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BROTHER GEORGES - ESTABLISHMENTS BROTHER GEORGES 376 HIGHLAND AVENUE V lzzl a S s r v C x „ i y y� V n 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 91L&k), Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Date Ty a of Operation(s) Type of inspection 386TH oL bbo FL6 r_-, S IH Food Service ❑Routine Address - � Risk Retail zoRe-inspection Telephone 79►-3Y4'3 Level ❑ Residential Kitchen Previous Inspection P ❑ Mobile Date: �r�7�- Owner HACCP YIN [I Temporary ElPre-operation �Sq C-,ST1(a1419-) ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC)3v�ro ��t� Time ❑ Bed&Breakfast El HACCP General Complaint In: Inspector 6a6�53 Qtiv~ Out: Permit No. ❑.Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ pose an imminent health hazard and require immediate Tobacco 590.009(F) Violations marked may ❑ y P q Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [112. 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 ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE ,_. 114. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(P.otarltlally Hazentoa 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 REQUIREMENTS FOR HIGHLYSUSCEP.TIBLEEPOPUI.ATIONS(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_(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 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-2X590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3x590.004) 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 (FC-5)(590.006) 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 a�90� Special Requirements (590.009) within 10 days of receipt of this order. Other DATE OF RE-INSPECTION: a.0oc 1 � In Inspector's Signatur �� IJ/J/a-/� Print� y)0) )„n��J�„� PICS Signature://n ``� C.C�`(� I Print:� lJ�l� SC 'C(`B. Page-) of z Pages I 1 7 111 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 5 Cross-contamination FOOD PROTECTION MANAGEMENT 1I 3-302.11(All) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* j I Contamination from Raw ingredients _ 2-103.11 Person in charge.-duties 3-302.1 1(A)(2) Raw Animal Funds Separated from Each Other* EMPLO"EEHEALTH I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to -- - - - --_--- - 13-302.11(A) F2xdYrotection" require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Foot Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An tJtensds* Applicant To Report To 1 he Person In I Contamination from the Consumer Charge* 5900)3(G) Reporting by Person in Charge* I 13-306.14(A)(B) Returned Food and Rescrvlce of Food* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions' Food 590.003(E) Removal of Exclusion;and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food' 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Fund Law' 4501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitisation Temperatures- 3-201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashinn Hut Water 3-202.13 Shell Eggs* I 1 Sanitization Temperatures* 3-202.14 I Eggs and Milk Products.Pasteurized" I 4-501.114 Chemical Sanitisation-teutp.,pH, 3-202.16 I tee Made From Potable Drinking Water* I concentration and hardness. 5-101.11 I Drinking Water from an Approved System* ( 4-601,11(A) Equipment Food Contact Surfaces and Utensils Clean^ 590.006(A) Bottled Drinking Water* I (i.,.l 2 4-61 Cleaning Frequency of Equipment Focd- 1590.006(B) Water Meets Standards in 310 CMR 22.0* I Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I 4-70_�. 11 Frequency tri'Sanitization of Utensils and3-201.14, Fish and Recreationally Cauglit Molluscan I Food Contact Surfaces of Equipment* shellfish* 4-703.11 Methods of Sanitization-[lot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority I 12_3(11 11 Clean Condition-Hands and Arms- 3-202.18 Shellstock Identification Present* 12-301.12 Cleaning Procedure* 590.004(C) _j Wild Mushrooms* I 2-301.14 When to Wash'" 3-201.17 _ _ Game Animals* ] it Good Hygienic Practices 5 Receiving/Condition 1 2401.11 Eating,Drinking or Using Tobacco* 3-202.1 L PHFs Received at Proper Temperatures* ) 240112 Discharges From the Eyes,Nose and 3-202.15 Package hitegrity� Mouth* 3-1 01II FnntSafe mid Unadulterated 3-301.12 Preventing Contamination When Tasting* I ( 6 TagsJRecords:Shellstock 112 Prevention of Contamination from Hands 13-202.18 Shellstock Identification* I ( 590.0(11(8) Preventing Contunivat nm from 13-203.12 Shellstock Identification Maintained* Emplo Tags/Records: Fish Products 113 I Conveniently Facilities I Gonveniently Located and Accessible I 3-402.11 Parasite Destruction* 3-402.12 Records.Creation,and Retention" I 5-203.112Numbers andPlcemetCapacities* 590.004(7) Labeling of Ingredients* I 15-204.11 AcceTocatssibility, azul Placement* I 7 Conformance with Approved Procedures I 15-2175.11 Accessibility,Oueration and Maintenance I IHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygeu packa(Rng,criteria* I 6-30 LI I Handwashing Cleanser, Availability I 5-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision '*Demes critical item in the federal t999 Fu xl Code or 105 ChiR 590.010. CITY OF SALEM BOARD OF HEALTH Establishment Name: 39-6714ESI� Date: S—� —t"1 Page: Z of Z Item Code - C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Uffie No. Reference R—Red item Verified PLEASE PRINT CLEARLY , �t—t0� Nj, 1 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/ Exclusion violations before the next inspection, to observe all conditions as d Scribed, and to ElRe-inspection Scheduled El Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I nde s a d that noncompliance may result in daily fines of my iv o rs or s ens{frevocation of ❑ Embargo ❑ Emergency Closure your food permit. / I ❑ Voluntary Disposal 0 Other: r t 3-501.14(0 PHFs Received a4 Temperatures i Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(trema 4-22) (Conti41'F,45 F Within 4 Hours, ( PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives i 119 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives*' I 590.004(F) 41'745"F* 3-302.14 Protection from Unapproved Additives* i 13-50L16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I 140`17 * 7-101.11 identifying Information-Original 3-501.16(A) Roasts Heid at or above 1300F. Containers* 20 Time as a Public Health Control j 7-102.11 Common Mame-Working Containers* j 3-501.19 I Time as a Public Health Control* I 4 r ?01.11 Separation-Storage* ' f 7-202.11 .Restriction-Presence and Use* ` 590•004(H) j Variance Requirement 17-202.12 Conditions of Use* ` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 j Toxic Containers-Prohibitions* I POPULATIONS(HSP) 7-204.11 i Satdtizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-841.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnin labels* 7-204.14 .Drying Agents.Criteria* j '! 17-305.11 ( incidental Food Contact,Lubricants* I 3-801.11(6) Use of Pasteurized Eggs* I 3-801.1 I(D) flaw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Cnteria* Raw Seed Sprouts Not Served,* 1 17-206.12 Rodent Bait StatinnS* 3-801.11(C) Unopened Food Package Not Re-served. " ( 7-206.13 I Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY > TIMEITEMPERNTURE 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 Pathogens.*`"b°°`° 3-40LAIA(1)(2) Eggs- 155°F 15 Sec. { '�"2Pfc Eggs-immediate Service 145'FlSsec* 3302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game { E PW t Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3 401.11(Ax2) Ratites,Injected Meats ats- 155`17 15 j 3401.11(11)(3401.11(11)(1)(2) Pori:and Beef R -130'17121 min* I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* � catering, mobile food,temporary,and 31101.11(A)(3) Poultry,Wild Game,Scuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see.* above if related to foodborne i ihtess t 13-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other { 145*F t` 590.009 violations relating to good retail f 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165°F* Special Requirements. y 3401.11(A)(1)(b) All Other PHFs-145'1715 sec.' I 119 Reheating for Hot Holding 1 VIOLATIONS R A.RITED TO GOOD RETAIL PRAC77CES _ 3-403A I(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors fisted above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 145 CMR ! 140'17* 590.000. 3-403.14(E) Remaining Unsliced Portions of Beef item Goad Retail Practices FC 540.+700 1 Roasts* i 23. i Managament and Personnel i FC-2 .003 i 18 Proper Cooling of PRFs I j 24. Food and Food Protection ! FC-3 .004 1 25. E-auiomeri and Utensils i FC-4 .005 i 3-501.14(A) Cowling Cooked PHFs from 14VF to ! 26. Water.Pltimbina and waste FC-5 .006 ! 70°F Within 2 Hours and From 7WF 27. I Phvsical FaciAN FC-6 .007 ! to 41°F/45°F Within 4 Hours.* i 28. I Poisonous or 7owc Materials i FC-7 .008 i 3-501.14(6) Cooling PHFs Made From Ambient ! 29. I Special Requirements 1 .009 1 Temperature Ingredients to 41'F/45'F ! 1other ! 1 Within 4 Hours* Denomi�riticat rvni in the federal l9c)9 Fex-;d Cale w'105 C.MR 590.000. 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 S'Ai-&-, Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. NameD to Type of Operation(s) T pe of Inspection &Ro'TH& -CrWP_ LS RCi 4mvizi0� SbA ! l?144 Food Service Routine Address Z-,( H/ LristO qJ6 Risk Retail Re inspection Telephone Level ❑ Residential Kitchen Previous Inspection P El Mobile Date: °►fig• Ownerr� HACCP YIN El Temporary ElPre-operation t OS q I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Time El Bed&Breakfast ❑General Complaint SVLIc�(�6aflG/p In: ❑ HACCP Inspector n P J�u lam. Out: Permit No. ❑ Other Each violation`checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.909(E) [IItems) Tobacco 590.009(F) ❑ Violations marked may pose an imminent health hazard and require immediate Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT M�l 2. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties R<3. Handwash Facilities 'EMPLOYEE HEALTH PROTECTIONpROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded G?S.Toxic Chemicals APPROVED SOURCE E] 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. F ❑ 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 <Hot and Cold Holding IIB.Separation/Segregation/Protection ❑20.Time as a Public Health Control Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR,HIGHLYSUSCEP.TI6LE-POP6LATIONS(HSP)' E]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_(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 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-2X590003) order of the Board of Health. Failure to correct violations Food and Food Protection (Fc-3xso.o0a) 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 (Fc5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have aright 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 a9. Special Requirements (590.009) within 10 days of receipt of this order. 34.0. Other DATE OFRE-INSPECTION: Inspector's Signamr • �U^7y[I1V/l Print:'�y2 �M / PICsSignature: IPrint: nfi ll� 12 L42al� Paget of_kPages I 1 � _ , 111 Violations Related to Foodborne Illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Raw Animal Cross-contamination 3-302.1 I(A)(1) Raw Animal Fcwc(s Separated from I � I 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* j I Contamination from Raw Ingredients 2-103.11 Person in charge--ditties 3-302.11(:1)(2) Raw Anunal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 1 3-302.1 t(A) Food Protection" require reporting by fund employees and , 3-3()2.15 Washing Fruits and Vegetables _ appiicauts" _--- --_----I 1 � 3-304.11 Foal Contact wish 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* 13-300.14(A)(B) Returned Food and Reservice of Foal* __ 1 590 003(G) Reporting by Person in Charge* I - - Disposition of Adulterated or Contaminated 3 1590.003(,D) Exclusions and Restrictions* Food i 590003(E) Removal of Exclusions and Restrictions I .1-701.11 Discardine or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 1 Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) Compliance with Fund Law* I 4-501.1 t 1 Manual Warewashmg-Hot Water 3-201.12 Fwd in a Hermetically Seated Container* I Sanitivation Temperatures* 3-201.13 Fluid Nfilk and Milk Products* I 4-501.112 Mechanical Warewaslung-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized" I 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 lee Made Ftont Potable Drinking Water' I _ concentration and hardness.* l 5-101.21 Dunking Water from an Approved System* f 4-601.1 I(A) Equipment Food Contact Surfaces and Utensils Clean" 590.006(A) Bottled On Water* I I ri 1590.0(H(f3! Water Meets Standards in 310 CMR 22.0* I ( 4-6011 t Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* SheAbsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Cauglit Molluscan I ( Fail Contact Surfaces of Equipment* Shellfish* 14-703 11 Methods of Sanitization-[lot Water and 3-201,15 Molluscan Shellfish from NSSP Listed ( Chemical* Sources* - Game and Wild Mushrooms Approved by ( 110 Proper,Adequate Handwashing Regulatory Authority 2301.11 'Clean Condition-Hands and Arms;* 13-202.18 Shellstock identification Present* I 2.301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 2-W1.14 When to Wash* 3-201.17 Game Animals* I I I1 Good Hygienic Practices 5 Receiving/Condition I 2-•101 11 Eafing,Drinking or Using Tobacco* 3-20111 PHFs Receiver)at Proper'renhperamres* I ( 2401.12 Discharges From the Eyes,Nose and u 13-202.1 5 Integrity* Mouth* Pack 3-101.1I Food Safe and nsduhcrated 3-301.12 Preventi m,Contamination When'fasting" Contamination from Hands 16 Tags/Records:5hellsfock I I 12 Prevention of fHdI 3-202.18 Shelistock Identification* I 590.004(E) Preventing Contamination fiom 13-203.12 Shellstock Identification Maintained' Employees* Tags/Reoords: Fish Products 113 I Handwash Facilities 3-40111 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* I I 5-203.11 Numbers and Capacities* I 590.00.1(7) Labeling of Ingredients' I 15-204.11 Location and Placement* 7 Conformance with Approved Procedures I 15-205.11 Accessibility,Operation and.Maintenance I /HACCP Plans Supplied with Soap and Hand Drying 3-502.I1 Specialized Processing Methods* Devices 13-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability { 18-103.12 Conformance with Approved Procedures"` 16-301.12 Hand Drying Provision 'Denotes critical item in the federal 1999 roodCode or IDI C&IR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: S' 8'' JP Page: Z of nem Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Ram Verified PLEASE PRINT CLEARLY I RoJTic-t'G 1 rs S P u-CTi 1 e� rra'�O '"C`yI� Fol-l-�t.�t�3 1a I I �' S�� --rld>; m,tfisw 6av8. r.r `fyi�: C�FL.a tett; I-Iw� � ��i�-O ✓R �F GI<LC�OJS�. j= Z` I I I Iw SCb"'=v \Raas b,-\\It k_&"' W11i4 A 13✓l LMsg aP S � reccD Dvk6 0-\s A,40 C-,G\ Pei 1'stz c. 4 k4 18 S-:tyro) WAS- ^-ti ( ck51v_-L)eJ$ HtN� -> t.vA51� S\et�t_ T'dv.,P Z5RS'N-tivL'EO . K<--ee � S"•2d I Hd%c�o M1 I --V�SS\CSW 1�41� da QiV )IL_0J I 11r\C� �a6U,iY\6. "97�a6LgVlala(� Ci�.E:YA� 'Thl� �ac�0 MASA S,v„L ter"' v �� r I Faai ti aac'n Ani�► Suter(., da-t\-\t . I IZ7 L-Sd_J)7 C — h,ci�s>; patc�PPt.a�.S �CaC�cvrb� dN Tt� I�iTGN�tJ W)ojo�wS��., awat5 �. S 2� 174h -001'41N%k7 LIGFNR.� �gS\ �s�R\o�- dP� Sim- rlaen dx \aA 1�1 I f�t3�.oSD fn IAR�A'C� A.�`A INFE.1v8T��• 1 I � 54.x`1 C, -�r►�a c�,t<� �0k� tai t �tv a* 'lgwbl, vSEG� s\-) K 2� 1 b ca�"W F!a*1zs lam_ 4�� F_ t-v "t L&'Ea ij o�1 Po�O I rk Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 4 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 P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: r 3-501.14(C) PRFs Received at Temperatures Yloiarions Related to Foodborne 1/1ness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 410E/45T Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs Food or Gator Additives 19 PHF Hot and Cold Holding i 14 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F1 41*145°F* 3.302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PI-Ts Maintained at or above C 15 Poisonous or Taxic Substances I MT. * 7-101.11 Identifying Infonnation-Original 3-501.16(.4) Roasts Field at or above 1307. Containers* ( 20 Tme as a Public Health Control 7-102.11 Common Name-Working Containers* I 3-501.19 Time as a equir Health Control* 7-201.11 Separation-Storage* 590.004(H} Variance 7-202.11 Restriction-Presence and Use* e Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.12 ShemicalsCriteria iChemicals° * 21 3-801.11(.4) Unpasteurized Pre-packaged Juices and 7-204.1_ Chemicals for Washing Produce,Criteria + .Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria" ( 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Foal Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and j 7-206.11 Restricted Use Pesticides;Criteria* 1 Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations° 1_801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME(i EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Pathogens.*EMrrnr*rnrlwt 3 401.I1A(I)(2) Eggs- 155"F 15 Sec. Not Otherwise Processed to Eliminate Eggs-Immediate Service 145TISsec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Gam Ego*Ego* Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130T 121 min* j 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3401.11(A)(2) Ratites,Injected Meats-155°F 15 sec * catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild(lame,Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ra6os-165T 15 sec. I above it related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Corked in a practices should be debited under#29- Microwave 165T* Special Requirements. 3.4()1.11(A)(1)(b) All Other PRFs-1457 15 sec. 17 Reheating for Hot Holding 1 VIOLATIONS R FLATEO TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PIFs 165T 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, car be 3-403.11(C) Commercially Processed RTE Food- found in the following sectiorts of the Food Code and 105 CMR 1400P 594.000. 3403.11(E) Remaining Unsliced Pordimc of Beef i Item i Good Retail Practices I FC ( 530.000 Rtmats'; 128. 1 Management and Personnel FC-2 .003 I IS 1 24 Food and Food Protection Proper Cooling of PHFs FC-3 .004 I 125. 1 Equipment and Utensils -- FC-4 .005 I 3-501.14(A) Cooling Cooked PRFs from 140°F to i 26• I Wates.Plumbism and Waste I FC-5 .006 1 70OF Within 2 Hours and From 70`F 1 27, Physical Faclity i FC-6 I .007 to 41T/45T Within 4 Hours. * 1 28. Poisonous or Toxic Materials FC-7 .008 � 3-501.14(B) Cooling PHFs Made From AmbientI I Special Requirements .009 I Temperature Ingredients to 41T/45T 3o' I Other 1 Within 4 Hours* III sour�zrx. *rk-nouy critical item in the federal 1999 Fuad Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH - Establishment Name: Date: S Page: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified 11 PLEASE PRINT CLEARLY I24 Clio-M `1 IL�k 0 1-1t4' oiLmi6c Tdec�i . Y4 LU Vae,r.') e.4 r,_N I c1�(2� t;Za»� � 61q i P�m� >a�� toy Cda'"l�'atm u t� ac+t:, o�ciat"�l-1�i�r -•. G�.l�laot�2c• I 1 I 12� (5vI� If '11'-�G-avcx9�� f`rlicax� T1aU ucs1� 1 12.5, ucP.ea�' q"Tt� �Su7aL-at�c� 1�� aJ �v��o �•6 ar 7.�5� 1aC� ->� Si��_ S- � G�G`�n-�z: 'T•1�iflcs�L�U` G.�c>,1 �, r n,�L�.caroa�- I )q '3Sa).)LN C1 3L " P_C=,6\ p �w7 \N ACbrtllS ��ve`C, dYf1a'v Cavt'�c� eat I�LdF, S 20 I s�.��, Cot_ Q�r�,,a,�,`I u�z�+>��w ti=�� ,�.�� S�� ►� �> 1 nY \-1\dF e61— Ct✓la\a . I � I lei 3.y)_) lin cam 9o&v n-v �,acZ ld-o S zo \4 of dt,- �eww Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Cl Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: t 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to - 'r Factors{Rens 1-22) (Cant.) 410F145'F Within 4 Hours. PROTECTION FROM CHEMICALS J 3-501.15 Cxfline Methods for PHFs J 14 J Food or Color Additives J J 19 PHF Fkn and Cold Holding J 3-202.12 J Additives* J 3-50IA6(B) Cold PIIFsMaintained atorbelow 3-302.14 Protection from Unaporoved Additives* 3-S011fi(A} Hot F* ( 590.004{F) 4I PHFs Maintained at or above J 15 Poisonous or Toxic Substances . PPH 7-101.11 Identifying Information-Original 140 . * 4 � 3-501.16(A) Roasts Held at or above 130°F. Containers` J 7-102.11 Compum Name-Working Containers* J J 20 Time as a Public Health Carnal J 3-501.14 Time as a Public Health Control' J 7-201.11 Restrain -Sterane" ( 590.0Q4(H) Variance Requirement 7-202.11 1 .Restriction-Presence and Use* i J 7-202.12 Conditions of Use* J REQUIREMENTS FOR HIGHLY SUSCEPTIBLE J 7-2033.11 Toxic Containers-Prohibitions* J POPULATIONS(HSP) J 7-204.11 Sanitizers.Criteria-Chemicals* J 1. J 7-204.12 Chemicals for Washing Produce,Criteria' J 21 3-801.11(A) Unpasteurized Pte-packaged Juices and J 7-204.74 Drying Agents.Criteria* J 1.Beverages with Warning Labels" 7-205.11 Incidental Food Contact.Lubricants* ( 3-801.11(B) Use of Pasrtially C Eggs* J 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D} Raw or Partially Cooked Animal Food and 7-306.12 Rodent Bait Stations° ( Rau Seed Sprouts Not Served 7-206.13 Tracking Powders,Pest Control and ( 3-$01.11(C) unopened Food Package Not Re-served. " Monitoring* ( CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Pasted f a Consumption of 16 Proper Cooking Temperatures for f Aoimat OtherFoodwise '14tar are Raw.EliminatUndercoe or PHFs i Na t?therwise Praressed to Eliminate 3401.d1A(t)(2) Eggs- 1550F 15 Sec. ! PO '*�xnre,n ar Eggs-Immediate Service 145'F15.cec' I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 349LIl(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155'F 15 sec. " 3-401.I1(B)(I)(2) Pork and Beef Roast- 130'F 121 rein* J SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, f residential kitchen operations should be Stuffing Containing Fish,Meat. It debited under the appropriate sections Poultry or Ratites-765'F 15 sec.* above if related to foodborne il Iness 3-401.110(3) Whole-muscle,low Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F Special Requirements. i 301.11(A){i)(b) All Other PHFs-145'F 15 sec.$ J 17 Reheating for Hot Holding ( WOLA77ONS R -L ATED TO GOOD RETAIL PRACTICES 3403A I(A)&(D) PHFs 1650F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Tijpc" foodborne illness inrerventions and resk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code mrd 105 CMR 1400P 590.000. 3-403A I(E) Remaining Unsliced Portions of Beef ( % Item I Good Retail Practices ; FC 59A.1HIt) j Roasts* ( 23. i Manaaament and PersonnleFC-2 .003 L J lg J Proper Cooling of PHFs i 1 24. i Foal and Food Protection I FC-3 .004 i 1 25I Equipment and Utensils I FC-4 .COS 3-501.14(A) Cooling Cooked PRFs from 140'F to i 26„ Water.Plumbing and Waste i FC-5 .006 70'F Within 2 Hours and From 700E 27. Physical Facility FC-6 007 to 41'F145'F Within 4 Hours.* i 28. Poisonous or Toxic Materials FC=7 .008 3-501.14(6) Cooling PRFs Made From Ambient 1 29. Special Requirements 009 1 Temperature Ingredients to 41'F(45'F 1 30• i other Within 4 Hours* 'Denotes crincat iem in the federal 1999 Feat Cale w'105 CMR X90.000. CITY OF SALEM BOARD OF HEALTH '1 Establishment Name: Date: Page: 7I of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified l PLEASE PRINT CLEARLY I f Z 54s�`116� G 16L — �m�taM oG3lP r �1;1s� ala `�`TL Fa-:0117S W417)4- 939kvL_ 1Ln�t�1. 5 20 I 9>�asLC Hme0 Coca-k-likUT nF 9:W-- rrj�41) 1S pfLbH N 0,Vctx Ca Lav'rS _ if oglsA I rssL -)X-,L..1 TSIv9_ 44kA Pete -'N2 )40v-,. C)F GC.'*^stX . -f+aakQALA\�3 S= Z' I 2S' �SaoaS - 74£ Vt1 :V Ca l» S) 1 v\as �� N'6F(73S T1aG8f�ulA11 LL�clac�lcT� S tc' -Z'cs I ZS SSv�a� ^-TWG �L�ao� e��o wP1.l. \ )•� � Co\t �.��c 6�r��E� ba ��1� >,'e I L10.ihra�'ta a�r+`O C-rM.--•F,_ �l -�CVcsvla�.1V� ('�'�tae� —t'�l� F�L,goa.. (ar16� S 33�e.Jl0) C.�dL -7144. H\C\ ntrar-�' 14MN 9�r�taavv. f}.g�Lao.oi� �� SZo I �peY+, fll�P"S 'f� {�Q►-*z.�'dr'�' CRoS s cm�i&o�1a�S�o� Discussion ith Person in Charge: Corrective Action Required: I ❑ No ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance El Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: ) 1 l I3-507.t4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness lnterfentions and Risk According to law Cooled to Factors fltetns 1-22) (Cont.) 4i'F/45*F Within Hours. PROTECTION FROM CHEMICALS { 3-01.15 Cooling Methods for PHFs { t 14 { Food or Color Additives ( { 19 PHF Not and Cold Holding 3-50L16(B) Cold PHFs :vlaintruned at or below f 3-202.12 Additives* 590.004(F) 410/45"F* ' 3-302.14 Protection from Unapproved Additives" 3-501,16(A) Hot PRFs Maintained at or above { 15 Poisonous or Toxic Substances * 7_10L11 Identifying information-Original oasts Containers* 3-501.16(A) Roasts Held at or above 130'F.' I { Time as a Public Health Control 7-102.11 Common Name-Working Containers* 1 { m � 3-501,i9 Time as a Public Health Conucotrol* l 7-201.11 Separation-Storage* ( { i 590.004(H) Variance Requirement 7-202.11 Restriction-Presence and Use* { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 j Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 { Sanitize"..Criteria-Chemicals* 7-204.12 { Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and i { { .Beverages with Warning labels*7-204.14 Diving Agents,Criteria* 3 Use of Pasteurized Bit { { 7-205.11 Incidental Food Ccmtact,Lubricants* { ( 3-801.11(D) Raw or Partially Cooked Animal Food and r { 7-206.11 Restricted Use Pesticides,Criteria* { Raw Seed Sprouts Not Served * ` { 7-206.12 Rodent Bait Stations* 1( { 3-801.11(C) Unopened Food Package Not Re-served. " { 7-206.13 I Tracking Pawders,Pest Control and i Monitoring* I CONSUMER ADVISORY TIMEtt EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or Not Otherwise Processed to Eliminate PHFe ,„,,,, , 3-40i.I IA(1)(2) Eggs- 155°F 15 Sec. Pail v�rens.* Eggs-immediate Service 145°F15see. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155`F 15 sec.* SPECIAL REQUIREMENTS { 340111(11)(1)(2) Pork and Beef Roast-130`F121 min* { 3-QlA l(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering,mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other t 145°F* 590.009 violations relating to good retail J 3-401.12 Raw Animal Foals Conked 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.° { t { 17 Reheating for Hot Holding { WOLA77ONS R:LATED TO GOOD RETAIL PRACTICES 3-10AI(A)&(D)I(A)&(D) PHFs 165-F 15 sec. * (Items 23-30) r 3-403.11(B) Microwave- 165'F 2 Minute Standing I Critical and non-critical violations, which da not relau to the Time" f foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the fol1mving sections of the Food Code and 105 CMR 1400F* 590.000. 3-303.11(E) Remaining Unslic:ed Portions of Beef jlann ! Good Retail Practices FC 590.000 Roasts" 123. 1 Management and Personnel FC-2 .003 ! { lg Proper Cooling of PHFs { 1 24. ! Food and Food Protection FC-3 .004 i 1 25. 1 Equipment and Utensils 1 FC-4 .005 t 3-501'.14(A) Looting Cooked PHFs from 140`F to I26, Water.Ptumbjnp and Waste t FC-5 .006 t 70'F Within 2 Hours and From 70`F 1 27. Phvstcat Facility FC-6 .007 to 41`F/45'F Within 4 Hours. ' 1 28. Poisonous or Towc Materials FC-7 .008 3-501.)4(6) Cooling PHFs Made From Ambient ! 29. Special Requirements 1 009 j Temperature Ingredients to 41*17145°F Iii 1 30' 1 Other i Within 4 Hours* r 'D nc+raj criticat ivra in the f-dersl 1999 Food Cade or 105 C-MR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: S� of Item " code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data No. Reference R-Red Item Verified PLEASE PRINT CLEARLY � r1 4-?02 1 C) dL —'31 Starlt�ufcilL vC+kT Gd1're.�l� ReAvn K tea �.sEo A00SC X94 iyP, S _� 'Zpa s'j t-A e o=l (LZ.Pua t.0'_ Ttafc Q_jM'ALt �dfaQ�n I - Tra.? tAn*� vtvtT ,r c Tr�oaLov VNi t �� S 2-c, 1iea1T C^J�cdl.t i�A.1..0- STc31Zt's `f1'�2�. S+gtS)'f1 Zt t�f 4 �a1-�11a�1 t�i�l.oR..t pLt tmf) PPL�P Adl.2s�( S'a i'�Fyd�T' Q.61-aif rev)�ia.lotW)1or�. wIT41 `rwil - r>n,@,_A"P CLal1e� 11n, A n'w%-2S'r; ,$A1-5' 9>c"C," each 5-� i-L� 'r�,rarn� C�R�-.s1 d.� i3tP• S`I2�t� f�F..1r lnr`'PML. ice.vt t,r. l n rxa� I Fs�� rs�a� P6>✓�P ren ,4 Qn_r=y6r+-r C4xxs cc c'TA6--, III (AnwrA' I z5 4-?oats` - T S 12_-�c4,UL iLvea+. Awlvn �r -t �41T�1V� C Neva., " &MPL OV\�_v_- o3S� tlsrt=� TawlS� f� R y/o L Ct +AN ►�llu1?s. Dl$1a�S �a O S'Zc �Z5 L1Ad, ' T4M-, 4i4vv, �lz.�N A,Imltlrc7 r0.�r� it� �a� �aos�TIZC� t�.V3s 1-f-PT da10. DtLel C4-b 1-.4 114 D R.ytaJl�. Discussion With Person in Charge: Corrective Action Required: I :3No I ❑ res 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 It your food permit. — - ❑ Voluntary Disposal ❑ Other: t 3-501,W(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(diems 1-22) (Cont.) 41'F145'F Within 4 Hours. + CHEMICALS I 3-501.15 Cooling Methods for PHFs PROTECTION FROM { 14 { Food or Calor Additives j 119 PHF Hot and Cold Holding { 3-501.16(B) Cold PHFs Maintained at or below 13-202.12 1 1 Additives*' { 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Addirives" I t { j 13-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 1 st 7-101.11 IdentifyingInformation-Original [`E{ 3-501.16(A) Roasts Heid at or above 1300F. Containers* 7-102.11 Commas Name-Working Containers* { j 20 i Time as a Public Health Control j 7-201.11 Separation-Storage* I i 3-501.19 Time as a Public Health Control* I 7-202.11 ,Restriction-Presence and Use+ { 1590.004(H) Variance Requirement { { 7-202.12 Conditions of Use* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( { 7-203.11 Toxic Containers-Prohibitions* j POPULATIONS(HSP) ' 7-204.11 Sanitizers.Criteria-Chemicals" { 1-204.12 Chemicals for Washing Produce,Criteria* I 21 3-801.11(A) Unpasteutirxd Pre-packaged Juices and ' I Beverages with Warning Labels+ { 7-204.14 Drying Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* ,t ( 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.31 Restricted Use Pesticides,Criteria* I Raw,Seed Sprouts Not Serv,d. 7-206.'2 Rodent Bait Stations* + 7-206.13 Tracking Powders,Pest Control and 13-$01.11(C) Unopened Foul Package Na Reserved. " Monitoring* CONSUMER ADVISORY TiMEITEMPERNTURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of l 16 Proper Cooking Temperatures for Animal FoodsThat are Raw.Undercooked or PHFs Na Otherwise Processed to Eliminate Pathogens.*cfbea s IA, .I 3-401.11A(1)(2) Eggs- 155°F 15 Sec. ' Eggs-Immediate Service 145'Fl5see+ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game E > Animals-155'F 15 sec. SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pori;and Beef Roast-130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-1557 15 590.009(A)-(D) Violations of Section 590.009(A)-(D).in sec.* catering,mobile food,temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, msidential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections t 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 rood retail 3401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec.* j j 17 Reheating for Hot Holding ( VIOLATIONS R:LATED TO GOOD RETAIL PRACTICES 3.403A I(A)&(D) PHFs 165'T 15 sec. * I (Items 23-30) 3403.11(B) Microwave- 165`P 2 Minute Standing Critical and non-critical violations,which do nor relate to the Time* fiwdborne illness interventions and risk,factors listed above, can be ;r f3-403,11(C) Commercially Processed RTE Foal- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. e 3403.11(E) Remaining Unsliced Portions of Beef than 1 Good Retail Practices I FC 690.0W Roasts': i 23. 1 Management and Personnel FC-2 .003 i j 18 Proper Cooling of PHFs 1 24. Foal and Food Protection ' FC-3 .004 1 25, 1 Equipment and Utensils I FC-4 .005 I ' 3-501.14(A) Cooling Cooked PHFs front 140'F to 1 26, i Water.Plumeno and Waste FC-5 OW ; 70`F Within 2 Hours and From 70'F ; 27. i Physical Faci ty FC-8 .007 r to 4I`F1450F Within 4 Hours. + i 28. Poisonous or Toxic Materials FC=7 .008 3-501.14(B) Cooling PHFs Made From Ambient ( 129. Special Requirements .009 1 Temperature Ingredients to 41'F145°F 30. 4iher ' Within 4 Hours* �- 'Anutev CtihC:.t t�^m in the E^.deral i"9 Fual Cade ut 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Q� Establishment Name: Date: S' P-/ W Page: to of 6 Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY JS -)) r✓)aL —CL£s >rU G �ca.tua�S FO�ao S�s,ar� � L 1t�� 'DISH t,. Ai 14 em-�A, s= � S'1Z:7st1_ AU_ AAL6rae- N A /� n joSOI .n-Ts GN6rr a tm �. Mrf�E� I 2s a r-A ` 4c-- P i 91 � DIA 6"'33 I ►+,r�cu��- `rr-�slflu�,.u�,� ��-ca:,.� -r�-�� Pi�� . 125 C��tS i a+ ti do +ccts. RV tLr, \X clav TN-R-, Q.-ncio, waLLl _ 17 as 4jUl o 2y 5Zp-zuL) ZS SCpaLsS " T'4b ". Z ,QA TWatWVW, J CLeWa+a� x`70 l2 �a`1CS� LIQ - Q+ a�si G StLa�aa. �a f�� P� tca� is t Sc�Mc Dtc��c�Ioa IlV4 C__ I 112 SWW�t?)� �.��-- 8br-+�lny�� dC1SPlwE� f•+a�s�OLtrt6 C�;r_t+a' Stivi:a.- t..,f\� tatTw�. P�Wd\,�, S'-�, e SL o,aty i�ivli\a TWA, h��.�o1f+c. I F Discussion With Person in Charge: 1 Corrective Action Required: I ❑ No I ❑ res I have read this report, have had the opportunity to ask questions and agree to correct allI ❑ 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 your food permit. 0 Voluntary Disposal ❑ Other: l r , 'i 3-501.t4(C) PHFs Received of Temperatures Violations Related to Foodborne Illness intemenflons and Risk According to taw Cooled to 1. Factors(items 1-22) (Cont.) 41=£^'/45`F Within 4 Haus. ' t PROTEC71ON FROM CHEMICALS 3-501.15 Cooling Methods for PHFs { 14 { Food or Color Additives I 19 PHF Hut and Cold Holding l 1-501.16(B) Cold PRFs Maintained at or below { 3-202.12 Additives*' { 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives` { { 15 Poisonous or Toxic Substances { i-SOf,16(A) Hot PHFs Maintained of or above 140°F. # 7-101.11 identifyingInformation-Original Containers* 3-501.16(A) Roasts Held az or above 130'F. * { { 20 Time as a Public Health Control { 7-102.11 Commcm Name-Working Containers* { 3-50I.t9 Tim as a Public Health Control' { 7-201.11 Separation-Storage* S { 7-202.11 .Restriction-Presence and Use* ( 590.004(H) Variance Requirement 1 { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7-203.11 'roaic Containers-Prohibitions* POPULATIONS(HSP) l { 7-204.11 S Chemirs.cals Criteria-Chemicals, 21 3-801.il(A) Unpasteurized Pre-packaged Juices and t { 7-204 12 Citemieals far Washing Produce,Criteria* { / { { Beverages with Warning Labels*7-204.14 Drying Agents.Criteria* { 7-205.11 Incidental Food Contact,Lubricants* 3-80I.11(B) Use of Pasteurized Ems* { t 3-80I.l l(D) Raw or Partially Cooked Animal Food and { 7-206.11 Restricted Use Pesticides,Criteria* I Raw Seed Sprouts Not Served { 7-206.12 Rodent Bait Stations* { 3-801.11(C) Unopened Food Package Not Re-served. ' { f 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY ( TiMEtrEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted far Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or ` Not Otherwise Processed to Eliminate PHFs Pathogens.*a*`Maar 1 3-401.IIA(IX2) Eggs- 155`F 15 Sec. Eggs-immediate Service 145'F15sec* 3302.13 Pasteurized Eggs Substitute for Raw Shell 31401.11(A)(2) Comminuted Fish.Meats&Game { Eggs* Animals-155'F 15 sec.* I 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. s catering, mobile food,temporary and 3401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 see. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.409 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. 3-401A I(A)(1)(b) { All Other PHFs- 1450F 15 sec.* � { 17 Reheating for Hot Holding { VIOLA77ONS R ELATED TO GOOD RETAIL PRACTICES 3A03.I I(A)&(D) PRFs 1657 15 sec.* (Items 23-30) 3.403.11(B) Microwave- 165°F 2 Minute Standing CMicai and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, cam be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 COIR 140*F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef i Item ! Good Retail Practices 1 FC 590.000 j Roasts" i 23. ; Management and Personnel f FC-2 .003 i { 18 Proper Cooling of PHFs 1 1 24. i Food and Food Protection I FC-3 .004 1 25. 1Equipment and Utensils i FG-4 .005 3-501.14(A) Cooling Cooked PHFs from 140"F to ! 26. Water.Plumbing and Waste I FC-5 .om 70`F Within 2 Hours and From 70°F ( 27. Fisica!Facifity 1 FC-6 .007 to 4VF/450F Within 4 Hours.* 128. Poisonous or Toxic Materials FC-7 .008 ! 3-501.14(B) Cooling PHFs Made From Ambient ! 1 29. Special Requirements ! .009 I er Temperature Ingredients to 41°F/45'F II( 1 Ott' Within 4 Hcans* 'Dernxes critical ivm in the federal 1999 Feed Cade w103 CMR 590.000. { CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 5- 9' 1 Page: -7 of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 9W_-' ?} \& IUG EnaT Av-o TX1AvI)L )V3 ' 9vOKV;Tbo I Ca 111�C11.C�P�'-C1� I 2.S' S"ia•�S — `�'t� Sr�ota la.m-' ra�� ►-k��.c>:ra., l-)�av� da c��vn �ct4 Laa�M�. lAr'[� S Zo- Rja'F�vc.,. `►T s16v�_Nv� c �-F,raa T41F. ��o� r:lio"0 t4aLCK�.'• 1 1 25 ICS C�i taai. r�6E�7Su a. t�aa� Pads ��b �+A� I? 1'A� S zo I �� . (L.Z;t�l�, fU �� Joat?r•.�. .�1�' Pc,o11 e-tT., ww"�'•�+. TDa t'1 It Sa1,;,X I Q� � 't� ►bo�A�roFt ops I wl �a111 Cs�r G'gQv�t�bo1_ 8 S-�K4_j cls -►-faa �JL qtr•., c�..Pt�m�a- T ot; 9,144E, IOtA) s -2. 1 I sav1-m t,&L. /ae,.�wv .,),Q-6Qruz9. 4+u'_� )q642 ►� 1 Fw.�,c73 ne,,� R&-X_.vw Q 6r4ewN —17b GA% r>xw>.S. To PtL�v�r� n Lctos� I 1 Cccfl�c.��aARoe� , FD si cussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i f i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41°F/45`F Within 4 Hour&.' PROTECTION FROM CHEMICALS 3-50!..15 Cooling Methods for PHFs ! i 14 Food or Color Additives 19 PHF Hot and Cool Handing 3-501.16(B) Cold PIIFs Maintained at or below 3-202.12 Additives* 590.004(M 41'!45°F* 3-302.14 Protection from Unapproved Additives* , 501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 identifying Information-Original I , I40`F. * ' 3-501.16(A) Roasts Held at or above 130°F. Containers* t 20 Time as a Public Health Control ( 7-102.11 Common Brame-Working Containers* 3-501.14 ( Time as a Public Health Control* ! 7-201.11 Separation-Storage* �S 7-202.11 Restriction-Presence and Use* ( 590.004(H) Variance Requirement { 7-202.12 Conditions ofUse'r REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(NSP) i 7-204.11 Sanitiurs.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce.Criteria* I 21 3-801.11(.A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact.Lubtioants* 3-801.11(B) Use of Pasteunzed Eggs* t 3-801.11(D) flaw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts No Served t ! 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 T 22 3-603.11 Consumer Advisory Posted for Consumption of liMEfiEMPERATURE CONTROLS I ( 16 Proper Cooldng Temperatures for Animal Foods Ttnat are Raw,Undercooked or Not Otherwise Processed to Eliminate PHFs ( Pathogens.*`"°`°"'J°a eU 3-401.11A(1)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.1 I(A)(2) Comminuted Fish.Meats&Game � Ear Animals-155'F 15 see. " SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) 1 Pori: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 I 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, C debited under the appropriate sections Poultry or Ratites-1650F 15 sec. above if related to foodborne illness 1 3-401.11(C)(3) Whole-muscle,Intact Beef Steals interventions and Tisk factors. Other it I 145T* 590.009 violations relating to good retail .i 3-401.12 Raw Animal Fowls Cooked in a I practices should be debited under#29- i Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. S 17 Reheating for Hot Holding VIOLATIONS R e'LATEO TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 1657 15 sec.* (Items 23-30) 3-403.11(B) Microwave- 165"F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- � found in the foilor'ing sections of the Food Code and 105 CMR 1400F'r 590.000. i 3403.1l(E) Remaining Un,liced Portions of Beef 1 Item i Good Retail Practices 1 FC 590.000 j l Roasts* ! 23. : Management and Personnel ', FG-2 .003 i 18 Proper Cooling of PHFs 1 24. i Food and Food Protection ( FC-3 .004 7 1 25. Equipment and Utensils I FC-4 .005 7 3-501.14(A) Cooling Cooked PHFs from 140°F to Water.Ptumbino and Waste ! FC-5 .006 ! 70'F Within 2 Hours and From 70°F i 27. Physical Facility FC-6 .007 to 410F/450F Within 4 Hours. ° 1 26. Poisonous or Toxic Materials ! FC=7 .008 i 3-501.14(Q) Cooling PHFs Made From Ambient 129. Special Requirements 009 Temperature Ingredients to 410F/45°F Other ! 1 Within 4 Hours* 'Denote:;crinica!ivm in the federal 1999 Foal Cale of 105 CMR 590.000. , t CITY OF SALEM BOARD OF HEALTH (+� Establishment Name: Date: `� i b)f Page: O of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item VerifiedPLEASE PRINT CLEARLY I� 3 5d�11� t�� -�tF►� -rsz� ��r v��r t �� i �f,= 53°�. ��aa T►a� ��c� s � yr+•�'1� '� rr,aai��i� oa ?br+G'. oF �-))"F � ��l.ow- JS 7•20J)l GAo, - TN? S9,,1117)1 I.1L+ S&wS\vN Fjw4.1c� A dkeiva -0-4z_ )tom f aL i>ac� S Z h Si� G1iErr�\clay) f36trov+ roea� SS3t�alT� I�u PO��dt:n5f' C)llilc - s�a.v� tzN �vl�cEv tk'j� 1-rr,�LEO. Lq�S1 _ Aar r- SPNIS�Z.Er� �vUK�I'1 l=� �3-u)Wtn C16L I G'-AL c 9-R:,Av,, Hajbe_--Z•� 140a 3 P)a s'rc c t Ld)t2- WrT)-t OPrE_ nr'4N*t " bi.so S2`)� PeWM T40 }n�Vz�• sirSnct�tE. P)a�'S Fa'✓m•-, aayc a �'S+3t,�. ,a.r� SLID ��oS_ � 3•�zv GIbL. -�i1��. t,,I)es�w 10t,, l�-,�RrI�., �n�-�.-��ti tlaa� P��i c�st�� w��u Gz�bha � ZC ��" �� . S�v,�faevc*C� Q�a�:l i=�.ao,c� ��r�:� �oaa-► 1a r`�,F:v'Fs.,S(' -i &r4cit_ vel'? > y '7'1 navlal> `V�- A��olt� ►Jct DtF� osi��a. 7&� �zs iRP t -�CC. Scan-�� t•i ht�f;ol �� St6'Lz R E drP�S6 `f� M�T�ty, S Discussion With Person in Charge: I Corrective Action Required: I ❑ No ( ❑ Yea I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understAnd that noncompliance may result in daily fineso }^enty-fiv door su sion/revocation of C1Embargo ❑ Emergency Closure your food permit. / /� �/ ❑ Voluntary Disposal ❑ Other: J r N ✓ V i 3-501.14(C) PHFs Reccived at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(@ems 1-:2) (Cont.) 41'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS F ( 3-501.15 Cuohna Methods for PHFs 14I f Food or Color Additives ! 1 19 - PHF!tot and Cold Holding 3-501,16(B) Cold PRFs Maintained at or below 13-202.12 Additives*' I 590.004(F) 4101450 F* 3-302.14 Protection from Una proved Additives" t E i-SOl.lfi(A) Hot PHFs Maintained at or above 115 Poisonous or Toxic Substances ° 7-101,11 'identifying Information-Original --- 140 F. 4 3-501:16(A) Beasts Held at or above 1300E. I Containers* " 120 Time as a Public Health Control i 7-102.11 Common Name-Working Containers* I i. 7-201.11 Separation-Storage* I 3-501.19 Time as a Public Health Contrtat* 7-202.11 .Restriction-Presence and Use* I590.{)04(H) Variance Requirement 7-202.12 1 Conditions of Use* ^• I : t Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 I t l POPULATIONS(HSP) ( 17-204.11 1 Samtizers.Criteria-Chemicals* 1 21 3 BUl.il(A) Unpasteurized Pre-packnged Juices and ?-204.12 Chemicals for Washing Produce,Criteria* I Beverages with Warning labels* ! 17-204.14 Drying Agents.Criteria' 't I' , i Use of Pa 17-205.11 Incidental Food Contact,Lubricants* , �) 3-801.3-8U13-801.11(l)) Raw or Partially Ci1(B) tially Cooked Animal Food and Eggs* I { 17-206.11 Restricted Use Pesticides;Criteria' 7-206.12 Rodent Bait Stations*.13 Tracking Powders,Pest Control and �- Raw Seed prexns Not Served. 7-206 3-801.11(C) Unopened Food Package Not Re-sensed. } Monitoring" : • ' l x v i CONSUMER ADVISORY t TIMElTEMPER4TURE CONTROLS v 22 3-603.11 Consumer Advisory Posted for Consumption of l } ' 16 .Proper Cooking Temperatures for Animal Foods!teat are Raw,Undercooked or PRFs t Not Otherwise,Processed to Eliminate 3-40i.IIA(1)(2) Eggs- 155°F 15 Sec. t I Pathogens Eggs-immediate Service 145°FlSsec* 3-302.13 Pasteurised Eggs Substitute for Raw Shell 3-401.11(A)(2) " Comminuted Fish.Meats&Game Ems* Animals-155'F 15 see. 3-401.11(B)(1)(2) Port;and Beef Roast-130'F 121 min* I SPECIAL REQUIREMENTS 1 3.401.11(A)(2) Ratites,Injected Meats-155`F 15 , 590.009(A)-(D) Violations of Section W.009(A)-(D)in / sec. * catering,mobile fwd,temporary and 340LI t(A)(3) _ Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be 4 Stuffing Containing Fish.Meat. debited under the appropriate sections I Poultry or Ratites-165'F 15 sec, * •. above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,law Beef Steaks ^ ' interventions and tisk factors. Other 145°F d'. 590.009 violations relating to good retail 3-401,12 Raw Animal Foxis Cooked in a practices should be debited under k29- Microwave 165F Special Requirements. 117 I 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec. Reheating for Not Holding 1 VIOLATIONS RELATED TO GOOD RETAIL PRAC77CES 3-403,1 I(A)&(D) PHFs 16S F 15 sec. * - (Items 23-30) � 1 3-403.11(B) _ Microwave- 165`F 2 Minute Standing I Critical and non-critical violations,which do not relate to the Time* ` foodborne illness interventions and risk factors lister]above, can be 3403.11(C) •• Commercially Processed RTE Food- found in the fc, wing.sections of the Food Code acrd]U5 CMR i 140°F* 590.000. ' ' ! 3403.11(E) Remaining Unsliced Portions of Beef `� j Item ; Good Retail Practices FC 590.0w 1 Roasts*' 1 23. 1 Management and Personnel FC-2 .003 i 1 18 ! Proper Cooling of PHFs • I 1 24. 1 Food and Food Protection ( FC-3 .004 125. Equipment and Utensils I FC-4 .005 r' 3-501.14(A) Cooling Cooked PH rs from 140`F to 1 2f,, Water.Plumbinq and Waste ' ' FC-5 .006 70'F Within 2 Hours and From 70'F 1 2-T 1 Physical Facility FC-6 .007 1 to 41`F/45'F Within 4 Hours. * 1 28. ; Poisonous or Toxic Materials ' FC-7 .008 c 3-501.14(B) Cooling PHFs Made From Ambient ' 29. 1 Special Requirements I .009 1 Temperature Ingredients to 41°F/45'F• 30. 1 Other ! ! Within 4 Hours* 'a-o(rwv cnacal item in the f derxi 1999 Fwd Cale w 105 C-MR 590.000. i t A-1 Exterminators P O. Box 310 Lynn, MA 01903-0310 781-592-2731 ORDER .Y: 1002387 m.oerc cAlE 5p':2r,. Time In: '/12/7011?25 PMs BILL-TO 146SS3 LOCATION 146SS3 Time Out: 5/12/2014 3:15 PM MADRID SEAFOOD INC BROTHER GEORGE'S &PULEO DAIRY customer Signature BROTHER GEORGE& PULEO DAIRY 376 HIGHLAND AS S 376 HIGHLAND AVENUE Salem, MA 0197 Salem, MA 01970 _ • Jack Phori '908-943-8851.RICA Phone. 978-74t-3883 xMAIIJ Technician Signature Alt,Phone: 978-741-3883 xMAIN Alt Phone: 908-944-8851 aRICA-' �u Donald Gwi ner \ License 79642 Purchase Order Terms Service Description Quantity Amount me COD REGULAR PEST CONTROL SERVICE 1.00 4900 Subtatat 49 W Tax 0.00 ' Total Due: 49.00 w. GENERAL COMMENTS/ INSTRUCTIONS _ FRONT COUNTERJRR/KITCHEN/PREP AREASIOH ICE& - -- DINING ROOM onelast service mzy 12th,needsAcoipt - - - fm.�W3laetse[yrce,moving in June per `pay c.o.d. • : .. ' - :. ya, InspeFj all areas outside for burrovrs and 1» Inside¢.ylace,inonitors and wet rodent bait Bait for ants front counter. r -„ ,,,..PRODUCTS APPLICATION SUMMARY _ Material ^• _ Lot# EPA# A.I.W. Active Ingredient Finished Qty Undiluted Qty - - GawaUon i 7T73-218 00025% Ddetlaalone. 20000 Each Gourmet Ant Bait 73766-1 6.00000.',, Ursodmm Odabmate Farahy IODOO Ounce 10000 Ounce P€kTACTIVITY #Area' # Devices Pest Totals ➢, ' Nan'Nutri. DEVICE INSPECTION SUMMARY x None Noted. r a. AREA COMMENTS _ `•M o None Noted. , a,r, . t a ` r I 1 � DEVICEINSPECTIONEXCEPTIONS None Noted.. t' - t � , Y • r INSPEC I(W)ETAIL Nrve Noteil. . t•� r ', br 1 i ' -n i 'F• COPIED AREAS MUST BE VACATED FOR _ HOURS.THOROUCHL✓.'bENTILATE TREATED AREAr BEFORE THEY•ARE REOCCUPIED,DO NOT ALLOW ADULTS, , C CHILDREN,OR PETS ON TREATED SURFACES UNTIL DRY, v, .” ., , CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT or FOOD 8,AGRICULTURE Pg$jIClD€BUREAU CONSUMER SHEETS,VJRFFFE''1 1 �TATEMENT*POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANI<,5, 2-7 DAV'PRIOR70 APPL1CAfiION't1ME.THE ABOVE_SEP.VICE 4K5&°EN SATISFACTORILY CWPLETED. A-1 Exterminators P 0. Box 310 Lynn, MA 01903-0310 781-592-2731 ORDER #: 1002387 morr,DATE. 5/1]/20}9 PRODUCTS APPLIED Material AS.We Rnuhed Qty Application EgUIPment Time EPA# AI ConcenLation UnchhRed pry Application Method SA/Cu Ft Lot# Generation 0.0025% 2,0000 Each 3.12.39 PM 7173-216 n/a Bait Station Target Pests: Mice Gourmet Ant Bat 6,0000% 10000 Ounce 3:12:55 PM 73766-1 n/a 1,0000 Ounce Crack 6 Crevice Target Pests: Ants A OCCUPIED AREAS MUST BE VACATED FOR HOURS.THOROUGHLY VENTILATE TREATED ARE45 BEFORE THEY ARE REOCCUPIED DO NOT ALLOW ADULTS, CHILDREN,OR PETS ON TREATED SURFACES UNTIL DRY CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD&AGRICULTURE'S PESTICIDE BUREAU CONSUMER SHEETS,WRITTEN STATEMENTS,POST114G NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION TIME THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED. L INS 5-1 ' � 4" ommonwealth of-Massachusetts' W -IV1-1 . ..... A, --abity of:Salem, Zq -Nif�l ' Board oUllealth > 120 SVasWngton Street;4th Floor �, Mayor VE A IINf, 1161J, I, V, SALEM,MA 01970 k-A ria Food/Retail EstabhshmeIIt Permit' " Z's Is M, A It, i�o 6�iTE PRINTtD, -'x -v V, is n�kW 41 -,�-ESTABLISHMENT- NAME Brother"-George,--,,-,-, -B -li&Iand;Av6iie E, -Alelqu��- 4:2004-6,00086 ;--3761 Ir 14 V,Salefff t6 *'Ar- I� , �P'IMA401970�," is — - . -, -- - - ..- V I: 'A 6CATEDAT: SALEM, i Ilk, Issued,-Permit Ex-?iresl'-:V,�` Fie-Restrlcti6is/Notes-- 04 -FOOD SERVICE .. i8664 T ESTABLISIMEM m AQM J 4, "9 Vill 7 lsll� !sVZ 'Q Nm- V 'fs 4 ah S :4as !,,:g, _ Q F174 4- Jsii,, .Vs �tPERMIT EXPIRES , 6ej3j %4 - Bo -aid df.Healt] 770J 'A I j Nsf A Is, v-2 T-L ra - A,-, c Y,'t VA 4 A Nm This-Permit is'riot transferable-idd-fitfisfbe reissued upon change oflownership ot-locafibn.-Tht-periidti�istbe--posted In a pronnnent IoCad.on in the Establishment. �tr In accordance With the State SanitaryjCodi,-•beo&-anyre-vo'natio'os,improvements,or equipment changes are '. �p 1,�-',�-'`all plaiisfoisiiehmuit7besubirdttedt6'imi'if,-iipiovidbjitlieSidiiiiBoard.of' eilth -V a�de 1 A N LL _4 Is CITY OF SALEM, MASSACHUSETTS rebx�xeattb r BOARD OF HLAI:1-r 120 WASHINGTON SI RFE'r,4111 FI OOa KIMBERLEY DRISCOLL TxL.(978)741-1800 FAX(978)745-0343 LARRY RANIDIN,ILS/REI IS,CI 10,CP-FS Iramdin(a�sale.m.com MAYOR - HIiA]:17-I AG1?N'P f Food Establishment Permit Application (Application must 7be submitted at least 30 days before the planned opening date) 1) Establishment Name: f,�rC�HVI, / PL&��5 /�/F n 12) Establishment Address: 37(e 94ti /�lij2G! e� r- l!v4V - v P�20 13) Establishment Mailing Address(if different): I 14) Establishment Telephone No: g,g- 74 /-(( 3 5f ) _ /(q //-� 15) Applicant Name&Title: ?b SG ( i(oj�)YI✓�� IJd/74,rine /J,9rICno .1, 6) Applicant Address: 3,)_ / d��L7G( --e'l // 7) Applicant Telephone No:q)7 39Y3j/d-e- 24 Hour Emergency No: 5wer— Emaikjo/vt'7n41'IW(f0 ®f NPI 8) Owner Name&Title(if different from applicant): J 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&%m=ation �pp // / /� An individual 7� G5. 4-fft(�la, Owner lOW115 -W ftirnr A partnership Other legal entity I �a / rrervwdrL rl it r r I I 12) Person Directly Responsible For Daily Operati/on (Owner, Person in Charqe, Supervisor,Manager,etc.) Name&Title: Ja 4 of v7 0 4 /"1=rrr r) Address: 7Q GUAj 5.141 /_ 4110'e-11? yLl x�IG1�� / V /�/17� Telephone No: 9/7--30 3/2? Fax:(917-7,,'b Emai n 11.f1 "", ® 'io' Emergency Telephone No: .. 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: Date: l"Y /�� Amount: " aJ 1) Food Establishment Information ,Nater Source: 15) Sewage Disposal: /?Public Water Supply No: (if applicable) /16) Days and Hours of Operation: 17) No.of Food Employees: / 18) Name of Person In Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) j 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ,ss Yes No 20) Location: 22) Establishment Type(check all that apply)' (check one) 11 Retail( Sq, Ft) 0 Caterer anent Structure ZrFOOd Service-( Seats) 0 Frozen Dessert Manufacturer obile d'Food Service-Takeout 0 Residential Kitchen for Retail Sale 0 Food Service-Institution 0 Residential Kitchen for Bed and { Meals/Day) Breakfast Home 0 Food Delivery 0 Residential Kitchen for Bed and 21) Length Of Permit: &eakfast Establishments-_------_----------- (check --_(check one) RETAiI STORE RESTAURANT 401diln"ual 0 Less than 1000sq.ft. $ 70 0 Less than 25 seats $140 Seasonal/Dates: 01000-10,000sq.ft. $280 0 Residential Kitchens $140 0 More than 10,000sq.ft. $420 0 25-99 seats $280 0 More than 99 seats $420 TemporarylDateslTme: - - 0 Sed&Breakfast)Childcare Services!Nursing Home $100 -- - ------------- •----•--------------------------------_-..-._...._--------- - ---•-- ----------------------- ADDITIONAL PERMITS 0 MAKE ICE CREAM,YOGURTISOFT SERVE $25 O PASTURiZATION $25 0 TOBACCO VENDOR $135 0 ALL NON-PROFIT $25 (Including,church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(dme7empersture controls required) Non-PRFs-non-potentially hazardous food(no timeltemperature controls required) (check all that apply): RTE-ready-to•eat foods(Er.sandwiches,salads,muffins which need no further processing Sale of Commercially /^F Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Prepackaged PHFs Cold Folding for Single Meal Service : Susceptible Population Facility 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 Meats for Catered Retail Sale Events or institutional Food Service Offers RTE PHF in Bulk Quantities To be comnteted by the Board of Health 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 as instructed by the Board of Health on how to obtain copies of 100 CMR 590.000 and the Federal Food Coda j/,v�� 24) Signature of Applicant: s"` Pursuant to MGL Ch.62C,s 49A I certify under the penalties of perjury that 1,to my best knowledge and belief, Have filed all state tax return and paid state taxes required under law. 25) Social Security Number or Federal ID: 26) Signature of individual or Corporate Name: Masdachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name /, ate PResidentja1cKi1n'h8en of ODeratioTyge of Insoaction k10)1 LJ G�a�l P _ R{� d Servie tine Address /�Ao tall Re-inspection Level Previous Inspection Telephone q/)Q ❑ Mobile Date: Owner HACCP Y/NElTemporary ElPre-operation o I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) T,I, ❑ Bed&Breakfast ❑ General Complaint Inspector Out: Permit No. [I HACCP El Other Each violation checked requires an explation on the narrative page(s)and a citation of specific provision(s)violated. VVVVV 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) ❑ 690.009( 11 action as determined by the Board of Health. ✓ [FOOD PROTECTION MANAGEMENT-,;,;, _ _ , d1 El 12.12. Prevention of Contamination from El 1. PIC Assigned/Knowledgeable/Duties 013. Handwash Facilities ❑MPLYEIE HEALTH 2. Reportng of Diseases by FoodI PROTECTION FROM CHEMICALS Employee and PIC El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIM EMPERATURE CONTROLS(Potentially flazardoua Foods), El 4. Food and Water from Approved Source 1 _________ ❑ 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 ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing L.REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing .. . .J �I ❑ 11. Good Hygienic Practices Lc9N$uMER ADVISORY,-,:�, -: •� � ` -�� - El 22. Postingof 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel FFc-2)( order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-a)(s90.00 s)o.00a) 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: Inspector's Signatu Imo - Print: PIC's Signature Print: ILIL Page of ages 7- 3 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination i 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated front" Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I I I I Contamination from Raw Ingredients I 2-103.11 Person in charge -duties 3-302.11(A)(2) ( Raw Animal Foals Separated fromEach EMPLOYEE HEALTH I Other* _ Contamination from the Environment I 2 1590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection'" f require reporting by foot employees and 3-302.15 Washing Fruits and Vegetables I' applicants* 13-304,11 I Food Contact with Equipment and 590.003(F) Responsibility Of A Fad Employee Or An Utensils* Applicant To Report To The Person in I I Contamination from the Consumer Charge* 590.003(G) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Fad and Reservaced or C of Food* Disposition of Adulterated or Contaminated 13 1590.003(0) Exclusions and Restrictions* I I Food 590.003(E) I Removal of Exclusions and Restrictions I 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE rte* 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces j 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* . 3-201.13 Fluid Milk and Milk Products' I ( 4-501.112 Mechanical Warewashing-Hot Water �. 3-202.x3 Shell Eggs* I Sanitization Temperatures* 13-202 W Eggs and Milk Products,Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 ice Made From Potable Drinking Water* ( concentration and hardness.* 15-101.11 Drinking Water from an Approved System" I 14-601.11(A) I Equipment Food Contact Surfaces and 1590.006(A) Bottled Drinking Water* I Utensils Clean* 590.(H)6(B) Water Meets Standards in 310 CMR 210* I 4-602.11 ( Cleaning Frequency of Equipment Contact Surfaces Surfaces and Utensils' Y Shellfish and Fish Froman Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipinent� `I Shellfish* I 14-703.11 Methods of Sanitization-Hot Water and ;) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 110 ( Proper,Adequate Handwashing I ' Game and Wild Mushrooms Approved by Regulatory Authority 12-301.I I Clean Condition-Hands and Arms* f 3-202.18 I Shellstock Identification Present* I 2-301.12 Cleaning Procedure* 590.004(0) I Wild Mushrooms" I 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 I I Good Hygienic Practices 15 ReceivinglCondition I 2-401.11 Eating,Drinking or Using Tobacco* 1-202.11 I PHFs Received at Proper Temperatures" I 2-401.12 Discharges From the Eyes,Nose and 3-202.15 I Package lntegrity* ( I Mouth* ( ; 3-101.11 I Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* I' 16 I Tags/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 I Shellstock Identification Maintained* I Employees* Tags/Records:Fish Products I 113 Handwash Facilities 3402.11 Parasite Destruction* I Conveniently Located and Accessible 3402.12 Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients' I 15-204.11 Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance I IHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging,criteria* I 16-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision Denotes critical item in the federal 1999 pond Cade of 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH iA Establishment Name:a t ( ntavto�� Date: �1� /� C Page: 0-,N-of Nem Code C-Crmcal Item v `� DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified /l PLEASE PRINT CLEARLY 4O i 1 � jf0' �Go _4 1 _, L44� -1 Lib (�..L v r I ✓` c I v�,V t1t1�P� I .�rallh Gif) 'In �P. Wd0 � , f��S — Lv\ I 'LA)no{��no � t ON 1 1(DMf$ fMia F Discussion With Person in Charge: I 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 Exclusion violations before the next inspection, to observe'all conditions as described, and to p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I under tand that noncompliance may result in daily fines of nt -five dollars ors ensign revocation of ❑ Embargo ❑ Emergency Closure your food permit. ' ❑ Voluntary Disposal ❑ Other: 3-501.144C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cuofed to Factors{items 1-22) (Cont.) 41'Fi45°F Within 4 Hours. PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs ( 14 1 Food or Color Additives ( ( 14 PHF Hot and Cold Holding 1 3-202.12 Additives* ( 3-501.16(13) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 3-501,4(Fl Hot PH F* ( 15 Poisonous or Toxic 5ubatsnces ( 3-501.F 6(A} Hoc PHFs Maintained a[or above 140`F. 7-101.11 identifying Information-Original { * Containers" i 3-502.16(A) Roasca Heid at or above 130'F. " ( 20 Time as a Public Health Control 7-102,11 Compton Name-Working Cantainers* ( 1 7-201.11 Separation-Storage* ( 590.( 19 Time as a Public me nth Control" 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement ( 7-202.12 Conditions of Use* E REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-203.11 Toxic Containers-Prohibitions* ( POPULATIONS(NSP) 7-204.11 Sanitizers.Criteria-Chemicals* ( 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and .Beverages with Warning labels* ( 7-204.14 Drying Agents.Criteria* ( 7-205.11 Incidental Food Cantata.Lubricants* ( 3-801.11(B) Use of Pasteurized Eggs" 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* l ( ( 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and " Monit tt tie CONSUMER ADVISORY 1TMEITEMPERATTJRE CONTROLS 22 3-603.11 1 Consumer Advisory Paged for Consumption of 1 Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHF9 Not Otherwise Processed to Eliminate `%CDix rN2tMt 3-401.11A(I)(2) Egg- 155T15 Sec. Pathogens.* Eggs-immediate Service 145*Fi5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell j 3-401.11(A)(2) Comminuted Fish.Meats&Game { Ego 3 Animals-155°F 15 sea:. ( 3-401.11(11)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS of Section 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 ! 590.009(A}-(D) ca orations of Section temporary and in sea.* i catering,mobile food,temgarary and 3-401.1 I(A)(3) Poultry,Wild Game,Staffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F IS sec.* above if related to foodborne illne s 4 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F " 590.009 violations relating to rood retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145°F 15 sec. ( 17 Reheating for Hot Holding VIOLATIONS R:GATED TO GOOD RETAIL PRAC77CES h 3-403.11(A)&(D) PHFs 165°F 15 sec.x ( (Items 23-30) 3-403.11(B) Microwave- I65-F 2 Minute Standing Critical and non-crifical violations,which do not relate to the Timc* foodborne illness inter entions and risk factors listed above, can be 3403,11(C) Commercially Processed RTE Foul- found in the following sections of the Food Cade and 105 CMR 140°F* 59aOOO. 3-403.i1(E) Remaining UnslicedPorcitmsofBeef 1 Item Good RetailPracttces FC 540.000 i Roasts" i 23. Management and Personnel ( FC-2 .003 j ( 18 ( Proper Cooling of PRFs ( 124. j Food and Foci Protection I FC-3 .004 125. Equipment and Utensils 1 FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to ! 26, 1 Water.Plumbing and Waste _ FC-5 .006 70°F Within 2 Hours and Front 70`F 1 27. I Physical Facility FC-6 .007 to 41`F(45'F Within 4 Hours. * 128. Poisonous or Toxic Materials FC-7 ,008 ` 3-501.14(8) Cooling PHFs Made From Ambient 129. j Special Requirements .009 ; Temperature Ingredients to 4l'Fi45°F ' 30. 1 Other Within 4 Hants* 7 r 'Denotes critical watin the L-decal 1999 Food Cale or 10�C.MR X90.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: on _ o. L3 .3 _ Date: —inl— Page: of Rem Code C-Critical Item (�EC� DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Rem Verified PLEASE PRINT CLEARLY h/,)/p a 1�� . _. /� l � p (_/M^-yv,- n — U F� Ian �2/VL�Q D� �.�[J . I AAA,l ,u f� l 1l2l/L CaXQdn n _ �D/1i1. C��lYa Inn JA i I I I I I I Discussion With Person in Charge Corrective Action Required: I ❑ No I UY Tes 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-inspectio chedu ed ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I under and that noncompliance may result in daily fines of_yA«pnty-fiv dolor s ns vocation of ❑ Embargo ❑ Emergency Closure — your food permit. IU —_ ❑ Voluntary Disposal ❑ Other: 3-501.14(0 PHFs Received at Temperatures 1 Violations Related to Foodborne 111ness inter•✓entlons and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41'171457 Within 4 Homs. 3-503.15 Cooling Methods for PHFs { PROTECTION FROM CHEMICALS { 14 { Food or Calor Additives ( { 19 CHF Hot and Cold Holding { 3-501.16(13) Cold PRFs Maintained at or below { 3-202.12 Additives* { 590.00•i(F) 41°145°F* 3-302.14 Protection from Unapproved Additives' 1 ( 3-501.I6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances ' 140 7-101.11 ldenti6ringInformation-Original Roasts Containers* 3-501.16(A) Roassts Held at or above, 130'F. f 20 Time as a Public Health Control 1 { 7-102.11 Common Name-Working Containers* {{ 7-?01.11 Separation-Storage* 3-501.19 Time as a Public Health Control* i{ I 590.004(H) Variance Requirement { 7-202.11 .Restriction-Presence and Use* . 7-202.32 Conditions of Use* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* { POPULATIONS(HSP) { 7-204,11 SanChemicals Criteria-Chemicals* { � 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 1 { 7-204.12 Chemicals fru'Washing Produce,Criteria" { geveaages with Warning labels* 1 { 7-204.74 Drying Agents.Criteria* { { i � 3-801.11(B) Use of Pastem-izeci Eggs* I 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 * {f 7-206-12 Rodent Bait Stations* - � 3-$01.11(,C) Unopened Food Package Not Re-served. f 7-206.13 Tracking Powders,Pest Control and 1 Monitoring* CONSUMER ADVISORY TIMETFEMPERITURE CONTROLS 22 3-603'11 Consumer Advisory Posted for Consumption of P6 Proper Cooking Temperatures far Animal Foods That are Raw.Undercooked or ` PHFs Not Otherwise Processed to Eliminate Pathogens.*Enx`1n" 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Eggs-Immediate Service 145°Fl5sec* 3-302.33 Pasteurized Eggs Substitute forRaw Shell 3-401.11(A)(2) Comminuted Fish.Meats&(lame � Eggs* Annuals-155°F I5 sec. * ) SPECIAL REQUIREMENTS 3.401.11(13)(1)(2) Pori: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 ford,temporary and t 3-401.1 I(A)(3) Poultry-,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish.Meat. debited under the appropriate sections r Poultry or Ratites-i 65'17 is sec * { above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 -Raw Animal Foods Cooked in a practices should be debited under#29- li Microwave 165F* Special Requirements. 3401.11(A)(1)(b) All Other PIFs-145°F 15 sec.* { 17 Reheating for Hot Holding { VIOLA77ONS R ELATED TO GOOD RETAIL PRACTICES J 3-403.11(,1)&(D) PHFs 165°F 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 Time* foodborne illness interventions mut 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 140oP 590.000. 3403.11(E) Remaining Unsliced Portions of Beef { Item 1 Good Retail Practices I FC 540.000 i Ro4asts" 1 23. 1 Management and Personnel I FC-2 .003 i 1 Proper Cooling of PHFa 24. 1 Food and Food Protection I FC-a .004 I + { IS { { I 25. ? Eauiumomand Utensils i FG-4 .005 I 3-501-14(A) Cooling Ccxmked PHFs from 140°F to 26. I Water.Plumbinq and Waste FC-5 .006 1 70`F Within 2 Hours and Front 70°F j 27. I Physical Facility FC-6 .007 to 4I°F/45°F Within 4 Hours. * 128. ' Poisonous or Toric Materials ! FC=7 .008 i 1 3-501.14(]) , Cowling PHFs Made From Ambient i 129. , Special Requirements ! .609 1 1 TemperatureIngredients to 41°F/45"F IIi ' 30' ! Other Z Within 4 Hours* ^nnr llencxec critical tom in the federal 1999 Food Cale o'IV CMR 590.000. 1 r I A-1 Exterminators Integrated Pest Management T. P.O.Box 310 — g 9 Lynn,MA 01903-0310 Detailed Service Report 781-592-2731 ORDER #: 872404 Work Date: 2/25/13 Time In: 2/25/13 2:04 PM Time Out: 2/25/13 3:00 PM Customer Signature BILL-TO 146553 LOCATION 146553 MADRID SEAFOOD INC BROTHER GEORGE'S &PULEO DAIRY BROTHER GEORGE&PULEO DAIRY 376 HIGHLAND AVENUE 376 HIGHLAND AVENUE Salem, MA 01970 Technician Signature Salem,MA 01970 U Phone 908-943-6851<RICA Phone 976-741-3883 MAIN Alt Phone 978-741-3883YFlAIN Alt onone 906-94 -0851 xRICA Donald Gardner License#: Purchase Order Terms Service Description quantity Amount None COD REGULAR PESTCONTROL SERVICE 1.00 49.00 Subtotal 49.00 Tax 0.00 Total Due: $49.00 GENERAL COMMENTS/INSTRUCTIONS Service Instructions: FRONT COUNTER/RR/KITCHEN/PREP AREAS/OFFICE& DINING ROOM Tech Comment Inspect all areas bait far rodents back door and storage replace monitors Inside tin cats.replace wet rodent bait, OCCUPIED AREAS MUST BE VACATED FOR HOURS.THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED.DO NOT ALLOW ADULTS,CHILDREN,OR PETS ON TREATED SURFACES UNTIL DRY. CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD&AGRICULTURES'S PESTICIDE BUREAU CONSUMER SHEETS,WIL ITS STATEMENTS,POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED, INS 5-1 CONDITIONS/OBSERVATIONS Reported Severity Responsibility Reviewed Open None Noted. Resolved This Visit ' None Noted. PRODUCT APPLICATION SUMMARY Material EPA# A.I.% Active Ingredient Finished Qty Undiluted Qty Generation 7173418 0.0025% Ddethlalone 8.0000 Each 0.0000 Each PEST ACTIVITY #Areas # Devices Pest Totals None Noted. DEVICE INSPECTION SUMMARY - Device Type #Inspected #Inspected w/Activity #Skipped #Replaced None Noted, AREA COMMENTS None Noted. DEVICE INSPECTION EXCEPTIONS Device Type Device Name Exceptions Reason Area None Noted INSPECTION DETAIL ` Area Time Device Type Status Pests Captured None Noted. Areas Time Type Status Pests Captured Printed:2/25/13 Pail C A-1 Exterminators Box31 P.O. Box 310 Inte9 9 rated Pest Management Lynn, MA 01903-0310 Detailed Service Report 781-592-2731 ORDER#: 872404 Work Date.2/25/13 INSPECTION DETAIL Areas Time Type Status Pests Captured Kitchen 2:29:04 PM Area No Activity PRODUCTS APPLIED Material A.I.% Finished Qty Application Equipment Sq/Cu Ft Time EPA# A.I.Concentration Undiluted Qty Application Method Weather Lot# Generation 0.0025% 8.0000 Each n/a 2'58'03 PM 7173-218 1.00000000 0.0000 Each Bait Station n/a Target Pests: Mice TIJ17 f-tf C 11i;C1 Printed: 2/25/13 f ` .,.�' r[T Page:2 A-1 Exterminators Integrated Pest Management P O.Box 310 g 9 Lynn, MA 01903-0310 Detailed Service Report 781-592-2731 ORDER#: 878493 Work Date 3/25/13 Time In: 3/25/13 2:36 PM Time Out: 3/25/13 3:05 PM Customer Signature BILL-TO 146553 LOCATION 146553 � ` MADRID SEAFOOD INC BROTHER GEORGE'S &PULEO DAIRY BROTHER GEORGE&PULEO DAIRY 376 HIGHLAND AVENUE 376 HIGHLAND AVENUE Salem, MA 01970 Technician Signature Salem, MA 01970 Phone 908-943-8851 xRICA Phone 978-791-3883 MAIN Alt.Phone 978-741-3683 rMA]N Alt Phone 908-943-8851 xRICA Donald Gardner License#: Purchase Order Terms Service Description Quantity Amount None COD REGULAR PEST CONTROL SERVICE 1.00 49.00 Subtotal 49.00 Tax 0.00 , Total Due: $49.00 , GENERAL COMMENTS/ INSTRUCTIONS Service Instructions:FRONT COUNTER/RR/KITCHEN/PREP AREAS/OFFICE& DINING ROOM Tech Comment: inspect all areas outside for burrows Inside rebait for mice prep area and kitchen. Warehouse replace monitors and wet rodent bait. OCCUPIED AREAS MUST BE VACATED FOR HOURS.THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED.DO NOT ALLOW ADULTS,CHILDREN,OR PETS ON TREATED SURFACES UNTIL DRY. CONTRACTING ENTITIES HAVE RECNED ALL MASSACHUSETTS DEPARTMENT OF FOOD&AGRICULTURES'S PESTICIDE BUREAU CONSUM SHEETS,WRITTEN STATEMENTS,POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATION THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETED. INS 5-1 CONDITIONS/OBSERVATIONS Reported Severity _ Responsibility Reviewed Open None Noted. Resolved This Visit None Noted. PRODUCT APPLICATION SUMMARY Material EPA# A.I.e/ Active Ingredient Finished Qty Undiluted Qty Generation 7173-218 0.0025% Dlfethialone 3.0000 Each 0.0000 Each PEST ACTIVITY #Areas # Devices Pest Totals None Noted. DEVICE INSPECTION SUMMARY Device Type #Inspected #Inspected w/Activit #Skipped #Replaced None Noted. AREA COMMENTS None Noted. DEVICE INSPECTION EXCEPTIONS Device Type Device Name Exceptions Reason Area None Noted. INSPECTION DETAIL Area Time Device Type Status Pests Captured None Noted. Areas Time Type Status Pests Captured None Noted. Printed:3/25/13 Page:1 Ad Exterminators Integrated Pest Management P.O.Box 310 9 9 Lynn,MA 01903-0310 Detailed Service Report 781-592-2731 ORDER #: 878493 Work Date:3/25113 PRODUCTS APPLIED Material A.I.% Finished Qty Application Equipment Sq/Cu Ft Time EPA# A.I.Concentration Undiluted Qty Application Method Weather Lot# Generation 00025% 3.0000 Each n/a 2:53:59 PM 7173-218 1.00000000 0.0000 Each Bait Station n/a Target Pests: Mice Printed:3/25/13 Page:2 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4h Floor Salem, MA 01970-35Pq Tel. (978) 741-1800tFax(978) 745-0343> City/Town of :W oAy\ Address: / FOOD ESTABLISHMENT INSPECTION REPORT Tel.(l,W i/�I y) I�6 A- 1 Name C� , () ate Type Operafionfs) Typeo6inspection ��E� P_ _ r�� j nod Serviceoutine Address Risk / ❑ Retail 0,R�inspection _ A Level ❑ Residential Kitchen Previous Inspection Telephon n I `� ❑ Mobile Date: Owner �jl _ (� 1^ HACCP YIN ❑ Temporary ElPre-operation q vi f dU 6 I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Ti ❑ Bed&Breakfast ❑ General Complaint _ El HACCP Inspector j Out: Permit No. E]Other Each violation checked requires ane lanation 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 Anti-Choking 590.009(E) ❑ IV Violations marked may pose an imminent health hazard and require immediate Tobacco 9 590.009(F) ❑❑ - corrective action as deterAllergen Awareness 590.009(G)mined by the Board of Health. ,,.t / f FOOD PROTECTION MANAGEMENT__ -_ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ 13. Handwash Facilities 'EMPLOYEE HEALTH _ - -._ "OI{'� ' `PROTECTION QROM'CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives F006 FR_OM _ APPROVE_D S-_O_URCE_ E] 15.Toxic Chemicals 7 _ - _ _ _ El . 4. Food and Water from Approved Source TIMErmMPERATURE CONTROL_s_(Potantiany H_areid_ouri 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 C/ [120.Time as a Public Health Control No [ 9. Food contact Surfaces Cleaning�q/0 Sanitizing REQUIREMENTS FOR MIGNLY,SUCECEPTIBLE=POPULATIONS(N$P) ❑10. Pro M Ace'8 .....g� �`e� � gQ� ®21. Food and Food Preparation for HSP _ p q ate andwashing _RAD_VI_SORY.__ _ ElfCONSUME11. Good Hygienic Practices ny-_IW22. posting of Consumer Advisories Violations Related to Good Retail Practices-(Blue !T-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-3X590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4X59o.o05) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FcsXs9o.00s) 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. /ll 30. Other 6�A DATE OF RE-INSPECTION: c 1- rv1 ZAiWn. Inspector's Signature: /� ,-°�J�+ 6 Print: YJ �/'w,, ^ ---�-,,�32 ' `I PICS Signature: /�y/r r v ' ' Print 111 ' Page ot'�ges I T III Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I g i I Crass-conal Foods p 3-302.11(A)(1) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility I Cooked and RTE Foods* 590.003(6) Demonstration of Knowledge" I Contamination from Raw ingredients 2-103.11 Person in charge-duties I 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590,003(C) Responsibility of the person in charge toI Contamination from the Environment 3-302.11(A) Food Protection I require reporting by food employees and applicants* 3-.,3 02,15 I Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In I Contamination from the Consumer Charge* 590 003(G) Reporting by Person in Charge* 3-306.14(A)(13) I Returned Food and Reservier of Food* f I I I IDisposition of Adulterated or Contaminated I 13 590.003(D) Exclusions and Restrictions* Food Foodod 1 590.003(E) Removal of Exclusions and Restrictions ( 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food* 4 I I Food and Water From Regulated Sources I ( 9 Food Contact Surfaces 590.004(A-B) I Compliance with Fad Law* 4-501,1I I Manual Warewashing-Hot Water 13-201.12 I Food in a Hermetically Scaled Container' I Sanitization Temperatures* 3-_01 o .13 Fluid Milk and Milk Products' x I ( 4-501.112 Mechanical Warewashing-Hot Water 1 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products, Pasteuti7.ed* �___ 4-501.t 14 Chemical Sanitization-temp.,pH, 13-202.16 1 ice Made From Potable Drinking"'a'er* I concentration and hardness.* 5-107.11 Drinking Water from an Approved System* I 14-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' I Utensils Clean* I ( 590.i)U6(B) I Water Meets Standards in 310 Cri1R _2.0* 4-602.11 Cleaning Frequency of Equipment Food- __ Shellfish and Fish From an Approved Seume I Contact Surfaces and Utensils* 3-201.13 Fish and Recreationally Caught;vloliusc.,n I 14-702.11 Frequency of Sanitization of Utensils and Shell5sh* Fad Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from vSSF listed { Chemical* J Sources* Game and Wi.�d M;shrooms Approved by 110 Proper,Adequate Handwashing RegulatoryAuthorlty 2-30I A 1 I Clean Condition-Hands and Arms* i 3-202.18 I Shellstock identification Presem* I 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 12-301.14 I When to Wash* 3-201.17 I Game Animals* I 111 I i Good Hygienic Practices 5 I Receiving/Condition I 12401.11 I'Eating,Drinking or Using Tobacco* J i 3-202.11 ( PHFs Received at Prover Temperatures* I 2401.12 I Discharges From the Eyes,Nose and I 3-202.15 Package:nteprity* ( Mouth* l 13.101 t 1 foal Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* 16 i Tags/Rerorde:Shellstock I 112 I Prevention of Contamination from Hands 3-202.18 I Shellstock Identification* 1590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I Employees* I Tags/Records:Fish Products E 113 I I Handwash Facilities 13-402.11 I Parasite Destruction` ( I I Convenientty Located and Accessible 13-40^_.12 I Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(.0 Labeling o1 Ingredients' -I 15-204.11 I location and Placement* g I Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance i IHACCP Plans I I I Supplied with Soap and Hand Drying 13-502.11 I Specialized Processing Methods* I Devices J ' 3-502.12 I Reduced oxygen packaging,criteria* 16-301.11 I Handwashing Cleanser,Availability 8-103.12 I Conformance with Approved Procedures'` 16-301.12 Hand Drying Provision 'Denotes critical hent in the Weral 1999 Paxi Calc or 105 CMR 590.000. CITY OF SALEM p BOARD OF HEALTH Establishment Name: 6/1N OAkA ('1emc,�o— Date:_ —1—L3 Page: o'Z of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Pb. Reference R-Red item Verified /� ^'� (� PLEAS E PRINT_LEARLY (IAM O —A)9L,f IT DMIG� CwSrdlJI FSI �ao�17 ��t� D I I _ r WAX - I nMuMcf pX/� yam' -�° _ ( 1( ) L"IGQ a\tt 1r- fTn 1.0 _ /lo,{Y _ AQ GD19 I O,�r A,� 1 1D��Ao�� - �ost� m MOA,, ,_I rV kms � I , 0 �1 ao I � ? c-iy, V . rr� - (,I IPiP V n D.(-10L,0 Discussion With Person in Charge: Corrective Action Required: I ❑ NoYes I have read this report, have had the opportunity to ask questions and agree to correct all UL/Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. ndersC3 ❑n that noncompliance may result in daily fines ofZejnyjl, dolla r su pen 'on/revocation of Embargo Emergency Closure your food permit. � — ❑ Voluntary Disposal ❑ Other: r e 3-501,14(C) PHFs Received at Temperatures ! Violations Related to Foodborne Illness.Interventions and Risk According to law Cooled to Factors(tems1-22) (Cent.) 41Fl457Witton4Hors. PROTECTION FROM CHEMICALS { 3-501.15 Cooline Methods for PHFs 14 { Food or Color Additives { { 19 PHF Hot and Cold Holding { 3-202.12 Additives* { 3-501.16(13) Cold PI1Fs Maintained at or below 590.404((1 41 3-302.14 Protection from Unapproved Additives* I { 15 Poisonous or Toxic Substances { 3-501,16(A) Hatt F* PHFs Maintained at or above 140`(. 7-101,11 Identifying Information-Original ( 3-SOI.i6(A) Roasts Held at or above, t3fl' Containers 1300F * j 7-102.11 Common Name-Working Containers* { { 20 Time as a Public Health Control j { 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage* { 590.404{H} Variance 7-202.11 ,Restriction-Presence and Use* { j { { 7-242.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Container-Prohibitions* { 7-204.11 Sanitizes.Criteria-Chemicals* i POPULATIONS(HSP) { 7-204.12 Chemicals for Washing Produce,Criteria* j 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and { Beverages with Warning labels* 7-204.14 Drying Agents.Criteria* 7-205.11 incidental Food Contact,Lubricants* ( 3-301.11(13) Use of Pa Partially l Eggs* I { 7-206.11 Restricted Use Pesticides;Criteria* j 3-801-II(D) Raw or Partially Coked Animal Food and { 7-206.12 [rodent Bait Stations* � Raw Seed Sprouts Not Served- 7-206.12 Unopened Food Package 7-206.13 Tracking Powders, Pest Control and Package Not Re-served " Momtarmp' CONSUMER ADVISORY T1MEti EMPERATURE CONTROLS 22 3-603.11 ConsumerAdvisory Posted for Consumption of 16 Proper Cooking Temperatures for { Animal Foods That arc Raw,Undercooked or PHFs ` Na Otherwise,Paacessed to Eliminate Patboacas.-* 3401.1 IA(i)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 145'F15se:.* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Ear .Animals-155'F 15 see. t SPECIAL REQUIREMENTS t 3-401.11(11)(1)(2) Pork and Beef Roast- 130'F 121 mm* { 590.009(A)-(D) Violations of Section 590.009(A)-(D) in a 3-401.11(A)(2) Rattles,Injected Meats-155`F 15 k) sec.* j catering, mobile food,temporary and f 3-401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, ( residential kitchen operations should be y ( Stuffing Containing Fish,bleat, i debited uptier the appropriate sections {{{ Poultry or Ratites-165'F t5 sec, * 1 above if related to foodborne illness 3401.11(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 I practices should be.debited under#29- Microwave 165F* 111 Special Requirements. 3-401.11(A)f i)(b) All Other PHFs- 145'F 15 sec.* { 17 { Reheating for Hot Holding { VIOLATIONS R .LATER TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec.* I (Items 23-30) y ( 3403A I(B) Microwave-165`F 2 Minute Standing Critical and non-critical violations, which do nat relate to the l Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the follnwing sections of the Food Cade and 105 CMR 1400(* 590.000. i 3403.11(E) Remaining Unsliced Portions of Beef Hem i Good ReiaJ!Practices FC 590.000 t Roasts* 23. 1 Mantmement and Personnel I FC-2 .003 i 1g Proper Cooling of PHFs { 124. i Foal and Food Protection i FC-3 .004 j i 25. 1 Equipment and Utensils 1 FC-4 ,COS I ` 3-501.14(A) Cooling Cooked PRFs from 140F to ( Water.Ptumbinq and Waste t FC-S .006 70'F Within 2 Hours and From 70F 27. I Physical Facility . FC-6 .007 I to 41'F145'F Within 4 Hours. * 1 28. ' Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 1 29. 1 Special Requirements .009 I Temperature Ingredients to 41'Fi45'F 34, I Other f Within 4 Hours* 'Dcnotea critical ivm in the f deral 1999 Food Cale or 105 CMR 590.000. t CITY OF SALEM //�'� BOARD OF HEALTH Establishment Name: !!�� ""�(64eA GQ`201X1�0 Date: Page: 3 of, � Item Code C—Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY v T`1VnA OA P A _ o'© In. nnn n o.sh awn ar—�o� l �� -fir p5 —�i�OP_ r_=Q3 SSL cXo on o+ 1(lP �S2�dn'Y?,t_ v \ -e'v yQ-'N-, IZ - 61 M Ski, A7 K) dna A-Pn ' ArJ ro Discussion With Person in Charge: Corrective Action Required: I ❑ No 17'res I have read this report, have had the opportunity to ask questions and agree to correct all p^oluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to �e-insp �("ection Scheduled El Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that � noncompliance may result in daily fines oft ty iv oll or suspension/revocation of mbargorL]� Emergency Closure - your food permit. ��_ ❑ Voluntary Disposal ❑ Other: r j ' 3-501A4(C) PHFs Received at Temperatures Vioiailons Related to Foodborne 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 Hot and Cold Holding 14 Food or Calor Additives 1 1 3-501.16(B) Cold PIIFs Maintained at or below 3-202.12 Additives* ` 590.004(F) 410145"F* 3-302.14 Protection from tlnaEDroved Additives'k j 3-50L16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140°17. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°E. Containers* " 7-102.11 Common Name-Working Containers* 1 120 Time as a Public Health Control j 7-201.11 Separation-Storage* r 3-501,19 Time us a Public Health Comro l* 7-202.11 Restriction-Presence and Use" ( 590.004(11) Variance Requirement ( 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 Toxic Containers-Prohibitions* ( POPULATIONS(HSP) 204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 1 ! 21 3-801.11(A) Unpasteurized Pre-packaged Juices and { ( 1 .Beverages with Warning labels*7-204.14 Drying Agena.Criteria* 3-b01.11(B) Use of Pasteurized E s* 7-?05.11 hicidental Food Contact,Lubricants* i 3-801.11(D) Raw or Partially Cooked Animal Food and ( 7-206.11 Restricted Use Pesticides,Criteria? I 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 Monitorimr' CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 4 Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHPs 1 Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. pathot'ens'*�t�07 Eggs-Immediate Service 145°Fl5see- 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Creme Eggs* Animals-155°F 15 sec. " 3-401,11(B)(1)(2 Pori and Beef Roast- 130°F t21 min* SPECIAL REQUIREMENTS -441.11(A)(2) Ratites,Injected Meats-155`F 15 590.O04(A}-(D) Violations of Section .590.009(0)-(D) in ^ see.* catering, mobile ford,temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to faodtbrne illness 3-401.11(C)(3) Whole-musete,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to goal retail 3401.12 Raw Animal Freels Cooked in a } practices should be debited under#29- Microwave 165°F* i Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. j 17 Reheating for Not Holding I WOLA 77ONS R2LATED TO GOOD RETAIL PR4CT10ES 3-403.1 i(A)&(D) PRFs 1657 15 sec. * (Items 23-30) 3-40111(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the 'i Tire" foodborne illness interventions and risk,factors listed above, can he 13-903.l 1(C) Commercially Processed RTE Food- found in the fallowing sections of the Food Code and 105 CMR 140°F* ( 590.000. ( 3403A I(E) Remaining Unsliced Portions of Beef i Item 1 Good Retail Practices i FC 590.000 j Roasts* 1 23. 1 Manaqement and Personnel I FC-2 .003 I ig j Proper Cooling of PHFs 1 24. 1 Food and Food Protection I FC-3 .004 ! 1 25. 1 Equipment and Utensils FC-4 .005 I I1I1 3-501.14(A) Cowling Cooked PHFs from 140`F to i 26, 1 Water.Plumbinq and Waste ! FC-5 .006 1 t 70°F Within 2 Hours and From 70°17 j 27. i Physical Facility FC-6 I .007 i 1111 to 41"fl45°F Within 4 Hours.* 1 28. Poisonous or Toric Materials FC-7 7 ! .008 I 3-501.74(6) Cooling PHFs Made From Ambient ! 1 29. Special Requirements p 009 1 Temperature Ingredients to 41017/45°F lil ' 30, Other } I Within t Hours* Denore+;ceifica.ry m in the ledernl f`ri79 Foal Cale a'tU5 C:4tR 911.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4s' Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat Tyke of ODeration(si, Tyee of Insoection l l'.1� Q, f(xa ha I Food Service ❑ Routine Address ( �' t_ Risk Retail L3 Re-inspection 3'7� ' `i VV�C�Vlri, f f1f�'- Level ❑ Residential Kitchen Previous C178> t -3 $3 Inspectionection Tele hon ❑ Mobile Date: Id$ at+ Owneri_ HACCP Y/N ❑ Temporary ElPre-operation'2oSCLjF41 f l fll CL I I El Caterer El Suspect Illness Person in Charge(PIC) / Time El Bed&Breakfast El General Complaint 1 (A lb l`1WC. tL , I In: .a ❑ HACCP Inspector 6. rx d '� I Out: O ' Permit No. El Other Each violation checl(ed 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 I [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities [EMPLOYEE HEALTH ' y - - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives E) 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals i�FOO.D_FROM APPROVED SOURCE-"'-`"-'""" � ="" Y 0 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 (:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16.Cooling L PROTECTION FROM CONTAMINATION - _ J ❑ 19. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE-POPULATIONS(HSP)! El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices pCONSUMER 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)(s90.0 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)(590.008) 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 5901nspacfFOm 14d Inspector's Signatur /, e Print:F �_ PIC's Signature: - c 5 v - Print: f tb -P_W, ,q < I Page of&Pages I 'Hi.. .r t' �.iT. •fir-.-...w•*�,-..n . ^f'.' Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT I 3-302.11(Al(i) Raw Animal Foods Separated from I 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* . I I Contamination from Raw ingredients 2-103.11 Person in charge-duties I 3-302A I(A)k2) Raw Animd Foods Separated from Each I Other" EMPLOYEE HEALTH I I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304,1 1 I Food Contact with Equipment and 590.003(F) Responsibility Of A Foal Employee Or An Utensils* Applicant To Report To The Person in ( I Contamination from the Consumer Charge* 590.003(G) Reporting by Person in Charge* I 13-306.1�4(A)B? I Returned Food and aced orResery of mina[ +I I ( J Disposition of Adulterated or Contaminated 13 590.003(D) Exclusions and Restrictions* I Food 590.003(F) Removal of Exclusions and Restrictions I 3-70111 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* J ' 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* l 1 4-501.112 Mechanical Warewashin 3-201.13 Fluid Milk and Milk Products* I g-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized* I 14-501.114 Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinking Water* I concentration and hardness. 15-101.11 I Drinking Water from an Approved System* I 14-601,11(A) Equipment Food Contact Surfaces and 1590.006(A) I Bottled Drinking Water* I Utensils Clean* J i 590.006(B) I Water Meets Standards in 310 CMR 22.0" ( 14-602.11 Cleaning Frequency of Equipment Food-' _ Shelmsh and Fish From an Approved Source ( Contact Surfaces and Utensils* 4-702.11 I Frequency of Sanitization of Utensils and 3-201.13 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish` 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* I, Sources" I to I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 12301,11 Clean Condition-Hands and Arms* 13-202.18 Shellstock ldenhficationPresen * 2ICleaning Procedure* I 590.004(C) Wild Mushrooms* ( i 2-301.14 ( When to Wash* 3-201.17 I Game Animals* I 111 I Good Hygienic Practices g I ReceivingtConditlon ( 12-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* I 2401.12 Discharges From the Eyes,Nose and 3-202.15 I Package Integrity* I Mouth* 3-101.11 Foci Safe and Unadulterated * 3-301.12 I Preventing Contamination When Tasting* I I 16 I Tags/Records;Shellstock I i 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* ( Employees* Tags/Records;Fish Products I 113 ( I Handwash Facilities 3-402.11 ( Parasite Destruction* I ( I Conveniently Located and Accessible 3-402.12 I Records,Creation and Retention* I i 5-203.11 I Numbers and Capacities* 590.004(7) I Labeling of Ingredients' I 15-204.11 I Location and Placement* f 7 I Conformance with Approved Procedures 15-205.11 I Accessibility,Operation and Maintenance I IHACCP PlansI I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* Devices 13-502.12 ( Reduced oxygen packaging;criteria* I 16-301-11 Handwashing Cleanser,Availability f 18-103.12 I Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision .Denotes critical item in the federal 1999 P(xxl Code or 105 CMR 590.010. CITY OF SALEM -- BOARD OF HEALTH Establishment Name: 11Yl f1r 5R/ Date: l- Page: of of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 6 c'TF Q I OIC, hr�e �-fsY ai i cd�r�y f�� `e .moo �z�(,�. %�-� cul'b�i►�-� I 1-fer�� _�p �-� \I ic':E-�ry t rl- �►l � cn �� Rl�r I ru kir I' ; c e'10 '. I � j 1 j I 1 Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Cl 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 derstand that noncompliance may result in daily fines of tity-five dollars o suspbnsion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. f�' pr �/)} ❑ Voluntary Disposal ❑ Other: r r r l 3-501.14(0 PHFs Received at Temperatures Violations Related to Foodborne lUness tntementions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41T-145F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1$ Fddtl or Gator Additives 19 PHF Hot and Cold Holding 3-50L16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 410145"F* 3-302.14 Protection from Unapproved Additives* i-50[Aii(A) Hot P11Fs Maintained at or above 15 Poisonous or Toxic Substances - 1401F * 7-101,1) Identifying Information-Original `1;. I i r � 3-501.16(A) Roasca Held at or above 130'F. " Containers* 20 Control 7-102.11 Common Name-Working Containers* { Time as a Public Health m 7 201.11 Separation-Storage* 3-501.19 Time aa Public Health Cnntrvl* I 7-202.11 .Restriction-Presence and Use* 590.004{113 Variance Requirement 7-202.12 Conditions of lis,* 7-203.11 Toxic Containers-Prohibitions* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ,l ( 7-204.14 Drying Agents.Criteria' { _Beverages with Wanting labels* 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized Eggs* i h 3-801.11(0) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteriaa 1 Raw Seed Spreads Not Served.' 7-206.12 [rodent Bait Stations* 3-&01.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and " I Monitoring* CONSUMER ADVISORY 'i TIMEITEMPER4TURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 Proper Cooking Temperatures for Animal ponds That are Raw.Undercooked or PHFs Not Otherwise.Processed to Eliminate pit c�Yttcre rnrza±t i( 3-401,11 A(1)(2) Eggs- t55°F 15 Sec. Pathogens-* kS} Eggs-Immediate Service 1450F15see. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155°F 15 sec. " 3401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see. * catering,mobile food,temporary and residential kitchen operations should be � ( 3-491.11(A)(3) Poultry,Wild Game.Stuffed PHl•'s, � Pe ') Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-l65'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 i 3-401.12 Raw Animal Foals Cooked in a ( practices sbould be debited under#29- 1 Microwave 165°F* Special Requirements. i 3-401AI(A)(1)(b) All Other PHFs- 145'F 15 sec. 'r ) 17 Reheating for Hot Holding VIOLA77ONS R LATER TO GOOD RETAIL PRAC77CES 5 3-403.11(A)&(D) PHFs 165T 15 sec. x (Items 23-30) t 3-403.11(B) Microwave- 165`'F 2 Minute Standing Critical,and non-critical violations,which do not relate to tire Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- Jound in the following sections of the Food Code and 105 Ci14R y 140`F* 590.000. 3-403.11(E) Remaining Unstieed Pinions of Beef 1 Item ! Good Retail Practices ; FC + 590.000 Roasts* 1 23. 1 Management and Personnel 1 FC-2 ( .003 lg Proper Codling of PRFs 1 24. 1 Food and Food Protection' FC-3 .004 t i 25. I Equipment and Utensils i FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 340`F to 1 26. I water.Plumbinq and Waste ' FC-5 .M6 i 700F Within 2 Hours and From 700F 1 27. Physical Facility FC-6 .007 I to 41`F/450F Within 4 Hours.* 1 1 28. ' Poisonous or Toxic Materials Fe-7 .008 3-501.14(B) Cooling PHFs Made From Ambient t 1 29. I Special Requirements 003 1 Temperature Ingredients to 41°F/45°F Ii) 30' ( Other Within 4 Hours* y 'D.notcc critical Ilan in the federal 1999 Fuad Cale or 105 C.MR 590.000. i , Commonwealth of Massachusetts �+Wl ` City of Salem _V .x - or Board of HealthKimbeiley Driscoll-, a •s 120 M Washington Street,4th Floor aYor SALEM;MA -01970 Food/Retail Establishment Permit `4 DATE PRINTED: '01/03/2013 OESTABLISHMENT NAME:., ;. Brother George_ - Fite Number:BHF-2004-000086 - 376 Highland Avenue - - - Salem,, _ 3 ` '" ;MAS 01970 ' w r LOCATED AT $- SALEM, MA 01970 Q a, : 4 Permit T ` - - ..; �<,u: - v.- „ , - -. g Type Permit No. '' ` Perrot Issed' Permit Expires " f `Fee Restrictions/Notes � +FOODSERVICE BHP-2013-0299 `Jan-1`2013 _,kaDec 31 2013 $280:00 : = u ESTABLISHMENT v x r tj -,Total Fees: _; $280.00 .. _ Ole is it M t tgC IT .., � 9 PERMIT EXPIRES:` Oeceinber 31 2013 Board of Health _ This Permit is not transferable and must be reissued-upon change of ownership or location.The permit must be posted . T. 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>- S a , Y y yA CITY OF SALEM, IV f MASSACHUSETTS ' rn»xeauh Bongo OF HF.AI: If 120WAS]ZING ONS1RI LT,4111F1,OOR KIMBERLEY E-RISCOLL Tri-(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,RS�RI:�,IiS,CI-ICI,CY-FS Iramdinns-alem.com M�YCR I II';Al;I'I I AG 13NT Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) /, 11) Establishment Name: 1 ro7 &I' /�L'oul s ///� n�/(-�i - 2) Establishment Address: 37(, �(Cjml/G�iltL� µ✓ Swl-,v G�A.. L/ 1C; O 3) Establishment Mailing Address(if different): 5� 4) Establishment Telephone No: p/7�- 741- 3 L' F/3 / 5) Applicant Name&Title: ?05-q ( �5 f(�j lI17✓�(' lJd`7G v/h,:�F IL,4e- o 6) Applicant Address: 3C) / Q CU �� j 7) Applicant TeBephone No:1917 � 3/��' 24 Hour Emergency No: 504(f--504(f-- Email-1/71j0.7"Ar /✓re✓v 8) Owner Name&Title(if different from applicant): V 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 SapnLatlon� D // / An individual 0� C5'174T/ff4A., bwtner � /ou115S1"d 'qf m1i4y9C Apartnershi.6 Jarr�� wd7L LL tl L 1 Other legal entity 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor,Manager, etc.) Name&Title: Jb44N P, 4 Afrr-rr) ] / / / p/� Address: 3n0� �QW V5,,I,, ��1 r/ til yGl .3, 37rW/ 4r/d f /I Telephone No: v//7 - Y 3�Z� Fax: ?.P-b-520.2—?.P-b-520.2—iJ- ?.Pd' EmairJ44 44114✓ �7/ -' ® 'v'i" Emergency Telephone No: V 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: / �� Date: /�� / Amount: �" Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) 16) Days and Hours of Operation: 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures( if 25 seats or more): /r Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) 0 Retail ( Sq. Ft) 0 Caterer � r anent Structure .PP Food Service-( Seats) 0 Frozen Dessert Manufacturer mobile ESFood Service-Takeout 0 Residential Kitchen for Retail Sale 0 Food Service-Institution 0 Residential Kitchen for Bed and ( Meals/Day) Breakfast Home 0 Food Delivery 0 Residential Kitchen for Bed and 21) Length Of Permit: ................................----------------------------------------------Breakfast Establishments____---_---------_--_-_. (check one) RETAIL STORE RESTAURANT nual 0 Less than 1000sq.ft. $ 70 0 Less than 25 seats $140 Seasonal/Dates: 0 1000-10,000sq.ft. $280 0 Residential Kitchens $140 0 More than 10,000sq.ft. $420 0 25-99 seats $280 0 More than 99 seats $420 Temporary/Dates/Time: 0 Be g Breakfast/Childcare Services/Nursing Home $100 ADDITIONAL PERMITS 0 MAKE ICE CREAM, YOGURT/SOFT SERVE $25 0 PASTURIZATION $25 0 TOBACCO VENDOR $135 0 ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare 8 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(Ex.sandwiches,salads, muffins which need no further processing Sale of Commercially ,PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs 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 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 To be comnleted by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1,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�4jee instructed by the Board of Health on how to obtain copies of 105 CMR 24) Si and the Federal Food Co U'L) �) ✓S�j' \ 24) Signature of Applicant: /UU ,y/C,/ ,/' \ Pursuant to MGL Ch. 62C, se. I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax return and paid state taxes required under law. 25) Social Security Number or Federal ID: 26) Signature of Individual or Corporate Name: Commonwealth of Massachusetts _ _ A E - - City of Salem31 r soars of Health Kimbeiiey Dnscoil = .'. ., ..y. r Mayor Y 120 Washington Street,4th Floor hsp __ $ SALEM,MA 01970 _ �• 7 . Food/Retail Establishmeni Permit` DATE PRINTED: 10/01/2012 ,<..�:Y�n sup R ' t� mak# _ t - ESTABLISHMENT NAME: Brother,George - Z- . 'File Number:BHF-2004-000086 376 Highland"Avenue y j .a.ti's F's -..� z.'=',=a _ ,m•-- r _- ��_a� M " x- - `t-_ x„- 2 ti ' w Salem SMA 01970_ ' - LOCATED AT o ' 'z EM, MA 01970,3 ,a . .Permit Type Permit No. -_ "Permit IssuedPermit Expires - - Fee Restrictions/Notes _ - FOOD SERVICE BHP-2012-0602 - Jan 1,2012 c Dec 31,2012`_ $280.00 ESTABLISHMENT . Total Fees: ..y r $280.00 yn tS PERMIT EXPIRES , December 31, 2012 ' .1 s v Board of Health -T, 4 { This Permit is not transferable and must be reissued upon change of owne_rship;or lbeadinii The permit must be posted } IT in a prominent location in the Establishment.In accordance with the StateSanitary 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, WQ MASSACHUSETTS BOARD or HvAL II Publ cIie�th 120\Y'ASHIN(71'ON S'IRILITI',4"'FLOOR KINIBERLEY DRISCOLL Ti1L.(978)741-1800 FAX(978)745-0343 LARRY RAMDIN,1Lti/RL;I-IS,CHO,CP-FS MAYOR Iramdin0snlem.com IIEAJ; IIAG ENT Food Establishment Permit Application (Application must be submitted( at least 30 days before the planned opening date) 1) Establishment Name: 2) Establishment Address: 3 ]�q l gv,�Ar�1 iV �i .wt )lp t 3) Establishment Mailing Address(if different): 2 �j 4) Establishment Telephone No: ung, 1cl O 5) Applicant Name&Title: ( v 1 6) Applicant Address: —�b u I)V-nd 11__,,�- 7) Applicant Telephone No: C[I-I �q ')I7ff 24 Hour Emergency No: 9/IW Email:�pi'1WnCIVVryVn)ICIJn/� �YY1g11. 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 QA corporation "" r An individual Q(1y� �S�l(�CY (IblO� QW tv 3d Vii1w1 rrMeIY) ,1�, A A partnership �Jc�l�rnxt9-, Oxv2N (7 � 1 1 Other legal entity 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor,Manager, etc.) Name&Title: '�nvw{lo' �D� ze( ) /� Address: 3 /`� �^ CtlM )DDX�1(/1 MA ®1�, � I Telephone No: �� zpu,�j J0X Y Fax:(ply�� Oy Email:�nY�n11A Nero(C��inc�tUl. Emergency Telephone No: �J 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: 101 Date: Amount: V Food Establishment Information 14) Water Source: 15) Sewage Disposal: 1 DEP Public Water Supply No: ( if applicable) 16) Days and Hours of Operation: 7 JG.YS 11 hbUaS 17) No. of Food Employees: 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): V<es No 20) Location: 22) Establishment Type(check all that apply) (check one) O J,2etail( Sq. Ft) ❑ Caterer ermanent Structure 97, 00d Service-( Seats) ❑ Frozen Dessert Manufacturer Mobile ® Food Service-Takeout ❑ Residential Kitchen for Retail Sale D Food Service-Institution D Residential Kitchen for Bed and ( Meals/Day) Breakfast Home D Food Delivery D Residential Kitchen for Bed and 21) Length Of Permit: -- - - - - - - - ------------------------------------------------------------Breakfast Establishments-------. / (check one) RETAIL STORE RESTAURANT V( D Less than 1000sq.ft. $ 70 D Less than 25 seats $140 Seasonal/Dates: D 1000-10,000sq.ft. $280 O Residential Kitchens $140 D More than 10,000sq.ft. $420 1125-99 seats $280 D More than 99 seats $420 Temporary/DatesMme: -------------------------------------------------- ----------------------------------------------------------------------- D Bed& Breakfast/Childcare Services/Nursing Home $100 -------i ffo------ ly ff----------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS D MAKE ICE CREAM, YOGURT/SOFT SERVE $25 D TOBACCO VENDOR $135 D ALL NON-PROFIT $25 (including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs-non-potentially hazardous food(no time/temperature controls required) (check all that apply): / RTE-ready-to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially ✓PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs 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 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 To be completed by the Board of Health 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 Co 24) Signature of Applicant: 6C,- &4-tk4kCAr-rr n t Z Pursuant to MGL Ch. 62C, sec. 49A, I certify under the penalties of perjury that I,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: "- -3 f4t,? 26) Signature of Individual or Corporate Name:_ 11 Jl)tA_) — 1 t' Invoice Date Invoice# 10/5/2012 11868 Go�Kierclo/ -7Zea/Rent/a/ 781-592-1519 y1 Bill To Brother George's 376 Highland Ave Salem,Ma 01970 P.O. No Terms Net 15 Description Qty Rate Amount Heating Tech Jon 100.00 100.00 Service to side by side cooler not keeping temperature;cleaned unit and adjusted refrigerant charge;freezer running at t degree refrigerator is running at 38 degree's. RECEIVED CITY a0F tAjEP.L1H sop o Thank you for your business. Subtotal $100.00 PleSwas piscoa to: Sales Tax (6.25%) $0.00 Swampscott Refrigeration, Inc. 1 163 Essex Street hese Lynn, MA 01902Total Telephone: 781-592-1519 Flndusan $100.00 Facsmile: 781-581-7605 91 Facebook . Email: swamphvac@verizon.net Payments/Credits $0.00 swampscottrefrigeration.com Balance Due $100.00 ' ", DISC4YEIY Y1 A i a Past due balances in excess of 90 days may be submitted to collection. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 . FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name (� Dade Tyoe of Ooeration(sl TT pf Insoection v� I I aS') m Food Service ® Routine Address 3�6 (}Gln�a/Y1Clnl r'. Risk ' ❑ Retail ❑ Re-inspection 11 r' d Level ❑ Residential Kitchen Previous Inspection Telephone Mobile Date: q"7$ `*?Y -3$$3 ❑ Ownery HACCP Y$) El Temporary ElPre-operation �11 qov f � SGI �[LI ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) " Time ❑ Bed&Breakfast El General Complaint -UWt o WCICL In: gl3vanl ❑ HACCP Inspector 1.7 f �) rhe S I Out: [I;30 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. FOODPROTECTIONMANAGEMENT ' I El 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH -. I ❑ 13. Handwash Facilities �_ - -HEALTH {PROTECTION FROM CHEMICALS . ..} ❑ 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals LFOOD FROM APPROVED SOURCE { El 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Fooda) ❑ 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 PROTECTION FROM CONTAMINATION 1 ❑ 19. Hot and Cold Holding El 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control E 9. Food Contact Surfaces Cleaning and Sanitizing L REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS_(HSP): ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices r NSUsDIISORY OPot ng Consumer Adwsones a a 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)(590.00 4cited 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-8)(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:590MSPectPo 141 n ( Inspector's x Ins Si atur tgaG;v I I P � i Print:�ll;,�,b�h.�� , PIC's Signature: ��/ � ) I Print.J U/l o 6PTl e(t,I A,- I Page I of5 Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION S FOOD PROTECTION MANAGEMENT I I Cross-contamination 3-302.1](A)(1) Raw Animal Foods Separated from I 590.W3(A) Assignment of Responsibility* I Cooked and RTE Food,* 590.003(B) Demonstration of Knowledge"' Contamination from Raw Ingredients I 12-103.11 Person in charge-duties I 3-302.11(A)(2) Raw Animal Foods Separated from I EMPLOYEE HEALTH Other= I I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by food employees and 13-302.15 Washing Fruits and Vegetables � applicants* 13-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A F(xxl Employee Or An Utensils* Applicant To Report To The Person In I I Contamination from the Consumer Charge* ( 3-306.14(A)(B) I Returned Food and Reservice,of Food* J 590.003(G) Reporting by Person in Charge 13I590.003(D) Exclusions and Restrictions* I I I DispastronofAdutteratedorContaminated Food 590.003(E) Removal of Exclusions and Restrictions I 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I I Food* J 4 Food and Water From Regulated Sources I ( 9 I Food Contact Surfaces 590.004(A-B) Compliance with Food law* I ( 4-501.111 Manual Warewasbing-Hot Water 1 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* 3-201A3 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I S<'u am Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized* 14-501.114I Chemical Samtization-temp.,pH, i 3-202.16 Ice Made From Potable Drinking Water- concentration and hardness. * J 5-101.11 Drinking Water from an Approved System* I 14-60L11(A) Equipment Food Contact Surfaces and 590,006(A) Bottled Drinking Water* I Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* I 14-602'11 Cleaning Frequency of Equipment Food- . Shellfish and Fish From an Approved Source I Contact cy Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and I 3-201.14 Fish and Recreati(maily Caught Molluscan I Food Contact Surfaces of Equipment* Shellfish* I 4-703.11 Methods of Sanitization-Hot Water and I , 3-201.15 Molluscan Shellfish from NSSP Listed I I I Chemical* Sources* Game and Wild Mushrooms Approved by i 10 I Proper,Adequate Handwashing RegulatoryAuthorttv 12-301.11 1 Clean Condition-Hands and Arms- J. 3-202.18 Shellstock identification Present* I 2-301.12 Cleaning Procedure* 590.004(C) I Wild Mushrooms* I 2-301.14 When to Wash* 3-201.17 I Game Animals* I 111 Good Hygienic Practices 15 I Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* I 12-401.12 ( Discharges From the Eyes,Nose and 13-202.15 I Package integrity* I Mouth 3-101.11 I Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* 16 I Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 I Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:'Fish Products I 113 Handwash Facilities 3402.11 I Parasite Destruction* I Conveniently located and Accessible 3-402.12 Records.Creation and Retention* I 5-203.11 I Numbers and Capacities* 590.004(1) Labeling of Ingredients' I 15-204.11 I Location and Placement* 1 - . I Accessibility, Operation and Maintenance 1 520511 A I Conformance with Approved Procedures I Y I /HACCP Plans ( Supplied with Soap and Mand Drying 3-502.11 I Specialized Processing Methods* Devices i 3-502.12 I Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 I Conformance with Approved Procedures* 16-301.12 Hand Drying Provision 'Denotes critical nem in die federal 1999 rood Code or 105 CMR 590000. CITY OF SALEM �,II BOARD OF HEALTH / Establishment Name-cnn ( YIeX Ge.O oe. Date: �I�aS �l�, Page: a of 5 Item Code C—Critical Item `' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r tTltoe, rr)a(Qe"c�`iaY) ' (,cts cna�� C� /LP;-�n�It�rr11n-,,i tAtif, Ylt7�P rM4 '/i< V\4 4,1V)� r + J �rz I M ftkss a". no-" I" rip • N C. - o u-echiu . vu I _e _ ry US Invid nnS4 VW t) bP �r, (��r° (�,(Pa S�. � �tr6YI ��t�yl �"o �l(',• I 4 c)go.004 C {(�/)�� I� h�f�wgll cf+ jme, creq rl 1\�Cil-liexs i,s cylppivt�- P'd/ a s:k be c( )VIminC I IZ25 _111 InCST Clef( 17';11�h �) 1csLc ,��Pc�v11S S�l�•`� I I a5 59v•oo5 Ail irP, eAQee rV"e e-"ri w, icy/ rti hutld�, e• 1 t/ CSP �rr p CRVi(� �nniC nc vl�lll( ('�41z�2"Vl I r,P C'J7`2.Q'.VVI `�TP�'?.�(S• jII las oto-oos notrVTnovu Pu ,� r of 4_not vx- 1�_*ekjyl �lt¢ iCP ('u ay't1 W_F I V/ IAll iM orF \ f'4i�r � i " 11p' m _ , I _ I Discussion With Person in Charge: I 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 P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I u erstand that noncompliance may result in daily fines of twent -five ollTocation of oEmbargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 1 1 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors{hems 1-22) (Cont) 41'F/45'F Within 4 Hottrs. PROTECTION FROM CHEMICALS { 3-501.15 Cooling Methods for PHFs { PHF Hot and Cold Holding 14 ( ( Food or Color Additives { { 19 3-50L16(B) Cold PHFs Maintained at or below { 3-202.12 Additives* 590.004(F) 41°145°F* 3-302.14 Protection from Unagnroved Additives* I 3-501.16(A) Hot PRFs Maintained at or above ( 15 Poisonous or Toxic Substances { 7-10111 Identifying information-Original 3-501.16(A) Roasts Held at or above. 130'F. * { Containers" { { { 20 Time as a Public Health Control {7-102.11 Common i\Tame-Working Containers* { 7-01.11 Separation-Storage* { 3-501.19 Time as a Public Health Control' { { 7-202.11 .Restriction-Presence and Use" { 590.004(H) Variance Requirement 1 { 7-02.12 Conditions of Use* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* f POPULA71ONS(HSP) { 7-204.11 { Sanitizets,Criteria-Chemicals° { 7-204.12 Chemicals for Washing Produce,Criteria* l 21 3-801.1](A) Unpasuanized Pre-packaged Juices and { 7-204.14 Drying Agents.Criteria* { .Beverages with Wanting Labels* { 7.245.11 incidental Food Contact Lubricants* { 3-801.11(13) Use of Pasteurized Eggs* { { 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 I t'D) Raw or Partially Coed Animal Food and I Raw Seed Sprouts Not Served, { 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. x 1 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEti EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted its Consumption of l I Animal Foods That are Raw.Undercooked or 16Proper Conking Temperatures for PHFs Not Otherwise Processed to Eliminate , 3-401.I1A{I}(2) Eggs- 155`17 15 Sec. Patbogens.*e"°""'n""' t Eggs-immediate Senice 145°Fi5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* 9nin ala-155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Park and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(Aj(2) Ratites,Injected Meats- 155`F 15 see.* catering, mobile food,temporary and 3401.11(A)(3) Poultry,Wild Game.Staffed PHFs, residential kitchen operations should be Staffing Containing Fish.Meat. debited under the appropriate sections Poultry or Ratites-165'1715 sec, * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Fouls Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-441.11(A)(1)(b) All Other PHFs- 145°F 15 sec. { 17 Reheating for Hot Holding { WOL.A77ONS R SLATED TO GOOD RETAIL PRACTYCES 3-403.1 l(A)&(D) PHFs 165°F 15 sec.* { (Items 23-30) 3403.11(B) Microwave- 1650 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 Foal- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef 1 Item '; Good Retail practices 23. FC 590.000 i Roasts* j 23. ; Management and Personnel FC-2 .003 i 18 { Proper Cooling of PHFs 1 24. Food and Food Protection ' FC-'s .004 j 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to ; 26. I Water.Plumbing and Waste i FC-5 .006 i 70°F'Within 2 Hours and From 70°17 127. I Physical Facility FG-6 .007 i to 41'F/45'F Within 4 Hours.* i 26. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 129. Special Requirements i .608 Temperature Ingredients to 41017/45°F 1 30, I Ott1er Within 4 Hours* 5s*nro„ .ra.c: 'Denotes critical wino in the federal I W9 Food Code w'105 CMR^90.000. - CITY OF SALEM BOARD OF HEALTH Establishment Name: ��t�2 Date: Q/as Ila Page: of ,5 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION bete. No. Reference R-Red Item Verified PLEASE PRINT CLEARLY x'A-e at c_oP, ru\ocl dzal-b- re a o e'rn ,/ I ��u rP. it I b I rx rc��rct t�� l ' tIMsYY�Fr �4sr i �n i< i P . las �0,00. Ih51c�o, � irni f �(�r a,��Pv' ��s sfwust, D�ll�<,.e I�i.n ►�"^ �.Igr,r_,�I_,_,� ✓ I 1a4 Sao.00y (', cit Q. ripen—lipsio u5+ Jo�) da{ I✓ las tea.ooh t�1� 5. r rw,v) Nzt ft nvt C o-o np rci l l' e cm- 0 o ✓ I l_ q-!70a.il 2 o , it n-'*VQ,-j;nr4 Ao.(T;c acnonfd Pr-( i'o ttk V)((-sc/p, E cjw-d ,/ 1 \ =-�t��Y e (7✓ i c PQ I-flA t �CP V�C I1�1( Pir as X0.005 7l�-fi rig , \) ' aS �.p �, (24 C-)Y) VC��r1oJP, is P fi �C1.ht I?,� , C7YI 1�P�ro.i! � ( f�V2V1 �iSfi,(P. i CP, buil(4 vn. i - y I las 590. ocr')- Ffs o .egl �a _01P \Itc I �`2gt1 nwm-{-', (-t+ �m � t� rcir So �✓ las SRO-oc Vc'k Age VIC4' m-y V G p i�e��he(a I c J- ecc � on -IM,P 1.,�N�m. 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/ i 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 and t nd that noncompliance may result in daily finesof tyugnty-five ollars or pensn evocation of ❑ Embargo ❑ Emergency Closure your food permit. (/� ❑ Voluntary Disposal ❑ Other: r r e 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cued to Factors(mems 1-22) (Cont.) 417145°F Within Haus. PROTECTION FROM CHEMICALS { 3-501.15 Cooling Methods for PHEs I 14 { Food or Color Additives ( { 19 PHF Mot and Cold Holding { { 3-50116(B) Cold PHFs Maintained at or below ` 3-202.12 Additives*' ( 590.004(F) 41°145°F* 3-302.14 Protection from Unapprovedditi Adves* 3-501.16(A) Hot PRFs Maintained at or above 115 Poisonous or Toxic Substances 1400F. * 7-10111 Identifying Information-Original 3-501.16(A) Roasts Heid at or above 130'E. Containers* * r 20 Time as a Public Health Control 7-102,11 Common Name-Working Containers* { 3-50IA9 Time as a Public Health Control* 7-201.11 Separation-Storage* { 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 'Tonic Containers-Prohibitions* { POPULATIONS(HSP) 7-204.11 Saniriurs,Criteria a-Chemicals* { y { 7-204.12 Chemicals for Washing Produce,Criteria* { 21 3-801.1 I{A) Unpasteurizedtrageit Pre-packaged Juices and � Beverages with Wanting labels* { 7-204.14 Drying Agents,Criteria" 3-80I.l1(B) Use of Pasteurized Eggs* 0 7-205.11 incidental Food Contact.l ubdrants* 3-801.11(D) Raw or Partially Cooked Animal Food and { 7-206.11 Restricted Use Pesticides,Crtteriar Rain 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 TIMEJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of ( 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or Not Otherwise.Processed to Eliminate t PHFs Pathogens.*Fsx'.A rnrzrmr '+ 3-40i.I IA(i)(2) Eggs- 155F 15 Sec. Eggs-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game { Ems* y ` Animals-155'F 15 sec. SPECIAL REQUIREMENTS 34011I(B)(1)(2) Pork and Beef Roast-130°F 121 min* { 3-401.11(.0)(2) Ratites,Injected Meats- 155'F IS 590-009(A)-(D) Violations of Section .490.�9(A)-(I3) in # See.* catering,mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-101.11((2)(3) Whole-muscle,Intact Beef Steaks interventions and Tisk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a � practices should be debited under#29- Microwave 165F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. * { 17 Reheating for Hot Holding { VIOLATIONS RtLATED TO GOOD RETAIL PRAC77CES 3-40311(A)&(D) PHFs 165°F 15 sec. * { (Items 23-30) 3-1(13.11(15) Microwave- 165`F 2 Minute Standing Critical mid non-critical violations,which do not relate to tate Time*` foodborne illness interventions and risk factors listed abate, 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. 1 3-403.11(E) Remaining Unsticed Portions of Beef i Item I Good Retail Practices 1. FC 590.000 Rousts* i 23. 1 Manaaament and Personnel ! FC-2 .003 18 Proper Cooling of PRFs 124. i Food and Food Protection ( FC-3 .004 i 1 25. Equipment and Utensils I FC-4 A05 3-501.14(A) Cooling Cooked PHFs from 140`F to 26, ( Water.Plumbinq and Waste j FC-5 .W6 70`F Within 2 Hours and From 70`F 12T I Physical Facl tv i FC-6 .007 to 41`F145'F Within 4 Hours.' ' 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambiens 129. Special Requirements '009 I Temperature Ingredients to 41 OF145°F i 30' i Other Within Hours` s<dcr,ws�c, *Dzzv:, x critical itzni in the f-doral 19"Foal Cmie w Ips C3tR 190.000. CITY OF SALEM r _ BOARD OF HEALTH Establishment Name:'4\-', .X 1pof'q'2 Date: q� 191 Page: LI of '1 Item ' Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Ids �oeoo5 �" p��p,l �ffto.�iic (�6�r oiqrf' hc« r6ca +(I aCy'twwwlc *f - zrn rf. ✓ ''�V�s��o cr�'Yl�! ('� Pry �� ro V�QCt • IQ5 sgaocs f�(9,vlclt►Jc(,S�I ire f i p, i;< h Ire,-tle,lt�r(. /�f, ( �i}1� ° hl� cic�ci�� ,tl,�� ✓ I Vlin I kQ�f inQ( reed `t"}PQ Gr✓'�--'(oss �fn' I/ �C t A I <Qj cYIIVQ`1 rL� v14 l)«'A a Q--Pmt�vR . anvil R — rrCD j V-4 he "-i'nrre 4 k�ptweD )_(-'P h jmM I " las `:R o e0a) z ' ,Hws h�e1k- 51�u<t-r cav;t' mnee� u, (d Of ) �e I�r QV P r �0 I �f�iotl�{'nrm I X Ia5 �f0•oo5 IY �!/1 � cir�e_�t�x�c�"a �vvtt�Ictsvt �Frfe� nn art�l t^ -f-one RYr,ial�t Izw j�Pw(Xrm o ?(Ac�VITx) A ��( rk�N + c�roJ�(� �Ino. Plt�fYP, I colt vt>? .taut dl"() C-AW U - I aJ" J'gvOC35 i_ l(I, I n� /� t i/1ra.< t:�2(!C1 )✓IA J� l�.li il}'1 t G _l" •� ,�/ C3 VA 60iaog-(l,c\- '�AIJ �PDdll �e lJ I � ;\ll bo�rl cel' Sr�;ln� uw�t i�- d 1rJlce(4 ce _( Ff ✓ �j . . �� ❑ . 11"P'7i )(-�CAc�'. Or N vicer(o (`11 Ili V �X7C•f it e 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 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 d rstand that noncompliance may result in daily fines 9�4wenty-five dollars susp sion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. C / JJ I - ❑ Voluntary Disposal ❑ Other: Y 3-501.14(C) PHFs Reccived at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors Oleins 1-22) (Cont.) 4t'Fi45°F Within 4 Hours. PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFs I j 14 Food or Color Additives ( 19 PHF Hot and Cold Holding j 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below ' 3-302.14 Protection from Unapproved Additives* 590.004(F) 4101450 F* { 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101,11 Identifying Information-Original „ 3-501.I6(A) Roasts Held at or abuse, 130'F. Containers* { { 7-102.11 Common Name-Working Contam=F* I ( 20 Time as a Public Health Control j 7-201.11 Separation-Storage* j 3-501.19 Time as a Public Healtb Control* j 7-202.11 .Restriction-Presence and Use* { 590.0W(H) Variance Requirement { 7-202.12 Conditions of Use* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 'q 17-203.11 Toxic Containers-Prohibitions* { POPULATIONS(HSP) { 7-204.11 Sanitizers.Criteria-Chefnicais* ( 21 3-801.1](A) Unpasteurized Pre-packaged iuices and j 7-204.12 Chemicals for Washing Produce,Criteria* j Bevernges with Wart»nt Labels* 7-204.14 Drying Agents,Criteria* j . 7-245.11 Incidental Food Contact Lubricants* j 3-801.i1(B) Use of Pasiemizetl Emv { j 7-206.11 Restricted Use Pesticides;Crtieria* 3-801.11(D) Raw or Partially Cooped Animal Food and Raw Seod Sprouts Not Served. * ` r { 7-206.12 Rodent Bair Stations* { 13-$01.11(C) Unopened Food Package Not Re-served. Tracking Powders,Pest Control and " Monitoring* CONSUMER ADVISORY T1ME)I EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of i ( 16 Proper'Cooking Temperatures for I Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate V 13-40i.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.* t Eggs-immediate Service 145°Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155°F 15 sec." j 3.401.1I(B)(1)(2) I Port:and Beef Roast- 134°F 121 min* I SPECIAL REQUIREMENTSofSeectti 3-401.11(A)(2) Ratites,Injected Meats- 155OF 15 590.009(A}-{D) VioiaViolationsnsof Son 590.009{A}-(D)in see.* catering, mobile food,temporary and 3401.11(A)(3) Pouitry,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(42)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145OF* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a { practices should be debited under#29- Microwave 165'F* i Special Requirements. t 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. j 17 Reheating for Not Holding ( VIOLATIONS R.-GATED TO GOOD RETAIL PRACTICES 3-403.1I(A)&(D) I PHFs 165°F 15 sec.* I (Items 23-30) 3-40111(B) Microwave- 16Y F 2 Minute Standing � Critical and non-critical violations, which do not reline to the Timc* foodborne illness interventions and risk factors listed above, can be ( 3-403.11(C) Commercially Processed RTE Foal- t found in the following sections of the Food Code and 105 CMR 1400P I 590./000. 3403.11(E) Remaining Unsiiced Portions of Beef ( Hem ( Good Retail Practices ' FC 590.000 i Roasts* i 23. 1 Manaimment and Personnel FC-2 .403 i ( 18 Proper Cooling of PHFs 1 24. 1 Food and Food Protection I FC-3 .004 1 1 25. i Equipment and Utensils I FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 26. ( Mater.Ptumbinq and Waste FC-5 .006 70°F Within 2 Hours and From 70°F 127. i Physical Facility FC-6 .OD7 I to 417/45'F Within 4 Hours.* i 28. ! Poisonous or Toxic Materials FC-7 .008 ! 3-501.14(B) Cooling PHFs Made Frorn Ambient ! 129. ( Special Requirements .009 1 Temperature Ingredients to 41°F/45°F !i ! 30. i Other ! Within 4 Hours" Dentes anneal rum in the tederai 1999 Food CNIe or 105 C-MR 590.000. CITY OF SALEM `_ BOARD OF HEALTH / Establishment Name: .1Q_` r)k 1� G ' Cj e' Date: q 1 a5 (I2. Page: 5 of 'Cl Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item verified PLEASE PRINT CLEARLY a`/ 5g0.00> Nut do N)('5 fX _ - ,D C&I'v . botwo 117 590.Ov7 �jn oxo. �` a rr D 0x � ci�r . �L��nce i� 5� "c-'aem it w1u�i� ✓ t b ru rlakre f?-I a� PO. cC> I , � th r1,�51n roovn C .� _ hit lJo Dov I'cL� cc_ yexS 1 V in I I ✓ T7 SRO oci d " A�MeC 'I IIFry Cf e ✓ Lo , " P� Y Q t�rYIC ,SSCP I P �n�. iiM �Px Ur �ilS rt,✓P.��ri �.(orxvlcv,_ I P . I _ . , l a5 OA0. �c -�n.>,e1 h.l eh�eX t S V00-M 5 (�e ✓ I i as �51Pf0, 00.1 c tC Yl� t ni{ t P l� i' 1 e Y 1 ( V �i ✓ *+PA vicL�Yil�ef=�Y'11Asfi t,Jcf (�In PP2PY , � � `(��-th 5�es�i nV� t✓,��P �a.reSL� ., �� y i r7l c�i'�"(iuf_� "�o {'»P cuff Pyr{ .� I I Discussion With Person in Charge: Corrective Action Required: ❑ No Cl Yes , I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines q,Yf�vr suspen i ent -five dollar on/revocation of ❑ Embargo ❑ Emergency Closure your food permit. C / 12 Voluntary Disposal ❑ Other: ti t ! 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to ftotora{items 1-22) (Cont.) I 41'F145'F Within 4 Hmirs. PROTECTION FROM CHEMICALS 3-501.15 ( Cooling Methods for PHFs 19 114 1 Food or Caton Additives ( I PHF trot and Cold Holding i 3-202,12 Additives' 3-50LI6(B) Cold PHFsMaintainedatorbelow 3-302.14 Protection from Unapproved Additives* i 590.3-501.16(00 (F A) Ho4l't1PHFs Maintained at or above 45'F* 15 Poisonous or Toxic Substances � 140`F. * 7-101.11 Iden ifying Information-Original 3-501.16(A) Roasts Held at or above 130'E. Containers"` 20 as a Public Health Control 7-102.11 Common Name-Working Containers* i 7-201.11 Separation-Storage* 3-501,19 Time as a Public Health Cnoaol* 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* 1 POPULATIONS(HSP) { 7-204A I Sanitizers.Criteria-Chemicals* � � 21 "t_gpl.tl(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals few Washing Produce,Criteria* 1 7-203.14 Drying Agents.Criteria* Severaz"withWarninglabels* 7-265.11 Incidental Food Contact,Lubricants* 3-80L I UB) Use of Pastem-tzecl Eggs* 7-206.11 Restricted Use Pesticides;Criteria* j 3-801.11(D) Raw or Partially Cooked Animal Food and 1 Raw Seed Sprouts Not Served-* 7-206.12 Rodent Bait Stations° 3-$01.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powdets, Pest Control and * I { Monitoring* CONSUMER ADVISORY r TIME/TEMPER4TURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of i i6 Proper Cooking Temperatures for I Animal Foods That are Raw,Undercooked or PHFs I Not Otherwise Processed to Eliminate F 3401.11A(t)(2) Eggs- 155`F 15 Sec. j Pathogens.* °"" 1111�n Eggs-Immediate Service 145'Fl5sec* I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E=* Animals-155'F 15 sec. 3.401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 1 3-401.11(A)(2) Ratites,Injected Meats-155*F 15 590.004(A}(D) Nidations of Section 54mporary and in sec.* catering, mobile load,temporary and i 3 OL11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be t Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 1.5 sec.* above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F a 590.009 violations relating to garb retail 3901.12 Raw Animal Fads Cooked in a practices should be debited under#29- 1 Microwave 165'F* Special Requirements. 3-461.11(A)(1)(b) All Other PHFs-145'F 15 sec. i 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403A 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 relate to the Time* foodborne illness inter entions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found it the following sections of the Food Code and 105 CMR 140°F* 590.000. 1 3403.11(E) Remaining Unsliced Portions of Beef ( j Item 1 Good Retail Practices j FC 590.000 Roasts* 23, i Manaqement and Personnel I FG-2 .003 18 Proper Cooling of PRFs i 1 24. 1 Food and Food Protection i FC-3 .NA j 1 25. i Equipment and Utensils I FG-4 .005 1 3-501.14(A) Cooling Cooked PHFs from 140'F to i 26. i Water.Plumbing and Waste 1 FC-5 .ODS i 70'F Within 2 Hours and From 70`F ( 27. 1 Physical Faclfity i FC-6 .007 to 41`F/45°F Within 4 Hours.* 1 26. ' Poisonous or To)dc Materials FC-7 .008 j 3-501.14(B) Cooling PHFs Made From Ambient 129. Special Requirements .009 i l Temperature Ingredients to 41-17/45°17 30• 1 Other i Within 4 Hours* s5•u''mae� Dzrntea-incai nem in the L^dersl 1999 Fwd Cale ur 105 CMR 590.000. S , Berkshire AHEC - Secure Online Registration Page 1 of 1 Berkshire AHEC Area Health Education Center About Us Confirmation of Registration 30th Anniversary Event -- ----- --- -- - Online Registration Thank you for registering online! You have completed the process successfully!You should receive a confirmation of your registration via email shortly. Please close your Education and Training browser window at this time or return to our home oaee. Health Careers Public Health Initiatives Registration Summary Conference Management -- - — --------------------------- Connections Confirmation of Order In the News Print Confirmation Contact Us_ Julio Garcia Site Map Food Allergen On-line Training Home Financial Option Quantity Amount Food Allergen Fee 1 $1000 Program Subtotal: $10.00 Subtotal for Julio: $10.00 Grand Total: $10.00 Amount Paid:($10.00) Balance Remaining: $0.00 Order Confirmation Number: 37448654 (tieraGW,rO ,rCardstGC G! �iaUaerd, �N�addhtRlP G Cieeaavlp drat' �. , Gir.Rsti�igt to b'eGtar Hir0�G6 Copyright©2012 The Active Network,Inc. Terms of Use Privacy Policy I About Active.com �iC�VH@4t Online Registration Event Management and Registration Sonv✓are https://thriva.activenetwork.com/Reg4/(S(om21 inujje5Ogt45krom1a55))/Forfn.aspx?regke... 10/1/2012 Commonwealth of Massachusetts s 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: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0237 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2011 A Board of Health �( Al 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 J, $ BOARD OF HLuTH 120 WASHINGTON STREET,4"FLOOR To. (978) 741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUNIOSALEN4.CONI DAVID GREENB.aun4,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT e,q,D V4 F C/9�C"O 0x NAME OF ESTABLISHMENT .✓J RA///37,7071/6-2/ 1J6r'0X-A!9f _ TEL# 97? ADDRESS OF ESTABLISHMENT37f( /`/�g�l�Q/�C�f�yPcll(AO FAX# ✓y,/� 01470 MAILING ADDRESS(if different) EMAIL-Business': ///i� Website: OWNER'S NAME L/�OfOr �—S !/%LY/�7��9 TEL# ADDRESSC�214Ue/'/O✓/L 4h e (,�)e Ile,-P STREET CITY STATE -'13 /?ZIP CERTIFIED FOOD MANAGER'S NAME(S) 0��JZ �.Q/ll/fl CERTIFICATE#(S)j �7J 7-3 (Required in an establishment where potentiali,.�hazardous fpodared) 7 EMERGENCY RESPONSEPERSON �CCl/Q/d >°/S HOMETEL# R5 P.DAYS.OFOPERATION ° ': " �, - -Monday ; I' :'.Tuesday;_: "-Wednesday, ,i =^Thursdays',-; Fddav` Saturdayt,. *-k'.`.Sundayr- :•J HOURS OF OPERATIONi`� Please write in time of day. "�C!/r/ 70�/AJ 70 �m!.E � dam ��ir, �omm ��//P/rI 70M/(//D1 /I/, �Ool /v0 (For example I lam-1 1pm) / !! TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------- ----- ------------------------------------------------------------------------------------------------------ RESTAURANT YES NO less than 25 seats - 140 (Outdoor Stationary Food Cart$21 25-99 seats Q=$280'\ more than 99 seats =$420-' BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME - ..... - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YE NO $25 TOBACCO VENDOR S 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 1,to my best knowledge and belief,have fled all state tax returns and paid all state taxes required under the law. / >//r�%llU 07d' Signatureai Date / Social Security or Federal Identification Number Revised 10/7/11 FOODAP2011.ad c CheckB&Date /I2-) 117a $ 0 CITY OF SALEM Q(' BOARD OF HEALTH Establishment Name: I 7C-(, Date: Page: of Item - Code , ' , C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red nem Verified PLEASE PRINT CLEARLY f� re-it7YS bk ct-)Y, 'n-F' -MIS c- -,r,�1 uotlM ci, d I I f'(�� Vic�ic"�(�115 1101C�c� mi ,,(,3rhk-? kaov \XV,// I I I 1 I 1 I j j I I I Discussion With Person in Charge: Corrective Action Required:7 No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal-FootlUccle�i-understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. X \ / Y/ ❑ Voluntary Disposal ❑ Other: A \/ /-7— Violations Related to Foodborne Illness interventions and Risks ccor lint,w Lae, Cwod to Fartars{ffettrsI•Vj {Cont-) 1�14)'F Witbm,4 Hours Gxlliw ;YTuLho&for VHF PROTECTION FROM CHEMICALS fa 19 PHF riot and Oold ifloWing Food or Color Additives Cold MlFt, Mairklained at or belov. 3-202,12 11'/45'F` 3-302,14 Protection from I lilapia-mcd Addirvcs' IILK VHFMaulf"Ined atle-th,yVC IF Poisonous or Toxic Substances !40'F, ko,=.,as Held at or above 130'F, contaillms (11,11 1 CoyanoniNarne - Workiner,Containert, 20 Time as a Public Heaffti Control ll lim,t4saprityll'. palth",knluclP 7-20t.li 'S'Palaulai-storago,� i -Prt,�nc�and U,c' -2w,1! V;,riav,,,C fc-ovircm-lit 7-202.12 Cwahotxl:,lt Use' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 7-^03 it Toxic Container, -Probiln!'on,' POPULATIONS(HSP) 204J Sinni-/ocs,r2dicriz,- Chcmicads' 'l,K4., Chaoiiicalt,for A'a,hicg V!ndiie,,Ovc:,,al (A" I V;,P,,�lewc,e i wid 7-�fW W 1 8Cvev;t—t,nith Warnilliji Drying Accvl�.Crnv�tij' -1-205 1 Incich-mal ll�Ki Cknl(no,Lubi icaws" _hilt I I 'R;tu of Pa,tml): C,,ak;d Aunnall FocxJ and tied 5VYOWq"NO"Solverl. -206. Rkhlem Ea'n slinon"- -�06 i3 '11!1 cj j I iii Pll�ltjcr Z, I',jj C'niTT4.1:kit I 1,11"ptned Nxxl Pcrd�ae� Not R�-sclNed rvionilorinq, CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 -�Ivgvn!et Piia,d i-ir i'mraurption tic Fcxid lqiat zvv kim, Utraer",akttl ei Proper Cooking Temperatures for PHFS .;tri Olin rwi,�e Prxv,sed to iilhnhrlu, 40 1 1 iik(1)(-,) F4's- 1,i5-5 I,)Sl'c. jliall:dietv cwr'lv I 15'1;3 1 ev";Sorminji, tar Raw Shelf 0'qcolntwd FiNh, Nleot, An4wils- 155"F I�<cc. SPECIAL REQUIREMENTS 3 401.1!1R)t 1),2) Poll, ond kAx'st - I 123 nun* 01.11kAttz"? i Famc< 155'Fl.. sec. aicring mOnIc hyod,temporal v and 1 3-401 ll(A):3) Prailtr),Wild Gant(-Stufred 11UN, kit0mi rap(%mcari:; ,hould hL Claflme Coalanony Fish, Merl, i 6ehlcd urido lite app""PriAhe sea zi(ms 3-401.11(Cr3i Wlwlcqmi,,lo, War, Kof`,Sicak. ai.d rill, (:3:lorc Other 145,7 5'40000 violatiow,roknin�,,to "),ld retail Raw Animal (,c,)kQfl m a lil:lice\ hould bc debited under 1129 Miecowave 165 F, 5p;-,131 }401,lltAli,10) All Othei IIHF, - 15 s;,cI 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,40.11 i A) (0) PHE: 165-T 15 ties,. ' I I tens 23-30) iA..�,l i(B) &n" 1(,5' f 2 Nfintile� Sj,n -which thi,itj; elat,I')lite unro, reption'; k 't tat fors bwe-f obola, jn I'l, �-403J hn I comineteIall, llccxts>ad RTF 1w,XXI- Food CU,(old 103 C-MR 140'F' 90.l)io, 3-10? I I(L) I Relimmin", un�lwed K'I ns of Berl ffleu {load Rofa;lFncnces, i FC 590,000 i 2? ai�fla -1 ma') (�O ae:Pla,cenci FC 003 PC 18 Proper Cooling of PHrZ 1.24 FI)d�%nd!=ocri Prc,[�tto,, 1 004 5. a ,_i„ epl Arot ut-,v's F C, 001 -5 Cv�,Iilll�,Cooked PHF� from 140,F it, 10m,,le �Z— ow 70"F Within 2 Hoon and From TIT' Ph,^:Cal pa=111-pi FC-6 W7 --- W* 11311 , Hollis, pcqs,!,Aj-,'i '-'Xic Nlacjreifa 7 008 3-50LW(H) (cA)hn PHI s Meklc F(wnAalhient R,.q, Aremen F7 T'rolv'famm hirredi,,m*it)41 1%,41i F 011-te, o luedl lion q zl,c l"let;,! V F."Xi k:"Jc"r I 10K CMR-'91V '91V(ool CITY OF SALEM r t, BOARD OF HEALTH Pr 0#1P,,_Name: V�o,Y_ Date: ��a6�O Page: / of Nem Code C-Critical Nem No. Reference R-Red RedItem 'DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dete It PLEASE PRINT CLEARLY VerlNed ening i�Sr f_H nr) tis cc)"A Q Cried ?F f-�,7 P� e�llshr tf I ✓ �,i 1 r�_ i -t'h - � t f"_ _Zev- +,n .hP p vcApe", I v I ✓✓ II_ � -SIS ivy {-orc e -I kP c,-x/erPc - I I I _ /" Fc11 �P-�1;a�2raf-�rs -r-(-ree�crJ � G,cx.0-e �IrS��(� acct�rc�e rn�lerr,l�r! I I -h�,,.r��ft✓r�. I _ ✓ �< 0. C t C4 M �( 2 >LZ�t S .V-)P C-Ce Qvl BCl + r. Wa I N o_k-t-+D -Vl, 0kr-1-tc- kaS (ert -()Y) - I dean I I ✓ IRIS aff- ^Y,�P In ��c6s cd�o-/kt �.cl t�.Ca. � ��v� . ✓ ck 4cx�v� c�rx�r _Sf I V)a':; agrg Qt 110 k-4,Datr/,'�Pcf/ �1VY11t1('.G�C� Gck,(�S, U Y V 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/ li violations before the next inspection, to observe all conditions as described, and to Exclusion L3 Re-inspection Scheduled EI Emergency Suspension comply with all mandates of the Mass/Federal Fo`e-d-@ode,Lunderstand that noncompliance may result in daily fines of twenty-five ,ollars� spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (cant.) I 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS ! 3-501.15 Cooling,Methods for PHFs 14 ' Food or Color Additives I 119 PHF Hot and Cold Holding ! 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* I 590.004(F) 41°/45°F* 3-302.14 Protection from Unapproved Additives* ! 115 Poisonous or Toxic Substances I 3-501.16(A) Hot PHFs Maintained at at above i 140'F. * 7-101.11 Identifying Information-Original ° Containers* ( 3-SU1.16(A) I Roasts Held az or above 130 F. * I 7-102.11 I Common Name-Working Containers* I 120 I Time as a Public Health Control 17-201.11 I Separation-Storage- � 13-501.19 I Time as a Public Health Control* I i 7-202.11 I Restriction-Presence and Use* ! 590.004(H) I Variance Requirement 7-202.12 I Conditions of Use* 17-203.11 ( Toxic Containers-ProhibitionsREQUIREMENTS FOR HIGHLY SUSCEPTIBLE* POPULATIONS(HSP) 17-204.11 Sanirizers.Criteria-Chemicals* i 7-204.12 Chemicals for Washing Produce,Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Juices and ' 17-204.14 Drying Agents.Criteria* Beverages with Wanting labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Egos* 17-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and ' Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders,Pest Control and 13-801.11(C) Unopened Food Package Not Re-served. " ! Monitoring* CONSUMER ADVISORY TIMEMEMPER'ATURE CONTROLS 22 3-603.11 ( Consumer Advisory Posted for Consumption of 116 Proper Cooking Temperatures for ( Animal Foods That are Raw,Undercooked or ` PHFs Not Otherwise Processed to Eliminate 3-401.110(1)(2) Eggs- 155°F IS Sec. Pathogens.*E '.1/1j 1 Eggs-Immediate Service 145°F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals- 155°F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* ( SPECIAL REQUIREMENTS 3.401.11(A)(2) Ratites,Injected Meats-155°F 15 J 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* I 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, 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 I 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- Micruwave 165°F* Special Requirements. 3.401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 117 I Retreating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PHFs 165°F 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 Tithe* foodborne illness interventions and risk factors listed above, can be 3.4(13.11(C) Commercially Processed RTE Food- I found in the folloxdng sections of the Food Cade mrd 105 CMR J 140°F* 590.000, 3403.11(E) Remaining Unsliced Portions of Beef I item I Good Retail Practices ! .FC 590.000 I Roasts* 23. 1 Management andPersennel I FC-2 .003 I 18 I Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Eauiptnem and Utensils ! FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 126. Water.Plumbinq and waste I FC-5 .006 70°F Within 2 Hours and From 70'F 1 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * 126. Poisonous or Toxic Materials j FC-7 I .008 I 3-501.14(B) Cooling PHFs Made From Ambient ! 29. Special Requirements 1 I .009 Temperature Ingredients to 41°F/45017 I ! 30. 1 Other Within 4 Hours* s�wa« rc-x *Ihnores critical hem in the federal 1999 Foal Cale or 105 CMR 590.000. CITY OF SALEM • 11 BOARD OF HEALTH ^ �1 Establishment Name: _ 1^� I/L �7P�(GP Date: h l7 Page: a of a Rem Code C-Critical Item — ' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 06 ) I � ,-ft-1 -to VLQ W 3 c A.Q I^_ I I a b i 1 I i I I i I I � I 1 I Discussion With Person in Charge: Corrective Action Required: ❑ 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 toExclusion comply with all mandates of the Mass/Federak�od-Co nderstand that El Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines-of-twen y-f iv ollars or uspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHN Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to law Cooled to Factors(Items t-22) (Cont.) I 41'F/454 Within 4 Hours. PROTECTION FROM CHEMICALS I 13-501.15 Cooling Methods for PHFs 14 I Food or Color AdditivesI I I9 PHF Hot and Cold Holding 3-202.12 Additives* 3-50116(B4 Cold PHFs Maintained at or below 3-30114 Protection from Unapproved Addiuves* I � 59 01.160 Hot P ° s 15 Poisonous or Toxic Substances ( 13-50 L 16(A) Hot PHFs Maintained at or above 1400F. 7-101.11 Identifying Information-Original I 3-50116{A1 I Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 I I Time as a Public Health Control ' 7-201.11 Separation-Storage* 13-501.19 I Time as a Public Health Control* I 7-202,11 Restriction-Presence and Use* ' 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* I POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* I 121 3-801.I I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact Lubricants* 11 Use of Pasteurized Eggs* Partially 7-206-11 Restricted Use Pesticides,Criteria* I 13-801.11(0) ( Raw ord Sprouts Not Served.Cooked Animal Food and Raw Seed SpI 17-206.12 Rodent Bait Stations* ( 3-801.11( 7-206.13 Tracking Powders,Pest Control and I 10 Unopened Fond Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods-That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-40L11A(i)(2) Eggs- 155°F 15 Sec. Pathogens.*E"0`'" Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F 15 sec. * 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 I 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * I catering, mobile food, temporary and 3-401.11(A)(3) I Poultry,Wild Game,Staffed 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 3-40L11(C)(3) I Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590,009 violations relating to good retail 3-401 A2I Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165`F* Special Requirements. 3.401.11(A)(1)(b) I All Other PHFs-145'F 15 sec: 17 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.403:11(A)&(D) PHFs 165"F 15 sec.* I (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 listed above,can be ' 3-403.11(0 Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CAIR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef ( Rem ( Good Retail Practices 1,17C 590.000 1 Roasts" 123. 1 Management and Personnel { FC-2 .003 I 18 I Proper Cooling of PHFs 124. Fowl and Food Protection FC-3 .004 1 3-501.14(A) Cooling Cooked PRFs from 140PF to ( 25. I Eq ter,Pluent and Utensils FC-4 .005 1 126. I W ales,Plumbing and Waste i FC-5 .006 I 70'F Within 2 Hours and From 70"1 27. I Physical FaclUty FC-6 .007 to 41°F/45'F Within 4 Hours.* ( 28. Pat sonous or Toxic Materials I FC=7 .008 i 3-501,14(B) Cooling PHFs Made From Ambient 129. I Special Requirements .009 1 Temperature Ingredients to 4I'F/45°F ( 1 30, 1 Other ! I Within 4 Hours* s«rofmmtcn`-a ex. *Denotes critical nem in the federal 1999 Food Cale or 105 CMR 590.000. CITY OF SALEM 5 BOARD OF HEALTH Establishment Name: Q-Y,r,-M-ier I `l-e-nf C)v Date: Page: of Item Code C-Critical Item v DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I No. Reference R-Red Item Verified � PLEASE PRINT CLEARLY � IA Piz r, viciovv-/ `i I �n0 -�^l�'"ftlllvlr`.I IA/P ; -0 111 =� . . �J .,- , . ._., , - - - •�- - - - - • �--' I.• .- , I - ✓ '�nw,� n r � e�"c��ln I�� eo � (iinc� �"� i �� nc,-�I s-In1�Tf' �n 4 -�C�ra h�r�(1 t��n�n`�. I � PYW/'f'l Ir v�P �o �4 �., n►�; o I - o- rl _ t I � rtri' C( o/�OnNlrEc � .�� ner (-T, t' 1/)v _ . Y - - - Gtran < . in hu cK fi-) 1 ,p ryTin4- 4 / t c1PC1 IPS-{, -) ke 'in 10,v'. vk,�) )e c`c vC� �eaqI f q C I Orrvi(-i J-)(P �v y 7 I k�vJ ✓ V('Cnd C104YS Ic (nVrCC 4�, ��U , 1n hDC• e ui `ec' • I r-"a�p D C-r- t V" , 1 c'� oc_� v-I 4" I-fp r c I n `� of ojlk1 •0 c�N (! t /�i� keA - 3'( ( lcyl-t� i� ct )C�e 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 / inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines_o-f-twen --fi/ve dollars or uspe 4i• n/rev-c tion o ED Embargo L3 Emergency Closure your food permit. -- ❑ Voluntary Disposal— ❑ Other: ^ - '-501 14(t'i Ptf s Received at Temperatures " Violations Related to Foodborne illness Interventions and Risk According to Law Cowled to Factors(/terns 1-22) (Cont) "l I`F(45`F Within 4 Haws. ' PROTECTION FROM CHEMICALS ( 3-501.15 Cowling Methods for PHFs j j 14I Food or Color Additives j j 19 PHF Hot and Cold Holding 203.12 Additives* j 3 501.i6B) Cold PHF.Maint.:ined at or below 590 0tN(f) , 41°i45°F- 3-302.14 Protedron from Unapproved Additive,' i 3-501.INA) i lot PRFs Maintained at ur above j 1g Poisonous or Toxic Substances l ' lnkaniation - Orr-incl ! !4(1 F' Ident!f3 in'b 5ta I Iii A) Puost,Hctd at or abovc 13('j:,+ j l ontainers^, j - ; 7 103.11 1 Common Namz - N', rk,r,il C,ntl.un.tr..'" �34f _ ! Time as a Public Health Control ------- "' !; L- -�-_ Fin' ss a Public l inalrh t'unu'ol' _ ! j Z2U3.1 i E'.e,tticnrn -Pt erx n..aiul t.•e' "LVari;cnie R�na'went 7-2O'2.12 (.',aulnxtn"ofllw, ._.. j 7 '.03 It 'Ceti'.Colll nnco -Pcoh:hr:on." REOUtREMENT5 FOR HIGHLY SUSCEPTIBLE i 7-204.11 Janitize[,,Critcri., -Che:niely' - "- ___ POPULATIONS(HSP)_ 7-7W.12 t'hcnlical>fol Ua,hte'Frrti:r:e,(d A:na' 21 j i-\Oi.11fAf Ciirni reurrred Pre-paci-aged Jmcec mid '�--"'—'—"--'--"-' ! i1Ct'eCe2e�511th KtianollL l•a Wls" 7-204 14 Drtinq Apent,.Cnleria' _ _ Lg;of Pa>tcurired l;:r't:' ! 205.1 t 6z;id:nl al f a.Kl f'ornart. Loht:csn!s'---_- .��....--_-�� -tiG1.l It1?? kaw. or Paw:dk C(;)k'd AnitTt) FCxal and I �?-2U6 I Ke.trn:kd Use pc•:+uder Cgvua ! _� .-_ 1Zan Sx d i?r„nh hot Scrwd. ! : 7-'06.12. ! RSKirt:: Bali <.gXui i "C, s” (.�•• Ited(P,n43 Pa,f',istr \or R.,: <cnca 7-220(1 !3 Lr.i.!ng Pnsder:. 1YI%i Contn.l aura �..--— I `4,nitt=fi't CONSUMER ADVISORY _ .�----�--2222-- ±L?' li ,m,oino[ Rcf.m.ory:'<ntr,l i,rrCous imptiun<.f I TIME/TEMPERATURE ATURE CONTROLS j ;�,n;,:f I 'x+d 't7tre ea ftau Cndrro,r,kr,i,. 16 ! Proper Cooking Temperatc,es for ! I PHFs I ! i �`r'i <?rltrr•;!,e!'rt,,:x•ss ;l:.�tainuuare I ( ` W. j t', ;r� :;,-,i Ft S:,hs-ilot'lir R.m' S1,4 __ �F.;�n Inuaad;atr tie,�lu' 1 '1'1-11.ec i ! f �`-h:O,;t._'Cr�_)1'. .._ ~k!:PC_ 1!'rlex'';d "?9cAAc . 'S f.i4 _... ;./•,,i •q,i S>P-;r):^: IA_LRb,E"i0L9•"fRhEoM! cJPNiTllS1:;: i n<:,x ae; K,,,' R ..,,1 r"J eiii l-'-3 ."-F-1,_(K'i—'/; t i�J it: j c• ` etcr :tz. int,btl::l:'+:u.1iillporat v attd "ts ,:ntr , 'id -St-u-;ti4-'+l- - hi" uC!na'trHad,rllii spjlro,rt,t=.cc ,r.tinm, j fill ' , _ � . L ", 'j, ,i, .Cid , _ i' Al — : '4 j 5,[d;idn t4= tf,?t r4i101,!, L j 7 �r•,} -..�:i rt"r : _ . ,t ,t _ _ I 6t' Lr7if)r4":rhEi-"4'.:.c. �ici C+vColfe)'RfLt9 ieC:77CF:.i t2F<rnr•.3 t_i(➢f Ifh; .tt,.ru„'11.'-..fir. 1_ �inn:'r Sc:ndin,_ C'o.":1. .. ,-t p."„ :'n."r,,. ;ru:rh do nn: -eNtz ., =1r, f ulir :?I„'s= C:;:t,•Q.,+., „117,: ,,r:bre ji.h'd .,r+t{y, ;.4Q3.1I{i't ('onsetrichY; !tM F,ti,i rin.t :r:SL, . .. :,, ':c .,. . . , ria "w": .,J•}a:r+ Inti r,t'Ft :40 F' :v;[ a.. 2222-- -- � - - !I(L) Reremaiw U!,,heec u P,•, rtti i•1 iirc! ttei7 '_Gnod Retail Practices _ : FC -_,_590.0du _- 1 t8 Proper Cooling of PHFs - - -- ---�� '- - - - --2222-- -- -- w--- t 2.1i iPxi xf`Fr07tJ1{9. 501 H(A} {'<Kdinv xi r z: - _- ------- n. -- - ---._--- -` - _ -'- _C: r..<i E Ff 1's t:,rt<: f ftiy=Io= „,,, 7.r( R1urn 2llnnrs.rrd from 7:!"1 _ _ - _. -t; �7 ' I _ _ FC-7 Axl _ _ ,UL t4tB; i'unhue HF,Si.,de F=.an: � T.'mpeoitate Sner.>Lit:r tt. +1'i,.ti F j :_. -_ .-_ - _ ”- ___ ._ ---._-__ . - -... _• j h;ftnm-111+tlr,` pro, 'I it irar:e: 1).10I'ud C.,'.• - p? 4i., ..,:ni "t 6 r .y t - CITY OF SALEM 1BOARD OF HEALTH / Establishment Name: p)r01VIS_r Date: ��i ! O Page: of CQ_ Item Code C-Critical Item v DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R–Red Item Verlfled PLEASE PRINT CLEARLY � .. - N of tte c211�t -for a_ I in<, t c 1�an o� et�lt�a iY�r.h�cl�on �% �v�o uueQL fii o< tI o "I I +C�kkt er " Pc hli ��v� I.tillrtutc-)lr-jli4 'c P I � I 0_�n I } � I I � I I I I 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 Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fe=eral ood Code. I understand that noncompliance may result in daily fines of twen -fiv dollars or susp n ion/r ovation of ❑ Embargo ❑ Emergency Closure your food permit. - / ,,,((( /.fit/ ❑ Voluntary Disposal ❑ Other: V jP_ IT i u V — 1 3-501,W(C) PHFs Re.x'ived at Temperatures Violations Related to Foodborne fitness Interventions and Risk 4ccordi ab to taw Cooled to Factors(Items 1.22) (Cont) I I'F/45"F Within 4 Howl. k PROTECTION FROM CHEMICALS I 3-501,15I Cooling Method for PHFs PROTECTION 19 ( PHF Hot and Gold Holding 14 I Food or Color Additives 3-501, 16(B) Cold PHFs Maintained at or below ! 1-202.12 Addit icO 590J)(f4(F) 41"145"F^ 3-302.1) Protection from lhianoro%ed Additives' 3-501,IN A) i lot PHFs Maintained at or above 15 I I Poisonous or Toxic Subst} ances 14(t F. t01.11 I Identif in1'+ tnfoitmunn -Ctnginal " . I _ t-N 1 16kA) I Rua,t:Held at or abote 1301•. 'v I f l unrainer.' I(P_ I t I Common Narl - W 4rlp l ,slifaw n", 1 21) ._ .2222 1 Time as a Public Health Control t pi o:'a. a Puhlit iiaalth Control _ i i-..z0 L 1 1 j ti<pa,.tuon-Stu,at;c" _ t- ----- --- - I }?�(.j,}{}_ 7-202.1 i I l:catrict h>n - i'r•'uncc utd {,,c" � _"_ 7-202.12 V Clmdnion:of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE !, / 103 I1 I loth Cuntainel: -Pruitihc:on,' '04.11 J:m zer,,Crher,:+-C'hr„»c:dc^ i POPULATIONSitSPL-- ; . .-- � --ICnpueunvedPre-pat-l. gcdAmcsand 12 ( h.nti:a.!n t}. — _ •ruinc" zlit.na' Rat rrn2es with Warning Iabls-- ---- 1 ,c of pace:»ird7704.14 U,tnw Avcvta.Crictia" 305.1i htridenal ('r»ract. l_lr:cans i 't-yPl , liih k'o" ,:r P:w;ad" 0Kok. d Animni Ftwd and 7-2'06.(1 Ra,oicledt'sv Pe,gcvlcr' cnrt.):tT ?G.I_ to!:t B.nt 4;auo;e.^ k:t'. Seod Svrrm, Rol `served. " 7. 7 ; _-.! : FC: 1 ;r(i l;:•+i+�,Bd I iiuvi Pacl.t�. ho: kr-se-tea. 'i 1-06l3 tl.tckfng pnndn':. P;at!}, t.!aad — >fiuuntun;� I .._ ..-- ---- -- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-W,' l 1 -ou,not,r Ao,:;»+,. P:.icd :,rr i tiuma:ptirm 0, 1 ,lnim of i-nnl' Plat .»'c Rata. C:idcicx,ted.; 16 I Proper Cooking Temperatures for ! I a : PHFs , t -�.+t ",tilt f,"kc!Yt+a'st;t tr.:ain:tn.ve 101 11.1(1 .tit, F".u: 155 !' 1 .t'. ;,cl,>,<,t,...', 1;,VSab.;aatrtc RawSIwIf I L•tu»:di'ttc 4c,�1,. 115`1'1{, ; i "1 i) .- SPECIAL REQUIFIEMENT S :...—_ _ .- _ _ _. -- ._. :lt)i Qt.t'•;}1, \n'h.t:n,.a t; S.Yi0.`4 : t?,(}if9::`.5..,1)1 is i-�iilyi`(A1.�. K.q;,r•. 1"tei'..d 14t ttn t 'S !' t.. _I cawri6v, tnot-11:. Sit, tl:jnporai and i ; 4ir1.11rR i'?; i1;,tdtrt \\11d(i;qP?.. $ta'+�.�V(;E,'2..222 rc�.c',P7:.:21 t,itCD2tt Oj;Ci.:fio^d ,IjiiVid he a^d:=ilA' aphp•, :tn4' <rt�itffic i it Wi ... ...-__... 222......2. . ..__-_. -. .. _._ _. , 17 ! _ _t Fc.'he.t,nn for tiat'iv!,i,y ;'i:,;L,4i's`N:)' RfELd"t '.` TOt ', 0D Fi'I=.�?`.»PL PRACifCt�.A :-aD3.ti(AP;:lir )'t"l ips'r" '",vct {dtent.2?-iii{ 1(7=.t lfh) ",Oros:at.- Irs•' G211i:s:: :d:rnL'nc C,1;: a r t,.. ,, , ,.: t,o„i,...., ,+:•rrl Jo,:;n 'o re !-rr 1"I:UC' i.v„'ia:i,p:,..., .,.,r,,.;r;. 'x” er-< t1,,410,lor,i',t, ti:Y9':' ,wt 6, 403AItU) (lmunsrta:!r f';u.z„ 3 '?'ii 1•i,.t f,......cin: •z'.'a .v,: . 4 ,n t<.' `•s:rlCat;' zdPii (1t71, I :,lty.F• :,rr_Dri.t : diem -Goa.)Rerarf Prac2rccs -_-__ -_- FC 590 0_00 rC_ l_ ! x- - -- �l (g Ptuper Cooling o4 PHFs j E••:'n;'"'d oa;n Prole^t-,, _.- 2S "r"3�, rrcnt and Uta,:s,'y S01 E"t(A I ;':nrl utf C:xrF:d PF1Pt f�:IIt. I:i t' ., 1 -__ __ _ _ - - __- __ .—_.. __ _ _ ••.c _.._ J r 2C. +,:::t_t ' FC-5 UOc h,eF' Wtth,n T ($tort e:'ut Ft,xn 7J"t ! ',' .F-"i.•" - p ;Q". - .. •� _ FC 8 6(Y7 7 ._. a � ._ _ _ " do ? 501.14(11) f1 C011hi8 Hirt %hidC 11:4li a:a!'ieut 1__�.-222.2. \r:,thin4lltxtr.' '1tL0otY�.Y!bC.lt tlOq d+iL.�. ,b•, . "tyt„x.t ,:'c•d i..: . ',?I' :. 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S'. • ._ ,C^, tb }v, Y:,x yX. ,_ . dye �°i s'.L., Commonwealth of Massachusetts i City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 08/26/2010 ESTABLISHMENT NAME: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Nates FOOD SERVICE BHP-2010.0536 Aug 26,2010 Dec 31,2010 $280.00 ESTABLISHMENT FROZEN DESSERTS BHP-2010-0537 Aug 26,2010 Dec 31,2010 $25.00 Total Fees: $305.00 PERMIT EXPIRES December 31,2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS * t e BOARD OF HEALTH 120 WASHINGTON STREET,4".FLOOR TEL. (978) 741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGR1;ENt A1JM, (_.sAiasnt.CONI DAVID GREFNBAUNf, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMITeTG/OPEERATE/A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_�KlT7�e�/�O7P s��/�f70ri��o�T TEL# ADDRESS OF ESTABLISHMENT�� h`iq.��©l/ZAff 919 FAX# MAILING ADDRESS(if different) 'O�i P O C oatt/ lP EMAIL-Business': Website: r OWNER'S NAME �26 YoPr w7l TEL# c �) ADDRES o STREET Q/ CITY /STATE ,t- ZIP CERTIFIED FOOD MANAGER'S NAMES)—/ 4�Zg/ZC//5 CERTIFICATE#(S)��]I (Required in an establishment where potenti azardous food is prepared) LL EMERGENCY RESPONSE PERSON 4S-OSTGYroa/IN/� HOME TEL# n S_T J;DAYS OF OPERATION Monday J Tuesday 1 /Wednesday i Thursday J Friday J Saturday j Sunday I HOURS OF OPERATION 79n> // Aj '�j�� . ///� 74rry- /�Ji7j %✓I,-//wh �G/i� l/ 7i/jj70irt -//��1r7DA>r// 0/19 Please write in time of day. (For example I1am-11pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------- - RESTAURANT S NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats -$28 more than 99 seats =$420 - ----------------------------------------------------------------------------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME - ---------------------------------------- ------------------------------------------------------ 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 retuL nd paid all statet es required unde the law. ,Signature Date Social Security or Federal Idenhiication Number Revised 424/07 FOODAP2008.adm Check#&Date I ti r $ j 1 CITY OF SALEM BOARD OF HEALTH Date: August 4, 2010 Name of Establishment: Brother George's Restaurant Address: 376 Highland Ave Owner{s}: Ricardo Reis Phone: 908-943-8851 The proposed owner Ricardo Reis and the current owner Roger Garcia presented a Floor Plan and Menu for review in accordance with the State Food Code. Both the floor plan and menu are approved as presented. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION Roger Garcia is certified and will continue to work at this establishment until Mr. Reis receives his certification. There must be at least one full time CFM at this location. Please provide a copy of Mr. Reis's certificate upon completion of the course. A "Person in Charge" or"PIC" must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. CHOKE-SAVING There must be someone trained in choke-saving techniques at the establishment during all hours of operation. FLOOR PLAN Hand wash sinks must be well located in all food preparation areas. The hand sinks must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. A dishwasher will be used for washing; rinsing and sanitizing all utensils equipment, and dishes The dishwasher must have a final rinse temp of 180°F or a chemical sanitizer may be used. The dishwasher must be equipped with an audible alarm to indicate when the sanitizer is empty. MENUIFOOD PREP All food must be held at 41°F or lower, or 140`F or higher, at all times. Therefore, soup and other hot items should be brought to the appropriate internal temperature before being held hot. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. Food must be cooled and heated quickly. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. All refrigerator/freezer units must have internal thermometers maintained at proper temperatures as stated above. UNDERCOOKED FOODS The consumer advisory is posted on the menu. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises, including the dumpster area must be kept clean and sanitary. A change of ownership inspection will be conducted on Thursday, August 5, 2010 @ 10:OOAM. An plicptio d check was not submitted. Di enbaum Date Acting Healt gent o Reis iv D to o of Garcia date( N� �y�'� n ia,ww- -T...f,_ 'rw`�V'�'M`t»...i'f�"n.•S^... .h .. 6 w' r'-v^.. .Tr. -4 ,--rt -.... 1 ^.,,sx + � 't�r�^..i'.f 4j.r,n^��,/�.:r �{77 r...,t Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor ` 9 A Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / Dat Type of Ooeration(s) Type of Insuection W rbA�S rf-0 C -Q ) ��11 o I [/'Food Service ® Routine Address / Rfsk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous nspeciion � Telephone �� / / ❑ Mobile Date: 7`l`f� C �/� f /o�, Owner /� / HACCP Y/N [I Temporary Pre-operation mut, (t /' ( rc"x I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Tim¢ ❑ Bed&Breakfast ❑ General Complaint In./� , � ❑ HACCP Inspector �? ��h�fn I Out:h 44 Permit No. ❑Other Each violation checked relquires 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 [I_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 E] 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION '" - x'19. 3t nd 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 T-N-1 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-3)(sso.00a) cited in this report may result in suspension or revocation of T25. 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: 55901nspecfFo,mbl4 me 1 1 / / //� /n/�A-nf 1 Inspector's Signature: " Print: / r �/[({n/�\l( )/OIJO //J PIC's Signature: -�� / /� Print: �i/Pw CCCrrr-+C{ll"'( �I I Page ofages r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1590.003(A) Assignment of Responsibility' I 3-302.11(A)(1) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge," I Cooked and RTE Foods* J 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11 i A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 1590.003(C) Responsibility of the person in charge to ( Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection° applicants"` 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To'I'he Person In I thensih* Charge" j Contaminator,fwm the Consumer 590.003(6) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590,003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590A03(E) Removal of Exclusions and Restrictions I I Food 3-71)1Al 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" ( d-501.111 Manual Warewashing-Her Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures" 4-501.1 t2 Mechanical Warewashing-Hot Water 3-201 13 Fluid Milk and Milk Products* Sanitization Temperatures 3-202.13 I Shell Eggs* I em p --- 3-202.t4 I Eggs and Milk Products.Pasteurized* i 4-501.114 I Cheinical Sanitisation-temp.,pH, � 3-202.16 ( Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 I Drinking Water from an Approved System* 4-601.11(AI Equipment Food Contact Surfaces and 590.006(A) Battled Drinking Water* I Utensils Clean* " I 4-602'11 Conanine Frequency of Equipment Paid- 590 006(B) Water Meets Standards in 310 CMR 22.0Contact Surfaces and Utensils` Shellfish and Fish From an Approved Source 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 ( Methods of Sanitization-Hot Water and 3-201 15 I Molluscan Shellfish from NSSP Listed I Chemical* Sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1 ?011 l. Clean Condition-Hands and Arens" Regulatory Authority 2 ( ------ 3-202.18 I Shclistock Identification Present* ( 2-301.12 Cleaning Proc:edme* 590.004(C) I Wild Mushrooms* ( ( 2-301.14 When to Wash* 3-201.17 Game Animals* I It Good Hygienic Practices g Receiving/Condition I ( 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures F I i 2 401 12 I Discharges From the Eyes,Nose and 1 3 2.02.15 Package Integrity` I Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" f i P 12 Prevention oContamination from Hands fi Tags/Records:Shellstock I 3-202.18 Shellstock Identification* 1590.004(6) Preventing Contamination from 3-203.12 Shellstock Identification Maintained', ( I Employees* Tags/Records;Fish Products I 113 Handwash Facilities 1 3-402.11 ParasiteDnstnictron' Conveniently Located and Accessible- -- - 3-40'_'.12 Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(1) Labeling of Ingredients' I 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibilih'.Operation and:Maintenance IHACCP Plans ( Supplied with Soap and Hand Drying ( 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashiug Cleanser, .Availability 8-103.12 Conformance with Approved Procedures' I 16-301.12 Hued Drying Provision 'Denotes critical nem in the Weral 1999 Foal Cade or 105 CbtR 590.000. CITY OF SALEM t / BOARD OF HEALTH / Establishment Name: x �n o i �.v maxi, Date: // r,�� , Page: o`er of Item Code C-Critical Hem r °' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red nem Verified PLEASE PRINTCLEARLY �I /I r((14(- 4, �//ir/V�i n1,4-% ),,) 4-. W"1/ { V .Ve" j?J=- r r�r �(C� rPd7 rn ro _�-- ref er A ,I, !'�- /1 r n�A -1�7 t I - Dor r Lr./1.✓Y .x- �, rPiJc�—��a F�„a Vea f � L—I l �( 42 r �1 /�As� C �Oi�i'J„✓1� V Ini(/ �J r f I� 'K od ,/ T ✓ `1fI( J /,115. �L110 ru1Jb)J�I'1 'C �� C(o 61e(S rr ctk,c IIS `, 1-16.A0 �� S�tl,n w C--4yy /v/- o i1Jn/!►- I sl, _c-I,>,r _S� Iv; ,�[�_ � J/2cGrr ynruA�� l I IT— 4 SZI. \ )'”<S <C.— 111 L) C, '�T CVNPO/ 440rVii-j)Y / 1 t15hGe a� �AJ� 71111 L/R'T Discussion With Person in Charge: 'Corrective Action Required: I ❑ No 1� Yes I have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Emersion violations before the next ins P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I,under tan that noncompliance may result in daily fines of enYZA five dollars or�usp/en ion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /J�(j� /y t �� J Ute// ❑ Voluntary Disposal ❑ Other: PHFs Recervrd at Temperatures I ` Violations Related to Foodborne Illness Interventions and Risk According to Lam Cooled to 1 Factors(Itehls 1-22) (Cont) 41"F/45`F Within 4 Haws. PROTECTION FROM CHEMICALS ( SOt 1 I Ccxdinq tethods forPHFs 19 I I PNF Hot and Cold Holding I14 I Food Color Additives -26?.12 r;d{litivivcs'" 3_,0!,16(B) Cold PHF.Maintained atorbelow .. . . � i,';p?,id_ _ Protection front LInaF)pru:ed Additives' (Y)41-)(Y)41-) -01'145`F- ivcy' i-Y01 I6f:A:; I Int I'FiF�Sfainlained at ur above 15 I Poisonous or Toxic Substances i I01.11 ktetttd' mr inftxtnaiinn Ori inai !4(1..1 f Y !- HCtd ai of above 130°I'. + l Dltt.11netS' --- r 102.1 I �Ct'mmrm Name--N',rkme Cun:,ua,trr,` `0 Time as a Public Hearth Control FII It:s i Public i-tealrH Control, i-2(}(.II __._. Sipa,.tuott-ShnagC" ___.--. .__—._.-j_ s aft^:,tir Fri 'In.c Rr urct 7ul: "7.207..7 ! ( Itc,t;-irtion -1't rsc:ncc,mJ i.,"' I -=-=---------- -t \��=- ----'�---`------- i 7-202-12 x s Cor.rtd Us,; " REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ! -.'.11311 Toxic CbI "Cemnct:_Prolribtant,�__.—._.__—{ 7-204.11 ( \.tnitin•t}.Cnrcna-Chr,tnc ls' POPULATIONS{HSP 7.'04 ,, -�- --. 1 .. i F2I i-ti'n lii,t7 �l:r,astcnnrd Pt.:-n�;:,,:Cd 1ViL"t,, _ I. r Chum,:ds t„I R'a.hi:::Pr'rn rt t,( tnana'___ i r- -- -- ' Rriet;::ea with ah:N. 2!)4 i ---——-- '--j ! ! ?t?S.it ( hxati;nt.{I Faxl i , . ,, lIFSr t_.�- Paaeun. d Eca. !Zu i nt _U .n...le, ('arena';_.__-__.--v__ `t t_w' I'r:ck,n+*P,trdr:.):�: . „m:'r ;.ud i �--. .-"'-- CON __.__.__..- _-- . TIMEiTEMPERATURE CONTROLS d_ i t ! , ,;r t:. t t z': : rs y':{, t:J ;=,r i'ci{sntrit ,+;.of {` V'!:: t t^J ,'u '1` ll .,,n .,,.. t.l'de'r6lh"'V'i{': r 16 ---------- Proper Cooking Tomp etatwes tar - i %. PHFs { ` i ' ,ia•. .. ,u i'iP'drL,c ,. .. - ..bs. ,. 'Litt a.,,i --- i .i: :!f•A)i �l p,.,it;r Int"a••.t' nir Rs :. � { 7S nit,l) ,`;, c. ,:: .. .r t..S<t,•,�.'•,ti:;'!f':': .:�t '., lid 11"fli 1l:14 Cita'(' rt.pL IU11,i:5 t a :^ PI::7 df K:..`. .:,di•iii i; s:wn,. F'ty 5,:.,{ r ., tC ' - ?7,i flr)t'stt..l!i. f 1.j1!' ' i i I t • i { C;J00,tv?p TA,L • +: - fl, ll :u,'2_irlV I,It7.. ifi 'r .r,. ^ S(1 1:thi :nrlt.^,f'. 0,ca zi adp ,. ,.: ,:{'.t...> . `:t:r h, ir' ..w is rw. . : . %,na%„ rn, '.h: y, :r;.. its - .. O ::rf, td:if, v"/;i, 'W ,-1'1 /. it t'; 1.'n,n,,,t:rails 14 t,~z.,c'» !1 �I. k.--- ;,,un.. ,r, , f:.: a.. if -- ------- -. ''-. '- -r--c - > !k .•., I I�:.'rn:imint,, L't„l,.�e:l R attc n,.dli:•c! � Ilan? Good Retail li'actrc"t; fG � '90 000I _ . - _. - __ 5anao_^.rt_t o^.a pFr":;._:>� F:- � - �-tI., .. !F3 i Prtiper Cooling of PHFs 1 2.t Fcv-C 'd`,},><t',ctec t:< _ _ ---__ Ft - + _004 ;te•'s_re- i-'tP.fC't>,Jnt2 C.w,1'd PFiE'=' !^sm 1-at _... .__- xj -(it ttl[fun 2 ibwr<',�;J Prom ' J �C;; .,.4' 4145 F Uri&❑a n Hop”. _ _ ets !'us r ..;; :1,-x' _ FC _ '.N'rt- Fwio An,Mcn[ n !-' _-_'-'a`x-°,� ..:{,;.• _ ---- - --- 'll of{araarrelnrrc,Gcnl.t:,aii;'i.:; I: lttti'm.311<nr.,: ' 'lleot,t•'>.na,al poll. it tF:t„ ` -CITY OF SALEM — ee ' BOARD OF HEALTH f Establishment Name: ns K/lc>, (�-�_u Date: (/iS �(�) Page 7 of - nem Code c-CNdcal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION }t Ito. Reference R-Red Item .VeriTled PLEASE PRINT CLEARLY . ^I `t5 � 3J� / l _ _ pew / Iti h6+ hed ,,} un( — riAocPd b 44 rn ltr c-,.� 1/ . ankh ��- Yt�ir�r y Uti�_ �.�.•n n� r_.v Nn p_O �.0./�J,�-r, /e��L�ll-Q �n/�/'7 ti(D�."Z-- -.;� 0 A) •r �Ich�'t-/. �'h(. I�. � !' OO��f �_ l (_./ 'j r, J,nC hn.Ao k - �.,• A�l , 1/ I .�"'�"" norc _ J Ile.�nSnc.r,�.. .,✓ /', c�'A-->_, _-Aa c. kw1 C, .,.'.�',�� /��.�c r, ��. c�: ms--=-�--�n, 1� l�It�m-�OOn Ot-bn^ln../ e��tiY1 �1✓+'7Y"i1,,7 J'� V _ / >'' I 1. rl 17 I'1 /1� i .--T�-v--v t wi - rJ• �r�✓r�e-1 _/� ` I/ r 1 V I-,F- I ^i��—ice .r.�• r -/ C(7 r, r _.' � ( I(Ir �I Discussion With Person in Charge: Corrective Action Required: ❑ No ,/ I t� /Yes I — " t ❑ Voluntary Compliam�e ❑ Employee'Restriction/ t, 1_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 1n Re-inspection Scheduled ❑ Emergency Suspension _ comply with all mandates of the Mass/Federal Food Code. I understa -that (kV noncompliance may result in daily fines of�`twenty-five dollar�or su pension revocation of, ❑ Embargo ❑ Emergency Closure your food permit. / /I ,/(/ � _ �� (/ v �. �,r,/2 f ❑ Voluntary Disposal ❑ Other; • � _ S4''I iaf{a PHFs Received at Temperatures I Violations Related to Foodborne Illness interventions and Rltik According to Lam Cooked Iu 1 Factors(1teMs 1.12) (Cont.) 41 i/4 5"F Within 4 Homs, PROTECTION FROM CHEMICALS ( i-501 1 S Coolingl4'Irlhod, for PHFi, 14 f Food or Color Additives 119 PHF Hot and Cold Holding i 50'..16(BI Cold PHI-s MHinlained at or below' -202 I2 Additi}v.' Silk)(Hl-r1=) 41"145"P" 3-302.14 Protection fromLinapprv'.ed Addiit',es' ' j IS i I I Poisonous or Toxic Substances '- 11Is` ;/ i lot i HF,z Maintained at or abo}e i 101.11 Identiryint,infn!mannn - Orr: R .?ina! i I vitt t' ' l I i_bU 5t.Held at„r abol'e 13v`1' � I ' ------ '0 Time as a Public Health Control i i02 11 tCcanm"n?:,:n:'-- R'n;k.,:;_('lrn',nnr.!•` ! t---- i -� fi:n,•a< .; - FxlLs.itlt i'omrol _.__.�.—" -- -_....__.. .t I ",).7.lit }r. �:•:r:'C};,c•itti.ailtl:! '.'-702 1I I 1j Ppb iCUott - P, 5<llce'w i 1:••., i .—....--.___. 7_2t11,17 Cotltlmlm'.VS Prc.int,,v."n•' I REQUIREMENTS FOR HIGHLY SUSCEPTIBi.E - --- — ------ POPULATIO14S(HSP i " '044 h.tmt:::_a_,. i'mrri:'_"-Ctrtds^ -f .—�—.--- ---_ qty^vii!kt?,t `1)ip4;znncrd Pr. pat}:acct)exec and ! � C41i!ui al,t,•t }}a I7 .k'.,,U_!:l_<ii:;r:;.t' � t ; l_�..._. _-_- R cot`e,.shit l+mmnc lobe s r_`l)a.ia !3r;s:;Pir'ena.t`sucta' 7 's()5i _ J lmid:m•P I;+v!i\av i-uiaieallw ! . Azilwd t't..1;' d ti+xh•ca iS,ul 5'at:ort'.' — — 5<.I 1`r{_: i l :�h'd::,i i,ixt; 1 !s itic! 17. �qi\c:. ` _t•:Y i_ I ".!C"!ar! '.-,h\,Ia'•, I=..: ! '8t'i,.i d;dt .. ___ ___. i 6a :'/TEMPERA'WilE f:GNTRGLS ur: '?x: ' ,.. i=!;,:•,`, • .. 'nt<"!':,,ii¢' r. otm Ct 3iUY5 lc, , r, 5: ; , :> .mit .:.'.U:. ,it:.+_•c,4: • ,. . .}• . `.t n. ''A'�:d (:... tie,,-. ,!..!;- .. .. ., al 1 :;r i'lit,-:UL;',.; 1:;i. �„. ,: . ... .,. ir'�. P,. i',.i:agi.•�. �.p'!;L; \^�¢"„ Int:. . , e. ... t� " .. .:/. .� aY , . . "3`;l i(i•; %,t;:urate i,:!..i�.,,{! p,„,:,n,.•i l;rt., ter,^r ' is acd:ie:�,l t>,,t r rs yet •Lootlna of ariFs `+i'i , ttAa CHI=> aon, r f,' - - - - { . . ',v onto .. Ilour>:r',I Fr,n.. ,'? a 3 >- _ ,�!.' - .. __ - "� ._ __ •�` - , } Oil:. — ` 5U1.,.;,S;t Pi1F, '.Leri: F' 1mf-: :.t r CITY OF SALEM t BOARD OF HEALTH / ! Establishment Name: R-44" r lf_o Date: 111r, 11"" Page: 4, of c- Item Code C-Critical Rem DESCRIPTION OF VIOLATION/ PL'AN OF CORRECTION Date.. .' No. Reference R—Red Item `. Verified t . y^ PLEASE PRINT CLEARLY rOA..-1.1, J 4n-)AA / �� 5`IhnrAlnlAQIUq n11- 1A -r7v �/Qcc�.t i �_�fiS t rn/ sin-Q A./h )A / lle(c 4A�1Q�JI r�I S�n1P Ii PA PQK11Ir 4-n 4i. ,✓1 �['n�IY�-�.� YO �✓1 i� un n f F�i�a3 � 1 .: -� l I� ✓ N � Mr,,� �,� A,- SII-,4JcJv,, oci- (o ot, I cdw-v-; ,Uro, tp q�✓ %k f o,,4", ,d � G.�� ( !! ✓ I,J4(l ,UA AIrc� �ln(� 11,Ir � c�, �c, rl% NnoaL7 �9r-, n, .� I I I _ -I } Discussion With Person in Charge: Corrective Action Required: I ❑ No s I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to )� Exclusion violations before the next ins P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understandt noncompliance may result in daily fines of tw y-fiv doll rs ors spension/ evo ation of ❑ Embargo ❑ Emergency Closure your food permit. /y/ ❑ voluntary Disposal ❑ Other: • u t 3-501 14(C) ' PI-F!,Ree ived at Temperatures - Violations Related to Foodborne illness interventions and Risk According to Lau Cooled to Factors(lteMs 1.22) (Cont) I 41'Fl45`F Within A How's. PROTECTION FROM CHEMICALS 3-501 15 Cinlin0,Methcd furPHFs j 14 j Food or Color Additives I j 19 I PHF Hot and Gold Holding 3.5(p.ln[It) Cold PHFs Maintained at or below 3-20212 Additnctil 590 044 11'!lS f 3-302.14 Protection from Unapproved Addiuvet` i I i-59LIhi:`) Hot PHh> Maintained at or above 15 I Poisonous or Toxic Substances ( { IOL11 i IdcnUfyui,Z` lnftumation -onginal d(l`t x ! 1J':1,iPt U ko.iai,Held a(of .ibovc 140"1 71iI2.11 C,ynmau\;mi; - K'orkinc(',+m.um,ra." �! ! ,0 1 Time as a Public Health Control — -- --.. f ..-. 1: j t Itm a>a Public:Hr,ilih C ontrol- 7-7o 1.i i 3rpn,auon- Slut al r" t<, --- _..__------- * ItenLie000 -frcs::na•.uv! t ,r' "--�� ,-_7t)`tt+H) _ �1`rr ar:e',euutr,,ownr 7-'I)2.i2 j t'uudni•ai>„f Ute" i 203 11tori Cuntutnet: –Prohth'!1on,! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i POPULATIONS(HSP) _ '-204.1 I S:mitizrlti,C'rnrna - Cl,cmic:ds- — — — -�r 1� t. ,•a { _',i i -i9`}t - l;;l{,.,icw t/ed Pre-pati abed Juicea wid j % 204 Id ' D„n�i2 Arrotn.CrIwiU , j Rr;:ra^.e< iutti}�';,trntne I�il.cls' {15 it i ln,id.nt.8 l:xx+C'c rntnct. Luhn u,fs'__.._._ Sdt Iift I L,:,•1Pstemized_Ee,- i'5c Pt.rit.,?eS�Ct ItoI!,, ? 1101.1 Iti+} it,,t,�nt P-tmai1} Animal FtvtJ and I_. �._---_-.-.__.. 12 r,: ti,.,d 1n1,•itb \cA Scfv:i`.. ! 1 7-206.12 1 12,xlr I't lia:t\1911Orn` ,----_ __.;_._.__.__ _ J ! % 'oti 13 1r.,Ct.at¢P,,uilc.'r<. 1're:t -------(-:_Ltac b,x+„ i`arC.tEr ti„ Re_scrt t�1 i `.li RtitOn n,” :;ONSUMFit ADVISORY 22 3 (,1,' l' i [ ,;,uowf 1m•t.t tv O,.tr,1 i-tr i',vR'U.mp i to of TiMEtTEMPERATURE CONTROLS ' 1� i t aam:i I ,•,xt 17S:F .Ira R:,•; 1.t:,k't::,:,� .1 s}: i s Prnpar Ccnsklrg Temperatures for j I I I � �,�, �tSl,r• 1 .1117 fiatl,• .. t5' t' `' -`' - ---- f ..thn�••n_' ___, •t_: ' C.- i.e. .' , ,,, ..,..v.:: :it tti. .i.tokJ,t Sit?fl unto:u:atr ^•ca'i,_ 1 ,51-1 _ 1 ,.:'t S)t•T' i i:,n};;anat:.1 }:r.h. ti1.::r.,:; C:•,-t:. - • SPECIfiLREOUIRFM NTS �Fu,t °q)d H - f Ro" ,_i'i I' tu:r . . - kd+:it 1,•itu..t} kith ! ;_ - --t .. .� (t1) ';5,''v;t a t•. `l:'15(a 'L'i i}:.•Fr—. , I i,...'1... f .`,aihrt, `.LtiJ[ f.ti.' t'aa,y--ttt:,-,, --� r:',:,: l:' 'i ' t'Cn:C. nh {fi:,..• •.,t;h' i . kit . V:;41;: , i ...r_ , yC, ( Fi✓nG.he^to, Ho bt- .. 1 .`f`; e - .. • I_h ,t' _ . . 1:u N', tR,Jt .� ('Z,}M,t l `i • i0` �' 1'. ':c, . _ __. I12e1U5 7{. y ), . ,t .1,.t.1 I'll; \41.1".ak- Iii"! Vr,,t.t glam6 it nc. ,. ,t:f v ..::f . . ,rrs'r:,:,.rt•;; <bxt ., .1.uP; :n,.,[;:, nn ,'?': . r.,nF. , .,rr:: "it Jrt,11., 1'•11'.1 d;r . ,d^I t.'•. ki"I C omwlrialh 1'ut, :,.;d ''k i• ; .at - ._ , rs,:;it t9t t., •, la,ui:?,d% :,.;i .',• ('i:.'� 1 _a0? i1(I•� Rc'nruoitr7 La:,rra Po:rn t e•: . 11-1-t ,( r Item Goal f{eraP-ac'bces l FC 5411,t_ID_G__ Ii.,at!" 2 CC; ` — i--- „-d t-a:{i_P;o_tx,'!:nr '- ------- -;--Ft - s- l z4 t-N ! (;, { Proper Coaling of PHFs - -- - -- -- - -- -- ------+-- - '- -_-- 1� Within Ct ) 4 I,r*u„.r:d 1-nu't 2!i ,pmnnt an„lltwis,!s n r t1joF: - IT-,,i r2 yd,t!Bt nt,�,.:,,,�,�.d';Jt^'3 _ , F_{' 0K), .o ;i'F:Ii"F 141t!•tn-' tb",,, ! d8 •:}n�.la 'nay:- tvi,:'r:=,,,'s -FCL— _. .ti•A - ^o , _ .U1.IFtu (",t,link,PNF:.9'1::< Flo,n a:ni-teut t :.-'-•___ -_:_-t-''''id.n�=tl _r•:r*•t9r'. --__-h• I tcmt':I alum '.11er:,i:r;m,;,.-1:`tda<•I. - j -W-ithitt111,xitr•` - - - - • n,;n,:_,_ .•;:Po•{ dt'},-:,.u9.1 ,. Jiinit, ,I:..:PJ�t *;,7 • "olid ...,,�,.,�•_a �. ..r.os;„•...•.flw-' G':b-="k'-+..r.A .t a..�t�F. r+ #� . .x f, d '!�".3 't"»iL*f�',�,« i�„r. �a 1.( L }..�... Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT �TeL (978) 741-1800 Fax(978) 745-0343 Name Z T pe of Ooeration(s), Type of Inspection k(_6 (5�k^vc G P /° 19. Food Service ❑ Routine Address � / i ^p � ❑ Retail [,Re-inspection S n N Level ❑ Residential Kitchen Previous/Inspection Telephone (�ZP.� -��- ��r� ❑ Mobile Date: IUg11p Owner 7Zd/ HACCP YIN ❑ Temporary ❑ Pre-operation _f 4C J p/� ,) 44 &-cr/a I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC), i imedv ❑ Bed&Breakfast ❑❑ HGeneral ACCP Complaint Inspector (,)5C'Otj ( �� pot+ J 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 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 P 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)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: t 559JIn;xctFomK l<tloc �� `�/ J✓�� Inspector's Signature: I />' P/ Print: PIC's Signature: ' / /r ,p�� Print: _t-vnf (n C1 R C�n I Page!of? Pages ,,6Ct0 - 7 Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination I t 596.003(A) Assignment of Responsibility" I 3-302.1 I(Au]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I ( Cooked and RTE Foods* 2-103.11 I Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH ) Other' 2 590.003(C) Responsibility of the person in charge to ! Contamination from the Environment require repotting by food employees and ( 3-302.11(A) Food Protection" f applicants* 13-302.15 Washing Fruits 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 I Utensils* Charge* I Contamination from the Consumer 590.003(6) Reporting by Person in Charge' I 13-306.14(A)(B) I Returned Food and Reservtce of Food* 13 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590,003(E) Removal of Exclusions and Restrictions I I Food J 3-701.11 Discarding of Reconditioning unsafe I FOOD FROM APPROVED SOURCE I Food* J 4 I Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law* I 4-501.1 I 1 Manudl Warewashing-Hut Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 14-501.1 t2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* ( Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized'" ( 4-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * _ 4-601.1 1(A) Equipment Food Contact Surfaces and ( 5-101.1I Drinking Water from an Approved System° � J 590.006(A) Bottled Drinking Water* I Utensils Clean* 1590.006(B) Water Meets Standards in 310 CMR 22.0* I ( 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I ( 4-702 1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* I 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Regulatory Authority I 2-301.11 Clean Condition-Hands and Anus* 3-202.18 I Shellstock Identification Present" ( 2-301.12 Cleanine Procedure* 590.004(C) Wild Mushrooms* I 2-301.14 When to Wash` 3-201.17 Came Animals* ( I it Good Hygienic Practices 5 Receiving/Condition I 2401.11 Eating,Drinking or Using Tobacco* f 3-202.11 I PHFs Received at Proper Temperatures* I 12401.12 I Discharges From the Eyes,Nose and 3-202.15 I Package Integrity* Mouth* 3-101.11 ( Food Safe and Unadulterated'* ( 3-301.12 I Preventing Contamination When Tasting* 6 I Togs/Records:Shellstock I ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from I3-203.12 Shellstock Identification Maintained* Employees* Tags(Records: Fish Products 113 I Handwash Facilities 3402.11 Parasite Destruction* ( Conveniently located and Accessible 3-402.12 I Records,Creation and Retention* 15-203.11 Numbers and Capacities" 590.00401 I Labeling of Ingredients' I 15-204.11 Location and Placement* f 7 Conformance with Approved Procedures 5-205.t I Accessibility Operation and Maintenance I /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* I Devices 3-502.12 I Reduced oxygen packaging,criteria* I 6-301.1 t I Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 6-301,12 Hand Drying Provision •Denotes critical item in the fedetal 1999 Fwd Code or 105 CibIR 590,000. e ' i ' CITY OF SALEM �,i BOARD OF HEALTH Establishment Name: A-,�!'/l v r ra.z'rn o Date: 1121 Page: of Item Code C-Critical Item ° DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date." No. Reference R—Red Item : .Verified _ 1 PLEASE PRINT CLEARLY p� / y� i i 1 Discussion With Person in Charge: Corrective Action Required: ❑ No )U Yes I have read this report, have had the opportunity to ask questions and agree to correct all IpiVoluntary Compliance ❑ Employee Restriction/ "1 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 tw my-Wveollars or suspentsion/revocation of ❑ Embargo ❑ Emergency.Closure your food permit. AZY ��((( 0 Voluntary Disposal 2 Other: .. r ?-SUIJd((;) PHFS Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accxvding to Lau Cooled to Factors(Reins 1.22) (Cont.) 41-F145`F Within 4 Hours. PROTECTION FROM CHEMICALS 13-501.15 Cooling Methods for PHFs 19 I PHF Hot and 6old Holding 14I _ _ Food Color Additives ?-21)2.12 Addttiec,'r 50!.16(10 Cold PHFs Mainumed at or balow I iv590004(F, l Additives' I I - 41`/4I'll" 3-302.14 Protechnn from lhtapnru\ed ` � i-Sf)LIb(A) Ih,t PHFa M1faintained at or above 7 i i Poisonous or Toxic Substances 7 101.11 I Identifying g 1nfolmalion - Orla•inal I 140 1- ° Ri,islaHeld at,v-tbove130°F, -- l onlalrlcpS, 7 1111. 11 ! Commnn Nara,- W orkine i'uaran;,r.,• ! ! 20 Time as a Public Health Conti of ` —__--___ - ';_.{)I 1 fitnc as a Pub1i,: Nc:dth Control`_ -2tSL1 iSrpz,.tcton- Stu,akc1 __.: -�---'- -, ?-202.I i i Pe,trcr.on-- pwsc rice<wd h.C' `op n0.1i H1 - 1'_riar.;e i;e utn'tfxnt 7:102.12 Condition:of i tsc` 7 '03 11 T,;`k Conuunzn -Pmhih{:sot, ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i L201.1 I Sanit,::cl,.C'neria-(`hC,.licnlc- — —� POPULATIONS(HSP) t'lwnj! ab nit XN'a,hmr h,16,z (-utrua" 21 ! c 801 11,,11 Unpa:ieur{Jrd F'r;:-pseCs:,cd ltiicec and RC\'efaaea a ith A'ar:nag I�i6oI:.: i .',04.14 1)r;mg m Atteut,.Crria" '• ;-Slit l i!At t..:o: Pa`tru,i;:.d} ae:•' ! "i ?05.1} _ Ll�icfama! f.+xl t'uniact ia,ht,ta�!a_.—� 1,::u „r Patletll>C,at{sd Animal Food and i �_-�__— i I Ii iRa tic•h7 �ltl,llll� �V 19 ;)^!'ot:.i. 17-20'6.',2 t R,Kien: B,:;f Ste(inrt>. I I-_---__ _ _- _— liCI tL:aT •'CLt 1'.w4' l3iC.i�: ti'ai Ri- ,:2i\e:! ! • r� ,rn I Fr.eR!n�1'o;ulrr., Pca! ('nniicl,u:,1 ! .___-__._._._._- __. _ �,fiqpz,xlqo, CONSUMER A.AL4SORY _ v;•, I : a»,u�ia.r kt,nor, tr Conse i'osir.; ; nt, on ofti TlBtiEflEh3PERATURECONTROLS 22 3 t low irt, R,i . linacr v> ec7, , i�, -� -- - -- i Proper Cooking Temperatures for i F'_HF_s - .i (IN I:U is{,:; I i:_�- 15j'r !i t Sith:ry:a.. Katt St,..• f: i fl?itt' SPECIAL RECtU1F1"tMEN's5 _ � : ;OLi•t!-rtt::>, i )'.:4acr°):�C'. R :�i - 't_P'{' i' 4')t 1 (AII'., � i{., :ie` sal:`t,P>,,' � ,'i„ •+va.?-i!)? :.. <i. {'i SPa Eti'ti Yi',slip.. .;}i :G icr pc,ra,:ani 4-it PHI i`.tnt8^,ey. t{.,q NTT i:,'bt,,t! rl&l the i J• !t., �. j{ITT:, I^` ._i tT. `., • ': . . t 'C,:'t(r , , ,-i,:i L.:�' t :`..i ti: LI•...i. :,i;"::; I:.,t�:•:'a', � ""fl .',L,:,,. .. .. 3... -.,.,. . :t.S. ., 1 R. i lin?for Pini r�3ft:„y v:,^„✓2 i IvK i Rc!.r�i EL '�0 6,00D p?f�;..:;. ,�'PA V 1,1(J,,. 1)t ikl` i6i'9 :n ' .. tlteme2 -301 fa11,1'uo a\c- I >- f- nbtr S:tndm;; C.n, rt. ... ,y, s. r.n.il Ilo. 'l. :a, ,..:-1. a,••n: :an• : +r,: _ I:we' L;..dLrr:.e. � h:�s, ,,r: r•at??,.�nl „a:'r,:', tax;.::v .' ,;Y-t clt:'i,. _;3.1}'C} � i:mlmer:I":Ii, P.,.,,,...'. !?'[(- 1"-a1 .a .,r,•;;r,:F,; )„ . a ,. :h" 40"d t .t. ,,,. ' 1:C(;'.;Itt ,.,t.f•i I I{L) � }tCpull Ina, lP,^ro'ne of!i..r. ! ltem'r I V_-Goad RetaJ Practices _ � FC 590,000t - -'-------- -- - -- - -- ' 23 Ria to em•._t ar,d P9r:;:+r;nr.'f rC l iS,i_� . 24 ._irv,d:tod'rxxi Pt;ltCGO.. FC: t 18 Proper Cooling of PHFs -_ _- _, - 501 H(A) Cbtdfne C fi,,Iktd PHF: Frons I'W'l lit 1 26 e,u:p--- -- Ana - --- - - --.— I C _n it0`: _. 2r -..._.tr a'.ei Plc.^u,��q_U'a 4Vt:rta- _ cC -5 . C1013 -a r _ - ___. ._. -_- -.-_ .__... _ __ _--. ry f' ,bunco 2 Hourr:ni3l From 'it '1 I ?_' -11--;a'Fa-"ih; ' G{' -3.- _ _i _ n,.1;'F-k45 F\b ithin= tit au: ' f 5-n . :�ys rai' r i=xr- v� r-Ld!5 FC - - wit 5111 b1iHl C'o,•iin_PRF •vlitdc Fn'm Ambient `-� r -'.- --'-f`:E 1'cml'r rains)msrd'u:i,t,{:--iii[r.15 h . Within d lluur.. 1'y:i.,b..•,.n:ral;�^ID r,p,•i.df., ,.tri:: vc`o. i,:,t ¢,t:,S:,!ad: Commonwealth of Massachusetts e City of Salem ' Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0056 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT FROZEN DESSERTS BHP-2010-0057 Jan 4,2010 Dec 31,2010 $280.00 Total Fees: $560.00 PERMIT EXPIRES December 31,2010 I nn�li Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 . CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIIvMERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUM(,U7,SALEM.CONI DAVID GREENBAUNf, ACTING HEALTH AGENT 2010 APPLICATION)) J)FOR tP�ERMIIT'TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1�7Y0'1�lP--IZS �PO � P.� TEL ADDRESS OF ESTABLISHMENT 44 64/.I/Ile FAX# MAILING ADDRESS(if different) rC del O 6 4 o!- q-V q EMAIL-Business': bo A)2 Website: IUdn/e— OWNER'S NAME "Q)l "� // C6RCf Cj TEL# q'9:!&- 2141-2N3 ADDRESS 140 /HnP' to,; LVAIA) 0 W7, STREET11 CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) D if Ur7 U . CERTIFICATE#(S) 8 S ODOz!��-Cy (Required in an establishment where potentially hazard /us food is pre ared) EMERGENCY RESPONSE PERSON J (io c�4►u�/ ��$I 0� 3000 HOME TEL# DD�2Sgy z �1 . .�'. n —. FHp ` reT' I4pAXS�OF'OPER4TION;�1$ Mopday;s�.;�C? ;T>vesday;�; � SINetl'riesday;;�„'�sT�iUrsday ,�R,Ing; Fiiday; 9JMVSaturtlay7V, ¢WoS'ynday§= I HOURS OF OPERATION �!y b A �. j Please write in time of day. (For example1lam-11 pm) 'T/ �,�w•1 k(�M I �( yPwt I �P� �/ � P�4 1� " ✓ P� TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------- - - ... ------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140-- (Outdoor $140 _(Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats 420 --------------------Y-------ES---------------------------------------------------------------- --...-----------------------$--100......BEDlBREAKFAST/ NO CHILDCARESERVICES/NURSING HOME.---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVEYE NO 25 TOBACCO VENDOR S 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 require der the law. Signature / Date (7/0 Vo (. Social Security or Federal Identification Number Revised424/0 FOODAP20 .adm Check#&Date THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF ' >rJFu Massachusetts Department of Public Heap I Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name �j,f D Date/ Type of ODeration(s) Type of Insoection YP� f"�cXGP c F, (',C I Food Service E] Routine Address r lI t �'MD Risk bbb ' ❑ Retail �e-inspection /�_ I Y11 Level E] Residential Kitchen Previoug Inspection Telephone i � -S E] Mobile Daterj ,� Owner r /�y HACCP Y/N E] Temporary E] Pre-operatTo(i V, 1, UVrC, Ll I ❑ Caterer ❑Suspect Illness Person in ChargAPIC) i, Time ❑ Bed &Breakfast ❑ General Complaint ❑ HACCP Inspector /�I `>� / Out: / Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco 1 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. V1 o k�Ai�5' Cvyrc •1 FOOD PROTECTION MANAGEMENT ❑12. Prevention of Contamination from Hands/,Lr_yX ❑ 1. PIC Assigned/Knowledgeable I Duties EMPLOYEE HEALTH E]13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑14. Approved Food or ColorAdditives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑15. Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans Ell 8. Cooling PROTECTION FROM CONTAMINATION ❑19. Hot and Cold Holding ' ❑ 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items 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 (Red Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report,when signed below C x 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (FC a)(5so.0o5) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature ) Print, PIC's Signature: [ / Print: , 'i71k Page�of 2 Pages .,. FORM 734A AM SULKINCO )CHAR STOwN.MSA / -� .s e Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-eontaminadon I I 1590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal 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 I 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 13-302.15 Washing Fruits and Vegetables* 590.003(F) Responsibility Of A Food Emplyee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 13-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) I Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 14 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501 111 Manual Warewashmg-Hot Water Sanitization Temperatures* 13-201.12 Food in a Hermetically Sealed Container* 3-201.13 Fluid Milk and Milk Products* 14-501 112 Mechanical Temperature-Hot Water 3-202.13 Shell Eggs* I Sanitrzation Temperatures 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* concentration and hardness* 13-202.16 ice Made From Potable Drinking Water* I 14-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 1590.006(A) Bottled Drinking Water* I 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* I Shellfish and Fish from an Approved Source I 14-702.11 Frequency of Sanitation of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* I 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I I Chemical* Sources* 10 Proper,Adequate Handwashing Game and Mid Mushrooms Approved by 2-301 11 Clean Condition-Hands and Arms* I Regu/atoryAuthority 13-202.18 I Shellstock Identification Present* 12-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* I 3-201.17 I Game Animals* 111 Good Hygienic Practices 15 1 I Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202 11 I PHFs Received at Proper Temperatures* I 2-401.12 Discharges from the Eyes,Nose and Mouth* 3-202.15 Package Integrity* * 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated 6 I Tags/Records:Shellstock I 112 Prevention of Contamination from Hands I 1 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from Employees* 3-203.12 Shellstock Identification Maintained* 113 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 13-402.12 Records, Creation and Retention* 15-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintamance 7 I HACCP PlansConformance I with Approved Procedures I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 16-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen packaging,cntena* I I6-301.12 Hand Dryin¢Provision I 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. $ CITY OF SALEM BOARD OF HEALTH Establishment Name:�}YX 4,lr G<&(C/o- Date: _s!a (�c1 Page: 114- Of r� 't Item Code C—Critical Item v DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date S No. Reference R—Red Item - - - - - Verified i I PLEASE PRINT CLEARLY' 1 t � I � ? I 1 � Id t I i i � 1 1 j 1 r 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 / Exclusion j violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I und-er_s_ta�nd that noncompliance may result in daily fines,o>�ty-five doll51rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure } your food permit. ,rr D� /�/ i f� ❑ Voluntary Disposal ❑ Other: j Vff f { � t , Violations Related!to Foodborne Illness interventions and Risk j Awkm ding to L:w 1-Itoled to Factors(ffeuts 1-22) (Cont.) 11 4 Htqw,, CtitIfln,�M,,fbodt f�)t MfFs PROTECTION FROM CHEMICALS 19 PHF'Hcn and Cold Hauling 14 Food or Color Additives ('<)I,[I"!W, Mmovi�;Iwd t'loq "tow ?0212 i+K;00 T 3-302J4 ProteLtion Addiftxs' Poisonous or Toxic Substances 3-5M intAi Hot MannAntid nine above 101 11 khmtirying 1.'(A) Rki,it',t,Held.0 or al:tuvc. I 10T, ?line as a Public Heath Control 7 102 11 ccartion"Namr,- Working Confaiiw' 26 1 It 'imf'�1"a Put;1iL, S'�P;iia6ua--swrtlgc� Vat iaT(•c Requit-Qwen; 7-20-),It Rce'victioll- Pfc&cn,:e and U"('" 7-202.12 Condition"of Us"'* REGUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-','.t),l t I Toxii,CLM111111W, 0!701ilbi!Wnr POPULATIONS(HSP) 204.11 Sartilimi, Cmerni -cbenlicl.' t I I r1 -0!A I I A) fi,�.,pao-agcd hmes wid "1-21,14.12 cbemic.iL'f"r wa'hing PrIiiince,C'I itenix" 204 1.4 Dryuig AgeuLs,Crinci ia' 'Vilki %Vwnifip 7- — ----I o(A) it cot Pa�t�,niz Cd T20,I I Incidental I,oj Ct,nj3m [Atli,tmm ' -W 1.i it,{); 7-206.11 po'irwed USv Pe'ticniet,ciiteri'l* kii'-`SI "'PT0,11, "(,l �irfvcd. - 7-206.12 R(Nlefil f1jit Sr.tumit" 8W.) No R, '7206 13 CONSUMER ADVISORY TIMErrEMPEAATURE CONTROLS 12 'i 6W I I t".nswnei At!,n,<ev Tni,nei!f,,r Cuwumptim of 16 Proper Cooking Temper atwes for !jq!��A 1,At I,Thdta't: kiln. ctidclf'�'L.d in 0'!!wrV'isc In 11imma,'& i4{)l I!Atl)')� PHFs Fgg, i,55 F 15<ec -e njbW10ne fo! Raw Shell Eggs-homethatt:Set vicc I is°Fl 5'ec- 'A 0 1.11(A)(1) Comminuted Fish, Mealy&Gnilw Animals, 15:,'F 40 1.11(B)(I)i Poll,;,nil Roast - 1-,01min' ` 121 SPECIAL REQUIREMENTS -40 1.i I(t1i)( Ratite: fui3O--,d 155-� 1` Violau:xl,tni SQ,:nioi! 500,0001 A D In ryi,bli,, t�xxi,tenp,imy and 3 40 1.11 WO t Poulin,Wild Gariii:, Slutfc(l PHFs, bt shiffino Cont-.dilirw F,ah, Meat, ticbi;W walci the ions Poultry fir,kalller I .lwve it rc4n'�d to fty'AN)rnt, ;111'm unlict slcn4s qluerwllli011s and ris% taciom Officr 4C)0jlt)o Viol refadrlO lit^itkyd I i:10 R;m,Animal Fowl,Cwkcd m a !rM"tices '114"Ji lx)d&'ilcd ulldcr 1129 - ficiowive 165'F 401,11(At(Dib) Ali Otheit PI ll--ti -- 14517 15 Reheating tar hot Holding VIOLATIONS RELATEV TO GOOD RETAIL PRACTICES Pill-, 165'T JJ sec. I I tlieurs 2,1-30) 1 1.403.11(H) Mienmaw- 165' Fi'Miqw,Standin', C'iii�a;'tn'l tn.ir',1;fsru; wl.*h.-L-iw: t';Me Time I ftwditinme ilhws"' nn't.,WI-Iny wO';,4"'wfors loft'dal-ove Z,m be 3-403.11 tC) (Imunimally Ptmo:;.red RTF Ftx,,J fmold ni nlwft/lbi'w'rvt';Wrt.fil ih, F,>,jd Ct-dca,,d 110('41 ' 1461F' -1Q0,Out) Rernanon"I.nslwej Portivits of Beet t Ilam Garod Rs#a+iPretices iviana�1gl,!,11 I Fr 2 003 lk�0,10 _aqi;L�r -' _____ _1 ..---- IN Proper Cooling at PHFs FN i F��Janci Feu;Piov,.!i0*r1 i'C 'i 061 25' -qu�pn i;Inj t�' f 4 00� =-50114\) Cwhn,Ctxxk��(' I`HFg Imat 26 'Natil:,Pti.rpretcand'q'Ja atc, FC 5 70'F Witlim 21 1 iows tind Front 7r)11' 'A !0 4 I'F!45 F Withm I How:, -7 008 3,501,14n1i) Cokllim,,IIHF< Made Fioni,*Aolbioa 29 R�nv"- 009 22= TernWattire InLrcdieitts to 4)"Fi-15 I, "rho %Vuhi a 4 rkxirs'� 4 li.f"Ael.nuull Innn m th, 1,11t)"):",,1(",:1,"r 1115('%41<5ni)titi(I 11 +.,I+a 4: . �. ,;,�5� .S". us.�".t �S):�..'.. .ri'i :a` � •`•iry':P1..r".�'li. '4:i++tt`.x1 aww..wnM'W A`wr...r T.•Y . + Salem Board ofS Health Massachusetts Department of Public Health Division of Food and Drugs Salem,Washington Street,4'"Floor 9 Salem, MA 01970-3523 I , FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name I j N r 7r5 /J' I TYpe of O Service an(s), TYpe ut Inspection 7) _ i+- C�I-_Food Service p'Routine Address �- �I I ' Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone Cr-w- r El Mobile Date: -( "' El,,4 ElPre-operation/u Owner ;Z� ? r c ,4 HACCP Y/N I El Caterer El Suspect Illness Person in Charge(PTC) n C, Time ❑ Bed&Breakfast 0 General Complaint HACCP t In: ),J Permit No. C]Other Inspector � ' 0OV\ b�.,4)) I Ou i1� 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 ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE„ "" , -' - •';,,� ` ..x.. � -, TIMER'EMPERATUREOONTROLS(Potentially Hazardous Foods El 4. Food and Water from Approved Source (, y ) ❑ 5. Receiving/Condition ❑ 16.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. Separation/Segregation/Protection - ❑20.Time As a Public Health Control N4 Food Contact Surfaces Cleaning and Sanitizing •REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(MSP)', ` ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. 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 ins ection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C ' N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you C;27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing X28. 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: ,IJre, o3j; Inspector's Signature') J( Print:-- toDh / PIC's Signature: ' � � Print: p I I o �'.{� ho L� (`( I Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination , j 1 590.003(A) Assignment of Responsibility* j 3-302.1 I(A)(J) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* j Cooked and RTE Foods* j 2-103.11 Person in charge-duties j Contamination from Raw ingredients 3-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge toContamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection' applicants* 3-302 15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-104.11 I Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* j Contamination from the Consumer 590.003(G) Reporting by Person in Charee* 3-306.14(A)(B) Returned Font and Reservice of Food'' j 3 590.003(D) Exclusions and Restrictions* I I Disposition ofAdulterated orContaminated 590.003(F) j Removal of Exclusions and Restrictions j Food lUl.l1 Discarding or Reconditioning L,•male FOOD FROM APPROVED SOURCE Food* J 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A B) Compliance with Food law* 4-501111 Manual Warewashine-HotWater 3-201.12 Food in a Hermetically Sealed Container* ( Sanitization Temperatures* J 3-201.13 Fluid Milk and Milk Products* ! 4-501.112 Mechanical Warew•ashing-Hot Water 3-202.13 Shell E'-s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114I Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water concentration and built 5-101.11 Drinking Water from an Approved System` j 14-601.1 t(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* j 9-6021 i Cleaning Clem* J 590.006(6) Water Meets Standards in 310 CMR 22.0* j . eaning Frequency of Equipment Food- Contact Surfaces and Utensils Shefliish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan 1 I Food Contact Surfaces of Equipmen Shellfish* t* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed j Chemical* Sources* At Mushrooms Approved by ( 310 Proper,Adequate Handwashing Game and u 12. 01.11 Clean Condition-Hands and Arms` __� Regulatory Authority _ .3-202.18 I Shellstock Identification Present* 2-301.12 Cleaning Procedure* _ ' 590.004(C) j Wild Mushrooms' 2-301.14 When to Wash* 3-201.17 Game Animals* j if Good Hygienic Practices g Receiving/Condition j 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 j PHFs Received at Proper Temperatures' 2-401,12� I Discharges From the Eyes. Nose and 3--202 L5 j Package Integrity- j Mouth* 3-101.11 Food Safe and Unadulterated* j 3-30 L 12 Preventing Contamination Wien Tasting* j 6 Tags/Records:Shellstock j 12 Prevention of Contamination from Hands 3-202.18 j Shellstock Identification* ( 590.004(E) Preventing Contamination from 3-203.12 j Shellstock Identification Maintained* Employees* I3 Tags/Records:Fish Products j Handwash Facilities n Conveniently Located and Accessible 3-402.11 Parasite Destruction'^ 3-402.12 Records,Creation and Retention* j 5-203.11 Numbers and Capacities" 590.004(1) i Labeling of Ingredients` j 5-204.11 Location and Placernent* f 7 Conformance with Approved Procedures 5-205.11 Accessibilitv.Operation and Maintenance /HACCP Plans I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* j 6-301.11 Handwashing Clemiser, Availability _ 8-103.12 Conformance with Approved Procedures* ( 6-301.12 Hand llrying Provision 'Denotes critical nem in the federal 1999 Pool Cade of I o5 Cv1R 590000. i i CITY OF SALEM l BOARD OF HEALTH I Establishment Name: Dater �+� Gr Page: of 5 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION' Date No. Reference R=Red Item I'Verified ' / ( PLEASE PRINT CLEARLY A )nn� i7 ' I�-� a �,�- .c�11'Q � n, tlnr l� T)/('i1 SJ)✓L' V1...I C(/IJn,�I ��n., 11� !y-,r7' �:: .�/ :/ WP 0L l I �-��, �, �(. U ✓ I/.-Y�f- G��;�;L.I-„ �'e-t�) sv�-.'iw, ch..�- �.� /-.•:...�-. /nr,r �A -�n Gln . �- -+�-�rA 1 �>11-. ./ r T • Intt-rr ,/�F 1'x1u_ S�,C �lrl �i✓�oit,� I SYI/-h)i j 1 �17/ro�P f -i LA Al00r_lA / 1 I F,IVlralx� Ven /,J I�n+�i .f + �on_vi.o �, , �r� Y1Joor✓ S�N , - I G 1i1 ��) iii Y L� > . �� D �ivinUCirXilrr_ lAu/1 f/Yx.�r� r✓,TN / 1�Pinn ir �� K , I ( n li E �� h�� 1,nA./G.r r _K�J�",P I�.<<_ < ��_nn� �-(<, C"oD 1'6-1'6-o I _ ��,.i ri o"Rs ra fE4 v"red A, ,1.,.__.J, �.r c 1r/)Jr71c0 - II I s .�_ SA.1A.dl � � r-��-Inn le ,-( k-1'/I U � C4� r L,' IrJ -. /L )</4(It /,1.�()0� ��>g•� , _ Discussion ith 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 scribed, and to Exclusion � Re-inspection Scheduled ❑ Emergency Suspension cDmply with all mandates of the Mass/Federal Food Code.. I u•derstand that noncompliance may result in daily fines 6f t enty-five/ olld or suspension/revocation of 13Embargo ❑ Emergency Closure your•lood permit. t��,) !!! t� ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne fitness Interventions and Risk 10 (-titled to Factors(he?"$I-v) {Cor t.) WIhin,l Rlors, Collin,Wlho&�.)r VHFs PROTECTION FROM CHEMICALS i 19 i PNF Hot and Cold Holding 14 Food or Color Addinves: cold 1`11F.Mallawtiod al or beAw 1-202,12 3-3(12,14 Privainm from I inalifirzye.d Additives" IF Poisonoi,a or Toxic Substances 3 of I -to €iPHI-, \tuv dred.,l orabow i46'F 101,11 J&,nufying IntoT inatiorkOm,i-- nal I I fi,Id at or,aIovc I:i(roF. Comainefs' 20 Time as a Public Health Control 7-102,11 CoalplonNanle,7-201-11 S<paz awn—swrug3-5o i.i as a plimic I ioaJth("gilrol &' Vai:snor ftequlreIllclll 7-2;):z 11 ruld U,e" 7.202.12 Conditions of"';s-�, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ft POPULATIONS(HS l-2013) 11 Toxic Con(aimp,—profilb):Iolis;� i-201.11 sallitizei;'Crile.-iii -Owloicl,)%: C5 wid 7-'204.12 Chollicak for wa,hing 11;'Alwe,Cliterl'i ;ms. ,vlih 1,3hls, 7 204 W Dnhw Agcnt,.('rwria" -flo I,I 1,1)) Ray.or 0,ol"-d 'Arlmll Fli,j and (rites m* So'd, Spr(" tits\k,*,S�j v�ki, 1 7'205.12 13ait siatlow'! FIXXi NLI::o%e NCI R,:-WrYCZI 13 PeStc,)Wrol and C—ONSUMEr -i ADVISORY , TIME/TEMPERATURE CONTROLS t-io I I orlswa'k r'(lsloj f Ir Com-allption of 16 Prom Cooking Tomperatutes for I ,ds I'llat are Rav" 1,111den'lokol i; PHFs OthertJ!" 1-limin"ot 3,101.11 A(I �9 F gx- I sri. )��d rg�, .1ol RAW Shelf lisawdiaw Ser-ox I ITT I5: ,* 401.I I(A)(2,i Coomminted F;sh Mclw-K Coim L:g ; Anjimtk 15 se,". SPECIAL REQUIREMENTS -401�i I(B)i Ii2) Porti and llt�cf Itkiiist - 1301 1)! mill, vio!"'Als f1i Sc:!',Otl in ?•-164.!1(Ali I ftrwv�, - 1,55 F 5 S:G. * rat,,f iii1g, mobil,, fwo, o:mp,raiyand 3 401.11+A 0) P,'u,try.Vi'i I d(11n se, 'To lti'd i it I Ft Tmdtnl:al 0�llon ofle-:ttions should be S111(filig Covil.1111inl;FUsll. Moat, 111Q Pmitiv or katiw�-i05 F iS sec. I ztlxwc!f,a'(.il,:dttatip)iIolmic fflnt-s, 3-"(,'1.11(Q Wlwle-muade, In'rict BIO Steaks ium vewuor's al)d rink Samtra (hfirr 145"1" 514(1.0(19 relitioil- v,eIolxl retail :+--401.12 Rays'Awlwl F(txh,Corked in a I:rat.U,Qt hould he WN"Ld under#29 - Microwaw W'F Sp,-cluoi 3tcquirct silt:.. '401,11(A)(J)lb) '01 Othei Plif ;-- 1-45`r 1^sec 17 Reheating ter Hot Holding VIOLATIONS RELATED TO 0000 RETAIL PRACTICES 103A 1(A)&t 0) PHI-S W'1� I,�wc. - Q(ems 23,301 (b) MIC:ovtive- 165'f-2 NItam,&aa<hn, Cl r1hf:,Fl whivi,down reiate v,114C 1 m1e, ombe J-403.11(Cf Commemdly Prtxiasrd FTF Fixtd "'(:h, i""i'l Cod_^,lnd 1115("WR 140'F' jloiRr) Remaillin" ullsliced Pot tions of B 0' Good Retaid Practices FC 1590.000 .3, Minavm'I 3,d pef'A'n"d FC- 2'� 18 Proper Cooling of PHF$ 24 FC j 00", 1 2S E, 001) 3 501.14(A) Cthilulf,cookd PRF" from I w,I to pfun,rtm(� nd'N�sl, F C - X0 .... ...... 70,'F Within 2 1 fours and Frrup 1 1 27 Phw,-,�.� FC-E, 1 007 po,�Ly;i?m�i roxi,Plater_.;„ �c- 7 008 t,41'T',145 F Wiflau 4 Hinuzz 3-301.14(B) C(,oliiqg PIIR�Made Nom Ambient jl�Spe".I� 009 — -2- Tcmptrawre hwrckficot,x:41 F/45'F lvithin'l holm s DO."s': rluc,A ill F,w Irl a! NQ,1 Food i;car or 10 4 MR p9n il:);) CITY OF SALEM %� ' BOARD OF HEALTH Q� _ i k cr_")jCCt Date: 4 I�fI Page: of Establishment Name: rn Q., , �� _ , Item Code c-Critical nem -,DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION " ' Date No. Reference,. R=Red Item - - - Verified PLEASE PRINT CLEARLY AI__4 ,n//, _c nn�r. - I�c�cb I�� ➢ t ��n .of CUIos� 1 1 91- C7 j7JArQ Sr(fx 14 S-JWA G v i/n r fnwA rk,<C MI S.S n4 AOiM,3 AA01 7 �4 .nr ,Joortl 4-1/a /Cw Lj A )O41r cIOG/1 j . � ltJ.16fAAa/`�'ry+ Qill C/u (1 S,rJ r,I- J- //J1 f��i�12 Cnd A)aO tie t7 orin,c G 1 7A\1s Irl\1(19 �cd ch� 1�, �a ��,✓��,r, � 1�GCr5 +� `QCcaror� r1n e� t CInI ( .� :nLPi G� n�� tw =net IL7vn /^ U/t1( � fr` l/c�finr —f�l J •C-(�U c7� /�,.--7 I/ m S.a� Discussion With Person in Charge: I Corrective Action Required: ( ❑ No I �1 ' Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Rbbstriction/ violations before the next inspection, to observe all condii':ri �dvscribed, and to Exclusion P , �g,�-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Codunders and that W� noncompliance may result in daily fines o enty-five do oysuslpension/revocation of ❑ Embargo ❑ Emergency Closure your food permit_ l�Ar/ Y f/t J .(�,A' ❑ Voluntary Disposal ❑ Other: Z. rl v ,501 1410, PIIF� Re-"lwj at re{ paralurv'7 Violations Related to Foodborne Iftness Interventions and Risk Factors(item 1-221 (Cont} I-Fr451'- Within a Hours i 501.)1 Me:bnA,for Il-flas PROTECTION FROM CHEMICALS PHF Hot and Ca. Holding 14 Food or Color Additives 1-50!.tri(B) Cold PHF':Milinto'ned at oy lictoa; 3-102.14 proaIctlem Irons Ullappruked Addinivt:s' 16,A) il"t Plh�j at of ati'yvc 15 Poisonous or Toxic Substances 140'F 7 10131 IdentifiewI; Inforindoort 0660al 11 3-sol.if,iA! Kis"aV bled at"e'inovv 1 10T, Cijlauil'rs�' Three'as a Public W.'311h Control -,-I t}2 I I 0,uiruou Naw-- Work;en�Conwena70 rs* 1 7 m ifSefaial.rin 7.202.11 lleslriokeu- Po's"nocand U'e' 7-203.12 Condidow,of Use' 7 ?03 11 Comawie, Prohillvant l REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Ndnili7421,%.CroCri,! -010!IiC�IW POPULATIONS(HSP) it s'li'llf'sl) 2(,14A 2 Chemicals for A'"�hieejz Pfodlice.C li 7 -104,14 DrVilw, Ititern,,.Crllerrs" i �-hill.I l'Be 1 11 Paw tent i:'!el s -i-2og,11 lintrienuil 1;,iA(Aawam L th)icailW 1-lef(el ill0i R" I'.r Re!liall" telk(-d Annual Fixed'Ind '.20,6.11 R;s'ricned Ust. PCii6dCe;'Cri:,,lu" 7 20002 R(Xleul Bait SUORITISI l�.WA T-n"f:�trvd'Ux-i.Pa,!::tjar 'Noi Re-screed. --?06 1.3 Ti'lCking flo%%dero Pr54 Control and Mowiorina4 CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 2" j 10-, 11 OnIum"T iloit�d ('er(7ousulleptivir of 16 Proper Cooking Temperatures to, Al'im'A Food, fnitalc R"U' Uu&?'A,,'kCd t; PHFs ':'q "Viz,f"ise Ork'+er:s:d!o Eliminate 3..101 11 A(lr(:n Fog- 155'1, 15Sx'. Pnahowm�,' 1 5� -,it Snh.oiuro-tea Raw Shell F-'-� Injuwdi,tn;Servict: I ; Fl5se, cunnoillljlrd F'�h' Nfe'v�&' (imir: initials l5i"F 3`sv'. ;-401.1 If B)(I),'?) fit it K and]feel Roast I�0't' 121 mile SPECIAL REQUIREMENTS i-4k)1.11 2) Ratite, lniw,:d lAral,- 155 F 15 Sevilon "")I)(V4f"k) (D) in sor. creis°ring, nt d,tie lixal,tempts:is and .A-4(31.1 it,,Sot 3) PouIw,, VN fld Game. Slurred 111417s, i rcmdt;rnial kitchen opelat;()ns yhkltlld be CrsntallaroFish. Main, on'tor ThIc 11,I)a rriate w0toas 'b�yc if ie:LiIt od itt iIllwss Polito l'or lkafiws-165�F 15 3-101.1 lemact Beer"ilcaks naoivellliitri�and risi. fiiclore Othff reidlin", to�eokd retoi! 3-49JJ2 Raw Annnal FoKk Co,&,�d in a rraclice'\'Imild be 16i!L41 under #29 - 105'1- 1 3461,1 l(Ai(l)(1h) All other III IF". - 1a5"1715 "ec 17 Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4}i{ J)) (1111., 1r5"F 1 2-1-30) 3-403,11(B) Micrownvc C-1 ill,'J *;d n:m-t r:nf%ll n'kich do nw relqt,-;,n thr Tirne" foo'llee"rele i"I'll's", "n."I vcrooee,;+itst Y,A Jet,Vei3 livie,i ed.ow, we be, 3-403.11(C) Carnincroally RTFI-,x4 f"lat'i ill 'Ij the food Codrand P15 CAIR 14o'F� 1 Roinamine Unsheed Porti,,nsof lice' Item I Good FC 6.90,000 PC 2 Of FC- It GN 1 18 Proper Cooling of PHFs I '�a ro*'�t'ind tiwisill's OC 4 005 .r 501AhA) Coolme Cooked PKFe le-lim 140'I'to ------------ --p-, Wa`-�t,P!umbine:I tred tV w lj, 701:Within 2 1 foiu-:and From'10'I' �7 1 P rn/it ,,it Fal:0 s 1, FC—f 007 w 41'1=(x5 F Within 4 flnu,�. 28 i rrretsorious or Time-klnten,as; F(" '7 003 ffl '.� t4,'R`r Conling PHFi klat,ic From Ambicol L 29'--- I-Spaco;R-uWartqit-• rX J'q hirreelients i,,4)'-Fi45'F 0nic'; Within 4 '-'calls` PYWI-vcdi"zIclo Commonwealth of Massachusetts b City of Salem Board of Health Nmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0330 Dec 30,2008 Dec 31,2009 $280.00 ESTABLISHMENT FROZEN DESSERTS BHP-2009-0331 Dec 30,2008 Dec 31,2009 $25.00 Total Fees: $305.00 PERMIT EXPIRES December 31, 2009 Board of Health (� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Paye 1 CITY OF SALEM, MASSACHUSETTS ` BOARD OF HEALTH 120 WASHINGTON STREET,4T°FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 NLWOR IDIONwFOSALEM.COI 0 � �"� JANET DIONNE, ED ACTING HEALTH AGENT DEC —8 2008 ...,, .,r r'LALTH 2009 APPLICATION FOR PERMIT TO�QPER�A1TE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT he R� &Q-fvQ� TEL# /T V CJ 71`5 ADDRESS OF ESTABLISHMENT 3 l �l' FAX# MAILING ADDRESS(if different) alem EMAIL-Business': J� / Website: OWNER'S NAME 200x1 r ll/�K�G,If ( I G TEL# ��I' ZLILI- OS� ADDRESS �( � , K n R oe6'!� L�INIV 04 01-907, TREET CtrY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food iss prepared) EMERGENCY RESPONSE PERSON TU I I'D 64 R Cl U HOME TEL# �nl- 1 -09 -300D DAYS OF OPERATION, Monday I ':'Tuesday' j -Wednesday i. :.Thursday 1, F,dday ! Saturday- j ' ., Sunday I HOURS OF OPERATION 2 r/ Qyyl } !/yy) ! a� �1 Q f,( Please write in time of day. Il Q"1 YjJ t17 7 p (Forexamplellam-11pm) `�� k•-t k� (( �1� ( I"I^t (1 (� t ). Ql� G� 1 TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ------------------------------------------------ -- --- ------------------------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats _ (Outdoor Stationary Food Cart$21 25-99 seats 0 more than 99 seats =$420 BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES --------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE ES NO Q$ 35 TOBACCO VENDOR YES NO 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 d app ed by the Salem Board of Health. urs nt to MGL Chapter 62C, action A I ert'dy under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax return and p id all stat¢taxes fired un r t e law. Sign ture Date ( Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date r 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 1744-6455 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment: Deli unit in kitchen needs general cleaning around inside of door hinges. Rogelio A. Garcia PIC: Roger Garcia . . Inspector: Elizabeth Salandrea Date Inspected:Correct By: 410/8/2008 Risk Level: Permit Number: BHP-2008-0281 IStatus: I SIGNED OFF #of Critical Violations: 0 { Time IN: I Time OUT: { Urgency Description(s):' BLUE: All other violations noted in the 10/1/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations i] must be corrected immediately . or within 90 days) I _ ----------- _ _ City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 08,2008 ) Page I oft t� f Item Status Violation Critical Urgency 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 08,2008 ) Page 2 oft Page 1 of 1 David Greenbaum From: Janet Dionne Sent: Wednesday, December 03, 2008 8:35 AM To: David Greenbaum Subject: FW: David, Paulette has a concern about Bother George on Highland Ave. He has been putting out unbundled cardboard. Can you or Liz take a look and send a letter if you see violations. I think trash day up there was yesterday. Let me know what you find. Thanks Janet From: Paulette Puleo [mailto:prp600@msn.com] Sent: Tuesday, December 02, 2008 12:44 PM To: Janet Dionne Subject: Hi Janet, I went in to talk with Roger about the 30 or so cardboard boxes he had out on the sidewalk for trash pick up, however he was not there. I think it would be more effective coming from you. None of the boxes were broken down. This is something that has been going on for many years. Thanks, Paulette 121�� %HS T\aq-T Tl-1 `� ti TG I \V H'c S�� 4� W e i Jdv� � 2�r ^aVF 1 � K/ 12/3/2008 OAi¢dreN Melva are served with French Fries $3.95 JC40 4OPO4M (Cones&Cups) Junior$2.50 • Small$3.00 • Large$3.75 Peanut Butter&Jelly Grilled Cheese feavots Hot Dog B rot . r Chicken Fingers Vanilla • Chocolate • Strawberry • Chocolate • Walnut Fudge Hamburger Chocolate Chip • Peanut Butter • Apple Strudel • French Vanilla Cheeseburger .• �� Honey Grapenut • Frozen Pudding • Mocha Health Bar Maple Walnut • Fresh Fruit Banana • Mocha Chocolate Chip Pistachio Almond • Butter Crunch • Mint Chocolate Chip `',, _ ' Ra ry Ba r Side Gideps Oreo Cookie • Vanilla M&M • Black Raspberry �.. Cookie Dough • Cappuccino - Chicken Fingers (4 Pieces)......................................... $4.25 �- FrenchFries....................................................... $1.95 Milk Shakes........................................................ $2.40 Pickles ............................................................ $1.00 Frappes............................................................ $4.00 r ColeSlaw.......................................................... $1.95 Frappe Float....................................................... $4.50 PotatoSalad....................................................... $1.95 Ice Cream Soda .................................................... $3.30 Non Fat Frappe .................................................... $4.50 Sugar Free Frappe ................................................. $4.50 SOAPS: Cup$2.25 Bowl$3.25 Malt .............................................................. $4.50 Normal Hours Freezes............................................................ $4.50 Monday - Saturdayr • PM (Some Ice Cream Flavors may contain nuts) 8"j NOW. Small$3.45 • Large$5.95 (Breakfast • ' ( r 4 Junior Small Jumbo eaowder. Small$3.25 • Large$4.45 Banana Boat ........................ $6.25 Sunday 7 AM - • PM Sugarless Ice Cream................. $2.75 .......... $3.15 ........ $4.00 • 88VBIAgeB Sundaes............................. ................ $4.25 ........ $5.25 Sherbert............................ $2.75 .......... $3.15 ........ $4.00 Orange,Lemon&Watermelon Winter Hot Chocolate................................ $1.25 Hard Yogurt......................... $2.75 ..........$3.15 ........ $4.00 Hours Tealar Re Vanilla,Chocolate,Coffee,Strawberry&Red Raspberry • • . • . Tea(Regular&Decal) ....................... $1.15 IceTea....................................... $1.45....:........................................ $1.75 Sunday Coffee....................................... $1.4S........................................... $1.75 Ice Coffee ................................... $1.45........................................... $1.75 Milk/Chocolate..................`!.......... $1.25........................................... $1.75 Toppimps .354 Raspberry&Lime ........................... $1.75............_....................__..... $2.95 1i r Peanut Butter • Hot Fudge M&M • Oreo Cookie • Marshmallow Daiey ynke Small $1.25 Large $1.75 Orange • Apple • Tomato • Grapefruit Drive up service X010009 .900 S469101$ Coke(Classic&Diet) • Sprite• Orange • Root Beer r • • • i i i "Consuming raw or undercooked meat poultry,seafood, shellfish or eggs may increaseyourrisk offoodhorneillness, 978 - 741-3855 especially ifyou have certain medical conditions" 5%Massachusetts Meal Tax acced to all orders' 376 Highland Avenue, Salem, MA 01970 BF04414st Samdwielieg DiMMOF Choice oft sides Eggs are served with toast&homefries Chicken(3 Pieces) ................................................. $6.25 Extra Cheese 0.756 • Extra Egg 0.756 • Extra Egg Beater 0.256 PONT (A8 f dile#are served with chips. Chicken Breast .................................................... $7.95 Bread:White,Dark Rye,Light Rye,Raisin Bread,English Muffins Extra lettuce and tomato on burgers Chicken Kabob ................... $7.95 ................................. 1 Egg.............................................................. $2.75 BBQ Steak Tips .................................................... $7.95 2 Eggs............................................................. $3.45 Y4 Pound Hamburger............................................... $3.25 Roast Beef......................................................... $7.95 1 Egg&Bacon,Ham or Sausage .................................... $3.95 Cheeseburger ..................................................... $3.75 Chicken Fingers Served with French Fries $6.25 1 Egg&Hash ...................................................... $4.25 Grilled Cheese ..................................................... $3.25 Spinach Pie with Salad............................................. $5.95 2 Eggs&Corn Beef Hash........................................... $5.50 Grilled Cheese with tomato ........................................ $3.45 Sliced Turkey.......................................:.............. $7.95 2 Eggs&Bacon,Ham or Sausage .................................. $4.95 Grilled Ham&Cheese ............................................. $3.75 Locanico Greek Sausage) $6.95 2 Eggs&Locanico or Kilbasa ...................................... $5.95 Eastern Sandwich(Ham&Egg) .................................... $3.45 Fish&Chips ....................................................... $6.95 3 Eggs&Steak..................................................... $7.95 Chopped Ham ..................................................... $4.95 Fried Haddock Plate ............................................... $6.95 EggsBenedict ..................................................... $6.25 Scallop Roll........................................................ $6.95 Scallop Plate ...................................................... $9.95 3 Slices of French Toast or 3 Pancakes ............................. $4.25 Steak Tip Sub&Fries ...................:..r...................'.... $6.95 Fried Boneless Chicken Plate ...............................'....... $6.25 1 Pancake or 1 French Toast........................................ $2.50 Cheese Steak&Fries ...�............... ...................1... $6.95 Shrimp Plate ... $9.95 ................................................... 2 Pancakes......................................................... $3.75 Grilled Hot Dog.........'.................'...................... ... $2.95 2 Blueberry Pancakes ............................................. $4.25 B.L.T Sandwich ..........................`.......................... $3.75 ' �, Sadads 2 Chocolate-Chip Pancakes ........................................ $4.25 Western Sandwich(Ham&Onion) ....... .....................l.... $3.45 2 Banana Pancakes................................................. $4.25 Crabmea[ ...............................I..................... $5.95 Garden Salad ................................ $2.95................---...................... $3.95 . Bagelor Roll with Cream Cheese .................................. $1.95 Egg Salad.......................................................... $4.25 Greek Salad ................................. $3.75............._........................... $4.95 Gourmet Muffins $1.50 Chef Salad................................... $4.25..............._....................... $5.25 Cold Cereal with Meal ............................................. $2.25 Chicken Caesar Salad ........................ $6.25 BowlOatmeal ..................................................... $2.45 1 Caesar Salad ................................ $4.25 Breakfast Sandwich t fn y Chicken Kabob .............................. $5.95 ............................................... $3.25 1 1 5 2 2 2 Special with French Toast or Pancakes........................ $6.25 CBN Sa wjuga • Hamed Chicken Salad • Roast Beef Wad peate 2 Eggs,2 Bacons,2 Sausages Hamburger • Cheeseburger • Turkey Served with Garden Salad onlyor Potato salad&Coleslaw Side orders: Bacon$2.50 • Ham$2.50 • Kilbasa$2.95 • Sausage$2.50 B.L.T. $6.25 ' j( N � - g Tuna Salad .......................:................................ $6.25 Locanico$2.95 • Steak$4.95 - Chicken Salad ........ $6.25 ON18400tteg are served with toast and home fries { Crabmeat Salad.................................................... $6.95 40ONNpet SAMdwitAoi are served with chips Egg Salad...............................:........................... $5.95 Plain $3.25........................................................... •� Cheese ............................................................ $3.95 Onion ............................................................. $4.25 1. Roast Beef ..................................................... $5.75 Pepper ............................................................ $4.25 Cole slaw,Swiss Cheese&Russian Dressing N 25$5 Ham............................................................ . Bacon ............................................................. $5.50 2. � Mushroom ........................... $5.50 Lettuce,Tomato&Cheddar Cheese kease.............................Broccoli .......................................................... $5.50 3. Roast Beef ..................................................... $5.75 not ushtuhons ... $5.50 Lettuce,Tomato&Blue Cheese Ham rn(H ...&Onions) ............................................ ........ Western(Ham&Onions) ........................... $5.95 4. Chicken Salad ............... ........................... $5.25 Corned Beef....................................................... $6.25 Sliced Apple&Muenster Cheese CornedBeef Hash ................................................. $6.25 S. Turkey Breast ......................:........................... $5.75 Denver ,Onions&HamPeppers) $6.25 Sliced Turkey,Lettuce,Muenster Cheese&Cranberry Sauce - ' ( PP ) .................................. 6. Tuna Salad .........................`.`........................... $5.25 1 Mexican (Cheddar Cheese&Salsa) ................................ $5.95 t Spanish (Onions,Tomato,Mush&Red Peppers) ................... $5.95 Lettuce,Tomato&onion Ve a Onions,Tomato,Mush&Peppers) $6.25 7. Rueben Corned Beef .........................................'... $5.95 Meat loversSausage),Ham&Bacon ....................... $6.95 Swiss cheese,Russian dressing&Sour Kraut Greek(Spinach,Feta Cheese,Onion&Tomato) ..................... $6.75 ( ...... 8. Roast Beef ..................................................... $5.75 Spinach and Feta Cheese........................................... $6.25 Mayonnaise,BBQ sauce&Cheese + ti 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-6455 Separation Segregation/Protection FAIL Critical ❑� RED Owner: . omment: Hussman fridge compartment had raw fish being stored above ready to eat items. Properly organize fridge to separate Rogelio A. Garcia PHFs from RTE foods. PIC: p Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Roger Garcia omment:Sanitizer bucket behind counter too strong at approximately 400ppm. Provide sanitizer of proper concentration IDSpeCfOf: (200ppm)at all times. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Elizabeth Salandrea Time As a P blic Health Control FAIL Critical ❑� RED Date Inspected:Correct By: 10/1/200$ omment:There were items such as baked potatos and cooked sausages at room temperature.All potentially hazardous items must be held hot at 140°F or higher,or cold at 41°F or below. Risk Level: acon under heating lamp measured at approximately 98°F.All potentially hazardous items must be held hot at 140°F or higher,or Permit Number: cold at 41'F or below. \\__\\k\e ) BHP-2008-0281 row fish found thawing at room temperature.Thaw frozen PHFs in refrigeration or under cool running water.Fish put into Status: refrigeration at time of inspection. VIOLATION 1#of Critical Violations: 4 iTime IN: Time OUT: ,, i Urgency Description(s): :BLUE: ;Violations Related to Good :Retail Practices(Critical 'Violations must be corrected immediately or within 10 6days)(Non-critical violations :must be corrected immediately r within 90 days) - -- City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 08,2008 ) Page 1 oft t~ / i d Item Status Violation Critical Urgency ,RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions Vmment:A knife was laying in a container of baked potatos with the handle in the potatos.Store utensils in food so that handles and Risk Factors Require extend outward to prevent cross contamination. immediate corrective action) 10060ok was observed rinsing off his gloves after completing a task and wiping his hands on apron before starting a new task.Gloves must be changed between tasks to prevent cross contamination,and employees may not wipe their hands on aprons. Equipment and Utensils FAIL Non-Critical BLUE VComment:Walk-in freezer needs a visible,accurate internal thermometer. ' ilk cooler at front counter needs general cleaning. acks in Blodgett oven need general cleaning. licer needs a general cleaning. 416#11i unit in kitchen had a broken thermometer in it.Provide new visible,accurate internal thermometer for this unit. Same deli unit needs general cleaning around inside of door hinges. aster needs general cleaning. Hood filters have some grease build up.Clean and de-grease the filters. P�olator and general area has grease build up.Thoroughly clean and de-grease the fryolator. elf under grill needs general cleaning. Ice cream freezers need de-frosting. Physica�l/F�cility FAIL Non-Critical BLUE !/Cg mment: Back screen door has gap at bottom.Provide new door sweep to seal gap. BrDrive-through window at cash register partially open at time of inspection;there is no screen on this window.Window must remain closed when not in use. Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 08,2008 ) Page 2 of 4 IMPORTANT FMESSAGE ) FOR �S DATE `1`112 -42R —TIME P.M. M OF PHONE q?�H - 7-S-41" a �'� 3 AREA CODE NUMBE EXTENSION O FAX O MORII F AREA CODE NUMBER TIME TO CALL TELEPHONED LA-PLEASE CALL CAME TO SEE YOU 1 WILL CALL AGAIN ' WANTS TO SEE YOU RUSH RETURNED YOUR CALL ' WILL FAX TO YOU MESSAGE Y SIGNED CAelm =) FORM 4009 MADE IN U.S.A. !\ L-:J l(z-► - cl��.ecX.z��re��-ter, rs _ I ' ' I • i ' I t 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency 1 Telephone: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 744-6455 Hot and Cold Holding PASS Critical RJ RED Owner: Violations Related to Good Retail Practices (Blue Items) Rogelio A. Garcia Food and Food Protection PASS Critical BLUE PIC: Equipment and Utensils FAIL Non-Critical BLUE Roger Garcia Comments: Hussman freezer in kitchen holding at approximately 15°F.Turn up/repair to maintain maximum temperature of 0°F. Inspector: Physical Facility PASS Non-Critical BLUE Elizabeth Salandrea Date Inspected:Correct By: 1413/2008 [Risk Level: - J Permit Number: BHP-2008-0281 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: All other violations noted on the 3/27108 inspection report have been corrected. Violations Related to Good Retail Practices(Critical Owner to notify board of health when Hussman freezer in kitchen has been repaired. violations must be corrected immediately or within 10 :days)(Non-critical violations "must be corrected immediately or within 90 days) 9 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 09,2008 ) Page 1 oft ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions .and Risk Factors (Require {{ immediate corrective action) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 09,2008 ) Page 2 of 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 744-6455 Hot and Cold Holding 161 FAIL Critical ❑d RED N t Owner: omment: Pork roast being held hot measured at approximately 90°F. Pork to be discarded. Rogelio A. Garcia Violations Related to Good Retail Practices (Blue Items) PIC: - Food;aZZ,d Protection baC�n held Ivl t�mo-j— 7370 FAIL Critical BLUE RogerGarciaInS eCtOr: ment: Bacon and eggs out at room temperature. Potentially hazardous food must be held at 140°F or higher or at 41°F or lower. Inspector: ";IX oS �J} "n�"dFa �v 'I .9tdt� Elizabeth Salandrea 9=Coke fridge in front had�binger ales and T2 diet cokes outdated.Items removed at time of inspection. Date Inspected:Correct By: Equipmen nd Utensils FAIL Non-Critical BLUE 3/27/2008 -- - omment:All ice cream freezers need thorough cleaning inside. Risk Level: ;r ,11c,i Au'-) somoHussman freezer in kitchen holding at approximately 15°F.Turn uplrepair to maintain maximum temperature of 0°F. I- Permit Number: beFsl cctl of -y'i it CO Permitneeds general cleaning. #'c, BHP-20.08-0.2_8_1 Status: ell refrigeration unit in kitchen needs general cleaning. VIOLATION _ Ikeolator and immediate area has build-up of grease.Thoroughly degrease and clean this area. #of Critical Violations: p/ 2 SI system due for cleaning 3/2008. Entire ansul system must be professionally cleaned. Time IN: Time OUT eelving under grill needs general cleaning. Urgency Description(s): 64eat slicer needs general cleaning. BLUE: Violations Related to Good odgett oven needs general cleaning. Retail Practices (Critical Lrioor in kitchen needs general cleaning. violations must be corrected Physical Facility FAIL Non-Critical BLUE immediately or within 10 days)(Non-critical violations ment:There are a number of water stained ceiling tiles in the dining area. Investigate source of leak and repair; replace stained must be corrected immediately ceiling tiles. or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page I oft .r Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to Reinspection in one week, all violations to be corrected. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 oft 1 Commonwealth of Massachusetts a City of Salem Board of Health iGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0281 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT FROZEN DESSERTS BHP-2008-0286 Jan 7,2008 Dec 31,2008 $25.00 Total Fees: $305.00 PERMIT EXPIRES (December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 5 , zi CITY OF SALEM, MASSACHUSETTS 'aai'. . !�� BOARD OF HEALTHON "> ➢eq� 120 WASHINGTON STREET,4'r'FLOOR 4 1"9 T7EL.(978) 741-1800 KIMBERLEYDRISCOLL FAX(978) 745-0343 *Ov21 MAYOR ISCOT110 SALEM.COM 0/_ ?0®� r c JOANNE SCOTT, HEALTH AGENT �Y 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �] [� � NAME OF ESTABLISHMENT 6 1 Pi TEL#*5� 20-36 ly ADDRESS OF ESTABLISHMENT 3 I ,n4 U p�e. FAX# �-385 MAILING ADDRESS(if different) <gltom EMAIL-Business': / Website: OWNER'S NAME /1b /qETEL# ADDRESS f1Ph uAq aup, Am °K,D 01970 STREET n CITY STATE �1ZIP C, CERTIFIED FOOD MANAGER'S NAME(S) ) /rT,GliI��I G CERTIFICATE#(S) (Required in an establishment where potentially —It...rd, Rod is prepared) n EMERGENCY RESPONSE PERSON Z) IIb (�P],RCIQ HOME TEL# �br/f/- W� —3000 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION _4:4� 11 , I r1/ f I (PleaseForex niDlei6meofday. , ��p � 7 i-f) l 'fll VD (For ezamDle llam-11pm) / //h`�" . TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than I000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -. -------------------------------- ... -�a---.. ------..---"...... RESTAURANT ES NO ess than 25 seats =$ (Outdoor Stationary Food Cart$210 25-99 seats <0 more than 99 seats =$420 ----------------------------------------- -------------------- --------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES, .........---------------------------------------------------- ----------------------------------------- ---------------- MAKE -- ---------......------ MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO 9$ 3� TOBACCO VENDOR YES NO 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 roved by the Salem Board of Health. P suant to MGL Chapter 2C, tion 4 A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax ,etu and�paid all state xes r quirg5l un er the law. Sign uf�'e Date( � C Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Datepe M Jan 03 00 ;2:2op Jeanne Scott Salem BOM 970 '745 0343 p.G NOV-29-2097 09110 aw Mite" 99scOwa4 CaUNT 1� {�P.02 Choke Saving Course Re stration #or�1; � r Each attendee must complete a registration Form Ii :! kk ro re6er,e a vats x+the C"a sa.ind Coerce Repiemalion Form,tilcasc earnPlete Mw MUR1 Registration form to die Sakm Huard tit Health.Course providod by When Socvnds COM 0 i 410ass size I&tim`ted and will be o,a Coat tome Am acne bawl. i "t 'Rcowintion Fee is Non-Refucdable i ' <, , P i c •Rcgistntioo Dcadiinc is Friday,Docamber 2A,2007 at 4:00 p.m. � �: }, .. is Date of Rcglsrration �. Fon>,Completed by Mamr._' I ltaQRCt Restairmu:(>Pl1LL's�J Hu;uness phone- t? "I—:3°� , -. State At Zip, 0! �! Q' ` Email: I understand thet the mformmbon proved d 10 the Clp'of Salem A When Secoadr CoaWt. tonfidcniial aml i hcrtby attatt that the InformAtut supplied on this Course Appiicattan la . acawrarc I t�lt t}�, �; Cant^ Chokc Saving Claw SS 00 per Pmsun Course pate: wednrcday,lanuarY 16.200h Time: 2 p m,to a P.m. Letatwn: Cuv Ilah, Of)wwhmgtoa Street,Flax 1,Salton,MA • • i,,l 1 Fi I have read and wudetstand the a registration 119 eyuirnntntt. i Student Signature: . M4 Date;X01 Q 1 is � 1 Refute the completed appUtration and payraant to: Satem 9oard of ! 120 washinons r' Salm.MA Z1t70r:" I' E Jan 03 as 12:2Op Joanne Scott Belem BOH 879 gas O341 P.c NOv-ei-iaeT a1th10 �w N"a" YaCO"US COUNT w-a1 t , Choke Saving Course Rgostration Pe G. Earb standee must compleft a Regtstrad" Form 2,' � to n:aene s ywuam dhc Choha taviaS Cuytae Rayiatntell Ftvm,please coutpdete attd Rghhartsion(uno to the Salem Board of Meaith Cowrie provided by When Suooads COyftC 1gF A � . •Ciao site is lim"tett and Witt be on a(kit oww AV"onvo haus. f 1 •acRletcNiga Fee is Noa•Retitndahle •RgtsVmioa dkadiinC is Friday.Decarnbe.28,201 at 4:00 p.m Out a(a iatrrnoo �_ Z -t_Q_ff Fe r u Compietad b}. ' .. Re:ueta t: .tet .loll 8mme.•nddr+:r•• amz j.�.,�A / Car-row Bucinna Phnne scree a Zip_ Q!I' 10 . I 4 „ I urdwitind that the inlormaiion ptovbded to the Cky dSsiem de W hen Seconds Coeur. 41A be'.. apn(idential arnf I hcrtby sacral chit tno hn(orsawioa supplied n<this Course Appiiaryon is e acarate. (; Cott. Choke Saving Clio. S5.00 per person f Coons Dole. Wcdnes48%,lanuary 16, 700a Tkaa: Z p nt.it,0 p m. t ' LeestluaCity HdI 17ii Wehmaton Jt.wn. Floar i,4aiern,MA .1� y ;h 1 have raw atal widehctaud use above M61AI to"" its 7"rCmM% i iBOa r'� Gi ;i 4tadenc S wnr: c rtit � 121 h itaa:p j,__r�_l." i Rotura the Completed appdketion tad paynnnt to: sa Wa Aaarli of i 120 IN ft MA 3970, 1 Sake►MA di'7l�P ;++; ' 1 a A 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-6455 Handwash Facilities PASS Critical ❑d RED Owner: Comments: Kitchen hand wash sink obstructed. Sink to be free and accessible at all times. Rogelio A. Garcia PIC: Violations Related to Good Retail Practices (Blue Items) Roger Garcia Equipment and Utensils PASS BLUE Inspector: Comments:Oven requires thorough cleaning. John Gehan Date Inspected:Correct By: Hussman freezer requires general cleaning. 7/5/2007 Salad/sandwich unit missing thermometer. Provide visible and accurate thermometer. Risk Level: Meat slicer requires general cleaning. Permit Number: Can opener requires general cleaning. BHP-2007-0186 Front milk refrigerator requires general cleaning. Status: SIGNED OFF All ice cream freezers require thorough cleaning. #of Critical Violations: Silver King Milk dispenser requires general cleaning. 0 Time IN: Time OUT: Unit with bagels requires general cleaning. Physical Facility PASS BLUE Urgency Description(s): BLUE: Comments:Kitchen walls require thorough cleaning. Violations Related to Good Back door has visible air gaps. Seal gaps to prevent entrance of rodents or insects. Retail Practices (Critical violations must be corrected GENERAL COMMENTS: immediately or within 10 days)(Non-critical violations All violations from June 26, 2007 have been corrected. 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. Jul 05,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) J City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 05,2007 ) Page 2 oft IMP6RTAPJT MESSAGE FOR _ t• - — - 3, �,. A.M. DATE �pl U TIME law. . M i PHONE S,'' S B 3 AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBN F AREA CODE NUMBER TIME TO CALL TELEPHONED �' PLEASE CALL CAME TO SEE YOU 'I WILL CALL AGAIN WANTS TO SEE YOU RUSH 1 RETURNED YOUR CALL WILL FAX TO YOU --��- MESSAGE + SIGNED FORM 4009 MADE IN U.S.A NOTES EO� tyvl\ e trarne of six months. This release will e7pire bn 2007. ,a ,Tenant/Lessee Owner/Lessor Address Address Address of Unit to be inspected t Date 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-6455 Handwash Facilities FAIL Critical RED Owner: i OD6'mment: Kitchen hand wash sink obstructed. Sink to be free and accessible at all times. Rogelio A. Garcia PIC: Violations Related to Good Retail Practices (Blue Items) Roger Garcia Equipment and Utensils FAIL BLUE Inspector: omment: Oven requires thorough cleaning. John Gehan Date Inspected:Correct By: _19ussman freezer requires general cleaning. 6/26/2007 ad/sandwich unit missing thermometer. Provide visible and accurate thermometer. Risk Level: M�e [.slicer requires general cleaning. Permit Number: ener requires general cleaning. BHP-2007-0186 Status: _.Fri5nmilk refrigerator requires general cleaning. Open L.AWIce cream freezers require thorough cleaning. #of Critical Violations: er King Milk dispenser requires general cleaning. 1 _ Time IN: Time OUT. ± nit with bagels requires general cleaning. r Physical Facility FAIL BLUE Urgency Description(s): BLUE: Comment:-Kitchen walls require thorough cleaning. Violations Related to Good Back door has visible air gaps. Seal gaps to prevent entrance of rodents or insects. 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. Jun 26,2007 ), Page I 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 26,2007 ) Page 2 oft S WOOOCHUCK PLL1M13ING HEATING, N 2166 MAIN STREET GROVELAND; MA 01834 o ( 972-8274 0 FULLY 11?ISUREO m .Customers Order No,��fj Date /,/, Name Address J76 p r-. Phone m SOLD X Cp p. LN/,PGE ON ACCT MDS£ RETD PAID OUT kAYAWAY P f � 10 i m r71 U) � - U, ! AIIC121Asvdrvlumvd%OAGA MUST be m"om"nuC by tNs bill M TAX S �I � 4 f I�I 1 d �C L t� 1 �j _ ; �� '� i � _ _ - , � � " ."-' � "�� /i ��- �� %moi%�=- i �/ -� i�� i /� JOB INVOICE NORTH COUNTRY SHEET METAL P.O. BOX 669 7982 IPSWICH, MA 01938-0669 (978) 356-4647 CUSTOMERS ORDER NO DATE OR`pppDMMMERSSSEEEED ORDER TAKEN BY DA7 VjflD ❑ A M _ / ❑ PM BI LL TO PL"kil /J/ /� PHONE ADDRESS {_f/ / MECIjAJ�G�/ CITY -Ari /")_ �1� HELPER J JOB NAME AND LOCATION / E DAY WORK DESCRIPTION OF WORK (J\ /` I ,.p ❑ COrvTKaCT 2 hL QUANT. / DESCRIPTION OF MATERIAL USED /J PRICE AMOUNT �/ r✓GaY1��.�( /fa (1 .%lC!, -Al �FA �''✓� �/ !L4/ /v FGr rJ O /�6v h✓ /i� unar /��/L�G.t�- ow/veil o F- //cvs' hwolees aro C.O.D. unlw prior amngomaMs have be= E" F=�r�� Installer until payment Is made In full & will be removal Is not our responsibHlty. 2% per month will —J&.: zu -11 o :;a .los. n" minimum service charge of $5.00 per month. dil iw¢a hrid"ng attornalt fam ' !"HOURS LABOR AMOUNT TOTAL MECHANICS @ MATERIALS HELPERS @ TOTAL LABOR gLwgw stn m I hereby acknowledge the satisfactory TOTAL LABOR TAX completion of the above described work. SIGNATURE DATE('lM$LETFA�� 1j TOTAL 'r JOB INVOICE NORTH COUNTRY SHEET METAL P.O. BOX 669 7983 -. IPSWICH, MA 01938-0669 (978) 356-4647 CUSTOMERS ORDER NO DATE ORDERED ' p ORD/ER TA/KE�/NJB�Y��/ DATE dRSED BILL TO �Z6 j[��K. PHONE ///""" ADDRESS MEGHA CITY A HELPER JOB NAME AND LOCATION J� oAY-ORK ONTR DESCRIPTION OF WORK / J -n ) / EX7wCi (� -Y//' �f ld�/$�5 Q ❑ E%TRA 'zC rJNv To Ls4 lv - viv/7 OUANT DESCRIPTION OFMAfERIALUSED PRICE AMOUN ,4 7-m-, E clr c1c 0,4,..' ,601- / /UA/I/b aff e2 No Lv, �E/1 �i oICI r1f h&OZ;1L[% Immion ore C.O.D. udws prior arra cumenb ban sR.. .. n ze yment Is numb ver will 2f.- installer e ind>Iter mWl payment is made In trill & wlll be rolnovat Is not mw responsibility. 2% por month will AR, o.y. minimum servies charps of $5.00 per month. rv, w osorm for all wmcuen w.ce hrehrt7ng attorney face. HOURS LABOR AMOUNT TOTAL MECHANICS ® MATERIALS HELPERS ® TOTAL LABOR a rias a es I hereby acknowledge the satisfactory ( TOTAL LABOR TAX compleLon otihe above sglb, SIGNA':UFi � DATE COMPLETE) TOTAL 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 Narrre / ri to TYoe of Ooeration(s) Type of Insoection �eljyoe 9' I4 �)� Food Service ❑ Routine Address 2 j7 I Risk ' ❑ Retail © Re-inspection J 1 ur �Y'1I Level ❑ Residential Kitchen /Previous Inspection Telephone �w V 7 _ 3�0 .� ❑ Mobile Date:j /fix > ❑ Temporary ❑ Pre-operation Owner KDCAe ULu �� HACCP YM I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /� _��t �r Time ❑ Bed&Breakfast ❑General HACCP Complaint `� In: ❑ Inspector __1 A I Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 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 _ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE_. ._i.. ' " - ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. 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 N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(5so.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5801ns IF.r 14 G0, �l 1 � Inspector's Si naGire•f L Print• I p g . I W)/ /1 l npho� ` A � 66 . 1 PIC's Signature: Print: Page o6tPages \j Violations Related to Foodborne illness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cross-contamination . I i 590.003(A) Assignment of Responstbihtys 3-302.11(A)(]) Raw Animal Foods Separated from 1590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 12-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302.1](A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment - _) require reporting by food employees and 13-302.1](A) Fool Protection" I applicants* 3-302.15) Washing Fruits and Vegetables I 590.003(F) Responsibility Of A Fant Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3..306.14(A)(B) Returned Food and Reservice of Food' 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(F) I Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 14-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetical If Sealed Container( I Sanitization Temperatures" 3-201.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical W arewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures*- 1 ( ---- - .. . ......,,_.._ 13-202.t4 Eggs and Milk Products.Pasteurized* I 14-501.114 Chenrical Sanitisation-temp.,pH, 13-202.16 I fee Made From Potable Drinking Water" concentration and hardness. ' 15-101 11 ( Drinking Water from an Approved System* 1 14-601.11(A) Equipment Food Contact Surfaces and Utensils Clean- 590.006(A) Bottled Drinking Water* ---- r � 4-602.11 Cleaning Frequency of Equipment Food-- Water Meets Standards in 310 CMR 22.0* � Contact Surfaces and Utensils* ShelNish 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* 4-703.11 ( Methods of Sanitization-HotWaterand 3-201.15 I Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by to I Proper Adequate Handwashing Regulatory Authority ( 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* I 13-201.17 ( Game Animals* ' ( it Good Hygienic Practices i I S ( I Receiving/Condition I 2401.11 I Eating. Drinking or Using Tobacco* 13-202.11 ( PHFs Received at Proper Temperatures" I 12401,12 Discharges From the Eyes.Nose and 13-202.15 ( Package Integrity* I Mouth* Unadulterated* 3-301.12 Preventing Contamination When Tasting* I 3-101.11 Pcwd Safe and Lnadultcrated � -___ from Hands i Prevention of ro I fi TagslRecortls:Shellstock � 12 Prevtif Ct _- - - I 3-202.18 Shellstock Identification* ( 590L04(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Employees* 13 Handwash Facilities Tags/Records:Fish Products 1 � Conveniently Located and Accessible 3-402.11 Parasite Destruction- 3-402.12 Records,Creation and Retention* I ( 5-203.11 I Numbers and Capacities* 59(f0040) Labeling of Ingredients" I 15-204.11 I liwation and Placement* 7 Conformance with Approved Procedures ( 15-205.11 ( Accessibility.Operation and Maintenance IHACCP Plans I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* I Devices _ 13-502.12 Reduced oxygen packaging,criteria 6-301.11 Handwashing Cleanser,Availability 18-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying P ovision °Denotes critical item in the federal 1999 Foal Cade a 105 C64R 590.000. CITY OF SALEM t � BOARD OF HEALTH Establishment Name P YDII/ P )h' Date: _3 / ? r Page: of Item Code C—Critical Item J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item � - ,PLEASE PRINT CLEAfiLY . t Verified I Id � I All 1�2 HO7) Y/ -tko" l -as-d� �� 't�Q /hC�Y��fior� rn�� 4�%� 4�. 7h�.�G'/�1 {' — — ` 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 O Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P LI Re-inspection Scheduled ❑ Emergency Suspension i F comply with all mandates of the Mass/Fede al Food Code. I understa d�at noncompliance may result in daily fines of tw my-five dollars suWnsii Ll of ❑ Embargo ❑ Emergency Closure '. your food permit. ��] /// // y fob J fi J� n' ❑ Voluntary Disposal Other: _ -5(11 !Tw" i PRFs Received at Temperatures Violations Related to Foodborne ifiness!rlferven ffunsand Risk Ac.cording*o Law Coaled to Factors(Items 1-22) (Cant.) 4 I'F/45"F Wsthin 4 P( PROTECTION FRC-NA, CHEMICALS 3-50!.15 I Cooling,Methods for PHFs PHF Hot and Cold Holding 14 Food or Color Additives I0...i_ 3-501.16(B) Cold PRFs Maintained jt,z helow ;-2A,:J;,.ivq', 590004(F) JTI, 3-302 14 Pn�lcctiojl tier, mi, 4P/45'F* rovcd A(kldjve�• 3-501ANA) Hot P1417s MJiluained at or above 15 Poisonous or Toxic Substances 140'F, 7-lol.11 Idtludynoz lnformd:lou OnInnal 3-501.16(A) Roasts Held at or above 130'F. I Containers' 7-102.1 1 Comm'yn Nanle, -W',-. 4m corltaifl-r'� 76 Time as a Public Health Control '20I.1 1 Separation--Sloraec" I 13-101.19 Time as a Public Health Conuol.2 7-20111 Rest6LIion-P ,sere and 1590.0041 ff) Variance Requirement 7-202.12 Cmd;tions of Ilse" 7-203.11 'toxic Cor'rainel.s REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 i Stutitizels Cricna- Chemicals' POPULATIONS(HSP) 7-204.:2 Cl;cmicals f,WaNhwe Produce,Criteria" M 13-8,01,11(A) Unpastcluized Pre-packaged Jtucec and 7-204.1 Beveragzes with Wirnine Eab D;v:n,,,, Agents.Ci�i ej!n I I 7 205A] 3-W 1.i I(B) Us:of Pasteurized EggO Incidental Food Contact,Luhrwaw,^ 3-801.I I(D) RauorPaitedlyCockedAninial Food and 7 ?06,11 Rcciricle, �l�,e Pcsti&Ls.Criteria Raw Seed Sprouts Not Sened. 7-�06.12 Rod,st Bail Siatirns' 3-801.1](C) I Unopened F,Axt Package Not Re served. 7-206.13 Tracking Powders.Pest Cost,"] and CONSUMER ADVISORY TIMENEMPERATURE CONTROLS 22 3-603,1 1 Consumer Advisory Posted for Consumption of 16 Proper CotAino Tcmperatwes for Annual Foods'li,it are Raw.Undewooked or Not Otherwise Processed to Eliminate PHFs 3-•i01 11Al1n(2) Eggs- 1!;:; F 15Sea lomieu:;ne Service 145'1715sec, 3-302.13 Pasteuri/ed Eggs Substitute for Raw Shell 3-={01.1 I(A.;2) Co rnininuted Fish,Nleaus&Game Arrinials- 155'F 15 sec. 3_101.11(BylV2) Poll, f,rd Bcol Koist- 130'F !?l min,t SPECIAL REQUIREMENTS 3-401.11(A)(2) Rants, Injected lvicals--155-F 15 390.009(AHD) Violations of Section 590.009(A)-(D) in sec, c-lering. mobile food. temporary and 3-401.11(A)t3) Poulin, Wit i Game, Stuffed PI-ITs, residential kitchen opetations should be Stuffint!C"atairlinu Fish,Meat, i debited under the appropriate sections Poultry or parites-1 65T" 15 scc. above if related to foodborne illness 3-/01.11(C)(3) 'Xhol- muscle, in,del Beef Steaks interventions and risk factors. Other :45'P 590.009 violations relating to good retail 3-701.17 Rfivs Amu,d Fonds Cooped in :) practices should be debited under #29 - Microwave 165`1`* Special Requirements. 3-401.: i(A)(1)(h) AI: Other PIJFs 115'F75s,c. ` 17 Reheating f0r Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&,(D PHFs :65`F15 sec. (Iterra 23-30) 3403.11 tB) Miurowave- lfj")1, Mil, iutc Standing Ctimal and non-r rhical violatiomt, wInJi do not relate to the foodborne illness into vcnfi,ns and risk fa,tors IiNled above, can le! I(C) Ctatenercialh,P!ocessed RTE Food - found in zhefolhAvinp suctions of the Food Code and 105 C?UR i 1:J I .51110.000, 3-403.11 IF') "nshced Portions oBoer r Item Good Retail-Practices FC 590.000 Manaqernent and Personnel FC-2 00, l` 18 Proper Cooling of PRFs 1-24l Food and Food Protection FC-3 .004' 25� Equipment and Utensils FC-4 '005 3-501.14(A) Cooling Co�,kecl PE[Fs From 140"F it) IZ6- Water, Plumbinq and Waste FG-5 .006 (1`'F Within 2 Hour,and Front 70-F 27. Physical Facility FC-6 007 to 41'Fi45'F V;!,hin 4 Eicatrs. 1 28. Poisonous cr Tars:Materials F__- .008 Cooling PI'Fs Made From Anihient 29, -5(j].14(R) So-cial Requirements .009 TI-mperatute lnj•redicncs to4l'F/45'F 30, 1 Other Within 4 Denotes unneil hent mine 1999 Fond'',&_-or 105 Ck;:<590 on". Massachusetts Department of Public Health Salem Board of Health Divisioi of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Named yf /_/t Date Type of Ooeration(sl, Tyee of Insoection iXlII vA l-1P./)K;L •Q j'11)5 /)-7 I [9`Food Service ❑ Routine Address �TI o , I-�A�1n( Risk 'E] Retail ©'Re-inspection f/ YTl I Level ❑ Residential Kitchen Previous Inspection Telephone IO j ' ?) ❑ Mobile Date: / Owner ff(h� HACCP Y/N El Temporary ElPre-operation �A n 0 f 1 � I \O ;-0 gyp. I ❑ Caterer ❑ Suspect Illness Person in Chayge(PIC) �1 l l(�f Time ❑ Bed&Breakfast E] General Complaint In: ElHACCP Inspector ,, 1 1jy l I 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 -x°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(Potint alty 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 2(j 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-z)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(990.0044)) 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 V 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 6 Ino fFoi 6 14tloc"^ Ins ector'slSi ature• Print: �� I I P : rq I t)r, R Q/N l �/" . Ake, NG 11 (VkD I PIc'sSioature: V 1� - �l�al�77+j Print:_. - I Page! Of-?Pages •� Iv y � l �v.. Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) _ PROTECTION FROM CONTAMINATION � FOOD PROTECTION MANAGEMENT 15 Cross-contamination 1 590.003(A) Assignment of Responsibility' 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 12-103.11 Person in charge-dutiesI I Raw from Raw Ingredients 3-302.11(A)(2) Raw Amind]Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 13-302.11(A) Food Protection` applicants'' 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 13-3(W.1 I Food Contact with Equipment and Applicant To Report To The Person In Utensds* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) ( Returned Food and Rescrvice of Food* 3 590.003(D) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1! Discarding or Reconditioning Unsafe FOOD F IOM APPROVED SOURCE Fail* 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 Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization'lenhperatures* 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashing-Ilot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized* I ( 4-501.114 I Chemical Sanitization-temp.,pH, concentration and hardness. 13-202.16 Ice Made From Potable Drinking Water' I " 4-60 L I I(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* I Utensils Clean* 590.006(A) Bottled Drinking Water* I 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* ( Ch q yill ShelHish and Fish From an Approved Source ( Surfaces and Utensils* 4702.1 I FFTegUrequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* -- -- --- - Game and Wild Mushrooms Approved by 110 ( Proper.Adequate Handwashing Regulatory Authority 2-301.11 I Clean Condition-Hands and Arms* 13-202.15 Shel(stock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild MushroomsT I 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 I Good Hygienic Practices g Receiving/Condition I 12-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I ( 2401,12 Discharges From the Eyes, Nose and 13-202.15 Package Integrity" I Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Togs/Records:Shellstock ( 112 Prevention of Contamination from Hands 3-202.15 Shelistock Identification* I 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Employees* Tags/Records:Fish Products I 113 Handwash Facilities Convenientty Located and Accessible 340111 Parasite Destruction" 3-402.12 Records,Creation and Retention* I 15-203.11 Numbers and Capacities* Labeling of Ingredients* 5-204.11 I Location and Placement* 590.004(1} 9 9 11 205 A - . I Accessibility,Operation and Maintenance 7 ( Conformance with Approved Procedures 5 ( I Y I /HACCP Plans 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 5-103.12 Conformance with Approved Procedures* 16-301.12 Hand Drying Provision 'Denoles critical item in the federal 1999 Food Cade of 105 CMR 590.(1(0. CITY OF SALEM �/ BOARD OF HEALTH Establishment Name_ V 0 I Y 1 V, l_I�D+ �� Date: 1 - �Q Page: of Item Code C-Critical nem J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified .--� PLEASE PRINT CLEARLY - (1Wj1)4 �hz-e �� i»ar,� ✓orl� j/sas i_'/�7/hl1)') <7) -717) G %sS�� /f' �� /_ �v�o� a/ l� /3 5_ .�dd��s /n/A< GvUSh huds D),4>rrd,�'d /h 1 / 1 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 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-Wenty-five dollars or sus -nsl-n/revocation of ❑ Embargo ❑ Emergency Closure your.food permit. /� ,Q %� ❑ Voluntary Disposal ❑ Other: ;,501 ]-,'Ci PHIFs Received et 1'ca�l?erat ares Violations Related to Foodborne Illness Interventions and Risk According to I.aw Cooled na Factors(Items 1.22) (Cont) it F/45"F'Xithin 1 Homs. " PROTECTION FROM CHEMICALS I .15 ;atlin;c Medxds fJr PHFs j 14 Food or Color Additives I 1S PHF Hot and Cold Holding .9-2(12.12 Additrvee" 3 501.16(11) Cold PIIF:. Marna;ncd it or tviow 13-302.1# Protection {tour Unapla-med AddtOvec* I 590.004(F) 41'145` F, 3-501,16(A) --lotPHF!. Maintained,it or above 15 ( Poisonous or Toxic Substances !40-F 7-101.11 Identifvmc lnforuatnon-Original - - - Containers" i --51'L I(,,(A) Roust;Held at or above 130'F, j 7-102.11 Common Name-Working Containers* I ( 20 Time as a Public Health Control 7 201.1 I Separation-Shxace„' ' 13-501 (r) Tinto as a Public Health Control' j i-20211 Restriction-Presence and ITse'. I 59tJ.001(H) uianccRequirenteni j 7-1102.12 Conditions of Uec' 7.2}3.1 l Tonic Container! -i' en iionrREQUIREMENTS FOR HIGHLY SUSCEPTIBLE " ) '204.1I Sanitizers.Criteria-CC'h};emirAs* I POPULATIONS(NSP) :-Sol 111,B) Use of 21 3$O1.Ili_A) thrpImcurizedPorpackagedimtesand 7-204 12 Chemrcfor Waahtne Produce,Criteria" 4eveiagei with \Yarning labels* 7-204.14 Dryin-Ag:agents.CriteriaI Pasteurize-:;Eeei 7-205.11 Incidental Food Contact., Luhncants^ ( 1 ; 501 I I(P) Raw or P,ttially Cool:edAnoint Food and 7-206.11 Restricted Efe Pesticides,Criteria' I k:v, Scrd Sprouts Not Se:vrd. ' 1-206.12 Rodent Hart Stations, I ;-S01.11(C) IInnn d Not eserved erred Pcxx. Pcrl:ag>; R _- 7-206.13 ']'racking Powders.Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-003.1 i Consumer Advisery Postcd for Consumption of 16 Proper Cooking Temperatures for Amnrd Foods than are Raw, Undurn onkel ar PHFs Nut Ofliarwis_ Proce:sed to Eliminate 3-401.IIA(i)(2) F,gg:: 155=FISSec. Eggs-hrmediuteService 145`1715set, ?-302.13 P.•ateurircd Egg,Substitute for !taw Shell 3-401.110)(2) Com,mnuted Fish t�lenls&G.tme L£)"`r Animals- 155`"r' l5 sec. " SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites; tnjectedh'teats- I55'F S j 3-401.11(13)(1)(2) Park and Hect Roast- 130°5nti '' 590.009(A)-(Di Violatioos of Section .590.009(A)-(D)in I sec. * tatering. mobile food,te-nporarf and --401.11(Aa3) Poultry, Wild Game,Stuffed PI-fFs. residcrtial kitchen operations should be Slatting Containing Fish,Meat, debio-d cinder the appropriate sections Poultry or Ratites-165'P 1S sec. above if:elate,, to facrubome illness ,-401.11(0)13) R9tn(e muscle,Intact Beef Steaks inti: enPons and rhlk factors. Other 145'17* I 59(),009 violations relating to good retail 3=101.12 Raw Animal Foods Cooked rn a practice.should be debited under 1129- Microwave 165`F ` I Special Requirements. 3-401.1I(Anlyb) All Other PHFs-- 145^F 15 sec. * I 17 Reheating for Hot Holding ( VIOLATIONS R.:LATED TO GOOD RETAIL PRACTICES ,-403.U(A)&(D) PHF. 155'•F 15 sec. s (Items 23-30) 3-403.11(15) Microwave- 165' F 21'Imu1r Standing Critics.%:::a?non-rriti,:Ott^Manan, which-do nor relate to the Time;= f„odboirr illnecr inte,,,en;%:nes and risk factors li,,ted,hove, inn be 3-403.11(0) Commercially Processed li f F F'rxd- found ar thr,l,lloring de(tunas of the Food Code stn,/.'05 C NIR 14WF` 590.000. 3-403.11(EI Remaining Uns iced Portions of Reef I Itcm Good Retail Practices FC ( 590.P00 Roasts" 23. Mona„emery and Perennel FC-2 003 13 Proper Cooling of PHFs 24. Foal a-d Foo?Prote iron FC - 3 004 25. Equipment and Utensils FC-4 I .005 3-501,14(A) Cooling Cooked PHFs from 140`F to 26 Water Plumbing aro Waste: FC-.5 'I .006 j 705 W;thm 2 !lours and Frum 7(1'51 127. Phvaical�Tacility FC,-6 1, 007 to 41"F/450F within 4 Hours. '" I 126 Poisonous or Torr,Fdla'erias PC-7 .003 j 3-501,14(13) Cooling PHFs Made I iota Ambient 20 3recial Reoulrements .009 j Temperature Ingredients to-11"F/45'F 30, Other j Within.11 fonrc'. I *Dcnoizs cried item in Ihr tederal 1999 Fund Code or 105 C@IR 5901100. CITY OF SALEM BOARD OF HEALTH 7 Establishment Name: V� 1�� Date: Page: of v Item Code c-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified � PLEASE PRINT CLEARLY i . �s //-) -11`17,4 -/-/, 7 G - 1 77llo�� jelr�U. j I � I � I I ! I , I 1 I _ I f [ 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/ 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 understa tha noncompliance may result in daily fines o� entve doJ{ars or "sus n/revocation of ❑ Embargo LJ Emergency closure = your permit. �/f jll ��hj // ❑ Voluntary Disposal ❑ Other: _-Si;LId(:.; ( S'41>r,Rtcetv:d at'I anpecttureti" - Violations Related to Foodborne Illness Interventions and Risk. A.covi ng to Law Cooled ur �I Factors(items 1-22) (Cont.) l 41"F/35` Within 4 Hours. PROTECTION FROM CHEMICALS 3-;)0;.10 Coal rn me" ds for 111-114s 14 Food a.-Color Additives 19 ( PHF Hot and Cold Holding 3-St)1 16(6) Cold PflFs Maintained at or below 3-202.12 Additive,* --� 590.004(Fi 41''!45` F' 3-30114 Pruiection front 1 Tnaprrtwed Addtf:ves* ( 3-501.16(A') Hot PHFs Maintained at or aboee 15 Poisonous or Toxic Substances ( 40--E 7-101.11 tclenni}-mc Informal lon--Original 3-507.16 : -- - Containerc* t-1) Roast;Held at ur above 130,F 7-10111 Cotmnun Narnc-Working Containers% � ( 2(} Time as a Public Health Control 7-3(1I.I 1 Separation-Stor teo' ( 3-301.19 j Time as a Public Health Comm:* i 202 11 Restriction-Pres,cnct and I rse' 591)OO.u(t41 Variau.e Regmreutent 7-20.12 Conditions ns of fisc" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 'i?ti3 11 'toxic Container,-- Pruh,httinns" POPULATIONS tHSP) 17-204.11 San;tizer's,Criteria-Chemicals^ I 7-203.:2 > 121 l 3-801.11(A) G:o;:steur¢cdPov-packaged.luicesand Chemicals fin!GVashmc Produce,Cn.eria"' ; 7-204.13 Dryutg Agents,Criteria' Beveraces with War;;mti Czbel;'. 3-86.1 l(L) Log" 7-205-11 Pasteur;zed 1,gs* j 7-205.1 t htcidemat F;,„d Contact..1-ubru;tmts^ - - * J 3-801.11(1)) Raw or Partially Cooked Anunal Food and 7-206.11 Restricted Use Pesticides.Criteria Ratv>crd SPn;u?<t:rn Se:'tzd 7-206.12 Rodent g P sderSiots.n e ! ?-ou 1.1 I(C) Unopened Food Package Not Re-served. " 7'L06 13 'Tracking Powders.Pest C'oatrol and Monitoring- CONSLJMFR ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1 : Consumer Ade;soty Posted ;irr Consumption of Animal Foods That arc Raw.Undercnoked or 1n I I Proper Cooking Temperatures far PHFs Not Othermsc Processed to F.!imutate Eggs- 155`F 1,, 71-tt3- 01.1I All 1(2) Shueeau.* 3-+02.13 PaStearlLed Eggs s Subauurte for Raw Shell Eggs-hnmedinte Service I.15°F]Slee* 3-+01.1 If A)(2) Comminuted Fish,Meats&Game E;::_s Animals- 155'F 15 see. 3-401.11(6)(1)(2) Pork and Beef Roast - 130"F 121 min"' SPECIAL REQUIREMENTS 401.1 (A)(2) Rnntes. Injected Meats- I55°FIS 590.009(AHEI) Violations o;Section 590.009(Al-(D) to sea x catering, tnribile f�td, temporary and 3-401-11(A)(3) Poultry,Wila(lame,Snuffed Pi-IFS, r_std'iniai ki:cti4n operations should be Stuffing Containing Fish,Ideal, debited under the appropriate Nections Poultry or Ratites-165'1- 15 sec. ^' above ,f related it, loodborne illness 3-101.11(Cl(3) Whole muscle,Intact Beef Steaks interventions and Fish factors. Other 145-F* 590.00() vioiations relating to good retail 3-.101.11. Raw Animal Food;Cooked in a pra, cs should be debited under#29-- Microwave 165'F* Special Regn6ternent3. 3-301,11(A)(1)(b) All Other PHFs- 1.15'F 15 sec " j 17 ( Reheating for Hot Holding VIOLATIONS R-LA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(1)) PHFs 165`F 15 sec. : (Items 23-30) 3-403.11(6) Microwave- 165"F 2 FvLnnte Standing G-inn'tI<ar<1 urn-rrirkal eiollahwrs, •,,hich do nrt,elate in the Tints" foodborne dates.!Intert+crtion,s and risk la(!ors tiered above, eon be -303.1 I(C) Contnerinlly Puxessed RTE Fix,(!- ,find in the folknt ing scrri,ue:u!the F'nn<I(ode(11"I1!)5 C'Mk 140°F' 51)(3 Ono, 3103.1 ItE) Remaining Unsficed Portions of Beef Item Caed fietaFl Pracllcrs FC 590.1J00 Roasts' 23. Management and Personnel FC-2 .003 18 Proper Cooling of PHFs f 24 Food ms:l Foal Protecion FC-3 .00.4 j 3 St11.14(A) Cooling Crx}ked PHFs from 110'F to i 1 `5' Equipment ane Utensils FC-4 .005 I 26. Water,Plumuinq.rd 01aste i-i, -a .005 70'F Within 2 l four.,and From 70'17 ( 27 ah•riicxl Factitty FC-6 .007 to 41'F/45'F Within 4 Hour;. ' n Posonous cr Torn Maturiats FC-7 .008 3-501.14(B) Cooling PI-IFS Made From Ambient 129 1 Spocid Rectu!eme;»s 009 Temperature ingredients to 41'Fi451F j 30. ! Otho. -------------_ Within 4 Hours:` 'Denotrr critical item at the&deral 1991)Fotnl Code or 105 CNIR 50+,OfiO. 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 / Date Tyoe of Ooeration(s) Tvpe of Inspection ) `. �D - I ❑ Food Service URoutine AddressJ Risk ❑ Retail /El Re-inspection 4/jp ��IdY t h��J�� " Level El Residential Kitchen Previous Inspection Telephoner^ �- - El Mobile Date: �I3883 El Pre-operation Owner '� Grip I U C\� r�� ti HACCP YIN 1 ❑ Caterer ❑Suspect Illness Person in Chargel(PIC) Ch. )�� Time I El Bed&Breakfast 0 General HACCP Complaint _% In: Inspector . I-)I n h rip I Oct. 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 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 : TIME/TEMPERATURE CONTROLS Potential) Haiardous Foods F-1 4. Food and Water from Approved Source (Potentially ) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures r ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating +.} ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18• Cooling ! PROTECTION FROM CONTAMINATION " [119. 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): S� of Health. Non-critical (N) violations must be corrected immediate) or within 90 days as determined b the Board Official Order for Correction: Based on an inspection Y Y Y today, the items checked indicate violations of 1 MR of Health. OS C � N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an / ✓ 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations ,/ 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-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 590inspectFomK 1e Coc Inspector's Signa re• jj( Print: 1 PIC's Si ature: Y` !' Print:" " 1 Pag g e/ of/ es 1 g" li/Gl/� d�lX)P!'1(1 /�/1� tin Pa Violations Related to Foodborne illness . Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination i i 1 590.003(A) Assignment of Responsibility* 3-302.11(A)O) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Fcxals* 2-103.11 Person in charge--duties Contamination from Raw ingredients 3-302.11(A)(2) I Raw Animal Foods Separated from Each EMPLO`EE HEALTH Other` 2 590.003(0) Responsibility of the person in charge to I I Contamination from the Environment require reporting by food employees and 13-302.11(A) Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1 1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* I I Contamination from the Consumer 590.003(6) Reporting by Person in Charge* 13-306.14(A)(B) ( Returned Food and Reservice of Food* 3I590.003(D) Exclusions and Restrictions* i I I Disposition ot Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* _ 4 Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" ( 4-501.1 t 1 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* ( Sanitization Temperatures* J ( 4-501.112 Mechanical Warewashin 3-201.13 Fluid Milk and Milk Products* I b- Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Ptoducts,Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 Ilse Made From Potable Drinking Water* ( concentration and hardness. " 5-101.11 I Drinking Water from an Approved System* I 14-60 L 1 i(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* J 14-602.71 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.04' Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I 4-702.1 1 Frequency of Sanitization of Utensils and 4307.14 Fish and Recreationally Caught Molluscan ( Food Contact Surfaces of Equipment* Shellfish* I 14-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I ChemuaF` Sources* Game and Wild Mushrooms Approved by 110 I I Proper,Adequate Handwashing _ Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 12-301.12 Cleaning Pra:edure* 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 Game Animals* I 111 Good Hygienic Practices 5 Receiving/Condition I 2-401.11 Eating.Drinking or Using Tobacco" 3-202.11 PHFs Received at Proper Temperatures* I 2-401.12 I Discharges From the Eyes, Nose and 3-202.t5 I Package Integrity* I Mouth* 3-101.11 I Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* 6 I 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* I Tags/Rewrds:Fish Products 13 I I Handwash Facilities 3-402.11 Parasite Destruction* I I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients' I 5-204.11 I Location and Placement* 7 Conformance with Approved Procedures I 15-205.11 I Accessibility.Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria* I 6-301.11 Handwashing Cleanser,Availability 18-103.12 Conformance with Approved Procedures' I I b-301.12 Hand Drying Provision *Denotes critical tient in the federal 1999 Foal Code of 105 CMR 590.0(10. CITY OF SALEM BOARD OF HEALTH Establishment Name: "'Jf Ol Y101� �EU17�e Date: I ' T "l/ Page: of ! Item Code C—Critical Item `-J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified 1 PLEASE PRINT CLEARLY I *)vt n e rrmd I ';z<-- c- C-zi ny-1-79'a,P oil- -�'Ipn /J;m n6/ rPa rll K / 01 v/,11�2k2 All /Bart,. �/?1117; -74-0 '✓,ate /�� f'`'P/,I/7� �a�.� fv vrrr� /h �� rm a � �{-/ine or' i/t�,�l`541 1 �irY . I ✓� 5— /G� l_'/ al'-) i'hv 0GviIXi sz//rv/P-57 �h4tl_✓ Xil ZIZ I ,v /cr 7� a..L? OA- 1 �� i�Prn�t�e l/wi/Haa� . fhorrr� I 'h 1 r aftta Ohd Marl I.Wydnal �Fiozl` rle`ns S rPd iul�h ��s a 1.9PA lP/dK-G(Ved I 74 �' l7ir rr��-�r�i�l 'r_✓/S�or��.�. ,�P l��r'G fn �tGip� �_�!-��1� `tv 1�1�,�,t��'� � Discussion With Person in Charge: / j Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all L3Voluntary Compliance LiEmployee Restriction inspection, to observe all conditions as described, and to P / violations before the next ins Exclusion t comply with all mandates of the Mass/Federal Food Code. I understand that ❑ Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily finesof twenty-five do cars o suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ n��r ❑ Voluntary Disposal ❑ Other: 4 3-50: �;Ca PHPs itec.ei•;ea at'P.n:peramms Violations Related to Foodborne Illness Interventions and Risk According to[.am Co,iled to - Factors(aeras 1.22) (Cont.) aI'Fi l'i'P Within 4 Hours. PROTECTION FROM CHEMICALS 3 '•'A.IS Coolie"Mcititds for PHFs � 14 ( Food or Color Additives 19 PHF Hot ono Cold Holding ' 3-501 I6(B) Cold PIIP:.Maintained at ell below 3-2.02.12 Additives* 500,00-1,F) 41 r-}q r. 3-302.•.4 Protection from Unapproved Aldi!n'es* 3-50 i.INA) ]-lot PHFs t4ainta nei at or above tg ( Poisonous or Toxic Substances - i 4tt'F 7-101.11 Identifying information-CA i;mal :30" 3-591 }bi A) Rcast,held : Containers" - :u or,'.a+�'e '. 'z ! 120 Time as a Public Health Control 7-11,2.1 I C'oi n ion Name-Working Containers` ! 3-501.?9 Tima as a Public Health C'o:tirul* 7-201.11 Separation-Slortgc` 7-202 11 Regriction-Presence and Use 5110.004(11) Pariana; Keq.:�em^tit 7-202.12 Condition,of Use* 7-203 If Toxic Container,-Prohibitions" RFOUIREME!JTS FOR in€ow Y SUSCEPTIBLE POPULATiCNS(HSP; 7-204.11 Smnizers.Criteria-Chemicals' 7-204,12 Chemicals for Washing Produce,Criteria'` f 3-801.11 f•t) iinpasteunn:e(Pre-packaged kccec and 7-204.14 Drying Agents.Cmeria'" 8eceratzes will, 1Varning I.ahc:s° 7-205.11 Incidental Food Contact. lubricants" l ?-501.]1(13: Use of?asteurized LL- Incidental Raw of Peitially Cooked Aminal I-otxl and 7-206.11 Restricted Use Pesticides.Criteria* it.nc Seca Sprouts N•.,t Ste:Ned. 'z 7-2106,12 Rodent Bait Stations' 1 x-w.I I f::} Unu,retcd rood.Pa:.kage `Jct Re-ren-ed. a' 7-206,1+ 'h-acking Powders,Pcst Control and Monimrin0 CONSUMER ADVISORY TIMEITEMPER9TURE CONTROLS 22 3-603.:1 Co^sumer Advt;ory Posted for Consumption of Amino! """,r -ds iliat arc Rata Undercooked or 16 I Proper Cooking Temperatures for I N,q("thoiv is-- Prmes,ed to Eliminate PHFe 3-401.i 1 A(1)(2) FIT,- 1-55'F 15 Sec. Path,•gctt�..'``"`:,°". an Egos immediate Service Ii5`F15sec� I `-=`7-•13 i'astcazed FFg.;Substitute tot Raw Shell 3-401.11'A)(2) Connnznuted Fish,Meat,&Game Ani trials- I55'F 15 sec. 3-401 11(13)(1)(2) Pork and Becf Roast- 130'F 12_1 min* J SPECIAL REQUIREMENTS 3-401.1I(A)(2) Ratites,Injected Pleats- 155`17 15 590.0091A)(l)) Violations of Section 590.009(A)-(D) in sec* catering. mobile food,temporary and l 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residccltial kitchen operations should be Stuffing Containing Fish, Neat, debited under the appropriate seciious Pouitry or Ratites-165''17 15 sec ;. above if related to foodborne illness 3-401.11(C')(3) Whole-musele,Intact Beet Steaks interventions and rid, tactors. Other 145'F' 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited wider 629- Mictowave 165='17* Special Reyuiretnents. 3=101.1 I;At(1)(h) All Othet PHFs-- 145`F 15 see. 17 Reheating for Hot Holding VIOLATIONS R>:LATED TO GOOD RETAIL PRACTICES 3-403.11(4)&(17) PHFs 165`17 15 sec. :' (Items 23-34) 3-403 IUB) :Mie ruwave- 1650 F 2 Minute Standing mtnch do not relate to the Time' ,foodhnnn= and ri,skJa(tars list d above. can he 3-403.111 C) Commercially Processed RTE Foal- faun(in die(alluring scrr,ens:,f the Foo,'C ude mad 125 C')L1R 140"F" 590000. 3-403.11 i'E) Remaining Unsliced Portions of Beef 11 Item Gccd.9eta;l Practices FC 1 599.999 I Roast.* 23. flanaclenient and Personnel _FC-2 .003 18 Proper Cooling of PHFs 2a Food and Fool Piufeclicn FC-3 004 125 Equipment and Utensis FC-4 .005 R-5(H 14(.A) Cooling Cooled PIJF•s from 140`F to ( 26 Water,Plumbing and\Naste FC-5 .006 70"F Witnni 2 t-Tours and From it)'F i 27. Physical F lmhty Fi--6 AO% m 4l`FI45'F Within 4 Hours. W 1 28. Poisonous of I cxic fsls:eriala FC- ', .008 4--)01 14(13) Coolim,PHFs Made From Ambient 29. Special R3quiremonts 009 Temperature hiVedients to d["F/4i-F 30. Other - ---- - Within 4Ii 'urs` (lcnoi-•s<nucal Item in the t.deral 1049 Food('ode nr 105 CNIR 590 000 CITY OF SALEM BOARD OF HEALTH 2 Establi )rnent Name: I JYl3 l / OAlk (_1�(l��P Date: / d Page: t ) of `EY ? Item bd C-Critical nem y (� _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION DatA No. �iRevf nce R—Red Item Verified r PLEASE PRINT CLEARLY / l�lr�sf /�laS'h ha��ls S�iahs ht) hd7% I - irlar>7vhs u /'llii,7s` /',PS�y�'n�. ✓ I - I n'a�dcrp nrl 4Y��e o <' t o/J- , -- 7APM- '1�Mr/00n/ /o" /11�j '711/a c th w)�iJ�h�n�f y � %SS/j h/Z Jfad � � �71l�_vq�l/as / % r 1.7 47Y7111 +v Gv AMIc � � s G�=rpl a�4. � / I Pi-aJQ,9elcI h0-67Y1 rah hoc d'F Jtl ho t 12ii1*n and _hsW-C F I JtL�1i�f �o ho l�1�r✓� /a�d� af7d 7 7: Ih-� Discussion With Person in Charge: Corrective Actidn Regbired: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understd� at noncompliance may result in daily finesZowenit -five &ollars or si�pensi n/revocation of ❑ Embargo ❑ Emergency aosure 11 your food permit. 1 / j -:� ❑ Voluntary Disposal ❑ Other: �) uU 3--,(,:..-1(r-.) PH.1l,Recened.., Comt>eranures `J Violations Rotated to Foodborne Illness Interventions;and Risk ;ic.rrdtng to fano Cooled to Factors(items 1-22) (Cont.) 4:,F!45+`nrithin d Hnur� " j ";-501.15 Cl,ohn'?;tfcthothlbrPFIFS PROTECTION FROM CHEMICALS 9 PHF Not and Cold Holding 13 Food or Color Additives +-Sill Ib(B) Cold mnrbelow 3-202.12 Additive`' ! 590.004(f) .41145`F' 3-302.14 Pr)LCeti011 from I)uapproted Additives* ( 3-501.16(A) .lot PIIFs Maintained at or above 15 Poisonous or Toxic Substances ( ;4W 7-101.11 Identifying lnfnnnotion-Ot igmat ! 3-:101,tt,(A) Roasts Hdd at or above 1.'-.(7"F. 1- Containers Pima;as a Public Health Control 1 7-IO2 11 Common Name- tNorking Containers'" �� p , .,;.r7 1. Time as a ,u,,;;e _.. Healib Conhn': 7-01.11 Sepal ation--Stonnte* 19(1.00-lau Variance R:duir�ment 7-202 11 Restriction-Presence and Use ^_02.12 Conditions of Usa ',--203 11 Toxic Containers-Prohibitions+' Pt7FULTiOREOU€IATiONS(S(HSP) FOR HIGHLY SUSCEPTIBLE7-2(74.1 I Saniuzers,Criteri.i- Chcnncals' 7-20112 Chemicals for Washing Producc,Critetfa' ( -;_SUI.IlfA) Unpasrem;led Pre-packaged luice>and I Bevet'.tn-e.with Warning 1 ah-Is- 7-204.11 Drying al Foo.Crites ct, =.K)I I I(B) Use of Pasteurized krus, 7-205.11 Incidental Fwxl Contact. Lnbncants` : c,,31 1 I(D) Raw or r'arhaily Cooked\Hung Fo.:d and l 7-206.11 Restricted Use Pestiudes.Crite�ta* k.nv Send y;.routs \ot Sorted. ' _) 7-206.12 Rodent Bail Stauons i 3-8f.!.1;(C) Uropenetl F.rx1 Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitorin„* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisor} Posted for Couauniption of Amnml Rod-, That are Raw. Undercooked or L6 Proper Cooking Temperatures for Fs Not Otherwise Processed to Eliminate 3-401.11.41 U(2) Eggs- 155"F l.i Sec. Pathogens.'ea;..rea vseo, ggs Eggs-harnediate Svrcice 145°Fl5,ev 3-3t)-'•1-t Pasteurized Fggs Substrlote for Rev,Shell 3-401.11(A)(2) Comminuted Fi;h, Meals&GG lnte I H^gs'"•' Animals- 155F 15 see. SPECIAL REQUIREMENTS 3-401.11(B)t 1)(2) Pork and Beef Roast - 130T 121 min4, 3401.11(A)(2) Raines.Injected Meats- 155715 590.00i,'(A)-(0) V,oialionsofSection590.t)09(A)-(D)in sec. cater.ng, mobile th,.xl, temporary and 3-401 I i(A)(3) Poultry,Wild Game,Stuffed PHFs, r,_sidenGal kitchen otter&cions should lie Stuffing Containing Fish,Meat, debited inulcr thePlaopriaic sections Poral n nr Ratites-165"F 15 sec above If related to kx)dborne ilhiess 3-401.11(C)(3) Whole-muscle. Intact Beef Steaks interventions and risk factors. Other ]45°F 590.009 l"olations relating to good retail 401.12 Rain Animal F.xds Cooke,)inn I oracticec should be debitett under 1129- Mioowave 165`F* Special Requitements. 3-101.11(A)(1)(b) All Other PHF.,- i45^F 15 see, + 17 Reheating for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ;"401.11(A)&(111 PHP, 165'F 15 sec. 4` 1 1 Iteirts 23-30) 3-403.11(B) Miunwave- 165' F2 Minato Standing' I Cilwal and nor,-rridtal ciola6un', 'ae¢rh d„aor relate no the Time* foodborne:i 1:,:.rs iiaeioenlionv and nisi,tar tors k'sted abort, can be i 3-403.11(C) Commercially Processed RTE Fixxl- found in the fuliwivic, se,tion v of rite food Code'and '05 Ct/t ;-463.11(E) Reniaiumg Linshc^ed Portion,of Beef Mem Good Retail Practices FC 550.000 Roasts" 23. Mariagement::nd Fe,sornel FC-2 003 18 Proper Cooling of PHFs 24. Fooe and Foptl Protecti m FC-3 ! 004 i 25. Equipment and'Utensils FC-4 ! .005 3-501.14(A) Cooling Cooked PHN from 140"F:o j 26, Water, Plumbup and Wa•=te FC-5 .006 70'F Within 2 Hour..mid From 70`17 27. Phos:c=1 Facil;iy FC-F 007 to 41`F/45`P Within 4 Homs. 4 ( 28. Poisonous or Toxrr Matenals FC-7 .008 _ 1 3-501.14BI Cooling Pffs Made From Ambient IF_29._ Special Requirements 009 Temperature higredienis to 41"F/4i`F 30. Gthor Within 4 Hours; 1,:i„Jr, Dem,tas critical item in the!ladeoil 1999 1'00,1 C.9-.!e or 105 CMR '90 001,. 1 ' CITY OF SALEM �j�n, �I r /l BOARD OF HEALTH Z Establishment Name: J/ V ' /( , (_IQ�)y Date: I D 7 Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. • Reference R—Red Item Verified PLEASE PRINT CLEARLY , ,, c A /'hl)AV I 1 I � 1 I � 1 1 I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction I have read this report, have had the opportunity to ask questions and agree to correct all / Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I unde, a d that noncompliance may result in daily fines-of-twenty-five, ollador 4su�re sign/revocation of El ❑ Emergency closure your food permit. �� I ❑ Voluntary Disposal --- ❑ Other: 11 N sem. 350: i 11C) "Hir's Reccn Pd,-: Pemper,nuren• ` ., Violations Related to Foodborne Illness Interventions and Risk .At cored ug it)I_aw Cooled to Factors(items 1-22) (Cont.) { ,I c!71 5'F Within a Hours. ` PROTECTION FROM CHEMICALS { SUI I I Coabm=i\1,-�thcds for PHk I la Food or Color Additives I 19 i { PHF Hct and Cpld Holding 3-50;.1n(R) Cold PIiFs Maintained at of below 3:02.12 Additives" 590 001if) i 41°/*<,1 F:. 3-302.1-} Protection from lhrippnwed Additives* I I i-sol.16(A ( Hot PIi-: Maintsi izd at or abut e 115 Poisonous or Taxis Substances _ . t 7-101.11 Identifying Information-CJ:iginal ( Containers' 3-50L j 6(A) Roasts Held at of above 130'F '" ) 7-102.11 'Common Name- Working,Contairets" ( 20 Time as a Public Health Control I '-'OLI1 Separation-Stuff gee" I 3-:i01J9 Tiuiz is a Pttills Health Cumrol* { 7-202 11 Restriction --Pretence Laid Use k ( 590 I'590 ( V.::iance Requirement f 7-2(32.12 Conditions of llac" "7-203 11 Toxic Containers-Pnrhibitinns" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPU_ATIONS(HSP)7-204.11 Swtirzers,Criteria-- Chaniads'' 21 { �23-Yfi i.:IlA) 1:nT;nsr_ur,red Fto-packa,;ed James and 04.1..y ChemicalsVd for aslung Produce Criteria" 1 { 1-204.14 Drying Agents.Criteiin' I Bevcraeeswith Waining1.abels': 3-801.11(B) Use of PaSlee,i Zed E°dS'" { 7-205,11 ResIni-tricted Food Contact , .rhea tat ' ( -801 I I(D) Raw or raitiatly Cooled Anunal Food and 7-206.11 Restricted tine Pzstitules. Criteria* { I Raw Secd Spinus Sot served. :` 7-206.12 Rodent Bait Station,- j 3-e:Ul.l i(C) I Unnpencd F oixi Package Not Re-served 7-206.13 'Frackim3 Powders,Pest Control and Monitoring'" CONSUMER ADVISORY TIMEITEMPER 1TURE CONTROLS 22 3-603.11 Consumer.Ail,isory Posted for Con.uutptiun of 16 Proper Cooking Temperatures for Anunal Foods'Ffat irc Raw.Undeicsmked of { PHFs Not Uthenvir.e Pr:+cersed to Eliminate 3-401.11.4(1)(2) Eggs- 155'F 15 Sec. 'adutgrns.= "�""'v:no• Fags-htmtediate Service 145°1715aer- i-302.13 Pneteunled Fggs Substita e for Raw Shell 3-401.11(A)('2) CumminutedFish, Meats:FG:one Eggs* Animals - 155'F 15 see. 'k { 3-401.11(B)(1)(2) Pork and Reef Roast-130''F 121 min* I SPECIAL REQUIREMENTS 3101.1](A)(2) Ratites,Tnjertui Meals-155'F 15 59()1.)r9(A)-!I)) Viclat rens of Section 590.009(A)-(ll) in sec. '" ( caterin& mobile food, temporary and 3401.11(A)(3) Poultry, Wild Game,Stuffed YH)is, residential kitchen operations 4iould be Stuffing Containing Fish,Meat, debited tinder the appropriate sections POttltr}'or RatitetA65'F 15 sec. "' above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks nntervcrtions and risk factors. Other 145'F 1 590.009 violations relating to good retail 3=401.12 Raw Animal Foods Cooked in a piaetiecs shouli !)- debited nyder#29- Microwave 165^F" I Special Requirements. 3-401,1 l(AI(1)(b) All Other PHFs- 145'F 15 see. * { { 17 Reheating tot Hot Holding ( VIOLATIONS R,1ATEO TO GOOD RETAIL PP,ACTICES 3-403.11(3)&(D) PHFs 165'F 15 sec. a ( (Items 23-30) 3-403.1 I(B) Microwave- 165' F 2 Minnie Standingic<J and non-rritk.al�'udark;ns, which do nut rrlorc to the Time* foodborne illness hoereannons and risk fnnnrs:'isted above, can he 3-!03.L1tC) Commercially Processed RTE Feud- ! ibund in tnejollori.ing.rerteons uj<'he Food C'nde diol lQS!'b9k 14WF* I 51+0.000. 3-t03.11(E) RemainingUnslicedPoitionsoi'Beef I %tem Good Retail PracticesFC 590.000 { Roasts` 23. %Ianapemant anC Petsonnel FC-2 o03 24. °rod .d Paid Fiore,^^hon FC-3 004 18 Proper Cooling o4 PHFs I 25 E:wpment and tPensis FC - 4 .005 3-501.14(A) Cooling Cooked PHFs from 140`17 to { 2Bn . _ ------_..06---- Wafer,Flumbinp and tlo, r FC-5 0 70'P Within 2 Hours and From 70'F 127. Physical Fac,lity FC- 6 .007 to 41-F/45"F Within 4 Horns. " ( ( 28. Poisonous or Toinc Materials Fr -7 .008 3-501.14(B) Cooling PI-1Fs Made From Ambient 129 1 Special Reauirements 009 Temperaaue Ingredients to 41'FFt5"F 30. ! Uthei _- Within 4 Flcatrao '`rmn,F • Denim:cnn.al itc-n m the roieial 1994 Foot)Cods or 105 0R 590000, CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH pay ggg g 120 WASHINGTON STREET,4TH FLOOR e _ g wv' D SALEM, MA 01970 �` 3 TEL, 978-741-1800 DEC - 20Qg` FAX 978-745-0343 Kimberley Driscoll WWW.SALEM.COM CITY OF SAL CM Mayor JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &-A-CR,t�, rJ (geoY-G}t'"_ TEL ADDRESS OF ESTABLISHMENT 33CPTF��I�pQIJ7///� tJit,6412, FAX# MAILING ADDRESS(if different) 4a lev x`'!,14 EMAIL--Business': t Gwr.ur's OWNER'S NAME � n P� r 0 A 67 99_6 / TEL# S 'Ce t!l ADDRES ?, f Q (JC'.NN fQ fN 5glellLf OI47�Q STREET CITY r STATE , ry� ZIP p CERTIFIED FOOD MANAGER'S NAME(S) r CERTIFICATE#(S) F'wi 00OZS. (Zq r (Required in an establishment where potentially htazardl Aous food is prepared) `} J� EMERGENCY RESPONSE PERSON O [ ID c1%au Q HOME TEL#�'�„�q 0 3Q� DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday ; HOURS OF OPERATION I Please write in time of day. IForexample tlam-ffomf ? 1 T 1 7 t 7 T I I 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 25-99 seats � more than 99 seats =$200 B-ED-/-BREA- 'AS--T.. Y. .._ ......E.. N-O-.. . _. . ..... .....- .... -- -----$10--- ------ ----- -- --------- ----- -- S 0 --- ----.------------ ------ ---- I---- .... ... ..... ............_...... ...... ...... .---------------- ---- -----..........-...... - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE1 E NO $5 TOBACCO VENDOR Y S NO 0 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 62G, Section 49A, I certify under the pains and penalties of periwy that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law f! Signatw'e Date p Social Security or Federal Identification I/dentification Number --------- ------ ---� �.1 9 -------- '��L � Y'—t Y' $ --------------- ---------- ------ --- Revised 1 Ill 0,FOODAP2 07 adm Check#&Date Q4 -oaTony!ealtholfmassachusetts Rtii 4 . D Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Brother George File Number:BHF-2004-000086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0186 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT FROZEN DESSERTS BHP-2007-0200 Dec 20,2006 Dec 31,2007 $5.00 Total Fees: $155.00 PERMIT EXPIRES December 31, 2007 A 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 3 of 18 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 744-6455 PIC Assigned/Knowledgeable/Duties FAIL ❑d RED Owner:, Non-compliance with: Rogello A. Garcia PIC: Anti-Choking FAIL Roger Garcia Tobacco FAIL Inspector: John Gehan EMPLOYEE HEALTH Date Correct By: Reporting of Diseases by Food Employee and PIC FAIL ❑d RED Personnel with Infections Restricted/Excluded FAIL ❑J RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source FAIL Q RED BHP-2006-0030 Receiving/Condition FAIL Q RED Status: FULL COMPLY Tags/Records/Accuracy of Ingredient Statements FAIL RED #Of Critical Violations: Conformance with Approved Procedures/HACCP Plans FAIL ❑d RED 22 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection FAIL W RED Foodborne Illness Interventions and Risk Factors(Require Food Contact Surfaces Cleaning and Sanitizing FAIL ❑J RED immediate corrective action) Proper Adequate Handwashing FAIL RI RED Good Hygienic Practices FAIL S6 RED Prevention of Contamination from Hands FAIL d❑ RED Handwash Facilities FAIL RED PROTECTION FROM CHEMICALS Approved Food or Color Additives FAIL RED Toxic Chemicals FAIL ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures FAIL 0 RED Reheating FAIL J❑ RED Cooling FAIL RED Hot and Cold Holding FAIL RED Time As a Public Health Control FAIL RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP FAIL Q RED CONSUMER ADVISORY Posting of Consumer Advisories FAIL ❑d 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. Sep 07,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL BLUE Equipment and Utensils FAIL BLUE Water, Plumbing and Waste FAIL BLUE Physical Facility FAIL BLUE Management and Personnel FAIL BLUE Poisonous or Toxic Materials FAIL BLUE Special Requirements FAIL BLUE Other-See Notes FAIL BLUE GENERAL COMMENTS: 736:All vilations have been corrected. Owner to contact BOH when ceiling tile project is completed. i City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 07,2006 ) Page 3 of CITY OF SALEM BOARD OF HEALTH / Establishment Name: Y7'2-6Tr1-'q2 Date: 51-7/06 Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PrLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 ; I 1 I la�Zi2r�nay %D. 1 e- O�/! ( �ocl e- lw' il�i_ryTi��✓ D� j 4�'FS77_,Av 7-//5 I"/Lb� rf7 I 4z � 1 i 1 f 1 I I I sDiscussion With Person in Charge: Corrective Action Required: ElNo ElYes e 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 El Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understa dd-that noncompliance may result in daily fines of enty-five dollars of Sulso nn/io h/revocation of ❑ Embargo ❑ Emergency Closure • your food permit. /{�/f �I�� LI Voluntary Disposal 0 Other: IJ;C., PI-IFs Recei+'ed at Temnertores Violations Related to Foodborne Illness Interventions and Risk According'o t..r;. Cnolad to Factors(Items 1.22) (Cont) 4I`R4.5"F N4'irhin 4 Hour,. ' PROTECTION FROM CHEMICALS 3-:,(11.15 Coutitoz Methos for PHFs 14 Food or Color Additives 19 PHF Hat and Cold Holding 3-:il) 16'L i Cold Ptit�.\;,ttntained at or below 1 3-202.12 Additiccs" 59t)N) 4t-(15" F` 3-10114 Proteeuun from Unapproved Additives, 13.501 ItSi ) Hot %'His Maintained at or above I S Poisonous or Toxic Substances 1401' 7-i01 11 Identif)-nig Information-Original ( 3_501 J 6(. ",) Roasts Held at or above 130°P. " Container's' I 12g I Time as a Public Health Control 7-102,11 Common Namo-Workin Container." 7-2.01.11 Separation-Slorake° � I ;-5'�1.(v -'i into a Public HealthCon:uil" j 7-202,11 Resn-icilon--Presence and Use* 590.004(H) Valiance RequirrutcM 7-202.12 Condition,,of Ilse" 7-'03.1 I Toxic Containers.-Prohibition,' REOti':R POPULATiO NTS FOR HIGHLY SUSCEPTIBLE 7-204.1 I Satiitizers.Catena-Chemicals^ 'IO LS(HGP) 7-209 12 Chemicals for Washing Produce,Criteria" r l 3-801.11(A) I Unpasteun/ed Pre-packaged.luices and 7-204.11 ( y i Bcwrtaes with Waluing I abcls' ' Diving Agents,Criteria' 3-801 Il(B; Une of Pasteurized 1,caS* 7-_05.11 Incidental Food Coniae-1, Tubrteants* 3.g(;,-1.110) Row or PattiaJ:v Cocked Animal Food and 7-206.11_ Restricted Use Pesticides,Crites* Raw Secd Sprows Not Served. " 7-206.12 TracksRodenlicit vers,Pe 3-80!.I1'C) Unopercd Feed Package Not Re-scr. ed. " "l-20fi.l3 'Tracking Powders,Pes[Control and I Monitoring* CONSUMER ADVISORY 22 1-60; 11 Consumer,4d�isory Posted for i.'o❑sumption of TIME/TEMPERAP URE CONTROLS Animal Foo;i:That ate Rww.Undercooked or 16 I Proper Cooking Temperatures far I Not 0;hemisr Processed to Eliminate PHFs vr:rwr 3-101.!lA(I)(2) ( hnmedEggs- I finediatc Service Ids"F15seex It See. Pwh.)_ens T =r.,,a,= I 3.3;12.13 Pe;aeunreu Eggs Substitute for kaw Shell F,ggx- 3-401.11(A)(2) Comminuted Fish, Meat,&G,mie `hL" Animals- 155-F I5 sec * SPECIAL REQUIREMENTS ef 3-1Ul.iI(•4)(2) kantes, InjcctcdMr<its- I55"FIS 3-4o 1.11(B)(1)(2) Pork andlectRoast- 131'5I21nun'" 590.00y(A)-(D) Violations of Section 590.009(A)41)) in sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residcatia) kitchen operations should be %uffing Containing Fish,Meat, ( debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to tix>dborne illness 3-401 1 I 00) Whole-tousele,Intact Beef Sfet;ks intcrvc;itioa3 and risk cwC Drs. Other 1.15'F* 590.009 violations relating to goad retail ! 3-401.12 Rnc;Animal Foody Cooked in a acuses should he debited under 429- M;ciowave 165`F* Special Rcquitements. 3-40).11(A)(10)) All Othei PHFs- 141'F 19 rec, * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(AWD) PHFs, 165715sec. (Items 23-30) 3-403.11(13) Microwave- 165'F2 Minute Standing Ciitira7 and nun-r ritical violalrurn, which du not relate to the Time* ,?ordhnrnc ill..ass nnerventi,�to and rivk)'o(!ora li,cted db<we, (an be 3-103.1 I C) Commercially Pnx essed RTE Food- (tun(!in the jo!Lnt nr,,vcrtivrs q(the Food C'<,de acrd 105 CbIR 5(;0J)09. 3-}03.1 I(E) Retraining Unsliced Portions of Beef I i Item Good Goed Retail Practices FC 590.000 Ro:nsts, 23. _ - wana emem and Percrnnei FC-2 .003 fg Proper Gaoling of PHFs 124, Food and Food Protect on FC-3 004 4-501 14kA) ChCooked PHF,,from 140`F to 25. .qu'pment and Utensrs FC--4 .005o5 (` r cxrnv- 26 'iVatei Rumbinq and l°last; FC--5 .005 70'F Within 2 Hours and From 70"5 127 Physical Faci:sly FC-o .007 to 41`F/45'F Within 4 Hours I 28. Poisonous or Try Ma?eria!s FC - 7 .00E----_---_I 3-501.14(B) C,of in.,,PHFs Made From Ambient 3. Special RCgrIFemB^ts I -Dori Tempeiature Ingredients to 41`T/45"g 30, Other 1 Within 4 Hours: ' Denot< crmcal item m the C�lam: !094 Foot Code or 105 CNitt 590 WO 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 744-6455 PIC Assigned/Knowledgeable/Duties PASS RED Owner: Non-compliance with: Rogelio A. Garcia Anti-Choking PASS PIC: Roger Garcia Tobacco PASS Inspector: .john Gehan EMPLOYEE HEALTH Date Correct By: Reporting of Diseases by Food Employee and PIC PASSJ❑ RED I8?24&60� I Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS ❑./ RED BHP-2006-0030 Receiving/Condition PASSd❑ RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS [] RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS [ RED 2 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. Aug 25,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related t0 Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS W RED Toxic Chemicals PASS U RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑J RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS j] RED Time As a Public Health Control PASS D RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS I] 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. Aug 25,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE � Comments: Bacon thawing out at room temperature. All frozen foods to be thawed under running water or in a refrigerator at 41"F or below. i Equipment and U ils FAIL Critical BLUE ments:Hussman Freezer requires thorough cleaning. helves in kitchen require general cleaning. Iftneath cutting board requires general cleaning. �p tired incorrectly. Mop to be hung to allow to air dry. ,,�est strips available at time of inspection. Test strips to be readily available at all times. unitizing log not up to date. Log to be maintained daily. cning of silver king milk dispenser required. unit being used must be running correctly or discarded. ream unit that is not running,must be running properly or discarded. ntire ice cream area requires general cleaning. L ice cream freezers require thorough cleaning. L joa-'cream freezers must have thermometer that are visible and accurate. �Zbrea requires general cleaning. ce scoop stored directly on ice. Ice scoop to be stored with handle outside of ice or in a labled container stating ice scoop only. uice Idairy refrigerator requires visible and accuratew thermometer. Water,Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE L'"ments:Walls of storage room require thorough cleaning. .!Floor beneath ice cream cash machine requires thorough cleaning. Many water stained ceiling tiles in establishment. Tiles were to be replaced by this routine. This is a repeat violation. A monetary citation may be issued. 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. Aug 25,2006 ) Page 3 of 4 Item Status Violation Critical Urgency fl5gged drain on floor in ice cream area. Repair drain to working order. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: \' 738:Owner to fax over 3 months of extermination reports to Board of Health. 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. Aug 25,2006 ) Page 4 of Brother Georoe City Of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Violations Related to Good Retail Practices Address: (Blue Items) Food and Food Protection FAIL Critical BLUE Telephone: 744-6455 COMMENTS: Bacon thawing out at room temperature. All frozen foods to be thawed Owner: Rogelio A. Garcia under running water or in a refrigerator at 41OF or below. PIC: Roger Garcia Inspector: John Gehan Date: 8/24/06 Risk Level: Equipment and Utensils FAIL Critical BLUE 1 HACCP: No COMMENTS: Hussman Freezer requires thorough cleaning. Correct By: 9/7/06 All Shelves in kitchen require general cleaning. Permit Number: BHP-2006-0030 Status: VIOLATION Beneath cutting board requires general cleaning. #of Critical Violations: 2 IMop stored incorrectly. Mop to be hung to allow to air dry. No test strips available at time of inspection. Test strips to be readily available at all Time IN: OUT: times. Urgency Description(s): sanitizing log not up to date. Log to be maintained daily. BLUE: Violations Related to Good Retail General cleaning of silver king milk dispenser required. Practices (Critical violations must be corrected immediately or within 10 Milk unit being used must be running correctly or discarded. days)(Non-critical violations must be City of Salem Board of Health 120 Washington Street,4th Fluor SALEM MA 01970 (978)741-1800 GeorMS®2005 Des Leaders Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 1 Brother Georoe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency corrected immediately or within 90 Ice cream unit that is not running, must be running properly or discarded. days) RED: Entire ice cream area requires general cleaning. Violations Related to Foodbome Illness Interventions and Risk Factors ALL ice cream freezers require thorough cleaning. (Require immediate corrective action) Ice cream freezers must have thermometer that are visible and accurate. Coffee area requires general cleaning. Ice scoop stored directly on ice. Ice scoop to be stored with handle outside of ice or in a labled container stating ice scoop only. Juice/dairy refrigerator requires visible and accuratew thermometer. Physical Facility FAIL BLUE COMMENTS: Walls of storage room require thorough cleaning. Floor beneath ice cream cash machine requires thorough cleaning. Many water stained ceiling tiles In establishment. Tiles were to be replaced by this routine. This is a repeat violation. A monetary citation may be issued. City of Salem Board of HeaBL 120 Washington Street,4th Floor SALEM MA 01970 (978)741-1800 GeOTM54D 2005 Deb Lauders Municipal SOhd)ons.Ina COMMONWEALTH OF MASSACHUSETTS Page 2 Brother Genroe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Clogged drain on floor in ice cream area. Repair drain to working order. GENERAL COMMENTS: Owner to fax over 3 months of extermination reports to Board of Health. Inspector Signature PIC Signature City of Salem Board of""Ith 110 Washington Street,4th Floor SALEM MA 01970 (978)741-1800 Geo7Ms6100S One Lauriers Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 3 FROM PHONE NO. Aug. 26 1998 01:39AM P1 03i V2006 14:21 iHllj9:/bol rat ani Wurwiunu �� Al A-t Exterminators Div Control professlonel5 d M=h 30,2006 Brother George's&Pulao Dairy Ann.: Chuck Puleo 376 Highland Avenue Salem,MA 01970 Desr .Mr.Pulco: The following is a ropy of the work order for the service rendered on 1 i 28105. TIS( services for January and February 2006 were missed due to an error on he part of k 1 �tterminators. The regular monthly service is due to be pet&rmed the third Friday of every month If you should have any questions or comments,please feel free to contact.)w office. Sincerely. 44wardoriona ' Service Maw r 183 Shapero Sheet gym MA 01902-4597 7611992.2131 B00-8254826 7V.W2.764i cox I FROM PHONE NO. Aug. 26 1998 01:39AM P2 Dd/d0/[Oth16 FLUtpd�f71�f1�I}DctlU57n04: .++ ��•�� ^��w ..•� .• ��os1 lass" Lhid,llAa PLEASE -46101t ,�1 p0e�en INV®ME RO.1101310 Lyn 1,MA O1BOy0310 , �T7t 1 PAXM01 teo1 Pest e00 Tvirks co"I PTOTeammale 220123 CURRENT + ;ppAYS en DAYS eD DAY$ haer n*! oen " •• b02b c._e:.aa•w .1 c..,v.w��i� . 00971118 Fri i@1 11/18/0'x, BROTHER GEORGE•S RESTAURANT CCN=gL poq REGULAR PEST --f1WRVL 40. 0 375 HLGHLANO AVENUE SALEM MA01976 Numgo UNrrPRoe ANOUNT MOUee OLPp 1374. 744-6455 �09/30/0 'DG30 -10700AtR MULTI CTMP T .—.�/ -- DATE PROn CTA CHECK NOFRUIT^TA LP COMMCNTS — (] no MC ❑N (a SA D16CCVER PAT Ol1JE BD INSPECT/TREAT AS NEEDED ACCT s --'-� EXP XXDATE IALEA TM 0.0.0.0 Gm❑ A/OO ••OTAL DUE ••OTµAM00NT10 DIRECTION& ANOELO/CHIUCIC ENr!RE DLDD MUST CI)l,I..C:CT CGt7 t'N fel-L `3. RViG CF NOT THERE/6G DACa, !,.ro -..Y< IUT /t-I ADDITHMAI COMMENT& cOMMERC14l4AMTmoNREPORT - (.L O O . Ceuntw SlPirwr—Clem ................... ❑ r� Drat AroM—Clem ............. .......... a Drat Ale"— cern............. ....... ❑ L7 OiNnq Arose-01mm ......... ............. ❑ Q Employee AReM-CTed ....... 13 Q - LPakR Area-Clean ........•...... ....... Ll O RESIDENTIAL WAWA NTY SIPORMOITON 51ore5e Aron-Oryrnlsad .......... C� fl DAtILU•G TYPE WARRANTY YEA❑ NO 0 I FeRNq 0 3 FDmIH O 30 Dgys ❑ 8000 ❑ 2 Femlly C1 R pemuY ❑ BO DRys L1 8= O RMSON POR NO WARRANTY •Panint renis reDuestoa....._......................_..-........- _........................ POST APPLICATION RBLIDIRING •Poo,mnlwon.-.................................. ................................................. C7 NteaSeMbohroom raemmanot ,o.�•w ........,,L7 ftORDU p y VE MURT 0 TILATE 1 EATED A EA NDYRed -00maflurl't""I wepmw......................._..,_................ .......... ....nx R&OROUBNLY 0NOTALOWADU ARlA aOROTNEY ON ........,•,___•.•,'.•„ ..__................0 RREATEO UN Do NDT AL`Ow ADULmfp40REN.OR PETO ON •Rodem pTpaOnp nw0ea.................... LJ TREATED BURFACsr UNTI`DRV F .Qthy CONTRACTING ENTITIES Da mnseACHuserT$DER•RTwgrtDFR000aADRcuLTUReePaenuDE nNe OWS PRftRtAUfA TO AAAPTRU C44 De@-•TMCAeDV!aBlI11DCRLA6 BEEN 3A71EEA4TOSILY COM/B]LQETED--- 1.STOMffi f I / / 1 0 I �NO, SEE REVERSE EIDR FOR PERTINENT INFORMATION YMne-OR.w Geon oe Ar,-Owkrne.20” NA-RmMente Cow FROM PHONE NO. : Aug. 26 1998 01:40AM P3 Ad Exterminators '®0`�®��C PLEASE REMIT PAYMENT'-O: 783 SHEPARD STREET,LYNN.MA 01902-4597 INVOICE C P.O.Box 310 Lynn,MA 01903 0310 • 761.592-2731 1-800-525-4825 FAX 761.592.7641 ir1L�d7 CURRENT ( 300AYS ' iU GAYS ( 900aV$ Pest and T¢nnite Control PrOteSS10naIS w DATE DAY T Pi, DATE t-te ACCT NO `"`.cl[. r.nr• • f'••-.•l.Y;C�p. r Qe{D2 Vr;,l? Fri 1411. L :',i'! iiJif; 6'.C1tHT::r GE'i;F"tCdii' `,: RE-SS'TFjuRfIN-F CONTROLFOR Rplit.AR PETS-t CC)NiROL- 276 HIGH',,alv!) ,')V'=Niff' HAVICE.C)iA GR NLMBER UNITPRICE AMOUNT S`I: F.M IIIA 019701 MOUSEGLBD 970 744-6455 1 : /c_'!?105 Q6,?0 0700AM Cl MULTI-CT TRAP __ r DATE �• PROTECTA CHECK NO- PROTECI'A LP COMMENTS --� RTU MT STA ❑MC O VISA D DISCOVER RAT GLUE BD INSPF.C1'/TREA1- f)r; NEEDED v' ACCT.0 �ql -- ,A'�.' WIA'dDl✓ EXP DATE -- }( SALES TAX I I OeklNik IL,RQGM A'4\6• %,"r_- C.ODp GHGO NrC❑ TOTAL DUE '^ % TOTAL,AMOUNTPD - Sw,j, U V/Q C {e6LAAeA q4 bi �; tiro 2La co0F ;.Aj ,s 'o ff be cfecv �1Al.Q T ADDRIONAL COMMENTS . pno�plea�S , R-PbAI fP.J� . \ 1iN+ o W� ASX .1 011Te.A TA(A., (�vL I h q� P vac% rI,/t, �N PS. . ,.AN) U S l "41 u cAje /`O"— .. COMMERCIAL SANITATION REPORT 1 Floorai ...Cl Clean VES NO ...................... n , Countilt Surfaces— ean . . . Drain Areae—Clean .. .. D , D c..._❑ Rest Rooms—Clean ........................ p.l.., D iF " Dining Areas—Clean ....................... D. D Employee Areas—Clean .................... D D &1. Locker Areas—Clean ......... ... ......... 'd' Storage Areas—Organized O , . RE31DEN71ALWARRAa1TY INFORMATION- Storage D DWELLING TYPE ` WARRANTY YES NOD .y Comments T Faintly, Q 3 Family, Q 30 Days. :1 80 Days O 2 Far* Q— 6 Family D 00 Days 11 6 Mas. CT REASON:FOR NO WARRANTY •Penial sewlee req uested........,..................... ................................. ..... .. ..Q POST APPLICATION REQUIREMENTS •?oon aeriiTetion...............................................•......•..., ..........•..............� •KRGhen/bathroom cab.nets not prepared OCCUPIED AREAS MUST BE VACATED FOR HOURS. . ...... .. ...................... .. THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE •Clasel5lfuntiture not plepaEed........................ ... ............. . ....� REOCCOPIEO.DO NOT ALLOW ADULTS.CHILDREN.OR PETS ON •Rodent proofing neededl. .................................12 TREATED SURFACES UNTIL,DRY -Other ' CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD'9'AGRICULTUAR'$PESTICIDE I TIME IN ^.UREAU CONS;;MEP,SHEETS,WRITTEN STATEMENTS.POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 DAYS PRIOR TO APPLICATIgN;1ME.THE ABOVE SERVICE NAS BEEN SAT3FACTORI4,YCOMPLETED. Wao-1 n OUVO Eft?QNATVRE H NAlT1RE ;' �•(;�- , —1_T. 4) ;''• vF� 1-tGie�/`' .: Y�... r, Oak OC/COCC CTnTG cno OCOTIAICUT IHC/fOMATI/N.1 WhIIA—Mnrn r.^m, ...u...L, ' 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: _ PROTECTION FROM CONTAMINATION 744-6455 Handwash Facilities PASSJ❑ RED Owner. Violations Related to Good Retail Practices (Blue Items) Rogelio A. Garcia Food and Food Protection PASS BLUE PIC: Roger Garcia Equipment and Utensils PASS BLUE Inspector John Gehan Physical Facility FAIL BLUE Date Inspected: Correct By: Comments:Water damage on ceiling tiles in mens restroom. Find source of leak and have repaired. Replace any stained tiles. 3/21/2006 Repair and replace any ceiling tiles that have been water damaged from the past. Repair any leaks causing damage. Risk Level: Owner to repair any water damage around skylights throughout establishments. Owner to find source of leaks and repair by next routine inspection. Permit Number: Owner states materials to repair tiles are coming in on 3129106. All tiles to be replaced or repaired by next routine inspection. BHP-2006-0030 GENERAL COMMENTS: Status: Open .. 537:All violations from 3/21/06 inspection have been corrected unless noted. #of Critical Violations: Owner to fax over to Board of Health last three months of extermination reports. Owner states they are having 0 difficulties with exterminator. Owner to pursue other options immediately. 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. Mar 29,2006 ) Page / of2 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 29,2006 ) Page 2 oft 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone. FOOD PROTECTION MANAGEMENT 744-6455 - PIC Assigned/Knowledgeable/Duties PASSd❑ RED Owner Non-compliance with: Rogelio A. Garcia Anti-choking PASS PIC Roger Garcia Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Inspected' Correct By: Reporting of Diseases by Food Employee and PIC PASS 0 RED 3/21/2006 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level:. FOOD FROM APPROVED SOURCE Permit Number. Food and Water from Approved Source PASS Q RED BHP-2006-0030 Receiving/Condition PASS RED Status: Open Tags/Records/Accuracy of Ingredient Statements PASS RED At of Critical Violations. Conformance with Approved Procedures/HACCP Plans PASS RED 3 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. Mar 21,2006 ) Page I of Item Status Violation Critical Urgency RED'" PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑d RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑Q RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL 0 RED •-✓ Comments: Hand wash sink in kitchen obstructed. Keep hand wash sinks clear and accesible at all times. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS ❑o 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 ❑Q 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. Mar 21,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comments:Spinach stored on floor in kitchen. All foods must be stored 6-8 inches off of the ground. Equipment and Utensils FAIL Critical BLUE Comments: Microwave in kitchen requires thorough cleaning. 0<6`ssman Freezer/Refrigerator requires thorough cleaning. ynussman Freezer holding at 11°-22°F. Freezer must be holding at 0°F or below as mandated. Repair unit to hold proper temperatures. �-�Silver King Milk dispensers requires thorough cleaning. ce cream units require thorough cleaning. L,We cream unit by front entrance had broken door. Repair door to working order. L Mfr and Juice refrigerator requires thorough cleaning. tiadk',Refrigerator requires general cleaning. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE Comments:Water damage on ceiling tiles in mens restroom. Find source of leak and have repaired. Replace any stained tiles. Repiar and replace any ceiling tiles that have been water damaged from the past. Repair any leaks causing damage. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 532: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Mar 21,2006 ) Page 3 ofd ' Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800II 4 GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 21,2006 ) Page 4 of -�- � ��o� -- -� v�s�ons° CabvU��r3�� — lice ��-�_� � -- — 1 _ I ___. __ _-_ _ I I� _ f -_ -_ ____ _ -- __--___ _' I ____--_.-_ - __ � .-_ __ -�-____ _ � _- _ _ _ _ _ -_'t___ __ _ __- _ _ � ;wV 3� 5 L ,t. i ("gssea Awa Y 1moni j _ 376 HIGHLAND AVENUE, Since/928 SALEM, MA 0 1 970-1 744 TELEPHONE (978)744-6455 Breakfast serve €U Noon Monday thru Friday Good Morning `till 2P.M. Saturday & Sunday Eggs Special Omelets 1-egg (any style)- $1.95 Veggie (mushroom, onion,pepper, 2-eggs (any style)- $2.70 Tomato ) - $4.45 1 egg with bacon, sausage, or ham Western (ham & onion)- $4.60 - $3.15 Denver (ham, onion, pepper) - $4.85 2 eggs with bacon, sausage, or ham Mexican (salsa, cheddar cheese)- $5.50 - $3.70 Spanish (saut6ed onions, mushrooms, (homefries& toast served with above tom.,pimlentos) $5.50 orders) Homemade Corned beef hash (homef ies &toast served with with 1 egg- $3:75 above orders) 2 eggs- $3.95 Egg Beaters on above Omelets additional Fried egg sandwich- $1.95 $1.00 Fried egg sandwich with bacon or ham-$2.60 Eaas Benedict - $5.50 Puleo's Breakfast Sandwich- $2.60 (egg, meat of your choice & cheese on a bagel) French Toast & Pancakes French toast- 2 slices- $3.35 Additional slice of cheese with order- 3 slices - $3.85 .30 per slice French toast with bacon, ham or Additional egg with any order-.45 sausage 2 slices - $4.35 Egg Beaters with any of the above, .35 per egg 3 slices -$4.85 French toast made with EggBeaters Omelets 2 slices - $3.60 - 3slices - $4.15 Plain -3 Egg omelet $3.00 French toast made with Egg Beaters, Egg Beater-$3.75 bacon, ham or sausage - 2 slices- $4.60 3 slices -$5.35 ADD- American, Cheddar, Swiss, Butter milk Pancakes - Full - $3.35 Muenster Cheese Tomato, pepper, % order- $2.70 onion, mushroom -.50 Der item Blueberry/Choc. Chip Pancakes Meats - Bacon, Sausage, Canadian Full Order-$4.35 % order-$3.35 bacon, Ham or Hash - $1.25 Der item Waffles - (served Sat. & Sun.)-$3.35 Our Sausage is precooked before we grill it! Add any toppings on any of the above-$.75 per We do not cook Vegetables unless specified. topping 1102 Public Health Safetv_Advisorv_ Raw or undercooked food can be ----------- - ---- -------------- -------------- hazardous to your health.( "rare" hamburger or egga ordered undercooked). es Small A La Carte Beveraa- Large Orange Juice $1.05 $1.50 English Muffin - .85 Apple Juice Fresh Baked Assorted Muffins — 1.15 Tomato Juice Bagels— Plain or'Assorted Grapefruit Juice With butter— 1.10— Cream Cheese Grapefruit Cocktail - .35 extra Iced Tea — Iced Coffee Toast—White, Wheat, Soda — Coke, Diet Coke, Sprite, Orange Pumpernickel, or Rye -.85 & Root Beer Milk Assorted Cold Cereals - $1.35 Chocolate Milk - Hot Oatmeal - $1.50 Hot Chocolate - $1.20 Tea - .95 Side Orders Decaf Tea — .95 Home Fries - $1.45 Coffee - $1.10 (with 1 refill) Sausage/Bacon/Ham - $2.10 Flavored Coffee - $1.20 Homemade Corned Beef Hash -$2.50 Canadian Bacon - $2.10 Ric s - $1.30 - $1.80 Raspberry Lime Raspberry & Lime Bevond Breakfast---------------- SOUP Cup - $1.65 Bowl -$2.50 Salad Dressinas Chowder ( Thurs. & Friday ) Garden - $2.95 Italian 'h salad - $1.95 Creamy Italian Cup - $2.25 Bowl - $2.95 Chef- $5.75 Blue Cheese Russian Low Cal Ranch Side Orders French Fries $1.85 Cole Slaw $1.50 Chicken Fingers $3.70 1/02 f J - Gourmet Sandwiches Club Sandwiches Your choice of bread (Choice of bread &French Fries) Served with pickles and Potato Chips Turkey- $5.75 1) Roast Beef, Cole Slaw, Swiss Tuna - $5.75 Cheese & Russian Dressing - $4.75 Ham - $5.75 2) Ham, Lettuce, Tomato & Cheddar Chicken Salad -$5.75 Cheese - $4.50 Roast Beef- $5.75 3) Roast Beef, Lettuce, Tomato & Blue k Hamburger- $5.50 Cheese Dressing - $4.50 Cheeseburger- $5.75 4) Chicken Salad, Sliced Apples & B.L.T. Club - $5.50 Muenster Cheese - $4.75 5) Sliced Turkey Breast, Lettuce, Muenster Cheese & Cranberry Children's Menu (12 and under) Sauce - $4.50 Served with French Fries and 6) Tuna Salad, Onion, Tomato, Lettuce Beverage - $3.75 - $4.50 Choice of: 7) Rueben, Lean Corned Beef, Swiss Peanut butter& Jelly Cheese, Russian Dressing & Sour Grilled Cheese Kraut - $4.95 Hot Dog Chicken Fingers (Substitute French Fries for Chips -.60 extra) Hamburger From The Grill Cheeseburger Hamburger 1/41b. 100% Beef- $2.50 Cheese Burger 1/41b. 100% Beef Heart Smart Foods with American Cheese - $2.60 (Lettuce& Tomato on above Burgers-.25 Fat Free extra) Grilled Cheese - $2.25 Smart Dogs-Soy Franks $2.10 with tomato - $2.45 Grilled Ham, & Cheese -$2.85 Low Fat with tomato - $2.95 Western Sandwich - $2.95 Boca Burger-Soy Protein $2.90 Eastern Sandwich - $2.85 (70%less fat than a beef burger) Grilled Hot Dog - $1.90 Gardenburger-Soy Protein $2.90 B.L.T. - $2.95 (vegan, 98%fat free) Chicken Finger Plate, served with (No chips included with above French Fries -$5.75 orders. Lettuce,tomato or chips with above burgers .25 extra) Deluxe Buraers Boca Breakfast Links-Soy Protein 1/31b. Burger served on a Bulkie Roll with $2.10 Lettuce, Tomato and French-Fries (2 links, 65% less fat than a sausage link) Hamburger - $4.50 Cheese Burger - $4.75 Bacon Cheeseburger- $5.20 Public Safetv Advisory Raw or undercooked food can be 1/02 hazardous to your health, ("rare" hamburger or eggs ordered undercooked). r Ice Cream Cone or Cuo Child's -$2.00 Small - $2.65 Large -$3.10 1 scoop 2 scoops 3 scoops Jimmies&Nuts-AO extra Hard Frozen Yoaurt Small -$2.70 Large -$3.15 Sugar Free Ice Cream 1 scoop 2 scoops Milk Shakes - $2.40 Freezes - $4.00 No Fat Frappe $3.95 Frappe - $3.80 Ice Cream Soda - $3.30 Skimmed milk and Malts - $4.00 Plain Soda - $2.50 non-fat Yogurt Frappe Float - $4.20 Tonic Float - $3.35 Sugar Free Frappe $3.95 (no syrup added) Ice Cream Sundaes Junior - $3.95 Jumbo - $4.50 Any flavor ice cream, topped with your choice of one topping — Hot Fudge, Strawberries, Pineapple, Hot Butterscotch or Cold Chocolate. Topped with Fresh Whipped Cream or marshmallow. Topped with nuts or Jimmies and a Cherry. Banana Boat Junior - $4.95 Jumbo - $5.85 One split Banana, 3 scoops of your choice of Ice Cream, topped with Strawberries, Crushed Pineapple, Hot Fudge, or Hot Butterscotch covered with Fresh Whipped Cream or marshmallow. Topped with Nuts or Jimmies and a Cherry. Ice Cream Flavors Vanilla Fresh Fruit Banana Hard Yoa_urt Chocolate MochaChocolate Chip Vanilla Strawberry Pistachio Almond Chocolate Coffee Butter Crunch Coffee Chocolate Walnut Fudge Mint Chocolate Chip Strawberry Vanilla Chocolate Chip Oreo Cookie Red Raspberry Peanut Butter Vanilla M&M Apple Strudel Black Raspberry French Vanilla Cookie Dough Suu_arless Ice Cream Honey Grapenut Cappuccino Vanilla Frozen Pudding Chocolate Mocha Heath Bar Sherbert Coffee Maple Walnut Orange Maple Walnut Lemon Strawberry Watermelon .... Raspberry and seasonal special flavors ToDDinas ( .75 perserving ) Peanut Butter Raspberry Blueberry Marshmallow City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Brother George File Number:BHF-2004-0086 376 Highland Avenue Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions Notes FOOD SERVICE BHP-2006-0030 Jan 2,2006 Dec 31,2006 $150.00 ESTABLISHMENT FROZEN DESSERTS BHP-2006-0031 Jan 2,2006 Dec 31,2006 $5.00 Total Fees: $155.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 26 CITY OF SALEM, MASSACHUSETTS �� BOARD OF HEALTH 1p j 120 WASHINGTON STREET, 4TH FLOOR Ill lll��111666 SALEM, MA 01970 QEC 2 2005 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. 1978-745-0343 F SALEM MAYOR WWW.SALEM.COM CIT( OF JOANNE SCOTT, MPH, RS, CHO BOARD HEALTH AGENT 2006 APPLICATION FOR PERrIT TO OPERATE A FOOD ESTABLISHMENT / e NAME OF ESTABLISHMENT L�Y(7�r 1 Z?$� 1neD�Ci P� TEL# 1��1 ADDRESS OF ESTABLISHMENT t� Q� f C�.�('�1 ave., MAILING ADDRESS (if different) B/� - e OWNER'S NAME ( UID /� "IF.III�GA TEL# -Z 5 / ADDRESS .5 CJI Goedon z5 CITY LL11U N STATE (�\ t4. zip F) 1 cl 06 CERTIFIED FOODIMANAGER'S NAME(S)_6p7 C110 &gjLUq CERTIFICATE#(s) 00 (required in an establishment where potentially hazardous food is prepared.) Zq EMERGENCY RESPONSE PERSO ZU I1 O rulci FI M TEL# 0 00 HOURS OF OPERATION: Mon. Tue.�Wed. Thu 1l'�( Fr �Sat. - Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -------------------------------------------.....-------------------------------_------ RESTAURANT YES NO less than 25 seats 25-99 seats , 15 more than 99 seats =$200 - - - -- ---------------------------------------------.-....------------------------------------------------------ BED/BREAKFAST YES NO $100 --- ----------- ------------ ------------------------------------------------------------------------------------......------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE ES N:(��d—() $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chap er 62C, c ion 49A, I certify under the pains and penalties of perjury that I, to my best k edge and belief ave f' �l tate tax r/eturn�s and paid all state taxes required under the law. I /��a/OS bZ(D -- `�0 ^x (41 Ign t e Dale ' Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03105 FOODAP2 adm Check#&Date /3013 /d-G-BS �/S5� F a 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Non-compliance with: 744-6455 Anti-Choking PASS OwnerTobacco PASS George Christofor PIC: FOOD PROTECTION MANAGEMENT Roger Garcia PIC Assigned/Knowledgeable/Duties PASS ❑J RED Inspector: EMPLOYEE HEALTH David Greenbaum Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 11/15/2005 : Personnel with Infections Restricted/Excluded PASS 0 RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0349 Receiving/Condition PASS Q RED Status: VIOLATION Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS 0 RED 4 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 15,2005 ) Page / of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑d RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing 9 FAIL Critical ❑d RED immediate corrective action) Comments:The cutting board is stained and scored. Resurface or replace the cutting board. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities V FAIL Critical RED \,/Comments:The kitchen and counter handwash sinks found obstructed. Keep handwash sinks clear and accessible at all times. ✓There is no hot water at any handwash sink. Restore hot water to all handwash sinks to be maintained at all times. /The kitchen handwash sink missing soap. Provide soap at the kitchen handwash sink at all times. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASSd❑ RED Toxic Chemicals PASSd❑ RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑d RED Reheating PASS ❑d RED Cooling PASS ❑Q RED Hot and Cold Holding ✓ FAIL Critical ❑v' RED Comments: Eggs stored at room temperature. Store all potentially hazardous foods at a temperature of 41°F or below. Time As a Public Health Control PASS 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Nov 15,2005 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection FAIL Critical BLUE Comments: Potatoes stored on kitchen floor. Store all food at least 6-8 inches off the floor. Equipment and Utensils FAIL Non-Critical BLUE Comments: The milk cooler needs a visible accurate thermometer. V The microwave needs a thorough cleaning. yThe ice cream freezers need a thorough cleaning. vClean the ledge by the window. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 369:Reinspection in one week, all items to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 15,2005 ) Page 3 of 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 744-6455 _ PIC Assigned/Knowledgeable/Duties PASS 0 RED Owner: Non-compliance with: Rogelio A. Garcia Anti-Choking PASS PIC: Roger Garcia Tobacco PASS Inspector: EMPLOYEE HEALTH David Greenbaum Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 11/22/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS 0 RED BHP-2005-0349 Receiving/Condition PASS RED Status: Status: OFF Tags/Records/Accuracy of Ingredient Statements PASS 0 RED SIGNED#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 GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 23,2005 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS Q RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED immediate corrective action) Comments: Cutting board is stained and scored. Resurface or replace the cutting board. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS Q RED Toxic Chemicals PASS F/I RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS Q RED Reheating PASS 0 RED Cooling PASS 0 RED Hot and Cold Holding PASS ❑% RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS Q RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Nov 23,2005 ) Page 2 of 3' 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 Comments: Provide a protective cover on the milk cooler light. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 377:AII other violations cited in the 11/15/05 inspection report have been corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 23,2005 ) Page 3 of a IMPORTAW MESSAGE 1 JL~"� _ ) FOR ✓1�:� U DATF �� y TIME M 214n 1040 OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOBIl F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL 11 WILL FAX TO YOU MESSAGE CZ742 I pp 11 JJ / / D SIGNED / -tIfOC FOR f1009 FOREIIIWWW U S A NOTES r � ( IMPORTANT-MESSAGE ) FOR DATE �9�` 7'-D.T TIMER M.M. OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOEIII F AREA CODE NUMBER TIME TO CALL TELEPHONED jPLEASE CALL WANTS AGAIN ANTS TO SEE YOU RUSH CAME TO SEE YOU I WILL RETURNED YOUR/CCAA'`�L WILL FAX TO YOU MESSAGE / ¢ / fORM SIGNED 09 + 9%1 s MADE IN U.S.A. NOTES ( IMPORTANT MESSAGE ) FOR —� DATE TIME �4P Vf� OFM � 7PNE :!: AREA CODE NUMBER EXTENSION O FAX ❑ MOBII F AREA CODE MCIMBER TIME TO CALL TELEPHONED PLEASE CALL HCAE S O SEESEE OYOU�� RU RETURNED AGAIN ' RETURNED YOUR CALL 1 () WILL FAX TO YOU MESSAGE/)!*-eA-v of-2,Y/� ,AV— � (� \ t 0� SIGNED FORM 40 ��■��RRR MAGE IN lJ. A �I NOTES i b(i 0101 CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 __FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: Food Service Name of Establishment: Brother Georgds Address of Establishment: 376 Highland Avenue Owner's Name: Rogelio A. Garcia Restrictions: Application Date: 3/17/05 Permit for Food Establishment 286-05 Frozen Desserts/Ice Cream 012-05 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. (40-0- HEALTH AGENT I J CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 9{ 120 WASHINGTON STREET, 4TH FLOOR s SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION nFOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT LOY'Ot"1 / ey /r0e_o/Yg2S . TEL ADDRESS OF ESTABLISHMENT .3�� f I I (aY1 �/�I/UD (U(I�eU U� _-)AAJ 1_ 414 ofq}o_ ( �_Cty MAILING ADDRESS (if different) /� So ni L OWNER'SNAME �noodi C7 A, r AR.6ck TEL ADDRESS_690 605'70x1 5 CITY LUAU N STATE ZIP 0190s— CERTIFIED j90s— CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON `U'll) (DQ�C( I HOME TEL#`tboy 3U0 � . Lw,n !w 7—S HOURS OF OPERATION: Mon.—Tue.—Wed.—Thu.—Fri.—Sat.—Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO / less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 eD more than 10,000sq ft. =$250 RESTAURANT YES NO less than 25 seats = 00 25-99 seats =$150 more than 99 seats 200 BED/BREAKFAST YES NO, $100 0 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and p id all state taxes required under the law. 0-2 c0 - 7f — ir„ z(� Signature�FOODAP2.adA- Date Social Security -- Federal Identification Number Revised 11103 Check#&Date 'Z J-(q -OS- Do�t Ctvd. � pws 1nod boa ( � ) Ckh 6Y) - - J uu� � r^ _ .s t �- f } � ��,��• 1 f_ �� 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-6455 Non-compliance with: Done Owner: Anti-Choking PASS ❑ George Christofor Tobacco PASS ❑ PIC: *4 - FOOD PROTECTION MANAGEMENT Done Roger Garcia PIC Assigned/Knowledgeable/Duties PASS ❑d RED Inspector: Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 3/10/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level FOOD FROM APPROVED SOURCE Done Permit Number: - Food and Water from Approved Source PASS RED BHP-2005-0349 Receiving/Condition PASSr❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations: . . plans PROTECTION FROM CONTAMINATION Done Time IN. Time OUT. Separation/Segregation/Protection PASS ❑d RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS ❑J RED 17. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑J RED BLUE: prevention of Contamination from Hands PASS ❑�/ RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASS RED violations must be corrected immediately or within 10 days)(Non-critical violations GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Paze I oft 376 Highland Avenue Brother George must be corrected immediately PROTECTION FROM CHEMICALS Done or Within 90 days) _ Approved Food or Color Additives PASS RED RED: Violations Related to Toxic Chemicals PASS ❑Q RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS ❑�/ RED Cooling PASS ❑J RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE 47- 4 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev Mar 17,2005 ) Page 2 oft 376 Highland Avenue Brother George City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-6455 Non-compliance with: Done Owner: Anti-Choking PASS ❑ George Christofor Tobacco PASS ❑ PIC: George Christoforos FOOD PROTECTION MANAGEMENT Done Inspector: : PIC Assigned/Knowledgeable/Duties PASS ❑J RED Janet Dionne EMPLOYEE HEALTH Done Date Inspected' Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 3/7/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS ❑J RED BHP-2005-0349 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED PARTIAL COMPLY #of Critical Violations: Conformance with Approved Procedures/HACCP PASS RED Plans 2 Time IN, Time OUT, Notes: 10: 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. Mar 10,2005 ) Page 1 of 376 Highland Avenue Brother George must be corrected immediately PROTECTION FROM CONTAMINATION Done or within 90 days) Separation/Segregation/Protection PASS ❑d RED RED, Violations Related to Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑J RED ,Rutting board stained&scored-resurface Foodborne Illness Interventions or replace and Risk Factors (Require kl`<an opener had accumulation of food immediate corrective action) debris-thoroughly clean&sanitize. /Ice scoop stored ontop of ice machine- provide proper container cleaned& sanitized and labeled 'ICE SCOOP ONLY". Proper Adequate Handwashing PASS Non-Critical RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS ❑/ RED Handwash Facilities FAIL Critical RED ,Kandsink being used for beverage disposal. Sink to be used for handwashing only ,same sink to be labeled"handwashing only". PROTECTION FROM CHEMICALS Done Approved Food or Color Additives PASSd❑ RED Toxic Chemicals PASSd❑ RED TIMEITEMPERATURE CONTROLS(Potentially Haz Done Cooking Temperatures PASS ❑Q RED Reheating PASS ❑Q RED Cooling PASS ❑J RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑J RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 10,2005 ) Page 2 of 1a 1 376 Highland Avenue Brother George Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE 0,Xeatloaf&amencan chop uncovered at time of inspection.all food in storage must be covered. �, Tusmann fridge had some uncovered food. all food in storage must be covered t,A for customers drinks had containers stored in ice. nothing shall be stored in consumers ice containers to be srored in different manner. Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS Non-Critical ❑ BLUE Wack door and screen door need door sweeps to seal holes to exterior Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 10,2005 ) Page 3 ora CITY OF SALEM c BOARD OF HEALTH Establishment Nam )i�� titan e, Date: 9 - '7 ^Q � Page: / of e�l�/ / t nem Code C—Critical Item J DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY tFi6Z)eS , i�ucrlls �arlih�s) tl�f�� />z� /7W'//6wiA- Ch�n�r1�)r' 1401f f I -l`alllri -(-,/DS h//U.o "h Yjdl!?f ! hRezP terns . >< d11)1r?qt atea . %1r.�hpr o� /�r,cpo�r �l 1,�� iPIPn� se�xl ioOV a/ /�rilr�� _ I - ,he_ /m I'Ve i /nh l-� �n6n71As. /1tl /f�lirlieyS' -la G,e QV�Zf /D i 11 r CISI. q I - /Ro&> ih 4A MI-) (2)V& 1'011bvd /,V'IIA lol,[lc �in�Sdtr`�, �hCl 1�Pfk/P . //.r_fi " /9r h4 r l ul - l,,/17llS -1,7 a4 1 AIAA/ AIA W 1011 R Za 9V(_16 )(W lo' /o � { Y)4lS7 k ) A-/1 Nhpk Iii h-lai m* s ha l,� kvph /ijm l�� . I� _ Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes G 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 LJ Re-inspection Scheduled ❑ Emergency Suspension ` comply with all mandates of the Mass/Federal Food Code. I understand that F noncompliance may result in daily fines of twent -five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � _ ❑ Voluntary Disposal 0 Other: 1 _ 5h1 14;C; YIiF's I2ee,jvcd at 7•emnoratbres Violations Related to Foodborne Illness Interventions and Risk 4c.ording to Lay. Cooled to Factors(Items 7.22) (Cont.) 1 4i'Fr45`F Within 4 Hours. PROTECTION FROM CHEMICALS .':5 Cooling Methods for PHFs 14 Food or Color Additives 1 19 ( PHF Hct and Culd Holding 3-203.72 Additkcc+ - 511.16 Bi Cold P1-1Fs Maintained at or below j 590.004(17) 11'/45"F" 3302.14 Protection fromUnapi-co�edAlclinves' ! .Ifi(A•) Hot PHFsMaintalnec' a:orabooe 15 Poisonous or Toxic Subntances ( 140'F 7-101,11 ! Identifying Information-Origin, Containers'" 3-517i.16(A) Rvas'sHeWat:orab� eve 13,')'F. Control i 7-102.1 I Common Name.-Werkir:g Conntine,rs' 20 Time as a Public Health-- 3-507.-y tune as a Public Heuttb CennW 7-201.11 Sestranon- PrseStorage' ! 590.Otidf Vdrance Requirement 7-202.11 � Restriction--Ptrsel?cr and Usek 7-20?.12 Condition;ufUse" i-203.I I 'toxic Container.,--ProNbitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 L Sanitizzrs,Criteria-Chemicals"' POPULA710NS(HSP) 7-203.12 Chemicals for Washing Produce,C•ritcriiO ( 21 -4-801.1 I(A) lUnpa.,tetnved Pre-packaged Juices and 7 204 1413ererages with;1'artrine Labels^ Drying A>;ents.Criteria" 3-WIJ1 11(R) Use of Fasrctuized F;c_s' _ OS.I l Incidental Food Contact.Lubricants" 3-Y()i.11!Di Raw in Faitiaily Cu,r:ed Animal Food and 7-"_06,11 Restricted Use Pcrticides Criteria" Raga-Sued S rota,Not Screed. " 7-206.12 Tracks Bait Siars.P` 3-801.11/C) Unopened ILod Packaee Not Re-served. " 7-206.13 � 'Tracking Powders,Pzst Control and ! MonitoringT CONSUMER Anv€soRv TIMEITEMPER ITURE CONTROLS 22 3-60:.11 Corrormer Ad%ciary P+,sted for Consumption of Amoral Foo(k That ate Raw, lindercoot ed of 16 Proper Cooking Temperatures for i PHFS Not otharv,,i e Processed In'Eliminate `"=•-n rs;�z 3-401.11A(I)(2) Eggs- 1`15'F 15 Sec. Padan,,ens." ` Eggs-lmmediate Service 145'F15secn 3-302.13 Pasteurized Fggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats Fr Ginn. Animals I WF 15 sec. v 3-401.11(6)(1)(21 Pork and Beef Roast- 130'F 121 min* � SPECIAL REQUIREMENTS ?-40L1t(Ai(2) Rautes,Injected Meats-155'FI5 ( ")6009(Ab(1)) `liolationsofSection 5911.009(A)-(ll) in sec .. catering. rnobiie food,iempotary and 3-401.11(A) 0) Poultry,Wild Game, Stuffed PHF;, residential kitchen operations should be Stuffing Containing Fish, Meat, debits, under the appropriate seciions Poultrti or Ratites-165'F 15 sec. j above it related to foodborne illness 3-401.11(C)(3) Whole-muscle, intact Becf Steaks interventions and rick tactors. Other 1450F 590.0,t)9 violations relating to good retail 3-401.12 Raw Anima!Foods Cooked in a ptactices should be debited under !(29- Microwave 165"F* Special Rcquircmeuts. 3-401.1l(A1(1)(h) All Other PHF;- 145`F 15 see. ' t7 Retreating for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&iD) PHFs 165'F 15 sec. * 'Ile is 2;_30) ?-40?.11(B 1 Microwave- 165' F 2 Minute Standing Critical+aid non-rrdi(.al vrotatfons, rohich donor relate tr. N:e Time* fi odbome illness intetrenu•)n..and irsA fa,, vcs lio(,d above. ran be 3-403.11(C) Commercially Processed RTE Food- ,found in the foll.n„ing sertionc,:f rhe Food Code and 105 CIrfR I40'Ft 540.001. - --- 3-103.11(E) Runaining Uns7iced Portions of Beef I /te+n € Good Ratan Frartiees FC 1590.000 Roasts" 1 23. ! ldanagement and Forsonnel FC 2 .003 18 Proper Cooling of PRFs 1 24.-----' YProtection` V 0104 Foo?and"burl FG-3 I 2E. Equi-dont nd Uten•tic FC-4 .005 3-501,14(,k) Coolutta Cooked PPibs from 140"P to -- - , o _ --0 --_-- 2F,. Water . I!�nb!.^,o and V'e a-tn P{'--5 I 006 701F Within 2 flours and From 70`F 1 27. Physical Facility FC-6 .007 to-4 `F/45"F Within 4 Hours. " 28. Poisonous or Toxic ldaier!a!s FO--7 L003 ! 3-501.14(6) Cooling Pffrm Made Fron:Ambient 29, Soscda!ReCuiremontc 009 Temperature Ingredients to 4I"F/45=F 130. Other Within 4 Flour^,* t•mrrt.oe-I d,,- Denoie�cnuc it nem it,the frderal 1999 Fund Code or 10.`,+.:P9R 590()00. CITY OF SALEM \ �/ " BOARD OF HEALTH Establishment Name: C��I'7/P_ Date: Page: of Item Code C-Critical Item u DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY �cf"iahl�.Shrnv"est rn �YD�oS.S n� rh�/�rl /llcll]2i?S - tIM� (/tom/fc j t n125; I PC d)n Gua //s /n Fnao/ %rPp areasr (' Ion /i"o r leJ �.rPorn ) l2�ed he a-C! Y)//y /4,,p f Xvval d eb/ns I i L"*'� h)a// IlAwma- let !'PPU'/Yl l'fiPC� / hPQr /.iihNi�ii) f-o �t� cam_ T�ryrn� �h� r rvnn i t�,Lcr✓- / 1 ✓F/n.�Qs `fhrnUGfhovf Waal/ /'loch/nLI /Yla.� su�"e �o /'/0/x/7 lirv✓�v � I � " .t�IQbl� .SPl1ilC� /.rJ/hr✓auJ h/i{2 /h S'ChP�/7 — l'�fJ/,riv �r r2D//JI'Ti sr•rE'art J T T v - J,rliPs Pos4m7Jrn 47/0.S Discussion With Person in Charge: Corrective Action Required: ❑ No Ll Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violationsviolations 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 t I noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (v ❑ Voluntary Disposal ❑ Other: k 50),I fl PHF,Rr<en•ed at 7 emper.a urea -- Violdions Related to Foodborne Illness Interventions and Risk Accor;lin"to i.aw('ruled to Factors(items 1.22) (Cont.) 41'Ft-15'F Within 4 Hours. ' *PROTECTION FROM CHEMICALS 3-50' ' CtiolmE Methods for PFIFs i14 PHF Hot and Cuid Holding 14 ( Food or Color Additives 3 E;l I Vv b) Colt?PRFs'Adintained at or below 1 3-202.12 AddinteO 590.004(1) 41°145- F, 3-302.14 Protection from Unapproved Additi,es* ! 15 Poisonous or Toxic Substances 3-501,1((A) PiotPHF, NFnatamedatorabove � 7-101.11 ldentifym);hifortn.!oun-011ginal I I F Containers- 1 3-501.t6l,A; Roasts Heid at or.:bove 130°F. 7-102.11 Comnan Na:ne- Wrrkina Containers" ( 2fr T aic as a Public Health Control 7-201.I1 SeP.uation-Storage` ( 3501 '? Ti in- c;e Public Health Control'" j 7-202.11 Restriction -Pretience and tisek 5'-'U.004i,H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxin Containers-Prohibitions"' REQUIP.EMEN?S FOR HIGHLY SUSCEPTIBLE 1204.11 Sanitizets,Cr!ter!.i-Chemicals POPULA"i'IONS(HSP) > 21 I-x(71.:7(A) Unr..astcurizeci Pre-packaged Juice;and 7-20-1.12 Clieniicals for W'ashine 1 ioduce, Critcr;,-,� Be,vraees m2h Warnim;1.,hell^ 7-204.14 Dieing Agents.Cnieria"' 1 3_SO;.i 7 iP.) Use o: Pt:;trnrizel Fags* 7-205.11 Incidental Foul Contact,Lubricants" 7-2(16.11 Restricted Use Pesticides.Criteria* j 3-801.11:Lt Rain or Partially leol;ed Animal Food and kai. ;:sed Sproms h'ot Served. 7 706.13 Tnxck,ng Powder,,.Pest Control and 12 Rodent Bait Stations` 7-201, x SO L 11(C) Unopened Ravi Pockage :Not Re-seined s; i Monitoring°' CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-h()3.:I Cue;umer A.dtisory Posted for Consumption of ! 16 Proper Cooking Temperatures for Amin,: F;uirls'lhat are Raw.Undercooked or i PHFs i:ot vtlietwi:x Proces,ed to Eiitninate 3-401.J 1 A(1 1(2) Egg, 151°F 15 Sec. � "" `•tis'� Eves-Immediate Set%ice 145°Fl`scc, 3-?(12.13 Pasteurized Eggs Substitute fat Raw,Shch 3-401.17(A)(2) Comminuted Fish, Meats&Comic F"k!'s� .Animals- 155-1 15 sec. 3-401.11(8)(I)(2) Poo,and Bcef Roast - i i0"F 121 niin'" SPECIAL REQUIREMENT'S 3-401.11(A)(2) Raines, injected Meats- 155'F15 590009(A!-t Eo Violations of Section i90.009(A)-(D)it, sec. ,: catering, mobile flood, temporary and -1401.11(A)(3) Poultry,Wild Came,Stuffed PRFs, I resideul:al kitchen operations should be Ctuffing Containing Fish,Meat, debited under ti:6 appropriate ,ections Poultry or Ratites-165'F 15 sec. ( above itrclated to foodborne illness 3-401.11(C)(3) Whole-niascle, Intact Beef Steaks ( interventions and rill:factors. Other 145cF T 590.009 violations relating to oocl retail ,,_:;!}LJ 2 Raw Animal Foods Cooked in.: pracgce,should be debit.-d under/f29- Mi rowate 16.5`1' Soccial Requirements. 3-40 1.1 i(A)(I):I) All ocher PHFs- 145"F iS sec. 17 Reheating for Hot Holding V;0L4T1OM9 fi.=LATED TO GOOD RETAIL PRACT'iCES 3-403.11(A)MD) PHFs 165'F 15 sec. ' (I(erns 23-301 3-403.1 I(H) Microwave- 165=F 2 Muwte Standing ! Critirnl sed tw,, rriticol ciulahon::, which do„ot relate to the Time* !aor•'hrrn,;dl,u:s.c iaterve.,*ions unci risk fiators listed above, ran be 3-403.11(C) Commuroally Processed RTE Food- Krivoi it t/te following.,rr.�tienc o)the Food Code and 105 CAIR i 1d0IF- 5110-00(0 1-403.11(E) Remaining tnshc•ed Portions of Reef ttem T GoodRetailPractices IFC580.000 Rosm ; t CITY OF SALEM � / BOARD OF HEALTH Establishment Name:4'h y r7� !? ( l�D>? Date:_ .�'.��'ers Page: of Item Code C-Critical Item ✓ DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY / — �, Y/ ze /,rra -eco /na end ��Urr� ✓�� /oa rzr/cJ llaa//7 - I I 11 4o,.? 0911'g� Xe llo13 f '�7 "e �r7s>r l o- /h CL s � �Ja r� aQaa/YI -7-wAdern/,)#i /Jurnorl G�4,147e Chi/��t�arac /.n�r/�te,1 u ��'Yla/S�irrp `/i l/rte/CSG-. �7./a�/_c s9�o� �iRo�vria/� �'lnGn/r�o. rn�ss/n Clo�ec - r�o/CLCf1_ //�ih S'x Li.�P Cuve�2. I Discussion With Person in Charge: J Corrective Action Required: I ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ e 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. c ��' /A- ❑ Voluntary Disposal ❑ Other: I 4t11.I4t_;; PIAR;Reser+ru at Temneratu.e,c i;61ations Related to Foodborne Illness lnterventions and Risk Ao:ordine;n law Gv-.Aed to Factors(items 1.22) (Cont.) APFi45"F Withia 4 Hours. " 'PROTECTION FROM CHEMICALS +-�01.I Cooling kle.li mis for PHFs I 19 PHF Hot and Cold Ho'ding 14 I Food or Color Additives 3-50;.;6Qi Cold P1(P.Msnmained at or below 3-202.12 Additive.' 59'1Ut!?(F) 4!'145 I- - Protection from Unahpruted Addmves* � Z 501 I+s(.A 1 3-lot PHFs)viaincuned at or above 15 Poisonous or Toxic Substances 140 7-101.11 Identifying tnturnonion-Original 3.50' I6(A; Roasia Heid at or abote 130'(4 ` - - Containers" 7-10111 Common Vast.:- )Vorki n;;Containers'" 2J Time as a t'ubl:c Health Control 3-50'.!9 Time as a Pu',Iic-1?eulth CuntrolP 7201.11 Separation-Stvizwe" ( l F:a sire-nte 7 202.11 Restriction-Presence and Use-' 590.(i(11,H) variance 7-202.12 Conditions of U,:e* 1 7-203.11 Toxic Containers-Prohibitions* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-204.11 S;utitizec+,Criternt-Chemicals- I POPULATIONS(HSP) 7-_04 n .12 Chemicals for Washing Produce,{uce,('nteriaI it ( =-80L11(.A) thtp:istewizedPre-packaeedJuices and ' ! Boweratees with Wmrrine Labela� 204,14 Drvtn-,Agents.Criterin'' 7-205.11 Incidental Food Contact,Lubricants,- I 3-801.11IF) LSC of Pasteutimd Eggs* 7-206.11 Restricted Use Pesticides.Criternr'r 3-3W.1I+,P) Raw or Partially Cooked.animal Pooel and Kew Seed Sur-tuffs Not Served. " 7-206.12 Rodent B:tn Sauinns^ ! l 7-206 13 -Cracking Powders.Pest Control and '-801 I1(1'; Unupcl:ed F,xxi Facka-w Not Re-served. i Monitorin„`^ CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3 603A I Consumer Adkisory Posted `:)r C'oneumption of 1 Anima' Fo.�ds that are kaw.Undercooked or (6 I Proper Cooking Temperatures for No; Oti:en-J!:e Processed to Eliminate PRFs 3-401.11-A(1)(2) Eggs- 155°F 15 Sec. Eggs-Immedi:ae Service 145°F15,e:., 3 301.13 i'.isteunzca 8gga Substitute for Raw Shell 3-$OLIIfA)(2) Comminuted Fish, Meat': 3:Game Animals,- 1557 15 sec. j 3-401.11Ili)(1)(2) Pork and Beef Roast- 130"F 1?1 min" SPECIAL REQUIREMENTS 3-401.1 1 i.Al(2) Ratites. Injected Ntea:s-155'1 IS S90 0091'A)-(D; Violation,of Section 590.0.09(,A)-(D) in sec, > caterin, mobile fctod,ten;potary and 3-401.11(A)f 3) Poultry, Wild Game,Stuffed PI-fFs, residential kitchen operation; should he S!uffine Contaimne,Fish,Meat -!d-) under tP:e eppropri:Uc sections Poultry or Ratites-165'F 15 see. ^ above if related to fodborne illness 3-401A I ClOi Whole-muscle,Intact Bcel Sleaks mterventions and nsk faciors. Other 145°F* 1 590 009 violations relating to good retail 3401.12 Raw Animal Fowls Cooked in a practices should be debited under/1'29- bhcuiwace 165`F' I Special Reyuiremcnts. 3-401,11(A)0)(W ;All Other FHF, 145'F 15 sec. * i 19 Reheating for Hot Holding j VIOLATIONS RL1ATED TO GOOD RETAIL PRACTICES 3403.11(41&(D) 1111175 I69'F 15 sec, ([tern,;23-30) i-403A I(B) Micrussave- 165°F 2 Minute Standing I Cra:ud and nun-entice1 ciula6orrs, which dr)rot relate to the Time* foodborne illness i+i?e,renri�m.;and risk la;tura (fisted uLuve. can be 3-403.11(:') Commercially Processed R11 E Food- toxnd in the(Mina-ing ,ertiamut rhe Fu,d Code ar-d 105 Ct19R 140'F" 590.00n. ;463.11(F) Remaining Unsliced Portions of Reef Item ! Good Retail Practices I FC 590.006 i Roasts I 23. Management and Personnel FC-2 003 18 ( Proper Cooling of PRFs 124 Foos and Rxxi Protection 1 FC-3 004 25. EgU'pmenl:and Utensils R)-4 .005 3-501.i 4(A) Cuoting Cooked PHFs from 140'F to 26 6Nat Phnnbicg and Waste Ft'-5 .006 70'1 Within 2 Hours and From 70"F j 27. Physical Pacifity FC-u ! 007 to 41'F/45'14 w'ni+fir.4 Hours. '" 1 1 28. Poisonous of Toxic Malanals FC-7 1 .008 J 3-501 H(B) Coulm_'PHPsMade Flout.Ambient i 29. P':c;alRequirements 009 J Tempetature lmrredients 1„41°F145'F ! 30. Other ---------J Within 4Hours.k ,s-nni•t..,o...M. Dc114es an¢.al nem a+tht fvferal Ino;Fod Cod:or 104('AIR 59^(,Y0 CITY OF SALEM BOARD OF HEALTH Establishment Name: ,t7Y�T/!P_ Y (�P�Y77_�_ Date: a7 _0? S_ Page: of Item Code C-Critical Itkn,OL/ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red It li n /�� PLEASE PRINT CLEARLY Verified I Zxt^ � - h�� ii v �f��h�r - I sil�1� /sup i2 /l�K - IWO I ��X° o'� .,�P'`� niu �i�✓�a /`"l,�rc�n��-as S��td " ' /"aa�' l��o,P.� �»nS'�ivc^-�im� �n�l Yv�a Irl ✓eA/a,�� : /� �/n ed e?p)lz na 7'7 s he- ", i� c� /2-/ LiM,7 I ' I ' a I 1 I I 5 I _ lnn�f Yui, l�lan�-e__ 1 - I 1 4 1 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/ s inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: J 3-503.34(0) PH Fs Received-,'Temperatures Vglations Related to Foodborne illness Interventions and Risi, Ac-'ending to Law Cooled to Factors(Items 1-22) (Cont.) .I I"F!45"-F lath;n'hour;. 'PROTECTION FROM CHEMICALS 1.15 Cooling Methods for PHFs 18 PHF Hot and Cold Holding j j 14 ( Food or Color Additives 3 202.12 AddilivesF 3-50:.16(0) Cold PII � Maintained at of below � 590'):-( ,) 4t° F ;,ti5'F" 3-307.14 Rotecron irotn t?n:q)Provrd Additives" I I ;-501.I6(A) Tint PHF. Maintained at or above j 1S Poisonous or Toxic Substances j 7-101.11ll klentitjing Into]r,,ration-On};ii40 Fa! -- Containers" .. i0 . . .. .... � j 3-50 1 fit A) Roasts Held at nr above i "P, , j 7-102.1 ICotmtton N:;nie--Working Container," i 20 Time as a Public Health Control j j (7-_Ol.l 1 Separation-Slorase" 9 Time a,a H:blic I{::alib Control*, j 7-20211 Restriction-Presence and Use" j 5a:).004!,H) Variance Rc•gnirement j 7-202.12 Condition;of Usu'' j 7-203.11 Toxic Containers - 1 ohibitionn"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitizers,Critena-Cheinnalss j pOFtJLA'CiONS(HSP) 7-203.12 Chemicals for Wachme Produce, Criteria" ' 21 3-501.1 i(A) Unpasteurized Pr:-packaged Jokes and ( 1 I Heveia;res with"arningl.abels'7-20-1.14 Drviug Agems.Crttetia* , 7-2(15,11 hu•idental Food Contact, Lubneants^ j 3-801.11(13) i Ise of Pasteurize,:)E+4gs;° .;-SOLIl(P) Raw orP:.rtia3lyCooked AnitialFtnidand j 7 206.11 Rodenticd lice t'estic�des. Cnterci' Raw Seed Sprouts. Not 4rred. 7 206.12 Rodent Ban Stations, 3-501.11(C) Uoapened Foci; Packam ::\'of Re served. " 7-206.13 Tracking Powder, Pest Control and - Monih ring* CONSUMER ADVISORY TIMEITEMPER4TURE CONTROLS 22 3-603.11 Cansurner Advisory Posted for Consul iption of i Animal 1-Ijods Thaf arc Raw. Undercooked is lfi ( Proper Cooking Temperatures For Not fhherwi,e Processed to Eliminate PHFs "'r..;:.,. .en 3-401 11A(l ill) Eggs- ISS`F IS Sec. I Pathogens.- Eggs-htmiediate Servieo 145"Fl5sw 3 302.'.3 Pzsicur+zed Eggs SubA!ute t�Ir Raw Shell 3-401AI(A)12) Comminuted FWi, Meals&Game 0 's j Animals- I55'F 15 sea j 3-401.11(H)(1)(2) Pork and Recf Roast- 130"F 121 min" i SPECIAL REQUIREMENTS 3-401.1 t(A)t2) Ratites, Injected Rlcats-155'F 15 590.nu9(,A0-(E') Violations of Section 590.009(A)-(D)in see. 'r colcring. mobhe fend, Icmporai},and 3-101.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen opetations should he Siaif ne Containhte Fish, Meat, uCbited under the appropriate sections Poulhy of Ratites-165"F 15 sec. ' shove if'related to foedhorne tllnrs 3-40 LI I(C)(3) Whole-nimcle,Intact Peet Steals interventions and tick facture. Other 145"F 590.009 vielat,ons relating to good retail 3-401.12 Raw Animal Foods Cooked in a ptoclices should hr debited under/t29- Mictowave 165F* Special Rccluire ncuts. 3401AI(A)(I)(b) All Othe, PHF,-- 145°F 15 ser. j 17 Reheating for Hot Holding ( VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES ,403.11(A)&(L)) PHFs 165°F 15 see. ' I (Items 23-30) 3-403.1 I(B) Miexow'ave- 165°F 2 Minute Standing I ctili,ul and nun-rri!icu7 cisiairons, nha@ do not r•:lute to the Time* jiiodbrmne illncs9 iete.vnntirms and riot jot or r limed above, can be 3-403.11(C) Commercially Prmessc d RTE Food found)in the 1x410I uoq serlions of III,,F'uud Coo--mid 103 CMR 140`F" 590.0iDU. 3 703.11(0) Remaining Unsliced Portions of Reef j Item Good Rerml Practices FC 1580.000 j Roasts* j 23. Mananement and Person-elFC -2 .003 j 18 Proper Cooling of PhFs 24 Few and i o d Protection. FC-3 004 2.5. Gqu:nnr;rri and Utensils FC-4 I .OU5 3-501.14(A) Coaling C(-x)kcd PHFs from 140`F to 1 26. i^later, t'lumbinn and Waste °O-5 .006 j 70`F Within 2 Heim;and From 70`'F ; 27 Physical Facihy �U-6 .007 f to 41')F/45"F Within 4 Hours. 28 Poisonous or"I ex:c MatmaL FC - 7 .008 1 - --- --- 9 3-501.14(13) Conlin,PHFs,Made From Ambient 29 Spew!Pequirements Opo i 'Fornperature lrigedients to 41"F145-F 1 30, Other Within 4 Homs" , Ueuoir:critical dem In 0 I I:dewi 1090 Food Code or 105 CRIR 5M 000 � I - CITY OF SALEM BOARD OF HEALTH Establishment Name: Aro+hf. (7Ye0r11 ,1_._ b Date: a• /5-(D 5 Page: of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' PLEASE PRINT CLEARLY / ` I X69 P �O r G Q ' PID 9O�er� yi P� OL 12 � _f4'es e sta b/5// 11%W 4 e l ('fai 1/en g7t i lk,"u -ry rP✓ ew• t i or -_.A _ee I ✓�eu�r�ui.att ��o�a ,r /�//o,r oyl t1e, anq.ie_ o1xz1-e44e_ ,// WQ�i.nu ✓P�1-e i C(h(rs. l'2 lly�U ut' l�I�I 5-f7�fiCu(_. nr/Ar -�D r I , 1)/.Pptin D-C,q-v `i"X//HG o,r I I I t2oure�.�Pd v��e.��ro,�cv� -Gi�� rIo-/ice re�ui��d � ixa,...• � I I � , -f K< O/J Erte, ' S evv/cP5 0� L/r�i s� L /2 ,tk bae &d4 r07.15 Mx-751 be- 17&?1v-Jlcc,4 OU441 2l 5, 9/a"l-s, 1 6,- IUo loav-e hcp- r cow-tee o l v�agcj 4 fu �- I A W7 o-E 41- e vhd&,06w4-4 ac6f"l 91--e.r I 4V Mr J7aeC la- 0-71J QX P4 /k001`1 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/ 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. 0 Voluntary Disposal ❑ Other: f 5n7 I ;i PHFs Re.en•ed at Tc zopennures Violations Related to Foodborne Ulness Interventions and Risk I ,4crordins lo Iaw Qxi!ed to Y Factors(items 1.22) (Cont) 11° ;4j"'F Wnldu,l Hour, ' PROTECTION FROM CHEMICALS I +-501 i5 Cxoline Metbuds for PHFs I 14 Food or Color Additives =g PHF Hot and Cold Holding ' 3-501 161 L) Cold Pfli,�'viaintaincd at or below 3-202.12 Addiuv-e.' 590.004(F) sl"/--5'17:1 3 302.14 Protection from tlnanproaed Additive;' i ! 3_50!.16(.A) ( Not YFEF, Maintained at or:tbnve 15 Poisonous or Toxic Sub::tancas 1 10'F' 7-101.11 Identifying Information-(h+tsinal ( 3-5(li.lhs.) Roasts Held at or above 130-R Containers 20 Time as a Public Health Control 7-102.1 : C'omrnuu Name.-Working-Conlainers' I 3_,:: � �, � ',-20i.!I Senaratiun-Storx>:e ,1.I) i true as a P::,hc.Health Control 7-202.1 1 Restriction-Presence and Ilse* 590.0;Vk;HI Variance Requiremeni 7-202.12 Conditions of Use" 7-203.11 Toxic Contain :.-- ProhiMtions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7-204.11 Sanitizers,Criteria-Chemicals-' POPULA(SONS(LISP) 1 7-'04.12 Chemicals for W::,hmc Produce,Criteria' I 21 ( '-811LII(A) j Unpasleuri,edPre-paclagedJuicesand o BevetgeecundiW'arnim_?abets^ 7-_04.14 Di sing Agents.Criteria' ` 1-S()!.! +, . G (13) t.r of Pasteurixd P_cs' j 7-'205.11 Incidental Food Cunlaet. Luhnrints 13-30 L 11 t D) Raw or Partially Cooked.Annual Foal and 7-206.11 Resir,cted Use Pesticides,Criteria' Raw Seed Sprouts Not Served. 7-206.12 Rodent Bsi+. Statiuns" 3-801.11 i C! Jnopencef F,od Pack32r Not Re-served + 7-206 I3Tracking Yowdecs, Pest Control and Monnoring- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS e2 3-603 1! Consumer Adv+tor:Dusted for Consumption of 1 16 �roper Cooking Temperatures for Foos Ilvd arc Aaw,Ondercooi cd or ' Not Otbemise Prote•ssed to Nliminate PHFs Parho�ant.." =err.:,::cca : 3-401.11A(U(2) Eggs- line" 15 Sec. I --;;+2.L g Eggs-fu:mediatt Seraice 145`17?5sec+ Po'aeurimd E€€>Sabstiurte fi•r Raw Shell 3=l01.11(A)(2) Comminuted "ri;h,A-leats&(Same i Eggs Animals- 153'17 I5 sec, ` 3-401.1l(B)(I)(21 Purl, and Beet'R+rtst - 1301" 121 nein' SPECIAL REQUIREMENTS ? 401.t 1(A)(2) !irrt+tes,Injected Meats- 155'P L', 590.U09L1)-t D; Violations of Section 590.009(A)-(D) in sec, * catering. mobile food,temporary mid 3-a01.i i(.-1)t3) PatlOy,bC+ld Game. Guifed PHrs re�idcntial kitchen one^rations should be Stuffing Containing Fish, Meat, debib:.d under the appropriate sections Poultry or Ratites 165`17 15 sec. above if related !o loodbo nc illness 3-401.11+(:)(3) Whole-muscle intact Leet Steaks intervention and risk factors. Other 1451F a 590.009 violations relating to eood retail 3-401.12 Raw Animal Foods Cooked in a practices should be der4ed under#29- Microwave 105'F* Special I?eyuircment;. 3-401.1 I(A)(1)(b) All Other PHF':;-- I45'F 15 see, 17 Reheating for Hct Holding ( VIOLATIONS RcLATED TO(,OOD RETAIL PRACTICES 3-403.11(A)&([)) YHFs 165`17 15 sec. * ( (Items 23-3041 3-403,1!(B) Microwave- 1(15°F 2 Mmule Standing I C'io,al and nun-Truk:al i iolanort.s, nary h do real rehgre to the Time" foodbr;rne iIlnes.c imue*denhons read ii.ee'.jaru+rs U.Ird above, ran he 3-403.1'(C) Commercially processed RTE Food- ( found in the f,,(lol,hh�section.l of the"bud Code and 105 C.MR 140''FT 59QIN+(). 3-403.11(Et Reniamm:,_ Uneliced Portions of Reef I Item Good Retail Practices FC 590.000 Ro::ita* 23. Managament and Personnel FC--2 .001 18 Proper Cooling of PHIes I 24 Fooa and Food Pro+ect!co FC-3 .004 2t5, Equ-emL: and�Uler,stis 10-4 .005 3-SOLW(A) C'twhngCokedPHF:froml4(f"Flo --� 066 1 26 Water, ^iumbxxl and Waste FC-5 ,OOG 70'F Within 2 Koons and From TPF j 27. Physical Facility _ 1=C--6 1 007 to4i'iq/45"FWithin4 Hours. " 23, poisonous er I oten Material FC-7 .003 f i-501 14(L) Cnoling PF1Fs Made From Ambient 129 Special Recivaements 009 Temperature Ingredients to 41`V45`F 130, Other --j- ---- --� Within 4 l lour�)e • .°^:'11 *Depot"entmai item m the('de,e,i 1099 Fund Codex 105 CNIR 5901+00. CITY OF SALEM / BOARD OF HEALTH E Page: of Establishment Name: fes/ Ca,�,O, Date: ;? /5 - U 5- a '2 Item Code C-Critical Item Q DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R-Red Item Verified r PLEASE PRINT CLEARLY I la rr ih �D?n d ie u j/// di -j 17 of Ln f/lu 4 uu`rl &rte Jve 1. v-Y, 0-42- /19- r d -7 Or 1.17 -�6J�oG,�/o-a, R-irO_ /.t�C /'•-�d/ IF I • I I I � 1 1 ° I 1 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to c ❑ Re-inspection Scheduled O 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. -z ❑ Voluntary Disposal ❑ Other: 3.101 14i' PW':,Recei%ed,^'lempesuures Violations Related to Foodnorne Illness Interventions and Risk Ac:ord:nv lo tau,Cooled kr ` Factors(Items 1.22) (Cont.) ,, 41`'Ft-45`. Within'l Hnm-;. ! 3-50!.15 Coaling Mid cx6s for PHFs PROTECTION FROM CHEMICALS ! 19 PHF Hot and Cold Holding (; Food od oor r Color Additives ( 3-501 IN B" Cold Pf lFs lt,ttnta;ocd at w'below 3-202.12 Additive;* ( 590.0041-1 41'145" P` 3-302 14 Protection front Unapproved Additives* i( I-%i,IWA)' Hut PHF; ,nh.; •mamed at nr above I5 Poisonous or Toxic Substances � 140'17. k 7-101.11 ldentityarig lnforiwmon-Original ;_5f};"1 t�(p,) Roasts Held at r'•r above 130'F * ! Coutatnc-v` ' ! ! 7-102,11 Conuuun Name-Worl.ing Containers* ! ") j Time as a Public Health Control 7-201.11 Separation-Storage'" ( 3-501 Tim:as.:PUNic Health Coohol* ! 7-202.11 Restriction-Presence and Use: ( ( ')9(1.004:(1"1) V'.rian.e Requirement ! 7-202.12 Conditions of Use" ! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 203.11 Toxic Container,. -Prohibilions*' j ! 7-204.11 Sartitizers.Criteria-Chemicals" j POPULATIONS'HSP) Produce, 121 3-80I ll(A'' Uupaaemrrze+Pre-packaged h.rices and ! 7-_v 04 1'2 Chennads for WashingI roduee,Criteria' i 2.04.14 Drying Beser:yCes with`Natnine Libels 7- Agents.Criteria* I e,ns� ! 7 205.11 ( htcidcnial Food Contact,Lubricants 3401.H(4) Use of Pasteurized E 3-SG LI I(Dj Raw or Pnrtiiily Cooked Animal Fuad sell 7-206.11 Restricted Use Pesticides, Criteria` Raw Secd SPrnur:s!,;of Ser vrd. 7-206.12 ( Rodent Bait Stations" ( ! 3-801.i I Unopened mood Packs)=,e Not Re-served. 7-206.13 Ira,king Powders,Pest Control and ( Moniturine' CONSUMER ADVISORY TIMEITEMPER>TURE CONTROLS 22 603.11 Consunrat Advisory Pu::ted for Consumption of lfi Proper Cooking Temperatures for ! .4nitiml Fuods That are Ram. Undercooked or PHFs Not()therwise Processed to Eliminate 3-J01.I L4(I)(2) fists- 155"F 15 Sec. lathogcns.* '11111L',:WX El-,-8-hi mediate Scrr,ice 145'F15scc* 302.1? Yasteurized Eggs Sofs[ihne fisr Raw Shell 3-401.11(A)(2) Comimnoted Fish, Meats&(::one I Epgs.;. Animals- 155-F 15 sec. :° 3-401.11(13)(1)(2) Pork and Becf Roast- 13WF 121 min': SPECIAL REQUIREMENTS 3-401.11(A)t2j Ratites, !greeted Nteata-- 155"F 15 590 000(A)-(P) Violations of Section 590.009(A)-(Dl in sec " ( catering, mobile food. temporary and 3-401.11(;.)(3) Poultry, Wild Game,Stut;cd PHFs, residential kitchen operations should be Shirting Containim. Fish,Meat, dehitcd under the appropriate sections Poultry or Ratites-165`F 15 sec. "' above if reLned to foodborne illness 3-401.11(C)i31 Whole-muscle,hitact Beer Cteaks interventions and risk factors. Other 145'F* 590.(109 stick?ion::reining to good retail 3 401.12 Raw Animal Foods Cooked in a ! precticcs should be debited under 1x29 - Miciowave i65`P ` Special Requirements. 3401.1 HA)(1 tib) Ail Other PHI-t, - 145"F 15 sec * j 17 Reheating for Hot Holding VIOLATIONS fia ATED TO GOOD RETAIL PRACTICES :.d03.11(A)&(U) PH F, 165'F 15 sec. " j ([terns 23-30) 3-403.11(B) toliciowave- 165'F 2 Minwe Standing Ceiircrd aur!non-rrincal violglnms. s•hich,In nal o4ate Io the Time* f o"'Fborrw Illness into rve0ion,s'and risk factors liaterl,ohm:e, can be i 3-403.!1(C) Commercially Processed I2TE Food- form.,in tyre fnllorriag srreirrs of the Fond CCude'and 125 CAIR 140"F" ti).uUO i 3-403.i I(E) Remaining Unshced Portions of Beef ! item Good Retail Practices F6 590.000 Roastsx: 23. MManagameni and Personne! FC--2 003 i8 ( Proper Cooling of PHFs :24. Food and Food PM'oot:nn FC-3 .004 i 25. Equipment and Ut,rsrs G^-!� .005 3-501.14(A) Cooling Cooked PFFs from 110"F to 26. `Nater,F_Iutob n4 ano Waste FC-5 008 70"F Within 2 Hours and Front 70'F 27 P`Js:cerl Faciaty F'"-6 A07 to 41"F',t45"F Within 4 Hours " ?P. PdCnOl13 or Toxic M,ceria�s FC-7 .002 3-S t ( 29 spi'r'al Recal"enivnis n _ 01.14tI3) Cooiim;PFFPs Made From.ambient � . O9 "Temperature Ingredients 1041"F145'P 30. ' Other ---� Within 4 Hours* ' 1:)euotee critical item in tlt;fccia al 1999 Funk]('oda or I0`.C M k 591)000. N• w Tr,"+�'11 ... _...r .. -,,- ... . _. -a.r _.... • 7 -r4 . ... ..m.r Y^ '+�.y�`'M• ... Mr machusetts Department of Public Health Salem Board of Health 120 Washington Street, 41" Floor - islon of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name�7 y� Date /r Type of Ooeration(s), Type of Insoection :'?w-I Y)P_ V lel o(Jy�{P�' �J' - I f'b�I f1 Food Service ❑ Routine Address��0 1 '.n�I �,) A,, Risk ❑ Retail � Re-inspection Telephone t fl (tYY t �U� Level ❑ Residential Kitchen Previous Inspection Telephone`, 441 _ 3 m ❑ Mobile Date:a-? -QS" Owner n / J HACCP Y/N ❑ Temporary ❑ Pre-operation /) AIP 1 ✓I S r7]Y71Y�S ❑ Caterer El Suspect Illness Person irdfiargeBed& Breakfast El General Complaint In: El HACCP Inspector/ 711 i)in in _ Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 1 13. Handwash Facilities EMPLOYEE HEALTH J® ' E1_2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.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 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP , ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions J� 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 p of Health. today, the items checked indicate violations of 105 CMR i7 N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) 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-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 590lns dFomr Nd. n . ns ectb s i to e: _ Print: v PI Signature: (i j r Print: t,� f_ _ ,/. / /. -��./�I ` ^ n, ( �.l /�� (` , i i� l 1( Page of tom!Pages Violations Related to Foodborne illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 I Cross-contamination I i9f.00A) 3-302.11(A)(1) Raw Animal Foods Separated fiorrn I I 590.003ifi) ( Demonstration of Krim0edee" Cooked and RTE Food;" 1 2-I O.i 11 Person in charge duties. I 1 Contamination from Raw ingrudienfs 3-302.1 I(A)12) Rase Aninwl Foods Separated from Each i EMPLOYEE HEALTH Other` 2 59().U031'C) Responsibility of the pet:.on 1n chase to Contamination from the Environment require reporting by fool employee,and 3-30.111(A) Fo(x! Protection" t appbcants- ( 9-302.15 Washing landsand Vegetables 590 003(f) Responsibility Of A bond Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Repan To The Person In Utensils" Chane* Contamination from the Consumer 59U.UO3(C;) Reporting by Pui,on in Charge" 3-306.14(A)(B) Returned Food and Reservice of Foil° 3 590 0030D, 53e;:htsions and Re!iiiiaitu'Vill. Disposition of Adulterated or Contamm✓ted 590.003(6) Rculoval of Exclusiom and Re:trietiun:. Food i 3-701.11 Discarding or Reumditiomne Lrisafe j FOOD F IOM APPROVED SOURCE Fox1* 41 Food and Water From Regulated'Somc2s ( j 9 Food Contact Surfaces 590.004(A-B) Cumphanccwith food Law* -I-501.11i ,Man.ralWaiewashing-Her Water 3-201.12 Food in a iternietical!v Scaled Container' Sanitization Tampemt 3-20 i.13 Fluid Milk and 1\4:16 Pn)dcctsr ares 1 I 4-501 112 Mechanical W'arewashing-Hot Water 1 3-202.13 5he!1 Eves- Sanitization Temperatures"' 1 4-501.114 Chemical Sanitisation-tenn> , I 3-20-2.14 'igg:and Milk Prvdnc[.,pas.ur!,:ed" I I 1 ..I>H concentration and hardne,+. " X0216 ice Made FromPotuble pptie Water ( 14-604 I ICA) Equipment Foxl Contact Surfaces and 11 f)rinking Water from an AAppyroved Sy,ini' ( Utensils Clean" f 590.0061.4) Pottivd Drinkme Wai?r" 14-602.11 Cleuning Frequency of Equipment Fuol- 1 590.00f,(B) Water Meets Stand%"rd;in 310 CMIR 21I.0'" Contact Surfaces and Utemils* Sneffish and Fish Fram,an Approved r.ourca 4-702.11 Frequency of Sanitization of Utensils and 201.1 d Fish and Recrea:amaliy Caught Molluscan Foul Contact Surface,of L+ptipinent' ! She;!t7<h;. I-103.11 Methods of Sanrtizatiun--F(ot Water and ' 3-201.15 Molluscan Shellfish bora NSSP Listed I I Chemical^ Somres* 10 Proper,Adequate Handwashing Gama and Wild rrooms Approved by Requtatory Authooarity ( 2-3101 11 Clean Condition- Flauds and Arms'" y 1 3-?02.1 L; SliciNrock ldentihcano,a Present2-301.12 Cle in ng Nocedure* 1 t2-301.1} when to Wash,. 1 590.004(C) t4%lir,' Mas1!r,bJmE" .t_2Jr LP! Carne Anv n)al,(` I1 Good Hygienic Practices ( g ! >aecelvingfCor,d:Yion ! 2-401.11 Fating,Drmkiug or Using Tobacco" 3 302.11 "(h=o Rece:vod at Prover Temper wiser ' 2-401.12 Discharges From the E}ec, Nose and 3-1.021.1 r'lckapehite6ty* Month* 6 I 3-101.11 Fond Safe and Cnwju!!erated" 3-301.13 Preventing Contaminaunn When T,:stinf?::. 1 agafRecords:Shrlistock I 12 Prevention of Contamination from Hands 1 32(`2,1$ Sh Iictnek ldertitics or. 590.004(E) Preventing Contamination from 3-203.12 Shellst„ck Idert,ficahon Maintained' Employee,;* 1 Tags,noccrds:Fish Product:; ( 13 Handwash Facilities Conveniently Located and Accessible 1 1 3--10'2.? ! P:.:.:sitr.Deal notion 3-<f07.12 Recoras.Cieatinn and Rete .5-204.11 Location nt,uni, 15-''03.11 Numbers cation mud Placement' ,;ltd Capacities' 590 O(W f: Labeling ofingredients• � 5-205.1 t Accessibility,Operation and Maintcnatu:e 7 Cops,mance wish Approved Procedures I IHACCP Plans I Supplied with Soap and Hand Drying Devices 3-502.1 .Sp:ciA¢cd Proee,,:,in;;Adcr}ex15* ; 6-301.11 1landwashiug Cleanses.Availability 3-502.12 Redt:ee:t oxvge❑ nseksging,criteria"` I :5-103.12 Cuniormcnce ¢a.h .Approved Prncedurc>' 6-301.12 Band Drym�Provisiou- '1)Cn,,I,,m,cAl it_tu in ll;r;ecLerei °v9 Feud t.oaz a t05 Ck4R n(WoO. k I CITY OF SALEM J" _ BOARD OF HEALTH Establishment Name: `f- ro C r 69A1%jR/ Date: Page: cZ of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION V Date No. Reference R—Red Item PLEASE PRINT CLEARLY verified (� /3 Ck_ NPre>/S/�/l n / h� /l n/off idle ti 4/0.11 4,a - �`�Lf e e 116 'F 7411 he -7w, oc/ / �_�)ru�l 1 r I C QIJA/Tt�7h// I ,4// o s` I - 1 � Discussion With Person in Charge: t Corrective Action Required: ❑ No {I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all LiVoluntary 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/FederalFood Code. I understand that noncompliance may result in daily fines of twenty ive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Sul ILC} Pllf s R ocleed at'!'emperatmes Violations Related to Foodborne Illness Interventions and Risk Ace- C-1 ng to taw Coined to Factors(items 1-22) (Cont) al F,%45`F tY'ithin 4 Hours. ' PROTECTION FROM CHEMICALS ' '(1' i5 1 Co%,!tiii, Me,h:ds for I'HF's 13 Food or Color Additives I 119 j PHF Hot and Cold Holding 3-202.12 Additr;ec' ( 3-50L16r13) Cold PIIFs Ni mnouried at or beln,v 01 004(F1 41"/45° F- 1-302.14 Protection from tinappruvecl AddntivcO- I 13-501.10(A) lint PHFs Maintained at�r abrr;e I$ Poisonous or Toxic Substances ; lU"'F 7-101.11 Idennfvmg Information-Original 3-501.1 o A) Roasts Held at or ab 13U`F Containers" 7-102.1 1 C.omnton Name-Working Containers* ( 20 Time as a Public Health Control I ?-till 15 7-20!.11 Separu[ion-Sun age" Time a,a Fublic I-lcalth Control" 7-20111 _ Restriction-Presence and Use'" I ! �'}0.004(1-1) \rauancr Requitement j 17-202.12 Condition;of Use" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Tunic Containers-P wnions-` I POPULATIONS(NSP) 7-110-1.1 I Smtitizerc,Criteria-Cftzmneal5^ I 7-'_04.12 Giemicalsfor WashingPiudine,Criteria' ! ( 21 3-801.I1�,A) UnparcuniedPic nackagedJtuce;;mud ftc,einges urth t\'arninglatbcls' 7-20$.14 Drying Agents.Criteria" I 2.801 li(B; Use ofPaswulizedH,_esx j 7-205.11 Incidental Food Contact, Lubricants I 3-S01. W i Raw or Pat l,aiiy Cooked Animal Food and 17-206.11 Restricted Use Pesticides.Criteria* ( Flaw Seed Jurnuts Not Served. .x j 7-206.12 Rodent Hatt Stations' ( j ;-SOI.€IOC) Unopened('root-Packaec Not Re-screed. " 7-206,i 3 Tracking Pnwd.r:,Pet Control and ( -- - Moratoring' CONSUMED ADVISORY TiMEITEMPERATURE CONTROLS 22 603.11 Concnmer Advisor} Rested lot C'on<ampnon of Animal Foods friar are Raw, Undercooked or 16 Proper Conking Temperatures for Not C)thcroise Processed n,Eliminate PRFs eve,.or«,;r.=sat 3-401AlA(l)(2) Eggs- 155`F15Sec. Pathog,ns." ^cs-Immediate Servicc 145`F15sce` -302.!3 Pasreu --' nzed Fggs Substitute fir Rai+,Shell 1=40Lil(A)(2) Comminuted Fish, Meats&Game EgY`LL Auintak- 155-F 15;:cc. _ 3-401.11(8)(1)(2) Pork and Beet Roast - 130'F 121 minx SPECIAL REOUIREMENTS 3-401.11(A)(2) Ratites. Injectccf Monis-155°F 15 590 001)(A)-(D) Violations of Section 590.009(A)-(D) in sec. _' catering, mohile food, temporary and 3-40L11(A)(3) Poultry,Wild Game,Stuffed Pl-IFs, residential kitchen operations should It, Stuffing Containing Fish,Meat, dt hited under the ::ppropri.ne sections Poultry ur Ratites 165'F 15 sec. " above if I ciated to foodborne itincss -401A 1(C)(3) Yi'hole-muscle, Intact Beef Steaks inter ventions and risk factors. Other 145°F,. 590.009 violations I cladnz to good retail 3 401.12 Raw Animal Foods Cooked in a practices should be debited under #29- Mi.aowave 165''k Special Requitemcots. 1 ,'01.1 l(A)(1 i(b) All Other FFIi's- las"F 15 sec. j 17 Reheating for Hot Holding VIOLATIONS R�LATEO TO GOOD DETAIL PRACTICES 3-403,11(A)&t D) 13IIFs165"F 15scc, (Items 23-30) i-403.t I(B) Microwave- 165'F 2 R4uwle Standine Critical nn;?nor criti,.a[cartuhuns, t,lash do nor rei,eer m Ilio Timer' ( Ioo,dhom, dbme:�v iutet-vennon.v,Inti risk jorurrc ifsted abovr, con be 3-403.11(C) Commercially Processed RTE Food- found in the joUmrin,g se,tions of the Food Cone and 105 CMR I 140'F'r ( .S.)o.(I()t7, 3-403.11(P) Remancto, Unsliced Portions of Beef i Item Good Recall Practices FC590.000_ Roasts* 23. Manati-ment and Personnel FC -2 .003 j IS 24 Food and Food Protection FC-3 004 Proper Cooling of PHFs 3-50 L 14(A) Cooling Cooked PHFs from 140`�F to I 25. WatEcitioment mrd eandUtensils FC-a .005 26 Water, 'lambing and Waste FG-5 .00B 70'F Walun 2 flours and from 70"F 27. Physical Faelay FC-6 007 _-- to 41 'F/45'F Within 4 Flours. r 28. Poisonous or Toxic Material- FC-7 .008 3-501,14(-) Cooling PI-IPs Made From ,kmi neat ( 29. Sordid Fleguitement5 ()Cg Temperature Ingredients to 41"F/45 30, Other Wnhin,1 Floorc:z Dcno:es rnncal nen,in(hr taleml 1999 Food Cod,or 105 CNIR 590 000 l i l� .. '" dT •r.A.rt e'I`.." •` tie♦�+...t..�:,f... Y, .^A'M.:a.......-rWv".hYb'nL.r ,. rs..c..n...sF+t"r+.^�n .1r�r,y.yw,r:,y.-re 4,, . -.�. _. 7' , Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4`" Floor Divigion of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name � Date Type of Operation(s) Type of Inspection l�Y-i)'}"�' 0 (1,06V4,0, />C" I F1 Food service p'Routine Addres's �9 11 Risk "LJ Retail ❑ Re-inspection qqjc 1�/11��1100)1_ ki Y , Levels ^ ❑ Residential Kitchen Previous Inspection Telephone Y y (��R- � � _ � �' S� I ❑ Mobile Date: Owner / pi iv' -A" P (j'^ I `�) ( rn� I HACCP Y/N I ❑ CatererEl ❑ Pre-operation p lv l71 El Suspect Illness Person in thaig9(PI Oa Time ❑ Bed&Breakfast El General Complaint Yivl,ao In: ❑ HACCP Inspector 1 i i'v)1 y 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 690.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. ? ✓ FOOD PROTECTION MANAGEMENT L�� 12. Prevention of Contamination from Hands ❑, 1. PIC Assigned/Knowledgeable/Duties 2113. Handwash Facilities (a) EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded [114.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding G2"8. Separation/Segregation/Protection ❑20.Time As a Public Health Control [79. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC-3)(590.004) 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 (5 (Fc-a 990.009 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 5SOOns tFmm-14 do IIIn'' et'tor's-S/ignature: Print: AIR yAl. 1 ,l/(l I.�P iC's Signature: Print: Page of Pages � .:-- l fry- �c".l-� (l� `v � Z171 Violations Related to Foodborne Illness ' Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 (7ross-cordaminabon ( 1 590 Ut!3;r1) ( Assignment of Responsib;li[y"' 3-302.)1(A)(1) Raw Ani;;al Fords Separ l.'d filow 590.01"O(B) Demonstration of Knowledge" ( CGwke,.`and RTF.F.axk* � 2-!03A I ( Person in change -duties Gontammpiion from Raw Inyvedien!s 3 302.!](A)(2) Raw Aninu;i F,,ods Scparattd from Each EMPLOYEE HEALTH Othvr" 2 540.003(C) Resp0nsibditv of the person in charge to Contamination from the Environment require reporting by boil employees and 3-302.1 Ii Ai Fatv", >rotv:(:cn" applicants* 3-302.15 Washme rruits and Veget,.blcs 590.003{P} Responsibility OlA Food Employee Or An13-3fW.11 Food ConG;rt'„ith Equiputeni tmd Applicant To Repot To The Person hi Uten,;!'" Charge* Cor,aminatian from the Co::surner ,rn in Charge* it , ,ice 59t1.003(Ci) Reporting by Pcrs g 3-306.1 trelltii) Rctten.d Fcixl and Rr.LtLicr o(Food* 3 590.00'CDt Exclusions and Rrshictions" Dspx_Ricn of Adu,4e,ated or Contaminated 59 1 om ternoval of Exclusions and Rcstrictions Fogy F.} I i 3-701.11 D;sca:rdmg0rRecrn:daiamneUnsafe FOOD FIOM APPROVED SOURCE F,,)o&' 141 Food and'Water From Regulated Sources 4 Food Contact Surfaces 4-50:.111 Nlanual \Varcwahinc flotWater 540.00='(A-B) Compliance with Food Law'" � - 3-201.12 Food in a Hermetically Sealed Container' Sanitization Temperatures' 3-201.13 Fluid Msilk and Milk Products* d-501.112 McLhanical Waiewashing Hot Water 3-202,13 Shell Eggs* S:mitizur atinnTeruperates"•' f-5(11.114 Chemical Sanitization-tenip.,pH, 3-202..14 1•.ggs and Milk pr0ducts.Pasteurized` (, ' concenhL aon;md hm'dues a 3-210116 _0'1.16 lee Made From Potable Drinl0nc Witter I {-(,Ol 1 I(A b: urnment F,„x]0,ntact Surfaces and 5-101.11 Drinkme Water from an Approved System' ) y ' Lltrnsds Caatr' .590.006(A) 13ottledllrinkmeWater* i 4-602.11 Cleaning Frequency of Egmp;n,:nt Ford- ; 590AOt,{B) \\'acct Meets Standards m 310 C'Mti 22 0* Contact Surfacce and Ctcnsih.'" Shel67sh and Fish From an Approved Source 4-70.1,11 Fictp+enev of Sanitizitr,n rf Utensils and 3-20i.14 Fish and Recreeuionally Cau0it Moiluscan Food Cnnc,+ct Surfaces or ;yuipmenr* Shellfish* ( _ in 4 7-.,.1 i Merh,xis of SamtiS,,a .,un- 4,,t Nater and 3-201.15 Molluscan Shellfish front NSSP Listed Chemical Sources* + I6 j Proper,Adequate Handwashing ! Came and Wild Mushrooms Approved by - 2-- Ci, io - ,r: Regulatory Authcri4, , - 301.11 - .nn C:ndtu n - Hands and A,-nv, 3-202.1 t Shellstock Identification Presem' 2-301 12 C^caning Pr(x-edlJr'* 590.W)4(C) Wild Munluooun" 12-301.14 Wheu fog Wash* 3-201.17 Game Anunals* I1 Good Hygienic Practices S Receiving/Condition 1-40L!1 F,rnrte. Drinking or Using Tobacco' s-2(2.11 PIIFs Received et Proper Temperatures" i 2-401.:2 Discharges Fromthe tiycs.Noseand 3202.15 Package hde:goty;' Mouth': 3-101.1 t Fond Safe and Unadulterated" 3-301 1 Prewatim Contamiti :0n Wlien Tasting* 6 TagslRecords:Shelistock 12 Prevention of Contamination from Hands 3-202.15 Shellstockldentilicatiun " 590.004(E) PrevewingCbntanunanonhour ' _i-2{I;.I7 Shellnarek l:Ientil\cation Niaintametl* F.mPlovees' Tags/Records:Fish Products ( 13 Handwesh y Lpceies ?-302.11 Patasite Deshuccion* Norville, an t ocafedand Acaessrhle _',-203.L: Nnntlx•rsandC:+�tclies^ 3-402,12 Records,Creation and Retention"' 5-204.1 1 =_ceattoa and P!aca;:em" 590.004(1) LabelinConfor of ingredients` 5-205.!1 Accessibility,Operaiior,and\Maintenance 7 Conformance with Approved Procedures ; /HACCP Pians Suplied v✓rth Soap and;1a(14 Dilvirig 3-502.11 Specialized Processing Methrxis* L,evr'cs 3-502.12 Reduced oxygen tae.k tRi6-30!.11 n uiteria" Hondwashing Cleanser. Availability j 6-301.12 iFaftd Drying Pnmi, ,3-103.12 Conformance with Approved Prr,cedures" l:;n [know,:neral he.:n in the fedsal 1999 Feud i o0e,ir 015 CNIR 590(jN; CITY OF SALEM BOARD OF HEALTH ? Establishment Name:16VA- 1P. Y' ( l P_ /,1rG�P_ Date: d 7 0 Page: C� of Item Code C-Critical Item t! DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item PLEASE PRINT CLEARLY - - Verified I,. -f'hC -f-all11 l2, - Nand c/r,k hlio( no sc�cp - Saav 1-;D At.,, �rlgr�ljn- l /wi` L� l_3 G - i-farm ink 1-D1171179 licvc7 v licair . I h�h�l�/.tshrra onlu . ✓a� fes I'qr'Inl? /Dor>7 /xDo� (rite _ Fay f��e l tM//ho( fed. ✓ate - .�hcer� rioot�< 6piPwl /'tall/, /ha ✓9 C - nG h/r/1r � .S'tdrn�d sc�ran( - r�surce oy2 YP/�/ate 1 F. --Aorou h l (llnrn and S�inlc/h c�` 'efzu �/� ISPs �h� b�fzin� t�lrrrth� � � o/dS ffUS�rnr�rl Ic e oh.d Hilss/nq wc&, 1l VISI (AF /Ie�eFe /_fl !//iJnfTJI/l�nCf GZt Pfi�� f U� 4/ or QrInUJ /J_S �1///1/�l✓CC/CCY . /C6- CICCri� � IL/ 69 v/�iMI9��ei� it�i�i<� rai�rpc✓ /7� O �I r/2 h-P/o�u I - r isSl,�/rn bi'�Icf ':�612)n. All {7�n�1 th S1zr�� r I � rnl,sf fes. r/,vPreN . OPS' =1 )w'( no6 � � Ctvinonn ( C (miiit`v/t 41( tit1r,l ,Ir ,r ,l�f�� r, (v�, rJ rli b��s Discussion With Person in Charge: ) Corrective Action Required: I ❑ No I ❑ Yes II ' I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Ll 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. 1� ❑ Voluntary Disposal 0 Other: 3-5(!;.;4(C) PI-IFs Received.--r Tennieratures ISI Violations Related to Foodborne illness Interventions and Risk According io Law Cooled to Factors(items 1.22) (Cont.) 51`F;45'T Within 4 Hours. " 3 i0i 15 Cooling Medwd:.for PIib's PROTECTION FROM CHEMICALS p! pHF Ha and Cold Holding 14 Food or Color Additives 5)z t1.16(B' l t Cold P11Fs Maintained at of below 3-202.12 Additive:` 0-}(i_,l ? 3-302.14 Protection trom Iinappruved Add7tives` 0 I$ Poisonous or Toxic Substances 3-50 L 16(A) [tut PPH 8 6' hlaint4.ced at or ahrn,: 7-101 11 Identifying mfonnauon-01ip:na( ( 3501.1 6(:A) Roast,field utorabove 730'F. " Contancr�^ 7-102.11 Common Narne-Workine Conlainen'° ( 26 Time as a Public Health Control 7-201.11 SeParaliun-SUirage' 350 L 19 f ime as a Public Heath Control* 7-20211 Restriction-Presenceand U,e' 590004(9` Var.nnce Reyunemen: T 7-23.12 oo til'els REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 !I Toxic eic Conn tainer,-Ymhibi[ions" 7-204,11 Simitizers.Criteria-Chemicalr�- POPULATIONS(HSP) ,� , i 21 3-801.1](A) Unpt:tenriz,d Pr.-packaged 7uicei and 7-'?0-1.1.. Chemicals for Washing Produce, Criteria" Be�etagcs with W'arnine labels' j 7-204.14 Drying Agents.Criteria' }-807.11(B) Use of Pasteurized F�}gs* 7-205.11 Incidcmxl Fund Contact,Lubricants* 3-301.1 I:D) R:.w or Parti:::iy Conked,Annual Ftxx}and 7-206.1 i Restricted Ilse Pesticides, Criteria* Roc:Seed Surouts Not Sertied. * 7-206 12 Rocicnt Ban Sranons, 3-,,'0!.1 1(C� Unopened Food Pacha= Not Re served. " 7'06 13 Tracking Powders, W,st Cuntwl and I Moniturine^ 1 CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.! 1 (Ansumer Advis:ay Posted :or Censuniption of Animal Feeds What are Raw.Undercooked or efi I Proper Cooking Temperatures far PHFs Not Olherwite Processed to Eliminate Paihupctts. 3-401.11 A(I)(2) Eggs- 155°F 15 Sec. 3.302.15 P:,steurized E,des Substitute :-or Raw Shell Eggs-htutediate Ser?-ie 1.15'Fl5ser" j 3-40J.I I(A)(2-i Commutnted Fish,Meat;S,Game Eges. Animals- 155'F IS sec 3-401.17(13)(1)(2! Pork :md Beef Roast- 130°F 121 nein* SPECIAL REQUIREMENTS 3-401.11(A)t2) Rattles, Injected Nteats-1553E IS Q0009;A)Ar)) V o!ations of Section 540.o,)9(A)-(D) in sec. ,r3-401. r catering, enab=le food. trniporary and 3 401.11(A)(3) Poultry,Wild Game,Stuffed PFIFs, residenita.l kitchcat operations should be Smi'fine Containing Fish,Meat, debited water it, applopriate sections Poultry ta Ratite::1653E 15 sec. ,; above if related to foodborne iliness 3=401.4 !(C)(3) Whole-muscle,Intact 13ee1Sterks interventions and risk Calors. Other 145°F m 590.0)() vic!ations telat+ng to good retail 3 401.12 Raw Animal Fonds Conked in a practices should be debited under #29- Microwave 165`F* Special Requirements. 3-401.1 i(A)(}Nb) Ail (}thee PHFs-- 1'5"F 15 sec. J7 Reheating for Hot Holding VIOLATIONS R.LATED TO GOOD RETAIL PRACTICES 3-403.17(A)k(i>) PHFs 165`F 15 see. * (Items 23-30) 3-403.11(6) Microwave- 165'F 2 Minute Standing Crii«al and wm r;itkol v(o(dfians, winch do+roe relate to the Time* ,jvodb-rne dlr:esy nnriventin;z;and 11.41 j;v101- ' ted above, can he 3-403.11(C) Commercially Processed RTE Fwd- found!;,th'..JulGnrhn,e sections of thr fount Coate and 105 C,141? 14WF" ( 590.0.0_0. __ 3-103 II(E) Rzmainine Unstieed Portions of Beef ' •'tem Good REiail Practices FC 590.000 R"asts" 23_-1Managenient and Personnel FC -2 .003 ;g ( Proper Coaling of PHFs 24. Food end F•tod Protection FC-3 004 j 2`; Equipment and Utensils FC--4 :305 3-5(il.ld(r\) C'uuhrgCuukedPHFs from l40`Fto 26. Water_Plurnblrigand'A'aste FC-5 .006 70-F Within 2 flouts and From 7016 27, Physical Facility FIC-6 .007 t��41'F/4-5 F Within 4 Hours. " 125. I Po,socuus of Toxic Materials FC--7 .002 3-501 14;Bi Cuolin PIIFs.Made From Ambient _29. SIW(a l Requircm its 003 I Tenapenature Ingredients to,41'F/45:F 30. tither Within 4Iiours •Denntrc smell 110311 m 1110(cderal 1999 hued Cade or 105 CMR 5901100. CITY OF SALEM a BOARD OF HEALTH t Establishment Name: _ WI Y10v l lPD Q Date: S Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY � n/� G -• nfLC. UR.L-t hnd ( ow nvn --k n-kot.2 readcl P4 iL I -Piv)c-AS P +-0t,i Irnoats i-D he s-Zv-P( 1 l- J1)W (-- .(1 K(f9OCI( h) eo-I ` q owteVLA-- (-_,vD s ri1n-f74mI(telrtf)oil. ✓ s' I tock DV/00ltllr /C60r_t.l_ 1-Lo nrPri ['100 &'- (IV la U-0anIhc 1 IICJQ 0 Wrl M ( btio+Pty I a/a<�' I - 611 r l-D wiz uo vv_.0 rt s a o 0 n n a I C L_P n o t h� 1 r1Q P r)S . n J nsl �A -6:> I Sin i �e�A I Cbn-Ii,n Al ( L(a 1 J - cs r 49/1 i yi r wr )� eve i oh ons f-o t I IC i s h of m. Sl t 86-)G �0 v C� e)-2_s) {nnt�ti�r, li� o "Prv�tc-1V \As) bOw_ AAo.vvin r,Ftiio4-e.r2 mC_t vi+nl n-e(-4 4e In up o+' 4-1 I L4 S- C v10+ nl Cup °i�e � 4D rtnrxh yup �� i5 Inr.rl czrt^.u1�� laho�. o(' -P,),)d s v-)�i �)o 6 n-, a r ihrSm�Hvu < ( Orkin � I Savu h _ ' 100 Scoo1`1 A rAcu"rn� (A-ho\n n-' taty� I jxz� c��1�V1S- Tho�vUreHlu r 1an � A S(afl 41� ci�c .�c� o r yp(Tm P I I O C'4�' Vvk 6 s -t r�Cl n 1 / -fbo 6 (�p h vi S Gv\ )oo+I-n rn c r u n tis fi s v6 _s - A-( I � I Ytee d. �1nvYtwraH Cl.tl� I N % - C t1,0 rymM tj o04 n + hna nl IhS e(,-h6n _ 'uta--ek- iv be vvnninaeL+ Discussion With Person in Charge: / Corrective Action Required: I LlNo 4.1❑de's I�UI=� 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-tidollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �,c (� d ❑ Voluntary Disposal ❑ Other: i :.`;a.!dt C) 1 ✓HFa Rercrved at'fentper.i?urns ' Violations Related to Foodborne Illness Interventions and Risk Accorli ng to Ia"•Cooled to Factors(items 1.22,) (Cont,) j "(^F;45"p Within 4 Hours. ' PROTECTION FROM CHEMICALS -i 5W.i5 j Ccolina".leaanis for P1`tFs j j Id Food or Color Additives 3g j PHF Hut and Cold Holding 3-20'_.12 Additive,* 3-501.16tB) Cold PfIRs Maintained at or below 590.004(17) 41'/1S`F" 3-302,14 Protcetion from l in,ppmsed Addiirec*- 13_jU;,i 6(.4) Hit FHFs Main[ rnecl at.:r above 15 Poisonous or Toxic Substances i4U'F. 7-101.11 klenut}nng lnfbrmatnat-Original 3-SUI 16t.A) Roaets Fide at of above 130"F. * Container;' 7-102 11 Conunon Name-Workin-Containers" j j 20 Time as a Public Health control t1 3-501 !y Titre a;a Pu6hc Hcalrh!'vnuolt j 7-2UE11 Separation-S.or:tee" ( V;lii nceRcouu'cment 7-2U2 11 Restriction --Presence and like'" i 7-202.12 Conditions of Use' 7-203 11 Toxic Container,-Prohihitiims* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE u ( * POPULATIONS{HSP)7-�04.I1 Sanitizers,Critena --Chemicals 7=_'01.12 Cheaucals for Wash:ne Pnx(uce.Criteria j 21 3-til.I l(A) Unpasteurized Poe paekagG,i Juice:and ( 7 04.14Drying Agents.Citing;` Bcretae'.,• 1th Wcrning I'al: . Raw SCd 3-80!,it(B) UsnofPast,wimdE,_es* 7-_'05.106.1 I Restricted l 7-21 eidentalFood Contact,Enbrtcams` ( 3-801AIiD) P.aworPaOalfvCooked.antandFoodsnd j ir;r Pesticides.Cri[eret'" Lsprouts Not Ser•,ed..x 7-206 1"2 Rodent Hail Stations- j 7-'_06.13 ]-racking Powders.Pest Control and j 3-801.11;C) Unopened Food Pack;ew Not Reser cd. Monitorin CONSUMER ADVISORY TIMEIi'EMPERCTURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal 'roods ilnd are Raw,Undercooked or .16 Proper Cooking Temperatures for (PHFs NO 0Anerwise Processed to Eliminate 1=,• ,. 1 3.,401-1IA(i)(2) Eggs- 155,'F 15 Sec. -� P,u'r.,,gens. r,I.., . °'' Yccs-hnntediateServiec 145`f'15scc^ -302.13 Pasteurized F?gCs Suba'ututr for Raw Site]] ' 3401.11(A)Q t Comminuted Fish, Masts&Game Epen;- Animals- 155'F 15 sec. * 3-401.11(B)(I)(2) Pork and Beef Roast- 130`'F 121 min' j SPECIAL REQUIREMENTS 3-401..11(A)(2) Ratifies. Injected Meats- 155'F 15 I 590.009(A) (D) Volations o/Section ')90.009(A)-(D) in sec, * catering, inobile fall,temporary and ,401.1 I(A)(3) Poultry,Wild Game,Sniffed PHFs, teniden€ial kitchen operations should be Stuf*.'n CouUuning Fish,A-teat, aehited ur:de: U:::approPria,e ceceons Poultryor Ra1ites-165'F 15 sec "' bove if related to foodborne illness 3-101.1 I(C)(3) Whole-muscle,Intact heel Sleaks interventions and risk factors. Other 145'9F°' 590.009 violations relating to good retail 3-401.12 Race Animal Foods Cooked in a practices should be debited under#29- Microwave 165"F* Special Requit'entents. 3=401 110,0)(6) .111 Other PHF,- 145'F 15 sec " 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 I1(A)&(D) PHFs 165'17 15 sec. "' (I€t-nn 73-36) i-403.11(B) Microwave- 165' F 2 Minute Standing Cnl 'ui nnai nun-rre!h.'d w4a!ians, w6,ch do nal relate to the Tl ale" foodborne dtness b)rerrennons,and nsk factors ti::!ed nbn»e, cam be 3-403.11(C) Commercuiliy Pmce.sed RTE Food- round he!/re Ibilov irtn sections of the food Code and 105 CAIR 140'F" 59(0061'. 1 3-103.11(6) Remaining_Unsliced Portioncof Reef Item. Good Retail PracticesFf. 590000 Roasts* 23. Ma.^.agement ar cj Petsoarel FC-2 .003 18 ( Proper Cooling of PHFs j 24. Food and:--ax1 Protxtior, FC - 3 .004 � 25. m 28. Eguipera and Utensils FC -4 605 1-501 14(A) Cooling Cooked PHF< from 140"F to Water, a; . 0--------� i � (✓glut, : t.mhi^.r,and Waste Fi;--S �!, .006 � 7017 W4ihin 2 Flours and From TFF 27 Physical Facdnv FG-6 1 007 I Lo 41'Fl45'F Within 4 Hour, 28. Po„onus or Toxic Marenals FC-7 j .008 -I 3-50L 14(B) Coming PFIFs Made From Anitaant 29. spodni Rec etemonts 009 Temperature Ingredients to 41"F!45°F 30 Other j Within 4 H„urs'^ :,w,:.:r.....�z.•., 'Duro(e,enn:.al item in nn•f,, rat 11)1)9 F,md Code or 105 CMR 51)6 000. 'CITY OF SALEM BOARD OF HEALTH f Establishment Name: VU td'10�� Q/ Date: 'l1 Page: - T of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R-Red Item Verified :r PLEASE PRINT CLEARLY C oic t a: �hPIYYI[))'11P (� 12 YYl(tt11�Z(IYlOC� �t 'I Ca' +eiim 0P L(( ° F (1✓ 19101 � (7� r1n�f�1 - 4 ✓ � ' -/jVtna I )Vl i - Svoliko hood w AoIvA r (or, nin, �j Arc� , rn�llct� al r (-;X -�oc1 (A10-b�)ets_ ✓rel awin i n _ \ , V rw,`� 7ivi f� ni Ilc 4hol WeV40- WCu Y_ I nL- A A 4 1 1 1 t/a 4 r�ri C,6IMO r ,v,n_ nt,p l� �M ci w(A I -f o vd ( ,y) t( � <- Ya o,Q m u R1 �§ 1--f C4 rti + (xN rnlzs 4Zc�k�►xnnnS - 1 �}�', G1r1P11S - l��n �(Irr(r1-hnnc f `1%44 (Al(1nnor)Q - rrrti�\lnitpr e ��1 St I�,nc� hn ;�r�S SI�YI +b toe_ 1 G fid` S0.n_AZh7--e0 4t nS l-)r Sp ,vi 4 oi-I rl-viv ( ino 0rP/k vi , -h52 (r0 t G u-6An 4'r) 1-aP, (-) M rbra /,J oorh I d )/'ier +7(m M o U -h(v .Q.S/ f ✓� k)0 "yl)0 � UjiIinC i�n(, tln-17AI ho A_ SOHt h SCA +D (� yti n l 1,11171n (-1 o,l Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Violations before the next inspection, to observe all conditions as described, and to Emersion P El Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 1 noncompliance may result in daily fines of twenty-five dollars °�r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (' rC ❑ Voluntary Disposal ❑ Other: 1 PHFa Receive:'.at Temperaairr: Violations Related to Foodborne Illness Interventions and Risk Accord:,g to Lav:Corded to Factors(/tents 1-2?,) (Cont.) PROTECTION FROM CHEMICALS � ? 501.! i Coohne Mother:for PF:F, 14 Food or Color Additives I 19 PHr Hot and Cold Holding _ - 3-50; 16(R) f:nld Pl IFr,:1. imainedatot belov, 3-202.12 Additives 59n.004(17) 41`/45°F' 3-302.14 Protection from (inapprol Additives" -501,INA) Hilt PHFs Maintained a or above 1.5 Poisonous or Toxic Substances 7-101.11 Bdentt t}'inelnfonrrnion-OngWWI-,i°al 3-5(11.16A) rtes , *"F * Cunt.nners°` t +.s H:Id at or above 13(, 1� 2g Tirtte as a Puttil!c H.alth Control 7-102.11 C'umtnon N:ime-Workima Containers' 7-261.11 Separation-Sh,ragc l into as a P.;Lt l-lca!tir Control'. ! 590.004(H) VananceReauiroari t 7-902.11 Restriction-Preseno:.:uud t;se" 7-202.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2 .1Toxic Container Prohibitions" POPULATIONS(HSP) i 7-2(W04.111 Sanitizets,Criterra-Chcmi:.:ils' 21 S'W.1:(AJ Unp istoinzed Pre-packaged Juice:and 7-2(",J2 Clieoucals for W'ashine Produce,Criteria 7-204.14 Divine Agents.Criteria: I t3ercrsea aCh tA.u'nilg Labels` 3-SO:.i I(E) lise v9 Pasteurized L 7-205.11 Incidental Pacd Contact. Lubnrantc' g,gs' 3-80 .11iD) 'dam _iVal tial lyCtwkedAmiii IF,usoanti 7-'_'05.11 Restricted Use Pesticides.Critena=- I Katy Seed Sprouts iti,�t Se:ved. 7-206.12 Rodent Batt Station,°' 7-206.13 Tracking Puvtidrrs, Pest Control and '-801.11/C, Unopened Food Pac:kaste Not Re.-scnvd._' Mor itorin_" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1 i C'ansumcr Adisoty Posted for Consumption of A::mwl -roods'i flat a:c Rav%Undcrcouked or 16 I Proper Cooking Temperatures for PHFs N,a Outei w.i:e Proccs,ed to El:minate 3-401.1IA(t)(2) Eggs- 155'F 15 Sec. PnrhrrgcnS.' Egos-Immediate Serl'ice 145'F 15se:W 01.13 Paateun:c,?IF 2,;Substitute for Q'm shah 3-401.11(X)(2) Comminuted Fish, fileats 8c Game Et t s Animak- 155-i'F 15 sec. 3-401.11(13 (1 (21 Iso SPECIAL REQUIREMENTS), ) Pork and Beet Roast- 130 F i2i min 3�401,I1G1)i2) Rol IS 590.009(Ab(D) Violal;ons of Seelioa 590.009(A)-(D) in � , sec. catering, mobile Food,teruporary and 1!{;1N�) Padtrr;,Wild Game. Stuffed IIHFs, re:i0cr•hal kitchen cperationc vhould he Stuffing Containing Fish, Meat, debited under the appropriate sections I Poultry or Ratites-155°P IS sec. '= :diose it related to 1'codhomc dlneas 3-401.11tC)(3) Whole-muscle,haunt fleetSieabs intcrveutions :,:?d ti,l factors. Other 145°F x. 590.009 violations eelaiing to gond retail 3-401.1_' Raw Animal Foods Cooked in a ptacti_es should lac debited under N29- Microwave 165`F* Special Rc yuirernenrs. 3-401.11(A)(1)(h) All Office PHYs- 145"F15see. '- 17 Reheating for Hot Holding VIOLATIONS RiXATED TO GOOD RETAIL PRACTICES 3-403.11(A)R(D) PHFb 16.5'F 15 :ec• * I (Items 23-10) i-403.11(B) Microwave- 165° F 2 Minute Standing C„truJ and non-criti:.ul vwh'W,w,, ndnch do not,-elute In rile Trine" ,foodborne iltne;v ittte'recnL:;n::and ri.;b-fn;^ors fisted uteuve ran be 3-403.11(C) Clmtmcicially Processed RTE Food- ,found bt thijawmrc ing section, of the Fond Calle and 105('MY 140`F` 50.01,70. -- 403.11(L) Remaining Cnsliced Porticos of Heel I Item ! Gr Retail Practices FC 590.0oo Roasts* 123. 61anaorl and Personnel FC--2 .003 I IR j Proper CooSng of PHFs 24. Food and Foca Picteciiun FC-s 004 3-5 i ,. 25. Enuipment and Utenslis FC-4 .005 Ol 4l.1) Coating Cooked E IF::from I.(1`P to 26. Water, Plumbinq and W aerie FC-5 006 7WF Within 2 Hours and From 70°F 27. Phvsic.^.!Facility Ft: -6 007 to 41"F!-t:i"r Within 4 Hours. * 28, Poislmrn:s or Toxic tJatetals FC-7 .008 2-501.14(1:) Cinlhnl PHFs Male.From Ambient ). Spccia!Requirements 009 I Z'empm rrare Ingredients to 41'1-,/45'F3e, Oiler/45`F I i Witlna4 (lour;,` *Uel nr,<aui�ai iicm Ili the feller..! !999 Food('ode or N5 CNiP 5V0 000. — CITY OF SALEM ' /� BOARD OF HEALTH Establishment Name:_ V/)� k) (7lPU K7J P. Date: n7- 7 -D Page: of a Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 N, . Reference R-Red Item Verified PLEASE PRINT CLEARLY I ✓ate G - '(��I �1v1rr (1)PI/ X11114 ro,� 1' f) r � -I-, 1o foy 1 e Ir,/91;q. � QI �C'0 1 /,vVP0 E 4ec-,4 �Avl +b i-�l ' t) Ijv ChnQ0A +7) Ion 1- l +7- Iy,Ta {'o < -1) n �7rt��Ov rT, In�o �17On ✓/a G -- G1ntjfc'. v1f,-( IU% hwyln i hon b(-,n I 1 I 1 r v4.�.-n l-P G�vvv,I+- i —�- h'wWo ,x 117///v/-ffo) Discussion With Person in Charge: t CorrectiveJAction Required: I ❑ No I ❑ les 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 LI Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food-Code.-1 understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. ❑ Voluntary Disposal 0 Other: 3-501.!4((,) PHFs Rei'eived'at'remlv^'ature� Violations Related to Foodborne Illness Interventions and Risk. i A,carding",East Cc»iui to Factors(Items 1.22) (Cant.) ef 41''F/45'F Within 41?-urs. PROTECTION FROM CHEMICALS 15 CotdittK tkleth:,ds fu PHFs 14 Food or Color Additives ( i 1!F PHF Hol and Cold Holding 3-501,16(H) C,Id PHFs ,Maortained at it bcluw f 3-262.12 Alditr.esx SQo.(1(/4tF) 41'/4S" 7-302.11 Protection tenter Unapprostd Addasses� 3.501.1"5 A) lin,Pff,:: khnc:wined at oi A the 15 ! Poisonous or Toxic Substances 4.)'F 7-1x.1.11 Idcnut}ang Information -Ongina! I 3-501.76:A) Roast,H,'Id at.•r::hove 530'F Container,' 20 Timor as a P:abiic Heal*.n Centre! 7-100.11 Conme.ntVarne -Working Conon nerd '1-30 Tina ore a Pus!: l-t::dthC'ontrc+i'^ 7-20 L 1 1 Separation-Storahe" j7-202.11 Re,tricl,on--Presenc:aml l-'se" Stlit�lii4(H! Von;mec Rei;:uiet:+ent I ! 7-201.12 Condrtion•.of tile" 7-203.11 POKieC'(altamers-Prohibits+ons' i REOUiPEMENTSFOR HIGHLY SUSCEPTIBLE j 7-20".11 Sanitizeia.Criteria-Chemicals' I POPULATIONSHSPj 17-204 12 Chemicals for fWaehing Paxtuce,Criteria" ! 121 13-801.1 l(,A'. Unpasteurized Pre-packaged suint;.and tiesetane+. v;rth\Warning Labels' ? 2(14.!4 Drvin1Apents Criteria" i •7aO),II lnetdrmal Food Contact, Lubricants^, 1-801.1 (W 1 Use of Pasteurized E,•as" 3-801 1 IlD) ':, Raw or Paxbaily Cooked Amr)al Ford and 7-206.11 Restricted Use Pesticides,Crueria" 4u�s Seed Sprouts Tb�t Scr,ed. '/-,!Of).12 Rodent Hct Stations* ! Unopened Prod Package Nn: Re-servicel. 7-206.13 '1'rac•king Powders,Pest Control and i Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 >-60311 Consum=er Adve ory Posted fir Con.antpimn of .Animal hoxk That a=rt Rate.t,oderaad..ed or 16 i Proper Cooking Temperatures for Nor Other«,isc Frocessed to Eii!ninate PHFs I i oa F;<,.•:.: :.,oar}461.1 iAt I)(Y, Eggs- 155'F 15 Set. In(aeens Eggs-lmmedtate Sm-c+ee 145'F I$se:. ! 3-31!2.13 P=asteurized Egg;Substituty till Raw Slid! Foo,: 3--F07.'.7lA)(2) Comminuted Fiih.Atrats&Gallic Animals- 155'F 15 sec. SPECIAL REOU1REtr1ENTS 3-401.17(H)(i)t'_) ( Pork and beef l:oast- 130'F 1'21 mint' 1 >9U.609(.0)-(I)I Vielal:uos u( Section 590.009(A)-(D)in 3-40L1 l(A)(2) Ratite,. h:3ected h4c;ll::- 15i'F l5 i . set ; cuiertng, mobile fotxl temporary and 3-401.11(A)(3) Poultrv,Wild Game.Stuffed PHP, i resident==s kitel:;n operations shou!d be Stuffing Containing Fish,Meat. debited under the appropt;mi: sections Poultry or Ratites-165 F 15 set. ` above if related to Foodborne illness 3=101.1 I(0(3) Whole-muscle, Intact Heel Steaks I intern•:ntior: and risk factors. Other 745 F= 590.009 violation, relaUn� to f,00d retail 3-401.12 Raw Animal Foods Cooked in a Ptactr.es should bo debited tinder 1f29 - Microwave 165-F° ( Special Pequirententa. All Other Pl-fFs - 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RaA TED TO COOL!RETAIL PRACTICES ! i-403.1 PHFs 165`F 15 sec. * (Items 23-30) 13-403.11(11) Microwave- 165'F 2 Minute Standing Critical and++nrr-crniad violations, trhich da not rc(alr tr,the j Time" I %6n(.l5crre 11roest inter l"Mriony and:iso facmrt !,steel above, our be 3403 11(C) Commercially-Porcessed RTE Food- ( %pard ie the tnllaw;ng tertim,c(f;pie Feof Code,and 10.5 Ch•I,4 3-40? I I(F:) Remaining Cnshced Portions of Heel I lien coed P.e:crit Practices FC 530.000 ! Roasts, 1 -=_ Manacemerrt and Pe+sonnd FC-2 .003 ]g Proper Cooling of PHFs I 24. pool[:aid Food Protection -C -3 004 25. Equipment and Utrnsi:s K;--4 .005 3-501,14(A) Cool,ng Cooked PHFs Loc 140`'Fto ! 26. �� VJak:r.Flumbinq and Waste ! FC-1 .UOo 70°F Within 2 Hours and From 70'F 27 Phvs ca Facddy it FC--8 .007 m41`F/45°F'Withm4Hours * I _28.-__ IPoisonousorTrxicMaterials FC-7 ,008 3-501.14(H) Cooling PHFs Made From A lament 129 Special Requrennents .009 Temperature Ing,:clients to 41'F/45'F 30 Other Within 4 Hours.. ., ' Dantdn...rilical 105 CMR?9000(1. COURT DOCKET NO - CITATION NO. CITY OF SALEM D p13. t t 9 1 VIOLATION NOTICE r 4„ NA{MEE((LLAfSTy,iIFIR_ySTT,,'jINNIITIAL) /1f/jQ STRES� IQI� j CJ )v V W�AnSTATE T LICENSE NO. f UC EXP.DA.TE DATE OF OWNER'S NAME(LAST,FIRST, N INITIAL) �'— f11'/f C S'1YIS �jYaS STi5�R_1�1 A �L/ IWN STATE ZIP REGIST�NO. I STATE EXP MAKE/TVPE VERB C IIL �,/� � 111 DATE OF VIOLATT}IO�N•'` TIME DATE CITATION WRITTEN veRsorvAL [imKAM P. !YT / EIYES Q ❑NO LOBATION OF VIOLATION ENF,ORCIN,rDEEP r l� b tIPI�YZte of iI#t, 1 OFFENSE Dy AP. 9E0� INE FS S . ed,j t/&f!jilrlJ-R71557/1L� f'l hlci7t41!'F.t r NE J B C OFFICER I.D.NO TOTALFINE tZ �d OFFICER"CERTIFIES COPY GIVEN TO VIOLATOR /�-�� ,, / El IN HAND X �,i Ijl'vi(,J !{.��' ❑ BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 07970 TEL.(508)745-9595 X 257 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 I _ COURT DOCKET NO. CfTAT10N NO.-. CITY OF SALEM pD � .aq QOj I VIOLATION NOTICE 1 -cl > c y ��uu ' sTREErgODR mRow�STATE ZIP EN !�-t7fl. I >1 �� LICENSE NO. a .DAT ID OF BIRTH, OWf)ISr'S NAME(LAST, �G_. Q F� >wm �Sin ET �RE � mROWN STALE ZIP I 7 SOV / � d REGISTRATt NO SYAfE EXP DATE I MAKERYPE VEfy� o00 DATE OF VIOLATION TIME DATE CITATION WRITTEN PEPsoNnE !� //��c Iun�Rr ,] o oma ' /I� 1f ❑AM !fJ`3 (]VES L' PM .�r (ANO i A m �LO"C�ATIOYN tO7F"'VIb`LtAET'IO�4 oRC� nD T.gr ,9 � tfh OE•F� G1 NS y� HAP �o^E6Ta FINkS Q ::a> lfaJ:ltn -r77Ss.�/7[� i. W a i Q B !r' C .D OFFICER _ I.U.NO TOTA FINE yd 1 1 x n I,' } . DUELI Er _ OFFICFpft CERTIFIES COPY GIVEN TO VIOLATOR Q + (( / f1 ❑ IN HAND Q X \y�L.y'.!`^i t.'I✓�J� ❑ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY , m x ORDER OR BY CHECK MADE PAYABLE TO: w ( CITY CLERK CITY HALL 3 WASHINGTON STREET Q SALEM,MA 01970 Q z TEL.(568)745-9595 K 257 o I HEREBY ELECT TO EXERCISE THE FIRST OPl ION AS STATED ON REVERSE,CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNF OF $ CASE H i P O SIGNATURE a SEE OTHER SIDE FOR FURTHER INFORMATION 6: m x 37 ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL J a m L a OPT T F' j co Z T. m �' a A COURT DOCKET NOCITATION NO Q ' CITY FSALEM' A2925 Ary Q2r� VIOLATION NOTICE AG�G NAME(LAST.FIRST,INITIAU, Ry-Ae e 6p-lvne. $TREETADDRE 7 �iss TATE ZIP G�)ti(h( D � flITYrrOWN s 111�3�i1� LI((C.�EN,S9E 1N�O/��(�,/J�` LIC jEXj/P��DATE�,. DATE OF BIg7H OLlX�lf ER'S NAME ST.i�f IY I INITIAL) 4 EET ffOWN STATE IP STR"S�I IO ff 15� 14d�JY.Iry�.1tZV REGISTRATION STA1Er EXP.DfyTE r MAK E VE COLOR DATE OF VIOLATION ❑ T�ION TIMEj, y DATE CITATION WRITTEN ua�ea� EIYES (9' (.l� �l f QPM cy, � NO LOCATION OF VIOLATION I ENFORCING DEPT. o eem'T OFFENSE 1 CHAP SECT FINES A rP.y /f VYrI((r7Y1S h�1:il'tisrtnk ss��oa yrr,ds -- G •ii B C OFFI R 1 ID NO TDUEL�$ I FINE O FILER CERTIFIES COPY GIVEN TO VIOLATOR t h 1 �'y�/ �} XIIN HAND X f _ 291QXJ XSL/ ❑ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO `J 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 H SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL r N Oc> � COURT DOCKET NO CITATION NO. I m z CITY aT SALEM A s � jVIOLATION NOTICE A2 NAME(LAST,fIRST,INITIAL `1`p-''''''''II i� STREETADD ESS riCITV/TOWN STATE ZIP o� 1F 4�9� .A LICENSE NO. �P E DATE OF BI� O „ OWNER'S NAME(LAST, IRST,INITIALt} (��! l C5 - =m e IS-f'ut os I y m— � 0 O 3t7� STA ET ADDfl SS OItYtTOWN STATE ZIP l €g� o zO i 1 C l O R IS7RATi STATE FXP.D&il MAK E YEAR OL 0 t�0 D �m _ �y5j� f O O m Q z OAA OOION TIME,QPM DARE CITATION EN 'IPEK'uN� 3 0 YES S f t� aM wjuny I op _y ONO LOCATIpN` OF N� »J ENFORCING s eING EPT� Lu g OFFENSE CHAP. SECT. FINES A` iA2 660 �c. __.. /•i5„.ir'r,7+ii"ta t.'1y7t49 ., r,, .'� 6� 133 OFFICE �• ' ^' I,D NO TOTAL - O ` DIUNE F �� O O ICER-CERTIFIES COPY GIVEN TO VIOLATOR IN HANI1 I1 _a m 'xC X °�.i.t 7 !: ?N Ali i t _J 6Y MAIL Z n DO NOT MAIL-CASH-PAY ONLY BY POSTAL NOTE,MONEY O z ORDER OR BY CHECK MADE PAYABLE TO. Oz '1 - CITY CLERK 0 CITY HALL z 93 WASHINGTON STREET SALEM,MA 01970 TEL(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSL PAYMENT IN THE AMOUNT OF ; $ CASE# — Q O c0 c 3m -- Z n z m S GNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL V p w { mc) $� ox B `° �. 4 w OD i - CITY OF SALEM, MASSACHUSETTS ' s3L BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR �fa 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: Brother George Address of Establishment: 376 Highland Avenue Owner's Name: George Christoforos Restrictions: Application Date: 12/15/2003 Permit for Food Establishment 156-04 Frozen Desserts/Ice Cream 010-04 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. V HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • n 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT R j2V�t L ts'(V k-6L %A2 TEL# em- ADDRESS OF ESTABLISHMENT -7 19tLA N-> /-I V i=wr_ MAILING ADDRESS (if different) 1t OWNER'SNAME CP7,e(Tc- (--I.)6tfkTbry-va� TEL# 15)3 7VrYY6 ADDRESS V Qt V i\'T v]- A-V- CITY Swu-u, STAT ZIP rZ16-7 � CERTIFIED FOOD MANAGER'S NAME(S) ' CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON .-')GtYL1 , HOME TEL7,0-yy HOURS OF OPERATION: Mon. Tue. Wed.-_Thu.—Fri.—Sat.—Sun. �7 1111 'J-9 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO S� ©� less than 25 seats = 0 25-99 seats =$150 more than 99 seats BED/BREAKFAST Y�S NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT.SERVE YES NO (i) TOBACCO VENDOR 61,9 - o y YES NO 0 k j55 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 b C!.T wledge nd belief, have filed a+I stgte tax returns and paid all state taxes required under the law. n d-��i.r-� Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------ ---------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date A9- Q' 3 W I 1 9 3 hiss- - Z >v tt '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 tJ _r14tr� ^� � Date Tvpe.of Servicion(sl, TypeEl of utInspection /AW tT mood Service �❑ Ryutine Address 1 % m1r d 44,tQ A-ow Risk ' ❑ Retail �J Ae-inspection Telephone y Level El Residential Kitchen Previous Inspection I ? H- 6�PfS' El Mobile Date: Owner HACCP Y/N Temporary Pre-operation G�vK,,� G�ai see Fnt�n I F-1Temporary ❑ Caterer ❑Suspect Illness Person in Charge(PIC) 974M Time ElBed& Breakfast [IGeneral Complaint Out: ElO herr ��t�fJ�At1M{ I J. �MS I Out: Permit No. 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 El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE 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. ooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control L✓-19.9. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 2- 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, signed below, when C x p 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-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 501nVwFo. 14 tlOc jure I o '6 /�a ,ire/ ,A /I Print: "PIC's Signature: &c.1 ,i 'n�_Y,U1.W ri�1-lX.. Print: �-L�2 f- )' •i i f( T71 /-��( J Page of Pages s Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-221' PROTECTION FRCNI CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gros;-conte,n,nahon 1 590o03(A)Asvgnnte::t ofRc;ponsibility' 304II(Ai:'; RawAnumtiFo:els ,ttreacdfrom 590.003(B, ` Cenwn;trdi,on of Ku-owledge'. Cool,cl and RTE ( 2- {)>.i 1 ( E'er.,on in char;te --dutiesI Cortami^dtian rrorn Haw In�redenc; -30;:.11iA)(2) Raw Animal :=oods5rpar:t�dfrc;t:Fath EMPLOYEE HEALTH I I Other, 2 500.003(C) Recpowrb,i,ty of tin person ;n chm"ge W Contrroin.ation ircm the Environment require rep•.,rtine by fnod etupinveus and 3-30;:.11:A) 11,x1 Protection" imlicants* ( 3 io2.i 5 ';da:hine Fruits and Ve_etabies 5'90 003(F, Re.ponf.rbility Of A F,,,,d Employee Or Aa ! 3-304.1.1 R?nd Crmta,'t',=,iih Equip rent rid Applicant To Report To TIrt Person Uteu<;::; Ch.n:;e ! ::nnrsrination from the Goncuroer 51,'0 003(6) Reporiing by Person in Charec- 4-306.:4(AUi 4! Rrunned Fr,::d and Rcse:!,ice of Food* 13 159n(!f;3(f)) E.cchv,ions and Restrictions'" Cis,^rrn!,irn of dduitera sr,'or Gonta^inat.=d I 59000,A,E) Remuval of Exchoions and Res,ric:io,:s });<cariioe,or Rrcoec;iton:ne lincate - -- FOOD F'1OM APPROVED SOURCE i'o� 4 ' Foad and Water From,Reoutated Sources 9 ! rood Contact Surfacers SP. ; r 590.604(A-Rl Compliance t,�nh Food Law" { I I ,i Manua, lranrwnshinc- Hut +play:r 3701.14 Foo•1;na t-lernrsi:ally Scaled Container'. j Sanitiz.a:o.^.7?a;nrran;ms" I3"Oi It Fluid MiA} and rttdk Products* I ')-`sGLiIZ Meehxmad 4r"t:rewashirl;-Hot Water 3-202.13 Shell 1.;,,s'x Sanitization Tentperwures* 3-262.14 F-ggs and Miil:Products, Pasteurized"' � =t-Si)l.l I4 Chee:;cal Saniti%atiu,.temp.,1114, unaentiallon and haadncs. 3-202.16 ter Made From Potable Drint.in;; S-stem 4-00i.i 1 v vrcnt Fo,)d Cortr£,rt Surfaces and 5-101.! ! I;r:nk:rt Waver&uw;a Apprcn ed S�stent" i.-.) ltere l7tene a,Clea 590.006(A) Bolted Drinking Watur* 940 006(L) Water Mets Standards in 310C22.01 A-+0_.' j eeyucucy oLquipment Fod- Contact Suifaces and Utensils` SheXiM and Fish From an App.•cwcd Source Frey:x:up of Saeaiz,,oion of Uieostts:mei 3-1tH.14 Fish and Recreationally(:aught Ylolluu"f° ( I Fri+0 Contact Surfaces of L,quipmei Shellfish" t 4=r:03.11 Mrthoc}c of Satti,ization-Hot Waterand 1-201 15 MuHu,ccau Shellfish from NSSP Listed I I Chetuic:+l' Sowce,* I i0 I Prrper,Adeouste Handwashing Game and!4hkt A?ushrocros.5,;:prov?d by ( 2-301.11 Crean Q•ndtti Inn-- Hands.md A,HIS* ReQolaton,Authority 3-202AS Shetlstirck Identrivat;,m Proscm,' 0-aning Precvd,"L, •i90.00.1(C) WildMnahrcsoln:' 2-101.1= 6ihcntoW:sh" _0;.!7 ,^,arae Animals* ! I1 Good Hygienic Practices I IRoceiving/Condition 2-40!.`1 airs,Jin:xic or U ilw obacco"` I, 202.11 PI-TFs Received at Proper Temperatures" 2-10:.!2 i)ieahatrrS -rom the Eves, Now and ?x(12 17 Package Integrity- Mouth' 3-'0 i.l I Food Safe and U tadultcrata;* 3-30;.12 Prevenue Con; mmai:on When Tatting" ,4 6 'fags/Records:Sheiistock ( 12 I Prevention of Contamination trom Hands 2-214.13 Shelistoi!:Mentificatnm* ( 590.00-h E; Preventine Contamination front 7, I E.:r,plo�res" ?"2u;,i2 Shetock t•a.,entilication Maintained" Tngs/Reco;ds: Fish Products i I j i Flanowasn Facilities 3-402,11 Patasrte Ek-struction" i ' Convent?rely Located and Acres: bio i3-402.i 2 Records. Creation and Retention Nun;bre..,:nd Ca;>e¢iites^'" j 590.0("{7) Labeling of ingredients' i `-2u4.1 i I trarkri and Placement'I "li Acttast,ilio. C,pl'rdI:�9l and M.rooenaact 1 7 Conformance with Approved Procedures - 3 iHACCP Plans ( I Supplied✓:itn Scap and Hono Drying ti02 1 t Specialized Processing Methods* Dep1QE' 3.5;)7.14 Reduced oxygen pac}:aging,.c!'n^sial" I 6-3011 7 t-lacd•wachine C leanser, Mailability I -tr - 11 i I ( h-3011-, Hand Drying Provision � :� 12 Ct;nGxmance With nttruved pnwedures- ilenoles mt uil nem it the federal 1999 705('SIR S90."W. CITY OF SALEM BOARD OF HEALTH p Establishment Name: /4//rsrNiEl� G Atd''X_ Date: <)GA0/ Page: Z - "r of. Z c nem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R—Red nem Verified PLEASE POINT CLEARLY fhn '/July/hcr : / 9 G 9 s` S-farPct' Q � rrn�yvt �ri� �l�nl"-i�/lc� tf��irl"�fnuc' �nr�r In /j rwt)Qf be hol a� l�/�u� . da 6,1-1 J7h��l l�/r' /ooh C'�h.�i52- h/a�✓� - >4fl nV6ioe a/,,-,4" /'i od ih /., al ov vof9Dr-f Adlw Gaon _/J 1 I � 1 I I 1 I Disgussion 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 P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that "0 noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your,food permit. ❑ Voluntary Disposal ❑ Other: 35U�.,d(i;'i PHFs R:oen;c�l at'Pc�tip�rmvrc Violations Related to Foodborne laness Interventions and Rink Arc,Iruin,�to E aw Cooled to " Factors(items 1-22) (Cont.)' -11`F/45`:-t5'nrhin 41- loins-PROTECTION FROM CHEMICALS ( nni.(` Gsihnr M=[hod, h,*PIAFe � 14 Food or Color Additives ( 19 PHF Hot snd Cold Holding 0'_.12 ldditivc ' ' 3 S0 16:B) Celli PHFeMainia:redatorbclow 2 590.004(F) JI'145`F* Protection from Uuappn"ui-ed Ad3_ ;I ditives^ St 16(A') Hot PHF< klaintanted at or above -, 15 Poisonous or Toxic Substances at, 7-I0I.11 IdentiNutclntonnaiinn-Or:ging( RnastsHellat ),above IifI'P. * Containers' 7-102.1 1 Common Natue. --Working O,ntainera` i � 2E) -lase as a Public Health Control 1-201.11 Separation-Stra agc 1-501.19 lime as a Fabbe Health C inu'ol 7-202.11 Restri,hun-Preserve and Use* i 5%0.0041 H` Variance,Requirement 7-202.12 Conditions of Use" 7='03.11 Toxic C'nntainers-Prohibitions,; REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-201.11 Sanitizets,Criteria-C'hemica,:;' POPULATiONS(HSP) 1 7-., t Produce,,.oduce,Criteria' t' 3-80i.i ItA) 'Umpe,teun?cd Pre-packaged Junccs and _04.12 Chemicals for Washing � " 7-20.1.11 Dr5-rnr Agents,C'nteria" i;rr,eotges with )o1arnine Labcts:. 7-205,11 Incidental Food Contact.Luhncants" 3-8( 1 11iB, Use of Pasteurized EEL- 7.206.1 I Restricted Use Periic.ider:. Criteria, r ^501.11(1 ) Po or Pani%.:Cool:eu .Ani ned Frxxi mid I (I Ram Seal Surouts Net Served. z 7 206.12 Rodent Bait Stations" L 111C I Un,'•- ckat, \i t Re-served - I tenet F;nr. PP.., ,e ;': ' 7206,11 'i'racking Pgwdcr,,Fen:i:ontrol and ( � � I Monitorial, CONSUMER ADVISORY TRME/TEMPER ITURE CONTROLS 22 3-603.1 i Caneu,ner Ad,;n,oiy Posted for Consumption of 16 Proper Cooking Temperatures for I Auiatal FbncL'That are Raw. Undercooked or PHFs Not nthervnse Processed to Elirnncate 3 101.I l A(I It 2) Eggs- I SSP IJ Sec. j P:;thoger,s. E_,cs-htmmdiate Service 145^F15se,' 3i)?.t3 Ysteurizcd E;gg::SuhntituL- For Raw Shell 3401.E i(AA') Comminuted Fish, Mears&Came Animals- 155-F 15 sec. s 3-40!.! !(13)(1)(2) _ Pork and E3reC Roast- t30'b' 121 rain* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites; Injected Meats-- 155"F 15 590JY)-,)"k)-(0) Vioiations of Section 590.009{A)-(D) in 1ec• , ! catering, inohile toed, temporary and i-401.11(A)(3) Poultry, WildGarne,Stuffed PHFa ieradential kitcren oper,aions should be Stuffing Containing Fish,Meat, debited undcr ti:e al) prouriate sections Poultry or Ratites-165'F 15 sec. '^ a?,ove ifrzlated to foodborne illness 3-101.1 1(00t Whole-mnsre,Intact Bee( Steaks inter ver,tions and risk (actors. Other 115`F5'40.009 violations relatin,,to good retail 11ol.1 2 Raw Animal Foods Cooked in a practtcc', should be debited under P29- Mlciowave 165-1- * SpecLti Requirements. 3-401.1 l(A)(1)(b) All Other PHFs - 145'F l5 sec E7 Reheating for Hot Holding VIOLATIONS R SLATED TO GOOD RETAIL PRACTICES j 3-403.11(A)&(D) PHFs 165'F e,5 sec. * (items 23-3f!) .i-403.1 I(B) Microwave- 165'F 2 A4nnne Standing C%vita ui and non-rritn'al vrntatanu, rvOch do nor whar,to file Time' foo,9An"le:11re^v inte, -eations and risk factors fisted above can be 3 3-403.1 I(C) Comnlcn,ially Processed RTE Fara- I ./nw;d,'r the/i,(U;a-ittg secttnr.::of the Food Code and I05 C'hPk 140"F" 590.0(ti. 3-403.11(E) Remaining Unshced P„mons of Reef ftem Good Retail Practices FC 1 590.006 Roasts* 1 i3. htanag2meril and Percrnne! FC-2 1 .003 24. Food and Food Protection FC-3 004 18 Proper Cooling of PHF, - 25 Equ,pmeil and Utenals FC-4 _ 005 3-Sill I4(�1) l'vnhm;,Cooked PH Fs from 14(Y'17 it, 26. Water, Piumbinp am Waste ! FC--5 ( .006 _ 70"F Within 2 Hours and From 70'F 27 Physical Foci:ih, I FC-6 007 to 41'F/15'F iklthm 4 Hours. " 28. Po-sonous or"E ar..c Marais rc-7 .003 3-501 14(B) Cooling PHFs Made From Ambient 29, Special Requvemeno; 009 Temperature fngredientsto41'F'a5`F 3o Othei With:rt41lours* *Derole:critical item m ihr uyu Food Codv or 1,6 CNIR 590 o00 w- Iliassachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Fo9d and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat / fTYoe of_Ooeration(s), Tvpe of Insoection 13d-o wx/- G6u�tt: V/V1,/1 9-FoodService El Routine AddressRisk ElRetail E] Re-inspection Telephone X76 /I _k/t-4NO r&./& Level ElResidential Kitchen Previous Inspection -7yy,.4 ,Ins �44 ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation G&a.ths ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: El HACCPI Inspector r O Permit No. El Other L) G�.c niK1A utit l�. �t,,,.iNs I 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 ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. ooling PROTECTION FROM CONTAMINATION I 19. Hot and Cold Holding 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control [ /9 Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑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 LII immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): T of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations U5. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: /dy S 5Mns IFO� 14 d� In e' ' i n / Print: PIC's Signature: �, r Aa i 7^ted (I Print: L)R G _4 ( / ( _Tuj O o hl�Page i of 3 Pages w -'w Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( R Cross-contactinatror. 1 Responsibility' j ?-302.1 !(:1)(l) Rapt RmmalFoods Set'•a:nedfrom 590.003( B) Demonsh'ation of Knov,led£e* ( Cook d and RTE I nods'. 2-103.11 Person in charge - duties Cootaminatior,from Ray"Ingredients 4-30'..I I(Ai(2) Ra-,v Animal Fuods Separated front Each EMPLOYEE HEALTH Othcr^ ! 2 590.003(C) Rcspounibiiity of the person in cha'ee to Contaminat:on!rom the Environment require reporting bg foal ennplo)ees and 3-30111(A) P.zod Piolection" applicants" 3-?0'_.15 W'sshiut Fruits and Vegetables 590 uW(F) Responsibility Of.A Fund Employee Or in 13304.11 Food Contact twill: Equipment and Applicant To Repnrt To The Person In I UtcreAs* Clan^e Contamination from me Consumer 590.003(G) Reporting by Person in Charge' ( 3-_OG.I 4(A)Q?) Rctu;u:,i Foal and Resernice of Fo(>J" 3 590.003(D) Eeciosions and Restrictions'I ( Disposition of Adulterated or Contaminated 5910.003tE) P,inoval of Exclusions and Restriction, Food 3-701.1 i Dise:udnig or Reconditioning Liisafe FOOD F IOM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces Sy0.O0d(:\-B1 Comph:tee with Food Lava:" 4-501 1 1 1 Nlanu:d Wawwashmg-Rot Water Saanvation Temperatures 3-201 12 Food in a Hermetically Sealed Contaner^ , 3-Ml 13 Fluid Milk and Milk Products" i 4-501 112 Mechanical W'arewashing-I-Iot Water ! Sanitization Tem teratures" 3-202.13 Shcll Eggs* j 3-20''.14 Begs and Milk Prodncn,Pastzurinst* 14-501.114 Chemical Sanitization-tetup.,pH, ! coaccnh:vion and hurdttee c. A, 3-202 16 Ice blade From Puiabie Drirnkuw Water` i 4-601.t i(A) Equipment Food Contact Surfaces and 5-101 11 Drinking Water from an APprosed S"tern"" eanih.Clean* 4 602.11 590.006(A) Bottled Drinking Water„ j 0Cleaning Fregnen,y of Equipment Food- 590.006(B) Water Meeta Standarrk in?10 CNIR 22 Or Contact SurLtcc:and U'tcnsils� Shellfish and F,sh From an Approved Source iz tnrnt a utensils and 1-702.t; ?^cciuzncy of Sant e t 3 201.14 Fish and Recreationally C,night Molluscan Recreationally o FctA Contact Snriatces of E9uipment" Shzlltieh^ 4-713,11 Methatis of S:,r:ar,;ati:m- Hot NVaie r and f 3-201.15 Mollusca] Shellfshfram'VSSPIaatcI ;heroical' Sources" Game and Wild Alushrooms Approved by t0 2^ Proper,Adequate Handwashing Pegulatory Authority "01,11 Clean Condition--Hands and Arm,' 3-202.i 9 Shellsto k Identification Present" � � 2-3(11.12 Qeaning Pmcedvi-t! I I 590.004fC/ Wild Mnshr+xttns` 2-301.i4 When to Wash't 3-201.1 7 Game Animal:," 41 Good Hygienic Practices 5 Receiving/Condition 2-40111 F,amng,Dr:uking or Using TobaccoT +-202.!1 PIIFs Received at Proper Trmperatures`r ( 2.401.12 Diacharges From,the Eyes.'Nose and i 3-202.15 Packagelnteerity* °.butt ' 3-30 12 Preventia�_Contem:nalion When Tastin1.;. 3-!(D.I1 Food Safe end Unadulterated ' or.of Preveari 6 Tags/Records:Shellstock i 12 Contamination from Hands -.18 ShciMockIdentification' I 590.004E) Preventing Cuntaminationfrom 3-203.12 Shellstock Identtti cation Maintamed' Empicvecs' ! Tags/Records: Fish Products 13 Handwash Facilities Ccnveaont}l Located and,Access,ble 3-402.11 Parasite Destruction` 5203.71 Number t.and C::paci ties' -402.1'2 Records,Qrauoa and Rrtenhi»:'' � �90004(?) Labeling of Ingredients' 5-2Oi.I I L:AcAion and Haccm�nt* 1 7 ! Conformancewith Approved Procedures ! ! -217 11 Access:bilit)y.Oner.:h or.and:1.n uttcn:utcr ! i Supp4ed rAl,",z5vap and(land Drydty I /HACCP Plans ! Devices i 3-502.11 Specini:zedProcesoingMethods" 3-502, 12 Reduced Uxygen packugi::g,critet:a" � b-301.ll thutdirastune r�leanner.Avuiiability S-i(i3.12 Conformance with Approved Procedures, 0-301.17 Fls.ndDrsingFt,nision Dernh:•ratan:dem ni ihe'1 edcrd I o1,9 R,uc(-,)Je.,r 105 Gilt 5'10.060 CITY OF SALEM BOARD OF HEALTH Establishment Name:YU, V 1L1 Pni Date: lo - Z ( - O c� Page: c-�_ of 3 Item Code C-Critical nem 3 DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I (�vt��l p_ l.h,eperfi�ivi 'Ln��f �-1n o -�llnu>lv� C_ I (4- njo kyr .Q471II17or� - / PSuv /op ov k�a/ ^v - u' fFz�nrlrrfir�hu��n sink I v, rare P�_P_6 (1)W/1 v1aJSS/rn1,A f-etaor-fnrrlels- /)u�na,, dlv.rf-J�rJE?du /��rf�Jusels �/ �/f firu�S'. �P_enlacc c( a f lhS��.zv)2__ � A l' �< f3roacl l�rt�ue-(z S�i�rw� (rn �n� a�' hro(' � �ho� {'tnoo.� �harliJr,fc. t�r-Pia�� ani hoo 1DMd rkr he- A141 e-Al 11 -l-nJ/i t)J= L1/ F ilr 1�olinuos a ti9 C 1ln,/.P4 / /n rr?ok G,n/-)l -/7s /9 C X —F_aasc'J7'-tod � �1 P/77 '1OrW.0. - PR {ice/lI l�ii �6r l0,�kv/ ). (7jo 1-neCPf1>_ 4vao vC A61Y ate �/ /iJYYJ,J/2�irn 1 n � I Cl? ('i-6261 mt_ ' 1�12z /rl t�rPD�i12- TG,rvnrg111,J l Ia�nn fr/PP 471-74 C -'l n n �poA voe Ln I'JO!'k rrrn)'YL� A /n�'/'/Ji12/ll/�1�1/(Vl A /� -i 7 71/ C-�O hvl s - -141 Am � 8 _ l c7/Y D r (l l re c kzLAI)i - pj� )had as ( Olcxlc.^Fs `G�n�•f r�laor� O.Oue OUO1L Pvu'lrh 6hnl 2Cl -/-,v ,pdt IAOU f Cnzss {a✓u In a," Di _ 1 scussion 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/ 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 Foo?i 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 =`�+I lli:') I PHFrR.:retvecl.:rT::.mlfratures Violations Related to Foodborne Illness Interventions and Risk 1 Ao_ordi ng to Lao Cool:d to Factors(items 1-222) (Cont.) 41"F/45'-F Within l Rows. PROTECTION FROM CHEMICALS 3-501.!5 Jnnlmg Methods for PHFs � j 19 l FHF He"and Cold Holding 14 Food or Color Additives 3-501 I�?< .3-202.12 Additives" B I Cnki P11Fs Maintained of or belov. 3-'1(}2.14 Protecnnn from (Tnapproved Additives'° S9U.Ofid(F) 41:1:35'F=: ? SOI INA) F;,a PF[Fs Maintained of or above 15 Poisonous or Toxic Substances ( 130"F a-101.1 I Idenhfyin&information--Original I 4-501.1 b(,1) Roasts Held at orabove 730`6' " Containers* j 26 I Time as a Public Health Control 7102.11 Common Name--WorkiugConrainers*11-201.11 Separation-Stu:ace" ( :i-5(11 19 Tlme as a Public health Control* 7-20211 Restriction-Presence and Use -59000+[1) V'm'tacoeRequirement j 7-202.12 Conchtions of( s'11 7-203.11 'toxic Containers-Prohibitions"; REQUIREMENTS FOR Hl{;HLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Smitizens.Criterei - Chemicals* i 21 3-801.!!(ALa ntenrtzed Pic-packaged Juices and 7-204.12 Chemicals for Washing Produce Crnera": f' ) P+'' 7-204 14 Drviug Agents.Crnena' I Bev'erat;_es with 1A'auning I.tbelc -i-801,1 l(B) Ils:of Pa:aeutizeci E+,«,:; 7-205.11 btcidcm al Fend Contact. Lutrncar,L;' 3-801 11 t t?) Rav .:r P.ntially Q�ol:e;t Animal Food and ?-^_06 11 Restricted Use Pe aicides.Cde;n tar' i Rave Sted Sprouts ti.-t Srv:d. 'x 7 206.12 Roaient Bait 4iatiors" q..lnl.11lG ' U=)cned Fa,d Packa .- Not Re-served. " 7-205,13 'tracking Pov<ders, Pest Control and I I )',- Munitoriuq* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consutucr Advisory Posted Eur Consumption of Aunnu' _roods lbat are Raw. I.fndercouked of 16 Proper Cooking Temperatures for I N.,t Otherwise Processed to E!unuaate PHFs 3-401.I1A(i)(2) Hggs- 151°F 75 Sec. ( HKL's-Immediate Set s-ice 145-F15r.eer ( =-302.13 P.steunzed Figgis Subsnnne for Ravi Shcil 3-401.11(A)(2,i Comminuted F,rh,Meac:&Gain ! `ggs Animals- 15SF 15 sec. '" SPECIAL REQUIREMENTS 3-401.1](13)(1)(2) Pur6 and becf Roast- 130"F 121 min* 5g0.0(}o)tA)-(D) Violations of Section 590.00ILA 3-401.11(A)(2) Ratner, Injected Meats- 155°F 15 I t -(D) in� sec. " catcrin,,. rnobile fool,temporary a nd ?-401.11(:'lli 3) Poultry,Wild tame, Stuffed PHPs, I re.,iderdi:d kitchen operations should he StutTutg Containing Fish,Meat, debited under the appropriate sections Poultr} (a Ratites-165'P t5 ser. 11above if related to fa.dyorne i[liters j 3-401.11(C)(3) Whole-muscle, Intact beef Steaks intewentions and r;sk factors. Other 145°F r I 500.009 viola(i ons relating to good retail 3401.12 Raw Animal Foculs Cooked in a nracuces should be debited under#29- Microwave 165^F' Special Requir.mcatts. 3-401.11(A)(1)th) All Othea PHFs- i45`'F 15 sec. i" Reheating for Hot Holding ( VIOLATIONS R.''LATED TO GOOD RETAIL PRACTICES ?-403.11(A)&(D) PHFs 165'F 15 sec. 1: 1 (Meme 23-30) 3-403.11(B) Microwave- 165' F2 Minute Standing Cruiral and nun-rruical violations. ,rGrch Jit not rr7urz a,t/re Tmre" foodborne itlne.�s intcrvenrions and ri€kj:r,ays lived obov<a, ran be z 403.11 f C) Commercially Proce.sed RTF Food- found in nig sections o%the Food Code and fill CNfH 140'F" 590.000. 3-103.1 i(E) Remaining Cn:aiced Portions of Beef I Item I Good Retail PracticesFC 590.000 j Rousts": 22. Manawrijent and Personnel FC - 2 .003 18 Proper Cooling of PHFs 24. Foal and Food Protection FG-3 004 j 2E. &,domcnt and Utensils FC -4 005 3-5(11 WtA) Coating Cooked PHFs, from 140`F to j 26, Wa':er,Plumbing and SVacto FC--5 i ,000 70`F Within 2 l lours and From 70"F 27. 1 Physical Fac lily FC- 6 1 007 to 41`F/45"F Within-t Hours. t 28. Poisonous or Toric 4/laterals FC--7 ''i 008 z 501 14(131 Cooling PI-IFs Made From Ambient 1 29, Special Hegvirements 009 Temperature Ingredients to 41`F/45°F 3u. : 011ier Within 4 Hours f °r""".",".:."• 'Denote crtt:cal item In the faier.J 1999 Fund Code or 105 CMR 590 000, CITY OF SALEM �J BOARD OF HEALTH / ✓� Establishment Name_ YM V M r�P'Irwne. Date: & '�/ - 0 7" Page: J of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item I_O Verified PLEASE PRINT CLEARLY - anD Pl*r v_ - /Uo S41?a"-YV1000 I I I I I �nl/ / ✓CI�I �GtO {�PvVu_r-I P/0- Discussion /0Discussion 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/ violatipns 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-jive dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-i0:.:=o ; PHFs Rrcrirord at ienxp,�raturrs Violations Related to Foodborne Illness interventions and Risk A-_cording:o I...;:Cooled to Factors(items 1-22) (Cont) 4:_F/451'17 W:,hir.41-lours. PROTECTION FROM CHEMICALS I '-501,1` Cooling Method-,for PHFs j 14 I Food or Color Additives I )n PHF Hot and Cold Holding 3-2(13.1^_ � .Additivcc;> I 1-Y)1.16(�, coldP}iFs'>F ^.darn:d at orbelnw 590 004i F) 4l'/45' l-', 3-30? 14 Protection front Unahprmrod Additives r ( i-; :m01.16(A) ,lot PIJFs Wneed at or above 15 Poisonous or Toxic Substances I 40' _ i 1-101.11 kientif}'?neLtiurmannn-th'iginal j it1.16(,1t Roasts I-ieidatorabovel3?t'F. i- Containers" 7-102.11 Cotmmtn Name -Working, Containers"` j ( 20 I Time as a Public Heeith Control I _01.11 Separation--Stotuge'' 3-501 19 'Time as a Public Health Contr'o'.'' j j 7-202.11 Rtstrlction--Presence and Use" j 1590.ti{li�f-i) Variann: Rrcun-emcnt 7-20.12 I Conditions of Cie'" i 7-203.11 I 'Gixic Containers-Moinhitions"` REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2() I POPULATIONS;HSP) 4.1 I ( Sanirizers.Criteria --t'hemicals^ 7-261.12 ( Chemicals for Washine Produce,Criteria' 21 13-SQ L I It s) Unp:,tctu'tzed Pre-packaged Juice-,and 7-264.14 I Drying Agents.(,I teria I Beroetages ivnh W'arnin)_�l.abels 3-601.11(H) Use,of Pasteurized Eggs' 7-205.11 Incidental Ford Contact.Lubrrcantr 3-80'..'.i{]j) Raw or Pa:6,tlly Cooked.=.nitual Food soil 7-206.11 Reotttcted Use Pesticides.C'riteria'- gaw-S-ed Spr;uts Not Se!yed. '= 7-206.12 Rodent Bait Statiurs" j 3-90i.t l(C') Unopened Taxi Package\ui 12e.-sen'ed * j 7-206 I3 Tracking Powders,Pest C'ontroi and Nlonitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 t-603 11 Consumer Adt nary posted fon Consumption of Animal Foal: Haat are Raw. Undercooked of 76 Proper Cooking Temperatures for I Not Oritrrw:se Prccessed,r Eliuunate PHFs - v,caro 3-40111A(1)(2) Pigs- 155'F 15 Ser.. Pathugens.T Eggs Immediate Sin ice 145`F15sec* 3-;02.13 Paatcunzed Eggs,Substitute for Raw Shell 3-401.11(A)(2 s Comrninnted Fish,Meats 8z Game ' Eggs' Animals- 155'F 15 cec. SPECIAL REOUIREMENTS 3-401.11(A)(2) Rahtes. Injccte 3-401.11(8),!N21 Purkand BectdMeats- 155°F 15 d - 130`5 131 onion" { 590.009(A) ;D) Violations of Scction 59f10091,A)-CD) in Mc sec, r cslerine. moble 1(x)d, temporary and -401.1 1.11( )0) Poultry,b'vild Game, Stuffed PHFs, resrac•utiai kitchen operations should be Stuffing Containing Fish. Meat, CiChiied tinder dm apnrcpriate sections Poultry or Ratites 165'F 15 see. * above i;reiabed to fpodhorne illness 3401.!W)(3) Whole-muscle, intact Beef Sleaks mleiien6ons and risk factors. Other 145-F"' 04v o a,- 59G.0._ iei:aian:;to:tains to U(nd retaii 3401.12 Raw Animal Foals C,mked in a i1r;nticcs should b,-debited under 1129 - Microwave 165"F* Special Requirements. 3401.11(A)(1)(h) All Othet PHFs�- 145'F 15 sec. ' 1'7 - Reheating for Hot Holding WOLATIONS RJ.ATEO TO GOOD RETAIL PRACTICES 3-403.1 l(A)&(D) PH Fs 165'F 15 sec. * I (Itelm 13-30) 3-403.11(B) Microwave- 1650 F 2 Minute Standing C,iteral and,mn-(ritiral viobitions. whit do we relate to the Time" (ao,dhrrne illn,-ss inten-ewior,c and rill,/iu'tor� lived above, inn be 3403.11(C) Commmrtnlly Processed RTE Food- ,found in the foliox-ing.,goons of the Food(,,de and 70i('.WR 110"14"' 590.1)(4 3-101.1 t(E) Remaining Unshced Portions of Reef :-Item C;ood Retail Practices FC 590.000 Roasts' 23. ManawmenT and Personnel FC-2 .003 j 1g Proper Cooling of PHFs 1 24. Ford and Faxi Protection I FC -3 004 .'.5 E'Qd�pmoni apo utensils FC-4 .005 3-501.14(^t} Cooling Qmked PHFs from 140`5 to 1 26 'Nater.FlumbinQ ano WJ ste FC-5 006 ----� 70°F Within 2 Homs and From 70'F ; ( 27. Phvs!cal Faciiily to 41-F/45"F Within 4 Hours. * 28. Poisonrus or Toxic Materials FC-7 .002 -50f.14(B) Cooling PHFs Made From Ambient ! 29. Special ReouIcrnerts 009 Temperance Ingredients to 11`F/4i`F ( �.-----__-.3ij Other Within.1 Hours* ' Den.les entitai item rn the fzdzra; l,rny R:oJ Crud-of 105C MR 590 OnO, I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c 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: Brother George Address of Establishment: 376 Highland Avenue Owner's Name: George Christoforos Restrictions: Application Date: 12/14/2004 Permit for Food Establishment 80-05 Frozen Desserts/Ice Cream 010-05 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 lo�""cation 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 52 120 WASHINGTON STREET, 4TH FLOOR ffi SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT MEMORANDUM Date: November 5,2004 To: Food Establishment Owners From: Joanne Scott v RE: 2005 Food Permit(application enclosed)DUE DECEMBER 3TH Enclosed is your appliaatil for a 2005 Food Permit. The application and check must be received in this office by.QECEMBFF. 3, 2004. The fee is as indicated on the application, EXCEPT all non-profit agencies pay$250.' You will be issued a $100 ticket for late submission of application and/or fee. Partially completed applications will be considered late and subject to ticketing. A few reminders: • Again,the application must be filled out COMPLETELY. • The 2004 Food Permit is valid only for the owner listed on the application. Change in ownership, during the year, requires a new application to be submitted to the Board of Health, as well as a review of the floor plan and menu of the establishment by the Health Agent. • Any change in the establishment including a change in the menu or renovation must receive prior approval by the Board of Health. • The Food Code requires that each establishment having a seating capacity of 25 persons or more shall have on the premises someone trained and certified to remove food lodged in the throat,and to have insurance adequate to cover such employees. Thank you for your cooperation r CITY OF SALEM, MASSACHUSETTr, LCA lJ 1( BOARD OF HEALTH— _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 - VLA 13 004 V TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FORPERMIT TO OPERATE A FOOD ESTAPL'ISSHMENT NAME OF ESTABLISHMENT 60ftfe�/�I pPC� 1/VCTEL#'75"��.38S-7 ADDRESS OF ESTABLISHMENT AYE MAILING ADDRESS (if different) OWNER'S NAME e5gEa ( f, tJ TEL# ADDRESS CITY T/9CE/L1 STATE /IFI' ZIP 0/970 CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PE//R��SON HOME TEL# � -7 eP0u -7 Fri. 7Sat. 7 Sun.7-7 HOURS OF OPERATION: Mon. '7 Tue.,-;1,-7 Thu._L L L TYPE OF ESTABLISHMENT 'j_ FEE check only RETAIL STORE YES NO less than 1 000sq.ft. =$ 50 # 1000-1(`'ao6sy.`t.-,, =$100 more than 10,000sq.ft =s£50 RESTAURANT 9ES NO / less than 25 seats =$10 ,\ 25-99 seats =$150 U more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YE NO TOBACCO VENDOR YES NO $50 a1i nION_PROF/T(srrch as churr-h 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 Estab!ishment. 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 bessk wled e and be lef, have filed all s ate x returns and paid all state to es require nder the law. / I. rz�� of �'- oG 03P%X Signature f Dale Social Security or Federal Identification Number - ------- ---------- - ------------------------------------- - - - - - --------------------- ---- - - -- ----------------------- - - -- - -- qq �7C - / - Revised 11/03/03 FOODAP2 adm Check#8 Date n�(/ �� / G X105 , 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 NameDate TYoe of Ooeration(s), Tvpe of Insoection O"? ()PURQ� I/9- ;? 04 1 9 Food Service ❑ outine Address 7/ // q /'nom Risk El Retail l] Re-inspection �X �, Level El Residential Kitchen Previous Inspection Telephone �J�J � _ l �{ I ❑ Mobile Date:/a-/S 6'3 Owner L HACCP Y/N ❑ Temporary ❑ Pre-operation Pi_S ,f'o,-, El Caterer El Suspect Illness Person in Charge jPIC) /) G Time E] Bed&Breakfast El General Complaint (7�lo el¢_t Pa In: ❑ HACCP Inspector ,✓ YWk/ S /7. �f PZr/�i2i/rr� Out: Permit No. El Other Each violation checked regdires 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 ContaminationfromHands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El13. Handwash Facilities - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals It, El4. Food and Water from Approved Source 4 TIME/rEMPERATURE 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 ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.009) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590007) 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 5 Ing lForm 14 do ^/ Inspector's Signa[ ,� �/ ' 'nt: PIC's Signaturc! ,�� j.� P int: Paged ofA Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S I Cross-contamihatlon l 590.003(A.) AssiutmentotResponsibility'' 1 3-;02.11(A)t1) Raw Animal Fo"IsSeparmcdtiom 500.003(B) Derttottctration of Knowledge` ( Cooned.;nd RTF Reels" 2-103.11 Peron in charge-duties ( Contam4,aticn from,Raw Ingredients 1.302 1 i(A)('2) Raw Animal Foods Scteratrd tru n Each I EMPLOYEE HEALTH Othcr 1 2 590.003(0) Responsibility of the person in charge to j Con63minatwn from the Envaonment j require rcportiu�by food employees and 3-302A WV Fo:xl ProtectionT applicants` j 3-302.15 W'ashmg Frim,and Vet e-ble; S90 003(F) Responsibility OFA Food Employee Or An 3-;04.I 1 Ewxl Contact with Equipment and Applicant To Repon To The Person In 1 ttensiis' Charge' j Contam;nation from;the Consumer 590.003(G) Reporting by Person in Churk'e" 3-306 14W(B) Retained Foo!and Resen ice of Food* 3 590 0030)) Exclusions and Resn'ictionO D%sposiiion of Adu,kerated o+ Contaminated j 590.0031 F) I Removal of Exclusiom and Rectnetiuuc Feea 3-701.11 DisQirchng or Recunditioninc Unsafe FOOD F IOM APPROVED SOURCE Food' 141 Food and Water From Regulatea Sources 1 9 Food Contact Surfaras j 5,)0.004(.4 B) Compliance with Ford Law-` 4-Sol III Manual Warew whin',-Ibot Water 3-2ul f' Food in a Hennenca{iy Sealed Ccmutiner" Sanili/atlon TetnperatuteSa` 1.13 Fluid Milk and Milk Produc4'' 3-2t6 . 4-501 112 Mechanical Wa,r washing-Hut W,uei Sanitic:t;on Temperanu'es- i 3-202.13 Shell E---0 � 3=2()2.14 Ergs and Milk Products.Pasteurized" 4-507.11•, Chemical Sanitization-temp., 1AL omcea 1`� Ice Made From Potable Drinking Water � Equipment F and hm act S ." � -i-60 1.1 F;qe.j!s C Fuuei Co,rasa Suri'acrs and i_I+I7.1 I Drinking Water Prom,.n Aputaveci Cysteni` � hien a!s Clean" j i(M.006(A) Bottled Drinkine Nater'" 4602.11 Cleaning Ftequenty of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22 0* j Contact Surfaces and Gtcn als'" Shellfish and Fish Froin an Approved Suizee 4-702 11 Frcquencv of Sauitizatnm of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fond Contact Surfaces nt Equtpmeot' Shellfish" I 4;03.11 !Methods of Sanitization -Hot Water and 3x17.15 Molluscan Shellfish from NSSP Listed Che;mca7' Sources'" i 10 ! Proper,Adequate Handwashing Came and Wild Mushrooms Approved by I I Regulatory Authority 12-30 1.11 Clean Ccadmon-Hands and ArniO .i-201 l a Shellstock Identification Present* 2-30I 12 Cleaning Prcxednrc` � 51-)0.00=4(C) Wild Mus}inrotns` 2-301.14 «hen to Wash* 3 201.17 Game AmmaN' j l I Good Hygienic Practices y Receiving/Condition 1 2-10!.11 Fantle,Drmkmg or Usiva Tobaecnn j 3-201'r I i PflFs Received at Propel Temperatures' j 2-401.12 Disrharg•_s Faun}the Eyes.Nose and 3-202.15 Package lntegrity" ( Mouth- 3-101 I1 FexrJ Safe and linadul(erated ` ( 3-";01.22 Prev�miim,Contaminanon when fastiq j 6 Tags/Records:Shellstock ' 12 Prevention of Contamination from Hands 3-202.73 .Shellstock Identification' I �90.004(E) PierentingComrem:aationftom ' 3-203.12 Shellstock Identification MaintainedEmplowec* 13 Handwash Facilities TagsiRecords:Fish Products Conven;antly i.ocaied and Accossrofe j j 3-402.11 Par'ac:t;Desnuetion' 3-402.1'2 Record,.Creation and Retention" ( 5-20'.1 t Tdumhon and Placement" j 5;'t}.1)04Q) Labeling of Ingredients' � , 5-204 11 Lcxahcm and Placement`" j I g Conformance with Approved Procedures 1 5 2t15.I i Ao essibiiity, Operation and Manitenance !HACCP Plans j I Suop;ien with Soe(o mrd 1-;and Orving I 3-502.1 l Seecidhzed Processing,Methods* Devcoe 3-502.12 Reduced ox^gen packaging,critei a° 6-30i.I I }iancrxlu)mR Cleznser.Availability 8-703.12 Conformance with Approved Procedures" 0-301.12 (-la:;d Fir•.ing Pnrvi.;ion `Uano!cs u:Ocal uatn in the fedeul 1997 hood Gid.:or 105 CMR 51,'(1,0(10 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 19A Page: a of 9� Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PAINT CLEARLY - 45 -- /rr�'//in.0 ._C/�I�� -Av 1S> . 0 l/A/P 1 /7„{��wiDV�nAD�ID`d Co/� o Ia Pr7'” Ci/w 1z'—,I -�/Ad FnA 0 /QP.C, /7//P / - — ` I Z/J4 n/ci I. Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les 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 f Res of twenty-five dollars oar s spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /� / — e I �L ❑ Voluntary Disposal ❑ Other: i <` a 14(C', PH!'::Pcce;,ed a:Temp.rl'utes Violations Hol red to Foodborre Witess Interveritions and Risk i Ac-o,.uirrr i, Cvolml to Factors(Items 1-22) (Cont.) I I"7745'7 W;to;!-1 HOUIS 11:(Ki:o"�'Method, 5n'!'H;-; PROTECTION FROM CHEMICALS 3-501.15 19 P,4F Hot and Cold Holding 14 Food or Color Additives f,i r(P.) Mannaowd at o: 3-202.12 Additive,'` 3-3021<t P-otc-c-tion fmni Urqprowd;kids ivcs* 590.004(F" 4 F 3-501•i tqlk) Ho'PIFs !""a:ntai liml at o; abo�e Poisonous or Toxic Substance.,,. 7-101.1 Identitpiie,Information-Onginal 3-501.1601) RoQst> Held as o: :,bole ;3WY Containers" ! 10 Time as a P-0b:k:Health Control t 7-10,11 Common Nanta-Workin.,,Contautcr,;' 1 7-'_01.11 Svpatation-Stotage14 3-501.19 'Enc, w a Pat,,!,,--1 lo4,il.h C()ntid'l 7-202,11 Rctridlon--Pre:;ence.and lNc" j 590.00,'(H) VWIM!Ll: 7--02.12 Conditions of LrsCT 7-203 11 folic Containers-Prohibitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-,-04.11 Sanitizers.Criteria-Chemicals', POPULATIONS(HSP) 7-204 12 Chemicalt,for Nkashin^Produce, Criieria'; 213-80:.1 I(A) Unpa�icurl/ed Pic-packaged J-uice: art] I Warnin-', 141bols* T2Ul.1-1 Dryirn,Alllentq,Criteiia* Incidental Food Contact,Lubflcants� 1-80IJ I(D) Raw or Partralk,Cooked Anima!Foud,ind 7 '-&01.11(6) Us,,of Pisteurizeu E'g- -205.11 7"206.11 Restricted Use. Pesticides,Criteria* 7-106.1-) Rodent Hart Stations* Raw Sced Sprouts No:Sere d. 7-216.13 Tracking Powders,Pest Control and I unopcned Food Pa-kagf-Noi Re-scrvci. Nllonntorinr' CONSUMER ADV;SORY TIMEITEMPERPATURE CONTROLS 22 3 40', 11 Consumer Advisor) Posted for Conamiiptiojj of lfi Amn'-al Foods"limas ars kaw� Undercooked or Proper Cooking Temperatures for Not PHFs Othermise Processed to El:ontnne 3 401.11A(!)(2) E'-'s- 155'7 15 Sec UR,,,q-Immediate SCrNILC 14517 12.13 P.vilcunrzccl Ec-,Subsnititte for Ra" Sltc!l i ,101 I i(A)(2) Comminuted Fish,Meats&GamsEl,,gs� Animals - 155'7 15 sec. ffl)(1)(2) SPECIAL REQUIREMENTS 3-401,1 i Pot k and Beef Roast- 130'F 121 min- 3-401.11(A){2) Rafitc:,, Injected McLts- 155'F 11 590 oQ9(A)-H)) Vioiations ol'Section 590.009(A)-(FI)in see. catering, wrlbile food, temporary and 3-401.11(A)('3) POUltIV Wild Cattle.StUffied PHN. lesidenflall ki[ci,,_n opera tions should be Stuffing Curtaining Fish. Ment, debited inidet the appropriate sections Poultry or Ratite.-165°P 15 se,, above if related to foodborne iflness 3-401.11(C)(-,) Vbole-muscle, InIxct Beef Slealss interventions and brctorc. Other 145'7 590.009 violl-fl,ions relating to good retail 3-401.12 Raw Animal Foods Cooked in a practic,s should be debited under 4#29 - Nliclowase 165 F* Special Requireinents, 3--101.1 1(A)(I All) All 01hei PH-_s- 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RiFLATED TO GOOD RETAIL.PRACTICES 3-4,)3.11(A)&(D) PHFs 165`17 15 sec. 1z I (Metas 23-30) Ic 0 11(B) Microwave- toff` r'2 Mintite Soundiun, CnImai and nor, c,ai,all woiahom, which do not rllhac to the Turle* ;T111cs.`cn.:rr,nri,,w read!in,( factory 11sted above, can he 3-463 11(C) Conymcrciall)Po,",sed RTE Food finirl];n the fi:8oll inp ccctioyvi'Y'lrhr pooa CoA,and lo CAIR 14WF$ j 590.oo(), 3-+03.11(E) R,,lniaining Lnsliced Portions of Beef I train Good Retali Practices FV 590.000 Roasts* 1 23 I AanaQeme,,t and Pcrsonncl 1 F0,--2 .1003 Proper Cooling of PHFs 24 -rood rood F00o Proteclion FC- 3 .004 25 Fquq)m,,lrt anc�Utensils FC-4 .00.5 3-501.1-1(A) Cooi n.g Cooked PUFs front 1,10'F in 1! 26 vVater.tliurn!);nq and Waste FC-5 '006 7WIF Within 2 Hours an([Fenn 70-F 1 27 Phvsical Facilely F-1-6 OOT to 41'174517 Within ; Hours 2 Poisonous 0,ioxic Materials FC- 0019 3-501.14(61 Coohng PHFs Made Front Ambient 0, Special Reouirerents temperature ingredients to 41'F/45 Within 4 Hourq; I'Qnl"01 InIWOI 1:oTll in till[LliVFJI I'M)l-v,,d Cede w I0i CIMR 590.000. r^_,r"- ..... ............si-w..++�'>,^-"�...ri.•i'h.mr^•.+'�'.rW�....� . ., ,. ., .'vra'671�PA..Jam.i'k�+,N6i,(rKi"^�jr�..+^".t°"n"^"'u...+..s..n+....-�.+.•. `TH.E COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name //�� pp Date Tvoe of OoeratI n(s) Tyne of Insnecjion, f J.P A- O'e geeege� /a- /�5 0.3 [Food Service [?] Routine �k Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone �r i`.5 ❑ Mobile Dale: Owner / Ie HACCP Y/N ❑ Temporary Pre-operation Cm�Dl2Qe /V �oIeos ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint N� In: ElHACCP Inspector V /�� Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items)- Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE [1 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans ❑ 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 3 immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR o Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: � �. -�'- Print: PIC's Signature: n O Print: CT- ' Page_Lof Pages FORM 734A HOBBS&WARREN -BOSTON l Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.1 I(A)(I) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 1590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 I I Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Samtizanon-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P"P g8 � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Ho[Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1 Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 11 Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 I Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and I 3-202.11 PHFs Received at Proper Temperatures* Mouth* 11 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* - 6 1 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* Tags/Records: Fish Products 13 ndwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5'203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* -- - 5-204.11 Location and Placemen[* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability I 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* - *Denotes critical item in the federal 1999 Food Code or 105 CbIR 590.000. f CITY OF SALEM BOARD OF HEALTH Establishment Name: 1!_%1t17// Date: Ia- /.s- /,' 3 Page: of of -_ f I Item Code C-Critical Item ? DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item PLEASE PRIM CLEARLY Verified f — 2 _C�j k�//li/°Z ) 7 — Y ULC/P2 i/oP/Io I �N• i�//rc 4 ,OlePz, 7-X Al Y9 �f f3P7/>UP9�+. r 9 C_ - //;,A 1_/+Yd ,cA)P.r// ,flr Cn/X,-.7 471!'r A_10a� ��ih ///9i 07.5- —/I/ y--f-i,,.o AZ n//' ,c Y4/Alo�j 91C e-- XoA te-a'-Ay �,v��,✓ - . ,_ Jh/!/O -./�P.C�k'e. -f-a �/Pi/m G'�rrfsi�rn a� .�i��1/�,� `�i�r3s /rr_ rre �,✓�,°.v..� - 4 -Li/c,�rnP✓�,`c /re rmr � 1r 5�''vr /�, ca,/ pi/ /rte , S�n�� t>/•v�oA E �l/ 7/x/ 2- mor k Ajevrk D/mss-ir `J7'J,7''/�iNC� /_Ynlinr7 \V, a7 -,b'a�,i �_air,%,�z�ne .,�P.�.% <<//,ao� /r�/�i,P��/�✓ - � /FtC /v" lvefclC in//p.aP,17 �Piob�G/1 �/XOD� �7I�P L5eZ C7 AT r/> 1 'C� % 7- /.S //r Ao,P-/a/lW f�� a<e �J_vG/v �1it� �"//) _civ 1//�s7 Pf? -0.//., �.Ales. r I �iY/h � [��/,rY/P.�°A,�.Pt/,Ld1�Y/fN/l Q' 774 0 -�7UrJ ,C'1,41 Vol/� Y O P/ - 'E I� I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑Yes €I I have read this report, have had the opportu ity 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 LI Re-inspection Scheduled L11 Emergency Suspension with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. i ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 7340 HOBBS 9 WARREN - BOSTON { { 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 to41*F/45°F Within 4 Hours.* PROTECTION FROM CHEMICAL$ 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(8) 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* 13-501.19 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 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 1 Beverages with Warning Labels* 7-204.14 Drying Agents,Catena* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 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 4 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PRFs Pathogens.* Enechm 11112001 3-401.1 IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec 3-401.1l(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.*I catering, mobile food, temporary and 3-401.1l(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 risk factors listed above, can be Time* found in rhe 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 Unshced 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. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: /.�1 -A Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION _ Date 1 No. Reference R-Red Item Verified ,t / PLEASE PRINT CLEARLY + 2-//Y,;' I 1 I I YI a N.O A,0X1ASX1.4,a / • 1� �v 1/�!Y]/A/(r7iA oL� Q � �/7/'J'I /i1 LZ/ ?(71 X5..92/ '1-J2//L CY fi CCIf /n11PS,A7W9S "Y AO 776-/. Ik c`a.P<yp - I Discussion With Person in Charge.' Corrective Action Required: I ❑ No ( ❑ Yes c 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 El Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that nAncompliance may result in daily fines of�'^'ent -five dollars or suspension/revocation of ❑ Embargo Ll Emergency Closure your food permit. �3 JJJ��111 ❑ Voluntary Disposal ❑ Other: 4•. -:iW.;=:(C) PF Fs Received e.t Tenpe:amret. Violations Related to Foodborn€.1 iness interventions and Risk Accoroiae bi LauCowled : Factors(Items 1-22) (Carr.) -;I'Fi45'F iVithin 41fta:a. Coalite P PROTECTION FROM CHEMICALS lelhcr is for PI-IF, ( 1Y PHF Hot and Crld fielding ( t; Food or Co!ar Additives _ - ,..•III I6(S:) i tir!d PI?".,?r!^u rr s;ned a2^r brlow 1201 t'_ A,lditisec' 590.00-i;F` 1 41"x',-1=r: ! 3-302.11 Protection iron Una(rprored Additives` ! 3.v?i.ifi(.11 tIo!PF1Ps?.1a;o:adned at or abusro ( )� Poisonous ar Toxic Substances 7 101.11 klenUhv:c (n tonuatmn--Ch i;tinal I ;-SC1.lbL11 Rwa,ts Heldaf of abi)ie Con6tiuer;.'" ( 7-102.1 1 Common Name-tN orking Containers' � ( J'' t Time as a Fubtic Health Control 1.'9 Tune as a Public lkalfh Control* 7201 11 Separation-StonCee' 7-202.11 Restriction-Presence and Use^ ( 590.00:(H) Vananu;Rcquireumot 7-20_.12 Conditions of(iSe` 7-203.11 '1'osicContainci,-11ruhitntions; ( REQUiREMENTSFOR HIGHLY SUSCEPTIBLE 11-204. Sanitizrs.Critetia -C'hem;calsx ( ?OPULATiCNS(HSP} 7 2")4 12 Chemicals for W'ashin)•Pnduce;C'riteriaT ( ( 21 3-801.! !(A) Unpa,leunied Pte-Fackagod.nuke.ar,6 i : Herer;igc, with Warning label=* 7 20-.14 Drying.Agents,Criteria= ( ( 3-SOI.i I(B 1 its;of Pasteui iz-d 7-205 it hicidcntal Food Contact,Lubricants' ( 3.301 i IL;D) Raw of Paxiiallp Crwkecl Annul!•uod and 7-1.06.11 Restricted Use Pesticides.Criterla'r k< w-Dred Sprouts No Scrvcd. 7-2Ofi.12 Rodent Bait Stations!. ( ( 3-901.111,0 Unopened Food Package Not Rc-sen-cd. 7-206.13 'Craclan g Powderh.Pest Contin and Monitoring, CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Cons: im Atb isory Posted for Conauniptiroi it Aminal Foods That stn Raw, Undercooked or lfi proper Cooking Temperatures for N.;(r)tltnnvise Poxessed for Eh;nu,ate PHFs 3-401.1 JAH)(2) Eggs- 155`F 15 Sec Eg„s- immcchate Servim 14S°Fl SseeF i-302. 3 Pas trmi;ed Eggs Substitute tor Raw Shv(I 3-401.11(A)(2) Comminuted I-ish.Bleats k Game Animals -15.5'F 15 sec. ( 3-401.11(B)(1)(2) Po,kandBeefRoast- i30'F 121 nuu' ( SPECIAL REQUIREMENTS 590. -)+ Violations of Sei . 9(A -( m 3-�lUi.1L(A)(-) P.atites, hijened&teats- li5`FIS 009(A)-(TViollion 59000 ) D) see, catering, molisle food, temporary anti 3-401.11(A)(3) Pooh:y, Wild Gaune.Stuffed PHFs. restdenil:d kioc;cn operations should be Stuffing Containtng Fish,Meat. debited under ,lir appropriate section Poull:y ur Ratites-165'F 15 tcc. ` above if rehited to loodtome Ilbies, ,3-401.11(0)(3) Whole-muscie.!niart Beef Steak, int.rventioas drid rink factors. Other 14.5'F* 590.009 violations tasting to Brod retail 3-401.12 Raw Animal Fooxlh Cooked in a pra.:!ices should be debited under #29- Microk .ave 165`F* I Sp:cctal Requirements ( 3-401.11(A)(1}(b) All Other PHFs - 145'F IS sec. IT Reheating for Hot Holding ( VIOLATIONS R-LA TED TO GOOF)RETAIL PRACTICES 3-403.1 1(A)&(D) PI-(Fs 165"F 15 sec. °' (Metas 23.30) 3-463.11(B) Microw,vc- 1 W F 2 Minute Standine Critiwl c:i:d::on-(rine iii which do not relole to the j Trane" 1,ooboi .. illness inicrventians and nsd factors !ivied above, can he 3-403.11(C) Commercial lg Processed RTF Food - fwaid in rhe followw',:.ee tions.+f!fic Foot!Cmhv inti! 105 CUR 140°F' 5C>0.0itQ ? 4(13 I I(E) Remaining Unshced Portions of Beef Item I Good Retail Pracficas FC 590.000 Roasts^` 23. 1 laanaQ9rnent and Pe:sennel 1 FC-2 .003 �--- - ( 18 Proper Cooling of PHFs 24 Fe:,and Food Pro'ec6cn I 'FC- .3 _ 064_ _ - 25 Fqumment and Utensil:i FC--, ,OUS 3-501.14(.4; Crwhng Cooked PHFs from 140'F to 25. Water.Pl.rnbinn and Waste FC-5 .008 70"F Within 2 Hours and From 70`'F ! 27 Phys:ca:Fac.lity FC--6 007 to 41"F/45'F Within 4 HOLIrS. * 23 Poisonous er TOXIC Materials FC-7 .003 3-501.1a(B) ICoolingPFIFsMadePromAmbient 12t' SPecialReguirements .009 Temperature ingredients to 41'FIs5"F 30 +Other ( Within 4 Hnurs` ""• " st 'D:now,Unocal uenr in the lederal 1999 Foil Code W IM C\n2 590.000. ' CITY OF SALEM BOARD OF HEALTH ff Establishment Name: Date: t) 3 Page: / of A Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY v.1/4A//sL/ x�✓/ �.9.sr/u /—/. » ✓(/ S�a../d/1-.r -� �if!'�/e.n n -� l�il/v03_ , r /7 JaAl/If0,4 aS f�i/su�o1 /// �/a //Fo pa'/.S4.-,9 z m�.I�..n� ). (),.fsoi _n-n�r nrnal oc , JC/.,y Qf/�.s /va �i/.-,C! /.L/va J•a,-. 7 / n✓J0. A h�� ,.&41� At ifs_ n� 1 41s . �iti>s / �o 12D/2.u/ ! 11-4 /4 /N Ire Y7/// S/ -1 174 �N�/O G !/7✓ /� /"W"- D/ 1 1/O of O ✓ y/r 9/11✓. ' I I A,'4 a' ,<-e, ,l7n-,-t.A 1 ,.�, (�•f -F -IIJ dI V GY//�•.�, .�6.. �-N: afz/ mAAj / 'J✓�r Lr /'.a /n.,n .' ) / /v. 10h V/55-4 f)1"�/s /`� 74-;,V/ ✓/4', •'t I -1-✓///�--/ (Y//w.�S�C✓ t � .-i �'NC D S�// CJ-S C7/ S�/'�9 1,!^ tLu/dam 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 El Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension ' comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: rti I — 3-501 14(C) I'I4Fs Received at Teruperntut,s Violations Related to Foodborne Illness Interventions and Risk Accor ding to Law C„ded to Factors(items 1-22) (Cont.) 4I"F/45'F Within 8 Hours. " PROTECTION FROM CHEMICALS I 3-5('1.15 Ctx+lutg Methods for PHF: 114 Food or Color Additives 119 PHF Hot and Cold Holding 3-501.16(B) Cold PRFs Mawlmned au or below 3-202.12 Additives- ;90.o0'.(F) 4i'/4`'F< 3-3(}2.1=4 Protection trout Unappi-med Additives'" 3_ait.16( 1) Hol PFIFs `;imma;ned at ou abrne 15 Poisonous or Toxic Substances I 140'F, 71ULI1 ltlentut}aug (nformahon-Original I 13-i0IA(,(A) Roasts Held atrnabo�e130'F. ' I Containers'" 20( 1 Time as a Public Health Control _103.11 Common Name--WorkignCnmainer>* I 35t}1.19 Time;Is a Puhiic 'rIeahh Control" 17?Ol 11 Separation-Storage" I 7-202,11 Restriction-Presence and Use x I 15`)0.604(1-1) Variance Rcquirewent 7-02.12 Conditions of t isc' 7-203 11 Toxic Containers-Plnhibdious^ I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sanuizers.Criteria-Chemic ls* I 7-'-04.12 Chemicals fou Washing Prolate, Cr;izria" ( 21 ( ;801.1 I(A) i}npasteun:+ed Pre-packaged tutees and Beverages wish Warning f 7-205,11 Incide �abeLsk 7-2(14.14 Dcide' Agents.C:rfteria' I 13-f;0 t 1(131 Use of F'neteurizcd Egg,` ' ntal Food Contact,Lubricants' I ( 3.801 i t(D) ( Raw'tit Partially Cooked Anima!Food and 7206.11 Restricted Use Pesticides,Criteria' I Raw Seed Sprouts No; Served. ?-206 12 Rodent Bait Stations* I 13-801.11(C) I Unopened Fond Package Not Re-sened M J 7-206.13 Tracking Powders, Pest Control and Monitorine' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 1-603.11 Consumer Advisor Posted for Consumption of 16 Proper Cooking Temperatures for Amnul F:x ids"Pkat are Raw,Undercooked or PHFs Not Other ke Processed to Eliminate Pathogens."-40 31.11 Aft 10 Eggs- 155`F15Sec. 3.302.13 Pastcmui.edF>>,SubstimrefurRiwShell Eggs-lmmc""'Service 14S`Fl Ssec* Eggs 3-401.1 I(A)(2) Comminuted Fish. bleats 3,Game Eggs* Animals- 155'F 15 sec. * 3-401.11(Bt I (2) Pork and Beet Roast- 130"F 121 tam SPECIALREQUIREMENTS O 590 009(4 -(,DI r 3401.11(A)(^_) Ratites,Injected Meats- 155"F 1'; ) Violations o, Section 590.009(A)-(U) in sec. * catering, mobile food. temparary and 3-401.11(A)(-,) Pouluv,Wild Game. Stuffed PIIFs, I residential kitchen operations should be Sim'img Contauung Fish, meat, i dchitcd under the appropria is ,ecti;,n: Ponitty or Ratites-165'F 15 sec. " above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Bmf Steaks I interventions and risk factors. Other 145`F A, 590.009 violations relating to t*ood retail 3-401.12 Raw Animal Fouls Cooked in a practices should be debited under 1129- Miciovwave 165`F* Special Requirements. 3-401.11(A)(1)(bl I All Other PHFs - 145'F 15 see. 17 I I Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.111A)&(D) I PIIFs 165'F 15 sec. * I (Items 23-30) 3-403.11(13) Microwave- 165'F 2 Montle Standing Critical ural nun-critical notations, which do,not relate to the Tirane" foodhorne rt6res intemeurious and risk luctrm fisted ahote, can he 3-40111(C) Commercially Pux:essed I2TE Food- Lound in the following ser mans of the hood Code and 105 CbIR 140'Fx 590000. 3-40311(El Remainine Unsliced Portions of Beet Item I Good Retail Pt'actices FC 590.000 Roasts* 23. ! Management and Personnel FC-2 .003 _ Proper Cooling of PRFs ?a Food and Fad Protection FC-3 .004 18 ( j I uipmant and Utensils IFC-4 .005 3-501.1d(A) Cooling Cooked PFlFs from 140'F to 26. Water. Plurnbinq and Waste i I FC-5 005 70'F Within 2 Hours and From 70'1; 1 27 Physical Facility I FC-6 .007 to 41'FI45'F Within 4 Hour,. 1 I 1 28 Poisonous or I oxlr,Maierials ! PC-7 .005 3-501.14(B) Cooling PHFs Marie Plum Ambienti29. J-Special Requirements ! 009 - - -' "Ientperature Ingredients to 41'F/45'F 30 Other Within 4 Hours' "''`" " :.`',`> " Denote,,meal item m the fed;ral 1999 Prod Cute of 105 Csill 590.0K). CITY OF SALEM BOARD OF HEALTH z Establishment Name: 12>ro-(La 66 e0q< _ Date: /o? — 47—d3 Page: of - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` 't No. Reference R-Red Item Verified W PLEASE PRINT CLEARLY All -F lo'YvS ,cC/?,c_.., )A I-s- n M--f-( 'P f s f R lo A,- r ` -0" 4v o 19zP� /7 P.P.`r r•-r y /-7 , r I /7,. / �l I I � I � � I t 1 = I Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ res 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 your food permit. r J tLlVoluntary Disposal ❑ Other: 3-501 14tC) PHFs Received at Tcruprratutes Violations Related to Foodborne Illness Interventions and Risk Accordimq to I aaCooled to Factors(items 1-22) (Cont) 41'F/45'F Within 4 Hoots. " PROTECTION FROM CHEMICALS 3-501.1' Cooling,Methculs for PHF� � ' i9 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(6) Cold PHFs Maintivacd at orbelow 3-202.12 Additives` 4;90.ia),hF) 41''145^F': 3-302.14 Protection It our Unapproved Additives' i-501.1"(A) Hut PHFs Maintained at of Mime 15 Poisonous or Toxic Substances 7-101.11 Identtfpie,Information-Ori Anal i Roa•[oaq -5Ol.l(.{•�) c Heid at rn aho,e 130`P. Containers" ' 20 ( Time as a Public Health Control 7-102.11 Couunon Name-WorktnC.Contamers" f 3-501 19 Time a:a Puhlie fIeaith l:antroP" 7-201.11 Separation-Sh)ragc" I ';90004(fI; \'amuse Requirenicat � 7-202.11 Restriction-Presence[me.Use* 202.12 Conditions of U;c' 7-203.1 I Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chenhcak POPULATIONS(HSP) 7-204.12 Chemicals for Washing Puxlnce.Ctiteria" 121 13-801.1 I(A) Unnasrevriz:d 1're-peckaeed Juices and 7-304.14 DiSinq Agents.C'rned,0 ; Be,eraces with N'arnim;:,Labels* 7-205 11 Incidental Food Contact,Lmbucant '- ( '-8')1.11(6) l ice of Pasteurized Frps* 3-SUI I IID) Raw of Pdrnally Cooked Animal Food and i 7-206.11 Restricted Use Pesticides,Criteria* R2 ,,% Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* ( ;-801.1 I(C) Unopened Fo(id Package Not Re-ser,ed 7-206.13 Tracking Powder,,Pest Control and _ Monitoring' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 x,03.1 t ! Consumer Advisoty Posted for Connuuphon 04 lb Proper Cooking Temperatures for ' Annual food,`lliat are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate ;-401.11A(1)(2) Eggs- IWF 15 Sec. Pathogens. °. E,_es-Immediate Service 145'F'15secs ' -3ir2.13 ( Pasteurized E'rs Substitute fu: Raw Shell uhr.; 3-401 1 I(A)(2) C'ouuninuted Fish. Mems&Game Animals- 155`F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(6)(1)(2) Pori,and Beef Roast-cled Mer 130°5 121 min" juU UU9(A)-(f)) Violations of Section 590,009(A) (D) in 3-401.11(5)(2) Ratites,Injected Meals- 1555 15 Yec . ciderins, mobile foal, temporary and 3-401.1 I{A)(3) Poultry,Wild Game. Stuffed PHFs, ( residential kitchen operations should he C1ebii d under the nnrnn''ral� Deed C�:a Stuf(mg G'ontduung Fish,Meat. rt_ r- Poultry or Ratites-165'F 15 sec. " ! above if related to foodborne illness 3-401 1 I(C)(3) Whole-muscle,Intact.Beef Steak:. interventions anti risk Factors. Other 145"F' 590.009 violations relating to good retail 3401.12 Raw Annual Foods Cmiked in a I practice's should be debited under H29- Mirrowave 165"F * Special Requirements. 3-40t.11(A)(I)(b) All Other PHFq-- W5'F15sec. 17 ( Reheating for Hot Holding VIOLATIONS R=LATED TO GOOD RETAIL PRACTICES 1403,11(A)&(D) PIIFs 165'F 15 sec. (Items 23-30) 3-403.11(6) Microwave- 165'F 2 Monne Standing Critical and non-r reheat violations, whichdo not relate.to the 'rune' Iiodboine illuess interremions and risk factot,s listed above, can be 3-103 11(C) Commercially Processed RTF Food- found in the following:.ertioas of the food Code and 125 CMR 14110F* 59U.0U0. 3403 1 l(E) Remaining Unsliced Portions of Beef � I Item Good Retail Practices I FC 590.000 1 _ Roasts' 23 Management and Personnel FC-2 .003 1 18 Proper Cooling of PHFs 24 Food and Food Protection FC-3 004 __ 25 1 equipment and Utensils FC -4 .005 3-501.1 4(A) Cooling Cooked PHFs from 140'F to F"-----TTTT- I 26. Water, Plummnq and Waste FG-5 .006 ; 70°5 Within 2 Hors and From 70'5 127 Physical Facility FC-6 007 to 41"F/45'F)l Within&Hours. I ' * 28. Poisonous or Toxic Materials FC - 7 .008 3-501.14(B) Cooling PHFs b9ur(e.From Ambient 1 29. Special Requirements .009----- Temperature tngrechent+to4l'F/45`F 30f'( n 1 Other Within 4 Hours" ''"'')_ Dmoies a Chad item in the teder l 1999 Fo,xl Okle of 105 CMR 5940.000.