HomeMy WebLinkAboutANCHOR IN-FOOD - FOOD �ncho2 fin_ 00 d� .
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Town of Barnstable BOARD OF HEALTH
John T. Norman
Board of Health Donald A.Gaudagnoli,M.D.
Banns ABM F.P.(Thomas)Lee
°$ A 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt.
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; 0apter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 929 Issue Date: 06/01/2022
DBA: ANCHOR IN
OWNER: LCOF HYANNIS OPERATING LLC
Location of Establishment: 1 SOUTH STREET HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 22 OutdoorSeating: 0 Total Seating: 22
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: 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:
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Town of Bam4t`+ ble )MaPC3 �t+�I �lt�; Iniftg3s.
InSpectiong ServicUT es � U
Public Health. DiNrision oo�► b1_ OAP �a'Lq
Thomas McKean,Directpr
APPLICATI N"fi D.. T Ts+ C?P RATE I A I ; 1it 1S t� ET
DATE � �� NEW OWNERSHIP RSH.IF' V RENEWAL—
NAME
ADDRESS OFFOOD ESTABL'ISH'AMENT: k sosayN nn a _S?►
MAILING ADDRE&%(IF DIF"F'EREN ON ABOVE,-)-
E-MAIL.ADDRF_SS:
TI_LF Pl-IONE'NlJMI1ER 4P FOOD ES'TABLISFU19ENTr s
TOTAL NUMBER OF 6AT"ROOMS'_
WE IA,NVATI,R,: YE.�.+_NC-Z ....(ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL, � DATES OF OPERATI:CIVt_ 1�.� _ TO.___._/ /-
NI~NIBE.R OF SEATS: INSIDE: OUTSI`DE: L -rOTAI.: '
SEATIN( : MUST O TAN A COAlMON VICTU LER S LICENSE FROM I ICE S NG DIN".
*Q SI E PJMNG, REMINDL,R***.
OUTSIDE DINING.M'US'I'HE APPROVED BY THE HE—ALTH DIV,AND LICENIXG AND MEET OUTS fIE DINfE
3EQUIREMENDS.
'S WAIT STAFF Pf OVICED FOR OVI'S1131 MINING? 0 b
IS AN AIR CURTAIN PROWDED AT WAITSTAFF'SERVICE DOOR(°Sr.
TYPE OF S'CABLI HMENT, {PLEASE CHECK ALL THAT APPLY BFi..€}W)
N/FOOD SERVICI
RETAIL FOOD-ONLY required for T#'S foods(foods eequiring refs° erath)A/Bret ry
SHED&BREAKFAST
C(Jl"TINENTAL,BREAKFAST
—COTTACE FOOD INDUSTRY(formerly residential kitebto)
MOBILE FOOD
—MOBILE
DAIRY DESSERT MACHINES,,.,(410'�ITHL Y LAMB ANALYSIS R.EQUIREP)
�CATERI,NC; (CATERING NOTICE REQUIRED BEFORE EVENT(SE.E PACE#2)
SEASONAL MOBILE cat KEW FOOD ONLY***
af,�S,L LA LL 50 01_-4 1
iw�'iA�ii;rart�ri€�rvmstl-(tE:rCt�tGlttdib,d�:
ONVNERINFOWMAT, tON
FULL.NA.M6 OF APPLICANT
St)LE UWtiz YES NCl C).fl.B t)t'1"Nit 1' 'CfE
CORPORATE ADDRESS: s
PERSON IN CHARGE OF DAILY OPERATIONS* eV(%.-
List(2)Certified Food Protection Matta ers ANT)at least(1)Allergen Aworeoev¢Certified Stoff
,All FOOD ESQ'ABLI SJIMEN"IS"mu:st have l Certified Food,P-roteCtion Mona er PER,S".JVT-
**ATTACB-COMES OF CERTCFICA`IS"The H ait6 Viv. w:itl N_OT use past gears* reconts,You
mint provide new copies and POST THE CE . . :�F�ICATES at •our foodl establishment.
-rttlied Food M€tna erng, Exnir�t�t,�t_.t�rate �41�c. e� icy ren Expiration Date
a0d 7
2. � lr" +n I t�_ 7 Z. �� '1
41;,ICNATt�YRE A CAN�r DATE.
*EQ0D P4L CY INFORM�A
5EA5C}NXL FOOD SERVICE:All-seasonal rood establ ishinertts,itictocling mobile truc6 must he inspected by the Health Div.
►rirrr to opmitEfr11 P se call Health IV; at 509-li =46 4 ter liedu:le your ins ccti�n, E'le ill�C least.(7�c�l:va its advance.
FR.,Ol N DAIRY Dt...SS FRT& Frozen dessens nium be tested by tt Staao Certified l ib prior to opening and monthly tht ul'ler,
with rnple'res4uhs sublitittad to the Health Div, Faiture to do sty will resott in the suspension ar revoca-lon of your Frozen Car t
Pert;1n'tt Unli l the above lemrn are.tnet.
CATERING POLICY-, Anyone ttto caters within t[,e Town of Bmtqahle Must notify theToimt by fug or trtlit prior to catering
rent.. You trrstst ec>mtatete a e t firs notice roulid at tq ;e�wwjj'is��` trftt°+ qt txtt i ,try t t r ttit°i ic�n�a►sI tsti €v . t.
OUTDOOR CCT KINQ Outdoor cooking,preparation,or<ti piay°of any t°oW product by a Ito d eitaWishment is prohibited'.
NOI'(C E Permits NA Annually from Jap aatv ist to Dec,3 I"`each eatett pr yvar., IT IS YOUR, RESPONSIBILITY
TIt COMPLETED F'PRI,tCATION(S)AND EtFC LJ1.R1:D FEES Ry DEC tst.
Q; Apptit:gioa 1,vnt0AF(X)L)AVP kf..V��049,d",
I
Op\ME r TOWN OF BARNSTABLE_ ...,. .. ..HEALTH INSPECTOR's Establishment Name: Date: - .Page._ _
,.:.: of
, .
PUBLIC HEALTH DIVISION' aoa 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
7 MASS. g. MON.-FRI.
4A ,a3y. �• HYANNIS,MA 02ti01 soa-asz as4a No Reference,. ,R Red_Item PLEASE PRINT CLEARLY-,
FOOD ESTABLISHMENT INSPECTION REPORT
Name _ Date 3 . e of .. T Insipection -
OnfiWon s
Address / ` Risk Re inspection
Level Retail. Previous Inspection -
Telephone Residential Kitchen Date:
ti.
Owner _. HACCP Y/N emporary Suspect Mobile rlllness
Caterer General Complaint
Person in-.Charge:(PIC) . Time Bed&Breakfast HACCP
A
In:
Other `
'Inspector. Out:.
44
Each violation checked-re' ires an explanation on the narrative page(s)and a citation of specific provision(s)violated:
Violations Related to Foodborne Illness`lnterventions 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) ❑ 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.Disease's 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
z - tiu1
❑ 11.Good Hygienic Practices ❑22.Posting-of Consumer Advisories _
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1 S 9 r l_ ��
Critical(C)violations marked must.be corrected,immediately. (blue&red items)
Corrective Action Required: ❑ No ❑.,Yes.,1 �5.�V6F
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 4 non-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 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 C=2 critical violations and less than 9.non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590;007) aggrieved by this order,you have a right to a hearing. Your request must
( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials FC-7 590.008 g violation,4 to 8 no tical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
Ins ector's Si t e Print:
30.Other DATE OF RE-INSPECTION: p g
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 Sig atu 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 Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours*
( ) g 14 Food or Color Additives
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives
3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
g 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 1'40`F
*
7-102.11 Common Name-Working Containers
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control
590.003 Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* *
(� P ty3-302.15 - 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* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions*
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food*
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* * 3-801.11(D) Raw or Partially Cooked Animal Food and
- 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
P 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* * 3-801.11(C) Unopened Food Package Not Re-Served*
4-501.112 Mechanical Warewashing-Hot Water Monitoring
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System*
4-601.11(A) Clean Utensils an Eggs d 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
590DWA) __Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eh'°d-11112001
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
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 hSP.ECIAL`REQUIREMENTS''`:_'7,.--:,.',
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* Proper,Adequate Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By 10 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 - Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition -- 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 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 fvodborne
3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification Maintained*
Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
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
* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 26. 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
2
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 8. Physical Facility FC-6 .008
2 . Poisonous or Toxic Materials FC-7 .00
NACCPPlans 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*
87103.12 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.
FOOD
i
Town of Barnstable BOARD OF HEALTH
John T.Norman
�j Board of Health Donald A.Gaudagnoli,M.D.
JBMA '%8'#' LE": '' 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 929 Issue Date: 01/01/2021
DBA: ANCHOR IN
OWNER: DISTINCTIVE WATERFRONT HOSPITALITY LLC
Location of Establishment: 1 SOUTH STREET HYANNIS„ MA 02601
Type of Business Permit: BED AND BREAKFAST
Annual: YES Seasonal:
IndoorSeating: 22 OutdoorSeating: 0 Total Seating: 22
FEES
FOOD SERVICE ESTABLISHMENT: YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST: $30.00
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
For Office Use Only: Initials: �_
'"�' Town of Barnstable
Date Paid Amt Pd$ _
'�e, p BnRxsrnB Inspectional Services
: ns
f4l
` ,`�r Public Health Division Check# /��1� � ` °Ia
D MA
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 TcQOaO NEW OWNER HIP RENEWAL
NAME OF FOOD ESTABLISHMENT:
ADDRESS OF FOOD ESTABLISHMENT: S9_�PW-7 t
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �VY� �Q,
E-MAIL ADDRESS:
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: MCA/
TOTAL NUMBER OF BATHROOMS:1
WELL WATER: YES NO .. (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE:: -o�� `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)
3ED&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
ram.
♦j
OWNER INFORMATIO
FULL NAME OF APPLICANT S r7I
SOLE OWNER: YES/NO OWNER PHONE # - Co
ADDRESS_
CORPORATE OWNER:
CORPORATE ADDRESS: ��c
PERSON IN CHARGE OF DAILY OPERATIONS: 4 G
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.
a c�
r*SNURE 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/api)lications.ast).
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January i st to Dec. 3 1"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
l� p1F BOARD OF HEALTH
Town of Barnstable
QYw John T. Norman
af' Board of Health Donald A.Gaudagnoli,M.D.
BAtRN-WABL& i Paul J.Canniff,D.M.D.
aka . 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: 929 Issue Date: 12/10/2019
DBA: ANCHOR IN
OWNER: DISTINCTIVE WATERFRONT HOSPITALITY LLC
Location of Establishment: 1 SOUTH STREET HYANNIS, MA 02601
Type of Business Permit: BED AND BREAKFAST
Annual: YES Seasonal:
IndoorSeating: 22 OutdoorSeating: 0 Total Seating: 22
FEES
FOOD SERVICE ESTABLISHMENT: YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST: $30.00
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: QA
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
For Office Use Only: Initials:
' .' Town of Barnstable
Date Paid Amt Pd$
&UMSfABLE. . Inspectional Services MAPM
Check# �6 r
Public Health Division
Thomas McKean, Director L4D�F
200 Main Street,Hyannis, MA 02601 \_l A x
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE/OI/ !` 4? NEW OWNERSHIP RENEWAL `V"
NAME OF FOOD ESTABLISHMENT:_4M6Wy11'-'—A0j
ADDRESS OF FOOD ESTABLISHMENT: lfl �✓. '�!(,/V/s
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: S K i Q yt r Yti��tll C Owe
TELEPHONE NUMBER FOOD OOD ESTABLISHMENT: 6 W�_
� �,
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO ... (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#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
�..r
A�
OWNER INFORMATION. /
FULL NAME OF APPLICANTK/��r� l
SOLE OWNER: YES/NO OWNER PHONE#
ADDRESS
CORPORATE OWNER:
CORPORATE ADDRESS: �� �
PERSON IN CHARGE OF DAILY OPERATIONS:
List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
2.
/0
CSIGIA4AYWOF 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 htty://www.townofbarnstable.us/heaIthdivision/at)plieations.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FonnsTOODAPP REV3-2019.doc
l
INC r TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: A Date: fJ Page: of
q OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30A.M.
i snnNsrne�e. - 200 MAIN STREET a? 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS,MA 02601 �/! 1 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY .
�A �679•A� / 508-862-4644
rFOM FO D ESTABLISHMENT INSPFCT N REPORT
Name i Date Type of TvDe of I s ec ion
Ooeration(s) outi
Address Risk Food Service Re= action
Q Level Retail revious Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness 02
General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCOPI, /
Othe
Inspector � �
Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and 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) ❑ i
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 8
❑ 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 El Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑-Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal El 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 ardless of the number of.critical,results in an F.
B=One critical violation and less than 4von-critical violations re 9
25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to'6 non-critical violations=B. Seriously Critical Violation=F•is scored automatically if: no hot
26.Water,Plumbing and•Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If ,
27.Physical Facility (FC 6)(590.007) aggrieved by this order,you have a right to,a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
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 Snon-critical violation =C.
29.Special'Requirements -(590.009) within 10 days of receipt of this order.
30.Other - DATE OF RE-INSPECTION: Inspec o S nature Print: C1
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 ' ture 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 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: 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 t 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) x 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* _ -
( ) 3-306.14(A)(B)Returned Food and Reservice of Food* 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* Raw Seed Sprouts Not Served*
7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501112 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment
5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg""°e iiirzooi
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 590.009 A Violations of Section 590.009 A m cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-�) ( )-�)
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* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 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* Lu 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
520411 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 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.
,r,E TOWN OF BARNSTABLE. HE An INSPECTOR'S Establishment Name: n f L� - 3-1 Date: t� l� Page: of
`oF row OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
• 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
BABNSfABLE.
mass. MON.-FRI.
HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY
rf0 FOOD ESTABLISHMENT INSPECTION REPORT
Name ,1 n Date o ? Tvoe o jyaff3ztftDection
Operation(s) ou
Address Risk Food Service Re-inspection
dd ` ^�` Level Retail Previous Inspection
Telephone Residential Kitchen D e: �/�
Mobile r -operation -�
Owner
HACCP Y/N Temporary. cC ness �r'�'
Caterer General Complaint
Person in Charge(PIC) Time reakfast HACCP (:
In: �tt i � yL _L her
Inspector ��� �a 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) If
❑ 0
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 d fi d
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ci L
❑ 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 ❑ 11.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 SP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and.Food Preparation for HSP Lo
❑ 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: tzf No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating J�� I(� ,�/within 90 days as determined by the Board of Health. D 1 tv ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an Inspection today,the dems ❑ 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.
B=One critical violation and less than Orion-critical violations 9
25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment perrnit 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 obsery 7 fo 8rion-critical violations. If 1 critical refrigeration...
29.Special Requirements (590.009) within 10 days of receipt of this order.
violation 8 on critical violatio =C.
if
30.Other DATE OF RE-INSPECTION: Inspect r $ignat a Print:
31.Dumpste�screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Outside Dining Y N PI g t Pri
Frozen Dessert Machines: Z
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 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F)
P 7-101.11 Identifying Information-Original Containers *
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* *
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F
7-201.11 Separation-Storage*
Applicants* 3-302.11(A) Food Protection* 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)Resumed 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*
q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004 A-B Compliance with Food.Law* * 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 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* TIMEITEMPERATURE CONTROLS
3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 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 Drinking Water* 3-401.11(A)(2) Comminuted 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*
4-702:11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surf
aces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS i
4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or Violations of S 590.009 D cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165 590.009(A) (D) Vio Section (A) ( )
in
15 sec*
Sources* ing,mobile food,temporary and residential
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
* 2-301.14 When to Wash* 3-401.11 A All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )(I)(b)
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceRequues should be debited under#29-Special
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne
12 Prevention of Contamination from Hands 3-403.11 g illness interventions and risk factors listed above,can be found in the
3-101.11 Food Safe and Unadulterated* (E) Remaining Unsliced Portions of Beef Roasts*
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* F1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification*. 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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 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 or105 CMR 590.000.
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03/13/2012 08:27 5097752423 ANCHOR IN CAPE COD PAGE 01
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One South Street •Hyannis,MA 02601MA 1A- A1A4t-t','0
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Tel: (508) 775.0357 • Fax: (508) 775-1313 • Email:Wo@agchoriri.com •Web:www.anchorin.com
,03/13/2012 08:27 5087752423 ANCHOR IN CAPE COD PAGE 02
Moyer Diebel: Products:Undercoumters:35 JHT rage 1 of 1
Dishwashem..17ftuawashe ,WwaWashers
HOME ABOUT PRODUCTS I$ALES IPARTSISERVICE INEWSIEVENTS CONTACT ICANADA
Product Category:Undercounters
3 Models in Undercounters,Next(201 HT)
Products: 351HT
wed-help viewing spec sheets or manuals?
Standard Features
• ENERGY STARO Qualified
• Rinse sentry feature-Ensures proper 1 BUT final rinse
temperature
• Counter-balanced,double skin door
• Clog-resistant filtering system
• Stainless steel Hnse-arms with removable end caps
• Pumped drain
Liquid detergent and rinse-ald dispensing pumps
• Top,side and rear panels
• 2 kW tank heater
Flexible fill and drain
• Pressure regulating valve
• Top mounted detergent and rinse-aid prime switches
• Low 0.65 US gal.water usage per rack
• Energy efficient-30 Amp,breaker only for 40T rise(40 Amp. breaker only for 70T rise)
• 120-second cycle time.24 racks per hour capacity
• Complete with one peg and one gat bottom rack(20"x20")
Top of page
USA:Moyer Diebel,3765 Champion Blvd.,Winston-Salem, NC 27105
800-228-8350
For Canadian Products, jt Here
Last Modified March 23,2012 1 Site Map
Entire contents 0 Copyright Moyer Diebel 1997-2005,All rights reserved.
Reproduction in whole or in part without permission is prohibited.
An Ali Group Company
0 R O U P
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http://www.moyerdiebal.cojn,/detail,phP?id=l46&catid-l&category=Uudercounters 4/12/2012
03/13/2012 08:27 5087752423 ANCHOR IN CAPE COD PAGE 03
Project W
Item No. IRA
Quantity
STANDARD FEATURES z
• ENERGY STAR°Qualified M
Simply Engineered Better . Soft start,protects dishes and glasses from chipping �
or breakage
• Proprietary Non-Corrosive Engineered Composites are C
used in parts that appear to be plastic z
35'� H Rinse Sentry feature-Ensures proper 1806F final -4
rinse temperature
Undercounter High Temperature
Overflow Type Dishwashing Machine - Counter-balanced,double skin door
with Bulletin Booster Heater Clog-resistant filtering system
is,; Stainless steel rinse-arms with removable end caps
�..
• Pumped drain
• Liquid detergent and rinse-aid dispensing pumps
• Top,side and rear panels
• .2 kW tank heater
• Flexible fill and drain
• Pressure regulating valve
• Top mounted detergent and rinse-aid prime switches
• Low 0.85 US gal.water usage per rack
• Energy efficient-30 Amp.breaker only for 401 rise
• 120-second Lytle time.24 racks per hour capacity
• Complete with one peg and one flat bottom rack
(20"x 20")
SPECIFIER STATEMENT OPTIONS& ACCESSORIES
Specified unit will be Moyer Diebel 351 HT undercounter high ❑70'F rise booster
temperature dishwashing machine with built-in booster. d CST-Combination sink/table
Features include 14-1/2'door opening clearance,standard liquid Machine on right P/N 403561
detergent&rinse-ald dispensing pumps,top and side panels.
Unit will have standard pumped drain,dnse-sentry feature to ❑CST-Combination sink/table
ensure proper 180"F final rinse temperature and stainless steel Machine on left P/N 403562
rinse anus with removable end caps for easy deaning. ❑Flat bottom dishrack P/N 101273
1 year parts and labor warranty. ❑Peg dishrack P/N 101285
El 6"Stand PIN 0712393
o05 (�17RS—17"Stand P/N 0708757
NSF.
CA
Mayor Mabel—USA
3765 Champion Blvd.,Winston-Salem,NC 27105 Tel-,336/661.1992 Fax:336/661-1979 800/228-8350 www.moyerdiebel.com
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03/13/2012 08:27 5087752423 ANCHOR IN CAPE COD PAGE 04
351 HT
Undercounter High Temperature
Simply Engineered Better Overflow Type Dishwashing Machine
pY g with Built-in Booster Heater
Dimensions shown In inches and[millimeters)
�24'I609 463/4'17035,E
s 9
ae
O
2a' oq
33-112,IOBer , 35.5351
z'Is12L 0 4"t3
Front View Side View Phan View
Mote:Allow additional 3'clearance from wall.
Ulllitles SPECIFICATIONS
1 Electrical
209-240/60/1;3 wire+ground;hard wrong required(See boxes Mow) Capacity
2 Hot Water NSF Racks per hr. 24
140"F On.connection for 40'F dra boos W. Motor Horsepower
110"F Min.connection for7WF rise booslar. Wash 1
S ft.long 112"I.D.flexible fill hose with 3/4"FNPT connection,
Flow pressure 1S-22 psi(124-152 kpa),PRV stlpplied Water Consumption
3 Drain Connection Gal.per hr.(max_use)
6 ft,long,31C I17.flexlblehose. US gal. 20.4
Marc drain flow;8 US gpm Gal.per rack
351HTWth40'F Wu»6aoper 351HTwith MT Rim g U5 gal., 4.85ecmc Bonger
Temperatures°F
Minimum MaXIFTIUM
Maximum Ra1rd s� Wash(minimum) 154
R—Spacs Amps Aramft Dwk. �s.Spua Amp. Ampadey OvAcs Rinse(minimum) 180
208/60/1 22 30 30 2091 0/1 29 . 40 40 Pleating
230/60/1 24 30 30 230/60/1 31 40 40 Tank heat,electric(kW) 2
Electric booster
(kW required for40T rise) 4
(kW required for 10°1 rise) I
Uncraud Crated ttaV
1 Time Cycle in Seconds
Height 33-1/2, 39-1/2" I
_ Wash 100
Width 2e 25" Lt L2 N G Rinse is
Depth 25" 25-1/2' Dwell 5
Ship Wt.Ibs 148 145 "Note:Electrical supply service Total 120
must be a 3- re plus ground Waming:Plumbing and electrical connections should
From levdinq rRt prov dq� for connection as shown_ be made by quallfted personnel who wOl observe all the
applicable plumbing,sanitary and safety codes,
i
Due to an ongoing value Analysis program at Moyer Dlebel,specifications in this catalog are subject to change without notice. (1 M)1/12
'USGBC and related logo Is a trademark owned by the US.Green Building Council and Is used by permission,