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Home My WebLink AboutSAM DIEGOS - FOOD y SAM DYEG®S 2q�} - O©lp- f ' �► r Town of Barnstable BOARD OF HEALTH flJohn T. Norman + ' Board of Health Donald A.Gaudagnoli,M.D. BAWNS ABLE. : F.P.(Thomas)Lee,. •bs. . 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. "rar ° 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: 192 Issue Date: 01/01/2022 DBA: SAM DIEGO'S MEXICAN COOKERY & BAR OWNER: SAM DIEGO'S, INC. Location of Establishment: 950 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 294 OutdoorSeating: 48 Total Seating: 342 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: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: j,y, j ''• 1 U �. Town of Barnstable 7 I Inspectional Services NAM 262 id Public Health Division �P ` P _q;2- Thowas McKean,Ditector 200 Main Slrcet,Hy=zds,MA 02601 Office: 508-862-4W Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT BATE_o �A NEW OWNERSXIP RENEWAL NAME OF FOOD ESTABLISHMENT: M � ADDRESS OF FOOD ESTABLISHMENT: LV MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 20 a . TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATE)k:YES NO> ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: -iM OUTSIDE; �TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE D G MUST BE APPROVED THE TH D V D L C LASING D MEE OUTSIDE NING R.OUIREMENTS: IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPL4 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 NOVICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL. MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV OR INCP CTION PRIOR TO PERMIT BEING ISSUED PL E CAL508-862-4644 Q:1APA-601,Fozx TOODAFY 2020.doc OWNER INFORMATION• FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# ADDRESS_ /6/ 7 I Q! rfi l/ CORPORATE OWNTR: CORPORATE ADDRESS: 41WZ t PERSON IN CHARGE OF DAILY OPERATIONS: Lust(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff AU FOOD ESTABLISHMENTS must brave 1 Certified Food Protection Manager PER SHII+T. "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 O-WWA -&A) 47- Al(� 2 L /a l� -A�i(gi l00- SIGNATUIROF APPLICANT DA,T T ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to oyeninvP ,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.2sp. OUTDOOR.COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3?each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND UQUIRED FEES BY DEC 1st. Q:44pplicatioD PomtSTOODAPP REV3-2019.doc I w BOARD OF HEALTH Town of ,Barnstable John T.Norman Board Of,Health' _ Donald A.Gaudagnoli,M.D. TRUN ABA Paul J.Canniff,D.M.D. . v MAS F.P. Thomas Lee Alternate �a � 9• 200 Main Street;Hya`nnis,rMA 02601 a Phone: (508) 8624644' Fax: (508)790-6304 www.townofbarnstable.u`s Permit to Operate a'Food Establishment In accordance with regulations promulgated under allfhoriity 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: 192 Issue Date: 01/01/2021 DBA: SAM DIEGO'S MEXICAN COOKERY & BAR OWNER: SAM DIEGO'S, INC. Location of Establishment: 950 IYANNOUGH ROAD HYANNIS.' MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 294 OutdoorSeating: 48 Total Seating: 342 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: �TNE t For Office Use Only: Initials: Town of Barnstable _ Date Paid � AmL_Pd s BARNWABLE. : Inspectional Services 039. a` Public Health Division Check#4qRb2- lao2 ATED 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_� NEW OWNERSHIP RENEWAL 7 NAME OF FOOD ESTABLISHMENT: /2A6S ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: G2k) 771 ON, TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: A OUTSIDE: ff TOTAL: 3 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. ,� // IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPL 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 ,J SOLE OWNER: YES/NO. D: /' OWNER PHONE # SOfson�}J��1SI �JI' ADDRESS_�1J CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date All men en Awareness Expiration Date 2. SIG URE 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.townotbarnstable.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 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. e,►f�[vsr�e� Paul J.Canniff,D.M.D. 1639. 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: 192 Issue Date: 12/10/2019 DBA: SAM DIEGO'S MEXICAN COOKERY & BAR OWNER: SAM DIEGO'S, INC./ROBERT KERSHAW Location of Establishment: 950 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 342 OutdoorSeating: 0 Total Seating: 342 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 10/22/2019 18:12 15087710174 SAM DIEGOS-HVANNIS PAGE 02 �\0� Initi>tig: Town of Barnstable -- 4. nnte Pia it.4 nntttM�nnra, 8 Inspectional Services Public Health Division '�"` I Thomas McKean,Director i t 211/7 200 Main Street,Hyannis, MA 02601 f Of6cc: 508•.862.4644 Fax: 508-790.6304 APPLICATION FOR PERMIT TO OPERATE A FOICi ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL X :S NAME OF FOOD ESTABLISHMENT: _ ADDRESS OF FOOD ESTABLISHMENT: '�5'1 iv1,5 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 1�J E-MAIL ADDRESS: _ 67 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �� l TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO (ANNUAL WATER ANALYSIS REQUIll-=) ANNUAL: SEASONAL: DATES OF OPERATION:_I I TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUA.LLER'S LICk:NSE FROM LICENSING DIV. ***OUTSIDE DINING REMINnP.2j,*** OUTSIDE DINTNG,MUST BE A PRO�F,D BY THE HEA.LT1T DIV.AND LIC".,17NNTNG,AND M TIT OUTSIDE DINING REQUIREMENTS_ IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SE CER DOOR($)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APP Y 1MLOW) FOOD SERVICE _RETAIL FOOD-ONLY required fc-r TCS foods(footle requiring refrigeration/freezer) _BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kiteben) _MOBILE FOOD FROZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSUs REQUIRED) _CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE. PAGE#2) *** SEASONAL,MOBILE&NEW FOOV ONL.V*** REQUIRED TO CALL FAITH DIV.FOR INS ECTION PHi1pR TO PERMJT BEWG ISSUED PLEASE C&LL 508-862-461L�� Q;\Applicntion Fnnna1F00DA"2020.doc 10/22/2019 18:12 15087710174 SAM DIEGOS-HYANNIS PAGE 03 OWNER INFORMATION: FULL NAME OF APPLICANT &J am— SOLE OWNER: YES lef PHONE ADDRESS /,/ l , /k ® l- 12;1�/ -.- CORPORATE OWNER: V CORPORATE ADDRESS: 1&4� PERSON IN CHARGE Of DAILY OPERATIONS: b hook A) - List(2) Certified Food Protection Managers AND at least(1)Allergo.n Awareness Certi>fed Staff All FOOD ESTABLISHMENTS (must have 1 Certified Food Protcrltiion Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div,will WOT use past years' records. You must provide new copies and POST THE CERTIFICATES at,your dbod establishment. Certified Food Managers Expiration Date r en Awareness Expiration Date 00 SIGN URE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile woks must be inspected by the Mealth Div, prior to openinal! Please call Health Div.at 508-862-4644 to schedule your inspecti3n, Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozcn desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with~ample results submitted to the Health Div. failure to do so will result in the susig;nsion or revocation of your frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notiFi theTown by fax or mail prior to catering event. You must complete a catering notice found at Itttn://www.townofbarins.tsoble`os/henitlidivl Ion/epplicatiQns.rso. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st, QMpplication FormsT00DAPI'RFV3•2019.doc Bellaire, Dianna From: Teri Pratt-Masson <samdiegos@verizon.net> Sent: Tuesday, November 12, 2019 3:38 PM To: Bellaire, Dianna Subject: RE: 2020 Food Permit Hi Dianna I had three of them at todays exam at the Fairfield. I'll have certificates to you ASAP Teri From: Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us> Sent:Tuesday, November 12, 2019 3:15 PM To: samdiegos@verizon.net Cc: Bellaire, Dianna <Dianna.Bella ire@town.barnstable.ma.us> Subject: FW: 2020 Food Permit Importance: High Hi; I've received the payment today. Please let me know when you will have the Servsafe Food Manager's schedule to take their class and we need one of them to be the allergen person as per the new code. Please read below. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnsta'ble.ma.us From: Bellaire, Dianna Sent: Thursday, October 31, 2019 9:06 AM To: hyannis@samdiegos.com Cc: Bellaire, Dianna Subject: FW: '2020 Food Permit I forgot to mention we need the payment too. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us I From: Bellaire, Dianna Sent: Friday, October 25, 2019 3:50 PM To: 'samdiegos@verizon.net' Cc: Bellaire, Dianna Subject: 2020 Food Permit Hi; I received youir faxed application. Please be aware this is a 2020 Food Permit and all but 1 person has their Servsafe expiring in the February of 2020. Clarke expires in May of 2020. We need someone from the February to renew their Servsafe. I've attached all the Servsafe classes in the area. Please call me if you have any questions. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us CAUTFOWThis email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's.email address and know the content is safe! 2 i x t T BOARD OF HEALTH � Town of Barnstable Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. E BARN9T.ARM = John T. Norman pass 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ° Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 192 Issue Date: 12 20 18 DBA: SAM DIEGO'S MEXICAN COOKERY & BAR OWNER: SAM DIEGO'S, INC./ROBERT KERSHAW Location of Establishment: 950 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 342 OutdoorSeating: 0 Total Seating: 342 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: a� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: �I FOR ESTABLISHMENTS WITH SEATING: C PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Us � Initials: Town of Barnstable p • Date Paid l0 1� ( AmPd s D Inspectional Services s9 a t6 . � � I j & Public Health Division Check# H Cmh- 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 ( d DATE -A .1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(1F DIFFERENT FROM ABOVE): ,,�LgAA�I� E-MAIL ADDRESS: �Md regD.s @ VP�'1 ZQA) . A)e_ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 04 TOTAL NUMBER OF BATHROOMS:—(Oa — WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ / TO U�� V NUMBER OF SEATS: INSIDE:3CO OUTSIDE: 'ri�r�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 SERV E DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APP Y BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES...(ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL.MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FortnsTOODAPPREV2018.doc I PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT / e6l,5�au) SOLE OWNER: YES/NO D. VVOWNER PHONE ADDRESS CORPORATE OWNER: 5 FEDERAL ID NO. : CORPORATE ADDRESS: 260 Z4&Lwou&y4 kd /sue /V 1 PERSON IN CHARGE OF DAILY OPERATIONS: _ Aohe f U)/1 e-rS List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Aller en Awareness Expiration Date SIGNNTM OF APPLICANT DATE I ***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 508-8624644 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/apf)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.31'each calendar year. 1T IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application Fomu\F00DAPPREV20I8.doc oF.K�E roy TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: /c3//� Page: of P` '6 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. i BARNSTABLE, = 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � ,639. `0$ HYANNIS,MA 02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY p s rfD MPS FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 ' Name 6 Da1e10'?j Ty a of Type of Inspection Oneration(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness d Caterer General Complaint Person e44aK(PIC) Time Bed&Breakfast HACCP In: Other Inspector S. Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1 ❑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 El 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control o ❑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 v Critical(C)violations marked must be corrected immediately. (blue&red items) ` 1 1 11q Corrective Action Required: o ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based'on an inspection t5eeiems ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 6=One critical violation and less than 4 non-critical violations g ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations ob 4 to 8s n ritlerved 7 to 8npn-critical violations. If 1 critical refrigeration. s receipt of this order. c I violati within 10 days of ons=C 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspe or' Si t r rint: 31.Dumpster screened from public view a -.3 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's g ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N LY9510 Al , (.EAICICC S�O Dumpster Screen? Y N �) III Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH__ 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* - P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11 Variance 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) I Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* 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°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* 8g Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ep 1nve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130*F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145*F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* pacti her 90.009 violations d be debited stingunde to good retail 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-001.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) 8 illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Ln 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 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27() g g Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .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 590.006. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFt�E rqy TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: _ Date: O Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY MP'� 50862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name '1 vC Date / e o filns ec ion s Address Risk Se Re-inspection �� ` Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile. Pre-operation Owner HACCP Y/N Temporary Suspect Illness ^ Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP \ 1 Other Inspector y� Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as.determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �'• /. ,-��, FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures �� ❑ 5.Receiving/Condition ❑ 17.Reheating Q. 1 �� \ c t) ❑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,,%eparation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) b 1 L�)?0.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP V❑ Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ,�pl 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 F]'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 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 0'26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If back-up,sewage If no critical water, a 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. g p,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y P 30.Other DATE OF RE-INSPECTION: Inspector' n 1 . 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N _�'_ �•G)" t F-� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI S' ature Print: B`- Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y N 1 \� , `r��,lT / ry Dumpster Screen? Y N J\ lO Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12• Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140'F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces ' 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate i 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E7/ctim 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces ofP Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F IS sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential y I Game and Mid Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-40311(E) Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to thee me . illness interventions and risk factors listed above,can be found inn the h the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.r�ro TOWN OF BARNSTABLE HEA INSPECTOR'S Establishment Name- Date ICJ-�LVJEI I Page: of OFFI HOURS PUBLIC HEALTH DIVISION 8:00-9: A.M. % BARNS'1'ABLE. • 200 MAIN STREET - 3:30-4:3 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss.,639.p�m HYANNIS,MA 02601 MON.- RI.508-86 saa No Reference R-Red Item. EAS PRI T EARLY FOOD ESTABLISHMENT INSP CT ORT ' Name Dat e o oInspection Te Address Risk ra e Level Telephone Residential Kitchen Mobile Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector u : Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and 4sk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ a Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTEC�I,ON MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating kc�Iwo ❑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) �Q Corrective Action Required: ❑ ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 43' within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ardless.of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than Orion-critical violations 9 )( ) cited in this report may result in suspension or revocation er the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 no critic I violations. If 1 critical refrigeration. within 10 days of receipt of this order. vi lation,4 to 8 non-critical atio =C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: I sp c r' ure Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Si a re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted - Y N Dumpster Screen? Y N 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) kAssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives .. .. Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F __ _ , 55_ 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) Responsibility of the Person-in-Charge to - Other*- 7 9102.11 Common Name-Working Containers* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F - Applicants* 3-302.11(A) 7-201.11 Separation-Storage*Food Protection* p 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 11 Variance Requirements 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* . .3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590,004( ) q 590DW(G) Reporting by Person in.Charge* - Contamination from the Consumer X 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* 1,,, ,REQUIREMENTS FOR, 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition ofAdulterated or Contaminatcd - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpaste..nrized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and water From Regulated Sources - g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B).Compliance with Food Law* 4-501.111- Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 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* TIMErfEMPERATURECONTROLS 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(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 - Drinking Water from an Approved System* _ * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* cff crlvc tunoor 4-602.11. _Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 2 So Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11' Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed _ _.Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)igcater- 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 Cleanon n-Condition and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12 Cleaning.Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to as * Other 590.009 violations relating to good retail _ 590.004(C) j Wild Mushroom _ _ _ - _ -, - - _ _ Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices _ 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* N590.004(E) 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* Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-101.11 Food Safe and Unadulterated* 12Prevention of Contamination from Hands O g * Critical and non-critical violations,which do not relate to the foodbome 3 403.11E Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR•590.000 13Handwashing Facilities 3-202.18 Shellstock Identification* 3-50I.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 * 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 (-T) 9 9 27. Physical Facility FC-6 .007 7 Conformance with/ilpproved 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 1 Reduced_Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. - *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 7 TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Dater Page: of k$ OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BAR'Nis,`E. i 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS MON.-FRI. HYANNIS, MA 02601 No Reference R-Red Item PLEASE RINT CLEAR a3q. �0 508-862-4644 FOOD ESTABLISHMENT INSP,99CTION REPORT Name 1 ate vpe of sec io p outine Address isk Fo Ser pecti n eve) DM7 Telephone Residential Kitchen Date: Mobile Pre-op r Owner HACCP YIN Temporary Suspect III ess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector Jll Each violation checked requires an explanation on the narrative 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) ❑ 41 0 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r" FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS G ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control Q) Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSfI .Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 6 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations yy�� C-1 1 I Critical(C)violations marked must be corrected immediately.y (blue&red items) I Corrective Action Required. ❑ No Yes Non-critical N immediately or violations must be corrected imm y ( ) 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 ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cri ical vi lions. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 vio 4 to non-critical viola• ns= ' 29.Special Requirements (590.009) within 10 days of receipt of this order. - 30.Other DATE OF RE-INSPECTION: Inspecto i lure t: 31.Dumpster screened from public view O Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered N #Seats Observed Frozen Dessert Machines: Outside Dining N PIC' nat^ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted ,' N Dumpster Screen Y N 1 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) Assignment of Responsibility* $ 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 3-202412--y - 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45 F 15, Poisonous dr Toxic Substances EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C Responsibility of the Person-in-Charge to - Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F ( ) P tY * 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F - Separation r * _ 7 201.11 Separauo Storage* Applicants 3-302.11(A) -Food Protection* 20 Time as a Public Health Control 590A03(17) Responsibility of 7-202.11 Restriction-Presence and Use*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 Reuirements- 3-304.11 Food Contact with Equipment and Utensils ) 9 590.003(G) Reporting by Person in Charge* --- - - 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer 7-204.11 Sanitizers,Criteria-Chemicals* «, _ _ , , ° , - REQUIREMENTS FOR 3-306 14(A)(B)Resumed Food and ReserAdulterated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria*•... HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions _ Disposition otAdulterated 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 Source's r9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* Compliance 590.004 A- - liance with-Food Law* _ _ __ * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - 4-501.111- - Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F IS sec CONSUMER ADVISORY # - - - - -Concentration and Hardness* 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 Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cave 11112001 -4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 316 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min * - - Shellfish and Fish From an Approved Source Eggs' 4-702.11 ' Frequency of Sanitization of Utensils and Food ' 3-401.11(A)(2) Ratites,Injected Meals-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - - - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Shellfish* r 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - Din cater- .3-201..15 _ Molluscan Shellfish from NSSP Listed_ Chemical* ( ) ( ) ( ) ( ) 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 i Game and Wild Mushrooms Approved By _ 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 1 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 - ShellAoclC Identification Present* - - -- 2-301.12 - Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C)_ Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail _ _ _ -_ __ _ - _ ( )( )O 3-201.17 Game Animals* 11 Good Hygienic Practices 47 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 - -- Eating,Drinking or Using Tobacco* ' 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands - Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 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 .094 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 Cabello of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ -' 6-301.11 - Handwashing Cleanser,Availability pp t 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen.Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback&2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 0 °F SME rq TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: !� Date: Page: of �4 I I I " ( .i l OFFICE HOURS ARE PUBLIC 2 0 MAIN STREET SION c TI I 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �' HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �p �639•pie j 508-862-4644 - 'FDN1P` FOOD ESTABLISHMENT INSPEIICTI N REPORT Name Date a of Type of Inspection peration(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: ' Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other if 161 Inspector Out: :Z� kcs I Each violation checked requires an a planation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) 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) ❑ O- FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS fA ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) c. ❑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(H$P) ❑ 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 lleln Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations - - Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9.or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 8 non-critical violations. If 1 critical refrigeration. ) violation,4 to 8 no cri' 28.Poisonous or Toxic Materials (FC-7)(590.008 be in writing and submitted to the Board of Health at the above address ip al violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe to s Si In r Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's i r Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related'to-Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* - 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* '- ; 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *-- 19 _ PHF Hot and Cold Holding 2-103.11 Person-in=Chazge Duties - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) n 590.003(C) Responsibility of the Person-in-ChargeOther* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ge to - - -- - - - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se aration-Stora e*- - - - Applicants* � - "- 3-30211(A) -Food Protection* 7-202.11 Restriction-Presence and Use*P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15. _- Washing Fruits and Vegetables 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 Rlated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Resuictions g � ) Disposition of Adulterated or Contaminated - - - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) I Jnpasteurized 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 Sdurce"s 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* 4-501.441 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* _ _ y _ _ _ _ p 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112' Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13_ Shell Eggs* _ __ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water.* Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11. Drinking Water from an Approved System*. _ Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Battled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg-m.e rmlpnt 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 Shelifishand Fish.From an Approved Source. _. _ _ 3-401.1l(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 incater- 3-201,15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) Ratites-165°F 15 sec* Sources* 10 Per,Adequate Handwashing ing,mobile food,temporary and residential I Game-and Held 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 IdentificationPresent* - - --2-301.12_ _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * _2-301.14 When to as * Other 590.009 violations relating to good retail 590.004(C). Wild Mushrooms Wash*_ _ - _ _ __ _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding 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* 3-443.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23.30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 1 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 1.59ff.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003- 5-20411 Ltion and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . oca . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 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 009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.,590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i j Op THE r -� TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name:� Date• Page:� of e -W� ,.,"{ T I t: OFFICE HOURS D ASO B AR E. PUBLIC 2 0 MAN STREET EEVTSION ; t ". t 3:oo'=s:30A.M. Item Code C-Critical Item SC TION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MASS. HYANNIS,MA 02601 soe-s-FRI. No Reference R-Red Item I0T CLEARLY" FOOD ESTABLISHMIENT INSPE TI EPORT Name Date 12e of Type of Inspection O e Routine iv Address Risk ood Servi Re-inspection Level 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: CA �2_zd - - . Each violation checked requires an xplanation 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) ❑ J FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals _ FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and.Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating P- T-3; ❑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 y ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) . Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure El 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. Equipment and Utensils (590.005 25.E ui - (FC-4 B=One critical violation and less than 4non-critical violations 9 q p ) ) 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)(596.007) 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 Snon-critical violations. If 1 critical refrigeration. atio , to 8 -c"tical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. _ 30.Other DATE OF RE-INSPECTION: In a is S t Pri 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed 'Frozen Dessert Machines: Outside Dining Y N PIC's S" tur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.). FOOD PROTECTION MANAGEMENT ,'__ _ _ PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L14 Food or Color Additives' Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* _3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and-Cold Holding _ - 2-iO3.1'1 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 I - - - - - - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 3-501.16(A) Hot PHFs Maintained At or Above 140°F 590.003(G) Responsibility of the Person-in-Charge to - - - - - - Other* - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants*- - 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* _ 590.003(F) Responsibility of A Food Employee or An 3-302.15_ _ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* ( )590.004.11 - Variance Requirements- 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR . 3-306.1.4(A)(B)Returned Food and Reservice of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions _ ( ) Disposition of Adulterated or Contaminated - - - - - Food _ 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9" - - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501:111 - Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 ' Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-.202.13- Shell Eggs* _ _ __ _ Sanitization Temperatures* 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 Ma&From Potable Drinking Water* - .. - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.1-1 Drinking Water from.an Approved System* 4-601.11(A) Clean Utensils an Eggs 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 cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* M 590.006(B) Water Meets Standards in 310 CR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 155 Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 1 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meals-I55°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - 7 'Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-20L15 Molluscan Shellfish from NSSP Listed _ _ __ _ _ _ _ Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under - Game and Wild Mushrooms Approved By - 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.1$' Shellstock Identification Present* - -- 2=301..12 _ _ Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C)_ Wild Mushrooms_ _ _ _ _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 1 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 IS sec 3-202.11 PHF's Received at Proper Temperatures* Al2 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45_°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision ° 29. Special Requirements .009 3-502.11 1 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen.Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.Qp0. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t" No...... Fmc. 2.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T ..... .. ..... -----OF.......16.. Appliration "fox M!ipviittl Works Tutuitrurtion Vrrmft Application is hereby made for a Permit to Construct ()4 or Repair ( ) an Individual Sewage Disposal System at: Loc ton-Address o Lot o p Owner dre s 1 Installer Address UType of BuildinV Size Lot_..__-__•____-__•-__-___--_-Sq. feet a Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures -•-----------------•----.-.---------------.----------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. P" Septic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter___--_.-_._-__ Depth._-.-._"---..._ xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet_..______61_.. Total le ch tg ar a_. __._________Sq. ft. Z Other Distribution box ( ) Dosing tank ( ) N� � ""* Percolation Test Results Performed by.------------------------------------- •-••••-•..••-- e a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.----_------.--.----- Q f=, _ Test Pit No. 2................minutes per inch Depth of Test I'it-__..._.:..:_.__:... Depth to.groundwater.:.._____:.__,____.__ 9 ............ n Description of Soil-.- T ®U. �. - - ------ -------- -------- ---------- ! 0 ._.__ ' .A__ .. _- U W ------ -- -------------- --- `------ -- x Nature of Re �irs or Alterations—Answer when applicable.:��_. -------------------------------------------------------------------------- ---------------------------------• -•-•-............-......--•---•--••-------•.... Agreement:, The undersigned agrees to install the aforedescribed Individua ewage Disposal System in accordance with the provisions of Article XI of the State Sanita Code— The unders n d f- er agrees not to place the system in operation until a Certificate of Compliance has en issued by the bo d f health. ned - --- --- .-- ---•--•---•------•--•- ................ ........ .......... ""�� el. Application Approved By......= --------• / r- Date Application Disapproved for the f 011 win re s:.................. ------ __ __--_----- -_---- ___ - -------__.. ...... .............................................................. - --- --- ------- .......... •. . PermitNo.......................................... ............. Is sued...... ............................................... Date No...... FEs...,Z...... THE COMMONWEALTH OF MASSACHUSETTS �, _^BOARD %�HEA....�C�CF/ '' 1-......OF....... -- . Appliratioo -for UiBpoott1 Norkii Towitrortioo Prruld Application is hereby made for a Permit to Construct (>�. or Repair ( ) an Individual Sewage Disposal System at: •••--•--••-.`.Y � . -$---------- T -•---•--•-----------------------••----•--•--•-----------------------------------..........-•---- CU.. 1 r2.�.ai�tis.� cJfZ±�LI-.-- oIrlt1 1i ► 5- e� Owner dress .+ W r�6T__I--_, ��2----� �-w ('---------------------------------------- ! 1 i.'► 1 ��. tii� N.Ar2wlcl�j ,�1��F) ,a Installer Address UType of Buildinpi Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --------------------------•- No. of persons-------..-.................. Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow----------------------------------------.-.gallons. Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth............ xDisposal Trench—No-____________________ Width.................... Total Length.................... Total leaching area.-.-_.-.._.....__---sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet........-........... Total leaching area.---.._.-_.--___.S(1. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------- ------------------_---- ........................... Date---------------------------------- W Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-___---__-----.------ f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ............ ---- ----------------------•-------••••---------------•---•---••--••••----•-•-••--•-...•---..._--•--•......-•-••------•--... Description of Soil '; C�31.i x t --" x ---------- ------------------- ------------ �--:.--------------------------------------------------------------- (---- ------------. ----------- ..:. U Nature of Re airs or Alterations—Answer when applicable. ..- l✓� .5 r¢--• ---- 5•••-- U �0_1.�.------------------- ----------------------------------------------------------------------.... Agreement: The undersigned agrees to install the aforedescribed Individua ewage Disposal System in accordance with the provisions of Article XI of the State Sanita Code— The unders n d fur er agrees not to place the system in operation until a Certificate of Compliance has en issued by the bo rd of health. ned .. •-• ---'- --• -------------••------------ t' J--------- -------------- - Application Approved BY1 /---- Date Application Disapproved for the f oll win reasons-------------------------------- ............................................................................. --.........-•--•----••-•-•---------------------------•---••......---------------_--•.----•-•-----••---•------------------•----•-•...-------------•-------••-...------------------........---------•--. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Z HEALTH ....... OF........... . ............ �rrtifiratr of 10.1,outliliatta Wie�(n CE I Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b .... --- ----- ............... � In a er has b cc dance with the provisions of . rttc X/I of The Sta e Sanitary C9de as described in the application for Disposal Works Construction Permit No.-�}.�.....1��................ dated__._�p___—_�_ C` �S THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATL--------•••••-•--••••-••----•-----------------------•--•---•--•-----•------••--- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT No. L �j FEE . 6,c Permission is hereby grante to Construct ) or Repair dividu�Sege Dis oral Systeat No..... �- ?l�Lt--------- . .......... ......r.. . �- v treet �2 73._ as shown o the application for Disposal Works Construction Pe it �_.__.. Dated.......................................... -..................... i� 1 ._. -- _ J Bard of Healt j DATE•----� ---------------------------------•••- ................. ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r%r= ` ❑ pro to c . • . TOWN OF BARNSTABLE • w " OFFICE OF ssa.Moke$. f BOARD.O HEALTH �R F' t`�°A t6j9'I ae�MAIN STREET • HYANNIS, MASS. 02601 OUTSIDB CAPES f The Board of Health may grant variances from any of its' regulations providing the applicant for such•variance can prove satisfactorily to the Board that the. granting of said variance would not be Inconsistent with accepted public health practices and would not create nuisances to public.health or to the environment. The following are some of the criteria that must be met prior to the Board's consideration of a variance from Regulation 14, Town of Barnstable Health Regulations: (a) The dining area must be set back ten (10) feet from the property line, sidewalk, or public •. _.acccos war (P4......6 .G.o, atc.). a divider, such as a small fence, shrubs, etc., u:ust mark the designated setback. (b) The dining area must be part of the restaurant property whether leased or owned. The be mentioned on the described remises as in the case of a Common . dining area must P , Victualler's License. (c) Sufficient restrooms, both for customers and employees, must be furnished counting the additional outside seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (d) A self-contained drainage system aesigned to eliminate. odors will be required for all outside dining area. Conveniently located hose bibs with vacuum breakers must be available for washing down the dining area. (e)` Provision must be made by the applicant to protect *against the entrance of rodents, flies, roaches, and other vermin, into the outside dining area and Into the parent establishment. All entrance and exit doors used by food 'service personnel and customers, must be screenedand provided with air curtains meeting National Sanitation Foundation g.; standards. •y PACE 2 All windows or openings used for the transfer of food will be, screened and provided m the cu stomer's s entrance will be provided t wl h air curtains. An entrance separate fro P t P ' = for\ the transportation and serving of food outside:. Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. ' et from an outdoor dining(f) . Trash dumps.ters stall be situated no closer than 50 fe g area. If such,a dumpster is in the line of eight from the dining area, it roust be hidden from view by.`a stockade or other such fencing. The area around the dumpster and stockade r: must be kept clean and free of litter. Dumpsters must' be kept closed with adequate covers designed to prevent entrance of rodents and vermin and completely free of odors. (g) , The patio or other dining area su►face must be of such construction or material as to be readily cleanable and not be susceptible to Inordinate amounts of dust, mud or debris. (Brick, tile, concrete, or similar type washable surface, would be examples of acceptable material). (h) Tabie tops must be so designed and of such material and workmanship as to be smooth, non-porous, easily cleanable and durable] and shall be in such repair as to be readily maintained In a clean and sanitary condition. (1) . Silverware, used for dining outside, must be handled In such a way that contamination of the eating surfaces by the hands of food handlers is negligible. (Rarely enforced by Managers). (j) Seating capacity shall be determined by the Board of Health after submission of plans and visual inspection. (k) A menu shall be submitted to the Board at.the time of application for a variance. (1) Food service personnel must continuously police the dining area for paper and other trash. Placemat clips, cup holders and other such devices must be utilized to prevent blowing paper. Covered trash ref:eptacles must be provided in close proximity to the dining area, and must be kept from overflowing. i A 'PAGE 3 y (m) Strict clean-up practices must be adhered to. Waltresses, waiters and/or buspersons j a must be employed to clean up after each patron as in Indoor dining. Each establishment must abide by all regulations contained in Article X, Minimum Sanitation Standards for.Food Service Establishments, of the Commonwealth of Massachusetts, Department of Public Health Sanitary Code.' (n) Outside food handlers must have easy access to handwash sinks, clean cloths, and to -facilities where sanitizing solutions can be easily prepared and disposed of. (o) Hair nets or other effective hair restraints, such as hats covering all exposed hair, shall be .worn by all outside food or drink handlers. Beards and mustaches must be neatly trimmed. THE ABOVE CRITERIA ARE NOT INCLUSIVE T CONSIDERATION. THE BOARDAND ARE ONLY FURNISHED SRESEIRV.S STANDARDS THAT MUST BE MET MUM PRIOR TO THE RIGHT TO DENY VARIANCES FOR ANY OTHER CONDITIONS THAT MAY APPLY TO SPECIFIC LOCATIONS. ANY'VARIANCB GRANTED BY THE BOARD MAY BE REVOKED FOR SANITARY VIOLATIONS AFTER AN OPPORTUNITY FOR A HEARING IS PROVIDED THE PERMIT HOLDER. • '1 vr. A, 46.,,sc:, ; +�' •4, a !`�^ a ,+ .l 'k' �� .� K� ~�r'n ft r,� f r ; 7 - �.' .-=.' �` .r �, s'`r�aSe z ,�. l.. dr: :a` � �,. .s•�y wt:. t L - :C�. 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S a ♦ I- k �r `_, f�a ,s ,i r= :tb,ll f }.°'a=`•.1 ' S s ?� N.,, j ` :x � ;.�f i t •a b '�7rr' `f` ^t+ !sue .� r✓ '-.v, 3.. r• hv' n, 1 r r Zx ry,," a t S.r`a a r• r 't. !' a .... 1 '• .N s'. +t k''a,a ♦„-� .� - ;. ' rr" a .•�ff,. r{ "c. J++ '•a 'G S•°ek• r t..,r � r ,^ty{,,a s �ry h� �.a � . ,t �t r'� Vr S`.5. * ,.�, z3 .... �. r a Ys ..f" r �Mr: Robex-t•W. Kershaw,,.Gen+ •a3f' Iariag r �? `;'i �, •' t :�� w ' J .V {slam •Dsega4:8, r tt` a Yp; Aca v ~W3 :.xk M a itJr' ti`1? S,, r 5 r `Y p� aK r � r{'M ♦ wAr t;. � l Yano u3gh. Road Ra td•. �rw��l• �r Tt�. r n rs �.l lri.,r. "r 43.f�e r b� r".Zj!` t' F r ,a * � x to l'.'; *.r v�.`L- 3 4, c• -�z t '<:�.4' +. 9 �`��•tr r �.„3 }° .•a� iS`..•: t t•r r�s Hyannis ♦ .a a 'a~ : s a '• tr • •. Z ,."n S o C a'uF ;.. `,} ..js f �. t3♦. , :a.rkv ;l � ' _ ✓, ( r+ ' 'r L•� p •.,. a; d p `� �i- FS ° � ^�'.",�� bt "n r4'._ .`s 3 r.•y i. ,ra '.,ai. � �i.. x r e Dear Mr. xershaws '''' ♦ :., �� a .r :a s �,. a , a„ S'.ra 3, ;� ,� y -„§ +• 'fit „ Ry'!".? r ey.z�ro art l t wr ash t t�. ♦x v+ ja= �?' h L-. _�' ,.•a r ♦!. '_r n .`C yi •3 t1kj,.ti �i r y.J iS.; .ter .. ,'e•', ri,rl.� tAA, t• ,: '� You 'are granted a variance "on a Ftr :ax is�`£rom 2Regulaticxr 14 a T ofL •thel fit aan% ;Rea l tfh. Regyulations; -�pro�ibi;Ung,outs ide 'during" iih` a •.the .-fQi.L • .t .. conditions r,;�'.` rK.'y" rrtY ';{ y r13 r.'Y 3 -Ja -•C f�>� "• ` " r$ t �N r r '.'c ' ..j, •a ''vi •s a c y,: a a '':.z r - S'rf`- ..�^'`. t.r i_ ,. ^' r i�=, w`<4 � :. � t7'•4 � •:•! 7�-.� i c Paragraphs;A `to `0;,�contained ;in the-Minimum YCriterta � ~, • rr. pp <'! for``Variances fors Outside DAing must be` strctl`' ^5� adhered r ♦j ar ♦ ' ,{ c -�...,, '�,q ,,. � er �' ' 9 w t x r. •� R'1„':.-rZ h t w;7'"' � r 3 � r r a«� ;' , ``a �'„� • ;, e ♦ r �':'� �i,.r ti K: w• S .:.,fir 7'R��r�'�r}'. z , P J 5,- t : . `; � - t,.. .a 4f r F.•` Y � , # t f'•'- �i•" .� p., q 4 �` � t�"A+'. ,t`� 1 f 1 e.q k'` J_ f_ You are , resfirioted to five tab es o four with a a •maxi-, �k r mum- overall. cagac3ty�crf 118';;pexs�ins��'` . �� J�r�}� �,•r , � ^ � �,� ,� ti. e _ •,. 3 r ,. tb`t.2. t *:F r-'' fp y",�+"x fyh :` w t 6 , v '" r• .. G ..,. Y •, d-. • F ';` 3s t`7 e:,,�� - rt .er R. �: a r S n•° ..�f t tF "' ., i .+•<.. 3 -.S`ti "#. u�t'`�'. a r a:,,. �^ _ _ w A•: �; i' E 3 Y,•You4 must._receive the�J apgraval rof.-'-.the,'Seiectsren canes --the r s c ern .change u�your descriptio- r of premises.,�.. ! •,; r ��•� t •._ +., ax .:. 3 {e i 3 ';- .a+° ..s i, rt,rh ,•+..r _,• £,M.T�•`'.r` �f _:'� !'!' •`x�+C sr._ i�M`aa'• �t�.tiz+ .{ _� a� •' S 3 = Z � '" *3. 4� � a_:'"'`d: r y E4 .�` Th .Board rser�ies a rights to revo# e his variance ♦ thezYeveh.t vx 6f ions .afa~Article X Mari mu 'Satr - �. t.,in L c .y4 - ,y .. a�'tatson,=Standards ford•Food�Ser.�tice , 9stabl shore ts- end` �'r. ,• " 4, r,a v t ti r �. _a s J the, Town of;`Harnstahle :I3ea2th Regina a~ons, ' or, the 'cr3.ter .a contai;ned`.> r , Pa •ag=aphsM A :to k4� 'Minimum. Standardsr fur Outai'de Dinin�F•iare%;r�bseruecl. .•� .-!" i.7 ; a .F. .t. ,a,".s 4; a r s F'2, •t,. a i,a. , L ., z '-. r 3': -t•r. `-i r: r 3 Z..e a S' y a ,r .,,�+t�,z r �'`" •, i7, `*;r , .. � r r .t ,r ,. 7�', � t ✓ -1 �. ;it ah.'y i�� a *`. c t � e � t� *r3r` 3„iti _�{ � J - . very truly. yours �;k. ` ' ,� r. • _ .t i a t 3 atL ,€' �t:' t �;: 4. a � raid , • • 3 e a .J' '^ t �. -,r1: r"'s } .. t ?� Po- •x•P �'. -far a ``� 3,. Z �k '�t`^ t. l brx �` t{'+fie d.�.Fr1 *1._.rj,.-+e �.a4td ! w-i r �,at� y. r T �•if a, .'»n i •? � :'�r ,�,.;{`a �•.?-r • � r ,S._:� vc`vv � ar 's.�w �.i.k :-,- �.}��.'$ 3� � z.! Z�, � ��' S� �,! .�. * ..t ..f C •wxr� � .r•''r.,'•f a{.M.� � .: � t : r"' �"+ �..�_^r �:`x�y Robert",L' � Childs Chasrman t '•� °n .r 3 ,�„ a 3x 4 X a•��.., �•t• a^ 'i Fs .t{'J^ -ems °-..'t ., . > t "V.^ 4" _ t .� tr �r r -ti. .t K r S,a � s- ,+; t s r l.a. E e ! w r t` ^r� ,'3•`s 't J.ls."'� 3 V ? .Y.... J, �� aa< ! -•..' •� .,i. r .�'$ r it•` �, � { `'w.'�lcy♦r`t �� ..�Jf i,�, �'t.rti ♦ ?� �. 3¢" . • f ....� ��7.LYii a S.. �augh t �' "..r ,' • "r . t 1 ~ p•- l� Rk.l :E�•X. t-a -4 �., ' �' '4+ ' 16 t �, at �t fi � i t' 3.�•�•, X`t .'' c - rn -`% t- .z:z f J'•� [� x�T i-a,,,_f p. r �- w f �•'. 'r' -t l <.,�. 7 �'-ti` l r `[ S r t* 4 al .►.+ tr' 8 p,;1 t ` ��. D : l y HMI'P,�. Inge M •D Ya t� '• +' is J.'- B©Akb-OF.. 33rat'1J.ili1 a '�� 2 .�. .•t" t. rr 3 Y +z i s<.; •'r t• ,,� 1 y 3p_r c�r. a k -.ti • �.. '�' '" ] �'Y }�, �,�,a a }},y, /�s a 7�y b r s' , �:� � '`3 Jt'�r4'`' �y t A ✓• f, "+ c S,ik�, :� 1 f r. •�jjjj��f�YP .t. ","+_� - � 1�`} c.,,)„f Lt-$-'R•a :r' r N tt<, of� i y�•'" 3� re¢ r �, � `+ r ✓ �` v`4 Y A �� ? �4,. � : ,j. J fi '.!T j y°• t 'i�riii,/�I1llil� L '� - ,c €` r f"+, r •'y a. t �^ .?. .r r .. • 'Y E'.e -r� 'r .. cc Licensing.-Ager<t � �rr - _ ��j r .:.:r•"ff "t!�4 `J�� :11�� r,��y ••>ti Y �. Y � F}4 -�� 1. r ��,ll♦`�a rt i � ,�. s.~ ;•u K wV r ; z�. ,. S s' r• ''"�Y� � •� asS``�ly� [Ct�-,,.�. « t� '-a.i. e+�.,� " + b �_r ,�. ',' p., 3..t e � '�,V jy`: a j� �` - d 4 , '' � .6 .. . ' r 1. f� �.jy, .4�SY-•r .� r �, " •Vsr• t. rr ^•�. ` r 1 "!• � Dr, 6•"r. a .. r, a, r,v ....'�r- •a - � . t�. t- - . : �• .a•.,.- - s'. C 'wr,. �Y a fi"•1 T 3 +`'' a ✓ .. - ,s.� yyL #r'• � +3,r•�• '•, ,. [ ,�~ '. t ! �a, . 'r=x�: � �`"� '#_ �,."'w L.3 � *ry„'Js}a .}'� •* yw+;� ��r, -} y I;•.. - - �:.,aYai .. �� - a t�.+ wr K-A; s r+ r i�� }� rt i� yi � .'f a � 'r9•. .. •$ � _ T ,,.) n 1 f� N� n s�G Mexican i Cookery G Dar i I, 950 Iyanough Road • Route 132 • Hyannis, MA 02601 Board of Health 397 Main Street Hyannis, Ma 02601 April 15, 1983 Gentlemen: Sam Diego ' s, Inc . , located at 950 Iyanough Road, Hyannis, Ma. , hereby requests a varience from Regulation 14, concerning the service of food and beverage for outdoor cafes. The plans for an outdoor patio located on the Southeast corner (Route 132 side) of the resturant have been submitted to the Town of Barnstable Health Department . These plans have been drawn up in accordance to the necessary criteria by which the Board may consider a varience from Regulation 14, Town of Barnstable Health Regulations. The proposal concerning the materials, location, drainage, and seating capacity have all been taken into account. We thank the board for their consideration into this matter, and would appreciate your earliest possible response . Respectfully, P Y, Robert W. Kershaw General Manager, Sam Diego' s; Inc . r r10 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of RECEIVED Environmental Protection Southeast Regional Office UG 1 4 1991 William F. Weld HEALTH DEPT. Governor jOwNOFBARNSTggLE Daniel S.Greenbaum Commissioner August 12 , 1992 Mr. Thomas A. McKean RE: BARNSTABLE--Public Water Board of Health Systems, Aqua-Health Town of Barnstable Treatment P.O. Box 534 Hyannis, Massachusetts 02601 Dear Mr. McKean: It has come to the attention of the Department of Environmental Protection (the Department) through newspaper articles published in "The Register" and "The Sandwich Broadsider" dated June 22 , 1992 , and June 25, 1992 , respectively, that a reverse osmosis treatment system has been placed on line at Sam Diego' s Restaurant in Barnstable for the purpose of providing treated drinking water to the restaurant customers. Although this restaurant obtains its potable water from the Barnstable Water Department, an approved municipal public water supply, the addition of a treatment process and subsequent dispensing of drinking water to the public (<25 persons per day) , constitutes the establishment of a separate public water system. In this regard, it is a requirement of the Massachusetts Drinking Water regulations that the treatment system be approved and the restaurant registered as a consecutive public water supplier before it is allowed to dispense this treated water to the public. The Aqua-Health representative, Mr. Barclay Hanson, and Sam Diego,* s Restaurant have been contacted regarding this requirement. If you have any questions, please call Lee Tripp at (508) 946- 2763 or 2760. Very truly yours, Awren�ceS. Dayian,. C ief Water Supply Section D/LT/lr Lakeville Hospital * Route 105 9 Lakeville, Massachusetts 02347 0 FAX(508) 947-6557 • Telephone (508) 946-2700 -2- cc: Barnstable Water Company P.O. Box 326 47 Old Yarmouth Road Hyannis, MA 02601 Mr. Barclay Hanson Aqua-Health 217 Main St. Orleans, MA 02653 Sam Diego's Restaurant 950 Iyanough Road Hyannis, MA 02601 DEP-BOSTON ATTN: Julie Smith �YTMET�� TOWN OF BARNSTABLE �^ OFFICE OF = Baaa a rye15s.13. = BOARD OF HEALTH i639'Y 367 MAIN STREET p'�p \�lr HYANNIS, MASS. 02601 May 4, 1988 Ms. Mary Mahoney II Arlington Street Boston, Ma 02116 Dear Ms. Mahoney: In reference to your telephone conversation with Donna Miorandi, Health Inspector for the Town of Barnstable on May 4, 1988, the Board of Health verifies the records for Joshua Clark, 158 Wintergreen Circle, Osterville, Ma., sent to you are true and complete. Very -ruly yours, Thomas A. McKean Director of Public Health TM/bs THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IMF� , C DATA c�tttue ofxss�rl�rusps i3ARNSTABLE SUPERIOR Court JOSHUA CLARK, A minor by ARTHUR CLARK, Docket No. 45336 his father and next trien PlaiatiQ(e) M. R. C. P. SAM DIEGO'S Rule 30(a) & p� A TRUE Copy ATTE e 45 KEEPER OF RECORDS FOR`fendant(e) Z-t7: BARNSTABLE BOARD OF HEALTH 367 MAIN STREET Y'-2O-'-5j HYANNIS , Iv1A 02601A.DEEPUTy 11`F Greetings: YOU ARE HEREBY COj�jgANDED in the name of the Commonwealth of (Massachusetts in accordance with the provisions of Rule 45 of the ?Massachusetts Rules of Civil Procedure to appear and testify on belialf of the defendant _ A before a Notary Public of the Commonwealth, at the once of Attorney Mary W. Mahoney \o. 15 Standish Avenue in the City of Bra; itree MA 02184 may 19 _, at 10 : 0 0 oil the 2nd day of o'clock A. AT., and to testify as to your knowledge, at the taking of the deposition in the above-entitled action. And you are further,required io brim- ulth you any and all books, photographs slides and records of any kind.-and description relating to the treatment rendered to JOSHUA CLARK, d/o/b/ - 2-13-68 , 158 Wintergreen Circle, P.O. Box 563 , Osterville, MA 02655. WHEN YOU RECEIVE THIS SUBPOENA PLEASE CALL MARY W. MAHONEY AT (617) 267-7502 Hereof fat III! not as }'ou N611 answer your default under the pains and penalties in the law in that bel►alf made and provided �J /y Dated —/ , 19 Atto .eV or defendant Melick & Porter A� Address 11 Arlington Street Boston, MA 02116 City or Town (617) 267-7502 DIY Commission expires / �� , 19 'Strike out the words"And.you are further.required to bring with you" ualcs�.the subpoena is 6S Docamenta or tangible things, in which cage'::production of po quire the production' Pace provided, document.or tangible things should be dedgnated in the ITEM NO, REMARKS ` CORRECTED BY co�s� n .N.v ev+dQ,nce` . t��., _ � - �2. S`�o� Imo/ .. .;�� • -' ��. � . ! .. 3'��.,�a,-•�c �,�- .�' ,Jc,''ti,,'S�E sue.!"-�- �21f� 1{� E � ►^o how-- {4-(0— "�r. `ctGlY. .�nc� vi ' 2U ho•N 9. Ar �1/ ,r, 1 r-_.'S .Y's f r' ,~ } '�y.r•t...r�R�J�C.� Cl N Y=.} uuttitutapeaitL-I of ` ntamfadjuseti BARNSTABLE gJPERIOR court Dnckct No. 45336 JOSHUA CLARK, A Minor by ARTHUR CLARK y His Father and Nextrieff. •ntifi(it) n I. I;. C. h. VA. Rule 30(a) SAM DIEGO'S Dl•(l'n tf ulll�Y� Keeper .of the Records of o: TOWN OF BARNSTABLE BOARD OF HEALTH 367 Main Street Hyannis , MA 02601 Greetings: YOU ARE I-IEN.C13Y C0�• M.:1," DI:O in (lie naine of (lie Con:ntonxealtli of Ma;sac!:usetts i accordance with t):e provisions of Fula a:, of the Massac!iusetts Rules of Civil Procedure to near and t^st:iv on b;:!:aif .,i TOWN OF BARNSTABLE BOARD OF HEALTH Core a Notary Puolie of die \..'/111aJf ��'C�!1!l, at t!Ie of Melick & Porter torne Mary W. Mahoney O 11 Arlington _ Street, tilt: C:itt• of Boston, MA 02116 oil the loth day of 19 $z_ :It 11:00 o'clocl A. \I., acd testify as to your knl:,alyd,c, at tl-k- u;i:ing of the deposition in the above-C!ILIUCd action. end \-ou are further rcq-,;:red to brit)-, t-ot; any and all books , photographs, slides and records of any kind• and description relating to the treatment rendered to JOSHUA CLARK, d.o.b. : ' 2-13-68, address : 158 Winterqreen Circl P.O. Box 563 , Osterville, MA 02655. A TRUE COPY CONSTABLE .r-cof I:til not its )-oil will .an swor your ref:cull u:Iticr t!Ir fi:(ins :tnd lw,nalties in Ole law In that It l Ia!C ci•tc',c r.nd provided W. t'�.t(1�C1 D:t t c cl4141 ) /. 1 9 8 7 Mar; Mahoney I ,:.")-1CV /Or Melick & Porter 11 Arlington Street_ pJet rc.s V /�ocnry 11u61ic� Boston, MA 02116 t- / ef t:Olnrtll.i$Iotl CYpIreB ///� , 1J •:U or Town -Ike out the words "And you are further required to bring M•u4 yc:'• un(rss (lie subp.e)-n into require -. Production Doeunwn(s or tonkibic thins• in witich case production of doc� cnt or tangible thinac ehoutd 6e de ;Hated in the tee prowl cd. ........... it-.:•.:" •/ T N f bW •.. Vd w i BARNSTABLE. i 92 �O 1619 Ito MA'1 1' .36 7 Kin Sireel, -Avannij, Mam. 02601 NOTICE OF MEETING The Board of Selectmen will hold a meeting on Tuesday, April 5, 1983 at 11 :00 a.m. in the Selectmen's Conference Room, 367 Main Street, Hyannis, Ma. on the application of John E. McMahon d/b/a Baker Boy, Route 132, Hyannis , Ma. ( between the Marlin and Sam Diego's) for a new common victualer license. -31 John C. K1 imm Martin J. Flynn kEEWh� Jeffrey D. Wilson Board of Selectmen Town of Barnstable Legal Ad - BP 3/31/83 PLEASE BILL LEGAL AD TO: John E. McMahon 83 Old North Road Pocasset, Ma. 02559 i i y� I E T� No.--VI="a----- w OFFICE OF THE BOARD OF HEALTH o BABBSTABLS, t OF THE MASS. amp�a` TOWN OF BARNSTABLE, MASS. 4 N SEWAGE DISPOSAL PERMIT f Permission is granted to !_____>_ ____`__ " ___to construct ___ t Upon the Premises of Sketch � In the village of _ 100 or more feet from any source of water supply R 20 feet from building ` 10 feet from property line Health Officer. r- .Q 0 4ANGEBI'<?G E 7 '1 l�A f h' AND FGROF?FR 7-/,E S /N C• E H r' I. MA/�NG L E E•H. C I MANIdGL E - EL �'- E.N•C. I MANHOL E -- E.N C Z MANHOLE Ca VER, /8•, DIA - COVER , /8 CJ/.9• E.N,C. 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" , L) t: �77- -_ , .. i QL;ICI�`, N� 1 `�f� 57 5G t.) 62 65 u7 7r��68 l S I � 0 �. i _ 2.+ 1y 68 /7 d WAP.�Vi:'SH 7 75 77 78 CHEF'S LINE 79 �� 7 � CU ---- - L 3 ICE MACHINES v.zw LEGEND SYME30LS -- ------.__-- _ 263 5 81 71 71 8j 84 7 FLOOR DRAIN FLOOR SINK � ) T85 87 85 i 89 9)� 92 40 � 'JE DESIC-9IP12 10 9 8 7 _ - — - SHELVING U) JJ LIQOUR WAITRESS STATION ?4 ?� ?g 0 STORAGE 11 13 14 ,., . .a.,.,.a..m..,. .,. .�.�.. .. :. ,�_, . . .,.,_ -- - ..,� - z;-t,.t_. .. _.� - �..�� :r�-:.. .•�.•. _ �n� _. ., .:.. .s,. ....,..7 _,.. ..,,.,... - -- ----- — DOUBLE WALL SHELVES a . .1 > ^ 12/4/98 REVISED ILI1 . .,.s,.u.-.....w-.. ..... . .. -.r,+useiscm.ias;.fa�+•a �*a L,/ ' a . 7/98 REVISED A\ 5/27/9 8 REVISED ui,TE: 5 98 I r I �� DRAWN BY 5�3s Y SCALE: 1/4"-1'_-0" 7 t a o u O _ J _-.... .,.. O _LL n x® co < O^ DIN:N'. ROOM _ UJ �- 5 Gf) � D M Gj plate hev-1t T-9" c aing platy 2x8 floor joint& 2a _ _. THESE DRAWINGS ARE THE SOLE PROPERTY y v., .r.. -- ---:. � ✓ OF UNITED DtSI:,N GROUP. AND UNITED r�-__, ,,. ✓ EAST FJUnSERVICE SUPPLY CO. AND Art, NOT TO BE USED IN WHOLE OR IN DART -a "s a 1� WITHOUT THE WRITTEN CONSENT OF U,:'TE E II f!IIPI'1 >31'�C,�� [PjLA� DESIGN GROUP. tl J�IJ��". ��.J�/�.Ii I�" r� i i J OWNER AND ALL CONTRIkC MRS TO CHECK 1f ,� C AND VERIFY EXISTING DIMENSIONS AND CONDITIONS IN FIELD BEFORE STARTING / CONS(RUCTION AND T11 NOTIFY UNITED r " +; fi?�,A9 pitch: /�G D TAIL CHANGES. DESIGN GROUP OF ANY MATERIAL OR Dining/ Lounge { t , APPROVED BY: 2/�• Ft r r H f p a a i a a , - - — - - x . ..- - ..,: _ ... : M� .:.... ...,, .�.,..- r ,M:+�.... .,.. ..::. .:.fi-=.. .' ..tea•." ,�� k a l � Y _ _ _--_- .... ..— ... _.ibV. .. _._ +:.wr•. ...-.+a.,..-....- . .. y.r ._r.__ ..w......« _............. .rx - e.r-..........,....+..,...... ........ ,_..r-...w - - w_. ,.. _„.._.. +... .►.—•- . .- .w._ � ... .__,_ _.�.:..< .;-... .....,....® .. .w wr .,..,.. arW,:aiw _. ... :. .... .. '"w"".M^^_ ... 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QTY DESCRIPTION ELECTRICAL WATER WASTE GAS STEAM REMARKS E-- f- I— J 3 a_ O = � J O O tV m _jui LL Y = � CL a- U 2 � Z (n � m CL Z w * Q 1 1 WALK IN COOLER EasnNc U * 2 1 WALK—IN FREEZER r s 3 1 ICE MACHINE FASTING ` 4 1 ICE FLAKER MACHINE 7.1 1 X 1 4" w K IV I Vi FA V Fl TL ER p U 5 - I —SPARE NUMBER— TING WARE SLANT SHELF UNIT C L� 6 3 SHELVING UNITS SORTING � � * 7 1 27"UNDERCTR REFRIGERATED S/C L� * 8 1 WAITRESS STATION MILLWORK ��.. >k * L 9 1 96"WALL SHELF WALL MOUNTED * 10 1 MICROWAVE OVEN. * w/BAat SPLASH 11 1 96"UTILITY STAND 0 * 12 1 COFFEE MAKER THREE BURNER ! 1 C * 13 1 WATER & ICE STATION DPOP—IN .� * 14 11 1 SODA MACHINE AA 15 2 1 INSECT CONTROL FANS 120 1 X 16 1 IBENCH SCALE 12 1 x CTR TOOP MODEL 17 LOT SHELVING 4 TIER r� 18 1 CLEAN DISHTABLE cf.�u CFRS vrJ 19 1 RACK SHELF UNIT 23 1 PANT—LEGS-DUCT ® O Q Z 1 36"WIRE SHELF : ,, LO 22 1 DISHWASHER 51.8 34.5 3-114 208 3 X 4" 1-1 w/tloOSTER 23 1 U SHAPED SOILED DISHTABLE 2' W/SiNK °.. LL 24 1 WASTE DISPOSER 1 12� 1 X 1 1 2" 2 HP w/coNTRa PANEL m 25 1 PRE-RINSE SPRAY 1tL" 1 fl" DECK MOUNTED 25 1 DOUBLE OVER RACK SHELF TABU MOUNTED 17 2 HAND SINKS - w/FAUCETs � 28 3 HOSE BIBS T C 29 1 POT SINK 2 2 - -1 COVED CORNERS w/FAUCETS L, 30 1 DOUBLE OVERSHELVES WALL MOUNTED 31 2 CURTRON STRIP DOORS 32 1 WALK-IN COOLER 120 1 X INDOOR BOX BLOWER COIL 120 1 X CONDENSING UNIT 203 3 X 4" 1 33 OT SHELVING 4 TIER Ox Lll , 34 1 WALK-IN FREEZER 12D 1 X & RAMP 1 BLOWER COIL 208 1 X 1 CONDENSING UNIT 208 3 X 4" FL TOP DATE DESCRIPTION 0 35 2 96"WORK TABLES w . EN eASE * 35 1 DRIVE UNIT 37 1 POT RACK CEILING MOUNTED Z s 38 1 FOOD PROCESSOR p 39 3 DBL.OVERSHELF TABLE MOUNTED _ 40 LOTSHELVING 4 TFR � 41 2 DUNNAGE RACKS 42 1 MOP SINK 1 1 1-1 w/FAUCET ® 12/4/98 REVISED 1 43 1 72"WORK TABLE FLAT TOP W 1/13/98 DED MECHANICAL 44 1 BOOSTER WATER HEATER 30 .m 12) 1 X 4" 4" 105 GAS !HOT WATER ® CC 6/17/98 REVISED COVeD CORNERS W/ FAUCET 45 1 120-WORK TABLE W SINKS 1 1 -1 � 4/27/98 REVISED 1 46 2 60"WALL SHELVES WALL MOUNTED DATE: 5/"I/98 * 47 2 FRYERS ; Q 48 1 36"WORK TABLE w ACId SPLASH DRAWN BY: SAS 1�ps.uRSIHELF 49 1 CONVECTION OVEN 6.0 1 3 12D 1 X 4- 55 SSIN s1A _- �wsH SCALE: 1/4"=1'-0" * 50 1 SIX BURNER RANGE Q M UAL nlnNG 51 1 TILTING BRAISING PAN 5 120 1 X 1 1 1 80 * 52 1 STEAMER, CONVECTION W;,''�TAND & WATER MIER 5 Q 53 1 EXHAUST HOOD .4 120 111 1 EXHAUST FAN 41 2{� 1 X E v _ Z 1 MAI'F�IIP AIR FAN 1 203 1 X 54 1 5 S WALL PANEL 55 1 48"WORK TOP FREEZER 7.0 II � 120 1 X s C s 56 1 FRENCH FRY WARMER 12D 1 X C(IJNTER TOP MODEL 57 1 TUI BOFRY 28 208 1 X 1-1 4-204 * 58 1 ICE CREAM CABINET wINc WELL o 59 1 43"WORK TOP REFRIG. 4.5 1 i 120 1 X s o 60 1 72"CHEESEMELTER 1 60 a 61 1 FLOOR TROUGH �' WA 62 1 DOUBLE STEAMER 4.0 12D 1 X 4" 1-1 1 90 GAS FIRED * 63 1 INSULATED WALL PANEL 64 1 CHARBROiLER 4" 150 w c.BASE 6 1 EIGHT BURNER RANGE 4' 160 w W .RAWERS BELOW �i 1 96"REFRIG.EQUIPMENT STAND 7.2 1 4F 120 1 X _.J * � „67 2 HALF SIZE CONVECTION OVEN COUNTER TOP MODEL co Q 68 1 CONVECTION OVEN 6.0 1 I 120 1 X 4" 55 A�I FlNISH = W 69 1 EXHAUST HOOD 6.0 .5 12D 1 X ® � _ 1 EXHAUST FAN 1)1.23/4 208 1 X U 1 MAKE-UP AIR FAN 1-1 208 1 X W V co e — 70 1 S S WALL PANEL 71 5 MICROWAVE OVENS 1 X ® z Z 0 72 1 24"WORK TABLE w .A Q Ww 73 1 FIRE SUPPRESSION SYSTEM 150 120 1 X }- d. 74 1 PASS-THRU REFRIG. 7.2 1 4 120 1 X M.INTERIOR _ L` /5 1 36"WORK TABLE k TOP 7+6 2 REFRIGERATED PIZZA TABLES 1 X s C Lu 77 4 HEAT LAMPS 1 X 78 1 DBL.OVERSHELF LE MOUNTM ry 79 1 HOT FOOD TABLE 50 120 1 X 1 i' 4° 40 MANIEM 80 1 PASS-THRU REFRIG. 7.2 1 4 120 1 X INTERIOR • 81 1 44"PIZZA PREPJABLE �j 82 1 TRAY REST - WE SHELF BELOW * 83 1 ROLL-WARMER DRAWERS 3.3 Q7 208 1 X * 84 1 REFRIGERATED PIZZA TABLE 55 14i 12D 1 X 85 1 HEATED HOLDING CABINET 18 2138 120 1 X : 85 1 66"WORK TABLE 87 1, 60"WALL SHELF WALL MOUNTED • 88 1 42"PIZZA PREPJABLE 55 i 4i 120 1 X * 89 1 ROLL-WARMER DRAWERS 120 1 X * 90 1 96"WORK TABLE � LJ 91 - -SPARE NUMBER- L;_i 92 1 96"WALL SHELF WALL MOUNTED * 93 1 COOKING AND HOLDING UNIT 288 60 20B 1 X � ~ 94 1 REACH—IN REFRIGERATOR 1Q0 1 h 12D 1 X WZM ALUM.INTERIOR +� 95 $ - e�zcr> s 96 5 SHEET PAN RACKS 97 2 72"WORK TABLES u ELF 96 1 60"WORK TABLE i ND£�E�F , L END SPLASH ® 99 1 36"WALL SHELF WALL MOUNTED 1CD 1 84"WORK TABLE A '` 101 - -SPARE NUMBER- * DENOTES EQUIPMENT NOT IN CONTRACT. w NOTE ALL PLUMBING AND ELECTRICAL CONNEC;IC3NS FOR EQUIPMENT NOT IN CONTRACT }4 � TO BE %FRIFIE3 BY GENERAL CON TRACT C2. uE�E NAwrtn_5 ARE THE SOLE PROPEZTY 4t r UN �F GESGM CROUP, AND UN Fp I¢ EAST r C)ODSFPVICF SUPPLY CO ANO ARE I3 i i0 r.+E USED IN WHOLE OR IN r'A.R i k{ HE WRI T TEN CONSENT 0 L,yi ED ,k f 1 ONn� � Nu p i L C,ON7"SC'IO�tS i0 .,^,H}=CK yr;, F �!. <!<;r dO li c�; r g .' 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INVERT 6 va ;;; 3/4"TO I I& o' EL.y�•. r' J INVERT WA S H E D o'f r— EL-YS.�.7 w STONE �— D, T ��DIA .S �) C o U �8' �� T L 1OF1 •7 LE OF GROUND WATER TABLE 1�V E` 47 i4 SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY ' DATE 4/.7/d3 TIME 1�/!n/ J, k'ua, .��;� sr%J�: BOARD OF HEALTH TEST HOLE I TEST HOLE 2 77// .3 �$TErso.✓ //�;c.�, /?S ENGINEER ELEV. 4,9. 77 ' ELEV. yB. 7 . . . Et 59.1' DESIGN DATA /'pAZSE ��A�O n C Sa S.v C NUMBER 0 =A -5,0 Roc. TOTAL ESTIMATED FLOW 175.0. GALLONS/DAY 6 [ y2.77 b 6 c N3z 91. BOTTOM LEACHING AREA /5,3. 9 SQ.FT. /PIT SIDE LEACHING AREA SO FT/ PIT vrZ�,i:. -;.<i.>,,.� ��; XIS= 7� � � r ,[ _,z• ,5e' TOTAL LEACHING AREA . 9.7.8 SQ.FT PERCOLATION RATE c' MIN/INCH E ij �s.i7 `96.2 LEACHING AREA PER PERCOLATION RATE g'-.'. . SQ.FT. 6P� iilO WATER ENCOUNTERED NUMBER OF LEACHING PITS —�' X. 6 •��'.' pf'�^` �Q07r�i✓�a 0.7 FG✓,.`/J .��-�0. w.i.Tr/ ,j� Oi .STq�✓t'`. APPROVED . . . . . . . . . . . BOARD OF HEALTH DATE AGENT OR INSPECTOR COTS i•+ Z 3, fI oC.�s.ci✓ c r No � PETITIONER