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HomeMy WebLinkAboutDRAGONLITE - FOOD - CLOSED i 7FI,GONLITE 620 Main 5t.i r Town of Barnstable BOARD OF HEALTH John T.Norman $" Board of Health Donald A.Gaudagnoli, M.D. w TBIA RN B F.P.(Thomas)Lee,. ran&. Daniel Luczkow,M.D. Alt. 63� . 200 Main Street, Hyannis, MA 02601 A 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: 266 Issue Date: 01/01/2022 DBA: DRAGONLITE RESTAURANT OWNER: SHU INC. Location of Establishment: 620 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 120 OutdoorSeating: 0 Total Seating: 120 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVE D-06/2011-Variance granted for the operation of acidification of cooked rice. Manager shall ensure that the pH log is kept and coorective action is taken whenever the pH is greater than 4.3 or if more than 1 hour, discard the rice/water mixture and sampling container. 11ME r � For Of ce • Initials: � a Town of Barnstable 3� Date Paid Amt Pd$ maNsrABLE, t Inspectional Services '�- 1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE'A FOOD ESTABLISHMENT / DATE NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: SHU ItJP d//b/c Dn966N LIr' rCS-fi i4U T— ADDRESS OF FOOD ESTABLISHMENT:AOU MAIAI �V, , �y�N�s M A-o2bo1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ?U. Monft-A a rnaat. rh m A TELEPHONE NUMBER OF FOOD ESTABLISHMENT: OS - TOTAL NUMBER OF BATHROOMS:3 WELL WATER: YES NO V... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER " OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR.OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring 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 42) *** SEASONAL,MOBILE &NEW FOOD ONLY* REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FonrosTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT_BpAj L.( j SOLE OWNER: YES/ 'O D.O.B OWNER PHONE # ADDRESS-�,4&A--j->A r, y& moul(� MA- a�ti73 CORPORATE OWNER: 1 Ar , CORPORATE ADDRESS: F 'YAIVAll S, MA: oa44 j PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. WO M=,_Lid 05' l Z act SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FornlsTOODAPP REV3-2019.doc Town of Barnstable John T.NOF o BOARD No HEALTH � rman Board of Health Donald A.Gaudagnoli,M.D. M3 NSTABM Paul J.Canniff,D.M.D. MAM F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 266 Issue Date: 01/01/2021 DBA: DRAGONLITE RESTAURANT OWNER: SHU INC. Location of Establishment: 620 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 120 OutdoorSeating: 0 Total Seating: 120 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.n FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVE D-06/2011- Variance granted for the operation of acidification of cooked rice. Manager shall ensure that the pH log is kept and coorective action is taken whenever the pH is greater than 4.3 or if more than 1 hour, discard the rice/water mixture and sampling container. I— I I f�3 0V- For Office Use�zHE rqk, Initials: Town of Barnstable Date Paid Amt Pd / e� : Inspectional Services MASS „f a v 'g Check# CM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE AFOOD ESTABLISHMENT DATE jA —o1b NEW OWNERSHIP RENEWAL V/ ` NAME OF FOOD ESTABLISHMENT: �Vvjw ADDRESS OF FOOD ESTABLISHMENT: Goo i�Q-i,91r ��,,�T"7/I_�N(S� N& U2,6dj A-K MAILING ADDRESS(IF DIFFERENT FROM ABOVE):ll E-MAIL ADDRESS: t p 1)n tQ a) 1 Ma �( o urn tv TELEPHONE NUMBER OF FOOD ESTABLISHMENT: J( d� ) r - qq TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO--L/' ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�_ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING_ REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) y FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT MEN ( tp�f(._ Ll,-t J J< SOLE OWNER: YES NO D.O.B OWNER PHONE# ADDRESS_ ICJ b, (I/L—Y n�OJL, W Q2103 CORPORATE OWNER: ,' i CORPORATE ADDRESS: (� Yn�/N �`�„ [4"7 C*,ym S, 62i4- 6267- 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. S NARY Lit) 43 / o y/ av lq I. Il' 08 � �i,( / I:- / 20 L 2. M L Ij / o / 1[� 6i 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 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 1 st to Dec.3I't 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 y r�2 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM Paul J.Canniff,D.M.D. MAM 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 266 Issue Date: 12/10/2019 DBA: DRAGONLITE RESTAURANT OWNER: SHU INC. Location of Establishment: 620 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 120 OutdoorSeating: 0 Total Seating: 120 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,�A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED-06/2011-Variance granted for the operation of acidification of cooked rice. Manager shall ensure that the pH log is kept and coorective action is taken whenever the pH is greater than 4.3 or if more than 1 hour, discard the rice/water mixture and sampling container. For Office Use On • Town of Barnstable Initials Date Paid Amt Pd$ w &TABLE. , Inspectional Services 1 1639. Public Health Division check# x. QED MAy a Thomas McKean,Director ' r 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I9 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT-SHU IIIIC, d/h/a M G� - p r ADDRESS OF FOOD ESTABLISHMENT: (0" m . !�S"f�T—�^/1j�, M40?100 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: I 1 l nd ni—e n�M 11 , Law? TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 3 WELL WATER: YES NO V... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: I U OUTSIDE: WNF-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 REOUIREMENTS. 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) 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 FormsTOODAPP 2020.doc I - /-r OWNER INFORMATION: / t FULL NAME OF APPLICANT 11 E l t�tl(fal�fy L� to SOLE OWNER: YES/6 D.O.B OWNER PHONE# ADDRESS �� Cpn�//U/�— III— & 0?-6 73 CORPORATE OWNER: CORPORATE ADDRESS: r � � 1��nr�C, oV 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.y�T_Ll V (73 / d /26N i. Injum I / 45 /2U14 2.(Y1p yffi=7 LIU d l Qq I)d �rve �1�A �l l Flo20130 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc IL - ► � Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNSTABLL =' John T.Norman A 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate qua 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: 266 Issue Date: 12/20/18 DBA: DRAGONLITE RESTAURANT OWNER: SHU, INC./MEN-CHUNG LIU Location of Establishment: 620 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 120 OutdoorSeating: 0 Total Seating: 120 FEES FOOD SERVICE ESTABLISHMENT: $300.00 _ YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - - - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED-06/2011-Variance granted for the operation of acidification of cooked rice. Manager shall ensure that the pH log is kept and coorective action is taken whenever the pH is greater than 4.3 or if more than 1 hour, discard the rice/water mixture and sampling container. r FVEyti For O Initials: _ o„ Town of Barnstable Date Paid �� Amt Pd$ Inspectional Services �. nn FD�s`0$' p Check# �v, ' Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I- ~l O NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:Wd WC, A& 3 A(&� RESTAV 900 J— ADDRESS OF FOOD ESTABLISHMENT: 6.y m 4 l 4 J 1 ,e 6!9n i"�J, MA— DUO D MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: I l'u, NO a fie A a f y .g TELEPHONE NUMBER OF FOOD ESTABLISHMENT: gygy TOTAL NUMBER OF BATHROOMS: WELL WATER:YE5 NO .. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 1zU OUTSIDE:MOwF—TOTAL: 2-0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? �TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE TAIL 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 FormsT00DAPPREV2018.doc I - ---- ---- - .. .. PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT N C/V C.1`I SOLE OWNER: YES CNO) D.O.B 10 Lr7 OWNER PHONE # ADDRESS L CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: �p'�� (y) jtJ S � IV,tJ2S P�(1 02 � / PERSON IN CHARGE OF DAILY OPERATIONS: fY P ✓ L%Q j List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Aller en Awareness Expiration Date 1. 3 D6 2. M(l QEL �,E-L s#-A o a®i q� Y / 26 Ao SIGNATURE OF PLICANT 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. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPPREV2018.doc OF THE TOk, TOWN OF BARNSTABLE. _ .. .. HEALTH INSPECTOR'S Establishment Name: Date: Page: of PUBLIC HEALTH DIVISION OFFICE HOURS 8:00-9:30 A.M. BARN ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � M639. �0� HYANNIS,MA 02601 MON.-FRL ' No Reference R-Red Item PLEASE PRINT CLEARLY 508-86 2-4644o p, TFOMn+ FOOD ESTABLISHMENT INSPECTION REPORT D Name Tj(Re o Type of Inspection O Ro Addres Risk/ ood Service e-inspection Level a pection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 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/Seegation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 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. 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. Facility Physical C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y y (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must i ' 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 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) y P within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N V,, . 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.) t.. FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* ; 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding_ 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-]02.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 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* Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Re q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(1)) 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 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and -ide in cater- * Ratites-165°F 15 sec* in mobile food,tem o and residential Sources g• P �Y 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3 401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to 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 practices should be debited under#29-Special 2 401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, 1= g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 3-203.12 Shellstock Identification Maintained 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. CF THE TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of '4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .63. �0� HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT --r Name Dates a of Type of Inspection e io Routine Address I Risk o ervice s Re-in �' Oection Level p Telephone Residential Kitchen Date: 41 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness /-LZ > Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 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 '11t ❑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 l� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 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. 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 i non-critical. If no critical water,sewage back-up, infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Vv- #Seats Observed Frozen Dessert Machines: Outside Dining Y N P[Pm ' Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N J Dumpster Screen? Y N �.�... � ...r.� .... -r r "-.--•�.....��� y.--..- T '--r �..t_^"^�r�y.,.w�..-v....._-.- .. ..-� -..-._..._--�-r w--.. -fir -�...;+-�• --�1"t' . ti.. --�J .r . ... t- .-...�. � _-- � ....!. .. ... •e. _ 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* +' 3-561.15 Cooling Methods for PHFs 2-103.11- Person-in-Charge Duties- Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Addifives* 19 PHF Hot and Cold Holding. Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) - EMPLOYEE HEALTH-- 3-M2.1l(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* - 7-102.11 Common Name-Working Containers* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* - Applicants*-- - 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Peison'In Char 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G). Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) Com P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 ShellEggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* off-ewe 11112001 _ 4-_602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf of Equipment* - . - i Shellfish* 4-103.11 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- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P 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. * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 9 violations relating to good retail 590.004(C) Wild Mushrooms __ _ practiceess should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* 3-202.11 PHF's Received at Proper Temperatures* (Blue Items 23-30) a Integrity* - 3-202.15 Package * g grty 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* r 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 15.90.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* Temperature 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. :?�oF.HE Tor TOWN OF BARNSTABLE . HEALTH INSPECTOR'S Establishment Name: Date: Page: of v` 'OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Moss: �0l HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 p'FO MP�� FOOD ESTABLISHMENT INSPECTION REPORT Name Date aZ, Tvoe of T s pection to 9butine h S C Address , Risk ood Service Level Previous Inspection Telephone f Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 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 PQ ROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ✓��`�tL�(t/1 ❑ 8'Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) L-V-- ❑ 9:;Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 1:0.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 1'I`.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 Requ No Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employe Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo o checked indicate violations of 105 CMR 590.000/Federal Food Code. g Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 5.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4von-critical violations regardless of the number of critical, results in an F. 2 2 .Water,Plumbing and Waste (FC-5)(590.00 ) establishment permit and cessation of food establishment operations. if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 to 8von-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.D im ter screened from public view ( ^2 Permit Posted? Y N Grease Trap Previous Pumping Date ` ase Rendered Y N ��(/✓` /1 #Seats Observed Frozen Dessert Machines:_7_'4DOutside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N - - ._�z-.,.. .� -•ter ��._. ::���.�__ :. _.�:..�• ».'-- 3- � ...�,. ^. _,ry y� .,- W " � .. ^' r..-��...= .�,..d--.- +r.. rir ..!' i.rt..-. -.. _ r'-"'-.v.....r.. .. �..- - r -....�..-._..� ,. , _ � _.r- .. ._ Violation related to Foodborne Illness- Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items-1-22) and Risk Factors(Red Items 1-22) (Cont.) f 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 3-501.15(B) Cold PHFs Maintained At or Below 41°F/45°F * - EMPLOYEE HEALTH � - - 3-302.11(A in )(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Contaers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*. * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants - 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 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* uiremen[s - 3-304.11 Food Contact with Equipment and Utensils* 590.00411 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Re q 590.003(G) Reporting by Person in Charge* -_ _ _ _- - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*, 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources- 9 ' - ' - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * _ - _ Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11 A(1)(2) Eggs-]55°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ell cti e 11112001 4-602.11_ _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* - - - - - - - 4-702.11 Frequency of Sanitization of Utensils and Food 3-40L11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed i', Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- - _� -A" - Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 0 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* 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* 3403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and.risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F (A) 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 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 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `pQ tHE Tp� TOWN OF BARNSTABLE HEALTH wSPECTOR,s Establishment Name: - Date: Page: Of L OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE, ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � 6 - •� HYANNIS, MA 02601 M-8 -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY p +639•n� - 508-8 - TFOMP� FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Tyne of T f Inspection )ZIerat' tine Address . Risk Fo Service ection Level -'Retail- Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r ✓ 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 L EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. I Embargo❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils . (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations 9 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N V V\ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o 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 7-101.11 Identifying Information-Original Containers* 590.004(F) * - 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An - 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report T6 The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS.FOR, 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food - 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources _ 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.1.11 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13_ Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ery give 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 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* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Recelving/Condition � g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 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 * 3-501.14 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement �) g Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pF IKE row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of 1 OFFICE HOURS �a Eo: 7- PUBLIC 0 MAIN LTH ST DIVISION 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. v ;'79. �0� HYANNIS,MA 02601 MON"- 6 No Reference R-Red Item PLEASE PRINT CLEARLY. �ptFD MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name C Da Tvoe of Type of Inspection O on s Address - Ris - od Service Re-inspection i Level Retailnn ectiom e Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) ftN A- ' Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11,Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑,Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. I ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ® 90 Emergency Closure ❑ Voluntary Disposal 00 ther: 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 g re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations if no critical violations observed,4 to 6npn-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. '28.Poisonous or Toxic Materials FC-7 590.008 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation;4 to 8npn-critical violations=C. .30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view �s Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Si at re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N e 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 ColorAdditives 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 7-101.11 Identifying 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 Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Pelson-in-Charge to 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140`F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Wazewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and in 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1IA(l)(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* Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145*F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cri a 1/1r2001 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* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D m.cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* ( ) ( ) ( ) ( ) Sources* ing,mobile food,temporary and residential 10K2-301.14 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Mid Mushrooms Approved By Clean Condition-Hands and Arms* RegulatoryAuthorily 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* Cleaning Procedure* 165*F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When to Wash* 3-401.11(A)(1)(b)All Other P11Fs-145*F 15 sec* Other 590.009 violations relating to goad retail 3-201.17 GameAnimals* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* . 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 3 403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70*17 to 41*F/45*F Item I Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41*F/45*F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials JFC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.eE roi TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: ✓ -3® Page: of `GYP qo+ OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. enxNsrnsLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MONHYANNIS,MA 02601 -F4 08-8 508$62-0644 No Reference R-Red Item PLEASE PRINT CLEARLY rFG Mpr FOOD ESTABLISHMENT INSPECTION REPORT Name Date (Tvoe of T ection 10 �o me Address Risk Se_rvic nspectio L' Level et ' nspection Telephone [✓ Residential Kitchen Date: AD 772G Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) / i Time Bed&Breakfast Other HACCP - 5 ' C✓ In: Inspector �n^ 'n,t Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. C L Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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) Q,,o ! _ C FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands v� ❑ 1.PIC Assigned/Knowledgeable!Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS lJ 1 ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives fp/� 5 rV\ ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) V ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 5 ❑ Ad 5.Receiving!Condition ❑ 17.Reheating l� ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling P V�j M ❑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) 1.:u,)l ` VAW 1719.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY I ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue 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. Jra ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension �_l C N Official Order for Correction:Based n aion today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4non-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 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of,food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special-Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpst screened from public view �p Omvo Permit Posted? V Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's qignaturS 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* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-102.11 Common Name-Working Containers*2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separationg-Storage* Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.1](C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice 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 c""e riuzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 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* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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 5 Re ceiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.1](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 L-4 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils .0053-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste .006590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* � S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °F.NE rOk TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified mnss. MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY A .e3q.p 0� HYANNIS,MA 02601 508 862 asaa rF1)M FOOD ESTABLISHMENT INSPECTION REPORT Name Dat / ( Tygeoff Type of Inspection a 'o s Routine Address / Risk 7od Servic e-mspection Level Previous nspection Telephone Residential Kitchen Date: _ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Led Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance"with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.ProperAdequate Handwashing CONSUMER ADVISORY 1 V6 `` 1 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ®Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n violations tical,violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008 9 violation,4 to 8non-critical violations=C. _�• 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: - Inspector's Sipr tM Print: 31.Dumpster screened from public view fry Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si r Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ,i% Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 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 590.004(F)3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge*, * 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental-Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders;Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145T 15 sec* Animal Foods That Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145*F* kitchen operations should be debited under Game and 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. * 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 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*17 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) 8 illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 3-501.14 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement �) g * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F� r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Datea Page: of 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 HYANNIS,MA 02601 MON.-FRI. No Reference. R-Red Item PLEASE PRINT CLEARLY �pr fD M�p 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat a of T ns ection % O outin Address Risk [ ood Service pection - A. Level a Previous Inspection V� Telephone • ✓ Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS GK ❑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 IgA ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding r ✓ .i PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) DI) cae4,ln ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP L t ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11..Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations v� Aj Critical(C)violations marked must be corrected immediately. (blue&red items) �� Cor c Actio 1�equ red: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® Voluntary" mpliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, he Items checked indicate violations of 105 CMR 590.000/Federal Food Code. C] Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 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 )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. ' .28.Poisonous or Toxic Materials (FC-7 590.008 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-Critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si a e 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw 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 Se azation-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3 202.13 Shell Eggs* Sanitization Temperatures* __ TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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* Equipment Co* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) omminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 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.l l(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 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3 403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* �) 8 illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * 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 Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* ■ 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. DoF.HE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: C e. ` ew Date: Page: of / ro OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 639.e`0 HYANNIS,MA 02601 nn 508-8-8624644-FRI. , No Reference R-Red_Item. P EASE PRINT CLEARLY . 'FDN1� FOOD ESTABLISHMENT INSPECTION REPORT r S tj rr Name Date Tvpe of eT ype-of Inspection I / Routine r Address Risk Food Servi Re-inspection U r, l� bell Level Previous I sp_e�ion , e C Telephone Residential Kitchen Date: ���2�/fdi Mobile Pre-operation{{ Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint i Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector `' Out: `� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 'L ' U Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / F9 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS L.t. �L41 dr ❑ 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.Pro per 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 ( JJ Critical(C)violations marked must be corrected immediately. (blue&red items) �I I I( Corrective Action Required: ❑ No ff es Non-critical(N)violations must be corrected immediately or Overall Rating per' within 90 days as determined by the Board of Health. Q14untary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure Voluntary Disposal ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in.an F.. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste, (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have:a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violatio -critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspect r' Sign r Pr 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 ignature Print: 1 Self Service Wait Service Provided Grease.Trap Size Variance Letter Posted. Y N (� ^rn 1' r.► / . Dumpster Screen? Y N v `�J Y V Lam` 1111 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* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH � 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140`F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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 Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 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* eg°"9e virzoot 4-602.11 - Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 ( )-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section temporary 9 A * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2-301.11 Clean Condition-Hands and Arms the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3 403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-10i.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 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 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S: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. Imo, °F INE r°� TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: 0, Date: A3. 4 Page:�_of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Mew. �•� HYANNIS, MA 02601 08-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �gtEO MAC° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT �� f (�f.v Name o n e Date 13 / !me of lygamftsipection 1 on Routine �' Address c Risk Food Se He-inspection Z d G"V r Level Previou In ection a Telephone Residential Kitchen Date: j (27 G Mobile Pre-o rat n0 Owner HACCP Y/N Temporary Suspect Illness �: vj� 90 Caterer General Complaint / o Person in Charge(PIC) Time Bed&Breakfast HACCP �d In: Other Inspector �, hAn //L _Lc_ Out: v Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. C, ` 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) ❑ (.� - Go Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ¢',r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 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 n 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ NoD-Yes Non-critical(N)violations must be corrected immediately or Overall Rating �1``�7 �f 1� within 90 days as determined by the Board of Health. LK01untary Compliance . ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, a items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of.critical, results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4nori-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. viol 4 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe is Si ure Prf %,t, L 1� 31.Dumpster screened from public view �, �l GN7 /Y✓► 'A' 'Ir) AVi 1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign tur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N i 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.* •=v- * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14. Protection from Unapproved Additives - - Contamination from Raw Ingredients Poisonous or Toxic Subst nces 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 a EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) 7-101.11 Identifying Information-Original Containers* 2. 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - _ 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR.. 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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* elf cnvc tiuzooi 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* 3-40 1.11(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 Ratites-165°F 15 sec* (A)-(D) Violations of Section 590.009(A)-(D)in cater- . Sources* 1p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F me 2 Minute Standing Ti * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 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 * 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 l0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. n J� SEEM FOOD MANAGER CERTIFICATION TRAINING FOOD SAFETY CONSULTING HACCP SYSTEM DEVELOPMENT April 14, 2011 Thomas McKean, Director Health Division 200 Main Street Hyannis, MA 02601 RE: Dragon Li a Restaurant(620 Main Street, Hyannis) Dear Mr. McKean, On behalf of the owner at the Dragon Lite Restaurant,,as referenced above, and pursuant to Massachusetts Food Code 3-502.1.1, we are requesting a variance for the operation of acidification of cooked rice. I have attached a copy of a HACCP plan for your approval,'as required by the Food Code. Should you have any question regarding this matter, lease feel free to contact me directly. 9 9 P Y Best regards, CD n Sam Wong, PhD, REHS/RS „o MD Consulting. tr �- r MD Consulting, P. 0. Box 133, West Boylston, MA 01583 T(508) 835498 Email: mdconsulting@charter.net www.SafeChineseFood.com i 1 Sushi Rice Hazard Analysis Critical Control Point (HACCP) Plan Dragon Lite Restaurant 620 Main Street Hyannis, Massachusetts Developed: 4/14/201 1 Annual Review/ Revision: Annual Review/Revision: Annual Review/ Revision: Annual Review/ Revision: Annual Review/ Revision: Copyright 02011 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 1 Table of Contents HACCP Team Members 3 Description of the Product and Its Intended Use 4 Flow Diagram of the Sushi Rice Process 5 Standard Operating Procedures for the Sushi Rice Process 6 Standard Operating Procedures for pH Measurement 7 Corrective Action Procedures Decision Tree 8 HACCP Table 9 pH Log 11 Recommended Analytical Laboratories for pH 12 Vendors for Supplies 12 Employee Training Record 13 Attachment: Certificate of Analysis of Sushi Rice Sample Disclaimer The information presented in this document has been compiled from sources and documents believed to be reliable and represent the best professional judgment of MD Consulting. However,no responsibility is assumed or implied by MD Consulting for any damage or loss resulting from noncompliance to the specific procedures in this document and all applicable federal,state,and local laws and regulations. An updated plan will be maintained on premise for review by the regulatory agency. Regulatory agency will be informed of any significant changes in the process that will affect the accuracy or effectiveness prior to implementation. Updated plan will be submitted to the regulatory agency by the establishment for review and approval. Copyright©2011 MD Consulting All rights reserved. No part of this document may be reproduced,stored in a retrieval system,or transmitted in any form or by any means,electronic,mechanical,photocopying,recording or otherwise for any purpose,without the prior written permission from MD Consulting. Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 2 HACCP Team Members Shay Y. Liu (Owner, Dragon Life) Ms. Liu is the person-in-charge, and is responsible for supervising the monitoring process, perform verification procedures, and conduct ongoing staff training. Sunil Sharma (Sushi Chef, Dragon Life) Chef Sharma is responsible for conducting the monitoring procedures. S. Samuel Wong, PhD (Principal, MD Consulting) Dr. Wong designed this HACCP plan, and is responsible for initial staff training. s Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 3 i ��f��X �..��; Description of the Product and Its Intended Use The product is Sushi Rice. It is the base for nigiri sushi and maki in Japanese cuisine. Ingredients list: Cooked Rice: Each batch of cooked rice is made from: 4 cups of Rice (Sushimai Brand) 4 cups Water Vinegar Sauce: 14 cups Mizkan Rice Vinegar (4.2% Acidity) 1 .5 cups Salt 13 cups Sugar Sushi Rice: 1 batch of cooked rice 1 cup of vinegar sauce Acidity Study: pH of freshly made Sushi Rice from this recipe is 3.96 (please refer to attached Certificate of Analysis) Copyright 02011 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 4 Flow Diagram RECEIVING N f y r: `� DRY�STflRAGE x; GOOKING OFRIGE 3 MIXING r Y xkE ICID N CCP R PROTEGTE'D STORAGE C MAKING; SUSH1 SERVING Copyright 02011 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 5 Standard Operating Procedures for the Sushi Rice Process Cooking of Rice 1 . Wash rice in a large container with water for 3 - 5 minutes, and drain thoroughly. 2. Place rice into the rice cooker, and add water. - 3. Cover and start the cooking cycle. Making of Sushi Rice (Acidified Cooked Rice) 1 . Remove cooked rice from the rice cooker and empty it into a large food- grade pan with a depth of 2 to 3 inches. 2. Use a spoon with long handle to spread the cooked rice evenly over the bottom of the pan. 3. Add the vinegar mixture to the cooked rice in the pan. 4. Use the spoon to thoroughly mix the rice with the vinegar mixture. The maximum product depth in the pan should not exceed 3 inches. 5. Let stand for about 15 minutes for the rice to absorb the vinegar mixture. 6. Check for pH level. Perform corrective action as needed. 7. Empty the rice into a washed and sanitized rice.holder for protected storage until being used for sushi production. 8. Discard all remaining sushi rice at the end of the day. Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 6 Standard Operating Procedures for pH Measurement pH Paper: Micro Essential MicroFine MF1613 pH Paper pH Measurement of Sushi Rice 1 . Place approximately 2 tablespoons of thoroughly mixed sushi rice into a clean sampling container (e.g. half-pint food-grade plastic container). 2. Add approximately the same volume of distilled water to cover the sushi rice. 3. Mash the sushi rice with a spoon until most of the grains have been crushed and it becomes a slurry. 4. Pull approximately 1-inch long pH paper from the dispenser, and tear it out. 5. Immerse half of the 1-inch long pH paper into the sushi rice/water solution in the sample bottle for 5 seconds. 6. Compare the color of the pH paper against the color chart on the pH paper dispenser. 7. Record the pH value that matches the closest of the color of the pH paper on the pH Log and initial the entry. 8. The pH value should be around 4.0. 9. If the pH value is between 3.7 and 4.0, record the value as 4.0. 10.If the pH value is between 4.0 and 4.3, record the value as 4.3. 1 1 .If the pH value is higher than 4.3, perform corrective action procedure and record on the pH Log. 12.Discard the sushi rice/water mixture and the sampling container. 13.If the pH value of the sushi rice tested is consistently (more than 3 batches in a row) higher than 4.3, submit.a new sushi rice sample to a certified analytical laboratory for validation. Revise the standard recipe (page 4 of this document) with the new validated pH value. Record the date of this new validation on the cover of this plan. Include the Certificate of Analysis (laboratory report) in this binder. Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 7 Corrective Action Procedures Decision Tree pH Measurement pH<_ 4.3? YES Serving NO Corrective Actions Needed Standard Recipe Used for NO 2 Sushi Rice YES Production. Discard Rice Remix Sushi Rice and Retest for pH InF NO < 1 hour Since pH <_4.3? Made?> NO YES YES Add Vinegar Mixture Remix Sushi Rice and Retest for pH 1. Record all Corrective Actions on pH Log. 2. Re-train staff on the use of standard sushi rice recipe. Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 8 HACCP Table Hazards Process Step CC Biological Critical Monitoring Corrective Actions HACCP Verification P Chemical Limit Procedures Procedures Records Procedures Physical Receiving No - - - - - - Dry Storage No - - - - - - Cooking of No - - - - - • Rice Transfer to No - - - - Mixing Pan Acidification Yes B: pH of What: pH • Verify use of correct recipe Record pH of Person-in-charge: Outgrowth of finish sushi and procedure, including every batch • Review pH log Bacillus rice <4.3 How: Mix sushi correct use of pH paper on pH log weekly cereus spores rice sample • Remix the rice and retest a Record all 0 pH of recipe and toxin with distilled pH corrective validated by production water to make • If<1 hour since made, add actions laboratory a slurry, and additional vinegar mixture Record every 12 test with pH and retest pH weekly months or paper • Discard the rice if >l hour verifications whenever since made by Person-in- recipe changes Frequency: charge • Modify HACCP • Every batch of Keep daily plan as acidified records for at needed cooked rice least 60 days • Annual review intended to be of HACCP plan used for sushi Who: Sushi chef Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 9 Protected No Storage Making Sushi No - - - - - - [Serving No - - - - - - Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon Lite 10 PH Log Manager Verification: Date: (Keep Log for 60 Days) Date Time pH Corrective Action(s) Staff Signature Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon'Lite I I r Recommended Analytical Laboratories'for Testing pH (for Annual Verification) l . Microbac Laboratories, Inc. 100 Barber Street Wo rcester, MA Ol 606 �(508) 595-0010 www.microbac.com 2. G & L Laboratories, Inc. 246 Arlington Street Quincy, MA 02170 (617) 328-3663 www.gllab.com Vendor for pH Paper pH Paper: MF1613 Micro Essential Laboratory, Inc. P.O. Box 100824 4224 Avenue H Brooklyn, NY 11210 (718) 338-3618 www.microessentiallab.com Copyright©201 1 MD Consulting. All rights reserved. Reproduction of any portion of this document without written permission from MD Consulting is prohibited. Dragon site 12 Dragon Lite Employee Training l . The sushi chef and/or designated employees are trained ed in the proper use of the pH paper. 2. The sushi chef and/or designated employees are trained in how to properly use the pH log. 3. The sushi chef and/or designated employees are trained in proper preparation of the sushi rice recipe with emphasis on the precise and consistent measurement of the ingredients. 4. All sushi employees are trained in.proper employee hygiene which specifically includes: a. Proper handwashing b. Appropriate attire c. Proper hair restraints d. Prohibition of jewelry 5. All sushi employees are trained in proper use of foodservice gloves. 6. All sushi employees are informed of their duty to report to the Person-in-charge when they are experiencing symptoms of foodborne illness or have been diagnosed with specific diseases. An updated blank Employee Reporting Form is provided. 7. All sushi employees are trained in proper cleaning and sanitizing of equipment, utensils and the physical facilities. 8. All sushi employees are trained in the proper procedures for preventing cross-contamination. Date of Training: April 14, 2011 Trainer: Sam Wong, PhD MD Consulting Name of Employees Trained:. 1 Suni � ShurMCX 2 �' l ' 3 4 5 6 i i R+ Microbac Laboratories, Inc. Phone:508-595-0010 Massachusetts Division Fax:508-595-0008 www.microbac.com 100 Barber Avenue•Worcester,MA 01606 CERTIFICATE OF ANALYSIS MD CONSULTING Project:Rice Report: 1106230 RO.BOX 133 Project Numiter. nice Reported: 04/081201 i 15:49 WEST BOYLSTON,MA 0)583 Project Manager: Sam Wong DRAGON LITE 1106230-01(Food)Sampled:04/07/2011 12:00;7 pe:Not specified Rcporting Analysc Resv)t Limit Units prepared Analyzed Analyst tvieal(A Notes Microbac Laboratories,Inc„Camp Hill Division M ICROBIOI OGY(MASSACH[TSFTTS DIVISION) pR 1% S.U. 040711 1945 040711 1845 LBL AOAC The resaits in Mix reparr appiv to the samples anatvzed in ue,onlanc,Willi the riratiu of _.^-". custw(v document.This anal tiral rrpart must he reproduced in its entirep. Nancy Burnett,Laboratory Director COMMONWEALTH OF MASSACHUSETTS 5 � V CITY/TOWN OF Barnstable �l0 Sty 4 ' APP CERTIFICATE OF INSPECTION LIGATION FOR C Date_ foiey --�5 1 4' ( x ) Fee Required $ 40.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building code. Section 108,15, I hereby apply for a Certificate of Inspection for the below--named premises located at the following address: Street and Number; 6.2 z9 02AIIV S'� Lys}-NIV U . y 1 i�0 Name of Premises: IDRA (�QN�-I. :_ ES / 46J Purpose for which premises is used: �STAU P,6i\I Licenses) or Permit(s) Required for the Premises by other Governmental Agencies: License or Permit A enc [A)A/ rF �vA/ n �,8aLSZI. Certificate to be Issued to: �}-��� �N( C�l'ti�. ��Iq IL_I_TE REST Address: Q S— O Owner of Record of Building: C— Address: Z W & .� Name of Present Holder of Certificate: Name of Agent, if any: it wvt,l1 ' SIGNATURE OF PERSON(30 WHOM CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT INSTRUCTIONS: 1) Make check payable to:' TOWN OF BARNSTABLE 2) Return this application with your check to: BUILDING COMMISSIONER 367 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: 1) Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2) Applicatiun and fee must be received before the certificate will be issued. 3) The building official shall be notified within ten (10) days of any change in the above information. CERTIFICATE EXPIRATION DATE: , , ( i pf ZHEJ _ The Commonwealth of Massachusetts. Town of Barnstable 2019 TED MP'�a Certificate of Inspection Dragonlite Restaurant Certificate No. Issued to Men Chang Liu Type: Building -Certificate of Inspection IC-18-265 Identify property address including street number, name, city or town and country Certificate Expiration Located at Map/Lot 308-062 11/30/2019 in the Town of Barnstable 620 MAIN STREET (HYANNIS), HYANNIS Location Use Group Classification(s) Allowable Occupant Load 1st A-2: Banquet halls, night clubs, restaurants, bars 198 Restrictions .6.2-Bar_ �.. C 136 DWi.ng--Room Maximum Seating Capacity This Certificate of inspection is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind clear glass and\or laminated and posted in a conspicious place within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Building Commissioner Brian Florence Date of Inspection 11/19/2018 Signature of Municipal Building Date of Issuance Commissioner 10/25/2018 The Commoubjealtb of Alazoarbuzettz . TOWN OF BARNSTABLE , In accordance with the Massachusetts State Building Code,Section 108.S, this CERTIFICATE OF INSPECTION is issued to DRAGONLITE RESTAURANT �1 QCertifp that I have inspected the premises known as: DRAGONLITE RESTAURANT located at 620 MAIN STREET in the Village of HYANNIS Count})of Barnstable Commonwealth of Massachuetts. The means of egress are sufficient for the following number ofpersons: Location Capacity Use Group Construction Type BAR 62 A2 DINING ROOM 136 11833. 11/1/96 11/1/97 Certificate Number Date Certificate Issued: Date Certificate Expired:- The building official shall die noted within(10) days of any changes in the above information Building Official i a " - r� r , J, g4XV; _ - \r P i r - - _ Authentic Chinese Cuisine rli -1 n& zechaa Spicy Whole Fish H-5.n&Amazin Chicken H-11. Seafood Wor Bar Szech�ian, Mandarin and 75. Shrimps and Scallops in Ga c Sauce H 12. S p y 9 �� 4 �,J Cantonese Cuisine ' I �r L6I I HEOR1 SIPECIALS smlmD,,Di� L \ \ a CC\a 3.00 P.M.,.. �� " `� ' (EXCEPT SUNDAYS AND HOLIDAYS •NO SUBSTITUTES PLEASE) y : �s r „ p .. 50 _r \ L 1-A. House Wonton Sou .... 7 . , ) .. Shnm Chuken Pork with.Ve etables , ,• �M �. ,, , ., �. � �. .. �.,�1':, .-,� „,�\ �,.L..1 \,.,, ,.House S ecial��.................... ............ .. .Beef Tenyalas;'Beef Broccoli; L 2-A. Pekin Noodle (Rice not included) .. .... 6 50:w g r F d. 4,. •"i Soft Noodle;Bean Sprouts with a Tasty Brown Meat Sauce.., ,¢ • �,r „. ,. f Pr ty �• „� � a.. m. . .�, Noodle Rice not included .. ......... ......................................................:.....6.50,rte +w„ \ �. ma, with Sltn s Chicken. Pork and:Ve etables.,� �,�•w.'h�". i.,?S,d ,�,,: ��e �Mdw .�\fi• ,. u\�,�1� .:1 a .,r� .„,�P�,. ;, ..; ' � �.I� � � � �, ,a� ;r ., �•��,� ,M � :, rnp, g . � � ��.., L3: •Luck Special.........: . ...... ... ...:.. . ..:: ... ... ..... ....6.50: ' -.. Chicken Wings,Mixed Ve eta6les,Park Fried Rice. • e L'-4 t"'Deluxe S._ec►al .. - : 7 00 ........ w a ;\ v, e'\42, la,,�S ,..,,! ,,.,,,,5 , \ R'U Crab Ran oon Pork Chow Mem B Park Fned R+ce , ,,. \N H-14. Lamb Chops H 16. Mussels In Oyster Sauce r\ p'l .., ,. p y �� FS� H �m d �a � "': n ,,. L:S., Shopper;Special...... ..... ....... .... ... .... 7 00JW �-- • Jum6o'Shrimps,Mixed Vegetables,�3 Pork Fried Rue -�' L6. :Businessman Special ......... `........ ... y .. .;... ,,, ken m er Mt d Vegetables"f�'Pork Fried Rue. ,, � k t ,,,, 1 s •.., ,,,.. .., ., ,- ALL xe g � \ � � , � ,:• OPEN YEAR. '�'� 1 ,.., u.: .inmxemu„ �,.. ,vhmmcr 4 „r rt , \ ..c.. .,...,. ,�, � .. �. .,..� � r ,._... �^k• ,. . ,,; 1, � �\$. �•t ��''1�1w,,. c'a-: a ..... ......... ..................... ......... .... ecial,... ...................... ... ......7.00t_. Wyk •. m%'+2 • ' .' t+ �EggFoo Young,Epgg Roll'Pork Chow Mein,�3 Park'Fried Rice. +' Ate'' x _ e • . 3 -Millionaire SpeciaF . .7.50= 1's d 4f • • • • ; o L°8. o ......... ........ ....... ._...... ..... Pork Strips,Egg Roll,Barbecued Boneless Spare Ribs, Pork Feed Rue. gt. t y s `l t dEno Exotic Tropical Drinks �Main Street Spectal ....:.. .. _.. ..... .:... .:.. .............6.50""" . .» ,. § Barbecued Boneless SpareRibs,Mixed Vegeia6[es,£?Pork`Fried Rtce r,` ' `tl t' LIO-A. Gourmet'Special ......................................... ......... .......................7.50 - In Our Delightful ` Egg Roll,Chicken Fingers,Barbecued Boneless Spare Ribs,&Pork Fried Rice. L10-B. Beef Teriyakis...................... ..... . ............................7.75 ><I k v Crab Rangoon;Chicken wings, Pork Fned Rice: _ Cocktail Lounge _ ciz LUNCHEON CHEFS RECOkrAENDATIONS H-1.-irs- Beef, Chicken Szechwan Style (All Served with Pork Fried Rice or Boiled Rice) t _ H-20. Pineapple Shrimp Dishes with Special Spicy Sauce:Please tell waiter if you prefer mild or,hot spicy sauce. , L11. Chicken with Garlic Sauce '..............:........ .................... :.....6.50 • S Cooking (Diced Chicken with Mushroom,warn Chestnuts) � Home Chinese o0 Q L12. � Spicy Chicken with Peanuts............................... t 6.50 b � Style Chin n J, L13. Snow White Chicken :........ .........6.50 a _........ 1 Sauteed white Meat Chicken with Pea Pods water Chestnuts) R * 1 n .7 ' ............................... ................................. ............ .. a , L14• hunks Sauteed Chicken cooked in Garlic Ginger TastySauce 7 00_ `�1� _ i� SUMMER HOURS . €. .. 6 50 ,. - , L15. Moo Goo Gai Pan.............. ....... ................................ ....... .... .. .00 p.m. (may vary) ' . �. until 11 Sunda 1.00� .m Shnm s.with Cashew Nuts ..7.00 ,,• �w L16. , , pp _ SauteedShnm with Vegetables Cooked in Brown Sauce => " • Monda Thursda 1'1:3 a: until 1100 .m. ma V <-! L17. Sweet&Sour Chicken and Egg Roll............................................................- 7 00_ T y y' p (may vary) �i �` / L18. Spicy Shrimp with Tomato Sauce and`Omon 7.00 '• • ► I Friday & Saturday: 11:30 a.m. until 11:00 p.m. (may vary) a. P y P .... *` _ g. L19. ro z_$eef with Pea Pods,Baby Corn,,&Fresh Mushrooms 6 50 - �•- L20-A. Hunan Pork .... 6 50 FOR TAKE-OUT ORDERS PLEASE CALL (Broccoli,Green Peppers,Baby Cam,Straw Mushrooms in Chefs Special Sauce) # - ' H-7a.-�5- Sesame Sparkling Chicken Leo-B.elo� Hunan Beef ............... � t H 9.-4�- Shrimp & Chicken Hunan Style L21-A. Mushroom Chow,Yoke with Beef ................. v 6 50 ► - . + --, L21-B. `=Mushroom Chow Yoke with°Pork :............... .......:��....................................`� � 6.50 rg rr• L22-A. Vegetable with Beef..................................... . ..6.50 g L22-B. Vegetable with Pork _ L.- luncheon6.50 Special served dlalll� ... " L22-C. Vegetable with Chicken ................ .... .... ......_ ) .6.50 C L23. ro Yu Hsian Chicken �@ g g ......... ... .... .. ... 2�. ...6.50` W (except Sundays and Holidays) (Shredded Chicken with Assorted Vegetables in Garlic Spicy Sauce) o - m . - L24• Mixed Vegetables with Shrimp...... ...... � ..... ... . ..7.00 _` 1 :30 d.Ill. t0 3:00 p. L25. Shrimp with Lobster Sauce _ 7.00 s Qk 3 J ' a y � L26. Chicken or Beef with Broccoli 6 50 m a ,, _..... ....... e . tl • `- ; L27. Light VegetableslDelight.... ......... ......... ........ .....:... ......... ....... . .6.25 'r, 6 Main Street H n S,yMass. L28-A. Chicken Chow Mein and Egg Roll - 7.00 s' _. L28-B. Subgum Chicken and Egg Roll...... ► 7 00 . C ._ Tel: (� ®gyp ® Q L29. yLo Mem,&Egg Roll:(w.A. Pork Lo Mein B.Chicken Lo Mem C.Beef Lo Mein)' 0 JL�.1. (508)-, �� �'7494 /" 9481 L30. ro aBeijing Pork ............. .. ..... i ...6.50 , H-10. Coconut Shrimp 125b. Chinese Baby Choy w. Tofu & Mushrooms ? LO.MEIN (SOFT NOODLES) ,, snmu Large H (Served with White Rice). .PLEASE NOTE: All our dishes are cooked to order. $ BEEF HOUSE SPECIALTIES Ser If for an reason can not eat certain 53. •Pork Lo Mein ......................................................4.75 7.95 102. Beef with Mushroom....................................................9.95 H 1.�BEEF,CHICKEN SZECHUAN STYLE ..... ..12.50 y you 54• ' Chicken Lo Mein............... .... ...:.....................4.75 '7.95 103. Beef with Broccoli or Pea Pods Sesame Sparkling Chicken and Beef with Shredded Vegetables in Spicy ingredients such as com starch,oil,sugar,or ( ) ••••••_•••••••.•...•ce..•••••.9.95 Tasty Sauce. hot spicy sauces.Please let us know before 55. Beef Lo Mein.......................................................:5.00 8.95 104• Beef with Pepper&Onion in Black Bean Sauce........9.95 H- 2.�GENERAL TSO'S CHICKEN ...............:............11.50 56. Shrimp Lo Mein................... .......................... ...5.25 8.95 placing your order.. F P 105. Beef with Onion m Oyster SBUCe................................9.95 A Mouth Watering Dish Made with Big Chunks of Chicken Marinated, 57. Dragonlite Lo Mein .................................. 8.95 106. Beef with Mixed Vegetables .............................: 9.95 Dipped in Lotus Flour Fried and Sauteed in Chefs Special Spicy Sauce. 58. Vegetable Lo Mein ..............................................4.75 7.00 107. Three Delights................... .. ....................10.95 H-3a.�CHICKEN WITH ORANGE FLAVOR..............11.50 H-3b.�BEEF WITH ORANGE FLAVOR 11 WI O G .. .50 APPETIZERS 59 House Special Pan Fried...........................:................ 12.50 (sated chicken, Beef and Baby Shrimps with Assorted Vegetables in Garlic • •• •. •• (Both Sides Pan Fried Noodles To with Assorted Vegetables,Be Chicken, Brown Sauce) A Dish Made with Thick Slices of Prime Beef Sauteed in Orange Flavor 1. Pu Pu Platter(For Two)..............................................16.50 Shrimp and Scallops) Topped g Hot Spicy Sweet Sauce. ($8.25 Per Additional Serving) 108.ro•Crispy Beef.................................. . . .................11.50 (Egg Rolls,Boneless Ribs,Fried Shrimps,Chicken Wings, 60a. Rice Noodles(Stir Fried with shrimp,Chicken,Pork and Vegetables) 7.95 (Thick Slice of Prime Beef Marinated Made Crispy Sauteed in Our Special Hot H- 4.'�HONEY MOONERS(TWO DISHES IN ONE)12.50 60b. Rice Noodles in Singapore S le. 7.95 Spiry Tangy Sauce) Jumbo Shrimps with Chili Sauce and Sliced Pork with Black Bean Sauce. Chicken Fingers,Beef Teriyaki,Crab Rangoons) Style ............................... 2. Spring Rolls (2) (with Shrimp)....................................4.20 109.-,ei,- Hunan Beef ................................................ .... ..... ...9.95 H S.,-&AMAZING CHICKEN........................................10.95 (Sliced Tender Beef Stir Fned.with Fresh Vegetables in Hunan Spicy Sauce) Tender White Meat Chicken Stir Fried with Assorted Chinese 3. Vegetarian Spring Rolls (2)..........................................4.20 CHOW MEIN (Dry Noodles) Vegetables in a Special Hunan,Szechuan Mixed Sauce,That Makes 4. E Rolls 2 with Pork 4.20 110.�Sar Cha Beef ............................................................. 9.95 This Dish Amazingly excellent. Egg ( ) ( ) ••••••••••••••••••........................•• (Slued Beef Sauteed with Pea Pods,Baby Cam,Fresh Mushroom,in a Special ..........................5. Barbecued Spare Ribs (on the Bone) 7.95 OR CHOP SUEY Flavor) H- 6. GINGER SHRIMP(OR CHICKEN) ................10.95 61. Meatless Chow Mein or Cho Sue 6.50 ...... ..................................9.95 Large Shrimps Stir-fried with Vegetables in Ginger Brown Sauce. 6. Barbecued Boneless Ribs..............................................7.50 ( P y) ••••••••••••••••••••••• 111.� Gong Bo Beef....................... 7. Peking Ravioli (6) (Home Made)................... 62. Pork Chow Mein or Cho Sue 6.95 (Szechuan Spiced Beef with Vegetables and Peanuts) H-7a.'�SESAME SPARKLING CHICKEN....................11.50 ..•.••.••..•6.00 ( P y) Thick Slice of Prime Beef Dipped in Lotus Flour Fried and Cooked in 8. Vegetarian Peking Ravioli (6) (Home Made) ............6.00 63. Chicken Chow Mein (or Chop Suey) .:......................7.25 112.�Kan Sho Beef................................................................9.95 0 64. Beef Chow Mein(or Chop Suey) 7.50 (A Famous Spicy Shredded Beef with Vegetables in Garlic Sauce) an is sesame sauce. -7 9. Chicken Fingers............................................................7.25 .... i .� Exquisite11 5 10. Pork Strips „7.25 65. Shrimp Chow Mein (or Chop Suey) ..........................8.25 H- S. MONGOLIAN BEEF 10.95 .................................................................. SWEET & SOUR .......................................... 11. Fried Shrimps 6 8.2 66. Subgum Pork Chow Mein (or Chop Suey) ................7.50 Tender Beef with Green Scallion, Onion, Garlic, in House Special P ( )•...••..•••.•.•..••..•.•..•.•.•.• ..8.25 67. Subgum Shrimp Chow Mein(or Chop Suey) .......... .7.95 113. Sweet&Sour Pork ......................................................7.95 Sauce with Hot Sizzling Plate.(Can be Spicy on Request) . 12. Teriyaki Beef(6) ...................................................... ... 13. Teriyaki Chicken(5) .....................................................7.25 68. Subgum Chicken Chow Mein (or Chop Suey)..........7.50 114. Sweet&Sour Chicken ................................................7.95 H- 9.-a.SHRIMP AND CHICKEN HUNAN STYLE......12.50, 69. Chicago Chow Mein or Cho Sue Brown Sauce) -7.50 115. Sweet&Sour Shrimp Two Dishes in One.Sauteed Young Shrimps in Chili Tomato Sauce and 14• Chicken Wings g ( P y) ( p•••••••••••.•••••••• 9.50 White Meat Chicken Cooked with Pea Pods in Hunan Spicy Sauce. 15. Crab Rangoon ..............................................................6.50 70. Hong Kong Style Chow Mein....................................12.50 116. Honey Wings................................................................7.75 H-10. COCONUT SHRIMP ........................................12.95 Cris Thin Noodle Topped with Shrimp,Chicken,Be" and Fresh Vegetables)16a. Sue Mei (Steamed Shrimp Dumpling) 6.00 ( pp p g ) Fried Coconut Jumbo Shrimps, Garnished with Fresh Vegetables in P P g)•••••••••••••••••••••••• Chefs Tasty Sauce. 16b.a. Hot Wins ....................................................................6.95 SEAFOOD M00-SHI g H-11. SEAFOOD WOR BAR ......................................16.95 17a. French Fries,Crab Rangoon,Chicken Fingers............8.95 Moo-Shi is a Classic Mandarin Dish.These Dishes Contain Meat, Lobster Meat,Shrimps,Scallops,with Selected Chinese Greens,Pea 71. Lobster Sauce (Meat Brown Sauce)....(Sm.) 4.50 (Lg.) 7.50 Mushroom,Cabbage, Pods,Water Chestnuts,Fresh Mushroom,Gin 17b. Egg Roll, Boneless Ribs, Chicken Wings....................8.95 g ,Dried Lily Flower,Scallion,and Scrambled Eggs. � get,Wine in an Exotic 72. Shrimp with Lobster Sauce (Brown Sauce) ..............11.25 Sauce over a Sizzling Plate. 18a. Scallion Pancake ..........................................................4.35 Served with Four Pancakes.(Extra Pancake:350 each) 73. Shrimp with Cashew nuts..........................................11.25 H-12.�SZECHUAN SPICY WHOLE FISH ................:.M.P. 18b. Cold Sesame Noodles ..................................................6.50117. Moo-Shi (Chicken, Beef,Pork,or Vegetables) ..........8.75 Crispy Whole Fish Garnished, with Shredded Carrots, Black 74•'�Yu Hsiang Shrimps (or Scallops) in Garlic Sauce ....13.95 118. Moo-Shi Shrimp ..........................................................9.50 Mushrooms,Green Peppers,Ginger,and Spicy Wine Soy Sauce. SOUPS75. Shrimps and Scallops in Garlic Sauce :.....................13.95u H-13. MONGOLIAN LAMB ........................................12.95 19. House Won Ton Sou (For Two) ................................7.50 76. Sesame Sparkling Shrimp ..........................................12.50 PORK Tender Sliced Lamb Stir Fried with Scallion,Onion Garlic in House . (Shrimp,Chicken,Pork and Vegetables) 77.'� Spicy Shrimp with Tomato Sauce and Onions ........11.25 Special Sauce with Hot Sizzling Plate. 20. Oriental Seafood Chowder (For Two) ........................8.50 78. Shrimp with Pea Pods and Broccoli ..........................11.25 119. Shredded Pork with Garlic Sauce................................8.25 H-14. LAMB CHOPS ..................................................12.95 ........... . 21. Hot and Sour Sou (For One 3.25 79. Shrimp with Black Bean Sauce and Vegetables........11.25 120.-& Peking Family Style Pork..............................................8.25 Lamb chops slow cooked w.Tomato,onion,Carrots in a Tasty Curry ......................... •• g` Flavor Sauce Served on a Hot Pot Can a is on Request) 22. Won Ton Soup (For One) 3.25 80. Rainbow Shrimp .....................................11.25 121. Hunan Style Pork 8.25 i H-15. FISHMAN'S PLATTER (FOR Spicy eq. ) 17.95 ............................................ ................... ....................................................... 122. Pork with Broccoli............... 8.25 "s w""""" 23. Chicken Noodle Sou (For One .3.25 Shrimps Cook with Fresh Vegetables in Light Sauce. •••••••••••••••••••••••••••••••••••••• •• Clams,squid,Shrimps,Salmon,Scallops,and Vegetables with Ginger, P )"""""......'•'•"".•""' 81.� Shrimp with Vegetables&Onion in Curry Sauce....11.25 123. Pork with Mixed Vegetables ........................................8.25 Scallion Sherry Wine on Flaming Hot Platter. 24• Egg Drop Soup (For One) ............................................3.25 82. Clam with Black Bean in Garlic Sauce ....................11.95 H-16. MUSSELS IN OYSTER SAUCE ......................10.05 25. Beef with Scallion and ParsleyFor Two 7.25 124• Pork with Black Mushrooms........................................9.25 ( ) """"""""" Steamed&Cooked w.Garlic in Oyster Sauce over on the Soh Noodles. 26. Chicken Corn Soup (For Two).................................... 83.� Fried Squid (Calamari) ........................:...............:.......9.50 ......•••••...................• (in Garlic&Ginger,Scallion in Chef's Spicy Tasty Sauce) H-17. HONEY ROASTED DUCK................................14.00 84• Squid Stir Fried with Vegetable in Ginger&Scallion..10.95 VEGETARIAN DISH Lon Island Duck Glazed with a Very Mild Spicy and Sweet Honey Sauce. . FRIED RICE smau iarle _ 125a. Vegetarian's Delight......................................................6.95 H 1S.�S .. .00 85. Hunan Shrimp 11.25abba ..... ......... - HAN HAI DUCK............... ..........................14 ' "" "" Broccoli, Pea Pods, Green Pe 27. Pork FriedRice....................................................3.9 0 (Stir Fried with Assorted Vegetables in Garlic Brown Spicy Sauce) ( peer, Carrots, Cabbage, Waterchestnuu, Stir Duck Roasted to Perfection,Mariam ea through the Night for the Best 28. Beef Fried Rice ...................:................................3.95 6.75 86. Lobster Chinese Style .................... Fried with White Sauce) � Flavor,then Cooked with Shanghai Sauce with Fresh Vegetables. ...............Market Price 125b. Chinese Baby Choy w.Tofu&Mushrooms Stir Fried..8.95 H-19. PEKING DUCK (WHOLE) 29.00 (HALF) 14.50 29. Chicken Fried Rice..............................................3.95 6.75 (Whole Fresh Lobster Cut and in the Shell,Cooked with Ginger and Scallion) •••- 126. Sauteed Pea Pods with Waterchestnuts ..7.95 H-20. PINEAPPLE SHRIMP .....13.95 30. Pork Fried Rice with Bean Sprouts 3.95 6.75 87. Lobster Cantonese Style ..........Market Price •••••••••••••••••••• •••••-•••••-••••••••••••••••••••• (Fresh Lobster in the Shell,Cooked with Brown Meat Sauce) 127• Broccoli with Garlic Sauce ..........................................6.95 Large Shrimps Lightly Coated Flour w. Pineapple, Cucumber and 31. Ham Fried Rice....................................................3.95 6.75 Celery in a Delicious Cream Sauce Served as a Cold Dish. 32. Subgum Pork Fried Rice 4.50 7.50 POULTRY 128. Bean Curd Family Style 8.25 ...................................... 33. Shrimp Fried Rice................................................4.75 7.50 Cara�cn Ga lic s own with e)ea Pods' Black Mush'°°n`. Bamboo sha°�: DINNER COMBINATION SPECIAL PLATES 34• House Fried Rice...................... . . . 89. Chicken with Broccoli in Garlic Sauce ......................8.95 . . . ...........••••••••••.4.95 7.95 8 95 129.�Yu Hsiang Eggplant ................................ 8.25 (D-1) Egg Roll Beef Teriyaki, Chicken Fingers 90. Moo Goo Gai Pan ..................................................... 35. Subgum Chicken(or Subgum Shrimp Fried Rice) 4.75 7.50 (Chicken White Meat Stir Fried w.Pea Pods,Mushroom,Water Chestnut and (Eggplant wi Spicy Garlic Wine Sauce) and Pork Fried Rice..................................................7.95 36. Vegetable Fried Rice............................................3.95 6.25 Cabbage in Light Sauce) 130.-4%.Sauteed String Beans with Szechuan Spicy Sauce......8.25 (D-2) Boneless Ribs, Chicken Fingers and Pork Fried Rice 7.25 37. Plain Boiled Rice ................................................1.25 2.50 91.--&Yu Hsiang Sliced Chicken ................................':.............8.95 131.-&Szechuan Bean Curd in Hot Spicy Sauce....................8.25 (D-3) Chicken Wings,Chicken Fingers&Pork Fried Rice..7.25 38. Fried Brown Rice ................................................2.00 4.00 (Chicken w.Vegetable in Garlic Spiry Brown Sauce) 39. Japanese Style Fried Rice (Shrimp,Ham,Onion).... 7.95 92.�Gong Bo Chicken ........................................................8.95 - s Spare Ribs, Moo 0o Gai P (Diced Chicken and Vegetables Mixed with Peanuts in Szechuan Spiry Sauce) c a °++ Band Pork Fried Rice..................................................8.95 F x DRAGON LITE DISHES an 93. Hunan Chicken............................................................8.95 h �•- • ,- (D-5) Beef Teriyaki,Lobster Sauce and Pork Fried Rice ....8.95 EGG F00 YONG (WITH GRAVY) (Sliced Chicken with Assorted Vegetables inn Hunan Spicy Sauce) (with Boiled White Rice and Absolutely No M S G) R; (D-6) Chicken Fingers, Mixed Vegetables with Pork 40. Meatless Egg Foo Young ..............................................6.50 94. Lemon Chicken............................................................9.50 , r ,r x - and Pork Fried Rice. .8.95 �132 MTO FU DELIGHT : 8.25„ .... ...... ...:,.. 41. Pork E Foo Young 6.75 (Chicken Breast Battered Fried in a Clear Flavorful Lemon Sauce) (D-7) Chicken Wings,gg g••• 95. Chicken with Pea Pods&Waterchestnuts..................9.50 m. (soft Bean Curd unth_Vegetables Steam with Garlic Sheny).rBeef w. Broccoli&Pork Fried Rice ..8.95 42. Subgum Pork Egg Foo Young........................................6.95 ,� ; "" `' Y (D-8) Boneless Ribs,Light Vegetables Delight 43. Chicken Egg Foo Young ..............................................6.95 96. White Meat Chicken Stir Fried w. ,133 CHICKEN STIR FRIED-FANTASIA 8 95 Vegetable in a Sesame Peanuts Sauce........................9.95 (chicken�„ii►i Assorted vegetables Quickly Ccoked,ri'�iA Sauce)ti�":I n and Pork Fried Rice.......................................... ......8.95 44• Ham Egg Foo Young......................................................6.95 g „r A 1 Boneless Ribs White Meat Chicken with 45. Beef Egg Foo Young......................................................7.50 97.�Empress Chicken(or Hon Sue Gai-no Spicy)............8.95 134 ,STEAMED,SIHRIMP=SENSATIONS 11:25 k (White Meat Chicken Battered Fried m a Spicy Ginger Sauce,Garnished with x x Assorted Vegetables&Pork Fried Rice...................:9.95 46. Mushroom E Foo Young 7.50 pry # (Fresh Shrimps ands Assorted Chinese Ve etables in Natural Flavor) Egg g Fresh Vegetables) - = �8 , A-2'1D Beef Teriyaki,Sliced Chicken with Tree Mushrooms, 47. Shrimp Egg Foo Young ................................................7.95 98. Chicken with Cashew nuts...........................:. €135,�WHITE CORAL-AND JADE .. .. 12.95. Water Chestnuts,&Green Peppers in a Spicy ............9.50 Fresh Scallo s ukl"Cooked to Retain Flavor and'Surrounded a ith 48. Egg Foo Young Chinese Style ......................................7.95 . (with Diced Vegetables in chefs Special sauce) `x . r ( p ,- y ,�k broccoli) Garlic&Wine Sauce&Pork Fried Rice 9.95 99. Curry Chicken..............................................................8.95 - +� x �% A 3 Chicken Fingers,Tender Beef with Green CHOW HO FOON (FLAT SOFT NOODLES) (White Meat Chicken with Onion inCunySauce.) 136 STEAMED FISH SUPREME k ,.::- .. 11 25F 100. Som Hop Chicken............... 9.95 rx:,(Cod FishF�Uea stea;red with Ginger.Scallion mid Back Mushroom 3%`: Scallions,Onions&Carrots in The Chefs 49a. Pork Chow Ho Foon 7.25 ' ' ' (chicken and Beef Sauteed with Pea Pods,Waterchesmuu,Baby cam,Fresh ��iAU Cooked:to Perfecton) riy Y F > Special Sauce&Pork Fried Rice................... 9,95 49b. Vegetable Chow Ho Foon.................................. ... ..7.25 Mushroom in Black Bean Garlic Sauce) , A-4 Crab Rangoons,Shrimp Stir Fried with 50. Chicken Chow Ho Foon..............................................7.95 101. Gai Poo Lo Mein...........................: ......15.50 Oriental Fresh Vegetables&Pork Fried Rice.........:11.5.0 51. Beef Chow Ho Foon ....... ... 7.95 (W%te Meat Batter Fried Chicken surrounded by a cemtii;,uiion of Tender HOT AND SPICY A-5 '�General Tso's Chicken&Light Vegetables Delight "' """""""" "" """ Sliced Beef,Large Shrimps and Ham Stir Fried with Fresh Vegetables in Brown g g g 52. Shrimp Chow Ho Foon (Big Shrimp) ........................9.25. sauce Resting an Top of Pork Lo Mein) We can Alter the Spices according to your taste. &Pork Fried Rice..................................................11.50 HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 RICHARD R. FARRENKOPF S�nv�Ze G�' eteCtll'td Salle 46UBd BUSINESS: 775-1300 CHIEF EMERGENCY: 775-2323 March 14 , 1986 Board of Selectmen Town of Barnstable Town Hall Hyannis, MA 02601 Re: Dragonlite Restaurant, 620 Main St, Hyannis Dear Board Members : This Department reinspected the Dragonlite Restaurant on March 12, 1986 for the correction of the problems outlined in our letter to you of February 24 , 1986 . At this time, the following had been corrected: -The roof exhaust system for the Rib Cooker has been modified so that the requirements for clearance and the proper grease catch has been installed; The existing hood equipment has had shields installed to protect the roof from grease impingement; proper grease catchers have been installed on both vent fans; the grease build-up behind the hood was in the process of being removed; -The masonary chimney has been rebuilt from below the roof line and brought up to a higher level above the roof; also, a sheet- metal surround has been installed to protect it from grease impingement; -The heavey coat of grease on the roof has been removed. The affected area of the roof was removed down to the wood under layment and retarred and graveled. On March 13, 1986 we reinspected the work done to remove the grease build-up from behind the hood. This work had been completed and an acceptable sheetmetal grease shield has been installed As of this date, the Dragonlite has met all of our requirements for their license renewal. Following is a brief synopsis of the work required by this De- partment for this year' s license renewal: r n Board of Selectmen March 14 , 1986 Page two January 16, 1986 : Initial inspection for license renewal; (10) ten violations noted; January 22, 1986 : Inspection of Rib Cooker and roof area; (2) two violations noted; January 23, 1986 : Review above violations with Restaurant management; January 24, 1986 : Letter sent to Selectmen' s office requesting license revocation; February 3, 1986 : Specs for hood system for the Rib Cooker given to R. J. Perry Co. ; February 20, 1986 : "Show Cause" hearing at the Selectmen' s office; February 24, 1986 : Reinspection of the above 12 violations, found 8 violations corrected. Work was in progress to correct the remaining 4 . However, some work was found to be done improperly, and additional violations were noted. March 12, 1986 : All violations corrected except 2; March 13, 1986 : Remaining 2 violations corrected. Sincerely, h1d4l Lt. Dean L. Melanson . Fire Prevention Officer for Richard R. Farrenkopf, Chief Hyannis Fire Department Encl. cc: Dragonlite Restaurant Sheldon Segerman Board of Health Building Inspector Wiring Inspector Gas Inspector 1 . 1 Y n ,t} }. _ c V.rY. , 1. g" v� ' f ..+r 1 4 NOV ti '' , .+,� +t R.w � rr+�� % M ' .�' ` t 4 Li.»fj J^ .°. l t a ;� s + ' 6. < c, ,, :: r r-,VA y�_ -0 r, st-` x� •'..✓s R _ ' r +. ..r ?'• r r'r:. t p ;k � ^• 11. a . r:. ! tyt,; � %I P s,, t'! .,.r ,k I '�.? el,.'_ °tt' 1 rt :e a.; •t"" - ., y .a • .t zr.f 1L f r.y f'+ +t 1 kt n �£ �x .�ti t ! y j s .r f)'• `u i r r gi , } i 1 a « +r, +� , R"+ � + •. f� r., t a `* 4 I r a ,i x zt r 4 y Y ri 'r r f s. ♦' t K 1 'i r,_ , , ;.. ? fi x 1 `,.6 }; ,,!I I _ t},. 1°t t�,y ,t r F ni� '-, .'r :� l rrx '�4 i L `: -.r d e %' ..; ` - r } +' +.d, �.,�,P i r i •" _--ia }' 1 s tom#'v y s 'vSs " is r r < t .t t, t 4^ tl..'� . �. f t' S,t+ a M Y 's,... tY" y ✓r 4 N y p -�. r _ _ 1 ".e .�.. w a ° aW Y .� "" ;� " < s. t, !+ f #' �,. r. :r' I �,�, - ,. 5,.: ' + ��y .. - y}^� + i 4 I. p me ,4,r '",� t }..` !' -s ley+- .� t+ & `a k T "t"" 't u °fr Y y' y"*'-r k s fir..y ,}( r r ,� ,� .? t t 4 x. } i. 4 a t , < t r4fi+ 4 k Z ;Ir # },.+i r ,. f d `� a ;. r } l " t*, v 1% R W/..='w+-r `,I k k''r ^'`y;r +k.ir g t`!„yf;+§ '- i I Y;,` 5� �r � .Y �ct+J t .,t 1- !Y �, ,�k, - yY - " t ;�' � t � '< f , y .4 f"a �F r 1 ,tr r.. sh I," .""t -'-I r "k i S w tti -Wi a r; S,C l r R``.r-k' 'v�, y + ° `2_. k ," A' }. + r_7 ' ,,, rt4 ,":. y+,� e {td,• .+,{, 'd � ^I°t. ^. 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Ii a d lL" t + 1 ...rr r• r r bra,.ry.r"} . t y..^s�• - '+ i. d i . +w a. y1 , +� + •• k e''ir' .•,1•. y ILI 14A `S;Wi';�,;+ey ,', W '; { • y _ .�fc a}ti C F: ✓ ,,. R1�' ...Ntt �,t *� :^r „? d P ,y f,-t +` �;.0 ' t �' - 1` n 1. - * of .,.� S'.r "r '� a-< j! ♦ " +j +; s r*e r �'! r, 2 S,F •ti r sr. ti.t g' i. g . t r s -.I;. !a¢,,J` N .,i 4 s,P f , I. '� rz''s �' i•�:r cty••,y'r v l,..a+'� '`' S .,4I t +.l I, .1 + r tit �1.. tt' iar �� ^.• c�.., t a z* r * � , }. + t s Pik ;,. i F +'.,, r* s ; ' t w• ''�tt# 3 R a �, ..+ + 2 g 0. f,, '`� •'L•,... .1� • .j, 7 t +„ ,,,1 �b�Y ,k � 3 s� f s".,` U zi_ } _i. "31 -+ir'. i •�+.'_ '� t:..`. a" ^,j' i••k t.• ,,; ,,F --- ,, '+ ,4Y" I. >,+ ,•M i F_1 1" ! dx• t,i.,�- r 16 -,-, r t. r ,:r, •✓ ' - ,< r qi r"'.X .. I k 4At r g <[a1 - • R ,t'. - 3.' r .,- _ _,} ...',+ ' .t " . . ," a 1 A; ,�,� ,a x tr _ .L . a. THE COMMONWEALTH OF MASSACHUSETTS ��---- BOAR® OF HEALTH ........ .........OF....... .�,. AVVlirativu for BWVaoal Works Ton6trnr#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . - --------------Loc ion`Addre§a_ t- or Lot No. 1 .L........... .et ....................................... . .........•-----•------------."......... .-•-.--- Owder Address W -----• - - 4; C...&............................................................ ...... Installer Address .. UType of Building Size Lot.................... S.... q. feet a Dwelling—No. of Bedroom -_ ... :................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building o. of per ons............................ Showers ( ) Cafeteria ( ) a C� --------------------------- Other fixtures --" -- ' �--� W ;1.Design Flow............................................gallons per person per day. Total daily flow-----------------________...................gallons. WSeptic Tank—Liquid capacityjAvc-G-2gallons Length____Ifl ._.. Width---6-e........ 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........................ (zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --••---•--•-••--••-----------•-•-------•----••••----•-•-•---•-•................................••--•......................................................... 0 Description of Soil.... .. ...-----[.4-ileA J........2'4.-------G-A-A b4..-------- X �`� Lst IL x U ....•-•••-•-----------------••--••-•--------•-•-----••••••-•----------••-•-------•---------....••-•••-----•---•---•-•-------•-•------•---•--••------•.................................................. w VNature of Repairs or Alter tions—Answer when applicable._.�' '�' _._..fQt �-_-/7� -_-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issue the b r o Ith. g Si � Application Approved B Da PP PP Y •-• ......--•---•-------•---•••••- Date Application Disapproved for the following reasons:.............................................................................................................. -•••------•••-•-•-•--•-•-----------------------------•-•--•-•---------•--•---•-----..............----••--......-•----------•-•-•-....-------•-------------------•--••-•---•-••-----•------•--•--•------•- Date PermitNo...................................................------ Issued-....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - f G' ¢ y7.-.........OF... ,71. F .. . 1,Z-4.. ......---••- Ap iratinn for Mipasal Worko Tonstrnrtion Vvermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loc tionaAddress � or Lot No. '-""'""'................... -------------------•-----•---•--•---•--....- r............................................... .. djess ------------------------------------------- -------------•---•--------------A � Installer Address UType of Building Size Lot................ Sq. feet ►-1 Dwelling—No. of Bedroo .........................................Expansion Attic ( ) Garbage Grinder' rinder (c `)'~ Other—Type of Building e► c_ a •_ yp g _ .. _ 2._�NO. of persons............................ ShowersCafeteria ( ) Other fixtures �tli [Aicj r.� "' ''" ----------------------------------•-------•-•-----------•-•---...-----....-----•------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------:.....gallons. Srptic Tank—Liquid capacity8toroi, .gallons Length._f__"7o ..... Width. . Diameter................ Depth.............. 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 ( ) , a Percolation Test Results Performed by.......................................................................... Date......... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0W ,. •-------••-------------------------•------------•-------•-------••----•-----......----•-••-------•--....----------•-------.....•--...................--..---- �/ ,Description of Soil......................................................................................................................................... W \ U ......................................................................................................................................................................................................... W ............................••----.......__......--•---....._...---.....•---•-....._................_.. •-- •---..__...... U` Nature of Repairs or Alterations—Answer when applicable.94ep ..... ....... --------•------------------------•---•----------------------•-------------------------...---•---•-•-----••------------•----••-----•••-•------------•--......-00, - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha issue the aid ofAalth. Si ----• Da ApplicationApproved BY --..................................-........................ ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. _ --------------------------------------------------------------------•----•------------.....----•-------•-------•-...-•------•---•-------••-•-------------------•-------------•---•--•-•----••---••----- Date PermitNo.......................................................-- Issued_................. Date ..—THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF (�rr#if irtt#ie of T,antpliattrr IS S TO CERTIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired by..... ....-----••--.... .. .•-- .•--••-•-----•- '''" Installer at................ has been inst llled• n accordance with the provisions of TITLE r of The State Sanitary Code as described in the application or D'.posal Works Construction Permit No.............�� -`►5 ----- dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACT RY. DATE..................................................�f -. Inspector h G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4.1,, r ...........................................OF No..A ............. .._...............................•.-....._ , .�J.. .. FEE.- ....-•---.....-- �in�rnntt arks Twaanntrndian anti# Permissionis hereby granted----- ....... 4 -......-----••---------•----•-•--------------------------••-------------•-•----•-•---...---................_.... to Construct ( ') or�,Repair ( ividual Sewage l Dis osa System P Y ................................................................................................. Street as shown on the pl' on for Disposal Works Construction Permit,No__..._. . __ Dated.......................................... .......................... ....... ----•----•--•-------------------••---••---...----•.............._ Board of Health DATE. �� !' ..--------------•----------------•-•--------------...... FORM 1255 A. M. SULKIN, INC., BOSTON *THE BA6l19TOBLE. i lase. J`?C rt o MAY - // .367 Kin sileel, Jd yunnii, Masi. 0260/ February 18, 1983 TRANSFER OF AN ALCOHOLIC LICENSE: In accordance with Chapter 138 of the General Laws , as amended, GOLDEN EAGLE RESTAURANT, INC. , d/b/a THE DRAGONLITE RESTAURANT, Chuck D. Fong, Mgr. has petitioned the local licensing authority for a transfer of its annual , common victualer, all alcoholic license, located at 620 Main Street, Hyannis , Ma, to SHU, INC. , Ute Euler, Mgr. Said application is for the same premises as currently licensed. A public hearing on this application will be held in the Town Office Building, 367 Main Street, Hyannis , Ma. on Tuesday, March 8, 1983 at 10:00 a.m. John C. Klimm �w��- � � Martin J. Flynn �4E�sF T `' �QOG `Gym d<i/Si�C U4� /o�LD T Jeffrey D. Wilson Board of Selectmen Town of Barnstable Cape Cod News Legal Ad - 2/23/83 PLEASE BILL: Stephen Jones Esq, 436 Main Street Hyannis, Ma. 02601