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Home My WebLink AboutBANGKOK CUISINE - FOOD Bangkok Cuisine aq�{- 20 Independence Dr, p(��.I Nyalni b F�RMERL Y NAKED OYSTER r� n s p4� T Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. tA%NSTABtX- F.P.(Thomas)Lee,. MA$fi. Daniel Luczkow,M.D. Alt. }, 039. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 616 Issue Date: 01/01/2022 DBA: BANGKOK CUISINE HYANNIS, INC. OWNER: BANGKOK CUISINE HYANNIS INC. Location of Establishment: 20 INDEPENDENCE DR HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 53 OutdoorSeating: 0 Total Seating: 53 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: GQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED 12/22/2020: RESTRICTED TO 53 SEATS. Shared grease trap with Awakening Coffee House. A shared grease trap maintenance agreement must be signed by both parties and filed with Town Engineer's Office.This variance is not transferable. For Office Use nitials: T 'O"+ Town of Barnstable oc o a•2. BARNFrABLE. : Inspectional Services 1639. �e� Check Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Ac�PPLICATION FOR PERMIT TO OPERATE`A FOOD ESTABLISHMENT DATE o`�—o�o ( NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ov of I ADDRESS OF FOOD ESTABLISHMENT: i yt of�& C—e- EJy 4Y6?Pyl t/ MAILING ADDRESS(IF DIFFER�EgqN��T FROM ABOVE): E-MAIL ADDRESS: S15a "'uV�a�� N �OI M6(f (G► t-1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 61T I - 3 3 �( V TOTAL NUMBER OF BATHROOMS: 2— WELL WATER: YES /NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: '� SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSID SIDE: TOTAL: - 3 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) s 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 t OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# ADDRESS 1 1 vv� ri(�.)1 CORPORATE OWNER: qa CORPORATE ADDRESS: t�� W " '', 1 ""`'1 W ay n 4,1� f A PERSON IN CHARGE OF DAILY OPERATIONS: 44Z I(jO LC$)" 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. (X- (�tK SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc `l• � > Town of Barnstable BOARD OF HEALTH �Y John T.Norman SD' Board of Health Donald A.Gaudagnoli,M.D. aAn,NWxaLL t Paul J.Canniff,D.M.D. 1a s ,0 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 616 Issue Date: 01/01/2021 DBA: BANGKOK CUISINE HYANNIS, INC. OWNER: SAMSAK SANGWORN Location of Establishment: 20 INDEPENDENCE DR HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 53 OutdoorSeating: 0 Total Seating: 53 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: -- --- - - - MOBILE-FOOD: � J MOBILE-ICE CREAM: C � FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: � �F 4 4l� f opt For Office Use Only: Initials: Town of Barnstable Date Paid ,S Amt I'd$ wtrtsreate, Inspectional Services t� • � v� 1659. �� Check# 2— p'fDN1Aya Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �11V DATE 11 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: '��K.--60 y'l h(!� ADDRESS OF FOOD ESTABLISHMENT: �o j�d"e po dwe f)p k, MAILING ADDRESS(IF DIFFERENTFROM ABOVE): E-MAIL ADDRESS: cJsa m. j rli TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( Pk) TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES --NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO c NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: A 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*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QA Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# 2�- 2 y ,y ADDRESS 1,q 9 W�1t�h4l W ck 4YOM I►S MA- oa 6d 1 CORPORATE OWNER: 5dm!�Z 941 CORPORATE ADDRESS: l `�� W�I � ✓ CA PERSON IN CHARGE OF DAILY OPERATIONS: �UaPun I 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. ale K� �Gs`hel�ht� i la G�� SycPul� SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. Prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters.within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.as1). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Apphcation FormsTOODAPP REV3-2019.doc Bellaire, Dianna From: ` Scali, Richard Sent: Wednesday, November 18, 2020 2:57 PM To: Bellaire, Dianna Subject: RE: Bangkok Thai - 20 Independence All our paperwork shows 53 seats,including the Cl. Matt Eddy just called me to tell me he is going to lower the seats for the Coffeehouse to reflect the total 66 seats for the building.Also they may apply for the BOH variance go to 72 seats. Which would give the Coffeehouse either 13 or 19 seats and keep Bangkok Cuisine at 53 seats. R- From: Bellaire, Dianna Sent: Wednesday, November 18, 2020 2:48 PM To: Crocker, Sharon Cc: Bellaire, Dianna Subject: RE: Bangkok Thai - 20 Independence There are a lot of problems with this file. The Naked Oyster was granted 72 seat variance which was above the 66 seat requirement for a 1,000 grease trap. The permit has always had 72 seats printed on it since the time Naked Oyster had it. When it changed hands, it looks like no one had them re-apply for the variance and they just received the permit for 72 seats. However,it looks like they have been filling out their applications with all different kinds of seating. They had a couple of years 56 seats,a couple years 53 seats and a couple of years 50 seats. They haven't filled in 72 seats. However,this has been going on way before I came along.They should have gone before the board with a new variance. If they needed one,but I am guessing they had less seats and didn't need to go before the board because they had less than 66 seats. No one ever changed the permit. That's Donnie's territory and he will need to do a seat count. We don't have anything definite that shows the actual seats in the file from Bangkok Cuisine. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail'),including any attachment(the "Information'),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only."The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Crocker, Sharon Sent: Wednesday, November 18, 2020 2:02 PM 1 -" To: Bellaire, Dianna Subject: Bangkok Thai -20 Independence Please verify w/Richard Scali with their number of seats. Apparently,in site-plan for new coffee shop, Richard said they were only licensed for 53 Seats. Our variance allowing 72 seats applied to old owner, Naked Oyster and would be considered closed/void when they moved. Database has 72. Baxter Nye will be applying to share the grease trap—if they are granted a variance for that grease trap to be used for 19 seats (bringing the use of grease trap backup to 72—IF BOH approves. Thank you. Sharon Crocker Office Manager Town of Barnstable-Health 508-862-4739 The information contained in this electronic transmission("e-mail'7,including any attachment(the "Information"),may be confidential or otherwise exempt from disclosure. It is for the,addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attomey's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. 9 ti 1 � f rCA 1 OLE r A SHEVCINKO tnr wc�safiJ }- p lgn �et;q Ihe:ids set W for the 5erx5dfe®Food Rrat�lia�t�`�ificcfion 6iantir►cdia►, wa ch rs o' �Rec�6-d 6e d by 1F►e.Amerkan:Natid»at Star►dards(nstilute(AW, ' n or Food Protedwn.(CFP'). 1 f � k iP9'1 5a7 R{`'} Wel C� qr Y UMBER' EXAMFQR�+1F1C `„ Rr� DATE. Of. EXPI'RAfiIOPN . e9N/S ' T1Cy. f8C6Nf11CONOiY mqui mM ls. 'qM? may,, - b+a000rd�rce wAh Mw4ime ' •. �QOlbt�diocwl��iiNt+ � aeeadenoiboltAeNtA6 �, te,be�rra.iY q ionsm.175wkidwpeNd sutsoo .¢d06oaars, Op THE To TOWN OF BARNSTABLE,,. _ HEALTH INSPECTOR,s Establishment Name: _ l Date:j] .Page: of Yo OFFICE HOURS BARNSfABLE. PUB200 MAIN ST LIC HEALTH RETSION - : 0-s:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M qq. `0$ HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prFO MA'S° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Cu�s� Date? Tvoe of T sec'o ouf Addres Risk �ery Re-inspection ry Level Previous Inspection Telephone V Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP a In: Other Inspector Out: -Y>� �a Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lo I lid ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1, (_o Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: o ❑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 P eparation (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 tensils (FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbi 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 Fa 'ity (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous r Toxic Materials (FC77)(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. 29.Special R and (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspecto ig a t: 31.Du p er screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatures 1� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 7-102.11 Common Name-Working Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation20 Time as a Public Health Control 590.003 R of A Food E An 7-202.11 Restriction-Presence and Use* (� Responsibility y Employee yee or 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 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 y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 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 crave irirzooi 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 r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity 8 g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 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/Rewrds:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000: oF.KWEro{, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: i �v Date: �f blPage: of OFFICE'HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A f639. `0�' - - HYANNIS, MA 02601 508-62-4644 No Reference R-Red Item - PLEASE PRINT CLEARLY _ """`' FOOD ESTABLISHMENT INSPECTION REPORT Name CV 1�1 a1 Date 3i -Type of • risnection sC Rou Address Risk Re-inspectprevious Inspection Level Retail p Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness (\ Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector �, 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 Itemsj Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ d 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 G;&3.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 5� S ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑.11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health: Overall Rating luntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report when signed below b a Board of Health member or its agent 24.Food and Food Preparation FC-3 590.004 p g y g A=Zero critical violations and no,more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, p ( )( ) 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 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. I within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C.. 29.Special Req rements (590.009) Y p 30.Other DATE OF RE-INSPECTION: In spe Si at 31.Dumps screened from public view 1� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N /'. w 1!` i . w h.,...;^ #,. "...---•:^k-3�/" -;-•- . .�-..y; •w'-,•..,,.��...r`. ,.ice.-" � Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F 2 � Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130`F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* * 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Contamination from the Consumer Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* 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 Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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 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 Came,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 AutWildhority 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.ou violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices shhould 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* 1$ 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 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41"F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices O 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC 7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical Rem in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp TllE r ,. TOWN OF BARNS BL � U-'-HEA TH INSPECTOR'S Establishment Name: Date: Page: of � ""No 11 O FICE HOURS PUBLIC HEALTH DI ION 00-9:30A.M. • BARNSTABLE. • 200 MAIN STREET (�Q� 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION D to Verified �A M67q: `0i HYANNIS,MA 02601 U 50$N.-F64 RI. o Reference R- ed Item P PRI T CL LY 'EO MP�p FO D T LISHMENT INSPEjCTj0NjR Name Date o s o g Routine Address k Food Se-� e sue ion ' lo Om� vel I Previous I s i Telephone Residential Kitchen Date: Mobile Pr . -o p . i Owner HACCP YIN Temporary Suspect Iness (- Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other 100 Ins ec or p t IXIVub Ut: AIM') yFyn1_11K1r_ ' Each violation checked requires an explanation on the narrative/)age(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 ,D PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands NEN .PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities LOYEE 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 /Zzj� v J ffvnI FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Q 11 ❑ 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 - ] 90.Proper Adequate Handwashing CONSUMER ADVISORY AAA - r ❑ 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 ❑ p ❑ ❑ p ❑ within 90 days as determined by the Board of Health. VoluntaryCompliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an tion today,the I ms ❑ 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 4non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 26.Water,Plumbing and Waste if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot g (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-c Ical v' lations. If 1 critical refrigeration. violatea 29.Special Requirements (590.009) within 10 days of receipt of this order. IVA 4 to 8 non-critical violons 30.Other DATE OF RE-INSPECTION: Ins ec is Si natu rint 31.Dumpster screened from public view n 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 Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * g3-501.16 A Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to Other 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*7-202.11 Restriction-Presence and Use* 20 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* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR _ 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg,fiv 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-155'17 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 Violations of Section 590.009 A( )-(D) ( )-(D)in cater- 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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiRequices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. `oFTHE row _ TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of `�Yp bow OFFICE HOURS PUBLIC HEALTH DIVISION : 0--s:30A.M.3:30-a:3o P.M.BARNSfABLE. 20 MAW STET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. v: `0 HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prEo MPS° FOOD ST LISHMENT INSPEC' I N REPORT 508-862-4644 Name to vDe of ec io - (Routine Address IleVe ood Servi -inspection it Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time tied&Breakfast HACCP pt f -, Other Inspector )uf t. r Each violation checked requires an explanation on the narrative pa a 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 r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �y ❑ 3.Personnel with Infectious Restricted/Excluded %T5nEMPERATURE Toxic ChemicalsFOOD FROM APPROVED SOURCE 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 v �„ PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP 0.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No f❑ Yes C0 Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ P ❑ y y � ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils - (FC-4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation er the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and.less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 da s of recei t of this order. violation,4 to 8 no critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Insp s e 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 P I Cl Stgnatur Print: IV U Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated a 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 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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* 183-401.11A(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* effe c"°e innom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Han dwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23.30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin 9 Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F[0 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 Y b 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability PP 28. 1 Poisonous or Toxic Materials I 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 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. M�cY'\lam I � allrotrpage:'iTOWN OF BARNSTABLE HEALrH..irlsPECTORs Establishment Name: ate: . of Wo OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE, • 200 MAIN STREET 3:30-a:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. $. MON.-FRI. �p .ass.pro HYANNIS, MA 02601 soa-as2�saa No Reference R-.Red Item PLEASE INT LEARLY TFON1P� FOOD ST LISHMENT INSP C ION REPORT Name ate I JjAjjg Type of Ins ec ion O s out' Address ood Se tctl'n el Re ai PreviTelephone Residential Kitchen DateMobile Pre-oOwner HACCP Y/N Temporary Susp Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP / Other Inspector - Each violation c ecked requires an explanation on the narrative ages)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ wa Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �V;,VS Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT A13. 2.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties Handwash Facilities EMPLOYEE HEALTH OTECTION FROM CHEMICALS 6a i� ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals i 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 onPROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control IF7-- ' ❑ 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) r Corrective Action Required: No Y Non-critical(N)violations must be corrected immediately or Overall Rating A 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,th 2 ms ❑ 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 (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in-suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (F.C-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 no critical violations. If 1 critical refrigeration. 29.Special Requirements (5901009) within 10 days of receipt of this order. violation,4 to 8 non critical v lations C. 30.Other DATE OF RE-INSPECTION: In s Signatur p int: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N t!/ Dumpster Screen? Y N Violations related to Foodborne Illness- - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD_ PROTECTION MANAGEMENT _ PROTECTION_ _ FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * _ 19_ _ PHF Hot and Cold Holding 2-103.11 Person-in--Charge-Duties- - - - - - 3-302.14 Protection from=Unapproved Additives Contamination from Raw Ingredients (B) 1.5 Poisonous or Toxic Substances Cold PHFs Maintained At or Below 41°F/45°F 3-501.16 EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from EachIdentifying * 590.004(F} - ( )O P 7-101.11 Identi in Information-Ori mal Containers L -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=1b2.11 Common Name-Working Containers 3-501.16 A Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F * _._ _ _-_ ., - - _ 7-201.11 Separation-Storage* _ - - - Applicants -3:3D-2.11(A) - Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ _ _ 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 590.003(G) - Reporting by Person in.Charge* _ - _ _ 7-203.11 Toxic Containers-Prohibitions* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* „t. .REQUIREMENTS-FOR. 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria*Y HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) � Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated -- - -- -- - - - - -- - -- - - ---- -- .Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages g with Warning Labels* 4 I Food and Watel'Frofir 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-SOi.l-11 - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations _ 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* - -3-201.13 Fluid Milk and Milk Products* - - 4-501.7112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) I 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. 18 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from.an Approved System* _ _ _ _ _ _. _ Equipment_ * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sgec"°e urnooi 4.-60211 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 3t0 CMR 22Ai Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish-and Fish F_rom.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 4-702.1 I -' Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* - 'Shellfish* - - - - - - 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009(A)-(D)in cater- - _ ,�_Molluscan Shellfish from NSSP Listed _ Chemical* ( )-( ) * - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P rarY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms-Approved By- -- - 2.301.11 Clean Condition-Hands and Arms* RegulatoryAuthortty 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to' 3-202.18 ' Shellstockldentification Present* - - 2-301.12 .. _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail -_ 590.004(C) �- Wild Mushrooms*__ 2-301.14 When to Wash* g g 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* 3-201.17' Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices ld be debited under#29-Special Receiving/Con-dition - - ' - ' 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 _ _ _PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne _ 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-20 Shellstock Identification* ( )13 Handwashing Facilities 3-501.14 A Cooling,Cooked PHFs from 140F to 70° °F 3-203.18.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P * 3-501.14(B) Cooling PHFs Made from Ambient � 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement 5205.11 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* ty' �Within4llours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices () 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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. TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name. Date: , wage_: of p�• "tip OFFICE HOURS . PUBLIC 2 0 MAIN 8T STREET : 0- :30A.M. 3:3o-4:3o P.M. BARNSrAaLE. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.9. `0� HYANNIS, MA 02601 soe 8sz asaa No Reference R-Red Item PLEASE PRINT CLEARLY N1A�� F0PD TA ISHMENT INSP CT ON REPORT 9 411 Name Date lue o slpection g outine Address Risk Service ection Level II_ Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness 141 Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspector Out: Each violation checked require fan explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or 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 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 6=One critical violation and less than 4non-critical violations g (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,-4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to non-critical violations=C. P q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Ins ec r' S' u Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig to Print: /1n Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N P 7� Dumpster Screen? Y N Violations related to-Foodborne Illness ' - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives t - 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 3-202s1'2`�" Additives* 3-501.15 Cooling Methods for PHFs =Charge 2403.11 Person=in Duties - - - - - - Cooked and RTE Foods.* * _ 19 PHF Hot and Cold_Holding_ 3-302.14 _ Protection from=l3napproved-Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information 7-102.11 Common Name-Working Containers-Original Containers* 590.004(F) 7-201.11 Separation-Storae* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - - - - - - - - "" - 3-302-.11(A) - Food Protection* p g 20 Time as a Public Health Control 11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 7-202. 3-501.19 Time as a Public Health Control* 3-302.)5. 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 ui ment 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* _ y REQUIREMENTS FOR 3-30�.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 g ) Disposition of Adulterated or Contaminated - - - - --- -- - - - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 -- 'Food and Water From Regulated'Sources 9 - - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 1g3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e�crave 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 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 ( )( ) Whole-muscle,Intact en operations 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11 C 3 Wholle,Intt Beef Steaks 145°F* kitchen should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3 401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin g 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 * 5-20 .11 Accessibility;Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. 1 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 ` i 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* a 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. "' ar � -TME r0 � TOWN OF BARNSTABLE j NEA�rH wsPECTOR�s Establishment Name: Page: of 1. OFFICE HOURS d PUBLIC HEALTH INSTREET DIVISION � � ��I�i� 3:30-4:30A.M. RN ABLE. • (Y�1'!V(,,�La� 200 MAIN STREET I V7 3 30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 659.p�m� HYANNIS, MA 02601 J ��So�N 2� - No Reference R-Red Item PLEASE PRINT CLEARLY . EED MP'� 644 FQOD ST BLISHMENT INSP CTION REPORT (- 1 •- r Name ) Date a of �e of Inspection G r I a Routiwe-� Address / G Food Sery- �1 Re-ins b let Retatl P-revious Inspe lion Telephone Residential Kitchen �� 7 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness i' Caterer General Complaint Person in Charge(PIC) - Time Bed 8 Breakfast HACCP n, Other Inspector I Each violation checked requires an explanation on the narrative age(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and R1sk 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) ❑ / im,PLOYEE D PROTECTION MANAGEMENT 12.Prevention of Contamination from Hands ) ' /1 r V 1.PIC Assigned/Knowledgeable/Duties / r / 9 9 Handwash Facilities v v� HEALTH i'ROTECTION FROM CHEMICALS a i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives H ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals v ° { ' FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) / i ❑ 40 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures v ❑ 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 / ry / M� '/ / PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) r F ❑ 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 �� - j G * v� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations NI s J 9J r Critical(C)violations marked must be corrected immediately. (blue 8�red items) orrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ Y Y � ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection day,Ithems ❑ 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 6=One critical violation and less than o 6 non-critical violations 9 "26.Water,Plumbingand Waste if no critical violations observed,4 to 6uon-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-cr ical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. viol n,4 to 8 non critical viol ions ,C. 30.Other Inspe or's ' nature ? Print: PATE OF RE-INSPECTION: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / o #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC Signature r Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �j s iy Dumpster Screen? Y N 1 U 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 14 Food or Color Additives _. .. Law Cooled to 41°F/45°F Within 4 Hours* ( ) gnment of Responsibility* 8 Cross-contamination PHFs 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 ldln% Cooked and RTE Foods.* Additives* PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* - - F3-3O4.11 (A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements. Food Contact with Equipment and Utensils * ( ) q590.003(G)- Reporting by Person in Charge* 7-203.11 Toxic Containers-ProhibitionsContamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR . - . (A).(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � � Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food-and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS * 4-501.114 Chemical Sanitization-Temp., CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized P••pH. 16 Proper Cooking Temperatures for PHFs ' * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf crNe 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* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* - 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed P14Fs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NS_SP Listed Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 - Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 * Other 590.009 violations relating to good retail ( ) ( )( )(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 2401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PI's 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 :003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied w th Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590ForTnback6-2doc *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. r oF.Y ► TOWN OF BARNSTABLE �' HEALTH INSPECTOR'S Establishment Name: ° f Datert Page: of 6A "lo / OFFICE HOURS P PUBLIC HEALTH DIVISION 8:00-9:30A.M. w BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. SY. r//� M -FRI. HYANNIS,MA 02601 soa-8sz-4saa No Reference R-Red Item - PLEASE PRINT CLEARLY '4A °e,s. �• -a rFD MP'�a , FOO ES BLISHMENT INSP C IOE0 RE ORT y , Name l� a Date �' ° Type of �vne of-Hasnection •° I) / O er' s Routine r Address ° Y isk Food jrui a Redinspectio ` ffff }✓ v l y Level Retail P48 reviou I e n 1 ( Telephone Residential Kitchen Date: �i n " Mobile Pre-opuIr"n I w Owner HACCP Y/N Temporary Suspect Illness 1 O Caterer General Complaint Yit Person in Char ?(PIC ( Time Bed&Breakfast HACCP In:/ ( Wn Inspector 1 ) "f 4" r a . IV Each violation c 'ecked requires an.explanation on the narrativeIr page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ A p n _ / Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / y ? n / FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties 3.Handwash Facilities EMPLOYEE HEALTH 'PROTECTION FROM CHEMICALS / if � v ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives d , C/ ❑'l Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals - FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ° r ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Y Y ❑ 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 OTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control y17 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / / r ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP t e �h ' V LS 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices �/1❑ yg' ❑22.Posting of Consumer Advisories 1`ar(/ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating 9 ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the I ems ❑ Embargo Emergency Closure Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of io ons observed,7 to 8von-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 a 29.Special Requirements (590.009) within 10 days of receipt of this order. v iolatio 4 to 8 non-critical vioj#tlons.-1C. g 30.Other DATE OF RE-INSPECTION: I l pector's nature `Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N y v .� , #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 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives ILaw 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* 3-50115 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41*F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C Res onsibili of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) P ty� 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 2Q 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-Prese ce and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004(11) _ Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing Hot Water - 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe critic uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern o 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* the a ro riate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave PP P 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure*._. 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-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* reven am on 3-403.11(C) Commercially Processed RTE Food-140°F* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 78 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 and Fr from*17 to 1 7/45 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. o• '►op�� TOWN OF BARNSTABLE. HEALTH INSPECTOR-s Establishment Name: Cf I � % ate: 'age: of OFFICE*HOURS �Y PUBLIC HEALTH DIVISION - 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 6 39. `0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item P•EASE PRINT EAR Y p a 508-862-4644 'EON1P� FOOD ESTABLISHMENT INSPECTION REPORT .�.�.� Name i C�.;; Date e o Type of Inspection p Routine Address Risk <Zood Service_ Re-inspection �r Level Retai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary spect nes Caterer enera ompaint re Person in Charg®(PIC) Time Bed&Breakfast HACCP �1 Other In, V�1J Inspector Out: o 7 J Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. p Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ v 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 r FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures - ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control I ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �- 1 ❑ 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) m Corrective Action Required: ❑ No , Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ® luntary Compliance ❑ Employee Restriction/Exclusion Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items �O& Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6.non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to 8.nori-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements (590,009) within 10 days of receipt of this order. violation,4 8 non critical violations=C. 30.Other Insp or I t e In. PATE OF RE-INSPECTION: 31.Dumpster screened from public view (Z I 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 Waft Service Provided Grease Trap Size. Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 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* Require Reporting by Food Employees and Contamination from the Environment 7- ( ) 7-202.11 01.11 Separation-Storage*Common Name-Working Containers 3-501.16 A Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces `• 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control Seed Sprouts Not Served* ol and 3-201.13 Fluid Milk-and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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* 3-40L11A(1)(2) Eggs-155°F 15 sec dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Mushrooms Approved By 2-301.11' - Clean Conditi -Hands and Arms* Regulatory Authority on _.. _. 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23.30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands -- 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 2 Equipment and Utensils FC-4 .005 Within 4 Hours 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance 6.26. 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 I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. 1 Aiways record Time if possible;otherwise, choose l3=breakf2sL, L=lunch, D=dinner Discard Previous Versions Menus for Bangkok Thai Cuisine - Hyannis - SinglePlatform Page 8 of 12 L NOODLES Choices Of Veggies &Tofu, Chicken, Beef Or Pork For Seafood Add $2.00 Pad Thai $8.95 , Pad Kee Mao $8.95 thin rice noodles wok tossed in tamarind `, f,lat noodles, eggs bell peppers,fresh basil, sauce, egg, green onions, bean spouts and tomatoes and-onions ground peanuts, Pad Glass Noodles $9.95 Pad See Eew $8.95 glass noodles stir fried with onions,carrots, flat noodles, egg, broccoli. tomatoes eggs. baby corn and snow peas t Pad Yellow Noodles $8.95 Lard Na $9.95 wide rice noodles and thai herbs wok-cooked stir fried flat noodles with broccoli in a light with onions, bell peppers,tomatoes, egg and brown gravy sauce bean sprouts s http://places.singleplatform.com/bangkok-thai-cuisine-9/menu?ref=google 2/27/2017 ✓JOfO Always record Time if possible;otherwise, choose B=breakfast, L=Lunch, D=dinner Discard Previous Versions .o°SHE rok TOWN OF BARNSTABLE LTH INSPECTOR'S Establishment Name: Date: -Page: of v to � ®Q OFFICE HOURS PUBLIC HEALTH DIVISION V 1 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 639• .0 HYANNIS,MA 02601 50s 862-44644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FO"""`p FOOD ESTABLISHMENT INSPECTION REPORT Name _ _ Date a of Tyne of Inspection " Routine erati Address Risk ervice coon -ifevel a al n Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector '/�',I V,^V,J - La Out: G �' Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEfrEMPERATURE CONTROLS(Potentially Hazardous Foods ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 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 violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 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: /gyp Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8F3-302.11(A)(2) Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 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 Addifives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * EMPLOYEE HEALTH Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Ho[PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* ' Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporti g by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q n 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions _ Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 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. CONSUMER ADVISORY gg 16 Proper Cooking Temperatures for PHFs 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* Eb""°°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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 � Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Proper,Adequate Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 10 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A g 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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* 1 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. `oFTru rpm TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page: of PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. - BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3v. HYANNIS, MA 02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY �pTFDN1A�� FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 Name 1 Date Tyne of Type of Inspection 1 O er tion s Routines �, 3 Address ? Risk od Se e-inspects r Level Retail a ouw9 s nsl spection �• 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 - F 7, I^,, _ In: Other Inspector /� Out: Each violation checked requires explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities • � EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating vlw- [:] 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ---•� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding r PROTECTION FROM CONTAMINATION ❑ e 20.Time As a Public Health Control W CdL� ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ( t ❑ 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) C ❑orrective Action Required: =O-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 o 6 non-critical violations 9 26.Water,Plumbingand Waste if no critical violations observed,4 to 6pon-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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8pon-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: /�� -- 31.Dumpster screened from public view ell ►'"" 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 IN Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Itcros 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties _ 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 7-102.11 Common Name-Working Containers Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* � 7.202.12 Conditions of Use 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 q590.003(E) 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR3-306.14(A)(B)Returned Food and Reservice of Food*Removal of Exclusions and Restrictions 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 Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 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 crave inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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 M' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* - ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es should violations relating#to good retail 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* yg 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.12 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 5-20511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* . Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r' THErc dv TOWN OF BARNSTABLE 11. HEALTH INSPECTOR'S Establishment Name: - - Date:W.13 age: - of �P o PUBLIC HEALTH DIVISION OFFICE HOURS 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS." pr t6;q ,0� HYANNIS, MA 02601 M-8 -FRI. No Reference R Red Item PLEASE PRINT CLEARLY F°Ma+ FOOD ESTABLISHMENT INSPECTION REPORT sos-as2asaa Name Date - T e of Type of Inspection it ,�^' Address �o Routine v 1 Risk pod S Re-inspection Level I Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation k Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: "�1" hs',c Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. y� 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) ❑ r Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities i VA EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ✓ d--_ �L�.. ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals /l)'� ` Ilk T- FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentia Ha o Foo s) U� ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 1. G- 1f{ ❑ 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 �%�✓� �. \ G� ✓ " 5 PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIB POPULATIONS(HSP) S �� ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP J 10.Pro erAde uate Handwashin❑ P q 9 CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories slzu g 2_ h Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined 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 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 b a Board of Health member or its agent 24.Food and Food Preparation (FC-3 590.004 p 9 y 9 A=Zero critical violations andno more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, )( ) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6npn-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature //�) r.- Print: 31.Dumpster screened from public view.` 1/ C. _ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N � � ��N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions r. Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 1 g PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 1 g 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* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to Other 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment Applicants* 7-201.11 Separation-Storage* 20 Time as a Public Health Control PP 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* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated - 7.204.14 Drying Agents,Criteria 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and Food FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Ariimal Food and g Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs 3-603 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 .11 Consumer Advisory Posted for Consumption o Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate Equipment 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ery`d°e vuzom 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* Shellfish and Fish From an Approved Source 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* 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* ing,mobile food,temporary and residential Sources* 10 Proper,Adequate Handwashing * kitchen operations should be debited under Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F P Gamea and Wild Mushrooms 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 Regul2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 3-202.18 Shellstock Identification Present* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Hygienic Practices practices should be debited under#29-Special 11 Good Hyg 3-201.17 Game Animals* 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Critical and 0) 3-202.15 Package Integrity*' non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 5-203.11 Numbers and Capacities* Within 4 Hours Tags/Records:Fish Products 24. Food and Food Protection FC-3 .004 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance. Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. f pF114E rpk, TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page:, of gyp`• 1'0 OFFICE HOURS '\ f PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9$ MASS. 3 .0 HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY orFD MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date a of jype of Inspection T= er Routine Address Risk Sod Service Inspector Level eta a spection Telephone Residential Kitchen Date: Mobile Pre-operation Owner ° HACCP Y/N Temporary Suspect Illness 41 Caterer General Complaint Person in Charge(PIC), lI ,P Tim / Bed&Breakfast HACCP 6 In: TD 7'5' Other Inspector Out: i Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ _ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands zp 1.PIC Assigned/Knowledgeable/Duties ❑ 9 9 ❑ 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) O ❑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 LV 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 -fcvc-CA ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Q 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories �- Y��f1r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 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. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view C� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI&Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-101.11 Common Name-Working Containers 3-501.16 A Roasts Held At or Above 130°F* I Require Reporting by Food Employees and Contamination from the Environment * ( ) 7-201.11 Separation-Stora a Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* P g 20 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bai[Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and Not Served 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts * 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. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of -601. A) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4 11( Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency 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 Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009(A)-(D)in cater- Chemical*Molluscan Shellfish from NSSP Listed * ( )-( ) * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g S 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) 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* Temperature Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 , * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doo *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE BAR-W ' Ordinance or Regulation WARNING NOTICE Name of Offender/Manager � � �"-fit h141�-t- r r � Address of Offender r) MV/MB' Reg.# I r f Village/State/Zip 1_A1, AAA � !AAA 6)1-1. ) ► Business Name, M r ,�� v 11r ' /�'1 G � �a pm, on f o % 20�If Business Address ' (/,+°• ' '? {�✓` ✓«- . Signature of Enforcing Officer Village/State/Zip 6174 Location of Offense � �" ( _h - !!7 `"7 41� Enforcing Dept/Division Offense / w` 5 . '"/�r+C� C .�•rk t ,s r` ✓ FactMr � 2c "w-"' L."JOWA11 KITI. 51,0i'�7w'K — 11f1PJ,494' A1A-_,t1J4(_ ki-4- 1_fyffl� fW This will serve only as a warning. Ate this time no legal action has been/taken q �� It is the goal of Town agencies to achieve voluntary compliance of Town /& Ordinances, Rules and Regulations. ' Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result/ in, appropriate legal action by the Town. /e 4 -�e(l 4;(j,,/`i 5*1) WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �� ?' w �~� TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager '1t� i' '�. �. � Address of Offender ;v t. x.,. fr /L,t MV/MB Reg.# Village/State/Zip 14 /t+-4 1, e / ,s Business Name l;, f �,, R`;rr t � am pm, on 20 ;J f , Business Address J, f /[`.r_.fl t d. f r+t'r" r A l � ��II. r _ Signature` of�Eiiforcing Officer Village/State/Zip _6 rI 1. , " . Location of Offense , -7 L F, st 4k Enforcing Dept/Division ` Offense ri"7f .lii l ,^ ; , t to, 4, e,7 Fact's� L� Dl ` ttt"f �� t•i f; �c i� ! /'t 1 .t frt`, ! r,�' 14 D Lr 111-1 1�lr1+ el i This will serve only as a warning. Atith s time no legal action has been taken-'i' I�t is the goal of Town agencies to achieve voluntary compliance , of Town �. Ordinances, Rules and Regulations. Education efforts and warning notices area attempts to gain voluntary compliance. Subsequent violations will result in, appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. r'f E TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: '� Page: of �P� o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSfABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. '4A 059. .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY ,FDMA,. 508-8624644 FOOD ESTABLISHMENT INSPECTION REPORTeA Name Date a of T section utine Address Risk od S ction Level Retai Previous Inspection Telephone -7 -1 y Residential Kitchen Date: Mobile Pre-operation Owner ^ Stir HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC)VGA-h, PIA Time Bed&Breakfast HACCP In: I' Other Inspector Out: I Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ �" Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 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 Ll ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures C C ❑ 5.Receiving 1 Condition ❑ 17.Reheating L L O ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling L ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ` I ❑ 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 LA Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations j�kd -- --r ��Jm - n 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g Y ❑ 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 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4n6n violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view 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 gnat a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 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 3-501.15 Cooling Methods for PHFs Additives*)(1) Raw Animal Foods Separated from 3-202.12 Additi * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge[0 7-]02.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130'F * 7-201.11 Separation-Storage 20 Time as a Public Health Control Applicants 3-302.11(A) Food Protection* 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* Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eb cmc rnnoor 4-602.11 Cleaning-Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* - Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole_muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-001.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification.Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004O 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 tt29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3 403.11 C Commerciall Processed RTE Food-140°F* Blue Items 23-30) 3-201.15 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* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �oFI E roty� TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page: of o� OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF,CORRECTION Date Verified Si MASS. J Yp ,639. �0 HYANNIS,MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY `reo MPS° FOOD ESTABLISHMENT INSPECTION REPORT 508-862 4644 Name Date oe o section g outin Address i ood Service ---spection Previous Inspection Telephone Residential Kitchen Date: ff Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) L<A= fi (� Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT 44 ❑ 12.Prevention of Contamination from Hands n_n�, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities v' i tA EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control - ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) -'Total al Number of Critical Violations Critical C violations marked must be corrected immediately. �� ❑( ) y (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, a items checked indicate violations of 105 CMR 590.000/Federal ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 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 (t C-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility aggrieved b this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y ty (FC-6)(590.007) be i Y Y 9 g q violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Ryqrents (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpsted from public wy n( �Permit Posted? Y7Grease�lTrap Pile�vious Plumping Date Grease Rendered Y N C�2 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 1's Signature f 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 r.` Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives a Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Other*_ 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F* Applicants* 3-302.11(A) Food Protection* 7-201.11 7-202.11 Restriction-Presence and Use*Separation-Storage* 20 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 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition ofAduIterated or 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* g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria 4 Food and Water From Regulated Sources * 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law*41 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(l)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * egecriw raizooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g * 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3AOI.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Authority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 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 PHFs Received at Proper Temperatures* Discharges yes,2-401.12 Disch From the E Nose an ( )d Mouth* 3-403.11 B Microwave-165°F 2 Minute StandingTime* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140'F* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) g 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 .00 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans J 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 crtcal item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. of IKE row TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: I�-- - f`�`� Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. • BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. MASS. 00. e Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified +639•p�0 HYANNIS,MA 02601 N1 INSPECTION REPORT soe-asz asaa No Reference R-Red Item PLEASE PRINT CLEARLY rFDP` FOOD ESTABLISHMENT Name Daj@, �5 Type of of Inspection v s O� Address Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: 1 Mobile Pre-operation t r Q Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP _ G 1S In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations_Related to Foodborne Illness Interventions and Risk Factors(Red Item-sl Anti-Choking 590.009(E) ❑ , Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ _ c O ki �. `�• 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 Q FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) C, ❑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 V❑ Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) .Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or © Corrective Action Required: ❑ No Yes Overall Rating within 90 days as determined by the Board of Health. oluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils FC-4 590.005 9 or more non-critical violations=F. ( )( ) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violations and less than 4 non-critical. If no critical. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspec Si r 31.Dumpster scaXeed from public view - �Zi �'`� J Permit Posted? Y Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observe- Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: . Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N e- Dumpster Screen? Y N l Violations related to Foodborne Illness ' Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 .-••- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from.Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-m Charge[0 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage*Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 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* Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer '3" 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rered or of Food Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 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 Wanting Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * effe cme 1/1i2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* � Ratites-165°F 15 sec* ing,mobile food,temporary and residential ` 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate ro riate 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 77 Reheating for Hot Holding r. practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers an P d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 2 . Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans i 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. .K► F BARNSTABLE HEALTH INSPECTOR'S Establishment Name: /`� Date: Rj� ]/)-P-a e: of `pa oy� TOWN O OFFICE HOURS °^ PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3: FP.M. MON. RI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v mAss $, MON.- �A '639• HYANNIS,MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEA Y """'� FOOD ESTABLISHMENT INSPECT ON REPORT Name Da t a of TVoe of Inspection J , Operation(A) Routine Address Risk Food Se-, Re-inspection Level Rea Previous Inspection Telephone Residential Kitchen Date: Mobile re-opera io - Owner HACCP Y/N Temporary Su c Iness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP (Lj In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives C I ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control �+ ❑ 0.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ TO.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating VoluntaryCompliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,t items ❑ p ❑ ❑ p ❑ 9 y p checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical violations 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 =F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g s o e e to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I spector's i t Pn 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' na ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i 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 i 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.* * 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) P 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control * Time 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 me 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* 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* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* * Raw Seed Sprouts Not Served* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 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* Ef eewe 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 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 ( ) ( ) ( ) ( ) Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165`F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2 401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention with P Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p INE rpm TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: c Ibage: of b OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ' BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MARS.. `0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red PLEASE PRINT CLEARLY �.e 508-862-4644 ,EDMP,a FOOD ESTABLISHMENT INSPECTION REPORT Name a ZIA V, Date Tvoe of sec ion O er Routine ^ Address i Previous vel RetailInspection ood Service on � - �e Telephone �( Residential Kitchen Date: �� v Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) 'r Time Bed&Breakfast HACCP 1 In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands C��T ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS h' v, ❑ 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 D 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) r^ ❑ 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 f 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 todWeitems ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations g 26.Water,Plumbing and Waste (FC-5)(590.006) establishment.permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.o08) 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 anon-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view 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.) , FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7- Common Name-Working Containers 7-202.11 01.11 Sep g Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 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. Contamination from the Consumer 003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated orce,of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 31401:11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/I12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P rarY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When 3-401.11 2-301.14 Wh to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices t 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the 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 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 P Tags/Records:Fish Products 5-203.11 Numbers and Ca pacifies* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and.Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF�He ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page of 1' OFFICE HOURS BAR E. Pu6Lic HEALTH 2 0 MAN STREET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS •� HYANNIS,MA 02601 M-8 -FRI.4644 No Reference R-Red Item PLEASE PRINT CLEARLY �A +639• 508-862 "" p FOOD ESTABLISHMENT INSPECTION REPORT Name Date ype o of sec io d C p outine 40 Address sk ood Service ion Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation ' Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector L Out: t 4zv 454n -- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. i Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) nf- l 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 ' V 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/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 ��rr ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Lc I. 0 Lq N. Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations1044.-AIA Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage 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. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N I &,�( Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-2 2) and Riblt Fitulurs(Red Reins 1-22) (Coil.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45`F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140`F Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 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 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* Conta�rrination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reservior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-80111(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* . Raw Seed Sprouts Not Served* 3-201.12 - Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Jce Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-1 Cooking 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' Not Otherwise Processed to Eliminate F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Equipment 590.006(A) Bottled Drinking Water* ` 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cnvc rarzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Fish From s.in 310 CMR 22.0* _ Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* - Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority - 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165`F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145`F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165`F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commerciall Processed RTE Food-140`F* (Blue Items 23-30) 3-101.11 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 g 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140'17 to 70`17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-SOl.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 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. oFI EJoh� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of P o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 059. .0� HYANNIS, MA 02601 MON.-FRI. No Reference R Red Item PLEASE PRINT CLEARLY Ma+° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date Ofgjwe of TXp&2g±4VsRection 6utine rA .� Address Risk ood Service ction evel Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other VIInspector J�,� Out: 011 L-Offl Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today; a items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 6=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster scre ed from pubic vii w Permit Posted? YN {\`ease T revi�is Pun(ping 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 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.) y FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* ' 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 1 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe cmc 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* 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- * Ratites-165°F 15 sec* in mobile food,tem o and residential Sources g. P �Y 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the a ro riate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave PP P 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* A 1 b All Other PHFs 145°F sec 15 * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* en 3-401.11( )( )( ) s- practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 590.000 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Temperature Ingredients[0 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 I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 1 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p IKE r°k, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name:_ 6an� ko k ► A; C v e` �j! Date: a L Page: Of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:MON.-o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p e 9. `e� HYANNIS,MA02601 08-8 - 64 5o8-Ssz asaa No Reference R-Red Item PLEASE PRINT CLEARLY rED MA�� FOOD ESTABLISHMENT INSPEC ION REPORT � i✓1 Name �r^� C✓i✓` Date T e o o Inspection (A A4O s Routi rr ` Address r� i Risk ood ervice nspection )I ``�� `'� Level Previous Inspection p N G• 2 r l G f-xY A o Telephone Ir Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ,� O Caterer General Complaint Person in Char a PIC Time Bed&Breakfast HACCP c g (PIC) Other oo - o (1t.n f" J �� nJ n In: Inspector C Out: a I C I Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. fin' MiNiations Related to Foodborne Illness Interventions and Risk Factors Red Items Anti-Choking 590.009(E) CU A ions marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ An as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIO e ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1.Good Hygienic Practices ❑22.Posting of Consumer Advisories [ions Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ntical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes ❑ Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address C=2 critical violations and less than 4 non-critical. If no critical refrigeration. ( )( ) violati sery ,7 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector' Signa a Prin 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 (/(J ry Dumpster Screen? Y N v- ._,� .."°^".•w�.......:,..n.•-r-�,�.,,aj:r..�„,..r....s^L. w-a^+_+-.. .....-r'-.=ems-w1..rltw>ro.'<<=....ro^•., ....r; -eR...r+-.-T.-�. 1L<r`. �r'•1.�1f�_^-^^3.mw..:,'S;r...-..:.�•R .._...-. .... �.-- ..._ ...._.__rR..r"'�'y.-..o.•-^+.rK^a•+,*'�-+rn.�--yy�'e_- w ..._. -�' *r-.e. ..ry-Y^"c.e �.__ .e•.+.�-.:N d, ..M's•....r.�.f.-e.r -r... -.� Violations-related to Foodborne'lllness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) I * EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* � g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* ` Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants*ts* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 WashingFruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* _ g * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or - 3-306.14(A)(B)Resumed Food and Rated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I lMonitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff cave utnoa 4-602.11 Cleaning Frequency of Utensils and Food knimals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing ContainingFish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ry 590.009(A)-(D) Violations of Section temporary and a ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Fonds Conked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 1 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 4 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) Cooling Cooked PHFs from 140°F to 70°F 3-203.18 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 an P d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients` / 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 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF.Ne row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ,�Jot :gC�a�i;,o� Date: Page:_ of q OFFICE HOURS J p ° PUBLIC HEALTH DIVISION .8:00-9:30 A.M. - BARNSTABLE. 200 MAIN STREET 3:MON.-FRI. MON._FRi. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,639. �m HYANNIS, MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MP'�p FOOD ESTABLISHMENT INSPECTION REPORT Name C� c �� Date Tvoe of sec io vIl g outine Address Risk od Sery Re-Inspection Level Retail Previous Inspection OMA Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint 66 Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other D Inspector 0 �v�" �, �h Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. i:blations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ lations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �O , ction 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) \ r' ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating Vr 11 ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ` PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 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 lations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations w Critical(C)violations marked must be corrected immediately. (blue 8,red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes Overall Rating within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection todaWeitems, 23.Management and Personnel (FC-2)(590.003) checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than.4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violation and less than 4 non-critical. If no critical v 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address ns or 7 to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violati 30.Other DATE OF RE-INSPECTION: Inspecto s Signa r Prin 31.Dumpster screened from public view " V c S Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N J #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 ';(Ie Ali fr. Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red items 1-22) and Risk Factors(Red items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE-Foods.* ' * - 19 PHF Hot and Cold Holding as 2-103.11 Person-in-Charge Duties _ 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to. Other* * 3-501.16(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* 20 Time as a Public Health Control PP - 3-302.11(A) Food Protection i 590.003 Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * (� p ty3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(I1) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501,111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 1- Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods Thatare Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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 4-702.11 3-401.1 l(B)(1)(2).Pork and Beef Roast-130°F 121 min* Eggs* 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 '°t' -'f�^ 4=703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or - 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By. 2-301.11 Clean Condition-Hands and Arms* P 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 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 77 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 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. Managementand3 3'Personnel FC-'2" ' ..00 + w 3-402.11 Parasite Destruction 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.12 Records Creation and Retention C 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005_ Within 4 Hours 26. Water Plumbingand Waste• 3x' •..FC=5_ .006T�- 590.004(J) 9 9 Labeling of Ingredients* Supplied with Soap and hand Dry 27. Physics cility FC-6 .00 Drying Devices - 7- - - l Fa 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback5-2doc *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. ISE roq. �' ' TOWN OF BARNSTABLE &HEALTH INSPECTOR'S Establishment Name: Date: , Page: of C)p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTARLE. • 200 MAIN STREET ® 3:M N.- P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. 1639•A 0 HYANNIS,MA 02601 soa-as2 asaa No Reference R-Red Item PL S PRINT CLEARLY rFD MA+ FOOD STABLISHMENT INSP C ON REPORT Name Date Type of Tyne of Inspection FIA Routine K ' 4YTD (A Address isk Food Servi Re-inspection Level Previous Inspection Telephone Residential Kitchen D Mobile Pre-operati O Owner HACCP Y/N Temporary c Ilness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspecto!]�Qffl Ou a h violati on checked requires an explanation on the narrati a page(s)and a citation of specific provision(s)violated. ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ on Iolations 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 _s 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 L r Innie-.1 PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health ControlEv ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils 9 or more non-critical violations=F. (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility FC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of y ry ( )( ) C- ritical violations and less than 4 on-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address viol 'on bserved,7 to non- ical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. O n ecto s S"gna re Print: 30.Other DATE OF RE-INSPECTION: Cpq 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig lure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 1// .: ..-.. .-.�.�, �.n,.:.+^-•-----�:. .. mac... _�.+'. --,ti.��,;•...---:»r�- .n�",r-^�w°`vti:-..+... ....�...:.._ e��F--,-"".sr,`7.;�c... z*f+°ir.:f-d`-`'-+--.+w-1-7..ap':isl''c'^a:�.-.�.-�•=-a`„�[,...-ass.-�-.e•F:.-.+r•�swuwrs-y=•=-"`'..,+�..-r•..ti.-a. -..-., Violatitins related to Foodborne Illness Violations Related to Foodborne Illness Interventions C 1 Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C). PHFs Received at Temperatures According to 1 590.003 A Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g 14 Food or Color Additives * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives - Cooked and RTE Foods.* - * - -- 19 PHF Hot and Cold Holding 2-103.11 � - Person-in-Charge Duties - -. - _ _ 3-302.14 Protection from"Unapproved Additives � • ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances r 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 EachIdentifying * 590.004(F)- * - ( )O P 7-101.11 •- Identi in Information-Original Containers * g g 3-501.16 A Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to - Other 7-102.11 Common Name-Working Containers* ( ) * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Storage* - - +lpplicants*- - ._ - _ -_ - - - • -3-302.11(A)- Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Pers6n In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 4 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ,., .... . . . . . REQUIREMENTS-FOR _. _ 3_-306.14(A)(B)Returned Food and Reservice of Food* 7.204,12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions arid,Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g - - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked.Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk-Products* - - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 15 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-Imme Service sec diate Sice 145°F 15 * 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* Effective iruzooi 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) Park and Beef Roast-130°F 121 min Eggs* 4-702.11 . •-Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By _ * 3-40L11(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 retai ls 3-201.17 Game Animals* -11 Good Hygienic Practices practices should be debited under#29-Speci 77 Reheating for Hot Holding Requirements. 5 Receiving/Condition- - __ 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 '005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with.Soap and,hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �oFt"E'or,p 4 . TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: cage: o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BABMASS. E. ` 200 MAIN STREET 3:M N.-F30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. 039•n�0� HYANNIS, MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P` FO D EST BLISHMENT INSP CT ON REPORT Name Date a of Tvoe of Inspection Operation(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect IllnessAt MIN Caterer General Complaint VON 1C Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violatio c ecked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. I"tions Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ lations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ' EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ' ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling .24 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding O PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control Q ❑ 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.P_roperAdequate Handwashing CONSUMER ADVISORY �1.Good Hygienic Practices ❑22.Posting of Consumer Advisories iolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No El Yes 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical 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 4 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 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspect natu 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 Signatur Print: p Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �^v••1- �f�� T IOW R24V Dumpster Screen? Y N ,,�- ,..-ac+.z.-.-+..rsL;'.�'a�:li .""''^""�'S;rry+-t*v.�""''.'„+'µ'.^"�ra.... ..vs�+6•sYt' -+.�. rti+,rr-s. '�.'TY.""-."'.'�r+.-^+w-�-^"''^`.. _ _ _ _ Violations related t6 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 Law Cooled to 41°F/45°F Within 4 Hours* g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* - 3-302.11(A)(Ij Raw Animal Foods Separated from 3-202.12 Additives* I 3-501.15 Cooling Methods for PHFs 2-103.11 Person-.in=Charge Duties Cooked and RTE Foods.* * - - 19 - PHF Hot and Cold Holding - - -- 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients F15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11'(P;)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) 7-201.11 Separation-Storage* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* _Applicants* 3-302:11(A) Food Protection*__ - _ _ - 20 Time as a Public Health Control - 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of Food Employee or An 3-501.19 Time as a Public Health Control* * _ 3-302.15 Washing Fruits and Vegetables 7:202.12 Conditions of Use* Applicant To Report To The Person In Charge * 590.0 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * �( ) 9 590.003(G) _Reporting.by Person in Charge*_ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) - Removal ofExclusibns and Restrictions - - - Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and e FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served, 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-401.11A(1)(2) Eggs-155°F 15 sec 3-202.16 Ice Made From Potable-Drinking-Water* --- _ _ Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff criv 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 8 �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* - Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Id Mushrooms Approved By _ * ( )( ) P Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Fonds Conked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* I65°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 retai 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Speci 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 3-403.11E Remaining Unsliced Portions of Beef Roasts* O 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 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* 3-402.12 Records,Creation and Retention * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices Within 4 Hours 27. Water,Plumbing and Waste FC-5 .007 O 9 9 27. Physical Facility FC-6 .007 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other r02.12 Reduced-Oxygen Packaging Criteria* 103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `pp THE rpm ��. TOWN OF BARNSTABLE EALTH INSPECTOR'S Establishment Name: Date: Page: otzz2-2- •P 4•� OFFICE HOURS PUBLIC HEALTH DIVISION s:oo-s:3oA.M. ' BARNSTABLE. • 200 MAIN STREET ``1 3:30-4:30 P.M. �' mass. �l O MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �Ar,679•e�0 � HYANNIS,MA 02601 508-8624644 No Reference R-Red Item O r PLEASE P NT C ARLY FD MP'� �./FqQD&STABLIAHMENT INSP C ION REPORT Name Date" MO. e o �e of Inspection RoutineAddress iskd Servic Re-inspection eve) Previous Inspection Telephone Residential Kitchen Mobile 7HA D 7 Owner HACCP Y/N Temporary i' Caterer aint Person in ChargeVO (PIC) Time Bed&Breakfast �. In: Inspecto , Out: Sh violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding L PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control r Ili 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ P ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP /r, " 10.Proper Adequate Handwashing CONSUMER ADVISORY -11.Good Hygienic Practices 22.Posting of Consumer Advisories Y9 ❑ 9 Violations Related to Good Retail Practices act ces Blue Items) Total Number of Critical Violations t ( t 1 Critical C violations marked must be corrected immediately. I r items ( ) Y (blue 8�red ) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils 9 or more non-critical violations=F. (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 non- ritical. 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 vi ations observed,7 to 8 non- riticN iolations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins or' Si nature nt: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N PIC's` #Seats Observed Frozen Dessert Machines: Outside Dining Y N Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N c: . �.r*^•,e�+s,:-:'='K'+•, «v-k...-'--+"-"°-`-""'-m---.*".,,-^n.•-?ra.+-"..-..r+g.a.-.saw 3. ,r .. ._:..:.-..- -•�-.. '^rr----�^"-T'-- - �--b.-r-.,..:„-.. •�---.-•-`^�-�.r----�`tr,-----"�-.; Violations related to Foodborne illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT_ PROTECTION_ _ FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives l Eaw 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.* - -* Fig-- PHF Hot and Cold Holding- 3-302.14 Protection front-Gn pproved Additives ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances � I 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH - 3-302.11 A 2 Raw Animal Foods Se arated from EachIdentifying * 590:004(F) * - ( )O P 7-101.11 --- Identi m Information-Original Containers 2 590.003(C) - Responsibility.of the Person-.in-Charge to . Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F - 7-201.11 Separation-Storage* ' - Applicants* 20 Time as a Public Health Control 3-302.11(A)- Food Protection* 590.003(F) Responsibility of A Food Employee or An 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 * 7-204.11 Sanitizers,Criteria-Chemicals* 3 590.003(D) Exclusions and Restrictions • ' • '� •- • " • � REQUIREMENTS 1=0R _ 3,306.14(A)(B)Returned Food and Reservior of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) emoval of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food _ 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources y' - - Food Contact Surfaces -� 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590:004(A:B)_ Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 -- Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products*- - - 4-501:112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 _ Shell Eggs*- Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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 Fiom'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 Drinking Water.from an Approyed 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 5-101.11. Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game_ _ _ _ 4-602.11 _Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Pathogens* Effective uu2oaa 590.006(B) Water Meets Standards in 310 CMR-22:0*' Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food - 3 401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - - - - -4-703.11 Methods of Sanitization-Hot Water and -- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or I' 3-201.15 Molluscan_Shellfish from NSS_P Listed _ _ __ _ __ __Chemical* g g r 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing - '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 '2-30r.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 ret, 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Speci 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 oodborne 12 Prevention of Contamination from Hands * f * 3-403.11E Remaining Unsliced Portions of Beef Roasts 3 101.11 Food Safe and Unadulterated ) g Illness interventions and rtsk factors fisted 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 * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical 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 INSPECTORS Establishment Name: Dater ® Page of y0 I\ i I ":l '�•, OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARMA BLED 200 MAIN STREET 3"MON.3FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A +639. HYANNIS,MA 02601 I- , ,�... spa-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFO MA�a ,, FOOD F STABLISHMENT INSPFJCTION REPORT Name Date a of -Type of Inspection p Routine Address Risk pod Servic Re-inspection Level Previous Inspection Telephone Residential Kitchen Mobile Pre-opera' Owner HACCP Y/N Temporary Suspect Illness Caterer- General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP (rj (sj In: Other Inspector Out: TWA h violation checked requires a explanation on the narrative page(s)and a citation of specific provision(s)violated. ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals �= FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ` ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition A ❑ 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) VA ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP \� 10.P_roperAdequate Handwashing CONSUMER ADVISORY P 41.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No El Yes within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility FC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of Y Y ( )( ) C=2 critical violations and less than 4npn-critical. If no critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations o sery d,7 to 8 non-critical violations=C. refri g 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I ctor i Print: 31.Dumpster screened from public view I A�; Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's tne Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ��'l _.r'TYr-csro'�«.x•-*`�r'�'�..•.��.^^"'�*"'..._ . _ .es•:,-cam.«ore->^--- ..-_..---•.--.-----•---�-"•+r-�-r..'•yt'ia..x.a: . --'�-,.,._. _..�._-._"---. _�_-••...,.-r„�,-.�..,,..�...-....-,.,.,.. -,.- �aryv-'"-�++e'ti-t} 4 � Violations related to Foodborne Illness `- Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) _ and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs. Cooked and RTE Foods.* - -- * PHF-Hot and Cold Holding - 2-103.11 -- - Person-in-Charge-Duties - - - -- - -- - - _ 3-302.14 Protection from•Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 1=515 Poisonous or Toxic Substances 590.004(F) 'EMPLOYEE HEALTH - 3-302.11ZA)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information--Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7=102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants * 20 Time as a Public Health Control [3-304.11 302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 302.15 Washing Fruits and Vegetables e 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G). Reporting by-Person in Qhlrge* _ _ -- -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 Reated or of Food*i 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions` - - g ( ) Disposition of Adulterated or Contaminated Food _ 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources- - y-- Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ _ - 4=501..111_ Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served * _ _ � 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3=201.13-- - Fluid'Milk and-Milk Products 4-501.112- Mechanical Warewashing-Hot Water Monitoring 3-2202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY - _ _ Concentration and Hardness 22 3-603.11 Consumer Advisory Posted for Consumption of -- - - -Potable * - - -- - - . .Con rY P W - 3'20216 Ice Made Ffom Potable Drinking Water* 3-401.11A 1 2 Eggs I55°F 15 sec g OO gg Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 DrinkingWater from an Approved System* o PP Y Equipment* Not Otherwise Processed to Eliminate * l3 401.11 A 2 Comminuted Fish Meats&Game * Effective uirzooi 590.006 A Bottled DrinkingWater ( )O Pathogens* 1f ( ) _ 4-602.11_ _ Cleaning Frequency of Utensils and Food _ _ Animals-155°F 15 sec* Pa g 590.006(B) Water MeetStandards 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* -.�hellfish*- - - - -- -- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContainingFish,Meat,Poultryor 3-201.15 Molluscan_Shellfish from N_SSp Listed _ _ _ __ __ Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - -- Ratites-165°F 15 sec* Sources* - - ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under _ _ _ _ Gam handand Wild Mushrooms Approved ey.. 2-301-Y17- 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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail` ( )( )( ) 3-201.17 Game Animals* - - Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 -Receiving/Condition - -- -. _ _ 2-401.11 _ _ Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore * 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 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. 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. `oFV*rp a TOWN OF BARNSTABLE l M HEALTH INSPECTOR'S Establishment Name: Date: Page: of °lo OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. MASS. �!. MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 16!1 .• HYANNIS,MA 02601 I + 6oe-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MP�a 00 ..ES ABL SHMENT INSP CT ON REPORT Name Date I Type o Type of Inspection Operation(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile, Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: ch violation checked requires In explanation on the narrative page(s)and a citation of specific provision(s)violated. ations 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 d v ❑ 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 YS 4-1 i ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding IV 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.P_roperAdequate Handwashing CONSUMER ADVISORY I MA ll.Good Hygienic Practices 4 V❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of )( ) C=2 critical violations and less than 4npn-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. I Print: 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view Es Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's n Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN //l ""l '",i�v+r..--:xT- _.�_ ._,,sti:°:r..v�r.+r�:�.��;,i:iFS". F<- ---err--- �n rrzry�V^..s ;)�'s�'-.•=-+r'--- Wsi.a>:w.y„_•i..".L�.:.s�.r.7t...�.,.is'try;!-rs.�*"�GYe•ts�Ji-^'ff�t'�-r :"-'S - "`�.^- Y-.liar - ^ ^;�.¢a..�_c..+--�«'Scv^�-`a"".-"'*�'�=�`.�+...'°`-r`-`"'-... ,. �.�..�,::...--�:�.-�.�-----•.•-v �'l•a.-N=SX�..,*'y'r'."Y.']i-��'r-;...,.y,,. r--...{,++ 7 €. V7o/ations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F$ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* i9 PHF Hot and Cold Holding - . 2-103:11 -Person-in-Charge Duties - _ Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - - 590.004(F) EMPLOYEE HEALTH - - - � - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment - 7-201.11 Separation-Storage* Applicants* - - - - * _ 20 Time as a Public Health Control _ 3-302:11(A)' Fdbd'Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables - * Applicant To Report To The"Pelson 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 FUR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP dwh 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated -- - - + - - - - - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4- " - Food and Water From Regulated Sources - g Food Contact Surfaces `' 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - - - 4-501.111 _ Manual Warewashing-Hot Water 7.206.12 Roden[Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P * 3-201.13 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 _ -Ice MadE From Potable Drinking Watet* - Concentration and Hardness* 1$ 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 _ prinJjng Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe c"°°uuzooi _ 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Watei Meets Standards in 310 CMR 22:0*�� - Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shel ish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* -4-702.11-- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* ' -- Shellfish*' - - - -- - - - -- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS - 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present*- - - 2-301.1.2 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 i - 11 - Good Hygienic Practices practices should be debited under#29-Specia 3-201.17 Game Animals* 17 Reheating for Hot Holding Requirements. 5 - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 foodbornc 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 I' 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1$ Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 andP 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 520511 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 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 Cade or 105 CMR 590.000. ��STo�ti Town of Barnstable 4 BARNST"U . Board of Health XAS. i639• �$� 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Paul Canniff,D.M.D. May 30, 2006 Ms. Florence Lowell 20 Independence Drive Hyannis, MA 02601 RE: Naked Oyster 20 Independence Drive, Hyannis Dear Ms. Lowell: You are granted a variance from Section 322-3 of the Town of Barnstable E-Code, which requires in-ground grease traps at all food service establishments to be designed and constructed based upon 15 gallons per seat. The variance is granted with the following condition: The in-ground grease trap shall be inspected monthly and pumped at least once every three months by a licensed septage hauler. The Naked Oyster, proposed to be located at 20 Independence Drive, Hyannis, will have a seating capacity of 72 seats. An in-ground grease trap currently exists at this location with a capacity of 1,000 gallons, designed to handle a maximum seating capacity of 66 seats. This variance is granted because the seating capacity proposed by the applicant will be only six (6) seats above the estimated handling capacity of the existing grease trap. Also, the applicant agreed to inspect the grease trap every month and to pump the grease tr at least once every three (3) months or more often when needed. Sincer yours, Wa ne M' er, M.D. Chairper on Board of Health WM/slc Q:\WPFILES\NakedOyster5-30-06.doc D-Y 5rw-2 o i I _ r I FINE r • DATE: r • FEE: '* 3ARNSrABLE, MASS. 9� 1639• �� y� REC. BY prEOMA'tA Town off Barnstable { SCIiED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION M Property Address: Assessor's Map and Parcel Number: 2 9 06ZSize of Lot: �7 S Wetlands Within 300 Ft. Yes Business Name: No Sub/division,NaJme: r APPLICANT'S NAME:�`e h(� L. V11(�( Phone 3 Did the owner of the property authorize you to represent him or her? Yes 7g-- No PROPERTY OWNER'S NAME CONTACT PERSON`Name: PM r IC Pill tp— Name: h�— � U)e L Q o Address: ajCAddress: Phone: i 6 Phone: . VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 06 C ca e � 3;a-3 - NATURE OF WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets Four(4)copies of the completed variance request form /) Four(4)copies of engineered plan submitted.(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans kbraitted(e.g.house plans or restaurant kitchen plans) +v li Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) . Variance request application fee collected {no fee for lifeguard modification renewals, grease trap variance renewals [same ownerAeasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems - [only if no expansion to the building proposed]) h Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A Miner,M.D.Chairman NOT'APPROVED Sumner Kaufman,M.S.P.IL REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC ` OF K Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMSTAeU& Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 616 Issue Date: 12/10/2019 DBA: BANGKOK CUISINE HYANNIS, INC. OWNER: SAMSAK SANGWORN Location of Establishment: 20 INDEPENDENCE DR HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 72 OutdoorSeating: 0 Total Seating: 72 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: x , For Office Use Only: Initials: � '"E"°''a Town of Barnstable ffi4-84a t: Dataid mt Pd$ `-e P BARNgTABLE : Inspectional Services ' '�39. Public Health Division i°rEo � rr, Thomas McKean,Director N` 200 Main Street,Hyannis, MA 02601 t»; Office: 508-862-4644 Fax: 508-790-6304 IK O APPLICATION FOR PERMIT TO OPERATE_ /AFOOD ESTABLISHMENT DATE NOV NEW OWNERSHIP RENEWAL '�/ ell NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: OcO 1111'�. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: w0 I K- @k) �� C TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 2- WELL WATER: ES /ol*NO (ANNUAL WATER ANALYSIS REQUIRED) AL: SEASONAL: DATES OF OPERATION:_/_/ TO ANNUAL: — NUMBER OF SEATS: INSIDE: OUTSIDE: — TOTAL: L 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*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: I, FULL NAME OF APPLICANT SO M SA S ,atVOf w SOLE OWNER-8 WNER: YES NO OWNER PHONE# O�' ADDRESS 161 Kl WO.- Dr- AY a Nyl I S MA• MW CORPORATE OWNER: McS� �— UIGWort�. CORPORATE ADDRESS: ln2 � �br. �`�- �Is m�• 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. (bt1V(W Q 't'r Jam/ Y`_, '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/heaIthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH Paul 1 Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. UAJLNS'A0M John T. Norman *6°S 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections .5 and 127A, a permit is hereby granted to: Permit No: 616 Issue Date: 12/20/18 DBA: BANGKOK CUISINE HYANNIS, INC. OWNER: SAMSAK SANGWORN Location of Establishment: 20 INDEPENDENCE DR HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE j, Annual: YES Seasonal: IndoorSeating: 72 OutdoorSeating: 0 Total Seating: 72 FEES — ----- ------ - - FOODSEIRVICEESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: ' FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE f Restrictions: d FINE royti For Office Initials: Town of Barnstable � U d Amt Pd$ • Date Paid MEW Inspectional Services . 9� 1639. p'Fo► '° Public Health Division Check# Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 / APPLICATION FOR PERMIT TO OPERATE A FO D ESTABLISHMENT DATE ! NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Ll!:�>Om K� "60;El` ADDRESS OF FOOD ESTABLISHMENT: (v Q ` Qu(t MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 0JA tS E-MAIL ADDRESS: w '� r TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - � TOTAL NUMBER OF BATHROOMS: WELL WATER: YES -- NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 0 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) �OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc r PLEASE CALL 508-862-4644 OWNER INFORMATION: /, FULL NAME OF APPLICANT- SOLE � � �rl� SOLE OWNER: YE OWNER PHONE# ADDRESS ( � �( CORPORATE OWNER: FEDERAL ID NO. CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: M TO 61,1 / /V 17— 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 Auger en Awareness Expiration Date U s ke V(Gtrukr 2. PgA U rf oi &a. 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/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPPREV2018.doc f 1 - 1 PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 616 --130ARD OF HEALTH 1170612- PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulati der authority of Chapter 94, Section 395A and Chapter . n; oh a permit is hereby granted to: SAMSAK SANGWORN /A. ISINE HYANNIS INC. Whose place of business is: _ E . - HYANNV 2f 1 Type of business and any resit - FOY ,ABLI �M To operate a food establishoept ~BILE ; RESTRICTIONS IF ANY: r'"._�y SEATING: 72 ANNUAL: P(EIS . :_ 1 SEASONAL:. TEMPORA Yj. 1. `_ E EtS �OAR0 OF HEALTH Y. RETAIL FOOD STORE: __ � r• ,� ..'��e ,.L�Cinniff, D.M.D, Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE UU rl^ y1�;1i�Sawayanagi RESIDENTIAL KITCHEN FOR BED+BREAKF`�\S -,— Ale- _ -a A. Guadagnoli M.D _ e d � rmir MOBILE FOOD UNIT: Q E } TOBACCO SALES: -;`-� vie -OF ` FROZEN DESSERT: .'tr Thomas A. McKean RS CHO CATERER: m " Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VIC ALERS LICENSE Town of Barnstable P Regulatory Services BMWSTABLE, * Richard V. Scali,Director BAMSTABLE MASS. 'rFc► Public Health Division BPRHSABE•CEY9VLLE•mN -HNN15 163q p� nnNsnxsYl�- OSTRVI a-Ws MRNsADIE 1639-2014 Thomas McKean, Director 200 Main Street,_Hyannis,MA 02601Office-.- 509 863 4644 Fax: 509 790 6304 PPLIEAT p10N? FOR-PEItM3-T—T-O 0PERA-T E-A-PO E-ST -L-I-S[lul DATE: NAME OF FOOD ESTABLISHMENT: �� ADDRESS OF FOOD ESTABLISHMENT: . go C MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 13SM worm J;Q TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS*: INSIDE: G OUTSIDE: TOTAL: �G * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: A NNOCtL , TYPICAL HOURS OF OPERATION MON-FRI: OO n,�, TO I G : 00' �jjQyl DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:Wpplication Forms\Foodappldoc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? -- i5 AN AIR CITRTAiN PRnVinFD AT WA-ITSTAFF SERVICE DQOR(SI? CONTACT INFORMATION: FULL NAME OF APPLICANT YE ADDRESS I G 2e pn'f� Yan� , M A - odbe l PHONE IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION: FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SE-1RVVS1AFE.) �1' . Q Lora Sz'h-oVohe1 ko EXPIRATION DATE: 9 EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON . THE CERTIFICATE*** ST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF.. . noechow &kw jxf- EXPIRATION DATE: ff SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp3.doc PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 616 BOARD OF HEALTH January 1, 201 PERMIT TO � STABLISHMENT In accordance w r Oti s �gatgaib* ority of Chapter 94, Section 395A and a r; ectr�rk=5"die a .-. hermit is hereby granted to: trt � �� mac. SAMSAK SANGWO DIY SINE HYANNIS INC. Whose place of business is EPEN ANN1�$, G 1 Type of business and any er : . EI / .TAB LISy� , .. To operate a food establishirtnent ir>mthe ABLE r 4 RESTRICTIONS IF ANY: ' �'-�_F.. i r tl:'.L 1'.,,a 1': 1 e f L SEATING: 72 e SEASONAL: TEMPORA2k _ � E E sR OF HEALTH RETAIL FOOD STORE: � v FOOD SERVICE ESTABLISHMENT: : y e Miller, M.D.,Chairperson a0. J.Canniff, D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: `��d ° RESIDENTIAL KITCHEN FOR BED+BREAKFAhN •ti � ii; .. nichi Sawavanagr MOBILE FOOD UNIT: �, 4" � Er�IS � TOBACCO SALES: FROZEN DESSERT: Tho-mas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE ' PERMIT NOf, TOWN OF BARNSTABLE ISSUE DAt 616 BOARD OF HEALTH 12/22/20 PERMIT TO OP -EQ61YESTABLISHMENT �F In accordance wiit"i reg i oft& t4a at pm -s miff ity of Chapter 94, P _ - Section 395A and ChaetPr £frcti{-tlee GeLL a, ,a'�ermit is hereby granted to: ppp SAMSAK SANGWORhl,- = D/lam-_ 1--- vlB fk (� l�9SINE HYANNIS. INC. Whose place of business is: ` --0j�_0EPEN� -; r%NNIS, II�k;oo' Type of business and any resfr o ,TABLISF IT — pox To operate a food establishnferit-in-the T 1 ABLE -„ RESTRICTIONS IF ANY: •E — __.`" � u 1"'2. T'�a`fy'l =p— Cam•,� 1'_/ k i � SEATING: 72 t - -=_ ANNUAL:'.YS =.: —� •k E�. _ ;SEASONAL: TEMPORARY'_ =_ _- =• .FEES .ram_z �,bbAgb OF HEALTH RETAIL FOOD STORE: — FOOD SERVICE ESTABLISHMENT: 41'J.Canniff, D.M.D, Chairperson _ r RESIDENTIAL KITCHEN FOR RETAIL SALE: ,Jichi Sawayanagi E z "� - ,_ __r-D RESIDENTIAL KITCHEN FOR BED+BREAKFASTS y onald A.Guadagnoli M.D. MOBILE FOOD UNIT: _� ` rCf}it TOBACCO SALES: ` __ FROZEN DESSERT: — rF=�=�� Thomas A.McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE M I Town of Barnstable �U� U �'THE r Regulatory Services 3-710 ti DST T Richard V. Scah, Director BARNS * 1ARNSCMM • ararvsrae�•ar+rer Cmlrr•rrr— „AS p Public Health Division M P=Ni KLL15•dSMVILLE•W3Ta4RYS Eu 1639. 0 1639-2014 rev Mpg a Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 •o s APPLICATION FOR PERMIT TO OPERATE.A FOOD ESTABLISHMENT w ca DATE: I c�— — b NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: ao (y( dZpeN dAK COY m- h S E-MAIL ADDRESS: S cSaVl W 0 �0� 2� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS*: INSIDE: �_ OUTSIDE: TOTAL- * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: 2 ANNUAL OR SEASONAL OPERATION: ,4 NN U Gf. TYPICAL HOURS OF OPERATION MON-FRI: 11 : G fi R M TO 10 DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) C'��S iV11�1 IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY ZFOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) r � , ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT Sj M S K (su h mo r VL SOLE OWNER: YES /NO ADDRESS 02— Inc IV-G J)YiV& Wyan►1i S PHONE # 5( L(gb 930 - 8S-9 IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS 9 CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES .RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH�� OF THE CERTIFICATES*** ' LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) , 1. praluovt f)uh-r EXPIRATION DATE: �L, / aU/� 2. (VCO�C� C�r� �VIC�nllSefi N� E RATION DATE: �� l 3 / °2o�j ', EFFECTIVE FEBRUARY 1, 2011 EACH F OD ESTABLI HMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. �1. rvoG-fC4ct a e- S()Aklo e�- EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:WWpplication Forms\Foodapp2.doc 616 BOARD OF HEALTH. January 1, 20151 PERMIT TO OPE ,E�STABLISHMENT In accordance with u s o e er hority of Chapter 94, i Section 395A and Ch excti y� a ermit is hereby granted to: I SAMSAK SANGWOR IMP HYANNIS INC. Whose place of business is: PEND EV 14YANN 1 Type of business and any ri r �t ABLISI c To operate a food establisf I nt in e . T r� BLE : F X RESTRICTIONS IF ANY: SEATING: 72 ANNUAL S A SEASONAL: TEMPORAIRR . . _ E E SF HEALTH RETAIL FOOD STORE: AL IVliller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: 0 RESIDENTIAL KITCHEN FOR RETAIL SALE: J. e, p u Canniff, D.M.D. s . RESIDENTIAL KITCHEN FOR BED+BREAKFA J . ichi Sawavanagi r SQl MOBILE FOOD UNIT: l TOBACCO SALES: e FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE 616 BOARD OF HEALTH January 1, 2014 PERMIT TO OPERATE,,&FOOA-;ESTABLISHMENT In accordance with rggtiiatu s romulga ht.►ority of Chapter 94, Section 395A and Chapter i I Inn 5 t�f 1Geu�es1 Laws,a permit is hereby granted to: CUISINE HYANNIS, INC. SAMSAK SANGWORN Whose place of business Is 2 (IDPENDEPikfR HYANNIS, MA #k2�U1:- Type of business and any regtrit>Irns Fi �f2i1BLISHIIiii #r To operate a food establishitie.. I LE _ RESTRICTIONS IF ANY: � 5 SEATING: 72 ANNUAL XEI M' �� r t h,M1 d SEASONAL: TEMPORARY: �r* r E s , ... sC3R,l 0F HEALTH RETAIL FOOD STORE: ~" u 41 Erpe Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT: ;$2QX RESIDENTIAL KITCHEN FOR RETAIL SALE: } `ti - m «" , '' a Canniff, D.M.D. k RESIDENTIAL KITCHEN FOR BED+BREAKFAST „�� 4urttchl SaWayanagi MOBILE FOOD UNIT: ��wr `f� rn'ItX{�l .TOBACCO SALES: FROZEN DESSERT: rs sue. -ram Thomas A. McKean, RS, CHO CATERER: ,.__,.• - Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE - I r ISSUE DATE � IPERMIT NO: TOWN OF BARNSTABLE 616 BOARD OF HEALTH December 21, 2011 � . �? PERMIT TO OPERATE A FOOD'ESTABLISHMENT ` I :� � - I I In accordance with regulations procnnlgated under author►ty of Chapter 94, Section 395A and Chapter tf1,'Sect�nn 5 of the General Laws,a per.:mit is hereby granted to: f SAMSAK SANGWORN F D/BIA ' BANGKOK HYANNIS INC. Whose place of business is p5PENDENi D RI VE r 1YANNIS, MA 028©1 E t;E.,# TABLISHMENT Type of business and any restrictions x To operate a food establishebt in the m TO . : OF BARNTABLE RESTRICTIONS IF ANY: C 4Y SEATING: 72 ANNUAL YES s' SEASONAL: TEMPORARY x ; { .. BkOARD OF HEALTH Eti.E S x, XiNayrter.Miller, M.D., Chairperson RETAIL FOOD STORE: gzso oa ;: p�ul J. Canniff, D.M.D. FOOD SERVICE ESTABLISHMENT: 4,1fr RESIDENTIAL KITCHEN FOR RETAIL SALE: r n. Jun chi SawaVanagi RESIDENTIAL KITCHEN FOR BED+BREAKFAST r3 r + P�rmt�ExPlies MOBILE FOOD UNIT: 3•, � � � ,Qt;embers'I 29"T ,, CHO 'TOBACCO SALES: k_..:-: .:� ;.:.- Thomas A. McKean, RS, •�, FROZEN DESSERT: Director of Public Health CATERER: NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE f i I i t i r , f � 1 i 3oga . R Town of Barnstable 1 ot1HE 1p� T o�� Regulatory Services Barnstable 11 > Thomas F. Geiler, Director mericaGly • BARNSTABLE, MASS. a Public Health Division lilt Thomas McKean, Director . 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 5087790-6304 PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: ' G NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: �,Qh� �Ys � ptnni�. MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCELS) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: OUTSIDE:OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: �y� TYPICAL HOURS OF OPERATION MON-FRI: TO ® ; 60 m j11 jM DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF.SEASONAL: APPROXIMATE DATES OF OPERATION: TO / / ***-REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY ✓FOOD SERVICE RETAIL FOOD , BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) QAHealthWpplicaiion FormsToodapp I Am 1 ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS 102 Y— 40'6e- ki 15, A) �a � PHONE # IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): t, LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** I.— �t�1101 r IOIVd EXPIRATION DATE: 1 I j 1 2-/ 2. K-h .. (� ir�6� EXPIRATION DATE: I 1 / �) /Xeg 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Heal(h\Application Forms,Food appl.doc -\ Dl11 L 616 BOARD OF HEALTH December 22, 2010 PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with reg�ulatio promulgated,un authority of Chapter 94, 5 Section 395A and Chapter 11,sSectionT f th G6' l"L``aws aTermit is hereby granted to: SONSAK SANGWORN t%/A BA. .I HYaA NIS INC. alo Au 2010 Whose place of business is: j 20 I4 € ENDENGE DR1V H1(ANNISy,'MAU26,01 Type of business and any res,(ri4641sfi F4 D$ ERV CEl- BLISHIfII!EN� . To operate a food establishment In th LE RESTRICTIONS IF ANY: �� g. NU SEATING: 72 ANNUAL YES r� ,` :. K ,' SEASONAL: TEMPORARY k, �#} F k E S c c SOARD OF HEALTH RETAIL FOOD STORE: 0 � e � t FOOD SERVICE ESTABLISHMENT: 5250 d0 IN - A3 �e'Miller,M.D., Chairperson Rw PauLJ.. anniff D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: ` ' RESIDENTIAL KITCHEN FOR BED+BREAKFASt%P,- nlGfii Sawavanagi MOBILE FOOD UNIT: A� Permit E ff.S TOBACCO SALES: FROZEN DESSERT: u � Thomas A. McKean, IRS, CHO CATERER: _w = Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE Town of Barnstable . �OFTHE l�y� Regulatory Services Barnstable I S '� o Thomas F. Geiler,Director AFAmenca City 9Kks& Public Health Division� s6s .� �fD 9. 1% Thomas McKean,Director 2007 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE:eV4�r,-22 i I NAME OF FOOD ESTABLISHMENT: c I�kl �' HVOP 6 ADDRESS OF FOOD ESTABLISHMENT: 2a H 0hn-1e7', MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 1 NUMBER OF SEATS: INSIDE: 22 OUTSIDE: TOTAL: 11 TOTAL NUMBER OF BATHROOMS: 2 ANNUAL OR SEASONAL OPERATION: ANUAQ L TYPICAL HOURS OF OPERATION MON-FRI: I I'UO; AA TO ra DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: . / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY JFOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) QAHealthWpplication Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS 102- ► I , r�_ �r yam' f� �i a bO PHONE# C)- S l IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMEN TS CONDUCTING FOOD PREPARATION(EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. ► YQ,(W CA �e�. V U1 EXPIRATION DATE: 2. a G lrCk vk ( �G EXPIRATION DATE: 3. EXPIRATION DATE: 4. EXPIRATION DATE: ,loa 2,Q2. / If SIGNATURE OF APPLICANT AND DATE Q:\Health\Application FormsToodapp l.doc HOUSE SPECIALS '61 LUNCH SPECIALS ......19.95 SAWASDEE KHA Served with 1+Yee h 56. Bangkok Duck Crispy boneless half duck topped with Tamarind sauce. Soup Or Salade Of the Y `Da 57.*Basil Duck A flavorful dish of crispy half duck with hot (Dining Room Only-No Take Out) r , basil sauce. 58.Choo Chee Duck Slices of half duck with Red coconut ENTREES curry sauce. 59*Crispy Whole Fish or Fillet Your choice of meat: i with choice of sauce!! ......................................... Market Tofu/veggie,chicken, pork, beef... 7.95 •Tamarind sauce Shrimp ... 8.95 > • Hot basil sauce 1. Pad Thai Rice noodle with egg, scallion, bean Y ' • Gingersauce sprouts and ground peanut. • Red coconut curry sauce 2. * Mama Kee Mao Stir-fried yellow noodle with 60.Salmon Tamarind Seared salmon fillet topped onion, scallion, bell pepper and basil leaf. , •' . with Tamarind sauce. 3. Fried Rice White rice, egg, mix peas, pineapple and 61.Salmon Curry Seared salmon fillet topped with tomato. Red coconut curry sauce.62.Char-Grilled Salmon Served with Tamarind sauce Served with rice: BANGKOK CUISINE and side of veggies. 4. Bangkok Curry Choice of: }n 63 Stuffed Salmon Stuffed with crab meat and wrapped Red curry, green curry or panang curry with TI} AI kESTAMANT in a large flat noodle,topped with Chef's assorted vegetables. Tamarind sauce. .................................................... 20.95 5. Broccoli Medley Sauteed with mushroom, carrot DINING * TAKE OUT 64.*Hot Pot Mix Seafood in hot&sour soup with and baby corn. lemon grass, lime juice,fresh mushroom, 6. *Cashew Nut Onion, scallion, mushroom, Lunch & Dinner tomato and basil leaf. pineapple and bell pepper. 65. *Stir-Fried Shellfish with mixed seafood,bell pepper, 7. Ginger Mix Fresh ginger, mushroom, onion Open 7 Days a Week , onion,mushroom and basil leaf. scallion and bell pepper. 1 1 :00 am - 10:00 pm 66.Seafood Ginger Stir-fried mixed seafood with fresh 8. *Hot Basil Bell pepper, onion, mushroom, green ginger,bell pepper,onion and mushroom over angel beans and basil. Sunday 4:00 - 9:30 hairnoodles.......................................................... 20.95 9. Veggie Delight Sauteed assorted fresh vegetables 67.Soft-Shell Crab over angel hair noodles with vegetables with thin soy sauce. and basil leaf in red coconut curry sauce. .............. 20.95 10. Pork Bean Sprouts Scallion, carrots and tofu with www.bkkcapecod.com 68.Stir Fried Soft Shell with scallion,onion bell,egg,curry brown sauce. powder sauce. .....................................................20.95 11. *Kapow Kai Ground chicken, bell pepper, string Side order of white rice or brown rice...1.25 beans and basil leaf. sticky... 1.50 veggies...3.00 12 *Spicy Bamboo with scallion, bell pepper, 20 Independence Drive mushroom and basil leaf. Hyannis, MA 02601 13. *Duck Cashew Nut Stir-fried with chili paste, 508'771 -1338 onion, scallion, bell and pineapple .............$10.95 14. Bangkok Duck Choice of sauce: Hot basil sauce - or red coconut sauce...................................$10.95 Please Try Our Authentic Thai Cuisine ` 3:00 p.m. Served Monday thru Friday • 11:00 a.m. - ,42� APPETIZERS -"� "2' SALADS '� 4� NOODLE DISHES � 1. Spring Rolls Crispy rice pancake stuffed with vegetables, 20. Bangkok Salad lettuce,carrots,red onion,cucumber, Choose Your Choice of Meat: and chicken,served with sweet&sour sauce .......... 4.95 tomato,boiled egg&fried tofu,w/peanut dressing.. 5.95 Tofu/Veggie.....................................................9.50 21.Chicken Salad Thai style.Ground chicken seasoned Chicken or Pork ..............................................9.95 2. Crab Rolls Stuffed with crabmeat and cream cheese 4.95 y Beef ..............................................................10.95 with lime juice dressing .......................................... 7.95 Shrimp 12.95 3. Fresh Rolls Soft rice paper stuffed with vegetables and P •••••••••••••••••••• • • • • • ••••• ••••••••••••••••••••• chicken served with sweet&sour sauce.................. 4.95 22.*Yum Nua Thin slices of grilled beef seasoned 38, Pad Thai Stir-fried rice noodle with choice of chicken/ with lime juice dressing .......................................... 7.95 shrimp,or pork,or beef,or tofu/veggie.egg,scallion, 4. Chicken Satay marinated in coconut milk and Thai * sprout,peanut Thais ice. .......................... .... 10.95 herbs grilled on stick served with peanut sauce and 23. Yum Kung Jumbo shrimp seasoned with chili paste P ,P P • and lime juice dressing on a bed of lettuce.............. 9.95 39. *Thai Spaghetti A spicy noodle dish stir-fried with choice cucumber dip ......................................................... 7.95 of chicken/shrimp,or beef,or pork,or tofu/veggie.egg, 5. Tofu Triangles Golden brown fried tofu served 424 ENTREES 30 tomato,pepper,scallion and basil.......................... 10.95 with sweet&cucumber dip .................................... 5.95 Choose your choice of Meat: 40.*Pad Kee Mao Large flat noodles stir-fried with onion,scallion, 6. Dumplings Pork and vegetables served with Tofu&Veggie ..................................................9.50 egg,mushroom,bell pepper and basil leaf in a medium sauce. honey soy sauce...................................................... 6.95 Chicken or Pork ...............................................9.95 41.Mama Kee Mao Stir-fried yellow noodle with onion, Beef.............................................................. 10.95 egg, mushroom,scallion,bell pepper and basil leaf. 7. Chicken Wings Fried wings served with sweet Shrimpor Squid or Scallop 12.95 42. Lad Nar Large flat noodles cooked with egg,topped &chili sauce........................................................... 5.95 q p............................. with House gravy sauce with broccoli carrots,scallion Mixed Seafood ......................................... .. . , 14.95 •'inky in the Blanket Crispy whole shrimp stuffed with and mushrooms. veggies,served with sweet&sour sauce ................. 6.95 24.Ginger Mix:Slices of ginger,mushroom,onion, 43. Pad See You Stir fry large flat noodles,egg,broccoli, scallion and bell pepper carrots,mushroom in dark soy sauce. 9. Shu Mai Shrimp and veggies,served with honey 25.Broccoli Medley:Sauteed with fresh mushroom, 44.Mee Siam Angel hair noodles,egg,broccoli, carrots, soy sauce................................................................ 6.95 carrot and baby corn in oyster sauce. mushroom and scallion. 10. Fish Cake Fish meat,chili paste,green bean and 26.Snow Peas:Sauteed with onion,mushroom carrots 45. Pad Voonsen Silver noodles,egg,broccoli,carrots, lime leaf,served with sweet&cucumber dip.......... 6.95 and baby corn. mushroom and scallion. 11.Shrimp Tempura with veggie tempura and 27. *Cashew Nut:Sauteed onion,scallion,mushroom, 4� FRIED RICE 4- sweet sauce............................................................ 7.95 pineapple and bell pepper. 12.Chicken Teriyaki over lettuce ................................. 7.95 28.Asparagus:Stir-fried with onion,scallion,mushroom Tofu /Veggie.. ......................................................... .95 and carrots. Chicken or Porkk 9 .........................................................9.95 13.Steamed Mussels with Thai herbs and basil leaf..... 7.95 Beef.......................................................................... 10.95 29.*Hot Basil:Stir-fried with bell pepper,onion,mushroom 14.Platter Combination of spring rolls,chicken satay, Bangkok Shrimp......................................................................12.95 fish cake green beans and basil. 46. B kok Fried Rice Jasmine white rice stir-fried with for one.,wings,pinky,dumpling,shu mai and tofu............... 9.95 for two ............. 17.95 30.*Spicy Bamboo Bell pepper,mushroom,scallion and egg, green peas, pineapple, tomato and your choice of basil leaf. meat. 31.*Spicy Thai Eggplant Exotic Thai eggplantwith bell 47. Pineapple Fried Rice with egg, tomato, pineapple, green 14� SOUPS 30, pepper,mushroom,scallion and basil leaf peas and curry powder. 32.Spicy Crispy Bean Thai Style-sauteed with string beans 48.Crabmeat Fried Rice Jasmine rice, crabmeat, egg, Tom Yum Kung with lemon grass,lime juice,fresh and lime leaf. tomato, pineapple and peas.....................................13.95 111Wushroom and tomato . .......................................... 3.95 33.Sweet&Sour Tomato,cucumber,pineapple,onion, 4� BANCKOK CURRY 35� 16.Tom Ka Kai Chicken in coconut milk with galanga, and scallion. lime juice and mushroom ....................................... 3.95 34.Pad Karie Onion,pineapple,potato,tomato,carrots,and TofuNeggie..............95 Chicken or Pork............ 11.95 .95 17.Wonton Soup with slices of pork and veggies bell pepper in curry powder sauce. Beef .......................................................................... 1 Shrimp,,,,.,„..............................................................133.95 in clear broth.......................................................... 3.95 35.Veggie Delight Sauteed assorted fresh vegetables with 49. Red or *Green Curry Sauteed w/bamboo, green beans, 18.Veggie Soup Vegetables and tofu in a clear broth.... 3.50 thin soy sauce. bell pepper, eggplant and basil leaf in coconut curry 19.Noodle Soup Thai style noodle soup with chicken, 36.Steamed Veggies Steamed assorted fresh vegetables sauce. shrimp and bean sprouts in a famous Thai clear broth 7.95 topped with peanut sauce. 50.Yellow Curry Onion, bell pepper, pineapple, tomato, Beef Noodle Sou .................................. 7 95 37.Bangkok Garlic Sauteed fresh garlic and black pepper on carrots and potato. P .......Seafood Noodle Soup ............................................ 8.95 a bed of broccoli,carrots,snowpeas and bell pepper. 51.Masaman Curry Onion, bell pepper, tomato, potato, Your choice of meat: carrots and peanut. Tofu/veggie,chicken or pork................................ 10.95 52. Panang Curry onion, carrots, bell pepper, snow peas and Choose your taste ofSpicyness: Beef ....................11.95 or Shrimp.............. 13.95 lime leaf. *Medium Spicy **Hot&Spicy ***Very Spicy 53.Mango Curry Chicken, shrimp, onion, carrots, bell Side order of white rice or brown rice...1.25 pepper and mango chunks....................................... 14.95 We do not use MSG. Sticky Rice...1.50 veggie ... 3.00 54.Shrimp Choo Chee w/veggies, red sauce................14.95 55.Seafood Curry sauteed w/veggies,green sauce........ 15.95 *Consuming raw or undercooked meat,poultry,seafood,shellfish or egg may increase your risk of food borne illness. BANGKOK HYANNIS INC . 20 INDEPENDENCE DRIVE HYYANNIS MA 02601 1 , 600 SQUARE FOOT P' O ENTER SIN 0000 Rm" OOO OOOO OO O O O O0000WOK O � BURNER �C 11 KITCHEN co13 H x z COOLER O O O� O O ❑O O O O O • DINNING ROOM 2. -000 OO O�o o �o oDo � ❑I co I COUNT ER BAR LADY MEN pCD o Nl� ----------- O O O O O O 0 ®O \ tzi 05� 2m /64' '5�5� j� a TOWN OF BARNSTABLE Z010. AUG 16 Pill 10 29 BANGKOK HYANNIS INC . NoT� 20 INDEPENDENCE DRIVE -A I I NevJ C 62U f)une� HYYANN I S MA 02601 QlA6 ak(i ir' w a I ( 5 1 , 600 SQUARE FOOT torge �WM � P ENTER IN F rrJ Ro w 0 0 Dw0 0 0 0 ' , 0 0 O 0 0 O O O BURNER K 7 ' 0 :10 O O O O 0 O x KITCHEN , , Q 0 z COOLER m x 0 O 0 O 0 O F-10 TGl1 e _ s x DINNING ROOM 2'5' " 00000OF Do L 0 0 0 rt-�] IF CO ER AR ❑ H Ftl cq I ii 0 $' LADY MEN p )9 o LJvii ICe-�iv� Ice Mh'�v�e O 0 0 O 0 0 OO C) , t-, m O :1 O 0 0 0 0 tij4- 14aV 64' h_ p ■ i ,I _ � l Q -A . n: i • lj t� f ► � 4a i ( r { (IIIIII �� _ � -� ._.,,�a ( �` � x ti I �� ,� M • � _ 4' � 1¢� � ( �. �I R j tr ��. .�F� �'tr" �;; , h. �y,�� 'A !- t r '�'' 5:7." y F ,; ;�., 1 h .r�.�. X�` 1 � • � . 3 • / � _ -" • �� ,. ,. � - .. �,. �.- �.. i W, x 1; J.r t*, f �y j" ' . .'e r j' Ar t t .tea. t� tell f 4 R TOWN OF BARNSTABLE 2010 AUG 16 AM 10 29 TOWN OF BARNSTABLE 2010 AUG 16 AM 10 29 BANGKOK HYANNIS INC . NoTC 20 INDEPENDENCE DRIVE - )ace _A uau ip VAeV(� 2;QY II l � HYYANNI S MA 02601 o�nC� C��Qir w a l I ,5 I 11600 SQUARE FOOT -488 1 �t %x 4 CA) I P' ENTER IN 0000 '=J Ro W O O [] [] 0000 Ow0 O , O O OF O O O O O BURNER is K O 110 7 7 O O s O O O O O O r KITCHEN Co H 9�Sh m 'Q O z COOLER .0110 O❑ O O❑O O O S Eid ��le. Tale. � DINNING ROOM <-- 2'5' 00000 O�O O []O OE]O � CO ER AR On � � H l L; $.0 LADY MEN 0 )9. S u�� ice-��► Ice Machih� O O O O O O OCR , O O O O O O � ¢ kA 1„l 64' c « . f • Y.•.',: � °-.tea#. ,.�r _ r ri1 s a3 •ctive look of Stainless Steel or Brass in Your Operation. Ji Ice Chests ; 4'.Polished Brass Glass Racks rDeep drawn seamless ice chests are �rnsulated with large ice storage Railing is 2"diameter. } - complete line of ; ! acapacity.Sliding stainless steel bin Tess steel and brass :l ,cover included.5"backsplash.8"D �`e available. ... 4 dice bin:Optional?circuit Cold Plate - on r ,'as available 8S471 available,call for information.NSF. c.� o o P r (, tWaaanty: 1 Year Parts.Ships I o o �eel finish 3 H g b❑ Z ailabili- y rfto►►i IA> All welded w 3`v 2C w P o,FYI: ODE: USA stainless steel ;, ° a x N g N - v, . ►n•Stock °EAGLE. construction. i a ) >.N o VNI H 5R ty, ; H� 1682 63 lb Ice Capaci 24°W x 18"D x 33 1/2°H,50 Ibs t a{ c° N �3 l �7E385 824 Ice Capacity,30'W x 18"D x 33-1/2°H,60lbs W`" m features into ,. VW x 12"D ,r 47E379 101 lb Ice Capacity,36"W x 18'D x 33-1/2°H,70 Ibs N N 5703 also station with r7E383 63 lb Ice Capacity,24°W x 22'D x 33-1/2'H,59 Ibs i � available in ono . racks and stain- 9689 82 lb Ice Capacity,30V1x 22"D x 33-1/2"H,62 lb! ,° x Y �^ 85471 is a stainless rain on ice bin7E393 101 Ib Ice Capacity,36°W x 22"D x 33-1/2"H,71 Ibs r _ in 3�re glass steel. ` )b ',it is pre- call for infor-. 08, rt _ f4 h Cocktail Units i = cd w x o}install. V 11 Insulated deep drawn ice bins with o a o N N1{erts acounter to bottle troughs.All 304 y o o C U U o`� ��o mom second j $1429.00 stainless steel.5"backsplash.8' ��- 3 ,'deep ice bin.Cold Plate Units have t C _ y a. b pq �? = "tck is a I, t%N \' x " cast aluminum 7-circuit cold plates ,. �, t~, C o'y v Z ` tack, r r � �w 4 mounted flush with interior bowl Y C { N bA Z bottom.7E368&7E369 NSF. i Ct. " `N' bD'N'�'�'" W 0 / tWarranty: 1 Year Parts.® AGLE. �- G`� j Shrps from DE. t �3 '� t 7E324 6'W x 18°D x 33-1/2'H,13"Drainboards,86 Ibs...........$789.00 7E332 '- 7E335 7E333 USA 7E327 TW x 18°D x 33 1/2'H,19' Drainboards,90 Ibs............639.00 + 7E335 60 lb Ice Capacity,24"W x 18"D x 33-1/2"H,58 Ibs ...........$339.00 7E328 8'W x 18"D x 33 1/2"H,25 Drainboards,104 Ibs.;... ....849.00 7E346 75 lb Ice Capacity,36"W x 18"D x 33 1/2°H,70 Ibs ............439.00 i 7E321 6'W x 22°D x 33 1/2°H,13 brainboards,100lbs.... 849.D0 7E323 7'W x 22"D x 33-1/2'H,19'Drainboards,113 Ibs...........925.00 C 7E331 60 Ib Ice Capacity,24°W x 22'D x 33-1/2'H,88•lbs :...........369.00 ..999.00 459.00 + 7E325 8'W x 22"D x 33-1/2'H,25'Drainboards,123 Ibs......... ,7E334 75 lb Ice Capacity,36°W x 22'D x 33-1/2'H,100 Ibs .......... i 7E357 w/Cold Plate,60 lb Ice Capacity,24°W x 18"D x 33-1/2"H,88 Ibs ..979.00 rrome- 1E368 w/Cold Plate,75 lb Ice Capacity,36"W x 18"D x 33-1/2'H,100 Ibs 1089.00 ' Drain Pipe Kits r.ited.4" 7E366 w/Cold Plate,60 lb Ice Capacity,24°W x 22"D x 33-1/2'H,97 Ibs..999.00 In•Stock titers. ►n•Stack x7E369 w/Cold Plate,75 lb Ice Capacity,38°W x 22"D x 33-1/2"H,101 Ibs 1119.00 9M300 For 3 bowl Eagle Sinks ...$39.99 • 'Accessories 9M310 For 4 Bowl Eagle Sinks .,..49.99 , ..........$55.99 .',7E332 Single Plastic Bottle Holder For 7E335,7E331,7E357,ZE366 ....$15.99 For Eagle bar sinks in this column. —® EACLE ..........:54.99 7E333 Bottle Holder,Holds 4 Bottles,For 7E346,7E334,7E368,7E369 ...29.69 Combo USA Units in Kit 'Cocktail Workstations - plete with. Wlth Speed Rail °: ters.2A757 Deep drawn tube. `ice'bin with ., tic W ` €, drainboard has ►n Stock highly pol- f fished stainless s Drains ....$6.99 steel construc- s ` 9E363L -3/4'Drains..9.69 *tion.Welded a r( s 1 i ..........12.89 crossbraced �®�, Combines 3 bowl sink,ice bin,and drainboards into one Y galvanized 1 it J YJ� r unit.Faucet,drains with overflow,and 24"speed rail includ- 13.69 legs.8"D bin. ' ed.5"backsplash.Bowls 10"W x 14"D x 10"H.Ice Bins Includes 24" . Y 9E367L 15-3/8"W x 19-3/4"D x 8"H.Optional sealed 7-circuit cold single speed railr i plate available,ca S"backsplash.Optional? ll for information:NSF.Ships from DE. ® i 9E351 7'W x 18"D x 33-1/2'H,13'Drainboards,110 Ibs ..............$989.00 I'. circuit Cold Plate available,call for "=EAGLE. USA information.NSF.Ships from DE. 9E352 8'W x 18"D x 33-1/2'H,19'Drainboards,122 Ibs ...:.........1029.00 9E367 4'W x 18°D x 33 1/2°H,24°Drainboard,63 Ibs . •• $655.00 ', 9E359 TW x 22"D x 33 1/2"H,13"Drainboards,1218 Ibs .............1019.00 9E371 5'W x IB'D x 33-1/2'H,36"Drainboard,73 Ibs ................ 9 2, 9 gE�3�74^4;W x 22°D x 33 1/2°H,24'Drainboard,65 Ibs ................645.00 9E361 8'W x 22"D x 33 1/2"H,19"Drainboards,132 Ibs .............1075.00 9E377 5 W x 22°D x 33-1/2'H,36'Drainboard,75 Ibs ................719.00 $3when Ordering:3Spec Left(L)of.R Drainboards, side Ice Bin. 1179.00 9 5P505 $ When Ordering- Specify Left(L)or Right(R)side Ice Bin. ilesale.com See page 129 for Under Counter Dish Machines. RAPIDS - Awn of Barnstable CF TFIE Tp� Regulatory Services Barnstable ti�P� ti� Thomas F. Geiler, Director A"merlmCity Public Health Division * BARN STABLE, MASS. �a Thomas McKean, Director 7007 �p 1639. 1%, 200 Main Street rED MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 'G cc fl Pre- Operational Check List vzS ORO .� This is a check list with some requirements to help you in facilitating your opening at the time you request. Please go through the check list and make sure that any thing pertaining to your facility is done before the pre-operational inspection. Please call if you have any questions. *Floor- clean - any broken tiles should be replaced repainted/resealed where needed coving in place and clean *Ceilings- clean not stained smooth and washable above any food prep area food may not be stored under any sewer lines that are not shielded to intercept potential drips (3-305.12 (F)) *Paint- anything that may need painting (epoxy paint must be uses in any prep area or on floors) no unsealed wood except for cutting boards. *Dish washers- Low temp. - sanitizer strips present and the machine must test out between 50-75 ppm, log must be available, temp of rinse cycle 120-140 degrees High temp- 150 degrees wash and 180 degrees rinse *Hand sinks- clean, stocked(paper towels hung, soap dispenser with soap,hand washing signs, Water temp. 110 degrees) *Bathrooms- all clean, working, coving in place, no food storage, hand sinks as noted above, lid on trash in ladies rooms, working automatic door closures if open into any kitchen or food storage areas. *Personal belongings of employees must be stored away from any food area or prep area. *Refrigeration- lights working, shielded (may be plastic coated), clean, proper temps (below 41 degrees), thermometers present in all refrigeration, gaskets clean *Freezers- clean, defrosted, thermometers present in all units, temp 0 degrees or below, gasket around door clean *Grill cleari,.hood clean, vent working, lights working and shielded y 0 *Ice machine clean, scoop hung, placed in clean bucket, or upside down on a plate *Gloves and/or tissue paper and/or utensils to handle ready to eat foods *2 bay sink/3 bay sink- minimum temperaturel20 degrees sanitizer and sanitizer test strips present *Mops must be hung, to air dry, above mop sink or bucket-they may not drip onto floor *Knife holder- clean *Glass storage- shelving clean and netting under glasses shielded above prep area, if sleeves are used they must be clean and have end caps *Grease trap- pumped (if applicable), show verification *Doors- all doors must be tight fitting- no air gaps self closures need on doors open to outside All screen windows and doors must be free of holes and tight fitting Doors (without screens may not be propped open,will result in violation and a fine) *Permits- posted in area where can be viewed easily by inspector Food license posted Safe food handling certificates (at least 2 and one of these people must be on premise at all times of food prep and serving) Outside Dining *Air curtain installed and working above door/doors that employees use to serve food (if it is self serve then an air curtain is not needed) *Screen door- must not have holes or air gaps around or on bottom of door (If employees serving food outside an air curtain and a screen are both needed. If air conditioning is used (at all times) and windows and doors are not open then you may forgo the screen door. *Hose and hose bib- to be on premise, located and easily accessible to clean patio area. *Trash cans to have lids *Washing solutions or buckets to be accessible for wait staff Application Fee: $.100.00 plus P9it Fee- $250.00 ol- $200.00 - $285 fo permarkets ccam�,,,,,, Name of Business: `/l/[ �CQ� hnl ( e, - DATE Address: h ,t Iva nnjI Owner: So b9lic b'cm worK # Seats and Standing Capacity: U —_---- Indoors• Outdoors: a RESTAURANTS FOR STAFF USE :Menu Approved Denied. I~loor. Plans— Received, Staff Meeting Review Date: Application form In-ground Grease Trap or GRD with a variance. Sewage Upgraded.of Town Sewer Water Supply- Approved Source, if well, annual testing & licensed Operator Han.dwash.Sinks—location,number., design and signs Touchless fixtures Three Compartment Sink and Dishwasher (high or low ternp?) Visual. or audible device. Test. strips, Log Book - Low sanitizer - Type. of Sanitizer: Quats, Iodine, or Bleach? (Show storage Location on.Plan) Mop Sint:--Mops to be hung properly and dried Frozen Dessert Machine (:Dairy) Yes No Drain Boards—air dry utensils and equipment Ventilation. Systems for Hoods (Cleaning contract) Number of:Bathrooms Proposed: 1. Touchless Fixtures --- 2. Ventilation Systems 3. Self-closing door(if located off the kitchen) 4. Soap Dispensers—Moiuited 5. Paper Towels Mounted 6. Handwashing Sign 7. Women's Room— • Covered trash bin or sanitary napkin dispenser. Floors, Walls, Ceilings (Smooth easilyclean.abl.e surfaces) FINISH SCHEDULE SEE ADDENDUM ATTACHED] Lighting—SutfcI . t/ligha.ing shielded Refuse containers Covered (sufficient number and size, durable easily cleaned, insect & rodent resistant) .Du npste.r impervious ground and b.locked..fro�.n public view. Touchless sensor-operated faucets at restroom sinks. Touchless sensor-operated faucets in handwash sinks in.food preparation.areas. Dry storage room location shown on floor plan Lockers for employees in designated area. Poisonous or Toxic Materials (storage located.marked on plan, labeled containers) Cut Sheets (for all .food equi.pnlent) Screens 'or Windows and Doors • Plan approval shall 1)a granted or denied within 30 days. Revised 04/17/2007 • This list is not inclusive of all Federal, State and Local requirements - Q:%j)61es/Reskitl0.doc *. ®��1F1EI. IDATE: �, �. B 3 9 iA FFB 3 . s6g9 `0� 1 g 2�00 SREC. By A 2�� ATEpNep'�A �� TOINNOF >, �1cNSTABLE ' HEq �v f Barnstable H�THoFPr SCHED. DATE: oard of Health 1 �f G 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Mu h VARI ORM LOCATION Property Address: .1 Y►( j/� ((`- P Q m n ?S 0 a'b Ol Assessor's Map and Parcel Number q : J Size of Lot: Wetlands Within 300 Ft. Yes Busm e: No Subdivision Name. APPLICANT'S NAME: a d(e d -�C Phone `7-7 3�10 Did the owner of the property author ou to represent him er? Yes ✓ No PROPERTY OWNER'S j NAME �j D /' � CONTACT N } /_ Name: I-K Y'`lie /�C tit l7`Y �� Name: Q Ue CDl Dt'1')Y/0 Address: 6usf q �gess: 55 �7i?iJ Phone: J�D g 0 33 / — Phone:— VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) re�� lDr1 /p C, a42a eafS ovC' re�S . IV 0 i n emaLove Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of floor plan submitted(e.g.house plans or restaurant kitchen plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[Same ownerneasee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S., Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ APPETIZERS Soup of the Day 2.95/3'.95 New England Clam Chowder 3.50/4.95 Manhatten Clam Chowder 3.50/4.95 Wellfleet Oyster Stew 8.95 Littlenecks on the 1/2 shell 6.50 Wellfleet Oysters on the '/2 shell 7.95 Jumbo Shrimp Cocktail 7.95 Raw Seafood Sampler 8.95 Yellowfin Tuna Sashimi 9.95 Baked Stuffed Mushroom Caps 6.50 Baked Clams Casino 6.95 Oysters Rockefeller 8.95 Oysters Casino 8.95 Scallops Wrapped in Bacon 8.95 Grilled Jumbo Shrimp 8.95 Hot Antipasto 10.95 Mussels Marinara 7.95 Mussels Dijon 7.95 Native Steamers 9.95 Pan Seared Codfish Cakes 6.95 Grilled Portobello Mushrooms 7.95 Chicken Quesadillas 6.95 Shrimp Quesadillas 7.95 SALADS Mesclun Field Greens 5.95 With Tuna Salad 7.95 Caesar Salad 5.95 With Grilled Chicken 8.95 Greek Salad 6.95 Chefs Salad 7.95 SANDWICHES Turkey Breast 6.95 Albacore Tuna 6.95 Grilled Chicken Breast Sandwich 6.95 BBQ Chicken Sandwich 6.95 '/2 lb. Black Angus Beef Burger 6.95 Boca Burger 6.95 ENTREES Linguini with White Clam Sauce 10.95 Calamari Marinara 11.95 Scrod Francese 12.95 Pan Seared Scallops ala Vodka 13.95 Shrimp Scampi 15.95 Seafood Saute 17.95 Baked Encrusted Salmon 15.95 Grilled Chicken Risotto 12.95 Chicken Stir Fry 12.95 Grilled Pork Tenderloin 12.95 Veal Scaloppini 15.95 Grilled New York Sirloin 19.95 Grilled Filet Mignon 19.95 ,�S 0 :22 AM DOWN CAPE ENGINEERING 508 362 9880 P. 03 • S ARQPOS[O aRVRO.r3 10 K eaYa'10!0 11ACN PrrS wrN Z'Or 3/a- 1-1/2'OOYILE rAVED SIOr[Nr N-20 Olaf 10 �• 3'tIASiOK AND r1UER rAlft TO T.0&s1Mw.ysO:i(M. OX.=T 10 R,RAS WN o-NC+Me PWC AT 3S P"C"AS 'FRESH HOLES ROAD' T uTkm PQ( (UNCONSTRUCTED PRIVATE WAY) COX TO WAD[CNANGY N/F L (s REGUM) � PACKAGING nmuSTRIES _ _ Uf>L N r; •� M. to Troll _ - LOCUS W ,, .1 •sC AReUO P S - pj r 1 r rt Sq+Ca _ r U ASSESSORS CORTRACM 10 f1 _ rti PLAN REF. F WJWY wlpr p"m TO ANY 1+ \ +'�• ` ass �� /fZONING: BU' 01140 scup /� _ it NEC.) w.6 �� atr r BUSINESS no FOR AT ` 47 4r7 Ira• H ` a7. M. r IGHEAY arlmr aas+ 36 AT is / BUSINESS • ii + ass / TO OPACC 0) rlas A y 11 �� ""d'a WDUSTRIAL 1 AT Awn au� 8 ii as Km) Iry 3.5.2,S)G.P. GR i + 471 L° LOT COVERAGE D aSnNG rac"A i ;; _ b a evILDVNc J Tuv. - u i J i i r • f `aty �/1 ►J.R,CN..6i0 vvw Tom IV i i 1 1! E Ai1prS Ass SITE DATA: A+�A TOTAL AREA OF WT 106.16E i, 1 AREA OF WETLAND -1325: AREA OF UPLAND 22.91' y J i/ aN _ � .s.s ARMS OF BUILDINGS 9.47.' i; i I { 47.6 AREA OF PAVEMENT 26,366 + f ►a0 st.e 1 YISC. 61PERNOUS;i COfF TOTAL RA OUS PERVI 36.85 Sam 1 ry o f W,•.e ' CL.ao X UPLAND COVERAGE 311 M/9. ;i I vQ W / \ X NATURAL UPL NO X BUILDING C&WMAGE i + i PRp.1:1 rr.RAP WT. 6 r6 / NCR A601(I m CA i+l AATEL44.0RYCTU1cs/ 11 ,i 11pfTS NalE t N,\ ♦ nm . � s 41.0 PROP.1:1 li RM A[r. � t 9 \ J Eby' \ rURN t 1 \ FYI r-tts .5 i0 10 :21 AM DOWN CAPE ENGINEERING 508 362 9880 P. 02 Y� � I f+.�jl+ywwri.Y yrria•� • f �•Rf I••I.•r rll.M.R 1�Y•}•R �,,Ya RRIC f f 'I , lulospbL>e 11Ya!�) �,•' (c it �. - 'AM w Vat et 2OW n�srroewr�wwDisp e rd S (f �q r /'. ant r 0w.06 a woo*IF ME r ft ti"' '� .o.r. l.��s,ry,y• r.. +�r...... r f f�r••@'Z' if �`--- r w Ia eaoum�R orr ar lw•wc M=r1�1i1r r !t f( 1 _ 1 r �t I• rIi � ' RMw \ .+..•rRs+r.r.r. r ii i� •f t :ava.+ twins., URNS �•r / !r .1 t +@ r wrret o4uouur r� ag"mar•u'"Raart 1- .�•.r a43 I i/ ` ar •velar ►$jw.Q I r •Ad One a out i •�•� _ i 4F 1 /\ • •sii/M i / \ --��••rf�re t ��MKt 4• �I ...e•..r `,�� +� �` r�srxrnr SITEPLAN �,a ..r... OF p MXPENDENCE OMWE �� R � ti /`4 W w�Nw.•, rnt M KYANNIS, MA .++als• w4 . �. hallo)wR a,^n n►s, b,e"" �•,�� roa ruts U"rr nwsr �11� q1�• Lflrts to O sum V_ �It ' doers cW a sec CrIft tr,N01N12" ' 'I Rrl ti RqA aL r KAND Stnr.VWNS �+ fr.aRw K>±fli O er t�relRq r a j i aphis , InA . ....»»_»......----- ---------»»»____---_..-»-..»_--_»-___--»_..»-----_----.__»__-»___------------__-_-_----------------------------- 40 ban LAV I 1 1 I uv S I CY l—,c) no Rc) In (w) CD 1 1 1 1 1 1 1 —JJT� SUNCOMNfc ww&x� Lj-re-(.0-5<� (ci ci In 1 I ARBEUTA 1..._J TENANT STARSUCK'S . 0 u..l...... 1 1 I 1 I I 1 I , 1 I »mcxvim�rs�va UWEr e.0- 1 ►��u1t�Q�onw211�sio 1 I , 1 1 1 GROUND LEVEL PLAN GROSS FLOOR AREA = 9,472 SF 3/16"a 1'-0" For Woll IYP69 tee Shoal A-4 "'" .,. hr ConxtrueUon company 1 �• ,o I (.r CMtllm[ivRt[QoaNd71 111YY CAPE COD COMMUNITY COLLEGE FALL 2001 COMMUNITY SERVICE 09/14/2001 JAY SNOW 06/15/1956 REGISTRATION 505'568 020-48-8930 AS COURSE TITLE START DATE LOCATION DAYS TIME AMOUNT CF040 41 SERVSAFE 10/05/01 CGll F 08:00 165.00 LEP 14 2001 BUSINESSOFTUITION 165.00 Amt Rec I d �CJ r Check/Rec No _n(b MATERIAL 0.00 Date. By p_� REGISTRATION 0.00 LATE FEE 0.00 METHOD CARD NUMBER EXP ID CHK / 505568 FALL 2001 505568 SNOW JAY SNOW TOTAL FEES 165.00 20 INDEPENDENCE DR HYANNIS MA 026010000 NOD McKean Thomas From: McKean Thomas To: Brigham Anna Subject: Mall Liquors/ SP # 56-96 Date: Monday, December 30, 1996 4:39PM The applicant has submitted the requested information to the Public Health Division in regards to site plan review. Therefore, I do not object to approval of this project at the site plan review stage. However, permits should not be issued for construction of any food establishments at this site until after indoor floor plans are received and reviewed by the Public Health Division staff. Page 1 McKean Thomas From: McKean Thomas To: Brigham Anna Subject: Mall Liquors/ SP # 56-96 Date: Monday, December 30, 1996 4:39PM The applicant has submitted the requested information to the Public Health Division in regards to site plan review. Therefore, I do not object to approval of this project at the site plan review stage. However, permits should not be issued for construction of any food establishments at this site until after indoor floor plans are received and reviewed by the Public Health Division staff. Page 1 1 TOWN OF BARNSTABLE SITE PLAN REVIEW y DATE: December 16, 1996 49 TO: TomMcKean FROM: Anna Brigham, Site Plan Review Coordinator RE: SPR-56-96 Mall Liquors, 20 Independence Drive, Hyannis, (294/62) Proposal: Construct 2 new buildings containing a total of 4 separate retail establishments with parking and drainage. *REVISED PLANS FOR JOINT REVIEW ON 12/19* Please submit this form,with any comments or additional requirements you may have regarding the above referenced application,to the Building Commissioner's office by December 12, 1996. I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. (Signature) r Town of Barnstable J6,0 OFFrCE USE ONLY t, , 1 6 Application for Site Plan Review jAcdon Due By- Location Legal Description: Barnstable County Registry of Deeds Book 7899, Page 93 Planning Board Subdivision Number: N/A Assessors Map and Parcel Number: Map 294 Parcel 62 Property Address: 20 Independence Drive/Route 132, Hyannis, MA Owner of Property Applicant Name: Lavinia M. Chiotellis,TTrustee of Name: Daniel M. Griffin, Jr. Lavinia M. Chiotellis rust Address: 771 Seaview Avenue Address: 70 Crestview Circle Osterville, MA 02655 Centerville, IVfA 02632 Phone: N/A Phone:. (508) 790-8971 Engineer Agent Name down cape engineering, inc. Name John W. Kenney, Esquire Address: 939 Main Street Address: 12 Center Place, 1550 Route 28 Yarmouthport, MA 02675 Centerville, MA 02632 Phone: (90 3f7.-4541 Phone: (508) 771-9300 Storage Tanks Utilities Zoning Classification Existing Proposed Sewer District: Ind./Bus./Highway Bus. Number: 0 'Number: 0 Public X Flood Hazard: N/A Size: Size: Private Groundwater Overlay: GP Above Ground: Above Ground: Fire District HyannisLot Area: 106,168 Sq.Ft. Underground: Underground: Water Number of Buildings Contents: Contents: Public: X Existing: 0 Private: Proposed: 1 Parking Spaces Curb Cuts Fire Protection: Demolition: 0 Required: 73 E-asting: 0 Electrical Total Floor Area Provided: 47 Proposed: 2 Aerial: X Residential: N/A On-Site 47 To Close: 0 Underground:-x Office: 1 . 00 (MP7.7.anine) Off-Site: N/A Totals: 2 Gas Medical Office: Natural: X Commercial: 9,472 In Historical District: Yes Propane: (Specify Use)Package Storei ffee Wholesale: op In Area of Critical Environmental Concern Institutional: (E.O.E.A) Yes,® Industrial: Project within 100' of Wetland Resource Area: &NO 4 4 To be reviewed by the Building Commissioner Zoning District: Industrial, Business•, Highway Business Old King's Highway Regional Historic District: N/A Listed in National and/or State Register of Historic Places: N/A Perimeter setbacks: Front: 69.24 Side: 40.00 ± Rear: 30.00 Lot Coverage: 40% Overage of Upland - See Plan Attnched9 Type of Use (Zoning): Retail Store, Restaurant, Office, fii Storage Flood Plain Zone: N/A Elevation: See Plan Attached Number of Floors: One (plus a mezzanine level) Floor Area: 19,944 Including Mezzanine Level First: 9472 Second: N/A Other (Specify): Basement 9472; Mezzanine 1,000 Parking Requirements: Retail/Office/Storage/Restaurant Required: 73 Provided: 47 Handicapped Spaces: 3 Are there Assessory Buildings? N/A Accessory Building Floor Area: N/A Please provide a brief narrative description of your proposed project. Relocation of Mall Liquors, a fine wine and spirits shop from Route 28 to propQ,ed site. Wine and Spirits Shop will contain a 1,000 square foot mezzanine level for office use and will use basement for storage. Buildings may also contain a 1,500 square foot upscale coffee shop or similar type of use. I assert that.112ave completed(or caused to be completed) this page and the Site Plan Review Application and that, to the best ofmyknowlecfge, the ' ormation submitted here is true. Signature Date 5 -.. ---4 '!� �n C • 0 Sullivan Barbara From: Sullivan Barbara To: Brigham Anna; Sullivan Barbara Subject: Site Plan Review#56-96/mall liquors Date: Tuesday, May 21, 1 9:54AM A floor plan shall be submitted to ow sinks, restroo , and other equipment, if/when a food service establishment is proposed. Any food service establish nts, if prop o d, will require inground grease traps. All Board of Health outs' a dining c ' eria shall be adhered ncluding ten (10) feet setbacks if outside dining is proposed. L r CPI- Page 1 TOWN OF BARNSTABLE• SITE PLAN REVIEW DATE: May 20, 1996 � T Tom McKean FROM: Anna Brigham, Site Plan Review Coordinator RE: Site Plan Review# 56-96 Mall Liquors 20 Independence Drive, Hyannis, Map/Parcel: (294/62) Proposal: Construct 2 new building containing a total of 4 separate retail establishments with parking and drainage. Please submit this form,with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by May 30, 1996. I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. ((Signature)o 7re s► � !z-7- , . you) 5tkr'� � � � �pP s Pn,PeS —AT� too �� Je► l.w► ,; �rvPasetQ/ � � r�j�.ee �,,�AA,,�Q �a�ec✓a�— jn Cl„ o ard n n� C rif-e/7s kcal 5 i s uN f OR SITE PLAN V UK O F ll CE USE V ONLY i �E RECEI VED CjON DUE BY �OCR 7 ION l/� _ e�lTc' Lt :gaa Descriptions, /NI�EJV/)6�4(Cb � fanning Board Subdivision Numbers AF L ssessor 's flap and Parcel Numbers In Z.?q I 21 roperty Address: Ll L:a of Lj M� OWNER OF PROPERTY APPLICANT ame: LAyM+It� M. cµtoTtLLtS Name: M,(Z ddress:so. doY. Al 02MOVI .,F 61A Addresss agyM, 99A5EiN d� zZo FALMo�TH� •Ro• ff rANNrS /j'1+F' 6Z6e1 goner Phones / Sa8-7tTo-y77a ENGINEER AGENT(interest owner or applicant) ame: "A—K? /,yY rQ& Name: ",10ftN ty Ak?yNcY ddress: /l�.�ru 5r' Address: rZ 44)% VL IX444 A-ZKovl�'f Qi�r /f'1e� 1 �-0 OM ZR Cy'h/T£IZyrGc.E. AJ� hone: Phones E T3ykt5 UTILITIES -ZONING CLASSIFICATIONS) 11S1i4G FC1SED Sewer District: t�,�i�G� t ; NJ Nurber: uux,ber: D Public Flood Hazard: it Ze: Size: I•r.sv,te_ Groundwater Overlay: !�P At•ove 6rourd: At,ove Gro nd: Fire District: {;t:,i?ro:•�,Land: L�ndervr��anQ: hater; LOT AREA:/A�f sq. ft. Contents: --- Contents: F•ut-Ilc X - Frivate: NUMBER OF BUILDINGS Fire Frcte.-'tion: Existing: O LAF! IH(, i-FAAL-FE LUTS Proposed: c. :egt�sred: Existing: d Electrical: Deaolition: n r0Vidzd Arsal: X )Ii 61te: To Close: Vnder-ground:_ TOTAL FLOOR AREA (in sq.ft. ) Total: — tas: Residential: Natural; x Office: IN_HISTOFICAL GISTFlCT:(ves)_ (no) A Fropine:_ Medical Office: Commercialr 1Y,S/ 41 IN AREA OF CRITICAL fNVIFOWNTAL (specify use) _ CONCFFN rf .u.E .A. ►s (ties)_ (no)_ holes ` tlholesale FF-0JECT hITHIN loo, OF IRETLAND RESOURCE AREA: (yes) Y (no)_ Institutional: Industrial: C0:.41:io 1.i $14 rLAA r The Site Plan she ncj one or more appropriately sc��r drawings of the \\ property. drawn to ng�r's scale. clearly and accurate i 0lnil such elements Of the following information as are pertinent to the development activity proposed: 1) Legal description, Planning Board Subdivision Number (if applicable). Assessors' t}i�t hap and Parcel number and address (if applicable) of the property. ' fCt 2) Name. address and phone number of the property owner. and applicant If different than the property owner. 2 3) Name. address, and phone number of the developer. contractor, engineer@ other design professional and agent or legal representitive. 4) Complete property dimensions. area and zoning classification of property. 5) Existing and proposed topographical contours of t►ie.property taken at two-.foot W) contour Intervals by a registered engineer or registered land surveyor. 6) The nature, location and size of all significant existing natural land features, including, but not limited to. tree, shrub, or brush Basses. all Individual trees over ten Inches (101) in caliper, grassed areas, large surface rock in excess *of six feet (6') in diameter and soil features. 7) Location of all wetlands or waterbodies on the property and within one hundred feet �A (100') of the perimeter of the development activity. ❑ 8) The location, grade and dimensions of all present and/or proposed streets. ways and easements and any other paved surfaces. 9) Engineering cross-sections of proposed new curbs and pavements, and vision triangles measured In feet from any proposed curb cut along the street on which access Is proposed. ❑ 10) Location, height, elevation. Interior and exterior dimensions and uses of all _buildings or structures, both proposed and existing; location. number and area of floors; number and type of dwelling units: location of emergency exits, retaining _ walls, existing and proposed signs. 11) Location of all existing and proposed utilities and storage facilities Including sewer connections, septic systems and any storage tanks, noting applicable approvals If received. — --- 12) Proposed surface treatment of paved areas and the location and design of drainage systems with drainage calculations prepared by a registered civil engineer. ® 13) Complete parking and traffic circulation plan, If applicable. showing location and dimensions of parking stalls, dividers, bumper stops, required buffer areas and planting beds. 14) Lighting plan showing the location, direction and intensity of existing and Proposed external light fixtures. ❑ 15) A landscaping plan showing the location, name. nor and size of plant types. and the locations and elevation and/or height of planting beds, fences. walls, steps and paths. 16) A location cap or other drawing at appropriate scale showing the general location and relation of the property to surrounding areas .including, where relevant. the Zoning end land use pattern or BdJacent properties, the exlot)ng street oystrm In the ra area and location of nearby public faclIIt(es. 1�1 17) Location within an historical District and any other designation as an N Historically Significant property. and the age and type of each existing building and structure on the site which is core than fifty (50) years old. ® 19) Location of site with regard to Zones of Contribution for public supply wells as determined In a report entitled "Groundwater and Water Resource Protection Plan, Barnstable. ilassachusetts" prepared by SEA Inc., Boston, IIA, dated September, 1985, which is on file with the Town Clerk. 19) Location of site with regard to flood Areas regulated by Section 3-5.1 herein. 20) Location of site with regard to Areas of Critical Environmental Concern as designated by the Commonwealth Of Massachusetts. Executive Office of Envirorvmntai Affairs. r J . rc hLvl �t_!� t) Ir+f. tv1L,►1Nt, �vnnlSt_i 0hLt : �• Zoning District .Old King's Highway District or Listed in National and/or State Register of Historic Places B X-o Perimeter set backs: Front p _60 � o Side — 3� Rear — le 3d Lot Coverage l3,7 _ �.:,' vim,! 1�^�Cpt u cu 5 �® Tupe of Use ( zoning ) Flood Plain Zone C-- i £1 evat i on Number Or Floors / Floor Area: 1st lHis�� 2nd Other (specify) - � Parking Requirements: Required 73 Provided Handicapped Spaces Are there accessory buildings? Accessory Buildings Floor Area PLEASE PROVIDE A BRIEF, NARRATIVE DESCRIPTION OF YOUR PROPOSED PROJECT. con.;tlru ct C., IS I assert that I have completed (or caused to be completed) this page, the Site Plan Review Application and the checklist on the back of the application and that, to the best._ of my knowledge, the information submitted here is true. FE � z©N (signature) (date) • 6 T Division of Land YJ5 NU'., Is this a division or fifty(50) acres or more of land which was in 1 py common ownership -is or 1/1/w Is (Ills a division of flftecn (l5)acres or more of land which was in common ownership as of 1/1/88 and which was the result Hof an earlier 1 � subdivision within the last seven (7)years? Is this a develupn'c"t wltich proposes to divide laud in eonnuon ownership into thirty (30) or more residential dwelling units? Is this n development which proposes to divide laud In consn'ou owltcrship Into ten (10) or more business, office or Industrial prcullses? Cmatlon of more than 30 dwelling units Is this a developnicnf, 111el"clint;the expars%lrn' of cxlstllig clevelopnicrils, that is plan 30 dwelling units? ned to create or accoannsodale more than ( 1 Commercial Construction Will the development create retail or wholesale business: office or Industrial dcvelolm'cut: private, health, rccrcattional, or educational dcvclol)mcnt with a floor area as follows: 1) Ncw construction greater than 10.000 square feet? 2) Addition or auxillary buildings greater than 5=0 sclu;ire feet? t ! !Xl 3) Outdoor commercial space greater than 40,000 square feet? - Il � 4) Use eh;u');t�s witkat 1►;cve a &-)or area greater thvl 10,t?U0 square feel? 1 Ixl Facllltics for Transportation to or from lllarnstable County Will the develop)licit( construe( or exp;"sd raclimes tar transhortatiurs to or from Dan'stablc County? Access To T1,c Coast Or A Cr¢at Pond Is tills developilsctst ;c bl-ld9c, road or drlvcw;ry prc;vicling direct vclsicular acce.%s to Mc coast or;'great poiltl-t Historic Structures Will thc.drvclUl,t"c"t dcnsollsh or s"hst;c"ttally aller au lllsturic rslructure listed will' the National or M;'ssachuxcits Register of I1lstoric ]places, outslcle a 11"u'Ic1p;'1 historic district or oc,isidr. the 01d 1Ct"gs llil;hw,ry Historic District? (Note: Repairs, upgrades. changes, allcratlorls or ex(cnslons to a singlc family 110111c arc of exempt from Commission review unless the proposed rcpalr,upgrade. change, "Ite'atioss. or extc'rslon Is greater than 25%of Ilse flour arc:' the existflig dwelling.) ,7 TOWN OF BARNSTABLE CF THE TO �' 4o OFFICE OF 13ARWSTAZLB � BOARD OF HEALTH y MAS& pp 1639• 367 MAIN STREET HYANNIS,MASS.02601 March 24, 2000 Mr. Dave Colombo 488 South Street Hyannis,MA'02601 RE: Naked Oyster 20 Independence Drive,Hyannis i Dear Mr. Colombo: You are granted a variance from Board of Health Regulation Part 11, Section 1.00, which requires inground grease traps at all food service establishments to be designed and constructed based upon 15 gallons per seat. The variance is granted with the following condition: • The inground grease trap shall be inspected monthly and pumped at least once every three months by a licensed septage hauler. The Naked Oyster, proposed to be located at 20 Independence Drive, Hyannis, will have a seating capacity of 72 seats. An inground grease trap currently exists at this location with a capacity of 1,000 gallons, designed to handle a maximum seating capacity of 66 seats. This variance is granted because the seating capacity proposed by the applicant will be only six (6) seats above the estimated handling capacity of the existing grease trap. Also, the applicant agreed to inspect the grease trap every month and to pump the grease trap at least once every three (3) months or more often when needed. Your second request for a variance to provide only one restr6om facility, separate from the patron's restrooms is not granted. The Board of Health regulation specifically requires separate toilet facilities for male and female employees, and separate toilet facilities for male and female patrons at each food service establishment with a seating or standing capacity of over fifty (50) patrons. Seventy-two seats are proposed at this food service establishment. The Board of Health may vary the application of any provision of these regulations, with respect to any particular case when, in its opinion, the enforcement thereof would do manifest injustice; provided that the decision of the Board of Health shall not conflict with the spirit of any minimum standards established by these regulations. Colombo a ' The applicant failed to establish manifest injustice and this application for a variance conflicts with the spirit of the minimum standards established by the regulations. Therefore, your request for a variance from Part II, Section 1.00 is not granted. Sincerely yours, Susan G.Rask,RR Chairperson Board of Health SGR/bcs colombo "-qq .011 C9- q -0 4 � 09No. , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes i PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS �06 01ppYfcation for Miopaal *p5tem Construction Vermtt Application for a Permit to Construct Repair( U rade )Abandon( ) O Complete System ❑Individual Components PP � P ( ) Pg ( ) P Y P Location Addres��s rClL��ot No. Owner's Name,Address and Tel.No. Assess?r's 4ap/ParcelC�f h e17 �/PJ 6� Installer's Name,Addre ,and Tel.No �/J�_G 4 Designer's Name,Address and Tel.No. A j Ci,rJ�Gi' �©� �(I�C �/1�'J/JL<//77 ��/OLj>'��E•Y/ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Re ai o Alterations( swer when applicable) 00o Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a rtifi- cate of Compliance has been iss ed b his Board of Health. Signe `"—� Date Application Approved by % n Date Application Disapproved for the following reasons Permit No. Date Issued . D- 9 D y �d s`1 No. T�_ � � L��, _: '* Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes _ '.PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppr4ahon for Mgogar *p.5tem Construction Permit 6 - Application for a Permit to C struct Q<)Repair(; ')Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address r Lot No. Owner's Name,Address and Tel.No. AssesXap/Parcele/ rh4P/1 tL -el V` — 97Y? Insttalller's Name,.Add ,and Tel.Noo "717G-6 6 3 Designer's Name,Address and Tel.No. �c/7/'�GY 9 Type of Building: Dwelling No.of Bedrooms Lot Size sq._ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per-day. Calculated daily flow gallons. Plan Date �~ Number of sheets Revision Date Title -Size of Septic Tank Type of S.A.S. Description of Soil ` o A /) Nature of,Repairs or Alterations( nswer when applicable) PY / V v Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a rtifi- cate of Compliance has been issued b is`Board of Health. / Signed i. . 11 e `-"- ' Date J Application,Approved by`, �r Date 1 Application Disapprovdifot~the following reasons, Permit No: Date Issued u., THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY.that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by 1�''_ i / at /_,) _ ass been constructed in accordance with the provisions f Title 5 and the for Disposal System Construction ermit No,'..� Lwdated Installer Designer The issuance of this rmi g Y t Shall not be construed as a guarantee that the s t m ;ll function as des ned Z,12 DateI�7 Inspector 77 o — ©------------------------------�— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS miopoar Construction Permit Permission is hereby granted to Construct( )Repai�r� )Upgrade( )Abandon( ) System located at (4�P.-_� C�lV A/D and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. j i Provided:Constructi/on)mushbe,ccoompleted within three years of the date of thi`s,permit. s � / Date: l f 1-i' �I q" t Approved b � �� c / �X SHOREY Septic Tank PRECAST 1 ,000 Gallons/H-20 CONCRETE ST-1000-H-20 PRODUCTS / \ 91 oll 6'-0" SHOREY PRECAST CONCRETE PRODUCTS 36 Great Western Road 351 Whites Path N. Harwich,MA 02645 S.Yarmouth, MA 02664 (800)439-0956 - (508)43070956 • TOWN OF BARNSTABLE THE Tp�Y OFFICE OF rd BAg$9TOSL$ BOARD OF HEALTH i i MABB.'Op 09 i63q• `g 367 MAIN STREET HYANNIS,MASS.02601 March 24, 2000 Mr. Dave Colombo 488 South Street Hyannis,MA 02601 RE: Naked Oyster 20 Independence Drive,Hyannis Dear Mr. Colombo: You are granted a variance from Board of Health Regulation Part II, Section 1.00,which requires inground grease traps at all food service establishments to be designed and constructed based upon 15 gallons per seat. The variance is granted with the following condition: • The inground grease trap shall be inspected monthly and pumped at least once every three months by a licensed septage hauler. The Naked Oyster, proposed to be located at 20 Independence Drive, Hyannis, will have a seating capacity of 72 seats. An inground grease trap currently exists at this location with a capacity of 1,000 gallons, designed to handle a maximum seating capacity of 66 seats. This variance is granted because the seating capacity proposed by the applicant will be only six (6) seats above the estimated handling capacity of the existing grease trap. Also, the applicant agreed to inspect the grease trap every month and to pump the grease trap at least once every three (3)months or more often when needed. Your second request for a variance to provide only one restroom facility, separate from the patron's restrooms is not granted. The Board of Health regulation specifically requires separate toilet facilities for male and female employees, and separate toilet facilities for male and female patrons at each food service establishment with a seating or standing capacity of over fifty (50) patrons. Seventy-two seats are proposed at this food service establishment. The Board of Health may vary the application of any provision of these regulations, with respect to any particular case when, in its opinion, the enforcement thereof would do manifest injustice; provided that the decision of the Board of Health shall not conflict with the spirit of any minimum standards established by these regulations. colombo The applicant failed to establish manifest injustice and this application for a variance conflicts with the spirit of the minimum standards established by the regulations. Therefore, your request for a variance from Part II, Section 1.00 is not granted. Sincerely yours, Susan G.Rask,RN. Chairperson Board of Health SGR/bcs colombo 09 w 0 J ,EVE Town of Barnstable Department of Health, Safety, and Environmental Services BAMSPABM "� sbgq. Public Health Division 9� �� rFDNa 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health TO: Anna Brigham, Site Plan Review Coordinator FROM: Thomas McKean, Director of Public Health<� DATE: May 14, 1996 RE: #00116 Mall Liquors The Health Department has the following comments/requirements regarding this application for Site Plan Review: • What are the new uses proposed? TOAF BARNSTABLE SITE PLAN REVIEW a DATE: May 13, 1996 „r TO: Tom McKean MAY 1 3 1996 CP FROM: Anna Brigham, Site Plan Review Coordinat e 19 ,. RE: Site Plan Review# 00116 Mall Liquors Route 132/Enterprise Rd, Hyannis Map/Parcel: 294/62 Proposal: Move existing business and construct new buildings for new uses. *INFORMAL DISCUSSION* Please submit this form, with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by May 16, 1996. I have the following/attached comments/requirements regarding this application for YiS-Ye Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. (Signature) cc�� F SO,tETIIITY_CONSTB�Uc-ill®� n MAINTENANCE AGREEMENT SUBMITTED TO: WORK TO BE PERFORMED AT: NAME : Great Awakening Coffee House ADDRESS: 20 Independence Drive & Hyannis, MA 02601 Thai Cuisine Restaurant The Robert B. Our Co. will to perform the labor necessary to complete maintenance of exterior grease trap at 20 Independence Dr, Hyannis. The 1000-gallon exterior grease trap will be pumped every 90 days at a rate of $300.00 per service. Each party agrees to be responsible to make payment for (2)two of(4) pumping services per year. NOTE—This agreement may be withdrawn by us if not accepted within 30 days.Any alteration or deviation from above specifications involving extra cost will be executed upon written order and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents,or delays beyond our control. We are not responsible for any irrigation lines,trees, bushes,shrubs,or plants unless specified in writing.The Robert B.Our Co. is not responsible for driveway damage due to the weight of equipment/machinery. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above Customer Signature ��/, 771Y-, O09-47-" Customer Signature Date: 11/2/21 Signature TOl,Lgt0tvrte, 774 994 1736 Authorized Robert B. Our Representative Tel: 508-432-0530 24 Great Western Road, P.O. Box 1539, Harwich, MA 02645 Fax: 508-432-7057 363 Whites Path,South Yarmouth, MA 02664 Web: robertbour.com ooti000 �c�booa'' 6oaooa a00000 aooaoo QaoQao' aaCoca aoa000` ago aoo aaoaaa cocaca Doaaaa a00000 aaoaoo; aoacoo 000000 0000aa oaoaoo s e L AREA 0 PAVEMENT -39 74Q 11 $ _ a PA 485 <S1M@ 0 ' LOWER. S1N=2 053 -TOTAL 39 740 -:... PAVE 35. .UPPER 2.2 2. WER _ t a - . ... .. '44L WOODEN :SIGN , ,_ -r _ � � TW _ 51.0 . ..; . _ x : Fl2OM :VISION _ c-� � o_/f! I � I ,. , , _ , / AREA OF WFTI AN(� . - 13 751 ,.. . , �... a. ,.. ,. , ,._.az. , .G. �,... y .� - .:,..,w ":.,-' o*-. i ._. t '. .. .� . . ;i.., ,k ,..,.y :�.:.,,: 4 .Y�::F-:'4� '.- :.. '� . _ R:l. .Y x... M.r'iB�i R+ �^.,Y,.a3itNG)A C1YPnr...&.wt..?exNa. Vans✓uau•..,.arscs .w c.... e..v-...�...M...<:......�..u........w..,..,.p...,,.... _ _.. _.. ..._ ..... ...._...._ wk'�;,;�;�`� �'.•�,..�. .��«.i�'.,.-s'�.,��'�Ka^:�'�^�r;:9`�'',S"`a'`,�.`i�'.n..«,.�.: ,�:::.,�. s�`,e.U�',�=-..`�:�a�.ww�,:"�::.«:�a�.s>:1..rn�. <..xal �,��:<.�r:+.,:,.�aJ^N, asoe,,;:-_,..l�,vi��.'.'�'v3.tc�.ara:.::a3r�':.ros>...a�Fsa�e�.�,.,es�3r�><..,,e., ,. �.,�....x...sara.,� s i i �� I I I I "FRESH HOLES ROAD" (UNCONSTRUCTED PRIVATE WAY) t, r NSF MAY 1 3 " '� !� 50 PACKAGING I a INDUSTRIES I P' E! ItitINARY 1 66.-718 ' Q�_ I on t� - tt _ - r ASSESSORS MAP 294 i U4, PARCEL 62 IN HYANNIS, MA �l ' ' t ,' �; _ •' ZONING: BUSINESS, HIGHWAY BUSINESS & INDUSTRIAL. PREPF\RED FOR II t ' / ' �1, BUSINESS FRONTAGE: 20 ft UTIL. SETBACKS: 20' front" %' {� PROP. DRYWELLS v SOLE 1 -JLJ� // t ; �;`� h HIGHWAY FRONTAGE: 20 ft 4=LL I lJ 1` FXt ' r `n I r �/ BUSINESS AREA: 40,000 sq ft S-ntYG 6.5 t t \ *� It I� SE-fBACKS, 60 front Ii 1I SEWER UNE (r T /30' side 20' rear 20 C ' 20 40 60 Feet 11 1 INDUSTRIAL FRONTAGE: 20 ft 58. J AREA: 90,000 -sq ft ® SETBACKS: 60' front Spy // 30' side/rear DATE: APRIL 1, 1996 JI , ' 4g SCALE: 1" = 20' 1 1 j PROPOSED' , j Or - --. — ----------- - ----- -- - 11 tA.. BUILDING 2030.. sf - — 11 1 j 52 Co XJC�t' cr J 11;1 1 Q1 M t Lli to & v PROPOSED 1� t 03 BUILDING `sR 1 / �5' o /N �l 11 it jl N 8,584 sf _ i � I 1 ,; Y •� NFSS ZpNF 11 , 1 1 t <10 z- , a 1 � 30, 11 trl l ,1 / � 20' TOTAL AREA OF LOT 106,168 sf: 11 t I � / � (o 1 , � II 11 l l a % COVERAGE OF LOT / ' �io l a Q AREAS OF BUILDINGS 15,000 sf 14.1 % 11 If If / / -�, / If C-vM O / Q 2- AREA OF PAVEMENT 35,160 sf 33.1 / / 'AREA OF WETLAND 13,251 sf 12.5% I �. AREA OF UPLAND 92,917 sf 87.5% 69 PARKING SPACES PROVIDED /' PROP. DRYWELL / 6 01' PROP. DRYWELL 5 5< PROP. 40• 1 GREASE B TRAP PROP. DRYWELL _•_T o ROPOS D SS \ _ z ,- BUILDING Co PROPOSED NE` BUILDING / ` \ 1 620 sf o 2,400 sf / 1 PROP. STONE 27• 4 S RIP RAP WALL k ` Jos PROP DRYWELL �p ` l_ tij POND ELEVATION = 33.5' r • I Q ON AREA OF WETLAND & POND a N F ■ ' 2 0 13,251 sq.ft t z / / LA—Z—BOY CO, 0.30 Acres i ,IAJ a , i G , 1T CUP , f r> 1 ,, 4;' -- ; • 1 +_ GRAVEL 'i PARKING f • EDGE c z j GRAVEL `\ PROP. STONE - PARKING ' RIP RAP v PAVEMENT ` � r IL?� F 732 2 ;. R 0' ' off 508-362-4541 fax 508 362-9880 DATE � _ ARNE H. OJALA, P.L.S. � , ' � down cape engineering, inc. CIVIL ENGINEERS LAND SURVEYORS 939 main st. yarmouth, ma 02675 JOB# 96-09 > 96-091