Loading...
HomeMy WebLinkAboutBARBYANN'S - CLOSED FOOD Barby Ann"s 120 Airport Rd. Hyannis n Town of Barnstable BOARD OF HEALTH o� John T. Norman Board of Health Donald A.Gaudagnoli, M.D. BARN BLE, F.P.(Thomas)Lee,. �$ 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 195 Issue Date: 01/01/2022 DBA: BARBYANN'S OWNER: SNARKY, INC. Location of Establishment: 120 AIRPORT ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 150 OutdoorSeating: 30 Total Seating: 180 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i dt THE For Office Use • Initials• LM Town of Barnstable _ Date Paid' l Amt Pd$�--��V SABNSTABIE. ; Inspectional Services ia 39. �Eo a Public Health Division Thomas McKean',McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A F OD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: '✓ar� (4\ ADDRESS OF FOOD ESTABLISHMENT: 17,0 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: G &I W, R TELEPHONE NUMBER OF FOOD ESTAB ISHMENT: )7 l b - -7 l r TOTAL NUMBER OF BATHROOM : WELL WATER: YES NO .. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL. DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: LfO OUTSIDE: AfO TOTAL: 110 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 DOORS ? / TYP + OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) '{ FOOD SERVICE RETAIL.FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL 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 FormsTOODAPP 2020.doc `� OWNER INFORMATION: ` FULL NAME OF APPLICANT SOLE OWNER: YES/NO D.O.B OWNER PHONE # ADDRESS CORPORATE OWNER: 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. 16�1� �4— / 3 /c 29 1.r4o A�A at 0 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 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 http://www.townofbarnstable.us/healthdivision/applications.asi). 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.31't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Apphcation FormsTOODAPP REV3-2019.doc 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* S 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 Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14. Protection from Unapproved 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants * 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 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 Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re Adulterated-or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* I 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* I Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean ContactEggs Utensils and Food Surfaces of E s-Imrnediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ctiw 71112001 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* 3-40111(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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)-(D)in cater- . 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 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. * 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 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 RecelvingiCondition 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* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F 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 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 .01)4 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 2 . Physical Facility FC-5 .00 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision ` 29. Special Requirements 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. �p THE Tq, TOWN OF BARNSTABLE HEALTH INSPECTOR`s Establishment Name: _Dater3 / C_ Page: .. of. y1 OFFICE HOURS BARN STABLE. PUBLIC 0 N STREET HEALTH RSION ' 8:00-9:30A.M. - 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A 639. `0i HYANNIS,MA 02601 508-s2-4saa No Reference R-Red Item PLEASE P NT CLEARLY TFD MP�� FOOD ESTABLISHMENT INSPECTION REPORT Name b �,�� Date Type of ns ec io Routine Address 1 r1 Risk = ection c�F9 Level Retail Previous Inspection Telephone Residential Kitchen Date: r ,C s Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspecto Out: Each violation checked requires 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 ���/v1 F� ❑ 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 OCLI 1 Zf� c I ❑ 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 ❑ 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 e 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 Advisories40 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 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, a 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 re ardiess of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation er the food if no critical violations observed,4 to 6 non-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 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within o receipt within 10 daysf i t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe tur 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 Signatur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N -� �F.ME rok, TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date:' f r .t Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item -DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �b 63: �m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEAS PRINT CLEARLY_ `CFO MAC a 508-862-4644 •'' FOOD ESTABLISHMENT INSPECTION REPORT Name Q� t� Date f Type of Ins ec io l n otitis Address Risk Qood Sery Re-inspection 1S v Level Retai Previous Inspection LIP Telephone Residential Kitchen Date: d Mobile Pre-operation O Owner HACCP YIN Temporary Suspect Illness ` Caterer General Complaint Person in arge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. S Violations Related to Foodborne Illness Interventions and Risk Factors Red Items) dd I (!�f ( 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 /' I EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r�j ❑ 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 t9l f ❑ 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 V 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 t 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 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 regardless of.the number of critical,results-in an F 25.Equipment and Utensils 6=One critical violation and less than Orion-critical violations 9 (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. 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 g 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-up, 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 non-critical violations. If 1 critical refrigeration... within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special equirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Insp is Si t e 31.jDumter 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• ure Prin• ` Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N J AIC& cc/�,� 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 Assi eat of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) gam14 Food or Color Additives 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 Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control ' 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 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 3-306.14(A)(B)Resumed 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) I Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* SanitizationTemperatures* TIME/TEMPERATURECONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//crivc rnnoor 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!101.11(A)(2) Ratites,Injected Meats 155°F l5 sec* 3-'L01.14 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165°F IS sec* in mobile food,temporary and residential Sources & P �' 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* P 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* foodborne 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 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 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* L18 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 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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. ARA 0 oF.r+E r TOWN OF BARNSTABLE._ HEALTH INSPECTORS Establishment Name: ^ Date: Pager of OFFICE HOURS PUBLIC HEALTH DIVISION' 8:00-9`:30A.M. BARN STABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAss. MON.-FRI. Reference .R=Red Item PL- SE PRINT CL RLY .e,9•p�m HYANNIS,MA 02601 508-ssz 4644 No R _ FOOD ESTABLISHMENT INSPVCTION REPORT ` Name Date a of ns ection s Routiney Al Address [RIM 0) Risk o Servr nspect n Level Reta Previous I e Telephone Residential Kitchen Date: Mobile Pre-o rIt Owner HACCP YIN Temporary Suspect I lr ess , Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector aall 1 0,) ,I ut: Each violati checked requires an explanation on the narra ive p g d a citation of specific provision(s)violated. / Violations Related to Foodborne Illness Interventions and Risk actors(Red Items) Anti-Choking 590.009(E) ❑ 1 4nF Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ l 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 f - s 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) mv ❑ 4.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 9r�� ✓ .. ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories L/ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations . Critical(C)violations marked.must be corrected immediately. (blue&red items) + ILA n Corrective Action Required: F] No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating I 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 e s ❑ 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 regardless of the number of critical,results in an F. �'25.Equipment and Utensils B=One critical violation and less than 4 non-critical violations 9 (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. 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 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right.to a hearing. Your request must 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 n9`h_criticPI violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. v ion,4 to 8 non critical 'olatio =C. 30.Other DATE OF RE-INSPECTION: ect i nat a rin 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 nature Print- Self Service Wait Service Provided Grease.Trap Size Variance.Letter Posted Y N "rC" v"� Dumpster Screen? Y N l 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) J Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-262'.12 Additives* 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 1.5 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) ( )O P 7-101.11 Identifying Information-Original Containers * 2 590.003(C) t Responsibility of the Person-in-Charge to- - Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F '� 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F 7-201.11 Se aration-Stora e* Applicants* - �- - -• � - * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* _ * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements -590.003(G) -` Reporting by Person in Charge* - - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* . . . REQUIREMENTS FOR. . 3-306.I4(A)(B)Resumed Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ; `- � ) 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* _ * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed S routs Not Served* 3-201.12 i Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 i 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 L Shell Eggs* _ _ _ _ Sanitization Temperatures* TIMEITEMPERATURE 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(I)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service.145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*. - _ Equipment* gg Not Otherwise Processed to Eliminate • 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg crave//t/zoo/ A-60211__ - _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 3 101.11(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 StuffingContainingFish,Meat,Poultryor 3-201.15- Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P �' 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* foodborne illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* __ _ _ __ _ _ 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. practices ]d be debited under#29-Special 5 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 Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* I � ( ) g 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 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Tempera 5-204.11 Location and Placement* 3-501.14(B) * 5-205.11 Accessibility,Operation and Maintenance ture Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 lHandwashing Cleanser,Availability 1 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 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. oF. r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: J Date, Page: of OFFICE HOURS PUBLIC HEALTH neNsrne�s. 2 0 MAIN STREET DIVISION 8:00-9:30A.M. 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9g 639. �•�' HYANNIS,MA 02601 50s 862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY RFD MP�a F D ESTABLISHMENT INSP C ON REPORT NameYA Date e of Type of Inspection ` Routine Address Risk fFood Servi Re-inspection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation �, Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint _ ,��MaSE�= Person in Charge(PIC) Time Bed&Breakfast HACCP f IAA In: Other Inspector Out: Each violation,checked requires an a planation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items L- 1 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) ❑4.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 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 165 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) 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. Seriously Critical Violation=F is scored automatically if:,no hot 26.Water,Plumbing and Waste. (FC-5)(596.006) establishment permit and cessation of food establishment operations. If 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 Snon-critical violations: If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. viola' to non itical 'olations=C. 30.Other DATE OF RE-INSPECTION: Insp ct 's Sig Pr' 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 S' natur � PrintX�Jck / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N j l,U n 7p 1' 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.) ^�' v 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 L 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 590.004(F) EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of-the Person-in-Charge.to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F* 7-201.11 Separation-Storage* Applicants* _ 3-302.11(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 _ _ _ 3-501.19 Time as a Public Health Control* 3-302.15 _ Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004-11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ .REQUIREMENTS FOR. 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) - - - 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-20L13 Fluid Milk and Milk Products 4-501.112 Mechanical Wazewashing-Hot Water Monitoring 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. 18 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * Bg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf cave 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 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 Surf aces 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 590.009(A)-(D)in cater- * Ratites-165°F IS sec* in mobile food,temporary and residential Sources g• P rarY 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* foodborne 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 practiceRequirements.sshould be debited under#29-Special 5 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items Critical non Critical and non-critical violations,which do not relate to the foodborne 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 3-202.18 Shellstock Identification.* 3-501.14(A) Cooling Cooked PHFs from.140°F to 70°F 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 1 1 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 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. ' y , �p ENE I TOWN OF BARNSTABLE HEALTH INSPECTOR`S Establishment Name: _ ` Date: 1 . of l OFFICE HOURS Page: PUBLIC HEALTH DIVISION' 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. $. MON.-FRI. .639. .0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY """'' FOOD ESTABLISHME T.INSP#cjfnON REPORT Name Dat_ vne of Ins ection utine, Address Risk ood SeM - ecti n Level Real Previous In Telephone Residential Kitchen Date:�1 tI i Mobile Pre-op r Owner HACCP YIN Temporary, Suspect Illness O Caterer General Complaint Person in Char a(PIC) Time Bed&Breakfast HACCP IV..� Other A In Inspector T5� Each violation checked requires an explanation on the narrative p e(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 1590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ O p FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities A3A 4- EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i -- ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives J _ ❑ 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 ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ,. _J _6f, ❑ 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 i ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories L Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) J Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating IS I within 90 days as determined by the.Board of Health. �E ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,tWite ❑ 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 regardless of the number of critical,results in an F. B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited,in this report may result in suspension or revocation re9 of the food.26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von7critical violations=B. 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 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 n -critical violations. If 1 critical refrigeration.. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8nnn-critical latio C. 30.Other DATE OF RE-INSPECTION: i ctor's S" t Print: 31.Dumpster screened from public view ;?:rff) � Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ig t e Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y N �VV✓\ \.J`���"�`n" "U "�i Dumpster Screen? Y N Violations related to Foodbo`rne 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 14 Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-20f.1-21'" Additives* - - 2-103.11- Person=in--Charge-Duties--- - - Cooked and RTE Foods.* - 3-302.14 Protection fr6Yii Llnappraved 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!102.11 Common Name-Working Containers* * Require Reporting by Food Employees and _ Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F *_ _ _ _ 7-201.11 Separation-Storage* - -- - - Applicants - - -3-302.11(A)_ Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15.__ 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 - 3-304.11 Food Contact with Equipment and Utensils* 590.004(11)- Variance Requirements - 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 - _ _ _ _ _ _ 3-30614(A)(B)Returned Food and Reservice of Food*. 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g s 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-80L11(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* - "- -' 4-501.111 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served Sanitization Temperatures*3-202J3 Shell Eggs_* _ _ __ _ _.. _ _ _ _ _ _ _ __ P 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11-, y Drinking Water from an Approved.System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//cew 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 Meat.,-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 Stuffing ContainingFish,Meat,Poultryor 3-20L15 Molluscan Shellfish from NSSP_ Listed _ _ _ __ _ Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* _ Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing I -- - - - - 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* foodborne illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C)_ Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices _ _ 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5' --Receiving/Condition- - -- 2 401-.1.1 -- 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* 3403.11(C) Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate tothe foodborne * 12 Prevention of Contamination from Hands - 3.403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the G Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lis- 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 ( ) 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 * Within 4 Hours* 23. ' Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 1 130. 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. `opIME r _ TOWN OF BARNSTABLE 0 V HEALTH INSPECTOR'S Establishment Name: Date: Page: of o c� OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Me v �� HYANNIS,MA 02601 soa-asz asaa No Reference R-Red Item PL E PRINT CLEARLY .. . 'FD MP+p F OD EST BLISHMENT INSPE TI N REPORT .. Name l Date 11hDe 0 Jype of Inspection 9 g Ro Address isk ood Servi e-inspectio Level Prev Ion Telephone r Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) dime Bed 8 Breakfast HACCP nl Other Inspector Each violation ch cked requires an explanation on the narrative p ge(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 41/1�ram ❑ 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) ❑4.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 oe 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 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 - within 90 days as determined b the Board of Health. Overall Rating ry p Employee ❑ ❑ y y ❑ Voluntary Compliance Em to ee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection tyay 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 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 B-One critical violation and less than o 6 non-critical violations 9 26.Water,Plumbingand Waste if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 7 to 8 non-critical violations. If 1 critical refrigeration. 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, , �thi 10 days of receipt of this order. 4 to 8 non-critical violat' s win = 29.Special Requirements (590.009) y p O UP 30.Other DATE OF RE-INSPECTION: Ins is Si ature 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 PIA Signature Print: If Self Service Wait Service Provided Grease Trap Size Variance Letter Posted, Y N Dumpster Screen? Y N .w 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 1q 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 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-20 , 2 590.003(C) Responsibility of the Person-in-Charge to_ Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-101.11.11 Separation-Storage*Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(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 _ 3-302.15 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 590.003(G) Reportin by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) g 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or 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 1 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 see 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effect-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 Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g tr 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*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* foodborne 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 9 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceess s shohould be debited under#29-Special Requirements. 5 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne 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 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. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. Op THE Tq," TOWN OF BARNSTABLE Z �. HEALTH INSPECTOR'S Establishment Name:� - Date: *Jft�ge_- f . v� Wo OFFICE HOURS PUBLIC HEALTH DIVISION f s:oo 9:30A.M. BARNSTABLE. ` 200 MAIN STREET Ei f® .3 -4:30 RM' Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA- g. ' S. N.-FRI. .0 HYANNIS,MA 02601 ,/O -862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY _ 'FDN1A'' FOOD ESTABLISHMENT INS E TI N REPORT r � Name Date T e of o ec ion er `O S Routine )Z, Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector A:�L 4HU1y(9t_r_ Q1 V Out: Each violation chec ed requires an a lanation 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) ❑ fit. 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 JCi 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 ❑ 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 V1 PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) g ❑ 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 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 within 90 days as determined by the Board of Health. Overall Rating ❑ 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) 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=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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. P q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspect r' Sig atu 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 Sig ur 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 I PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination F 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.* * 19 PHF Hot and Cold Holding g 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 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 3-306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated S � ) 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served 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* 3-401.11 A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eryecn°e rnnoor 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 rf cesSanitizationEquipment* 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- _ Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 Cl Condition Hands A * Regulatory Authority eanon on- ans an 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* foodborne 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 Requirements. 5 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* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 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 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 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41*F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* q, 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 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301. 22 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. 7 Op 111E TOWN OF BARNSTABLE _ -HEALTH INSPECTOR'S Establishment Name:LA feyliq Date: 1191A q Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00�-9:30 A.M. BARNSTABLE. '•` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � f6 9 `0� - HYANNIS, MA 02601 508-808-8MON -FRI.62-4644 No Reference R-Red Item ,r PLEASE PRINT CLEARLY ArED MA'S° � FO D E TABLISHMENT INSP T REPORT Name ^Date e o sec io Routin Address Risk F od Se. specti n Level Ret ' Previo Telephone Residential Kitchen Dater Mobile Pre-op ra on Owner HACCP Y Temporary Suspect III es 4Cattast General ComplaintPerson in Char a(PIC)I 2ON Nh 4a M!O&U-1 T me HACCP Other it Inspector ut Each violation checked requires an explanation on the narrative pa e(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) ❑ PZ4 G 60 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" 77 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 'M All ❑ 5.Receiving/Condition ❑ 17.Reheating lip ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 0 - ❑ 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 0.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 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 within 90 days as determined by the Board of Health. Overall Rating4 ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the ems ❑ 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 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 revocati6n of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 4K26.water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright 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 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 non-cri al violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. v' on,4 to 8non-critical viol ns- 30.Other DATE OF RE-INSPECTION: In p or's i t int: 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 P '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) Assignment of Responsibility* F 8 Cross-contamination1q 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 7-101.11 Identifying Information-Original Containers*Other* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to __. _ 7-102.11 Common Name-Workin 3-501.16(A) Hot PHFs Maintained At or Above 140'F g Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P S 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reportin Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) g by Person in Charge* Contamination from the Consumer ' 3 590.003(D) Exclusions and Restrictions* 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water _ 7.206.12 Rodent Bait Stations Raw Seed S routs Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and p 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 1 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 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef oti-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 Nish 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashingean Condition- Ratites-165°F 15 sec*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 Cl Cditi Hans an Arms* Hands A * Regulatory Authority 3401.12 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* foodborne 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 Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.1I(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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23.30) Critical and non-critical violations,which do not relate to the foodborne 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* 1 g 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. 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. �p THE r TOWN OF BARNSTABLE ,.HEALTH INSPECTOR'S Establishment Name: Date: Page:.=�bf OFFICE HOURS B AR E.Oi PUBLIC 2 0 MAN STREET 3:30- DIVISION' : 0 4 P.M.:30 P :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CO RECTION Date Verified MASS�63. �0 HYANNIS, MA 02601 - MON.-FRL No Reference R-Red Item P SE RINT CLEARLY 508-862-4644 �FOMP,e FOOD E TABLISHMENT INSPE TI N REPORT Name Date e of jXog of Inspection •o s outine Address Risk o e ction Level a ail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 1.01 Owner HACCP Y/N Temporary Suspect Illnesswla&n (vAl C Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector IJ2 Out: Each violation checked requires an ex lanation 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) ❑ v' 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) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling Wy ❑ 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 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 within 90 days as determined by the Board of Health. Overall Rating ❑ 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) 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. Seriously Critical Violation=F is scored automatically if: no hot 27.water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. P q (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspe a P'nt 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 Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance,Letter,Posted Y IN 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.) - a. 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 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 F15 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) * 7-102.11 Common Name-Working 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 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation * 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Em Use 7-202.11 Restriction-Presence and its 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 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g - 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Warewashing-Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef dive 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°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(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es sho9 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. 5 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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-102.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 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 Cooling Cooked PHFs from 140°F to.70°F 3-202.18 Shellstock Identification ( ) g 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 P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 4.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-20 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. &&7�p IKE ro ' TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date Page of. OFFICE HOURS PUBLIC HEALTH DIVISION 8:o0-9:30A.M. BARNSTABLE, • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3: �•� HYANNIS,MA 02601 M-8 -FRI, No Reference- R-Red'Item PLEASE PRINT CLEARLY 508-862�644 - 'FON1P�a FO D ESTABLISHMENT INSPEQtk9N REPORT Name IN Date of Type of Inspection e o s Routine Address Ris ood Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Ak Each violation checked requires a 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.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 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 within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ ❑ y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items 10 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) 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. Seriously Critical Violation=F is scored automatically if: no hot 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 anon-critical violations. If 1 critical refrigeration.n,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. v' 30.Other DATE OF RE-INSPECTION: Iv at Print: 31.Dumpster screened from public view tl- " 1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S n re07, 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) Assignment of Responsibility* 8 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 Cooked and RTE Foods.* *__ 19 PHF Hot and Cold Holding 2-103.11 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* ( Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 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, 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g 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 Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective iiirz°ot 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 590.00and - ide in cater- * Ratites-165°F 15 sec* in mobile food,[em or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved 8 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Y 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* foodborne 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 Requirements.practices should be debited under 929-Special 5 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 foodborne 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 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 I FC-7 1.0108 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. Epp tME Tp ' TOWN OF BARNSTABLE .HEALTH INSPECTORS Establishment Name: Date:` Page: of. Y OFFICE HOURS PUBLIC HEALTH DIVISION 8:06-9:30A.M. BARN STABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A a3y: �•� HYANNIS, MA 02601 sob esz aR644 No Reference R-Red Item PLEASE PRINT CLEARLY rFO MP�a 00 ESTABLISHMENT INSPIEU1ON REPORT - - -- - Name Date T o Type of Inspection �r loperation(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection IV Telephone Residential Kitchen Date: Mobile Pre-operation - T 4 Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP gzm In: Other Inspector Out: Each violation checked requires 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.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 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ 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 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 B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbingand Waste if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FG5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC76)( ) gg y y g g' q 590.007 aggrieved b 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 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 non-critical violations. If 1 critical refrigeration. violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Insp or' Signature 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' 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) Assignment of Responsibility* F 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Not 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 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 and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(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 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 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) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 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 1 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.]lA(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Sy stern* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep crrve 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards iri 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* 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)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P arY 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-03.11(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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodborne 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* 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 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 5-203.11 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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. oF. r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: � �A Y _ I u W � Date:C / 5/7Page: of 'l OFFICE HOURS p is PUBLIC HEALTH DIVISION 8:06-9:30 A.M. • BARNSTABLE, ` ' - 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �.. MON.-FRI. No Reference R:Red.Item PLEASE PRI TcCLEA �A 1639• �m HYANNIS, MA 02601 508-862-4644 / s / �� /•- L* A 'EDN1A�e FOOD ESTABLISHMENT INSP C/hIO REPORT ✓/ ff Name 's n Date ape of Tyne of Insaection , 1/A_ J� � ►o �� Opera#Gw(� Route Address Risk GW r Food Siee'` Re-msp ,- /0 nil ` Level Retail Previous Inspection Telephone Residential Kitchen Date: . Mobile Pre-operation � , LIX Owner HACCP Y/N Temporary Suspect Illness v Caterer General Complaint W Person in Char a PIC O Time Bed&Breakfast HACCP / r -/ Inspector /, J� Ins (PIC) - >�I�n. Other �!�) _I /, l J /. I P 2 / 0 10 r Out. r �*' _ Each viola ion hecked requires 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) ❑ / )yq /I _. 1d1/ i - Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands l 1 V A ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities I EMPLOYEE HEALTH PROTECTION FROM CHEMICALS AA, �! /rUt /1 _ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ' / '" I r Y077 L FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) fy I _ ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures � _ IZ� % _r / ❑ 5.Receiving/Condition ❑ 17.Reheating '4 , G , v V w , v ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ / ! .18.Cooling � ^ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding p 4 .r r 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 (C n ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories r "� - z Y r 1 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 within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspectio day,the I ems ❑ 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) 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. 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 C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,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 violati9 S observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address w within 10 days of receipt of this order. f violation,�•to 8 non-critical violationw02- 29.Special Requirements (590.009) Y p - - Ins a or's t �atulre /f � 'Prin 30.Other DATE OF RE-INSPECTION: p i l31.Dumpster screened from public view � ( ,, �(� � / � ./ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N d � #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sigh21 u e t Prin / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y 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) Assignment of Responsibility* 8 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 Coofing Methods far 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*. 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control tri 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Res ction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements _ 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 3-306.14(A)(B)Returned Food and Rrated or 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* * Raw Seed Sprouts Not Served Y Sanitization Temperatures 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 5-1 01.11, Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/1/2001 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Scoffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing ut on on-Hands an Arms* 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 CleanCondition Hdd A * 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* 2-301.14 When to Wash* 3-401.l l(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. 5 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 3-202.15 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* 3-403.11(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 Handwashin Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* g ( ) g Item Good Retail Practices FC 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 FC-2 .003 3402.11 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 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 5-205.11 Accessibility,Operation and Maintenance p 3-402.12 Records,Creation and Retention* 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. °F. r TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: '6 / l � IG ` Date: C�/ //7ftge: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE.` , 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 639, `0$ HYANNIS, MA 02601 spa-s2-4644 No Reference R-Red.Item PLEASE PRINT CLEARLY -- rFOMA�� FOOD ESTABLISHMENT INSP -C ION REPORT I r Datg T e o TVDe of Inspection ��l Name L 1! lJ f � Routine yjW) 11 it 1 A _ �• � J ' r t i s Address r ✓ v '- Risk r Food Service Reyin' -De 'lofty {� Level etail <evir ° pebtion _r a r / - Telephone Residential Kitchen Date: Mobile Pre-operation ] Owner HACCP Y/N Temporary Suspect Illness i Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: ,�� � n ✓ .I Each violation checked requires/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) ❑ i /) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Wr Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ `� - f ) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities (` ✓ y /' /�, EMPLOYEE HEALTH PROTECTION FROM CHEMICALS tY / ./ •/W `/^/ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives _ l e v I �� ( W _ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) b ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures to A ❑ 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 /�r PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control CAI!/l y/ / �( ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP f ,j7a j 1 /) ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items r Corrective Action Required: ❑ No { r ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils . (FC=4 590.005 B=One critical violation and less than 4npn-critical violations 9 )( ) 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. Seriously Critical Violation=F is scored automatically if: no hot 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must d28.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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation-4 to 8npn-critical violations=C. 30.Other Inspector's Sign Lure✓ / Print: DATE OF RE-INSPECTION: � 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ��,, or d j PIC' Sig Ature - / Pint: a #Seats Observed Frozen Dessert Machines: Outside Dining Y N � Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N \ k t/\ vtil Dumpster Screen? Y N �) V 6 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* r 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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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* g3-501.16(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 and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F 7-201.11 Separation-Storage* Applicants* 3-302.11(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 3-302.15 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 S90.003(G) Reportin by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ' g Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservior of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) 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 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products* - 4-501"112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 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 -601.11(A) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 4 5-101.11_ Drinking Water from an Approved System* _ Eggs-Immediate Service 145°F 15 sec Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe°mc uuzom 47602.11 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 Requirements. 5 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) gCritical and non-critical violations,which do not relate to the foodborne 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 3-202.18 Shellstock Identification ( ) 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 .00 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 1 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures77d 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. °F.K�E►oh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date c Page: of ti OFFICE HOURS d ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNS TABLE 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. '4 1639• `0� HYANNIS, MA 02601 508-862-4644 No Reference R-.Red Item PLEASE PRINT CLEARLY 'FDN1 F OD ESTABLISHMENT INSP IC ION REPORTAA Name. T I Date / Type of Tyne of Inspection / v I O e i' n Routine 1 ti✓/ v ) Address Risk ` rFood Service Re-inspection f �_ °' ?/ r Level Reta' Previous Inspection f�Jl Lrlld., Telephone Residential Kitchen Date: v NN" Mobile Pre-operation /_ Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP , © / 1 ] // - - In: Other f r� r � '1 �8 / P Inspector Out: Y y r )CH bl _ Each violation checked requires an e,41anation 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) ❑ r.•.- - 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 v ❑ 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 - T ❑ 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 Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) .n y ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Fond Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY W' �y, e- + �✓ ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 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 Ye Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ 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 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 B-One critical violation and less than 4npn-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. 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 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 non-critical iolat violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-criticalAviolations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspectorrs ignatur Print: 31.Dumpster screened from public view Permit Posted? Y N_ Grease Trap Previous Pumping Date Grease Rendered Y N I =A #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Slgn t�l a Print: Self Service Wait Service Provided Grease TrapSize Variance Letter Posted Y N n�•• Dumpster Screen? Y N �% t r 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 L 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* ( Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(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 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 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 3-306.14(A)(B)Returned Food and Reated or 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 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* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E7/crive tnnooi 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°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(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702:11 Frequency 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 Surf of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-103.11 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 temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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 Fuods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne 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 Requirements. radicsshould be debited under#29-Special 5 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* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3�03.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3AO3.11(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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 1 Specialized Processing Methods* 130. 1 Other 3-502.12 1 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. oFWE ror TOWN OF BARNSTABLE HEALTH iNSPECTOR,s Establishment Name: Date: V Page: . of o OFFICE HOURS PUBLIC HEALTH DIVISION 6:00=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 �A a3y. `0$ HYANNIS, MA 02601 Sob 862-44Rsaa No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1A`� FOOD ESTABLISHMENT INS PEC ION REPORT `. Name Dat Type of one of Inspection Routine Address Rh ood Se Re-inspection Q Level Re ai Previous Inspection f I& A �- Telephone Residential Kitchen Date: - C t. Mobile Pre-operation Owner HACCP Y/N Temporary Caterer Com I I Su eCsL �' Person in Charge(PIC) Time Bed&Breakfast HAC 14q In: Other Inspector Out: S Each violation checked requires 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) ❑ 0`� wi P C' Qa��(GZfi ov) -4 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ n FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PI Assigned/Knowledgeable/Dutie s ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Lam_ ❑ 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 A \ ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling i ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding t 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 HSI AIN ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ p ❑ y y ❑ 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- 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 B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. 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 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 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements . (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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 Signatu a 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) Assignment of Responsibility* 6 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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 3-501.16A Common Name-Working Containers* ( ) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(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 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G).. Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 1590.003(D) Exclusions and Restrictions* 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-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. L16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eyecti-111a001 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 3-201.15 Molluscan Shellfish from NSSP Listed Stuffing Containing Fish,Meat,Poultry or 590.009(A)-( ) Vio lations olations of Section 590.009(A)-(D)in cater- Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.11(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* 3 403.11(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* IS Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashin Facilities 3-501.14 A g 3-202.18 Shellstock Identification* g ( ) Cooling Cooked PHFs from 140°F to 70°F 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 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 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP.Plans 6-301.12 Hand Drying Provision 29. Special Requirements 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. °p.NE r TOWN OF BARNSTABLEHEALTH INSPECTOR'S Establishment Name: Date: /u Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1639. `0� HYANNIS,MA 02601 sob-862-4644 No Reference R.-Red Item PLEASE PRINT CLEARLY- FOOD ESTABLISHMENT INSPECTION REPORT ` - Name Date C ` IDTvoe of Tyne of Inspection O Routine Address r Risk ood Service a-mspec ion 1 Level etas lion Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires 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 Itemsl 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 IZIi FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) l ❑4.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 t PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) IQ ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY /� �c✓1 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories y 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 within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ P ❑ Y Y ❑ 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 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 B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within P within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signaure Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ,,�.e ,&;2 - -_ V Or #Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's S' nat re Print: .00 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N p �A A Dumpster Screen? Y N WWW 4. 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 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 590.004(F) -EMPLOYEE HEALTH � 3302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 11 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 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils ( ) Vi q 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 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E)' Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * _ 4-501.111 Manual Wazewashing-Ho[Water 7.206.12 Rodent Bait Stations 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* - TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made'From Potable Drinking Water* Concentration and Hardness* 16 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service Not Otherwise Processed to Eliminate ice 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101:11 Drinking Water from an Approved System* * gg 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef Ali-1/1,2001 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 _ 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency r f 3- 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-Hat Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* 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* I 11 - Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 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* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 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 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 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 4.11 Location and Placement* Temperature Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* 5-20 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .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:590Fomrback6-2doc *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. `oF. ror TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Pag: of p 4• OFFICE HOURS 0 PUBLIC HEALTH DIVISION 8:00-9:30 A.M. • BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS' HYANNIS,MA 02601 MON.-FRI. No Reference R--Red Item PLEASE PRINT CLEARLY �A 2639• �0 508-862-4644 'FDN1P`p FOOD ESTABLISHMENT IN P CTION REPORT Name Date a te Type of Inspection Address Risk rvice Re-inspe to Level Pre spection Telephone Residential Kitchen Date: Mobile Pre-operationbe Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector In:Out: Each violation checked requires 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.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 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 within 90 days as determined b the Board of Health. Overall Rating ry P ❑ ❑ P ❑y y ❑ 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 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 B=One critical violation and less than 4 non-critical violations g 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6npn-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. P q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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'A�Signaat .,.k 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) Assignment of Responsibility* F 8 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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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* 2 590.003 C Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) Po tY7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants*- 3-302.11(A) Food Protection* P20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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 3-304.11 Food Contact with Equipment and Utensils 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 3-306.14(A)(B)Resumed Food and Rrated or 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 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective mrzom 590.006(B) Water Meets Standards in 310 CMR 22.0* ' 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°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(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 Rci;ieatioually 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 temporary and - ide in cater- Sources* � Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* 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 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 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 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin g Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 --] 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 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. ` pp 114E rpm TOWN OF BARNSTABLE .. HEALTH INSPECTORS Establishment Name: Date:) 1100 7, Page: of p� 4 OFFICE HOURS ' PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, 3 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. HYANNIS, MA 02601 No Reference, R-Red Item PLEASE PRINT CLEARLY 1639' �0 508-862-4644 - .. lFD MA�p FOOD ESTABLISHMENT INSPECTION REPORT ,- M -, Name Date v �� e f Tvoe of Inspection r io Routine Address food Sewie -nspec i Level =Re ail 1 ^CJ Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. v 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) ❑ " L 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 1 ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheatingr-- ❑ 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) ❑ 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 ,-� Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: qr ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating /� ry p ❑ ❑ P ❑ y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-ins ection 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 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 B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. 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 8non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. p q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signatpre Print: 31.Dumpster screened from public view \^<- 1 oa Q-55 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's igna uri�c� Pr ` Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 1 ��� i�(/��A Dumpster Screen? Y N J 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* F$ 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 Cooked and RTE Foods.* *. 19 PHF Hot and Cold Holding 2-103.11 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* * 7-201.11 Separation-Storage 2 590.003(C) Responsibility of the Person-in-Charge to - Other* 7-102.11 Common Name-WorkingContainers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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 3-304.11 Food Contact with Equipment and Utensils* 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR , 590.003(E) Removal of Exclusions and Restrictions 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1l(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food.in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and p * 3-20113 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 3-202'.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg t-11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an.Approv_ed Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702:11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites.IgWmted Meats-155`F 15 sec* aces oY Equipment* Shellfish*-' 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* 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 Requirements. 5 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g 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* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F (A) g 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 1590.000 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. �p 114 TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name: Date: - (wage: _Of.-I` " .> 1 PUBLIC HEALTH DIVISION OFFICE HOURS8.00-9:30A.M. ' BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v MASS.9. `0� HYANNIS,MA 02601 8-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �p 508-862.4644 'FDN1A`' FOOD ESTABLISHMENT INSPECTION REPORT Name Date a of T e I s ec io p ine J Address Risk od Se 'ce spection - Level ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) r- Time Bed&Breakfast HACCP LU CaL In: Other Inspector Out: S V Each violation checked requires 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) S Action as determined by the Board of Health: Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands y l ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities rr EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l ❑ 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 S la ❑ pp ❑ 16.Cooking Temperatures �- ❑ 5.Receiving/Condition ❑ 17.Reheating LLL ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ILe ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 7 PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ',-C- ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ,` 4 - ❑ 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 Gl� s Critical(C)violations marked must be corrected immediately. (blue&red items). IU Corrective Action Required: �l`�G� ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ Y Y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection today,t e 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 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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. � 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view 1 n n AA Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N u V�I'IAi #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign a 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) Assignment of Responsibility* 8 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 Cooked and RTE Foods" + 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* - '"- " Contamination from Raw Ingredients 15 Poisonous or Toxic Subsiances 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) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Coon Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment P g 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control (F) Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003 Res nsibili of A Food Em to ee or An 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 3-304.11 Food Contact with Equipment and Utensils 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 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* 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-801.11(C) Unopened Food Package Not Re-Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 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 AnimalConsum Foods Tat Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e-d°°"°°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* 4-7G2.11 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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 foodbthe appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* Other 90 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 es should violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(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 Commerciall Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 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 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 2 . Food and Food Protection FC-3 .00 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* _ 30. 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. oF1HF r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: 0age:_�of OFFICE HOURS s ` BAR- NnAB,.e.o� PUBLIC 2 0 MAIN STREET SIGN 8:00-9:30 A.M. Item Code C-Critical It 3:30-4:30P.M. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. - MON.-FRI. 9�A ,639. `0� HYANNIS,MA 02601 soe-862-4644 No Reference .R-Red PLEASE PRINT CLEARLY . 'FOMP�' FOOD ESTABLISHMENT INSPECTION REPORT t Name �.� Dat Type of Im"Inspection jT outine Address Risk o Service ection Level Previous Inspection v Telephone �� Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 2>� n:�b0 Other Inspector Out: ) J C 0�5 c S Sdz�-�a� •- �u.: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. , L ' 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) ❑ L << , r G Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 1� J� ef - FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 5 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities AA �� � "D ,, EMPLOYEE HEALTH PROTECTION FROM CHEMICALSt\JV 1ika_6L,J -+-h ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ra ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals � FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 4Z2 � i ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating 6.Tags/Records/Accurac of Ingredient Statements _ ❑ 9 Y 9 ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding C 1 4 G PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control l *j G^ ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) elE- ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP \^ ❑ 10.Proper Adequate,Handwash ing CONSUMER ADVISORY Vw ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 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: `-r' ❑ No Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ® ❑ Volunta Compliance Y Y ry p ❑ 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 Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) 7��] 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 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 B-One critical violation and less than 6n violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6non-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements ) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. p q (590.009 Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view p/ -2 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed . Frozen Dessert Machines: Outside Dining Y N PIC's Si -ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N % Y N Dumpster Screen? (/ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions 'r 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 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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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* 2 590.003 C Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* O P tY7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or-Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage * 20 Time as a Public Health Control (� Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use 590.003 Res onsibili of A Food Em to ce or An 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 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1--)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y Pe 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. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an A roved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game 8 * Effective urnom 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 temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under RegulatoryAuthorily 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 Requiremenpractices should be debited under#29-Special 5 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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 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* F 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 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 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 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 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 Rem 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. TOWN OF BARNSTABLE -HEATH INSPECTORS Establishment Name: Date: ag of . OFFICE HOURS BARN ABLE. PUBLIC 0 N ST ET HEALTH IVISION 8:00=9:30A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. HYANNIS, MA 02601 MON.-FRI. No Reference -R-Red Item PLEASE PRINT CLEARLY. p +639• �e - 508-862-4644 rFD MPr° FOOD ESTABLISHMENT INSPECTION REPORT _ v1 Name Date yul2e o section outine 91 Address Risk ood Service ction Level a Previous Inspection 93 Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness - Lg Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP44- In: Other Inspector Out: _ �� (��i l Each violation checked requires an explanation on the narrative page(s)and a citation of specific provisions)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items] Anti-Choking 590:009(E) ❑ p� �A� Violations marked may pose an'imminent health hazard and require immediate corrective Tobacco 590.009(F) �-)La`� i� � V�/y Action as determined by the Board of Health. Allergen AwareneCd 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 Haz ❑4.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 J t L PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control S - ❑ 8.Separation./Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ Yes '1 Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating p ❑ Employee ❑ p Emergency P y y ❑ VoluntaryCompliance Em to ee Restriction/Exclusion Re-ns ection Scheduled Emer enc Suspension C N Official Order for Correction:Based on an inspection today,t 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 regardless of the number of critical,results in an F. )( ) 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 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. 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 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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 S' ature 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) Assignment of Responsibility* 8 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 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 5 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* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working 7-201.11 Separation-Storage* Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3=501.16(A) -- Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 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 3-306.14(A)(B)Returned Food and Rted 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 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-_Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective]orzool 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* r 3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec ing,mobile food,temporary and residential 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* 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. 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 59practices0.009 violations d be debited sting tounder goo Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 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 Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 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 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked Fr from 140°F to Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours andnd From 70°F to 41°F/45/45°F 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 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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.590Formback&2doc 'Denotes crtcal 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. °p 114E r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,639. �0� HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �.e50862-4644 rF°"""�' FOOD ESTABLISHMENT INSPECTION REPORT Name Date? Type of Type of Inspection O erigrlw Routine Address G Risk JR -ns io Level Re al evlo nspection 1 Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP " In: Other � Inspector �.v� Out: L r Each violation checked requires an explanation dn 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) a Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities v EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employpes and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM,ARPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and.Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving Condition ❑ 17.Reheating TA- 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 Z ❑ 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 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) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4 non-critical violations 9 (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. 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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration: 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8 non critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signatu 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 IN IC's i a Prin Self Service Wait Service Provided - Grease Trap Size Variance Letter Posted Y N QI Dumpster Screen? Y N V v 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* 6 Cross contamination 14 F000'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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* + 7-201.11 Separation-Storage* Applicants* 3-302.11(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 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) 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 Wazewashing-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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.1](A)(2) Comminuted Fish,Meats&Game Pathogens* ep-e-uuaoor 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* - - ing,mobile food,temporary and residential 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* 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 Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165`17 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 Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 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* 16 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 ( ) 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 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *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. `gyp IKE, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name, Date: Page: - of - &P o� OFFICE HOURS 4 BARNSTABLE. ` PUBLIC HEALTH STREET DIVISION s:oo- - 4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 200 MAIN ST 3:30- :30 P.M. y mass. �+ MON.-FRI. c�A te39, �0 HYANNIS, MA 02601 soa-asz 46aa No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1Py° FOOD ESTABLISHMENT INSPECTION REPORT Name Date T e o Type of Inspection O e Ro �� Address '" Risk od Service Re-inspection t:� �`c Level ection V Telephone Residential Kitchen Date: Mobile Pre-operation `i"S a✓ ~7 Owner HACCP Y/N Temporary Suspect Illness I Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: k Each violation checked requires 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) ❑ �SIL rr� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ , FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands a `` ❑ 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 iR FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)-\ / ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures \\` 1 ❑ 5.Receiving/Condition ' ❑ 17.Reheating VVV ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ,I y� n.� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding I V1 J PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control d ,` Y/- (:� Iv ❑ 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 yy ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories C 3.r et;v ' Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations i, Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ Y Non-critical(N)violations must be corrected immediately or Overall Rating �Za within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emerge Suspension i 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 regardless of the number of critical,results in an F. )(590.005 25.Equipment and Utensils (FC-4 B=One critical violation and less than 4non-critical violations ) 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. 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 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to Snon-critical violations=C. 29.Special Requirements (590.009 Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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 / P ddnt: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N / i9 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) Assignment of Responsibility* 8 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In-Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 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 3-306.14(A)(B)Resumed Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP " 590.003(E) Removal of Exclusions and Restrictions - Disposition ofAdulterated 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* 3-401.1IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effecn-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 Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g trl 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P rY 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 1 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 Requirements. 5 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 foodbome 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 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°17 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 P 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fomrback6-2doc *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. .MEr TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Pager of OFFICE HOURS BARNSTABLE. PU6LIC HEALTH SION : 0-9:30A.M. 200 MAN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A t°� �0 508-862 4644 \ HYANNIS, MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY 'EDN1P"' FOOD ESTABLISHMENT INSPECTION REPORT km A Name Date fT e of ns-fi vr on S tine Address /xr Risk �feMf_...d�Se Re-inspection 5 . ,�Level Previous Inspection ev Telephone Residential Kitchen Date: Mobile Pre-operation r � Owner HACCP Y/N Temporary Suspect Illness .,JakL L Caterer General Complaint Person in Charge(PIC) r ) Time Bed-&Breakfast HACCP �;� In: Other Inspecto Out: Each violation checked requires 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) ❑ n 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 L L� �i i v ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �� \ L EMPLOYEE HEALTH PROTECTION FROM CHEMICALS h , ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additivesjj�4 � ❑ 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 I .L ❑ 5.Receiving/Condition ❑ 17.ReheatingIle a ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 0� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding Y-h ' t� v (� PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULAT S ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY /�✓l. ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 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: N Non-critical(N)violations must be corrected immediately or q ❑ Y Lzj " within 90 days as determined b the Board of Health. Overall Rating y y El Voluntary Compliance ❑ Employe n/E si p ti c eduled' ❑ Eme ency Suspension C N Official Order for Correction: Based on an inspection today, a items ❑ Embargo ❑ Emergency Clos r ❑ 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 B=One critical violation and less than 4non-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 6 non-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 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 . 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt Within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.VOther DATE OF RE-INSPECTION: Inspector's Signature Print: 31. r screened from public viewf12 Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Vlolatlons related to Fuudbutiie 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 AccordiiT to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours-4 590.003(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 7-102.11 Common Name-Working Containers * . EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140*F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage*Applicants 3302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility of A Food Employee or An 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 Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions - Disposition of Adulterated or Contaminated g ) 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 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* 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* - 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//rrr°e uuzoor 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 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 PI-Irs 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 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P �' 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 B y 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Conked 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. 2-30114 When to Wash* * Other 590.009 violations relating to good retail . 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* -11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices Id be debited under#29-Special 5 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)._ Critical and non-critical violations,which do not relate to the foodbome 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 * 1 3 Handwashing Facilities A 3-501.14 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F[0 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback(i-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. `Op1ME ro TOWN OF BARNSTABL'E HEALTH INSPECTOR'S Establishment Name: Date: .Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION D6te Verified MASS. MON.-FRI. 1639• `0�' - HYANNIS,MA 02601 606-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY .007 'F0N` FOOD ESTABLISHMENT INSPECTION REPORT C1Z. IIAIV Name Dat 3( &Re of T section eb Address Risk F od ion Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 6 / Owner HACCP Y/N Temporary Suspect Illness ,ka Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP Other In: FVI- Inspector f'1(` ��/�� ut: 'r 75 Each violation checked requires 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) ❑ So Arco--- 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 \t!L mar FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) _ ❑4.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 A . -- ❑ 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 4 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,t e 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 regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) 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. 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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view T�N�Cffi� I AA LZI Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N e Print r #Seats Observed Frozen Dessert Machines: Outside Dining Y N Si � Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y Np 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) Assignment of Responsibility* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hoursx 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 7-101.11 Identifying Information-Original Containers* 590.004(F) , 7-102.11 Common Name-Working 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 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Storage*Se Separation- Applicants* 3-302.11(A) Food Protection* P20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or 3-302.15 Washing Fruits and Vegetables.An 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer .3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P * 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE 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* 3-401.11A(1)(2) Eggs-155°F 15 sec Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Ef°d-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* 4-702.1.1 Frequency 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 Surf aces 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 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources - - g, P �' 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 2-301.1.1 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* foodbornc 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 Requirements. 5 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 CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity* ( ) Critical and non-critical violations,which do not relate to the foodborne 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* 1$ Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F[0 70°17 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 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 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *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. Op THE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: - Page:: - of I OFFICE HOURS %PEAR E.O` Pu62 0 LIC HEALTH MAN STREEETSION 3::30-0-4:30 P.M. :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � MASS. HYANNIS, MA 02601 8-8 -FRI" No Reference R-Red Item PLEASE PRINT CLEARLY ,, t639• �e 508-862-4644 FOOD ESTABLISHMENT INSPECT ON REPORT -- Name Dat Toe of T Inspection O ra ' Routine Pkzz Address Risk ood Service ection Level Previous Inspection Telephone Residential Kitchen Date: - Mobile Pre-operation ir a L27- Owner HACCP Y/N Temporary Suspect Illness CA �-- Caterer General Complaint Person.in Charge(PIC) Time Bed&Breakfast HACCP In: Other .13 Inspector Out: Each violation checked requires 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) ❑ L _ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands S ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS I -or ontm( - ❑ 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 ❑ 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 i� l G ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HS r A (� ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined b the Board of Health. Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension Y ❑ rY P ❑ ❑ P ❑ 9 Y P 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 regardless of the number of critical,results in an F. . 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) 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. 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 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 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) PY within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view t- Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ign tur 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) Assignment of Responsibility* 8 Cross-contamination 1 q 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 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 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 EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from Each * 590.004(F) ( )O P 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 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F 7-201.11 Separation-Storage* Applicants* * 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant-To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 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 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) 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 Wazewashing-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 Wazewashing-Ho[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-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * Eggs Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff c"°e IiuZo°i 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°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(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 Stuffing ContainingFish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 Requirements. 5 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-165'17 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70`17 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 1590.000 * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45`F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other EJ 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doo *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. oFt ro 777 TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date �'!/ v age: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.. HYANN IS, MA 02601 MON.-FRI. No Reference. R-Red Item PLEASE PRINT CLEARLY 9�A 508-862-4644 'FON1P�° FOOD ESTABLISHMENT INSPECTION REPORTCCU, VeAct_ ) l Name Date ' (� T e of Type of Inspection } / � e a o s. ir-Qe outine �ionAddress Risk erve Level on -• W ✓1� i, /1✓'t' Telephone Residential Kitchen Date: - �� '"�R'" • Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other _ Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. c 1 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) ❑4.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 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) constitutes an order of the Board of Health. Failure to correct 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 B=One critical violation and less than 4 non-critical violations g 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6npn-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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' Signature /)_� V " Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Y ///� ' 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) Assignment of Responsibility* 6 Cross-contamination L 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.* �' * 19 PHF Hot and Cold Holding g 3-302.14 Protection from Unapproved Additives Contamination from flaw 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),R�•-' 590.004(F) v t�nmal 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 oI the Person-in-Charge to ,- 7-102.11 Common Name-Working Containers* 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* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or 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 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* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P * 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* TIMEITEMPERATURE 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(l)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* of'i"uirzooi 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 rf ces 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P �S' 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* foodborne 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 Requirements. 5 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 Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 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 ( ) 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 3402.11 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 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* 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. °F.ME ro TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: - Dater41�� Page: of ` wb OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ' BARNSTABLE. .' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,. A . `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT v Name f Date \ Tvoe of T Ins ect'o "O do outine Address Risk ood Service - spection 1 � Level Previous Inspection (n44 Telephone Residential Kitchen Date: Mobile Pre-operation Owner r ` L a HACCP Y/N Temporary Suspect Illness 9 V1 C` � Caterer General Complaint Person in Charge( IC) Time2 Bed&Breakfast HACCP IXZ7A AA _ Other Inspector �^ Out-5S6 4. V­ _-_ Each violation checked requires 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 I �� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ,`/V� � s EMPLOYEE HEALTH PROTECTION FROM CHEMICALS (/ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 6 F L1771Al i ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals `� / Ly FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially H dous Food ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Ar ❑ 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 f, PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control L) V_e AA ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 10 P) '• ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP �71.� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY us// ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 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 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 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 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=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 r 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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 Si to Pr* Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y Nt./---= Dumpster Screen? Y N X _j ��`� C1_4A �\✓`j i A Violations related to Foodborne Illness Violation 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* F 8 Cross-contamination 1q 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 Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 75 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 and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* Protection* 7-202.11 Separation-Storage* 20 Time as a Public Health Control PP 3-302.11(A) Food 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer 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 y 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* * 3-801.11(l Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * E ecrive mrzom 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 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 Surf aces 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 temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* the a ro riate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave PP P 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 Requirements. 5 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 Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 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* 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 3-203.18 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 Tags/Records:Fish Products 5-203.11 Numbers an P d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* 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(.f) Labeling of Ingredients• Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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. `�FTNE T TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: - Date: Page:.of OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A Me3 HYANNIS, MA 02601 sos-8s2-4MON Rs4a No Reference R-Red Item, PLEASE PRINT CLEARLY TFDN1P`' FOOD ESTABLISHMENT INSPECTION REPORT Name PX.40_15 Dat peo . T o nspection ` Ion sFfoutone Address Risk ood Service � ection Level Previous Inspection iL Telephone esidential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other (• Inspector Out: Each violation checked requires an explanation on the narrative page(§)and a citation of specific provision(s)violated. G 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) ❑4.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 �� 4 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 �c C� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY IC- 171 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 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: El 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) constitutes an order of the Board of Health. Failure to correct 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 B=One critical violation and less than 4 non-critical violations , g 26.Water,Plumbingand Waste if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ANA1__ ^_ Lt Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N � #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's %gnat a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N �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 * Food or Color Additives _ Law Cooled to 41`F/45`F Within 4 Hours* 4. 1 590.003(A) Assignment of Responsibility 8 Cross-contamination 14 590.003(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 Cooked and RTE Foods.* 19 * PHF Hot and Cold Holding 2-103.11 ,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 and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage 20 Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 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*590 03(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) .0 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* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1](B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 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* TIMEIrEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* pp y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * Ery afve inrzooi 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) I 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By P g * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clear Condition-IIands 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 Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165`F 15 sec* * 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 3-202.11 PHF's Received at Proper Temperatures (Blue Items 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140`F* Critical and non-critical violations,which do not relate to the foodbome 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'17 to 70'17 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 an P d Ca pacifies* 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 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. Poisonous ' Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 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* 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. THE Tp� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. '4 �6}9• �0 HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PL SE P, 'INT CLEA -_Y TFn MPS p, 508-862-4644 FOOD ESTABLISHMENT INSP CTION REPORT Name ` Date Tvoe of Type of Inspection Routine Addres G` Risk W 'Food Se Re-inspection i �. Level Retal Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation o- Owner HACCP YIN Temporary Sus egUll>ae Caterer General Com� , Person in Charge(PIC) Time Bed&Breakfast COP A n: t-'G Other / -15 Inspector �m=/VJ7);o5 ut. Each violation checked requires an explanation on the narra 1ive page(s)and a citation of specific provision(s)violated. 1 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) ❑ .�j . Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ & JV FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands .4 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS .1 ?PJ Y ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Y ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures r, ❑ 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-[31 J u y 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) © °/ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP lJ IN 0.Proper Adequate Handwashing CONSUMER ADVISORY 1 Y _ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories vAl 16 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations y 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 b a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) 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, constitutes an order of the Board of Health. Failure to correct violations g=One critical violation and less than 4npn-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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6npn-critical violations=B. 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 violations observed, violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of,7 to 8 non-critical violations. If 1 critical refrigeration.i 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address ,, within 10 days of receipt of this order. violation,4 to 8 non-critical viol tions C. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: In ec is S,g/attu VCE Print: ram/ 31.Dumpster screened from public view �(/ ' ` / jE Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN l� r �/ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PtfC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N l 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 Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives � 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-50t.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*. Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*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* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* L.2O_ Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 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 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 .003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.12 Chemicals for Washing F .003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g 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* q 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 Wazewashin Hot Water 7.206.12 Roden[Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 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* TIMEITEMPERATURE 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.I IA(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * eff-n-uuaoor 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) Poulhy,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 1 p 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* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwavet 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. Other 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 see* practice 0should.009 rbe debited olations and S to good retail #29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding Requirements. 5 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* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTs Food-Roast Critical and non-critical violations,which do not relate to the foodbome 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 8 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* ( ) 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 P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 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. p�ME T 0 ok, TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: - Date: Page: C of �v� c OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. ' BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MANS 9. `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPIVCTJON REPORT Name Date impe of Type of Inspection G p IR3 eRoutine Address Risk Food Se. i Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation - Owner HACCP Y/N Temporary Suspect Illness r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP IVAI In: Other y Inspector R5Out: ^ Each violation checked requires n explanation on the narrative page(s)and a citation of specific provision(s)violated. / r s) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Item Anti-Choking 590.009(E) ❑ � i Violations marked may pose an imminent health hazard and require immediate corrective Tobac 0 co 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 ❑ ❑ 9 9 13.Handwash Facilities /, EMPLOYEE HEALTH PROTECTION FROM CHEMICALSRT _ y ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - / ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals / r - FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) l' ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Q�/ U ❑ 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 0.Time As a Public Health Control / A! I ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 'moo ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP v ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes Overall Rating within 90 days as determined by the Board of Health. Voluntary Com❑ ry Compliance p ❑ 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. I ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report when signed below b a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004 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, ) constitutes an order of the Board of Health. Failure to correct violations 6=One critical violation and less than 4npn-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 6 non-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 C=2 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must critical violations and less than 9npn-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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 non-critical violations. If 1 critical refrigeration. within 10 da s of recei t of this order. v 4 to non-critical violations=C. 29.Special Requirements (590.009 Y p 30.Other DATE OF RE-INSPECTION: In pe or's ' n ur Pant: , /) 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i"A_ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig tur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N al V 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.) r V FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives � 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 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 5 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 and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 20 7-201.11 Separation-Storage* Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ted 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 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 Warewashin 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. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-Immediate is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe cnme innoa 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) I 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 temporary 9(A)_ ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* 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* foodborne 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 Requirements. 5 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* 3-403.11(2-401.12 Discharges From the Eyes,Nose and Mouth* B) Microwave-165°F g 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* gCritical and non-critical violations,which do not relate-to the foodborne 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* 1 g 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 Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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. of. row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: / fK Page:OFFICE HOURS ofi- PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNS ABLE. 200 MAIN STREET 3:30-4:30 P.M. - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAC MON.-FRI. HYANNIS, MA 02601 508-862-4644 No Reference R Red Item PLEASE PRINT CLEARLY - FOOD ESTABLISHMENT INSPECT ON REPORT NamePM Date Type of Type of Inspection ) RoutineOF I l r J Address Risk Food Service -Re-inspection Level eta' Previous Inspection Telephone Residential Kitchen Date: / Mobile Pre-operation 0 Owner HACCP Y/N Temporary rJs��ct lHraee''�� �T- 1 / Caterer eneral Comp�la1'ntr Person in Charge(PIC) Time Bed&Breakfast HAC In: Other Inspector Out: l Each violatio checked requires 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 Y ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals W a FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.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 n 10.Proper Adequate Handwashing . CONSUMER ADVISORY A M ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ❑ No ❑ Yes Corre Non-critical(N)violations must be corrected immediately or Overall Rating ctive Action Required: within 90 days as determined by the Board of Health. Voluntary Compliance❑ ry ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the tems checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure --E] Voluntary Disposal ®-Other:E 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 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 B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. 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 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 non-critical violations. If 1 critical refrigeration. within 10 da s of recei t of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009 Y p 30.Other DATE OF RE-INSPECTION: Inspec ig r 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 Signat e �' Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N t 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 Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives r 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 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 O P Y7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control** 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporti by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ng 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS r CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective/1112001 * 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 3-302.13 Pasteurized Es Substitute for Raw Shell 590.006(B) Water Meets Standards in 310 CMR 22.0 Contact Surfaces of Equipment* gg Shellfish and Fish From an Approved Source 4-702.11 Freque 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* ncy of Sanitization of Utensils and Food 3-401.11(A)(2) I 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,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g * 590.009(A)-(D) Violations of Section 590.009(A)-(D)imcater- Sources* Ratites-165°F 15 sec ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 * 2-301.12 Cleaning Procedure* 165°F* fodborne illness interventions and risk factors. 3-202.18 Shellstock Identification Present Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165'F 15 sec* 5 Receiving/Condition ( ) ( ) * 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 3-202.11 PHF's Received at Proper Temperatures (Blue Items 23-30) * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the Foodborne 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 8 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 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 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' I 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 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* 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. 6/`oF.He row ✓ TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: �� age: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ' BARNSTABLE. ' 200 MAIN STREET mass 3: FRI.P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified . MON.N.- 'cbp ,,,q. .0� HYANNIS,MA 02601 soe-asz asaa No Reference R-Red Item PL SE PRINT CLEARLY 'FD MP�� `• FOOD ESTABLISHMENT INSPECTION REPORT e Name Dated 17/ Type of Type of Inspection v Operation(s) Routine Address s/O� Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: o� Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP t In: Other ©- Inspector Out: Each violation checked requires 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) ❑ � G 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 --7 ' ZIZ'� ❑ 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 �O ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans 0,19.Hot and Cold Holding PROTECTION FROM CONTAMINATION 17120.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Prepara' n f H P - ❑ 10.Proper Adequate Handwashing CONSUMER ADVISOR ❑ 11.Good Hygienic Practices ❑ 22.Posting of Cons m i r ,l f 11" r Violations Related to Good Retail Practices Blue Items) Total Number of C itical Vi I s Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Overall Rating Yes 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 ❑ Voluntary Disposal ❑ Other: 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 anon-critical violations. F=3 or more critical violations. n no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical violation 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 4 non-critical violations s=F. 6,Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot '1627Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violations and less than 4non-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation erved,7 to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30, DATE OF RE-INSPECTION: Inspec s Sig at a Prin. 1 umpster screened from public view Permit Posted . Y N Grease Trap Previous Pumping Date Grease Rendered Y N Of #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' S natu Pri 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 Assi ent of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) gnm14 Food or Color Additives 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 7-101.11 Identifying Information-Original Containers* - 590.004(F)7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage.* Applicants* 3-302.11(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 3-302.15 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 * 3-304.11 Food Contact with Equipment and Utensils ( ) 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* 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* 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 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* TIMEITEMPERATURE 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 3-202.16 Ice Made From Potable Drinking Water 3-401.11 A(1)(2) Eggs.-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Eft-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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed * g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical , Ratites-165°F 15 sec* I * in mobile food,temporary and residential Sources & P ar•Y 10 Proper,Adequate Handwashmg 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under i Game and Wild Mushrooms Approved By 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. h*W 2-301.14 When to as * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 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 Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity - ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands _ _ 3AO3.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 13 Handwashin 590.004(E) Preventing Contamination from Employees* 1 g proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 9 Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203:11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFI Made from Ambient • 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours 26. ' Water,Plumbing and Waste FC-5 .006 a::`e'.. Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients* r,-# 27. Physical Facility FC-6 .007 :' 6-301.11 Handwashin Cleanser,Availability 7 Conformance with Approved Procedures l g 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision I 29. Special Requirements 009 3-502.11 Specialized Processing Methods* v 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* za 8-103.12 Conformance with Approved Procedures* "`` S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 596 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 3 L THE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: �1�13 Page: of °f °kq OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p 639, �0� HYANNIS,MA02601 08-8 -FRI. rED MA'�p soa-asz-4saa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name D � Da t G Type of sec ion OgeratigaW < Address/ Risk ood S Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illnessn - Caterer General Complaint Person in Charge(PIC) r Time Bed 8 Breakfast O herCP \ a O © r-_� In: Inspector Out: I I _ Each violation checked requires 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) ❑ �. S Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ,e ^ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALSl- ❑ 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) - s ❑4.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 Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No es within 90 days as determined by the Board of Health. Overall Rating Voluntary Compliance F] 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 ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 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 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Fa "ty (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 4 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonou 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 non-critical violations=C. refrigeration. 29.Special equirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Cs�� P t 31.Du p er 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 Sign ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N i e Dumpster Screen? Y N z �. _-- v.-.w.^: .._..-. -.�_.-J:-e-.r.,,r.�.. ,-.,,f,e. ..�a�:._..�s. . "S�+.Y+ Y"L.......,.:*»_ -:1"--"' - .;,,_ :�:]>'T' -- °."`."�."�r"'g.`b"`.ra.,...�-� ,. _ �•-•: ,--.:.,ti.,._.,. -4^.-,n..,:�r"L- -. . .....-. .-. -ViolationsTelatedao=foodbome4Ugess Violations Related to Foodborne Illness Interventions Interventions=,and Risk;F.actors,(R.edrItems 1-22) and Risk Facto (Red Items 1.22) (Pont.) =FOOD P.ROTECT.10.MANAGEMENT ;PROTECTION FROM CONTAMINATION PROTECTION.FROM CHEMICALS 3-501.14(C) PHFs.Received at Temperatures Accordingtto i 7 590.003(A) .Assignment ofResponsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to.41°F/45 F'.W.ithin 4:Hours* 590.0.03(13) Demonstration of'Kn_owledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12• . Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holdmg 2-3,03.11 Person-in-:Charge:Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or. elow;41'F/45F_ 15 :EMPLOYEE HEAL-TH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) liesponsibllity of the Person in-,Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140',F 7-102.11 Common Name-Working Containers* R Require eporting.by Food,Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above i 30'F * = 7-201.11 Separation'-Storage* Applicants_ 3-3.02.11(A) Food Protection* 20 Time.as a Pubhclieaith Control 59.0,003(F) Res onsibrlit of A Food Em to ee or An 7-202.11 Restriction-Presence and Use* P y P y 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health.Control Applicant To Report To The:P.erson In-Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 59.0.003,(G) Reporting,by Person inCharge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) ':Exclusions-pilRestngtions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 590:003(E) Removal of-Exclusions:and:Restrictions 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.43 Food m a;Hermetrcally Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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 Spell+Eggs* Sanitization Temperatures* TIMEITEMPERATURE 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 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155`F 15 sec 5-101.11 Drinkitg Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Dnnking1Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-662.11 Cleaning Frequency of Utensils and Food inmals-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* e Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* ; aces of Equipment* Shellfish* 4-703:11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater Sources* Ratites-165°F'15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 Shell stock'Ideiitification Present* 2-361.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 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.atiProper 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) a2 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne. 3-1.01:11 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 Ta s/RecordsrShellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs g P 9 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.-Retai/•,Practices FC 590 00,0 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 :004 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.1I 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 ( ' g 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials 1FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 1 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* l 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. zel f TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: G rV,Cg✓►✓J Date: Z / Page: of `pf THE Tp� v _ v o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3: - . FRI.P.M. MON - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, y A �639• HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FOpA"�� FOOD ESTABLISHMENT INSPECTION REPORT pC Ak / Name Pr r7l�A Date y e of Tyne of Inspection rn qq3O �,T/`P vtun Routine C, �-C n Risk od Sery p Re-inspection - - y ZV I � Q� HH�% Level Retail Address J Previous Inspection Cfl C CAm e r,'ch r Telephone Residential Kitchen Date: Mobile �rus v J 0'I% v urul Owner HACCP Y/N Temporary �ect Caterer Person in Charge(PIC) Time Bed&Breakfast HACCP W0 - �0 X 2 r "r In: Other ` Inspector d f N Out: I f H e 2 2 Each violation checked requires 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) ❑ �✓N C ( 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) ❑ W-d Cr FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ` EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ry- 0^ i' ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives #jr;, ❑ 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 ❑ 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 Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today, checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 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 anon-critical violations. F=3 or more critical violations. n no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical violation 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 4 non-critical violations s=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. 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 water,sewage back-up,infestation of rodents or insects,or lack of Y Y ( )( ) C=2 critical violations and less than 4npn-critical. If no critical refri eration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violati se d,7 to 8 non-critical violations=C. 9 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector -Signa r Print: i 31.Dumpster screened from public view �• � 0,1✓j Ij, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign re 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) Assignment of Responsibility* $ Cross-contamination 1q 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.* * 19 PHF Hot and Cold Holding g 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 75 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003 Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * (� P y3-302.15 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* 3-304.11 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) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) 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* q 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 Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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(I)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef"°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 rf cesSanitizationEquipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3�..01.14 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 Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in catet- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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* ( )O P 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* 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* r 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 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* * (Blue Items 23-30) 3-102.11 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g 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 Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained!` 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. I _ C Please Complete and Send or Fax to: Questions? Call.- 'Date: / / MDPH Food Protection Program Food Protection Program: (617) 983-6712 • 30S South Street,Jamaica Plain, MA 02130 Division of Epidemiology:_(617) 983-6800 #: Fax: (617)•9B376770 Entencs Laboratory: (617) 963-6509 ti P RrSON.PDMPLETI-NG INFORMATION v/ Name: W: (6TO,') - AffiBation: •❑ Local OH (to wn): ❑.State DPH (division): ❑ Other. REPORTER / .COMPLAINANT ' Name: AffiEsation: )ton mer s eci : -4 ❑ Laboratory division,. r ❑ Local BOH facility, ❑ Medical Provider address, ❑ State DPH town, etc. Ly ❑ Other ILLNESS INFORMATION Fer; l:� Symptoms: (mark if reported for anyone); rhea limiting. ❑ Nausea ❑ Abdominal cramps r ❑,Bloody stool ❑ Headache ❑ Muscle aches sQ Loss of-appetite ❑ Fatigue ❑ Dizzinessing in mouth ❑ Other symptoms: ...................................................... ............................................................ onset: _3�' Earliest Date: / ;Time: DAM ❑PM Latest (if > 2 itf) , Date: / �/ Time- ❑AM'❑PM i Duration: ❑ Less than 24 Hours• ❑-24-48 Hours- .D More than 48.Hours ❑ Ongoing ❑ Unknown III Persons: Age Name Address/Town W tyrs) Occupation Med'. Provider/W ❑ same as reporter(above) n 3 H .Medical attention received (Lj arryoneJ? �s ❑ No ❑ Unknown ff Yes, specify above:.T Stool specimens submitted(by anyone)? ❑ Yes ' No. Ql--i-Jnknown To SLI '? ❑ Yes ❑ No ❑ Unknown Medical diagnosis reported? FOOD HISTORY -� Obtain history back 72 hours prior to symptoms, or if organism identified, between min /mat incubation periods (p.2) -; if > 2 ill, follow above time frame for common meals (foods) only ; # Restaurant./•store where Date & TimeZ Ex 3 Foods consumed urchased name town Place consumed 1 5 013 �G 0Same las left/ ❑ Home / L [3 Other(spechW: ❑D 1 State Laboratory institute,305 South St,Jamaica Plain, MA,02130 - f6f7)522-3700 Sept 1999 (99SeptForm doc) •2 Always record Time if possible;otherwise, choose B=breakfast,L=lunch, D=dinner Discard Previous.Versions' 3 Total#persons(both ill and well)who consumed indicated food(s) FOOD HISTORY (continued)` # Restaurant/store where ` 'Date &Trme2- Exp3 rood(s) cansumed purchased.(name,town) Place consumed ' ��.El ❑'Same(as lefrJ ❑ Home ❑L ❑ Dther(specify): \ ❑D' _ ❑ E / ❑Same (as left) ❑Home ❑ L ��/'/ �/'�.1d O'Other(specify): ❑ 6 ❑Same (as ieftl El Home ❑ L ❑ Dther(specify}; B ❑Same.(as left] ❑ Home D L ❑Other(specify): ❑ D ❑ B ❑Same ias left) ❑.Home ❑ L El Other(specify): ❑D N TE FOOD TESTING Food(s) available for testing? ❑ Yes M- -5 ❑ Unknown Sent to SLI '? •❑ Yes ❑ No ❑Unknown - ff Yes,spec?fy foe fs) & sourc s , I Product and Manufacturer lnformafionfor Commercially-Processed Food(s) Product name: dode/lot # Expiration date: / / Package size/type: Manufacturer. Address: Incubation Periods for Selected Organisms brin Max ffn Max Mn Max B. cereus (short) .1 hr 6 hrs I .E. coii 0157:H7 3 days 8 days Staph, aureus 30 min 8 hrs' B. cereus (long) 6 hrs_'___ rs•_ 24 hrs Hepatitis A 15 days. 50 days Shigella 12 hrs 96 hrs Campylobacter 1.day 10 days, Salmonella(non-typhl) 6 hrs 72 hri Vibrio chdlerae ". few hrs 5 days ` Cyclospora 1 day 14 days Salmonella typhi 1 wk 3 wks Viral GI 12 hrs 48 hrs ` C. perfringens 6 hrs 24 hrs Shellfish poisoning minutes 'few hrs Yersinia 3 days 7 days 1 State Laboratory Institute,305 South SL,Jarnaica Plain, MA,02130 -• (617)522-3700 Sept 1999. (99SeptForm_doc) 2 Always record Time if possible;otherwise, choose B=breakfast, L=lunch, D=dinner Discard Previous Versions 3 Total#persons(both ill and well)who consumed indicated foods) p tME r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Ili rLc4 41 At Dater./2 /Z- Page: Z_of OFFICE HOURS p ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. i BARNSTABLE. , 200 MAIN STREET 3:30-MON. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 08-8 - HYANNIS,MA02601 FRI.I. �p i639• �0 soe-as2-as44 No Reference R-Red Item PLEASE PRINT CLEARLY 'FON1P�' FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tyne of a f inspection A Z O on s outin 70, 0 , e Vg Address Risk od Servic Re-inspection Z Level Retail Previous Inspection / l U Telephone Residential Kitchen Date: Mobile Pre-operation 3 8 A/-L t i /I,,T Suspect Illness Owner Caterer General Complaint Y/N ✓I° 6, -- V Person in Charge(PIC) Time Bed&Breakfast HACCP 1. '' t in r In: Other Inspector G [ w. S Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ✓�l!` n4f / k 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) ❑ 1� LJ. et Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands A ❑ 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) C f ❑4.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 Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes within 90 days as determined b the Board of Health. Overall Rating Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion Re-inspection Scheduled ❑ Emergency Suspension Ff�]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 ❑ Voluntary Disposal ❑ Other: 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 anon-critical violations. F=3 or more critical violations. n no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 Or more non-critical violation 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 4 non-critical violations s=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. 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 water,sewage back-up,infestation of rodents or insects,or lack of C-_2 critical violations and less than 4non-critical. If no critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations ob rve 7 t non-critical violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Si n lure Print: 31.Dumpster screened from public view (��f Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signal re 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) Assignment of Responsibility* 8 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* 79 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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* PP - 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 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) Exclusions and Restrictions* m 7-204.11 Sanitizers,Criteria-Chemicals* 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) 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* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112- Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE 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 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* a Animal Foods That are Raw,'Undercooked or., Equipment*-- Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3 401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef c"°°11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602:11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* Bi * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11 or and Beef R 30 eeoast-1 °F 121 min* Eggs* Shellfish and Fish From an Approved Source ( )(1)(2) Pk E s* 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 'x:?..'SPECIAL REQUIREMENTS- �4ul 4-703.11 Methods of Sanitization-Hat Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Ratites-165°F 15 sec* in bile food,temporary and residential Game and Wild Mushrooms Approved By Proper,Adequate Handwashing g'mobile �� 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 Requirements. 5 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 3-202.15 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 foodbome 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* 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"z x cn ':003- 13 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 * 5-205.11 Accessibility,O erasion and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils A. FC-4 .005 3 402.12 Records,Creation and Retention p Within 4 Hours* 26. Water,Plumbing and Waste :w FC-5z: '«. . .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 1 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. TOWN OF BARNSTABLE OFFICE HOURS: 8:30 - 9:30 A.M. , I: �;I HEALTH �« 12:as 2:0o P.M. Item No. In the space below describe All violations checked (1f N. Y. BOARD OF. "' m/ 1 367 MAIN STREET �/ ` - \EDMP� I��D HYANNIS, MASS. 02601 775-1120. EXT. 182 �.� W U� K i5!1 1) ./ 111 �� J��i�1 FOOD ESTABLISHMENT INSPECTION REPORT � e V :. yy (�, I n - �, _ � .�1�' �/�' ' �n ✓ GAG �f` �i`�l a/:T�`��' Establishment/Name /� /-d� Y�\1 t�l / V � Date I �. �.V y !1 �. / / Address A h4 t"(�� _ + �) Time Out 1/ r G A J W l7 j - I Telephone '/ 7 �✓"I 9 h r Type of Establishment: a 0� .� Food Service Purpose: f, / � o r,�tine __0I-�� Owners Name � / Follow-up Retail Food a Residential Kitchen _ Person In Charge Complaint Mobile Unit - Temporary Food Service Investigation +Inspectors Name-���� � Caterer Other - ��/ /tl�' - ! 1 T (,211/7)r-d� 1/ (7 A/cam Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is s �+ X followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and � / r1 " � / ; )AZ `/-45k critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. �> N C Rt. N C WT. Food [ Sanitary Facilities 1. Food Supply .002 4 29. Water Source .015 "' 4 2. Food Containers .002 3p, Sewage O16 r> 4 31. Cross-Connections 017 e 4 Food Protection 32. Toilets/Handwashing .018& 019 2 - 3. PHF Temperatures .004 4 33. Insects/Rodents 021 2 ' " 4. Facilities, Hot 8 Cold Storage .004 4 34. Plumbing .017 1 r1 5. PHF Re-service. .006 4 35. Toilet Rooms .018 1 f 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .0/9 2 '} T Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 2 R 9. Cross Contamination .005' 2 39. Outer Openings .021 1 V 10. PHF's thawed"cooked 8 cooled .005 4 40. Pest icide/Rodent icide Application .021 1 it. Food Handling .005 I 2 12. Dispensing Utensils .006 V 1 Physical Facilities 41. Floors ' .022 1 Personnel 42. Walls, Ceiling .022 1 !r V. 13. Employee Infections 008 4 43. Lighting .023 1 \X Y) 14. Employee Hygiene .009 4 44. Ventilation .024 V 15. Employee Clothing .010 +` 1 45. Dressing Rooms .025 Equipment 8 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 2 D 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 R 18, Non-Food-Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management + 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 � � �� k �" ��� � 21. Wiping Cloths 013 y 1 51. Bulk Foods .031 1 t a y- �- 22. Dish/Warewashing Facilities .013 1 52. Salad Bars 032 2 _ /1 _�� _`� �4 23. Pre-Scraped, Soaked .013 1 - w - ` 24. Wash/Rinse Water .013 1 No.of 13 Critical Items Violated 1 25, Thermometers/Test Kits .013 1 These items require Immediate attention. 26. Equipment/Utensil Storage .014 1 �/ 27. Single Service Articles .014 I //! r. 28. Single Service Re-Use .012 1 B cyo) SCORE n Inspected by �7r v ! � ? /1 Received by I. _ 13 CRITICAL FOOD HANDLING VIOLATIONS *-,- • Full Item Descriptions 1 1. Food from an unapproved or unknown source or food which is or may be Food- adulterated, contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome Is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, OoF; Y $ Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F C4 Facilities to maintain product temperature 0=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated the _gcA of hnt F_val ..�. 7 Food protected during storage, preparation, display, dispensing, service, transportation g Thermometers provided, conspicuous, accurate 9 No cross-contamination 3• The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted b food is working as a food handler in a food 17 Food contact serrates: design, constructed, installed, maintained, located Y 15 Non-food contact surfaces, design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free or all cleansers 6 A person not practicing strict standards of cleanliness and personal 21 Wiping cloths; clean, use restricted • P F $ P 22 Dish/Warpwaahing facilities: designed, constructed, maintained, installed. located, hygiene which may result in the potential transmission of illness operated Pre-flusheped, soaked through food is employed in a food establishment. 24 d Nash/Rinsewatera clean. temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling or clean storagequipme, dispensing 21 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 26 No reuse of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot3cold under pressure 8. Sewage or liquid waste is not uiopoodd of in an approved and C30 sewage xnd waste water ditnosal C31 No cross-connections, back siphonage,,backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets & Handwashing: number, accessible, design, 'lnstalled contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soup and towel dispensers, proper waste receptacles 9. Toilets and facilities for washinghands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant. frequency, P • P P Y clean installed or designed, accessible or convenient. 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical41Fl Facilities 41 Floors constructed, maintained, clean -articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and equipment vented as required Y P Y 45 Dressing, locker areas provided used, clean result in the contamination of the water. Other ed 12 Insects rodents or other animals are resent on the remises c46 PremToxiises s properly stored, labelled, ,art • f P P 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3))• Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items 'are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. 'r Town , ,of Barnstablo"- Date f7 ( Type Time Inspection Form for Food Handling Establishments Town of BARNSTABLE Name Address Licensee / / Owner Item Regulation Item Yes .No Remarks 1 14 Floors—Construction,clean,good repair 3 A} f 2 15 Walls&Ceilings—Good repair,cleaning methods 3 3 14 Doors&Windows—Screened,self-closing 2 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 6 8 Water source—Safe,hot&cold under pressure 6* 7 11 Toilet Facilities—Self-closing door, t clean,good repair,waste cans 3 lyl/tj 8 12 Lavatories—Hot&cold water,signs, soap,drying devise 3 9 6 Construction of utensils&equipment 2 10 7 Cleaning of equipment 4 11 7 Cleaning of utensils 4 12 7 Bactericidal treatment of utensils 6* 13 7 Storage&handling of utensils 4 / 14 13 Disposal of waste—Covered, adequate,vermin proof 5* 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 A4 �� P � 16 1 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 3 Storage of toxic chemicals 4 24 Miscellaneous 5 / Total out of ssible 100 *Critical Items require immediate attention— Reasons for compliance on reverse t Received by I Ar� QA'/`.y�'j, v / t ' Inspector s`f4 Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health authority. #15 Refrigeration: Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling;coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,he t food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service.Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—2°F.,located in the warmest part of the facility in which food is stored,and of such type and so situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below, or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below;or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees: Disease transmitted through food frequently originates from an infected food handler. A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food P r'y preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- e f i r single-service articles. Hand-washing is contaminat- ing food, drink, and food-contact surfaces o equipment, utensils, o s g g necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated.It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission of disease organisms to customers and employees.Effective cleaning will remove soil and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees, either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. - Improper storage of equipment and utensils,subsequent to cleaning and sanitizing;exposes-them to contamination and can nulify the benefits of these operations. Accordingly, storage and handling of cleaned or sanitized equipment and utensils,and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment creates a potential health hazard which can be guarded against only by effective control of such vermin. Since vermin require food, water, and shelter, control measures should be designed to deprive them of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall not be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. Town of Barnstable Date <i Type Time Inspection Form for u , Food Handling Establishments Town of BARNSTABLE ff f: t f 1"l/t,ic Name Address Licensee Owner Item Regulation Item Yes .No Remarks 1 14 Floors—Construction,clean,good repair 3 2 15 Walls&Ceilings—Good repair,cleaning methods 3 3 14 Doors&Windows—Screened,self-closing 2 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 r'` !- 6 8 Water source—Safe,hot& cold under pressure 6* ' c i+ i3ll 7 11 Toilet Facilities—Self-closing door, „ L clean,good repair,waste cans 3 8 12 Lavatories—Hot&cold water,signs, soap,drying devise 3 9 6 Construction of utensils&equipment 2 10 7 Cleaning of equipment 4 11 7 Cleaning of utensils 4 12 7 Bactericidal treatment of utensils 6* 13 7 Storage&handling of utensils 4 g r/ 14 13 Disposal of waste—Covered,adequate,vermin proof 5* 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 16 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 3 Storage of toxic chemicals 4 24 Miscellaneous 5 Total out of possible 100 'Critical Items require immediate attention— Reasons for compliance on reverse Received byt!:l� Inspector l Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health authority. #15 Refrigeration: Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling;coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,het food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service. Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—2°F.,located in the warmest part of the facility in which food is stored,and of such type and so'situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below, or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below;or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees:Disease transmitted through food frequently originates from an infected food handler. A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- ing food, drink, and food-contact surfaces of equipment, utensils, or single-service articles. Hand-washing is necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated.It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission of disease organisms to customers and employees.Effective cleaning will remove soil and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees, either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. Improper storage of equipment and utensils,subsequent to cleaning and sanitizing,exposes them to contamination and can nulify the benefits of these operations. Accordingly, storage and handling of cleaned or sanitized equipment and utensils;and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment j creates a potential health hazard which can be guarded against only by effective control of such vermin. Since vermin require food, water, and shelter, control measures should be designed to deprive them of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the,establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall nob be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. To' 'w' ' 'n' 'd Barnstable Date _ Type Time ,j/'"f!/K Inspection Form for Food Handling Establishments Town of BARNSTABLE Name Address Ja Licensee Owner Item Regulation Item Yes .No Remarks 1 14 Floors—Construction,clean,good repair 3 F 2 15 Walls&Ceilings—Good repair,cleaning methods 3 j / t�� 6f 3 14 Doors&Windows—Screened,self-closing 2 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 6 8 Water source—Safe,hot&cold under pressure 6* 7 11 Toilet Facilities—Self-closing door, clean,good repair,waste cans 3 r 8 12 Lavatories—Hot& cold water,signs, soap,drying devise 3 9 6 Construction of utensils&equipment 2 10 7 Cleaning of equipment 4 f '/ !I 4 ,'F� , 11 7 Cleaning of utensils 4 12 7 Bactericidal treatment of utensils 6* — -- 13 7 Storage&handling of utensils 4 '" r � !<..• r ui� v - 14 13 Disposal of waste—Covered,adequate,vermin proof 5* 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 /A"� �" "f "�""` r1 16 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 3 Storage of toxic chemicals 4 24 Miscellaneous 5 Total out of possible 100 *Critical Items require immediate attention— Reasons for compliance on reverse. 14t f t Received by / �- Inspector ,/ Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. _ #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health authority. #15 Refrigeration:Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling;coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,het food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service. Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—2°F.,located in the warmest part of the facility in which food is stored,and of such type and so situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below., or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below;or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees:Disease transmitted through food frequently originates from an infected food handler. A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility,of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- ing food, drink, and food-contact surfaces of equipment, utensils, or single-service articles. Hand-washing is necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated. It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission of disease organisms to customers and-employees.,Effective cleaning will remove soil and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees,either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. Improper storage of equipment and utensils,subsequent to cleaning and sanitizing,exposes them to contamination and can nulify the benefits of these. operations. Accordingly, storage and handling of cleaned or sanitized equipment and utensils,and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment creates a potential health hazard which can be guarded against only by effective control of such vermin. Since vermin require food, water, and shelter, control measures should be designed to deprive them of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall not be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. Ba �l Town ofrnstab e r Date Type Time !} ' Inspection Form for Food Handling Establishments Town of BARNSTABLE Name AP- r` p, Address / �ytlg eel 1;eye" c. 15 Licensee Owner Item Regulation Item Yes No Remarks; 1 14 Floors—Construction,clean,good repair 3 u, f . 2 15 Walls&Ceilings—Good repair,cleaning methods 3 R, f f f if 3 14 Doors&Windows—Screened,self-closing 2 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 Ado 6 8 Water source—Safe,hot&cold under pressure 6 7 11 Toilet Facilities—Self-closing door, clean,good repair,waste cans 3 " ' ` Z 8 12 Lavatories—Hot&cold water,signs, soap,drying devise 3 9 6 Construction of utensils&equipment 2 NO ( r 10 7 Cleaning of equipment 4 0 11 7 Cleaning of utensils 4 12 7 Bactericidal treatment of utensils 6* ! t r ` f< 13 7 Storage&handling of utensils 4 14 13 Disposal of waste—Covered,adequate,vermin proof 5* 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 16 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* j } 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 3 Storage of toxic chemicals 4 ' 24 Miscellaneous 5 Total out of possible 100 *Critical Items require immediate attention— Reasons for compliance on reverse y 7, wsf�EGT 4�{� Received by Inspectors IL Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health"authority. #15 Refrigeration: Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling;coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,het food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service. Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—20F.,located in the warmest part of the facility in which food is stored,and of such type and so situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below, or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below;or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees: Disease transmitted through food frequently originates from an infected food handler. A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- ing food, drink, and food-contact surfaces of equipment, utensils, or single-service articles. Hand-washing is necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated.It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission of disease organisms to customers and employees.Effective cleaning will remove soil and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees, either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. Improper storage of equipment and utensils,subsequent to cleaning and sanitizing,exposes them to contamination and can nulify the benefits of these operations. Accordingly, storage and handling of cleaned or sanitized equipment and utensils,and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment creates a potential health hazard which can be guarded against only by effective control of such vermin.. Since vermin require food, water, and shelter, control measures should be designed to deprive them of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and .cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall not be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. aAM F.P. Thomas Lee Alternate z �. 200 Main Street, Hyannis, MA 02601 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: 195 Issue Date: 01/01/2021 DBA: BARBYANN'S OWNER: SNARKY, INC. Location of Establishment: 120 AIRPORT ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 150 OutdoorSeating: 30 Total Seating: 180 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: 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: i oF '°wti Initials: Town of Barnstable For Office Use MEL Date Paid , C Amt I'd 30D r Inspectional Services 9cb NA M. `0�' A,E639. Public Health Division Thomas McKean, Director ; 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT +' DATE 9 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: [ Z.D ACrPj� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): {~U1✓►1f3 E !/��" 02,60 ) E-MAIL ADDRESS: L 0-0. to y1-- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ('D7-7 - � TOTAL NUMBER OF BATHROOMS:, WELL WATEXYNO v ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: I fD OUTSIDE: 3 _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)? It I TYP F ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL 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 Fortes\FOODAPP 2020.doc t t .-s �'.+h `� �+'`'` 'x3C OWNER INFORMATION: FULL NAME OF API'l.l(,%"I � t 9 t1t�, SOLE OWNER: `F:S)NO D.O.B j''`_t OWNER PHONE# ZZ-�1 r ADDRESS.. s{ �aVs �li, � Qtyl CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHiiENT'S must have I 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 estahlishment. Certified Food Managers Expiration Date AllertYeu Awareness Expiration Date _C, LZo _ R t SIG' ' TURE OF APPLICANT DATE ***FOOD POLICY IINFORMATION*** SEASONAL FOOD SERVICE:All seasonal food cstublishtni�fits,including mobile tucks must be inspected by the I lealth Div, prior to open og!l Please call Health Div.at 508-862-4643 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts roust be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Flealth Div, Failure to do so will result in the suspension or rev Per ocation of your Frozen Dessert Permit until the above terms arc met. CATERING;POLICY: Anyone wilo caters within the T'oNien of Barnstable must notity theTown by fax or mail prior to catering event. You MUST COIllplete a catering notice found ai httu:lhvww,townufbnrnstable uslhealthdit isinnl plicAtiuns itp. OUTDOOR COOKING:: Outdoor cooking,preparation,or display of any ibod product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31"each calendar year. 1T IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S).A\;D REQUIRED FEES BY DEC I st. Q l4ppli;;auarr FOrMST00DAPP RFv3-2019&,: 01 McKenzie, Marybeth From: MailArchiver@town.barnstable.ma.us Sent: Wednesday, January 18, 2017 1:44 PM To: McKenzie, Marybeth Subject: Fwd: Barbyannes permit From: "McKenzie, Marybeth" <Marybeth.McKenziega,town.barnstable.ma.us> Sent: Tue, 10 Jan 2017 12:02:07 -0500 To: "Beck, Vanessa" <Vanessa.Beck(a_,town.barnstable.ma.us> Subject: Barbyannes permit Vanessa, Please hold Barbysannes, 120 Airport, Hyannis health permit,due to work that needs to be done. I have given them a temp until the end of March 2017 to finish the work. Thanks, Mb 1 McKenzie, Marybeth From: MailArchiver@town.barnstable.ma.us Sent: Wednesday,January 18, 2017 1:44 PM To: McKenzie, Marybeth Subject: Fwd: Barbyannes sign off From: "McKenzie, Marybeth" <Marybeth.McKenziegtown.barnstable.ma.us> Sent: Tue, 10 Jan 2017 11:58:48 -0500 To: "Hartsgrove, Elizabeth" <Elizabeth.Harts rovegtown.barnstable.ma.us> Subject: Barbyannes sign off Hello Liz, I had previously signed off on Babyannes for 2017, but I did a recent inspection and I am putting them on a temp for their health permit until the end of March 2017.They have some work to do to the facility. I don't know if this changes your sign off, but I Just wanted you to know. If I need to do anything concerning licensing just let me know. Thanks, Mb �pfNF Town of Barnstable BOARD OF HEALTH . John T.Norman i Board of Health Donald A.Gaudagnoli,M.D. MRdsrARIZ '• Paul J.Canniff,D.M.D. MAM 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: 195 Issue Date: 12/10/2019 DBA: BARBYANN'S OWNER: SNARKY, INC., C/O JOHN CUNNINGHAM Location of Establishment: 120 AIRPORT ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 150 OutdoorSeating: 30 Total Seating: 180 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C�A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: -I For OfficeInitials Town of Barnstable Use Only. I�Amt Pd$ �- &UMSPABLE, : Inspectional Services 1=3 9a Public Health Division check# � �06 ' ED MA'S Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 . APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE II NEW OWNERSHIP RENEWAL` NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ���` �'�� "� Cp —� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: , Of TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO 1/�. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ✓ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE:32�_ TOTAL: I YFO 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)? YL TYPE,OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL 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:VWpplication FormsTOODAPP 2020.doc yi l-�9 OWNER INFORMATION: _p FULL NAME OF APPLICANT SOLE OWNER: 'E /NO D.O.B OWNER PHONE# J 6 2 Z'q ADDRESS_ CORPORATE OWNER: CORPORATE ADDRESS: �.C /� ^l L AIM PERSON IN CHARGE OF DAILY OPERATIONS: `-"° MI. 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. Joh4.. C�►�li 12- / 3 /ZoZ f 1. d�� ( �, (-u� I-Z SI ATURE 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 http://www.townofbarnstable.us/healthdivision/ai)plications.asi). 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.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc OFIKj Town of Barnstable BOARD OF HEALTH •` � O Paul J Canniff,D.M.D. Board OI Health Donald A.Gaudagnoli,M.D. �i aAotrs ,us John T.Norman MAC' F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 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: 195 Issue Date: 12/20/18 DBA: BARBYANN'S OWNER: SNARKY, INC., C/O JOHN CUNNINGHAM Location of Establishment: 120 AIRPORT ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: " IndoorSeating: 150 OutdoorSeating: 30 Total Seating: 180 FEES - FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- ---- -- - MOBILE- FOOD: MOBILE-ICE CREAM: Gi A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE } Restrictions: �OFtNE Tn. Initials: Town of Barnstable n Date Paid G' Amt Pd$ Ulm A$ . Inspectional Services i63q. 10 ���lEop Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fag: 508-790-6304 AP(P/LICATION FOR PERMIT TO OPERATE A. OOD ESTABLISHMENT DATE I Z'� O NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: ( .W ?1 K,l S 0240 d MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �—Xt rif - V� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( M 77) TOTAL NUMBER OF BATHROOMS• WELL WATER: YES NO ...' (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE:3.TOTAL: I o 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)9 TYPE,OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL 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) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc I s PLEASE CALL 508-862-4644 OWNER INFORMATION: (n, FULL NAME OF APPLICANT J06, , V n, SOLE OWNER: 6S/ NOS� D.O.B Z� OWNER PHONE# J -9 o - J 7� 2 2 ADDRESS (evk-- 011C ` �/►/`,�- 02k 3� CORPORATE OWNER: " FEDERAL ID NO. 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 en Awareness Expiration Date I. SIG TURF OF AP ICANT 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 http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation, or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3ls`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsT00DAPPREV2018.doc PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 5 BOARD EAL PERMIT TO OPERAT E A FOOD ESTABLISHMENT In accordance with regulat' er authority of Chapter 94, Section 395A and Chapter F719 L a permit is hereby granted to: J"w c RBYANN'S iNARKY, INC., CIO JOHN CUNNII6 . n g_.. - . IA` '= F Whose place of business is: YANNIS, _ Type of business and any resi FO ABLIt _ _ :u c To operate a food establishriet __, B �BLE ~,� a RESTRICTIONS IF ANY: r^'` � SEATING: 150 ANNUAL: ( S ec t. i .�, x V! y SEASONAL:. TEMPORA Y ?F. _ to A�, y�� 2 : OARd CIF HEALTH EES �+ s RETAIL FOOD STORE: �_ Z_- g 4AW.1e l�9nniff, D.M.D,Chairperson FOOD SERVICE ESTABLISHMENT: � 0.00 ' tY irhiSawayanagi RESIDENTIAL KITCHEN FOR RETAIL SAL ��� `�' G �: . a A.Guadagnoli M.D RESIDENTIAL KITCHEN FOR BED+BREAK�4'S K^ F � ermkln MOBILE FOOD UNIT: TOBACCO SALES: - Thomas A. McKean, RS, CHO FROZEN DESSERT: !, _ :: :-- ` _ CATERER: z Q - Director of Public Health -�.- � -- NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE � t� Town of Barnstable � r� Regulatory Services a�5� suvsrns�, Richard V. Scali Director, fp-I���- BARNSTABLE BAgMSTA MIUSEKFMAUE•M) r MYAMMIS. 1659. a`' Public Health Division Vb nMS1 3YW5.639-2014Yc 9ARN5ME 1639-2014 Thomas McKean, Director �Dg 200 Main S--treet, Hyannis,MA 02601_---- ----T---- --- ---- ------------ Offier- 509 air 4644 Fi- x- 5OR 790 6304 - P-LIC—ANION-FO-R-PERMIT-T-0-OP�RATE-A-FOO- D-ES-T-AB-L-I-SHMENT DATE: 1 NAME OF FOOD ESTABLISHMENT: / ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENTT FROM ABOVE): E-MAIL ADDRESS: '�'-� �� r �%�,(/Q� 9 ,Llk e9_ J TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (Iak) 77 - a 71 t___ NUMBER OF SEATS*: INSIDE: /1'0 OUTSIDE: elTOTAL: ( W--` * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPFOF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES ATERING OUTSIDE DINING (OVER) Q:Application Forms\Foodappldoc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF S .RVI F, DOOR(S), CONTACT INFORMATION: FULL NAME OF APPLICANT 9 SOLE OWNER: lfS /NO D.O.B V7 ej-y ADDRESS PHONE# IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 94 3P Z?74 STATE OF INCORPORATION: m L. FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) EXPIRATION DATE: / Z9 / Y2. EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THF NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. EXPIRATION DATE: G( / 20 SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp3.doc MAIL-IN REQUESTS - -Please mail--the-completed application form-to the-address-below. Also-include-copies-of youremployees' - - food protection manager training certificates at least two and toodallergen awareness training certi icate at least_one)_In_addition,_please_include_the_required-fee_amount_(see-fees-at-bonorn_ofthis_page)..__Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. 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 fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. To get a food permit application form, click here. To be able to access this form, your computer must have Acrobat Reader. Most computers have Acrobat Reader, and it will usually activate itself automatically. If your computer does not have Acrobat Reader, you can download a copy of it by going to the Adobe website. For further assistance on any item above, call (508) 862-4644 FEES: Bed&Breakfast Permit=$55; Food Service Permit 0-49 seats = $250; 50 or more seats $300; Continental Breakfast= $30; Retail Food Store—Less than 8,000 S.F. = $100, more than 8,000 S.F. = $285; less than 1,000 S.F. and Incidental to Business = $20; Residential Kitchen= $75; Frozen Dessert License= $30; Tobacco Sales Permit= $50; Additional non-refundable Fee for New Establishment or New Ownership $100, Late Fee= $10 Back to Main Public Health Division Page k Q:\Application FormsToodapp1doc AWL i PERMIT,NO: TOWN OF BARNSTABLE ISSUE DAT II� 195 BOARD OF HEALTH 12/221201" PERMIT TO ORATA0J1TABLISHMENT E In accordance witti rggfffao atd} EruthQrity of Chapter 94, I� e Section 395A and Chapter it I ctio o �Ge*41-- �a*rmit is hereby granted to: PI) ►NARKY, INC., C/O JOHN CUNNIN__QF 'D/tom_ _ - - RQ $YANN'S Whose place of business is:,_` -2Y}AiRPORT-9Q _NTM , MA2� D Type of business and any restri6tron, : Q4R` [I `y1 ABLISH NT To operate a food establish entan the T r ABLE _ - - RESTRICTIONSIFANY: L. '` _ _ ,, cry.• �.: - E � _ 2- = 4 c. ' c�'E�_- P_ [7 -' � it's'• - i t - SEATING: 150 -�- - . SEASONAL: TEMPORAf2Y: 15 E S /4=AO OF HEALTH _ ; RETAIL FOOD STORE: `ti ti i=- r.. ,T v= J.�? P= =. r W.Canniff, D.M.D, Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: `i. `t-�,;,���= >- ' `Jichi Sawayanagi RESIDENTIAL KITCHEN FOR BED+BREAKFAST'` Donald A. Guadagnoli M.D. e MOBILE FOOD UNIT: "�• "tom_ rr s TOBACCO SALES: _. `. t,' FROZEN DESSERT: Thomas A:McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE Town of Barnstable LA 'THE W 4 "o Regulatory Services �1N IARNSSABIE. Richard V. Scali, Director BABSTAS& LE13 0 n�nsn.Ys pus asaimv mv �neisr o 9. Public Health Division 16 +'' �D�iu4r rn Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 r� Office: 508-862-4644 Fax: 508-790-6304 cr s APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: obo l l NAME OF FOOD ESTABLISHMENT: �'�`JVI �►� 1 ADDRESS OF FOOD ESTABLISHMENT: _ r�i 12� 001"ji E-MAIL ADDRESS: b a r�� a nnr n �44 69- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( f)��- NUMBER OF SEATS*: INSIDE: It OUTSIDE: TOTAL: * Note: If indoor seating provided, see Lice ing regarding Common Victuallers License TOTAL-NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: t DO TO I Z .DO f`y DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) I"D IF SEASONAL: APPROXIMATE DATES OF OPERATION: —/ / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING.YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? / IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER:C� /NO ADDRESS QQ Z Q u C 64 ,111 PHONE# ` u 'TP - 7�.)K IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. YZ 7 STATE OF INCORPORATION - M FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST HE NAMESOF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) EXPIRATION DATE:/ 19 / zo I� 2. LDS �r9 EXPIRATION DATE: /21 EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** I -F46T THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp2.doc PERMIT NO: TOWN OF BARNSTABLE ISSUE DAT 195 :W, BOARD OF HEALTH January 1, 201 PERMIT TO QP _ STABLISHMENT In accordance w' r 4ti ga# r hority of Chapter 94, Section 395A and a erg' ect&W e�.• a ermit is herebyranted to: - 1 ' g iNARKY INC. C/O JOHN C Dom. �° �="�� BYANN'S Whose place of business i3 s IRPOR S, MAC Type of business and anyeitfis: _sd3E1 � TABLIS ' To operate a food establihnent ir>E the _ ABLE i< f RESTRICTIONS IF ANY: ESQ' h UNI SEATING: 150 ANNUAL r SEASONAL: TEMPOR ; E E s A �` B OF HEALTH RETAIL FOOD STORE: , �, �, �. j. y e Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: '' T 1' a 1 J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE unichi Sawavanagi RESIDENTIAL KITCHEN FOR BED+BREAKFA��'� _ MOBILE FOOD UNIT: :_ G; TOBACCO SALES: FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE own of Barnstable Regulatory Services Richard V. Scah, Director 1p BARNSTABLE �WSTAB�. B t4STA tf-MTERVWf-WNl,-HYM.NIS MASS. p' Public Health Division .a�U.� � r 16 �VI 1639-2014 1°rEc Ma � Thomas McKean, Director3�� 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT `: DATE: NAME OF FOOD ESTABLISHMENT: ► SPA j ADDRESS OF FOOD ESTABLISHMENT: i -0 E-MAIL ADDRESS: 6 Gf 0M S , L o TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: * Note:,If indoor seating provided, see Licens'ng regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: r ANNUAL OR SEASONAL OPERATION: A"h TYPICAL HOURS OF OPERATION MON-FRk� TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS)- N o► k_ IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE,OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ®. ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? _ CONTACT INFORMATION: FULL NAME OF APPLICANT < 09i SOLE OWNER: ✓ NO ADDRESS (put y�Gt^ �'� �,QW f1 ��k ✓� PHONE # '6- IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D O Z770� STATE OF INCORPORATION M I FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** r LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1, a-6V C EXPIRATION DATE: / �'/ Z& 2, �S ✓ EXPIRATION DATE:/ EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1, U b(�� I`�i� I� EXPIRATION DATE: fll li�C� Y IGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp2.doc 195 BOARD OF HEALTH . January 1, 2015� PERMIT TO OPE Q ESTABLISHMENT In accordance with ul,_ o er hority of Chapter 94, j Section 395A and Ch e ti a ermit is hereby granted to: , >NARKY INC. CIO JOHN CUM I All` z YANN'S s Whose place of business is: 2 PORT , MA ., Z: Type of business and any r i V ABLIS49. . To operate a food establis nt in e T BILE RESTRICTIONS IF ANY: t �` SEATING: 150 ANNUAL 1Y .SI � ..-, � �� � b SEASONAL: TEMPORARY V . u 1. 17 E S ' ASS: IDF HEALTH RETAIL FOOD STORE: fUllller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: 0 %RESIDENTIAL KITCHEN FOR RETAIL SALE k �a, = ul. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAS Ark J ichi Sawavanapi MOBILE FOOD UNIT: �°" r S TOBACCO SALES: r e FROZEN DESSERT: Thomas A. McKean, IRS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE Town of Barnstable °FEE To,, Regulatory Services Richard V. Scah, Director BAN TABLE 91ARNSfABLE sw s n -®rtmwue m rz•x u m MASS. Public Health Division �- - 16 � iss-zoia y.�a` Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: (At l D NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS: 60V— TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS*: INSIDE: I OUTSIDE: _ TOTAL: * Note: If indoor seating provided, see.Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: P ��✓�, TYPICAL.HOURS OF OPERATION MON-FRI: i 0 9 T O DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) ' "0r—c IF SEASONAL: APPROXIMATE DATES OF OPERATION: _/_/ TO ***REAI NDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD.SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST - RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES _ hj 6:7fERING �UTSIDE DINING (OVER) t . r !' OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND � LICENSING AND MEET ALL OF THE OUTSIDE DINING CJdTERIA IS FAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)?. CONTACT INFORMATION: ' FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS PRONE# ( ) IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 77�l STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD :PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.*-'--*PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH 'OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1. o ���^ '`` EXPIRATION DATE: / l f-/ 2. Cep l SV2T�. EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR BIMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NA NM OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. . �f � V1�i✓ �`"� EXPIRATION DATE: i SIGNATURE OF APPLICANT AND DATE I OAAnniicatinn Forms\Foodaoo2.doc ERMIT NO: 195 BOARD OF HEALTH January 1, 2014 PERMIT TO OPERATE:A FOOQ,.ESTABLISHMENT In accordance with regal^at' promulgated U►rdo avthQrity of Chapter 94, Section 395A and Chapter 1b1,,S2 1�on 5 oft general ,a�V ,:a p mit is hereby granted to: iNARKY, INC., CIO JOHN CUNRI•N IAA 0A EwANN S r p Whose place of business is: s' 1ORT R -IIS,MA 0�60'k Type of business and any resf<ri ` FIIfiRV1CCEIIBLISHMEf �. ci B To operate a food establishnie�t In th TO 1iLE� =�? �' �a RESTRICTIONS IF ANY: max; x � r SEATING: 150 ANNUAL YES. `� ' t ` SEASONAL: TEMPORARY: t, x Y. "' CAR QF HEALTH RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: „�_ 9 r; sL � lvliller, M.D., Chairperson b autl J Canniff, D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: w k '�,�� °� = : RESIDENTIAL KITCHEN FOR BED+BREAKFAST }` s r r4ainitihi Sawayanagi MOBILE FOOD UNIT: "+rc` CITIX�1S s ��r TOBACCO SALES: " e13'� FROZEN DESSERT: „�`�9 Thomas A. McKean, IRS, CHO CATERER: °L*.s._;- n.a"r. :.w:', Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE aW � Town of Barnstable -0 \ �1 O FTHE tOk� Regulatory Services Barnstable O� Richard V. Scali,Interim Director ^�-Amencaciry + BARNSTABLE, ' , ' 11-1 Public Health Division 2007I (a /2 �FD1A0r� Thomas McKean,Director 14 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT . DATE: NAME OF FOOD ESTABLISHMENT: `r ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP:4PARCEL(S) I TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: WO OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO L DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY OOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) fi.. ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT-INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS PHONE # C__) - IF APPLICANT IS A PARTNERSHIP, F,ULI, NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERVSAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF,APPLICANT AND DATE Q\Health\Application Forms\Foodappl.doc 195 BOARD OF HEALTH December 22, 2010 PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regt atinn xomutgated.undeir-,authority of Chapter 94, Section 395A and Chapter' es-�e f e ermit is hereby granted to: ►NARKY INC. CIO JOHN CUNNI, An /B/A A BARSYANN'S eo �, .. Whose place of business is: 1261AIRPORT RC)Af-i ,a YA tVIS, MA O fi01 ,. Type of business and any resfrltolas. FOftSERVICEESTABLISHMiT To operate a food establishment I� LE RESTRICTIONS IF ANY: FOR 200%FpOD PERMIT,WILL NEE, W L N GQO,ER FLOdR b& SEATING: 150 ANNUAL YES ' SEASONAL: TEMPORARY: �� fi F E ES � BARD�OF HEALTH � y ri RETAIL FOOD STORE: a r1e IV iller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT $25000 �� �PaulJCanniff D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE aro q �� ' RESIDENTIAL KITCHEN FOR BED+BREAKFAST m � r� u ,'JUnl f1i Sawayanagi MOBILE FOOD UNIT: -�=Permit Exq'ires, " TOBACCO SALES: ' December 31, U`1, FROZEN DESSERT: Y ,5' Thomas A. McKean, IRS,CHO CATERER: ' Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION.WITH A COMMON VICTUALERS LICENSE r r r Town of Barnstable f o?6 0, 0*1"E'O`y Regulatory Services Barnstable t, Di il G F Thomas F. eerrecor, r r A811m�-�-�•i�y�p + =ARNSTABLE, q -MASS 16 A Public Health Division Q 4� vplEO(Ap ` 2007 Thomas McKean,Director . 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 5087790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 14 10 NAME OF FOOD ESTABLISHMENT: Kill`f ADDRESS OF FOOD ESTABLISHMENT: tao MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: Z PARCEL(S) -01 y TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (S9 NUMBER OF SEATS: INSIDE: It) OUTSIDE:3,:> TOTAL: TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: ��.�w� TYPICAL HOURS OF OPERATION MON-FRI: l( 3, � � TO f 0? ~: D CD DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: TO -. i ***REMINDER*** ' SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING {OVER) Q_1_alIRAppIicaLion FormsToodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: ' ES /NO � ADDRESS PHONE # ) 7119 - IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. J9 �3Az 77r� STATE OF INCORPORATION 4V FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV=SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD-SANITATION CER11FIE6 STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.*"PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE - CERTIFICATE*** EXPIRATION DATE: 3 /Z 1 / 2.o 7 �_ 2. ' G-1kvu EXPIRATION DATE: 3. C"' EXPIRATION DATE: Z/ Z7/ 4. EXPIRATION DATE:IV SIGNATURE OF APPLICANT AND DATE QAHealth\Application FormsToodappl.doc PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 195 BOARD OF HEALTH December 28, 2009 PERMIT TO OP A - MzAgLISHMENT In accordance with u U k& of Chapter 94, Section 395A and Ct_a er, 1 n rit> is hereby granted to: NARKY INC. CIO JOHN CUN BI X: N'S Whose place of business is: ORT L1A 02 't Type of business.and any res itl � F I . A . ~ LISHME To operate a food establishnleqtf ith TO -LE RESTRICTIONS IF ANY: FOR 2007t D4f- IT,WIL. FLOOR ABLSEATING: 150 ANNUAL: Y S� BAIMST ` � SEASONAL: TEMPORARY. MASS"'. HEALTH RETAIL FOOD STORE: n ler, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE a .1 annlff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAS- t i SawaVanagi MOBILE FOOD UNIT: TOBACCO SALES: FROZEN DESSERT: Thomas Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE ' Town of Barnstable 'fe�12'510� y� °fj"ErO�y� Regulatory Services P� Thomas F. Geiler, Director mericn Clly BARN SfABLE, � ► " a Public Health Division 9 � 2007 �TFD"`A�a Thomas McKean, Director .. 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 5087790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: - d � , NAME OF FOOD ESTABLISHMENT: � /�`, G.vtw% ADDRESS OF FOOD ESTABLISHMENT: ic- ! kl'A MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: Z9 l PARCEL(S) (Q 7 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ??jam NUMBER OF SEATS: INSIDE: 13 OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: Vtl' � TYPICAL HOURS OF OPERATION MON-FRI: 3 1Z TO �Z w DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IN°V\J� IF.SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\HcaIMApplication Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT S OLE OWNER: YES /NO ADDRESS PHONE # IF APPLICANT IS A PARTNERSHIP, ULL NAME AND'HOME ADDRESS OF ALL PARTNERS c IF APPLICANT IS A CORPORA : FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHM T CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHME TS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD ANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EAC FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD S NITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIE6 ST F-ur" IS REQUIRES ONSITE DURING ALL -HOURS' OF OPERATION.***PLEASE PUT TI#E NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1• EXPIRATION DATE: / / 2• EXPIRATION DATE: . 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE QAHea I thV�ppl i c a tion formsToodappl.doc Town of Barnstable 0f tHE Tp� Regulatory Services Barnstable P Thomas F. Geiler, Director �1 n BARNSTABLE, q$A MASS. ���Q Public Health Division 0� lEp�.i a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: v` U A V M ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP:'�A PARCEL(S) O I q TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ��, ���- ?�►� NUMBER OF SEATS: INSIDE: t SJ OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI:- TO t DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING [S v� TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY f /' FOOD SERVICE RETAIL FOOD (A. , BED & BREAKFAST. W CONTINENTAL BREAKFAST y RESIDENTIAL KITCHEN v`F MOBILE FOOD _ TOBACCO SALES FROZEN DAIRY DESSERT MACHINES /CATERING OUTSIDE DINING (OVER) QAHeaIMApplication FormsToodapplAm ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT.INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES./NO ADDRESS PHONE # (� - IF APPLICANT IS.A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD.SERVICE,ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR-FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF_ IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF. THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: 2. EXPIRAT ION DATE: / / 3. EXPIRATION DATE: 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Health\Application Forms\Foodappl.doc Town of Barnstable �pIHE 1ph, Regulatory Services Barnstable Thomas F. Geiler, Director tA&AmedcaMyy * RARNRrABLE, 9$ 63; r Public Health Division 1007- ArFD MP'�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: /I �`� 14 ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: Zy PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ) NUMBER OF SEATS: INSIDE: l J�� OUTSIDE:3, TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: 4'f V1y�vGt , TYPICAL HOURS OF OPERATION MON-FRI: 39 : AI TO �- DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY &- YOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING =OUTSIDE DINING (OVER) QAHealth\Application Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS PHONE # C_) - IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME. OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Health\Application Forms\Foodappl.doc r PERM4T NO TOWN OF BARNSTABLE 12/28/2005 r 195 BOARD OF HEALTH n PERMIT TO OPERATE A FOOD ESTABLISHMENT J In accordance with regulations promulgated under authority of Chapter 94, .' Section 395A and Chapter,111 Section 5 of the General La.ws,:a permit is hereby granted to: JOHN CUNNINGHAM D/B/A``: _, SARBYANN'S p Whose lace of business is: 120 AIRPORT ROAD ,, HYAN,NI,$, MA 02601' Type of business and any restrictions: FOO©SERVICE ESTABLISHMENT To operate a food establishment in the. TOWN'OF BARNSTABLE RESTRICTIONS IF ANY SEATING: 150 ANNUAL: YES SEASONAL: TEMPORARY:- F E BS -. BOARD OF HEALTH RETAIL FOOD STORE: 4 FOOD SERVICE ESTABLISHMENT g25p pp Mayne Miller, M.D., Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE Sumner Kaufman,M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST `° ,yam S.t�san'Rask, R.S. MOBILE FOOD UNIT: Permit expires TOBACCO SALES: 12L37�2006g FROZEN DESSERT: Thomas A. McKean, IRS,CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE t '- j own of Barnstable I �g - . o° egulatory Services (' o ' �; Thomas F. Geiler,Director �n`�V�,�j s 9 �M .�d Public Health Division ` Thomas McKean Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: �� ADDRESS OF FOOD ESTABLISHMENT: Zo P r 2� ,/(� MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: 2�i`( PARCEL(S) L! TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL:. / TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO L : P11 DAYS CLOSED EXCLUDING HOLIDAYS (I.E.MONDAYS) /J IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMIlWIDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY Q / o X FOOD SERVICE , C�' RETAIL FOOD < N BED &BREAKFAST CONTINENTAL BREAKFAST M RESIDENTIAL KITCHEN MOBILE FOOD ry w cr rn TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING ---t4 OUTSIDE DINING �(OVER�)� Q:1Health\AppHcadon FormsToodappl.doc "`� ***REMINDER*** . IF OUTSIDE DINING YOU MA BE APPROVED BY THE BOARF HEALTH AND ' LICENSING. AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? ei IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT `^- 1 SOLE OWNER:' NO ADDRESS ' 'k (,Pve �✓�`f[�- PHONE #CSV) IF APPLICANT,I$ATARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 10 STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): , LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE.ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION'CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS , OF OPERATION.***PLEASE PUT THE- NAME OF THE ESTABLISHMENT ON. THE CERTIFICATE*** ` 1. Ins ��w' �^' EXPIRATION DATE: 2, EXPIRATION DATE:/ iJ 06 L-0-6 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: i SIGNA OF APPLICANT AND DATE QAHealth\AppHcadon Foras\Foodappl.doc r __ ***REMINDER*** IF OUTSIDE DIMNG,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA L IS WAIT STAFF PROVIDED.FOR OUTSIDE DINING?- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?' 'e . CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: �E) /NO ADDRESS ' Z'P COvJL­ - CIK/�. (C,�. Ckv eyolu m PHONE# JL�j� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 043,o Z 7 7T& STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): , LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF(I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004,EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION'CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE- NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. �1D�^�^ '`'�`�t ''�- EXPIRATION DATE: 2 EXPIRATION DATE: / / 3. EXPIRATION DATE: ID51 4. \J0 EXPIRATION DATE: `� /_ / . o.9 SIGNATURE OF APPLICANT AND DATE QAHealth\Application FormsToodapp I-doe l .L V r1 u ux ]ual llata Regulatory Servi o(v w' Thomas F. Geiler,.Directo • sAMerescE, • �� "ASS. r 'Public Health Division prED N1°�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax:%8-790-6304 APPLICATION FOR PERMIT TO OP ERATE A FOOD ESTABLISHMENT DATE: I NAME OF FOOD ESTABLISHMENT: �i✓��/ ADDRESS OF FOOD ESTABLISHMENT: (ZQ MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: ZR PARCEL(S) 9( TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: _ OUTSIDE: TOTAL: IeO TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: �w� TYPICAL HOURS OF OPERATION MON-FRI: TO Z: ; 00 DAYS CLOSED EXCLUDING HOLIDAYS J.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY f FOOD SERVICE RETAIL FOOD 0 BED &BREAKFAST .o CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES _7CATERING I/ OUTSIDE DINING (OVER—+) QAHQth\Application Fonm\Foodappl.doc �, PERMITJVO: TOWN OF BARNSTABLE 12/28/2006 195 BOARD OF HEALTH PERMIT TO MENT In accordance wit"eg atutns�omnlalted' Rr,au �ioritX of Chapter 94, O Section 395A and Ch4'e 111 1%;54&thi- er rt is hereby granted to: SNARKY,INC.,C/O JOHN CUN I RBYANN'S Whose place of business Is PORTS AA�, 1#NNS; 02601 � Type of business and any restriction,sf Fa�dp s�Rv C�Es' {ks41sHMENT To operate a food establish e'nt Fra tl�e mnJM ,q I S /8 RESTRICTIONS IF ANY: FOR 2004 FbO ;PE tMIT WILL NEED A NE_Wy WALK IN COOLER FLOG SEATING: 150 AN. f►L, YS ,. SEASONAL TECRAfAN Ae tY: k � FEES �.. � . 901 e . ' pFHEALTH RETAIL FOOD STORE: 0. FOOD SERVICE ESTABLISHMENT: $ O e Iller, M.D., Chairperson �P u Canniff, D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: At �w; RESIDENTIAL KITCHEN FOR BED+BREAKFAST: � �� Jls ichi S8W8Vanaw MOBILE FOOD UNIT: � '1°�3'�12�1 m � e`S. C�!• TOBACCO: v � 1� FROZEN.DESSERT: ' Thomas A. McKean;RS, CHO CATERER: Director of Public Health NOT VALID.UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE PERMIT NO: TOWN OF BARNSTABLE JANUARY 1, 2005 195,.. BOARD OF HEALTH —`� PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws, a permit is hereby granted to: JOHN CUNNINGHAM D/B/A: BARBYANN'S Whose place of business is: 120 AIRPORT ROAD , HYANNIS, MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 150 ANNUAL: YES SEASONAL: TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: Wayne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: $250.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2005 � FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE f Town of Barnstable �so= * �oFt ra,-o Regulatory Services p 0 D r Thomas F. Geiler,Director EAMSTABLE, 9� MASS. ,0� Public Health Division Alf1 39. 1 Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: _-4/y,/0� NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: I Z� / �� ✓� G� f MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: z9 PARCEL(S) O TELEPHONE NUMBER OF FOOD ESTABLISHMENT: S( �K ) 71 - �t��� NUMBER OF SEATS: INSIDE: /S 0 OUTSIDE: So TOTAL: TOTAL NUMBER-OF BATHROOMS: S ANNUAL OR SEASONAL OPERATION: d vl rn,vw 1 TYPICAL HOURS OF OPERATION MON-FRI: I TO IZ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) N-°'- .IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY i FOOD SERVICE ; RETAIL FOOD C7) BED &BREAKFAST 'i �. CONTINENTAL BREAKFAST ; RESIDENTIAL KITCHEN ! MOBILE FOOD TOBACCO SALES �= FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER-+) QAHealth\Applicadon Forms\Foodappl.doc J ***REMINDER*** IF OUTSIDE DINING YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)? CONTACT INFORMATION: _ M FULL NAME OF APPLICANT SOLE OWNER: S /NO in i , ADDRESS py .�'Alt�-✓L t&L PHONE # CiL90 �1-9_- Z� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: a IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAME S OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD i SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1, ,,\, Culw � i EXPIRATION DATE: �(� / / 2, � ��r EXPIRATION DATE: Os�l 9/ / 07 3. EXPIRATION DATE: 4. EXPIRATION DATE: SIGNATURE OF APPLICANT AND'DATE'' Q:\Health\Application Forms\Foodappl.doc T, own of Barnstable Regulatory Services ' Thomas F. Geiler,DirectorBAM" AB Public Health Division i639 1� Ep M(d Thomas McKean Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 9 NAME OF FOOD ESTABLISHMENT: krt �� j ADDRESS OF FOOD ESTABLISHMENT:_ 7-0 ��rn.0/t ow"i J MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: Z9 'PARCELS)- 1 ' TELEPHONE NUMBER OF FOOD ESTABLISHMENT: O NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: o TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: V\Vxja TYPICAL HOURS OF OPERATION MON-FRI: TO : ,0 0 DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) �M � IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY /FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING (OVER---4 ) OUTSIDE DINING QAReatthUpplication Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND t LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? I IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION:FULL NAME OF APPLICANT q h ("vt AA w; SOLE OWNER: jYE,S/NO ADDRESS /2i C'V"� ,21 �,h �� � �I✓� PHONE # C�o ) 31b - Z� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. .o 3Da77 STATE OF INCORPORATION ,/° ` FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1, ol1v� wi w- EXPIRATION DATE: 3 2. EXPIRATION DATE: Co / Z/ O )/ 3. EXPIRATION DATE: 4. EXPIRATION DATE: 1 �2i o i off_ SIGNATURE OF APPLICANT AND DATE Q:\HealthWpplication Forms\Foodappl.doc `1 a. PERMIT NO TOWN OF BARNSTABLE JJANUARY 1, 2003 195 BOARD OF HEALTH PERMIT TO OPERATE A FOOD`ESTABLISHMENT In accordance with regutahons promu)Egated, nder authority of Chapter 94, Section 395A and Chapter 11 ;SehonS of the General haws,a permit is hereby granted to: JOHN CUNNINGHAM �p/g/A BARBYANN'S Whose place of business is 12Q„ALRPORTQAD, HYANNlS, MA 02601 ti ` Type of business and any restrictions FOOD SERUIGE ESTABLISHMENT To operate a food establishrrlent in t E RESTRICTIONS IF ANY ...0 SEATING: 150 ANNUAL YES . SEASONAL: TEMPORARY s, E E$ BOAFID OF HEALTH RETAIL FOOD STORE: Susan G. Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT $f700EY ` z sf RESIDENTIAL KITCHEN FOR RETAIL SALE Ralph A. Murphy,M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST " : " Sumner Kaufman,M.S.P.H. MOBILE FOOD UNIT: Permlt,explreS TOBACCO SALES: �,n December 31, 2003 FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: Town of Bauble °FINE T Regulatory Services ti Thomas F. Geiler, Director ��E� MASS.STABLE ` Public Health Division �ArE1 Thomas McKean,Director DEC 11 2002 367 Main Street, Hyannis, MA 02601 _ r Office: 508-862-4644 Fax: 508-790;6304 L-----_, ._. Renewal: No Fee SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. 2V o DATE I o Zg 19 �- APPLICATION FOR PERMIT TO OPERATE FOOD ESTABLISHMENT FULL NAME OF APPLICANT ���^'^ GU'�"'"`�'"�'s'A— NAME OF FOOD ESTABLISHMENT ' �iAp 0,'^-7 "mac ADDRESS OF FOOD ESTABLISHMENT I ZO L-rnzf�­ TELEPHONE NUMBER J ©� -7 TYPE OF ESTABLISHMENT: FOOD SERVICE v RETAIL FOOD MILK BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER:,," YES NO. IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION m j� FULL NAME AND HOME ADDRESS OF: �- PRESIDENT �o�� ,/�. �� ��� � (� ou TREASURER CLERK SIGNAT RE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# -bF 71-0'� q IS Foodesdwp/q PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2001 195 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: JOHN CUNNINGHAM D/B/A: BARBYANN'S Whose place of business is: 120 AIRPORT ROAD , HYANNIS, MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 150 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G. Resk, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: $170.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: 'o'LTOBACCO SALES: December31, 2001 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE p .kn0 , o',o Town of Barnstable A P°FUWE Regulatory Services Thomas F. Geiler,Director s r 9'" g Public Health Division 7-0' qj i6J9. '°rFwY" Thomas McKean,Director 0- 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $50.00 SEATING , , ANNUAL_ SEASONAL ASSESSORS MAP AND PARCEL NO. DATE I I� APPLICATION FOR PERMIT TO OPERATE'A FOOD ESTABLISHMENT FULL NAME- OF APPLICANT NAME OF FOOD ESTABLISHMENT ADDRESS OF FOOD ESTABLISHMENT A ro»r � K V k7 TELEPHONE NUMBER �`�� 7-7f- q -1 q� TYPE OF ESTABLISHMENT: FOOD SERVICE X RETAIL FOOD MILK BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES_ FROZEN DESSERTCATERING SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: A iW tii[''Y Lila.pp*.TT a" A "COIDPf)"-A TiON: Yu E A T an1TSTT1F1C A 9'TON NO tfN 1 1�tf'l.'U'a�i\.dX%A%i i'3vi1. a::^D �..u.ar�x...x STATE OF INCORPORATION V Y J FULL NAME AND HOME ADDRESS OF: � PRESIDENT �j,�nv� �n�i �-- Z� �v2 +y 1Ctw� �Z �����`I� VL1✓� TREASURER CLERK k SIGNATUft OF APPLICANT RESTRICTIONS: HOME AD ESS HOME TELEPHONE# <,OF. ? gg. Z�qt Foodestlwp/q YY oFtr Town of Barnstable sexrvsras[E Department of Health, Safety, and Environmental Services 1- per Public Health Division AlED1A0�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. IA p� DATE ` APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT J�In✓� cm l A rll�vke_ NAME OF FOOD ESTABLISHMENT ZiiJ�� uwy�1 �Q S��ilytl wr ADDRESS OF FOOD ESTABLISHMENT lZG A'k(no("r TELEPHONE NUMBER TYPE OF ESTABLISHMENT: r/ FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: YES NO -> IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS ACORPORATION: FEDERAL IDENTIFICATION NO. 04 3 o7,77s-. STATE OF INCORPORATION IYI FULL NAME AND HOME ADDRESS OF: '7` n f PRESIDENT `01�,+� 1h. GM�tn;�i\1 p�,� ' (/ ► 6y -4 11"1 dliG TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADD SS f .- 6"c HOME TELEPHONE# 1 0—7-1 1 foodest/db/q y ' PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2000 195 BOARD OF HEALTH _ - PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: JOHN CUNNINGH" D/B/A: BARBYANN'S Whose place of business is: 120 AIRPORT ROAD , HYANNIS, MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 150 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G. Rask,R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: $170.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $170.00 NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 150 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: ,s MILK: TOWN�OF£BARNS TABLE 7 'OF IiEAI�TH` RATEA F PERMIT TOOPEOLD ESTABLISHMENT t ,. PERMIT NO: 195 JANUARY 1 1999 AL In accordance incith reguiavons omu gated under author>Ity of Chapter 94, Section a39�5A and Chapte`rV ectlo �a�.of the General Lawsj a permit is hereby granted to: ' JOHN CUNNINGHAM , ' D/B/A: BARBYANN'S �a AM 1' Ili ���� ' Whose place of business is 120 AIRPO10t 0AD , Z,,' ANNIS, 601 . Type of business and any fe�st�lctio s: FOO SERVICE ESTABLISHMENT To operate a food establishment�rikl'the TOWN OF BdRNSTAB E� "; .:. .N I Permit expires: December h"'1999 'i' 10, .1 E.: . . BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P.H. C�PQ).2- Thomas A. McKean, RS, CHO Director of Public Health FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $170.00 NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 150 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES <: TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: :40" TOWN Ql=BARNSTABLE,,, ABOARD'OEAEAETH e PERMIT TO O A PERATE FOODcES, BLISHMENT PERMIT NO: 195 z `r�, ��� ,,. �� � . � �� JANUARY 1, 1998 In accordance w"tli'regulAd, promulgated under authority,of Chapter 94, Section 395A and Cha ter fmitf. ectian of the General Laws,-a permit is hereby granted to: � . w - JOHN CUNNINGHAM D/B/A: BARBYANN'S Whose place of business lww120,AIRPORT I1,,,.I=LYANNIS, U 601 ' , r Type of business and any..restrictions: FOOD SERVICE ESTABLISHICRENT x,. . Y ra To operate a food establishment �i"e TOWN OF BARNSTABLE if Permit expires: December 31��1998 F , XJI .a.. �4... Y BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P. Thomas A. McKean, RS, CHO Director of Public Health tv Town of Barnstable • Department of Health, Safety, and Environmental Services BAMSTABM MASS. Public Health Division t639• p'FS639 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING SQ ANNUAL / SEASONAL _ ASSESSORS MAP AND PARCEL NO. O-Lg`I 01 DATE I It o APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT 94/kn NAME OF FOOD ESTABLISHMENT 1 ✓� ►'�w�� ADDRESS OF FOOD ESTABLISHMENTY�� TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Oq 30 A STATE OF INCORPORATION #\A- FULL NAME AND HOME ADDRESS PRESIDENT TREASURER CLERK SIG/NA E)OF APPLICANT RESTRICTIONS: HOME AD RESS ('Qitn .a1v16 HOME TELEPHONE foodest/db/q FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $170.00 NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 150 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES ' TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN Ole BARNSTABLE r BOAI D OF !EA" PERMIT•T,O QPEI TE A,.FOODM F-STABLISHMENT PERMIT NO: 195 " JANUARY 1 1997 ,36 4 In accordance withregulations promulgated under auto of Chapter 94, Section 395A an Chapter 111, S'ec"44k he General caws a 5permit is hereby granted to: JOHN CUNNINGHAM D/B/A `BARBYANN'S ' Whose place of b usines is: 120AIRPOR S,511 MA 400-11- * �� Type of business and any, a ri ns: Fib. E I BLIS M T ... p �` r - � To operate a food establish -TOWN O TABL Permit.expires: December 3't 9g H& BOARD OF HEALTH Susan.G. Rask, R.S., Chairperson . e Brian R.Grady, R.S. RESTRICTIONS IF ANY: _ Ralph A. Murphy, M.D. 17 o Public ThorriasA. McKan ,CHO . ,�; � � _ _ . .- - -- �.r `� .• _ � . Director f P lic ealth . .¢,•, �.,z. t.w:.,�gyv'* -it n. '''.4r -.+t�- .-. �'- •wn-'- -•.-2Fa,;�-..i a,:` t+ .y. ..�:.:,.,,.... :.:�'... .. - _... TOWN OF BARNSTABLE TOBACCO CONTROL PROGRAM BARNSTABLE DEPARTMENT OF HEALTH 367 Main Street, Hyannis, MA 02601 Patrick R. McCormack, MPH Tobacco Compliance/ Health Inspector Tel: (508) 862-4644 E-mail.'mccormack . own.bornstnble.ma.us Fax (508)79076304 ETS INSPECTION REPORT Board of ���� Health: Village of: LfHyannis ❑Centerville ❑Osterville ❑Cotuit ❑Marstons Mills ❑West Date:// /j J /00 Barnstable ❑Barnstable Establishment Name: a v G7 N N ' Purpose of check: Address: o /�. Routine ✓— Telephone: Complaint Person in Charge: �' Other TYPE OF BUSINESS or i PLACE ❑ Cigar club/bar ❑ Office ❑ Bar ❑ Retail store a�$estaurant ❑ Public place Bar area of restaurant ❑ Indoor sports arena ❑ Retail food establishment ❑ Public transportation vehicle ❑ School ❑ Based on an inspection today,the items checked below indicate the violated provisions of Board of Health REGULATIONS AFFECTING SMOKING IN CERTAIN PLACES. ❑ Smoking in public places ❑ No signage ❑ Restrooms ❑ Bar area not enclosed if applicable) ❑ Improper si na e ❑ Waiting areas ❑ Seating capacity(20%max/enclosed area) ❑ No ventilation if applicable) ❑ ❑ Self closing doors if applicable) ❑ Improper ventilation if applicable) ❑ ❑ Negatively ressurized if applicable) ❑ Entrance was ❑ O� On this day, the above listed establishment, business, or public place is in compliance with BOH tobacco regulations Comments: elf ;u: je / e Inspected by: z;dl�le Z'e�� I FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: $125.00 NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: 150 RESIDENTIAL KITCHEN FOR BED+BREAKFAST: MOBILE FOOD UNIT: ANNUAL: Yes TEMPORARY FOOD ESTABLISHMENT: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 195 JANUARY 1, 1996 In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111, Section 5 of the General Laws, a permit is hereby granted to: JOHN CUNNINGHAM D/B/A: BARBY ANN'S Whose place of business is: 120 AIRPORT ROAD , HYANNIS, MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit expires: December 31, 1996 BOARD OF HEALTH Susan•G. Rask, R.S., Chairperson Brian R. Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. i Thomas A. McKean, R.S., CHO Director of Public Health t SEATING: 150 FEE SEASONAL: NO RETAIL: FOOD: $200.00 MILK: DESSERT: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 195 JANUARY 1. 1995 In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General laws, a Permit is hereby granted to: JOHN CUNNINGHAM D/B/A: BARBY ANN'S Whose place of business is: 120 AIRPORT ROAD , HYANNIS, MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires: December 31, 1995. BOARD OF HEALTH Brian R. Grady, RS, Chairman Susan G. Rask, RS Joseph C. Snow, MD Thomas A. McKean Director of Public Health !I .;Z SEATING: 150 FEE , RETAIL: FOOD: $200.00 MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FoQn ESTART,TSHMENT PERMIT NO. 199 JANUARY 1, 1994. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: JOHN CUNNINGHAM D/B/A BARBY ANN'S. Whose place of business is at 120 AIRPORT ROAD, HYANNIS, MA Type of business and any restrictions- FOOD SERVICE ESTABLISffiMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1994 BOARD OF' HEALTH Brian R. Grady, RS, Chairman Susan G. Rask, RS Joseph C. Snow, M.D. Thomas A. McKean Director of Public Health SEATING: 150 FEE RETAIL: FOOD: $225.00 MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 219 JANUARY 1, 1993 In accordance with Regulations -promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: JOHN CUNNINGHAM D/B/A BARBY ANN'S Whose place of business is at 120 AIRPORT ROAD, HYANNIS, MA Type of business and any restrictions FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, _ 1993 BOARD OF HEALTH Susan G. Rask, Chairman Joseph C. Snow, M.D. Brian R. Grady OU rmr' 4_4� Thomas A. McKean Director of Public Health SEAATING: 150 ANNUAL NUTABER FEE THE COMMONWEALTH OF MASSACHUSETTS 225 $2.25.00 TOWN of BARNSTABE9 Board of Health of PERMIT TO OPERATE A' FOOD ESTABLISHMENT Permit No. 225 JANLTARY i, 19--q2 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: SNARRY, INC. D/B/A BARBYANN'S RESTAURANT Whose place of business is 120 AIRPORT ROAD, HYANNIS Type of business and any restrictions FOOD SERVICE ESTABLISHMENT To operate a food establishment in TBWN OF BARNSTABLE (City or Town) Permit Expires DECEMBER 31, 19 92 Board of Health FORM 738 Re,1986 AGENT NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 41 $225.00 . . . . . . . . .d"�. A: . . . . of .. T5'I,I LW. . .. .. . . .. . .. . . . . .. . . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT 41 Permit No. .... . . . . .. !?�p d . d.. . . A . .. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: PEM DWG . . .dJb/ . . . . . . .. .. .HARBY&MI'S R=THWiT. .. . . . . . Whose place of business is . . . . . . . . .. . . . . . . . . . . . . . . .. . . .120 Airport. Road,. l'1yannis Type of business and any restrictions . . . . . . . . . . .. .. . . . . .' m. VIi72.W.ZAZT,j��'�, ,,IT, To operate a food establishment in .. . . . . . . . . . . . . . . . . . . .'�N. .O.F. . N�`I`. • :. .. , , .. . , ... I (City or Town) Permit Expires . , . . .. . .19 . . I I JAIL, ,I$UmgMr. �IR. .. . Copy . 9v5kq JPZAN�j. . . . .. .. .. . . .. .. .. .. .. . . . Board This Copy To Be Retained By Local (7 sr+pu.C... ,swu ,,m.T? ,, ,, ,, ,, ,, ,, , of Board of Health. Health FORM 738 HOBBS&WARREN.INC.-1986 M i MM AT NG: 150 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 270 V25.00 T:1Dz. . . of .. .R-, M-7-1 Mn . . . . . . .. .. . . . . . .. .. Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 278. . .. .. .. 1, . . . . 19.(�0.. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: . . .. .... . .rT T ,at.���. T?Ir'. . . . . . . . . . . . . . .. .'3 " v'nTMTr" ad ? LT�'ur .. .. . . . . ... Whose place of business is .. . . . . . . . . . . .. . . .. .. .. . . ..TZO.Ai rt .P.07L'I" .Hy xais .. .. ... Type of business and any restrictions . . .. .. .. .. .. . ..1'': ?:5 M-it Wmj.352Z!J Tj ti �•I�v. .. . .. To operate a food establishment in . . . . .. .. . . . . .. . .. 'Fj.Qs . ''s?'r—A T�� . .. . . .. . . . . . . . .. (City or Town) Permit Expires .. . ''_? ? s• •. 19 . . M.D. 01-:Zinnn Copy Ann 77m� . .. .. ... . .. .. .. . Board This Copy To Be Retained By Local ;i?'Ir FTp ( C,n' cis', <r, of Board of Health. Health FORM 738 HOBBS&WARREN,INC.-1986 • ' Agent Seating: 50 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS B $75.00 . ...... .. . Tocan .. of .. .Barnstable... .. .. ...... .. .. .. . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. .. .. .. ...... ..No.vemblrx.I. .. . 19. £3.7.. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Peter Boucher d/b/a Barby Anns .. .. ... ... .. .. .. ... ... . .. .. .. . .. .. .. .. .. .. .. ... ... .. .. .......... .. .. .. .. .. . . ... ... .. ... Whose place of business is .. .. .. ... . . ... . . .. .. .. .. . 251.Zyanough.R oad, B.yannis Type of business and any restrictions . . .. .. .. .. .. .. ... ... . Service Lst2h. .. ... .. To operate a food establishment in . .. ... .. .. .. .. .. ...o.. of Barnstable (City or Town) Permit Expires . . December 31 lq '8 Grover C.M. Farri-h, T.I)., Chairman Copy Ann ;Janeuktb€agiz Board This Copy To Be Retained By Local Tame) i.,,Crocker,, ,,,,,, ,, ,,,,, , , , , of Board of Health. Health .. .. . ... .. .. . .. . .. .. .. .. . . .. .. .. ... . . .. FORM 738 HOBBS&WARREN,INC.-1986 Agent it _;ATING - 50 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS --T-DWN..... of --......BAR-NSTARL--E-------------------------- Board of Health of PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT Permit 1\lo. ............................ 19----- Nave�nber---1-5---------- 95 In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: .............................. eter-Boucher----ti/b f$....------....BAR-B-Y-AN-N'S--RESTAURANT--------------------- Whose place of business is ---------------------------------251-1yanaugh-Rd.,11-yannis---------------------------- Type of business ---------------------------------------------------------F Od.ser.vice-.establishment-----------------------.-. To operate a food service establishment in---------Town-o€-Harns-teble------------------------------------------- (City or Town) Permit Expires .....December.31-----------------186...... Robert-L:--Childs;-,Chairman------------------------- Copy _ Ann-Jane-E-shbaugh------------------------------------------- Board This Copy To Be Retained By Local GroveT'-e:"Y:F-arriSjti'Fr'f;'a:"""""'-----""'---- of Board of Health. .................. . . ............ Health FORM 738 HOBBS&WARREN, INC. AGENT August 3, 71 Mr. Stephen J. Cotto c/o The Galley Restaurant -s Iyanough Rd. Hyannis, Massachusetts 02601 Dear Mr. Cotto: On April 20, 1971, an isnpection of your establishment was made by Mr. Evans, of the Barnstable Board of Health, and on July 20, 1971, another inspection was made by Mr. O'Hearn and Mr. Dorgan of the State Department of Public Health. Each time you were presented with copies of the inspection reports citing the noted discrepancies. Both inspections generally noted the same discrepancies Over the three month period. You are hereby notified that another inspection will be made on or about August 31, 1971. It is expected that previously noted discrepancies will be corrected by this time and that your restaurant will conform strictly to Article X. the Sanitary Code of the Commonwealth of Massachusetts. If not, action will be iniated by this office to revoke all licenses auth- orizing your operation. Francis H. Lambert, Agent Authorized by: Robert L. Childs, Chairman Joseph P. Macomber Gerald W. Hazard, M. D. BARNSTABLE BOARD OF HEALTH IKE/p �z C 3; Get b a....: 3t` t {- . "f '^ a.:• ` k`# October , 68: q e, ¢- e- Y k s�•. ,.r s •* r�, u •aY £ ♦4 ry -""[ fit. 1 „ < s �. JQss,ie�s:.Restaurant ' .° M w r b b e. i. 4 251 I �-anou`:h-Ri�� t � ,to - � A�„ t. . �� • - Eiyannis,rmassachi etts w` Gent lemon ; "K a.. Th to Fiat i°fY'.You"that ttte tiHoard_of Health�,:vii 11.not renew' your.-food'service germi t f orr,this.restaurant'until It has•,beenµbrougit .itp` to tlte. Standards of,�-Article X;,'of .the Tiassachuetts' Sanitary, Code. For further information please call bhi's office. ' Respectfully yours t r .i a a § •"< r d'^ {5r _, s t ti � � � VG } > t r,.." .r �� t . y' r>;per '� z � *-, t _ .� } .� � ;kq F - �N �� e f •k � P s Franc is,H. Lambert, R•uthor'Ued ant x ' Board of e flea It + "� Town of ;Barnstable•ek t } 'r r Ate' -0 ,'• �- .X , • t i '{ v.#' y`f .vy 54 d r.' 3 Ali `'' •'4� «;� tt�vP ,�. ;�' ,t t.. � `''.r , G _ Mr w_- •* 'r .F r � �' , $ a ,0 T SENDER? �'cmplete items 1 and 2.. e Add your address in the "RETURN TO" space on 3 reverse. W 1. The following service is requested (check one). 7E] Show to whom and date delivered-.-.-------- 150 ❑ Show to whom, date, & address of delivery.. 350 DELIVER ONLY TO ADDRESSEE and show to whom and date deliver'-1-1- -L 650 DELIVER ONLY TO ADDRESSEE and show to whom, date, and address of delivery ------------------------------ -------------- 850 2. ARTICLE ADD ESSED TO: Mr. Stephen J. Cotto Galley Restaurant-Iya 44 , Rd z Hyannis, Mass. 0260�1 m 3. ARTICLE DESCRIPTION: REGISTERED NO. I CERTIFIED NO. I INSURED NO. 833603 . rn to (Always obtain signature of addressee or agent) zI have received the art'cle described above. m SIGNATURE v Z N C 4, DATE Of ELIVER POSTMARK D G 5. ADDRESS (Complete only if req(jested) n m 1 m 6. UNABLE TO DELIVER BECAUSE: CLERK'S. v INITIALS D r o GPO:1974 0-522-803 4� a UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS �PNN1S?' ALTY FOR PRIVATE T22U 0 AVOID PANIWENT=--- SENDE:R INSTRUCTIONS NA i OF POSTAG6P.$$ Print your name,address, and,ZIP Code in the spa belowIg 4 1• Complete ite and 2 on reverse side. • Moisten gummems d ends and attach to back of a e2 F�f "� -r„ _• �-�°' RETURN h TO a i Irt Ir Dourd of Health R in of Barnstable 397 fVlain Street `A HYANNIS, MASSACHUSETTS 02601 t - - e �... � y .+, a • t , � •t `� r. t ri .Fa`F, 7 4.<.- �'t �x .v ae • h e«��y ' �.3" r t `. 4 ,, c" ". s' at '., i • r ... 4 a1' t / �t� r... - v�r �K'fM ;- k u.' f,e F.., x � jr, ; r•! s t • a . 3 :: 6 ? '" 4 cr ' .,V•,{t `,5 .''it - j , a. ., h ` r . •r .. r. T +s.^r d r 4r,.., ! 1�.r, b Yx g 14y eft " , >' �.1•, as �t t_ r i 'q' y "�. �, �- OCt©Y?®r- 21y =�9 lM r ,. .,, - ` ' 1 t��^-i R, t .[...fi ac r?.`t r'P ''�-e�/ j �.y'ya a�,ra'�� 4; �•, ;Y.,�. -Y '`-. t 41 ' Mr. Stephen; �.Cotto: r Galley' -Restaurant,".,..,-. '` K .; tit' � � • < y � ;' w* 'Iyanougli Road: , k Hyannis `.Massa:h s ,: ` .r -f - .,V, .., .. -.- :, •j - ' p :. � .. . „f ,+ t- • a -- 4t . 'S.. NOTICE: TQ`.A,BATE VIOLATIONS ARTICLE�X M�N�MI7NF 'SAN'�TATT4N ;.STA"At S FOR � FOOD SERVICE "ESTABLISHMENTS• x '< \ A S w The' Galley 'Restaurant 'byt.yc►U, at Iyanough Road, Hyanni ywas s, • inspected '-at approximately_ 2:3�Y F. I , , bctobe ' 16;. 1974, =and"`the f6l1bi4ng"violations were noted• �i ♦ 1 L`. •REGUL. ,} t,y � t I'MON :3 s l s' Uncovered 'food in refftgerafior REGULATION 5.5: Cook,did'not have -h�,t or heffectiveair _restrain . axe "washing-dishes .smo'k ng. a' cigarette in 1citch n•'ar.ea. ' -REGULATION 6,l.- Tood embedded.. i`n.'cseV'ide of,. wog3 near steam table'.: S M' }'REGULATION 7:2 ="Counters :"throughout {kitchen,area .sta'ied` with'}dried food, � �hel' where dishes stored, dusty r greasy,,spatulas ; T?irt 'kn3vee Knife with' handle:.taped,. 7,3: Dirty "clothes "an kitchenf to sie, r 3' <. F: 7:5 F06d contact surfaces hot ,sa itized 'prior_ to use': REGULATION,•.11:5 No ,toilet; tissue x:n,Meri'.s ''Roomr` t .> R` � rr.•� �c . ter. - REGUTATION. 13.i r' I3ump'ster not, closed Open fou l ,different 'times" 3n 4t four t dif fever t'firispections t. RE -AT 1.41.. erokex . wnc�ow -►.:balkrea ,P iv . ..} , . r,.+4 * ;J 's' 1• a '` - - 7 _REGULATION 'l5.lz; Floor' in--kitchen''not. flush, to call. `Dlrty under.. r ',equipmer t,,and `corners., } REGULATION , N l9 1 F1 u©re ht ea . . scent ,li,k. '� s. in�•'`kitch�en covered with •.h � dust: Y t REGULIATIOX l32.1: .operating` without }la valid ermit� Food Servi F P Service erm*t. J4�a:.'>M1 ^Yt" 'tr, . •. r *f ji F'; �r - r - .. -` - - •d r. •4A- r7► ,�' r rp z.? i a i �,t a r a' ,��'Hx car ;4.'tyr r` a� • " 4,.. 77 ^�. ..; •,. ! a tr ,Y.a .� �«d "�:'^ w 4aa { � is � °' . mot. t „ir '>°`.- Mr.. +Stephen ' Cot ♦� .,oct©ber Y217- 1974 ®n ,©GtQber, 8 .[ .974 'y031, �d'et'!V';'O ®2� �, t"*0 't3f �Attic e X1 M TtiEtitiM" � >� Sd A t r t , , a fan<Standare�s ,fcr Food Servile R `tab shment's '. ot signed `'3 r�C$ipt 'for thi► .Regulatxcan °.. You are directedo{ yc,�are �t s l;.t� eq"aba�ve discr'eaanc es, a�tn .x sewn_ a © receipt''of i+hi6 orr: �.�. iY rt C .� iu Qr t� digs 4+J t.: .f'�� d *rQ.�u l your, estzibizshruint'l,be�ng., c ,osec� for" fa l�ure,.tQ�in�intairi i�inir�ta� :standards':-� �1 You, are:.reminded. that` our,restaurant ``has 'been many '. /�/>�� .: in v3Qalat on o > 'Q W"1:�t7rS .C>nS f _l r .° You are also so- rem that ai2ure ;td coy P. with thi's order ,ci�uld, ,result in"a $500 ine, Each days failure :constituting a.rseparate viclat�.c�`n: r. ti 4 'a•a� .r_ y � •%F"� Yau mayG xec�uest a. ;hearing sefdre the �oa`rd o Health' if written tit-Ion', rec uestiz 9 same is, received rs'evr t,'7)' days after= the.'.dat�'archer A i�a7` V. served. . - � �� r•,5 of i� •e ,r:.a ° .. !'� ,," } � Director:`.'f'Publ 3.LC `Health `t k 4�� " K �.,�.! � ,�` f !� •L. r b�4e �+ i s ,'�'5 t � '4 �. : a." D a `y+� �Y. ` t r r r .' .0 'c J r T✓ ,4r4 1^ 4'� a fi 44 `* s r d �•' ,a .*> J.u' y ."{� �r r ` { .'.� A �> 3 • � ,r z � t a:' a I .r` -d .� x.i�. �, }1 aa� s �`�' � .r'Y �^� G *, yr ," -x .•� a r• ' .j. t, a �Y ;r 3 e 7r e. ;3 a. {' • e ' ex- «fir F " Y � �� °. " " ;'i t ;� 4 .,+ x-� �� r t,�•�: � A... ! ,. r^ '� ,, •.`, 4 .. �',:r,. e� Y :, r, � x. �� ''rid x �� r l r i r.ra� r w� r r.. ♦ 's i,_' t _ } ',�._' .,.a � Y ': .. ' d`x �'^>"�Ex> r r .•I;_+ �' -1! ... 'ram a ,.y � ° a ' ? k�' - t �! �" �4,, h t,. a ,y ,t� c q - .x pro. . �.•Rt r! � �•} .z r ' t}. .�• � a� ' = t July 1,- 1975 . Mr. Pau l Brown Chairman, Board 'of Selectmen Town of Barnstable p. Hyannis, Massachusetts 33ear Mr. Brown The Boardof *Health is very disturbed at your granting•a seasonal -Beer And Wine -License to`. the galley Restaurant,, ,- In� 1973 and 1974, under, the same ozanershlp, the', Galley was fined in District Court for operating without a Common ` Victualler's License. Prior to your licensing 'of this restaurant for hoer .and 'wine, you requested an evaluation by .the Health, Depart.mcnt, A ' memo sent" to you on prune -10 revealed many discrepancies and a violation that this restaurant• causes more problems than all.. � others in Town combined D A memo, with a dritten'inspect on report, Ilas sent to .you on 'April 16 informing,'you of..bur intentions to revoke the Food - 1I Service Permit .permanently. this ��me we requested you t® 1 take action to revoke the Common ,,Victualler's license. This roc was.• ignored and•. we. were, not even afforded' the courtesy of a, r4p�y.. t The Galley Restaurant survives only- because of constant ' . rep!:ated •inspections s by the-Health Department to es ;3.t fund- • tioning at, minimum .standards; This constant.,surveilance 'is at, great expense to the taxpayers :.and cannot be' continued, Any -further violations,Will result in immediate -court ,action, again :.. at great expense to the taxpayers y Your ,.rewaxding of_ hie restaurant with .a Seer and vine license ji`�'incomprehens'ible and makes a' mockery_of your function as a licensing board. _ . Page 2 July. I* . 19'7 Your disregard, of 'evaluations requested by you and lack.',df Communication witla a' Tavrr d epaitment, `can only result. in,ram- - ficatiohs detrimental -both to .thy: 'down a.1d•°your a�m credibility - as its' governirgdy Yours very tru y, z ,Robert L• ^Ch31dsa rznan Ann Jane fthbaugh , Gerald W. ;Hazard,. M, D. ` BOARD .OF ilFALTH , �o�1r1 M. ;Melly D ':GCtOr, of Public stealth JMKK/mm D . Ar .- � T o.ti t 1� a .�-` # aYa 4 •�`,'s e � _,��r T� ' r t -Mr, J006ph Da lu z ` Building( 1hape },or• `. `, f, . his, r.. TOM 0� lo Dear Joseph { y 't�� 4 n �the �estau���ztWe aro in for -rmaatcl contu3 . a . ure to'rt"t rt .n ,mur 'standards since. SMVY' tie` would great ' :appreca at e�ari.impaction' by,you r } ' _ concerning- his Common V ctual1er1 s ',lic6nse issued by the' Q ,^ Yours tzttl y;� recto of,Publ gealth cd.A. Se r 7 � .�, J`- ',y�F" 3 � a r�r` �;s ., ' Y,f s 'x� l ,Yt , u3 �. 4. � '; , "• , . , � x� � - °r .x. Via• ® er'i:rq r' ha:: � .. +•''.x' .. rf,.y y ..'y tr ♦'� r f , i • F• ' _ '•� rc s ";„ `;�,;•. ' is! a+• .. .. f y:. _. � � 3 April 10 75 Reference: Galley -Restaurant TO : Board of Select-men From: John M. Rel ly Dear Mr. Brown : I have been informed that the. Galley Restaurant has applied for a Licmor License. Attac-hed is 'a copy of a recent letter- to Stephen Cotto informi g him of our intention to revoke his food service, Permit permanently. It is strongly recormnended action b instituted to also revoke his Cori mon. Victualler' s License. Yours very truly, Join M. Kelly Director •or Public Health. Jiirj�rrn encl. I } June 24 .75 Hr. Paul. Brown Chairman, Board of Selectmen Town of Barnstable Hyannis, Mass. Dear Mr. Broom: n Enclosed is a copy of the last inspection by the Health Department. Although improvement was noted on the May 15th inspection, the latest inspection revealed many discrepancies, As you know-- the Galley Restaurant has caused the Board of Health more aggravation in consistently not meeting minimum standards than all the other restaurants combined: in the Toim. Yours very truly, John I•I. Kelly, R. S. Certified Health Officer J14K/mm encl.. 1 i NOTICE OF APPLICATION FOR ALCOHOLIC _.. - BEVERAGES LICENSE li In accordance with Chapter 138 of the General.Laa,s as Amended. PETER A. BOUCHER d/b/a BARBY ANN'S Name of Applicant New, Annual , Common Victualer, All alco- Kind of License _1 holic r Period Covered by License datE of Is ue iuntil--1.?�-3.V81 Location and Description of Premises 251_ Iyanough Road,— Hyannis, Ma. One story, three rooms and 2 cellar for storage. Entrances/exits to Iyanough Road. A public hearing on this application will be held in the Town Office Building, 367 Main Street, __ yannis, Ma. on Monday, March 23, 1981 at 10:30 a.m. Mary K. Montagna Licensing Board Alfred B. Buckler for the Torn of Gloria W. Rudman Barnstable Legal Ad- CCN 3/11/81 SEATING: 50 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS $75.00 .............TOM......... of ......................BARNS.TABLE----------•------- Board, of Health of PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT Permit No. ............................ September ' In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Peter Boucher d/b/a BATRY ANN'S ---- ----- ------- ------ -- ---------- ----- ------------ ------.. . Whose place of business is -------------------............ 51---TYANOUGH... D,-_HYANNIS............................. Type of business and_-auy.-restrictions_--------________FOOD--SE�BICE--ESTABLISHMENT To operate a food service establishment in.......TOWN--OF--BARNSTABLE------------------------------------------- ' (City or Town) Permit Expires ...............DECEPBiER 31,_._.19..T Robert L. Childs, Chairman -------------------------------------------------------------------------- Copy ---------Ann--Jane__Eshbaugh............................ Board Grover C.M. Farrish,__M.D.___.___ of This Copy To Be Retained By Local ...........".."""-__....... Boardof Health. ...........................................=-•---....-----......------...-•-.. Health ---------------------------------..------------..........----••-----........-- FORM 73'8 HOBBS&WARREN. INC. AGENT Date Fee , TOWN OF BAR NSTABLE Of — v OFFICE OF •� `� � Ali` - - i DLH73TLU BOARD OF HEALTH >oo 1639. `��° 3e7 MAIN STREET �o yAY k HYANNIS; MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. NAME OF APPLICANT Sn r "i TEL. NO. 7 7 5—•9 7 9 5-.. ADDRESS OF APPLICANT }2 i NAME OF OWNER OF PROPERTY DATE APPROVED TTn 1.n mm� SUBDIVISION NAME N•/A ASSESSORS MAP AND PARCEL..NUMBER Maw# 294 ParrPl #{' T SIZE T' nti ems. R� LOCATION OF REQUEST Northwest Side of Building —Pat—in ArA^ VARIANCE FROM REGULATION (List Regulation) yarjapce._from. Regulari^n #14 of 'Sanitation Standards . , REASON FOR VARIANCE (May attach letter if more space is needed) r; (-;:Please see attached 1 PLAN ' TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. ::, VARIANCE APPROVED NQT APPROVED REASON FOR DISAPROVAL F TH PT. 47 RnRST. Groyer'.C, M. Farrlsh,Chairman ' UN 1 2 �990 Ann Jane Ashbaugh A • James H. Crocker, Sr, • • BOARD OF HEALTH TOWN OF BARNSTABLE ,barb vanp' _, "..�. ,•: :.HYANNIS. MASSACHUSETTS ' 775-9795 �-,--- June 7 , 1990 To—Whom It May Concern , We wish to convert this exsisting patio space to a con- venient waiting area . On friday and saturday evenings we have had customers sitting on our steps , on the adjoining grass , and generally standing about while waiting to dine . We feel that it would provide a convenience to the public if we were allowed to provide them with seating and tables , also to allow them to be served beverages and choose from a small raw bar while waiting to dine . We would also like to offer , weather permitting , the avail- ability to have lunch outside on the patio during the afternoon . In no way would we exceed , at anytime , our present seating capacity of 150 . We expect not to increase business through these improvements ,. but to deal more effectively with the needs -and requests of our customers . At this point , we have or are in the process of meeting all the criteria in satisfying Regulation 14 , Town of Barnstable-Health Regulations . We invite the Board of Health to please come and inspect .th.e premises at" your convenience . We Remain Cordially Yours : cc : William T . Thomas r Peter Boucher John Cu i am outs a--6 19 T,� ,�j���2G,r✓/��T. C,�- �/� f���7JiC�J ;�U�2�sV'� T�� OA-J � 70 /rc� �,zJ,-G v��nu�� �U•uc� aviO OIL) Date Fee TOWN OF BARNSTABLE .. wt v OFFICE OF D,aYeT.si, BOARD OF HEALTH 3e7 MAIN STREET �o WO k• HYANNIS; MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled`'.-;::': . Board of Health Meeting. NAME •OF APPLICANT Sna ! '� TEL. NO. 775-979;5:.;'. . ADDRESS OF APPLICANT }2 NAME OF OWNER OF PROPERTY DATE APPROVED SUBDIVISION NAME_N/A 2T SIZE ASSESSORS MAP AND PARCEL..NUMB ERMajL# 294 Parral �TT 1 n6 A-res LOCATION OF REQUEST Northwest Side of Bui 1 di ng —Pat—;a_ Area VARIANCE FROM REGULATION (List Regulation) yariapce.-from. Regulati nn #14 of 'Sanitation Standards . , REASON FOR VARIANCE (May attach letter if more space is needed) (.;:Please see attached 1 PLAN '-' TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED__ " NQT APPROVED REASON FOR DISAPROVAL GroVer'.C, 14 Farrish,Chairman <, Ann Jane Ashbaugh ,N James H. Crocker, Sr BOARD OF HEALTH TOWN OF BARNSTABLE •.':':;' , : ::: arbvarl v HYANNIS, MASSACHUSETTS ' 775-9795 June 7 , 1990 To—Whom It May Concern , We wish to convert this exsisting patio space to a con— venient waiting area . On friday and Saturday evenings. we have had customers sitting on our steps , on the adjoining grass , and generally standing about while waiting to dine . We feel that it would provide a convenience to the public if we were allowed to provide them with seating and tables , also to allow them to be served beverages and choose from a small raw bar while waiting to dine . We would also like to offer , weather permitting , the avail— ability t'o have lunch outside on the patio during the afternoon . In no way would we exceed at anytime , our present seating capacity of 150 . We expect not to increase business through these improvements , but to deal more effectively with the needs and requests of our customers . At this point we have or are in the process of meeting all the criteria in satisfying Regulation 14 , Town of Barnstable—Health Regulations . We invite the Board of Health to please come and inspect ...the premises at' your zonvenience . We Remain Cordiall Yours': cc : William T.. ThDmas Peter Boucher John Cunning a el c 0 ale- 12 I-A' 7-011A-Ij /lat- The area north and east of the building is an asphalt parking lot. The area north of the parking lot consists of sand covered by sparse grasses and small shrubs. The area northwest of the building is wooded. The area south of the building is landscaped with grass and flowers with a small gravel lined parking area. Building and parking area locations are shown on the site sketch (figure 3) . The Site is supplied with municipal water and natural gas Electric power- lines enter the site overhead. There is---a 9` 0-OO-11 on septic tank located off-of the northeast , Ccorner of the building. The tank is pumped out by A & B Canco every .six months . There is also a 2 , 500 gallon ,grease trap- nor-th--of-the--building which is pumped by A_&; Canco every thirty days. There is no municipal sewer on the-Site. There�"are—no records indicating any-fuel �t storage on or- below the site relating to _potential _ J hazardous- wastes . There are no catch basins, other _1 easements , or wells for public drinking supplies . 1 Restaurant- refuse is disposed of into a dumpster on the, Site. Fryolater grease is disposed into a separate _j tdumpster. 2 . Environmental characteristics relative to hazardous materials : The section of the Site with the building and the parking ; lot slopes gently from southeast to northwest. The area . northwest of the parking lot slopes steeply to Fresh Hole Pond. The Interim Soil Survey Report classifies the soil surrounding Fresh Hole Pond as Hinckley Soils which are formed in sandy and gravelly materials , These soils are excessively drained and permeability is rapid. Surface water drains from southeast to northwest across the . parking lot into an area of medium to coarse grain °sands . The building isbordered with gravel and landscaping whic facilities drainage. Surficial geology is composed of glacial outwash sands underlain by crystalline bedrock at approximately 400-450 ft. below grade. Based upon groundwater surveys of an abutting monitored site and groundwater flow. maps (figure 4) , the groundwate flow direction - is presumed to be southeast. The depth tc groundwater is approximately 30 feet below ground surface The Site and surrounding sites are facilitated with municipal water. The Site lies within the zone of The area north and east of the building is an asphalt parking lot. The area north of the parking lot consists of sand covered by sparse grasses and small shrubs. The area northwest of the building is wooded. The area south of the building is landscaped with grass and flowers with a small gravel lined parking area. Building and parking area locations are shown on the site sketch (figure 3) . The Site is supplied with municipal water and natural gas Electric power lines enter the -site--overhead. There is-..a � `9 , 0.00 gallon septic tank located off of the northeastj ' corner of the building. The tank is pumped out by A & _B { Canco-every six months. There is also a 2 , 500 gallon grease trap -north of the building which is ,pumped by A , 4(Canco every thirty days. There is no municipal sewer .on ,the *Site. There are no records indicating any fuel J .(storage on or below the site relating to potential--`; (hazardous wastes . There are no catch basins, other] easements or wells for public drinking supplies,,.(Restaurant refuse is disposed of into a dumpster on they iSite. Fryolater grease is disposed into a separate' i dumpster. , 2 . Environmental characteristics relative to hazardous materials : The section of the Site with the building and the parking ; lot slopes gently from southeast to northwest. The area northwest of the parking lot slopes steeply to Fresh Hole Pond. The Interim Soil Survey Report classifies the soil surrounding Fresh Hole Pond as Hinckley Soils which are formed in sandy and gravelly materials. These soils are excessively drained and permeability is rapid. Surface water drains from southeast to northwest across the parking lot into an area of medium to coarse grain sands . The building is bordered with gravel and landscaping whic facilities drainage. Surficial geology is composed of glacial outwash sands underlain by crystalline bedrock at approximately 400-450 ft. below grade. Based upon groundwater surveys of an abutting monitored site and groundwater flow/ maps (figure 4) , the groundwate flow direction is presumed to be southeast. The depth tc groundwater is approximately 30 feet below ground surface The Site and surrounding sites are facilitated with municipal water. The Site lies within the zone of KEY woods coarse sand with some gravel `U. lowlying shrubs with some ferns and grass 0 paved area ( shrubs sand p dumpster (j 0 grease container ••••gravel border FRESH HOLES POND GTCE 2500 gallon crease trap �— ST - �L 9000 gallon septic tank (� tree / • yj grass ,�j • T ®transformer �©� (� � � � • Gj . _ C 1 O' C L oo C� o. N Q1 C Y i L d 00 r1 T a +� E Q t 0 x Z �} / O 1 � a k Q woo a U is steps L Z> ram <` > ravel parkfn•_g_w_r. — — sign AIRPORT ROAD Figure 3 Site schematic showing relevant features ,7{eats 7y L V�, J .Jy{!�•(�_J riM-•YI f t �G zawyu g�`�'lr�ta�4 Fyn 1 .. w ,y 3r- •N+ O oE 609 v . 1 tote ` i .. ul �•. ' � jg.lfil n. Goa, i f.WIT MIN RM K F �(X S - \j { 1'tT 33�� o 2s6 �Fjziy i D5 � P4 - .g OY t'F�, ram' x� "'giT 4tJt�,tj.. s' t AN 44 VANYW- s v. J °r!14t'7,lFjft c' ,4 1 t i r NOTICE OF APPLICATION FOR ALCOHOLIC BEVERAGES LICENSE In accordance with Chapter 138 of the General Laws as Amended. Name of Applicant _BARBYANN'�S INCH d/h/a_BARBYANN'S RESTAURANT. Peter A. Boucher, Mqr. Kind of License all alcoholic _�.�.�.��>_.���-��•••�-••�Q-��•~Y•�c�,tal.e.r, \ Period Covered by License __ date of. i ssiae unti 1_~12[31/88 Location and Description of Premises _-2.K.-Iyanouch._R3oad, Hyannis, Ma. A single story wooden constructed buildinq with half basement consisting of _a_!L-sihaDgd_dininq..�room_70_.ftw. long and 25 ft. widtl Jan. 21, 1988 - Approved with a bar seating 8 persons, kitchen, restrooms, three entrances, for 50 seats only. Must exits - one in front and two in rear. A public hearing on this meet all of the regulations • ~~•-__-i—Ff --ffi"'-" -i' *-*"'~-'- Ma- contained in 105 CMR 590.000 ��s a°cation w��l���he held in the `own Office Building, 3 a� MINIMUM STANDARDS FOR FOOD Street, Hyannis, Ma. on Tuesday, , JanuaryY26, 1988 at 10:30 a.m. ESTABLISHMENTS and the Town of Barnstable Health Regulations. '� )J _.____.._....._........._.._..._. ._._..._.. ._._....__~_........_.._.�~�_._.__.... Thomas A. McKean Acting Director of Public Health Martin J. Flynn Licensing Board William T. Friel for the Town of Francis I. Broadhurst Barnstable Legal Ad - BP for 1/14/88 Please Bill Legal Ad To: William Thomas Esq. 160 BAssett Lane Hyannis, Ma. 02601 TOWN OF BARNSTABLE yoF THe roe OFFICE OF i Dsas9T18L i BOARD OF HEALTH .� °o +679. �e� 367 MAIN STREET May k HYANNIS, MASS.02601 June 18, 1990 Peter Boucher Sharky Inc., d/b/a Barbyann's 120 Airport Road Hyannis, Ma 02601 Dear Mr. Boucher: You are granted a conditional variance from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at Barbyann's Restaurant, 120 Airport Road, Hyannis, Ma., with the following conditions: (1) You must meet all of the criteria contained in paragraphs A through O, of the Board of Health criteria for variances for outside dining. Failure to do so will result in revocation of your outside dining privilege. (2) The dining area must be set back ten (10) feet from the parking lot, sidewalk and other access ways. (See paragraph a of the Criteria for Variances) (3) You must install air doors and screen d000rs on all doors and apertures used in serving food or drink. (See paragraph a of the criteria for variances.) (4) The overall seating capacity cannot be increased. An equal number of indoor seats shall be removed or blocked from use anytime the outdoor seats are utilized. The existing calculated sewage flow exceeds 330 gallons/per acre per day at this site located within a critical zone of contribution to public water supply wells. (5) You must receive approval of the Town of Barnstable Licensing Authority. (6) This conditional variance expires July 1, 1991. The Board reserves the right to terminate your outside dining should any unsanitary conditions be observed. A copy of the criteria for granting variances for outside dining is enclosed. Strict compliance with this criteria is required. Very truly yours, Grover . M. Farrish, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE GF/bs Enclosure NOTICE OF APPLICATION FOR ALCOHOLIC BEVERAGES LICENSE In accordance with Chapter 138 of the Ocneral l.a%%-s -- - i as Amended. PETER A. BOUCHER d/b/a Name of Applicant _BARBY ANN'S Kind of License New, Common Victualer, Annual , All alco- _�____ �--'101 1 C date of issue until 12/31/81 - Period Covered by License �_�. _ __--- _ Location and Description of Premises _2.51__1yano"la_h RUd, Hyannis , Ma. One story; three rooms and one-half cellar for storage. Entrances/exits to Iyanough Road. A public heari app ica in the Town Office Buildin.g,367 Main Street, Hyannis, Ma. , on Friday, May 22, 1981 at 10:30 a.m. Alfred B. Buckler Licensin- Board — �� Gloria W. Rudman for the Town of John C. K1 i mm Barnstable hy�C �'h Legal Ad - CCT 5/11/81 "OV� April 23, 1981 A & B Cesspool Service 128 Bishops Terrace Hyannis, MA 02601 Town of Barnstable Board of Health 397 Main Street Hyannis, MA 02601 RE: 251 Iyanough Road, Hyannis Barbi Ann's (formerly Tinker's Kitchen) Dear Mr. Kelly: Due to the present circumstances, we are asking you, upon approval of the plans submitted by Mr. William Weller of Cape Cod Technical Planning Ass- ociates, Inc. , if possible, to approve a permit for Mr. Peter Boucher to open his establishment, Barbi Ann's. Mr. Boucher has done as much as possible to comply with the Board of Health, but the previous owners, Mr. Charles Thompson and Mr. Robert Forbes, have been at fault. We had planned on installing the system, consisting of a 2500 gallon septic tank and two 1000 gallon pre-cast leach pits on Monday, April 20th (holiday) and Tuesday, April 21st, but Mr. Weller did not have the plans ready for approval of your department. As a result, our company has a work scheduled until May Est A we have firm confirmation from our customers and are committed to the work schedule. Sir, I assure you that the work shall start on MaySd6and be completed on May 22nd of this year under the conditions of Title 5 of the State Environ- mental Code and Town of Barnstable Health Regulations. We are presently holding a deposit for the work to be done. Very truly yours, Bernadette A. Robin on March 101' Pall Mrs Mary ;m6ntagna, chairman Board ,of Selectmen, Town of Barnstable= H y annis, Ma.. .# Y , x Dear Mrs. #ttagnaYz. �,, The `septic system of Peter'A,.,,Boucher-d/b/a Barby Arias 0 s- formerly.Tinker`s Kitchen' 251 Iyanough Road, Hyannis, is sub-'-standard, We did not .sign their'-.previous+ application because the owners did not comply with Board .of Health orders'. , (400ies attached) , h n addition' ire. have not;recefved lens show n {t t the. am g . +' , y. p establishment .will be, upgraded to meet'Town health=r'egulations. This restaurant, under- previous ownership going back many years has always-.been. borderline and; had"been closed many times for, 'health violations*, At this point,+ we are- not convinced that the graa%ting of- a .,license is required.for, the g6od of the pub ic« ' Very truly you're, John M. Kelly Director of .Public Health - . JMK/mYft 6ncl,4,. 7 - rn ®SENDER: Complete items 1,2,and 3. -n Add y_w address in the"RETURN TO"space on 0 reverse. . _0 1. The following service is requested(check one.) ICYShow to whom-and date delivered............_a ❑ Show to whom,date and address of delivery..._Q u, ❑ RESTRICTED DELIVERY Show tc=whom and date delivered............ ¢ ❑ RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$_ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: fln Mr. Charles M. Thompson , A Thompson Enterprises , Inc.. z Iyanough Rd. , HYANNIS MA. n 3. ARTICLE DESCRIPTION: 601 T REGISTERED NO, CERTIFIED NO. INSURED NO. OO19775I 6 (Always obtain signature of addressee or agent) in m I have received the article described above. ma SIGNATURE OAddressee OAuthorized agent l7 2 /4. A ATF LIttRV POSTMARrn D Z S. ADDRESS(Complete only if requested) O n m _H T CLE m 6. UNABLE TO DELIVER BECAUSE: RK'S d INITIALS 3 D *GPO:1979.288-848 Q, pcC UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS PENALTY FOR PRIVATE SENDER INSTRUCTIONS usE TO AVOID PAYMENT j OF PosrncE Print your name,address,and ZIP Code in the space below. ,$ago ® I U.S.MAII I Complete items 1,2,and 3 on the reverse. -® i • Attach to front of article if space permits, j otherwise affix to back of article. i • Endorse article"Return Receipt Requested" I adjacent to number. ' RETURN TO BOARD OF HEALTH TOWN 8NMIMABLE P. 0. Box 534 (Street or P.O.Box) i 't HYANNIS MA 02601 (City,State,and ZIP Code) i i °r � a t ajr 'gin "*' to w. �.'` ,� as '� •_:. � ^, �• G'C t1be .�3 1980 fie. q } } "• rh eb �mp�scaj ,. r don't Rhompson' Ey4erpri 'r �* y0hough IioC18 .tr. - •- rtr 2 .e, r i d ate: �e T r lser � K�tcheri8i_#Iyan©ugh �0ad, Hy ihhis '� P ` 7eir 1A.L omp$Oi y k + . 'S' �. .l :` • ,ra :'. .. '; .. z,. �,. � . e' :. T � `6 :, ♦R T F 1 7j• 'you='i-er6 granted � c�rnditional ford serv�:ce 1aerm�t. tArh�ch�ex�a;ged y: Jung 84, to ape atef Tjihk6r s- e,Oh- YOU i re ,told Mat• In 4rd�t tQ conta� ' ��r pet on.y01�r,- as� X y t must �t radec� to" eot the rov .P xsa.cif fi t�.e 5, .. ' `cif;the State;: yr .k0r Omta s C I de d'`.the.,fia a th . Re at :oxas syou: have"not�aub�aitted- e�g�� ri�c� rplan�.as e�uir�:d nor' has. .the sy a ;sae . upg r :- 'Iou are; currently ap r�tirlg Without a '`food.a v�.e4 ;per�a��a wh�.ch?,14 "` `. requ red by.:the Commonweaith, You`~W ,�.l not be-,cjranted a> ft5od '�e���.Ce pax" �t �C�r:�98� •uar 1 you comply- with.,4.1 ,Of the, provis�ons :a� �rticle �; M�.h$�luTt1 Sanitation Standards fpx`-FOidd r ► ce'6 atabl shments,: 'mod. Title; ��� State�, nVir s `c/��gaz^eya♦�taj_y'�y�04e ' ypynj� c �eyy+t 4uyg, a}� ' t �. '=re arn�end,( at a ommon -y "Y e44{.fd L1.Y+;E:1±J.�A .� „?,Nr 4{y1.YJA.J'-9 1 -nd � � G ry t VY� r-. .� :r �r•s...fd�r- ..� a r S w n f Rober . 'Childs i�Ghaitm9in ¢ 4 Y a , Penn -Janb ,� 3 ..p.= ... * Hutchins F* Ingex �2� °�?�. � v� �l Mr i. Robert Forbes ' ;.n - ....r .. a •` } r � � s 5` '94, , :�, -' L ' o toy TOWN OF BARNSTABLE OFFICE OF i HAHB9TABLE, i > AS0? BOARD OF HEALTH ppA i639: ��� TEpMp�O.• 397 MAIN STREET HYANNIS, MASS. 02601 December 211 1979 Mr. Charles M. Thompson, President Thompson Enterprises, Inc. Iyanough Road Hyannis, MA. Re: Tinker' s Kitchen, Iyanough Road, Hyannis Dear Mr. Thompson: You are granted- a conditional license which will expire June 11, 1980, to operate Tinker' s Kitchen, Iyanough Road, Hyannis, using the present on-site sewage system. As the new system will have to be in operation by June 1, 19801 please have a Registered Engineer submit plans for the upgrading of the on-site system,prior to any construction, that will con- form to all of the provisions of Title 5, of the State Environ=."- mental Code and Town of Barnstable Health Regulations. Very truly yours , Robert L. Childs hairman . " Wan stam, M. D. Ann Jane shbaugh 1 BOARD OF HEALTH TOWN OF BARNSTABLE MK/mm cc: Mr. Robert Forbes • .• r ,. 4.1 eecember;21, 1979. f f f y • e "+ Mr.• Charles M. Thompson,'=President Thompson.Enterprises:, Inc. Iy_anough Road r . r Hyannis, .MAP - Re: Tinker's Kitchen, Iyinough"RoadHyannis ° f. Dear ,*,. -Thompso n:.1µ e You are granted, a conditional ,license`iwh ch will expire , ' June ,l,: 1980, -to operate Tinker s-Kitchen, 'Iyanough Road, Y Hyannis; us ng':the present on-site sewage system. - As the new system will' have f to be in'operation by' June A; 1980, please have a Registered Engineeul�m"itr, s plans for the upgradincl of the one-site system,prior .to any c6hatruction, that will cones i +` D form to all- of 'the_prov9 signs of Title 5;' of- the` State Envir©set*-' . mental Cole• and Town of. Barnstable Health Regulations. Verytruly yours, Robert L. Childs, `Cha rman i els am;-M D.. r' Ann Jane E bau h BOARD OF' HEALTH • :" TOWN OF BARNSTABLE - .. cc s Mr. Robert Forbes f :Jr, i. a r, December197 < Mr. Charles M. Thompson ; President : Thompson 'Enter_ prises, Inc: ..,. Iyanough Road Hyannis_ :e Tinkers Ki�Chen ' Dear Mr Thompson: We.are• in receipt' of"your,letter of -December 5,` 1979 ;. questing ra Bearing before'. the .Board of -Health-; regardi ng` our letter dated' November 30 1979,. ` .« •" t ,Y; - � earing has `been zbbeduled for; :00 P:M.: on.Wednesday fihe B , },. December 19 19,79, ,in the Board of Health office, Third ' Floor`, New Town, Hall" 367 Main'Street,: ;Hyannis, , x, Please cdnfirm ,the 'time and elate' withi -'the Board. of :Health office,' 775�1_120,j extension .ia2. z Very truly yours .a r , John•.M.' Kelly. `. k Director of Pub lic.Health ' w 1 i r-:l DEC 51979 JrOWN OF BARNSTABLE 90ARD at,HEALT i� December "5 , 1979 Mr. John M. Kelly Director of Public Health Town Offices Hyannis, MA 02601 Re: Tinker' s Kitchen, Iyanough Road, Hyannis Dear Mr. Kelly: In accordance with. Regulation 24 of Title 5 of the State Environmental Code, a hearing is requested on the order contained in your letter of November 301, 1979. Inasmuch as the order affects the operation of business at Tinker' s Kitchen on and after January 1, 1980, a hearing date as soon as reasonably possible is requested. Very truly yours, THOMPSON ENTERPRISES , INC. D/B/A/TINKER' S KITCHEN By:. . Ch `rles Yi... Th.omps n, Presidents" y O SENDER: Complete items 1,2,and 3. c Add your address in the"RETURN TO"space on reverse. w 1. The following service is requested (check one). Show to whom gnd date delivered. . . .. . . .. . UShow to whom,date,and address of delivery. ._¢ 09 RESTRICTED DELIVERY Show to whom and date delivered. . . .. . . .. ._¢ ❑ RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$- (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. & Mrs. Harold Ellis Murphy Way Hyannis, MA. 02601 Z 3. ARTICLE DESCRIPTION: z m REGISTERED NO. CERTIFIED NO. INSURED NO. m I 1532090 � - m I (Always obtain signature of addressee or agent) mv I have r ceived the article descr' L.,eied SIGNA U E Addya ee agent ;o H 4 DAT OF DELIAERY POSTMARK m Z 5. ADDRESS (Complete only if requested) m 6. UNABLE TO DELIVER BECAUSE: CLERK'S n1 INITIALS O 3 D GPO: 1978-272-382 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATE Print your name,address,and ZIP Code in the space below. USE TO AVOID PAYMENT OF POSTAGE, $300 • Complete items 1,2,and 3 on the reverse. • Attach to front of article if space permits.Otherwise U•S.MAIL affix to back of article. ®� • Endorse article"Return Receipt Requested"adja- cent to number. RETURN TO i BOARD OF HEALTH (Name of Sender) TOWN OF BARNSTAB•L• E P. 0 Box 534 (C" .State.and ZIP Code) I y 0 SENDER: Complete items 1,2,and 3. .Add your address in the"RETURN TO"space on reverse. 1. The following service is requested (check one). Sh6w to whom and date delivered. .. .. .. . . . io Fj Show to whom,date,and address of delivery. ._¢ RESTRICTED DELIVERY Show to whom and date delivered. .. .. . . . . . RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$_ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. Charles Thompson Tinker' s Kitchen-Iyanough Rd. Hyannis, ILIA. 02601 Z 3. ARTICLE DESCRIPTION: nREGISTERED NO. CERTIFIED NO. INSURED NO. 1532088 v m I (Always obtain signature of addressee or agent) 0 I have received the article described above. mSIGNATU ❑ A essee ❑ Authorized agent m z 4. c D T F DELIV RY ,UL4 sc xZ 5. ADDRESS (Complete only if requested n cs;` FT 6. UNABLE TO DELIVER BECAUSE: CLERK'S "' INITIALS O 3 D GPO: 1978-272-382 I I UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATE Print your name,address,and ZIP Code in the space below. USE TO AVOID PAYMENT • OF POSTAGE,$300 Complete items 1,2,and 3 on the reverse. ® I • Attach to front of article if space permits.Otherwise ILLS.MAIL + affix to back of article. ®O Endorse article"Return Receipt Requested"adja- cent to number. RETURN TO i I I Q BOARD OF HEALTH I I (Name of Sender) TOWN OF BARNSTABLE P+O. BOX 534 ' (Street or P.O.Box) HYANNTS MA 02601_- Q I (City,State,and ZIP Code) Z SENI)tK: Complete items 1,2,and 3. o -Add your address in the"RETURN TO"space on 3 reverse. I. The following service is requested (check one). X Show to whom and date delivered. .. .. .. .. . Show to whom,date,and address of delivery. ._¢ RESTRICTED DELIVERY Show to whom and date delivered. .. .. . . .. . RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$_ (CONSLTLT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. Robert Forbes m Tinker' s Kitchen-Iyanough Rd 9 Hyannis, MA. 02601 z 3. ARTICLE DESCRIPTION: z 0REGISTERED NO. CERTIFIED NO. INSURED NO. rn � _ I1532089 m i (Always obtain signature of addressee or agent) 2 I have received the article described above. m SIGNATURE ❑ Addressee ❑ A6thor,' ed-age>4 �r m OS. "I9z a. (SAT F DEIV Ry z 5. ADDRESS (Co plate only if reques e . m z 1 T 6. UNABLE TO DELIVER BECAUSE: CLERK'S 'n INITIALS O 3 D r= GPO: 1979-272-3e2 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATEUSE TO AVOID PAYMENT Print your name,address,and ZIP Code in the space below. OF POSTAGE,$300 • Complete items 1,2,and 3 on the reverse. • Attach to front of article if space permits.Otherwise M&NI IL affix to back of article. BOO Endorse article"Return Receipt Requested"adja- cent to number. RETURN TO I I BOARD OF HEALTH �r I (Name of Sender) I p TOWN OF BARNSTABLF P. 0. Box 534 (Street or P.O.Box) + HYANNIS MA 02601 A I i (City.State,and ZIP Code) q November 30, 1979 -3Mr. and Mrs. Harold•Ellis Murphy Road` , A - Hyannis, MA.` ' Re; a Tinker's• Kitchen, `IyanQugh,Road, Hyanni"s Dear Mr. -and- Mrs. Ellis: .* You were sent, a, letter, dated' February 13,, 1979, after your appearance :before`the ;Board. of 'Health. .that� informed you that prior to obtaining a Food Service Permit. January 1; 1980 you must upgrade .your~ sewage. system to conform to State and focal codes. A copy of :the letter is enclosed. .. To date, we. .have not received b ineering `plans-°for upgrading , the sewage system­as requested. You will not-be granted a permit for 1980 until all conditions. . outlined in th_e Board's letter ''of- February ' 1979, are 'met." . Very truly yours, M1 John M.' Kelly Director of Public Health } . y JMK iirp cc:, Mr.' Robert Forbes r ' Mr, Charles- Thompson SENT VIA CERTIFIED MAIL February. 13, 1979 y Mr.' and Mrs'., :Harold Ellis r Murphy Road , x Hyannis, Massachusetts Dear Mr'. and. Mrs. Ellis:, »; The Hoard of Health will, allow the° Galley Restaurant, at a Tyanough Road,.,Hyanni's,, to •operate with its' present on-Site sewage system until January l;, 1980. Prior, to obtaining a -Food Service Permit in 1980, the ,on=site•` sewage system'must be upgr+ ded to meet all,,.the provisions of Title '5,•.of..the State Environmental Code anc�.•Texan of �Barnes stable Hea1t1?" Regulations, r 9 . Please have a, Registered .Engineer,'^subm t•ypl:ans for the ,up- grading• of the on--site system to us prior. to 'any construction -of the-new- system, in., the event problems. arise with the•-present• system, the 'up-. gradang must. be done "immediately,or i tli+s establishment will 'be •,: ` 4 cloyed. In addition, all the requirements',of 'Article X, Minimumw, Sanitation .Standards, for Food Service Establishments, of the ` State Sanitary Code, must'-be mete.before i dsuance of a Food; s Service Permit. ,r . r Very truly yours ' Ann ,Jane s aug Cha rman 4 RRfi� ert L ills a ♦ ' ) .. ±t y f P A. : . Mandelstam M. -D ltJ./ - n ...0F`' - -HEA�,TH . . ` TOWN oF' BARNSTASLE. .cc: Mr Charles .Thompson a :'' q. n Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs WL Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347 .508.946.2700 Charles D.Baker Matthew A.Beaton Governor Secretary, Karyn E.Polito Martin Sutiberg Lieutenant Governor Commissioner July 10,2017 Republic Services RE: HYANNIS-BWSC Attn:Chris October Release Tracking Number:4-0026692 1080 Airport Rd Barbyanns Pub Fall River,MA 02720 120 Airport Rd NOTICE OF RESPONSIBILITY URGENT LEGAL MATTER:PROMPT ACTION NECESSARY Dear Mr,October: On June 5, 2017 at 2:32 PM the Department of Environmental Protection ("MassDEP") received verbal notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions.Approximately 20 gallons of hydraulic oil was released to pavement and soil after a hydraulic tank became dislodged from a trash truck. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act,M.G.L.c.21E, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless_ the context clearly indicates otherwise. MassDEP has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. MassDEP also has reason to believe that you (as used in this letter,"you"refers to Republic Services)are a Potentially Responsible Party(a"PRP")with liability under M.G.L.c.21E§5, for response action costs. This liability is"strict", meaning that it is not based on fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c.21E §5. This liability is also "joint and several", meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. This information Is available In alternate format.Call the MassDEP Diversity Office at 617.666-1139.TTY#MassRelay Service 1-800.439.2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Release Tracking Number 4-0026692 Page 2 of 3 MassDEP encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs Incurred by MassDEP in taking such actions. You may also avoid the imposition of, the amount of or reduce certain annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. MassDEP encourages you to take any action necessary to protect any such claims you may have against third parties. At the time of verbal notification to MassDEP,the following response actions were approved as an Immediate Response Action(IRA): • Continued assessment.. • Deployment of absorbent/containment materials. • Excavation and disposal of up to 5 cubic yards of contaminated soil. • All Remediation Waste must be properly stored/handled and disposed of within 120 days from the date of generation per 310 CMR 40.0030. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to,the filing of a written IRA Plan, IRA Completion Statement and/or a Permanent or Temporary Solution Statement. The MCP requires that.a fee of $1,470.00 be submitted to MassDEP when a Permanent Solution Statement is filed greater than 120 days from the date of initial notification. Specific approval is required from MassDEP for the implementation of all Immediate Response Actions (IRAs) pursuant to 310 CMR 40.0420. Release Abatement Measures may not be conducted until a RAM Plan is submitted pursuant to 310 CMR 40.0443. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. In addition to verbal notification, 310 CMR 40.0333 requires that a completed Release Notification Form(BWSC-103,attached) be submitted to MassDEP within sixty(60)calendar days of June S,2017. You must employ or engage a Licensed Site Professional ("LSP") to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling (617) 556-1091 or visiting http://www.state.ma.us/Isp. MassDEP has Kurt E. Klages of Jewel Environmental listed as the LSP of Record. Unless otherwise provided by MassDEP, potentially responsible parties ("PRP's") have one year from the initial date of notification to MassDEP of a release or threat of a release, pursuant to 310 CMR 40.0300, or from the date MassDEP issues a Notice of Responsibility, whichever occurs earlier, to file with Release Tracking Number 4-0026692 Page 3 of 3 MassDEP one of the following submittals: (1) a completed Tier Classification Submittal; (2) a Permanent or Temporary Solution Statement or,if applicable,(3)a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is June 5,2018. This site shall not.be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L.c.21E and the MCP. If you have any questions relative to this Notice, please contact Andrew L.Jones at the letterhead address or at (508) 946-2785. All future communications regarding this release must reference the following Release Tracking Number:4-0026692. Sincerely, �w" Dan Crafton,Chief Emergency Response/Release Notification Section Bureau of Waste Site Cleanup C/AU E W:\BWSC\Document Prep Folder\ER\Jones\4-0026692.HYANNIS.REPVBLIC.NOR.07-07-2017.docx Enclosures: Release Notification Form;BWSC-103 and Instructions Summary of Liability under M.G.L.c.21E MassDEP's Guide to Hiring a Licensed Site Professional ec: Board of Health Board of Selectmen Fire Department DEP-SERO John Handrahan, Data Entry /1 . 1-800-675-3622 SPECIALISTS We Make Disasters Disappear - - I II �� I i IF 1 www.disasterspecialists.com i Y } 7 y +a. i, ��� , / ._/,/ �J / ��� V v t� a I" 1' 40 r s P '#i; .� i ;� i ,r ., ,. t. -.. re.. xx l t ;� ����r __ ,,�, - � ; �, ` � �"' .rr' C.:.n'� 'I -•� � t - J��!'' _ �. :. ,n . S�. �L. � � / jf�' S p _�. i - ..�/. a. 4!. F. v. �4 R; 1SZ 1;.. ���il�� - t� � �r��, .��' �; , i C/ ��4 fa c, ; , C , r- � fit" /� , 4 a. r ^N � s r 4V�, AL 'y Aft_ 41�i •�. 4,t,` - -a r } � 1 °� �l�l��d� ��f�� � � �, ; v f r r„ r r AW ram' r .A: p 3�i�`�i� � ' �����' ��� �� �l � , T. � �':e�F� 4_.. _ - �.,,, �Y::_ / t-, 0 � Ii/✓�i Cd� �J .J U FRESAS DE ft F-O N IA AJAS 4 = - .111 ' '' N F i 'T �('r cq�Fi'��Q �r �� - _�; .f �. p i *� �� { _ t ���_ y �- _ r_t - - . _ _ a' w � �.! '�. _i .-:' ., �. of ! ... �„ _ - _.. .. -� _. ..� � _ , i 31le 4 -��' �h \_ .: �, �.,,,._ .�,. ��=� : .,r ;;. U �:: - }.�. ���� ���%r u i ... ,, . ,._ _ ,. . . _ �. ,. � . t:, � ..� yf I .t +--_. K ���.i z y_,t+�l�_.y yt�� ,_ e. "��;e.�, _�.-776 �,.1.:. '�� � rc - �.-_ �. a ^.. Y a 41' er �/ 1 x_ .,;�i , , `;, �; ''"`1 �� �� ✓ .���� ��i�ji i �- -.,raroE., '' ---. , J/��/ :�J �' C N �a A t!"f 1 �/ U J���� �: 3�', .. :, . _ __. _ ,,. �_ _�.. ,, �. �.< ? - �; ..,, .. - _ `'• .�. -�_ � � II _ -_ i` -� -� � _. � ... _ � _ Y , � ��� �� V/ 8 1 dik -VL -16 -. _ F-. �,,:_ .. _. - -- i° - - -, a i cr`i` t 4 R w r owdompow K rYr.r7l� _ +fir' F i. u �i�1��,��ii ��/��/i s i 1 - AL rra��r►wa r I � i s , A f ` f I I � t �l i ,i , Aw/ ' e �r I ..y � u s♦ _� ��, _. . - � ~ ®• - ' a �. �. J � .. � i .* J �� '��'":�: s w t; ���� �� ���� ���� ��✓ � � r r ji _ F I 1 y � F firl 5 1 d R'♦ d'. y R �'�` � .�- 4 ° �' �, � -� :� I ;y t Barbyann's Restaurant 120 Airport Road Hyannis, Massachusetts 02601 Post Health Inspection Plan of Correction Report October 26, 2017 Barbyann's Restaurant Hyannis, Massachusetts 02601 October 26, 2017 On October 24, 2017, Ms. Donna Z. Miorandi conducted a routine food service inspection. Ms. Miorandi found a total of 1 critical health violations and at least 9 non critical violations. In this report we will explain our plan of action in correcting and preventing future violations along with establishing a plan for better overall cleanliness. Critical Violation 19 -Hot and Cold Holding Description: Butter left out all night at bar. Bartender though since wrapped in aluminum foil it was ok. Plan of correction: Bar area will no longer have butter. Butter will be kept in the kitchen and bartenders will be required to go into the kitchen to retrieve butter. Although all violations are important, this was a critical violation as it is related to the safety and health of customers. All food must be kept out of the danger zone to prevent food borne illnesses. Checking for any edible item that is potentially hazardous that may be left out will be added to bartenders closing and opening duties and if there is any food found left out it will be disposed of. Violation 27 - Physical Facility,Lighting in Kitchen Description: Lighting is still not adequate. Some are not working and another is flickering. Plan of correction: An appointment with a certified electrician has been scheduled. We will inform him that some lights are out and flickering and have him fix immediately. Additionally, we will clean all covers of lights, and purchase more vibrant light bulbs for better overall lighting. Violation 27-Physical Facility, Painting of Ceiling Description: Ceiling needs to painted Plan of correction: We will most likely close for a day, either Monday October 30 or Monday November 6. We plan on not only painting the ceiling,but the walls of the kitchen as well. This will also help with the brightness of the kitchen. Violation 25 -Equipment and Utensils,Ice Bins Description: Repeat. All ice bins at bar and waitress station must have a barrier installed so that lines do not come in contact with consumable ice. Plan of correction: Perforated bus buckets have been purchased through our kitchen equipment supplier. All ice will be melted and/or disposed of after every night of operation. Ice bins will be thoroughly cleaned along with newly purchased perforated bus buckets. This will prevent contact with lines in the ice bin. Violation 26-Water, Plumbing and Waste Description: Ice bin at at wait staff station is slowly dripping water onto waste pipes below and onto floor creating much mold on surfaces. Plan of correction: An appointment with licensed plumber has been scheduled. He will repair pipes. Area will be thoroughly cleaned regularly to remove mold and prevent future build up. Violation 27 -Physical Facility Description: Tile floor under floor mat at wait station is weak. Tiles are cracked and missing-much deterioration. Must repair. Plan of correction: After plumber has came to repair pipes described in previous violation, all cracked tiles will be removed and replaced. If floor under tile is found to have a more serious problem, more serious repairs will take place. Violation 27-Physical Facility, Men's and Ladies Employee Bathrooms Description: Employee ladies and men's bathroom sink and toilet have foreign debris and build up. Must clean. Plan of correction: Both bathrooms have been thoroughly cleaned. Upkeep and scheduled total weekly cleaning of employee bathrooms have been added to employee to do list and will be checked on by manager daily. Violation 27-Physical Facility, Mops and Brooms Description: Mops and brooms must be hung up off floor. Plan of correction: Mop/broom rack has already been installed along with additional easy access hooks for frequently used cleaning utensils. Violation 24 -Food and Food Preparation Description: In basement shelving area of sugar storage has rodent dropping. Musc clean up and have Fowler check. Plan of correction: All items near area of rodent droppings have been disposed of. Shelves in basement were thoroughly cleaned and sanitized. Fowler representative came on Wednesday, October 25. We explained to the representative where the droppings were. New rodent traps were installed near the area and traps outside the building were replaced. When a Fowler representative comes it will be part of the manager's job to walk around with them and examine the areas. \Violation 26 -Water, Plumbing, and Waste Description: Many pipes in basement are leaking onto floor, some is water and other areas are grease. Plan of correction: An appointment with licensed plumber has been scheduled and problem will be explained and repaired. Violation 25 -Equipment and Utensils Description: Ice scoop for ice machine in basement not hung up as requested. It is laying on top of dirty ice machine. Light bulb in walk in freezer is not covered. Also box of bacon found on floor of walk in freezer. Plan of correction: Hook for ice scoop has been installed and is being used to hang ice scoop and ice machine will be cleaned inside and out. Shatterproof light bulb has been purchased and installed for walk in freezer. Although we had recently received a delivery of bacon and had not had the chance to put entire order away,we will do a better job of quickly receiving and putting items received as quick as possible to prevent items from being on the floor. Violation -Shellfish Tags Steamers in walk in did not have proper tag with them. All tags must be with current shellfish and kept for at least 90 days. We have created a better system of organizing tags and will make sure when receiving shellfish that tags MUST stay with items. Violation 27 -Physical Facility Description: Public bathrooms sinks are dirty, especially faucets. Men's room has a foul odor in it. P traps or urinal or lacking sanitation of flooring. Plan of correction: Public bathrooms sinks have been thoroughly cleaned and will continued to be maintained daily. Faucets have been polished. During scheduled visit we will discuss the foul odor with plumber and any plan of action. r ati. SEATING: 150 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS X 378 9A�D0�0 �� . . . . . . .TOWN. . . . . of . . BARNSTABLE. . . .. . . . . .. .. .. . . . . . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT 378 January 1, 89 Permit No. . . . . . . .. .. .. .. .. . . .. .. . . . . . . . . 19. .. . . In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a PerrmititBiss heerebby granted to: BNS Hyann Whose place of business is . . . . . . . . .. • • • • . • . • _. . • •120. . . . .Airport Road, .. .. .. . . s .. , ' .. Type of business and any restrictions . . • • • • •. FOOD SERVICE ESTABLISI. .. .. .. To operate a food establishment in . • • • • • . TOWN OF•BARNSTABLE (City or Town) Permit Expires . . .. December 31, 19 89 Grover C.M.Farrish,M.D. Chairman Copy .. Ann Jane••Eshbaugh. . . .. .. .. .. .. .. . Jame's 'hi:''Croc�cer; 'Sr:' Board This Copy To Be Retained By Local • • • • •• • • of Board of Health. Health FORM 738 HOBBS 8 WARREN,INC.-1986 " " " " "A'�jerit" " " " " " " " ' • ' UNITED RESTAURANT EQUIPMENT CO. SAVE... Order by Phone SPECIAL ORDER 1IN111114311 Rte. 146A,EDDIE DOWLING HIGHWAY — TOLL FREE— NORTH SMITHFIELD, RHODE ISLAND 02895 UNITEO RESTAURANT EQUIPMENT CO. R. 1. 273-1900 Tel.401-769-3220 `N. E. 1-800-55&7338 TRIP NO. CUSTOMER—NO. PURCH.ORDER NO. SOLD TO SHIP TO la-11 - DATE CREDIT AUTH. CODE JBY- SPECIAL IN RUCTI NS ITEM NO. , . .- ., :.> ,. . 5 -•:.„.. r, �.,.. .a ...,., l ��s.,.<,.. z�.,:.. us,,..x.- .<.. >. ,, k., ., „ m �., ,,. . ,3„s , hy,�:°-„,�a a ... & ,.�: � ,..a 3:.... ... _aRow a� a.. ., .,... ,.. , ,_°?.. ....._ fit,. •.. a, s, :c.,: �k�.,> . _., ., .M ,..: �_ _, ,.. , -r ,. ..., ,.,s4 �.. ,.,: .. �� ._. ... _. .z •_.. .psi'..-.. ^.�;. ,.. .. �' .:,, ;4,. •.�� �' &.:k _ ... .....,, �_ .. „-_ . � ,. -. .: ��.'..,. � :a .....,.� ....,.m.�,r�;�ks�: e;??.3. x�'�• xx.. �a^ ;. r �s.._ t A, .�. e >�,r>� S.,_,, ,.,.. � �� 3�5,�.. -z s�,.... ,�,,.. .e a ,a, <..:xa;,'':" .�.. >s,�..,u.s�r-. ,:ws'f, ,�€. ,<a;s .h, s.w'Aa �-axiom.,. -s"F,a£< ,ea��v�.a� �,;:, €�xe'�s.,_�r_.,,a:.aa� ,c;Y,a ;�.aa ar.�rg xr�.� ��'°.�a =a �. ,��F•�. All .. ......_:... av ..�....�3..: xS.�....,..a...r...<a• .,._.ro.^.,':,:x.,:-,s. �'_�_s,��....,..rxY�e AP_ a ,k..,._._. ,.. xi.r _�- -,�. _..,.. , xi. _.. ,. ,..,s.�-....- .a.. .:�'. fia.. ,s..a..<, � .,,. ,s �a.:e�, ,A�- s ,'� .�.., �•,Q �� <.. ��, a xir ,.� •_, �xi .a, . . r � aka-. �. _. � �. , �. � �,. _.. � �-.. � ,.. �.��,; e*§ .. ,g% -�>. ."- :_:. ;�- •s. - .:: x er-a minim x,.. .. „ `a§S.. �$.: �. .,.. .,�. ....,� .,._, s... _ .,fix_.. ... ,.ar ,.. .. � � s, �•. ,. .�< � �, , :���:. new � :,ag���- ,:.._, •-- „ 'as�.�'"- '�$ ..��.a,' ,: � , �' < s � .•..,� ,�&x.�m�, -�'� c�<e:... �.xi�€�'>�,.«.,5 ,rxa`.x�a..'.�r,�a�..�aa::�����a>��e Accepted by, subject to the above terms: (Signed) (Terms) / � ! (Date) a (Balance) INCIDENT REPORT (Extract NFIRS - 1) DELETE CHANGE OIDID INCIDENT NO. T—EXP.NO. MO DAY YR DAY OF WEEK ALARM TIME ARRIVAL TIME TIME IN SERVICE C,1:4 :=G TYPE OF SITUATION FOUND TYPE OF ACTION TAKEN MUTUAL AID REC'D GIVEN (A • III FIXED PROPERTY USE IGNITION FACTOR cc CORRECT ADDRESS ZIP CODE CENSUS TRACT cc 0 LL OCCUPANT NAME(LAST,FIRST.MI) HONE ROOMOR APT. w "ve 'Ri"' TA-UIR uj i CL OWNER NAME ILAST.FIRST,Mil ADDRESS TELEPHONE 2 ; -V2 GE,. YA 0 METHOD OF ALARM FROM PUBLIC CO.INSPECTION SHIFT NO.OF ALARMS d i 1% t- F DISTRICT NO.OF FIRE PERSONNEL 0.OF ENGINES NO.AERIAL APPARATUS 0.OTHER VEHICLES RESPONDED NO. RESPONDED :ESPONDED LL CNIO.OF INJURIES NO.OF FATALITIES FIRER ESERVICE OTHER FIRE SERVICE OTHER .0 e"COMPLEX MOBILE PROPERTY TYPE 0 0 AREA OF FIRE ORIGIN EQUIPMENT INVOLVED IN IGNITION W. Lu III cc tu W -i FORM OF HEAT IGNITION TYPE OF MATERIAL IGNITED FORM OF MATERIAL IGNITED 0 METHOD OF EXTINGUISHMENT LEVEL OF FIRE ORIGIN ESTIMATED LOSS(DOLLARS ONLY) NO.OF CONSTRUCTION TYPE STORIES EXTENT OF FLAME DAMAGE EXTENT OF SMOKE DAMAGE uj cc DETECTOR PERFORMANCE SPRINKLER PERFORMANCE uj* i,- L-1 .uj TYPE OF MATERIAL GENERATING MOST SMOKE AVENUE OF SMOKE TRAVEL 0 IF SMOKE cc SPREAD (h BEYOND ROOM FORM OF MATERIAL GENERATING MOST SMOKE OF ORIGIN IF MOBILE YEAR MAKE MODEL SERIAL NO. LICENSE NO. PROPERTY A IF EQUIPMENT MAKE MODEL SERIAL NO. INVOLVED IN IGNITION OFFICER IN CHARGE(NAME,POSITION,ASGMT.) DATE i.-- MEMBER MAKING REPORT DATE 1986 ARRAKIS PUBLISHING px WASTf' y(fi t•'^'•r":`-> 1:.,;_y.. _..,^.� > 1"�. "+___- yJr_..: ^.:T J-'.:'3^:y y; 71^ J. �_".,� f.^f�'-'-Y lti " IE _..�... T: TY'� . -.'`il: .. Yi Y'�:.�>�_ > J-!r'>S'>L�i..ff{a_:r♦ f...•i•Ta.i_a�1• f{_� r ti r•'•w Y'> i�� .i�a',i'i i.�L.:._ ...a.?'ir i f'.:.::'> i.S'r'« ).:'>"' i i JS a:' „`•�• <,q`;�.;f y..,-j•y:_•.�j!, •r •.i::�. r5A t+_l:!'% -r r"i!::r''.• ..I r-. Z iI'1 f f.._.1 �' ii•;'3 .._ f �._ 'Y'''i .a a_. i'.'S i.Y ._.:3 READ-! i.-.- .f'... iJ ':i.�S }ii'iti ._ .'i_.. Y••:_:a'.i•oi•is .. '>'�^ _.,.( ! f R •t _...% STATED _f.y _;..,_ THERE�;._ WAS, � . 7, y r`t',__.��,..,.. ...y- :�<i N I ":•>• ^ 'R R i,Y-i�a_y:� ir=ia_`,�w+ THAT{i-i i f.:a_.>'� :ri's•Jii f•:: .."i?•<S i't� a s'f ._r• ._�f- �:.�l..si .:.:'� J=>F'i>O `tit i...s'} i-i.a r.?:{..`'> T n)y ARRIVING r T? SNF . O« G iL , _ r i _ POUR IS THE . _MP _ t WITS - L YUT! ^ PV Z _ E ": U }: 9-i. J 7•.ry T 1.yJ...F.. .T r..!yr-., J...J lr . `�...;` r<.`v, r• ! .:. , J y,?i.)'!r ir'- J i •^5 ' ry t 1 - ;l i n. `1' y'..:�'^C'• "t-J l . 1.:�+1':i�'S 'Ilia'i i i�'..+�.i�.C 1�.i'rri: r"t'�+��• r 1��. t�'F S 3 i Y ' r ti.� "'•�r ' T��,_a k.` \.tihY i`Y�>'i >isi� !.•(y.�`.("YiJ2DIR Y•�•� X ,��I.�_� _Y•J (�, Yp,l.,•_.l f�yyS:6E;�,' y i J1 '!': J ''q J.r .tia.:!.'r i:'S> i?:3hi : i>h:.' >'i i>l'�a..+ :�F S ♦a_•i Sl i:�1'{.1.•1-> ���:i�f?i•�+i_.i f•: y shL s'�?ii')Y.^:{<.i i'�fa ..`t: i Y`s::i S :.i.j•.. _.•J'l'•".ri t{7 4�. WITH*'y.H THE iri 7 J!{_A M:: r%{,:.>..y_..Fi :..l r-�%�tr`r i , 2: •t.!.}y .n yr: •�.�..,-:•�i a`:J^ (`l r•• J'•' :.<•r i tea .. ._ P'i 3 '' i S'i= ..ri•.� ._ .. r'� ..... ',:. i:� � ":'�'.:: �.?l!-.^ 7glY� i� 1;S'Yl fYj:`S T.S):_+ h i i-i S>'::.: r• P'i S >a T J•f.i>'« iJf T:i4 T Yh! TiiL-_>sq D/{•_i PAST yam.-.yy ..k�= ..1.. ...••1. y.l Alit yli». ..)_y,y1� i"A_P'F ..l'f•? � i.>'F '„'1. J Y_.i•s a•s S Pi+.Z 1•i i f:a:_{i R !_d.E` r`•i RS7, •*''„ ,J IG ..• ; I•T WAS J ••r•r Ca i. r'•.r}ls' Y Z,: '•Y• 77��J.'•1.�:; t�i lb,}'t Cj ioe::. 1 r•ly+!r-l` �'•j.?,• 1, > ..�::.-�- 'i i +"51::••,'• a f P�ri•a� Pw/•;' �L"Y;. .a i�.• 3:: Si-/-: L' S' 1•if'�> s•s: 'Si�'r sC_s'f .�i .a >�f"' y`!:.:", 1 J!1,<�"'..., f.. ....r-. J:'•%i....."l."!'t '1,' (r., yY y... .. .._._,^; .�% `r'1 - l,y;�,_`:'••. 01- y„ 1_ f'-i"rT ";.r),-/;• -` Y.hi.•:.t i..+a.?'J:i(i..is _ '.::!•'a=.t.t>> r}1a:: "s'.L+rss s"'i..�J.f'..... �a_.;r,:i:...L >::{" r�Y'�i a :..1 a_is•�> >�a� >.:_ii �' T'$-}�.� J lrw1!)'!-1 S •7•F•} r:. :f•^:`:L� ;'i `lpll ':•ry Ty )•+..,....,`.J}y.rfr..`^! T: l!" Jt l+[:n l�l'1 r. t Y r -`'�i- T �L> a t r.:.. i � f_•�"i:�ti.• . T��IF i •rs`:.+:_� 7::f•ir i.i i �.. %'r L 1i r f"5:.: f a�^.Y:1+i_ i• _i�Y•i� HE "3ME i n"_L C CALL MIS " C r 4 C_, ? Y t + " a :, AND- THEY IN _ _S . i_ :i PIPE qi ri i ri: + w I p y,�lrv{':^•rr:.'.^>••p.t,}!'; WITSi ti r x::r•i .�J:'i .a . TY T!4 =Y i=!�184 T Yi _ ^T„<" J>1: _R1r.`:r(:J_ i •SPILL .i'-is.•H.i s sa.• D+.`•`i STATE PI PG Ci.:i r>-9:'N`f s..:f i AIRPERT READ. !-':.i,t•„ p T.. ir`•p J..• -,.J..` . -:•y.r.� .y.. J-L .-J ! r r_ .�' y y.. .,.r yam, :`�l ��r..�,(�^ J .e.7'.,1 .,J.) :vE)•b, 2.7.J' ri{ J^ti1';: `J)•rr-Jy i > i"� � . �L•.i i_,ti> . r�t «:!^a' •_�<f-° :�?•i'r•i v�>ti ' .,i'4 >'r�`�q i-sa_•. •:_+ i�i�: :.r.a.._ PY•� i•i� Fi:. Lf,2 :•;iJ�}•t i,�-S•� ,!i•. 'j�... !_ -"s..-� : RC ' . COVERED WITH , T . :. =_ LMT P qS iq ' ' L S . ! 06t w TRIER, NE f�i-?i:�cyr- 3L <':. ON,; rJ• _>b . W.A.14ii. • PROCESS - C_rS OF r:-..... +-p a.!:y •)-•,' >•rv. !t�.5-: ryJ!i ).,.. L•..'':i':I_ti-.•i a i•:_• :'lSr t: 1�f•i i•.:.+a_.a ti_: ep. .y.�J.a..f,•nJ^'.♦l.•.,f.. yl�.l.q,.1!".•._..r_r qJy C;1 f�.r.qJ Y:.1••�t- y �.._.._. [l _'O y''_` a ..n Y _.. e- ;,ir,,•-_ . i'. > Y'S>'i?'it.'}w: :S . ..YL:�i'f>': .:Y-i."�f l-.l:'h `.:.<i_i=<h l.:. �<i..�(' i..'.� r�:� �it•��,t .a p•i i..:i'Sti ><:.= i..<:.� •rf rr rY'qF I Q `i' •'�'y!!_'! \!1}'../,•1. �'.l:!y.l.i 2.:';'7 `Ji-: T'Jy: i.?' •. t_t J):"r •ry 'p•J ll a •'%J 1`�,f}y :`..� J".i n, ) 1••7,,. �f_ i•, a L.r i::ta"Y )�: li..��,.>._i U. ,> :' i•'i'4>_ S P:'=ti_(':_fi_.. :"1'` �:•`'��� SL?' i_. '�-% f::( :_!. 1Y>)''-F.�iw _.y3J I,��['.i"Y'J:. `. �. �-�:-;+_ "� ' �SY-- .:._._..y:::'.:"•:.:�'f.. t�i'3.-.r...:,� ___ 7 '..nn M1`ay:.Z' Jti ",tr!'-. r-. .4..y �.,.-. ... {_�>i ..a..•i::h:� .i�j'.. Y p.a.i• 9'Y_i_ ••"i:._ >•i::t..a_.,�<.;<r�f. r'J•,�:r•i.Li q _iali_•.t > ..i• ._ :.Ti.>..'tfL.;:_ :>•3.a... SP - O _`_ '>._..J.r J`_;•r:rr J "4J. `]'a',,;a,%-'.T '_ ._ ,pyt. f�y�j't ..%,1 Tr% y`y zy,�Jr.J7 q'`�'• :�Y;:i q':+'-`.Y' ^J'?' -CJt :+ i•rt' >i.' Y'i G.S%'ti.i �.•?':i.iv {_�s'1 i :.i. "a_�;'. r �l••it�z !'is':.i.� .i S_i i', Tom 5 i.'•r i•«.Y>'1 Lf - 'i .a .:i`?._•S .} i i r i..'4 T<` ��,rriY •r} '+- r, r JJ^ :{:'•' {;.r r�%o.•�J.:,',>r` !"•.r;f+rt,^_L'. -;.i�. ?Ll�� 'J,iJ`<!J •T•S-:. J`:rnrir-T. e•1 (i.�. :_.r_ _ .,._;r' ..ti.y. Y L'� >f 'Y-'''iJ r'L•'J"iK P'i i� ��-i,_ ,�'i�. . 'SL'•f AC.-Cl. t.' ..<J i'r'i L•i..''i i"ff:.. . _ 1�!'1<'I•' a a.'� li�t�>". Y'r'S•. . l:�" Jai.> i}'�{'r,S ,� . i_:3'i7:..'S is•:'..k Y`i�r�_'iti_q'}^i y'i' '.'< 1.i.i�'.ti.�'ai'} :t. f->'i_.i: .t�'.'�` 'ii. i'ij}� .:!')Y :`:i_._ r•'{�fia}::.i'ai 'i'}.t(' Y-i{i:i�SV'>tiOfri'y_.�i�.)i'trr'.•..i� Tfy 4ip 7}-V2> S1 Xi! S oi AFTER OUR QGQUSST. . �`ii R._ O('. y�`":.t `C'- ....,.i,iA:.7r••SS �tri�._.it a'•3 '-'S:•• J�r-_•l "_C?_ ;-.f"`'.("_ .. `,y-..y.ily,._..� ....HE , •L•J••f>a::.� S' "Y-iL > T .i(:: ♦rhY-f S i.:':'a!:3'''i.i.�S. y'i t:i? .L i:is_+`:.�i i::.� i i.� THE .:'•ti:�:.+'�i'.i:.� i..� t:_�:i',i'i:::./ THE r_ SPILL PTL _ AND Ji IYal :<r PROCESS, AND Pi i rG,_y SR. r `! _9 GR.: WOULD CiE: a THE AREA � .sm THE rites m s rSR'i_*i'.t1 sox (k^ Y q i"r•+:-•>J",a}.v- .tr,. c!. i t%'f'i F".?i ►i-'S._.'-�r _ E r 2.. i.,Jf_ ,.b; y..<y�',':,'1.'-, { -"fit:.>.r�^q!a yY.-...,y ,i •J t.. !•>.a h a_:.9::"i..•a:. Y-lr>T•sl_a_>•.'w' .i.• /z i i.: _. ._. ir.2:Y°i _t:_a::.i>'. Y•r.,.+•:.v tf i^.T.a. i..•i:_+'. :.:i>h Pia..:?>i_ 3> F'i?a.q SOUTH i R_:CX .rR. 42 Ri r.E_+."s•:'.i'1 HOMER, _.,f"_._'f^.T 7 �.3.;. A AND .7.. .. .. t:-.,STE Y'•', r;r PETER i. >" 3••>: .i l iri "i_"'. 'ii:. AIRED_.il" i:'l�� .r i'.{: WASTE a._ ..a SJ`�i�>-_f•�>:.<.. r " o' "a 04spi T.y y_C:'� . " :S t 5:S_ 7 C a NA. COMMERCIAL OlsErCp? L S i . DOT .5025 THIS HYDRAULIC.'. _✓ l.S_ _ ESTIMATED _ . 7n? ^. ' TO - _ i " ' _ i : GALLONS. I j I l JEAT01y:.11 !-'•rlc',:?•1.TT"r0 CLEAR, "'•.ry.`.. w", Y: r.;!>' F%:'^ ;v r• •TJl•.(r:_-'Y i.� �!Y 5 'y � :rf•' j-;:r :yi ._•i>h1+.: .i ti_<rti� ..•i_i::i'.t".s i•':_ +i._,,• i''r.i i'}iY �� : i.+:- J'SG i<is<::'i":i:,V.•::�. . i':�� '_. , ._ �t=•s-Y.t i tr�.rj w ."t::i•yi':E1'}Xi_1t't' w Q i:i'-PT,. .E,26 :CF. c ' I ` I t1_ Citizen Web Request Page 1 of 3 1 ' THE0. .. atnnsrAniE h1h55, q. rEH M F1 Management �' _d ln'AS� —q g ute to Users Search Requests Create Reauests o Request Information Request ID: 58827 Created: 6/5/2017 3:55:00 PM :r 'Status: Closed Assigned To: Miorandi, Donna Health Office Anonymous: No (Request Category: Chapter108 Hazardous Materials Routine work: No Estimate: I No (Date scheduled: I Estimated 6/19/2017 Change Estimated Completion Completion Date: Date: Sun Mod-rue Wed Thu Fri Sat 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 N 20 21 22 23 24 25 26 27 28 29 30 1 , 2 3 4 5 6 7 8 , Created By:. Soto, Kathryn Priority: Medium Health Office Citation Numbers: Requestor Information Y �. Requestor Re_ues Parcel Number Map: 294 Block: 014 Lot: 000 Fire Dept reports 40-50 gallon hydraulic fluid leak from dumpster truck in parking lot. Parcel Lookup. t Email: Track Request Progress Request Work History: Internal Note History: http://issgl2/intemalwrs/WRequest.aspx?ID=58827 6/6/2017 r v VI �• r+��. � �� ,� �r �-��'�+' j 1 � --�.� '7 �F� ,' r .., _ i.�i�. _ JJ '! "G' •�? "�'iµ:�. _ � _ � f_ .1 w _� � � `a -, d 4 3 ..lS UT Ir r " tip,i � �? � �' v '•�t'e� ♦.:. 3 � � p��7 i� i � `t S.•1 '4Y i • t. 3 • �I - Y II -u - �;,- �.i. f e I'. 1 c E x.r _ �... .� 3 r�_ Ms�. e �..r� * r . .���, � _ Ai �' � A a,.� �� �' f ,. � n a l - . ' J �I _� . � ..� M �1+ _ I .i 1, f� _� � • _ ;. �4 r_. y °r .,<<..a . —�: .., .. _ � k .�� y •. .�,. _ _ i. � _ :* TAL SERVICES :n a: �a� �.t 1 - , - �. ,� �"' �,,. � �_ , ,�;:. _ � ..�. L D• nap PF ASW r k � f m., r w� r,Y MI� Z ye15. " W�nrl. f 1 � .i K. l•- a ._ - __ ♦��1iwrlr x r// 1� � .�'- 4 •V ,� �� T -. p. ` _ .. .. A '�cy 1 -' f_ ^ ��. M i ��. �y -�,�n� �. r � � � r ,�. ; Cl��pAJI ;. �t �� � r �� .��,i ♦y /� �� :q" ' -' .w , y� � _ 'w •� t ` - i I Citizen Web Request Page 2 of 3 Entered on 6/6/2017 3:48:30 PM System entry on 6/5/2017 3:55:00 PM: by Miorandi, Donna Assigned to Miorandi, Donna DZM responded to a 55-60 gal hydraulic oil spill at Barbyann's Restaurant. Chief Dean Melanson and System entry on 6/6/2017 3:48:30 PM: Lt. Robert Hennessey were on site. Republic Services was the garbage hauler whose hydraulic Request Closed by miorandd line broke. Dealt with Tom Mengler was on site and is the Operations Manager for Republic. Frank Corp Environmental Services was the clean-up company that responded. Franklin Utility Corp. truck from New Bedford, MA was on site. Republic was the company that called DEP but DZM does not know who the contact at DEP is. Mr. Wengler said his boss had talked to them. DZM was informed that they were not coming down due to the fact that it was spilled on pavement which was erroneous as it was in the dirt as pictures show.6/6/17-DZM followed up today and all cleaned up and there were no waste barrels left on site. Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) i I Spell Check ; Spell Check Add document or image link: .._�.-____ _ Browse.. *You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 4.00 Response time: 0.50 *Time entries are in hours.Examples of time entries: 1.25,0.5,0.75, 1,3.5,0.25,0.10 *Response time: Measured from the creation date to your first actions on the request. *Do not include nights,weekends,and holidays in response time for most departments. Reopen O Reopen and notify citizen Reopen Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/intemalwrs/WRequest.aspx?ID=58827 6/6/2017 _ Qo No...2=.3 .5.4..... Fss........ ..°..: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..Town....................OF........aar s.tabs•e----------------......---••--••----------•------ Appliration for Uhip ti ai lVorki Tnmunrtinn Vamit Application is hereby made for a Permit to Construct N) or Repair ( ) an Individual Sewage Disposal System at: ........Air_port---Road /.e�0..................... .... y �is .......................................... � u� Location.Address or Lo N _ O ner --------------------------------Address Insta r Address d 4 6 17.4 Type of Building Size Lot_____.....f .......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (No `4 Other—T e of Building .._ No. of ersons._150 seat Showers Cafeteria P4Other fixtures --------------------;-••............................................................................................................................... d Design Flow....•.......................................gallons per person per day. Total daily flow......�250-.............................gallons. W • 9000 1 '0" 10 0" 10'll" r1; Septic Tank—Liquid capacity._.._..._...gallons Length................ Width._....._.._...._ Diameter._..____._______ Depth...._.•._._..... Disposal ClaUas No. .... ...:......... Width.._1.2A.___._._._ Total Length 21-6_1........... Total leaching area_401-- - sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leachingarea..................sq. ft. Other Distribution box ( ) Dosingtank ( ) Grease Trap (2500 Gal Cod Surve Consultants 5/16/84 Percolation Test Results Performed by.._...__Pe_.___..._ X................................... Date......................__.._......._.__.. Test Pit No. I................minutes per inch Depth of Test Pit--1��ii_..__... Depth to ground water_. none Test Pit No. 2__._2.____....minut --- es per inch Depth of Test Pit-.l44 g Depth to ground water--nOn _OF TP #1 0 12" Fill 12" l20" sand and ravel ' --- --------- •- O Description of Soil...TP..#2. 0-12" Fill,-12"-144" sand and gravel �o� _.ROGER tiN PAUL •AAd WN4EW1 Z No.3042 W •--•------•--•--•-•-----•----•---------------------------------------------------------------------------------------------------------------------------------------------------- .--- - VNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------- ------------------------------------•-•--------------------------------------------•---------•-----------------•----------------------------------••-• ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ccordance with the provisions of iiTl.E 5 of the State Sanitary Code—The undersigned further agrees not to place the system i operation until a Certificate of Compliance has issued b the board of I 'th. Sign b tt D 'e Application Approved BY `� = ........ - moo= l Date Application Disapproved for the following reasons----------------------------••--•------------•----------•--------------------------------------•----•-•••••••.... ---------------------------------........................................................................................................................ ............................................... Date PermitNo....fY f.?/.............................................. Issued - ....................... Date THE COMMONWEALTH OF MASSACHUSETTS 06-1 BOARD OF HEALTH 7 4.� �s�.s� s rh,,c.OF.................. ................................................................. C�rdifiratr of Tomphaurr THIS IS TO CERTIFY, Th t he Individu 1 ewa e Disposal System constructed k or Repaired g P �' ( ) ( ) by------------------------------------------------------ -------- • ------•--•-•------••---•----•........••-•-•-••--..............•-•-•-•------•---•--••-•---•----- d, /� Inst d, AlxlOok r / vt c at.. " ...f�-----------------••---- ----------------------------,--- ------•-------------•--•-------------------------------------------------------------------------------- has been installed in accordance with the provisions of Tlmu: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___. ��/'..53�.__........ dated----------...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... _< ' No....2=3 4 r FEE.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...----...Town...................OF........Barnstable.... ................................•...... } A ftra tou for Dioplaiial Works Tmitrurtion Prrutit Application is hereby made for a Permit to Construct X or Repair .( ) an Individual Sewage.Disposal System at ..--....Airport toad �. 11y A-*s ' Location Address or Lot No. ................ ...._._...--.�:a r. t! r---•------------------•---------•---------. .................--•-----•---••--•............... =--.� .._...................:........,...._...... W r Ow e, Address ....___�_...4-4..,t -„ .....................................•- .......---------____......._._....................._._..__....____....................... .... Instal' Address A 17 A Q Type of Building Size Lot_____'_S_________________::__Sq. feet U a Dwelling—No. of Bedroom ....................................•------Expans}g Attic�( ) Garbage GrinderReauaraft ( j a, Other—Type of Building ____________________� No. of persons_.._________ >:.. Showers ( ) — .Cafeteria .( ) a W Design,Flow_-Other fixtures g ---------------- allons per perso flay. Total c� hy©f�,ow '.:_12 ' g�}l�gis�� 1 ------- ....lU J.l WSeptic Tsl L>qutd capac>ty' ���g g Diameter...............: eh gallons Length_______________ ��idth_. j33 __.. x Disposal ' No,-----2............ Width___41Z!_____-_F.=Total Length_21.61......... Total leaching area___, sq. ft. Seepage Pit No--------------------- Diameter Depth below ' let__...._ Total�e� area..........•--.....sq. ft . z Other Distribution box•( ) Dosinig knk 6 SUrVey � 6 8� '~ Percolation Test Results Performed by..______Pe_____________ _. ______.____..__._.____. Date_ n__ Test Pit No. I________________minutes per inch. .Depth of Test Pit___ 4n.__._,_.Depth to ground water _._-___ ..._ (i Test Pit No. 2.....Z__-_ i' t „i pep 8f 4 Pit____ D to ground water-.-__-__ T ' ' I' 'x7 Z, —I�L s�aryc7 "grae td p TP �L-•t>=IZ �'�,3.1;--12 Tom, �attd••ared-c,�rave7:....i.--•-•--•----------=-=•=-_-=.:..:.:. � Description of Soil .................................................... ......................... RO === ..: CER G �1 PAUL ; N U •---------•--------------•- ,--------•..... ......--•-------------•-. -•---- AIFFEWIV7EW ___ UNature of Repairs or Alterations—Answer when applicable._...-.__ ___________________________________ ___ c_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i a ordance TmS:... the provisions of Ti :., S of the.State Sanitary Code—The undersigned further agrees not to place the system i operation until a Certificate of Compliance has been issued by the board df health., Signed. -• -.44 6J 0 Dat Application Approved By-------- /-----------------------------------------------=----------------------•-------•- ........... ... • Date ' Application Disapproved for the following.reasons-...........................................?................................................................ _.....--•••---••-••--•-•-•---••-••---•--•------•-----••-•-••-•••-•-•••----._...•--------•--•-•--•----- aY,, Date Permit No.-----P - "�............................. Issued er ' y --.....--- ---•------•--•--•-------------• Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ , U -...........OF............... Ffi! r�iltc %Trrtif iratr of fix mplianrr THIS IS TO CERTIFY, That e Individual ewa e Disposal System constructed ( X) or Repaired ( ) by- - �.- -------------------------------------------------------------------------•--•._...---••------ Instal at........ ....... --------•-- .......... c.lrr. .--.•.•-------------------------•-----•--................................................... has been installed in accordance with the provisions of TIT' j of The State Sanitary Code as described in.the l . application for Disposal Works Construction Permit No`_,, .......... dated_ .______________________________ :________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE. SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH .... ........................ . ............................................................ No .•....---•---•-•--•--._.......-. . No......... Y.. .� FEE---.. .._ �—...... Disposal Works %vniitrwtiort prrmit Permission is hereby granted............................y��,¢ts t.e4we...---••---•-------------------.••...------•---•-•-•---•--......---•--. to Construct ( or Repair ( ) an Individual Sewage Disposal�Systa at No. ' ' .i i r 1rc✓k fa �.�y� Street 7,1 X-31 !� as shown on the application for Disposal Works Construction;,P.ermit'No_ _________________ Dated.......................... ................ ....................................... --------- --•-----------------•-----•--.-_.... ._.._ / Board of Health DATE.....-............... .................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 1� � �.f * r e;,4. y 0 s« �t y +..} s.,� P •!i �. •'* "•4'.e se:- r�a. r 'f•,ar ,. �. ..� t 4. y k. � 4' a .. C. n •� 6i� •i , . •F. ,.T t '! r t � - 7^. , A.! J n,a� ti Y,`S 'i,. a y....h• ,q'j�-.A C• 1' / ! . '} thy o .. a• '"! " W `Zti ay- 1h t e d 4r q a s ,� �; .. ath •y ' ^kt !s° r• F, i' :'4,Ft r �i • t .<s*' f e,.' 9e..,} J ti e�. •.r '` w. � _i.• -• .. ' a t e, r!f ,dam - i �. �,`yr♦ "`� } - �• ` w�i.' - 1y4 . q i�" .t >i �y..:JSe •�fw�tst 4. �•, . �'r t} t.'' •, .i" $ t♦�.s - +"s'}^' .} W � + '{ i 3 C r..r •+ a X y - .t ,a=♦ M, . tf'i< a s ^; r s r i r :'fin. 4.. r• e h t. a}., tr t., 4 J sr, a f+ * .Tune 984 ' t r-'♦ f t$ Y`}t a k .1 t .+ + �i; it ..1� a w, 1. W �- i t {t'$�'• 4 `�,t jY�r } t- a �°t- k y+�,a x� try -r u� •i s s .4, i' ' ws,{ w a ,.i ..rr' S'♦.. ,.� d� 'Ci ,.Yh' s. t. r,k. .+ '�'"�^' R t, tF a7 ]w i^ '..* rr ,r''4�r ,- `A• r t �. f7i L,.` :{ h r �-.'r It + `S i j" t i. yh te., i ♦ �r. . s c > '`• t' � W ` ' �' + �' - .2r.i 'J s w. r : ., yC•, ts �hC •; y °";+.' ., t .♦ - . '9� � a + •.e 4<. ' y ) f - - :.f♦ ry. 9 �. { 4 • 1 f _L t .f,l +a J' . Y }i t �' .. t � .-� � �,..' ' . J _:fir,-�4 }l i r.••� w+, �-t ,.�,. , •S a � ;" ,t t '?y,�,a t . 'r Sa +i. t ft.'.e� 1 ` �,, f - •, t. '�` .* r 5,w W.r Y `.. `'+t a uper ♦x 2.-,r . e"��''�r�. 'F;:• <�kf. :'�tx t��: R,H �:'-.�, �r T i.Y.�••e,3 b� , � :•, �''�� � + , r }, . t, "L . Joseph' Campo8inteadent� Mr .t .¢ ♦ { , { '•-us €.# +"^ r.r_ Department of }Public Workb •' 4 r, TQwn qQf',Uihitable 1 „ ` Ma, .a ' Hyannis' W i ! ~�a ' ! _, � •� µ�. .r 4..+a.t y i �4 + t "Dear Mr,. Campo t '. i ', + r R i ' 1S •� ! « €c f : ti ` k "? 'S ♦ ,.r ? '7 ar 'kk .$ j, 4 f. ,♦ ♦ r'"^ k °• A 3', ." 1. { $ D.'"avid Bolton,, 49 Bay Lane, ,:Centerville wishes 'to have .a' 150 seat- �{ r t + ,� � a' ,restaurant located on Airport Roa i,.Hyap�ni®: He-=wishes to' AistaIL., 4 r r -.- + x a 7 + �•.i'aC ;4 ',,4 i i.-r, + ''y a 4� l 8n'onsite eewage- disposal'system:' �„qJ Yt +,',•• i' �rtr r' .ti ` l i ], iaS iad 1�r, \ + - 4 { � We ¢feel .he is within, 000. ,feet '6f- the'public sewer atidt then®fore _funder.',the "jurisdictioA wbf ,oar heakth regu atioi requfri, him' :rto::connect. He.feel�eti lib's estS 6b6h ;wi•11 be located _� 3000" : . �. a° ore than " r feet from public sewer. Y 74 i fY `S ��� �j♦ ,, ..ra •� -�A r t - .! ' ye'_ a_4 'p' • r b�. h ,� �,♦ .', We-'.would 1`ilCe {r E, an:`official Pinter retation of thow'^farshi's proposed', R ♦ x x business is-from publicA sewer. a q 9 �t �•. ✓ •, .. �,,' 4' - y.. s, ,rt brta''t a K1% . A copy of,his plan' with`loeus is at t t 3 t t r .�tP ..y r•ta f � ;.'' s:, h Very trulY�gou�s,• .. - '•�° . ,ti•� .,, � i,^ .. �-� t, '• •_ ;! , t r.-. k +' t s( 'r, •.w Y ice, � 1+-�� t- ti yq i. •' _ .•rS •�� �' � • a t c+ � .•c ;�'� ',� 7� •ta�a�. � : Y,QY J+ {�. �'ti ar d. s �♦ *:tj4r w'��",� t*r' S ( e<.- John,.M• Kell q ♦. , y 4.' 4 lip a Directoz of` Public Health r+ s ` ✓� ' rr` i, r S ai 1 k •" F pr i 1 q n'' ,,* 't, t }t '` +, 1 r -4 •!4�' l� r�• r a� t "? i.• `'" r. - .. f _,� ; : �, n r A YWv� Y aTMA/min : y .j 1 p . •4 enc l• l,' ♦ t ♦ ;tea. it r s i.'v ✓ .•. �Y,. - C Y �� 3±. ".d •• , e s" �' y "rr : t• .q♦;�. t. ' °..; .." ` `� .h• �q':r t '.+ } l��t�`I. .t,7 4 •f a s { �. •� °``. t •� ..a' t : - .i t Il.: .«,1y ♦ �,„ -� , . s• :may, ,�� ♦ .♦" ' s .. / i _ 'r,' '.t,' iy`- '"^*' f � .'ti• _�;; IW S� ��>t� t r:� ,,� t z r`r r ..1` 4 � A - " �'ti S r r �S,e,� . ,� _r- # :~ •- ,_ .�• aY �.' f C ! a 1 s �, t ; + . ±,h �•. C tf i • Y + �} r' s(, 1 � � l�p ^! 1y'.. � Y L• r y-{ � ^fR�J y9{� ,•I t t b S• S �,. ,� f .�` _ ���f5�Jk,p� f� -� ' .rr r4. r q ;sue r�♦ ' M J' i ,s >S r' :r •- - { h� t > S+ .. ` - i x•iy�.r 1� ♦k.a -s'r � p~ a .,. a � !' .'K t�i k�: -.+ ., y. ac` t •y.6 [ � rrry y '° a + ' qa ,ay p W e, 4�} t ,9, r ,- • t r + Fr j a r. �,y + •.��, t:k. � s- i,•i W` { n., i - e - .1 .+ .. � ' ' ��J �..s• � it q •.�5+. � �ay ' ,}, q �_ � -t` Lti� .♦ }�. '` ..r-t a tµ t�♦ t ' x$. ': W st+t.�., f :a 'Ri r,;8 <W r ri; t4 'K. l 1 .. •t ` '� 3 S �' .a bvr �'�yit t" r 1' ,4.�Y�, R' � d i f ,�- -'. +• '.a _ `' ��•E'r `i. fY � �� 'S •'t�r e t i r •� � u.. _r L ' i. '� $ a• S•eaa '`'iC R 'r. t:•L '�'' "r •3. s ✓stir ♦ "l� ..'�' ! 'i r r s a s •�..r="., +-, ... r ,��! +'.�#K..: ��' �. st., r,- .. t:q ''.�i` .'t' > k .r i, %y s ... - - ��.^ a �� �. DATE FEE •aFTNETp� TOWN OF BARNSTABLE P� f OFFICE OF i 13AflII9T = BOARD OF9 HEALTH 1I 7 YAE[. � °OtEo�A9 367 MAIN STREET HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days prior to the scheduled Board of Health meeting. f( n / NAME OF APPLICANT �n [� p T p TELEPHONE NO. �l 6 CIZ 6,5 ADDRESS OF APPLICANT ° a cr ce ►� � o -,�c �. MC4 f NAME OF OWNER OF PROPERTY ,� �• 14 v I LOCATION OF REQUEST I r rpe r'E— '�Ic.fa.11ltnc.S Y r Low , E VARIANCE FROM REGULATION (List regulation) :2eau 64IA� � , ,, c�-�,..� �� �sC VL© !- VARIANCE REQUESTED (Specific request) i 1: i' REASON FOR VARIANCE (May attach letter if more space needed) r t f: PLANS - Two copies of plan must be submitted clearly outlining variance requested. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROV,+ 6 I i Robert L. Childs, Chairmal] Ann Jane Eshbaugh . H. F. Inge, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE