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HomeMy WebLinkAboutKATIE'S HOMEMADE ICE CREAM - FOOD Katie's'Homemade Ice Cream 568 Main St Hyannis' BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. t aarzr+ cA�sLe R F.P.(Thomas)Lee,. a A Daniel Luczkow,M.D. Alt. 200 Main Street, Hyannis, MA 02601. Phone: (508)862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 769 Issue Date: 01/01/2022 DBA: KATIE'S HOMEMADE ICE CREAM OWNER: KGGK, INC Location of Establishment: 568 MAIN STREET HYANNIS„ MA 02601 Type of'Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 54 Total Seating: 72 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE j Restrictions: Variance granted on June 5, 2013, for Time as a Critical Control Point- 2 hrs. to hold waffle cone batter. i For Office Us Initials• Town of Barnstable e Paid Dat mod,$ P /ARNSPABM ; Inspectional Services �p qf, 1639. ``� Public Health Division �� q AjED DAA'�A Thomas McKein,Director ` / 200 Main Street,Hyannis,MA 02601 . Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 110 a021 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: -hie S O LQ- cx-cam ADDRESS OF FOOD ESTABLISHMENT: 5(0.g Tylo'm S0fe 'e}� \A k-w-\n%s MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 1e50C�-C�O m 4 oV2•C bm TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (M )-11 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO"' ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: 1� OUTSIDE: S-H TOTAL: a SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?-r\0 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)?� TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD'SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FonnsTOODAPP REV3-2019.doc ut� ?I OWNER INFORMATION: d FULL NAME OF APPLICANT SOLE OWNER: YE /NO $( OWNER PHONE # ADDRESS FS(O% mck\n skrel+ '(!jT-\0 S 1 a CORPORATE OM14E�jt�: 4ija CORPORATE ADDRESS: S(p$ M01W1 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date i• kd.�..\vih�1 rnbdi t�3 �2�3 ��(� 1. '� �t " � � 2 2. ,�,ey�5han®.h�r> — 103/ 3o /ate SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen.desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townotbarnstable.us/healthdivision/api)lications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31St 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 f Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. *' sr �e Paul J.Canniff,D.M.D. 6A F.P. Thomas Lee Alternate _6 � 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, 30156, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 769 Issue Date: 01/01/2021 DBA: KATIE'S HOMEMADE ICE CREAM OWNER: KGGK, INC Location of Establishment: 568 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 54 Total Seating: 72 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted on June 5, 2013, for Time as a Critical Control Point- 2 hrs. to hold waffle cone batter. r-r , OPINE Tp� For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$ BMWMBLE, Inspectional Services A 9� Public Health Division Check# t�gU3 �1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 I ILA 110 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Y,,A t Ies ttamUMG-dkZ 1 CSL C f ec�.m YG(.TY-I nc, ADDRESS OF FOOD ESTABLISHMENT: S68 YYIQ\n St're-e-t _ hV►OSnY��S ,X MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: Y-� ����C-�'e��M� Vwe,-C&rn -K TELEPHONE NUMBER OF FOOD ESTABLISHMENT: w -ni 1?89 ,!C TOTAL NUMBER OF BATHROOMS: C WELL WATER: YES NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: k / t JZJ TO -L /31 /2-1 NUMBER OF SEATS: INSIDE: N OUTSIDE: S4 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? N O IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? rv�r C TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY/ BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsWOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: 69/NO (oOWNERPHONE# UIT9 y ADDRESS e a 1 CORPORATE OWNER: Y�en\ooak CORPORATE ADDRESS: ybg rM0.�Y7rP& �11►01(�11(�( S PERSON IN CHARGE OF DAILY OPERATIONS: OGlmyl List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I•�,CQ�e1U� M1DG� 09 / cl /2.1 1. J�1�e�m�a1� Lk q TV 2. , J\���C�(y1,OG\\ \2/ 2N I LA / 2oZ0 SIGNA URE F APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering,notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application Fonns\FOODAPP REV3-2019.Joc r BOARD OF HEALTH limes Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aa►eNsr � Paul J.Canniff,D.M.D. z+�s 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ap 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: 769 Issue Date: 12/10/2019 DBA: KATIE'S HOMEMADE ICE CREAM OWNER: KGGK, INC Location of Establishment: 568 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 54 Total Seating: 72 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted on June 5, 2013, for Time as a Critical Control Point - 2 hrs. to hold waffle cone batter. For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$y' ' � AS& Inspectional Services 1 1 '6. Public Health Division QED MAy Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 `:` Office: 508-862-4644 Fax: 508-790-6304 t APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE V0 -21,11 NEW OWNERSHtIP RENEWAL NAME OF FOOD ESTABLISHMENT: Q-71 ADDRESS OF FOOD ESTABLISHMENT: 5�00 �nam S e-�'�. IOno Is MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: V-OCfiI''C-- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (Sog ) '1'l l - L0198 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ / TO— NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: a— SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N0 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) �C FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT KGte-1 e!n Ili mbc1 i SOLE OWNER: (OE /NO OWNER PHONE# 9 ADDRESS J(dg r0CkM Ste e�t tftLA ann S Mal Z7`�ro6 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 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.V-006 5 n V4,(n�>CA1 opal 1. J.�\���rm \1 kA 1 LA X)DA k1n /311 / 2o19 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to 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 htti)://www.townofbarnstable.us/healthdivision/annlications.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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. LQ�Appfication FormsTOODAPP REV3-2019.doc I .Q*rrt1 Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. QARNSTAUM John T. Norman 9 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 769 Issue Date: 12/20/18 DBA: KATIE'S HOMEMADE ICE CREAM OWNER: KGGK, INC ,I Location of Establishment: 568 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 54 Total Seating: 72 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: -- — - - --- -- — - MOBILE-FOOD: MOBILE-ICE CREAM: G�� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted on June 5, 2013, for Time as a Critical Control Point- 2 hrs. to hold waffle cone batter. I ; FINE rby, For 0 ffice UsInitials: Town of Barnstable 1w; Date Paid 6 Amt Pd$� Inspectional Services " , 163q. 10� A'F�► '° Public Health Division Check# Cash Thomas McKean, Director P4 7�q ` x. 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 1 al �! DATE � NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Kcuies tee, ueaiy) , nC., ADDRESS OF FOOD ESTABLISHMENT: S(01B m Q\n Srf?—et tj 0,0y'i 02-k9 O MAILING ADDRESS(IF DIFFERENT FROM ABOVE):: -2,ar( %.e � E-MAIL ADDRESS: Kptl es IC c v-c_aYY> ,eve ,C 0VY-% TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (15� )7? I - 6w TOTAL NUMBER OF BATHROOMS: 91 WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: J q TOTAL: `l?- SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING_ REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD _%__FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc 1 PLEASE CALL 508-862-4644 OWNER INFORMATION: a ,,may FULL NAME OF APPLICANT DY QS 1 GPI 1 1 K�Y, + 1 rI C- SOLE OWNER:Q/NO OWNER PHONE # (p g 9 ADDRESS MI M01\ 1 Sire--elk O CORPORATE OWNER: FEDERAL ID CORPORATE ADDRESS: man PERSON IN CHARGE OF DAILY OPERATIONS: Cl'� eu 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 AUPrLyen Awareness Expiration Date c�1 wn �m 2-O 2. 01sm I Z / -SIGN TURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application Forms\FOODAPPREV2018.doc °p IME r TOWN OF BARNSTABLE.. HEALTH INSPECTOR,s Establishment Name: - Date:� D� -a� _Page of "l OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` w 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. ,e39. �0 HYANNIS,MA 02601 soa-eat-4s44 No Reference R-Red Item PLEASE PRINT CLEARLY 'EDN1A�� FOOD ESTABLISHMENT INSPECTION REPORT Name Dat T e of T of sec ion - ti n s outine Address Ris od Sere - spection Level Previous Inspection Telephone -7 ? '( S-7) Residential Kitchen Date: - VL Mobile Pre-operation L K Owner HACCP Y/N Temporary Suspect Illness /l� ( I 5 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other _ r'� Inspector Out: � �- v Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ o 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) LleA- FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ L 13.Handwash Facilities f EMPLOYEE HEALTH PROTECTION FROM CHEMICALS JY/R ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives V ` ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control / ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ( •` Sf :LL[ «� ❑ 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) j ^ Corrective Action Required: l S ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating f �(J 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 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 a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y Nt PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y , N• toj , Dumpster Screen? Y Nkk. L( t � fs-m_ Violations related to Foodborne Illness - vlolatioas+,A a ed 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 4 Food or Color Additives Law Cooled to 41`F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12`- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* -*--- 19- PHF Hot and Cold-Holding:. . 2-103.11 Person-in-Charge Duties 3-302.14. _� Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) *- - - - --- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F P Y g - - - -- '7-102.11 Common Name-Working Containers* - Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage Applicants* - - - 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* ( ) 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 Reared or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition 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* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) liance P _ _ _ _ --_ _ - 4-501.111 --- Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical- Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* effe cr"'e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22. Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Soo urce 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - -_ -- Chemical ' Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - _2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-30114 When to Wash* Other 590.009 violations relating to good retail m . 590.004(C) , Wild Mushroo s* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirem npractices os]d be debited under#29-Special 5 Receiving/Condition - -2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* ! 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C "-Commercial- Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities _ 3-202.18 Shellstock Identification. 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 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 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 E3-5 02.11 Specialized Processing Methods* 30. Other02.12 Reduced-Oxygen Packaging Criteria*03.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p IKE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: _Page: of P. ryo� OFFICE HOURS BARNSTABLE. ' PUBLIC 200 MAN STREEETSION 3: - :30A.M. :300-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS-9. �0� HYANNIS,MA 02601 M-8 -FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY �A 508-862�644 'ED MP�p FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Type o Type of Inspection A. 4 E Routine Address .1 LOILI-1 Risk i od Se Re-inspection 41' Level Previous Inspection Telephone Residential Kitchen Date: Mobile E- n ,)- Owner HACCP Y/N Temporary spec n Caterer General Complaint -- Person in Charge(PIC) Time Bed&Breakfast HACCP - t In: Other Inspector ; / Out: l Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME)TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling li i ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HS ❑ 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. 6=One critical violation and less than 4npn-critical violations re g 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. n 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *- 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 * 590.004(F) ( ) P 7-101.11 Identifying Information-Original Containers * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F 7-201.11 Separation-Storage* Applicants* * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer F-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 Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Ho[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(t)(2) Eggs-155`F 15 sec dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145`F 15 sec* 5-101.]1 Drinking Water from an Approved System 8g Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff""°e uuzooi 4-602.11 CleaningFrequency of Utensils and Food * 4 Y 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 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical 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 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140'F to 70'F 3-202.18 Shellstock Identification ( ) g . 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 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 TagsiRecords:Fish Products24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction*. 5-204.11 Location and Placement* 3-50L14(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* 5-205.1.1 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 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fom7back6-2doc *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. �ptNE T TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - Date: Page:_ of ry OFFICE HOURS : BAR E.c PUBLIC 0 MAIN STREETSION 8:00-9:30A.M. - - 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/ N OF CORRECTION Date Verified 1639. l MO -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY � ,639. �e HYANNIS,MA 02601 508-862�i644 - �'EON1�`' FOOD ESTABLISHMENT INSPEC ION REPORT Name Da a Type o Type of Inspection i Routine 7 v' '• Address Risl lood Service Re-inspection Level Re Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operationIV Owner HACCP YIN Temporary Sus Caterer eneral Compla' t Person in Charge(PIC) Time Bed&Breakfast In: Other LL A Inspecto Out: �� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r 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 L ❑ 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 C Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ 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 o 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. 6=One critical violation and less than 4 non-critical violations 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 4 6 non critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address ( )( ) violation,4 to anon-critical violations=C. - 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N FIC's Signatu 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) I 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) A ssignment of Responsibility* I 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* g * 14 Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * in 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* 590.004(F) * 7-102.11 Common Name-Working Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140*F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* P g L.2O_ Time as a Public Health Control 7-201.11 Separation-Storage** 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202:11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 59 Applicant To Report To The Person In Charge*eporting by Person in Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 0.003(G) R Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 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 rnnom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 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. $ 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) 3-102.11 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 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 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45'F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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:59oFormback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF,HE►ow TOWN OF BARNSTABLE.: . HEALTH INSPECTOR,s Establishment Name: Date e: of Pag OFFICE HOURS 9 nRNsrns�e,o: PUBLIC 2 0 MAN STREEETSION 3:30-4:30A.M. Item Code C-Critical Item 3:3o-a:3o P.M. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p s SS. �e - HYANNIS, MA 02601 - so9-as2-MON FRI No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P�' FOOD ESTABLISHMENT INSPECTION REPORT Name DateM%e of e o section - o s Routi Address ` RiskSe ection Level Previous Inspection Telephone g� Residential Kitchen Date: [J / Mobile Pre-operation dW Owner I�SIC�C�ea ®I ,F ACCP YIN Temporary Suspect Illness r S Caterer General Complaint Person in Charge(PIC) I Time Bed&Breakfast O HACACCP In: Inspector �� Out: l Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. f Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ --- Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS tXZ,55tD ❑ 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 HS4 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lb G QI 11�t,� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ?- IOL~l ✓' Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating .within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,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 g p,infestation of rodents or insects,or lack of 27.Physical,FacilityFC-6 590.0 7 aggrieved b this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up, y ( )( 0 ) 99 y : 9 9 q If 1 I refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical al violations. critical g 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to S non critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view , Jomffifl JJA,71,� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC, $i natu Print: i Self Service Wait Service Provided Grease Trap Size Variance Letter Posted YN I ` tn/�Y\ LL� Dumpster Screen? Y N 1 `� (✓ Violations related to Foodborne Illness Wolations 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* 13-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* ed 3-302.14 Protection from Unapprov imAddifives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 1 g Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) ners 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* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control*. Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food ' 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Ware washing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1-)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(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* eff crt,c vmow 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* , Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By ( )O P Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating, Requirements. 5 Receiving/Condition g,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours*. 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention ty' P Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590_Formback6-2doc -Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I F.Ne TOWN OF BARNSTABLE l HEALTH INS.PECTOR's Establishment Name: .2 f (p r,(`e /v, Date: Page:_�Of ,L ..� � OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p39. �0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item. - PLEASE PRINT CLEARLY �p - 508-8624644 FOOD ESTABLISHMENT INSPECTION REPORT NameTTAM Date o Type of Ins_ ction r ef aces outine V _____t Address (o Risk Food Se Re-inspection13��'^. 7 Previou/ns ection CurLevelTele hone Residential Kitchen DateMobile Pre-opt on Owner HACCP YIN Temporary Suspect Illness o Caterer General Complaint 44� Person in Charge(PIC) Time Bed&Breakfast HACCPn C _ In: Other ,,)e u, Inspector r w. �� On Out: olo+'r �kh P5� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. t Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ffrNo ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �(�,, /� Q within 90 days as determined by the Board of Health. �11,1`j - /31 I V ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspectioh 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 if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address violations obse 7 to 8non-critical violations. If 1 critical refrigeration. ( )( ) violatQn � I violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspecto Pin. 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 SiPrint: 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) *- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants * 20 Time as a Public Health Control O 3-302.11(A) Food Protection 590.003 Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use*p y- - 3-302.15 .Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer 7-204.11 Sanitizers,Criteria-Chemicals* - -REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions 3-306.14(A)(B)Returned Food and Reserviceof Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff ctiv 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS _ 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By (3-401.11 C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C)' Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* ( ) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 i Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. 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:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t` � 1^1 __ FTC r° TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: I���1 I C.Q,��f^sM Date: /I Page: 1 of .° OFFICE HOURS -r PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 'cbp e3: `m$ HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rE' 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT ,Vv_ ` �r Name Date '� Ina of Type of Inspection Routine Address Ain Risk ood ervi Re-inspection IF Level Previou In pection I Telephone Residential Kitchen Date: 'I Mobile r -op a i n - Owner HACCP Y/N Temporary SZMpttr7hess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP �� In: Other Inspector � S ^ �S Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. I Violations Related to Foodborne Illness Interventions and Risk Factors(Red Itemsl Anti-Choking 590.009(E) ❑ ��- i 'J" Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4.non-critical violations 26.Water,Plumbing and Waste. if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot g (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have.a right to a hearing. Your request must 9 p' 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address viola' s observed,7 to 8 non-critical violations. If 1 critical refrigeration.ViKation29.Special Requirements (590.009) within 10 days of receipt of this order. , 8 non-critic I violations=C. 30.Other DATE OF RE-INSPECTION: Insp c is Si ture Prin f 31.Dumpster screened from public view 1n A v, Permit Posted? Al Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI gna 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 1 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130'F Applicants* * 7-201.11 Separation-Storage 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg rn-rnizooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR d Sou Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165*F* foodborne illness interventions and risk factors. 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 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands ( g illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* 3-403.11 E) Remaining Unsliced Portions of Beef Roasts* 6 TagsiRecords:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 ISpecialized 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. 3 McKJnzie; �1v9arybeth From: Katie's Homemade Ice Cream <hello@katiesicecreamcapecoo.com> Sent: Monday, May 24, 2021 8:25 PM To: McKenzie, Marybeth Subject: e: Menu & Floor Plan {{ Marybeth, We have installed the aV—curtain above the takeout window. I have also installed plastic LED light bulb in all of the fixtures in the entire shop.We will be switching to covered recessed lights when the ceiling tiles are switched to fire grade, washable,tiles.The tiles have been ordered along with the flooring. We are just waiting on an installation timeline for me to give you a finish schedule. As for the allergy label.We have it posted at our ordering window.We do not, at this time,give out paper menus and it is written on our website where the menu is displayed. I have had a plan drawn to scale, should I send it by mail or just submit a picture through email? All the best, Katie From: "McKenzie, Marybeth" <Marybeth.McKenzie @town.barnstable.ma.us> Date: Friday, May 21, 2021 at 9:23 AM To: Katie's Homemade Ice Cream <hello@ katiesicecreamcapecod.com> Subject: RE: Menu & Floor Plan Katie, Thanks for the menu and floor plan. If you are giving out this menus or have them available on a website please make sure that the allergen verbiage is on it. Also,the floor plan will suffice for now, but if you plan on keeping the area as a prep area,then you will need to submit a plan to scale and a finish schedule. Also, please let me know what you have decided on for the self-closing window.where the food will be passed out,which needs to get done right away.As we discussed, you will be given 6 months to upgrade the prep area finishes(floors,walls, ceiling)to meet code, if you decide to keep using it in this way. Regards, Marybeth McKenzie R.S. From: Katie's Homemade Ice Cream [ma i Ito:hello@ katiesicecreamcapecod.com] Sent: Thursday, May 20, 2021 2:46 PM To: McKenzie, Marybeth Subject: Menu & Floor Plan Marybeth, Attached are the menu and a rough floor plan where things stand right now. Thanks, Katie 1 C3 rl F I JFE CO Postage $ ru C3Certified Fee �f'oStmark N O Retum Receipt Fee ([tmar C3 (Endorsement Required) O Restricted Delivery Fee C3 (Endorsement Required) sp r=1 S M Total Postage&Fees � M Sent To rl ---------- O meet,Apt.No.; N or PO Box No. " - City,Stafe.ZIP+4 = 1 „Qt r1 . li n I S.- A 6Z(ob :rr rr. Certified Mail Provides: , - ■ A mailing receipt ■ A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. ■ Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. m For an additional fee,a Return Receipt may be requested to provide proof of delivery.Tb,obtain Return Receipt service,please complete and attach a Return Receipt,(PS Form 3811)to the article and add applicable postage to cover the fee.End&se mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. — o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ® If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT. Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 o Complete items 1,2,and 3.Also complete =ae item 4 if Restricted Delivery is desired. Agent ® Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Da of Delivery M Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? tJ Yes 1. Article Addressed to: 11 ,,n-- If YES,enter delivery address below: El No I i�o C.s t' merY1aax— 3. Service Type a (1( S , ICY) 3fLOertified Mail ❑Express Mail ❑Registered ❑ Return Receipt for Merchandise 0 Insured Mail ❑C.O.D. I V 4. Restricted Delivery?(Extra Fee) p Yes 2. Article Number [i ,7 012 ' `D 0 0 2 15 0114' ' OGn] (Transfer from service label) PS Form 3811. February 2004 Domestic Return Receipt, 102595-02-.M-1540 _ I UNITED STATES POSTAL.SERVICE First-Class Mail Postage i3 FeesjPaid USPS I Permit No.G-1� • Sender.- Please print your name, address,and ZIP+4 in this box • I I Town.of Barnstable Health.Division I 200 Main Street Hyannis,MA 02601 I McKenzie, Marybeth From: McKenzie, Marybeth Sent: Friday, May 21, 2021 9:23 AM To: 'Katie's Homemade Ice Cream' Subject: RE: Menu & Floor Plan Katie, Thanks for the menu and floor plan. If you are giving out this menus or have them available on a website please make sure that the allergen verbiage is on it.Also,the floor plan will suffice for now, but if you plan on keeping the area as a prep area,then you will need to submit a plan to scale and a finish schedule.Also, please let me know what you have decided on for the self-closing window.where the food will be passed out,which needs to get done right away.As we discussed,you will be given 6 months to upgrade the prep area finishes(floors,walls, ceiling)to meet code, if you decide to keep using it in this way. Regards, Marybeth McKenzie R.S. i I From: Katie's Homemade Ice Cream [mailto:helloCabkatiesicecreamcapecod.com] Sent: Thursday, May 20, 2021 2:46 PM To: McKenzie, Marybeth Subject: Menu & Floor Plan Marybeth, Attached are the menu and a rough floor plan where things stand right now. Thanks, Katie 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! i McKenzie, Marybeth From: Katie's Homemade Ice Cream <hello@ katiesicecreamcapecod.com> Sent: Thursday, May 20, 2021 2:46 PM To: McKenzie, Marybeth Subject: Menu & Floor Plan Attachments: HOT DOGS-6.png;floorplan.JPG h Marybeth, Attached are the menu and a rough floor plan where things stand right now. Thanks, Katie 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 HOT Sau ' l age t nature Hot DogsSweet or Hot Sausage: plain on a steamed bun...$S.00 (Sub Sweet or plot Sausage$1.2S Extra) Sweet or Hot Sausage:with peppers and onions...X00 Naked Dog: plain on a steamed bun...$3.75 Old Fashioned: onions, mustard, ketchup, relish... rent Your Own $4.00 Mac Doggy: Mac&Cheese... $5.00 (:Sub Sweet or Hot Sausage$1.2S Extra) junkyard Dog: Mac &Cheese, cheese sauce, :bacon Mutt Dog:Anything you'd like. As manycomplimentary bits...$5,50 toppings as you want and one additional topping...$5.75 Buffalo Dog; Buffalo sauce, blue cheese or ranch dressing, chopped celery... $4.S0 Complimentary Toppings BBQ Dog. Onion, BBQ and coleslaw... $4.50 Chaos Dog: diced onion, hot peppers, hot sauce, brown mustard.... $4.50 Yellow Mustard Chopped {anion New York Dog: Sauerkraut, brown mustard...$4.00 BBQ Mustard Chopped Celery BBQ Sauce Bacon Bits. Reuben Dog: sauerkraut, thousand Island, shredded Relish Celery Salt Swiss...$4.SO Mayo Lettuce Chicago Dag: diced tomato, relish, dill pickle, onion, Ketchup Ranch banana peppers, celery salt, mustard'... $4.75 Franks Buffalo Sauce Blue Cheese Kraut Dog:warm sauerkraut, diced onion and spicy Thousand Island' Hot Sauce mustard... $4.50 Chili Dog: Chili-$4.75 Chili Cheese tog: chili,shredded cheese...$5.00 Additional Toppings Sams Dog:chili, shredded cheese, diced onions, hot Sauerkraut... .25C Shredded Swiss....50C pepper spread, mustard.,.$5.50 Mac &Cheese.... $�'.25 Diced Tomato....25t l�l�iJly Cheese Deg: peppers&onions, cheese sauce... Cheese Sauce... .50C Dill Plckles.,..25C $5.25 Hot Pepper Spread....2SC Banana Peppers....25C Nacho Dog:cheese sauce, sai'sa and chips... $4.7S Coleslaw....SOC Chill... $1.00 Salsa....2aC Shredded Cheese... .50C MAKE IT A► COMBO peppers & Onions... $1.00 Tortilla Chips.-SOC Add chips&a drink for$1.75 more Sides Drinks Bag of Chips...$1.25 Lays, Ooritos,Cheetos, Sun Tortilla Chips Tortilla Chips with Salsa... $2.75 Bottled water...$1.75 machos with Cheese Sauce... $4.00 Soda Can:Coke, I?let Coke, Sprite, Nachos with Cheese Sauce, Chill... $5.00 Root Beer, Orange...$7.00 Cup Mac&Cheese...$4.00 Bowl Mac&Cheese... $S.00 Cup Chili... $3.SO Bowl Chili... $4.50 Add Shredded Cheese to Chill....50C i 9 aJ m ;�.>, -., ... _ ,� ,�.�. �. �,.. � ,,..ae, .r.�uw a � .:. � �..,.� a, S � � x +��• � �� ��^ '.,�� �^� arm nn me h tiJ , .. .. .. ,. a �.a -ume.,m;a,,�<z.,»sr~e �^ ..ma-: .�m� e eg.,�a`, .w..;�,_�ac �,a^�s,.^g-• a *a, va�,�,a�. . V v Po* �a J r ea �%4����� n m ,- -*«t•� .w,c+w` a n.-'s" '`:�A-W .h to ✓_ xN.+;,i �x....9e-.� ,s-m fit+,a Ko`. .-m o^F_ m.:,xo. g s .... .,.-?:-.n .,��.-ga,..;s ,="».v .Ce-may�*^.tw" _tea^`3�w-�-'.w.^iR' s��'�°v" A`w�"+£a & ��.� #.✓fra,•&, v+hi-@. a. war$` � a a «.r rya� r?r �✓h 'm ..:«:{. k, eM $ sn _ Message Page 1 of 1 McKenzie, Marybeth To: Julie Kimball Subject: RE: Variance procedure Julie Kimball Katie's Homemade Ice Cream 523 Main St Hyannis Re: Variance to use Time as a Critical Control Point Variance approved to hold the batter to make cones at room temperature for 2 hours and then any left over product will be discarded. Stickers with the discard time will be placed on the container and this variance will be posted with the food permit. Thank you, Marybeth McKenzie, R.S. Health Inspector Town of Barnstable -----Original Message----- From: Julie Kimball [mailto:katiesicecream@live.com] Sent: Wednesday, June 05, 2013 12:33 PM To: McKenzie, Marybeth Subject: Variance procedure To Marybeth McKenzie, Katie's Homemade Ice Cream is requesting a variance using time as a procedure for our waffle cone batter. We will place the waffle cone batter in the refrigerator and remove a small amount which will be placed in a container marked with a two hour time sticker. After two hours this container will be disposed of and a new container will be filled and marked with a time sticker. Sincerely, Julie Kimball Julie Kimball Katie's Homemade Ice Cream (508) 771-6889 6/6/2013 o-r r sags Page 1 of 2 Waclington, Ellen From: McKenzie, Marybeth Sent: Friday, September 20, 2013 8:14 AM To: 'Judie Kimball' Cc: Wadlington, Ellen Subject: RE: Variance procedure Thanks Julie. There will be a note put on the 2014 permit regarding this variance. Have a good winter and see you in the spring. Marybeth McKenzie -----Original Message----- From: Julie Kimball [mai Ito:katiesicecream@ I ive.com] Sent: Thursday, September 19, 2013 2:28 PM To: McKenzie, Marybeth Subject: RE: Variance procedure Hi Marybeth, If found this in my e-mails. I've posted it at the shop. Have a great day, Julie Julie Kimball Katie's Homemade Ice Cream (508) 771-6889 Subject: RE: Variance procedure Date: Thu, 6 Jun 2013 08:27:38-0400 From: Marybeth.McKenzie@town.barnstable.ma.us To: katiesicecream@live.com, CC: Ellen.Wadlington@town.barnstable.ma.us Julie Kimball Katie's Homemade Ice Cream 523 Main St Hyannis Re: Variance to use Time as a Critical Control Point Variance approved to hold the batter to make cones at room temperature for 2 hours and then any left over product will be discarded. Stickers with the discard time will be placed on the container and this variance will be posted with the food permit. Thank you, Marybeth McKenzie, R.S. 9/20/2013 lvmssage Page 2 of 2 a Health Inspector Town of Barnstable -----Original Message----- From: Julie Kimball [mailto:katiesicecream@live.com] Sent: Wednesday, June 05, 2013 12:33 PM To: McKenzie, Marybe'th Subject: Variance procedure To Marybeth McKenzie, Katie's Homemade Ice Cream is requesting a variance using time as a procedure for our waffle cone batter. We will place the waffle cone batter in the refrigerator and remove a small amount which will be placed in a container marked with a two hour time sticker. After two hours this container will be disposed of and a new container will be filled and marked with a time sticker. Sincerely, Julie Kimball Julie Kimball Katie's Homemade Ice Cream (508) 771-6889 9/20/2013 TOWN OF BARNSTABLE SITE PLAN REVIEW DATE: April 1, 1994 TO: Thomas McKean, Director of Public Health FROM: Kathy Maloney, Site Plan Review coordinator RE: Site Plan Review Number: 13-94 Margaret Sweeney 570 Main St., Hyannis Proposal to build deck to accommodate existing outdoor seating for Maggie's Ice Cream Mr. Sweeneyattended the March 3 1994 Site Plan Review meeting to discuss, his g � proposal. At that time, it was determined that there would be no increase in seating or in parking requirements and that a variance from setback requirements would be required. Mr. Sweeney was asked to submit an updated site plan and complete an application form. Mr. Sweeney is scheduled to attend the April 7, 1994 Site Plan Review meeting. Approval and signing of plans areexpected at that time. Please let me know if you have any additional requirements or concerns. "AP,f-LJ CA1'I UN FOR SITE PLAN *JEW • _ FOR OFFICE USE; ONLY DATE RECEIVED , ACTION DUE BY LOCATION �D Legal Descriptions J Planning Board Subdivision Number: (CeF Assessor's 11ap and Parcel Numbers (�308 2--76 —' Property Address: OWNER OF PROPERTY APPLICANT Name: Name: 4ddress: Address: 2 V O Phone: Phone:- 7L2 ENGINEER AGENT( Interest owner or applicant) vame: Name: Address: Address: Phone: Phone: S1'0FAi ZE.. TANk r UTILITIES ZONING CLASSIFICATION(s) :tilSYlNLi Sewer / District: /3 Nttr�Le: �_ NLIwiLer:_Q Public V Flood Hazard:_ C sae: Size: Private— Groundwater Overlays Above Ground: Above Ground:_ Fire District: h�5 Gnderoround: Vndervround. dater: LOT AP EAr p 1-5 )CRC sq. ft. r:ontellt.s Contents: Public s/ Private:_ NUMBER OF BUILDINGS Fire Protection:_ Existing: Ohe LE.).1116 ZPFk' c.S It RB CUTS / Proposed: -egcli:eJ:r xistin9: 1 Electrical: Demolition: 1�orl rrovjded:,-- roposed: `- Arial: A-1 Site: To Close: Underground:_ TOTAL FLOOR AREA (in sq.ft. ) .'rf Site: _ Total: Gas: Residential: Natural: ✓ Office: IN_RISTOPICAL DISTRICT:(,yes)_ ibef" Propane:— Medical Officer Commercial: _'�'SO� 4— IN AREA OF CRITICAL ENVIRORhENTA! / (specify use) (yes)_ (no) / Hholesale FEI)JEC7 WITHIN 100, OF METLAND RESOURCE AREA: (yes)_ (no) ,, Institutional: Industrial: TOWN OF BARNSTABLE BUILDING DEPT. D 9MIAEt 3 0 E C E I V E Al , '� , #J I LUI NG CUh111 5 1 uNtk_ • Zoning District _ old King's Highway District ► 10— or Listed in National and/or State Register of Historic Places Perimeter set backs: Front Side Rear Lot Coverage Tupe of Use ( zoning ) �. UI he SS Flood Plain Zone r10 Elevation Number Of Floors . Floor Area: 1st _D end Other (specify) Parking Requirements: Required Provided Handicapped Spaces Are there accessory buildings? u Accessory Buildings Floor Area PLEASE PROVIDE A BRIEF, NARRATIVE DESCRIPTION OF YOUR PROPOSED PROJECT. �. -1172D LCArdIx, z9 1 assert that I have completed (or- caused to be completed) this page, the Site Plan Review Application and the checklist on the back of the application and that , to the best of my knowledge , the information submitted here is true. ' �� ' signature) (date), 6 Malkus, Karen From: Wadlington, Ellen Sent: Thursday, July 11, 2013 4:15 PM To: Malkus, Karen Two restaurants have called to say they have in-ground grease traps: Katie's Ice Cream, we are trying to figure this out, but I think she shares hers with 572 Main Street, the little restaurant behind. There is a 1500 gallon grease trap there. Julie is looking it up, but WCP said Pete DeBarros pumped it. Kian n' Rylee has a 1,000 grease trap. He is bringing in the ticket where it was pumped and also he had the pipe to the street cleaned last year. Ellelr Mdlytolr 1 Town of Barnstable Barnstable Regulatory Services Department 11111.1 BARNSTABLE, MAC.1639. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 7/10/2013 Katie's Homemade Ice Cream 570 Main St. Hyannis, MA 02601 To: Katie's Homemade Ice Cream, This letter is being sent to inform you that our records at the Health Division office show your food establishment is not currently connected into an in-ground grease trap. The Board of Health wishes to inform you that at the time your property changes ownership or the property has a new leasee, or if there is a change in menu, the Board of Health and Department of Public Works will require the installation of a minimum 1,000 gallon in- ground grease trap. Mechanical grease recovery devices are not recommended by the Plumbing Inspector or the Town Engineer. According to the Massachusetts State Code: 310 CMR 15.230: Pretreatment Units-Grease Traps 3)Grease traps shall have a minimum depth of four feet and a minimum capacity of 1,000 gallons,and shall have sufficient capacity to provide at least 24-hour detention period for the kitchen flow. Kitchen flow shall be calculated in accordance with 310 CMR 15.203. (15.203 requires 15 gallons per seat i.e. 100 seats 1,500 gallon grease trap capacity.) If you have any questions or need more information, please contact the Health Division at 508-862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S.CHO Agent of the Board of Health I ' I C, o n o � I A-b oI I II o Q FnD p i INI01 S IA10 6 S WV s 19f ��ot r �o NM01 L� Aug. 25, 2016 9.2iAM k 1688 P. 1 ENVIR 0 TECH LAB ORA TOPIES,INC. MA CERT.NO.:M-MA 063 S Jrui Sebastian brrve Unit 72 Sanrlwlelr,MA 0,2563 (508)888-6460 1-804 339-6460 FAX(508)888-6446 Client Horne Katie's Homemade Location Hyannis.MA AddPeSS 547 Main St. Hyannis,MA 02601 Sample Dane 06110/16 Collected By Envlrotech/SA Sample 77me 11:45 Sample Type Frozen dessert bate Received oe11a116 Lab Order Number OW-162902 Well Specs NA I:ocatlq`�Sourae': .YYgle Collected` Time Collected ComrttetiPls' :14 08110116 11:4¢. VrtlChoc Ice c ,ajm Analysis Requested Units ]Recomme tiled Limits Analysis Result Method Date Analyzed Analyzed By Ice Cream Coliform lgrarn 50 32 Pour Plate 8/10/2016 me ;f,., "..cirr�tori+SQrrl ce bate lid edted Wine collected` ; , • ;:;.,.;;: 6 08/10116 1N6 Van/ ocyo yogurt Analysis Requested Units JRecomnrended Llmlis Analysis Result Memorl bate Analyzer! Analyzer)By Ice Cream Coliform (gram 50 >150 Pour Plate 8/10/2016 MC Comments: Sample A:Yes-Parameters for frozen dessert are within recommended limits. Sample B:No-Parameters for frozen dessert are not within recommended limits, Date Bf2212016 Ronald J. a r Laboral ry Irec%r r' V BRL Below Repartable Limits *See Attaches! Page 1 of 1 cCerti,'Icalton is not available for this analyze for non potable water soorples.. F F � o F ISF I- V40,P5 1-qftT � � 03� Flo W � 1 r o 'L_J i ' 1 The Luu In Deep* ireTech, ®1® � e'en .less Electric Fityer M Aei M1I.40C G lV�t } Double Fluke: Double! Oil Va -- r Ftyt6a relit ,l t Wr Il ' 1. i. Ans I QD Fir �i syst Food e, Ice Two FndG®�ndsnt OlI R vti Irs 4.6kpe rter 9.6kW 'foul i } I y40V 9. 3kW Total ►� f4� j f 243V / 0 Amp / S n0e Phase** B f ,s �' ,p l i0 AMP Dedicated S )rvice Required 13' Cord w ! NEMA 6- 30 PlugNEMar>so PLUG 39.80 L )s. .50 - 10f Lbs. Frerct Fries ! Hour (F1'on4ritoDone)* `CE.pacity will vary deizen ling, on French Fry T pe. , aides = 0" Back = 0' Top -- 24" p r' 5tainie: s Steel •� � 3 .sq—��oams o��rm.u—®�® t ' ..31 a Lb: . .25" D x 36" W x 3.1 I11 p �f phas a available up:)n request Au,omatl d or Manuai Dil Filtration / Disposal >;ystem I i 1ATIE1110 IL VENTLESO HOOD ANSW cii F-SupppEsain;y Sysi'L* IFULLY• INCLOSED STAINLEW; f TEAL CONBTnucrio Y lDUAL I A79RBT/AUTOMATED FOOD ;IELNERY WARRANrY PROOR ,MMAeLE CONTROLS 1 YEAR VAT i/LA®OR AND AUTOM iTEO OR MANUAL OIL FILT IATIOIN 3 YEARS ! LE :TRONIC CONTROLS PACKAGE Frf, i 1300-348 r Cot F ied at tljel w.aut.ufry i-.Gin ® L ® L Ea Mod in Technology, Inc. 257 Sir arano Drive • Marlbc-ro, M .01 752 508-460-98( 0 F 508-460-5090 We reserve ,e right to chaige srLcYicalions a Spearing o fhis tWiebn whir ;nonce ar,d vaithou'.vc rrine any obiigel,en for the equiprler'it prevwaa;ly br subs equ r,.Cir ssol 1 • The L e,7der I i Vell � Deelttli�sTechnology. • i . o CZ 12--mm 3=� Finally, a C 2L NTERT®R ventles,;and automated dei gip-frying system des gned to meet the demanc in(i requireme its of hicl i-volume foodservice operators providing in affordable, safe, and u., er friendly alt( rnative t) open deep fryers. AutoW tM ad el MTI-40C : A vontl ass, t ully-enclosed, fi Ily-automated countertop model featuring dL al '-ry baskets, program nabla controls, index endant oil vats and a iauilt in ANSUL0 fire suppres aic n system.I ie II ri Cc produces up to ®tllt)z of product pej-hour*. e p o o M i It"It"S A wo EawF As . . ELEC—RICi FRYER M1I.40C DUAL ®, AKET': COUNTENTOP MODEL PI fc( food produc in en ry chutes S€ le(t fry time on ---- — t kE gyp,ids or select pr)g ammable prf Sets. Fc A is fried to pe fection & womatically df ivered to ex:er or receiving I asket;. 40510%g"ph ur 3 4> w® 1190"IF Get Faded at %uuwr.auttofr exoni MENEM SEMEN AUT®FRY _ — - - A Patented Product of Mot on Technology,Inc No..-. (.QV4, Fps..3. _ t........... THE COMMONWEALTH OF MASSACHUSETTS - � -- BOARD OF HEALTH r ( TOWN OF BARNSTABLE J �4Avpfiratiliu for Disposal Works Tonstrnrtion jIumit Application is hereby made for a Permit to Construct ( ) or Repair (L-)-an Individual Sewage Disposal System at: ................_S- 5f------------. �// Loc�ption-,Address ��!_�r.,;te.r:GT ow cu« f. _ ..._S ir....�:r�l ,lNo �'!.(%o..... Sle_rv! r ........ Installer Address of Building Cc+"r,l t.�tD T 7„ri„I S.we- Size Lot----------------------------Sq. feet Dwelling—No. Bedrooms........................................... xpansion Attic ( ) Garbage Grinder ( ) . e p-, Other—Type of Building ............................ No. 'of persons............................ Showers — Cafeteria a Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-----------------_----.................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (sl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ---•-----•----------------------•--•-•-••-•-•------------...--------.......--------•••-•-•....--•---------- •------------------- .----------------------------- 0 Description of Soil........................................................................................................................................................................ x -•------------------------------------------------------------------------------------------------------------- ) -------- - ........ U Nature of Repairs or Alterations—Answer when applicable_.ri2� .!�_.... !' rr_s....... .4-7e—._��.8��..--.._. -------------------------------•-----------••-----------------------•-------------------•-•--•----.......-•------------------------------------••------•---••---------------------------•••------•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian a as en issued by the board of health. Signed -- --------- ...................�........ ...----------------- �1.-..2,f— 51. Dare Application Approved By -----------------_ A T-^ �• �- Me Application Disapproved for the following reasons- ------------------------------------------------------------------------- --------------------................................ ----------------- -- ------------------------------------------------................................--------------------- -- ---- ------------------------------------------------------ ........................................ IJare PermitNo. ......9. .�. ............................ Issued ........................................................- ate Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR����TTNSTABLE &rttftrate of Cantyltance THIS IS TO CERT- , That e I divi u41 Sewage Disposal System constructed ( ) or Repaired ( ) by o - --------- ....----. / C ' Installer has been installed in accordance with the provisions of TITLE 5 of The. rate qEnvironmental Code as described in the application for Disposal Works Construction Permit No. ---.--?.;I, . ........ ......... dated ....-.-.--.----:-.-.--.-.----------------.--.--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------- ---------------------------------------------------------------- Inspector ................................................................----------------------------- �- -= l l� FEE..... ,......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE / '1l Ampliration for Disposal Worko Tamitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( Chan Individual Sewage Disposal System at: 1 iL tid -� .......----- --S_70-•-- 1 , ' -=5-.C--_---•.. ' ........... .:1:: ._... --- •--- ......................... Location-Address or Lot No. .................. ..... .�tf !Q.s�...•......_......._ .......d�_b'-. •.... C.: ..CP.:s. ,y1...._. a�_'.:;�r-=1.a j�j Owner /J� / — / Address �/ 4''' �..� .1.:`� ........................... ... �' v 1!ti/11.f'?h ...a7:_....A!�s.���:............. Installer QU Type of Building Co,,,,e drQ To ) SiAddress ze Lot-_-----------------------Sq. feet �-, Dwelling—No.�f,Bedrooms....................................... Ex... pansion Att>c ( ) Garbage_Grinder ( ) Other—T e -of Building -" . a —Type g ...____. No. of persons_ Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------------- ------------•-----.. -- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ..-................. Width.................... Total Length.................... Total leaching area_...................sq. ft. ` Seepage Pit No-----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by................................- = Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit._........__..._.... Depth to ground water........................ 14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P --------•--------------------------------------------------••-•---•......---••••••........---_••----..-•---•--.............._......-•----......------.......O Description of Soil--------------------------------------•--- -..---- .......... --•-•---------------------------------- ----•-------........----------...--•------•.....-------- x U ---------------------------•-------•------...._...------------------••------------•------••-•-•-----••---------------------•------------••-----•--•------------------------....---••------•------------ w z --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------....... U Nature of Repairs or Alterations—Answer when applicable_-__ �;.� _l.�._.._ d- s_ _.._..TAc _.`,��cz�.�....... ---------------------------•----------•--•••--------------•---•----------------------•••-••-----........----------------------------------------------•--------------•---------------.......---••-.---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the �.:r ,� system in operation untila Certificate o Compliance" -------:as been issued by the board of health Signed, Uare Application Approved BY - .`... .-ate- .., - ---------- ----y. -awe Application Disapproved for the following reasons- ----------------------------- -------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------- --- ------------------------------------------------------------------------------------------------------------------------------- - -------------- ------------ - - Dare 'Permit No. ..:. J $--/n------------- ------------ Issued .................................... ....- Dare THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH TOWN OF BARNSTABLE Gertiftruie of Complianre t THIS IS TO CERTIFY, That the Indiv dual Seage Disposal System constructed ( ) or Repaired ( ) by .... G t�.......................................---------------------------------.................................... ............................ Installer at ............... ...5.7 7© .../ ', 1� ........ +---------------------------- ------------------------------ ------------------------------------------------ --------- ----- has been installed in accordance with th/provisions of-'TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. :.... -... ---..F_9-........ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE 'SYSTEM WILL FUNCTION,SATISFAC IORY. f DATE------------ ---------------------- -..............................-....... ------------------ Inspector: *............--------------------------............................. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE..... Disposal Vorkg Tonntrurtion "permit Permission is,-hereby granted-----------la4 ..A?...., ./ ...................................................................•-........... to Construct ( ) or Repair (j.-) an Individual Sewage Disposal System at No.....................a.:?.....f//NA.._... S T �.�, .� e..!.... �� ` j Street /.........................................................:.... as shown on the application for Disposal Works Construction Permit No..;,?2.�fff'..._ Dated............................::...a...... ��------- -- ------- Board of Health DATE..................�_ ------------------------ 1 FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS _ L � �' �eA J` s7/i irl-'WN OF BARNSTiiBLE 6 (�� .evcr��2 S F W A G E !� V!LLAGE �,i,,,yi ASSESSOR'S MA.? 6i LOT/1/� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ���•- �.� `�' LEACHING FAC;ILIT'Y:(type) '�'� Nize.),.., _ � RBI ' NO. OF BEDROObfS-/LJ�_L4-'RIVATE WELL OR PU C ; A + BUILDEROR OWNER R7- o T!oA---%-\ DATE PERMIT ISSUED:+ 14 gn DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� r� o II L � -w-rwwr- w-wr-ww- ' ----r - -- -wwrr-ww-wwwrw t:: C=C� , ----- U C-C= ZER Oft e E:eic:Fc A ao lin Mop *-- ~�N VC:T FI o or --M♦ -----+ — -- — _____ O F;!esu'E:ntri i Fre ezer Fre ezor Yogurt t �r�u�t -r-rwr-- �, ■:sue ��� OvenI Fonica.Court(Oop ----------------- I. T;)ke 0ul Wn d ow ---- -------------- ------- ------------------- �- 0000 "0 (� 0�� d 0 0 0 0 ��0 01� Fian ii�:a p R 3r�p --- •-------------- ------------------ --- — Flocr a a IS. - ---- :� Aie n s B�hr o)n ----- + A. 01 $11)n en's Bat hro orn I 00 rpw ' --------- rw-w- 0 0 � r.c�rr�rrron -- ��^S Hal way (ell ♦ \\\ Cerwnl:'rile , 1=udg�. 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