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HomeMy WebLinkAboutPANERA BREAD - FOOD PANERA BREAD v r 790 Iyannough Rd,Hyannis jtMi 1 BOARD OF HEALTH Town of Barnstable ' John T.Norman Board of Health Donald A.Gaudagnoli,M.D. nwnMWAUL , F.P.(Thomas)Lee,. MA$ Daniel Luczkow,M.D. Alt. 3s. ,� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 701 Issue Date: 01/01/2022 DBA: PANERA BREAD OWNER: BOSTON BREAD, LLC Location of Establishment: 790 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 89 OutdoorSeating: 18 Total Seating: 107 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions:. I Town of Barnstable For Office Use Only: Initials: � At�pd »�BARNSPABI£. » Inspectional Services Date Paid $ s639. ♦0 Public Health Division pTED MAC Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 10/28/21 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Panera Bread ADDRESS OF FOOD ESTABLISHMENT: 790 lyannough Road MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 1855 S Ingram Mill Road,Ste 100 Springfield,MO 65804 E-MAIL ADDRESS: licensing@teamhamra.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( 08 ) 862 _ 8015 ' ti R TOTAL NUMBER OF BATHROOMS: 4 WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 107 OUTSIDE: 18 TOTAL: 125 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? NO IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) X 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 FonnsTOODAPP REV3-2019.doc OWNER INFORMATION: FULL NAME OF APPLICANT_ Boston Bread, LLC t/ SOLE OWNER: YES/NO OWNER PHONE#417-887-7677 �S ADDRESS 1855 S Ingram Mill Road, Ste 100 Springfield, MO 65804 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Neil Downey 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 Aller en Awareness Expiration Date 1.Neil Downey 12 / 1 /2021 1. Pdeil-Bew+�e99 2. Tina Rinaldi 2 / 14 /2025 10 /28 /2021 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.townolbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FonnsT00DAPP REV3-2019.doc i t � Town of Barnstable BOARD OF HEALTH John T.Norman f Board of Health Donald A.Gaudagnoli,M.D. BARNSTAOL Paul J.Canniff,D.M.D. MAM 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ~ Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 701 Issue Date: 01/01/2021 DBA: PANERA BREAD OWNER: BOSTON BREAD, LLC Location of Establishment: 790 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 89 OutdoorSeating: 18 Total Seating: 107 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r/ �W► For Office Use Only: Initials: tia Town of Barnstable 9 Date Paid Amt Pd$BAMSTpgLE,g Inspectional Services ��� 0OMASS. Chk# �7� 1Aq i639 Public Health Division ec AlEO MAC a14 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE �� 1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 2LaCl ADDRESS OF FOOD ESTABLISHMENT:--- — ]�5Vit— r� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �$5� S J,V�ctrrwv„I i L.vLi�nC �.� cn �e` D E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: t , - O� TOTAL NUMBER OF BATHROOMS: WELL WATER': YES NO_4 ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: jt;L_ OUTSIDE: _TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?-f-��— IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?JAI/A 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: FULL NAME OF APPLICANT 1� j ���e(�i LLC— SOLE OWNER: YES/NO OWNER PHONE# � � (o-7 ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Aware ess Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. � e► � 1a � I �� 1 1. � e� � A SI NATURE 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"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 -� h ' csz Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. a;►arisrAu Paul J.Canniff,D.M.D. 1659. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate °ham* Phone:. (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 701 Issue Date: 12/10/2019 DBA: PANERA BREAD OWNER: BOSTON BREAD, LLC Location of Establishment: 790 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 89 OutdoorSeating: 18 Total Seating: 107 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: ,� 1t Town of Barnstable ce Use Only* Initials: Date Paid ")Amt Pd$ i Inspectional Services �� ���Zp `� col t639• �� Public Health Division Check# .• �fD MAC e 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 `i DATE Ib NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Tal' et�—CA-. Y eCA- ADDRESS OF FOOD ESTABLISHMENT: —I�D i�j c�i'L 1Lt-CFI MAILING ADDRESS(IppF DIFFERENT FROM ABOVE): IA- ty cwh 1 ' 1 LP 1 I E-MAIL ADDRESS: t td.m �. .i7 S l�t1G2� .CW�h(wv.�r�. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO__�_ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/_/_ TO O NUMBER OF SEATS: INSIDE: ' OUTSIDE: TOTAL: l aE; 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 `w OWNER INFORMATION: FULL NAME OF APPLICANTO�"�..b�"� Ye' �� SOLE OWNER: YES/NO rv� �? OWNER PHONE ©# ADDRESS�$��j J J.Y� ,►-GWir�I I 1\.6.� CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: L ,,� 1 i c—Qi r oJk List(2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. sa. IY �o J ��i 1. 1�1 ' . JD 2. F ' ^ /`/T 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 htti)://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 1st to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. i Q:\Application FormsTOODAPP REV3-2019.doc I i Y 1 MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the .check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed &Breakfast Permit=$55; Food Service Permit 0-49 seats =$250; 50 or more seats $300; Continental Breakfast=$30; Retai' Food (only TCS Foods) = $20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. = $285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry=$75; Mobile Truck=$50; Mobile Ice Cream Truck= $35; Frozen Dessert License=$30; Additional non-refundable Fee for New Establishment or New Ownership= $100-$500(see staff), Late Fee= $10 Q:Wpplication FormsTOODAPP REV3-2019.doc t qr �'s4".f'�'�-��.r�"�r�^'r.�,.",..%.c,� r.,.+J•S.rx,,:�'.rw�,�y;,id,�Y^ 1.F,,��.y a. �+...3", *i,`e ��.,�,'' .r s,F,1�' -?`�,?,!F�,'�"'.,r`" ,,,,.�i/o. ^;�nt`,�" ,� kx, � ��,�tii,[�r�. . ,t..r�� � ���+"��j�� ���� �;t"�'' d'' �r�.r. ���r'"�x,�':�,�r'✓F�'��.�y � •r�,�•'�r� tr'i ���.,A. - .• h� .',�.jp:;$� �Y "y �' ,,•..x,,r" .C��^'�,� ..rf ..y� r.'t^;y r""!^r �.' r '�,+'._�„�.:r"+".r+"'.;'`� '`,,A ,� YJ r' t ��"� �'' 3'�. `... i�,„r �'((ya tl rt� :� ,�'°�;� -:�, ,/'' .r.,..+^ .�'' n� •�' A�,,r i_ f ��r' y �.{p r � E��:'�'t�s.,n h, �•-'�.� ' a�-`i ��j/�f r ' , t t �.� t 1 �.`'' �,.�"� �N �;. ,,.,:';;� ., ';,`aa�,,,,^�.,f,*..w.,---., -� t r t�1,f1��J8.•�r.�'fd r`� � �k� PRESENTED T, ._♦ '�r 'K s- `' , .r 2 J l r 1 j t • {� f In Recognition of Successful:Comptet�ort of ReWiremen In CPR/A.ED (Adult / Child / Infant) t � 4/30/2018 Q a CERTIFICATION DATE HOLDER'S SIGNATURE t 4/30/2020 �'� �R 'Z EXPIRATION DATE AUTHORIZED SIGNATURE b' wwwAmericanSTImrg ThkaNResparfi*at Wed a bow toiumesAuRypassedstg6enlwtlonInaccordancewM national mgniMMlseaam4utlonstaMad mWAmedan Safety Tralning Institute artifintbntemnandmemant.'Amedon Safety Training Institute cc roses follow naUmut guldelloesset by the American Heart Assadatba(AHA),and the Mtemattanal lWwn Cmnmmee on Resuscitation(11011)•The Amedan Safe tyiaYilng lmtnute Isaw not dated,aftted wplk spa nse ed,arendomed by.Amedan Safety and Health lnstltuse(ASHII.AmedanHeutAmuttlanWW.orAmerlan Red GmtIARQ.andunlessatberwbespedbednoalfdlaUanoreodasement6Ynplied.SW SSFUIOUMPILMONDOESIWGUARANTEEFUTUREPERFORNMAN(. `. �r - ���i 'a.✓ ',s .X#,}r"` ";,a+' �Y," ,�rr ,„war .{,f+ "P 'y „y w '%i�.r*`" ,-^ .a s% ,.:.ar.,' n,..r`,'A`" '' e � x'x""�� ..'�"i*r"�,.^ :�•„#" :.:*„qd"" n�•'�`�.t ar`w �„s ,.'Tr�.;, ',¢k�"r':�"^� '�,'� `u.', a ,�.,�'" ,� a ,. x rpd" >�✓r A '�.'s✓" 'w�' ',��",`e st" =xt'� ,^z' '"q r` ,". d"s r •.��— e � M,,, " _�'��,4 '4'_:. � � s��"'�Y+:�"/,���..n., ,'�' ,a+' � �m - '�' ��dA'"_,¢��yri � ,�R Y INA �rxm,. .,a �`� S ;� ���,a.'�Z.� a, :n'``,�•r`�'+Aa ' '§ ��`«„ +; �;xs %.��.`�" „�'�. 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WA AX )'w 43' tea'r, -.. �`;'�;,s, .�.ry .y s" i '':,;w.:,k '*s< p€,� ' rk 'y + Df:,,' 4: `cn^.'sx :'wk+",ssS ., ,,@ "` S Ym$ -' .�'4`*=.'� ^qn ti" q+...,P*.. i t, , '@.:,'.1` t 1 i w I F �In RecogAia6ANOt Successful Corho et on c�f�Requ���erner is In � � � t Av % f €, Y YANII! s , CPR, D (Ad I /"Cf Ind / I n a n j` { � ��. �.x * J, ON S,yT m 7 08103/2019- CERTIFICATION DATE ' HOLDER'S SIGNATURE �. 08/03/2021 ° r•�; t. fi _- EXPIRATION DATE AUTHORIZED SIGNATURE t In WwAmeNsan5TI crg Th scenifies participant listed above has successfully passed skills evaluation in accordance with national cognitive skills examination standards,and American SafetyTraining Institute cerfification terms and conditions.American Safety Training Institute_courses follow national guidelines set by the American Heart Association.(AHA),and the International Liaison Committee on Resuscitation(ILCOR).The American SafetyTraining Institute is not associate(l,affiliated with,spon I sored,or endorsed ls American ' Safety and Health Institute(ASHO,American Heart Association(AHA),or American Red Cross(ARC),and unless otherwise specified no affiliation or endorsement is implied.SUCCESSFUL COMPLETION DOES NOT GUARANTEE FUTURE PERFORMANCE. �4 - Town of Barnstable rtH1G r BOARD OF HEALTH Paul J Canniff,D.M.D. 8,a Board of Health Donald A.Gaudagnoli,M.D. a, ST'ABM = John T.Norman MASS ,az9• . 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: 701 Issue Date: 12/20/18 DBA: PANERA BREAD OWNER: BOSTON BREAD, LLC Location of Establishment: 790 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 89 OutdoorSeating: 18 Total Seating: 107 FEES - - FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: i FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: a opIKE Syr For Office Use,onim. Initials: + o„ Town of Barnstable o2. Amt Pd$Date Paid SST Inspectional Services 9Cb i639. `0�' �.�gg prEDMK�A Public Health Division Check# 1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 f Q�- Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE �� L NEW OWNERSHIP RENEWAL, NAME OF FOOD ESTABLISHMENT: q0- erc� lJ r'CL—�L ADDRESS OF FOOD ESTABLISHMENT: —1 Ci D I\j QrN'b'nC:&�Ti ca_A a P,�A-S 1855 S INGRAM MILL ROAD,SUITE 100 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 'SPRINGFIELD,MO 65804 ' { (-4 c, E-MAIL ADDRESS: t ce n s l no, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: S( 03) '87w- To 115 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NOX ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?_ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? / TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refri eration/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 Forms\FOODAPPREV2018.doc ---------- -- 1 PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT_ 65`(+n SOLE OWNER: YES/NO OWNER PHONE ADDRESS l $ cS CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. La c, m G b / /,26.2-- L tn, 16 / / Z,23 3 aq � zc 2 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. Prior to openip_g!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPPREV2018.doc TOWN OF BARNSTABLE .,_ HEALTH INSPECTOR,s Establishment Name: \�lir�iC_� Date:����Page:, .. of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-6:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. � ,639. .• HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red Item. PLEASE PRINT CLEARLY iOlEo MPS° 50862-4644 " FOOD ESTABLISHMENT INSPECTION REPORT Name Date t Type o Inspection L ns Address X Risk- ood Sete a Re-inspection Level Re ai Previous Inspection Telephone Residential Kitchen Date: ` Mobile Pre-operations Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) N Jime Bed&Breakfast HACCPOther Inspecto : `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) ❑ i Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands V- 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) ❑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 aa PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control Q V ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Y Y ori � � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Base ins ection 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 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations re 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. d if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: n tor' atu \ 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 PIGS nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N ..-..r-w.--.�..._,_...,-�....-,y, ..�,,..--�........�' t•- � ..-.. ,� ,.r .•.• v-.: _a -- .•-• ,- _--.- - ...---_�., +. ,. .-�_.-. _.-.,. --•.- -vt J•k; -...., ....- - 1 .s..�.. .r - .�-._,. ti�-. _ -w..�.. Y s...-w�. ... Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from'Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F A Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16( ) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR-. 3-306.14(A)(B)Returned Food and Reservice of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions g ( �Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Ho[Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y lx 7-..06.13 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec CONSUMER ADVISORY Concentration and Hatdness* 22 3-603.11 Consumer Advisory Posted for Consumption of 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* E-d""°°uu2°oi 4-602.11 _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.1](A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or590.009(A)-(D) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 3-202. 8 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 3-201.4( Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec* $ Receiving/Condition ( ) ( ) 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 * 12 Prevention of Contamination from Hands 3-403.11 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* L18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products �5-205.11 03.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 04.11 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* 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 11.008 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 590.00P. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF�NE.,,y TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: �Q'�F��\ Date: � Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A ,6;9.>�0� HYANNIS,MA 02601 _ - More.-FRI.508-862-4644 rF0 No Reference- R-Red Item - PLEASE PRINT CLEARLY - MPy FOOD ESTABLISHMENT INSPECTION REPORT Name Date jr Type of T n ection p outine 1 Address ' �� Risk ervi ion Level a 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 :r Inspector Out: /V C !3 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) ❑ �1u Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 500.009(F) ❑ o> QS Kip Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands /y.,, ❑ 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 �v ❑ 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 ConsumerAdvisorieSr Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 1 ao� 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 it ms Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ 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 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 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. violation,4 to 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' i r 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' Signature Pint: Self Service Wait Service Provided Grease Trap Size .Variance,Letter Posted Y N l Dumpster Screen? Y N L] y W\ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 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* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hat PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)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 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E1/-d-1/1a001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D m 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 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under RegulatoryAuthority 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) Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From.70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 3-501.14 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement B) g 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,plidth 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. 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 r 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. oFt rok TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: C ` Date: J��/r Page: of . 10 OFFICE HOURS PUBLIC HEALTH DIVISION e:oo-s:soA.M. BARNSTABLE. • 200 MAIN STREET a: N. P.M. Item Code C-Critical Item M DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified "'Ass. •� HYANNIS,MA 02601 O -FRi. No Reference R-Red Item PLEASE PRINT CLEARLY .6yq• 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date )� / o Tvoe of Tve of Inspection Operation(s) Routine ' Address V Risk Food Service Re-inspection v 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: 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) ❑ a�1 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.ProperAdequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories t vv Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ Yes 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/Exclusio ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today a items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ 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 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 t 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 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: nspecto s at nn 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 Pri Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) 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* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation20 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 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* I Sanitization Temperatures* _ TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate . Equipment* 590.006(A) Bottled Drinking Water* 3 401.11(A)(2) Comminuted Fish,Meats&Game B Pathogens* Eff ctiw inrz0ot 590.006 Water Meets Standards i 0*s n 310 CMR 22. 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* ( ) Wt Mt Std Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf cesSanitizationEquipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP 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* 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 practices should be debited under#29-Special 17 Reheating for Hat Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.1 f PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) * 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140`F to 70QF 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70`17 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 * 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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices ("n 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PATOWNOF BARNSTABLE . /raEALTH INSPECTOR'S Establishment Name: Date: Page: of l / OFFICE HOURS Aa E°^ PUBLIC LIC MAIN STREET DIVISION 8:00-9:30A.M. - 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. .639.p.0 HYANNIS,MA 02601 508-862 asaa No Reference R-Red Item. PLEAS5 PRINT C RLYP� rED MPSF D P/ STABLISHMENT INSPE ON.REPORT ' ' IN Name D to pe of Type of Inspection S Routine Address sk Food SerJi Re-inspect' n yel Previou Telephone Residential Kitchen Date: �� Mobile Pre-0 r i Owner HACCP Y/N Temporary S t`y Caterer General Comp Person in Ch a(PIC) Time Bed&Breakfast Otheref�E� Inspector u , Each violation check d requires an explana ion on the narrativ page(s)and a citation of specific provision(s)violated. - Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Wm Anti-Choking 590.009(E) El - -/ 1 1, ­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 EN J ❑ 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) All; _ ❑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) ® A 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP /!'.Ft'J / Proper Adequate Handwashirig CONSUMER ADVISORY �F[\ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: lt-T[i No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. alll0 , ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on a ins pection spection 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 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 6pon-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non=critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical olations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 ' n,4-to 8pon-critiCal violati ns 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: In •e atu O t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Sig ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 00 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 2-103.11 - Person-in-Charge Duties - - - 3-302.14 Protection from Additives* - - - PHF Hot and Cold Holding Contamination from Raw Ingredients ! 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F _ _ .1.5. Poisonous or Toxic Substances - * - EMPLOYEE HEALTH 590.004(F)3-302.11(A)(2) Raw Anima]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* * _ -� Applicants 3-302.11(A) Food Protection* � 7-201.1'r-- Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility_ of A Food Employee or An _ _ _ _ 3-302.15 7-202.11 Restriction-Presence and Use*_ _ 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 1-1 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) 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 g ( ) Disposition of Adulterated or Contaminated t -- - 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-13)_Compliance with Food Law* _ 4-SOl.li1- - -Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 r Fluid Milk and Milk Pfoducts*- 01.112- Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 4-5 3-202.13 Shell Eggs* __ _ __ _ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - Concentration and Hardness* 3-401.11A(I)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-10.1.11 Drinking Water.from an Approved System* - _ _ 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or _ _ _- Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°fi-11120W 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 4:602.11 _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish.From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - '` - 3-401.11(A)(3) Poultry,Wild Game,Stuffed 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* , 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By _ 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3=202.18 Shellstock'Identification Present* - 2-301.12. Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C)_ Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 2-301.14 When to Wash* * Other 590.009 violations relating to good retail _ _ _ _ _ en 3-201.17 Game Animals* 11 Good Hygienic Practices _17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11.. _ Eating,Drinking or Using Tobacco* * Requirements. 5 _ Receiving/Condition- -- - - - - - g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity - ( ) Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* ' Within 4 Hours* 23. Management and Personnel FC-2 .003 520411 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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (>) 9 9 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. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000'. f`hgeu 41 Op TN6 rp�, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Awf)5 Dater,. ��Page.- of e -'1 OFFICE HOURS 's AR"N'�-EO PUBLIC 2 0 MAIN STREET 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �A ,639.p�0� HYANNIS, MA 02601 _ M -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rEn Mai 508-8-862-4644 FO ESTABLISHMENT INSP CT REPORT Name Da e e o Type of Inspection Routine Address Risk Food Serv' Re-inspecti n Level Previous i ` / Telephone Residential Kitchen Date: 149 FF Mobile Pre-op a k Owner HACCP Y/N Temporary us ect I nes Caterer General Com Person in Charge(P C) Time Bed&Breakfast Other i Inspectord2tl �x ut: A R Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. l Violations Related to Foodborne Illness Interventions dtisk 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 P RV RKJ� ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS Potential) Hazardous Foods (Potentially ) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures A iA A / ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 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 it 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 a n 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address i'c I violations: If 1 critical refrigeration. 29.Special.Requirements (590.009) within 10 days of receipt of this order. to n,4 to 8non-critical violati tolati =C. 30.Other DATE OF RE-INSPECTION: Ins or' ure 31.Dumpster screened from public view I Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N T #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S' at a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i d 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.*2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 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 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 Reate for 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 ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 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* TIMEITEMPERATUREC_ONTROLS 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-I55°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 5-10111 _ Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ce,-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_-`_--y 3-401.11(B)(1)(2) Pork and'Beef Roast-130°F 121 min* Eggs* ^r-.` 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* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing °3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145F* 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. 14 When to Wash*. * Other 590.009 violations relating good retail 590.004(C) Wild Mushrooms* 2-301 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec to ICI 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinkin or Using Tobacco* * Requirements. $ Receiving/Condition g• g g 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 actors listed above can be found ound in the f 6 Tags/Records:Shellstock [5- 0.004(E) Preventing Contamination from Employees* 1 S 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 3-20312 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 ` 03.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 04.I I 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* 05.11 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 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: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. oFVff ror TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: N�TM P)W&D Date: v Page: Of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:06-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. $ MON.-FRI. �A ,639.p�0 HYANNIS,MA 02601 soa-as2-4644 No Reference R-Red Item P E,4SE PFONT CL RLY rFD MPS FOOD EST BLISHMENT I NSPociriON REPORT Name ate Tvne of section I Routine Address isk Food Servi ecti n eve[ Previo F� Telephone Residential Kitchen Date: r l Mobile Pre-op71 e C /j Owner HACCP YIN Temporary Suspect III-ess V_� Caterer General Complaint I-M- (A Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector t: C. 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 ilk 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 IO2TECTION .Prevention of Contamination from Hands n ❑ 1.PIC Assigned/.Knowledgeable/Duties 3.Handwash Facilities , � ; EMPLOYEE HEALTH FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Iv ❑ 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.CoolingAM o ❑ 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) t42 ❑ 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 d ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as deterf'ned-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 toda ems o checked indicate violations of 105 CMR 590.000/Federal Food Code. ElEmbar g ❑ 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 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 6von-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 anon-critical vi lati 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 ons. within days of receipt of this order. violation,4 to 8non-critical viol lion n 1 d s= 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: In a Signature rint: 31.Dumpster screened from public view / Permit Posted? y N Grease Trap Previous Pumping Date Grease Rendered Y N (� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Si ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N f 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 I'' PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS - - - -- - - - - - - - 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3`202'f2- Additives* 3-501.15 Cooling Methods for PHFs 2-103.11- Person-irrmCharge-Duties - -- -- - - - Cooked and RTE Foods.* 3-302.14 Protection•frorii Unappio'ved AdditiJes* j' 19 - -- - PHF Hot and Cold Holding Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F __ 75 - Poisonous or Toxic Substances 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)-i - T-1a2.11 Common Name-Working Containers 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 7-201.11 Separation-Storage*) Food Protection* P g 20 Time as a Public Health Control ( P tyEmployee_ 3-30215. Washing Fruits and Vegetables _. 7-202.11 Restriction-Presence and Use* 590.003 F) Responsibility of A Food or An _ _ 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) - Variance Requirements- 590.003(G)-' Reporting-by Person-in Charge*--. - -- .- -- Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* . ,-, - REQUIREMENTS=FOR• - 3 306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions 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(13) 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* -501.112- Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 4 9-202.13 Shell Eggs!. _ _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS i 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* 1 g3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 8g 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* 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* - - 1 Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Poultry or Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical*. Stuffing Containing Fish, 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential -- Game and Wild-Mushrooms Approved By- - - * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under I Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3 202.18 Shellstock Identification Present* - - - - 2-301.12 Cleaning Procedure* 165*F* foodborne illness interventions and risk factors: * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms _ _ _ _ ( )( )( ) * 11 Good Hygienic Practices practices should be debited under#29-Special 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne d 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unslice Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* " 1 g' Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140*F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70`F to 41'F/45°F Item Good Retell 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 590.004(J) labeling of Ingredients` Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 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 1 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. 'I tiu SHET own of Barnstable �oF °tyti .k Barnstable Board of Health' Aa-America®City 4I+ BAFLYSTABLE. • , ®m� s MASS. 200 Main Street,Hyannis MA 02601 p®® JED MA'1 A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 9, 2012 Jason Berg--..--. Panera Bread c/o Boston Bread, LLC 3051 Oak Grove Road, # 101 Downergrove, IL 60515 RE: Variance_RequestD-enialr/--P_anera_Bread;.790=lyannough Rd,.Hyannis- Dear Mr. Berg, Your request for a variance at 790 lyannough Road, Hyannis, was not granted. You represented Panera Bread at the Barnstable Board of Health meeting on January 10, 2012. You requested a variance.from Section 322-4 of the Town of Barnstable Code to reduce the existing toilet facilities from four to two to allow for additional seating for the operation of a food establishment at 790 lyannough Road, Hyannis - 34 seats were proposed to be added. The total number of seats in this establishment would have been 127 seats. The variance may only be granted when, in the opinion of the Board of Health, the applicant has-demonstrated that the same degree of protection could be achieved without strict adherence to a particular provision or regulation. You did not provide the Board with any alternatives to accommodate patrons and employees in regards to restroom facilities. Also, the applicant failed to comply with the MA State Plumbing Code in the proposal. The female restroom would have had an insufficient number of fixtures. Therefore, your request for the variance was not granted. PER ORDER OF THE BOARD OF HEALTH Wayne filler, M.D. Chai 1 n Q:\WPFILES\DENIAL Panera 790 Iyann Rd Hy Jan2012.doc Excerpt from the Board of Health Meeting Minutes on 1/10/12: A. Jason Berg, Panera Bread — 790 lyannough Rd, Hyannis, Map/Parcel 3,11-092, request for toilet facilities variance with additional seating. Jason Berg presented a floor plan and stated that Panera Bread has 75 restaurants and the Hyannis location is the only one which has a separate employee bathroom. Mr. Berg said that their employee bathroom is seldom used. He fully plans to meet the plumbing code's requirement. Mr. Berg said it was not cost effective to keep one of the bathrooms as it would prevent the necessary increased seating needed to meet the revenue demand. Mr. McKean mentioned that the staff is not opposed to a unisex employee bathroom. The policy exists because in the past, a restaurant had run into the lack of toilet facilities and unsanitary conditions developed. The Board would consider a proposal to change one to a unisex employee toilet facility and convert the other employee bathroom to be accessible to:both the .f public and the employee. Upon a motion duly made Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the request of eliminating two employee bathrooms for additional seating. (Unanimously, voted TO DENY). (They may return to the Board to propose that one employee bathroom be converted to a unisex toilet and a second employee toilet facility be converted to be both public and employee use.) L , s ,.s �fME DATE: FEE: J • snat 1AS& 163 bgy.&�� REC. BY cS " Town of Barnstable SCHED. DATE: Board of Health ✓ 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Oy Paul J.Canniff,D.M.D. z L VARIANCE REQUEST FORM LOCATION .- J Property Address: 7 Qo j_yg1j 1W VQ`J l✓ 1/ & . !�tCf 0,�&/ Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: -PW Cg-A- No Subdivision Name: = APPLICANT'S NAME: 1450'n Belt6- Phone 633y'3�,� Did the owner of the property authorize you to represent him or her? Yes No * `v i PROPERTY OWNER'S NAME CONTACT PERSON Name: Name: Address: Address: 3,,7 F/ alk Aol a—wlle.A F Aa4,ti L- Phone: Phone: (2�3C-3 XY-6T dO VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 33doy o PM61/ o ' 7�f �, 3 / Pe 7, m ,''ia/ g t°a7 n G „_�r1so rr77acl�f�/ NATURE OF WORK: House Addition ❑ 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) l� Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) 1T 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 owner/lessee 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]) v Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC I BREAD December 27,2011 Re: Panera Bread Variance Application To whom it may concern: Enclosed is the application for the Health Department meeting on January 1Oth.This would be for the removal of our employee toilet rooms.After the renovation we will have 2 toilet rooms; men's with 1 urinal 1 water closet and 1 lavatory and a women's with 2 water closets and 1 lavatory. In addition we have 4 employee hand sinks throughout the kitchen. I understand that within the previous 6 months Chipotle and McGrath Saloon &Sports Bar both had variances granted for this purpose. Sincerely, ?4e,7 A4 Jason Berg j- Director of Construction CC: file �t �i Chicago Bread,L.L.C./Boston Bread,L.L.C.3051 Oak Grove Rd.Suite#101 Downers Grove,IL 60515 Office(630)324-0920 Cell(847)456-8094 Fax(630)241-2300 Email:iberp,@chicagobread.com A franchisee of Panera,LLC i Jason Berg Director of Construction Chicago Bread,LLC Boston Bread,LLC (1 a franchisee of Panera,LLC 6`G Panera Bread 3051 Oak Grove Road,101 Downers Grove,IL 60515-1195 (630)324-0920 ® Fax:(630)241-2300 www.panera-(hicago.com E-mail:jberg@chicagobread.com PANER KIDS-? TFRESH,FUN MEAL CHOICES VA— mac & cheese peanut butter & jelly i CC J grilled cheese kid's deli organic american cheese organic american cheese&your choice s R E A of smoked ham,smoked turkey breast or roast beef Add your choice of organic white or chocolate milk or apple juice as a kid-friendly alternative for an additional charge. ♦ ♦ SANDWICHES SERVED ON WHITE WHOLE GRAIN BREAD WITH A SQUEEZABLE ORGANIC YOGURT. .......... •.••....... ARTISAN BREADS SPECIALTY BREADS CREATED WITH OUR OWN MILD STARTER country. sourdough r=. french asiago cheese stone-milled rye cinnamon raisin sesame semolina tomato basil three cheese white whole grain three seed honey wheat focaccia yr^a' sea salt,asiago cheese ciabatta 4. �t whole grain .......................................................................................................... BAKED GOODS } ; L s� , cinnamon crumb coffee cake brownies sweet rolls scones artisan pastries cookies muffins & muffies .................................................. Many of our products contain or may come into contact with common allergens, {{ t including wheat,peanuts,soy,tree nuts,milk,eggs,fish and shellfish.Please ask to Il speak with a manager for a list.of ingredients:n your.order or visit panerabread.com. Si LrfCc!e, Si LfdtGt`e- t f SANJWICHES - 1 •' - HOTS-PANINI CRUST AND CRUMB INSPIRE SANDWICH CREATIVITY. Cuban chicken smokehouse turkey' on focaccia with all-natural,antibiotic-free on three cheese with smoked turkey, ® chicken, smoked,lean ham, sweet&spicy applewood-smoked bacon, smoked cheddar bacon turkey bravo napa almond chicken salad pickle chips,swiss, chipotle mayo &sun-dried tomato ale mustard on tomato basil with smoked turkey, on sesame semolina with all-natural, &sun-dried tomato ale mustard applewood-smoked bacon,smoked antibiotic-free chicken,diced celery, tomato & mozzarella ; gouda,lettuce,tomatoes&our seedless grapes,almonds&our special chipotle chicken on ciabatta with fresh mozzarella, signature spread dressing,served with lettuce&tomato on french with all-natural,antibiotic- roasted&fresh tomatoes, fresh basil chicken Caesar asiago roast beef free chicken,applewood-smoked bacon, &sun-dried tomato pesto smoked cheddar,tomatoes&our ancho on three cheese with all-natural, on asiago cheese demi with roast beef, chipotle spread antibiotic-free chicken,asiago,lettuce, smoked cheddar,lettuce,tomatoes, tomatoes,onions&our Caesar dressing onions&our horseradish spread frontega chicken® italian combo on focaccia with smoked pulled chicken, mozzarella,tomatoes, onions,fresh basil on ciabatta with roast beef, smoked &chipotle mayonnaise turkey, smoked,lean ham,salami,swiss, peperoncini,lettuce,tomatoes,onions ..................................................... ............................................................... &our special spread CAFE SANDWICHES mac & cheese with tangy vermont white cheddar CLASSIC SANDWICHES BECOME LEGENDARY ON GREAT BREAD. cheese sauce over shell pasta sierra turkey smoked turkey-breast ..................................................................................................................... on asiago cheese focaccia with on country with lettuce,tomatoes,onions, •••••• ••.••••.,.••• ••••••••I........ �•••�I•••� ••••.................... ••.I•••..•••. .. ' smoked turkey,chipotle mayonnaise, salt&pepper ,> hd t`, and CAFE field greens&onions tuna salad S O�P S & STEWS mediterranean veggie on honey wheat with lettuce,tomatoes, soup in a bread bowl* bowl of soup* on tomato basil with zesty sweet onions,salt&pepper peppadew—peppers,feta,cucumbers, choice of soup in a freshly baked choice of soup with our freshly lettuce,tomatoes,onions sourdough bread bowl baked bread &cilantro hummus "ADDITIONAL CHARGE FOR"YOU PICK 2"AND SIGNATURE SOUPS. smoked ham & swiss on stone-milled rye with lettuce,tomatoes, SOUP SCHEDULE onions,salt&pepper - � sunday monday- tuesday ..................................................................................................................... Q®steak chili Q®steak chili Q®steak chili � c Q®sonoma chicken stew .Q A©sonoma chicken stew Q®sonoma chicken stew / !P1Ml�LTM Si hdtGtl a ®m chicken noodle ®Q chicken noodle ®(1)chicken noodle HOT PA"N I N I broccoli onion french onion french onion cheddar broccoli cheddar broccoli cheddar GRILLING MELDS FLAVORFUL INGREDIENTS AND FRESH HEARTY BREAD. O creamy tomato 0 creamy tomato O creamy tomato - Q 0 black bean baked potato Q 0 black bean steak & white cheddar ®steak balsamlco cream of chicken&wild rice m0 garden vegetable with pesto cream of chicken&wild rice " on french baguette with seared top sirloin, on ciabatta with seared top sirloin, Wednesday thursday frlday caramelized onions,vermont white mozzarella, roasted red peppers, cheddar&horseradish spread fresh baby spinach,tomato&basil Q®steak chili - Q®steak chili Q®steak chili balsamic spread sonoma chicken stew p Q®sonoma chicken stew Q®sonoma chicken stew ®roasted turkey artichoke ®m chicken noodle ®(ID chicken noodle ®0 chicken noodle on asiago cheese focaccia with all-natural - french onion french onion - french onion roasted turkey,fresh baby spinach,roasted broccoli cheddar broccoli cheddar - broccoli cheddar red peppers,caramelized onions 0 creamy tomato O creamy tomato 0 creamy tomato &artichoke-parmesan spread baked potato m0 black bean ®Q garden vegetable with pesto Q Q garden vegetable with pesto _ cream of chicken&wild rice new england clam chowder HOT PANINI AND SANDWICHES COME WITH YOUR CHOICE OF FRENCH BAGUETTE, WHOLE GRAIN BAGUETTE,POTATO CHIPS OR AN APPLE. ©=signature saturday ®=all-natural Q®steak chili.Q®sonoma chicken stew,®®chicken noodle, ............................... �=low-fat french onion,broccoli cheddar,0 creamy tomato,®O black bean,baked potato Menu subject to change without notice. Q=vegetarian Additional soups available seasonatly.Subject to change. �► FRUIT SMOOTHIES c low-fat mango low-fat wild berry ®low fat cranberry orange low-fat strawberry with ginseng with ginseng FROZEN DRINKS ° frozen caramel frozen mocha frozen mango ` rl�etit�tiGtt�vl Si hdl�cve, ..................................................................................................................... SALA-DS BEVERAGES steak & blue cheese ® roasted turkey harvest salad chopped salad all-natural roasted turkey,field greens, iced chai tea latte iced green tea seared top sirloin,romaine,frizzled onions, romaine,fresh d'anjou pears,dried lemonade bottled water tomatoes&gorgonzola,all tossed with cherries,gorgonzola,pecans&cherry blue cheese vinaigrette and drizzled with balsamic vinaigrette orange juice organic white or a cabernet reduction chocolate milk .•................................................................................................................... organic apple juice �^ Pepsi-Cola fountain drinks and freshly brewed iced tea also available. SALADS ..................................................................................................................... chopped chicken cobb salad bbq chopped chicken salad ESPRESSO BAR all-natural,antibiotic-free chicken, all-natural, antibiotic-free chicken, romaine,tomatoes,applewood-smoked romaine,roasted corn,black beans, AVAILABLE ICED OR HOT,WITH DECAF OR SKIM MILK. bacon,gorgonzola,hard-boiled eggs, all tortilla strips&bbq ranch dressing, chopped&tossed with our herb vinaigrette drizzled with bbq sauce peppermint mocha caffe mocha espresso,foamed milk&peppermint espresso,foamed milk&chocolate with thai chopped chicken salad aSlan sesame Chicken salad with whipped cream&chocolate sauce whipped cream&chocolate sauce all-natural, antibiotic-free chicken, all-natural,antibiotic-free chicken, romaine,thai cashews,fire-roasted romaine, cilantro, almonds, sesame caramel latte chai tea latte edamame,red peppers,carrots,fresh seeds,wonton strips&our reduced- espresso,foamed milk&caramel with brewed black tea with honey,vanilla, cilantro&wonton strips all tossed in sugar asian sesame vinaigrette whipped cream&caramel sauce cardamom,cinnamon,ginger low-fat thai chili vinaigrette and drizzled &foamed milk with peanut sauce fuji apple chicken salad cappuccino grilled chicken Caesar salad all-natural,antibiotic-free chicken, espresso&foamed milk with foam cap caffe latte g field greens,romaine,vine-ripened espresso&foamed milk all-natural, antibiotic-free chicken, tomatoes, onions,pecans,gorgonzola, peppermint hot chocolate romaine, asiago, our caesar dressing apple chips&our white balsamic foamed milk,peppermint&chocolate hot chocolate &homemade asiago croutons fuji apple vinaigrette with whipped cream&chocolate sauce foamed milk&chocolate with whipped ..................................................................................................................... espresso cream&chocolate sauce CAFESALADS darkly roasted to produce a robust flavor,topped with a layer of`crema' greek salad classic salad Additional shots of espresso or flavored syrups available for an additional charge. romaine,vine-ripened tomatoes,feta, field greens,romaine,vine-ripened onions,peperoncini,kalamata olives, tomatoes, cucumbers,onions&our •••••• ••••• •••' •• ••••••••••••• •••••••• • '• ••••• •••• •• •••••••••• •• ••••• •"•••• ••••••••••• •'••••••• pepper&our greek dressing reduced-fat balsamic vinaigrette caesar salad COFFEE & T E A romaine, asiago,our caesar dressing freshly brewed coffee hot 'The Republic of Tea' teas &homemade asiago croutons light roast • dark roast hazelnut • Colombian decaf SALADS COME WITH YOUR CHOICE OF FRENCH BAGUETTE, WHOLE GRAIN BAGUETTE,POTATO CHIPS OR AN APPLE. C5 PB TM n BREAKFAST t SANDWICHES BREAKFAST SANDWICHES AND SOUFFLES AVAILABLE ABOUT • R MENU UNTIL 10:30AM WEEKDAYS/11:OOAM WEEKENDS Bread'Panera offers _ ads baked in ch steak, egg & cheese breakfast power sandwich •, - • _handcrafted, . • • - • , -d on sweet onion&poppyseed bagel on whole grain bread to providing you with fresh, food you can trust made ham, egg & cheese bacon, egg & cheese great tasting on jalapeno&cheddar bagel on ciabatta from the highestquality ingredientsandhighlighted by • • sausage, egg & cheese tic- sausage, egg & cheese . - . • -, . • . , - on ciabatta - on french toast bagel ingredients• • • •- I egg & cheese - - - bacon, egg & cheese on ciabatta on asiago cheese bagel breakfast sandwiches available on anv .Sryhatare bagel for an additional charge OPERATION DOUGH-NATION0 •- - • • • • is sharing. ...................................>..,..SOUFFLES..>.,...,,.............,..........,..... we're committed to ensuring that every purchaseI� That's why at Panera Bread feeds back into the community through the follow- four cheese spinach & artichoke ing programs. your - . we can make a worldof ham & swiss spinach & bacon - A portion of cash donations made in our bakery-cafes may be matched and donated to local hunger relief and other charitable organizations. ♦...............................>....,....,Hue,s,>H>•........>.,.....>,...,.........,...Nu,f>,,,................. Unsold bread is donated at the day's end to local hunger relief agencies. BAGELS & CREAM CHEESE donate ' " ' ' ' benefit a wide range of charitable organizations and causes. BAGEL PACKS ARE PERFECT FOR MEETINGS& FAMILY GATHERINGS S�`,,6we bagels bagel pack with premium ingredients and 13 bagels& 2 tubs of spreads delectable combinations of flavors, our y signature bagel line is irresistible dozen & a half JALAPENO&CHEDDAR,CHOCOLATE CHIP, 18 bagels ITS BACK CRANBERRY WALNUT,FRENCH TOAST, baker's dozen BLUEBERRY,CINNAMON SWIRL&RAISIN, 13 bagels SWEET ONION&POPPYSEED, CINNAMON CRUNCH, ASIAGO CHEESE half dozen bagels 6 bagels bagels classic flavors,baked fresh every day bagel & any cream cheese spread PLAIN,WHOLE GRAIN, SESAME, EVERYTHING bagel plain & reduced-fat plain flavored reduced-fat cream cream cheese spreads cheese spreads HAZELNUT,VEGGIE,CHIVE&ONION, HONEY WALNUT, New CRANBERRY ORANGE Panera Bread caters for five or more. Order your favorite sandwiches, salads, soups strawberry granola parfait seasonal fruit cup •• - = is available. Contact your local made with Stonyfield Farm,organic, Delivery low-fat vanilla yogurt cateringcoordinatorfor details. • • • • o , i i i BRE'A D t ' December 23,2011 Re: Panera Bread ZBA application To whom it may concern: Enclosed is the application for the ZBA meeting on January 10th This w Id be for the removal of our employee toilet rooms. We currently have 2 toilet rooms; men's with 1 1 watewaterc_loset � and 1 lavatory and a women's with 2 water closets and 1 lavatory. In addition we have� employee hand sinks throughout the kitchen. I understand that within the previous 6 months Chipotle and McGrath Saloon & Sports Bar both had variances granted for this purpose. I have not included payment though will forward credit card information or a check for the exact amount upon request. Sincerely, Jason Berg Director of Construction CC: file f Chicago Bread,L.L.C./Boston Bread,L.L.C.3051 Oak Grove Rd.Suite#101 Down ove,rL 60515 Office(630)324-0920 Cell(847)456-8094 Fax(630)241-2300 Email:iberrza,chicaeobread.com l{ A franchisee of Panera,LLC eucn�r�uce,t x.�ss Town of Barnstable Zoning Board of Appeals Application for a Variance Date Received For office use only: Town Clerk's Office: Appeal# Hearing Date Decision Due The undersigned hereby applies to the Zoning Board of Appeals for a Variance, in the manner and for the reasons set forth below: T,r"a . Applicants Name. J ZoOe)yi bcnq L4c• M4 PBrie,Phone: �Qzl `D 5Z0 Applicant's Address: �& l &4' t r: ; ,? �o� ;( , 16 Property Location: ,1y4hc—,i. ,Cd. 11v4hAI..5 Property Owner: , Phone: Address of Owner: _ if petitioner di;fers from owner, state mature of interest:' I Registry of Deeds/Land Court References: Deed Plan Assessor's Map/Parcel Number: Zoning District: Number of Years Owned: Groundwater Overlay District: , Variance Requested: `7e i re c;(r i t?S .. i Cite Section &Title of the Zoning Ordinance ' Description of Activity/Reason fa.r Request: 'I,t?e tjr,vJcf Lee io t'f;•,-7er-`Pt d / / �- 21✓1�l�tilee L-145l�>fc^7r7`i �c C1Gfdt Gaf�C't�'t!_ 7834 jPC� iJ�4 4r 6t:i' jj�ai'75. Attach additional sheet if necessary Does the property have any existing Variance or Special Permit issued to it? No_W Yes [ ] Permit#.: The Applicant's Name will be the entity to whom the variance will be issued to. If the Applicant differs from owner,the Applicant will be required to submit one original notarized letter from,the owner authorizing the application to the Zoning Board,a copy of an executed purchase&sales agreement or lease,or other documents to prove standing and interest in the property. Application for a Variance Page 2 Existing Level of Development of the Property-Number of Buildings: 1 Present Use(s): ;�K��'✓f=il7 Existing Gross Floor Area: 1-/S00 sq. ft. Proposed New Gross Floor Area: sq. ft. Site Plan Review Number: ✓y Date Approved: (not required for Single or Two family use) Is the property located in a designated Historic District?....................................... Yes[ ] No [4,— Is this proposal subject to the jurisdiction of the Conservation.Commission......... Yes[ ] Nod] Is this proposal subject to approval by the Board of Health .................I.,......:...... Yes,k) No [ ) Is the building a designated Historic Landmark?.................................................... Yes [ ] NOR HSve you applied for a building permit?........ ......................... Yes [ ] NoM Have you been refused a building permit?........................................................... Yes[ ) Now) The following Required Information,as applicable to application, must be submitted with the application at the time of filing. Failure to do so may result in a denial of your request., a Three(3) copies of the completed application.form,each with original signatures. o Three(3) ies of a 'we e 'certified pr curve t plan)a re (8 1I2 1" 11"x ing the dime s of the land, all wetlan s,water bodies,surrounding roadways and the location of the existing improvements on the land. • Three(3)copies of a proposed site improvement plan,as found approvabte by the Site Plan Review Committee i (if applicable),and building elevations and layout as may be required plus one(1) reduced copy(8 1/2"x 11"or I 11"x 17")of each drawing. These plans must show the exact location of all proposed improvements and alterations on the land and to the structures. • The applicant may submit any additional supporting documents to assist the Board in making its determination. Twelve copies of all supporting documents must be submitted eight days prior to the public hearing for distribution to the Board Members. i Signature: Date: 1 Applicant or Representative's Signature Print Name Address: Phone: Fax No.: i e-mail Address: l k All correspondence on this application will be processed through the Representative named at that address aril phone number provided. Except for Attorneys,if the Representative differs from the Petitioner,a letter authorizing the Representative to act on behalf of the Petitioner shall be required. Waste Water Services Inc.. Barnstable ABOH 2021 Pumping Log Date Locations Address Town Waste Quantity Disposal Location 4/1/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 15,800 New Bedford WWTP 4/2/21 Mashpee Village Amos Drive Mashpee Septic 28,000 New Bedford WWTP 4/7/21 Mashpee Commons 22 Steeple Street Mashpee Septic 14,000 Cranston WWTP 4/12/21 Mashpee Commons 22 Steeple Street Mashpee Septic 11,000 New Bedford WWTP 4/12/21 Mashpee Village Amos Drive Mashpee Septic 9,500 New Bedford WWTP 4/15/21 Bridges at Mashpee 462 Old Barnstable Road Mashpee Septic 17,000 New Bedford WWTP 4/19/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 12,000 Cranston WWTP 4/20/21 Bridges at Mashpee 462 Old Barnstable Road Mashpee Septic 5,000 New Bedford WWTP 4121121 Wendy Buckley 368 Old Plymouth Rd Bourne Septic 1,000 Plymouth WWTP 4/22/21 Marc Lieber 7 Clapp Ln Bourne Septic 1,000 Plymouth WWTP 4/24/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 5,500 Cranston WWTP 4/25/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 6,000 Cranston WWTP 4/26/21 Buck Island 481 Buck Island Road W Yarmouth Septic 5,000 New Bedford WWTP 4/26/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 5,500 New Bedford WWTP 4/27/21 Brady Sullivan 170 Clay Pond Road Bourne Grease 3,000 Wareham 4/27/21 Mashpee Wampanoag 184 Meetinghouse Rd Mashpee Septic 6,000 New Bedford WWTP 4/27/21 Panera 790 lyannough Road Hyannis Grease 2,000 Wareham 4/28/21 The Terraces 60 Daley Terrace Orleans Septic 28,000 New Bedford WWTP 4/28/21 The Terraces 60 Daley Terrace Orleans Grease 4,100 Wareham 4/29/21 For: DH Fletcher 21 Queens Bay Ln Bourne Septic 1,500 Plymouth WWTP 4/29/21 Mashpee Commons 22 Steeple Street Mashpee Septic 10,000 Cranston WWTP Wastewater Services Inc. 1997 Bedford Street Bridgewater, MA 02324 Ph 508-697-9974 Fax 508-697-9979 jordanlotterhand(&wwsiofma.com No. . Fee � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopogar *pztem Construction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. qq6 _. W714 OOWr's Name,Address and el.No. Assessor's Map/Parcel9� Installer's Name,Add s,and Tel No. S/Jr�Tl1J� Designer's Name,Address and Tel.No. �3TrrAG n�l�, Type of Building: Dwelling No.of Bedrooms�� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 11CC hPrCtA No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date RQ3 Number of sheets l Revision Date Title Size of Se an Type of S.A.S. -5Q(JC41 li/ice Description of Soil �Z Nat Rep or Alterations(Answer when applicable) / 'P Date last inspected: n/A 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 Certifi- cate of Compliance has been issued by this Board of ealth. Signe Date-, Application Approved by Date Application Disapproved fYthifollowing reasons Permit No. Date Issued -No. ­1 t Fee 90(8 —� THE COMMONWEALTH OF MASSACHUSETTS Entered in'computer: Yes, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphration for Miopozal *pe4em Congtructiott Vermit Application-for a Permit to Construct(k )Repair( a� )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i1 11 nel", { Owner's Name,Address and lei.No. Sor- Assessor's Map/Parcel J �0 ? �1fJr v�' ` R/ ij G. n ar -* 3 i'i .J rrA -" Installer's Name,Address,and Tel.No. �, �C�j�l� /)7S�7lrr(�n Designer's`Name,Address and Tel.No. 3-TrrA<-�r l �� Type of Building: _ Dwelling No.of Bedrooms — Lot Size sq.ft. Garbage Grinder( ) Other Type of Building f>dlC �P��iq No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date l ga t 7,1) 3 Number of sheets / Revision Date Title Size of Septic Tank ,Mr1 �/?2'7 /24F Type of S.A.S. -S('Ir)rl Brie___ Description of Soil N!�e of RepaiFs or Alterations(Answer when applicable) "t-�7ne'a- Date last inspected: n/a 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 Certifi- cate of Compliance has been issued by this Board of/ealth. /J Sig ne Et,- � // Date S Application Approved by Date rr Application Disapproved or the following reasons Permit No. r Date Issued b Y i THE COMMONWEALTH OF MASSACHUSETTS �p 1� BARNSTABLE, MASSACHUSETTS- � Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandoned( )by t at ha b constructed in accordance with the provisions of itle 5 and the for Disposal System b5nstruction Permit No dated Installer Designer The issuance oAZ s pe 't shall not be construed as a guarantee that the system Weplc s c . Date O 0 Inspector ----?�—���—————————————————————— ��_ I No. O Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS. -W5pool *pgtem Construction Vermtt Permission is hereby ed t Co tr ct( iair ( )Upgrade Abandon (n( ) System located at /l /(/ i 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. Provided: Cons tion ust be ompleted within three years of the date of thiprmit Date:_ Approved by t H� 7, �— FILLJE ) GREASE TRAPS F/, F/ C g p ErT t J W N p FV.= 55.70' SLAB ELEV.= 56.76' EXISTING t 1000 GAL GREASE TRAP. b' MW-51.07- v� _ (EXl NG 8" RIPE) ,---- s4 fl � i 1 g SMN- 2 '` d"'VG E„M_ ;, .ter y e •s n t, - V v '�aerG • a A 'u de R BREAD • • � or 3 � n �yx 1 1 PANERABREAD.COM OR.GETTHE APP � y Ill t Rapid Pick Up ;. d. Avoid the line. Iek x, R . Delivery y � .3 T'o home or office. 4Y 'I aid r 1 _ • ?."ma's` �N Catering`* is x s• ,._ From office meetings to special events., r •Minimum order of$5 required for delivery,exclusive of taxes and delivery charges that may apply.OuraAcxrut 4s+. 'deliver char a is not tip or gratuity 4� .� _ fe provided to the driver.Partici Participating baker -cafes only.,Gift � - s g p g ty P n g Y Y �,purchases and catering orders excluded.brdel must be placed online with credit card.Otlmer restrictions. may apply.Delivery hours may vary.Limited delivery area.Visit www.panerabread.com to determine if you're in'delivery area or for more information." "Appordering notavailable µµ s3r _•� - Uow ilo.n c Iho GET IT ON AnPI tllh APPI 1 N 1 n k IApl Min "g151 nip Ili US loth c nines ' A � {ep�.5i` lit r l A ppSto ATre Googe PIaYl S` ci ogit retl U Vti rn"11 <rmirles +,: t • '• � tp "LZS'rCJ c"ngl nl v nurv�c"oy v � MF a n k IGong 1 c N •'`t'',a �'•^� � y,.", •4 -� ern § t s... � :a r � mrl * �'; `ay^' �' r^" A+♦+1x}'r.,y a.. 2 duU W-1:1 rah tvw.'.- 1•-sv.ul:u.W:�xu_+.IM1Ic `'. lm�'+` �, " +�-r } .' e _ Drinks StartHot Drinks Cold Drinks our day Also available in decal,iced or with skim milk. Passion Papaya Green Tea Freshly Brewed Coffee (130 1200 Cal without ice,90 1130 Cal with ice)* Light Roast(15-25 Cal).Dark Roast(15-25 Cal). 'Agave lemonade ( Hazelnut(15-25 Cal),Decaf(10-20 Cal) (1401220 Cal without ice,901150 Cal with ice)* }� Coffee calorie info based on: with �� ° 1Zfloz(Small)116Ifoz(Medium)120floz(Large). Blood Orange lemonade Caffe latte(130 Cal) (1601260 Cal without ice,1101180 Cal with ice)* Espresso and foamed milk. Prickly Pear Hibiscus Fresca Chai Tea latte(240 Cal) (1001150 Cal without ice,701110 Cal with ice)* reakfast f Brewed black tea,honey,vanilla.cardamom, Unsweetened Black Tea(0 I 0 Cal) a cinnamon,ginger and foamed milk. W t t Caramel latte(390 Cal) Plum Ginger Hibiscus Tea(010 CaU G Espresso,foamed milk and caramel topped with Soft Drinks(0-440 Cal without ice,0-2BO Cal with ice)* Freshly baked bread; f f whipped cream and caramel syrup. *Calorie into based on 20 fl oz(Regular)132 fl oz(Large). Cappuccino(130 Cal) Bottled Water(0 Cal) over.easy egg � ' ' Espresso and foamed milk with a cap of foam. JOIa°Grapefruit Soda(90 Cal) Win. 4alid sauces'to,,taste k- � "" Caffe Mocha(370 Cal) `� 'r � - Espresso,foamed milk and chocolate topped San Pellegrino° ! r # tr with whipped cream and chocolate syrup. Sparkling Water(()Cal) µ m * Signature Hot Chocolate(510 Cal) Sparkling Fruit Beverage Orange(140 Cal) with chocolate chip marshmallows Spindrift°Seltzer Bittersweet chocolate flavored syrup mixed with foamed milk and topped with whipped cream lemon(0 Cal) and salted caramel syrup. Raspberry Lime(1O Cal) , " � � T= Hot"The Republic of Tea"Teas(0 CallB fl oz) Premium Orange Juice(160 Cal) Espresso(5 Cal/shot) Strawberry Paradise Juice(260 Cal) � ' � " .+ �" " ' For an additional charge: Organic Apple Juice(120 Cal) Add a shot of espresso(5 Cal/ea.) Organic White Milk(110 Cal) Add a shot of flavored syrup(50-60 Callea.) Organic Chocolate Milk(150 Cal) Substitute almond milk(40 Cal/8 fl oz)® t € g .fir ,r � r 4 .a Fruit Smoothies With Greek Yogurt r .- - �� Frozen Drinks { t Caramel(560 Cal) Mango(290 Cal),Strawberry Banana(250 Cal), Strawberry(280 Cal),Superfruit(230 Cal) - - Mocha(530 Cal) " �.t Non-Dairy Smoothies `* Green Passion(200 Call 2.000 calories a day is used forgeneral nutrition advice, Peach and mango puree and white grape and a p, but calorie needs vary. passionfruit juice concentrates blended with fresh w d ®Contains peanuts and/or tree nuts. spinach and ice. Q Peach&Blueberry with almond milk(180 Cal) ' $= " Peach and mango purees and white grape and passionfruit juice concentrates blended with fresh ft blueberries and almond milk. WINTER 2018 14 a . Sandwiches ar. , CUMM Made with over easy egg. Bacon,Egg&Cheese(460 Cal) Avocado,Egg White&Spinach(410 Cal)Applewood-smoked bacon,over easy Egg whites,Vermont white cheddar, egg,Vermont white cheddar,salt and avocado,spinach,vine-ripened tomato, pepper on CU Brioche. salt and pepper on a Sprouted Grain Bagel Flat. Sausage,Egg&Cheese(550 Cal) Sausage,over easy egg,Vermont Steak&Egg(550 Cal)white cheddar,salt and pepper on Seared steak,over easy egg, Brioche. Vermont white cheddar,salt and pepper on an Everything Bagel. Ham,Egg&Cheese(350 Cal) _ a Egg&Cheese(390 Cal) Smoked,lean ham,over easy egg. Vermont white cheddar,salt and Over easy egg,Vermont t pepper on Whole Grain. white cheddar,salt and pepper on Brioche. ,yq ' - r Craft -your oven Sandwich Swap Your Egg: Swap Your Bread: Flavor with Sauces: =f Over Easy Egg(BO Cal) Whole Grain(140 Cal) Basil Pesto(adds 30 Cal) .. ._ � EggWhite(30 Cal) Any Bagel(240-430 Cal) Sweet Maple(adds 60 Cal) { Scrambled Egg(100 Cal) Ciabatta(230 Cal) ChipotleAioli(adds 70 Cal) y s �v � p 40 Add 0 C as* Bacon(1 a l) Sausage(160 Cal) Avocado(45 Cal) �s€'+t� 1',• (y j ` �`� Breakfast Sandwiches are available until 10 30am weekdays/Ham weekends. f di5�JpCff ...,.,,�s.s ®n. .✓ ,., .. � � � }�' 2,000 calories a day is used for general nutrition advice,but calorie needs vary. � r� • � � r arF 1�� � � r. s 'Upchargeapplies. n Breakfast Oatmeal-, Yogurt & Fruit Steel Cut Oatmeal with choice of: u � g Strawberries,pecans&cinnamon crunch topping (340 Cal)® 1 a r a 0 4 Apple chips,pecans&cinnamon crunch topping (370Cal) Almonds,quinoa&honey (300 Cal)® ,-- Greek Yogurt with Mixed Berries(300 Cal)® Seasonal Fruit Cup(60 Cal) Apple(80 Cal) 11 e" Banana(90 Cal) m Souffles Savory ingredients and egg baked in our French inspired pastry. y; four Cheese(410 Cal) Spinach&Artichoke(520 Cal) o _ Ham&Swiss(450 Cal) Spinach&Bacon(550 Cal) Souffles are available until 1030am weekdays/llam weekends. •;� ' •r `a 2.000 calories a day is used forgeneral nutrition advice. ' but calorie needs vary. ®Contains peanuts and/or tree nuts. k i Brunch at home. From this Citrus Avocado Salad made with our Poppyseed Dressing,to Maple Coffee Glazed Bacon made with our Dark Roast Coffee,Panera at Home makes it easy to pull together a menu everyone will love. rd Explore delicious meal ideas and find our 100%clean products where you shop for groceries at PaneraAtHome corn. `AW 3 PANERA BREAD, FAIRM e a e v 1✓ y Cl Panera Kids" J Mac&Cheese(470 Cal) Shell pasta in a blend of creamy cheese sauce , r and tangy Vermont white cheddar cheese. x a Cup of Soup(90-310 Cal) ; i4 ; Z F ; a Check soup schedule for daily availability. Cup of Turkey Chili(170 Cal) Hearty blend of dark meat turkey raised without antibiotics and tender beans,slow �� ,� �.� ;��•=, � ,� �, � .r !"�` � �• �-,,- �.1 a cooked with veggies and spices. T y� ^•�:,�� *-- � •� -+ �_� � ^ I r M Half Salad .. Choice of Seasonal Greens(90 Cal), Caesar(160 Cap or Greekll=(200 Cap. Peanut Butter&Jelly(370 Cal)® _ Creamy peanut butter and grape jelly on n '* Whole Grain bread. Pastries Bagels Grilled Cheese(450 Cal) ° American cheese on Classic White bread Turkey Sandwich(280 Cal) '� �>� �� �� � ��� � p,�;" & Sweets & Cream American cheese and oven-roasted turkey " breast raised without antibiotics on Whole m _ x Artisan Pastries Cheese Grain bread. Brownies ° Ham Sandwich(290 Cal) Cinnamon Crumb Coffee Cake American cheese and smoked,lean Cookies Bagel Pack Baker's Dozen ham raised without antibiotics on Muff ies 13 bagels&2 tubs of 13 bagels Whole Grain bread. cream cheese spread Muffins Half Dozen Bagels "h Scones Dozen&a Half 6 bagels *Sandwiches also available 18 bagels on Classic White Bread. Sweet Rolls % Bagels Plain(290 Cal),Sprouted Grain Flat(240 Cal),Whole Grain(330 Cal), All items Served with choice of: Everything(300 Cal),Sesame(300 Cal) Bakery Organic Yogurt(50 Call Specialty Bagels I Apple(BOCa0 Freshly Baked Bread Cranberry WalnutMZOM(350Cal)®,Chocolate Chip(309Cal), Baguette(180 Cal) French Toast(350 Cal),Blueberry(349 Cal),Cinnamon Swirl&Raisin(320 Cal), Sprouted Grain Roll(170 Cal) Asiago Cheese Focaccia Honey Wheat Cinnamon Crunch(430 Cal),Asiago Cheese(330 Cal) Need more options?Order a half portion of any Asiago Cheese RyeBrioche Rolls Sea Salt Focaccia Cream Cheese Spreads salad or sandwich from our regular menu. Calories for 8 oz tubs are for 1 oz serving size. Ciabatta Sesame Semolina 2,000 calories a day is used for general nutrition advice, " Cinnamon Raisin Swirl Sourdough Calories for individual cups are for 2 oz serving size. but calorie needs vary. '` Classic White Sourdough Bread Bowls Plain(100/190 Cal) ®contains peanuts and/or tree nuts. Country Sprouted Grain Rolls Reduced-Fat:Plain(70/130 Cal),Chive&Onion(70/130 Cal), French Baguette Whole Grain Wild Blueberry(80/150Cal).HoneyWalnut(80/150Cal)®, t Hoagie Roll Tomato Basil Roasted Vegetable Medley(601110Cal) °A ., 2,000 calories a day is used for general nutrition advice,but calorie needs vary. ®Contains peanuts and/or tree nuts. Ali ANERABREAO� � WINTER201B 4 f 0A r sandwiches Individual half and whole cold sandwiches served with a pickle(5 Cal). Global flavors are Roasted Turkey,Apple&Cheddar Chipotle Chicken Avocado Melt Napa Almond Chicken Salad back b the bowlful. (half Cal I whole 710 Cal)® (half 390 Cal I whole 110 Cal) (half 350 Cal I whole 700 Call Roasted turkey raised without Smoked,pulled chicken raised Chicken raised without =f antibiotics.Vermont white without antibiotics,smoked antibiotics tossed with diced With fresh greens,savory umami broth,and cheddar,freshly made apple Gouda,avocado,fresh cilantro, celery,seedless grapes,toasted and cabbage slaw,arugula zesty sweet PeppadeWT almonds and special dressing, plenty of choices so you can eat the way you want, and mustard horseradish piquant peppers and chipotle and served with lettuce, from chicken to vegetarian to vegan. sauce on Whole Grain mayo on Black Pepper vine-ripened tomatoes,salt " Cranberry Walnut bread. Focaccia bread. and pepper on Sesame b 4 Steak&Arugula Tomato Mozzarella Flatbread Semolina bread. (half 250 Cal I whole 500 Cal) (one 350 Cal I two 690 Cal) Classic Grilled Cheese Seared steak,arugula,vine- Fresh mozzarella,vine (half 320 Cal I whole 640 Cal) ripened tomatoes,pickled p P ripened tomatoes,arugula, American cheese on Classic onions, arlicandherbcream g tomato sofrito,nut-free White bread. cheese spread,mustard basil pesto and freshly r horseradish sauce,salt and squeezed lemon juice on Mediterranean Veggie N +,„ $ pepper on Sourdough bread. Whole Grain Flatbread. (half 220 Cal I whole 440 Cal) V0� _ Zest sweet Pe adeWTM m teak&White Cheddar Panini y pp y, s S BBQ Chicken Flatbread piquant peppers,feta, ti. 940 C (half 470 Cal I whole al) (one 380 Cal I two 760 Cal) cucumbers,lettuce,vine Seared steak,Vermont white d tomatoes red • - = ., Smoked,pulled chicken ripened onions, cheddar,pickled red onions raised without antibiotics, cilantro jalapeno hummus, and horseradish sauce on a salt and pepper on Tomato Hoagie Roll. mozzarella,smoked Gouda,spinach,fresh cilantro, Basil bread. t ¢ Red Turkey&Avocado BLT frizzled onions and BBQ sauce Roasted " (half Cal I whole 640 Cal) on Whole Grain Flatbread. Turkey (half 280 Cal I whole 560 Cal) Roasted turkey raised without Frontega Chicken Panini° Oven-roasted turkey breast "., antibiotics,applewood-smoked (half 380 Cal I whole 150 Cal raised without antibiotics ���Br1 oth Bowls bacon,lettuce,vine-ripened �'�" Smoked,pulled chicken raised lettuce,vine-ripened tomatoes, ` tomatoes,avocado,mayo,salt red onions,mayo,spicy mustard, Ad without antibiotics,mozzarella, Y P Y d Half Salad,Half Sandwich,Cup of Soup and pepper on Sourdough• vine-ripened tomatoes,red salt and pepper on Whole or One Flatbread for an additional charge. bread. onions,fresh basil and chipotle Grain bread. Soba Noodle with Chicken 390 Cal lentil i The Italian mayo on Focaccia bread. Tuna Salad ( ) u noa with Cage-Free E 360 Ca l) Q 9 99( ) half 440 Cal whole 880 Cal 0 - ( I ) I I Bacon Turkey Bravo (half 330 Cal I whole 660 Cal) Chicken raised without antibiotics,Soba Cage-free hard-boiled egg,organic quinoa and Smoked,lean ham,Chianti y noodles,fresh spinach,napa cabbage blend, brown rice,lentil blend,tomato sofrito,fresh kale (half 310 Cal I whole 630 Cal) Special recipe tuna salad, roasted mushroom and onion blend,sesame and spinach with a lemon wheel in our umami wine salami,spicy sopressa, lettuce,vine-ripened provolone,arugula,s Oven roasted turkey breast p seeds and cilantro in our umami soy-miso broth. soy-miso broth. ar is,� g spicy raised without antibiotics, tomatoes,red onions,salt giardiniera and basil mayo on applewood-smoked bacon, and pepper on Black Pepper Soba Noodle with Edamame Blend(380 Cal) Vegan LentilQuinoaCM(280 Cal) a Hoagie Roll. smoked Gouda,lettuce,vine- Focaccia bread. Edamame blend,soba noodles,fresh spinach, Organic quinoa and brown rice,lentil blend, ripened tomatoes,signature napa cabbage blend,roasted mushroom and tomato sofrito,fresh kale and spinach with Ham&Swiss onion blend,sesame seeds and cilantro in our a lemon wheel in our umami soy-miso broth. sauce,salt and pepper on (half 370 Cal I whole 730 Cal) umami soy-miso broth. , Tomato Basil bread. Smoked,lean ham raised Lentil Quinoa with Chicken(390 Cal) All items served with choice of: All items served without antibiotics,Swiss, Chicken raised without antibiotics,organic Baguette(180 Cal) with choice of: lettuce,vine-ripened tomatoes, Sprouted Grain (110 Cal) red onions,mayo,spicy quinoa and brown rice,lentil blend,tomato Baguette(180 Cal) 2,000 calories a day is used for mustard,salt and pepper on sofrito,fresh kale and spinach with a lemon Chips(150 Cal) Sprougeneral nutrition advice,but wheel in our umami soy-miso broth. Apple(BO Cal) Chips1(16 0 Cal)Grain B011(110 Cal) calorie needs vary. Whole Grain bread. _ Chips Apple(BO Cal) ®contains peanuts 2,000 calories a day is used for general nutrition advice,but calorie needs vary. and/or tree nuts. 5 PANERA BREAD a WINTER 201810 �u. k Soups Available in a Cup,Bowl a , , or freshly baked Sourdough Bread Bowl. �y m=low-far O=Vegetarian EVERYDAY SOUPS SUN/TUES/THUR/SAT Black Bean m 0[0=(90-760 Cal) Cream of Chicken&Wild Rice 1 ' r Black beans simmered in a spicy (180-840Cal) •_n V vegetarian broth with onions, Diced chicken,long grain and red bell ! pepper,garlic and cumin. wild rice,celery,onion and carrots Chicken Noodlem(110=780 Cal) simmered in chicken Urdth with cream and select herbs. " Fresh carrots,onion and celery simmercd with all-white meat MON/WED w .w chicken breast in seasoned chicken Baked Potato(220-890 Cal) broth with traditional egg noodles. Russet potatoes simmered "m Y� a• `"" s b 114 "+ Broccoli Cheddar(230-900 Cal) with smoked bacon in seasoned . „ " + s Chopped broccoli,shredded cream sauce with spring onion c Pp r ,sf a' ^`� � ' r d and chives. carrots and select seasonings < .• `�x! 4 r = �` w. •+ simmered in a velvety smooth F R DAY r w i r tS, h cheese sauce. New England Clam Chowder Creamy Tomato O(200-860Cal) (310-1040Ca1) ?=„ramk Pureed,vine-ripened pear t Chopped sea clams,potato,celery tomatoes and fresh cream w ith hints of red pepper and oregano, and onion simmered in seasoned, a ;. pp creamy broth. 4 to ed with housemade Black Pepper Focaccia croutons. x n '�� �.► *fir/ F Bistro French Onion 0 9 0-8 6 0 Cal) onions in a savory broth AA yu"�a•�� � with a sherry wine vinegar - gastrique and sea salts,topped with gruyere and housemade Black Pepper Focaccia croutons. Turk hili Heart Cble(nd 0of d O k m)eat turkey raised without antibiotics and �Po tender beans,slow cooked with veggies and spices. r Pasta & Mac Chicken Tortellini Alfredo(750 Cal) Mac&Cheese Add Half Salad,Half Sandwich, (small470 Cal/large 950 Cal) Cup of Soup or One Flatbread Shell pasta in a blend of creamy a ermont `r 3 white cheddar cheese for an additional charge. cheese sauce and tangy V Tortellini pasta filled with three- s cheeses,tossed inalf redo sauce „� "�- ,� � �• and topped with smoked,pulled 3 ..,&W + chicken raise 43 k . . ..� r k d without antibiotics and parmesan. cap 2.000 calories a day is used for general nutrition advice,but calorie needs vary. WINTER2010 6 Q 9 t © � salads Southwest Chile lime Ranch with Chicken Spicy Thai with Chicken a (half 320 Cal I whole 650 Cal) (half 260 Cal I whole 510 Cal)® Smoked,pulled chicken raised without Chicken raised without antibiotics, antibiotics,romaine,arugula,adobo romaine,fire-roasted edamame, . corn blend,quinoa tomato sofrito blend, red pepper and carrot blend,fresh Half Salad fresh cilantro and masa crisps tossed in cilantro,roasted cashew pieces and freshly made chile lime rojo ranch and wonton strips tossed in low-fat ' topped with feta and avocado. Thai chili vinaigrette and drizzled Half Sandwich :n with peanut sauce. Ancient Grain&Arugula with Chicken (half 200 Cal I whole 400 Cal) Caesar with Chicken 1 k Chicken raised without antibiotics, (half 220 Cal I whole 450 Cal) Cup of Soup p ,` our ancient grain blend,arugula,red Chicken raised without antibiotics, r grapes and fresh apple and cabbage romaine,parmesan and housemade slaw tossed in sweet white balsamic Black Pepper Focaccia croutons 1�z -Small Mac&Cheese ° vinaigrette and topped with roasted tossed in Caesar dressing. r r � p and salted pumpkin seeds. Asian Sesame with Chicken One Flatbread Green Goddess Cobb with Chicken (half 200 Cal I whole 410 Cal)® (half 280 Cal I whole 550 Cal) Chicken raised without antibiotics, " Chicken raised without antibiotics, romaine,cilantro,toasted almonds, arugula,romaine,kale and radicchio sesame seeds and wonton strips ` blend,vine ripened tomatoes and tossed in Asian sesame vinaigrette. pickled red onions tossed in freshly ., tw ,: y made Green Goddess dressing and Caesar ' y � _f topped with avocado,bacon and cage (half 160 Cal I whole 320 Cal) free hard-boiled e gr 99 Romaine,parmesan and housemade Black Pepper Focaccia croutons tossed in + ) 141 Modern Greek with Quinoa Caesar dressing. '�� ' ' ,6 (half 260 Cal I whole 530 Cal)® r s'iq Quinoa tomato sofrito blend,romaine Seasonal Greens , � '" rf„� �, rk °� ' • � , � �� � s kale,cucumbers and kalamata olives (half 90 Cal I whole 180 Cal) ' tossed in Greek dressing and topped Arugula,romaine,kale and radicchio with feta and toasted almonds. blend,vine-ripened tomatoes,red onions and cucumbers tossed in reduced-fat Fuji Apple with Chicken balsamic vinaigrette. i (half 280 Cal I whole 570 Cal) Greek Chicken raised without antibiotics, " z aru ula romaine kale and radicchio (half 200 Cal I whole 390 Cal) ^ x 9 ened tomatoes, Romaine,vine-ripened blend,vine-ripened tomatoes, p red onions,toasted pecan pieces, feta,red onions,kalamata olives, , Gorgonzola and apple chips tossed in pepperoncini,salt and pepper „ sweet white balsamic vinaigrette. tossed in Greek dressing. ; V 2,000 calories a day is used for general A 1 items served with choice of: 1 1 l 1���1 � Inform ation nutrition advice,but calorie needs vary. " Baguette(180 Cal) * " ®Contains peanuts and/or tree nuts. ' Sprouted Grain A011(110 Cap Many of our products contain or may come into contact with common allergens, Chips(150 Cal) �= including wheat,peanuts,soy,tree nuts,milk,eggs,fish and shellfish.Before placing Apple(80 Cal) your order,please inform your server if a person in your party has a food allergy so y that a manager can,at your request,provide you a list of ingredients in your order. Additional nutritional information is available upon request and at PaneraBread.com. �y Menu subject to change without notice. r s 7 PANERABREAO 4 _ WINTER2010 8 t - C e a x4� 4 i � _ erz , 4 _ s . K F v Zi c a a Save time when you order online,and get back to what's important. We'll save your info to save you time. ' Ir Re-order from past orders,save our a , P Y payment and billing info, 3 7 •i 1, �i and save your cart so you can order at your leisure. r; Create the perfect menu. ®® Customize our assortments,add or remove ingredients and more to keep your guests happy. Easy to navigate. `? c A clean look for fast and easy ordering. 4' e''Order on the go. Do Place and track orders easily from your phone or tablet,too. PaneraBreadcom FAST&EASY ORDERING Prices exclude tax and may vary. ONLINE AT PANERABREAHOM wsmnue�c.roeeecn,r�otc�noey Menu subject to change without notice. , r,om��,s�>,.,�.e,.wre.m DELIVERY AVAILABLE ©2017 Panera Bread.All Rights Reserved. r ,,.,, v Sandwich Assortments Boxed Lunches Half Sandwich;Half Salad Boa Deluxe Assorted' s 83.99 Sandwicc Signatuie, 13.Box Cafe(90-200 Cal) 11.99, r _ a . Pre iniu Meet Eat Enjoy' , _ " 09 (200-3 0 tulgs " AssortedSandwi' m. A , * �: Signature' '11.99 (200-320 Cal) ,+1.75 ` From office mee' to< * � . � � " •, 6 Cafe, tore"(2 - `+_12 k ches 0.99 e � - 10.99 Signa ,: 00 280 Cal) O corporate conferences.client i o F.fi _, 9 q - +r Salad Bos *additional ch arge a to the calls to special events,Parlera t Premium Signature ,, See above for half salad calories •. Cate makes ;1 easfr ` m (400-650 Cap •. . 13.09 �Takes P�g y �� Signature(410-570 Cal)"� 11.99 See pp.6-7 for assortment = n and stress-free fora deliciously �,: . , t Cafe(180-390 Cal) 10.99 descriptions. W a, a successful meal: �. ° � ° : � , ��: ' •��- �. � „� � Sandwiches Salads -�•�a-. � � _� � ,� � ,.,,,. � ,,;q", " �� }�^��,��' � 4 Premium Signature Premium Signature , " " g The Italian Ancient Grain&Arugula with Chicken (half 440 Cal/whole 880 Cal) (3110 Cal) 62.99 Steak&Arugula Green Goddess Cobb with Chicken a, _ (half 250 Cal/whole 500 Cal) (2550 Cal) 62.99 #�'gu � ,.• '4, 1 Roasted Turkey,Apple&Cheddar® Southwest Chile Lime Ranch with Chicken (half 360 Cal/whole 710 Cal) (3350,CaD 62.99 Roasted Turkey&Avocado BLT Signature L (half 320 Cal/whole 640 Cal) Asian Sesame with Chicken®(2170 Cal) 60.99 Signature Modem Greek with Quinoa®(4730Cal) 60.99 * Napa Almond Chicken Salad® Fuji Apple with Chicken®(2790 Ca l) 60.99 (half 350 Cal/whole 700 Cal) Spicy Thai with Chicken®(2700 Cal) 60.99 ' Bacon Turkey Bravo® Caesar with Chicken(2220 Cal) 60.99 (half 310 Cal/whole 630 Cal) Cafe Cafe ^ Caesar(1570 Cal) 47.50 k Turkey Seasonal Greens(1040 Cal) 47.50 (half 220 Cal/whole 430 Cal) Sferra hhrke Greek(4400 Cal) 47.50 y i N1, t r (half 370 cal/whole 730 Cal) Ham&Swiss SideOptions Potato Chips(150 Cal/bag),Baguette (half 300 Cal/whole 610 Cal) (1080 Cal),Pickle Spear(5 Cal/ea.),Piece of Mediterranean Veggie Baguette(180 Cal),Apple(80 Cal) ,(halfSalad �2oca I/whole 440 cal) Ordering is easy. (half 330 Cal[whole 670 Cal) lO Order online at PaneraBread.com or call a Catering Coordinator. Soups&Pasta Drinks O Choose delivery or pick-up. Soup for a Group(320-1300 Ca l) 15.39 Passion Papaya Green Tea Turkey Chili(610 Cal) 20.39 (900 Cal/tote) 10.59 Select a date and time. Mac&Cheese(1890 Cal) 20.29 Agave Lemonade(980 Cal/tote) 10.59 Sweets Iced Tea(O Cal/tote) 10.59 ® Tell us how many guests will be there. Brownies(520 Cal/ea.) 15.79 Premium Orange Juice(1780 Cal/tote) 16.99 Cookie Assortment 13.69 Coffee(110-140 Cal/tote) 15.99 O Triple Chocolate with Walnuts®(320Cal/ea) Hot Tea(0 Ca Vtote) 15.99 5 Customize a menu that you and your guests will love.. Chocolate Chipper(380 Cal/ea.) Signature Hot Chocolate(4760 Cal/tote) 15.99 Lemon Drop(440 Cal/ea.) Spmdnft®Seltzer Lemon + Candy Cookie(420 Cal/ea.) (0 Cal/12 fl oz) 2.69 ea. For same day orders,give our Catering Coordinators a call to see how we can help. SpindriftO Seltzer Raspberry Lime Oatmeal Raisin with Berries(340 Cal/ea.) Raspberry Almond Thumbprint®(230 Cal/eaJ (10 Cal/12 fl oz) 2.69 ea. Cookies&Brownies 14.79 San Pellegrino®Sparkling Water Cancellations must be made 4 hours prior to pick-up or delivery time.If cancelling an online order, (0 Cal/16.9 fl oz) 2.69 ea. please call the bakery-cafe.Cancellation charges may apply Petite Cookies(100 Cal/ea.) 5.29 Bottled Water(0 Cal/16.9 fl oz) 2.19 ea. Cinnamon Crumb Coffee Cake 15.79 (470 Cal/serving) Pepsi-Cola Beverages Pastry Ring(3030 Cal) 9.09 12 fl oz can(0-150 Cal) 1.50 ea. 2-Liter bottle Mini Scones Variety Pack-Wild Blueberry (0-150 Cal/12 fl oz.serves about 6) 3.19 ea. (150 Cal/ea.),Orange(180 Cal/ea.) 7.09 PmeraBrea&com ®Contains peanuts and/or tree nuts 15 Menu Reference Guide Breakfast Assortments * Morning continental 4 54.59 Bagels&Morning Pastries 29.49 Earn rewards with every purchase. Morning Pastries' "' 29.49 Bagel Pack 15.99"' ,Join MyPanera®and start earning$20 in Rewards for every$500 you spend on r assortm See pp.4-5 for ent descriptions.° catering.Learn more at PaneraBreadcom/CateringRewards. Pastries Bagels Cinnamon Roll(670 Cal) Plain(290 Cal) planning a large event? Cobblestone(560 Cap Sprouted Grain Fiat(240 Cal) Pecan Roll®(720 Cap Whole Grain(330 Cap Our team of expert sales managers are here to help with planning for your large Bear Claw(&)(550 Cap Everything(300 Cap group event(100 or more).Whether its local,multi-state or national,we can help. Pecan Braid®(470 Cal) Sesame(300 cal) R Visit PaneraBread.com to learn more. Cheese(410 Cap ' Chocolate(420 Cap Specialty Bagels Chocolate with topping*(460 Cap Cranberry Walnut(?)(350 Cap We deliver. Cherry(460 Cap Chocolate Chip(380 Cap French Croissant(31 O Cap French Toast(350 Cap You've got enough on your plate.We'll bring your order right to your event *Available in select markets. Blueberry(340 Cap Cinnamon Swirl&Raisin(320 Cap Scones Cinnamon Crunch(430 Cap Cinnamon Crunch(550 Cap Asiago Cheese(330 Cap Change(540 Cap f s Wild Blueberry(460 Cap Cream Cheese Spreads Caramel Apple Thumbprint(490 Cal) Plain(100 Cal) Reduced-Fat: Muffins Plain(70 Cap ; «# Blueberry Muffin with Chive&Onion(70 Cap ` 4 Fresh Blueberries(460 Cal) Wild Blueberry(80 Cal) Cranberry Change(480 Cap Honey Walnut®(80 Cap • $# Pumpkin(580 Cal) Calories for 8 oz tubs are for 1 oz serving size. Apple Crunch(450 Cap m. • M 5.,r'�Wy,. Muffies Chocolate Chip(320 Cal) � Pumpkin(290 Cal) * 1�4 11­1'46k " ., Breakfast Favorites Breakfast Sandwiches r n Seasonal Fruit Bowl Made with your choice of scrambled egg ort Large-Serves 10(790 Cap 34.99 over easy egg. ?. t •,£.s s <:I Small-Serves 5(390 Cap 24.99 Bacon,Egg&Cheese(470 Cal/460 Cap 4.99 Greek Yogurt with Mixed Berries® Sausage,Egg&Cheese(570 Cal/550 Cap 4.99 (300 Cal/ea.) 27.29 Egg&Cheese(410 Cal/390 Cap 4.19 Steel Cut Oatmeal 4.69 Ham,Egg&Cheese(370 Cal/350Cal) 4.99 • ` .» with choice of: Avocado.Egg White&Spinach(410 Cap 4.99 ��; - • � �•-_ �;.„ •strawberries,pecans and cinnamon Steak& ry l �M Egg(570 Cal/550 Cap 5.49 +e _ crunch topping(340 Cap •apple chips,pecans&cinnamon crunch topping(370 Cap Breakfast Sandwich Sauces •almonds,quinoa and honey(300 Cap Basil Pesto(45 Cal/serving) Sweethlaple(80 Cal/serving) Souffles C 'ChipotleAioil(90 Cal/serving) 1 � . • �' Four Cheese(410 Cap 4.69 Sauces served in bulk container on the side for 10 sandwiches. ' • _ „ Ham&Swiss(450 Cal) 4.69 !r Spinach&Artichoke(520 Cal) 4.69 .� Spinach&Bacon(550 Cap 4.69 2.000 calories a day is used for general nutrition advice,but calorie needs vary 1 ®contains peanuts and/or tree nuts '` 5 x m s Earn$20 in Rewards for every$500 �. you y spendon catering. Here's how it worksiviernber card �.4 Join MyPanera. " �' N' • F • `"'� � Sign up at PaneraBread.com. _ n �. Order catering. Be sure to use your MyPanera account - - rr Get rewarded. Use your rewards on catering orders or individual orders just for you. BreaMast Assortments Learn more at PaneraBreacl mm/Cateringllewards it Morning Continental® Bagels&Morning Pastries An assortment of 4 freshly baked bagels and An assortment of 4 freshly baked bagels and �r-� 6 pastries.Served with cream cheese spread. 6 pastries served with cream cheese spread, i o butter and preserves,plus orange juice and butter and preserves.Serves 8-10. I coffee.Serves 8-10. •Plain Bagel •Cheese Pastry r' _^ •Plain Bagel •Cheese Pastry •Asiago Cheese •Chocolate Pastry Ywl •Asiago Cheese Bagel •Chocolate Pastry Bagel •Cinnamon Roll •Everything Bagel •Pecan Roll® •Everything Bagel •Orange Scone E :. •Cinnamon Crunch •Cinnamon Roll •Cinnamon Crunch •Blueberry Bagel •Blueberry Bagel Muffin with Fresh •French Croissant Muffin with Fresh •French Croissant Blueberries ' " ; Blueberries Bagel Pack Morning Pastries® Your choice of 13 freshly baked bagels with An assortment of 10 pastries served P 2 tubs of cream cheese spread. - with butter and preserves.Serves 8-10. .; • _ •Cinnamon Crunch •Cinnamon Roll Scone •Orange Scone French Croissant •Apple Crunch , •Bear Claw(4) Muffin v »''!� Y +' •Cheese Pastry •Blueberry • ' •Chocolate Pastry Muffin with Fresh _' - ' •Pecan Roll ® Blueberries c 2,000 calories a day is used for general nutrition advice,but calorie needs vary - - ®Contains peanuts and/or tree nuts _ " Oatmeal,Yogurt&Fruit Breakfast Sandwiches Seasonal Fruit Bowl®cc Made with your choice of An assortment of fresh fruits. scrambled egg or over easy egg. E ' , t• z* Large-Serves 10 Small-Serves 5, Bacon, &Cheese Applewood smoked bacon,egg, t i' �i. ,` 4 y Greek Yogurt with Mixed Berries®cc® Vermont white cheddar,salt and - ,; a • A pack of 10 individually portioned Greek pepper on 10 Brioche. r. yogurt parfaits with honey,maple butter pecan granola and fresh strawberries Sausage.Egg&Cheese t " f.' ,', ^� • and blueberries. Sausage,egg,Vermont white cheddar, salt and pepper on[W Brioche. .tu ®O Steel Cut Oatmeal cc® with choice of: Egg&Cheese f •strawberries,pecans and • ' ' ,, 'F j"9`'','�� ,"' n Egg,Vermont white cheddar,salt and � z cinnamon crunch topping .•,�C� ram. + Mid r +° t �"� ; •apple chips,pecans and pepper on Brioche. 4.,,� U � cinnamon crunch topping Ham Egg&Cheese ' •almonds,quinoa and honey Smoked,lean ham,egg,Vermont white : • �, cheddar,salt and pepper on r ic• • >= Whole Grain. , • ,.� � � � �m. , Bagels&Cream Cheese Kf{ Avocado,Egg White&Spinach Specialty Bagels® Egg whites,Vermont white cheddar, ` Cranberry Walnut ®,Chocolate avocado,spinach,vine-ripened tomato, Chip,French Toast,Blueberry,Cinnamon Swirl salt and pepper on a Sprouted Grain &Raisin,Cinnamon Crunch,Asiago Cheese Bagel Flat. Brownies Petite Cookies Bagels® Steak&Egg �J A pack of 5 Double Fudge Brownies. A pack of 12 petite Chocolate Chippers. Plain,Sprouted Grain Flat,Whole Grain, Seared steak,egg,Vermont white W Cookies Cinnamon Crumb Coffee Cake Everything,Sesame cheddar,salt and pepper on an �I 1Everything Bagel. VJ An assortment of 7 freshly baked cookies. An old-fashioned butter coffee cake swirled Cream Cheese Spreads®cc Your choice of: with cinnamon and finished with a butter Plain s U •Triple Chocolate with Walnuts cc ® crumb topping.Serves 10. •Chocolate Chipper Reduced Fat: C'Fl vorwith our saucev. -Lemon Drop Fre shly y,bRaked,fluted ring with cherry and :Chive&Onion BasiSwel?e Maple .. Plain •Candy Cookie g le •Oatmeal Raisin with Berries apple fruit fillings and our special recipe Wild Blueberry „ Raspberry Almond Thumbprint cheese filling.Serves 12. •Honey Walnut® ,.Chipotle Aioli,® • ® Sauces served on the side. " Mini Scones Variety Pack Cookies&Brownies Nine freshly baked mini scones,including SoufflLss An assortment of 4 freshly baked cookies r; and 2 Double Fudge Brownies. 6 Wild Blueberry and 3 Orange. F + I . Savory ingredients and egg baked in our French-inspired pastry.' Four Cheese Ham&Swiss q�r 2,000 calories a day is used for general nutrition advice,but calorie needs vary. Spinach&Artichoke® - SpLnach&Bacon Additional nutrition information available upon request. Menu varies by location,check with your local bakery-cafe for item availability See pp. 14-75 for pricing and calorie information. ®Contains peanuts and/or tree nuts ®Contains peanuts and/or tree nuts 12 O ' Sandwich Assortments Signature Salads Cafe Salads (� Make ordering easy with an assortment of our most popular sandwiches,packed together and Servesl0. Servesl0. U—I ready to serve.Or,customize your selection of sandwiches,salads and cookies to fit your needs. Caesar Deluxe Assorted Sandwiches Assorted Sandwiches 7 Romaine,parmesan and housemade Assortmentof 10 half sandwiches Assortment of 10 half sandwiches(5,whole ' Black Pepper Focaccia croutons tossed E4--) ' in Caesar dressing. (5 whole sandwiches sliced irkhalf), sandwiches sliced in half),individually ee, ` individually wrapped and labeled wrapped and labeled Serves 5 7." �" Serves 5. T � Served with: Served with: •5 bags of potato chips . *` r n "•choice of any Cafe Salad to share t `J J • � � � � , �. •5 pickle spears :�'" _•-' � 5 bags of potato chips fN 5 pickle spears. Q a See selections on the following pages: ah assortment of 5 cookies •Sandwiches AsilanSesamewithChicken pp 8-9 Chicken raised without'antibiotics •freshly baked Baguette r.. •Salads pp.10-11romaine,cilantro,toasted'almonds *' 4 •Cookies p. 12 es ti same seeds and wonton strips tossed 0 a additional charge vinaigrette 9 ~ �—I �i Salad upyrade available for an,,, n'Asian sesame� p.. w �. . s � � Seasonal Greens �ec Modern Greek with Quinoa®c� ® Arugula romaine kale and radicchio",. blend,,vine ripened tomatoes red onions Quinoa tomato sofrito blend,romaine, ,",.r and diced cucumbers tossed with kale,diced cucumbers and kalamata � - a „- � olives tossed in Greek dressing and reduced fat balsamic vinaigrette.. e f topped with feta and toasted almonds. See pp. 14-15 for pricing and calorie information. Fuji Apple with Chicken Greek 0 2,000 calories a day is used for general nutrition advice,but calorie needs vary. Chicken raised without antibiotics, Romaine,vine-ripened tomatoes,feta, arugula,romaine,kale and radicchio red onions,kalamata olives,pepperoncini, #. blend,vine-ripened tomatoes,red onions, salt and pepper tossed in Greek dressing. " = toasted pecan pieces,Gorgonzola .R and apple chips tossed in sweet white All salads served with freshly - balsamic vinaigrette. baked Baguette. Spicy Thai with Chicken Chicken raised without antibiotics, ( .. romaine,fire-roasted edamame,red pepper and carrot blend,fresh cilantro, roasted cashew pieces and wonton strips tossed in low-fat Thai chili vinaigrette and 4 A Z r drizzled with peanut sauce. Caesar with Chicken 1-41 Chicken raised without antibiotics, p - a romaine,parmesan and housemade black .01 pepper focaccia croutons tossed with 1 Caesar dressing. a a ' See pp.14-15 for pricing and calorie information. r (4)Contains peanuts and/or tree nuts ` Boxed Lunches Cold Drdik Totes i ,++w', Your favorite lunch item packed in its own Serves i0. box,labeled for your convenience and , " ' baked cookie. side and freshly Passion Pa a pays Green Tea Agave Lonade a a F Iced Tea a rs= ". - .• s�..�.., em ,a . x Premium orange Juice A Hot Drink Tote ft (f] elllll1111 SllatliYe Green Goddess Cobb with Chicken �c C� Chicken raised without antibiotics, Servesl0. Salads ;, _ Coffee arugula,romaine,kale and radicchio � 4 a blend,vine ripened tomatoes and pickled x 4' 'Hot Tea r—� Servesl0. red onions tossed in freshly made Green Th Goddess dressing and topped with g +Y Signature Hot Mocolate .�_ • . fi ' `, ,a Marshmallows. ate Chip 77 avocado,bacon and cage-free Served with Chocol khard-boiled egg. N - .;k + Y .; Sandwich Box Served with a whole sandwich a bag of Individual Be Verages pbtato chips a pickle spear and a cookie. , Spmdrift®Seltzer', Salad Box Lemon Raspberry Lime s Served with a whole salad piece of San Pellegrino*Sparkling Water' Baguette and a cookie. Bottled Water Half Sandwich,Half Salad Box Pepsi-Cola Beverages - �. 12 fl oz cans and 2-1_iter,;Bottles IL Served with a half sandwich,half salad. ` $ ° piece of Baguette and a cookie. - available Ancient Grain&ArngWa with Chicken raisedChicken without antibiotics,our ' Southwest Chile Lime Ranch ancient grain'blend,arugula,red grapes r +, �� and fresh apple and cabbage slaw tossed with Chicken Gc � �. -- �� ' � � � ��4 a • •» in sweet white balsamic vinaigrette and Smoked,pulled chicken raised without�.. m # pumpkin seeds. hlend,quinda tomatorugula;adobo corn ° „"',� , • �`��,k i � ,.•�, � � � �,,,,p " „sofrilo blend,tresh topped with roasted and salted antibiotics,romaine.a cilantro and masa cusps tossed in freshly with d feta lle and alimeroao ranch and topped do. " w .w m Food Allergies Many of our products contain or may come into contact with common allergens,including wheat, peanuts,soy,tree nuts,milk,eggs,fish and shellfish.Before placing your order,please inform your 3 �'��• `4. �. q ,�,-�,��,, f ,a. server if a person in our art has a food allergy so that a manager can,at our request,provide a� Y party 9 9 Y 9 p a a ""'►��q.W �" � ,�"� � i''" you a list of ingredients in your order 2,000 calories a day is used for general nutrition advice,but calorie needs vary. (f Premium Signature Roasted Turkey,Apple&Cheddar® Signature Sandwiches Cate Sandwiches W Sandwiches Roasted turkey raised without antibiotics, Vermont white cheddar,fresh apple Napa Almond Chicken Salad® Turkey r and cabbage slaw,arugula and mustard Chicken raised without antibiotics tossed Oven-roasted turkey breast raised r » , horseradish sauce on Whole Grain with diced celery,seedless grapes,toasted without antibiotics,lettuce,vine ripened Cranberry Walnut. almonds and special dressing,served with tomatoes,red onions,salt and pepper on lettuce,vine-ripened tomatoes,salt and Whole Grain. pepper on Sesame Semolina. Sierra Turkey - � ` Oven-roasted turkeybreast raised without _ rT" ,; U, c antibiotics,field greens,red onions,and chipotle mayo on Asiago Cheese Focaccia. r 1 «a+ T "+'' r Ham&Sviise �- A4 `. Smoked,lean ham raised without t, TheItalian antibiotics,Swiss,lettuce,vine-ripened M tomatoes,red onions,salt and e Smoked lean ham Chianti wine salami. pepper on Whole Grain. spicy,sopressa,provolone,iarugula. g spicy giardiniera and basil mayo on Roasted Turk &Avocado BLT Mediterranean Veggie a Hoa ie Roll. ` Roasted turke raised without antibiotics, Y Zesty sweet Peppadew'"'piquant peppers, applewood smoked bacon lettuce vine a feta,cucumbers,lettuce,vine-ripened a Steak& ripened tomatoes avocado pure mayo, Bacon'1�rkeyBravo® .p tomatoes,red onions,cilantro-jalapef Seared steak,arugula,vine-ripened tomatoes,pickled onions,garlic and salt and pepper on Sourdough. .R aOven roasted turkey breast raised without hummus,salt and pepper on Tomato Basil. antibiotim applewood-smoked baconrw, herb cream cheese spread,mustard r N 'smoked Gouda,lettuce,vine ripened Tuna Salad horseradish sauce,salt and pepper tomatoes signature sauce salt and pepper'i on Sourdough. ,4 , : Special recipe tuna salad,lettuce,vine on Tomato Basil. ripened tomatoes,red onions,salt and - -vL pepper on Whole Grain.P a soup , r ePPe Soup fora Group 'Mayo and spicy mustard provided on the side. "A tight lunch or a hearty addition to a luncheon buffet 7.• Y # Served with 4 pieces of freshly baked Baguette Serves 4. ; Catered to everyone. Turkey`=U I I � O. Hearty blend of dark meat turkey raised without Vegetarian - To qualify for our vegetarian category,each item must not include meat,fish and shellfish.Milk a antibiotics and tender beans;slow cooked with , veggies and spices.Served with 4 pieces of and egg products,and enzymes or rennet from animal sources are allowed. freshly baked Baguette: Gluten Conscious p 3 r - Serves 4. 9 likelihood of cross-contamination our bakery-cafe environment,this list is $"� a le for people with Celiac Disease,a heightened gluten sensitivity or a wheat allergy. t ,,, """ � Given the suitable Y -- Pasta 6 � w �.' � t ®Nut Allergy 'Mac&Cheese 4211 .$ Contains Peanuts and/or Tree Nuts. rss Shell pasta in a blend of crearriy cheese sauce } and tangy Vermont white cheddar cheese. Also,check out our Eat Well,Your Way Menus at PaneraBread.com for additional dietary ideas Served with freshly baked Baguette to help make menu planning easier Serves 4., .. . i Ask a Catering Coordinator for todays soup selections or visit PaneraBreadcom a See pp.14-15 for pricing and calorie information. °.. ®`Contains peanuts and/or.tree nuts t 2,000 calories a day is used for general nutrition advice,but calorie needs vary O Commonwealth of Massachusetts City/Town of Hyannis System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, 790 lyannough Rd use only the tab key to move your Address cursor-do not Hyannis MA use the return key. City/Town State Zip Code 2. System Owner: rab Panera Bread Name return Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 01/10/2022 2,000.00 p g Date 2. Quantity Pumped: Gallons 3. Component: GreaseDPT(Grease Disposal, Pumping and Transportation Services) ❑ Other(describe): 4. Effluent Tee Filter present? ® Yes ❑ No If yes, was it cleaned? X❑ Yes ❑ No 5. Observed condition of component pumped: Good 6. System Pumped By: Bob Brenton Name Vehicle License Number Waste Water Services, Inc. /Heritage Pumping Company 7. Location where contents were disposed: Wareham WWTP 01/10/2022 Signature o H Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1 ' O �❑❑❑ O O \s ❑❑❑❑ 0 f ❑❑❑❑ QQII--�QI O/ IGP FAP O O O NEW COMMUNITY ROOM NEW COOLER 0 � � � v e e e e Fl R � O LAI B 'Ilkt NEW FREEZER �T S/ O O o O CD c co 0 HYANNIS, MA 12- 15- 1 1 OPT-2 4 � � 3 a a � � f 1 2 a I F _ e, wzz VIZIA 5B 121 y j <:. r--ter--� — — - \� 34 I u I I I� I 7C 7C I r----, ----�r----,r-----I ; R COOLER 120 F8 I 119 F8 119 I 43B 11438 h 43 a OI I 43B I I I 2C I O I I O I I O I I 0 i17C2A ,,. 23 /I I I II a I I II I -- -- I 43C I I 43C I I 43C I I 43C 'T 9" X 14'-5 2" . . II II II I O O I II II II I L----JL----J 15 15 115 8B �J�---JL_ JL__J L__J I 44A I -----I r------I r------1 r------i ACTUAL SIZE) 121 I I 19 / BA Y I I I I i 43C i i 43C i i 43C i i 43C i I 6A 75 I 278 7F 16 12 7F :. 18 \ KER I II II II I CD 40 71 71 1 82 8A / 15 A ---- ----J ---- ----� I 0 11A .:::: PREP I I ---- ---- ---- ---- r �r �r �r , KITCHEN I' tD C1 s2 O I I O I I O I O I I O , 27C A4 ;. - 106 86 L - - - - - - - - - - - -- - - - J 43C II 43C I 43C II 43C I 7B 107 O A4 7 / i I I I I I I PROJECT LOCATION: 116 C101 DT11 / — —— — — — —— — —— —— ---- ---- ---- ----� ......: F ,20 I I 1 A4 / •� _ I 49 I 21A PANERA BREAD ........... . w-___f / C146 — / I I co DOUGH COOLER 28 C107 � DT14 a _ I I (6'-9 1/2" X 10'-71/2" 2C KP1 13A 116 ' // C106 21A I I ACTUAL SIZE 0 121 I I // BAKERY 28 I I A4 I ) 7F 17 " A4 50A L —— — — —— — -J I 68 4s 45D 14 16 BAKERY/CAFE NO. 3551 r / 30 OSERVICE I K 2 =- ___ __-- _ I f�. `' 8B - -- - RT 132 IYANOUGH RD ` 105 DT14 - - - - - - - - - - - ` 2� -- -- 0 120 I I ALL CHAIRS 117A COZY CORNER// DT1 `\\ C10146 51 62B � 6 j� 4 3 9 0 I I UNLESS NOTED 102 , 55 I I I _ HYANNIS, MA 02601 116 I I i C10 C181 BEVERAGE 21A L_ J I I 0 1 DISPENSER SB 84B 121 116 i�� CRATCHO—E27) 4.1 A4 76 60 19 28 47C 22 \ // 45D 33 45A O O II DT1 12 ,8 73 • UTILITY I 26 SPEEDRAILS T 45C 5 85 4®, 22 17 OFFICE 26 O 109 ARCHITECT: 11s Clio SERVICE 53A 18®4. 108 2 4. C100 C100 C118 53A C115 36 64 C115 II (CUSTOM) 1u4 19 FREEZER I i --- -- _ -- ---- ---- --- 3 10 (12'-6 1/2" X 8'-8 1 I VESTIBULE 4 A4 i--- — — ---- --- -- — — 0 35 100 �O 18"X12" i — -- I 125 2109 5 — ) 6 B ROP IN SINK I --yl Ir---- ---II Ir---- , ACTUAL SIZE O 41 72 Mann, Gin, Dubin & Frazier, Ltd. 1 A4 GS TS TOPPINGS 14"X 12" �___ _ ____ _ ___ _ ___ _ r_-� I 8 1 72A II C140 " AND SYRUP F " PUMP I 104 South Michigan Avenue 121 A4 83 30 30 30 FUTURE DT30 33 DT30 33 84B 84C 33 DT30 33 DT30 i 79 i — — 0 i \ / Suite 200 C142 DT3 O C018 C018 C018 C018 L—J — Chicago, Illinois 60603 117 0 2C 2C 2A Phone: (312) 424-2400 120 I I I C111 / DT31 (4) C139 C139 A4 C139 C139 / I I 20 Fax: (312) 424-2424 gDO C122 I I II PASSAGE 4®21 42A 121 I I I1 DT64 I I 112 10 4, 30 42D I :S H 117 DT59 IR �_. I I 17 C124 F4 4 F4 F4 4 F4 4 ! 4 F4 4 C140 4 4 F4 4 F4 4 0 29 CB 2C 59 M.E.P. ENGINEER: C147 119 15D 19 115D I 119 15D 119 15D 119 11 A4 19 115 19 115D 1 15D 119 (UNDER) 42 — — 241( 258 ,. �/ _ 3W9 s. Gmnd • snke 240 116 I I S.H. S.H 63 58A I C142 I 54 I 9 i3� Sa Lon* Mbeand 63US N R I I I 117 U DE 7 -1782 121 C128 ' / Phone �e(314�77?r0108 I I 1 A4 C 01E °° °O DT4 Tot lkemeyer DINING A4 4. 22 = I I 2 I 111 2 4 2 426 _ Aaodace. 103 0 ® 56 3 2 A4. u ? 0 n - - I Engineering Consultants . ..,...... �, o g g :....3 ZF9\ 9 NDER) 57 0 �� II 4 5 5 'I Mec)banical • Electrical • Plumbing 3 I 3 27 12D `;, I 15 I I 15G 115 15G rf /F9\ F9 }i F -8 6 ._.... ...... ....... t _.. ... 8 8 .. . : .......................... Drown y Checked y , _ � 1 =: 1 b b Date- ( 15 1� 5A 1 5 15 15A I, ii lU _ - - -- r = _= 02-28-03 ® 11 119 11 5G 121 I I s ;t No. Dates. Issue: El 02-28-M PHASE 1 03-28-03 ISSUED FOR PERMIT 1 UIPMENT PLAN _ EQ N - - �� A6 Scale: l/4We11-p� �s2 CASEWORK FABRICATION SCHEDULE 6-02 ^l� KEYED NOTES: QTY. NO. DESCRIPTION DIMENSIONS ACCESSORIES 0 I 1 C018 BLACK MELAMINE SHELF FOR DT-18 & MONITOR 23A"Wx166"Dx0"H - O MANAGERS DESK TO HAVE A ROLLED 5 C100 REGISTER CABINET W/ CUP HOLDER (30") 30"W x 36"D x 34"H - (POST-FORMED) FRONT EDGE. ; - C101 REGISTER CABINET (36") 36"W x 360D x 340H - O LAMINATE ON PARTICLE BOARD K10_ 0-7) SHELVING - LOCATE ABOVE o - C102 END CABINET - TRIANGULAR 135 DEGREE LAYOUTS 36"Wx 22 1 2" D - MANAGER'S DESK IL EVANSTON GENERALNOTES: - C104 END CABINET - TRIANGULAR 150 DEGREE LAYOUTS 360Wx 23 1 8""D 1 C105 BAKERY- LEFT 36 W x 33 3/4 D x 34 H (1) DTO, GLASS O3 CORK BULLETIN BOARD, APPROX. �Ty sS 1 C106 BAKERY - CENTER 36"W x 33 3/4"D x 34"H (2) DTO, GLASS 26 H (UNDER THE SHELF) 0 lip 1. AT LEAST 5% OF ALL FIXED SEATING OR TABLES SHALL 2 C107 BAKERY - RIGHT 36"W x 33 3/4"D x 34"H (1) DTO, GLASS FILLER PIECE BY MILLWORK MANUF., COMPLY WITH ANSI SECTION 4.30. - C110 ESPRESSO BAR 66"W x 36"D x 34"H INSTALL 2. FOOD SERVICE LINES SHALL HAVE A MINIMUM CLEAR WIDTH OF 36 INCHES. 1 C111 ROLLING CABINET-TRASH DISPENSER 30"W x 28"D x 31"H W/ OPEN TOP FOR TRASH O WATER HEATER 2 C115 CONSOLIDATION CABINET 48"W x 31 3/4"D x 34'H FOR LOWRATOR 3. TABLEWARE, DISHWARE, CONDIMENT, FOOD AND BEVERAGE DISPLAY SHELVES, AND - C116 CONSOLIDATION WALL 4'-1 1/2" H - ABBREVIATIONS APPROVALS: DISPENSING DEVICES SHALL BE LOCATED WITHIN REACH RANGE 1 C117 STEAMER CABINET 21 5/8"W x 30"D x 30"H — BY A PERSON IN A WHEELCHAIR AS SPECIFIED IN ANSI SECTION 4.2 1 C118 SANDWICH CABINET 21 7/8"W x 30"D x 34"H TO RECEIVE REGISTER DRAWER IGP — ISOLATED GROUND PANEL OPERATIONS: Date: 4. HANDICAPPED ACCESSIBLE SEATS SHALL BE PROVIDED AT TABLES AS 1 C122 HOT DRINK STATION BACK PANEL 69A"W x 260H x 3/40D M.D.P. — MAIN ELECTRIC DISTRIBUTION PANEL NOTED WITH THE HANDICAPPED ACCESSIBLE SYMBOL 1 C124 HOT DRINK STATION COUTERTOP — DOUBLE SIDED 32" x 72" L.P. - LIGHTING PANEL - C125 HOT DRINK STATION COUTERTOP - SINGLE SIDED 32" x 96" P.B. - PHONE BOARD PANEL 1 C126 COLD DRINK STATION COUTERTOP 32" x 96" K.1 - KITCHEN ELECTRICAL PANEL NOTES: 1 C127 ROLLING CABINET - TRASH DISPENSER 42" x 28" K.2 - DECK OVEN PANEL 1 C128 ROLLING CABINET - SODA DISPENSER 42" x 28" - C132 LOWRATER 16" DIA. KEY DONOT SEAL EQUIPMENT NO. 68 TO WALL. 1 C139 MONITOR ENCLOSURE 18?5"Wx16T"Hx12A'D DT01 - STEEL FABRICATION - SEE SHEET A9 DEVELOPMENT: Date: 2 C140 TRASH STATION WITH 12 " DIAMETER HOLE 22"W x 24"D x 450H 02 - EQUIPMENT NO. SEE SHEET A6.1 - C141g MENU BOARD(S) - PAINTED GREEN 12" X 24' C111 - CASEWORK NO. - SEE MILLWORK 2 C142 BUSSING STATION / RECYCLE 22"W x 24"D x 45"H SCHEDULE THIS SHEET - C143b MENU BOARD (L) - PAINTED BROWN 24"W x 3/40D x 36"H - FURNITURE NO. SEE SHEET A8 RESTROOM ACCESSORIES 2/03 NOTE: CASEWORK SUPPLIER TO VERIFY ALL QUATITIES MARK CT. DESCRIPTION MODEL MOUNT INSTRUCTIONS LANDLORD: Doti: WISCONSIN JUMBO SMOKED 66A CASEWORK FABRICATION SCHEDULE 6-02 O 5 TOILET PAPER DISPENSER FROM SYGMA - SUE DONOHOE 32" A.F.F. TO TOP PH (877) 794-6245 EXT. 7363 _ _ QTY. NO. DESCRIPTION DIMENSIONS ACCESSORIES WISCONSIN 84 OBTAIN FROM - Ob 4 PAPER TOWEL DISPENSER SYGMA - SUE DONOHOE PH 40" A.F.F. TO BOTTOM C143g MENU BOARD (L) - PAINTED GREEN 24"W x 3/4"D x 36"H (877) 794-6245 EXT. 7363 — C143y MENU BOARD (M) — PAINTED YELLOW 36"W x 3/4"D x 24"H 1 C145 COMMUNITY BOARD 48"W x 36"H Oc 4 SOAP DISPENSER I ** 40" A.F.F. TO TOP 2 C146 BREAD SAMPLE BOARD W BASE 240W x 12"D x 10"H RESIDENTIAL APPROVAL: Date: �d 4 MIRROR BOBRICK B-165-1836 40" A.F.F. TO BOTTOM 1 C146a BREAD SAMPLE BOARD FOR ESPRESSO BAR 240W x 12"D x 10"H MOUNTED ON TOP OF BACKSPASH 1 C147 MICROWAVE SHELF 36"W x 30"D x 10"H FOR 72" TABLE 4 GRAB BAR BOBRICK B-550-42 36" A.F.F. TO CENTERLINE C147—L MICROWAVE SHELF — LONG 48"W x 30"D x 10"H FOR 96" TABLE e1 ** C148 MENU BAND BOARD— POPLAR — WALL MOUNTED 10"D x 70"H ........................... . .. . ............... ... ...... .. .................... ......................... .......................... 0 4 GRAB BAR BOBRICK B-550-36 36" A.F.F. TO CENTERLINE ** C148a MENU BAND BOARD - POPLAR - SOFFIT HANG 10"D x 70"H * C150 BUTCHER BLOCK LEDGE 4 5/8"D x 49 1/2"H O * C152 MAPLE TRIM CAP - STANDARD DRYWALL CAP 6 D x 1 H DRYWALL PARTITION f 3 COAT HOOK AMERICAN SPEC. 0740-Z 72" A.F.F. ON DOOR, - C153 MAPLE PURSE HOLDER 5 x 69 x 10 " ........ ....... .. SHEET TITLE. - C154 MAPLE TRIM CAP - FOR MILLWORK WALL 1 1/2 X 7 CONSOLIDATION WALL ONLY O3 SANITARY NAPKIN DISPOSAL BOBRICK B-270 24" A.F.F. TO CENTERLINE 2 C161 MAPLE COAT RACK 16"W x 4"H KOALA CORP. MODEL .#CBK * C162 MAPLE CHAIR RAIL 3/4"x5" h1 2 DIAPER CHANGING STATION HORIZ-TAN CONTACT : REAGAN 30" A.F.F. TO BOTTOM * C164 SPECIAL HALF-ROUND CHAIR RAIL FOR QUILT 3/4"x 10" E O U I P M E NT HILLIER PH: 800-764-3454 ..... . . ...... ...... . .. ..... .... ...................................... ............. _................... ..... ... C165 PANELS W BATTENS - P A N j 2 PURSE HOOK CUSTOM (CASEWORK CO.) 42" A.F.F. TO CENTER — C168 STOOL-HEIGHT CAFE COUNTER 18"Dx LGTH. VARIES 0 _ C169 RECESSED PHONE BOX 100"W x 46"D x 170H GRIMCOCOLOR SCHEME" DRAWING FILE NAME: SCALE: k1 2 MEN'S ACCESSIBLE TOILET SIGN PH# (8 6x9 49-9941 60" A.F.F. TO CENTER - C170 WOOD SHUTTER - 4 FT. 24 W X 48 H 649—A6 DWG 1/4$$=if_On O PH# (800) 542-9941 I _ C180 SPECIAL CABINET CUSTOM 2 � GRIMCO 6x9 090058K 60" A.F.F. TO CENTER 1 C181 SPECIAL CABINET CUSTOM CUSTOM II (DARK) k2 WOMEN S ACCESSIBLE TOILET SIGN PH# (800) 542-9941 SHEET NO. 1 C182 SPECIAL CABINET CUSTOMjpp * ORDER FROM SYGMA SUPPLIER, SUE DONOHOE (877-794-6245X7363) C183 SPECIAL CABINET CUSTOM ** ORDER FROM LOCAL SWISHER CONTACT - C184 SPECIAL CABINET CUSTOM 0 , 2 4 B * C190 BOOTH SIDE WALL - 69" 2"D x 69"W x 480H t 1/4 = 1-0 * SEE EQUIPMENT PLAN, SHEET A6 ALL CASEWORK SUPPLIED BY CASEWORK SCALE FEET ** SEE SHEET A2, A2.1, A4 COMPANY, INSTALLED BY G.C. Copyright ©2003 MANN, GIN, DUBN + F RAZIER, LTD HYANNIS V ........................ . EQUIPMENT SCHEDULE 03 .. ........ EQUIPMENTSCHEDULELAST REV 15 0N: 2/03 LAST REVISION 2/ I...... ..... QUAN. NO. DESCRIPTION MANUF ACTLA ER MODEL NO. DIMENSIONS SUPL. I NST. NOTES QUAN. NO. DESCRIPTION MANUFACTURER MODEL NO. DIMENSIONS SUpL. I NST. NOTES ,� R IPS. A � - 1 18"STOR. SHELVING (Z., 5sh) METRO A1824NC 24"Wx18"Dx91"H E.S. E.S. B - 45D SS TABLE (72' METAL MASTERS T3072SBC 72"Wx30"Dx34.5"H E.S. E.S. A - 1A 18"STOR. SHELVING (Z., 5sh) METRO A1836NC 36"Wx18"Dx91"H E.S. E.S. B - 45E SS TABLE (84") METAL MASTERS T3084SBC 84"Wx30"Dx34.5"H E.S. E.S. A 1B 18"STOR. SHELVING (Z., 5sh) METRO A1842NC 42"Wxl8"Dx91"H E.S. E.S. B - 45F SS TABLE (96") METAL MASTERS T3096SBC 96"Wx30"Dx34.5"H E.S. E.S. A - 1C 18"STOR. SHELVING (Z., 5sh) METRO A1848NC 48"Wxl8"Dx91"H E.S. E.S. 8 - 45G SS TABLE (24") METAL MASTERS T3024SBC 24"Wx30"Dx34.5"H E.S. E.S. A PROJECT LOCATION: 1D 18"STOR. SHELVING (Z., 5sh) METRO A186ONC 60"Wx18"Dx91"H E.S. E.S. B 45H SS TABLE (30' METAL MASTERS T3030SBC 30"Wx30"Dx34.5"H E.S. E.S. A PANERA BREAD 2 24"STOR. SHELVING (Z., 5sh) METRO A2424NC 24"Wx24"Dx91"H E.S. E.S. B 45J SS TABLE (18") METAL MASTERS T3018SBC 18"Wx30"Dx34.5"H E.S. E.S. A "STOR. SHELVING Z. 5sh METRO A2436NC 36"Wx24"Dx91"H E.S. E.S. B - 45K SS TABLE (42") METAL MASTERS T3042SBC 42"Wx30"Dx34.5"H E.S. E.S. A BAKERY/CAFE NO. 3551 - 2A 24 ( ) - 2B 24"STOR. SHELVING (Z., 5sh) METRO A2442NC 42"Wx24"Dx91"H E.S. E.S. B - 46 MEAT SLICER BERKEL 909 19"Wx29.25"Dx20.12511H E.S. E.S. - RT 132 IYANOUGH RD 2C 24"STOR. SHELVING (Z., 5sh) METRO A2448NC 48"Wx24"Dx91"H E.S. E.S. B - 47 SS. TABLE W/ OPEN BASE (36") METAL MASTERS T3036STC 36"Wx30"Dx34.5"H E.S. E.S. - - 2D 24"STOR. SHELVING (Z., 5sh) METRO A2460NC 60"Wx24"Dx91"H E.S. E.S. B - 47A SS. TABLE W/ OPEN BASE (48") METAL MASTERS T30405 is 48"Wx30"Dx34.5"H E.S. E.S. - HYANNIS, MA 02601 3 BAKER STOR. RACK (Z., 5sh) METRO 244BNC 48"Wx24"Dx91"H S.W. OWNER B - 47B SS. TABLE W/ OPEN BASE (60") METAL MASTERS T3060STC 60"Wx30"Dx34.5"H E.S. E.S. - - 3A ARTISAN COOLINGK METRO A1836NC 36 Wx18 Dx59 H OWNER OWNER B 47C SS. TABLE W/ OPEN BASE (72 ) METAL MASTERS T3072S TC 72Wx30Dx34.5 H E.S. E.S. 4A COOLER/FREEZER SHELV.(EP., 5sh) METRO METRO SEAL II 2436NK2 36"Wx24"Dx91"H E.S. E.S. B - 48 OVEN DOUBLE RACK ADAMATIC DR02GHP 97.25"Wx60.75"Dx95.5"H G.C.', G.C. S ARCHITECT. 48 COOLER/FREEZER SHELV.(EP., 5sh) METRO METRO SEAL II 2448NK2 48"Wx24"Dx91"H E.S. E.S. B - 49 OVEN HOOD CAPTIVE AIRE 3624 VHA 96;Wx36"x24"H ADAMATIC G.C. S - 4C COOLER/FREEZER SHELV.(EP., 5sh) METRO METRO SEAL II 2460NK2 60"Wx24"Dx91"H E.S. E.S. B - 50A BREAD SLICER (THIN) OLIVER 711 (1/2 SLICE) 23 Wx28.75 Dx21 H E.S. E.S. - 4D COOLER/FREEZER SHELV.(EP., 5sh) METRO METRO SEAL II 2454NK2 54"Wx24"Dx91"H E.S. E.S. B - 51 BREAD SLICER (THICK) OLIVER 711 (3/4" SLICE) 23"Wx28.75"Dx21"H E.S. E.S. - - 6 STORAGE CAGE w/ CASTERS METRO SEC55DC 48"Wx24"Dx6O"H E.S. E.S. B - 52 SS PARTITION - CUSTOM 24"Dx6O"H „ G.C. G.C. - 6A COOLER STORAGE CAGE METRO METRO SEAL II SEC55DK2 53"Wx28"DX68"H E.S. E.S. - 53A SANDWICH PREP TOP (72 ) BEVERAGE AIR SUR 72-30M 72 Wx27 Dx35 1/2 H E.S. E.S. E Mann, Gin, Dubin do Frazier, Ltd. 54 SODA ICE DISP. 8 hd. CORNELIUS ENDURO 250 INTELICARB 30"Wx30.75"Dx39.75"H PEPSI PEPSI 7A WALL SHELF-24" (3sh) METRO 1824C 24"Wx18"D E.S. E.S. - / ( ) - 104 South Michigan Avenue 55 L UNDERCOUNTER REFRIGERATOR BEVERAGE AIR UCR27 W LEFT HINGED DOOR 27"Wx27"Dx34.5"H E.S. E.S. 0 Suite 200 - 7B WALL SHELF-30" (3sh) METRO 1830C 30"Wxl8"D E.S. E.S. - � ) / Chicago, Illinois 60603 55 R UNDERCOUNTER REFRIGERATOR BEVERAGE AIR UCR27 W RIGHT HINGED DOOR 27"Wx27"Dx34.5"H E.S. E.S. O Phone: (312) 424-2400 - 7C WALL SHELF-36" (3sh) METRO 1836C 36"Wx18"D E.S. E.S. - O / - 7D WALL SHELF-42" (3sh) METRO 1842C 42"Wx18"D E.S. E.S. - 55B UNDERCOUNTER REFRIGERATOR BEVERAGE AIR UCR48 48"Wx27"Dx34.5"H E.S. E.S. 0, P Fax: (312) 424-2424 55C U.C. REFRIGERATOR 3-DOOR BEVERAGE AIR UCR72 72"Wx29.5"Dx34.5"H E.S. E.S. 0 - 7E WALL SHELF-48" (3sh) METRO 1848C 48"Wx18"D E.S. E.S. - ( ) - 7F WALL SHELF-60" (3sh) METRO 1860C 60"Wx18"D E.S. E.S. 55D U.C. REFRIG. (3-DOOR W/ GLASS) BEVERAGE AIR UCR72-GLASS 72"Wx29.5"Dx34.5"H E.S. E.S. 0 8A BAGEL SLICER/TOASTER CART METRO 2430NC 30"Wx24"Dx38"H E.S. E.S. B, D - 56 TEA BREWER BUNN-O-MATIC TU-3 9.25"Wx20"Dx31.25"H E.S. G.C. M.E.P. ENGINEER: 8B BREAD SLICER CART OLIVER CUSTOM 23,3/8""wx24 7/8"Dx26 1/2""H E.S. E.S. B - 57 TEA DISPENSER BUNN-O-MATIC TD-4T 9"Wx15.5"Dx18"H E.S. E.S. - 9 DISHRACK/SHELF METRO METRO SEAL II 2424NK2 24 Wx24 Dx73 H E.S. E.S. 58 COFFEE MAKER GRINDMASTER AMERICAN ICB 400 22.5"Wx17.75"Dx36"H E.S. G.C. 0 3>� �. . e e �. � 63118 10 BULK BAGEL MOBILE RACK METRO CUSTOM 18"Wx30"Dx69"H E.S. E.S. - 58A COFFEE INSULATED CONTAINER GRINDMASTER AMERICAN IC-175 10"Rx22"H' E.S. G.C. pie 014) 77 IM - 11 MOP SINK FLORESTONE PRODUCTS CO. MSR3624 36"Wx24"D G.C. G.C. - 59 EMPLOYEE LOCKER PENCO 6369Y 12"Wx18"Dx82' E.S. E.S. Q F= 194) TI?r m lkemeyer G - 11A MOP SINK FLORESTONE PRODUCTS CO. MSR2424 24"Wx24"D G.C. G.C. - 60 COFFEE GRINDER GRINDMASTER 495-MB 9.25"Wx15"Dx22.25"H E.S. E.S. - AMoclaw ry - 61 ESPRESSO MACHINE AUTO FRANKE ECOLINO 2-STEP 13"Wx24"Dx31"H E.S. E.S./G.C. Engineering Consultants 12 3 COMP. SINK (SS) METAL MASTERS EAGLE 314-22-3-24L&R 120"Wx28.5"Dx37"H E.S. G.C. (AUTO) 62A BAKER'S TABLE w u.sh. METAL MASTERS MT3672S 72"Wx36"Dx36"H E.S. E.S. Mom'ankAl - El`cui� - Plumes - 13 1 COMP SINK METAL MASTERS 314-24-1 30.5"Wx30.5"Dx37"H E.S. G.C. / - 13A 2 COMP SINK METAL MASTERS 314-24-2 56"Wx30.5"Dx37"H E.S. G.C. - 62B ARTISAN BAKER'S TABLE KEMLEE CUSTOM 48"Wx24"Dx34.75"H E.S. E.S. 14 SPRAY HOSE 1 2 3 Comp. Sinks FISHER C11775 8" centers E.S. G.C. - 63 MICROWAVE PANASONIC NE-8051 20.125"Wx14.75"Dx12"H E.S. E.S. Drown by: Checked by: Date•. ( � P ) _ - - 02-28-03 - 15 SPRAY HOSE (upright dishwshr.) FISHER 2210 WB w/Add on Spout 8" centers E.S. G.C. 64 SOUP STA110N RANDELL 3613 48"Wx30"Dx36"H E.S. E.S. E, P No. Dots: lasur. 16 WASTE VALVE (1,2,3 comp. sinks) FISHER 10677 - E.S. G.C. - 65 HIGH CHAIR MARSTON C-30-N SEAT HEIGHT 21" S.W. S.W. 02-28-03 PHASE 1 17A GREASE TRAP (SURFACE) - - see plumbing drawings G.C. G.C. - 66 OUTDOOR TRASH ALLIED FIBERGLASS 77C-2347FC 47" HIGH S.W. S.W. 03-28-03 ISSUED FOR PERMIT 176 GREASE TRAP (RECESSED) - - see plumbing drawings G.C. G.C. 68 SOUP RETHERMALIZER FALCON FABRICATORS WW-1 27"Wx30"Dx34"H E.S. G.C. 18 DROP-IN SINK (COFFEE) ADVANCE TABCO DI-1-10 10"Wx14"Dx10"H E.S. G.C. 70 18A DROP-IN SINK (ESPRESSO) ADVANCE TABCO DI-1-25 12"Wx14"DxlO"H E.S. G.C. - 71 COOLER COMPRESSOR - - - E.S. G.C. 19 FAUCET FOR DROP-IN SINK (18) FISHER 3515 4" centers/12" spout E.S. G.C. - 71A COOLER EVAPORATOR - E.S. G.C. - 19A FAUCET FOR DROP-IN SINK (18A) FISHER - - E.S. G.C. - 72 FREEZER COMPRESSOR - - E.S. G.C. - 20 ICE BIN (DROP IN) SUPREME D-12-IBL 11.25"Wx17"Dx7"H E.S. G.C. - 72A FREEZER EVAPORATOR - - - E.S. G.C. 21 A WALL MTD. SS HAND SINK ADVANCE 7-PS-50/7-PS-17 (SPLASH) 17.75"Wxl5.25"D E.S. G.C. G,H 73 HOLDING CABINET WINSTON HC4009 27.6"Wx36.4"Dx33.4"H E.S. E.S. - - - Cy 22 ICE CADDIE CAMBRO IC125LB 22"Wx26"Dx29.25"H E.S. G.C. - 74 - 23 ICE MACHINE (air-cooled) HOSHIZAKI KM-1300 30"Wx27.5"Dx41.5"H E.S. E.S. - 75 CONVEYOR TOASTER APW WYOTT BT-15-3 19.5"Wx26"Dx18.5"H E.S. G.C. - 23 A ICE MACHINE SCOTSMAN CME1356AS-32A 48"Wx24"Dx28"H E.S. G.C. 76 CRATHCO COLD BEVERAGE DISP. CRATHCO D25-3 17.5"Wx15"Dx27.3"H E.S. E.S. 24 ICE STORAGE BIN FOLLET 700-30 30"Wx40"Dx58"H E.S. G.C. - 76A CRATHCO MINI-TWIN CRATHCO E27-4 - E.S. E.S. EVANSTON - 24A ICE STORAGE BIN SCOTSMAN BIL H900 48.2"Wx33.75"Ox5O"H E.S. G.C. - 78 TRASH CART RUBBERMAID 1011-1028 30.25"Wx64"Dx38"H - - �yf - 25B WATER FILTER (4 pod) ELGE ABP-4 36"Wx27.25"H E.S. G.C. - 79 SAFE AMSEC CTH312120 21"Wx20"Dx3O 7/8"H E.S. E.S. U !1 l� " - 26 DIPPER WELL KENCO FW510 6"DIA.x5.125"D E.S. G.C. - 80 FILE CABINET HON R532CPP 18 1/4"Wx 25"Dx 29"H E.S. E.S. �- - 27A DISHWASHER (upright) JACKSON ES-2000 25.25"Wx25.25x66.25"H ECOLAB G.C. - 81 A (L) SALAD PREP TOP (86") RANDELL 9050 K A 86"Wx33"Dx35"H E.S. E.S. E, P 27B DISH COUNTER (DIRTY) - CUSTOM 30"Wx30"Dx37"H E.S. G.C. - 81 A (R) SALAD PREP TOP (86") RANDELL 9050 K A 86"Wx33"Dx35"H E.S. E.S. E, P - 27C DISH COUNTER (CLEAN) - CUSTOM 30"Wx30"Dx37"H E.S. G.C. 82 BAGEL SLICER OLIVER 702 30"Wx13"Dx21"H E.S. E.S. - 27D DISHWASHER HOOD CAPTIVEAIRE CUSTOM 42"Wx42"Dx24"H G.C. G.C. 82A BAGEL SLICER BASKET - CUSTOM 7.5"Wx17.5"DX10"H E.S. E.S. APPROVALS: 28 PAPER TOWEL DISPENSER WISCONSIN 84 12"Wx10"Dx15.5"H G.C. G.C. 83 BLENDER K-TEC BLENDTEC SMOOTHER 8-13/16"Wx11.25"Dx20918" E.S. E.S. OPERATIONS: Date: 29 SOAP DISPENSER ECOLAB 92633825 4"Wx4"Dx8"H ECOLAB ECOLAB - 84A CONSOLIDATOR SHELF - CUSTOM - STAINLESS 18"Wxl2"D E.S. G.C. 30 REGISTER w/ cash drawer MICROS SYSTEMS 2700 11.75"Wxl 8"Dx1 1.5"H MICROS MICROS - 84B CONSOLIDATOR SHELF - CUSTOM - STAINLESS 30"Wx12"D E.S. G.C. - 31 PRINTER OKIDATA 2700 6.5"Wx13.6"Dx9.6"H MICROS MICROS - 84C CONSOLIDATOR SHELF - CUSTOM - STAINLESS 48"Wx8"D E.S. G.C. - - - - - 32 FAX MACHINE PANAFAX OF-181 - OWNER OWNER - 85 SANDWICH TOASTER LANG PB-24-6 24"Wx14"Dx22.25"H E.S. E.S. - 33 MONITOR w/ VDU controller MICROS SYSTEMS 2700 12.25"Wx12"Dx10.75"H MICROS MICROS (1)C - 86 DECK OVEN POLIN STRATOS 3STA/4676 SERIES197 75.2"Wx52"Dx83.9"H E.S. E.S. - 34 CUSTOMER NUMBERING DEVICE TURN-O-MATIC TAKE-A-NU MBER-SYSTEM 10"Wx2.5"Dx8"H E.S. G.C. - 86A DECK OVEN (2-PAN WIDE) POLIN STRATOS 2STA/4060 SERIES197 52"Wx45.7"Dx83.9"H E.S. E.S. AND PRINTER HP VECTRA VLI8 - NCR NCR - 87 SANDWICH TOASTER TIMER FASTIMER MODEL 400 5"Wx2.56"Dx3.53"H E.S. G.C. DEVELOPMENT: Date: 35 MANAGER PC- 36 MICROPHONE ASTATIC AMC 109 16.25L OWNER OWNER - 90 ORDER ASSEMBLY STA110N METAL MASTERS CUSTOM 32"Wx34"Dx36"H E.S. G.C. I - 37 CREDIT CARD READER HYPERCOM T7P TERMINAL 6.5"Hx7"Dx1.5"H OWNER OWNER - 91 SS TAKE-OUT/EAT IN TABLE METAL MASTERS CUSTOM W/ 2 SHELVES 18"Wx30"Dx34"H E.S. G.C. 40 WALK-IN COOLER KOLPAK CUSTOM VARIES E.S. G.C. - 109 DIGITAL INTERNET RECEIVER/AMP DMX DMX AXIS (W/ WALL CABINET) 22.25"Wx22.5"Dx16.875"H OWNER OWNER - 40A FRESH DOUGH COOLER KOLPAK CUSTOM VARIES E.S. G.C. - 123 EMPLOYEE COAT RACK WASSERSTROM CUSTOM .75"Dx30"Wx4"H S.W. S.W. - 41 WALK-IN FREEZER KOLPAK CUSTOM VARIES E.S. G.C. - - 124 SALAD TICKET RAIL INFRA CORP. CM-330 30"Wx2.75"H S.W. S.W. - 42A BAG-N-BOX PROFITMASTER BIB#2 28 Wx16 Dx30.75 H PEPSI PEPSI - - 125 KEYBOARD DRAWER HON 4022 10"Dx21.5"W S.W. S.W. LANDLORD: Date: - 42B BULK Co2 -TANK NuCO2 SMALL TANK - 100 LB. 28"H x 20" DIA. NuCO2 NuCO2 - - 42C CARBONATOR CORNELIUS E2MHA/S STAINLESS INTELICARB 12"Wx9"DxlO.5"H PEPSI PEPSI - 42D BAG-N-BOX PUMP FLOWJET 5000 SERIES - PEPSI PEPSIyED NOTEs: GENERAL NOS A. EQUIPMENT TO HAVE 4" CASTERS W/ 2 LOCKING - ONLY ITEMS WITH QUANTITY NUMBERS LISTED ARE INCLUDED IN THIS SCOPE OF WORK. 43A OVEN RACKS (10 PAN CAPACITY) NATIONAL CART AL-2610-BORC-TS 28.5"Wx18"Dx73' E.S. E.S. - B. EQUIPMENT TO HAVE (2) SM & (2) 5M8 CASTERS - 43B OVEN RACKS (15 PAN CAPACITY) NATIONAL CART AL-2615-BORC-TS 28.5"Wx18"Dx73"H E.S. E.S. - C. WALL MOUNTED - .STAINLESS STEEL WORK TABLES W/ DROP-IN SINKS ARE TO BE INSTALLEO;BY THE G.C. G.C. TO COORDINATE THE DELIVERY & INSTALLATION OF ALL EQUIP. TO BE (SUPPLIED 43C TRANSPORT CABINET NATIONAL CART AL-1840EC-HD 27"Wx21"Dx68"H OWNER OWNER - D. FURNISH W/ RAILS (4) SIDES E. EQUIPMENT TO HAVE 6" CASTERS W/ 2 LOCKING AND/OR INSTALLED BY OTHERS. REFER TO SPEC. SECTIONS 01010 & 01640 FOR 43D UTILITY RACK NATIONAL CART AL-1820B 26"Wx21"Dx69"H OWNER OWNER - F. NOT USED NOTES ON SCOPE OF WORK & ITEMS NOT IN CONTRACT. RESIDENTIAL APPROVAL Date: 44A PROOFER - SIX RACK ADAMATIC APB-51-B 74"Wx65"Dx99"H OWNER OWNER - G. FURNISH W/ SIDE SPLASHES 4 4 PROOFER - FOUR RACK ADAMATIC AHP-2S70 68"Wx68"Dx78.25"H OWNER OWNER - J. NOT USEDURNISHED W/ FAUCET AH. SINK IS BBREVIATIONS: 45A SS TABLE (36") METAL MASTERS T3036SBC 36"Wx30"Dx34.5"H E.S. E.S. q K. PLASTID LAMINATE DESK TOP CLEATED TO WALLS. - INSTALL (2) 2" DIAMETER GROMMET HOLES FOR ELEC WIRES b Bowl G.C. General CoRFBcoF 45B SS TABLE (48") METAL,MASTERS T3048SBC 48"Wx30"Dx34.5"H E.S. E.S. A L. CUT OUT FOR DROP-IN SINK C.S. Casework Supplier H Height M. FURNISHED W/ STAND D Depth sh. Shelf 45C SS TABLE (60") METAL MASTERS T3060SBC 60"Wx3O"Dx34.5"H E.S. E.S. A,(1)L N. NOT USED E.S. Equipment Supplier S.W. Small Wares 0. EQUIPMENT TO HAVE 3" CASTERS EP. Epoxy Finish SS Stainless Steel P. FURNISH'W/RICULITE CUTTING BOARD Q. EQUIPMENT TO BE SECURED TO WALL F.S Furniture Supplier W Width SHEET TITLE: R. SINGLE SHELF SUPPORTS W/ SINGLE DIRECT WALL MOUNTS Z Zinc Coated S. 25' DRAFT INDUCER W/ MOTOR T. 100' DRAFT INDUCER W/ MOTOR EQUIPMENT U. EQUIPMENT TO BE BOLTED TO FLOOR SCHECDULE DRAWING nLE NAME: SCALE: 760-A6.1.DWG NTS SHEET NO. t i y Copyright©2003 MANN, GIN, DUBIN + FRAZIER, LTD HYANNIS