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HomeMy WebLinkAboutD.J'S WINGS - FOOD i 32 1?-23`? D.J's Wings 165 Yarmouth Rd Hyannis rtT Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli, M.D. WINsr,►sm F.P.(Thomas)Lee,. +b 9. 200 Main Street, Daniel Luczkow,M.D. Alt. Hyannis MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 259 Issue Date: 01/01/2022 DBA: DJ WINGS OWNER: DYS WINGS N THINGS, INC. Location of Establishment: 165 YARMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 108 OuitdoorSeating: 0 Total Seating: 108 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVE D-04/02/04-Shall install a (G.R.D) in accordance of Plumbing Code. The existing grease trap shall be inspected on a monthly basis and pumped once every 3 months. 0a 6uv, Town of Barnstable For Office Use Only: Initials: . . .� Date Paid AmtPd ,AM AS&STABIX ; Inspectional Services 16396` 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 �o(!� �ZI NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: At, ADDRESS OF FOOD ESTABLISHMENT: 110 5 `l d/rM loath 2e] n6 Mj 026o/,i>� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: CC,UA j d H rl 0-0 ccm TELEPHONE NUMBER OF FOOD ESTABLISHMENT: U 7� 4b TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO IV ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: Ind' OUTSIDE: TOTAL: L OF' 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? V7 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SER CE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) y FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD '. 2 FROZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSIS REQUIRED) �. CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL MOBILE& NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: - FULL NAME OF APPLICANT Cal i SOLE OWNER: YES/(g D.O.B 119 I OWNER PHONE # ADDRESS 'I(�25 `q a1rmyu t',- VetA"S Vn&-07&d 1 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: John Wt V) 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• Cn - 0� / 15 1.. 2. O fl Udyl S _ Ol / l q /2DZ�— 3, _fiat lor6 At -e, 1 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htty://www.townofbarnstable.us/healthdivision/at)nlications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:Application FormsWOODAPP REV3-2019.doc `oF* ►owti TOWN OF BARNSTABLE , HEALTH INSPECTOR-s Establishment Name: Date: Page: of ' OFFICE HOURS ` PUBLIC HEALTH DIVISION 800-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 330-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 659. �•� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY ptFD MPS a 508-862-4644 FOOD ESTABLISHMENT INSP CTION REPORT Name Date 7kpe of Type of Inspection Ro Address Risk Egod S. e-ins ectio _ t Lev Retail tion 1 Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: i Each violation checked requires an explanation'on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ` �- FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ' FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/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 6 Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4 non-critical violations g p (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) y receipt within 10 days of of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: I pector's Si n ture Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N t. #Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's Si Print: C-5Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N / W Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* ! 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous of Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F -EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) *. * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* 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 hood 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* 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 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* 3-401.11 A(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 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ctiw 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 SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 1 0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to ing Procedure* 165°F* foodborne illness interventions and risk factors. 3-202.18 Shellstock Identification Present* 2-301.12 Clean * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 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 3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc -Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.HF r TOWN OF BARNSTABLE HEALTH wsPECTOR's Establishment Name: Date: Page: of per "l OFFICE HOURS BARNS ABLE, * PUBLIC 2 0 MAN STREET 3:30-4:30 P.M. DIVISION : 0- :3A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON -F ,639. � HYANNIS,MA 02601 sos-ssz-4Rsaa No Reference R-Red Item PLEASE PRINT CLEARLY p'FDN1�p FOOD ESTABLISHMENT INSPECTION REPORT01 IL� Name DatJ A Q' Tvoe of T section vv OP&rajjQWs1 rR-5.1ijine Address Risk ood S spection 1. Level a Previous Inspection Al IAC� Telephone Residential Kitchen Date: Jo r Mobile Pre-operation JA 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) ❑ q FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS s ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additivesrp ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals W- FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) / ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating o ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling o ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time Asa 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 _ e Me 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 v within 90 days as determined by the Board of Health. E��? ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations if no critical violations observed,4 too 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 i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signa ure Print: 31.Dump ter screened from public view �1n /�� -� ,)JY� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' I t 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* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs __ Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge 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-ins Other*Charge to - 7-102.11 Common Name-Working Containers* * 3-501.16(A) Hot PHFs Maintained.At or Above 140'F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F - - Applicants* 3=302.11(A) _ Food Protection* 7-201.11 Separation-Storage* 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*590.003(E) Removal of Exclusions and Restric[ioons 7-204.11 Sanitizers,Criteria-Chemicals* - REQUIREMENTS FOR 3-306,14(A)(B)Returned Food and Re or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources � 9 - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P _. _ 4-501:111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a 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. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of ' 3-202.16 - Ice Made From Potable Drinking Water* - - - - - 3-401.11A(1)(2) Eggs-155'F 15 sec Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145"F 15 sec* 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 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 of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under - Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202:18 Shellstock Identification Present* _ 2-301.12- _ Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 2-401.11 Eating,Drinking or Using Tobacco* - 3-403.11 A&D PHFs 165°F 15 sec* 5 -- Receiving/Condition - - -. ( ) ( ) 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* 3-501.14(A) g Conveniently Located and Accessible Within 2 Hours and From 70`F to 41'F/45'F Item I Good Retail Practices FC 1590.000 3-203.12 Shellstock Identification Maintained* 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 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 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. IKE Tpk� TOWN OF BARNS-TABLE HEALTH INSPECTOR's Establishment Name: Date: Page: of _ OFFICE HOURS ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. 200 MAIN STREET 3:30 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 67q. `0$ HYANNIS, MA 02601 - 508-862-4Rs4a I. No Reference R-Red Item PLEASE PRINT CLEARLY. 'FDN1�'p FOOD ESTABLISHMENT INSPECTION REPORT Name Date of Type of Inspection _ Ion Routine Address Risk ood Serv" Re-inspection Level etail' Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Caterer Pert5rel Complaint ' _ Person in Charge(PIC) Time Bed&Breakfast f In: Other j Inspector Out: AZ 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 500.009(E) ❑ _ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ -� � �-��� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling / „ ,LC ❑ 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) t ❑ 9.Food Contact Surfaces Cleaning and Sanitizing 0 21.Food and Food Preparationrfor HSP,. ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Vim' 1 ✓ � Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating �- Voluntary Compliance ❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 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 4non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27. y (FC-6)(590 Facility .007) aggrieved by this order,you have a right to a hearing. Your request must Physical C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t 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 e 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 G Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N Dumpster Screen? Y N t-�-.-..�-_ .:.�...-,.-,-s.--�..-._-...-�.. ."r�o:���rr..�.. -..�-`--.�---'----- 'w--r�---� -- �..;,.,�„-�.�. -.�.�..----.""^� -" ..._r: .�. --, ....__.�s....-. ...----•-_ -.vim----•,�+�-..,., r .--� -�:-...,. . ti, -_. -..-- ..... -� �-`---..�a{ _ -�- 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) jDerronstrationof 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 HQt and Cold Holding. _ 2-103.11 - -Person-in-Charge-Duties--- - --- -- - - - - - - - - 3-302.14 Protection from Unapproved Additives*- Contamination from Raw Ingredients 15 Poisonous o?Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 7-101.11 Identifying 3-302.11(A)(2) Raw Animal Foods Separated from Each Information-Original Containers* 590.004(F) ners 2 590.003(C) Responsibility of the Person=_in-Chaz e.to- _ _ _ Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P ty g -- -- - 7=102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F " 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11.�1,:. 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* - - : -- 7.202.12 Conditions of Use Applicant To Report To The Person In Charge * 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G.)__I 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 3-396.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted.Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P E4-5501.114 .11�1 - 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* - - - .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* Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(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 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* Eg chw 1112001 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 and Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Ho[Water and StuffingContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed _ .Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Authority 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 ' Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 3-202.18 3-202.18 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 590.004(C)3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11. __ Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-202.l1 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 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 Supplied with Soap and hand Drying Devices Within 4 Hours 1 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. n BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Nff.A� � Paul J.Canniff,D.M.D. � 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, 3058, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 259 Issue Date: 01/01/2021 DBA: DJ WINGS OWNER: DYS WINGS N THINGS, INC. Location of Establishment: 165 YARMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 108 OutdoorSeating: 0 Total Seating: 108 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVE D-04/02/04-Shall install a (G.R.D) in accordance of Plumbing Code. The existing grease trap shall be inspected on a monthly basis and pumped once every 3 months. f �t ram, For Office Use On1v: Initials: Town of Barnstable Date Paid Amt Pd$3�r' Inspectional Services J a 9c� ', ,0� A�Eo��► Public Health Division Check# L Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL /. T NAME OF FOOD ESTABLISHMENS V Y 'qQ ADDRESS OF FOOD ESTABLISHMENT: I U (� I��J 4�Qh►� 5 I�'11 D2�al MAILING ADDRESS(IF DIFFERENT FROM ABOVE): S E-MAIL ADDRESS: UC.�V I'D 01 I 0 &P I W y► 1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: cwu► 17,J- "l 4ky TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO V ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / I /2-)TO I Z/3 1 l ZI NUMBER OF SEATS: INSIDE: 1 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 OWNER INFORMATION: FULL NAME OF APPLICANT- SOLE OWNER: YES/NO D.O.B OWNER PHONE# J�8 '3 7, `(o°D UC 0,g ADDRESS 1 L .Lo (tQ Py i P O b -1 ]9 UKt- CORPORATE OWNER: ( -1(L1 1j,1'1 0, ,�6r 'LtC - CORPORATE ADDRESS: G J "*6 PERSON IN CHARGE OF DAILY OPERATIONS: O �'� OA*tio M 4�A 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 cE,xyiiration Date C 2. EW A77 a�&- UP8 / SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal=ood 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 htto://www.townolbarnstable.uslhealthdivi,ion/applications.asp, OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application Forms\FOODAPP REV3-2019.doc r ' sr Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ■Amsren Paul J.Canniff,D.M.D. o 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate p 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: 259 Issue Date: 12/10/2019 DBA: DJ WINGS OWNER: DJ'S WIINGS N THINGS, INC. Location of Establishment: 165 YARMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 108 OutdoorSeating: 0 Total Seating: 108 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gi FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED-04/02/04-Shall install a (G.R.D) in accordance of Plumbing Code. The existing grease trap shall be inspected on a monthly basis and pumped once every 3 months. oF�� For Office Use Initials: a� Town of Barnstable Date Paid Amt I'd$ ,CAB Inspectional Services Public Health Division Check# RFD MA'S 0 Thomas McKean, Director '{ ' 200 Main Street,Hyannis,MA 02601 No Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I 44- NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: YY ``�� • ,, �^ ADDRESS OF FOOD ESTABLISHMENT:�` (t VrM 6 I Y , MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: V Y ' un TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: c / x WELL WATER: YES NO y ... (ANNUAL WATER ANALYSIS REQUIRED 5 TO ANNUAL: V/ SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: IQR _ 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 SER CE DOOR(S)?4� TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q: Apphcation FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES O (�D.O.B q OWNER PHONE#� D ✓ [ ( � ADDRESS -Pop-) I p SU 1 LGC/V —f CORPORATE OWNER: ^l W 11 an ' �p CORPORATE ADDRESS: �oz�_Vd PERSON IN CHARGE OF DAILY OPERATIONS: - W"- 4b 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 q lA a' — it Zo2� 1, 15 ap La, ll SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htty://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc r Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNS!'ABM John T.Norman MAs& F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 259 Issue Date: 12/20/18 DBA: DJ WINGS OWNER: 10HN CARLIN Location of Establishment: 165 YARMOUTH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 108 OutdoorSeating: 0 Total Seating: 108 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: ------ -- -- - - -- MOBILE-FOOD: MOBILE-ICE CREAM: CA FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: s PIKE�yti Initials: Town of Barf-istable > bDate P:i"—\ Amt I'd$'�W/ MAM Inspectional Services 9� 1639. ArED MA'�A Public Health Division check# 3 - Thomas McKean,Director C'� J 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ii APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE t ` ,9 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: W ADDRESS OF FOOD ESTABLISHMENT: G�► t � �'v'``I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: O I ,ry TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Ca VS TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: v SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL,: L SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? —_ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TY$E OF=_ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V/FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/(NO ) DO-B OWNER PHONE # 5V 34 2 7 ` `t" ADDRESS " 2 CORPORATE O R: FEDERAL ID NO. : qdU� CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1, vsh.vl Nar)S 4--1 ��- , 1 ���.�h �� i t 2-02 / / 2. V\ CA/rt;k) 1 f z1 Zo 11 261 IT SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPPREV2018.doc hj//oF•N�E rok TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: �I age: of v do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSfABLE, • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M639. �0� . HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 MFOOD ESTABLISHMENT INSPECTION REPORT Name Datfk De of o sea ction Onspatroff NS Routine Address Risk ervic fe inspection Level Retai Previous Inspection Al Telephone Residential Kitchen Date: - _ Mobile Pre-operation Owner chef f -7 I 1 <9 m4i I c HACCP Y/N Temporary Suspect Illness Caterer General Complaint - HACCP Person in Charge(PIC) + m Time Bed&Breakfast Other ) In: 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) 110 e 4 oa 6A42 " 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 s01 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals o� 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 �• t J� 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 �,tV� �/�/��� ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories U - v Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ^� Critical(C)violations marked must be corrected immediately. (blue&red items) f n I Q(7 pC• 4 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 ® m go Ebar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure Other: ❑ Voluntary Disposal ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4nori-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infes of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y P , 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ^ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / / L #Seats Observed Frozen Dessert Machines: Outside Dining Y N P C's I nature Pn Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N IV 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* 79 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* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 .Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 8 ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking 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* Eg-ti-innooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22. Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Soo urce 3�01.11(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 Poultry or Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish, 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 230 Cl Regulatory Authority - 1.11 Clean Condition-Hands and Arms* rms 3401.12 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* 3-03.11(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* 3A03.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. °F11Ero TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of �L OFFICE HOURS PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v Ma�q: HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �prFD MAr p' 508-8624644 FOOD ESTABLISHMENT INSPEC ION REPORT Name' Date 'e of T 3 oi�f Ian ec ion ion s tine Address Risk od Service - c Ion Level Previous Inspection Telephone m Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP V. In: Other J i Inspector Out: f Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 5 t~ - Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 1 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) - ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures s _ r ❑ ra- 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 if J a 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 a Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 01 within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ® Embargo ❑ Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Fond and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations rdless of the number of critical,results in an F. 25.Equipment 9- re a ui ment and Utensils (FC-4)(590.005 6=One critical violation and less than 4 non-critical violations q p ) cited in this report may. result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature r Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N v wV Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* g g 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 O Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003 F Res onsibili of A Food Em to ee or An 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements * 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*590.003(E) Removal of Exclusions and Restrictions 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reser of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP Disposition of Adulterated or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-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 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 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 ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * Effective r///zoo/ 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 3401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P �Y Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure 165°F* Foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 A 3-202.18 Shellstock Identification* ( ) g 13 Handwashing Facilities 3-501.14 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 1 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 11Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 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. FIKET TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: L age:. of OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. RARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified MA SS, �.�' HYANNIS,MA 02601 - MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �prFo MPS n 508$624644 FOOD ESTABLISHMENT INSPECTION REPORT Name 5, Date - 1 'Type of Tvoe of Inspection Rou' Address Risk Food Service e-inspection Level � -Inspe tion Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: 1w, - 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 Ile LC�' rlz� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical C violations marked must be corrected immediately. ( ) y (blue&red items) t� q Corrective Action Required: ❑ No -To Ye Non-critical(N)violations must be corrected immediately or Overall Rating J `� within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage bads-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-Critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view f Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining y N ZZ ur Print: } Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41*F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH, 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-202.11 Separation-Storage* 20 Time as a Public Health Control 7-20 .11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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* 1 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* 3-801.1](C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * 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* :4-7 -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 Cough[MolluscanContact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 03.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590 009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Authority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )(b) * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals 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 Receive Temperatures* d at Proper Temperat * 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* O g 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 Cooling Cooked PHFs from 140°F to 70`F 3-202.18 Shellstock Identification ( ) g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'17 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 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 27. Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF.HE,ow� TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTAB LE. ' 200 MAIN STREET 3:30-a:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �A _ -FRI. ,,39.a No Reference R-Red Item PLEASE PRINT CLEARLY 'qp 0 HYANNIS,MA 02601 s08-8as-8s2�saa rf°M FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tyne of n tion O er i s Routine �..� Address Risk Service spec ion fA Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other i 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) ❑ s Action as determined by the Board of Health. Allergen Awareness 590.009(G) ® L FOOD PROTECTION MANAGEMENT ® 12.Prevention of Contamination from Hands �lj l ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS U ko( ❑ 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 + ❑].Conformance with Approved Procedures!HACCP Plans ❑ 19.Hot and Cold Holding10 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 H ienic Practices 22.Postin of Consumer Advisories WL�M ❑ Y9 ❑ 9 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �l Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or 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 o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8 non-critical violations=C. 29.Special Re irements (590.009) within 10 days of receipt of this order. Inspector's Signature Print: 30.Other DATE OF RE-INSPECTION: - 31.Dump r screened from public view lkwa&e,��9:92 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's Si ' ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Poster) Y N Dumpster Screen? Y N V" 1 7f 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* 3-302.1](A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other*' 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7 201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Foam* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 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* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait 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. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"°°uuaow 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 3-401.1l(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and -residential cater- * Ratites-165°F 15 sec* in mobile food,tem o and residential Sources 1 p Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wiid Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* * Other 590.009 violations relating to good retail ( ) 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3 403.11 C Commercial] Pruessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooked PHFs from 140°F to 70*F (A) Cooling 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 1590.000 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* Accessibility, Temperature Ingredients to 41*F/45°F 25. Equipment and Utensils FC-4 .005 5-205.11 ,Operation and Maintenance 3-402.12 Records,Creation and Retention* ty Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p IME r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date:y"� Page: . of OFFICE HOURS i�sAaNsrAeLEoz PUBLIC 2 0 MAIN LSH STREET 3:30-4:30 P.M. DIVISION 8: 0- :30A.M. Item Code C-.Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A 639.a�0� HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item, PLEASE PRINT CLEARLY FFD MP'� 508-862-4644 FOOD ESTABLISHMENT INSP CTION REPORT Name Da Type of Type of Inspection 1) 5 O erati Routine Address Risk erv' Re-inspection It Level Previous Inspection aA PLO Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint .r Person in Charge(PIC) Time Bed&Breakfast HA M77In: her Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r . Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ - FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 04 ❑ 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 Asa Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HS ) C] 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 %"tl I Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6.non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. . If 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 8non-critical violations. 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ' Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ' A t� Dumpster Screen? Y N �" T u Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) - and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8' Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B)• Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 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 on 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.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 E s-Immediate Service 145•F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef-ti-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 r f ces of Equipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meal,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165*F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3 401.11(A)(1)(b)All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165•F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165•F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 foodbome 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 * 13 Handwashing Facilities 3-202.18 Shellstock Identification 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'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 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.�E r TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: 1IN,I Date: b 2 Page:��of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss q MON.-FRI. �p ,63v,p�m HYANNIS, MA 02601 508-862-4644 No Reference .R-Red Item PLEASE PRINT CLEARLY 'F0N1P' FOOD ESTABLISHMENT INSPECTION REPORT F Name t Date 2 Doe o Type of Inspection g Routine e a¢ G r i Address / V d Risk Food Servi Re=inspection �a I G Level Previous In pection / Telephone Residential Kitchen Date: l y�� n } Mobile Pre-o rats�n F 4 Y C ✓ p G t u c Owner HACCP Y/N Temporary u ness Caterer Gene a omplaint Person in Charge(PIC) Time Bed&Breakfast HACCP ` o� a In: Other ( 9 Inspector ` S Out: - F J Each violation checked requires an explanation on the narrative pages)and a citation of specific provision(s)violated. uJ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ - Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable!Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3,Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling . ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lo ❑ 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) 3 V5) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than Orion-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Serious) Critical Violation=F is scored automaticallyif: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If y - water,sewage k- f rodents C- critical,I violations i - critical ter s a e back-up,infestation o o is 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 2 c t ca o at ons and less than 9 non critical. If no g p, , critical refrigeration. F _7 be in writing and submitted to the Board of Health at the above address violations observed,7 non-criti violations. If 1 c g 28.Poisonous or Toxic Materials ( C )(590 008) 9 vi ,4 to no ritic Fvlolati s C. 29.Special Requirements . (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins a tor's SI t le n 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N , f �t/1 S #Seats Observed Frozen Dessert'Machines: Outside Dining Y N PIC s Signature Print: Self Service Wait Service Provided Grease.Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Coaled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or'Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 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 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge - * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 i 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 720414 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Prc-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef a°ve 1/1/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702,11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Mid 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 2-301.12 Cleaning Procedure* 165°F* Shellstoek Identification Present* foodbome illness interventions and risk factors. 3-202.18 Wild Mushrooms* 2-301.14 When to Wash* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 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:Shellstoek 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CA4R 590.000 * 13 Handwashing Facilities 3-501.1 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstoek Identification ) Item Good Retail Practices FC 590.000 3-203.12 Shellstoek Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 lConformance with.Approved Procedures* S:590Formback6-2doc `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.006. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. f y, t I � FTHE TOWN OF BARNSTABLE, HEALTH INSPECTOR's Establishment Name: -TJ W Aqf Date: 1 Page:" f _ OFFICE'HOURS AR E. PUB2 0 LIC HEALTH DIVISION .MAN STREET - 3::30-- :30A.M. 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MG7q; `e� HYANNIS,MA 02601 50s 862-446644 No Reference R-,Red Item PLEASE PRINT CLEARLY CEO a FOOD ESTABLISHMENT INSPECTION REPORT _ r Name Date 1,e of T Inspection ' on s out,* Address Risk ood Servi Re-inspection ` r v r�^ nn�� Level a ai Previous I sp ction Telephone Residential Kitchen Date: e.7,� ftj Mobile Pre-ope do Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint (� Person in Charge(PIC) Time Bed 8 Breakfast HACCP U r r/ �. In: Other Inspector J a l�A J X C- Out: A-i l Z- A& 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) ❑ S C Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ILL Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 1 �g I ® Corrective Action Required: ❑ No es Non critical(N)violations must be corrected immediately or Overall Rating 1 '4 k within 90 days as determined by the Board of Health. oluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. 9 Emergency Closure ❑ Voluntary Disposal [].-Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations,and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 6von-critical violations=B. 26.Water,Plumbing and Waste. (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observe ,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violatio ,4 to in critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspect 's Signat Pr Vt: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N .-� v, #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC - nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y, N �V 1 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* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 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 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * � 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. . 3-306.14(A)(B)Returned Food and R of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated ated o or r Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112. Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * Sg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cNve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.0016(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity* ( ) m Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification - g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 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 O 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 lConformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical.item in the federal 1999 Food Code or 105 CMR 590.000. oF,K ror TOWN OF BARNSTABLE HEALTH INSPECTOR•s Establishment Name: f W t 1 Date: Page: Of X ti OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. �p i639.a e HYANNIS,MA 02601 508-862-4644 No Reference. R-Red Item PLEASE PRINT CLEARLY 'FDN1�` FOOD ESTABLISHMENT INSPECTION REPORT Date Type o o •s ectio Name �. 7a� � Routine tl Address Risk o d Servi M spection ad . ° tnN Level Previou In�ection 4 Telephone Residential Kitchen Date. J'� Mobile Pre-op ration Owner HACCP Y/N Temporary Suspect Illness r` `v , �r Q Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP yr w In: Other Inspector k Out: e W. S 1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. or A '•� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) �^ Corrective Action Required: ❑ NoS Non-critical(N)violations must be corrected immediately or Overall Rating CD f I& 7 d lie within 90 days as determined by the Board of Health. S1401untary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the hems ❑ go Closure El Disposal Other: Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical v lations. If 1 critical refrigeration. = 29.Special Requirements (590.009) within 10 days of receipt of this order. violati 8 no critic 11 al violations - 30.Other DATE OF RE-INSPECTION: InspectVe 31.Dum ster screened from ublic viewP P Permit Posted?. Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining YN PIC' Pri 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* F 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 75 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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* _ 7-201.11 Separation-Storage* Applicants* - - 3-302.11(A) Food Protection* - P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS•FOR.. . . 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents;Criteria* 21 3-801.11(A) Unpasteurized Prc-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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* 3-401.1 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* Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg�n"11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130`F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165"F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 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 * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RT'E Food 140 F 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* 3-003.11(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 A * 13 Handwashing Facilities 3-501.14 Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) n g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12. Records,Creation and Retention* 5-205.11. Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 1 29. 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: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. l TOWN OF BARNSTABLE y FTHE � OFFICE OF I 11AH39TABL r BOARD OF HEALTH 0"M 0o 039. 367 MAIN STREET MAY k HYANNIS, MASS.02601 May 19, 1997 William Planinshek 165 Yarmouth Road Hyannis, MA 02601 RE: Ice Box Willy's Dear Mr. Planinshek: You are granted a conditional variance from Regulation 11 of the Town of Barnstable Health Regulations, which requires inground grease traps at all restaurants in Town. The variance is granted with the following conditions: (1) A grease recovering device shall be installed and connected to the three compartment sink. (2) All grease collected by the recovery device shall be rendered. There is an existing 1,500 gallon inground grease trap at this property which is connected to Box Car Willy's Restaurant. This variance is granted because the applicant stated it would be more costly to excavate the paved parking lot in order to install a second inground grease trap for this establishment. The Board is of the opinion that the use of a grease trap onsite will effective) reduce grease recovery device connected to the existing g p y the among of dairy products and grease entering the town sewer lines. jSSmerely yours, Susan G. Rask, R.S. ""� Chairman Board of Health Town of Barnstable SGR/bcs bomilly w McKean Thomas To: Ritchie Carol-Ann Subject: SP#62-94 and#03-95/Domino's Pizza and Box Car Willys SP#62-94/Domino's Pizza Revised plans were received on January 24, 1995 showing a grease recovery device. The applicant also obtained a variance for placement of the second bathroom in the second floor unit area above Unit#5. Therefore, I have no objection to site plan review approval at this time. SP#03-95/Box Car Willys A Board of Health meeting is scheduled to be held on February 7, 1995 at which time Mr. Plannishek will request a variance to expand the outside dining area (for additional seating). I reviewed the submitted plans received on January 23, 1995; 1 have no objection to moving forward at site plan review contingent upon the applicant receiving a Board of Health variance for additional seating in the outside dining area. i j Page 1 �i N 0. o`,NE t� TOWN OF BARNSTABLE DATE OFFICE OF FED "w"T' ' BOARD OF HEALTH RECEIVED BY I' mug, o May w� 367 MAIN STREET /�JL HYANNIS,MASS.02601F T VARIANCE REQUEST FORK ALL VARIANCES MUST BE SUBMITTED FIFTEEN (15) DAYS PRIOR TO THE SCHEDULED BOARD OF HEALTH MEETING. NAME OF-APPLICANT (30Z'G,A4\,_ — TEL. NO. 1 S` ADDRESS OF 'APPLICANT NAME OF OWNER OF PROPERTY SUBDIVISION NAME (�k�ti C/�oss► SDATE"APPROVED ASSESSORS MAP AND PARCEL NUMBER - � LOCATION OF REQUEST SIZE OF LOT_... ' Aec�SQ.FT WETLANDS WITHIN 200 FT.YES L NO VARIANCE FROM REGULATION(List Regulation)__ nASON FOR VARIANCE� (May attach if more space is needed) c` euee _�t 100 2o ( -e. s t►� -�01 �(�� lC� -CIS r AN - FOUR COPIES P MUST BE SUBMITTED CLEARL OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.S. , CHAIRMAN SUSAN G. RASK, R.S. JOSEPH C. SNOW, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE HANDED T0:-41 �l�''x^y`'4'/C 1 DATE: f�t> �1i��`�l TOWN OF BARNSTABLE Cf THE T�� �� OFFICE OF = IIAHIISTABL i BOARD OF HEALTH NAB& p� �0 1639• gem 367 MAIN STREET k HYANNIS, MASS.02601 June 14, 1991 William Planinshek Box Car Willy's Grand Central Station 165 Yarmouth Road Hyannis, MA 02601 RE: ORDER TO CORRECT VIOLATIONS OF 105 CMR 590.000, the STATE SANITARY CODE FOR FOOD ESTABLISHMENTS ARTICLE X AND ORDER TO CEASE AND DESIST OUTSIDE CAFE OPERATIONS Dear Mr. Planinshek: On July 2, 1990, you were granted a conditional variance from Regulation 14, of the Town of Barnstable Health Regulations, to have outside dining at Box Car Willys at 165 Yarmouth Road, Hyannis, Ma. , with the following conditions: ( 1) You must have met all the criteria contained in paragraphs A through 0 of the Board of Health criteria for variances for outside dining. Failure to do so will result in revocation of your outside dining privilege. (2) You must have installed electronic air curtains and screen doors at all doorways, serving windows, and apertures used in serving food or drink. (3) The inground grease interceptor shall be of adequate size to accomodate the seating capacity of 108. However, the outside dining area has been utilized and to date, screens have not been in place at all the open doorways and electronic air curtains have not been installed at all doorways, •serving windows, and apertures utilized in serving food or drink. Also, the conditional variance had expired on December 31, 1990 and was not renewed for 1991. In addition, on May 24, 1991, three (3) doorways and one ( 1) serving window were open and unscreened and no electronic air curtains were provided. Thomas McKean, Director of Public Health, handed you an order letter dated May 24, 1991 directing you to utilize effective measures to minimize the entry, presence, and propagation of rodents or of flies, cockroaches, and other insects. The order letter also directed you cease and desist utilizing the outside cafe. f - Later that day, you installed a screen door at the doorway utilized for serving food and drink and closed all the remaining doorways and serving window. Thomas McKean allowed the outside cafe to remain open for the week-end due to the installation of this screen door because you agreed to install the electronic air door on or before Monday 27, 1991 and to keep the remaining doorways and serving windows closed. On June 14, 1991 at approximately 1:30 P.M. , Thomas McKean observed two. (2) doorways and one ( 1) serving window open and unscreened, which are violations of 105 CMR 590.021, Insect and Rodent Control Regulation, of the State Sanitary Code for Food Establishments, Article X, and you shall correct these violations upon receipt of this letter by closing all the doors and windows which are open. You are also directed to install screen doors at all doorways and to install screen windows at all sliding windows within ten (10) days of receipt of this letter. You are further directed to cease and desist serving food and/or drink to the outside cafe upon receipt of this letter and until such time you receive a variance renewal from the Board of Health for 1991. The variance renewal cannot be granted until after such time the electronic air curtains- are installed at all doorways, serving windows, and apertures proposed to be used i" serving food or drink. You may request a hearing if written petition requesting same is received by the Board of Health; however the violations must be corrected regardless of any request for a hearing. Failure to comply with any order issued pursuant to this and any other provisions of the State Sanitary Code for Food Establishments may upon conviction, result in a fine of not more than one hundred dollars ($100) for the first offense and not more than five hundred ($500) for a subsequent offense. Each day's failure to comply with an order shall constitute a separate offense. This order, when signed by the Board of Health Agent, Thomas McKean, constitutes an order of the Board of Health to correct violations of these regulations that are indicated on the order within the time periods designated. PER ORDER OF THE BOARD OF HEALTH �6.a.­_:"Al . McKean Director of Public Health TOWN OF BARNSTABLE TO OFFICE OF i DsaalTeDL i BOARD OF HEALTH oO'EO 39 k 367 MAIN STREET HYANNIS,MASS.02601 July 10, 1991 William Planinshek Box Car Willy's 165 Yarmouth Road Hyannis, MA 02601 Dear Mr. Planinshek: You are granted a renewal of the conditional variance granted to you on July 2, 1990 from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at Box Car Willy's, located at 165 Yarmouth Road, Hyannis, Ma., with the following conditions: (1) The applicant must meet all of the criteria contained in paragraphs A through O of the Board of Health criteria for variances for outside dining. Failure to do so will result In revocation of the applicant's outside dining privilege. (2) The applicant must install air curtains and screen doors at all doorways, serving windows, and apertures used in serving food or drink. (3) The total seating capacity shall not exceed 108, both indoors and outdoors. (4) The applicant must receive approval of the Town of Barnstable Licensing Authority. This variance is not transferable and will be voided if the establishment has a change in use; change in ownership, or is leased to a party other than the applicant. The Board reserves the right to terminate the applicant's outside dining should any unsanitary conditions be observed. ' A copy of the criteria° for granting variances for outside dining is enclosed. Strict compliance with this criteria is required. Very .truly yours, Ann Jane Eshbaugh Chairman BOARD OF HEALTH TOWN OF BARNSTABLE AJE/bcs Enclosure TOWN OF BARNSTABLE �O f THE T0� ��Qfo OFFICE OF i BARISTAM i BOARD OF HEALTH MMS p o 39'Nit�"�� 367 MAIN STREET HYANNIS, MASS.02601 October 24, 1990 William Planinshek Grand Central Station 165 Yarmouth Road Hyannis, MA 02601 Dear Mr. Planinshek: On July 2, 1990 you were granted a conditional variance from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at Grand Central Station, 165 Yarmouth Road, Hyannis, Ma., with the following conditions: (1) You must have met all of the criteria contained in paragraphs A through O of the Board of Health criteria for variances for outside dining. Failure to, do so will result in revocation of your outside dining privilege. (2) You must have installed air curtains and screen doors at all doorways, serving windows, and apertures used in serving food or drink. (3) The inground grease interceptor shall be of adequate size to accommodate the seating capacity of 108. Official documentation of an adequately sized grease interceptor shall have been submitted to the Board prior to utilizing the outside dining area. However, the outside dining area has been utilized and to date, the Board of Health has not received any documentation of the size of the grease interceptor. Also, air curtains have not been installed and screens have not been in place. You are reminded that the conditional variance expires December 31, 1990. If you wish to renew the variance, you must show compliance with the above conditions. You are directed to submit documentation of compliance with the above listed conditions within fourteen (14) days of receipt of this letter. Non-compliance may result in termination of your outside dining privileges. Very truly yours, r Ann Jane shbaugh Chairman BOARD OF HEALTH TOWN OF BARNSTABLE AJE/bcs enclosure a i AA 19 `T Handed TO: Manager As Q%Iffmr,.N of Establishment: Id Attinemanager RE: NOTICI3'. TO ABATE VIOLATIONS OF 105 CMR 590.021, INSECT AND RODENT CONTROI, REGULATION, OF THE STATE SANITARY - CODE -FOR . FOOD USTAULISUMBNTS, ARTICLE X You are hereby notified to remedy the conditions observed below upon receipt of this notice: You are directed to utilize effective measures to minimize the entry, presence, and propagation of rodents or of flies, cockroaches, and other insects. The premises shall be maintained in a condition that prevents the harborage or feeding of Insects or rodents. All openings to the outside shall be effectively protected against the entry of Insects y• and rodents by tight-fitting self-closing doors, closed windows, screening ... screen doors { :shall"be self-closing, and screens for windows, skylights, transoms, intake and exhaust air ducts, and other openings to the outside shall be tight-fitting and free of breaks. Screening material shall not be less than 16 mesh to the inch. You may request n hearing if written petition requesting same is received by the Board of Health within seven (7) days. Failure to comply with any order issued pursuant to this and any other provisions of the State Sanitary Code for Food Establishments may upon conviction, result in a fine of not more than one hundred dollars ($100) for the fl.st offense and not more than five hundred ($500) for a subsequent offense. Each day's failure to comply with an order shall constitute a separate offense. By Order of the Board of Ilealth Inspector For office use only TOWN OF BARNSTABLE Received by THE T OFFICE of Date 2 .R. ,ARS,T,,,, � BOARD OF HEALTH ■1pp i6q 39. 367 MAIN STREET` Ito b�Y k' HYANNIS.MASS.02601.. •. VARIANCE REQUEST FORM Ali variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. L( APPLICANT QO�C r�2 W k t _S TEL. �Z 5 LI � I NAME OF n ADDRESS OF APPLICANT 6 CS off' NAME OF. OWNER OF PROPERTY C�► DATE APPROVED SUBDIVISION NAME ASSESSORS..MAP & PARCEL NUMBER. LOT: SIZE. 4 S LOCATION OF .REQUEST VARIANCE FROM REGULATION (List Regulation) c y — REASON FOR VARIANCE (May attach letter if more aCe i �eed�e p5 � ED CLEARLY OUTLINING PLAN FOUR COPIES OF PL VARIANCE REQUEST, VARIANCE APPROVED NOT APPROVED FEB 2.5. 1991 REASON FOR DISAPROVAL Ann Jane Eshbaugh, Chairman Susan G. Ras Joseph C. Snow, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE 'IHE Town of Barnstable BARNMASS.1639 Board of Health 9� ,0� ArED 1A°�A P.O.Box 534,Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. April 2, 2004 Dennis Carlin DJ's Wings,Ribs, Subs,n' More 696 Yarmouth Road Hyannis,MA 02601 DJ.s:Wtn s Ribs;Subs,ri Morey 165 Yarmouth Road„Hyannis,NEW LOCATION Dear Mr. Carlin, Your are granted a variance to install additional seating in lieu of the Board of Health Regulation which restricts the number of seats based upon the maximum capacity of the existing inground grease trap. You stated that you propose to install a total of 108 seats. The existing grease trap at 165 Yarmouth Road has a capacity of 1500 gallons-designed for a maximum of 100 seats. Section 15.230 of the State Environmental Code, Title 5, requires the grease traps to conform with Section 15.203 which requires grease traps to be designed and constructed based upon a flow of 15 gallons per seat or chair per day. Therefore, for 108 seats, a 2,000 gallon grease trap would normally be required. However, the Board of Health voted unanimously to grant you a variance with the following conditions: V(1 You shall install a mechanical grease recovery device (G.R.D.) in conformance with the ate Plumbing Code. (2�) The existing inground grease trap shall be inspected on a monthly basis and pumped once eery three months. The above described work must be completed before additional seats are provided at this food establishment. S' rely yPM.D. ay Mi , Chat an Board of Health box car �pF tQ(y� DATE: r • FEE: i lARNSTABIE, s NIAS& A REC. BY AIFD MAC Town of BarnstablqcHED. DATE: Board of Heal RECEIVED, 200 Main Street,Hyannis 026 Office: 508-862A644 MARG.Rask,RS. FAX 508 790-6304 Kaufman,M.S.P.H. TOWN Oe Miller,M.D. HEA VARIANCE REQUEST FORM LOCATION '' II G r Property Address: I L 5 �) et �f`1`1�U ll1 Pond �1�%I Gi k'l t`)`-� C)14 co&o r Assessor's Map.and Parcel Number: � � �' Size of Lot: Wetlands Within 300 Ft. Yes Business Name: Df'�5 (.��1 Yil�a R i�'�S� ��;}� 'yl ' ��'�Z1►' No �C Subdivision Name: DON N f 5 CA4i2L,t tJ APPLICANT'S NAME: �'$i )J&3,91060-)f,36:?`1170 Phone 5rT, 775 "9464 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON h n 5Iyno �ILe Ss4 -)er 1 Name: � r� Name: ��tt,�ttx� Address: LCi-+ J0-0111"VPWOA�— Address: jC00 ,t>fU 1 j U,31�i Lac � '�b�'r Fly "j, t Phone: 509 375 — 000,6 Phone: `5( � - VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Q O ' NATURE OF WORK House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Chet isl(to be completed by office staff-person receiving variance request application) \/ 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 tat days prior to meeting date at applicanfs.expense (for Title V and/or local sewage regulation variances only) V/ 4 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 ownedlasee 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 Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.PJL REASON FOR DISAPPROVAL Wayne A Miller,M.D. Q:\HEALTH\Application Forms\VARIREQ.DQC of1HEr The Commonwealth of Massachusetts .. may. . .. . XAM Town of Barnstable c� MA84 a a f 9y0Tf1639. O MAC 2019 Certificate of Inspection 13J.'s Wings, Subs 'n' More Certificate No. Issued to Eithne Carlin Type: Building -Certificate of Inspection IC-18-148 Identify property address including street number, name, city or town and country Certificate Expiration Located at Map/Lot 328-238 6/21/2019 in the Town of Barnstable 165 YARMOUTH ROAD, HYANNIS Location Use Group Classification(s) Allowable Occupant Load 1st A-2: Banquet halls, night clubs, restaurants, bars 107 Restrictions Bar/Dining Area 13 Bar Stools 4 Deck Upstairs 24 ront Dining Area 42 Rear Dining Area 4 Take Out Area 107 Maximum Seating Capacity This Certificate of inspection is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind clear glass and\or laminated and posted in a conspicious place within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Building Commissioner Brian Florence Date of Inspection 8/1/2018 Signature of Municipal Building c�— Date of Issuance Commissioner 7/22/2018 `t—o4u`V 7 U TP PPUE —1 lcl MF �(f,�/�Y r �� y / kUZIjEM ��c IL_. Aa 1 bw�Lv..�D. CDuNr� � _ •I SEAS i1'/67 1 (L1�_G rr'li�' te�uu s+4<H Ynw'S"C A. • __ _ __ __ 6 F'"�'� sf���o w inPs' a 608-478.6191 Y _ _ Clevlin !--'—'— - o%ustcm iisesigns � •' I - - cnD,91s1 !� _ Yw1ep'VO �/y ov lop . A .�,y . .. .. - .D' �M!.iP4ins a IaYouss py DC O.a.e to only.wnY Psnes use Is v P.an p le — ._ Exhibit A t RoAp ADDITIDNAL ADDITIDHAL 'PARKI24G PAMUNG PARKING ARMA \ _ P. G ARFA.U-11 -4- -". ' - - •�cS'w�+o�it%VG't9GRL�S.id,��� ''G4PlvuT. � _._ �� � ,• . all • - - ��/,�To--`:�rr'n,. '. �� _ � - � .. :vim- r THIS LICENSE SHALL BE DISPLAYED ON THE PREMISES IN A CONSPICUOUS POSITION WHERE IT CAN BE READ LICENSE No.7000263 A ALCOHOLIC BEVERAGES THE LICENSING AUTHORITY OF The TOWN OF BARNSTABLE, MASSACHUSETTS HEREBY GRANTS A COMMON VICTUALER License to Expose, Keep for Sale, and to Sell All Kinds of Alcoholic Beverages To eun t zFernses DJ's Win s 'n T To. --•• . ......g � ti�/a T' WW Wring s;� b� I ore _ .... ..�. -----•--------••••-------- � DeI %fin,Manage on the following de asbedemises � �, arm�tll ad H a Is t�.�`'- 'cam �`' a -;- m Three steel ralr,"ad o djacent tq�ood�uc � lg. Three a:trance r` i on east side of railroad carsF ° vo eme agency entr-nV%q xi s si e--of railroad tc�Ars one ergency entrance/exi o�north side of railroad`e ( rallroa�az office andstoage , n`e dining room and ' � �� v xr ,� c 'mow' -i .' kitchen and o ng cd tai ding bar and to ng'e �B vwitti sea mg for 20 and to g. and dining room seating for 4,inc�IPding pa�o area on eastslde .h k d � t W This h;e e is grante"'ands 0 ed upon fie express condi ion; at the ice.'see shall in � # : ' all respects,con o, to 1 the rovisiot r Control Act rC` ter3 of the General I� p � Laws,as americ p p ,rules or regulations made thereunder t ne�`7 ce'sin authorities. This license expire D`e: etnr 31,26Ia8 ,,tlnjes earlier suse�de ,adn'elled or revoked. r ... fc IN TESTIMO . � eesigncl cut feed their official gg signatures this 0, jft - Jana 2f108 The Hours during which A1coYtQ.'c TRICTIONS-See Below Beverages may be sold are: � t:.9k� �/. .g s Daily 10 A.M.TO 1:00 A.M. Liquor'till 12:3 •.•`'.�n�'�?:�_�;�,_.... ..................................................... 111. p !. ..................................................... ^--. a. NOT VALID unless issued in conjunction ....................................................... with a Food Service Permit. LICENSING AUTHORITY PAID: $2,700.00 RESTRICTIONS WE DELIVER a WE ACCEPT a DJ 's EGRESS �'G S, R j off' S N 1�1i 775-WING (775 - 9464) WE DELIVER 7 DAYS A WEEK 10:00 AM TO CLOSING ANY MENU ITEM! $1.00 DELIVERY CHARGE ON ALL DELIVERIES $10.00 MINIMUM DELIVERY ORDER YEAR ROUND HOURS Sun -Thurs 10 AM- 10 PM Fri- Sat 10 AM- 11 PM 165 Yarmouth Road Hyannis, MA 02601 (Located at DJ's Crossing) SOUPS 'N' SALA41 WIN SPECIALTIES CUP BOWL SM(10) LG(15) Homemade Chicken Noodle...................... 2.50............ 3.25 Buffalo Wings..................................... 7.50..................... 9.50 Homemade Chili........................................2.50............ 3.50 Buffalo w/Garlic................................ 7.95..................... 9.95 Hurt Me Chili 2.75............3.75 BBQ Wings...................................... 7.50 9.50 ... ..................... Jal'apenos, Cheese, Hurt Me Sauce YOU CHOOSE THE HEAT Gar* Salad....................................................................4.50 MILD-MEDIUM-HOT-HURT ME! VeggieSalad.......................................................................4.95 Greek Salad...................................................................... 7.25 Honey BBQ........................................ 8.25................... 10.25 .. . . -Tuna Salad........................................................................ 6.75 Teriyaki Wings*..................................8.25................... 10.25 Chicken Salad............................. ......... 6.75 Served w/Sweet 'n'Sour In'Celery Antipasto.................: 6.95 Lemon Wings...................................... 7.50..................... 9.50 ........................................... Plain Wings......................................... 6.95......,.............. 8.95 Chef Salad Char-Chicken Salad.......................................................... 7.25 All Small&Large Wing served Buffalo Chicken Salad.................................. 6.95 w/2 oz. Bleu Cheese 'n'Celery Mild-Medium-Hot w/Homemade Bleu Cheese.......................................add .75 BUCKETS OF WINGS Dressings: Homemade Vinaigrette, Light Raspberry Vinaigrette, Thousand Island, Ranch, Light Ranch, 25 PC 50 PC 100 PC French, Italian, Light Italian, Parmesan Peppercorn. Buffalo............................................15.25.......26.95.......49.95 Buffalo w/Garlic............................16.25.......27.95.......50.95 Bleu Cheese..:.......................ZS Extra BB 15.25.......26.95.......49.95 Honey BBQ....................................16.2s.......27.9s.......so.9s ASSORTED APPETIZERS 'N' MORE Teriyaki...........................................16.25.......27.95.......50.95 SM MED LG Lemon.............................................15.25.......26.95.......49.95 Plain................................................13.75.......25.00.......46.95 Fries....... .......................................... 1.00........ 1.95........ 3.50 Bleu Cheese 'n'Celery is Xtra w/Buckets Onion Rings.....................................................2.75........ 3.95 See Back under Bleu Cheese Chicken Fingers*.............................................................. 5.75 Fried Mozzarella w/Marinara...........................................4.75 BONELESS WINGS Fried Mushrooms* ........... 4.75 Jalapeno Poppers pp .............ers w/Ranch............................................... 5.75 Cream Cheese or Cheddar Cheese Boneless Buffalo Wings......................SM......................LG Chili n'Cheddar Skins..................... 6.50 All Flavors...........................................7.95 ....................11.95 Bacon n'Cheddar Skins.........................:.... 6.50 served w/2 oz. Bleu Cheese In'Celery 1 Potato Skins 4 Halves served with sour cream j *Sauces:Sweet In I Sour,Horseradish BBQ Honev Mustarg Ranch BUCKETS OF BONELESS WINGS Garlic Bread.............................2.50 w/Cheese............ 2.95 Potato Salad..................... ...............1.50 25_PC. 50 PC 100 PC Macaroni Salad................................................................. 1.25 All Flavors......................................21.95.......41.95.......79.95 Coleslaw...........................................................I................ 1.25 - Bleu Cheese 'n'Celery is Xtra w/Buckets Giant Dill or Sour Pickle................................................ .. 1.25 See Back under Bleu Cheese BABY BACK RIBS WING 'N' RIB COMBOS AppetizerRack..................................................................7.95 1-1-2 Combo.....................................,..............................17.95 Half('/z)Rack..................................................................10.95 1 lb. ('/Rack)Ribs, 2 lb. (10) Wings served any style Whole Rack.....................................................................16.95 w/2 Jalapeno Poppers* Half('/z)Rack w/Fries In,Slaw.......................................11.95 Whole Rack w/Fries m Slaw.... 17.95 2-2-4 Combo....................................................................31.95 """"""""""""" 2 lbs. (1 Rack)Ribs, 25 Wings served,any style SEE BACK FOR DESSERTS, - w/4 Jalapeno Poppers* BEVERAGES 'N' BLED CHEESE *Poppers may be substituted w/Mozzarella Sticks or Onion Rings 6104 DOGS, BURGOS, D.J *NRAPS, SUBS 'N' SANDWICHES 'N' MELTS SANDWICHES HotDog............................................................................. 2.50 WRAPS DJDog..............................................................................2.95 Cold Buffalo Chicken Wrapper....................................... 5.75 Chili Dog..........................................................................4.75 Thinly Sliced Chicken Breast:Mild-Medium-Hot, Hurt-me Kraut Dog......................................................................... 3.95 topped w/Bleu Cheese, Lettuce In Tomato Hamburger........................................................................ 3.95 Chicken Salad Club Wrapper.......................................... 5.95 Charbroiled Cheeseburger................................................4.25 Homemade All-White Meat, Chunky Chicken Salad topped Cheeseburger w/Fries......................................................4.95 w/Crisp Bacon, Lettuce In Tomato g Roast Beef Wrap w/a Zap!............... . ................. ......... 5.95 Bacon Cheeseburger......................................................... 4.75 Rare Cooked-in-House Roast Beef topped w/Crisp Bacon, �a Bleu Cheese Bacon Burger.............................................. 5.25 Homemade Horseradish Sauce, Lettuce 'n'Tomato Charbroiled Chicken Breast.............................................4.95 Bleu Cheese Bacon Roast Beef Wrapper........................ 6.25 Char-Chicken w./Fries...............................:..................... 5.75 Rare Cooked-in-House Roast Beef topped w/DJ's Filet-of-Fish...................................................................:.. 3.75 Homemade Bleu Cheese, Crisp Bacon, Lettuce 'n'Tomato BLT................................................................................... 4.75 Grilled Tuna Melt............................................ ... 4 4.75 F Grilled Cheese.................................................................. 3.25 COLD SM 7" LG 10" Grilled Ham 'n,Cheese...............................::....................4.75 Italian . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 Grilled Bacon Tomato In'Cheese 4.25 Ham'n' Cheese . . . . . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 ' .................................... Genoa In'Provolone . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.50 r Turkey 99%Fat-free . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 Roast Beef(Cooked-in-House) . . . . . . . . 5.25 . . . . . . 6.25 a TRIPLE DECKER CLUBS Cheese . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.25 . . . . . . 5.25 t Egg Salad . . . . . . . . . . . . . . . . . . . . . . . . .4.25 . . . . . . 5.25 Turkey Club.......................................................................7.25 Tuna Salad : . . . . . . . . . . . . . . . . . . . . . . . 4.75 . . . . . . 5.75 Roast Beef Club................................................................7.25 Homemade Chicken Salad . . . . . . . . . . . .4.95 . . . . . . 5.95 Ham'n'Cheese Club.........................................................7.25 All Cold Subs toasted upon request HOT TunaClub..........................................................................7.25 Cheeseburg Club...............:...............................................7.25 Homestyle Meatball . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.50 Char-Chicken Club............................................................7.25 Meatball Parmesan . . . . . . . . . . . . . . . . . . 4.95 . . . . . . 5.95 All Clubs topped w/Bacon, Mayo, Lettuce 'n' Tomato Chicken Parmesan . . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 Sausage Parmesan . . . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 All Clubs served w/Fries In Slaw Veal Parmesan . . . . . . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.95 Chicken Cutlet . . . . . . . . . . . . . . . . . . . . .4.75 . . . . . . 5.75 Cheeseburger . . . . . . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.50 Hot Pastrami . . . . . . . . . . . . . . . . . .. . . . . 4.95 . . . . . . 5.95 SPECIALTY SANDWICHES BLT . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .4.75 . . . . . . 5.75 Char-Chicken . . . . . . . . . . . . . . . . . . . . . .4.95 . . . . . . 5.95 DJ's Buffalo Chicken Sandwich....:................................... 7.50 Char-Chicken Bomb . . . . . . . . . . . . . . . . . 5.95 . . . . . . 6.95 Served mild-medium-hot, Hurt Me, topped w/Bleu Cheese, Onions, Peppers, Mushrooms, Mayo 'n'Cheese Lettuce 'n'Tomato SCRAMBLED EGG DJ's Day After Thanksgiving Sandwich.......................... 6.95 Pepper In'Egg . . . . . . . . . . . . . . . . . . . . . . 4.25 . . . . . . 5.25 Fat free Turkey topped w/Homemade Sausage 'n,Sage Western . . . . . . . . . . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.50 Ham,Egg'n' Cheese . . . . . . . . . . . . . . . . .4.50 . . . . . . .5.50 Stuffing, Cranberry Sauce 'n'Mayo Bacon, Egg'n' Cheese . . . . . . . . . . . . . . . .4.50 . . . . . . .5.50 DJ's Fresh Chicken Cutlet Sandwich............................... 6.95 Sausage Egg'n' Cheese . . . . . . . . . . . . . . .4.50 . . . . . . .5.50 Deep-fried Chicken Breast topped w/Lettuce, STEAK Tomato In Mayo Steak'n' 1 Item . . . . . . . . . . . . . . . . . . . . .4.50 . . . . . . 5.75 Steak'n'2 Items . . . . . . . . . . . . . . . . . . . .4.95 . . . . . . 5.95 DJ's Chicken Cordon Bleu Sandwich.............................. 7.50 Steak n 3 Items 5.25 . . . . . . 6.25 6 oz. Charbroiled Chicken Breast, topped w/Imported Ham Steak Bomb 5.75 . . . . . . 6.95 . . . . . . . . . . . . . . . . . . . . . In Swiss, Mayo, Lettuce In Tomato Items:Peppers, Mushrooms 'n'Cheese, Onions no charge All Specialty Sandwiches served on Bulkie Roll All subs available on wrap, syrian, white, wheat, bulkie or rye. All served w/Fries In Slaw SEE BACK FOR DESSERTS, BEVERAGES N' BLEU CHEESE. 1 HOMEMADE BLED GEESE 2 oz...................:...................:......... 1.00 w/celery...... 1.25 3 oz.................................................. 1.50 w/celery...... 1.95 6 oz.......................:..........................2.50 w/celery...... 3.50 12 oz..................................................4.50 w/celery...... 5.50 J SWEETS 'N' THINGS Homemade Brownies....................................................... 1.50 Cheesecake ............................2.50 Bavarian Cream Eclair..................................................... 1.50 � CarrotCake.......................................................................2.50 Snickers Chaos Pie...........................................................2.50 Chocolate Lovin' Spoon Cake...........................................2.50 BEVERAGES i 20 oz. BOTTLES Coke,Diet Coke, Sprite,Diet Sprite, A&W Root Beer, Canada Dry Ginger Ale, Orange, Grape,Fresca .............. 1.50 ARIZONA ICED TEAS Lemon, Diet Lemon, Ginseng or Green 20 oz.Bottle .............. 1.79 NANTUCKET NECTARS Kiwi Berry,Lemonade, Orange Mango, 4 Watermelon Strawberry,Fruit Punch, Grapeade 16 oz.Bottle .............. 1.59 OTHER FAVORITES 2 Liter Bottle,Coke, Diet Coke, Sprite,Root Beer . . . . 2.75 Poland Spring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.25 Milk- 16 oz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.25 SINGLE SERVE CHIPS/LAYS Regular Lays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Salt In,Vinegar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Sour Cream In,Onion . . . . . . . . . . . . . . ... . . . . . . . . . . . . .75 Doritos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Masterpiece BBQ Lays . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Rold Gold Pretzels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 1 co rrec,� S� i z.( Z� Co p� TOWN OF BARNSTABLE SITE PLAN REVIEW DATE: January 18, 1995 TO: Tom McKean FROM: Carol Ann Ritchie, Site Plan Review Coordinator RE: Site Plan Review # 03-95 Boxcar Willy' s 165 Yarmouth Road, Hyannis Map/Parcel: 328-238 Proposal: Add two decks off existing deck. Please submit this form, with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by January 26, 1995. I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. (Signature) A t,'� LI CATJ UN FUR SITE: FLAN REV1 EN FOR OFFICE USE ONLY DATE RECEIVED ACTION DUE BY LOCATION / , ' Legal DescriptionsdxC+4 wl �( A� d a� � Planning Board Subdivision Numbers Assessor's flap and Parcel Numbers 3�-Fr �� a3e Property Address: Q,40,moui-L VcA H L-.Y-iv Aj S OWNER OF PROPERTY APPLICANT / I J / Name: Chrns •�S � Names Q /!/ V WSG-�K 4ddress: c 2C -i we •z 62 - Address*. 16 �t1w(ov Phone: 324 , 1a06 Phones ENGINEER AGENT(interest owner or applicant) vame: Names Address: Address: T .Phone: OWN or rA_ Phone+�, SITE pl-AN REVIEWLF ® �P JA N 1 7 1995 ®1 g c BE C ZONING CLASSIFICATION(S) IT :1157liru PROPOSED Sewer District: Nunber: Nur,ber:_ Public_ --- ----Flood Hazard: 31ze. Size: Frlv:te_ Groundwater overlay: Above Ground:_ Above Ground: Fire District: �Y,14 find?roround:_+ Undergrounds dater: LOT AREA: sq. ft Contents: Contents: Public Private:_ NUMBER OF BUILDINGS Fire Protection: 1/ Existing: -2- LATI.186 STAACES CURB CUTS Proposed: =egiu red: _ Existing: Electrical: Demolition: ?I-ov]ded. Proposed: )n Sste: To Closes Underground: TOTAL FLOOR AREA (in sq.ft ?rf Site.* _ Total: Gas: Residential: Natural.. V Office: IN r157?FICAL fj1c7FlCT:(yes)NLj (no) Fro pine., Medical Office: Commercials yfl IN AREA Of CRITICAL ENVIR4NhENTAL (specify use) 0 �- CONCEFN IE.O.f.A. Is (pes)_ (no)-"Jo Wholesale FFOJEC7 WITHIN 100, OF AETLAND RESOURCE AREA: (yes)_ (no). Institutional: -- Industrial: Ct�lj � Gt 6 U,o"L /2 e�i V f2-es �02 To / LC� / j/Lc3 T p x !� S /��, Id, �s � ar-►M 4 i�v i,-�,s I O ti 1 ��_•rc hL�_ltW_t.(� t)_1�1h._ii1.Li�1NU i� f11 � j� n . r Zoning District Jl— old Kinq' s Highway District —Al— or Listed in National and/or State Register of Historic Places 1 Perimeter set backs, Front �S Side 5 Rear nZ — Lot Coverage �4 Tupe of Use ( zoning) Flood Plain Zone No Elevation 3 + Number Of Floors Floor Area, lst 2 n d Other (specify) Parking Requirements, Required l Provided 1-c,.-✓ ~ 1S v Handicapped Spaces rs Are there accessory buildings? Accessory Buildings Floor Area PLEASE PROVIDE A BRIEF, NARRATIVE DESCRIPTION OF} YOUR PROPOSED PROJECT. n //- 7 Cf CS I assert that I have completed (or caused to beocompleted) the back this of page, the Site Plan Review Application and the e application and that, to the best of my nowl dge , the information submitted here is true. (signature) (date) -,� C(OJ TOWN OF BARNSTABLE OFFICE OF NeaalTABG BOARD OF HEALTH NAB• A t639. `ea 367 MAIN STREET OR HYANNIS, MASS.02601 July 10, 1991 William Planinshek Box Car Willy's 165 Yarmouth Road Hyannis, MA �02601 Dear Mr. Planinshek: You are granted a renewal of the conditional variance granted to you on July 2, 1990 from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at Box Car Willy's, located at 165 Yarmouth Road, Hyannis, Ma., with the following conditions: (1) The applicant must meet all of the criteria contained in paragraphs A through O of the Board of Health criteria for variances for outside dining. Failure to do so will result In revocation of the applicant's outside dining privilege. (2) The applicant must install air curtains and screen doors at all doorways, serving windows, and apertures used in serving food or drink. (3) The total seating capacity shall not exceed 108, both indoors and outdoors. (4) The applicant must receive approval of the Town of Barnstable Licensing Authority. This variance is not transferable and will be voided if the establishment has a change in use; change in ownership, or is leased to a party other than the applicant. The Board •reserves the right to terminate the applicant's outside dining should any unsanitary conditions be observed. A copy of the criteria for granting variances for outside dining is enclosed. Strict compliance with this criteria is required. Very trulyyours, (� kAo-.- Ann Jane Eshbaugh Chairman BOARD OF HEALTH TOWN OF BARNSTABLE3 AJE/bcs Enclosure �oFTHe raw TOWN OF BARNSTABLE ��Q ♦� OFFICE OF BA"STAn i BOARD OF HEALTH y ■M6 � i639. `em 367 MAIN STREET C MP; k HYANNIS, MASS.02601 July 10, 1991 William Planinshek Box Car Willy's 165 Yarmouth Road Hyannis, MA 02601 Dear Mr. Planinshek: You are granted a renewal of the conditional variance granted to you on July 2, 1990 from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at Box Car Willy's, located at 165 Yarmouth Road, Hyannis, Ma., with the following conditions: (1) The applicant must meet all of the criteria contained in paragraphs A through O of the Board of Health criteria for variances for outside dining. Failure to do so will result in revocation of the applicant's outside dining privilege. (2) The applicant must install air curtains and screen doors at all doorways, serving windows, and apertures used in serving food or drink. (3) The total seating capacity shall not exceed 108, both indoors and outdoors. (4) The applicant must receive approval of the Town of Barnstable Licensing Authority. This variance is not transferable and will be voided if the establishment has a change in use, change in ownership, or is leased to a party other than the applicant. The Board reserves the right to terminate the applicant's outside dining should any unsanitary conditions be observed. A copy of the criteria for granting variances for outside dining is enclosed. Strict compliance with this criteria is required. Very truly yours, au� �L� Ann Jane Eshbaugh Chairman BOARD OF HEALTH TOWN OF BARNSTABLE AJE/bcs Enclosure 8�pyo�TNE>o�� The Town of Barnstable mr-OLtn Viol qi Health Department "a"T.n ru• 367 Main Street, Hyannis, MA 02601 �p t679• EO Y�Y k. Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health i April 12, 1991 TO: Board of Health FRROM: Thomas A. McKean�4- Director of Public Health it RE: Box Car Willey's On April 10, 1991 Health Inspector Jerome Dunning was asked two ( 2) questions concerning Box Car Willey's: 1) Outside dining area - When will the permanent structures/ plants be implanted to mark the ten (10) feet setback to the dining area? 2 ) Has Mr. Planinshek added any additional seats. If the answer is yes, when will he convert the 4,500 gallon septic tank into a grease trap? On April 11, 1991 Mr. Dunning went to the site. After his investigation, he returned and stated the following: 1) The permanent structures/plants are presently being implanted . 2) Mr. Planinshek stated he will not be adding any seats. I E TOWN OF BARNSTABLE p�OF TN Tp�♦ OFFICE OF _ ssaasrs� BOARD OF HEALTH y MAss. e 00 i639' 367 MAIN STREET 'ED MPY P" HYANNIS, MASS.02601 March 18, 1991 William Planinshek Box Car Willeys 165 Yarmouth Road Hyannis MA 02601 Dear Mr. Planinshek: Your request to extend the location of your outside dining area adjacent to (zero ( 0) feet from) the parking lot, . in lieu of the required ten (10) feet separation distance, at Box Car Willey's food establishment located at 165 Yarmouth Road Hyannis, is not granted. ,It is the opinion of the Board of Health that alternative outside dining area locations could be constructed at this food establishment. In addition, you did not introduce evidence that denial of this variance would be a manifest injustice, nor did you prove that the same degree of food protection and public safety required under Article X and the Town of Barnstable Health Regulations would be achieved. Your request for a variance to install an additional fifty-four ( 54 ) seats at your food service establishment, without increasing the grease interceptor capacity as required, was also discussed. You stated there is a 4, 500 gallon septic tank connected to your 1,500 gallon grease interceptor. The Board of Health strongly recommends that you hire a plumber to ensure the septic tank is connected to the proper sinks and that you hire a licensed Disposal Works Installer to convert the septic tank into a grease interceptor. This would eliminate your need to request a variance from the Board of Health. Sincerely yours, AAQ aAnnLJ4anEshbaugh, Chai an v sd e� _C Joseph C. Snow, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE TM:cst ICKEY November 12 , 1990 Town of Barnstable Board of Health Main Street Hyannis ,Mass . 02601 RE: Box Car Willy' s Hyannis I , Kevin Hickey inspected the grease trap at Box Car Willy' s in Hyannis ,MA. and it appears to be a 1 , 500 gallon capacity tank. Thank ou, Kevin Hickey P.O. Box 236 Centerville, MA 02632 617771-4128 11. Massachusetts Department of Environmental Protection 7 Bureau of Resource Protection — Drinking Water Program Consumer Confidence Report Certification r5 yi r1`1Vq TA l7l .- A. PWS Information � '•`ua_t Important: J. L '7 PM 3; 56 When filling out 1. Facility- the site or works at which the regulated activity occurs: (text hang) forms on the computer,use Barnstable Fire District _ only the tab key PWS Namefr�Jf'Q to move your Barnstable 4020000 COM cursor-do not use the return City/Town PWS ID# key. The community water system named above Jon R. Erickson hereby confirms that its Consumer Confidence Name °Q Report(CCR)was distributed to each customer Superintendent and/or appropriate notices of availability have Title been given in compliance with 310 CMR 508.362.6498 22.16A. Further, the system certifies that the Phone# information contained in the report is correct and 2005-07-05 consistent with the compliance monitoring data <;a / previously submitted to the Massachusetts Department of Environmental Protection. Sig 'ture Checkpll items B. Consumer Delivery Methods — Based on Population Served that ap .ALL distribution/ delivery/ For systems selling water to another community water system: publication must be completed ❑ My system delivered the applicable information required at 310 CMR 22.16A(4) to the buying before JuLY 1st s stems no later than April 1st of this year, or the mutual) agreed upon dates specifically included Y O P Y Y Y 9 P P Y � in a written contract between the parties. For systems serving less than 500 persons: Date Completed ['i1 My system used one or more of the following methods to notify customers that the CCR would not be mailed directly to them and is available to them upon request. (A copy of the notice is attached). ❑ Mail ❑ door-to-door delivery ❑ newspaper❑ posting notices Locations of Posted Notices ❑ My system provided a copy of the CCR to each customer by one of the following methods: ❑ Published the report in a local newspaper(a copy of the published report is attached). ❑ Directly mailed or delivered a CCR to consumers. For Systems serving between 500 and 9,999 persons: 2005-06-21 Date Completed ❑ My system provided a copy of the CCR to each customer by one of the following methods: ❑'Published the report in a local newspaper(a copy of the published report.is attached). N{ ❑ Directly mailed or delivered a CCR to consumers j ® My system provided a copy of the CCR to each customer by direct mail or delivery. CCR Certification•12/01 ccrcert.doc•Page 1 of 2 Massachusetts Department of Environmental Protection Ll Bureau of Resource Protection — Drinking Water Program Consumer Confidence Report Certification B. Consumer Delivery Methods — Based on Population Served (cont.) For Systems serving 10,000 or more persons: Date Completed El My system provided a copy of the CCR to each customer by direct mail. ❑ My system provided a copy of the CCR to each customer by the following direct delivery methods (other than mail): Locations of Posted Notices ❑ In addition to one of the delivery methods checked above, my system serves greater than 100,000 persons and as required has posted the CCR.on a publicly accessible Internet site: Web Address C. Good Faith Delivery Methods —A minimum of three of the following were conducted: ❑ Posted CCR on a publicly accessible Internet site at the following address: ❑ Mailed the CCR to all postal patrons within the service area. (List of zip codes used is attached). ❑ Advertised availability of the CCR in the following news media (a copy of the announcement is attached): ❑ radio ❑ newspaper❑ television/cable ❑ Published CCR in local newspaper(a copy of the published CCR is attached). ❑ Posted the CCR in public places, including post office, town hall and public library (a list of locations is (attached). ❑ Delivered multiple copies to single bill addresses serving several persons: i.e. apartments, businesses, and large private employers. ❑ Delivered to community organizations (list of organizations is attached). ❑ Post report or notice of availability in the lobby of apartment complexes. Other D. Mandatory Agency Delivery Requirements — For All systems: ® Delivered 1-copy of CCR and 1-copy of Certification Form to the local Board of 2005-07-05 Health. Date Completed ® Delivered 1-copy of CCR and 1-copy of Certification Form to MA Dept. of Public f 2005-07-05 Health. Date Completed ® Delivered 1-copy of CCR and 1-copy of Certification Form to MA DEP Boston 2005-07-05 Office. Date Completed ® Delivered 2-copies of CCR, 2-copies of Certification Form and 2-copies of ALL 2005-07-05 the attachments check-marked above to the appropriate DEP Regional Office. Date completed CCR Certification•12/01 ccrcert.doc•Page 2 of 2 2004 Monitoring Results for Barnstable Fire District Water Department Notes: + Some people may be more vulnerable to contaminants in drinking water than the general population.lmmuno-compromised 'Coliforms are bacteria that are naturally present in the environment and-are:-used as an indicator that other, persons such as persons with cancer undergoing chemotherapy,persons who have undergone.organ transplants,people potentially harmful, bacteria rn6y be present. r - with HIV/AIDS or other immune system disorders,some elderly,and infants can be particularly at risk from infections. These people should seek addice about drinking water from their health care providers.-EPAICDC guidelines on appropriate means zTurbidity is a measure-of the cloudiness of the water. V1le monitor it because it is,a good.indicator of water to lessen the risk of infection by Cryptosporidium and other,�microbial contaminants are available from the Safe Drinking quality. High turbidity can hinder,the effectiveness of disinfectants. Water Hotline(1-800-426-4791)... h 'Copper is an essential nutrient, but some people who drink water containing_co.pp:er in,excess of the action M!crobioloContaminant Con Unit ants g level over a relatively short amount of time could experience gastrointestinal distress Some people who drink MCLG. MCL EPA's Limits Levet Range Violation Years Potential Source of , Health Detected Detected (Yes I No) Sampled Contamination water containing copper;rn excess,of the.action level over many years coLild suffer.lver or kidney damage. Goal People with Wilson's Disease should consult their personal doctor. Total Coliform pos/neg 0. Presence ofcoliform 1 in September NA, NO - 2004, Naturally present in the environment. °Infants and young children are typically more vulnerable to lead in drinking water than the general popula- Bacteria' bacteria in<5%of monthly samples 1i tion. It is possible that lead levels at your home may be higher than at other homes in the community as a Turbidity2 NTU NA ' Tr 1.2 j o.5-i.2 No 2004 soil Runoff. result of materials :used in your.:home's plumbing. If you are concerned about elevated lead levels in your 1oo(o met limits home's water, you may wish to have your water tested and flush your tap for 30'seconds to 2 minutes before Radloctive Contaminants ....,.,. ,,. 77 W• n _.., w a using lap water. Additional irifuriirdliuir.is available from the Safe Drinkiriy 1Ndtei Hutlirle'(800-426-4791). Gross Alpha p pCi/I 10 115 12 jl 11 sample INO 2003 Erosion of natural deposits. - ' Radium 226 pCi/I 0 5 02 ii 1 sample NO 2003 Fmginn of nahtral deposits. State allows us 10 monitor.•.for some contaminants less than once per year because the concentrations morganrcccntamlr►ants fig , of these contaminants do not change frequently. Some of our data, though accurate, are more than one year Nitrate ppm. 10 10 1.2 II 0.2-1.2 NO 2004 Runoff from fertilizer use;Leaching old. from septic tanks,sewage;Erosion of natural deposits. Definitions Perchlorate ppm NA NA ND .• NA NO 2004 " Oxygen additive in solid fuel Maximum Contaminant Level (N1CL): The highest level of a contaminant that,is allowed in drinking water. ;p propellent for rockets,missiles,and MCLs are set as close to the MCLGs as feasible using the best available treatment.technology. p fireworks. Maximum Contaminant Level Goal (MCLG): The level of a contaminant in drinking water below which there Contaminant Unit MCLG MCL EPA's Limits Level lIl Range Violation IYears 1 Potential Source of is no known or expected risk to health. MCLGs allow for a margin of.safety, Health Detected Jf Detected (Yes/No)' Sampled Contamination Action Level (or AL):. The concentration of a contaminant, which, if exceeded, triggers treatment or other Goal �, ., requirements, which a water system must follow. Lead and copper t Treatment Technique (or TT): A required process intended to reduce the level of a contaminant in drinking Copper 3 ppm 11.3 1.3=AL 0.64(90th ` 0.12-1.48 NO 2003 Corrosion of household plumbing Water. percentile) 1 systems;Erosion of natural deposits; . Leaching from wood preservatives. 90th Percentile`. .90% of,samples are equal to or less than the number in the chart. _,. s 2 sites aboveiAL Lead° ppb 0 15=AL 5(90th i' ND-42 NO ' 2003` Corrosion of household plumbing NTU(or Nephelometric Turbidity Units):-,A measure of Clarity. - percentile) systems;Erosion of natural deposits. NA: Not applicable. 2 sites above AL ND: Not detectable at testing limits. ; I PPB (or parts per billionj: micrograms per liter(ug/1). F PPM(or parts per million): milligrams per liter (mg/1). pCi/L (or picocuries per liter): a measure of radioactivity. Pos/Neg: positive or negative for a particular contaminant. - i Non-Regulated Substances:Unregulated contaminant monitoring helps EPA to determine where certain . Collta iinants that may be present in SOuf ce Wate"Include: contaminants occur and whether it needs to regulate tlrosecontaminants. Microbial contaminants, such as viruses and bacteria, which may come from sewage treatment plants, septic Substance "'Unit Level Range Years Potential Source of Contamination systems, agricultural livestock operations, and wildlife. Inorganic contamiriants;,such.as salts and metals, Detected Detected Sampled j which can be naturally-occurring or result from urban storm water runoff, industrial or domestic wastewater Chloroform ppb 1.2 ND-1.2 2004 Naturally present in the environment. discharges, oil and gas production, mining, or farming. Pesticides and herbicides, which may come from a -`Sodium ppm 19 8 f9 2003 Naturally present in the environment.' variety of sources such as agriculture, urban storm water runoff, and residential,uses: Organic chemical con- Sulfate ppm 12 6.2-12 2004 Runofflleaching from natural deposits;industrial taminants, including-synthetic and volatile organic chemicals, which are byproducts of industrial processes „., wastes. and petroleum production; and can also come from gas stations, urban storm water runoff, and septic sys- tems. Radioactive Contaminants,.which can be naturally occurring or be the 'result of oil and gas production and mining activities. m What's the Quality of My Water?`' 0 70_J ,. ~ The The Barnstable Fire District Water Department is pleased to share this water quality report with you. It via 0 �• .,, describes to you, the 'customer; the quality of your drinking water. This report covers January 1 through a a December 31, 2004. Barnstable's drinking water supply surpassed the strict regulations of both the State Most h of Massachusetts and the U.S. Environmental Protection Agency (EPA), which requires all water suppliers to produce reports like this every year to each customer. In 2004 our water department distributed 191,922,000 gallons of water to our.customers. Our water source 1 is groundwater pumped from four gravel-packed wells, which are located throughout the District. Well #1 AL is located on Phinney's Lane, which is adjacent to our office. Well #2 is located on Breed's Hill, which is x; adjacent to the airport. Wells#3 and 4 are located on Route 132, which is adjacent to the golf course. Barnstable treats your water by adding KOH to adjust the pH to a neutral.7.0:. Town zoning laws limits and/or prohibits certain uses of the land surrounding the well fields and recharge areas. We have been working on a SWAP (Source Water Assessment Plan).An initial draft has been completed and we are currently awaiting the state's approval. The SWAP will list potential sources of contamination for our source water as well as our susceptibility to the potential sources of contamination.When the state approves our SWAP we will.make it available for review upon request at our water office. • In 2002, the President signed into law the Bioterrorism Preparedness and Response Act.The law requires every water system to conduct a Vulnerability assessment. Ours was completed in 2004. Preliminary findings t show that our system,is already in good order:A new Emergency Response.Plan will be developed pending ' final results of our assessment. Neither document will be available for public,view.- In our continuing efforts to: maintain a safe and dependable water supp.ly,it..rnay be necessary to make improvements in the water system,The-costs of•these improvements may be reflected in,the rate structure. ,+ Rate adjustments may be necessary in order to address these improvements If you have any questions about this report or concerning your water utility, please contact Jon R. Erickson,. Superintendent, by calling 508-362-6498 or by writing to this address: PO,Box,:5461.Barnstable, MA 02630- . 0546. Also,you'are welcome,and encouraged to-attend our regular Board of Water.Commissioners meetings For the 1 st Tuesday of each month at 4:30.PM at the Water Department Office.(1841 Phinney's Lane). y k Board of Water Commissioners:::Terry.W.`Karras,.Chairman; Evelyn G. Bassett, Member;. Richard P. Carroll, Member Tile ' v „ The U:S:�Environmental Protection Agency (EPA) wants,you to'know: + - In order to ensure that tap water is safe to drink, EPA prescribes regulations.that limit the:amount of certain i contaminants in water-provided by public water systems. Food and Drug,Administration regulations • j establish limits for`contaminants in bottled water that must provide the same protection for public health. Drinking water, including,bottled water may reasonably.be expected to.contain at,least small amounts of co ! a some contaminants.' The.presence of.contaminants does:not necessarily:indicate'that water poses a Cn } N ; Annual Water Quality Report health risk. More informatiomabout contaminants and potential health effects can be:obtained by calling a for the Calender y the EPA's Safe Drinking Water Hotline (1-800-426-4791). - _ ; , ,, year of 2004 ; t " W Il Barnstable Fire District �' The sources of drinking water (both tap water and bottled water) include`rivers; lakes;streams, ponds, maLOaS m X { reservoirs, springs;and,wells:As'water;travels over the surface of.the land or,through,the ground,.it dissolves. o m° � Water Department naturally occurring minerals and; in.some'cases, radioactive material; and can pickup substances resulting rn r O C from the presence of animals or from human activity. m PWSID#4020000 THE COMMONWEALTH OF MASSACHUSETTS BOARD ;OF HEALTH 7 . ... ........... . OF..................................... ` Allpliratinn 'or Bitipmal Workii Towitrnrtion Vrrniit Application is hereby'made for,a Permit to Construct (\,4 or Repair ( ) an Individual Sewage Disposal System at: + l G�.t y.t� -` -----•---••----------•----•- --•---•• --•--•--•---- ----------------------------••---------- Loc Address ' No. ...... ••.------••----•••••---•----•--•--•-•- --- -- Own -- A�dr s `�`/` Installer Address $ UType of Building Size Lot............................Sq. feet ,. Dwelling—.No. of Bedrooms _ _________________Expansion Attic ( ) Garbage Grinder Other-� Type of Building _ ' _------ __ No. of persons............................ Showers ( ) — Cafeteria ' Oth xtures ...................................................... ------•-----•--------------------------------------------------------------------------------- Design Flow_..__. �f.?�.. s_...._.____..gallons per person 7.7... r d�y. Total daily, flow---t > ___________________ a1loPns. W �-•� - WSeptic Tank Ligtud capacity_`6 allons Length___. width---- Diameter__- _._ Depth..... .......... x Disposal Trench—No:.................... Width___._______________ Total Length------- Total leaching area-1. _ .....sq. ft. Seepage Pit No.______�_- -____ Diameter........��-_. Depth below inlet_..___.___-___. Total leaching area-----------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date-------------------------- --------•- a Test Pit No.. 1 '�_._..__.__-_minutes per inch Depth of "Pest Pit____________________ Depth to ground water........................ �14 Test Pit No. 2... .....n inutes er inch Depth of Test Pit.p �............... De to ground water-- ----------.----- , -- ...... •-----•.--•• _ - -- -- . D Description of SoilP" •= ------------=---•---•-•••----•---•-- --••• ------•---•--•------------------- . ---•• -•-- --•- w 'S . ---- -----------------------------------------------------------------------------------------------------------== ------- - U Nature of Repair ', rterations—Answer en applicable..._. _.. ...._ -----------P- ------ 1_ C � -- �---=-------------�----.--------------------------------------- Agreement: Y The undersi ed agrees to install the afore cribed Indivi al Sewa Disposal System in accordance with the provisions of Article NI of the State Sanitary ode— The u er • ned f rther agrees not to place the system in operation until a Certificate of Compliance has b e ssued by t e o rd of he th. yy igned. ........... ----•--•.................................... --••.................. _�-/-- Ztr--------- Application Approved B ____-••--------------•-•---•---Date .._.---- Application Disapproved for tJ followi g reasons___ _________________________________________________________ ____ 1 --___--•-----•---•-•-------------------------•-•-•-•-•----------------------------------••-------- Date PermitNo......................................................... Issued.............. ......................................... Date ........ THE COMMONWEALTH OF MASSACHUSETTS C� J BOARD O HEALTH . ...... .........O F......... ... ......-.......................................... Tnti$irate of fInntplianrle MQ IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.... --•- ••-•-•- stalle Co 7 i has been installed in accordance with the rovisio � of I of The State Sanitary Code as descri ed in the _ application for Disposal Works Construction Permit No._ 7-___ ----------- dated.s___1 __.r��'_a.�._..__._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. + DATE.. "l-1'1— -----------.................................... � --e A-;• �- - , .�, lip s r � No......... -•---A..... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH .......... ... .. . ............OF..........................'.............................. :.................. Appliration -fear 13iiptuttt Works Tomitrnrtion Vrrmit Application is hereby'made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal System at + o -----=----------•- ---- ------ --••-.................................... 1 Loc io" Address I`o. '--•-- ... • ------ - ---••-------•--•----- ' /�Ow. � ------2........ --------------- Addr s W { `.. ---------•-••-- Installer Address s Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms _ Expansion Attic ( ) Garbage Grinder ( ) s U per, Other- Type of Building l ._. No. of persons............................ Showers ( , ) — Cafeteria ad Other 6 ` ----------•------------- Al W Design Flow __ s ' gallons per person p r d�y. Total dvl flow 7 ......... allgn� WSeptic T.nk Liquid capacity y, allons Length____/ __._ Width._ ...._. llnameter___ .._ Depth...___._ y Dis osal'Tren h No Width.-_ Total Length-------- j Total leaching Area-i , gft. ...............___sc. ft.Seep Seepage Pit N Diameter_.__.-. Dbelow l C _:__. Total leaching are. I'. z Other Distribution box ( ) Dosing tank aPercolation Test R€sups Performed by------ -------------`-------- ------------ Date----------------------------------- Test Pit No 1 _ minutes per inch Depth of 'Pest Pi ......... Depth to ground water --.-_.---_ :. f� Test Pit No 2 -t _n mutes er Inch Depth of Test Pit ' De to grq,�nd water ' G1' " =D .,.- 1 Description of Soil__" - •-- = --- . . .. �y -- --- -- - t r ------ -- ` -------------,--:------------------.--------------- U Nature of P.epanrs or lteratnons nswer en applicable - r"�' - `---•-redagrees -------- --------------------- Agreement The undersi to install,-the afore cribed Indivi al Sewa e Disposal System in accordance with the provisions of Article \I-.of,the State Sanitary ode— The a er gned f rther agrees not to place the system in operation until a Certificate of Compliance'has b e ssued by e o rd of he th. f Igned y •---------- �f x Date Application Approved B ___- : •-•------- _ ---------------------------------------- Date Application Disapproved for t e follow g sons.;.- .:--' ---------- --- ---- kE .............••••••-•---------------•. .. -- :----d ... Date----•------•-_------._....••--•-••-•-------•-------...-----•---------- y Date ,��'�-• • Permit No..............-- - ------ -." -----•-•-------•----- Issued.----. --------------•••-•rx` Date .a. THE COMMONWEALTH OF MASSACHUSETTS B BOARD OOF HE-AL;TH ex, � ........... .........O.F........ . ................................................... Q.,Prtifiiitty of Tompliaurr TAIS .S TV CE IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by - •-••- • ................... ---••----------•-•-•- -- - - - - •--- � � staller has been installed in accordance with the+ ovisio of N tc I of The State Sanitary Code as descri 'ed in the G application for.Disposal Works Construction Permit No.. �................. ----------- dated.~'.. . ........... THE ISSUANCE OF THIS +CERTIRcATE SHALL NOT BE CONSTRUE© AS A GUARANTEEJHAT THE SYSTEM WILL.FUNCTION SATISFACTORY. DATE -•-------•--------------------- Inspector-•-•- ....................... --------_-••- •----- --•--•-'--------------- .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C_ oyd .. ....::OF...........,,4.�. --------------------- �V �„., �•- No.. FEE........................ Dio gi 96rk trnrt' tt Permi sion eby granted ------- ----r-�- ---- -- -- to Constr/It ( r Repair ) aan/Idivndual Sew e �osal S tem �> at Noy:-€: � 9,� - `- ' Street 1=- ` ,. -------- -•------------•------ � as shown on the_`application for Disposal Works'Construction it Dated__ �r ,_,+���' P -/ ---------- DATE--- /OBBS ..` _.. � •--FORM 1255 & WARREN. INC.. PUBLISHERS h.l nti 3 rl�j Cl�ql _ 1�X1 u V Oi 0 O O CO 0 (Jo G o O O 00 LIJ ��► 3-J' O - - ins -- - 10 OHO OO 117,E - � q 0 , . ' 's (Zorc \ � vA N ' W L- N � OF N J` O co S w° DATE DESCRIPTIFFFFON w..n Ij f I6 , 11 3t 31 YI 28 27 T .T � 9 $ {0 <t T � T \(� 1 V O S i�Ww 17 r {5 I' r I , I i DATE- - m 022 7 `L004 `L ® DRAWN BY, R.D.C. 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X.W. HOT WATER V VOLTS CENTER LINE CHECKED SY- C.W. COLD WATER X.P. HORSEPOWER D.F.A. DROP FROM ABOVE A.N. W. DIRECT WASTE K.W. KILOWATT S. STEAM INLET ' I.W. MOIRE CT WASTE AMP. MLPERE R STEAM RETURN SHEET NO- F.D. FLOOR DRAIN S.R. SINGLE RECEPTACLE C.F.M. CUBIC FEET/MINUTE F.F.D. FUNNEL FLOOR DRNN D.R. DUPLEX RECEPTACLE COL. COLUMN G GAS PH. PHASE J.B. JUNCTION BOX K. B.G. BOTTLE GAS A.F.F. ABOVE nNfS ED MOOR C.P. CORD AND PLUG B.T.U. BRITSH THERMAL UNIT B.T.C. BRANCH TO CONNECTION F ® ® ® S E R DICE EQUIP AA E Ri SCHEDULE� ITEMDESCRIPTION ELECTRICAL WATER WASTE GAS MANUFACTURER MODEL REMARKS ITEM U NO. i 25 _ vi i N 1 1 BREAD CABINET CRAIG MFG. BC-24-30 ALL S S, 24"X 30" W REAR&RIGHT SIDE SPLASHES& 2 DRAWERS 1 + Ol - • 2 1 REFRIGERATED SANOW4CH UNIT NOT IN CONTRACT EXISTING VERIFY ELECTRICAL REQUIREMENTS 2 /A 3 2 WALL SHELVES METAL MASTERS W51560-16 4 ALL S S,60'X 1S" G.C. TO PROVIDE WALL BLOCKING 0 a 3-A 2 WALL SHELVES METAL MASTERS WS1572-i6 4 ALL S S, J2"%15" G.C.TO PROVIDE WALL BLOCKING 3-A • 4 - 1 HOT FOOD TABLE NOT IN'CONTRACT EXISTING VERIFY ELECTRICAL &PLUMBING REQUIREMENTS • 4 • 5 1 SLIDING GLASS DOOR REFr^,16ERATOR NOT IN CONTRACT EXISTING VERIFY ELECTRICAL REQUIREMENTS f 5 . • 6 t WORK TABLE NOT IN CONTRACT EXISTING 6 y, • , 7 1 F000 SLICER NOT IN CONTRACT EXISTING VERIFY ELECTRICAL RECUIREMENTS 7 ,fy 8 2 WALL SHELVES METAL MASTERS - WS1536-16 4 ALL S S, 36"X 15" G.C._TO PROMOE WALL BLOCKING) p 9 N y t 9- --1 -HAND SINK.•• 1 1 1-I ADVANCE TABCO 7-PS-60 W FAUCET,BASKET DRAIN&WALL BRACKET,MOUNT RIM ®34"A.F.F. G.C.TO PROVIDE WALL BLOCKING) O IO 3 'CASH REGISTERS NOT IN CONTRACT VERIFY ELECTRICAL REQUIREMENTS 10 p+C • 11 2 BAG IN A BOX RACKS NOT IN CONTRACT - Il • 11 1 ICE DISPENSER W SODA FAUCETS NOT IN CONTRACT BY VENDOR VERIFY ELECTRICAL&PLUMBING REQUIREMENTS 12 13 - - SPARE NUMBER- - SPARE NUMBER- - - - 13 1/ 2 5 S PASS-THRU SHELVES FABRICATE CUSTOM 2 UNITS, 1 61" X 18" NODE& i 58"X 18"WIDE 14 15•^ 2' MERCHANDISER REFRIGERATORS 10.6 1 1A 1 x TRUE FOOD SERV GDM-49 SELF CONTAINED UNIT W GLASS DOORS NEMA 5-15 PLUG _ 15 OD I6 1' FLOOR MOUNTED MOP SINK 1 19 2' METAL MASTERS F1915 W 312690 SERVICE FAUCET 312688 MOP HOLDER& 312689 HOS&BRACKET G.C. TO PROVIDE WALL BLOCKING 16 17 1 SHELVING UNIT METAL MASTERS EAGLEGARD EPDXY COATED, 4-TIER MOUNTED ON 74"HIGH POSTS 17 + A L" • 18 1 REACH-IN FREEZER NOT IN CONTRACT EXISTING VERIFY ELECTRICAL REQUIREMENTS 18 OJ 19 8 WALL SHELVES METH.MASTERS WS1560-I6 4 ALL S S,60'X 15" G.C. TO PROVIDE WALL BLOCKING 19 D 1 WORK TABLE W SINK 1 17 td METAL MASTERS T30605EM-BS ALL 50!60 %30 W/BACKSPLASH,UNDERSHELF.MARINE EDGE, (1)T&S B-0221-CC FAUCET& 7 FRANKUN 100-i335 LEVER WASTE GGGiii 21 1 HOT FOOD TABLE 12.5 2$ 2% I X RANDELL MFG. 3613 W MANIFOLDED DRAIN STO COMMON GATE VALVE NEMA 6-20P PLUG � 22 1 UNDEROOUNTER FREEZER 13.8 4 ID 1 % TRUE MFG. TUC-67F SELF CONTAINED UNIT W/CASTERS NEMA 5-75 PLUG - 22 , n • 23 1 PIZZA PREP TABLE NOT IN CONTRACT EXISTING VERIFY ELECTRICAL REQUIREMENTS 23 - O • 21 1 DOUBLE OVERSHELF FABRICATE CUSTOM ALL S S, 36"X 15" MOUNTED TO ITEM 25 - 24 W 25 1 WORKTOP REFRIGERATOR 8.3 1 120 1 X TRUE MFG. TWT-36 SELF CONTAINED UNIT W CASTERS NEMA 5-75 PLUG' T'' 25 2 WALL SHELVES METAL MASTERS WS1548-16 4 ALL S S, 48"%.15" G-C. TO PROVIDE WALL BLOCNG 26 • : 27 4 FRYERS NOT IN CONTRACT EXISTING VERIFY PLUMBING REQUIREMENTS - D DATE DESCRIPTION 28 2 FRYERS $ 140 PITCO.INC, SGISS S S TANK,DOOR, FRONT&SIDES,CASTERS&GAS QUICK DISCONNECT HOSE 2R 29 1 S S WORKTOP FABRICATE CUSTOM ALL S S 49-3 4"X 30 W REAR&RIGHT SIDE SPLASHES _ 3 A 1 REFRIGERATED SANDWICH UNIT 4.6 I 120 1 X TRUE MFG. TSSU-27-8 SELF CONTAINED UNIT W CASTERS&DOOR HINGED RIGHT NEMA 5-15 PLUG 3D 31 1 48"COUNTERTOP CHARBROILER 4- 116 VULCAN-HART VCCB47 W GAS QUICK DISCONNECT HOSE 'R 32 1 REFRIG.EQUIPMENT STAND 8.9 I 1'.J I X TRUE MFG. TRCB-52 SELF CONTAINED UNIT W CASTERS NEMA 5-15 PLUG - S 31 1 SALAMANDER BROILER 4 1 SOUTHBEND MRA-32 W LUE RISER, TO BE MOUNTED 70 ITEM 34 33 34 34 1 4-BURNER RANGE W/GRIDDLE NOT IN CONTRACT EXISTING VERIFY PLUMBING REQUIREMENTS 35 a1 35 1 EXHAUST HOOD W.0 0.5 120 1 % CAPTIVE AIRE CUSTOM ALL S S, 22'-6"X 56"X 18" HIGH W UGHTS.FILTERS&3"REAR&RIGHT SIDE AIR SPACES .._ - 35-A 1 EXHAUST FAN&DUCTWORK CAPTIVE AIRE CUSTOM REFER TO SHOP DRAWING FOR MECHANICAL REOUIREMENTS 36-A 35A 1 MAKE-UP AIR FAN&DUCTWORK CAPTIVE AIRE CUSTOM. REFER TO SHOP DRAWING FOR MECHANICAL REQUIREMENTS T8 to YrC OT S/S WALL PANELS CAPTIVE AIRE CUSTOM "L"SHAPED, 22'-6 X 56`X 78"HIGH W CHROME PLATED TRIM STRIPS& 1 INSIDE CORNER -_ 35C Ic 35 1• REACH-IN REFRIGERATOR 9.5 1 13T 1 % TRUE MFG. T-49 SELF CONTAINED UNIT W CASTERS&BOTH DOORS HINGED IFFT NEMA 5-15 PLUG DATE- 02-27-2004 37 1 HAND SINK Y 1 1-I ADVANCE TABCO J-PS-60 W AUCET,BASKET DRAIN&WALL BRACKET,MOUNT RIM®34"A-F.F. G.C.TO PROVIDE WALL BLOCKING _ 37 DRAWN BY- R.D.C. ID 1"" FIRE SUPPRESSION SYSTEM ANSUL OR EQUAL R-102 J.B. TO BE TIED INTO BUILDING ALARM SYSTEM BY E.C. G.C. TO PROVIDE WALL BLOCKING SCALE, 1/4'"=1'-0" 39 OT STORAGE SHELVING METAL MASTERS EAGLEGARD EPDXY COATED, 4-TIER MOUNTED ON 74"HIGH POSTS 40 40 1 WALL SHELF METAL MASTERS WS15108-i6 4 ALL S S. 108"X 15" G.C. TO PROVIDE WALL BLOCKING 40 41 - 1 3-COMPARTMENT POT AN SINK 2)1/Z' 2)1 3 METAL MASTERS FN2060-3-24-14 3 W 3 20"%20"SINK BOWLS, 2 24"DRAINBOARDS,SINK COVERS, 2 T&S B-0231-CC FAUCETS& 3 FRANKLIN.T00-1035 LEVER WASTES 41 42 1 UNDERCOUNTER DISHWASHER 455 6.7 ZS 1 X 1 I JACKSON JPX-300H W 70 DEGREE RISE BUILT=IN BOOSTER 42 43 1 & - f I i-1 T ADVANCE TABCO 7-PS-60 W AUCET,BASKET DRAIN&WALL BRACKET,MOUNT RIM®34"A.F.F. G.C. TO PROVIDE WALL BLOCKING 43 44 1 DOUBLE TRASH MODULE WAYMAR SM-T - 44 . 45 i WALK-IN BEER COOLER 5.0 tID 1 % WA BROWN CUSTOM OUTSIDE BOX,6-9-1 2 X 7-9 X 7-6 HIGH.W LYWOOD REINFORCED FLOOR W/DIAMOND TREAD PLATE 45 rcW. 4SA 1 COOLER EVAPORATOR COIL W.A.BROWN CUSTOM - 45-A O 45-B 1 COOLER CONDENSING UNIT W.A. BROWN CUSTOM OUSIDE PRE-ASSEMBLED UNIT W OUTSIDE PACKAGE LOCATION TO BE VERIFIED - 45-B 46 2 KEG RACKS NEW ACE 31842TT7 18'%42",4-KEG CAPACITY 46 - SPARE NUMBER- _ 47 .�. 47 - -SPARE NUMBER- _ 48 - —SPARE NUMBER - - SPARE NUMBER- 48 49 1 WATER FILTER MANITOWOC.INC AR-4000 C.W. FEED TO ITEM 50 BY PLUMBING CONTRACTOR IN FIELD G.C. TO PROVIDE WALL BLOCKING 49 50 1 ICE MACHINE W BIN 9.8 1- 4 ZB-23D 3 X S MANITOWOC,INC QY-1004A S-570 SELF CONTAINED AIR COOLED UNIT,830 CBS.ICE PRODUCTION PER 24 HOURS&430 LBS.ICE BIN CAPACITY 50 51 51 1 DROP-IN SINK 1 t 1-1 METAL MASTERS CDI-10-14-5-1 W FAUCET, TO BE DROPPED INTO ITEM 55 52 2 WALL SHELVES - METAL MASTERS WS15114-16 4 ALL S S 114"X 15" G.C. TO PROVIDE WALL BLOCKING 52 53 1 ICED TEA DISPENSER NOT IN CONTRACT BY VENDOR 54 1 COFFEE BREWER NOT IN CONTRACT BY VENDOR VERIFY ELECTRICAL&PLUMBING REQUIREMENTS - co W W _ 55 1 MILLWORK.BEVERAGE COUNTER NOT IN CONTRACT MILLWORK PROVIDED BY MILLWORK CONTRACTOR 5 56 .1 TRASH RECEPTACLE - NOT IN CONTRACT - 557 5 O �QW7 57 1 PASS=THRU WINDOW NOT IN CONTRACT MILLWORK PROVIDED BY MILLWORK CONTRACTOR x • 58 2 BACK BAR COOLER 7.0 1 120 1 % TRUE MFG. TBB-24-48 SELF CONTAINED UNIT NEMA 5-15 PLUG 58 59 V2 59 1' DRAFT BEER SYSTEM W OWER PERLICK CORP CENTURY TYPE OF CISPFJNSING HEAD&LOCATION TO BE VERIFIED WA 1 DRAFT BEER SYSTEM POWER PACK 10.5 1 12) 1 X PERLICK CORP 4404 AIR COOLED UNIT 5&A z U 60 1 SODA SYSTEM W 2 GUNS NOT IN CONTRACT - 61 - 61 1 36"COCKTAIL STATON 1 S62 UPREME METAL CRI-12-36-7 W -CIRCUIT COLD PLATE&SK-3 SINGLE TIER BOTTLE RAIL 61 Z W • 62 2 BLENDER STATION t5.0 1'L` 1 X 1/1 1 1-1/C SUPREME METAL CR-RS-15 FREE STANDING UNtT W UPLEX OUTLET RECEPTACLE y�6., Q a0 63 1 BOTTLE COOLER 4.6 1 120 1 Y. TRUE'MFG. TD-36-12 SELF CONTAINED UNIT NEMA 5-15 PLUG A X 64,.. '1 3-COMPARTMENT BAR SINK 1 1 ?-1/1' SUPREME METAL . CRB-53C W -4 SINGLE TIER BOTTLE RAIL 64 O 65 1 BAR HAND SINK I 1T 1-1 SUPREME METAL CR-HS-15 W AUCET&A-50 LEG CHANNEL 65 O 66 1 BOTTLE COOLER 7.3, 1 120 1 % TRUE.MFG. TD-65-24 SELF CONTAINED UNIT NEMA 5-15 PLUG y 66 F W 67 1 24"COCKTAIL STATION i SUPREME'METALCRI-12-24-7 W -CIRCUIT COLD PLATE&BK-2 SINGLE TIER BOTTLE RAIL 104 68 1 UNDERCOUNTER DISHWASHER 45.5 6.7 4 20B 1 X 1 1- JACKSON JPX-300H W 0 DEGREE RISE BUILT-IN BOOSTER 69 • 69 1 MILLWORK BAR TOP NOT IN CONTRACT MILLWORK PROVIDED BY MILLWORK CONTRACTOR _ 70 69 70 - - SPARE NUMBER- - SPARE-NUMBER- T 0 STORAGE SHELVING METAL MASTERS EAGL-EBRITE ZINC COATED, 4-TIER MOUNTED ON 74"HIGH POSTS T + CAD FILE NAME• + 72 1 REACH-IN FREEZER NOT IN CONTRACT EXISTING VERIFY ELECTRICAL REQUIREMENTS 72 • D79WDiC3/PLAN/36369 • 73 2 REACH-IN REFRIGERATOR NOT IN CONTRACT- EXISTING VERIFY ELECTRICAL REQUIREMENTS •DENOTES EQUIPMENT NOT IN KITCHEN CONTRACT. • •DENOTES'EXISTING EQUIPMENT NOT IN KITCHEN CONTRACT. _ NOTE: • . .DENOTES EXISTING EQUIPMENT TO BE RELOCATED. ALL PLUMBING AND ELECIRICAL CONNECTIONS FOR THESE FIFEV434CE ON FOR AFE N PRELIMINARY EXISTING EQUIPMENT AND EQUIPMENT NOT IN KITCHEN DNS AALLY• ALA EQUIPMENT CONTRACT TO BE VERIFIED BY THE INFORMATION SH THESE CKANSE PA OWNER iJID OR GENERAL CONTRACTOR. ARE SLIBAECT/RAL PROPOSAL SELECTED BY OWNER .. NOS.. QG TO VERIFY W/OWHSe BEFORE BED UNITED EAST IS NOT RESPONSIBLE FOR ANY Mt!fCEN MDT BE OAS�l UBLE MECHAt41CAL REQUIREMENTS FOR EXISTING EOUIPMENT EAST R W BE USED FOR CO6BLEF . T£�PLANS ARE US®FOR COKTNICID/l ' TO BE'::USED. 1T IS THE RESPONSIBILITY OF THE 11neTmuM UmWNn•W A°t�6' GENERAL CONTRACTOR,PLUMBING CONTRACTOR AND ° ELECTRICAL CONTRACTOR TO VERIFY ALL REQUIREMENTS THESE DOCII&ffPITS ARE Ae weam wlwk«myN wlQwl - - WITH OV41ER TO ENSURE PROPER CONNECTIONS ARE MADE. FOR PRELIMINARY& WwLLLm�mof]Yu.La Tm�Ivu. 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