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Home My WebLink AboutKOBI HOUSE - FOOD (2) r a } s 4 1 t s 1 H � , E , K6131',HOUSE 489.B66me's Way, HY r i �r p i I e 1 I i' r i n •� ,} k d . - - �.i a �� .�. -'t-� Y�• �� 1L.. •'�' V Ft ` & iY x�k ��':'. Y '�,? �'�'"` ^'+i14 y�y'A.n}iS. 'T w °,J� y� '�d ✓""''• � Y mot' s 4 z x � p f nx FORIVIE:RI:Y ORIENT EXPRESS :i .x � i s SyN it 2 ' Town of Barnstable BOARD OF HEALTH vy John T. Norman 3)' Board of Health Donald A.Gaudagnoli,M.D. BAMNSiAuLE, F.P.(Thomas)Lee,. 9 MASS Daniel Luczkow,M.D. Alt. + q ,� 200 Main Street, Hyannis, MA 02601 a Mai° 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: 535 Issue Date: 01/01/2022 DBA: KOBI HOUSE OWNER: RU' QING MO Location of Establishment: 489 BEARSE'S WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 41 OutdoorSeating: 0 Total Seating: 41 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - MOBILE-FOOD: MOBILE-ICE CREAM: ` Qp FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I Initials: "e Town of Barnstable For 0 Date Paid 1 ( IAAmt Pd$4;1,NAM _ Inspectional Services L639. A`� Public Health Division Check# � pL Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATEU A FOOD ESTABLISHMENT DATE l 2 1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: kebi 40U Lp ADDRESS OF FOOD ESTABLISHMENT: _ ? �'l V1 U( MAILING ADDRESS(IF DIFFERENT FROM ABOVE):`t(l q VJM -Z Iqj_01n{/l IS . E-MAIL ADDRESS: hO ( ` c TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: ?— WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: JI SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: -MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST 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*** REOUIItED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc I OWNER INFORMATION: FULL NAME OF APPLICANT PLO I am M 0 SOLE OWNER: YES/NO j D.O.B 6 j t I (q7 OWNER PHONE # 77Y Od� :l1192, ADDRESS � Q �[J l 'C ��V�}� Et, jTa CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: a 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 Exyiration Date 1. 6 VAO 0� /--30 1`2,5- 1. r-5, ( nq 2�� 2. 61, Z�� a_ i-3o &-U NATURE APPLIC T DATE -ikk 0 ***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/aiDDlications asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc OFt1 BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABLE, A Paul J.Canniff,D.M.D. MAS& 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 535 Issue Date: 01/01/2021 DBA: KOBI HOUSE OWNER: RU QING MO Location of Establishment: 489 BEARSE'S WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 41 OutdoorSeating: 0 Total Seating: 41 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD.: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: an 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 �pIME tp� For Office i • Initials: ti Town of Barnstable Date Paid MUMffrABLE, : Inspectional Services �. $ 1659• Public Health Division AtFG MA'S a Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A OOD ESTABLISHMENT DATE i I HIA110 NEW OWNERSHIP RENEWAL NAME OF 60D ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: Rq �� i•_.i dl/W� C" c�`'D �• MAILING ADDRESS(IF DIFFERENT FROMABOVE): E-MAIL ADDRESS: I;j1C V!W @4rmai — 011�1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( ��) TOTAL NUMBER OF BATHROOMS: WELL WATER: ES y+NO ... (ANNUA WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE ROM LI G 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 WAITSTAFV SERVICE DOO (S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST 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 Forms\FOODAPP 2020.doc G'f r' OWNER INFORMATION: FULL NAME OF APPLICANT ' SOLE OWNER: YE /NO D.O.B. 0 OWNER PHONE# v T u 7 '� ADDRESS 2� tMC1W V`-S ` G1N�V� t "� 1 02, CORPORATE OWNER: kZ Ste. CORPORATE ADDRESS: - F'� �`-"' "l O Z-V 0 1 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 2. V. } 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/apt)lications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsWOODAPP REV3-2019.doc I f� * Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. HARNSTABU& Paul J.Canniff,D.M.D. MAM `1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 535 Issue Date: 12/10/2019 DBA: KOBI HOUSE OWNER: RU QING MO Location of Establishment: 489 BEARSE'S WAY HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 41 OutdoorSeating: 0 Total Seating: 41 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Initials: � .� Town of Barnstable s Date Paid,M' AmtPd$ S Inspectional Services ' � anxrsTasLe. • Public Health Division Thomas McKean,Director Lo&- 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 F ' p APPLICATION FOR PERMIT TO OPERATE AY60D ESTABLISHMENT DATE 6'�' �® NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 75C�' ADDRESS OF FOOD ESTABLISHMENT: 1 c'7 2- 0 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 1 1. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 2 WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:— — SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: _ OUTSIDE: ' TOTAL: SEATING: MUST OBTAIN A COMMON VICTUA LER'S LICENSE FROM LICENSING DIV. Li ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? _ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V 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 Y± OWNER INFORMATION: FULL NAME OF VPV ICANT �'� C' V SOLE OWNER:(YESNO qq D.O.B �I OWNER PHONE^# `17� ADDRESS_ �1 P(N at U� Ot 1� I N I 0 7,-6 -71 CORPORATE OWNER: 14(4 CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Y Q 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 I t VIA )n�qnlvl AV 0 12, p 7-/-29711. B t V1 2. SIGNATURE OF APPLICANT DATE �iLA4 ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openiniz!! 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 1st to Dec.31"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 04tNE t Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. auzseAQee = John T.Norman nnss 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 prorrulgated 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: 535 ` Issue Date: 12/20/18 DBA: KOBI HOUSE OWNER: RU QING MO Location of Establishment: 489 BEARSE'S WAY HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 41 OutdoorSeating: 0 Total Seating: 41 _ FEES ----- ----- - FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - -- MOBILE-FOOD: MOBILE-ICE CREAM: C,�� 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: Bellaire, Dianna From: Stanton, David Sent: Monday, December 10, 2018 11:48 AM To: Bellaire, Dianna Subject: RE: Kobi House Yes,they are ok 2019 inspection. From: Bellaire, Dianna Sent: Monday, December 10, 2018 10:02 AM To: Stanton, David Cc: Bellaire, Dianna Subject: Kobi House Dave do you give them the okay for 2019 inspection only? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us f 1 r �k , FIME toy Initials: o Town of Barnstable Date Paid MAS& Inspectional Services Check# Public Health Division _V 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 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: o ADDRESS OF FOOD ESTABLISHMENT: 6�cles yu tE 7 ki I`S 0 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): G� E-MAIL ADDRESS: Jam' t ho O k— 6 d I01-iM a l I p Lan n TELEPHONE NUMBER OF FOOD ESTABLISHMENT: C,,2t ' - Q- TOTAL NUMBER OF BATHROOMS: Z. WELL WATER:Y S NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 4- TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV. AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S). TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST 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:VApplication FormsTOODAPPREV2018.doc -- --------- --------------- -- - - V PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO D.O.B DI III OWNER PHONE# �/j U S 7e S� ADDRESS_`4-1s'Q/S Vy-- r1-� Yt j S `f C Z.6 0 CORPORATE OWNER: He FEDERAL ID NO. : 2-6 - 24 q 1) CORPORATE ADDRESS: 1q/a 0Z6 0 PERSON IN CHARGE OF DAILY OPERATIONS: No 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 ller en Awareness Expiration Date f t`l0 12l /7,0 I. Q / / 07,01. 2. ` 6 l (tlz D SIGNAT O P 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/bealthdivision/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. t NOTICE: Permits run annually from January 1 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\Application FormsT00DAPPREV2018.doc OF(ME roN. TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Rage: of �P OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN5TABLE. " 200 MAIN STREET 3:30-a:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN O CORRECTION Date Verified MA55. P MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 9�'"rFD MP'�611 HYANNI S, MA 02601 saa-as2-asaa FOOD ESTABLISHMENT INSPECTION REPORT Name Dat due oIV 010e f Inspection O ns Address Risk rvice ectio Level Retail pection Telephone _ Residential Kitchen Date: y \ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector LL 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 C ❑ 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 HS\P' ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY r(� a 11.Good Hygienic Practices 22.Posting of Consumer Advisories- Violations Related to Good Retail Practices(Blue Items) Total Number of Critical ViolationsCritical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ElYes 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 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 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 i 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 violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view yh_MA"-V Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N La_,r2, &:�! #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Sign ture V Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y 14 V 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 r 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 Ce--;ta:m;naf'!=•:.-Raw ft?gred%en+s Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F +c EMPLOYEE HEALTH 3-302.1 I A 2 Raw Animal Foods Separated from EachContainers* * 590.004(F) * ( )O P 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Others 7-102.1 I 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* 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 -501.19 Time as a Public Health Control* * and Use* 3 Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.1 I Food Contact with Equipment and Utensils* 590.004(l l) 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* 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 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 * 4-501.11.1 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 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food ContactEggs 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* h]aerdw 1112001 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Shellfish*, 4703.1 I Methods of Sanitization-Hot Water and 3-20L15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* 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* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* * Other 590.069 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-401.1 l A 1 b All Other PHFs-145°F 15 sec 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.I1(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.I 1(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 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 * 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-SOI.l4(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. .H�E ro TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date ( Page: of WY, ya OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. MRHSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �4A .639.e�mm HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red Item rep rw'� 508-862-4644 PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Dat [Type of Tyoe of Inspection Rou' Address ` Risk Food Service - s e ion b n iy Level (� ious nspei liun ze•� Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP LZI el In: 0/ e Other Inspector C/fn_ �� Out.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) ❑ 10 Action as determined by the Board of Health. Allergen Awareness 590.009(G FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands i `5 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS c ❑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) ell 111 Corrective Action Required: o 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-inspect n Scheduled ❑ P-mer-gency 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 One critical violation and less than Orion-critical violations g ( )( ) 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 o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If f critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 ti 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8rion-critical violations=C. a29.Special Requirements within 10 days of receipt of this order. p q (590.009) 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 -0 � " '- #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 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 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* L19 PHF Hot and Cold Holding Cn-lamif.na"cr Raw Ingreeftent-s F_i.; Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140*F* Require Reporting by Food Employees and Contamination from the Environment 7-201 7-102.1.11 Separation-Storage*1 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 20 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* Time as a Public Health Control 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* 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements Contamination from the Consumer 1 3 1590.003(D) Exclusions and Restriction's* 14(A)(B)l Returned Food and Reservice * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 1590.003(E) Removal of Exclusions and Restrictions 3-306. Disposition ofAdufterafed or of FoodContaminated 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* F4 Food and Water From Regulated Sources F 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* 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* F3801 I I(C) Unopened Food Package Not Re-Served 3-2 02.13 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 3-202.16 Ice Made From Potable Drinking Water* -Concentration and Hardness* 3-401.11 A(l)(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* 4-60 1.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 see* 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* Eff-fi-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 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(B)(1)(2) Pork and Beef Roast-130*F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* - Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-40 1.11(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- Sources* F_10- Proper,Adequate Handwashing Ratites-165'F 15 sec* ing,mobile food,temporary and residential Game and Mid 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. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145*F 15 see* Other 590.009 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. F-5 - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 see* 3-202.11 PFIF'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* F12 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* 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 - 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 F 6-301.11 Handwashing Cleanser,Availability 128. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision :4. 1 29. 1 Special Requirements 1.009 3502.11 Specialized Processing Methods* 130. 1 Other 3_502.12 Reduced-Oxygen Packaging Criteria* 8 8-1_1 03.12 Conformance with Approved Procedures* S:590Formback&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. -•.IKE Toy, TOWN OF BARNSTABLE T HEALTH INSPECTOR'S Establishment Name: Date: / ` Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified otAss. a MON.-FRI. e,c• `0m HYANNIS,MA 02601 50a-862-464a No Reference R Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Dat ( of Type of Inspection �Semice Address Risk ins ecLevel 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 In: Other Inspector VIA Out: 14 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. �• vV �d-V k) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 7 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 l� ❑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 1Yi' ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 1� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations j �`p �z 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g y ❑ ry P ❑ 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 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 4pon-critical violations g ( )( ) 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 i non-critical. If f critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 ti anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8pon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signat a Print: ,� 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC'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.) r 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 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* 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* PP 3-302.1 l(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(I1) 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 590.003(E) Removal of Exclusions and Restrictions 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 Wafer 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* 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* 163-401.11 A(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 145'17 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 me 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 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* 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 * Stuffing Containing Fish,Meat,Poultry or 590.009 A Chemical ( )-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing g� P y 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. 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 3-202.15 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 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-SOl.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protect on FC-3 .004 * 5-205.1 I 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 g 590.004(J) Labelingof 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 1 Hand Drying Provision _ 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. °p THE r°w� TOWN OF BARNSTABLE • ...„. .- HEALTH INSPECTOR's Establishment Name: Date: Page: . of OFFICE HOURS PUBLIC HEALTH DIVISION e00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:3U-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A 9.A.O� HYANNIS,MA 02601 " oa-962-4644 No Reference. R-Red Item PLEASE PRINT CLEARLY a3 rFDMP, FOOD ESTABLISHMENT INSPECTION REPORT Name Da Type o I LMAIns ec ion g outine /Address �� Risk od v v Srvc sn Leve Os tall previous nartiwn <n Telephone, Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness (�t Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast o heCP (� `'��L(/�jj� r Inspector Out: Each violation checked requi es an explanation on the narrative page(s)and a citation of specific provision(s)violated. tj YVQ Violations Related to Foodborne Illness Interventions and Risk Factors Led Items) Anti-Choking 590.009(E) ❑ l.J Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �� n 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 `, n EMPLOYEE HEALTH PROTECTION FROM CHEMICALS U " ❑ 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 1 ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling z 1 I ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding c ` 1 PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control. ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) C ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP s ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories C 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: o Non-critical(N)violations must be corrected immediately or Overall Rating ❑ Yes within 90 days as determined by the Board of Health. �� ❑ Voluntary Compliance F] Employee Restricti n/Exclusion ❑ Re-inspection S heduled ❑ Emergency Suspension C N Official Order for Correction:Based on an insp tion today-fhe 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 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 p (FC 4)(590.005) cited in this report may result in suspension or revocation of the food 26.water,Plumbing and 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. 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 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 PI 's Signature Print: Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y N �n �� Dumpster Screen? Y N V 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.) _:,:aA 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 - Law Cooled to 41°F/45°F Within 4 Hours* 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* 3-501.15 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 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 * EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachContainers* 590.004(F) 7-101.11 Identifying Information-Original 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* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* LIP- 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* 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 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* I Beverages with Warning Labels* 4 Food and Wilier 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*. r 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. 1 g 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* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"°e iniaooi 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 Equipment* Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Cough[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 Ratites-165°F 15 sec* 590.009(A)-(D) Violations of Section.590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 10 Proper,Adequate Handwashing 2-301.11 Clean Condition-Hands and Arms* ( )( ) P 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 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 3-202.15 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 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. Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(4(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. oFT roh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of P. Y OFFICE HOURS PUBLIC HEALTH DIVISION 8:06-9:36 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 9 39• .0� HYANNIS, MA 02601 _ More.-FRI.508-862-4644 6 No Reference- R-Red Item PLEASE PRINT CLEARLY e FOOD ESTABLISHMENT INSPECTION REPORT Name Da a of Type of Inspection eration Rout' eo, Address (/ Risk ice e-inspection - f�� Level Rea ion Telephone 111170 Residential Kitchen Date: Mobile Pre-operation 01 Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: All el 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) ❑ y� 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 V ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME(rEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating i ❑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) 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 Itemsl Total Number of Critical Ucal 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 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. 28.Poisonous or Toxic Materials FC-7 590.008 9 ( )( . ) violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 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 Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N A� e Y� 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 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 j Person-in-Charge Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 8 3-302.14 Protection from Unapproved Additives Contamination from Raw ingredients y 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* * 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 1307-]02.11 Common Name-Working Containers* Applicants* 3-302.11(A) Food Protection* P 8 20 Time as a Public Health Control 7-201.11 Separation-Storage**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 590.003(G) Reporting by Person in Charge 3-304.11 Food Contact with Equipment and Utensils * ( ) q * 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* 4-501.111 Manual Warewashing-Hat 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 * 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 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. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(I)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of g8 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* Eg cave 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 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* in mobile food,temporary and residential Sources g. P aTY 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 3-202.15 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* 16 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 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 �Within4llours* 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. �p IKE I TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 6:00-9s0A.nn. s BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,a;4 `0 MON HYANNIS, MA 02601 -08-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY Arty, y e, 508 864 FOOD ESTABLISHMENT INSPECTION REPORT Name v / D / Type of Tv2e of Inspection 6 O e a' Rout Address Ris a +or D !7Level re ous nspection 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. f 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) ❑ 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 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 s f� ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling g7 k _ , 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 1718.Separation./Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP I n ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 2 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories O_ . (3.,1 Violations Related to Good Retail Practices(Blue Itemsj Total Number of Critical Violations ) . r� L C, 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 4npn-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. 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 o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 ofcritical ons observed, and less than i non-critical. If no critical water,sewage bads-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 8npn-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view qz,& /L& 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 rature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter.Posted Y N Dumpster Screen? Y IN 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 Acc,3rding 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 I2-103.11 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 y 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 * 59^.004(F) ( )O p 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* Applicants* s P g 20 Time as a Public Health Control 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* * 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 AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAduherated 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 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 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 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* Ery cnw mnooi 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 590.009(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 AutKINhority 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* 16g°F* foodborne illness interventions and risk factors. Other 9 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* e should ces 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 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 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 Supplied with Soap and hand Drying Devices i 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 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* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc I� *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 HEALTH INSPECTOR,s Establishment Name: Date. Pa9eC of OFFICE HOURS BARNSTABLE. PU62 0 MAN STREET 3:30-4:30 P.M. LTH SION - : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 508$08-862-06-FBI. No Reference R-Red-Item PLEASE PRINT CLEARLY �plEC MPS° - � FOOD ESTABLISHMENT INSPECTION REPORT 44 Name Dat Type of Tyne of Inspection Ooeration(s) Routine Address Risk ' Food Service Re-inspection Level Rctail Previous Inspection ..Y 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: l r �/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) ❑ s 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 �S ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '6 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 ❑ 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 r I 11.Good Hygienic Practices 22.Posting of Consumer Advisories - t ®, Y9 ❑ 9 Violations Related to Good Retail Practices(Blue Items] Total Number of Critical Violations - / "S 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 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 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 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 8non-critical violations=C. w 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 Signa a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N T ,..� .. -1. .� ..... �.-- -. -.,..... ._-..--. -...._.. -� .� _ ..� � -' _ -. .. .. __r. __ ,_ �- - -�-"�Y..-.'^y.r • w.^ -v - F-°w.J--" s. - ••,_ '�_ -{' y._r - y...�.w......-y.. - -. .,. -� ._ s-s-.way.- ._...- _„fc..-... _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 1590.003(A) I Assignment of Responsibility* 1 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* �21 0.003(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 03.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Con.-cmLaation from Raw Ingredients 1 S 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) p 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* p g 20 me as a Public Health Control 7-201.11 Separation-Storage** Ti 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 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 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) I 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. 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* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Effective mraoor 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f 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 1 7 Reheating for Hot Holding practiceRequues rhos ld 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 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 Tags/Records:Flsh 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 1.008 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 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. oFrr+e r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: .VPage: of q OFFICE HOURS PUBLIC HEALTH DIVISION. 8:00-9:30A.M. BARygrABLE. • 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. 94, .659. �0� HYANNIS,MA 02601 sob-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDNolls FOOD ESTABLISHMENT INSPECTION REPORT /1110 Name Date 47 Tvue of T ection O e a ' utine 40 - Address Risk Food-service = ection Level Previous Inspection - 01111 Telephone. Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other In: i 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 Wv EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ift ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMP.ERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures OX All ❑ 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 CONTAMINATION20.Time As a Public Health Control L ❑ 8.Separation/Segregation./Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIO S(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for H5P \ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ( (� f ,.-- ❑ 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 8,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 9 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 s violation,4 to a non critical violations within 10 days of receipt of this order. C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print 31.Dumpster screened from public view r Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature ' Print: L Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N R r 9 Dumpster Screen? Y N ovaV ry-.--+`�'S'_'e•.\ ` �}c-.c*-.-.-,a...-:..-.,...r,^ -. #,y '- _ - i.r . �- . _ .. ,�,.� .'s- a -��. _ .+tr,G � _ 1 w _ � .. y .. _.. _. _. - ° _..- �-,� a.e a:-. _.. .l. Violation related to Foodborne Illness *, Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 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 EMPLOYEE HEALTH 590.004(F) 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 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* LIP_ 0 Time as a Public Health Control 3-302.11(A) Food Protection 590.003 F Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * O P Y3-501.19 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 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 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* 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* 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 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* Effective 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 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 590J109(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* ( )( ) 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 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 Preventin Contamination When Tastin * * (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 3-403.11E 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* 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 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:59017ormback6-2doc *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. oFt row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Pagel _ _of, P, q OFFICE HOURS !�' ° ' •. PUBLIC HEALTH DIVISION 8:00-9:30 A.M. RARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.+'639• �� HYANNIS, MA 02601 508-808-86264--06FRI44 No Reference R-Red Item PLEASE PRINT CLEARLY `fen MP�> FOOD ESTABLISHMENT INSPECTION REPORT Name Date gy2e of T e of Ins ecti n s outine Address Risk Servic tion Level 5, Previous Inspection a R Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness 41 -� Caterer General Complaint Person in Charge(PIC) t Time Bed&Breakfast O HACthe InTI)o Inspector Out: 40 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) ®f FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities eeo) 42(n EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �1 00 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 44) FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foc4s) ❑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 W LVV` ❑ 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,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. B=One critical violation and less than 4non-critical violations re 9 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 o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( 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. 28.Poisonous or Toxic Materials FC-7 590.008) 9 violation,4 to Snon-critical violations=C. 39.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump 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 PI 's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 1K Dumpster Screen? Y N qV& - Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 41 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original oral Containers* Other* g 8 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* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 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* 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 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* ff 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- TrackingPowders,Pest Control and P 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* 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 * 22 3-603.11 Consumer Advisory Posted for Consumption of Concentration and Hardness rY P 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 590.006(A) Bottled Drinking Water* Equipment* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg crave tarzooi 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 Egis* 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 Stuffing Containing Fish,Meat;Ponl 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* 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 1 Cleaning Procedure* * foodbome illness interventions and risk factors. * 2 301. 2 C e oced 1 F 3-202.18 Shellstock Identification Present g 65 * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )ro) * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals , 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* 3-003.11(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 * 13 Handwashing Facilities 3-501.14 A Cooling 3-202.18 Shellstock Identification ( ) g Cooked PHFs from 140°F to 70'17 r5. 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* Management and Personnel FC-2 .003 Tags/Records:Fish Products P 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices590.004(J) Labeling of Ingredients` Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 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:59OFormback6-2doc *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&Wej A G Kobi House V+4' (V%./ F 489.Bearse Way 0 -1 YACVO ('-7�VliA1Gyr,5 Hyannis,Ma -! 02601 1 Cp.., HACCP PLAN FORTH PRODUCTION OF SUSHI RICE :r �r .k TABLE OF CONTENTS: Page 1:Signature Sheet (Cover Sheet) Page 2: HACCP Plan for the Production of Sushi Rice (summary) Page 3: Flow Diagram For the. Production of Sushi Rice Page 4: HACCP Master Plan Sheet for the Production of Sushi Rice Page 5:Standard Operating Procedure for pH Measurement Page 6/7: pH Log(master sheet & sample sheet) Page 8:Summary of Employee Training Elements for the Production of Sushi Rice Page 9/10: Employee Training Log (master sheet & signed Sheet) Page 11: Supplement L Kobi House 489 Bearse Way Hyannis,Ma 02601 HACCP PLAN FOR THE PRODUCTION OF SUSHI RICE Purpose: Cooked rice maintained in the temperature danger zone (41— 140°F) is susceptible to the outgrowth of spore-forming bacteria such as Bacillus cereus. Because the functionality of sushi rice requires its use at room temperature, the rice must be acidified to a pH value below4.6 to inhibitthe growth of these spore-forming bacteria. This HACCP plan addresses proper acidification of rice for room temperature storage and use. Recipe: Equipment: Rice Cooker, shallow containerfor rice, spoon or paddle. Ingredients: Rice, water, sushi seasoning 3.3%acidity w/y (Mitsukan Sushi seasoning CD-34 contains high fructose corn syrup, water, grain vinegar,salt, rice vinegar, monosodium glutamate and brown sugar. 1. 6.25 pounds of dry rice is mixed with 6.90 pounds of water in a rice cooker. The rice takes approximately45 minutes to cook. One batch yields4.2 liters of cooked rice. 2. Cooked rice (hot) is removed from cooker and placed in a shallow container. Using a spoon or paddle, the rice is spread to a depth of 4 inches of less. 3. 33.6 oz of MITUSKAN SUSHI SEASONING is added to 4.2L of cooked rice. 4. The mixture is thoroughly stirred to distribute the sushi seasoning and facilitate cooling. 5. The pH is measured immediately according to established procedures. (see: HACCP Master Plan, Standard Operating Procedures for pH Measurements, and Summary of Training Elements for the Production of Sushi Rice.) 6. Shelf-life:Same Day Use (maintained at room temperature) Discard unused rice at the end of the day. 7. The pH value of sushi rice formulated according to the above listed formulation and procedures was validated by an independent laboratory and found to be less the 4.6 * (see attached). Sushi rice acidification shall be verified according to the HACCP Master Plan. 8. This HACCP plan shall be reviewed a minimum of once per year or as needed by the PIC and shall be signed and dated to documentthis review. (see cover sheet) Kobi House 489 Bearse Way Hyannis,Ma 02601 FLOW DIAGRAM OF THE PRODUCTION OF SUSHI RICE Comair�ing of Dry rice R Cold Water . Itsukan°Sushi Seasonlrig Cook�ng;Of Rice, (Rice soaker) 3.3°lo.Acldity c�dificatan„of:CoakedRice' ��Tr"fero€Rice va CCP Shallow Container Sub Sampling of Sushl Rib SOS for pH Measurement Coaling'Of-Sub-Sample Sample Preparatan CaUbratlgn of pHg r Meter f Slurry of Tap Water ' Tap 1Nater f= � �� andSub sa€�ple)•, . sg H M jrebeaft,ut ry p pl ;Value>4.6 Room Temperature Bold' of Acidified Rice KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 02601 HACCP PLAN MASTER SHEET FOR THE PRODUCTION OF SUSHI RICE Critical Hazard Critical Limit(s) Monitoring Corrective Action Records Verification Control Point Controlled PRODUCTION Growth of pH value of What- Sushi Rice For rice made less than pH Log 1. Calibration of pH meter OF SUSHI RICE Pathogens finished sushi rice one hour, if pH value is daily prior to use. (Spore-formers pH < 4.6 @ 250C How -A calibrated pFfreater than 4.6, add more Corrective (Acidification to including Bacillus meter as per Standard vinegar until a value Action to be 2. Record Reviewed by PIC exempt rice as a Cereus) Operating Proceduresbelow 4.6 is achieved - record on pH performed daily. PHF using a for pH measurement Record new value. Log validated recipe) 3. pH of rice tested by a food Frequency - Each For rice made greater Records shall laboratory a minimum of batch than one hour, discard be maintained every six months or when rice for 30 Days daily pH levels are Who - Sushi chef or consistently higher than the designated employee To prevent laboratory validated pH Recurrence: measurement. Verify use of correct recipe. 4. HACCP plan reviewed a minimum of annually or as Verify proper use of pH needed by PIC (Signed and meter, including buffer dated by PIC upon review) integrity Verify adherence to SOP for pH measurement. Kobi House 48S Bearse Way Hyannis,Ma 02601 STANDARD OPRATING PROCEDURE FOR pH MEASUREMENT (Information based upon the use of Model IQ 120 meter/Accuracy+/-0.1 pH) Part 1—Calibration Procedure 1. Remove capfrom probe tip and turn on the meter.Keep cap readily available for subsequent use. 2. Rinse the probe in tap waterand blot dry with a clean,dry cloth or papertowel. 3. Apply one drop of 7.0 bufferto the probe tip or immerse in a subsample of buffer.Be sure to coverbotherthe reference junction and the pH sensor. (see Manufacturer's illustration as needed) 4. Depress the CAL button with the tip of the clip. S. After30 seconds,press the HOLD/CON button to confirm calibration.The display will show "CO"and flash the buffer pH value. 6. Rinse the probe in tap water and blot dry with a clean,dry cloth or papertowel. 7. Steps for3 through 6 using a 4.0 buffer may be repeated. BUFFERNOTE: Make sue buffer has not passed expiration date. Keep the buffer covered and properly stored when not in use. Part 2—pH Measurement of Sample 1. Place 2 tablespoons offinished sushi rice (as per formulation)into a clean container and cool to room temperature. 2. Add 1 teaspoon of room temperature tap water. 3. Mash the rice and water mixture with a clean spoon until a slurry is created. 4.. Using calibrated pH meterorpH test paper(see procedure) S. Wait until the reading stabilizes.This is the equilibrium pH. Record this value on the pH log. (Note:The complete record should include the Date,Time, pH value and initials of the person measuring the pH). 6. Rinse the probe in tape water and blot dry with a clean, dry cloth or papertowel. 7. Turn off the meter and replace the cap on the probe tip.Store properly NOTE: Referto manufacturer's instruction for troubleshooting,cleaning of sensor and replacing the batteries. I F Kobi House 489 Bearse Way Hyannis,Ma 02601 PH Log/ Calibration Log The pH metershall be calibrated according to established procedures and ata frequent established in the HACCP Master Plan. Follow the Standard Operating Procedure forpH Measurement Date/ Date Time PH of Sushi Corrective Action Initials PIC Daily Initials of Rice (if required) Record pH Meter Verification Calibration Date/Initials. f D& V-3 BCD ND C�, z �� Z AA:6 l� ( �2 2 Kobi House 489 Bearse Way Hyannis,Ma 02601 `' �J 1I�i HACCP PLAN FOR pH MEASUREMENT OF SAMPLE -t a Purpose: ` Cooked Sushi rice maintained in the temperature danger zone(41-140°F) is susceptible to the outgrowth of spore-forming bacteria such as Bacillus cereus. The functionality of sushi rice requires its use at room temperature, the rice must be tested to be acidified to a pH value below 4.6 to inhibit the growth of these spore-forming bacteria. • It is recommended that acidification of the rice using vinegar should occur as soon as possible after cooking. Rice acidified to a pH of less than 4.6 will inhibit the growth of pathogenic bacteria. Steps: 1. After you've cooked the rice,as soon as possible add and evenly distribute the vinegar. 2. Once the vinegar is added,the rice must be cooled rapidly to 50C(41 OF). 3. When the rice has cooled,you need to prepare a rice slurry. You do this by taking samples of your acidified rice from various locations of your batch with enough to fill a% of a cup. 4. Then add%cup of water to your%cup of rice and blend the two together for approximately 20 seco, s or until the slurry is created. 5. After mixing, insert your H a er or Hp strips(a pH meter also works) into the liquid portion of the slurry.-;If your reading is above pH 4.6,add more vinegar to your rice and repeat the process accordingly. 6. Wait until the reading stabilizes.This is the equilibrium pH. Record this value on the pH log Note: The complete record should include the Date,Time,pH value and initials of the person measuring the pH. a I i Kobi House 489 Bearse Way Hyannis,Ma 02601 SUMMARY OF EMPLOYEE TRAINING ELEMENTS FOR THE PRODUCTION OF SUSHI RICE 1. All employees involved in the production of sushi rice shall be trained properpersonal hygiene including: • Proper hand washing • Proper hair restraints • Proper clothing(clothing/use of apron) • Removal of jewelry during production 2. All employees involved in the production of sushi shall be informed of their responsibility to report to PIC when they are experiencing symptoms such as nausea,vomiting,diarrhea,fever, sores,or any other symptoms that may affect the safety of food. 3. All employees involved in the production of sushi rice shall be trained in the proper use of applicable food contact surfaces including: • Proper cleaning and sanitizing procedures • Proper storage procedures of equipment • Proper handling procedures of equipment • Proper proceduresfor preventing cross-contamination • Proper use and storage of wiping cloths 4. All employees involved in the production of sushi rice shall be trained on the elements of the HACCP Plan for the Production of Sushi Rice including: • Proper cooking procedures • Proper formulation of sushi vinegar mixture • Proper acidification of sushi rice through cooked rice vinegar mixture ratio control and mixture distribution • Proper subsampling procedures of sushi rice for pH measurement • Proper preparation of sushi rice for pH measurement • Proper storage and use of sushi rice • Shelf-life of sushi rice S. All employees involved in the production of sushi rice shall be trained on the Standard Operating Procedure for pH Measurement including: • Proper calibration procedures • Proper pH measurement of sample • Proper handling procedures of buffer/pH meter • Proper storage procedures of buffer/pH meter • HACCP critical limits • HACCP frequency of monitoring • Proper HACCP corrective actions when a deviation for a critical limit occurs • Proper HACCP verification procedures/frequency • 30—day retention of records . Kobi House 489 Bearse Way Hyannis,Ma 02601 EMPLOYEE TRAINING LOG The employees listed below have been properly trained in correctin correct procedures for the production of sushi rice as per the: SUMMAYOFEMPLOEETRAINING ELEMENTS FORTHE PRODUCTION OF SUSHI RICE EMPLOYEE NAME EMPLOYEE IGNATURE TRAINING DATE P A ez? 0 7 kAj VV$OAA c z- U C 7 This sheet must be signed and dated by the employee upon completion of training 7 Kobi House 489 Bearse Way Hyannis,Ma 02601 SUPPLMENT (NOT PART OF HACCP PLAN) GUIDLEINES FOR THE SAFE PREPARATION OF SUSHI 1. HACCP Plan for the production of Sushi Rice is followed.(see HACCP plan including Training Elements forthe Production of Sushi Rice.)Proper records must be maintained. 2. Documentations from fish supplier is on f ile regarding proper freezing of parasitic species of fish. 3. Propertemperatures control of fish during receipt and storage is maintained. 4. All sushi and related ingredients are properly handled as per the"No bare hand contact with ready-to-eat foods"established in the Food Code.Sushi chefs employ the use of gloves. S. Cross-Contamination is prevented through separation of raw and RTE foods,cleaning and sanitizing of equipment's and utensils between uses,and the propercovering of bamboo mat. Additionally,ingredients are properly protected during storage. 6. Co nsu m e r Advisory state me nts required as perthe Food Code are properly posted. 7. A PICis present during all hoursof operation. Kobi House 489 Bearse Way Hyannis,Ma 02601 I, Cheuk Wu, in the position of manager, initially present and implement this: HACCP PLAN FOR THE PRODUCTION OF SUSHI RICE. SIGNATURE: DATE: REVIEW/REVISION TO HACCP SIGNED BY DATE (Summarize change below) This sheet must be signed and dated by a PIC after any reassessment orchange to the HACCP Program or a minimum of once per year. I . r M%IAGRAM OF THI.PRODUCTION 011MI Rjrp Combining of Cary Rke rrlt Cold Watm Cooking mffte (rice cooker) A11t�ukAn 5►.�i Seo�dsi�tg M-M AM%Acidity 7'ra�fer of Rfoe to a ihsSow conWner Acidilicsifon at Cooked JUN Cam' I i subs mplins of 9wl�i Rice Cobli q of Snb4smapie t�s4tlplt+�''epti9R ^--- Cali bralAon of pfi (61"nT Of top wor Tap Water 1Mf�l�r and Iub4ample) PH Mmure meat 0f Slifry pR d41v®<4.6 R"m Toro erAtgre =PH die>4-6 Holding of Acidified Ikka Qis46 of Rine at End of My " intors�eti4n_ba��n��afl�odell�t�nHm�r/,�ce,�raav+� o,laH) calibrntlno edure 1,Remove cap front ptobe dP aid OUP on Ihs rtreter,lt®ep aap ro®dily available for dgU�C Uat:. - 2.Rim th©proiso in tap water and blot dry with a clew,k cl*or paper wwol. 3.Apply one drop of 7,0 buff to the pr061'tip or imnacrac in a out19oMle of buffer, Be sure tO toyer bath the rafbr®nce Junction and the pH sensor. (See Manufacturer's illustration as gaoled) 4.Depaears the CAL ba UN with the tip of flit onp, S.Agar 30 mods,press tU HDLDICON ftft to emilm nalibratdan.Tk display will show"CO"and Dash the butTer pH value. 6,Rinse dw probe in tap water and Wt tiny with a Olean,dry cloth of paper mWel. 7,$tip f0f 3 throueh 6 uelne a 4,0 buffer may be minted. I P PLAN FOR THE PRODUCTION OJWHJ RICH Purpose: Cooked rice rngirttainsd in the tempomture danger zone(41 - 1401F)is susceptible to the outgrowth ct`sp &.forming bacteria such u,$actitus Cereus. Because tho f tnetionaWy of sushi rice requires its use at mm tompemuro,'the rice must be acidified to a pH value below 4.6 to inhibit the growth of these spore-forming bacteria. This HACC?plan addresses proper aoidification of rice for room temperature storage and use, AC Equipment: rice cooker,shallow container for rite,spwn or paddle 1n$radienta:rice,water,sushi seasoning 33%wlv Mtsukan Sushi Seasoning CD-34 contains high fructoso carts syrup,water,grain vinegar,m mosodium gltrtamatc and brown sugar) 1. 6.25 pound®of dry rice is mixed with 6,90 pounds of weber in a rice cooker. The rice Wes approximately 45 minutes to cook, One batvh yields 4.2 liter of ce*ad rice, 2, Cooked rice(tot)is removed front cooker and placed in a shallow container.Using a Spoott or paddle,the rice is spraW to a depth of 4 inches or less. . 3. 33.6 oz.Of Mitwksm Sushi SeasoniMw,is added to 4.201L of cooked rice, 4. T6 rdixt ure fs f arm6ly sir to Astr 6e the sttsm seaaol�ng and rae,1160 cooling. S. The pH is measured immodistely according to established procedures. (See.,IMCCP rl Oter Aldn,Stemdanl Optrating PmCedura for plf MeaRuraMsml, and Summmy of 2'Wnintg gle nlfib-tha.Pr Acdon of Syghi Rica) 6. Shelf lifts: Same Day Use(maintained at room temperatum), Discard unused rice at the and of the clay. 7, Tho pli value of sushi rice formulated atcsrdin$to the above listed formulation ind procedures was validated by an McMdent 14bat(ry gnd found W be 19H than 4.6 *e anaoW). 81j8bi rice 4C1'di5 MdM 8h9U be VMFJed according to the I1ACC.P We*Plan. &. This HAaCCP plan shall W reviewed a minimum of a=Per P'lt:and shall be siVned and dated to d P Y�or as needed by the �t this review( rn � z ra lP u star meta Elm -me � i Cry! � ��fpm�a� +CoasrrlSvelltr �erss°�s �''�ettora � � a fiat � z man GFUW&cif Ideas pH vahie of WW—susW tide For rice ms&kss them PH lag i.Calibmicn of Of SuAi (Wm liJrmms fikaed sew one boor,ifpH vabm is meter I � i < •—a calibrated calibrated � �Y tea 4.6sadkl stare ceetive priarta me � liMAM cerem) 025-C PHmderas per vincger until itvalue actianto lie D Standard below 4.6 is aehaayssl reed 2.Record reviaw z Owding -renoed new value am pH log by PIC pertbrmed Promdrm for WHY pl-ime mwaxom Surricema&weater mm Thm case tsars; shall be 3.pI4 of rice tested o �n .� Frequency—each dkewd rice maktahzed by a feed laboratory a' Batch far 30&)m ofe�,ery To p mvent racarre wec Six mcnft or when CO Wbe—SUSW eW verify use of cared MYpalervels are + m or desigmted recipe.Verifyprepet c en tIy higher Employee use of pIH mcsm, tlr tl laboratoy bubfts bdbrmt& mdkided pH m Verif y edharence to nn+ctnerit SOP fvr pH measureaem 4.HACCF plan :p reviewed a minimim Of mmualhy or as needed by PIC i BY PAC Opm review) ( �dared ; G a:. i KOBI IIOUSE 489 BEARSE WAY HYANNIS, MA . 02601 110 HACCP PLAN FOR THE PROD t-CTION OF S U Sll3l PdCE TABLE 07 CC CL�aT o Page 1J Signature Sheet(cover sheet) Page•2 HACCP Plan for the Production of` ,,hi Ries (summary-) Page 3 Flow Diagram for the Production of".ishi Rice .. 1'aee HACCP Master Plan Sheet for the P ..duction of ushi Rice Standard Operating Procedure for r' %leasurement pagej pH Log(master sheet& sample shed) Paae 8 Summary of Employee Training Elements.for the Production of Sushi Rice Page 9 / 10 mployee Training Log(master sheet &signed sheets) Page 11 Lplement. ' C co 1 d m t z r i 11 �1 � p ( ab f - KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 02601 HACCP PLAN FOR 'rI-m PRODUCTION OF SUSHI RICE PURPOSE: Cooked rice maintained in the temperature danger zone (41 — 140T) is susceptible to file outgrowth of spore-forming bacteria such as Bacilhrs cereus, Becatrse the fucictionalit%i of sushi rice requires its use at room temperature; the rice must be acidified to a pl-1 value belo,, 4.6 to inhibit the growth of these spore•,forming bacteria. This HACCI' plan addresses prol.;er . acidification of rice for room temperature storage and use. rECIPE: EquIF-ment: Rice cooker, shallow container for rice, spoon of paddle Ingredients: Rice, water, sushi seasoning 3.3% acidity �\/v (ivlitsukan Sushi `,e_isonin'_C contains high fructose corn syrup, «rater, grain vine(_jar, salt. rice. vinegar, . monosodium glutamate and brown sugar). 1. 6.25 pounds of dry rice is mixed with 6.90 pound of�\titer in a rice cooker. T}l' rice take approximately 45 minutes to crook. One batch yields 4.2 liters of cooled rice. 2. Cooked rice(hot) is removed from cooker and placed in a shallow container. Usijlg,t e is spread to a depth of 4 inches or less.. e the rice p spoon or paddle, I 1 P 3: 33.6 oz of IvIITUSK4N SUSHI SEASONING is added to 4.2L of cooked rice. 4. The mixture is thoroughly stirred to distribute the st-— seasoning and facilitate cooling. 5. . The pH is measured immediately according to established procedures. (See: H.ACCP_'rlctster Plan, Stafr(lord Operating�'i o 'eaZrres f?r�'�H.Il r u err; ii, anti'S'ununary of Training EleMettts Jot the P)-Od fct ion of Sushi Rice) v 6. Shelf-life: Same Day Use(maintained at room ternpuraturc) Discard unused.rice at the eni j of the day. . T The pl' value of sushi rice formulated according to the above listed formulation and procedures was validated by an independent laboratory and found to be less the 4.6 (see attached). Sushi rice acidification shall be verified according to the 1-11-\CCI' Master Plan. g This HACCP plan shall be reviewed a nitrunu.rin of once per year or as iw-cdod by the P1C and Shall be signed and dated to document This r_yiew. (See cover sheet) KOBI HOUSE 489 BEARSE WAY' HYANNIS, MA 02601 - FLOW DIAGRAM OF THE PRODUCTION OF SUSHI RICE Combining of Dr J ice k%'011 cc-1 ? %V a iF r 1�iitsukan Scshi i C:ookinZ; of Rice 'Seasoning CD-34 (Rice Cooker) Acidity i -------- ----' Transfer of.R]Ce fo a9 Sil<7110 tS' Conlah. er Acidification of Cooked Rice i---------- I CCP ' I , Sub-sampling of Sush Rice _ I i Cooling of Sub-sanPle t Sample Preparation I (51u1't1 of Tap e—---- Tap r` atcr. Calibration of P'1-1 Meter I Water and Sub-sample) — �i PH Measurement ---- --'_! < :},; of S!Url-y - I Too 111 1 tie -!'1CUrc' > -1> pl I 1ue- 4.0 f ---- - - - !-lot ' ng ci t- ------------! . .-'.cidilicid KOBI HOUSE . 489.BEARSE WAY HYANNIS, NSA ' 01601 1.I11.(�cl' ��..�� r�n_ST! �i S� �� j � � c�� 1.T.�� .��r�:��N O SL�Sl- 1 �� CE Critical Hazard Controller; Critical Limit(s) iMonitoring Corrective Action Records verificaiion Control Point PRODUCTION Growth of Patho;;ens ptI value of finistred What Sushi rice For rice made less than pH Log 1.Calibration of'pl-1 OF SUSHI (spore-formers sushi shi rice '4.6 rr 25'C one hour, if plA value is meter daily prior to RI('i: including _ Hi;� Acalibrated pl-I -reatcr than 4.6, add more Corrective use. Bacillus curcus) mctcr as per Standard v rncgar until a value Action to be (Acidification to Operatin- Procedures below 4.6 is achieved — recorded on 2.Record Reviewed by exempt rice as a for pl-1 measurement Record new value pl-I Log PIC performed daily.._ 111-I17 using a validated Frequency - Each batch . I i�r rice made r than Records shall 3.pH.of rice tested by a recipe) one hour, discarrd rice- be nrrintaincd food laboratory a Who--Sushi chef or for 30 lhrys minimum of every six dc.sillmited employee To prevent recurrence: iilonths or when daily Verify use of correct p11 levels arc recipe. consistently Iriohcr Verily proper use cif pl-1 than thu laboratory meter, including buflcr validated pi l integrity nlcesurcrncnt. Verify adherence to Sol) for 1111 nrcasrrremeirt .4.1-IACCP phn reviewed a minimum of annually or-as needed by 111C (Si,�ncd >urd dated by 111C; upon review). KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 021601 STANDARD OPERATING PROCEDURE FOR pH TMEASURE EN i (Information based upon the use of Model IQ 120-pH rneter Accuracy 0.1 pH) PART I —CALIBRATION PROCEDURE i 1. Remove cap from probe tip and turn on the meter. Keep cap readily available for subscgL1C11t I use. 2. Rinse the probe in.tap water and blot dry with a clean, dry cloth or paper ta,vel. 3. Apply'one drop of 7.0 buffer to the probe tip or immerse in a subsaniple of buffer. Be sure to cover both the reference junction and the pH sensor. (See Manufacturer's illustration as needed) I 4. Depress the CAL button with the tip of the clip. 5. After 30 seconds, press the HOLD/ CON button to confirm calibration. The displ:l\' «d l shoe, ::CO„ I and flash the buffer pH values 6. Rinse the probe in tap water and blot drytivith a clean, dry cloth or paper to-,1 el. I 7. Steps for 3 through 6 using a 4.0 buffer.:may be repeated. BUFFER A`0TE: N'lake sure buffer has not passed expiration date. I ` Keep the buffer covered and properly stored when not 1n use.. PART 2— iaH !'"EASURk.ME T OF SAMPLE 1 Place 2 tablespoons of finished sushi rice (as per formulation) into a clean container and cool to room temperature. 1. Add 1 teaspoon of room temperature tap water. iylasil the rice and water mixture with a clean spook until a slurry is created. 4. Usma a calibrated pH meter(see procedure above), measure the sarrlple pH by placing a drop of dipping the probe tip into the slurry solution. the slurry on the probe tip or 'i mt until the reading stabilizes. This is the equilibrluim pH. Record this value on the pH lo`. (mote: The complete record should iri'clude the date. time pH value and initi:.11s of the person measuring the pH). 6. Rinse the probe in tap vl!ater and.blot dry ith a clean, dry cloth or paper towel 7. Turn oii'thc meter and replace the cap on the probe tip. More properly. NOTE: t0 M»1111I aCTllIC1�S liStlUCt:on for traubleshcotina,c:>>nil`of S�( �Or, il i 1''l`i;-:CIi1a F D dt 1 10`-. I KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 0?601 pH Log / Calibration Log The p meter shall be calibrated according to established procedures and at a frequency established in the 14CCP Master Plan. Follow the Standard Operating Procedure for pH Measurement i Date/Initials Daie Time pH of CorIecthre F; tic,n 'n;t a's rIC C ! u Record .of H meter sushi rice r required) calibration �nit:.is 1� i , I fo lr ° - -- --- j 2� - ------- i- L9 r i I _ - --- - ,VOTE. KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 0?601 SUMMARY OF EMPLOYEE TRAINING ELEIN,IENTS FOR THE PRODUCTION OF SUSHI RICE 1. All employees involved in the production of sushi rice shall be trained in proper personal hvsiene including: o .proper hand washing, o proper hair restraints o proper clothing(uniform/use of apron) o removal of jewelry during production r 2. All employees involved in the production of sushi rice shall be informed of their responsibility to report to the PIC when they are experiencing symptoms such as nausea; vomiting, chan-hea, fever. sores, or any other symptoms that may affect the safety of food. 3. All employees involved in the production of sushi rice shall be trained in the proper use of applicable. food contact surfaces including: o proper cleaning and sanitizing procedures o proper storage procedures of equipment o proper handling procedures of equipment o proper procedures for preventing cross-contamination o proper use and storage of wiping cloths 4• All employees involved in the production of sushi rice shall trained on the elements of the 114CCP Plan for the Production of Sushi Rice including: o proper cooking procedures o proper formulation of sushi vinegar mixture o proper acidification of sushi rice through cooked rice to vinegar tllixture ratio control anti mixture distribution o proper stibsampling procedures of sushi rice for pH measurement o proper preparation of sushi rice.for pH measurement o proper stbrage and use of sushi rice o shelf-life of sushi rice 5. A11 emplo\ees ins olved in the production of sushi rice shall be trained on the Stanilar(l Oneratin- Procedure ftr plf I easurement includin : o proper caiiilration procedures o proper pH measurement of sample o proper h--ndlltlV procedures'c*f buffer/'pH meter o proper storage procedures of buffer/ pH meter. o 1-1:\CCP critical limits o i-lACCP frCquency of momtorint) o proper H \CCP corrective actions when a deviation for a critic�xl limit occurs o props R ,,CCP verification procedures/ frequency o ii-citty rc'.�nuon of records KOBI HOUSE 489 BFARSE WAY HYANNIS, MA O211601 EMPLOYEE TRAINING LOG The- employees listed below have been properly trained in correct procedures for the production of susl3i ricee as per the SUI`IMARY OF EMPLOYEE TRAINING ELENIENTS FOR THE PRODUCTION,' OF SUSHI RICE ; EIN1PLOYEE NAI iE EMPLOYEE SIGNATURE i TRAII`IIi IG DATE FI ---� - �; t I 1 i ' 1 ---- I — I . i i i This sheet must he signed and dated by the employee upon completiol3 ot'trnlnll?�. I " KOBI HOUSE 489 BEARSE WAY HYANNIS, MA 022601 SUPPLEMENT (NOT PART OF HACCP PLAN) GUIDELINES FOR THE SAFE PREPARATI.ON OF SUSHI 1. 1ACCP Plan for the production oPSushi Rice is followed. (see HACCP plan including Triinin?Llen�cnt< for the Production of Sushi Rice.) Proper records trust be maintained. _. Documentation fi-om fish supplier is on file rc--mrding proper freezing of parasitic species of fish ;. Proper temperature control of fist! during !:c_ipt and storage is maintained. 4, all sushi and related ingredients are proper!• handled as p-r the "No bare hand contact :nth read. to eat foods" established in the Food Code. Sushi chefs employ the use Ofgloves. j. Cross-contamination is prevented through separation of raw and RTE foods, cleaning and sanitizing.of equipments and utensils between uses, an ' '.�2 proper covering of the bamboo mat. Additionally, ingredients are properly protected during_terLtge, red a:. per the Food Code are properly posted. 6. Consumer Advisory statements requi %. A PIC is present during all hours of oper.:tr.'.. J KOBI HOUSE 489 BEARSE WAY HYANNIS, MA � 0?601 I n the position of manager, initially present and implement this I1;1CCP FOR THE PRODUCTION OF SUSHI RICE. 160 SIGNATURE: DATE: 46 REVIEW/REVISION TO HACCP (Sum e.mari change below) � _W SIGNED BY � j D;�TE X i,G0 r i II i i This sheet must be signed and dated by a PIC after any reassessment or change to the I [ACCP Program or a minimum of once per tear. Y ENVIROTECH LABORATORIES, INC. ' MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Noble House/Joe Liu Location W. Harwich,MA Address 21 Route 28 ..y W. Harwich,MA 02671 Sample Date 10/05/1 Collected By Client Sample Time Sample Type Sushi Rice Date Received to/o5/10 Lab Order'Number DW-102991 Well Specs NA 4 Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By pH pH units 6.5-8.5 3.82 SM4500-H-B 10/5/2010 J LL - Comments: t v, Date Rotf/tld ! 1 Y Laboratory Me r 4 r , 1 .. j,�BR4-Below Repoy6ffe LAWO 'See Attached Page 1 of 1 �arto6 is prof pvctlldblafar tlds'analyte for Ron potable water samples.. � . 4 Li�� L:tn '08/0172011 14:12 FAX 508 868' 6446' ENVIROTECH LABORATORIES Q 0001/0001 EVWIR0 TECH LABORATORIES,.INC. MA CERT.NO.:M AM 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 I � Kobi House,Joe Liu 489 Bearse's Way A-2 Client Name Location Address 489 Bearse's Way A-2 Hyannis,Ma 02601 Hyannis,Ma 02601 Sample Date 07 em i Collected By Client Sample Time NA Sample Type sushi Date Received 07l26/11 Lab Order Alumber DW-112036 Well Specs NA ,y'� �.. Y w n r .{ � r�''.LF6�'-�. .4r ..�'� 'Y c:.,�N+,'�.�•'W`.,� 4�r�',M'a,�. "'�1^.?!-.;�5�� y '��'�T'1�.�°��}t• - i a.a e'.''S 3 Y'=' �' R. •u?�a}�+'X �" )...a•� ^„ � Y J�*„ R:�.+.ry;•yti ��r d s t�$''1 i i.�`�a sp" =n_ +�i yRf 5'�ti. 'r{4 i 3�,k- �% . .�.�1 ..r ....+�. ,-.u,`.. �.i?�,�. -r`L�;� .-�'� sK��' .ax�5�: - 5+= 3 .''��tt�.^ �n �".t,;;��ak+;� Na,�. '•(&ia''{a:;�� •�.:+ sir-crJ;fi' ��'- Analysis Requested Units Recommended Limits Analysis Result I Method jDate Analyzel Analyzed By pH pH units 6.5-8.5 3.60 SM45WH-B 7/2612011 RL M. .Y. 4x .,M iq. l,a ��'9 h' '.:B...��., '.�! F... .�W:�r�, :t•�Zr:'°-=. z _ .e�`° s: Y` �y� .`iv � :y•�rY,r�2.'�:_ �vhcr.. >:��-;= -•S"Y' .,�".S.✓.,s. c�.�s Analysis Requested Units Recommended Limits Analysis Result Method ate Analyzed Analyzed By pH pH units 6.M.5 2.43 SM45CM-B 7/26/2011 RL -- ---- - .._._.__...._.... ......._._._._..._.._.._._.._ _ _._.........._...._............._.......- - - - - - Comments: Date Ronald J. r Labaratory Di ecty BRL=Below Reportable Limits See Atradred Rage 101 i aCertifrcation is not available for this analyte for non-potable water samples.. � r t' { F q x ;r' i -low - - Alk w- 7 �} �1 i ti y 1 I',�, C ��, f 'r � �. t-�. .. l...-:.:_ �_ G., X�! �� ` _.�. y '{ ,{ � f �yyfyy C i„' 1� 1.'.' l }t�. Uk��xi p 1�� i o�;, 1Ly,� � ony i �� i '.t. t. � �.. ` _ �_ t y H. `+ 1 y JYf y A► <� � , ,; _ � .t � � � � � ��, .�� : - i , }1 J .I :. ' ;TT 'Y- .`. ,�-� 1a C-._ P .::' t._ ',l,_. S f i .d � \_ .\\ - \ . .�\�: �, - •��/% , . < . . a at Y , �� < � 4 �- 4. '�'Ay �^ y� $� w,� i �� 3: .�� ,' �,t � , ,.,, ' . � -� Y „':t /p• J (r • "� /� � '. :5 k� � �` w, `.,�`.... `R I r I,xl�'. o •�• y ` �? i f.� ]M r� �, � � �, _ � �# �;� �, ,..� + � _ r� alp .k• r. r . .��„�`q�.an �:�� :ac' �' a�� a i .. ..:.. M. _ . t' i - _ q V ��$SI. ?� _— 4Se�'"h bA.ram.. �F a `� �„ .' ` Otis �I )��,, y�� _ v��T�� r �� `� 4•vN.0 l{�° ::ref\ 3 �. � € � t�; w rihr. :�f _ 4 #� .. ,�... .:.. ,. 1 �, yr `.. i1�1�_, :, E 6 ark i� r �,.: NAB.�t �... w ., � ?.+� x" � �.. xti ;t' ;,'�.. r,. . 1♦'q, �i �► / i ��' �� , ; �_ - �►�' '�i�i � � �� -_ ♦`, f r:� L �. fi .t �. NL�. �� .� ` �� - �. r r From Sushi Bar Lunch Menu Nigiri Sushi and Sashimi 11:30 am-2:30 pm Sushi Sashimi Hibachi Grill 2 pieces 3 pieces ' Toro(tuna belly)......... ..... Market Price Rice Hibachi Vegetable ..... p $, Ma uroI(Yellowtal tuna ..................I•••...•. ��•� �� 7.25 8.25 or $1.75) Escolarwhite tuna ..........................� 6.95 795 Includes: House Sou and White y � � 9 ) � Substitute Fried Rice f Hamach ) ........................................... 7.25 8.25 " Sake(Salmon)..................................................... 6.95 7.95 Hibachi Suzuki Sake(Smoked Salmon) ......................... 7.25 8.25 Vegetable 10.95 Chicken 11.95 Red Snapper .... 6.55 7.55 ...................... p ................................................... Shrimp.....................12.95 Sirloin Steak................12.95 E Unagi(Eel) .. ............... 6.75 7.75 Filet Mignon 14.95 Scallop14.95 � - Ebi hrimp)......................................................... 6.55 7.65 Salmon ....................12.95 Lobster........................18.95 1 Ameebi(Sweet Shrimp)......................................8.25 9.25 Hokkingal(Scallop)............................................. 7.25 8.25 Ika(Squid)............................................................ 6.55 7.55 Tako(Octopus).................................................... 6.95 7.95 Bento Box Lunch O Hokkigi(Burt Clam)............................................. 6.95 7.95 Includes: House Soup and White`Rlce and daily Assortment Tama O E C )............................................. 6.26 7.25 9 Toblko(lyingake Fish Roe) ..................................... 6.95 7.95 (Substitute Fried'Rice Rice for $1.75) Ikura(Salmon-Roe).............................................. 7.95 8.95 I n Kani (crab)...........................................................6.55 7.55 V Chicken Teriyaki ....11.95 Salmon Teriyaki..........12.95 Traditional Roll or Hand Roll ' Sirloin SteakTeriyaki 12.95 9tJi"VlegM3eTerpta....12.95 % ---•----__.F.__..... _�.� _.._ _ ._.__ _.__�___ _.�_. __ Tuna Roll ...................7.55 Spicy Tuna Roll.............7.75 Sushi Lunch Salmon Roll...............6.95 Spicy Salmon Roll.........7.25 n Yellowtail Roll ...........7.25 Tuna Avocado...............7.55 Includes soup of the day U Salmon Avocado......6.95 Eel Avocado..................6.95 Avocado Cucumber.6.25 California Roll ...............6.75 Sushi Lunch ........... 12.95 Sushi&Sashimi Vegetable Roll...........6.55 Shrimp Tempura Roll....9.95 California Roll&4 pieces sushi Combination..........14.95 Chicken Tempura Roll 7.95 Philadelphia Roll ...........8.95 Chef's Choice:4 pieces sushi Spicy Scallop Roll.....8.25 King Crab Roll.............14.95 Sashimi Lunch....... 13.95 6 pieces Sashimi 9 piece assorted filets Chirashi........................15.95 HR�ACHff GERILLE C �►�'SSpecial Roll of Fresh raw fish assorted raw fish served on abad of rice ��WT�� Rainbow Roll..................14.96 House Tempura Roll...13.95 Kani Avocado wrapped with chef choice Deep Fried eel,salmon,shrimp 4 of fish filet wrapped on the outside cucumber roll,served teriyaki sauce Any Rol lS 1�.95 Any 3 Rolls 14.95 Dragon ROII......:.... . 13.95 and wasabi moyonnaiseon top. Y g •••• Crazy Tuna Roll ...etop.14.95 ��o (50089) �� Kani cucumber wrapped Shrimp tempura inside topped Choice: e with eel and avocado with spic tuna o Scorpion Roll .................14.95 Volcano Boll................15.95 Tuna Roll Tuna Avocado Roll. Spicy tuna, spicy salmon,spicy ��; (JOV) �JO-3683 Eel,Avocado,Cucumber with yellowtail inside and masago Spicy Tuna ROII Salmon Avocado Roll fish roe covered with Shrimp outside top with not sauce Salmon Roll Eel Avocado ROII Snow Mountain Roll.......13.95 Summer Roll..o...... an.1 5.95 Sic Salmon Chicken Tem ura Roll � Tuna,salmon, elbwtail Kan p ma sago Spicy p 489 Bearse s Way A-2, Shrimp tempura and seaweed inside with so _ paper Shrimp Tempura Roll Avocado Cucumber Roll topped with Kani and Mayo and spedQa sauce on op Roll California ROII stable Spider Roll......................14.95 Crunchy Lobster Roll .16.95 Vegetable Hyannis, MA 02601 Deep Fried soft shell crab, Lobster withsala soybean pap paper cucumber,avocado,and ma o rapped ybe page y Fuji Roll.....purains.........16.95 WWW.kobihousehibachi.com Alligator Roll ..................15.95 . Shrimp tempura inside Shrimp tempura,cucumber, topped with lobster salad. mayo topped with eel Christmas Roll............16.95 Spicy Titanic ROII...........14.95 Tuna,Salmon,avocado topped with assorted tiblk. Consuming raw or undercooked meats, poultry, seafood, Spicy tuna,tempura flakes inside with Eel Fortune................ 15.95 ew�sw salmon,avocado,and Ikura on top Kani,Shrimp,Avocado with shellfish, or eggs may increase your risk of foodbome illness, b�� omRFsscaa eel and smoked on top especially if you have certain medical conditions. S Appetizers Hibachi Grill ®inner sushi ®inner Platters From Kitchen Dinner includes a flaming shrimp, House soup Served with Soup and house salad Edamame......... .....................................................5.75 Sushi Regular............ 22.95 """'""""""' and salad, white rice and hibachi vegetables .......................................................... Boiled & green soy beans California Roll&8 Pieces Sushi Fried Bean Curd ....................................................................7.25 (Substitute Fried Rice for $1.75) Sushi Deluxe.........................................................................26.95 Gyoza ..................................................................................7.95 Tuna Roll & 10 Pieces Sushi Japanese Pan Fried Dumpling En��'�e Shumai ..................................................................................7.95 Sashimi Regular.......................................:..........................26.95 Shrimp Ravioli 15 pieces Sashimi ............................................Chicken Katsu ...........................8.25 Hibachi Sashimi Deluxe ...................................................................28.95 Lightly fried chicken breast coated with Vegetable.............................................................................16.95 18 pieces Sashimi Japanese bread crumbs Chicken................................................................................18.95 Sushi&Sashimi Combination............................................28.95 Chicken Wings.......................................................................8.25 Salmon ................................................................................22.95 Chefs Choice: 9 pieces sushi, 9 pieces sashimi Fried Japanese style Shrimp ................................................................................23.95 Combination Roll .................................................................22.95 GinzaSquid............................................................................8.95 Scallops ...............................................................................26.95 California,Tuna,&Shrimp Tempura Roll Deep fried seasoned calamari Filet Mignon..........................................................................27.95 Chirashi............................................................................... 26.95 Vegetable Tempura............................................................... 8.95 Sirloin Steak.........................................................................25.95 Assorted raw fish served on a bed of rice. Lightly Deep Fried Vegetable Lobster Tails win Lobster Tails 36.95 Unagi Don ........................................................................... 26.95 Shrimp Tempura....................................................................9.95 Grilled eel on top of seasoned rice Lightly Deep Fried shrimp Sa_ gamore Bridge................................................................ 52.95 Soft Shell Crab.....................................................................11.25 Two rolls,9 pieces Sushi&9 pieces sashimi Deep fried whole soft shell crab Entree Combination . Nantucket Island Ferry .......................................................65.95 Hibachi Three Rolls, 12 pieces sushi, 12 pieces sashimi From Sushi Bar Shrimp&Chicken Cape Cod Lobster Boat ......................................................79.95 _ ............................................................25.95 Lobster Sashimi, Crunchy Lobster Rolls, Baby Octopus......................................................................11.25 Shrimp&Scallop.................................................................27.95 8 pieces sushi, 12 pieces sashimi Kings Crab Sashimi ............................................................15.95 Sirloin Steak&Chicken ............:.........................................25.95 Lobster Tail Sashimi ...........................................................17.95 Sirloin Steak&Shrimp27.95 FromOur Kitchen TunaTataki 13.95 ........................................................ ......................................................................... Sirloin Steak&Scallop28.95 Lightly grilled grid served with our ponzu sauce """""""""""""""""""""""""""" Salmon Tataki 12.95 Filet Mignon&Chicken .......................................................27.95 (includes soup of the day,house salad) "'""""""""""""'"""""""""'""""""""""""""' Filet Mignon&Shrimp 28.95 Fried Rice PepperTuna.........................................................................13.95 ....................................................... Filet Mignon& Scallop.........................................................29.95 Vegetable................10.95 Chicken .......................12.95 Lobster&Chicken ...............................................................32.95 Beef(Sirloin Steak) 15.95 Shrimp.........................15.95 Soups Lobster&Sirloin...................................................................34.95 Noodles(Stir Fried Japanese Noodles) Seaweed Egg Drop Soup ......................................................2.95 Lobster&Filet Mignon .........................................................36.95 Vegetable................12.95 Chicken .......................14.95 G oza Sou 6.95 Lobster,Shrimp&Scallops ..38.95 Beef(Sirloin Steak) 17.95 Shrimp.........................17.95 Clear broth with dumplings Miso Soup ..................... ............................................ 2.95 Tempura (lightly deep fried) pA Soybean paste soup with sake,tofu and toasted seaweed h i I dl re n s Menu Includes soup of the day,house salad and white rice Vegetable Tempura..........................................:..................15.95 (12 years and under) Shrimp Tempura... 19.95 ,.,[� ...... Salads Hibachi Shrimp&VegetableTempura ...................:.........................19.95 Chicken 11.95 Soft Shell Crab Tempura.....................................................21.95 -.--..... ------- - ..................... Chrimn - - .. .. 12.95 Fresh garden salad with Japanese Ginger dressing ��p�p�/��j Sirloin Steak............. 13.95 Seaweed.Salad ..................6.95 ......... ................................. .......... - .................................................... Octopus Salad "'."'"""""".""'"'""' "'""""""".............................8.95 Filet Mignon..........................................................................15.95 Includes soup of the day,house salad and white rice Lobster Tails 19.95 Crab Meat Salad 8.95 ........................................................................ Chicken Teriyaki .................................................................17.95 .................................................................... Consuming raw or undercooked meats, poultry, seafood, Sirloin Steak Teriyaki..........................................................23.95 shellfish, or eggs may increase your risk of foodbome illness, Salmon Teriyaki...................................................................21.95 Before placing your order, please inform your Server if a person in your party has a food allergy. especially if you have certain medical conditions. Shrimp&Scallop Teriyaki ..................................................25.95 i �s ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Kobi House,Joe Liu Location 489 Beerse's Way A-2 Address 489 Bearse's Way A-2 Hyannis,Ma 02601 Hyannis,Ma 02601 Sample Date 07/26/11 Collected By Client Sample Time NA Sample Type Sushi Date Received o7as/11 Lab Order Number DW-112036 Well Specs NA iatysis Requested Units Recommended Limits A lysis esid I Method Date Analyzel Analyzed By 'Q (� pH pH units 6 5-8 5 3 60 SM4500-H-B 7/26/2011 RL ..,! dFt .la T�. ��- � e,?C i r i � -?"r A ysis Requested Units Recommended Limits I Anal t Method jDateAnalyzej Analyzed By pH pH units 2,43 3M450".-B 7/26/2019 RL mments: ____.... ..�_.._.._....._.,....... ._ �_._..._.__..._..............._Date...-_._�..��t✓:L.......__.._....._.__........._ Ronald A Laboratory D! cev BRL=Below Reportable Limits *See Attached Page 1 of i DCeritficatton is not available for this analytefor nonWtable water samples.. T000/TOOO(M SHIHO,LV2IOSV'I HOH,LOUIMIH M9 899 909 YU 9T:VT TTOUTO/80 Message Page 1 of 1 McKenzie, Marybeth To: joeliu78@hotmail.com Subject: Kobi House ,Morning Joe, I hope you survived the winter OK. I am in the process of reviewing approved HACCP plans. I am contacting you in regards to your HACCP because I haven't received your pH lab testing results for 2015. Please forward me a copy of the results. If you haven't had it tested it must be done ASAP. I will also need an updated copy of the recipe for the rice. Please indicate the amounts and brands of products used in the recipe. If anything else has changed from the original HACCP plan please let me know and I will revise your plan.Thank you and if you have any questions please let me know. Marybeth McKenzie R.S. '� 3/30/2015 :. 4lj . , WN i .�� VolMEL girl V J 9 }t 0?-,6 o f L`c� o ` d (1(942- ► VL v G� i S T� �I � N Pow )C&' C �O 'V'r\ __ i Al High Temperature DISHMACHINES Single Rack Dishwasher A hnsonDiverseycompany - Item. # ( FEATURES: m. ■ 60 racks/240 covers per hour. *1Z ■ Economical to operate.-Uses only .96 gallons of water per cycle. ■ Automatic soil purging system. Filters wash water and traps plate debris into an external t m t tray. Tray can be easily removed for dumping contents. ■ Heavy duty 12 and 14 gauge 304 stainless steel construction offers durable performance and years of trouble free operation. ■ Built-in chemical resistant industrial 5kW r heater and optional 12kW booster heater 3. z are proven to be more durable than ` commercial style heaters. ■ Unique spray arm system features upper and lower stainless steel wash arms with _ reinforced end caps. Specially designed pull-pins allow wash arms to be easily removed for cleaning. 9 ■ Top mounted control box is water tight and includes a rack counter, extended wash/delimer switch and easy to read temperature gauges. ■ Auto start/stop makes operation safe Corner Model and easy. ■ Field convertible for a wide range of ® u� applications. D ' - Top mounted control box is water External scrap tray maintains tight and includes a rack counter, clean wash water and prevents extended wash/deli-ner switch debris from clogging the drain. and easy to read temperature gauges. `�pII1 Fh ,liAn, 1115�W�M } "2 f . �rYEsiwi. Industrial wash tank and optional Unique pull-pin design allows booster heaters are designed for wash arms to be easily removed years of trouble free service. for cleaning. CMA Dishmachines 12700 Knott Avenue Garden Grove,CA 92841.800-854-6417•714-898-8781 • Fax:714-895-2141 •www.cmadishmachines.com CMA reserves the right to modify specifications or discontinue models without prior notification. Lit#0109 Printed in the U.S.A. ©2005 CMA,Inc. J %olM A High Temperature DISHMACHINES Single Rack Dishwasher A ]ohnsonDiversey company Water Inlet 3" WARNING:Electrical and plumbing connections Off The top Front View need to be made by a qualified service person who Left View 5" Min will comply with all available Federal,State,and Top View 180S r--------- --------- Local Health, Electrical, Plumbing and Safety _T codes. 2-1/2" T 2511 23 �t 13-1/2" Electrical Hook Up � 4-1/4"Off The top { _25-1/2"�� 9-3/4" 20-1/2" 1 5" Min Top View 180C �' 5911 79" 60" 25" 23' 80" Adj. Adj. o Drain " a6 �_25-1/2"--)� 9 3/4" to Specifications: MODEL CMA-180 USA METRIC USA METRIC WATER CONSUMPTION WASH PUMP MOTOR HP 1 1 PER RACK 60 60 DIMENSIONS PER HOUR 58 GPN 220 L DEPTH 25" (63.5cm) OPERATING CYCLE WIDTH 25-1/2" (65cm) WASH TIME-SEC. 49 49 HEIGHT 59"-60" (150-152cm) RINSE TIME-SEC. 12 12 STANDARD TABLE HEIGHT 34" (86.3cm) TOTAL CYCLE 6 1 61 MAX CLEARANCE FOR DISHES 17-1/2" (44cm) OPERATING CAPACITY DRAIN CONNECTION OFF FLOOR 11-1/2"-12-1/2" 29-32cm RACKS PER HOUR', 60 60 STANDARD DISHRACK 1 1 DIMENSIONS 19-3/4"X 19-3/4" 50X50cm WASH TANK CAPACITY 8 GAL. 30.3 L ELECTRICAL RATING VOLTS PHASE AMPS PUMP CAPACITY 68 GPM 257 LPM WITHOUT BOOSTER 208 1 28 WATER REQUIREMENTS 240 1 30 WITHOUT BOOSTER HEATER 180°F (82°C) 208 3 20 WITH BOOSTER HEATER 140°F (60°C) 240 3 21 WATER INLET 3/4' DRAIN CONNECTION 2" WITH BOOSTER 208 1 71 RINSE PRESSURE SET 20 psi 1.41 k/cm= 240 1 80 OPERATING TEMPERATURE 208 3 45 WASH"F(MIN) 155°F-160°F (68°C-71°C) 240 3 50 RINSE-OF(MIN) 1801F-1951F (82°C-90°C) SHIPPING WEIGHT WITHOUT BOOSTER 332# (151 kg)- WITH BOOSTER 375# (170kg) r- Summary Specifications: Model CMA-180 The model CMA-180 single tank, high temperature dishwasher is designed for years of trouble free service, producing sparkling results while conserving energy,water and chemicals.This machine is available with an optional "built in"booster heater, assuring a continuous supply of 180OF hot water, and is easily field convertible for either corner or straight installation. Unique soil purging system filters wash water and plate debris into an external tray.The CMA-180 is NSF, UL, CUL and CE approved. Available Models Available Options: ■ CMA-180S Straight ■ Exhaust Fan Time Control ■ CMA-180SB Straight with booster ■ Built-in 12kW booster heater Q ■ CMA-180C Corner ■ CMA-180 Conversion Kit Corner to Straight Q ■ CMA-180CB Corner with booster ■ CMA-180 Conversion Kit Straight to Corner ■ Dual power supply connections ■ Stainless steel dishtables ■ Alternative electrical available for export ■ Auto Fill CMA Dishmachines 12700 Knott Avenue Garden Grove,CA 92841 •800-854-6417•714-898-8781 • Fax:714-895-2141 •www.cmadishmachines.com CMA reserves the right to modify specifications or discontinue models without prior notification. Lit#0109 Printed in the U.S.A. ©2005 CMA,Inc. No. /_d�.... f FRs....1�................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G.� /�✓.................OF............. nySi Appliration -for DiBpwial Eurks Tonfi#.rurtion Vrrutit Application is hereby made for a Permit to Construct ( vl�or Repair ( ) an Individual Sew-age Disposal System at: ` I rn� / .................................- ------- ------------------------------•---= / cation-Add,; Lot Np.� •l / ..............•.-_•-S............................................ _...T.---•---•------T!../itJ..................... _.. ............................./l I....-- �+ Owner ^ dress c Installer Address Type of Building Size Lot- -------- feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `�da Other—Type of Building No. of persons............................ Showers Cafeteria Otherfixtures -------------------------------------- -------------------------------------------------------------------------------- --------------------(------)_ W Design Flow--------55lq_._/ T L_________ y. Total daily flow__...._�t. ...............................gallons. , � Af 1x Septic Tank—Liquid capacitv.� '_gallons Length-f,�____.__._ Width.____..__..._-- lllatneter...._----------- Depth--_d--_-�.,1.. Z!" Disposal Trench—No_ ___________________ Width-------------------- Total Length.................... Total leaching area_-__-______--_____sq. ft. Seepage Pit No....... �3___________ Diameter ............. Depth below inlet-_ ' _._______ Total leaching area-__ L ....sq. ft. Z ' Other Distribution box ( ,/� Dosing tank ( ) Percolation Test Results Performed by----CA_ ___________________________________________ Date......4�_..��I�J a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-------................. rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground ` - -- g!� pwater._____`-_--e_____---------- -- 0 Description of Soil... r --�'- % ----- �----- ....-•----_--_- -�.-�.- - - - ----- -xU ----- _ ' ^'T = d-------- - - UNature r / teration r w aPPlivable_ _ - --- = - of � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary de— The undersigned further agrees not to place the system in f he`lt Si operation until a Certificate of Compliance has b n Issu P P J ed by t apdvv gn "56 ? � � � A Date Application Approved By........ -c= --- --- -_l Y1 � =...�'� 1` � _ Date Application Disapproved for the following reasons: -•-----------------------------------------------•-----------------------------------••--- •--------•---•------------------•-------------------•- ......................-------------------------•---------••---------------------------------------------------------- ----------------------•--- Permlt No. / y-------- -----. Issued.. ......................... Date ~ 7 .Date a � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H H `y .............OF... ...... Trrtifirafr of ITTImpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( A<or Repaired ( ) by..!!.. .... - ---------•-- • ♦ Installs. " at-• . ' 1 'l g✓ � S'-o .a�s ll_ � has been installed in anc accorde;with the provisions of . e XI of The State-Sanitary Cod as described in the application for Disposal Works Construction Permit No _I�.�_�................. dated_- ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ?�« ...OF...... .- ..................... . FEE_ ... �i��r�ttl urk� C>zun�tr�trti>Qit �frr�tif Permissionis hereby granted..........................`............................................................................................. ...................... to Cons r ct (A or Repair ) an Individual ag�isp Sal System at No. f} 0 f gtF1 •�.k /' Street as shown on the application for Disposal Works Construction P No _ *-o. Dated... ��/ - -- ---•-•s..•-•-••----•---••--...•.Brd of He� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No......../d y. - Fmc...f V................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F 'A $i 96"L, � . . Applirtttion -fur Digiwial Works. Totwtrurtion jJrrniit llcation is ere' r' de for a Permit to Construct ryn ,I 0lpp yr ( V') or Repair ( ) an Individual Sewage Disposal �/"ti`system at: 9 ----•---- ------ ---"' '-----.vim T -....L...................................----•- ------------------------------•-------•------.....----•------•--------........--•--••-•-•-•---•--- �r / ocation-Addre / ,�/ yam,Lot Np.� .-i--..... �� .....-----•-----�/7!_d:>..................... .....44.C•-!Y� '-z!�i!+-..J✓..... _..�fC1.�vc_/!�o%l r...-------- Owner W iZSi✓ .�� j LI!�' L dre - a 4 p •_--•------•-------•------•---•_•---------------------------•-.. t......._....__............_. ........._................................................ .... Installer , Address UType of Building Size Lot- -_--.-_-Sq. feet .-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) per., Other—Type of Building Cmc Loci No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------- W Design Flow.......s.?��C?_._%bT `._...._..: y. Total daily, flow gall ns. /01 � Septic Tank—Liquid capacitvl�- -gallons Length/�_�...... Width............ Diameter................ Derth._d.�_.�/.. xDisposal Trench—No- ---------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----;,------.-___ iameter.. ............. Depth below inlet...�'3......... Total leaching area...t��%�....sq. ft. z Other Distribution box ( ,/ Dosing tank ( ) ~" Percolation Test Results Performed by----l*.:_61elt.o.......................................... Date...... Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground �i �• y water-_.------.._--._.__._. ----.....-- --- •-•- --------- ------ -- --•-•--•-- � r- ;� Description of Soil 4 10 x ----------= -------------•---••--•• -- ..... ---------- - .... .rj ------- A---------------r------------------- x U Nature of rs or 4�teratior er w applicable..... .....C r,=-- 7 4 Ar = Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by t L�a f healt / , Sign ........................... t -------------- --- Date Application Approved By...--`- --- -- L; = ----�-. - �-� _ Date Application Disapproved for the following reasons:.....................------- --•-•-----------------.....------.........-----....----------- .------••------- .......•••••-•---•---....--•••--•-----------••-------------•--------•••....-----•--••...--•--•--•••••--•------------....-------------------------•••--------......----------•-----••-• ------•-••••..... Date ----•....................•------- Issued.._. , -_',- Permit No.._...:./ y_. --__.....-_.•___ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H H qL .............O F... .. .. �rdif irttfr of Toutphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( A<or Repaired ( ) by ...:.-:-- ---------•-----•--••-•-••-•-••--•-•------••------•--••......•--••••--•- ♦ " � Installer at... _. .�.,�,��..r....�. tt jK. ..-f"(t9&....-•-...... +-p.Ab!1.d+16r�d....W � A��' ��,�5� has been installed inr`accordance;withe provisions of . e XI off The State Sanitary Cod as escribed in the application for Disposal Works Construction Permit No. .�.�. :.................. dated.. � � .�'_............... THE, ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. k ' DATE. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS- BOARD OF HEALT 7 hh ........ x FEE.f Y..' ---• �i��tt1 �rk� Cnnn�tr�rti�ait �frrttttt Permissionis hereby granted--------------------------`-................................................................................................................... to Cons r ct ( or Repair ) an In, ividual ag�isp sal System A@ Street as shown on the application for Disposal Works Construction P No . Dated_...�,/�...��............ 46 ......................... Board of He DATE...............•------.......--------...------------------------. ......------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a. ,. r 37 Fm , f- , t :.. , I , , , I j P I , r 5- , a _ F �zr vE• , :. ms' 1 :.' ! E e : P 5 c S , , w. - r : 1 .s x , 1 f • , - \ ^ '1 T V O x v 4 - , �C s. ti VY � r. • I . I I . ,- � - . I . . , " , ! � ",- - /,� ;q �l � I I� -i - - I 1. I . � , .. 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I I 11 I : : REVISIONS BY �, �.;.�- v�jv��-��►�p Z..�' ter-#'�t��- ��' • IDO _ Cox `: -- a k� Q1-t�'�'`-� 1UJ e ' 14 ,V 77 rA Ll A4)V'04-fco Pll� 1 tip •�,:� .:___y_-_ -- --- � ,�-� � ;� � 1 � + � � > �� . y ---- - •'- (}yr�y-...ate r , / �' f-. 1 a� Fi � �t;,,1 S` .1-- � � � � � �J _ -v ,•._.-' �� ("y�% � t!l�t' °..; ._a.-- t G.�3 V{ c�j r ; uj t r JJ V r,,.i {�� -_ .- �----=�------� .� ..t`(�._'"{Jim -..-•--� u-- fIr ram•. { ♦-_ _.._.. .. .. _....--_._ . Z -� { N r `� VA SCALEORAV , _ 1 JOB 141 C _ _ UkR up SHM -- _..._�.,_ ---��.-�..�-._::_--:_�--- ---- -: fib Er►v o — - . ._. _ AL OF . ------------- STOCKDRAFTMG FORM P40.101-51