HomeMy WebLinkAboutLITTLE MISS CUPCAPE - FOOD- CLOSED LITTLE MISS CUPCA�E
388 Main St., HYA
J ,
M fS r
C .
i
d -
pFIKE Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli, M.D.
BARNSrABLE. F.P.(Thomas)Lee,.
200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt.
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: 1025 Issue Date: 01/01/2022
DBA: LITTLE MISS CUPCAPE
OWNER: TAYLOR &TONYA STUMP
Location of Establishment: 388 MAIN STREET HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 40 OutdoorSeating: 8 Total Seating: 48
I
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: C,?� .
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
- - I
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
For Office Us • Initials•
Town of Barnstable
Laic P aiu �
a Inspectional Services
Check#
Public Health Division
iuvatatso tsac.:a�.wu�a�ua.a.aVt �"` aI/11f.
200 Mann Str s,MLA M91 r
Offim- 50&86Z-4W S Z%�-63ff j
'APPLICATION FOR PERNIIT TO OPERATE A FOOD ESTABLISHMENT
DATE `� NEW® RENEWAL
NAME OF FOOD ESTABLISHMENT:
ADDRESS OF FOOD ESTABLISHIYIENT: 3 720
h
MArr.nvG ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS-
TELEPHONE NUMBER OF AOD ESTABLISHMENT: U V 0 12!A
TOTAL NUMBER OF BA MS:
WELL WATER:YES NO__�...(ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL. SEASONAL: DATA OF OPERATION: I / TO
if j
NUMBER OF SEATS:INSIDE: OUTSIDE: TOTAL:
SEATING: MUST OBTAIN A COMMON CTUALLERsS LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REPAMEW"
OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIP.AND LICENSING AND MEET OUTSIDE DINING
REOUIREAUKM.
IS WAIT STAFF PRUViDED FOR UIIT FD_E DINING: aD
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
7TT AT TCrT♦"X WIOWWR aT_W4T AR
Y YL� %jr L'3I"Jul►aIllVI lit l: (YL ial<CH :1 1�AU 1H I APFLIf ill LV W)
FOOD SERVICE
RETAIL FOOD-ONLY mquW for TCS f"&(fco& _ram rfrig muon/freezer)
BED&BREAKFAST
CONTINENTAL BRF..AKFAST
COTTAGE FOOD INDUSTRY(f®rincaly:ed Idtchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES...PRONTHLY LAB ANALYSZ RE )
CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(ME PAGE#2)
SEASONAL,MOBILE&NEW FOOD ONLY*
REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
FI.EASE CALL U
Q:\Application Foms\FOODAPP 2020.doc
OWNER INFORMATION:
�FULL NAME OF AIPi'I.ICAIITT
SOLE OWNER: /NO D.O.B \ V' 11 OWNERPHONE# �I�A �6- /`U2q ;X
ADDRESS
CORPORATE OWNER: ry
CORPORATE ADDRESS: i v
PERSON IN CHARGE OF DAILY OPERATIONS:
List��,(2)Certified Food Protection
n Nfan$g�AND at least(1)Allergen Aware eci Staff
All MOD E�1t1yLTL�71117iL'lr l�wart L7LVC i C W ad 1 Vi1U I V 11VU 1 l�lllil t!�E r OCil l�1.
"ATTACH COPIES OF CERTIFICATES** The health Div.will NOT use past years' records.You
must provide new copies and POST THE CERT C;ATES at your food estahlishanent.
Certified Food Managers Expiration Late AllerEeD Awareness Upiration Late
DAPA
2. c D ���
SIG TU C DATE
***FOOD POLICY INFORMATION"*
*
SEASONAL FOOD SERVICE:All season food estabbshmm ftrhdJingmdb9c wicks i be inspeLled by the Health Div.
a it T�1........ Tl ST....taT.1MV GAO OLDS 4 ..1.aMt 1ST at t....,.a M) J..-...
iii10T�O 6�i?iur:: riGA�G Vatt ncnTTu Ltv.dl�vo-ova-'4v<r4�it3 Stii►tuut$yG�um�vu. rlc�c�at'i a�lr�l�f)usyJ in a(ItiBnCe. .
FROZEN DAIRY DESSERTS: Fwzendemms mum be tested by a State Cerfified lab prior to opening and monthly thereafter,
with sample results submitted to tie R Div Failure to do so wM 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 theTownby fax or mail prior to catering
event. You must complete a catering notice found at httv:/iwww.townofbarnstable.us/healthdiwision/anplications.asa.
OUT DOOR WrL.v'G: v tdooi c;oolc ri&pmparafiou,"msviw of any kwu p int c a fc5nci es` wuaiavetriri pn►nioited.
NOTICE: Permits run wally from IanuW Ist to Dec-3I'`each yew IT IS YOUR RESPONSIBELM TO RETURN
THE COMPLETED APPLICATIONS)AND REOUIRED FEES BY DEC 1st.
Q:\Application FormsTOODAPP REV3-2019.doc
i
Y •�� Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
SAMNST BLE Paul J.Canniff,D.M.D.
MAC' F.P. Thomas Lee Alternate
200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 1025 Issue Date: 01/01/2021
DBA: LITTLE MISS CUPCAPE
OWNER: TAYLOR&TONYA STUMP
Location of Establishment: 388 MAIN STREET HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 40 OutdoorSeating: 8 Total Seating: 48
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
y
D
�
`"E Town of Barnstable For Office Use Only: Initials:
'
Date Paid Amt Pd$ _
&MMS ABLE, ; Inspectional Services
�A039.p�ro� Check# (Y `
lFo3. Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE FOOD ESTABLISHMENT
DATE NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: 1, ULlcav�
MQADDRESS OF FOOD ESTABLISHMENT:
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: U
TELEPHONE NUMBER OF OD ESTABLISHMENT: ( -lif:�, .,A
TOTAL NUMBER OF BATHROOMS:
WELL WATER:YES NOIV---... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO
NUMBER OF SEATS: INSIDE: OUTSIDE: -5L—TOTAL:
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV,
** OUTSIDE DINING REMINDER***
OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? (�f
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED& BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL,MOBILE & NEW FOOD ONLY***
REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:Wpplication FormsTOODAPP 2020.doc
OWNER INFORMATION:
o� Sfi _
FULL NAME OF APPLICANT Q ���
SOLE OWNER: E /NO D.O.B 2 1, "1 t OWNER PHONE # 1645 .
U
ADDRESS
CORPORATE OWNER:
CORPORATE ADDRESS: I
PERSON IN CHARGE OF DAILY OPERATIONS:
List(2) Certified Food Protection Managers AND at east(1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
artist provide new copies.and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1. l v / 20 1. -WkY%M V3
2. -1u, -Az / /
-q
. n
PLI T DATE
***FOOD POLICY INFORMATION"*
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to openine!! 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 httn://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.31s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FormsTOODAPP REV3-2019.doc
I
c
time Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Healt1,l l Donald A.Gaudagnoli,M.D.
araerFsrABU& t Paul J.Canniff,D.M.D.
MAC` F.P. Thomas Lee Alternate
200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 1025 Issue Date: 12/10/2019
DBA: LITTLE MISS CUPCAPE
OWNER: TAYLOR&TONYA STUMP
Location of Establishment: 388 MAIN STREET HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 40 OutdoorSeating: 8 Total Seating: 48
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: Cap
I
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
�1NE For Office Use Only: Initials:
Town of Barnstable Date Paid . Amt rd$ '
&MMSTABLE, : Inspectional Services
,b t..�
Check#
Public Health Division `
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601 "o
Office: 508-862-4644 Fax: 508-790-6304 _
+1
APPLICATION FOR PERMIT TO OPERAT& A FOOD ESTABLISHMENT
DATE a� NEW OW ERSHIP RENEWAL
4
[Ati V
NAME OF FOOD ESTABLISHMENT:
C: a
020,oti
ADDRESS OF FOOD ESTABLISHMENT: I, 'MW
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
p I
E-MAIL ADD RESS: V( (+t M, Caw LDDn
TELEPHONE NUMBER FOOD ESTABLISHMENT: 5B -22-5--�
TOTAL NUMBER OF BATHROOMS: C
WELL WATER: YES NO .. (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL:^ SEASONAL: DATES OF OPERATION: ' / /- ✓
NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL:
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
x+ ZFOOD 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
QAWpplication FmmsTOODAPP 2020.doc
I
OWNER INFORMATION:
FULL NAME OF PLICANT
SOLE OWNER Y /NO D.O.B ' OWNER PHONE # ' p
ADDRESS /
CORPORATE OWNER:
CORPORATE ADDRESS: r�
PERSON IN CHARGE OF DAILY OPERATIONS:
List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records.You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1.� W /� /a � 1. 1�� / l / �s✓��
2.
SIGNA OF APPLIA NT DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast).
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January I st to Dec.3 I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist.
Q\Apphcation FormsTOODAPP REV3-2019.doc
of `x Town of Barnstable BOARD OF HEALTH
Paul J Canniff,D.M.D.
Board of Health Donald A.Gaudagnoli, M.D.
t a,RNgr,►Btz
John T.Norman
nss 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
ra 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: 1025 Issue Date: 12/20/18
DBA: LITTLE MISS CUPCAPE
OWNER: TAYLOR&TONYA STUMP
Location of Establishment: 388 MAIN STREET HYANNIS MA 02601
Type of Business Permit: RESTAURANT
Annual: YES Seasonal:
IndoorSeating: 40 OutdoorSeating: 8 Total Seating: 48
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: - -- - --- - -
MOBILE-FOOD:
MOBILE-ICE CREAM: ��
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES:
FFORESTABLISHMENTS WITH SEATING:
ERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I -_._ _ - -..._..-. .3- ._.-. _ ...... .. _ ..
r .
r
FIRE Tby� For Off Initials:
o„ Town of Barnstable _
Date Paid Amt Pd$J
BARNSTAB Inspectional Services
1639.ATEo ,, 6b2
Public Health Division
Thomas McKean, Director l ,1
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
j� PIPLICATION FOR PERMIT TO OPERATE A OOD ESTABLISHMENT
DATE v NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: LJ
ADDRESS OF FOOD ESTABLISHMENT: I I tiXA WI -1 02—UO l
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): C
E-MAIL ADDRESS: can
e
TELEPHONE NUM '&M
BER OF OD ESTABLISHMENT: -
TOTAL NUMBER OF BATHROOMS:
WELL WATER:YES NO� ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE:3 OUTSIDE: TOTAL:
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV. AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?
0
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED)
*** SEASONAL,MOBILE & NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
Q Upplication FormsTOODAPPREV2018.doc
r
PLEASE CALL 508-862-4644
OWNER INFORMATION:
FULL NAME OF APPLICANT 1
SOLE OWNER: ES/NO D.O.B �. OWNER PHONE# W _
ADDRESS � v,, ``J Mh-- 02LA
CORPORATE OWNER: WiM FEDERAL ID NO. :
i
CORPORATE ADDRESS: uug ?Tk a
PERSON IN CHARGE OF DAILY OPERATIONS: 71 0o
I k-
List (2) Certified Food Protection Managers AND aY least(1) Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date llereen Awareness Expiration Date
—601
2.
t'
OF APP C T 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 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townolbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and
Employee Signature Form.
NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
QAApplication FormsTOODAPPREV2018.doc
`oFt rokti TOWN OF BARNSTABLE_ , HEALTHwsPECTOR`s Establishment Name: Date: .Page. . of '
o OFFICE'HOURS a2'
PUBLIC HEALTH DIVISION 600-9:30A.M.
BARNSTABLE. • 200 MAIN STREET 3 30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION_ Date Verified
A_ `0� HYANNIS,MA 02601 MON.-FRI. No Reference .R„-Red Item PLEASE PRINT CLEARLY
MPS°' 508-862-4644
FOOD ESTABLISHMENT-INSPECTION REPORT
Name Date 'Type o T o I ection
O outineIJ
Address Risk ood Service ection
Level Previous Inspection
Telephone . Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP YIN Temporary Suspect Illness �fG�
Caterer General Complaint
Person in Charge(PIC) yime Bed&Breakfast HACCP
V76 U9, ( , Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors IRed Items)
Anti-Choking 590.009 ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.00 (F) ❑
Action as determined by the Board of Health. Allergen Awareness 590. 9(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
1 .
❑ 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 Foo S.
❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures q , / Aeli
❑ 5.Receiving/Condition ❑ 17.Reheating - -.1"
❑ 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 -t _
.❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
rQ
-0-401- A�, 4k::�
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �Critical(C).violations marked must be corrected immediately. (blue 8�red items) Corrective Action Required: No ❑ Yes
Non-critical(N)violations must be corrected immediately or No
90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ p
y y ❑ Voluntary Compliance Employe-Restriction/Exclusion Re-inspection Scheduled EmergencySus Suspension
C �N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9
(FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
( )( ) be in writin and submitted to the Board of Health at the above address violations observed,7 to 8non-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Mate als FC-7 590.008 g violation,4 to 8 non-critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE QF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster screen from b e
Permit Posted? Y N Grease rap Previous.PUmpirfg Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC'S S, a re Print: A `/�'
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N � �� �, \\,� _D
v I Dumpster Screen? Y N \/
.s.�v.-.a`ti-._.�^'.��.-w�.�_..wi^,...-.Kl+.-...s'...-.r.r-.vs.✓-.i.:..'+d_. +�.v-..-.�. -�...r-.. ..•-.4.--w.,�,..-. . w+•:.-++r"++.✓�r..+�: s+.�-r^+.,L.:,.,�• q,�-,.._ .meµ,. _
r-
Violations related to Foodborne Illness- Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C),, PHFs Received at Temperatures According to
1 _590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 _ Food or Color Additives Law Cooled to 41*F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 1 3-202.12 '. Additives* - 3-501'.15 Cooling Methods for PHFs
Cooked and RTE Foods.*.. _ * PHF Hot and Cold Holding_
2-103.11 Person-in-Charge Duties - - - 1 3-302.14 Protection from Unapprove&Additrves
Contamination from Raw Ingredients Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
1$
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 IdentifyingOriginalInformation-Original Containers*
2 590.003(C) Responsibility of the Person-in Charge to_ __ Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
Require Reporting by Food Employees and Contamination from the Environment
7-102.11 Common Name-Working Containers - - 3-501.16(A) Roasts Held At or Above 130*F*
Applicants*- 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control '
7-201.11 Separation-Storage*
I
590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*
PP P
Applicant To Report To The Person In CharB *e 3-302.15_ Washing Fruits and Vegetables 7-202.7.202.12 Conditions of Use*
11 Restriction-Presence and Use*
3-304.11 Food Contact with Equipment and Utensils* 590.004(11)- Variance Requirements
*
590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g ( )
Disposition of Adulterated or Contaminated
Food _ _. _. 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
3-701.11 Discarding or Reconditioning Unsafe Food
FOOD FROM APPROVED SOURCE I * 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 - Food and Water From Regulated Sources - y - Food Contacf Surfaces 1,7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A74) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and
- - - - - 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served*-
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and *
-" 3-201.13 Fluid-Milk and Milk Products*'- 4-501.11T Mechanical Wazewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 __ Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water*' "" - � 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or
* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec*
5-101.11 _ _Drinking Water from an Approved System _ _ _ _ * _
590.006(A) Bottled Drinking Water* gg Not Otherwise Processed to Eliminate
{ Equipment 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001
V _ _ 4-602.11 _ Cleaning-Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets�Star�dards in 510 CMR 22.0* - Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
IF Fish-From n Approved u e 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
_ Shellfish andaSo rc - _ _ _ - gg
- - - - - - 4=702.11 Frequency of Sanitization of Utensils and-Food
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
Shellfish* - ----- - - 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 o Section 590.009 A - D in ca[er-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) . ( ) ( )
* - - Ratites-165°F 15 sec* in mobile food,temporary and residential
Sources g• P az'Y
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By -_ - 2-301-11 -Clean Condition-Hands acid Arms* t the appropriate sections above if related to
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave
3-202.18 Shel]stock-Identification-Present* - _ _2-301.12 Cleaning Procedure* _ 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When,to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices - 1 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
$ Receiving/Condition -- -- 2-401.11_ Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
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 Packa a Inte rit * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
g g Y Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
P
Tags/Records:Fish Products
5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility ' FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008
HACCP Plans i 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
i
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
`-
F IHE r TOWN OF BARNSTABLE. HEALTH INSPECTOR s Establishment Name: Dater !D 3"ge: F of
OFFICE HOURS
R�NSTAB�E O: PUBLIC
2 0 MAN STREET
3:3030-4:30 P.M.
VISION : -
:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
BA�A 6,3 a�0� HYANNIS,MA 02601 M 508-8 62 4-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY
644
'FOMP' FOOD ESTABLISHMENT INSPECTION REPORT
Name L-ttke,(KLS Da e o section -
ifflw outi _ _
Address399( Risk ood See Re-inspection,
Level a ai 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
s
Inspector Out:
r
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) ed 0 14ok w",
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives I
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑ 6.Tags/Records/Accuracy(if 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 SP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22..Posting of Consumer Advisories + G
Violations Related to Good Retail Practices Llue Items) Total Number of Critical Violations V
Critical(C)violations marked must be corrected immediately. (blue&red items) e1 1 Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating Q� i
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items F] 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 t tion of F is scored automatically if: hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation rodents or insects,or lack of
a
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)
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's i nature Print: -
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y____N .
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 590.004(F)
3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* *
2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F
Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F*
* 7-201.11 Separation-Storage*
Applicants * 20 Time as a Public Health Control
3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*
3-302.15 Washing Fruits and Vegetables 590.003(G) Reporting by Person in Charge*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements
3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a 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.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145F 15 sec
Equipment ° * Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* gg* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e/r cri-uirzoor
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surf
aces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) ' Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 A D
3-201.15 Molluscan Shellfish from NSSP Listed * ( )-( ) Violations of Section 590.009(A)-(D)in cater-
* Ratites-165°F 15 sec* in mobile food,temporary and residential
Sources g. P- ary
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.
radicsshould be debited under ff29-Special
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
13 Handwashing Facilities
3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked Fr from 140°F to Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours anndd From 70°F to 41°F/4545°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/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria* _
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
oF. r TOWN OF BARNSTABLE HEALTH InISPECTOR s Establishment Name: Date .Page of
OFFICE HOURS
tP� ° PUBLIC HEALTH DIVISION 8:00-9:30A.M.
BARNSTABLE. 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
,65 HYANNIS,MA 02601 08-8MON -FRI. No Reference R-,Red Item PLEASE PRINT CLEARLY
�A +a3s• �0 508-862-4644
'EDMP�' FOOD ESTABLISHMENT INSPECTION REPORT
Name ftpe o T spection le
40
p -Routine-/, t/ r
Address ° Risk ood Service ection IV
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
Al In: Other
Inspector Out: v
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. O
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 YU
❑ 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 mod'
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 9�
❑ 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 1
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY a
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ® ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B.
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of
no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non,critical. If no critical water,sewage back-up,infestation of rodents or insects,or la
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's Signature Print:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y. N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions _
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 14- Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods:* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* * 590.004(F)
3-501.16(A) Hot PHFs Maintained At or Above 140°F
7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130*F*
3-302.11(A) Food Protection* P g
7-201.11 Separation-Storage*
3-501.16A
Applicants* -0 Time as a Public Health Control
3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*
*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � )
Food - 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601. ) Clean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or
11A
5-101.11 Drinking Water from an Approved System* ( Eggs-Immediate Service 145°F 15 sec*
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb die 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) I Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Stuffing Containing Fish,Meat,Poultry or
3-20L15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-.(D)in ca[er-
Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 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
Prevention of Contamination from Hands
_ : 12 3-403.11E Remainin 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
B Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70`F
3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Within 4 Hours* 23. Management and Personnel FC-2 .003
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient
Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements '009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. '
`oFIKE rows TOWN OF BARNSTABLE HEALTH
INSPECTOR'S Establishment Name: �.n "�C IDS /41 ---Date: �6 lq Page:_�of
P ° HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE, - 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
�y�`zen > FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644
Name G� Date M/'y Tvoe of T f Inspection i
►^ s outin %- I
Address Risk ood Service e- spection
^^ s' Level Re ai Previous Inspection ��/ I 1 `ctvv
Telephone Residential Kitchen Date: s"�
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness QO l
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector a , jr Out: ` �� c0 t
r
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. halo at/oil U0- 'J�tr
Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009(E)
❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 1 PX
�!
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ® _ ,nColo C/D
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands t' V K
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 ,r , 17
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '� �'I l TI CuAn
❑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 D(
❑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 fVL C.l�
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) I Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating 1 1.
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 1'05-'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 t F is scored automatically o la hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of
be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: ,n�Y'/^7,//�� , /(/{�
31.Dumpster screened from public viewAIIIA61 (J "/ ! r V r ' Y
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Signatur 1�� Print: ( _
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �J Y�d t/, L
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* S Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45`F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding
Contamination from Raw Ingredients 15 590.004(F)
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 Anima]Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140`F*
7-102.11 Common Name-Working Containers
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* 7-201.11 Separation-Storage*
PP 3-302.11(A) Food Protection* LIP_ Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-,Prohibitions*
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and AdulteReserrated
or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served
y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145`F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment
5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective iiuzoot
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* foodborne illness interventions and risk factors.
* 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )(b)
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condttion 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'17 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30)
[3-2102.18
02.15 Package Integrity (C) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodborne
01.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
03.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Within 4 Hours* 23. Management and Personnel FC-2 .003
Tags/Records:Fish Products 5-203.11 Numbers and Capacities*
5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
.
3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008
HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
1
p IME r TOWN OF BARNSTABLE. HEALTH INSPECTOR's Establishment Name: L /`1)' Date: Page:._ _of /.
`p O , .. OFFICE HOURS - r
PUBLIC HEALTH DIVISION - 8:06-9:30 A.M.
BARN STABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS,MA 02601 M-8 -FRI.62 4644 No Reference R-Red Item PLEASE PRINT CLEARLY
508-8
rEDN1 FOOD ESTABLISHMENT INSPECTION REPORT Y1L
Name C jJ Civerto,Pc
Date Jdlo TyRe o f Inspection
er io s , outine
Address Risk ervi = eotion
Level a ai Previous I sp ction
C-
Telephone Residential Kitchen Date: . G
Mobile Pre-opeY.tio�0
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint ,+ 0 +
Person in Charge(PIC) Time Bed&Breakfast HACCP S Z 2 L Q 6S e S t�i1 O
In: Other
py
InspectorQcAv LA, S m, Out: M re. °ne oc
1 C �eGke ✓ T oc�f'
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) ❑ Q f C f1i 11 0
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations \�
Critical(C)violations marked must be corrected immediately. (blue&red items) -) ® Corrective Action Required: No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an.inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations g
(FC-4)(590.005) cited in this report may result.in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 a
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or'lack of
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration.
29.Special Requirements (590.009) within 10 days of receipt of this order. viol on,4 8nnn-critical violations=C.
30.Other DATE OF RE-INSPECTION: Insp or's i ature Print: D
31.Dumpster screened from public view p( V I'C L✓F
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si Print:
NM
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y
Dumpster Screen? Y N
Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* *- 19 PHF Hot and Cold Holding
3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 590.004(F) * -
3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* 7-201.11 Separation-Storage*
PP 3=302.11(A) Food Protection* 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* 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 Reted of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
Not Served*
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts *
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* I Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
- . ean Utensils and Food C Surfaces f 000ntact uraces o * Animal Foods That are Raw,Undercooked or
5-101..11 Drinking Water from an Approved System* 460111A( ) Cl Eggs-Imrnediate Service 145°F 15 sec
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef 11112001
4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
aces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitizaliun-Hot Water and StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g Ratites-165°F 15 sec* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
Sources* ing,mobile food,temporary and residential
ut
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and A Mushrooms Approved By 2-301.11 Clean Condition-Han Arms*
Hands and A *
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(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* i 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'17 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.15 Package Integrity .. g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which.do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41*F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 r Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000:
Morgan
Stanley 327 - 001
PROPOSED 3000 GALLON /
CAPACITY GREASE TRAP
(H-20 RATED) /
PROVIDE VENT
00 3 0 9 —2 21 j o GREASE TRAP M
N ` o TO ROOF
Puritan \ \ Future ` /
\
\ Clothing \ `Restaura`t j\ New
Restaurant
cornpleX �\
B u.
Existing
MgsIrk
09
ETo PETER T.
STRMcENTEE
w I o CIVIL
No. 35109
�EPSIE�``° `�
A ENG�
PLAN REVISION: 2/3/12 — REVISE PIPING TO CAST IRON.
PROPOSED GREASE TRAP
394 MAIN STREET, HYANNIS, MA
Prepared for Four Hundred Main. Realty LLC, P.O. Box 2652, Hyannis, MA 02601
Engineering by: SCALE DRAWN JOB. NO.
Engineering Works, Inc. 1"=40' P.T.M. 112-12
12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No.
(508) 477-5313 1/24/12 P.T.M. 1 of 2
iMessage Page 1 of 1
McKenzie, Marybeth
To: Chris Graham
Cc: Wadlington, Ellen r
Subject: RE: 388 Main St. Grease trap
Morning Chris,
This is for your records:
3000 Gallon GT 15 gallons/seat = 200 seats
Pizza Barb one 49 seats inside
f
''0 seats outside
Rendezvous 50 seats inside � Z.
15 seats outside
yp t8
Little Miss Cup Cake 35 seats (as noted on plan) --
i 7
Remaining seats available = 41
I will put a copy of this in all three folders. Don't forget to check with Dave Anderson from DPW about the
connection too. Hope this helps and if you have anymore questions please let me know.
Marybeth McKenzie R.S.
-----Original Message-----
From: chrisgraham508@gmaii.com [mailto:chrisgraham508@gmail.com] On Behalf Of Chris Graham
Sent:Tuesday, March 11, 2014 2:13 PM
To: McKenzie, Marybeth
Cc: rpenn
Subject: 388 Main St. Grease trap
Hi Marybeth,
I'm just confirming per our conversation this morning, that the 3000 gal grease trap that services
394 ,and 390 Main St. Hyannis will accommodate 40 more seats for the proposed build out at 388
Main St. Hyannis ?Thank you for your attention to this matter Marybeth.
Chris Graham
I
I
3/12/2014
c
Now—
Li
M CROW VE C❑NVECTI❑
A ❑VE OVEN
REP, SIN REFRIGERAT❑R FREEZER �
PREP, TABLE x W
DRY STORAGE — v
ICE I� Ly-
FRP LINED S MAKE TRAS CD
—` C
}
STORAGE z Z
Tr
S o
PREP. TABLE
2 A o0
z -�
\ d
hSZ�� OI V
�ll
f o k
X Lj-
PREP. . TABLE TRAS PARTIAL
\ WALL x S�� Q
F so L CJ
STACKING I I i ��I I00
MAP W/D r _ W �
SHELVING. ! 0 O
-� _ U
C��,e
LOCATION( — WAGE
VILLAGE 1
I H S T A LLER'S NAME & ADDRESS
BUILDER OR OWNER
/�.�,
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
a
A
tl �
0 �
✓ r a
o �
4
McKenzie, _Marybeth
To: Tonya Stump
Subject: Frosting at room temp
Hi Tonya,
Just getting back to you about the frosting being left at room temperature. The product
you mentioned is butter, sugar, and flavoring which would be OK. The cream cheese frosting
will be refrigerated as you stated this afternoon. I' ll print this out and put it in the
folder for future reference. Thanks, Marybeth McKenzie
1
Page 1 of 1
FLAVORS
Baked from the finest ingredients,our cupcakes will leave delectable taste that you will always want to come back for more.Little Miss
Cupcape offers the following cupcake flavors:
Wicked Awesome Oreo
Chocolate cupcake with Twinkie filling,frosted with Oreo vanilla butter cream and topped with a scrumptious Oreo.
Vineyard Vanilla
Vanilla cupcake with Twinkie filling,frosted with vanilla butter cream and topped with a white chocolate whale.
Little Miss Buckeye
Chocolate cupcake with decadent chocolate ganache filling,frosted with peanut butter,butter cream and topped with a little buckeye.
Chark Attack
Chocolate cupcake with death by chocolate ganache filling,frosted with chocolate butter cream frosting and topped with a Cape Cod
chocolate shark fin.
Captain Carrot Cake
Carrot cake cupcake with white chocolate ganache filling,frosted with creamy cream cheese frosting and topped with a white chocolate
anchor.
Lobster Red Velvet
Red velvet cupcake with white chocolate ganache filling,frosted with cream cheese frosting and topped with a cute white chocolate lobster.
Seasalt Chocolate Caramel
Chocolate cupcake with chocolate ganache filling frosted with caramel butter cream frosting,sprinkled with sea salt and topped with a chewy
caramel.
Lighthouse Lemon Raspberry
Vanilla cupcake with fresh raspberry filling,frosted with a lemonicious butter cream frosting,topped with a sweet candy raspberry.
r ,
4 1
htty://mail.aol.com/38430-111/aol-6/en-us/Suite.aspx 3/6/2014
Page 1 of 2
McKenzie; Marybeth
From: lane [lane@capecodtileworks.com]
Sent: Wednesday, May 07, 2014 1:57 PM
To: enchantedcare@aol.com; McKenzie, Marybeth
Cc: 'lane'
Subject: PEI rating
Collection Name Chloe
White
Manufacturer Color/Finish W/Blank
Dot
Actual Length (Inches) 12.0
Actual Width(Inches) 12.0
Tile Thickness 8mm
Tile Finish Glazed
Material Glazed porcelain
Mosaic Yes
Mosaic Pattern Random
Slight
Edge Style rounded
edge
(pressed)
Surface Type Smooth
Moderate
-PE1'Rating to
heav y
traffic
Package Quantity 10.0
Sold As Box
only
Indoor/Outdoor Indoor/Outdoor
Frost Resistance Yes
Chemical Resistance Yes
Water Absorption Impervious
ADA Compliant No
Dry Coefficient of Friction 0.7
Wet Coefficient of Friction 0.5
Breaking Strength in lbs. 251-
499
Shade Variation Low
Color/Finish Family White
Square Footage Per Carton (Sq. Feet) 10.0
Common Measurement(L x W) 12-in x
12-i n
PEI rating is a system of rating the strength of the glaze that is applied to the tile against scratching and wearing.
Travertine is a,natural stone so will not have a PEI rating, but I have attached some information on limestone
which I hope will be helpful for you.
LIMESTONE is calcareous sedimentary rock composed of the mineral calcite(CaCO3),which upon calcination yields lime
5/8/2014
Page 2 of 2
(CaO)for commercial use. In its broadest interpretation the term includes any calcareous material such as marble, chalk,
travertine,tufa, limeshell, coral and marl each possessing different and distinct physical properties.The crystalline equivalents
of limestone having the same chemical composition are calcite and aragonite.
Please let me know if you need any other information
Thankyou
Lane Meehan
Cape Cod Tileworks
5/8/2014
McKenzie, Marybeth
From: Tonya Stump [enchantedcare@aol.com]
Sent: Monday, June 02, 2014 10:26 AM
To: McKenzie, Marybeth
Subject: Val Oil
Hi Marybeth,
This email is to serve as written notice that we will reapply the sealant on the point of
sale annually or more often if needed. Thanks, Tonya
Tonya Stump
1
Freccom of Expression I Arr!ericm Olean 1, p:llalncrit,RnC,i=).rom!prim 3orks.cti-n orius-91
flL�''i'1I;1CKTtik:5S' 1!d" REI-MV :d'lut 1NG;11911
NUN1MUM GROUT JOINT Rf_COMNICiNDATION: 1I8" SHADE VARIAi 10N: Low(V1)
w I
Performance Cimratteristies
OC.Q.f. IdvHa:ta Brauidng .humlccl fi?' our
1Nnl A�9crWd'.n bbongtt• PoIO H'd Itoc1112mc[+
>3001bd d0-'r,0 pub dLant � •.�q..
APWWadmb
IN I bWOR l X i t.ltltalt
ICES LT CUM _ COM Rl'S COIN4
`' 1'loorcl!'alior:(Gover�;f&
V�'allsiSal:kshlasltri: ,. `°'' 'u;;`
MnWrtMps
Pool Linings.
Pod DeaNg
^ I
•U aAW laity be s:olivabie Olt satin(d§:xyd,,:face anoltm s odpaciisllq iu dml"Colors.
`i
� Suitable Wi w447ior w?tlld in Fcu9ziri;!lad a::z•fml;'ding 6iimu.4s whoa)>.,!rvr,:5{u0ulivu mdfhUAs:ua lullu>~ul. ( �I
• !iuituUle for Leal hlin�a Hitit t!tc r•Xcd(tliue UI SYliiuit:xe C'1.11.ilild Amiysc WIGO a C;'110'luld-
.v . Lighl COIltgtyrCiyj L';1p1lSatiou s1- oM.uebail l:@ rvsut,Lw Ooorc snJ6u:vi Goths VR!y. dal foe uec on shower sia;'.OUord.
• eL
Wuicl',011.Braude.'ab•:t'uuiC dlipl%tY CuIILItIJR%.FIu4•:'L`jt�ilcui'�uY wit11 txl:4au:ro Itl li1;SC C6llCitipus ruqulic uxnm;mstioi- ici lAki1101 Selu0ll:)ti. !.
Downloads
[n�Wh'.LJAF>ti
L!N1.5
L1L61_t l'3�1.S:.�lli'iSl:d'
a tNr acl7 IILfiLU!,I!!inn l.Ql�'iil({l!'prigt_tf)
'1"ile Sixe
sad
CU'rJ"Y irJ/'i81 t7
(7.4:m x 2.4 GM)
P.Gbv put gadcn:D9
5®r":,..ct,amga•6 SQF.t.
(1511G"M t WWI)
t_
S x:Pirwnanl PfoCM.par t:d!N+;t C U,!ii''.'•1::
owl 10
M11sr�-nau�led Bn t2 x 12 o!cui.
NJ'!`L'3:
• {x 2!lintt•I>tsrl evniiii:fle ht sll';;bucld a!-Sa in,Whiw widt St:°ir:Wni[a dell iC I'!�!):Jmil;9"aik;with;iluas alitolt Mats(C1-102)w:-d sillin x hit.
'Cilupk wifh?�oJUtdi;CllSll.
512!2014- .r
Fmodarn of Expression Amoricaii Olean
M F H I A N C 1, 1:A 14
ChIcie"I'm
Pre-mounted Fiald Tilu and Dots
...... ................... ............... ..........
SATIN WHITE PINVVI46CL WVj'H$A,rlN WHITF. SATIN WHITE PINV0161ilL W-N GLOSS BLACK
CHOI DOTS C1102
Deo-alour.toO F10,10 T06 and Dots ?to-mounted Field Thu end Dow
Pre-Constirtioc; 14.1% P:-e-collsumer: 14.1%
J1osj-CcIjsujrjer: 17,31/1(j P0S1 C0I1SI.II11eC' I7.3/b
plaill:Monterrey,Nix Manufacturing Plam;Monterrey,NIX
p .40
.4
SATIN WHITE CK99 SLANK PINWHEEL WITH SATIN vvHitri CH99 BLANK PINWHEEL VVITIii SATIN WHITE CH99 BLANK kiNVJHEELWTH
OPAL CH-13 GREEN GARNET CH1 5 BLUE TOPAZ C002
al"d Dol O!Aloll: 0,06 pot Qpaonm clas:99tQFtIola
Pre-Consaimer: RMI, Pro-Cs.5asulluc 14.1% Pre-Consumev, 14.1%
Post-ConSLIMC1% 17.3% Post-Consumer 17.31/u POSL-corlsuilivi 11.3%
manufacturing PNM:Monterrey,MX Mw-itaftwturing,Plant,11vlonteri-ey,MX MgriufaQ[Urjjjg 11Itj:jt:Mc�nrerr cy,MX
of ��!2P—o 14 10:09 AM
1
j
AAAMIRACLE
$ 511 Porous Plus .............�'�Awlwis-Company
Natural Look Penetrating Sealer www.miracieseatants.com
Water,Stain&Slip PmtKdon for ;; and stain resistance.Apply 5u Porous Plus to all grout with a paintbrush.Any
■Grout ■Flamed,Honed&Polished Limestone <y 9 excess sealer that gets on the surface should be wiped off with a clean towel before
■Flamed,Honed&Polished Granite it dries.On larger jobs grout can be sealed by retreating the entire area including the
■Flamed,Honed&Polished Marble tile or stone surface a second time.Be careful not to allow the sealer to puddle or dry
■Saltillo Tile ■Terra Cotta Pavers ■Masonry on presealed surfaces.
■Sandstone ■Porous Slate&Brick ■Cement due Rmrmd
■Concrete ■Cantera/Adoquin ■Flagstone To remove accumulated 511 Porous Plus residue,use Miracle Residue Remover as
■Sanded Grout ■Stucco directed.
Uses E*tng Installation-Surface Preparation
■Interior&Exterior ■IGtchens ■Showers Surface must be dry and free of contaminants,including previously applied sealers,
■Garages ■Pool Areas ■WaILs
■ ■Patios ■Drive Ways dirt,lime&hard water deposits,efflorescence,rust&other heavy dirt and grime.
arag
Special Featuurenes Floor Coatingg/Wax Removal:To remove existing coatings and/or waxes,use Mira
■Water Resistant ■Stain Resistant ■Weather Resistant Strip or Finish Sealer Stripper following the instructions carefully.
■Acid Resistant ■Salt Resistant ■Freeze/Thaw Resistant Heavy Duly Cleaning.To remove lime and hard water deposits,efflorescence,rust,
■Slip Resistant ■Easy To Use ■Low Toxicity grease and other heavy dirt and grime use HDAC(Heavy Duty Acidic Cleaner)or,
■Non Yellowing ■Non coating ■U.V.Transparent Phosphoric/kid Cleaner as directed.For a non-acid deep clean use liquid Poultice
as directed.All stri pers and/or cleaners should be thoroughly rinsed with clean
PRODUCT DESCRIPTION water and the surface allowed to dry.
KEEP OUT OF REACH OF CHILDREN.511 Porous Plus is a unique formulation Sealing Existing Surfaces:Follow the application instructions previously mentioned,
designed for the protection of the most porous tile,stone and grout surfaces.511 except now,seal the grout and file or stone surfaces at the same time.When treating
Porous Plus penetrates into the surface and forms an invisible barrier that is resistant surfaces together,make sure that the recessed grout is saturated.
to moisture and stains,while allowing vapor to escape.511 Porous Plus is not a sur- Light Cleaning:Use Tile&Stone Cleaner,Porcelain&Ceramic Tile Cleaner,
face coating and will not after the natural look.All surfaces are harder and less slip- Limestone/Tuavertine Soap&Counter Kleen as directed.
pery.511 Porous Ptts can be used on interior and exterior applications.pi Porous
Plus is U.V.transparent,resists acid rain and will not yellow under any circumstances. SeaterCureTime
5u Poro s!Ptus averages 2 to io times the coverage of competitive products.(See 5u Porous plus will be dry to the touch in 1-3 hours and may be used for normal
coverage chart).511 products have been formulated for or applied to freshly poured foot traffic.For optimum results the area should be kept dry and free from staining
concrete to retard the evaporation of water. materials for 24-72 hours.
5u Porous Plus is on the approved sources list of the United States Postal Service. Coverage Chart-used as duetted
Test Data Material Cost per Soo sq.ft woo sq.fL 1500 sq.ft. 2000 sq.fL
Independent laboratory tests show 5u Porous Plus out performs sg15-.2 m. 45 sq.m. yo sq.m. i35 sqm. iso sq.m.
competitive products.Test results are available upon request for Staining,Static Sanded Grout 15.29,
pe P P q g limestone 15-.2
Coefficient 0f Friction,Tabor Abrasion,Surface Absorption,Freeze/Thaw,and Vapor Sathllo 15-•4
Transmission. San
Stonetone 15-.2
NOTE:For any questions concerning grout-refer to the grout Flamed Granite 15-.2 .--
manufacturers specifications. Textured Ma le 15..2
Bri5u Porous Plus will not stop acid etching. Concrete 15-45 s
Sample Testing laterra Cotta 15;z
Due to the differences of each substrate,several inconspicuous test patches should Cantera/Adoquin 15.4
be completed to assure maximum performance.User must determine suitability of Masonry 15-45
the product for their intended use. Polished Stone Cost per sq.ft/3000-4000 sq.fL(05-.07)
Color and Gloss Enhancenwd Cost per sq.ft.is based on a suggested list price of$24o/gallon.i gallon=3.785 liters.
For added color with"Textured and Non polished"surfaces,5u Seal&Enhance or MAINTENANCE
Mira Matte may be used.For polished marble,travertine,limestone and granite,
Stone Polish,Mira Dust,Marble Conditioner or Granite Brite may be used as direct- For ongoing maintenance-instructions please refer to Miracle Sealants Care Guide. ,
ed.i6Dr ceramic tile,Tile Restor or Tile Brite may be used as directed. Refer to the Miracle Sealants Product Recommendation Chart for specific product
s recommendations.
.„ SUp Reststanoe
'w SstCirnpregnator incrQases the static coefficient of friction on all surfaces. Storage
s Protect Neil n8 Surfaces Store 5u porous Plus in the original container,property sealed to avoid contamina-
Always protect neighboring surfaces including wood carpet,metal,landscaping and tion and solvent evaporation.Stored at 77°F(25°Q,5n Porous Plus will have a shelf life of12 months.
other non masonry'surfaces. Techntral Support
r FNEW INSTALLATIONS . r For additional technical support,contact Miracle Sealants Company at
�= Read entire label and PDS/MSDS before using 5u Porous Plus should not be 1-800-350-1901 or 626-443-6433 eXt•3013
diluted or thinned in;any way.5u Porous Plus should be used as is direct from OIBce Hours
approved container.> Monday-Friday from 8:3o am-5:0o pm PT.
$�_; : Asa Groat Release 1.626-443-64331-800-350-1901•Fax:1-626-443-1435
ply 511 Porous'Plus'to all surfaces prior to grouting.This step will allow quick and website:www.miraclesealants.com
easy cleanup after grouting.Grout can stain many surfaces if this procedure is not Product Damaged During Trai sportation
used prior to the grouting process.Apply 5u Porous Plus using a Mira Brush or a If pproduct is damaged during transportation contact
clean towel.Apply enouoh to wet the surface.(See coverage charts)Be careful not to ►nfo Trac @ i-800-535-5053
saturate the open grout joints.Allow 5u Porous Plus to stand for approximately 3-5 Additionalminutes for maximum penetration.Any excess sealer remaining at this time should Produds
be removed by wiping the surface with a clean dry towel.On very porous surfaces Miracle Sealants Company offers a complete line of water&stain repellents,sealers,
apply another application after the previous application has dried 2-3 hours.Any cleaners,polishing compounds,diamond abrasives,machinery and accessories for
excess sealer that has dried on the surface creating a residue/film,may be removed the tile,stone,concrete,metal,fabric and carpet professional or do-it-yourself spe-
by appNing Residue Remover.Apply Residue Remover undiluted to the affected area cialist
with a cltean dry towel.Let it sit for 1-2 minutes before buffing the area with a second
clean dry towel.Allow 5u Porous Plus to cure for 6-12 hours before continuing with
the grouting procedure per manufacturers specification.
After Grouting Once grouted,make sure that all grout residue is removed from the
surface with a clean sponge and water.Allow grout to dry at least 24-72 hours.
If grout clean up is not performed effectively,an additional cleaning may be neces-
sary to remove remaining grout residue or haze.For this procedure use Phosphoric
Add Cleaner,(HDAC)Heavy Duty Acidic Cleaner(Hydrochloric Add)or Epoxy Grout
Ftm Remover following the instructions carefully.
Grout Sealing ,
s
Once the area has completely dried,proceed with the sealing of the grout for water
'ObbMIRA- C-ME Safety Data Sheet
e:mmaaewae�.m.r-mawvma4meaemgva.Aaavm as snn¢�oa
� cp�Pawnly
Issue Date: 01-Feb-2012 Revision Date: 21-Feb-2014 Version 1
1. IDENTIFICATION
Product Identifier
Product Name 511 Porous Plus
Other means of identification
SDS# MSC-011
Product Code OMB No. 1218-0072
Recommended use of the chemical and restrictions on use
Details of the supplier of the safety data sheet
Supplier Address
Miracle Sealants Company
12318 Lower Azusa Road
Arcadia,CA 91006
Emergency Telephone Number
Company Phone Number 1-626-443-6433(Phone)
1-626-443-1435(Fax)
24 Hour Emergency Phone Number 1-800-350-1901
Emergency Telephone(24 hr)
For product spills, leaks or exposures call:
Infotrac 1-800-535-5053(North America)or 1-352-323-3500(International)
2. HAZARDS IDENTIFICATION
Appearance Colorless Physical State Liquid Odor Solvent
Classification
Acute toxicity-Inhalation(Vapors) Category 3
Serious eye damage/eye irritation Category 2
Aspiration toxicity Category 1
Flammable Liquids Category 4
Hazards Not Otherwise Classified(HNOC)
May be harmful in contact with skin
Causes mild skin irritation
Signal Word
Danger
Hazard Statements
Toxic if inhaled
Causes serious eye irritation
May be fatal if swallowed and enters airways
Combustible liquid
Page 111
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
�w
Precautionary Statements-Prevention
Avoid breathing dust/fume/gas/mist/vapors/spray
Use only outdoors or in a well-ventilated area
Keep away from heat/sparks/open flames/hot surfaces.—No smoking
Wear protective gloves/protective clothing/eye protection/face protection
Keep cool
Precautionary Statements-Response
IF INHALED: Remove victim to fresh air and keep at rest in a position comfortable for breathing
Call a POISON CENTER or doctor/physician
IF SWALLOWED: Immediately call a POISON CENTER or doctor/physician
Do not induce vomiting
IN CASE OF FIRE: Use CO2,dry chemical,or foam for extinction
Precautionary Statements-Storage
Store locked up
Store in a well-ventilated place. Keep container tightly closed
Precautionary Statements-Disposal
Dispose of contents/container to an approved waste disposal plant
3. COMPOSITION/INFORMATION ON INGREDIENTS
Chemical Name CAS No Weight-0/6
Petroleum Distillate 64742-88-7 Proprietary
N-He tane 142-82-5 Proprietary
Ethyl acetate 141-78-6 Proprietary
"'If Chemical Name/CAS No is"proprietary"and/or Weight% is listed as a range,the specific chemical identity and/or percentage
of composition has been withheld as a trade secret.""
Product contains a proprietary mixture of ingredients.
4. FIRST-AID MEASURES
First Aid Measures
General Advice Provide this SIDS to medical personnel for treatment.
Eye Contact Flush immediately with clean,free-flowing water for 15 minutes.Consult a physician if
irritation persists.
Skin Contact Wash off with soap and clean water for 15 minutes. If irritation persists call a physician.
Inhalation', Remove person to fresh air. If not breathing, administer artificial respiration including
oxygen. Provide medical attention. Call a physician or poison control center immediately.
Ingestion Do not induce vomiting. Call physician. Keep victim's head below hips to prevent aspiration.
Page 212
I
f MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
Most important symptoms and effects
Symptoms Eyes: Burning irritation.
Skin: Slight irritation,defatting of the skin. Material will place a clear coating onto skin.
Ingestion:Toxic
Inhalation: Irritation,dizziness, headaches-may cause CNS depression.
Indication of any immediate medical attention and special treatment needed
Notes to Physician Medical conditions generally aggravated by exposure-same as signs and symptoms of
over exposure.
5. FIRE-FIGHTING MEASURES
Suitable Extinguishing Media
CO2,dry foam.
Unsuitable Extinguishing Media Not determined.
Specific Hazards Arising from the Chemical
Product is combustible&may ignite if exposed to high temperature or direct flame. Heat will cause phosgene gas.
Protective equipment and precautions for firefighters
As in any fire,wear self-contained breathing apparatus pressure-demand, MSHA/NIOSH (approved or equivalent)and full
protective gear. Cool exposed containers with water to prevent rupturing.
6. ACCIDENTAL RELEASE MEASURES
Personal precautions, protective equipment and emergency procedures
Personal Precautions ELIMINATE all ignition sources(no smoking,flares,sparks or flames in immediate area).
Wear protective clothing as described in Section 8 of this safety data sheet.
Environmental Precautions See Section 12 for additional Ecological Information.
Methods and material for containment and cleaninq up
Methods for Containment Prevent further leakage or spillage if safe to do so.
Methods for Clean-Up Steps to be taken in case material is released or spilled: soak up with inert absorbent
material. Scoop up and place in a proper waste disposal container. For waste disposal, see
section 13 of the SDS.
7. HANDLING AND STORAGE
Precautions for safe handling
Advice on Safe Handling Handle in accordance with good industrial hygiene and safety practice. Use personal
protection recommended in Section 8. Keep out of the reach of children.Wash face, hands,
and any exposed skin thoroughly after handling.Wear eye/face protection. Keep away from
heat/sparks/open flames/hot surfaces.—No smoking.Avoid breathing vapors or mists.
Use with adequate ventilation. Keep cool.
Conditions for safe storage, includinq any incompatibilities
Storage Conditions Keep container tightly closed and store in a cool,dry and well-ventilated place. Store in a
cool,dry place, out of direct sunlight. Do not freeze, less than or equal to 32°F or heat
above 110°F.Store locked up.
1
Incompatible Materials Strong oxidizers.
Page 3/3
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
8. EXPOSURE CONTROLS/PERSONAL PROTECTION
Exposure Guidelines
Chemical Name ACGIH TLV OSHA PEL NIOSH IDLH
Ethyl acetate TWA:400 ppm TWA:400 ppm IDLH:2000 ppm
141-78-6 TWA: 1400 mg/m3 TWA:400 ppm
(vacated)TWA:400 ppm TWA: 1400 mg/m3
vacated TWA:1400 m /m3
N-Heptane STEL:500 ppm TWA:500 ppm IDLH:750 ppm
142-82-5 TWA:400 ppm TWA:2000 mg/m3 Ceiling:440 ppm 15 min
(vacated)TWA:400 ppm Ceiling:1800 mg/m3 15 min
(vacated)TWA: 1600 mg/m3 TWA:85 ppm
(vacated)STEL:500 ppm TWA:350 mg/m3
vacated STEL:2000 m /m3
Appropriate engineerinq controls
Engineering Controls Local exhaust: Recommended
Mechanical exhaust:General ventilation system should be provided.
Individual protection measures,such as personal protective equipment
Eye/Face Protection Tight fitting,splash proof safety goggles.
Skin and Body Protection Protective gloves: Plastic or rubber, chemical resistant
Protective clothing or equipment:Chemical resistant clothing.
Respiratory Protection Ventilate by opening all doors and windows. If exposure above the TLV or PEL require a
NIOSH approved respirator equipped for the exposure or suitable respiratory protection per
29 CFR 1910.134 is required.
General Hygiene Considerations Work hygienic practices:Wash hands thoroughly before handling foodstuffs, liquids or
tobacco products. Use common sense and care around chemicals. Never mix this product
with other chemicals. Consult your supervisor for all other hygienic and safety practices.All
practices depend on your specific business. Directions for use normally found on label
which will dictate engineering and control measures.
9. PHYSICAL AND CHEMICAL PROPERTIES
Information on basic physical and chemical properties
Physical State Liquid
Appearance Colorless Odor Solvent
Color Colorless Odor Threshold Not determined
Property Values Remarks •Method
pH Neutral
Melting Point/Freezing Point Not tested
Boiling Point/Boiling Range > 320 °F / 160 °C
Flash Point 62.77 °C / 145 °F
Evaporation Rate Not tested
Flammability(Solid,Gas) Not determined
Upper Flammability Limits Not tested
Lower Flammability Limit Not tested
Vapor Pressure Not tested
Vapor Density Not tested
Specific Gravity 0.80
Water Solubility None
Solubility in other solvents Not determined
Partition Coefficient Not determined
Auto-ignition Temperature Not determined
Decomposition Temperature Not determined
Page 4/4
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
Kinematic Viscosity Not determined
Dynamic Viscosity Not determined
Explosive Properties Not determined
Oxidizing Properties Not determined
VOC Content Less than or equal to 737 g/L
10. STABILITY AND REACTIVITY
Reactivity
Not reactive under normal conditions.
Chemical Stability
Stable under recommended storage conditions.
Possibility of Hazardous Reactions
None under normal processing.
Hazardous Polymerization Hazardous polymerization does not occur.
Conditions to Avoid
Heat,flame&sparks.
Incompatible:Materials
Strong oxidizers.
Hazardous Decomposition Products
CO2, CO, HF.
11. TOXICOLOGICAL INFORMATION
Information on likely routes of exposure
Product Information
Eye Contact Causes serious eye irritation.
Skin Contact Causes mild skin irritation. May be harmful in contact with skin.
Inhalation Toxic if inhaled.
Ingestion May be fatal if swallowed and enters airways.
Component Information
Chemical Name Oral LD50 Dermal LD50 Inhalation LC50
Petroleum Distillate >5000 mg/kg (Rat) =3000 mg/kg (Rabbit) >5.28 mg/L (Rat)4 h
64742-88-7
Ethyl acetate 5620 mg/kg (Rat) >20 mUkg (Rabbit)>18000 -
141-78-6 mg/kg Rabbit
N-Heptane - =3000 mg/kg (Rabbit) =103 g/m (Rat)4 h
142-82-5
Information on physical,chemical and'toxicological effects
Symptoms Please see section 4 of this SDS for symptoms.
Delayed and immediate effects as well as chronic effects from short and long-term exposure
Carcinogenicity This product does not contain any carcinogens or potential carcinogens as listed by OSHA,
IARC or NTP.
Legend
Aspiration ihazard May be fatal if swallowed and enters airways.
Page 5/5
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
Numerical measures of toxicity
Not determined
12. ECOLOGICAL INFORMATION
Ecotoxicity
An environmental hazard cannot be excluded in the event of unprofessional handling or disposal.
Component Information
Chemical Name Algae/aquatic plants Fish Toxicity to Crustacea
microorganisms
Petroleum Distillate 450:96 h 800:96 h Pimephales 100:48 h Daphnia magna
64742-88-7 Pseudokirchneriella promelas mg/L LC50 static mg/L EC50
subca itata mg/L EC50
Ethyl acetate 3300:48 h Desmodesmus 220-250:96 h Pimephales EC50=1180 mg/L 5 min 560:48 h Daphnia magna
141-78-6 subspicatus mg/L EC50 promelas mg/L LC50 flow- EC50=1500 mg/L 15 min mg/L EC50 Static
through 484:96 h EC50=5870 mg/L 15 min
Oncorhynchus mykiss mg/L EC50=7400 mg/L 2 h
LC50 flow-through 352-500:
96 h Oncorhynchus mykiss
mg/L LC50 semi-static
N-Heptane 375.0:96 h Cichlid fish mg/L 10:24 h Daphnia magna
142-82-5 1 1 LC50 mg/L EC50
Persistence/Degradability
Not determined.
Bioaccumulation
Not determined.
Mobility
Chemical Name Partition Coefficient
N-Heptane 4.66
142-82-5
Ethyl acetate 0.6
141-78-6
Other Adverse Effects
Not determined
13. DISPOSAL CONSIDERATIONS
Waste Treatment Methods
Disposal of Wastes Disposal should be in accordance with applicable regional, national and local laws and
regulations.
Contaminated Packaging Disposal should be in accordance with applicable regional, national and local laws and
regulations.
Chemical Name RCRA RCRA-Basis for Listing RCRA-D Series Wastes RCRA-U Series Wastes
Ethyl acetate Included in waste stream: U112
141-78-6 F031
G
California Hazardous Waste Status
Page 6/6
f -
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
Chemical Name California Hazardous Waste Status
N-Heptane Toxic
142-82-5 Ignitable
Ethyl acetate Toxic
141-78-6 Ignitable
14. TRANSPORT INFORMATION
Note DOT Ground: Combustible liquids are not regulated in non-bulk shipments per 49 CFR
173.150(f)(2).
DOT Not regulated (If shipped in NON BULK packaging by ground transport)
IATA Not regulated
IMDG Not regulated
15. REGULATORY INFORMATION
International Inventories
TSCA Listed
Legend:
TSCA-United States Toxic Substances Control Act Section 8(b)Inventory
DSUNDSL-Canadian Domestic Substances List/Non-Domestic Substances List
EINECS/ELINCS-European Inventory of Existing Chemical Substances/European List of Notified Chemical Substances
ENCS-Japan Existing and New Chemical Substances
IECSC-China Inventory of Existing Chemical Substances
KECL-Korean Existing and Evaluated Chemical Substances
PICCS-Philippines Inventory of Chemicals and Chemical Substances
US Federal Regulations
CERCLA
Chemical Name J Hazardous Substances RQs CERCLAISARA RQ Reportable Quantity RQ
Ethyl acetate 5000 lb RQ 5000 lb final RQ
141-78-6 1 1 RQ 2270 kg final RQ
SARA 3111312 Hazard Categories
Acute Health Hazard Yes
Chronic Health Hazard Yes
Fire Hazard Yes
Sudden Release of Pressure Hazard No
Reactive Hazard No
SARA 313
Not determined
US State Regulations
U.S.State Right-to-Know Regulations
Chemical Name New Jersey Massachusetts Pennsylvania
Page 7/7
I
MSC-011 - 511 Porous Plus Revision Date: 21-Feb-2014
Petroleum Distillate X
64742-88-7
Ethyl acetate X X X
141-78-6
N-Heptane X X X
142-82-5
16. OTHER INFORMATION
NFPA Health Hazards Flammability Instability Special Hazards
2 2 0 None
HMIS Health Hazards Flammability Physical Hazards Personal Protection
2 2 0 Not determined
Issue Date: 01-Feb-2012
Revision Date: 21-Feb-2014
Revision Note: New format
Disclaimer
The information provided in this Safety Data Sheet is correct to the best of our knowledge,information and belief at the
date of its publication.The information given is designed only as a guidance for safe handling,use,processing,storage,
transportation,disposal and release and is not to be considered a warranty or quality specification.The information
relates only to the specific material designated and may not be valid for such material used in combination with any other
materials oriin any process,unless specified in the text.
End of Safety Data Sheet
Page 8/8
� � �� � �.
_. �:
:�
� . _s`.i .. -C
y � _ tx�
f�
�r '
bfflft Q3 huguo=Wa
afflowd @WWNIe - e
me AM E99@4120
Definitions
Finishes: There are three primary stone finishes: Poultice: A liquid cleaner or chemical mixed
with-a white absorbent material to form a thick,stain-
-A polished finish has a glossy surface that removing paste.
reflects light and emphasizes the color and
markings of the material. Refinishing: Repolishing or honing of dull,
—A honed finish is a satin smooth surface with once-polished marble, limestone, or granite floors and
relatively little reflection of light.Generally,
walls.
a honed finish is preferred for floors,stair
treads,thresholds, and other locations where Renovation: Cleaning and repolishing of neglected
heavy traffic will wear off the polished finish. dimension stone surfaces.
A honed finish may also be used on furniture
tops and other surfaces. Restoration: Large-scale remedial actions taken to
restore a structure or area to its original or acceptable
—A flamed finish is a rough textured surface "near original"condition.Generally applies to historic
used frequently on granite floor tiles. structures.
Many other finishes are available and used throughout
the world. Consult with a stone professional if your fin-
ishNoteHistorical
does not match these three primary types.
Lippage:A condition where one edge of a stone Buildings
is higher than adjacent edges,giving the finished sur- In the case of historically important buildings and land-
face an uneven appearance. marks, many of the cleaning, maintenance, and
Maintenance: Scheduled cleaning,specific
restoration protocols are established by historical procedures, and inspections performed on a daily, preservation committees and other agencies/departments of the government. Please consult with
weekly, or other regular basis to keep the stone these organizations when developing your normal
in proper condition. maintenance program.
2
A Guide
to the Care & Cleaning
of Natural Stone
AL
A publication from the Marble Institute of America
Sealing Natural Stone
Several factors must be considered prior to The type of stone, its finish, its location, and how
determining if the stone should be sealed: it is maintained all need to be considered when deter-
mining how to protect the stone.
• What is the hardness, density, and durability
of the stone? In some cases it makes sense to seal the stone. Once
properly sealed,the stone will be protected against
• How porous is the stone and how fast will it everyday dirt and spills. In other cases, it is best to
absorb a liquid(also referred to as the absorption leave the stone untreated.Topical sealers can alter the
coefficient)? surface texture and finish as well as build up on the
surface, creating a layer that is less
• Is the stone expected to be in frequent contact durable than the stone. Generally,topical sealers are
with a staining agent? not recommended in exterior applications because
they can trap moisture within the top layer of the
• What type of finish was applied to the surface? stone, which may lead to surface deterioration during
For example,a polished surface is more resistant freeze/thaw cycles.
to staining than a honed surface.
The Marble Institute of America's position on sealers is
• Will the sealant affect the color or other as follows:
aesthetics of the stone?
The Marble Institute of America (MIA) recognizes
• If a resin was applied to the stone, how will the the benefits that sealers can provide in certain
sealant react with the resin? applications. MIA recommends that care be
exercised in the application of any chemical to a
• Where is the stone located (e.g. countertop, stone's surface. Although normally innocent in and
floor, wall,foyer, bathroom, etc.)? Residential of themselves, some sealers have reportedly reacted
or commercial? with some cleaning/maintenance chemicals
and/or with components within the stone surface,
• What type of maintenance program has the causing some reactions.
stone been subjected to?
Vif
If you have decided to treat your stone, make sure you ,
2
understand the differences between the types of seal- ," 3
ers available on the market:
Pam" yuesmrt�1"'w:Mi.vnMW�^"��
• Topical Sealers are coatings(film formers) ' „»
designed to protect the surface of the stone against water,oil,and other contaminants.They "^ "" %
are formulated from natural wax,acrylic,and .r-a- - -
other plastic compounds.When a topical sealer
,�.P°'.,..-'y`-�-
is applied,the maintenance program often shifts
from a program focused on stone care to a
program focused on the maintenance of the
sealer(for example:stripping and reapplication).
rmpregnators are water-or solvent-basedolutions that penetrate below the surface andecome repellents.They are generally hydrophobicter-repelling), but are also oliophobic
oil-repelling). Impregnators keep contaminants
ut, but do not stop the interior moisture
rom escaping.These products are considered
breathable," meaning they have vaporransmission.
Vanity tops and food preparation areas may need Before sealing, always:
to have an impregnator applied.Check with your . Read the Manufacturers Warranty and Instructions.
installer for recommendations. If an impregnator
is applied, be sure that it is safe for use on food
preparation surfaces. If there are questions, • Contact the manufacturer prior to application if
check with the product manufacturer. you are unsure or need clarification.The wood-
working analogy of'measure twice, cut once'
applies.
• Consider the life span of the application (1-year,
2-years, 5-years,etc.) - keep a log of each
MV d Ike
a
U
Toapplication.
• Don't switch from one product to another without
you understand fully understanding any potential issues. Not all
products are alike - again,consult with the
the
difference manufacturers.
• Consult with your stone professional as necessary.
betweenthe types • Ask yourself, does the stone need to be treated
in the first place?
of sealers available
on the market.
7
The Marble Institute of America (MIA) is the leading MIA publishes a monthly newsletter, markets a range of
resource for information and education for the natural technical publications and consumer pamphlets on
stone industry. MIA Members, numbering over 1,200 natural stone,sponsors business and technical meet-
worldwide, include marble,granite, limestone, sand- ings and seminars on industry-related topics,and pro-
stone,and other natural stone producers and quarriers, vides educational programming for architects and con-
fabricators, installers, distributors, and contractors. struction specification professionals. MIA also honors
outstanding natural stone projects worldwide through
The association's mission is to promote the use its annual Pinnacle Awards competition.
of natural stone and be the authoritative source of
information on standards of workmanship and practice For more information,
and suitable application of stone products. contact MIA at 440-250-9222,
e-mail MIAinfoCmarbie-institute.com,
or visit www.marble-institute.com.
Further Reading
Suggestions
ASTM International.ASTM C1515:Cleaning of Exterior
Dimension Stone,Vertical and Horizontal Surfaces,New "Chemical Cleaning of Historical Structures A Practical
or Existing. West Conshohocken:ASTM International. Approach,"Cleaning Stone and Masonry,by Rudder,T.H.,
Cleaning Masonry-Review of the Literature, ASTM STP 935, 1986.
by Grimm,Clayford T.,P.E.Construction Research Center, "A Case Study of the Cleaning of Marble at the Schenectady,
University of Texas at Arlington, 1988. New York,City Hall,"Cleaning Stone and Masonry,
Cleaning Stone and Masonry,Clifton,James R.,Editor, by Waite,J.C.and R.J.Chen,ASTM STP 935, 1986.
ASTM Special Technical Publication 935,American "A Macrosteriogra m metric Technique for Measuring Surface
Society for Testing and Materials, 1983. Erosion Losses on Stone,"Cleaning Stone and Masonry,
Keeping It Clean,by Grimmer,Anne E., by Winkler,E.M.,ASTM STP 935, 1986.
U.S. Department of the Interior, National Park Service, Stain Removal Guide for Stone and Masonry,by Hueston,
Washington, DC:U.S.Government Printing Office,1988. Frederick M.,NTC Enterprises Inc.
"Cleaning of Masonry Interiors of Public Buildings,"Cleaning Historic Stone&Tile Restoration Manual,by Hueston,
Stone and Masonry,by Roth,J.W., Frederick M.,NTC Enterprises Inc.,1998.
ASTM STP 935, 1986. Stone Maintenance Manual for Professional Cleaning
Contractors,by Hueston,Frederick M., NTC Enterprises Inc.,
1996.
4
i
MARBLE
INSTITUTE
of America
Scniq the Sr"r"lvtd.,r"the
Nmuml St...lndw ty
Marble Institute of America
28901 Clemens Road,Suite 100 • Cleveland,Ohio 44145
Phone:440-250-9222 • Fax:440-250-9223
www.marble-institute.com
0 2004 Marble Institute of America
t
Know Your Stone
Natural stone can be classified into two general • Sandstones vary widely in color due to
categories according to its composition:siliceous different minerals and clays found in the
stone or calcareous stone. Knowing the difference -_ _ stone.Sandstone is light gray to yellow
is critical when selecting cleaning products. or red.
Siliceous stone is composed mainly of silica or
quartz-like particles. It tends to be very durable • Slates are dark green, black,gray, dark
and relatively easy to clean with mild acidic cleaning _w I red, or multi-colored.They are most
solutions.Types of siliceous stone include:granite, commonly used as a flooring material and
slate,sandstone,quartzite,brownstone,and bluestone. for roof tiles and are often distinguished
by distinct cleft texture.Some notable
Calcareous stone is composed mainly of calcium car- cladding projects have also included slate.
bonate. It is sensitive to acidic cleaning products and
frequently requires different cleaning procedures than 3. Conduct a simple acid sensitivity test to
siliceous stone.Types of calcareous stone include: determine if your stone is siliceous or calcareous.
marble,travertine, limestone,and onyx. What may You will need:
work on siliceous stone may not be suitable on calcare-
ous surfaces. • 4 ounces of a 10%solution of muriatic acid
or household vinegar
What Type of Stone is It? • Eyedropper
It is advisable to maintain careful records about the Because the test may permanently etch the stone,
type, name, and origin of the stone existing in your select an out-of-the-way area(a corner or closet)
building. If such records do not exist,you should several inches away from any mortar joint.Apply a few
explore the following options before determining a drops of the acid solution to the stone surface on an
cleaning and maintenance program: area about the size of a quarter.Two possible reac-
tions will occur:
1.Consult with a professional stone supplier,
installer,or a restoration specialist to help identify 1)Acid drops will bubble or fizz vigorously-a sign that
whether your stone is siliceous or calcareous. the stone is calcareous.
2.Conduct a visual identification of the stone. 2) Little or no reaction occurs -stone can be
While there are exceptions,the following considered silicous.See note below.
characteristics are common:
Rinse the area thoroughly with clean water and wipe dry.
• Granites have a distinct crystal pattern
or small flecks;very little veining. NOTE:This test may not be effective if surface sealers or
liquid polishes have been applied. If an old sealer is
present,chip a small piece of the stone away and
• Limestones are widely used as a building apply the acid solution to the fractured surface.
stone.Colors are typically gray,tan, or .
buff.A distinguishing characteristic of CAUTION: Muriatic acid is corrosive and is considered
many limestones is the presence of shell to be a hazardous substance. Proper head and body
and/or fossil impressions. protection is necessary when acid is used.Again, it is
always wise to consult with a stone professional if you
are unable to visually identify the stone and/or are - - '
�- • Marbles are usually veined,fine-textured uncomfortable using the acid test.
materials that come in virtually unlimited
color selections.
3
f
�f
vahoi�":
YON
va s ar,
Val-Oil Sealer '
Producti
Seals Wood: Effectively protects against moisture Vehicle Type: Urethane Modified Alkyd Resin
penetrating into the wood surface. Does not raise the
grain,therefore minimizing the need for sanding. Sheen: 90+ Units @ 600 Gloss
Excellent for back-priming exterior wood and plywood
siding. Especially effective for interior applications such as Solids by Volume: 44%
wood paneling,shelves and crafts. Not for wood floor
surfaces or areas subject to abrasion. Retards Rust: On Solids by Weight: 52010
metal surfaces treated prior to exposure, it provides a
protective film that seals metal from corrosion-causing Weight per Gallon: 7.6 lbs./gal.
moisture. Use on steel & iron,fencing,lawn furniture,
tools,etc. Retards tarnishing of decorative, interior brass, VOC: Less than 450 g/L
bronze and copper. Chalky Surface Sealer: Use as a
primer to penetrate and bind mildly chalky or porous Viscosity: B—E Gardner Holdt Bubbles
surfaces in preparation for topcoating. Seals Masonry&
Concrete: Use as a sealer to protect masonry and concrete Dry Time: 77°F @ 50ojo Relative Humidity
surfaces from the deteriorating action of surface moisture. To the touch: 6-8 hour(s)
Also excellent for use as a "dusting sealer"on concrete Recoat' 24 hour(s)
and basement floors.
Surface Coverage:
300-600 sq. ft./gal.
• Seals brick and concrete At: 4.0 mil Wet, 1.6 mil Dry
• Seals wood
• Protective metal coating
• Controls cement dusting
• Retards rust and corrosion
Colors . .
Part Number . Do not freeze.
Clear 30 (Quart) • Keep container closed when not in use.
30 (Gallon) • Do not transfer contents to other containers
for storage or disposal.
• In case of spillage, absorb with inert material
such as sand or kitty litter.
• Dispose of contaminated absorbent, container
and/or unused contents in accordance with
local, state and federal regulations.
DANGER: Rags, steel wool or waste soaked
with this product may spontaneously catch fire
if improperly discarded. Immediately after
each use, place rags, steel wool or waste in a
sealed, water-filled metal container.
Shipping • Packaging
Freight Classification: Paint or Paint Related
Material. Protect from freezing.
Packaging: Quarts—4 per carton -p
Gallons— 2 per carton
Ln
N
V
W
O
Surface Preparation
Read the Lead Warning in Cautions section. General:Surfaces to be sealed must be clean and dry. Remove all surface soils and
stains as they may interfere with penetration and will show through the clear coating. Note:Val-Oil will seal out water and other
stains, but will not correct moisture problems coming from within the surface. If you suspect internal moisture, perform Moisture
Migration Test. The source of the internal moisture must be corrected before using Val-Oil or Val-Oil may turn white upon drying.
Wood: Remove any surface residues by washing with fine steel wool saturated with alcohol. While surface is still wet,wipe off with a
clean cloth. If wood has a rough finish and a smoother surface is desired,sand smooth and remove all sanding dust before
applying Val-Oil. Metal: Remove all rust and surface contamination from steel and iron by sanding or other rust removing
treatments. Remove tarnish deposits from brass and copper with household tarnish removers. Waxy mill oils or soldering fluxes
should be removed by washing with a rag saturated with mineral spirits or naphtha and allow to dry. See Storage and Disposal
section for proper treatment of used rags. Masonry: Remove all loose,powdery material and any efflorescence. Masonry may
contain excess alkali which can deteriorate coatings. Inspect for excess alkali,a white powdery deposit similar to efflorescence and
neutralize by etching. Masonry also may have moisture migration which is not readily apparent without testing. Test all masonry
for moisture migration before using Val-Oil. See Etching Instructions and Moisture Migration Test denoted elsewhere on this label.
Chalky Surfaces: Remove heavy,excessive chalk by washing with a broom and soapy water. Rinse well. Power washing is an ideal
way to cover large surfaces quickly. Allow to dry. Moisture Migration Test:Test for moisture migration by taping aluminum foil or
plastic wrap to the surface for 24-48 hours. If dampness is present when the aluminum or plastic is removed,moisture migration is
present. The source of the moisture must be corrected before using Val-Oil or the Val-Oil may turn white upon drying.
Application
Apply only when air and surface temperatures are 40-90 OF(5-32 °C). May be applied by brush, roller,spray or dip
application. Test on a small hidden area of project to determine final appearance before completing entire area.
Wood: Apply Val-Oil as supplied. Additional coats will increase protection and raise sheen level. Metal:Apply Val-Oil
as supplied. Additional coats are recommended for best protection. Masonry:Apply Val-Oil as supplied. On
masonry floors,allow to penetrate for 15-20 minutes,then remove excess with dry rags or other means. See Storage
and Disposal section for proper treatment of used rags. On masonry,Val-Oil is to be used as a sealer only, not as a
finish coat! Do not allow Val-Oil to pond or puddle or build a film on masonry floors. Val-Oil should not be applied
over previously sealed masonry surfaces. Chalky Surfaces: Apply Val-Oil as supplied. If spray applied, back-roll or
back-brush to work Val-Oil into the surface. Since the Val-Oil is being used as a primer, care must be used to
thoroughly seal all sections, preventing moisture from entering between chalky film and substrate. Allow to dry
thoroughly before topcoating with paint. Do not thin. Clean up with mineral spirits.
Cautions (27-30)
WARNING: CONTAINS PETROLEUM DISTILLATE. May affect the brain or nervous system causing dizziness,
headache or nausea. Causes eye,skin, nose and throat irritation. USE ONLY WITH ADEQUATE VENTILATION. Keep
away from heat, sparks and flame. Avoid breathing vapors,spray mist or sanding dust. If painting indoors, open
windows and doors or use other means to ensure fresh air entry during application and drying. If you experience eye
watering, headache or dizziness, increase fresh air or wear respiratory protection (NIOSH/MSHA TC23C or
equivalent) or leave the area. When sanding,wear a dust mask. AVOID CONTACT WITH EYES AND SKIN. Wash
thoroughly after use. Close container after each use.
WARNING:This product contains a chemical known to the state of California to cause cancer.
FIRST AID: EYE CONTACT: Flush thoroughly with water for at least 15 minutes. If irritation persists,get medical
attention. IF INHALED: If affected by vapor or spray mist, move to fresh air. If breathing difficulty continues,get
medical attention. IF SWALLOWED: Drink 2 glasses of water. Get medical attention immediately,
Delayed effect from long-term exposure: Crystalline silica may cause lung damage and cancer. Risk depends upon
duration and level of exposure to sanding dust.
DO NOT TAKE INTERNALLY. WARNING! If you scrape,sand or remove old paint,
KEEP OUT OF REACH OF CHILDREN. you may release lead dust. LEAD IS TOXIC. EXPOSURE
For additional safety and chronic health hazard TO LEAD DUST CAN CAUSE SERIOUS ILLNESS,SUCH
information, refer to the Material Safety Data AS BRAIN DAMAGE, ESPECIALLY IN CHILDREN.
C Sheet for this product. PREGNANT WOMEN SHOULD ALSO AVOID EXPOSURE.
M Wear a NIOSH-approved respirator to control lead
exposure. Clean up carefully with a HEPA vacuum and
n EMERGENCY MEDICAL TELEPHONE: a wet mop. Before you start,find out how to protect
N 1-888-345-5732 yourself and your family by contacting the National
N Lead Information Hotline at 1-800-424-LEAD or log on
aThis product contains less than 450 g/L VOC to www.epa.gov/lead.
The data on this sheet represents typical values.Since application variables are a major factor in product performance,this information should serve only as a general guide.
Valspar assumes no obligation or liability for use of this information.UNLESS VALSPAR AGREES OTHERWISE IN WRITING,VALSPAR MAKES NO WARRANTIES,EXPRESS
OR IMPLIED,AND DISCLAIMS ALL IMPLIED WARRANTIES INCLUDING WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR USE OR FREEDOM FROM
PATENT INFRINGEMENT.VALSPAR WILL NOT BE LIABLE FOR ANY SPECIAL,INCIDENTAL OR CONSEQUENTIAL DAMAGES.Your only remedy for any defect in this
product,is the replacement of the defective product,or a refund of its purchase price,at our option.
va l s pa I 1191 Wheeling Rd,Wheeling,IL 60090 800-845-9061 12/09
www.valspar.com
C
I
i . r
i
a 1
i
Little Miss Cupcape INC
388 Main Street
Hyannis, MA 02601
To:Town of�Barnstable
Cape Cod Chocolate Shells has permission'to use Little Miss Cupcape's licensed kitchen for
creating chocolate shells. Rent and occupancy schedule to be determined.
Sincerely,
Taylor Stump r
Owner
III .
Mov
cy. c.e a ,•skur
U
seroe � �
0
r
oflHE ro,y Regulatory Services
Richard V. Scali;Director
LE, : Building Division
9Qap .16 Tom Perry,Building Commissioner
rfD r"E`� 200 Main Street,Hyannis,MA 02601 '
www.town.barnstable.ma.us
Office: 508-862-403 8
j Fax: 508-790-ti230
Approved:
Fee:
HOME OCCUPATION REGIS PerTit#: .
TRATION
Date-Al
Name:
Phone#: LS=`7 5 8
O Address:_ g �-� NL� Ill IL S t S
Villa e:_
Name of Business: C �� �p j] L° �-}y 0 i ATE
Type of Business.- 126p1 ),fa in b 1- Ln i-A-{j tA�S
C 6 Map/Lot: ! O a 4 4-
IN ENT: It is the intent of this section to allow the residents Of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual.alteration to the
rj1 premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
` and no increase in air or groundwater pollution.
�- After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
.6 following conditions:
• The activity is coed on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit
• Such use occupies no more than 400 square feet of space.
-� There are no external alterations to the dwelling which are not custom
ary in residential buildings,:and there is
no outside evidence of such use.
(-, No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance he at,glare,humidity or other objectionable effects..
L, • There is no storage or use of toxic or hazardous materials
normal household quantities. ,or flammable or explosive materials,in excess of
.�j
Any need for parking generated by such use shall be met on the same lot containing the Custom
C, Occupation,and not within the required front yard. �y Home
• There is no exterior storage or display of materials or equipment.
• There are no•commercial vehicles related to the,Customary Home Occupation,n pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet m other
one van to one
3 length and not to
exceed 4 tires,parked on the same lot'containing the Customary Home Occupation,
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,-the street address shall not be
(� included.
rj • No person shall be y emp to ed in the Custom Home Oc
dwellin unit �' cupation who is not a permanent resident of the
g
I,the undersign ve read agree with th ove 'cdons f^--- ' -- `
� -uu,.n�e occupation I am registering,
Applicant
Mmeoc.doc Rev.103113
t
E -
j
A
°
388 Main Street •
- Hyannis,MA 02601
508-778-CAKE{22S3}
info@littlemisscupcape.com ❑ `
wwwllittlemisscupcape.com . `�-" 00 q
U, Li
r �
0
. o 0 p. .�•
o i ,
0
gyp 0
o ❑ (0
00
0
o 0 0
0 Bpi o
0 - r00
0000600 o 0
o °
0 1peqectTad� gwim o
0 0
Let Little Miss Cupcape make your next party
or event a piece of cake...CUPCAKE! o
o Delight your guests with our gourmet cupcakes designed
for any occasion!We make your special events more
memorable with our huge selection of freshly baked o
cupcakes customized to compliment your party or event.
° Little Miss Cupcape Caters...
Anniversaries Corporate Events °
Bachelorette o Communions
0 Parties Festivals o
Bar/Bat Mitzvahs Graduations
0
Birthday Parties Holidays
Bridal and Baby private Events
Showers °
0 0 0 Weddings
0
Located in the Heart of Cape Cod
0 388 Main Street,Hyannis,Massachusetts o
508-778-CAKE {2253}
0
0 Hours of operation vary with the season
www.littlemisscupcape.com
° o
0 0 �° f ® 0 0
O O 6 ' o
� o
Is your little cupcake having a birthday party?No problem!
Little Miss Cupcape has it covered.Choose from our three
O unique options to plan the perfect party.
O AffT Acts t9h.CQU&.._ 0
2 Cupcakes for Each Standard Party Supplies:
Child to Decorate Plates,Napkins,Utensils, O
Cupcake Decorating O and Party Candle
O Supplies:Sprinkles,Frosting, Specialty T-Shirt for
and Candy Toppings Birthday Child O
Cupcake Box Decorating Little Miss Cupcape
Activity Party Attendant
Endless Lemonade and Party Room for up to O
Water 2 hours
O
0 0 I~MPI MISS T P okok 0
Perfect for your little artist!This party includes everything
listed above,plus an additional cupcake to decorate.Three
cupcakes total—1 to eat and enjoy,and 2 to take home.
O O Price Per Attendee:$18'
O 2—Me,(Miss C► CU O O
Let's get creative!This party includes everything listed above,plus
a visit to our"Create-A-Cupcake Bar"—where each child will get to
custom order a third cupcake.Three cupcakes total—1 to eat and
enjoy,and 2 to take home.All children will also receive a goodie bag.
Price Per Attendee:$20' O
O 3—kWel(miss Custer, 0
This party includes everything listed up top,plus an additional
0 custom designed cupcake to match your party's theme. O
This package also includes party supplies to match your theme.
All children will also receive a themed goodie bag.Three
O cupcakes total—1 to eat and enjoy,and 2 to take home.
Price Per Attendee:$22' O
O
0 0 `JOtaQQc� Custetiw o
Our party planner can he p you create the party of your O
dreams!Whether you would like to enhance your party with a
character visit or another creative experience—we are open to
customizing your birthday party to meet your individual needs.
O Call for Pricing and Options
O O O
...... ............m n&� AA - - ....................
.. .
r .71 �
Per AttendeeO
Custom Candy Treat Bags......................$3.00
IceCream.....................................$2.00
O Pizza .........................................$3.00
Little Miss Cupcape Monogrammed Aprons....$12.00
Character Visit.................:.....Call for pricing O
......................................................................
0 •10 Child Minimum and 50%Deposit Due At Booking 0
Q M 1 w
o °40
U0O0 cooa '°° ao° on
0 o
I 0
0 0 �
o l �.
O �
o � ', - � 1, � I `."" fig. 1��' o
Avo v vv
o v o
i o
'00
v _
0
o ` 00
�1 ° I
(0 0 0 ( 1
-
o0
MISSCUPCAPE Ro�0 ❑
❑ _ ❑oLITTLE o 0v o
v ❑
❑
o o ° 0444a, C colw! Located in the Heart of Cape Cod ❑ i
o
❑
From the moment you step under the charming, � 388 Main Street,Hyannis,Massachusetts o ❑ ' ❑
pink-and-white,candy-striped awning and open the 0 508-778-CAKE {2253} g ❑ j ❑
cute cupcake-handle door,you are in for a TREAT d Hours of operation vary with the season ❑ ❑
(literally!).Little Miss Cupcape offers Cape Cod a www.littlemisscupcape.com o v ❑
whimsical world of cupcake fantasy.Let the sweet o 1> ¢ ® ❑ ❑❑ o
o
smell of our freshly baked cupcakes and cookies E ❑ �'
excite your taste buds for the perfect sweet I , - e ❑ ❑Ot Q 'a 00
❑
indulgence.Greeted by cupcake-dressed employees, 0 GV� / 0
let your senses wander with our enchanting sights, . IWO 0
nostalgic candies,and lively music!At Little Miss
0 Cupcape we bake from scratch each and every day I
using only the highest-quality,freshest ingredients A I 0 0
0
available.Our cupcakes are sure to satisfy your 0 War
o o
cravings with our original recipes.We leave out the
gross preservatives and never used packaged mixes! 0 9 J�,AQQ• "t6 Cupcape,Club!
Choose among our twelve decadent cupcake ••
flavors,Create-A-Cupcake Bar,specialty candies,and4 Earn 1 point for every Earn 25 bonus points '�'�' r 0
unique drinks.You are sure to find something to dollar spent when you register OJ
0
satisfy your sweet tooth at our bakery and delightful � Collect 50 points and online o
party room.Come experience Little Miss Cupcape receive a$5 reward A free cupcake during 0
0 for yourself.See you soon! ` valid on next visit your birthday month o 0
O 0 O O
a 1
RS Make your dream cupcake come to life with•our Create-A-Cupcake Bar!
A Choose from our yummy selection of fresh cakes,creamy frostings,and tasty
Ltoppings tcustomize our irresistible indulgence.
F o y g
OUR , a
- B ��►tes�l, l`70t� I Step I 1--+ 1Step 2 1--+ Step 3 t--+ Step 4
Choose a Cake Select a Frosting Pick a Topping Add a Scoop
4
. $ ' X. . k
B B"i9e Captaia Carnet Cake tI Ckorof* Ska�r Attad, Tod,Cke kfW �i,�ktkouse jaw* kwe Gems Cupcape
Rich chocolate cake filled with Traditional carrot cake filled with Decadent chocolate cake filled with ��$pbQJfh/{ Luscious lemon cake with a lemon Fluffy vanilla cake baked with
a milk chocolate peanut butter a white chocolate ganache,iced a milk chocolate ganache,frosted QQ a filling,frosted with a lemony fresh strawberries,filled with a
fudge,frosted with peanut butter with cream cheese frosting and with chocolate buttercream and Dark chocolate cake with a fresh buttercream and topped with strawberry marshmallow cream,
buttercream and topped with topped with an orange anchor topped with a milk chocolate shark raspberry filling,frosted with dark chocolate sweet lemon slice candy and iced with a pink creamcheese
a homemade buckeye chocolate. candyand green sugar crystals. fin and chocolates sprinkles. chocolate buttercream and topped yellow sugar crystals. frosting and topped with a pink
y g g y p with asugar-candied raspberry and g y g PP p
dark chocolate shavings. candy bow and rainbow sprinkles.
p
� x
Ted Sex`Red CVefuet Sea Sot Ckocd& Skips A Ckecobte cVu1e mA cVaudh Ml� i.ckedAumsow 0ma gP zm o6 tke(We&
Ruby red velvet cake filled with eQ Ck,(,p Cw& (To9k Classic vanilla cake filled with Moist chocolate cake filled with a 1 dare you to explore my creative
a white chocolate cream cheese �1 a vanilla cream,frosted with a marshmallow cream,frosted with concoctions to find the flavor
Chocolate cake filled with a dark Chocolate chip cookie cake with
ganache,iced with cream cheese vanilla buttercream and topped Oreo°vanilla buttercream,topped that tantalizes your taste buds.
chocolate ganache,frosted with cookie creme filling,frosted with a
frosting and topped with a red Boston with a white chocolate whale with a scrumptious Oreo°and Do you have a creative idea.Share
candy"B"and red sugar crystals. caramel buttercream,drizzled with chocolate chip cookie dough but- and sugar crystals. Oreo°crumble. it with us.We love new cupcakes!
caramel and chocolate syrup and tercream,topped with a homemade
e.com
topped with a chewy caramel candy chewy chocolate chip cookie and info@littlemisscupcape.com
and a pinch of sea salt. sprinkled with mini chocolate chips.
p
u
O'I& GN,tlyl.Qi tA' SOM Itiln!i g www.littlemisscupcape.com WW M for cupcape updates
ALLERGEN INFORMATION:Although we offer cupcakes without nuts and/or gluten,all of our cupcakes are baked in the same kitchen with the same baking equipment which allows for the possible cross-contamination of ingredients.
For this reason our cupcakes cannot be certified as a nut-free or gluten-free.If you have any questions please speak with a Little Miss Cupcape employee before placing your order
Bellaire, Dianna
From: McKean, Thomas
Sent: Wednesday, June 1, 2022 9:41 AM
To: McKenzie, Marybeth
Cc: Bellaire, Dianna; Logan, Erin
Subject: RE: Grease trap letter
I have no objections.
-----Original Message-----
From: McKenzie, Marybeth
Sent: Wednesday,June 01, 2022 9:40 AM
To: McKean,Thomas
Cc: Bellaire, Dianna; Logan, Erin
Subject: FW: Grease trap letter
Tom,
He submitted the letter stating seating: Pizza Barbone will have 111 seats, Lil miss cup cape will have 48, and the empty
Rendezous will have 0 seats.They are allowed 200 seats total in regards to the grease trap size. Please let me know if it
is ok to change the permit for seating.Thanks, Marybeth
-----Original Message-----
From:Jason O'Toole [mailto:jasonotoole@icloud.com]
Sent: Wednesday,June 1, 2022 9:04 AM
To: McKenzie, Marybeth
Subject: Grease trap letter
Hi Marybeth,
Please find the letter regarding the grease trap.
Thank you
Jason
CAUTION:This 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!
1
LLLCC
CGNSTRUCT55 N ..
Commercial Residential
358 West Main St.
Hyannis, MA. 02601
508-778-1461
Town Of Barnstable 6/1/22
Building Dept.
Attn: Mary Beth MacKenzie
408 Main St. Hyannis, MA. Pizza Barbone expansion. BLDC-21-57
Dear Mary Beth,
This letter is to inform you that the 3000 gal. grease trap that services Lil Miss Cupcape,
Pizza Barbone and the space once occupied by Rendezvous was serviced every 3
months, by DeBarros Septic service. With the expansion of seating for Pizza Barbone to
111 seats and Lil Miss Cupcape still at the original 48 seats and Rendezvous
unoccupied, we will have DeBarros service the grease Quarterly. When the time comes
that there is a tenant for the Rendezvous space, then we will revisit the seating
allowance and look at servicing the grease trap more frequently as directed.
Thank you,
Graham LLC
Gary C. Graham, Manager
W
M
U
❑FFIC DN W CD
COUNTER W/
I CONVECTIO I
m
ABOVE A OVE OVEN REFRIGERATOR FREEZER -I lO x
REP. SIN -PREP. TABLE -�112
DRY STORAGE
FRP LINED IC RAS
9�~� MA ER
STORAGE Z Z
PRIVATE 2
PARTIES D.W. PREP. TABLE QP qL R%
GOG�~�� /� 4 RM W
P , 2" A
D , � CIR qR
4
2 ; Q \/ Q� MOIRE 42"-ARM12IR
® IX PREP, TABLE RAS
0
I I I WALL AL GP COG'17
Sao FR ED
6 ICE CREq 50' DISPLAY ^4 O z
_l U�
� O% �F 4.�ti0 Q 6' ICE CREq
C
J
T❑ ATE - STACKIN ��, I I �I,�I
NORTH ST, ST AG EATS O MOP w/n
PARKING LINED CIl - ri DISPLAY Y MAIN ST, W Q
1' SHELVING 1' SHELVING �
I 41' CANDY
�� DISPLAY
(115 _ ' . U 0
Z X 4T (�
COUNTER I Ll
e �o O hull I I �I I I I I v )
X O
U
0 -
o �
N
-r LL -
• w
Q
- 0 .