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Home My WebLink AboutMAIN STREET (HYANNIS) s 4 KANDY KORNER 474 Main St. Hy. a4- Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. BARNS.TABLL F.P.(Thomas)Lee,. �n5 Daniel Luczkow,M.D. Alt. A. 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: 750 Issue Date: 01/01/2022 DBA: KANDY KORNER OWNER: KANDY K INC. Location of Establishment: 474 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 11/14/2017-Variance was granted on 04/14/2008 which requires a 1,000 gallon minium grease trap. ante ram_ For Office Us Initials: 'W Town of Barnstable s Date Paid f I lql • "M. : Inspectional Services Amt Pd$ ao 16 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 11/07/ 21 NEW OWNERSHIP RENEWAL, NAME OF FOOD ESTABLISHMENT: KANDY KORNER ADDRESS OF FOOD ESTABLISHMENT: 474 MAIN STREET, HYANNIS, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO BOX 101, HYANNIS, MA 02601 E-MAIL ADDRESS: PAULO@KANDYKORNER.COM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6 0 8) 7 71- 5 313 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER:YES NO—X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_X _ SEASONAL: DATES OF OPERATION:_! / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 24 TOTAL: 24 (seasonal) SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD X 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:1Application FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT PAULO PARAGUAY SOLE OWNER: YES NO D.O.B 06/14/1989 OWNER PHONE# 774-836-6432 ADDRESS_ 21 LIBERTY LANE, MARSTONS MILLS, MA 02648 CORPORATE OWNER: KANDY K INC FEDERAL ID NO. : 45 - 3843026 CORPORATE ADDRESS: 474 MAIN STREET, HYANNIS, MA 02601 PERSON IN CHARGE OF DAILY OPERATIONS: PAULO PARAGUAY 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. PAULO PARAGUAY . PAULO PARAGUAY 6 / 11 /2023 r 2. IRINA MERZLYAKOVA 5 / A / 2023 l 14 z 11 / 8 / 21 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/hesithdivision/applications.asi). 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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FonnsWOODAPPREV2018.doc 4' Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 IF.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: 750 Issue Date: 01/01/2021 DBA: KANDY KORNER OWNER: KANDY K INC. Location of Establishment: 474 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: Indoor eating 0OutdoorSeatin : 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.� FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 11/14/2017-Variance was granted on 04/14/2008 which requires a 1,000 gallon minium grease trap. o� �t For Office Use Only: Initials: Town of Barnstable y ��,,� Date Paid k iT �P�$—G *S = Inspectional Services `7 �► Public Health Division Check# �"� .P—``�D 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 11/07/ao NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: KANDY KORNER ADDRESS OF FOOD ESTABLISHMENT: 474 MAIN STREET, HYANNIS, MA 02601 MAILING ADDRESS(1F DIFFERENT FROM ABOVE): PO BOX 101, HYANNIS, MA 02601 E-MAIL ADDRESS: PAULO@KANDYKORNER.COM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6 0 8) 7 71- 5 313 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER:YES NO-X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X� SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 24 TOTAL: 24 (seasonal) SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) XFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST _COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD XFROZEN 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:1Application Fortns1F00DAPPREV2018.doc rtf PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT PAU LO PARAG UAY SOLE OWNER: YES NO D.O.B 06/14/1989 OWNER PHONE# 774-836-6432 ADDRESS 21 LIBERTY LANE, MARSTONS MILLS, MA 02648 CORPORATE OWNER: KANDY K INC FEDERAL ID NO.: 45 - 3843026 CORPORATE ADDRESS: 474 MAIN STREET, HYANNIS, MA 02601 PERSON IN CHARGE OF DAILY OPERATIONS: PAULO PARAGUAY 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 ,-�Cie'04 _ L. PAULO PARAGUAY 1, PAULO PARAGUAY 6 / 11 /2023 2. IRINA MERZLYAKOVA 5 / 23 /2023 aside 14&,& 11 / 8 / AD 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/henithdivision/aunlications.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 I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:1Application Foms1F00DAPPREV2018.doc �ptFtE Town of Barnstable BOARD OF HEALTH John T.Norman Donald A. � Board of Health Gaudagnoli,M.D.M D BARN ABLE, Paul J.Canniff,D.M.D. a 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: 750 Issue Date: 12/10/2019 DBA: KANDY KORNER OWNER: KANDY K INC. Location of Establishment: 474 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 11/14/2017-Variance was granted on 04/14/2008 which requires a 1,000 gallon minium grease trap. For Office Use Only: Initials: Town of Barnstable S = Date Paid 0 OIX� f Inspectional Services �►�'`� Public Health Division Check# � s' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 '� '� APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 1/O7/19 NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: KANDY KORNER ADDRESS OF FOOD ESTABLISHMENT: 474 MAIN STREET, HYANNIS, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO BOX 101, HYANNIS, MA 02601 E-MAIL ADDRESS: PAULO@KANDYKORNER.COM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6 0 8) 7 71- 5 313 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER:YES NO_X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_X _ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 24 TOTAL: 24 (seasonal) SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD XFROZEN 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:Wpplication FonmsT00DAPPREV2018.doc PLEASE CALL 508-8624644 OWNER INFORMATION: FULL NAME OF APPLICANT PAULO PARAGUAY SOLE OWNER: YES NO D.O.B 06/14/1989 OWNER PHONE# 774-836-6432 ADDRESS_ 21 LIBERTY LANE, MARSTONS MILLS, MA 02648 CORPORATE OWNER: KANDY K INC FEDERAL ID NO.: 45 - 3843026 CORPORATE ADDRESS: 474 MAIN STREET, HYANNIS, MA 02601 PERSON IN CHARGE OF DAILY OPERATIONS: PAULO PARAGUAY 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 L. PAULO PARAGUAY 6 / 17 /2020 1.PAULO PARAGUAY 6 / 11 /2023 2. IRINA MERZLYAKOVA 5 / 23 /2023 �ar�e 1/ Z 11 / 8 / 19 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/henithdivision/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.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:1Application FormsWOODAPPREV2018.doc Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. A.Ga a Board of Health Donald A.Gaudagnoli,M.D. BAnsrA6t .'_ John T. Norman �$ 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ara 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: 750 Issue Date: 12/20/18 DBA: KANDY KORNER OWNER: KANDY K., INC. Location of Establishment: 474 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- ---- -- -- - - —- MOBILE-FOOD: MOBILE-ICE CREAM: Ga� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: 11/14/2017-Variance was granted on 04/14/2008 which requires a 1,000 gallon minium grease trap. s - For Office Use Only: Initials: _ Town of Barnstable 2"�:,/3&m-_- Date Paid r� Amt Pd S.290 > MU, = Inspectional Services 101004 Public Health Division Check# rY`1 Thomas McKean,Director M. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ; APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11/07/ NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: KANDY KORNER ADDRESS OF FOOD ESTABLISHMENT: 474 MAIN STREET, HYANNIS, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO BOX 101, HYANNIS, MA 02601 E-MAIL ADDRESS: PAULO@KANDYKORNER.COM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6 0 g) 7 71- 5 313 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER:YES_NO_X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_X _ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: 24 TOTAL: 24 (seasonal) SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) XFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD XFROZEN 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:Vlpplication FortnsWOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT PAULO PARAGUAY SOLE OWNER: YES NO D.O.B 06/14/1989 OWNER PHONE# 774-836-6432 ADDRESS_ 21 LIBERTY LANE, MARSTONS MILLS, MA 02648 CORPORATE OWNER: KANDY K INC FEDERAL ID NO. : 45 - 3843026 CORPORATE ADDRESS: 474 MAIN STREET, HYANNIS, MA 02601 PERSON IN CHARGE OF DAILY OPERATIONS: PAULO PARAGUAY 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. PAULO PARAGUAY 6 / 17 /2020 1. PAULO PARAGUAY 6 / 11 /2023 2. IRINA MERZLYAKOVA 5 / 23 /2023 Pause 1/�tez 11 / 8 / IS 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/henithdivision/apl)lications.asi). 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.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPPREV2018.doc L °p THE ri TOWN OF BARNSTABLE.. _. ..HEALTH INSPECTORS Establishment Name: Date: - g)/ Page: of PUBLIC HEALTH OFFICE HOURS 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 asq: HYANNIS, MA 02601 MON.-FRI. No Reference- R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 Name Date / Type ofof e I e 'o 1 on s outine Address Risk o ervice ection Level ai Previous Inspection Telephone ential Kitchen Date: Mobile Pre-operation /Vl 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 a ❑ 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 t ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.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) /l „ I f n Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or lY Jzt within 90 days as determined b the Board of Health. Overall Rating Y Y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 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 non-critical violations re if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9non-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 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 day p s 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 Signatu a 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 3L202.12 Additives* 3-501.15 Cooling Methods for PHFs ding Cookd and RTE Foods.* ___ 19 PHF_Hot and Cold Holding _ 2-103.1-1 - � Person-in--Charge Duties e - - � - - - --- -- -- -- 3-302.14 _ Protection from Unapproved Additives* - - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- * --- - - - -- - I EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information._Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) �_Responsibility of the-Person-in-Charge to_ _ _, ;_ _ __ _ _ 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Time as a Public Health Control Applicants* -"' 3.302.1'1(Ay Food Protection* P g 20 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 WashingFruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* g * 7.202.12 Conditions of Use*- 590.004 11 Variance Requirements 3-304.]1 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 _ _ _ _ 3.3Q6.14(A)(B)Returned Food and Reated or of Foam* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources--- ' - 9 - -' Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* * _ - - P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* � 3-201.13 Fluid Milk and Milk Products _ 4'-501.112"�" Mechanical Wazewashing-Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIMErfEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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 Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System*_ _ _ gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E{f-nve urrzow 4-602.11 Cleaning Frequency of Utensils and Food _ I 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 * 3-201.14 Fish and Recreational] Caught Molluscan � * 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec Y g Contact Surfaces of Equipment Shellfish* 1 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4703.11 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 temporary and - ide in cater- * Ratites-165°F 15 sec*, in mobile food,tem or and residential Sources g• P �' 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. 2301.14 When to Wash* * Other 590.009 violations relating to good retail - 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y 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* 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 ( ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Item Good Retail Practices FC 590.000 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* Temperature Cooling PHFI Made from Ambient * 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 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. 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* I 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. 1 - oF. r TOWN OF BARNSTABLE . HEALTH INSPECTOR'S Establishment Name: Dat4_23�e: of OFFICE HOURS ARNSrAO�EO° PUBLIC 2 0 MAIN STREET 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. � MASS.q. `0$ HYANNIS, MA 02601 S08-8 08-8 -FRI.62-4644 0 No Reference R-Red Item PLEASE PRINT CLEARLY i°rE0 MA'S° ` FOOD ESTABLISHMENT INSPECTION REPORT G f Name Date Fl e of T i s ec ion /Operm!haftutine Address Risk d Servi - spection Level Previous Inspection Telephone If Residential Kitchen Date:. IF Mobile Pre-operation 4. Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed a,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 y ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities t e' EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ✓ VVV ❑ 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 _ L ❑ 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 (J Critical(C)violations marked must be.corrected.immediately. (blue&red items) Corrective Action Required: ❑ No ❑ es . Non-critical(N)violations must be corrected immediately or Overall.Rafing. within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Su nsion C N Official Order for Correction:Based'on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR'590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation F is scored automatically if: no hot 27. 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 Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to.a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. ( )( ) 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.Dum ter screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N IF #Seats Observed Frozen Dessert Machines: Outside Dining Y N P11 Sign ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y Nri t I Violations related to Foodboine 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 1 q 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-Chazge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) 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-Presence590.00411 and Use*7.202.12 Conditions of Use 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food. 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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. L16 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 Equipment 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 Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg cr;vc innoot 4-ti0z.11 Cleaning Frequency of Utensils and Fuud 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* 4-763.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential nt 10 Proper,Adequate Handwashing 40 Ratites-165°F 15 sec*3- 1.l l C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 Clean Condition-Hands an Arms* d As* ( )( ) p 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 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23.30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 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 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *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*K�E Tow TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: _Date: Page: of P� ~o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. = 200 MAIN STREET 3:30-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 �0� HYANNIS MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY 639• p ,, 508-862A644 FOOD ESTABLISHMENT INSPECTION REPORT Name 1 ` Date ffjZl Tyne of jyjw.Rf Inspection Operation outine ffoot fsl 0 Address � 1� � S� Risk Food Service - pection Level TED Previous Inspection Telephone Residential Kitchen Date: fM Mobile Pre-operation 6 Owner HACCP Y/N Temporary Suspect Illness S` v 6 Caterer - General Complaint 1 Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector pU�(�� Out: ' Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. D� 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) ❑ dJ CauJ 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 �� ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Itemsl 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 :mbar go Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food g ❑ g y ❑ ry p ❑ 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 6=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 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 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 -p q r W /� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N c� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 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) 4Assignment of Responsibility* a 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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 113 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Dii�ilcing Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EB give/11/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 see* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P �' I 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Weld Mushrooms Approved By 2-301.11 Clean ms Condition-Hands and Ar * 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* 17 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES" 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 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 g 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 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. oFi194*E► TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ,�ti�ko rpi er Date: j)_b04e Page: I of P� h� 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 MASS.: tee$ HYANNIS,MA 02601 soa-s2-0sn4 No Reference R-Red Item- PLEASE PRINT CLEARLY RFD MP'� - FOOD ESTABLISHMENT INSPECTION REPORT V,_ U - G g Name Date lyi2e of I s ection ) v O 1 D O e 'on s Routine N Address Risk Food Service nspection Z G `AVI Level PreviousJnspeQ�ion o` Telephone Residential Kitchen Date:Is p Mobile Pre-ope a ior?//G Owner HACCP Y/N Temporary Suspect Illness C_ Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP r In: Other Inspector Vd`) ( Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 9 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 / to c- O✓1 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP (} ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) O' Corrective Action Required: ❑ No 6'Kes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. Voluntary Compliance ❑.Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC 4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9rion-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 i critical refrigeration. within 10 days of receipt of this order. violat' to non-critical violations=C. w 29.Special Requirements (590.009) y p 36.Other DATE OF RE-INSPECTION: Inspe is Sig t re tint: 31.Dumpster screened from public view 6)VI) S41 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: c Up ,y o K(-Outside Dining Y N PIC gnature Print: Self Service Wait Service Provided Grea Trlp Size / 4.,w_.Variance Letter Posted N Dumpster Screen? Y N � � ma`s „: i`" .F_„ t r .�, •. - �r.� _ _ .. ,�„�„' , -. � _Y � 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.) 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* 9 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) 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* 3-302.11(i1j Food Protection** 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003 F Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* ( ) p y3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* � 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* from the Consumer ge* 7-203.11 Toxic Containers-Prohibitions* � 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. 590.003(E) I Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.IIA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Prinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//cri�urnooi 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 3 11 10 Proper,Adequate Handwashing -401. C Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By ( )(3) Wh I B h P Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity 8 g 3-403.11(C) 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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 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 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* t S.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 3:46 PM Cape Cod Septic Services Inc. 10/15/20 Invoices for KANDY KORNER Accrual Basis January through December 2020 Num Date Due Date Aging Amount Open Balance Jan-Dec 20 9905 09/24/2020 09/24/2020 95.00 9761 09/01/2020 09/01/2020 95.00 9670 08/19/2020 08/19/2020 95.00 9556 08/05/2020 08/05/2020 95.00 9465 07/23/2020 07/23/2020 95.00 9344 07/08/2020 07/08/2020 95.00 9175 06/12/2020 06/12/2020 95.00 8980 05/13/2020 05/13/2020 0.00 8898 05/01/2020 05/01/2020 95.00 8750 04/03/2020 04/03/2020 95.00 8577 02/28/2020 02/28/2020 95.00 8481 01/31/2020 01/31/2020 95.00 Jan-Dec 20 1,045.00 0.00 Page 1 Bellaire, Dianna From: Stanton, David Sent: Thursday, November 08, 2018 3:33 PM To: Bellaire, Dianna Subject: RE: Kandy Korner Hi Dianna, You can release his permit, he is up to date on inspections with me. Just an FYI,you will probably be getting a bunch of these. This is the reason I had always sent out a list of places that will need a hold (also the reason for the hold), in my area around the renewal period. The State wants inspections to occur at least once every six months, which is the target we aim for(we don't always hit it,sometimes its more, sometimes less, based on a lot of factors.) I'm still trying to learn this new process(for me anyways) of writing the ok for "x" years permit inspection. I think around September is when I was told about the new process, so I didn't know how it was handled and therefore the reason for the late writing of the notes. I am not really a fan of this new process as now I will need to start writing the ok for"x" years permit inspection starting in May, which to me is way too pre- mature, but that is the only way it would seem to work out with this new format of writing they are ok for"x" years permit"in time for renewals. I just have concerns that writing someone is ok that early in the year,there is still a very long time for that to turn around and change before the end of the year for many reasons. For example look at the one that just came up, Lorena bakery. I may have written down on the report they were ok for 2019, but now we might have a problem and they might not be ok. I will hopefully try and figure that out tomorrow. Thanks, Dave From: Bellaire, Dianna Sent: Thursday, November 08, 2018 11:28 AM To: Stanton, David Cc: Bellaire, Dianna Subject: Kandy Korner Hi Dave; Kandy Korner put in an application, paid for 2019 and I have his Servsafe/Allergen. I just need an inspection to release his permit.Thanks. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us 1 fWE'l • DATE: FEE: • snxNsrnei$; MASS. � 1639, `0� REC. BY i0Tf0�.t A Town of Barnstable SCHED. DATE: Lem Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. .�� VARIANCE REQUEST FORM LOCATION �1 y Property Address: 5� �(/j(�,/ Assessor's Map and Parcel Number: 30 U 7 7 Size of Lot:__(7, ��- Wetlands Within 300 Ft. Yes Business Name: /<01WCK r1 (--T No-- Subdivision Name:APPLICANT'S NAME:_"Poll L IqA�,Z-cU Phone So,Y -77/ s 31 3 Did the owner of the property authorize you to represent him or her? Yes , <_ No PROPERTY OWNER'S NAME CONTACT PERSON Name: 2140 L MOULU Name: �Q�r!t1 «u5d�-, Address:�7q A414/1,d 5T 6�/V/V/ 04 U /Address: Phone: SD X 7W 5-3/ 3 Phone: j U 7 7/^S 3/ VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if ore space needed-) r�o �x13c �� 4e ✓I 771— C} J +: NATURE OF WORK: House Addition ❑['!Pi!'i.. House Renovation O Repair of Failed Septic ystem Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTitle V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals [same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Cannifl;D.M.D. REASON FOR DISAPPROVAL C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.D0C �— rj2t. Y3oh' KtM X6(WC_ G`"/Fl�� eNt/v Paulo's ICE CREAM DATE: INVENTORY ------------ FLAVOR ICODE .ON TOP ,A B C BLACK RASPBERRY BRAS ! --1 CHOC CHIP CC CHOCOLATE CHOC ! COFFEE COF -1 COOKIE DOUGH DO FUDGE CARAMEL FCS MAPLE NUT MN -1 Mint Choc. Chip MCC -- __- -- -_ __ ------ - - - ---- -- STRAWBERRY STR TOASTED COCONUT TOAST -1 VANILLA VAN Yogurts SF RASPBERRY SWIRL -1 S FREE BUTTER PECAN - - ----------- ---- ----- BLACK RAS CC YOGURT CHOC PNUT BUTTER YOGURT ORANGE SHERBET -1 COFFEE ALM FUDG LO CARB -1 VANILLA NON FAT YOGURT LEMON SORBET A Soft Serve Vanilla, chocolate r ' AOWn of Barstable �OF —TOE\ Barnstable ',�Pw` - °'' Board of Health r �' �� A&AmsricaCiCy MA' 200 Main Street, Hyannis MA 02601 T + „ rFD '-- 200—i Office: 508-862-4644 Wayne Miller;M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi April 14, 2008 Paul Mazzeo Kandy Korner Gifts 474 Main Street Hyannis, MA 02601 RE: Kandy Korner Gifts, 474 Main Street, Hyannis, MA 02601, Grease Trap Variance Dear Mr. Mazzeo, You are granted a conditional variance from the Board of Health Regulation, PART II SECTION 1.00, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment at Kandy Korner Gifts, 474 Main Street, Hyannis with the following conditions: (1) The menu is restricted to fudge, ice cream and frozen yogurt listed on the menu submitted on April 8, 2008. No other food items are authorized to be prepared or served. (2) A two-bay sink and an in-line grease interceptor shall be installed in accordance with the State Plumbing Code. (3) These variances are not transferable to another owner or lessee of this establishment. (4) These variance may be revoked anytime the operator fails to comply with a condition of these variances or anytime unsanitary conditions are observed. The variance is granted because the menu is limited. The application appeared to comply with the Board's grease trap variance guide. Sin erely yo rs, a ne l er, M.D. Ch irman Q:\WPFILES\KANDYKORNER Grease Var Apr2008.DOC f r 1. - �tr�, Town of Barnstable Barnstable Regulatory Services Department i fnRxsrnaLe. Public Health Division 200 Main Street, Hyannis MA 02601 2001 m Office: 508462-4644 FAX: 508-790-6304 - Thomas F.Geiler,Director Thomas A.McKean,CHO 7/10/2013 Kandy Korner 474 Main St. Hyannis, MA 02601 To: Kandy Korner, This letter is being sent to inform you that our records at the Health Division office show your food establishment is not currently connected into an in-ground grease trap. The Board of Health wishes to inform you that at the time your property changes ownership or the property has a new leasee, or if there is a change in menu, the Board of Health and Department of Public Works will require the installation of a minimum 1,000 gallon in- ground grease trap. Mechanical grease recovery devices are not recommended by the Plumbing Inspector or the Town Engineer. According to the Massachusetts State Code: 310 CMR 15.230: Pretreatment Units-Grease Traps 3)Grease traps shall have a minimum depth of four feet and a minimum capacity of 1,000 gallons,and shall have sufficient capacity to provide at,least 24-hour detention period for the kitchen flow. Kitchen flow shall be calculated in accordance with 310 CMR 15.203. (15.203 requires 15 gallons per seat i.e. 100 seats 1,500 gallon grease trap capacity.) If you have any questions or need more information, please contact the Health Division at 508-862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S.CHO Agent of th&-hoard of Health - - 1_ 1 t '- ��{� �j °• �, ram' ( f .� � ..� ,� tall q r /" �� '�1f�y. _ •�'' t; a ' . r J �r i n - , yf n s{' 4t -- `r to i I 3.� �r t t 1 �I a wk r s f I � son AWN J1 50 M 4A �i b y sr-•— i _ e 7 P� . T b.. Y 01 yi quj* 1 - C -- 41 ! �T �3. 1 E Citizen Web Request • • Page 1 of 3 g"' 1,6 ,rll� a,6 t 1 a; u G°iedr:.esday, March 102010 OWN\wid : Citizen Request Management TO�.vr!`•.wadisrlg. Route to Users Search Requests Create Requests Request Information Request ID: 26172 Created: �7/15/2009 1:25:46 PM Status: Closed Assigned To: McKenzie, Marybeth Health Office Anonymous: No Request Category: Article X- Food : Product Integrity Routine work: No Estimate: No Date scheduled: I Estimated 7/29/2009 Change Estimated Jun July 2009 Aug Completion Completion Date: Date: Sun Mon Tue Wed Ahu Fri Sat 28 29 30 1 2. 3 4 5 6 7 8 9 1.0 11 i 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2.9 30 31. 1 2 3 4 5 67 8 I Created By: Crocker, Sharon Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Request Y Kandy Korner DETAILS: RequestCaller said when she inspected Parcel Number Map: 308 Block: �?$ F Lot: 000 the candy her children bought at Kandy Korner, there were small white Parcel Lookup worms. Found a worm in two different peanut butter cups. f Email: I _ I FTrack Request Progress http://issgl2/Internal WRS/WRequest.aspx?ID=26172 3/10/2010 Citizen Web Request • • Page 2 of 3 Request Work History: Internal Note History: Entered on 7/21/2009 8:36:00 AM Entered on 7/15/2009 1:25:46 PM fby McKenzie, Marybeth by Crocker, Sharon Infested product taken off shelves, Moths found in sugar-free candy display. Red or confused flour - — - beetles found in other candy. That product was also System entry on 7/15/2009 1:25:46 PM: disposed of at time of inspection. Please see reports on different inspections. Assigned to McKenzie, Marybeth System entry on 7/21/2009 8:36:00 AM: Request Closed by mckenzim Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) �Sp I Cheeky ,� `�'"rjSpel(C�f�ck �� Add document or image link: _-----____._.-.. " You can also type in a folder name to see everything in the folder Current Links: L Time worked on request: 3,00 Response time: 1.00 *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. r Reopen Reopen and notify citizen Re�l?en Public Use: Printer Friendly Version Internal Use: Printer Friendly Version i I http://issgl2/InternalWRS/WRequest.aspx?ID=26172 3/10/2010 Citizen Web Request Page 3 of 3 http://issgl2/Internal WRS/WRequest.aspx?ID=26172 3/10/2010 ' gear v , p e VIA I t3 q O H- ssachusett epartm of ublic Health 'sion of FT d Drugs -6 e tjUtvs� vev�� FOOD EST HME T INSPECTION � ' SPORT PPe, l � y e� l. �runt�' Zr IV A1 l v h;1 S Establishment Name OR he ►- Date q Address -1 7 -4Ih 11 �o TirrZ�:�ln ,, Out �� rl Z Telephone - S Type of Establishment: Purpose: Owner's Name Z� eO Food Service Routine Retail Food Z Follow-up Person In Charge p t,) 0 a z eC) Residential Kitchen Complaint Mobile Unit Investigation Inspector's Name Temporary Food Service Other Based on an inspection today, the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked undercolumn"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrativ age(s). This report serves as official notice of violated provisions and official notice to correct said violations. P C&_ r,r�S WT N 0 N C \V^ Food t Sanitary Facilities 1. Food Supply as-- �.002 � '�'Y �� t2. Food Containers � 29. Water Source n_f �� ,y\ .015 30. Sewage �r�' �7f 016 4 4 31. Cross Connectiarr��- .017 4 Food Protection -• 77 U 32. Toilets/Handwashing .01.8 8 .019 2 3. PHF Temperatures .004 �, 33. Insects/Rodents 021 2 4. Facilities. Hot & Cold Storage P.004 34. Plumbing .0175. PHF Re-service .006 :_ 35. Toilet Rooms .0186. Spoiled/Damaged Foods q..t,_ .003 y 36. Handwashing Areas .019 7. Food Protected fC .003 37. Garbage/Refuse .020 8. Food Thermometers 1 .004 38. Outside Disposal 020 9. Cross Contamination 0�6^ .005 39. Outer Openings f t&4 -;t-VI .021 r 10. PHF's thawed, cooked& cooled------ .005' PP 40. Pest Application �Otl.021 11. Food Handling � .005 12. Dispensing Utensils sceo-v 69 1 .006 p ysical Facilities f��n �'9w�r� 41. Floors .022 Personnel �.�------ Walls, Ceiling .022 13. Employee Infections .008 43. Lighting .023 t4. Employee Hygiene o � '� 41.009 "_ 44. Ventilation .024 1 15. Employee Clothing 1�""� �.0010 . 45. Dressing Rooms A25 1 Equipment & Utensils ther ------- 16. Equipment/Utensil Clean& Sanitized 4 .013 ``' 46. Toxics .026 4 17. Food Contact Surfaces 1 .013 47. Premises .027 1 18. Non-Food Contact Surfaces •1 .013 48. Living Areas .027 i 1 19. Food Contact Surfaces Clean 2 .013 49. Linen .027 20. Non-Food Contact Surfaces Clean 1 .013 50. Pets 027 t-1 21 Wiping Cloths 013 51. Bulk Foods .031 22. Dish/Warewashing Facilities 1 .013 52. Salad Bars 0320 R 23. Pre-Scraped, Soaked 1 .013 24. Wash/Rinse Water 013 No. of 13 Critical Items Violated 25. Thermometers/Test Kits 1 013 These items require immediate attention. 26. Equipment/Utensil Storage 1 .014 27. Single Service Articles .014 ReceMdb lnsjectpg bye 28. Single Service Re-Use 012 -- r '" =+ �= , • Full..Item Descriptions Food' a i C1 Food Source, approved, wholesome, w-« 2• `•CoA ainers, properly labelled Food Protection C3 Potentially hazardous foods at proper, temperatures: 140OF or above, 450F or below, O°F; rapid cooling of cooked foods within 4 hours-- C4 Facilities to maintain product temperature `- `C5' Unwrapped and potentially hazardous foods not re-served'. 6' Damaged, spoiled, returned foods segregated 7°1 Food protected during storage,, preparation, display,:dispensingj service, transportation 8 Thermometers provided, conspicuous, accuraie 9 No cross-contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 4 ^ 11 Food handling minimized 12 Dispensi'hg utensils stored . Personnel C13 Employees with infections restricted C14 Hands washed and clean; good hygienic practices4 t 15` Clean clothes, hair restraints r' Equipment & Utensils C16 Equipment, utensils sanitized (automatic and manual methods) 17 Food contact. surfaces: design, constructed,-installed, maintained, located. 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located ' operated 23 Pre=flushed,�scraped, 'soaked ` 24 Wash/Rinse' -water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing, 28 No re-use of single service articles Sanitary Facilities , C29 Water source; approved, hot&cold under pressure C30 Sewage and waste water disposal , C31 No cross-connections, back siphonage, backflow C32 Toilets & Handwashing: number, accessible, design, installed ' C33 ` No 'insects or rodents; harborage prevented 34 --Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, clean 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application Physical Facilities 41 Floors constructed, maintained, clean 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided used, clean Other C46 Tonics properly stored, labelled, used 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. Authorized personnel 48 Living/sleeping quarters and laundry separate 49 .Linen properly stored. , 50 No`pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected i Establishment Name Date 6 Address Page of 4 c Item No. In the space below describe all violations checked on front page. C-'7 Tcze ft-,4 k ey r vO Y G� ® d eum 0 S vv. t.r�e h 1 • __oo SST✓A U-jQj v C-tb C- A-%,v- js ®e)r- L E.M Via I - 4 P, t h k Discussion with Management awc.Q -p Ww,eL SA14JUInj Sv �+ \,r- p � � 13 CRITICAL FOOD HANDLING VIOLATIONS 1. Food from an unapproved or unknown source or food which is or may be adulterated, contaminated or otherwise unfit for human consumption is found in a food establishment. 2. Potentially hazardous food that is held longer than necessary for preparation or service at a temperature which is greater than 450 F 0=70 C) (in the case of cold, food). or less than 1400 R - (600C) (in ' r r •the .case of hot food). 3. The food establishment's facilities) are insufficient to maintain 1 product 'temperature. ' 4. ' Potentially hazardous food or unwrapped food that has been served to customers is re-served unless such re-service is allowed under section 105 CMR 590.006(G). 5. A iperson, infected with a communicable. ",,disease that can 'be transmitted by ''food is working as a food handler in a food establishment. } 6. wA person not practicing strict standards of, cleanliness and personal hygiene which may result in the potential transmission of illness through food is employed in a food establishment. .7. Equipment, utensils and food-contact surfaces are not cleaned and sanitized effectively and may contaminate food during preparation, storage or service. 8. Sewage or liquid waste is not disposed of in an approved and sanitary manner, or the sewage or liquid waste contaminates or may contaminate any food areas used to' store. or prepare food, or any areas frequented by customers or employees. 9. Toilets and facilities for washing hands are not provided.;, properly installed or designed, accessible or convenient. 1 G. The supply of water is not from an approved source or is not under pressure and the food establishment does not use single service articles and/or bottled water from an approved source. 11. A defect exists in4.the system supplying potable water that may result in the contamination of the water. 12. Insects, rodents or other animals are present .on the premises (unless allowed by Section 105 CMR 590.027(F)(3)) . 13. ' Toxic items are improperly labeled,, stored or used. Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation.