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HomeMy WebLinkAbout0206 MAIN STREET (HYANNIS) - HOTELS/MOTELS (3) America's Best Value Continental S fi fe/ f i rtH Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. 13AP.14srABM 3 Paul J.Canniff,D.M.D. Mns 200 Main Street Hyannis MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us - Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1078 Issue Date: 01/01/2021 DBA: AMERICA'S BEST VALUE INN OWNER: J &J HOLDINGS LLC Location of Establishment: 206 MAIN ST HYANNIS, MA 02601 Type of Business Permit: CONTINENTAL BREAKFAST Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 _ FEES_ J FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: $30.00 -- — -- - — -- - ---- MOBILE-FOOD: MOBILE-ICE CREAM: G. FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: CONTINENTAL BREAKFAST ONLY .,�: For Office Use Only. Initials: oF�NEipk, ,Town of Barnstable ~Q " Date Paid Amt Pd$ BABNMBL6, : ;'Inspectional Services �Q v� 039. MANN. prfDMPta C Public Health Division t Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 tI3 Office: 508-862-4644 Fax: 508-790-6304 [t 0! Lt APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 21 NEW OWNERSHIP RENEWAL NAME F FOOD ESTABLISHMENT: �`� gel— W�c Jc O A.A. ADDRESS OF FOOD ESTABLISHMENT: ' `�'Y) MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ""A Cne c0 fiy"\C.11, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 0 )Tll< - �LL!'> 'X TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: y DATES OF OPERATION: 5/ �/y`TO t� / 1 NUMBER OF SEATS: INSIDE: �6 OUTSIDE: TOTAL: tkz SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? J TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST VONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsT.00DAPP 2020.doc �y d OWNER INFORMATION: FULL NAME OF AP LIC, T 41 SOLE OWNER: / O D.O.B S !OWNER PHONE# b 1 ' 2-13 O ADDRESS `Z8L M.aiVX. t3 /14uCX- - t CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: �U rk. Cq List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIG ATIIRE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httu://www.townofbarnstable.us/healthdivision/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q1Application FormsTOODAPP REV3-2019.doc - Bellaire, Dianna From: Soto, Kathryn Sent: Wednesday, May 05, 20212:25 PM To: Bellaire, Dianna Subject: RE:America's Best? Just send it to him. He's all set From: Bellaire, Dianna Sent: Wednesday, May 5, 2021 12:36 PM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: RE: America's Best? No, he hasn't asked about it, I am just trying to get things off my desk. Let me know. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission "e-maul" includin any attachment the"Information"),may be confidential or otherl�ise exempt from disclosure..It is for the addressee only.This Information may be pri-vileged and confidential work-product or a privileged and corrfrdential communication.The Information may also be deliberative and pre-decisional in nature.r' s such,it is for internal use only.The Information map not be disclosed xxithout the prior written consent of the Director of Public Health and/or the Town Attorney s Office of the Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Soto, Kathryn Sent: Wednesday, May 05, 2021 10:46 AM To: Bellaire, Dianna Subject: RE: America's Best? I didn't do a report yet because I am trying to limit how many food inspection forms I use until we get new ones. I am going to need the forms for other inspections this week. I mean nothing is even setup yet so I wouldn't sweat it. Is he asking about it? From: Bellaire, Dianna Sent: Wednesday, May 5, 2021 10:02 AM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: RE: America's Best? 1 f Should I release their permit? Did you give me an inspection report? Let me know. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us T1ie information contained in this electronic.transmission("e-mail"),including any attachment(the"Information'),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Infornlation map be privileged and confidential work-product or a privileged and confidential conn.n:nunication.'11ie Information m.ay also be deliberative and pre-decisional in nature. As such,it is.for internal use only.The Information may not be disclosed N6thout the prior written consent of the Director of Public Health and/or.the '.'own.Attor..nep's Office of th.e'I'own of Barnstable.If you have received.this e-mail by mistake,please notify the sender and delete,it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Soto, Kathryn Sent: Tuesday, May 04, 2021 3:53 PM To: Bellaire, Dianna Subject: RE: America's Best? I inspected them this morning and they don't have anything setup. I checked the fridge temp so they are all set. I told them they could have coffee but they asked about their juice machine. The guidance specifically mentions coffee but nothing about other drinks. Maybe I should ask the state about that one ? From: Bellaire, Dianna Sent: Tuesday, May 4, 2021 12:56 PM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: America's Best? Kathryn did you inspect them for continental breakfast? I had a note they were opening this week. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or othery'Vise exempt from disclosure.it is for the addressee only.This Information maybe p.ivileged and confidential work-product or a ' privileged and confidential communication_The Information may also be deliberative.and.pre-decisional in nature.As such,it is for 2 =T Town of Barnstable BOARD OF HEALTH John T.Norman r Board of Health Donald A.Gaudagnoli,M.D. HARNNSTAG,e. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1078 Issue Date: 01/01/2020 DBA: AMERICA'S BEST VALUE INN OWNER: J &J HOLDINGS LLC Location of Establishment: 206 MAIN ST HYANNIS, MA 02601 Type of Business Permit: CONTINENTAL BREAKFAST Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR: 2O2O RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: $30.00 . MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: CONTINENTAL BREAKFAST ONLY of tq� Only:For Office Use Initials. Town of Barnstable DgtLhaij Amt Pd$ i L.� BAMSTABLE. , Inspectional Services 6 " Public Health Division Check# c� 8 '�eo Mai tir Thomas McKean, Director 0 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 SA:r ul va APPLICATION FOR PERMIT TO OPERATE A,��FOOD ESTABLISHMENT DATE ` ZJ NEW OWNERSHIP RENEWAL (/ NAME OF FOOD ESTABLISHMENT: `J'""�' 5 �7 V 4�VC ADDRESS OF FOOD ESTABLISHMENT: Z� (�/vl S A NN r O Z Gad MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ol w� Cq I?,- 60A alb TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO ... (ANNUAL WATER ANALYSIS REQUIRED) 73 ANNUAL: SEASONAL: DATES OF OPERATION-_/ / TO NUMBER OF SEATS: INSIDE: 2/V OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST NTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QPP �A hcation FormsTOODAPP 2020.doc �r .: OWNER INFORMATION: FULL NAME OF APPLICANT nn� SOLE OWNER: YES ONO� D.O.B ?'1'T B��OWNERPHONE # ADDRESS ` t l)OL w?/�i /2 U�P�`� ---t-Ltc CORPORATE OWNER: 5 CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 2. / SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinE!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc c� r MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed &Breakfast Permit= $55; Food Service Permit 0-49 seats= $250; 50 or more seats $300; Continental Breakfast=$30; Retail Food (only TCS Foods) =$20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. =$285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry=$75; Mobile Truck=$50; Mobile Ice Cream Truck= $35; Frozen Dessert License= $30; Additional non-refundable Fee for New Establishment or New Ownership= $100-$500(see stafo, Late Fee= $10 Q:Wpplication FormsTOODAPP REV3-2019.doc VHE ro TOWN OF BARNSTABLE HEALTH INSPECTOR•s Establishment Name: /�V ''C �V at!�/e: 2� Page:�_of l OFFICE HOURS [ ' P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BABNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v ,' es e� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �°rED MAC"' 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name e'e_,` Date K Tvoe of Tvne of Inspection �� r� Operation(s) Routine Address /_ �f�„ -'� �' - `S Risk If Food Service Re-inspection (�J `-L�� Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Owner HACCP WIN Temporary Suspect Illness y\Cyr Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector out:lp', Each violation checked re wires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 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 Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 1714.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 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 Items) Total Number of)Critical Violations � M Critical(C)violations marked must be corrected immediately. (blue&red items Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ® Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) regardless of the number of critical,results in an F. p constitutes an order of the Board of Health. Failure to correct violations 6=One critical violation and less than 4non-critical violations g 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If f critical water,sewage back-up,infestation of rodents or insects,or lack of FC-7 590.008 be in writing and submitted to the Board of Health at the above address violations observed,7 ti anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials ( )( ) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspecto S' atu a Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N ign re � AP�`�� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N I Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) * 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-20 Require Reporting by Food Employees and Contamination from the Environment 7-101.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * .11 Separation-Storage* 3-302.11(A) Food Protection 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.1 I Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) I Exclusions and Restrictions* ,7-204.11 Sanitizers Criteria-Chemicals* 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) I Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 1.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,PH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-]01.11 Drinking Water from an Approved System* 4-601.I 1(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 590.006 A) Bottled Drinking Water* Equipment* 3-401.11 A 2 Comminuted Fish,Meats&Game Not Otherwise Processed to Eliminate ( g 4-602.11 CleaningFrequency of Utensils and Food ( )O Pathogens* eta="°e inrzooi 590.006(B) Water Meets Standards in 310 CMR 22.0* q y Animals-l55°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 min* 4-702.11 Frequency of Sanitization of Utensils and Food Eggs 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-I55°F I5 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009 A Ratites-165°F I5 sec* ( )-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special $ Receiving/Condition 2-401.11 Eating,Drinking or UsingTobacco* 3-403.11(A)&(D) PHFs 165°F IS sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.1 I(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.12 Records,Creation and Retention* 5-205.1 I Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.00 J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .00 7 Conformance with Approved Procedures/ 6-301.I 1 H 7 Hand washing Cl Availability anwasng Cleanser, vaaty 28. Poisonous ci ci Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 3-502.11 Specialized Processing Methods* 29. Special Requirements 009 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °Ft r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: V� Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:0o-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date Verified eyq. `m$ HYANNIS,MA 02601 _ M- -FRI. soa8s2-as4a No Reference R-Red Item PLEASE PRINT CLEARLY- N1 FOOD ESTA13LI.AHMENT INSPJJCTION REPORT Jll Name Date of Type of Inspection _ Operations) Routine IV Address Risk Food- Service Re-inspection Level Retail Previous Inspection Telephone J Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP L 0. 0 IA/Elq _ Inspectopi R, /1,�� v I/ ,61 LP ther Each violation c ecked requires an explanation on the narrative ages and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ - Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities e - 1if V EMPLOYEE HEALTH PROTECTION FROM CHEMICALS "e ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives < rx � ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals + v, I x: FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) .Y `Y}pro ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - � ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.CoolingF ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding a .. 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 I '^ y - ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories LZ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating ISM within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items - checked indicate violations of 105 CMR 590.000/Federal Food Code: ❑ Embargo ❑ Emergency Closure El Voluntary Disposal El Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below b a Board of Health member or its agent p 9 Y 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations _B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F- 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6npn-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to a n 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address -critical violations. If 1 critical refrigeration. ( )( ) violation,4 to 8 non-criticalAolatiogl=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I e 's Signature 0� V Print 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: " Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N y� � Dumpster Screen? Y N _ t` f } Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* . 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding_ 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation Storage** 3-501.16(A) Roasts Held At or Above 130°F* - Applicants* I 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 590.003 (� P tY3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* I * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge*- Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - ( 3 590.003(D) Exclusions and Restrictions* I 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 11-601. A) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4 ( Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff°r'°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section and - ide ti cater- * Ratites-165°F 15 sec* in_mobile food,temporaryand residential Sources g• 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C). Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 - Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFI ro TOWN OF BARNSTABLE H ,LTH INSPECTOR'S Establishment Name: !(� AIG Page: of 40 OFF E HOURS , 1 / iAR"NS,`E.� PUBLIC 2 0 MAIN STREET SIONas.3oA.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3.30-4:30 P.M. MASS. � MON.-FRI. �p i6jq,6 m� HYANNIS,MA 02601 508-862-asaa No Reference R-Red Item PLEASE PRINT CLEARLY 'FDM1" FOOD EATABLISHMENT INS C ION REPORT Name J � ate Type of Type of Inspection lip/I Oneration(s) Routine Address Risk Food Service Re-inspection 49 Level Retail Previous Inspection Telephone Residential Kitchen Mobile It Pre-o Owner HACCP Y/N Temporary uspect Illness Caterer General Complaint Bed&Breakfa t ACCP Person in Char a(PIG) Time , Irk Other Inspector Each violation checked requires an explanation fin the narrative pa (s)and a citation of specific provision(s)violated. d �a Violations Related to Foodborne III less s)ess Interventions and Risk Factors(Red Item Anti-Choking 590.009 1 ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009 1 ❑ F. Action as determined bythe Board of Health. Allergen Awareness 590.009(G) ❑ 64 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 Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures c ❑ 5.Receiving/Condition ❑ 17.Reheating e ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control j ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / J ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP❑ 1 J 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories W Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations C_ Critical(C)violations marked must be corrected immediately. (blue&red items) l J Corrective Action Required: I ❑ No I F1 Yes Non-critical I violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled - ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non=critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than o 6 non-critical violations if no critical violations observed,4 to von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water;'Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If p,infestation of rodents or insects,or lack of 27.Physical Facility .(FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9.non-critical. If no critical water,sewage back-u 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no -critical violations. If 1 critical refrigeration. iolation,4 to 8 non-critical i ations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. O 30.Other PATE OF RE-INSPECTION: In ct I at 31.Dumpster screened from public view. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration nment of Responsibility* tI Cross-contamination 14 Food or Color Additives . Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* A 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *- 19 PHF Hot and Cold-Holding, _ 2403.41 Person-in--Charge Duties - - -- - - - 3-302.14 Protection from Unapproved Additives � - " Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) - *- - -- - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11_, Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to - •7-102.11 - Common Name-Working Containers* * Require Reporting by Food Employees andR4501.141 Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements Food Contact with Equipment and Utensils * ( ) 9 590.003(G)- Reporting.by Person.in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer - 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* _ { REQUIREMENTS FOR A)(B)Returned Food and Reservice of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( � Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 '" Food and Water From Regulated Sources Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Com liance with Food Law* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - Manual Warewashing-Hot Water 7.206.12 Rodent Bait 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of Fr m Potable Drinking Water 3- 1.11A 1 2 E -155°F 15 sec 3-202.16 Ice Made o g 40 ( )( ) Eggs n it an F Contact Surfaces f * Animal Foods That are Raw,Undercooked or 4 601.11(A) Clean e Utensils d Food Co t ct Su ces o Eggs-Immediate Service 145°F 15 sec 5 101.11 Drinking Water from an Approved System*- - . g PP ( * Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E7/eve innoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS i 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - Din cater- 3-201.15 _, Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) * - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P - Game and Wild Mushrooms Approved By- I -- - * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2-361.11 Clean Condition-Hands and Arms the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18- Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * ; 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices ould be debited under#29-Special 5 Receiving/Condition - 2�01.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items non-critical 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records.Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices PFC- 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenancei Within 4 Hours 26. Water,Plumbing and Waste .006 590.004 J Labelin of In redients* Supplied with Soap and hand Drying DevicesO 9 9 27. Physical Facility .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 7 6-301.12 Hand Drying Provision r 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* Sr 590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.