gCd tno -04�12 Chk�nllcats fol W-I>hil)e iii"ditcc C(it'll ia" V"arglill). lab-1s, 1 7 10 l,is Dr-.lug A,,,imm Cra,,riw° i 7— Sit s'(It; U,Q pa.wqli l:e.-I i i- - XI Cvnlact. J-Alb!leant,1 NX)d:Illd 7-205.I1 R,Yirwl^d U;lv Pe,midtts,Civetia' 7-2()bjl Rmieril Bell slatiml�,- Raw St td Sprow%Not Slryt-1, lior,;lcu Y-1,,,,i P3,1'ar, N,(,l R, I wcl,mg P:-m(ontrol and CONSUMER ADVISORY 221 140 ti Ad' TIMUTEMPERATURE CONTROLS !,oq,Ij far l"'msompu(n it 1 16 Proper Cmkirq Taaptnatutes for A�iio;.:l t1wt ,,!V Raw, PHF6 Egg- (5:i,F 15 s•:,. -151CL- Fl�� lillh.smul'. to! RawShelf 1159 I(A)f l) (-mn.mnw,\J Vish, ,,feals ",6jitic AwTvac-, I'.I"F L', .Cc, 3 401.1 I(BOY2l Kill, arld tk-ef Rlmm L:01` 121 roinl' �5PFCiAl, RFOUIREMENTS i,-4-6 —H -,-— I (Att') R,!Iite,, ll�jllo�d Witt'- I�s F 1,� i-45LIHA)!3) floultr. thrid rutile, Srui,*,cd Pilp'i, "hould K, CullfillC Fish. Allam, d"llsted the apprupri'tte (CCI lom Atuvo it r-:Ued to folsihomw blum BeJ iwi w;itlow,alt,! ist faclors (W)cr (45°F t' mia6tm,relmizw,to ,jo�A retail. 3--:01.12 Raw Animal.PoWs Cft ked m priloit'i.N holU 1�c d0);ied vnititr �29 - SIl"',sat Pt-rqlarellmltl loA)(I)tb) All (Irihei Vilk 14S"F 1,5 sec 17 Reheating for Hot Holding VIOWJONFrLATED TO GOOD PErA&PRACTICES 401t Ii AMU])) 1'1[f. I65r11i I-,StC, (Items 23.30) r- Nlinutc sEandli!t; cliin i -Illd nzw, whl,h down relaw',:lw tall lir 3-463.i I it,-) Commm ialiv RTY wim,'in th. lwr.V vi the 1,;i,li Cd,,an4 J05 Cilil? I (F) I Rf-maillin, ulk,,Itced Portlon<of I Good Relsid Practicl.,s 2 N' 24, F,xid;)rld FGw fit Proper Corillng of PH.FS 2J I C: --4 006 C�Yok,:d PHI-s fi,om 1,91\V it, Sol,141A) i Col,lin� 701'F Within 2 1 lour,awl FrOirk Phys—al. rc-o 007 501,H4 B) Cooling 41r., "Viade Fs'on?Antihero 21 41 '!0 ST ty Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,0 Floor 9 ( Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT ` Tel. (978) 741-1800 Fax(978) 745-0343 Name '1; Type of Ooeration(s) Tyee of Insoection I ] �C{al� O� �,t. r-> e,ne ,,.-i G,ll�! U� [JLFood Service ❑.Routine Address I t I t Risk ❑ Retail ❑ Re-inspection fc f lel^(^ • A , ^ C ^_ Level ❑ Residential Kitchen Previous/Inspection t Telephone C �Qi� _ ) ❑ Mobile Date: (r of -•,., - 1 Owner t _ z HACCP YM El Temporary El Pre-operation .,! �^'�?]d�C.7j n� ❑ Caterer ❑ Suspect Illness Person in Charge PIC) ` u r" Time ❑ Bed&Breakfast ❑General HACCP Complaint In�0) ❑ Inspector 5 Permit No. ❑Other ti _A Out: /(5 Each violation checked regbires an explanation on the narrative Out:/I% and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT' ' ,' . ., ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH . .. ;; PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [115.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source tiMErrEMPERATURE 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 I, i'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) El21. Food and Food Preparation for HSP El 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): 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing ^28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:,_ S 50MVs (Fo,m&taeoc J"A( Inspector's Signs Print: -l) PIC's Signature: PrintwaLI P,aageoT�qof 7 , Pages A /9y�- - �l ,V ✓ v Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I 590.003(•4) I Assignment of Responsibility.' I 3-302.11(A)f 1) Rate Animal Foods Separated from 590.003(8) Demonstration of Knowledge* ( Cooked and RTE Foods* _ 2-103.11 Person in charge- duties I I Contamination from Raw Ingredients 3-3 0211(A I(2) Raw Animal F x ds Separated from Each EMPLOYEE HEALTH Otherr 2 590.003(C) Responsibility of the person in chatge to ! Contamination from the Environment requirc reporting by focal employees and 3-302.1 t(A) Food Protection" applicants" 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fool Employee lir An j 3-304.1: Food Contact with Equipment and Applicant To Repott'lo The PeP40n In Utensils" Charae* Contamination from the Consumer 590.0(}3(6) Reporting bv Person in Charge* I 3-306.14(A)(B) I Returned Foul and Reservice of Food* I3 590.003(D) Exclusions and Restrictions* Disposition orAdulterated orContaminated 590.003(F) Rcrrorval of Exclusions and Restrictions l Food 3-7C1.1 i Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE food* J d Ford and Water From Regulated Sources j I it Food Contact Surfaces 590.004(A-8) Compliance with Food Law* I4-501.111 ManualWarewashme-Hut Water 3-201.12 Focal in a Hermetically Scaled Container* I Sanitization Temperatures* 3?01.13 Fluid Milk and Milk Product::' 4-501.1!2 Mechanical Warewashinn Hot Water 3-202.13 I Shell Eggs* Sanitization Temperatures* 13-202.14 F. gs and Milk Pr<xlucts,Pasteurized'* 4-501.114 Chemical Sanitization-temp.,pH, 13-202.16 ( Ice Made From Potable Drinking Water concentratton and hardness, * _ 5-101.11 Drinking Water from an Approved System' I 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Clean" J 1590,006(Ei) Water Meets Standards in 3 10 CMR 22.0* g Frequency of Equipment Food- Contact Surfaces and Utensils,. SheAtish and Fish From an Approved Source 14-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish' 4-703.11 I Methods of Sauiazation-Hot Water and 3-201,15 ( Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 I Clean Condition-Hands and Arms* Regulatory Authority I 3-202.18 Shellstock Identification Present* I 12-301.12 Cleaning Roadure 590.004(C) Wild Mushrooms' ( 2-301.14 ( When to Wash` 3-201.17 Came Animals* I 111 I Good Hygienic Practices - - $ Receiving/Condition I ( 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper TunperaturW 12-''101.12 Discharges From the Eyes, Nose and 13 602.:5 Package Integrity* I Mouth" 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastine"_I A Togs/Records:Shellstock i 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification I 590.004(Ei Preventing Contamination from 3-203.12 ShellstochIdentificationMaintained* I Emplov -rags/Records:Fish Products I � i3 Conveniently Facilities I Convenientty Located and Accessible 3-402.11 Parasite Destruction* 1 5-203.11 Numbers and Capacities° 3-40'_'.12 Records.Creation and Retention* 590.004U) I Labeling of Ingredients` 15-204.L 1 Lcx;ation and Placement* 7 ( Conformance with Approved Procedures 5-205.11 I Accesstbility.Operation and Maintenance _) /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser,Availability - 18-103.12 Conformance with Approved Procedures` 6-301.12 Hand Dry n Provision .Denotes critical item in the federal 1999 Foal Coote a 105 CMR 590.000. a CITY OF SALEM ;7 I /J" BOARD OF HEALTH Establishment Name: r5_I�J�Y�_ i"/,tt i;Z6 �iWA�lAi�ty� `' Date: /( ��Ka Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item = verified PLEEASE PRINT CLEARLY / n t t t z �A ), n�l„ �.� 71ZAAe' /'rC'_n1\ � SlIPC A V_Pid roCi,..' �5 - 4r00 IrWWJA1/Ci4_ C(AYKIti5 cva- Lwo ofd—j< ,44C c7� r✓1S,-i 44 0, Ii fs. ( 12.PC� L W% G 10 NCswr )-AM � Ar CI-4e d 60Z) ._7 ()�i&C-oat cV s 4.3 �� L� �Gc Co(., u/0- A)," GY�Ir✓Ir�, � I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ 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 comply with all mandates of the Mass/Federal Food Code. I understand that P i �e-inspection Scheduled Li Emergency Suspension noncompliance may result in daily fines(6f't enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: v i i_�- _,501.1** I PHR Reu rved at Temperatures Violations Related to Foodborne Illness Interventions and Risk Atxording to Lau Cooled to Factors(/tents 1.22) (Cont) -11F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 C.rolin 4cthods for PHFS 14 I j Food or Color Additives I 19 PHF Hot and 60id Holding 50!.16(B) Cold PHFS Maintained at or Mow ;_20212 AddniveO 5%O(WF, .41145"F` 3-302.14 Protection front Unappro"ed Addnrvc`' ! i-j(31.16;:\j Hot('H} > ntaoed at or above taiif Poisonous or Toxic Substances 1 J MIA/ I IdentdyingInframation - Ougina�. --- >—i-- -- l4ft'F I Containers, "!: i NAI 1 RI iris Had at or above 00,1: + _ Common" { -- �' -.-..i T:rce as a Public Health Control + 17102.11 Common Nsme - t\',n•kiu,{ .'nu!----` 13 --'-- - "_ ! fi•2,'asa!`uhF„H;a1;hComral" � r-2tJLl7 _ = ---- . :C ne.ai7iC9ieli{ ('!s:ncc and t..r^ 7-202.12 (',�rldrtiun,u(ly,e" i 7.203 11 1 T„xic Conwine[:,"-Prolnht!,+a,,,,. REQUIREMENTS FQ;3 HIGHLY SUSCEPTIBLE POPULATIMIS {HSPS-- , 1 7-204.11 � S.ati;irer,.C'[nrrin -C'hrmic,!c^ I ;-,r1! lhA, t _ 7-2 ?_04.12 ! Chemi,,ah t`n Wa>hn v,F•�+uutc,to ittr.a' 2 t, Llrtp::;,euri<ac 1'rc p ci,,ecd hues and 7104.W i Dpgnf;Amni .(:merit- L__ 1-7-05 If _ � 111nd:•rta! t-:xxl t'„ntact, tAdn!cate.__ -------------------- 'i •-ia.:. I !” 1�'IL� �:r I?t"j1:3!l`. t_141n1ti 'Ln!IrLil FrXA Ind 7-]06.!1 h,r�t!Yled t se Fe>!r.:dt•r' C Ittr,r^_ - { . 7 _ti_rJ `::otn, ?.,_, Scrrc.i. -rD t t ! 11.lC{,flt{t'''.d,irr:. I ":(.trtYt„f•t`:3 ,. "_ _.... .. _ _”__ ,C, ors ! I � 14 ADViSonY Tlt>r MEMPERATURE CONTROLS n l'cttt;atn:tti,:n<,; -----*---...----' ---'-----...—..—__.-_--- .` --._.. ._. .. i � .. , i •11. Fiat ...r iiS1. Undcr,.,oi,.•,t, ' i i;= � � Pro£.er Caokicg Tetrp?!,*sun=e--e: � YNFs � • ,. ,,,.., i'r,- ,.,(?lit ,uta e ; , I .,c." ic.r„�•:i,as. Se, n t :- t,lI. tat 5ic`I i--i Powe, c i c:: i ' „'•,";k:i,>.,::. :.,:It t+Ya;` nild : .i{,E,I IfAp, I I P,a:tr` \°i if9 j,t. ! i !, v G. }-,!C``")if. Aa.l(Oi:;,,.ho+atl hr �1t:nd C'",L"....P t'. b,,1. I,r..• i ..'•t .+ U.; ftl.:gj,::r:.,; Aft ,.A:pn.; V. F{,i-ai,`F(.' ,-ilr.0 r..:v rr .:_. j +--24�.f i,.4i,\.U;'• ; t_,:I., it'S''F is :c i ;au;t.r; 2:_361 3 Flt?.!i�tsi 1 ,`a::o•.+r):• U.a F=: ;,ieit,:r`,�,!r.,L`�c ., , ., ,,::::.. ., ,a � .,,,. .. :,• ,-t:,<. ,.. �<:-r,,. . ,,,� , _ 1�I;T! ',q+t7%' n t:'7.: e ..,r. :HP. .,, .. ,:,r•� +<L. r: G+'<'=t df'n,r r;;n(a• in0?.i I{c'j— i C',;m:n; iaih;P:o.,..td It'll 1',.:{ __" . ,.. .>!:F: i,,.t.,.. �•..... , �.7 '1?..<, .-",i<'_....' t'i` !'dfl; i . 4( b +...•vu V,,F! ,,,, • p,:�, tram „soC ^,ead Praot:;es t'c "530.Of}fi P:;4 )r.,:Yi ---{---- f _ ;vv_t'+^;i�tr xi r*ev't.�; , Ft _ (KA 13 Proper Cooling of PHFS _ . " __ __ ..__ ___ " i(21 rSt AI ;'t n+hne Gx,!,•,t PHI-r ht,ui 1kt`i Pu rr - __'_ .r` _ ._. __� _ i it;•P W!imn ' (4,tu:.,"d limn 7;PI' - --,--c, - - ----- "-- - -- - 4 ,' r'�.6::f.. .: :i!j QFC-r .007 f 'ti;hL:n i Hom c _ - !s�:r'.,x::.";'-:er.•:'a PC_ i 003--- - ,:nti •ra,um }n rcd,ua=t.•-i, t,-iS1 i oo- . "_---- - _- _"- -- - �; -_ + 5tl i,id,it ' r„u.,I:r Pl1F, ,,euh 111 9., CITY OF SALEM BOARD OF HEALTH Establishment Name: �J� I i �I /� tit/b4rt�c/.X Date: r_„tl c 9-( j� Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ✓' Date: No. Refarence R—Red Item -verified PLEASE PRINT CLEARLY - - _1 V r Tr n � / �CJJ ;1 fJ;1�-11A� C�nffOA,?_(,.vsOnT ✓Y 9LIC Un, 1LCl /- 4_nm, Cd_1r1� Ata4Li (I` - l I I1\4 rIn rThM AALY- rrU� d,7 �) �'ao�.(( / !19 fvltr:•An�.,� .1.,�/ /An 'l �in� kJ_.� � , 5V I (I o.�k _ std l%o,l7 CL�h� �/1�rf P vY3 4tJc Ian�) 7 1 1 ,/J, 40 6 rL�in , - f 15� �. � . h l mud c�,iu r =r2.%= I vA��.1C-�— ?v Illr�v !'�,uj7c,nKr A�D.Po�i M�r,r I 74V Af "^MAA) )/1, ei e-,W / a� c ' 1-NYCJ� ✓ Cj J'11CIVU IL( tie o.IPv1 A1.0,_0/ 51 I r^lo-A ul . n � ✓ fZ�� I 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 <ORe-inspection luntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/F deral Food Code. I understand that noncompliance may result in daily fines bf``t1wenty,,-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. \ � N Qi -0— Voluntary Disposal 0 Other: Y �Slii 14(C) PHFs Rec ived at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to LauCooled to Factors(Rents 1-2) (Cont) 41'F/45'F Within 4 Homs. ' PROTECTION FROM CHEMICALS � 3-501.7 5 Cooling Melho&for PHFt, � 14 Food or-Color Additives 19 i PHF Hot and Gold Holding "l-501.16it1) Cold PHFs Maintained at or below i 3-202 12 -Prate tion 590 004(1-) ( 411 /45"I" 3-3112.14 Protection atom Unauprai td Additives` ( 1$ 13S01.I6LA) Hot l'HF<Maintained at or ab,ive j I { Poisonous or Toxic Substances ! tot.]1 Idenitfving tnfnrmahon - Om;inal 140 F. i.i '1 7ht,t? Kt,asit,Hcld at or abvte 130"F „ — 101..11 I C mnu tame - N orlon,6a1:mn.;r>' 2!i _ _ _ Time as a Public omHealth Control — ;"in„`as a Public I lenlrh t'unh'ni' _ J ` ' 20111 � Ka,tii�a'�on -ht's,nccand i s,t;` "tt"{U�H'r _ �(_4,.r,:mcr t,cytort•in<nt -.-� j 7-:('i2-i2 t'.ruhUoa,of I 2t)2 1I T,xi, Cfintamet: —Fitail i:a,' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 2t)-1.11 ! y:fniti;eiti.Crnen;, -Cht-tnic:,k J - -----1 POPULATIONS (HSP) 7 ,r , { ---'--- I `t !-�i!i !ivt) Pr l:n}:a=lenri,ed y patkae,i Juk.ee and -- I 4.1. i t'In•nnc,dstnrt',a'h+i�eY:ot;u:c_C,nena' � , _ i—_--------. ._— —_-_._ �.-- 7- Uicc. ti'arutnyia!"�!s- .74 Ur,ins; :1i;ent .('na'ria" ------ � {1031 1'.':o[Pa.tru.ized F-7 ! :Vt i l_ _ lit;idenlai 1:•vl{'ut•.tar':. 1,ihnc.mi._ — 4I ---`-- ----' i 1{i ti—it niv ar Pal;':+1I} t_,K>}.'d >.a!!ic,7 Fc,cx7 an,i �`.1VIo.!i + F•'.tr,:.,'ti 4',r P;;.ric:,fc•. i�n t::aa` , -----'--1----__- 1-W6.12 —. _ ru . :,,out \'•. ' (' !'i l P„-...v , !iii, u„ a W C'on'tnaption ,I r i TWEI—icEMPERATSRE ONiTSCLS —__.�_--—.._-___.___.__ ,_ . . -' _ :,t.ii,t,11.,.J ;Ian .r� GooKing'i:'!:?ue,aft.res re: , i`, ,- - . t,.i , :obi ,. I . -.;.. � '.• 'r s n .t:• ^ - t }-an - in n,'cd,sic S;• •t., i ”"'r+° - . .. .. , td , i , S"Lv I AL C_La _ _ I ,. .. i ,. .e. ... ` ,ii?t.'r'i ti.4. ':F•:'!:, ia,i:,. ... :R::.f.`,:� IiG i 4:'! 11:-:i) ,iu rt{ih :Y iia i,,:[;', _-. j.f i ,.iv .r i'iLl!"'iw-so Sn•i-1 sit J,+iii, i.6:Li ritd 31-' , '? i.,i; tv i . .... ,. 'i- r .. i n tC # tial I^^d•;t,. "'S' ,5 Y','" z.. n. r -, - r � i ..:1.7.1 it,33A,i;i CHI, (Os i t''a:C tt t itcu,2'-l0}'• '« 10.3.11(kt; bh,,,,n, t„r- If-`�F 1','I't1tt, Si�:a,i!at_ . :r,. .,,., 1 Vt . ,:c%. , v+, nr... � 7!a :.i.�t,i.r/rn� 'G' r .�r, n1. .. •.e r:.¢;,r:b ' i'-:e,i Gi..n rdu 7., ' �;.4rt3.i !,r`i It'.,Jnnct:lu!I} Pan,: ..d !.:'i-i,t..( . ,,rdin iJ—}�r- r s ! Gno+.i F?efa,%P::r<'bnf=s --- i_ ea)fo , ? . !.1.' � iti Pt OitIcz.lpv!•ot'C! !'C!U('a1,,r la'[✓ It Y ftt , ti 'i>hf <a F1:a9fliiti:n+'ri F.'.;}iSQ•:.,•i•9 ! i't,_'_--. :}n_, tg ! Prot Cooling of PHFs -Y4 r-o,tl a"d`act P';;t•:`Gy'-- -.. ___ '_;'C . '__ C, — ' : 5U7 11{ql ! t',><ilin2 C,xik.:d PHG; it,+r;. !•:ft'I'L' _ _ _ _ri-,r--_'_ �-. :_- _. _. _____._�_____ .- :.. __- _i Wiunn t l Ivor.:anri From r t'l' FC-'i 007 ' ac;s.mo,isn 50l 1.3(13) C'in ifu_P,.i(F: M:tdt-i-toni Ami-itnt .'.' 3:'ni'd;F,=.,t::,eincN".. --- ---Gi3 ia!r}::•u:nirc rn ,cninn-ltttwir ' ... , 't,.':ri:v_,iL-":' .. < .:. ., 1,f'.,1. rl,•' : ,IIS ,t). ryi it •-,.r;:r3..y...1�� ,r.�,,,�•-.17 wT �^^'.M+.7l.r'.IrrV/'^.t<karyrA"«Pi�e,^"' ".vy''*'.` :y,y' d.., v-.. . ..„k r s Y e � .'.�,.5- e flat§achusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Oton St35234M Floor SalFOOD ESTABLISHMENT INSPECTION REPORT Tel:(978) 741,-1800 Fax(978) 745-0343 Name yy,� II D¢to Tyge of Ooeration(sl, TYQe of Inspection Y/055k-4 l W07- P"� `(.��U 4 I p'Food Service ❑ Routine Address / I I / Isk' El Retail SCJ Re-inspection In Level ElResidential Kitchen Previous Inspection Telephone J ❑ Mobile Date: dcL- 2e7r 1 r . ,��- El Temporary El Pre Owner HACCP YM I ❑ Caterer 11 Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint n In:3-,1-/ ElHACCP Inspector ;I Dv�h ', �� 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 MANAGEMENTEl12. Prevention of Contamination from Hands _ ❑ 1. PIC Assigned/Knowledgeable/Duties " + - El 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';"- "','-'`""' ,' ❑ 4. Food and Water from Approved Source TIMElTEMPERATURE 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 El 19. Hot and Cold Holding ' PROTECTIOtd FROM CONTAMINATION— �" ` � 9 ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control' ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ' REQUIREMENTS FOR HIGHLY SUSCEPTI9LE 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): 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 cf 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-z)590.0 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-x)(590. 0a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30..Other DATE OF RE-INSPECTION: S 5901nspe F.Po 14 d. Inspector's Signature: jerl Print: f � A PIC's Signature:�h�ti x C „( Print: {^---�� v rl (��1�� I Page of4Pages I � Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ( Cross-contamination I 1 590.0030) Assignment of Responsibility` 5-302-11',A)(]) i Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge ( ( Cooked and RTE Foods* 2-103.11 Person in charge -duties I ( Contamination from Raw Ingredients i-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH tither` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 13-302.11(A) Food Protection" applicants* 13 302 131 Washing Fruits and Vegetables 590 003(F) Responsibility Of':1 Fixxi Employee(3r r>vt ( °-3')4,11 Food Contact with Equipment and Applicant To Report To The Person In ULVinal * Charge* I I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and R.service of Food'* 3 590.003(D) Exclusions andRectrictions* I DisoositionotAdu!tefatedorContaminated 590.003(E) Removal of Exclusions and Restrictions I I Food 701 11 I Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 1 4-501.111 Manual Warewash ng-Hot Water 3-201.12 Food in a Hermetically Sealed Contauter* Sanitfzation'Fejiu eratures' _ 3-201.13 Fluid Milk and Milk Products* I 1-501.112 Mcchamcal Warewashing-Hot Water 3-202.13 Shull Eggs* I I Sanitizarion Temperatures' 3-202.14 Eggs and Milk Products, Pasteurized* I 14-501.11.1 Chemical Sanitization-temp.,pH, 3-202.16 I lee Made From Potable Drinking Water' I concentration and hardness. " 5-101.11 I Drinking Water from an Approved System* ( 14-601,11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* ( Utensils Clean- 590.006(B) Equipment Food- Contact Surfaces,nut Utensil 590.006(B) Water Meets Standard4-602.11 Cleaning Frequency s in 310 CMR 22.0+ I q y of E1 l s* I Shellfish and Fish From an Approved Source I ( 4-702.1 1 Frequency of Sanifrzation of Utensils and 3-201.14 Fish and RecieadonalN 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 I I Chemical* Sources* ( 10 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority ( 2-301.11 Clean Condition-Hands and Aims* 3-202.18 Shellstock Identification Present* I i 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms- I 12-301.1.1 When to Wash' 3-201.17 Game Animals* ( 111 Good Hygienic Practices ( 5 ( Receiving/Condition I 12-401,11 Eating.Drinking,or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* ( 1401,12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity' ( Mouth* 3-101.11 Food Safe and unadulterated* I f 3-301 12 Preventing Cont.unination When Tasting* ( 6 Tags/Records:Shelistock I 112 1Prevention of Contamination from Hands 3-203.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained` Employees'" Tags/Records:Fish Products I ( 13 ( Handwash Facilities 3402.11 Parasite Destruction" ( Conveniently Located and Accessible 3 402.12 ( Records,Creation and Retention* I 15-203.11 Numbers and Capacities* 54Q004(J) I Labeling of Ingredients' 15-204.11 Location and Placement* 7 Conformance with Approved Procedures ( ( `-=US.11 Accessnbility,Operation and Maintenance lHACCP Plans I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* ( Devices 3-502.12 Reduced oxygen packagin„cruet ia* ( 6-301.11 Handwashim Cleanser,Availability 8-103.12 Conformance with Approved Procedures^ 16-301.12 Hand Diving Provision *Denotes critical item in the federal 199Q Pond Code 01 105 CMR 590 000. i /i { Y CITY OF SALEM i BOARD OF HEALTH // J Establishment Name: �� lO)� 1/J v Date: Page: Z of ( Item Code c-Critical Item :DESCRIPTION OF VIOLATION-1/PLAN OF CORRECTION Date No. Reference R-Red Item ^ \ - Verified:: PLEASE PRINT CLEARLY I I - /t r tin 1 L'loJ?. �i1�nn U/J C1��S �✓1'/ d"f 41 Sr4 tM '3; h 14 TO). 1-1 b10 n�, , r;, �V2 �., jyw 7�4va �, 5� fi CSS 6 1-11,,,A.l 41)aJ'C rn t �cf OivO 7 cP / r')I I^_ / t t/ I�,��I�.C Jt < J5.c- J4 J Vl _f,A c �� 1 )'A' , x 67 j i i 7 I _ 1 _.. Corrective Action Required: I ❑ No yes Discussion With Person in Charge: � q 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. ` �\ V O ,n � O �-�,, f�flne A G�'�-lt.X.0—>`!, ❑ Voluntary Disposal ❑ Other: V 14((: PITFs kearvcd at Feurps;rstows Violations RinAed to foodborne Wness kind R?.Ick Aw)ldillg to La;'.Cooled In factors(items 1-2Z (Cont.) ,PF/451�'Wflllio I H066, 3 4a it.15 x1liti't Wnlks:ls for PH;':PROTECTION FROM CHEMICALS PHF Hot and Gold Holding 14 F<tad or Colm Additives atkat bckw .i-N:2,12 1 ?dciidwt�* 4 frolu kl'!I.kl).�','-o-cd -:z kqw fn-,)w I lo PHI Poisonous or Toxic',tdasroncrz 140 F. 7 Vi 1.11 ;-i b�j �501�l fi(A) Ww,�vz Held at or afxwc i Al-F Time as a Public Health Conti or 7-10-),l t i ?-:W1 I,) rime as a Public I iiall(l)Cornrol, 5ow)(341 H) variacce Reuturcrilent 7- REOUTREMENTS FOR HIGHLY SUSCEPTIBLE If "'6c Coatiami" prcl)i4i!:m POPULATIONS(HSP) safcl;..ek"crip:na -cllcmic,t,- I 11 ],X, Uriptlilcum.0't Clle)nica;t,for lvr,hlng B"er,t�w, witt) 'is arroll'. 205 It F,I%v i,r PwIlAl" C,a,i<cd Avinl%l RN'd x,i2 1-206 If1 Kcat :,A:•;.eva,!—,PcoCore!r: Ra;, St('it spictill i X"il Set wd 7 2 i 2 1 fl(x;:rll i"162i-kittl II(C; Uiviptned lic,lit Patlzak,,, Not Ri, 206 (_ 1 -< i :jc!ing V,�S' t imilk! aw� CONSUMER ADVISORY 22- 3.60, Co"inwi Aox iiory POLA'Al !.cr nMFJTEMPEAATURE CONTROLS Aiiiiiiiii HNO, iliac arc Raw, ok 16 Proper CookinIFHFs g T�nniwaftrfps for prkl;esst�A,,o I'linnitatv 's 101 11 f c 15 Sc -40 1.111 A)i,") J it.b Nlk,&,; i,: i i.cl, i,5 F I arc. SPECIAL REQUIREMENTS 40 I'l t(B)c 1 2) rlliv�k I 410LI it z6loe-� iniv,,it tcl; t� - 155-� i5 5,xi'l)OOt A 1-i D) vikyhlion�of Section 590JX;')iA) flit if; cawntm, in,I)III: lkwlsL telliporal V and ks iid Gaww, qn0fed PNF+ reti&nLat Litchen opel aiifsi.should I),- Fl�c- dehile'd under tile apprupit'lic Y."iloll's r, aht'k,e if rchiled fit fixtillickirw fflnk-,� ,ouio,,-)i k-jt,tt�� scc. Nh,a— 11113cl 3c�t intet verwon,;and ri:;l. facitkrs, Otbor (45°t4 4* 1 liwa Apra"'; 1",16: C,a,k-kk i.1 a pinoices, tould he dt,bitcd under k29 1 ,101 ll(Aafltibk Ali 001�i 041`�- 145'F t`? arc 17 Rehr-atukq for Not Holding WOLArIONS RELATED TO GOOD RETAIL PRACNCES wc 23.30) fWA!"It) r' 2%Ii!kwe swakf'! Crrww�.v%i kwl,-,rift,at whichdo rwi rTbxw:,;Mr 140+- j -90,01'u Item Good Retail Practices FC i"violl,;officer �D _klarka ement and Petoorcr el FC Yg Proper Coullit. ?4, -�,,)d�irid Food Proli.�fkkr, FC. 3__LM4 ,I or PHrS 5, Eq and Utensils F0 - 4 ON C.<At�kl V�11' funkiz 1 W'y"'O 121E; Vivatei.Plumbi trid`N-esteFG-5 1 IX)b xi 7 , 2 1 lovra t!:d FTokri'MIt FC-6 OOT --p �1!4:^F,1.15`F %V:n,ii,4 Hoic, I� 3 r FC-7 001C tW', klam Vrorn \rnHtnl 9 ,I f 'Pl4s lz L.%6.. Othe, `lvoh�n It X110 Deat'lek%trlttcal kol n11. le i al lw"k 14 k,'MIVY Commonwealth of Massachusetts City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2010 ESTABLISHMENT NAME: Boston Hotdog Co. File Number:BHF-2004-000268 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0262 Jan 11,2010 Dec 31,2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember3l, 2010 Board of Health � A This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 1.20 WASHINGTON STREET,4`FLOOR TEL. (978)741-1800 I{IIvIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGRF:r-.NBAUM(@a SALEM.CONI DAN'ID GREENBAum, ACTING HEALTH AGENT 2009 APPLICATION'1FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT v, F 6+ da9 cotlil vy TEL# / J " ADDRESS OF ESTABLISHMENT b W0,S n00tl S4, FAX# MAILING ADDRESS(if different) EMAIL- Business':-1rs-"6+cJb--_.co ,,9A64 rar Website: OWNER'SNAME �F64//Its //j!9/.�w./Ps TEL# 70/- 3-S/ -09-/3 ADDRESS l h7nda / yr /l/4h4 4 a'/9a& STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 3q;" e CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 4 ,7J-13f /�4�u u�PJ HOME TEL# 7}r/ 3 DAYS'OF'ORER4TION'`<4;0,ir.Mdhtla' ,;-> >s7uestla "b'w Wednesda; .','7tiirstla .": r=,`'F:rida' '„i , i = .SatuNaa% rk`:'.` aSuoda.. Y . ,.I HOURS OF OPERATION 1 Please write in time of day. (Forexamplellam-11pm) P TYPE OF ESTABLISHMENT FEE (check onlv)_ RETAIL STORE YES _ NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ffff§f�:Uik�------------------------- ------- -----------------------------------------------Ie-s.s t,h--------------------------- -- 80 RESTAURANT t ES NO less than 25 seats -$14 (Outdoor4Statiionary,Food Cart$210) 25-99 seats = X30 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME -.. Af)DITIONAL_PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state lax returns and aid alp I state taz�ed under the law. �� J n ? o 1' / r) Sigiature Date Social Security or Federal Identification Number Revised 424/07 F00DAP20 Yadm Check#&Date ' /D $� a—