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HomeMy WebLinkAboutDOMINO'S PIZZA - FOOD Dominos Pizza '3821,Falmouth Rd. M.Mil' art► r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudag noli M.D. ra �rti� e � F.P.(Thomas)Lee,. 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. 'era nur a Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1098 Issue Date: 01/01/2022 DBA: DOMINO'S PIZZA OWNER: KC PIZZA, INC. Location of Establishment: 3821 FALMOUTH ROAD, UNIT#4 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 19 OutdoorSeating: 0 Total Seating: 19 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE- ICE CREAM: Gr�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �1HE For Office UInitials: do Town of Barnstable Vq Date Paid d$ BARNBPABLE. : Inspectional ServicesMAM 639. `0$ � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11/30001 �I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: KC Pizza Inc" /b/a Domino's Pizza ADDRESS OF FOOD ESTABLISHMENT• 3821 Falmouth Rd. Marstons Mills, MA 02648 65 v`. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): hornrry Circle, Ma , MA 02 E-MAIL ADDRESS: domirnoscapeco&' mail.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( ) 49 700 2 TOTAL NUMBER OF BATHROOMS: X WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) X ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: r� OUTSIDE: TOTAL: J 9 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) X FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc I OWNER INFORMATION: FULL NAME OF APPLICANTKris Jones SOLE OWNER: YES/NO OWNER PHONE # -661 W l4 I ADDRESS 65 T ornberry Circle, Mashpee, MA 02649 CORPORATE OWNER: The same CORPORATE ADDRESS: The same PERSON IN CHARGE OF DAILY OPERATIONS: Aa-.,/q t-� 4"/ aI/a 1 z) Z/ 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 2r / S/ 2f bk /3 i SI NAT E F APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://w ww.townofl)arnstable.us/healthdivision/al)plications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC I st. Q\Application FormsT00DAPP REV3-2019.doc ,.r ` Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aaRNSTAU , : Paul J.Canniff,D.M.D. MA F.P. Thomas Lee Alternate � q. 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1098 Issue Date: 01/01/2021 DBA: DOMINO'S PIZZA OWNER: KC PIZZA, INC. Location of Establishment: 3821 FALMOUTH ROAD, UNIT#4 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 19 OutdoorSeating: 0 Total Seating: 19 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: 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: For Office e `NKE'°"yti� Town of Barnstable Only: Initials Date paj� Amt Pd BMMSPABLE. : Inspectional Services Mnss' Check# A 4 1659. Public Health Division ArED µp+a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLIICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE4� fy 212 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: re / /2 Z"p— Tn C. q� b d ®/l7/ �—S 19;Z 2 e— nADDRESS OF FOOD ESTABLISHMENT: 38.21 /—a� 10� � - P0-1—,5A/2S 14�11S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ,3 O/ ��✓�� v1 ��s� ��� D2��/ yy� E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - of- 112 O 7/ TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NOL ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? Nlk IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED a 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: ��yy FULL NAME OF APPLICANT �f S 149 Aes SOLE OWNER: YES NO OWNER PHONE# ADDRESS CORPORATE OWNER: �tY CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: 4S'e-// Z92 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 1l 120 l2 1. 1�S e, / 2. df a-d4-p /D l lel 2� - 4 A 12- 2020 SIG ATU OF A PLI ANT 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication ForinsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. + BARN 9TABLe. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate °N 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: 1098 Issue Date: 12/10/2019 DBA: DOMINO'S PIZZA OWNER: KC PIZZA, INC. Location of Establishment: 3821 FALMOUTH ROAD, UNIT#4 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 19 OutdoorSeating: 0 Total Seating: 19 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions, t"E Town of Barnstable For Office Use Onlv: Initials: Town Date Paid' Amt Pd$ BARNSTABLE, . Inspectional Services 039. a � Public Health Division Check k— fD MP Thomas McKean, Director �,�-(�- (Ct LO 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 a APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I I I � NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: �'Y10c 5 1 12Z� ADDRESS OF FOOD ESTABLISHMENT: lbga' MAILING ADDRESS(IF DIFFERENT FROM AB VE): 6 M4�rr 4-k 00649 E-MAIL ADDRESS. A0jr�iirn05 C CW vim 0L4r1, Como ',� ® v TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 0 ) 41 - 1 TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO \,/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: y SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 1 OJ OUTSIDE: 0 TOTAL: 10 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) V FOOD SERVIICE 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 REV3-2019.doc ^OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# ADDRESS �� ►'l0�'Yl b 2 F Gr f C�f, �(a�h e� �- �02�O CORPORATE OWNER: CORPORATE ADDRESS: SoiNI-Q. PERSON IN CHARGE OF DAILY OPERATIONS: NAcv'\A K0,,_ 5Pt"I 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 05 / 05- 1 Ao2( 1. kon l lec �WAPeSif j 1/ p-7 / a o Z'L U �� r- 2. 0),-A oLr 10�j I We_ 10 / 1� / ,Z-023 ()�� `5iddP �l�0 2- I zC9 13 A4 N (m(9 SIGNATU E O PPLICANT 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 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 ,Z EHr Town of Barnstable BOARD OF HEALTH t Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM = John T. Norman a s ., 200 Main Street, Hyannis, MA 02601 F.P.(Thomas)Lee Alternate Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1098 Issue Date: 12/20/18 DBA: DOMINO'S PIZZA OWNER: KC PIZZA, INC. Location of Establishment: 3821 FALMOUTH ROAD, UNIT#4 MARSTONS MILLS MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 19 OutdoorSeating: 0 Total Seating: 19 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD;, MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: .. ...... ......... . . r6. oF1we roy� Town of Barnstable For Office Use Only: Initials: o� 'i • Date Paid Amt Pd$ _ BAURMNSTA MASS. ` Inspectional Services 9cbAT i639' Check#Eo3. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: t c /p/Z Z O_ Tom,e- 1��/D ,00,-�7/p /S' Piz z a- ADDRESS OF FOOD ESTABLISHMENT: ZJ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): � %1 orh -e-rf-y r sGrr�J�J �/4 E-MAIL ADDRESS: dp /v-s GD nq/U., / TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (SA TOTAL NUMBER OF BATHROOMS: Z WELL WATER: YES NO7)( ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: )f— 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? N / IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED QAApplication FormsTOODAPPREV2018.doc it PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT 461S Jot)-e3 SOLE OWNER: YE /NO OWNER PHONE # ADDRESS 10rh -Pi/-r S4,0?, ae--7 CORPORATE OWNER: IV--H-r Jofides FEDERAL ID CORPORATE ADDRESS: !o S D 9 d1 ,�LrY (/!�• j'�'�7 � /� 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 A r en Awareness Expiration Date 1. lzoaTrilwila 2 / If � 20 1. /�i I-6n0- l r� L� lz 2-2/2 2. VX,Q r-r- Oka,�Z 1 D i l i 23 at,4:�k �[,,2-11Y SIGNA APP T DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FoansTOODAPPREV2018.doc IH4 E rok� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: I of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET s:ao-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,61g. �0� HYANNIS,MA 02601 M-8 -62- 64 46FRI44 No Reference -R-Red Item PLEASE PRINT CLEARLY 508 FOOD ESTABLISHMENT INSP CTION REPORT i/AJU SS Name �� Date 3 Type o f Inspection Routine Address 3 1 rZCj V I Risk Food Service Re-inspection !✓l t� �� ` t 1 Level al Previous Inspection UV Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP !�� , / n In: Other j_ Inspector d a� Out: Each violation checked re wires 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) ❑ fly( IA.,;/- 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 V. ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating -I ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling /'�✓t�f �y�Yt l C;d ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding L rr PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control �h / 7T ❑ 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 AL Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No es Non-critical(N)violations must be corrected immediately or Overall 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. ❑ 9 Emergency Closure El 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 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 t critical violations. If 1 critical refrigeration. FC-7 590 28.Poisonous or Toxic Materials .008 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to critical viola' ns=C. 30.Other DATE OF RE-INSPECTION, Inspector's gn ture Print: 31.Dump r screened from public view _Z) Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 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-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.1] Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated 7-204.12 Chemicals for Washing � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 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* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait 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* I 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(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef criw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 3-201.17 ) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 secGame 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* $ 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) 3-202.11 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* 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 Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Conveniently Located and Accessible Within 2 Hours and From 70'F to 41'F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* y 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* 30. 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. TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: Z of 2---- OFFICE HOURS BARNrAa�E PUBLIC 0 STREET HE NH DIVSION 8:00-9:30A.M. 3:30-4:30 RK Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 659. � HYANNIS,MA 02601 508-862-46" No Reference R-.Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT �� U Name r Dat Tvoe of Type f Inspection p uti CY Address Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation /A / Owner HACCP Y/N Temporary Suspect Illness If (NV )� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP ^ ,,In: �/I^^ Other. Qi'LS r/�F4- Gc�c Inspector Out: U F" 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) ❑ Mae 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 l - FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 1� 4.Food and Water from Approved Source 16.Cookin ❑ PP ❑ 9 Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction, Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations re if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 g violation,4 to 8 non- ''cal violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Stre Printumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered YN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N e-.-.�.i..�- �ei.- _.�..�,,..-.ti.._._..�-.-,. •_ ram, •-._r.l� •ti-"",.._ -Y"�.i�•�""--.,�v-�-.+..-.-.-�-:,. �_ �.���.•,`._.,.-....•�--,� .�....s�-- ,r _-�r--..... �.r-. .-._ .. �.. _ _ _ _ z, _<-�. .�_ -> .. .-.. . .-- - r- ..: -.- . Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions l 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-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated 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 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 Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meals&Game * E ecnve 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* L2-3O1.11 1 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 1 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 * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F kitchen operations should be debited under Regulatory Authority Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 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. $ Receiving/Condition 2-0 F Ol.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165' 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-165'17 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial) Processed RTE Food-140'F* Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140'F to 70'F (A) g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 � Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45`F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans - 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ,F,re roi TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: ���"���f' Date: Page: of ' 7- do OFFICE HOURS BARNSTABLE. PUBLIC 200 MAN STREET 3.30-4:30 P.M. DIVISION - .. - a04:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified FRI e3- �m� HYANNIS, MA 02601 M-8 -464 No Reference R=Red Item PLEASE PRINT CLEARLY °rF0 MPS° 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT. Name �� Date I Tyne of Type of Inspection 71 4e, r Routine Address / �', Risk d Service Re-inspectionLevel - ai Previous Inspection Telephone Residential Kitchen Date: e 4 �(d 6 Mobile Owner HACCP Y/N Temporary �( wrs � ✓ � C�P Caterer era omplai Person in Charge(PIC) Time Bed&Breakfast HACCP -- �0C/ , n � In: 3 �1 Other Inspector K Out: I�D Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. L �_'{ f l(� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ CAA N ('��� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) f Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 3 1 ; _ _ %, FOOD PROTECTION MANAGEMENT ❑ �12.Prevention of Contamination from Hands ��� 1 Y%•C� r-- 1 j ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities c EMPLOYEE HEALTH PROTECTION FROM CHEMICALS -� ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �.r C.C�t ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) �C ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18. oling RlykD % t, F­] 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding I1 �{� PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control INS - W.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ; ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating 1 �A ❑ VoluntaryCompliance p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Base on an inspection today,the items checked indicate violations of 105,C�MR 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 non-critical violations 9 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 =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-7590 ( )( .008 9 ) 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,gal rip -critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe or' Sign re Pri t: 31.Dumpster screened from public view /yam S Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size -Variance Letter Posted Y N Dumpster Screen? Y N ._ -•,,. _.._-�..-�,..-.- --.-.- .-mow...+...._.-.✓-i: .. .. "+-�- �------..v:....--L. -.-.-... .._�--'..,_. � -.. � x-:_�.r --... __`- _.�- ....._�... v. ....�...-_..__ .. .. - _. _ �. v ;rr �..... ... •• - .- -.., � . . -- -_^+- �^ .- Violations related to Foodborne Illness - Vlo/ations 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-fxom=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* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in--Charge to .. •7=1021'1'-•-'- Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* "7-201.11•-�•" Se aza[ion-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 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 terateResery ice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) _• Disposition ofAdulterated or Contaminated i - 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202,13 Shell Eggs* Sanitization Temperatures* TIMEIrEMPERATURE CONTROLS 3-202.14 I Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of - 3-20Z:76- 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 Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats.&Game g * s e�nve tnrzoor 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 ShellFsh.and Flsh�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 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* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - - _ 2-301.11 - Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding 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) Commercial] Processed RTE Food-140°F* (Blue Items 23-30) _ 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 3-202.18 Shellstock Identification* 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 Within 4 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 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. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 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. HEALTH INSPECTOR'S Establishment Name: n \� Date: Go 2( Pa e: of 'Op INE rp TOWN OF BARNSTABLE - � , - g : 4. .� o OFFICE HOURS PUBLIC HEALTH DIVISION 600-930A.M. BARNSTABLE, ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9�A ;39:s�0� HYANNIS,MA 02601 M-8 -FRI.62-4644 No Reference_ R Red Item PLEASE PRINT CLEARLY 508-8 rFOM"� FOOD ESTABLISHMENT INSPECTION REPORT Name tj p S Date Type of Type of Inspection �. c e 'on s Routine ) ( - Address r7p� Risk ood Servi Re-inspection `� Level a ai Previous Inspection t Telephone Residential Kitchen Date: .�-`� Mobile Pre-o n Owner HACCP Y/N Temporary ! Caterer General Complam ,e/� _ Person in Charge(PIC) Time Bed&Breakfast < �<N,t� p �: In: Other A� l 161a /t.( Inspector Out: 1 $ 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) ❑ , y Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ CAL-I, 'f Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ � .'j (�-,// K�Vjr FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ Aaqyz 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities C 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 ^/" �i Y`� CsV tea, c �- ✓� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) (N ❑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 } f, 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 �// 22.Postin of Consumer Advisories / `❑ 11.Good Hygienic Practices ❑ 9 , Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �� ✓!� Pprf Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes' h6 '�f 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 Suspensio C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure El 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 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If If 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) g 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 Sig ure 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: Y . PIC, Sigre f (� Outside Dining N Print: 'c� v\ Self Service Wait Service Provided Grease Trap.Size .c 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.O63(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives `" Law Cooled to 41°F/45°F Within 4 Hours* 590.OQ3(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 Additives Contamination from Raw Ingredients 7 5 Poisonous Or Toxic Sub9tances 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 - - -- - -__ _ _ Qther* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* _ - - - - Applicants*- 3-302.1I(A) -• Food Protection* 7-201.11, Separation-Storage*g 20 Time as a Public Health Control .. 590.003(F) Responsibility of A Food Employee or An _ -and Vegetables 7-20Z..l l_ Restriction-Presence and Use* 3302.I5-` '�W4shing'Fruits 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G.) I Reporting by Person.in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance 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)Disposition Returned Food and Reservior of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources - " " - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* ) Compliance 590.004 A-B j Com line 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-Z01.13 Fluid Milk and Milk Products* '4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 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 ctive 1/12001 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-155'17 15 sec* 3-201.14 Fish.andRecreationally 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 StuffingContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section temporary and - ide in cater- - * - - - - - - - Ratites-165°F 15 sec* in mobile food,[em or and residential Sources 70 Proper,-Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-30114 When to Wash* * Other 590.009 violations relating to good retail . 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding _2-401.11_ Eating,Drinking or Using Tobacco* * Requirements. $ 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 * 3-30.1.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity O Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* - 3-101.11 Food Safe and Unadulterated O 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 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Within 4 HoviS* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours*- 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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 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 F6od Code or 105 CMR 590.000. oF. T TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: VZO/ t(10 S Date: Z/ Page: ' of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss. MON.-FRI.HYANNIS,MA02601 sos-as2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY fib, ,e39•p0� rF°Mm FOOD ESTABLISHMENT INSPECTION REPORT C r C ✓) _ Name ���0 Date 3 Type of Type of Inspection Ro b Address .,D 2 �� f� Risk od Se- s e-inspection ` Level Retail revious nspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP -Lf(b In:Z;ZOPVj Other D f Inspector §60 Out: -?,.±YD ---. Each violation checked requirel 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 n�� � ) Ale- ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13,Handwash Facilities `_ L CiO EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 'IVVLe- ❑ 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 , n,,, j r ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding tj v� c.eQt3'J,,. I n PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control J ✓ [� t ✓t ❑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 �+ 0b Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation (�r `vi / Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No "rl esIV . 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 In pection 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 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically 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 cal vi ritical. 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 S' a, re' __ Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature° Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N � Dumpster Screen? Y N CL �Y 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 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 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* 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(13) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(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 * e ecn�trmoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* ing,mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing Game and IMId Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices - 17 Reheating for Hot Holding Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec* $ 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 foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsticed Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) kern 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. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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 q °p 11"4E ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name- .�.j Date: '3 l Z� Page: Of r OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9,30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS ,659. ,e� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prED1AP`p FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 OaD 1' Name c Date 3 Lt Tyue of In ec io f 'S Routine �) Address 'L, f�,� Risk Food Service Re-inspection 1 r(.�„( 02 r�-CI Level Previous Inspection '/ 3r 02Al p Telephone Residential Kitchen Date: Mobile Pre-operation [/lLf^•t(`J Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP -L In: 2)'�Q� Other Inspector Out: J� Each violation checked req Tres 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) ❑ l 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 a�^S. 6 A41; t 0 C a EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives kkTtVje l ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals l/ 41 FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) c ,�_ out /1 < ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures /� 1 Q ❑ 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 ,® 2t ^�� ❑ 8 eparation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIO (HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP Ll ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting nsumer AdViy L Violations Related to Good Retail Practices(Blue Items) Total N ber of Critical Violations --NvAes Critical(C)violations marked must be corrected immediately. (blue& red items) 1 ❑ 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,t e items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo 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 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 regardless of the number of critical,results in an F. 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) g 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non- lions=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signa fe Print: 31.Dump screened from public view J A Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's I a ur Print: C Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN o Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods.for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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 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* EB cAw mnooi 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 Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-(D) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutMidhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regu/atoryAuthor(ty 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* 3-401.1](A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. 8 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* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-201.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3403.11E 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 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' 1590.000 Tags/Records: Products Fish Prodts 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590,004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying g 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. THf k t s; . TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: � "�' Date: Page:,_ Of Z ^'Sam„ 5 OFFICE HOURS ' -`PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • '� -,r 200-MAIN"STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS" $ ,,. MON.-FRI. �A ,6aq,a. ,, HYANNIS, MA 02601 soe-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'E0N1"' FOOD ESTABLISHMENT.INSPECTION REPORT Name l/ld � Date of jnioBwection 0 rt !/I Rout' Address fY�� Risk ood Servic re-inspection Level Previous Inspection Telephone Residential Kitchen Date: e? Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness S - d Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP ` In: Other Inspector Out: 4 ) be- o Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. :� I _ ,F , Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ �W/ d 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 ❑ 1$.Cooling P . ❑ 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control stop .r ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. O ❑ 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 B=One critical violation and less than 4von-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590:008) 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other n. DATE OF RE-INSPECTION: Inspector's ature - 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 Signa�y Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y . N Dumpster Screen? Y N /✓_ ' s Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* . 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 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 Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Wazewashin Hot Water 7.206.12 Rodent Bait 3-201.12 Food in a Hermetical/ Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801:11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 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* ( )O Pathogens*' S90.006(A) Bottled Drinking Water* 3-40L11 A 2 Comminuted Fish,Meats&Game s ecmc rnnooi 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 * 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F IS sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 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 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2 401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F - (A) g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours* 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 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 Conformance with Approved Procedures* S:y59OFormback6 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, ror TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of q. OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. eAnnsrAeLe. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1 MASS. MON.-FRI. ,679. HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY, .erFD MP�p FOOD ESTABLISHMENT INSPECTIONREPORT Name Date yue of Type of Inspection O A Tess L�' 1 Risk Food Service Re-inspection , _ - Level coon -Telephone Residential Kitchen Date: _` p Mobile re-operation Olwner HACCP Y/N Temporary ss77 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) ❑ SLIto _ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ „% ` a FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands i ❑ 1.PIC Assigned/Knowledgeable/Duties e AT ❑ 13.Handwash Facilities - I 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 i PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 'Z V [ ❑ 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: N s Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. 0 ❑ Voluntary Compliance ❑ EmpKpa ri lion sio peGtf Sc ul cSJ s ns o C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency CI sur �G is osal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. s 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 viola ons. 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 re . and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.o08) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 to 8 non-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 14 #Seats Observed Frozen Dessert Machines: Outside Dining Y N RLCA Signature Pr nt: 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)jDe. Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives. Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 1 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) - * - w 7-101.11 Identifying Information-Original Containers* 2- 590.003(C)- Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P �' 7-102.11 Common Name-WorkingContainers* 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* - r ' = - 3-302.11(.4) Food Protection* P g 20 Time as a Public Health Control * 590.003(F) ` Responsibility of A Food Employee or An � _ 3-302.15_ Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 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 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* q- Food and Water From Regulated Sources' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B• Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and _ ( ) P - - - 4-501.111 - Manual Wazewashing-Hot Water - - - 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. j 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16- Ice Made From Potable Drinking Water* _ - Concentration and Hardness# 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System _ gg Equipment*• Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg,five 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 Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - 4-703.11 Methods of Sanitiza[ion-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 3-201.1$ Molluscan Shellfish from NSSP Listed _ _ _ _ * _ 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing - - -Game and Wild Mushrooms Approved By _ 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - - 2-301.12_ Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail -, 590.004(C) Wild Mushrooms* _ _ _ t. _ - _ ___ _ - 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17- Reheating for Hot Holding 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* * (Blue Items 23-30) 3 202.15. ,Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * - 12 __ Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated O g 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 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41*F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans _ 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* 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. -. I �., � (R)=Refrigerated ' Room Te • - • • • - (uness (rt)=room temperature Opened/Prepped In-use Product Unopened #Days unless noted #Days unless noted from mfg date Walk-in Cooler 1 Cabinets •Makeline Rail 1 Other "Opened,prepped,and in-use dates cannot exceed the unopened shelf life date- BlackiOlrvee Best�yate : � �(In brine}(R) (drained)(R) Chocolate Dipped Cookie 7 days from freezer' <' x Cornmeal �` 4morths �NERA M � 30 .; Garlic-Chopped Use-ky-date 30(R) 2(R) Green Olroes BesE oy date , '� ,x 14(i grrne}(R} - 2(drelnEd){R) H Green Chilies(can) 2 years or Best-by-date 7(R) 2(R) 00 Pan Release(spray) Best oy dates( V 6i} Parmesan Cheese Packet 4 morths Pineapple i - l USB t� date a„7 mdnnE R a r y ( )( ) � -:.,. ... Prepped Bread Sides&Pan Pizza N/A Dough Day's 1-4: 4 cumulative hrs"'I Day 5-6:2 cumulative hrs"' Sandi+nch BrearJ �> 6 day fromffeezer` µ Mp nc®eut Entl Of Days Soda Use-by-date Tomatoes uch dread je po ( )x (Jae by data 7(in brine}(R) r 2{dralned)s(R) w, n Banane Use-by-date 30(in brine)(R) 2 (drained)(R) d Fire Roastetl Red Use�y date; ��� (In brine}�{R) 2'(' ratned){R) �x w� .;. . ,,. .. C xf-- drained: d Jalapeno Use-by-date 30(in brine)(R) 2(drained)(R) Pepperoncinf(whole) _ Best-by date 30(In b rnr e}z(R) `2 (drain (R) z V Butter Flavored Oil(8F0) 9 months 60 original container 2 �tom, BBQ(red ar,brown) ', Use by date (R 41 x _ _.- Chma Magic 90 days or Use-by-date 4 GBrIiC Qil 81entl �E (Jse by-daiWn ui 4 a O U u Garlic Parmesan Use-by-date 7(R) 8 cumulative hours AM I Heartyf Marmara Use by date : 7(R} �g' 8 cumulahve hours .:.: YW y Pizza Use-by-date 7(R) 8 cumulative hours F E ar k, 10 Ranch f Use try d to x �x7{i?} 4(refrigerated ovemlght} Sweet Mango Habanero Use-by-date 7(R) 4(refrigerated overnight) Wing(mlld hot orhre} , Use ydate 30 Q Irgtnal container(R)* 4 ­­ "D Z _ r Crushed Red Pepper Shaker Use-by-date 30 Garlic&Herb use by data J, 30 ' Oregano Use-by-date 60 Powdered Sugar 1 year 30 `The shelf life`from freezer'supersedes the MFG shelf life. Roll bag and place in a clean,sanitized covered container. After being made from property proofed dough. Prep Area PREP-10©January 2018 Domino's IP Holder LLC e .N °p IKE roN, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: V ►V(,�l��l Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION' 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p MASS. a m HYANNIS,MA 02601 ,. MON.-FRI. No Reference R-Red Item PLEASE PRI T CL Y 508-862.4644 'EON1P' FOOQ ESTABLISHMENT INSI C ON REPORT Name Dat a Type of Insoection O ation Routine Address Risk Food Se Re-ins n Level Previ Telephone ® Residential Kitchen Dater /' IN , WK16/aL47 Mobile Pre-ope at on Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP AA In: Other Inspector O Each violation checked requires an explanation on the narrative ge(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 9 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALSat ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals C 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) f- ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSPI W ❑ 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 8�red items) f' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Rating ll Rang Overall 1✓//� 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 to s ❑ 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 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 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. lation,4 to 8non-critical vi ations< 30.Other DATE OF RE-INSPECTION: n cto s i U nt: 31.Dumpster screened from public view 4,>/ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's ign ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N y 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* 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 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 15 0.003(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* P4-702.11 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 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. 1g 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 * Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cri e 11112001 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* 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- 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 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )(b) 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. $ 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 3-202.15 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 3 403.11 Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated B) 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-50114(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* 3-50114(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 I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* 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, row TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: Date: Page: of p� 1 OFFICE HOURS BARNSTA9LE.o' PUBLIC 200 MAN STREEETSION - 3:30-4:s0 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date Verified � ASS. •� HYANNIS,MA 02601 M-8 -FRI62-4644 1a3v 508 . No Reference R-Red Item PLEASE PRINT CLEARLY p p. ' 'FD1AP' FOOD ESTABLISHMENT INSPECTION REPORT ! . Name Dat *Ae-of Tvoe of Inspection p Routine n Address Risk oo spection Level _ n 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 bL 'l f Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEfTEMPERATURE 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 QQ Critical(C)violations marked must be corrected immediately. (blue&red items) �J © 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 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 6=One critical violation and less than 4npn-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and.less than,9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7.to 8 non-critical violations. If 1 critical refrigeration. 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.Dump ster 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 IC' Signa ' e Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N D? � / Dumpster Screen? Y N �i! Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 590.004(F) Other* 3-501.16(A) Hot PHFs Maintained At or Above 140`F* °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 - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person-in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -REQUIREMENTS FOR. 3-306.14(A)(B)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 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ery-five 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 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutWIdhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )�) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items non-critical * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to then the me 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 3402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* - 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.HE tow TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: C ge: . of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified b;: �0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY- MP'�A 508-862-4644 FOOD ESTABLISHMENT INSPE TION PfiPORT Name Date a of i2ection a Ion Routine j Addres Risk s n -A 9Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness rweffA k A a "vk 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) ❑ Oils Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ -14 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 /'Jd ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or ColorAdditives CJn._Z�J ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals LA FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(P Ially Hazardous F ods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures If ❑ 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 ❑ Time PROTECTION FROM CONTAMINATION 20. me As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE P 9 ULATIONS(HSP) -- *A/A ❑ 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 Violatio s �-� ;� � 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 44ecdn 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 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requ' ments (590:009) Y p 30.0 p DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpste creened 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 Sign/ u�re N rint: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives- Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 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 Other* 3-501.16(A) Hot PHFs Maintained At of 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 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 * 3-304.11 Food Contact with Equipment and Utensils* 7_ 3.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204. Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 4,ncidental Food Contact,Lubricants* Beverages with Warning Labels* Q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Re 'cted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B).Compliance with Food Law* 4-50-1.I11 Manual Warewashing-Hot Water 7.206.12 Roden ait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Qwders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring*'" 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS * 4-501.114 Chemical Sanitization-Temp., H. CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized P�.P i 16 Proper Cooking Temperatures;for PHFs 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_ Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cave 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* 4-703.11 Methods of Sanitization-Hat 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 m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ( ) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )(1)ro) 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. $ - Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) Y 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) RemainingUnsliced Portions of Beef Roasts* Critical and non-critical violations,which b not relate o then the me illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 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. r 3821 Falmouth Road septic flows 1/4/2017 Summary by Down Cape Engineering, Inc. EXISTING Building# Use First floor SF FF flow 2nd fir SF 2nd Floor Flow Existing Total Flow 1 Animal Hospital 1306 434.0 904 66.3 500.3 2 Aztec Repro (mixed) 1026 .7.7.5 780 58.5 136.0 3 Tanning/Office 1156 72.3 1156 86.7 159.0 4 Office/mixed 2199 275.0 1320 99.0 374.0 5 Quick Stop (retail) 1391 70.0 1391 104.3 174.3 6 Pak Mail (retail), 1890 95.0 1890 141.7 236.7 7 Windmill (retail) 1154 132.0 1154 87.0 219.0 9 Office 1158 87.0 1158 87.0 174.0 10 Office . . 1070 80.0 1070 80.0 160.0 11 Office 899 67.0 899 67.0 1 134.0 Total: 1389.8 GPD Total: 877.5 Total: 2267.3 GPD Note:Animal hospital is changing from kennels to office visits,from 50gpd/kennel to 75 gpd/1000 sf. Site is not within a Zone II. All second floor spaces currently office use PROPOSED: No kennels in Bldg 1 and replace office with two 1 bedroom dwelling units on 1st and 2nd floors of Bldg 9 PROPOSED Building# Use. First floor SF FF flow 2nd fir SF 2nd Floor Flow Proposed Total Flow 1 Animal Hospital 1306 97.5 904 66.3 F 163.8 2 Aztec Repro (mixed) 1026 77.5 780 58.5 136.0 3 Tanning/Office 1156 72.3 1156 86.7 159.0 4 Office/mixed 2199 275.0 .- Iu � 1320 99.0 374..0 ✓ �25 a 5 Quick Stop (retail) 1391 70.0 1391 104.3 174.3 6 Pak Mail (retail) 1890 95.0 1890 141.7 236.7 (M 7 Windmill (retail) 1154 4132.0 1154 87.0 219.0 9 Residential 1158 220.0 1158 220.0 440.0 10 Office 1070 80.0 1070 80.0 ! 160.0 11 Office 899 67.0 899 67.0 j 134.0 Total: 1186.3 GPD Total: 1010.5 Total: ; 2196.8 GPD r Soto, Kathryn From: Kris Jones <dominoscapecod@gmail.com> Sent: Thursday,June 17, 2021 12:49 PM To: Soto, Kathryn; Rosen; Dominos 3779; Dominos 3068 Subject: Re: Recent inspection Attachments: Inv_WO019469_from_HARRISWARREN_COMMERCIAL_KITCHENS_16740.pdf Dear Kathryn, I just wanted to let you know that we took the following steps to correct everything that you addressed during the last inspection. 1. Invoice from Harris-Warren Commercial Kitchens has been attached. The Company found out that the temperature control wasn't set up correctly in the top unit. That's why the temperature in some of the toppings was off. 2. We have changed the way we are doing the prep so the buckets will be filled up to 2/3. So far our tests show that by doing that the temperature will not exceed 38 F. 3. We posted signs reminding the employees to keep the unit closed when not in used. 4. Our Supervisors stop at the store every day to verify the temperature. 5. We use fresh toppings and utensils if a customer informs us that they have any time of allergy. Please let me know if you need anything else. Thank you, Kris CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! On Jun 9, 2021, at 4:02 PM, Soto, Kathryn<Kat . n.Soto cgtown.barnstable.ma.us> wrote: Hello, I received a complaint regarding a potential food borne illness complaint(non-confirmed). Please see the attached inspection report for the site visit. I checked the temperatures and labels on the food items that were consumed and also on random items. I found two items in the food prep area unit out of temp range. All food in these units must be below 41F. When I inspected a couple months ago I found the same issue. The oven lets off a lot of heat and makes it difficult to keep the food cool especially if the cover is off. I felt the best solution is to keep the cover on the food except when food is being prepped. When I came in the covers were off and no food was being prepped. Also the bin at the end had cheese that was stuffed very high and more in contact with the air. The other issue I found was cross- contamination in several containers. Cheese in jalapenos, cheese in tomatoes, cheese in chicken, pineapple in ham, 1 I olives and cheese in pineapples and meat,cheese, olives in shredded steak. This a major issue for cross contamination. Also this is part of the allergy training that one person at each food establishment has taken and then given a certificate. The issues with food temperatures need to be immediately addressed as this is the second time I have come across this. The foods being out of the correct temperature range are what cause food borne illnesses so this is a very serious problem. I spoke to the director and he agreed that we need a written plan to show what will be done from here on out to make sure the temperatures on all the bins in the food prep area are below 41F. Feel free to reach out to me with any questions or guidance on this. Take care, Kathryn A�W M� Health Inspector Town of Barnstable 200 Main St Hyannis, MA 02601 508-862-4639 <image003.png> The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it. Thank you for your cooperation. <SKM_458e21060908320.pdf5 a Kris Jones Franchisee Domino's Cape Cod dominoscapecodegmail.com (508) 561 -1481 2 I JCE#512-Windmill Square, 3821 Falmouth Road, Marstons Mills, MA Date: 12-4-14 Summary of Wastewater Flows (LANDCOURT LOTS 1 & 2) Existing Proposed Building Description Flow d Description Flow d 1 Animal Hospital 500 Animal Hospital 300 2 Aztec Repo. 136 Aztec Repo. 136 3 Tanning, Office, etc. 160 Tanning, Office, etc. 160to%, 4-===.Dunkin Donuts "459 Dunkin Donuts =K- ' 385 5 Quick Stop 174 Quick Stop �174 6 Pak Mail 236 Pak Mail 236. 7 Windmill 219 Windmill 219 8 Bank . 291 Dunkin Donuts 565 9 Office 174 Office 174 10 Office 161 Office 161 11 Office 135 Office 135 Total = 2,645 gpd Total = 2,645 gpd Total Wastewater Flow for LANDCOURT LOT 1 = 565 gpd Total Wastewater Flow for LANDCOURT LOT 2 = 2,080 gpd Total Wastewater Flow for LANDCOURT LOTS 1 & 2 = 2,645 gpd r CV'a S �, �.Y ...r y= � F- j e $ yp w w.. 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PJ j �, �". e � � � ---- -- r ""ORDER . . .OFT Ma • • . • �oGP�,IY O�,NFo �oERAli I M,0DOMINOSn NOW ANY WA V PIE' C E of the P 1'E IOU p®i °RD ORDER� R o� EWARDS f ...................... ..................... PIZZA 7r 1wu-item minimum.*Handmade pan pizzas,bread bowl pasta&bone-in wings will be extra.Domino's Piece of the Pie Rewards®program is open only to U.S. ...idents 13,with's Pizza Profile account.Earn points in store or by phone,using the phone number tied to your Pizza Profile or by ordering online.Point t '.redemption only valid online toward a free medium 2-topping pizza at participating locations'Only one order of S10 or more per calendar day,excluding gratuities I and donations,can earn points.For complete details,visit dominos.com/rewards.Any delivery charge is not a tip paid to your driver.Drivers carry less than 520. You orust ask for this limited-time offer.fAininoun purchase required for delivery.Delivery charge and tax may apply.Prices,participation,delivery area and Lhaigesmay vary.Returned checks.along wilh the stale's minimum allowable returned check fee,may be,lectronically presented to your bank.W017 Duminds IP holder LLC.Demme so. Dcmino's Pizza'and the modular logo are registered trademarks of Dornino's HP Holder LLC. uU431 W i small $12.99 medium $14.99 large $16.99 x-large $18.99 ExtravaganllaTM - Pepperoni, ham, Italian sausage, beef, fresh onions, fresh green peppers, fresh mushrooms and black olives, all sandwiched between two layers of cheese made with 100% real mozzarella. MeatllaTM - Pepperoni, ham, Italian sausage and beef, all sandwiched between two layers of cheese made with 100% real mozzarella. Pacific Veggie- Roasted red peppers, fresh baby spinach, fresh onions, fresh mushrooms, tomatoes, black olives, feta, provolone, cheese made with 100% real mozzarella and sprinkled with a garlic herb seasoning. Philly Cheese Steak-Tender slices of steak, fresh onions, fresh green peppers, fresh mushrooms, provolone and American cheese. Honolulu Hawaiian - Sliced ham, smoked bacon, pineapple, roasted red peppers, provolone and cheese made with 100% real mozzarella. Deluxe - Pepperoni, Italian sausage, fresh green peppers, fresh mushrooms, fresh onions and cheese made with 100% real mozzarella. Cali Chicken Bacon Ranch - Grilled chicken breast, Garlic Parmesan White Sauce, smoked bacon, tomatoes, provolone and cheese made with 100% real mozzarella. Buffalo Chicken - Grilled chicken breast, fresh onions, provolone, American cheese, cheddar,-cheese made with 100% real mozzarella and drizzled with a Kicker Hot Sauce. Ultimate Pepperoni -Two layers of pepperoni sandwiched between provolone, Parmesan-Asiago and cheese made with 100% real mozzarella, then sprinkled with oregano. Memphis BBQ Chicken - Grilled chicken breast, BBQ sauce, fresh onions, cheddar, provolone and cheese made with 100% real mozzarella. Wisconsin 6 Cheese - Feta, provolone, cheddar and Parmesan-Asiago cheese made with 100% real mozzarella and sprinkled with oregano. Spinach & Feta - Creamy Alfredo sauce, fresh baby spinach, fresh onions, feta, Parmesan-Asiago, provolone and cheese made with 100% real mozzarella. Honolulu Hawaiian Phillytheese-S ak ! I r Cali Chicken Bacon Ranch k •-- .Pactflc Veggie S, m ( Memphis BBQ Chicken ` Spinach&Feta 212051 � Any delivery charge is not a tip paid to your driver.Drivers carry less than$20.You must ask for this limited time offer.Minimum purchase required for delivery.Delivery charge and tax may apply.Prices,participation,delivery area and charges may vary.Returned checks, ! along with the state's maximum allowable returned check fee,may be electronically presented to your bank.©2017 Domino's IP Holder LLC.Domino's®,Domino's Pizza@ and the modular logo are registered trademarks of Domino's IP Holder LLC.©2017 The 1 Coca-Cola Company,all rights reserved."Coca-Cola"is a registered trademark of The Coca-Cola Company. I 3 o small medium large x-large Brooklyn Style Only Cheese Pizza $7.99 $9.99 $11.99 $13.99 Additional Topping $1.25 $1.50 $1.75 $2.00 Handmade Pan Pizza Extra N/A $2.00 N/A N/A CRUSTS Hand Handmade Gluten a ... Pan r Free Tossed smau only. - ' Medium Only. - Add tonal Charge. Brooklyn swTex oo a d tl cit v cat Crunch FREE ore p a n n to to kor y Style CRUST 1d 0o rn r o s•DOESNOT Thin Large or mme d this pi mr eestomers wm canoe g d'sease cnstohn=gwtensensteressnonia X-Large Only. emrse judgment n consmmngms pia. SAUCES • Robust Tomato • Garlic Parmesan White • Marinara • BBQ • Alfredo TOPPINGS MEAT - VEGETABLES OTHER Pepperoni Black Olives Pineapple Bacon Fresh Mushrooms Cheddar Cheese Ham Jalapeno Peppers Shredded Provolone Cheese Beef Fresh Green Peppers Feta Cheese Grilled Chicken Roasted Red Peppers Parmesan-Asiago Cheese Italian Sausage Banana Peppers Hot Sauce Philly Steak Tomatoes American Cheese Salami Fresh Baby Spinach Garlic Linguica Fresh Onions 0 PREPARED TO YOUR TASTE AND BAKED TO PERFECTION. Available with a bread bowl for$1 more. . nx. w. Italian Sausage Marinara - Penne pasta baked in a zesty ChickenAlfreao " Tomato Basil Marinara-sauce with Italian sausage, a blend of Italian seasonings and provolone cheese. $6.99 Chicken Alfredo-Grilled chicken breast and Alfredo r sauce mixed with penne pasta and baked to creamy ' perfection. $6.99 Pasta Primavera, Pasta Primavera- Fresh spinach, diced tomatoes, fresh mushrooms and fresh onions, mixed with penne pasta and baked with a creamy Alfredo sauce. $6.99 Italian,Sausage Marmara Chicken Carbonara-Grilled chicken breast, smoked bacon, fresh onions and fresh mushrooms mixed with penne pasta and baked to perfection with creamy Alfredo sauce. $6.99 Build Your Own Domino's®Penne Pasta-Choose a sauce chicken ca`rbon2ra and up to 3 ingredients from more than a dozen meat or a vegetable toppings. $6.99 0 20oz. Bottle$1.99 2-Liter Bottle$2.99 Choose From: Coca-Cola®, Diet Coke®, Coke Zero Sugar'", Sprite®, Fanta®Orange, Barqs® f Root Beer, Or Pepper®, Fuze® Lemon Tea, j Dasani®Water �0Domino's Cape Cod is proud to support Cape Organization for Rights of the Disabled.For more 9CORD, information visit www.cordcapecod.org. ems, WEST HARWICH SANDWICH 508-430-7400 508-888-7757 . HYANNIS FALMOUTH 508-790-1920 508-540-8004 S. YARMOUTH MARSTONS MILLS 508-394-6688 508-428-7900 If there is anything we can do to serve you i OPEN O and your family better, please call Kris 0 Jones (owner) at 508-827-1803 or email i ® him at dominoscapecod@gmail.com. v��'10 DELIVERY CHARGE MAY APPLY. Drivers Carry Less Than$20.Any Delivery Charge is not a tip paid to your driver. Please reward your driver for awesomeness. Delivery Charge May Apply. Please inform your server if aperson in your partyfood allergy. 212051 ;...- .-.._._....... .......----.....................-----------------------------------------------------------------------------------------.......---------------------------.. 9,v 1 1 Dominos.com1 ? 1 1 Dominas.com1 it More Great Specials! _ a More Great Specials! Carryout a Large s Large T 3- opping Pizza x; 2-Topping_ - Pp� g Pizza $799 each $ 99 Rus Tax 9174 $ PI Ta E I _ 5029 Ress erl rgeisnt tppad ss tlrrver. O Any, sCharges [ tpPor lour A Pleas dya drive f omaness O 5 drive PI reward yo drive,for Ro �, Carryo l0 ty.LimintedThe Offer, awe s Limited Time Offer O _ i 1 to Dominos.com1 c I 1 to Dominos.com1 . t - 1re Great Specials! = R More Great Specials! g s Any Large. = Large 1-Topping Pizza, Stuffed 1 Rio Specialty Pizza Cheesy Bread &8pc. Chicken $ 14 each _ 9999 Plus Tax 9175 Plus Tax s 5863 1 a Any Delivery Charge is not a tip paid to your driver. g $ Any Delivery Charge is not a tip paid to yourdriver. Pleas dyour drive,f esomeness. ® t I ¢ Plea waN your drve f awesomene m ss e, Limited Offer. e � Carryo of Only.United Time Difer. ,. I e i 1 1 Dominos.cornfor More GreatSpecials! . _ 3 Two or More Large Pizzas With Up To 2 Toppings 1 5 ; $ 1 099each l� Plus Tax z_ Any Delivery Charge is not a tip paid to your 5385 "e tl veer.Please reward your drover for tvesonieness. nu T'me Offer Chicken Bacon Ranch Chicken Bacon Ranch-Grilled chicken ' breast, smoked bacon, creamy ranch and provolone cheese. $6.99 Chicken Parm Chicken Parm-Grilled chicken breast, Tomato Basil Marinara, Parmesan-Asiago and provolone cheese. $6.99 ' Italian Italian- Pepperoni, salami and ham topped with banana peppers, fresh green peppers, fresh onions and provolone cheese. $6.99 *- Philly Cheese Steak _ Philly Cheese Steak-Tender slices of steak, American and provolone cheeses, fresh onions, fresh green peppers and fresh mushrooms. $6.99 }a Buffalo Chicken w/Blue Cheese-Grilled chicken breast, Buffalo Chicken creamy Blue Cheese Sauce, fresh onions, Kicker Hot ` Sauce, cheddar and provolone cheeses. $6.99 Mediterranean Veggie- Roasted red peppers, banana t 'c Mediterranean Veggie peppers, diced tomatoes, fresh baby spinach, fresh onions, �t feta, provolone and American cheese. $6.99 � Y Sweet&Spicy Chicken Habanero-Grilled chicken breast, ChickenHahahero pineapple, jalapenos, Sweet Mango Habanero Sauce, provolone and cheddar cheeses. $6.99 �x 0 j d I Parmesan Bread Twists- Handmade from fresh buttery-tasting dough and E baked to a golden brown. Crusty on the outside and soft on the inside. Drizzled with garlic and Parmesan cheese seasoning, and sprinkled with more Parmesan. Served with a side of marinara sauce for dipping. 8 for$5.99 Garlic Bread Twists- Handmade from fresh I buttery-tasting dough and baked to a golden + ' brown. Crusty on the outside and soft on the inside. Drizzled with buttery garlic and Parmesan cheese seasoning. Served with a side ', of marinara sauce for dipping. 8 for$5.99 Cinnamon Bread Twists- Handmade from fresh buttery-tasting dough and baked to a golden brown. Crusty on the outside and soft on the inside. Drizzled with a perfect blend of cinnamon and sugar, and served with a side ofr sweet icing for dipping or drizzling. 8 for$5.99 ---- ='" Stuffed Cheesy Bread- Indulge in cheesy perfection. Our oven-baked breadsticks are stuffed with cheese and covered in a blend of cheeses; made with 100% l real mozzarella and cheddar. Seasoned with a touch of garlic and Parmesan. 8 for$6.99.Try all 3: Cheese only, Spinach & Feta or Bacon &Jalapeno. Add marinara or your favorite dipping cup for an additional charge. ' Parmesan Bread Bites-Oven-baked bread bites handmade from fresh buttery- tasting dough and seasoned with garlic and Parmesan. Available in 16-piece or 32-piece orders. Add marinara or your favorite dipping cup for an additional charge. 16 for$3.99•32 for$6.99 Dipping Cups 750 Each Ranch, Blue Cheese, Marinara, BBQ, Kicker Hot, Sweet Mango Habanero, Garlic & Sweet Icing I �r Z Specialty Chicken - A delicious combination of toppings, sauces and cheeses layered over 12 tender bites of lightly breaded, 100% Crispy 0acon&Tomato whole breast white meat chicken. $6.99 each • Crispy Bacon&Tomato -Chicken topped with Garlic Parmesan White Sauce, a Spicy lalapeno•Pineapple blend of cheese made with mozzarella and cheddar, crispy bacon and tomato:' •Spicy Jalapeno—Pineapple -Chicken °+ Classk Hot Buffain" topped with Sweet Mango Habanero Sauce, a blend of cheese made with mozzarella and cheddar, jalapeno and ; pineapple. x Went BBQ Bacan` • Classic Hot Buffalo- Chicken topped with classic hot buffalo sauce, ranch, a blend of cheese made with mozzarella and cheddar, and feta. •Sweet BBQ Bacon -Chicken topped with sweet and smoky BBQ Sauce, a blend of cheese made with mozzarella and cheddar, and crispy bacon. Wings - Marinated and oven-baked and then sauced with your choice of BBQ, Sweet Mango Habanero or Kicker Hot Sauce. 8 for$6.99 14 for$11.99 40 for$31.99 Boneless Chicken - Lightly breaded with savory herbs, made with 100% whole white breast meat chicken. 8 for$6.99 14 for$11.99 40 for$31.99 s Cinnamon Bread Twists= Handmade from fresh buttery-tasting dough and baked to a golden brown. Crusty on the outside and soft on the inside. Drizzled with a perfect blend of cinnamon and sugar, and served with a side of sweet icing for dipping or drizzling. 8 for$5.99 1w CiNB4adTwIu n' Marbled Cookie Brownie-An irresistibly warm and gooe blend of milk chocolate chunk cookie and fudge brownie. This sharable dessert is oven-baked at the time of order and cut into 9 pieces. $6.99 ¢ s Chocolate Lava Crunch Cakes-Oven-baked chocolate ' cakes, crunchy on the outside with molten chocolate Marbled C&ekie Brownie' fudge on the inside. Enjoy an order of two.$5.99 Chocolate Dipped Chocolate Chunk Cookie-$1.99 Classic Garden-A crisp and colorful combination of grape tomatoes, red onion, carrots, red cabbage, cheddar cheese and brioche,garlic croutons, all atop a blend of romaine and iceberg lettuce. $6.99 Chicken Caesar-The makings of a classic: roasted white meat chicken, Parmesan cheese and brioche garlic croutons, all atop a blend of romaine and iceberg lettuce. $6.99 Chicken Apple Pecan - Roasted white meat chicken, diced red and green apples, dried cranberries, praline pecans and cheddar cheese paired with a leafy spring mix. $6.99 Salad Dressing-Select from Ranch, Italian, , Balsamic or Caesar. PIZZA THEATER DOMINO'S PIZZA THEATER CONSTRUCTION MANUAL- Q4 `16 FLOOR COVERING . ..... .... FC 01 &WB O1 ITEM.Olympia Tile Arbor Collection,'Moka 6"x 24"Porcelain Tile ,�4 CUSTOMER LOBBY AND SERIES.Olympia Tile."Arbor Collection" E RETAIL FLOOR COVERING A,.�'_COLOR:Moka MANUFACTURER:Olympia Tile NUMBER:SKU-OL.AR.MKA.0624 www.olympiatile.com CONTACT:Kurt von Koss SIZE:6"x 24" Beaver Tile and Stone `NOTE:Installation to be at 1/3 or 112 offset 24700 Drake Road GROUT:Fusion Pro®Single Component®Grout-1/8"Grout Joint Farmington Hills,MI 48335 Custom Building Product#60 Charcoal 248.790.2197(Cell) PRICE:$2.10/sq.ft. kurt@beavertile.com i LOCATION:Retail Floor and Customer Accessible Restrooms CONTACT:Derrick Rose 248.476.2333 ext.124 FC-01:Retail Floor and Customer Accessible Restrooms. drose®beavertile.com WB-01:Tile to be turned on its side.Cap with Brushed Aluminum Schluter Strip ITS-02). � � ITEM: Daltile e Yacht Club Porcelain,'Cockpit-YC03'6"x 24"Porcelain FC-02&WB U2 ALTERNATE RETAIL FLOOR ANDu,; CUSTOMER°ACCESSI]3LE RESTROOMS COLOR:COCKPIT,YC03 , MANUFACTURER: NUMBER:SKU—YC036241P Daltile SIZE:6"x 24" National Accounts Desk NOTE:Installation to be at 1/3 or 112 Offset 877.556.5728 GROUT:Fusion Pro®Single Component®Grout-1/8"Grout Joint www.daltile.com Custom Building Product#60 Charcoal CONTACT:Jennifer McCormick ;PRICE:$2.02/sq.ft.. Daltile Representative 877.556.5728 E LOCATION:Retail Floor and Customer Accessible Restrooms Jennifer.McCormick@Daltile.com € FC-01:Retail Floor and Customer Accessible Restrooms. WB-01:Tile to be turned on its siderCap with Brushed Aluminum Schluter Strip(TS-02). ///�� t FC-04 ALTERNATE Y FC 03 KITCHEN/BACK OF HOUSE FLOOR TILE KITCHEN!BACK OF HOUSE F OLF OL OR TILE ' MetropolitanMANUFACTURER: Ceramics ITEM:Metropolitan Ceramics QUARRYBAS1ICS® ,Daltile Ashen ITEM:Gaal Daltile � 0 ..... !, _ r _ a s Quarry p Quarry Tile,8"x 8',OT03 } Canton,OH.44711 "507 Puritan-Gray" National Accounts Desk ,1 (330)484-4887 SERIES:Metropolitan Ceramics 877.556.5728 SERIES:Daltile—Quarry Tile , www.metroceramics.com QUARRYBASICS®Porcelain Tile www.daltile.com COLOR:OT03 Ashen Gray I CONTACT:Kurt von Koss NUMBER:507 i SIZE:8"x 8" Beaver Tile and Stone COLOR:507 Puritan Gra CONTACT:Jennifer McCormick y Daltile Representative GROUT:Fusion ProO Single Component Grout l 24700 Drake Road SIZE:6"x 6" 1/8"Grout Joint Farmington Hills,MI 48335 877.556.5728 GROUT:Fusion Pro®Single Jennifer.McCormick®Daltile.comiCustom Building Product#60 Charcoal 248.790.2197 Component®Grout kurtQbeavertile.com PRICE:$1.60/sq.ft. 1/8"Grout Joint CONTACT:Derrick Rose Custom Building LOCATION:BOH 248.476.2333 ext. 124 Product#60 Charcoal I drose@beavertile.com PRICE:$1.45/sq.ft. LOCATION:BOH FC 05 KITCHEN!BACK OFs HOUSE FLOOR TILE MANUFACTURER: ITEM:Summitville—Quarry Tile,6"x 6",Driftwood Summitville www.summitville.com SERIES:Strata 2 . COLOR:Gray CONTACT:Kurt von Koss SIZE:6"x 6" a�l� Beaver Tile and Stone 24700 Drake Road GROUT:Fusion Pro Single Component Grout—1/8"Grout Joint/ , Farmington Hills,MI 48335 Custom Building Product #60 Charcoal i E 248.790.2197 PRICE:—$2.86/sq.ft. kurt@beavertile.com 'LOCATION:Kitchen CONTACT:Derrick Rose -- ' 248.476.2333 ext.124 drose@beavertile.com __.... ..... ........ ........ ....... M.'�' 1 E 5* PIZZA THEATER FINISHES DOMINO'S PIZZA THEATER CONSTRUCTION MANUAL- Q4 `16 WALL TILE & FRP 1.WHITE SUBWAY TILE' a.__.. .., _ . . ... MANUFACTURER.Olympia Tile �` ITEM:Whrte subway tale www.olympiatile.com SIZE:3"x 6" CONTACT:Kurt von Koss NOTE:White grout to match the"100 Ultra White"3"x6"ceramic subway tile i Beaver Tile and Stone 24700 Drake Road LOCATION:Production/Kitchen area visible to the customer Farmington Hills,MI 48335 248.790.2197(Cell) kurt@beavertile.com CONTACT:Derrick Rose 248.476-A3—Fext.�,124 �+ adr so a®heave rtile_com o t WT 01 WHITE SUBWAY TILE' MANUFACTURER. ITEM White subway file Daltile �. National Accounts Desk NOTE:White y 877.556.5728 grout to match the"100 Ultra White"3"x6"ceramic subway file www.daltile.com LOCATION:Production/Kitchen area visible to the customer , CONTACT:Jennifer McCormick Daltile Representative 877.556.5728 E ,Jennifer.McCormick@Daltlle.com WT 05 RED SUBWAY TILE(OPTIONAL) - - - MANUFACTURER:Beavertile ITEM:3"x 6"Red Subway Tile CONTACT:Kurt von Koss NAME:Red Pepper , Beaver Tile and Stone SIZE:3"x 6 € 24700 Drake Road " - Farmington Hills,MI 48335 NOTE:Red subway the is an optional feature to the Pizza Theater. pry rss e C:248.790.2197 It is to be applied 60"A.F.F.with white grout to match the"100 Ultra White kurt@beavertile.com 3"x 6"ceramic subway tile ;> '1 LOCATION:60"A.F.F.throughout the production area where 3"x 6"subway f ={ tile is installed. WT 02 RFRF WALL PANEL MANUFACTURER:Marlite ITEM:FRP wall panel(standard) www.marlite.com NUMBER:P-100 CONTACT:Tim Pinnow TEXTURE:Pebble surface C:330.260,7631 tpinnow@marlite.com COLOR:White LOCATION:Kitchen walls that are not visible to customer _WT FRP WALL PANEL MANUFACTURER.MYrlite ITEM:FRP-wall' anel(standard) www.marlite.com NUMBER.P-106 CONTACT:Tim Pinnow, TEXTURE:Pebble surface C:330.260.7631 tpinnow@marlite.com COLOR:Beige FF xy g LOCATION:Kitchen walls that are not visible to customer ,. T VI T 04.FRP WALL � ' MANUFACTURER:Marlite ITEM:Crane Composites 'STC' FRP wall panel www.marlite.com NUMBER:731 CONTACT:Tim Pinnow, TEXTURE:Sandstone C:330.260.7631 tpinnow@marlite.com COLOR:731 Red LOCATION:As Specified,Reimage Chair Rail,Vestibule 16 ;� • i't r a,. PIZZA TH-EATER-SPECS - FINISHES (CT OMINO'S ZZIP A THEATER CONSTRUCTION MANUAL- 04 `16 EILING TILE CT Q KITCHEN/BACK OF HOUSE ff x ._a_...MANUFACTURER:USG ITEM::Scrcr ubbable ceiling file CONTACT:Chris Be <� n)amm NAME:Sheetrock lay in ceiling panel(Climaplus,Vinyl) s C:312.436.5458 NUMBER:3260 u cbenjamin@usg.com I SIZE:2'x 2' or 2'x 4' J f COLOR:White ' p 1 EDGE:Square N f LOCATION:Kitchen,BOH , NOTE:Back of house/kitchen ceiling tile to be white. c 02` .. _ ........... OPEN CEILING SPECIFICATION _ .... _ . DISTRIBUTOR:By General-Contractor€LOCATIONr-Lobby PI illy ��SGilj�;w CONTACT:Please see Page 14 of �4 the Construction Manual for paint 9 specifications and Page 18 for alternate lighting specifications for open ceilings. . � . CT 03 RETAIL AREA CEILING z MANUFACTURER:USG ITEM:Acoustical ceiling tile CONTACT:Chris Benjamin NAME:Frost Climaplus C:312.436.5458 NUMBER:414 cbenjamin@usg.com SIZE:2'-0"x 2'-0"x 3/4" COLOR:565 Sienna EDGE:"SLB"Shadow Line Beveled edge(or beveled tegular) PROFILE:Edge grid profile DONN CX-color to match 565 Sienna LOCATION:Lobby BRICK(RED) m _ MANUFACTURER:Glen-Gery Brick ITEM:Brick(red) www.glengerybrick.com NAME:Olde Detriot-Full Modular Brick CONTACT:Gabe Cantrell MORTAR COLOR:G402 Hamilton Parker P:614.358.7800 SIZE:3 5/8"x 2 1/4"x 7 5/8" C:614.206.1443 LOCATION:Exterior building material r gcantrelI@hamiItonparker.com ....: .:: BRICK(BLUE) x, .�. MANUFACTURER:Glen Gery Brick ITEM:Brick(blue) EC O1 brick with special blue patina paint* a. , www.glengerybrick.com COLOR:PT-11 blue special finish " CONTACT:Gabe Cantrell LOCATION:Exterior building material,drive-thru window bump-out C:614.206.1443 FINISHING:Kobolt Studios *Special finish applied by Kobolt Studios CONTACT:Jerry Ulibarri C:614.554.1934 - more- i�i�u a + B , AEROL SERIESHS Item# Project CZA U,� NSF 1\ J"L N� ..22" yf F•R N v / is b y 'H°- '2 is �a"°t „»�,g- � t'�� •'qe ' ': f Model HSEF Model HS Model HSF Model HSD Includes Faucet,Basket No Faucet,No Basket Includes Faucet,Basket Includes Faucet, Basket,P-Trap Overflow p t„ Model HSDT 'N`� Model HSF2S h Model FA HD �' Includes Faucet, Includes Faucet, Basket,2 side splashes Includes Faucet,Basket,P-Trap Overflow, Basket,P-Trap, S/S Apron,Prison Grade Overflow,With Towel&Soap Dispenser _ WIN ~� I NO Uf Model# Description R- 2 -; S 54 Soap Dispenser •'` , �' S-55 Paper Dispenser y S-56 P-Trap S-57 Wrist Handle(add on) S-58 Wrist Handle&FCT(Repl.) S-59 Metered Faucet x _ S-60 Knee Valves Model HSDTA Model HSDTAXHD S-61 Pedestal Base WFoot Valve Includes Faucet,Basket,P-Trap, Includes Faucet,Basket, P-Trap, S-62 Eye Wash Attachment Overflow,Soap&Towel Dispenser, Overflow,Soap&Towel Dispenser, S-63 Hands-Free Wand Stainless Steel Apron Stainless Steel Apron, Prison Grade S-64 H.D. FCT Upgrade(T&S) S-65 Replacement Faucet(CH) S-66 Replacement Foot Pedals S-67 Replacement Gooseneck S-68 Side Splash One Side S-69 Side Splash Two Sides S-74 Drink Bubbler email-sales@aeromfg.com AERO MANUFACTURING COMPANY• 310 ALLWOOD ROAD,CLIFTON,NEW JERSEY 07012 • VOICE 973.473.5300 FAX 973.473.3794 �„� ,C� ghts20tA t, ��dturi�g��mpary I �p c�rycaYlons subjexi t�ge�rvtth�uL�notXc�e s� ��� Pd�{ AER0 HAND SINKS BOWL BOWL UNIT UNIT Model# Ship Cubic BOWL BOWL UNIT UNIT Model# Ship Cubic Width Length Width Length Weight Feet Width Length Width Length Weight Feet 10 14 14 18 HSEF 9 2 10 14 15 17 HSFAXHD 30 2 10 14 15 17 H S 12 2 10 14 15 17 HSDT 35 2 10 14 15 17 HSF 14 2 10 14 15 17 HSDTA 35 2 10 14 15 17 HSD 15 2 10 14 15 17 HSDTAXHD 35 2 10 14 15 17 HSF2S 15 2 OEE�V 80K L F 10.00 ULL IIWEDJ 0 0 WAWA llL - Lc oo--j ModeIHSEF ModeIHS ModeIHSF ModeIHSD ----------- NSF ai' LK j­ Q fi ZI-1 L ff 7 ModeIHSF2S Model HSFAXHD Model HSDT Model# Description "" j /\�� "" � \� S-54 Soap Dispenser L S-55 Paper Dispenser S-56 P-Trap \/ \ S-57 Wrist Handle(add on) S-58 Wrist Handle&FCT(Repl.) S-59 Metered Faucet S-60 Knee Valves S-61 Pedestal Base WFoot Valve �I I ---- ---------- S ---- ---------- -62 Eye Wash Attachment FI �\\��%\/F S-63 Hands Free Wand 4- S64 H.D. FCT Upgrade(T&S) %fis \. / r fiG \�\/ S-65 Replacement Faucet(CH) S-66 Replacement Foot Pedals S-67 Replacement Gooseneck S-68 Side Splash One Side ModeIHSDTA Model HSDTAXHD S-69 Side Splash Two Sides S-74 Drink Bubbler All dimensions are typical(toL±/2"). For Accessories and Options see pages FS-7A,FS-7B. email-sales@aeromfg.com AERO MANUFACTURING COMPANY - 310 ALLWOOD ROAD,CLIFTON,NEW JERSEY 07012 -VOICE 973.473.5300 FAX 973.473.3794 Y 13'-6' JAMB TG HAVE BAMNG FOR WALK-IN SPECIFICATIONS a CLEAR NEVI DOOR SIZE: 13'-6'x 9'-8'X B'-3 3/4' 'J; 12'-10' PANELS: 0 ALL FTIANEDD PANELS ARE 4' EXTERIOR FINISH: e6 GA.. 6 r■ r■ nee d EXTERERM TCIP-26V�TUCCD GALvPM a uF� d � �� INTERIOR FINISH: i WALLS-26 GA STUCCO GALVALUME ai o _ 'd C(II0 ER cEa DNTo GA sTlscn GALVALUME . 71= FLOOR TYPE: ss L —J a a m 3 a CfDILER-1-1/2'VINYL SCREED a d d d I HEIGHT: DOOR R40074AO5040504 DD 8'-3 3/4' M 7•-11 3/4' THRESHOLD DETAIL 40 46x942=34x78 DR RH FLS C R DOORS: FRAME-26GW/CB_ PLUG=26GW/GL DON R40074AG5040504 46x9425DS 34x7B DR RH FLS CLR 'mom FRANE_6GW AID'SPLUCw26GW/0. J �"'r \ xmio .��. ACCESSORIES: COOLER \� yr® CD LICBNT 48'FLlO7RESLENT W/DUT BULBS S tv MICMPLATE A63 TREAD 36'DR EXT B CI)MI XPLATE 263 TREAD 36'DR INT -J ,'�••i.�.. •�. s a)BACICDiG GNLY FOR CLEAR-vU DIM CIDR 3•i.!•,•i.�RI�T.0 i..','i.!','i. C3)CLEAR- STRIP D4L78 �FACT (HARDVAIBtY MDUNTED) 13'-2' FLOORLESS COOLER WITH REFRIG: SEE SEPERATE REPR mmTm DRAVIING TO CENTER IF SLEEPER 1 1/2' VINYL SCREED DETAIL O O O Q x x f eal ti SPACING BETWEEN M Z CLIPS CL O� IS 23' t x: Aw 47 L A A .x a tn(r (F b i (� A t � it AMOM IMPORTANT NOTEI m I— ssSr A "m® • Note! �ww INPIIRTANTi VERIFY WALL HEICORS, 1-1/2' VINYL SCREED SIGNEM APPROVED PRDCT AL DDE14SMNS NO NETAL FDaSHES tm tttxvtta� MUST BE RECA 8/4 FAB. BEFetE APPROVING DRAWDNG CWITH SLEEPER MMENSIDN REBCIIREMENTS) R� IMPORTANT ' 12 PIECES m 44 LIN FT. a 4�w (]APPROVED AS DRAWN wts art ipG rvDm OCIERS�� ONDT APPROVED RESU81aT IMPORTANT ' �oEr •. ....;::•i''Fl�•;:,..�.. ;..� -� SIGNED u'°ru®_:r�rar<""�01m�a.'t°� ��MENIER twnixRa DATE oe�K ��nir�v As RFtrD m unOW p ma<AL � am FLUOR ALLOW MINIMUM 1' CLEARANCE p SLEEPER CROSS SECTION ALL AROUND WALK-IN. a■ Rw t� i� (ODLER 0ONNEC110N SIZES AIR oENr Fo1n0E c cm on-IIYT C= a MIRY Comm am tfn EYAPO TW Aoa®0 fEf INLET F F __ f 0 fff7f7ffR p aOP1E�1 mf�®1 � R a MR FAN i/ IGTEp Y I U I R T_� ■ T DEOMPTIaN IF]GIN 1rlII1N 1Y1 - P RU V M / M- Yam/ f�f 'T/ Nm� NP V MP V / aaA A 1 1 1 W.I.COOLER 33' 25-i/2' 9-1/4' 158 35"F 5'F 04A PC149MOP-2 1.5 7.0 60 1 1 1.1 1 11011 15 1 0 1 MC46-100.1EC KPR 1.6 [ o-Of CYCLE A=AIR W/nMEX 12G1" . E-ELECTRIC ( 1 CIFARANC[REpFED FOR /TR IE W�FRR aMxAMW. 11 ELECTRICAL L'f"""'" CONNECTION _ �1ffi .�3"1 J. t7 ��" Z09 9' TNf m 401907 SIDS VIRW q s, g {y' g PLAN VISS NOTESUCTION&LIQUID y C OR GROUNDPAD TDAN�ESAT� ASLINE ° N � m p oAlAmVm As Nalm OfEYla Alai IlFalsar CONDENSING UNIT ASSEMBLY FETE , ITEMS PROVIDED INCLUDE: am— REaENr sE�P ER�R1�Rs L. 3 1.Liquid Line Sight Glass FACTORY WIRING i --FIELD WIRING 0000 2.Temperature Line Filter/DriersConto ( ) 3.Liquid Line Solenoid Valve(Installed) 5. L1 L2 c 6.Expansion Valve n(Installed)ed I I I HIGH PRESSURE LOW PRESSURE ` 6.Condenser Fan Cycling(Winter Control) I I I CONTROL SWITCH CONTROL SWITCH - 7.Hermetic Compressor-Copeland 8.Crankcase Heater I I e;a � � AMC46-100 9.Hi/Lo Pressure Controls LAY RE I 10.Outdoor Housing-Galvanized 2 s I • 11.EC Evap Fan Motors-115V w -- ♦ SEQUENCE OF OPERATION 1 UNIT COOLER 115.60-1 OFF CYCLENOR AL CYCLE. THERMOSTAT. FAN MOTOR(S) IN ITSNORMA SPECIFIED EM ERATURE,, "1;ZVE PRESET ATA SPECIFIED TEMPERATURE, ♦ INITIATES THE DEFROST CYCLE,THE 1 THERMOSTAT DE ENERGIZES(CLOSES)THE LIQUID LINE SOLENOID VALVE AND THE REFRGERATION SYS EM PUMPS DOWN,AND CUTS OFF ON LOW PRESSURE CONTROL.WITH AN INCREASE IN TEMPERATURE.THE THERMOSTAT CLOSES AND ENERGIZES THE LIQUID LINE SOLENOID VALVE AND UPON A RISE —�' RAN IN LOW SIDE PRESSURE,THE COMPRESSOR %' C E STARTS. P (IF RECNREO) 11.20.12 3 CHANGED TO R WACONOEN9ER FAN CYCLE FAN fANTROL 6HITCHq (IF RFOUREOI 33 5�i�i�iii111 y�Ja�i[f n efp [2 TEMP CONTROL CY+^10 DT �DB'�6�]D J BD L-----" 5Ao-1 w1AM1746-100-1EC (115/I/O) WIRING DIAGRAM 208-230/1/60 L------L POWER LEADS FROM ��"�� Aw. .......................G MINIS IE11F+tlCm Evaporator Wiring Diagram OKOLPAK PAR � -- RawomAtloN TENNE5SEFE RE813-3 XD 9002B 9 AFSWFHE 05/12/2016 °d Bimple . Smart . w 1 a ' a XLT Oven & AVI Hood Technical/Rough-In Specifications for Gas & Electric Ovens & Hoods This appliance is for professional use by qualified personnel. This appliance must be installed by qualified persons in accordance with the regulations in force. This appliance must be installed with sufficient ventilation to prevent the occurrence of unacceptable concentrations of substances harmful � 2 to health in the room in which it is installed. This appliance needs an unobstructed flow of fresh air for CAUTION satisfactory combustion & must be installed in a suitably ventilated room in accordance with current regulations. This appliance should be serviced by qualified personnel at least every 12 months or sooner if heavy use is expected. Electronic copies of the Installation &Operation Manual, Parts& Service Manual, Architectural Drawings, &a list of International Authorized Distributors are available at: www.xltovens.com For use with the following XLT Gas&Electric Oven Versions: For use with the following AVI Hood Versions: Australian(AE) F Standard(S) E Standard(S) F World(W) E World(W) F O(N C E Intertek Intertek Q359 GAS40066 2000887 SAI Global XLT Ovens PO Box 9090 Wichita,Kansas 67277 US:888-443-2751 FAX:316-943-2769 INTL: 316-943-2751 WEB: www.xltovens.com Roof Curb Welded Duct Exhaust Fan Duct Wrapper Roof Top Unit(RTU) Roof ' . ., h. Valance Roof Joist A u . Ceiling Fire Suppression Box N Service Panel AVl Hood Gas C'' Service XLT Oven �� Floor Typical Store Installation ..... mom_.. .., ... Revision History Table _. i Revision Comments Date A New Release,Version—03 Updated Oven Electrical Requirements on Page 6 2/10/2016 B Updated Oven Electrical Requirements on Page 6 and Removed Korea Information 5/12/2016 Technical Support US: 888-443-2751 Technical Support INTL: 316-943-2751 Simple.Smart. • Utilities must be easily accessible when the ovens are in the installed position. Do not install utilities behind the ovens. ♦ 3.0 l [76] Gas Manifold 6.00 J [152] 3 ueueeeeeaeueYemie�uee _,,,, ,may Electrical Supply -. 3 zrM - � .�w:i7iwi4.wruivara. - 2 ¢ 7 48.00 � _77777- [1219] d 42.00 [1067] GAS MANIFOLD WITH SEDIMENT TRAP A sediment trap must be installed by the owner and/or General Contractor as close as prac- tical to the inlet of the oven at the time of installation. This requirement is in keeping with ANSI Z223.1-2012/NFPA 54-2012, section 9.6.7. The design shown below will effectively keep all con- taminates from getting into the gas valves in the ovens. The cost to construct the gas manifold is extremely inexpensive compared to the costs associated with oven failure, such as downtime, re- placement parts, and service call labor. Failure to install a sediment trap will void the product war- ranty. The Gas Supply manifold is available from XLT upon request. • A minimum of a 1 1/2 supply line is required. Item# escri tion t 1 1/4 Manual Gas Valve 3 IN 2 1-%2 Ball Valve 1 7 3 1/4 x 3 Nipple 3 9 4 1-%Pipe Cap 1 8 5 1-'/z x 10 Nipple 2 6 6 1-'/z x 3 Nipple 2 5 10 7 1-'/2 x 5 Nipple 1 8 1-%Tee 1 /-t 9 1-%2 x 3/4 x 1-'/2 Reducing Tee 2 �4�--► 10 l-%z x'/4 Reducing Elbow 1 1 • Do not use Teflon tape on gas line connections as this can possibly cause gas valve mal- function or plugging of orifices from shreds of tape. Use of Teflon tape WILL VOID warranty. Technical Support US: 888-443-2751 " Technical Support INTL: 316-943-2751 Simpfe.Smart. In the event you are required to install fire suppression, XLT offers an accessory kit for ov- ens, and also fire suppression piping for the AVI hood as an option. The Engineers at XLT have designed the fire suppression system for XLT ovens and AVI hoods to meet ICC and NFPA codes. Field installations can be more expensive, less effective, and can interfere with daily operations and maintenance. A fire suppression system consists of five(5) main components: Manual Pull Station Main Cabinet that houses the tank and valve Mechanical Gas Valve Oven Piping&Nozzles Hood Piping&Nozzles All of these elements need to be interconnected mechanically with wire rope cables, and a piping system must connect the tank with fire agent to the nozzles in both the oven and hood. The fire suppression system can be activated by either manually pulling down on the han- dle, or whenever the temperature rises high enough to melt a link in the hood. When the link melts or the handle is pulled, spring tension opens the valve which releases the agent contained in the tank and then sprays through nozzles mounted in both the oven and hood. EXPLODED VIEW OF OVEN FIRE SUPPRESSION Technical Support US: 888-443-2751 Technical Support INTL: 316-943-2751 Simple. Smart. ® wo ® S e sxa � 0bf sz x 'M � � J w� p 7 d z 1 e1' i s y �kwr � ass�"� i�s„„' sr � en.w sea C� �• ' a� Nee vreK rune �e iv *z' .. � � � � �ss � e r e�nerox arexey'�4xti n t f. acx ,�, a.,zx r ,�• f E � f I � p' � .Y�� a'x � o s"'`SS i r1 31Z AwlS r�» s ' ,f�'��. "• .:u.�r•r, ,.,., .. , Bey; .. .. � ..�"" TRANSPARENT VIEW OF HOOD FIRE SUPPRESSION �q 's'lr � „r rtA p,n 91,17 5 4,4 x � Technical Support US: 888-443-2751 Technical Support INTL: 316-943-2751 Simple. Smart. z r: € ice• € .} a . .<<_ l rC'4 I U — LL 1 i z� �) v N i� i Technical Support US: 888-443-2751 Technical Support INTL: 316-943-2751 Simple. Smart. M R-. 1 ® Exclusive Hood and Cover Design.NEW removable and washable filter to help deal with cornmeal Domino's built up in the condenser area, the filter also comes with an indicator light that warns you if if hasn't been c eaned by turning RED(light location shown tithe control photo). L x. r Control Area.NEW dual digital controls for both the rail and the base for holding more accurate Q temperatures. The Control also shows temperature in the base ar•d rail temperature(not food)under 4 the pants. Temperatures are visible through built DOMINO'S SPECIFIED MAKEIINE in viewing window on the front the compressor model DPT120R shown area. Also located in the window is the clean filter immediately indicator light,Not shown in the window is the-ail switch and master on/off switch. Lastly added i-mto tine rail controller is an audible alarm that will sound if the rail is outside of the factory specifi cation on temperature to alert the staff of potential problem, `r IMPROVED DESIGNS, i.s if X e Drawers. Base:tomes standard with(4)drawers and(2)doors located in the base. Each set of the drawers co-ties standard with insert pans to accommodate bagged products:pans or any combination, Drawer systems allow quick and easy access to products in the base.OPTIONAL adaptor bars can be purchase if pans only are required, Rail Drain.NEW improved drain with removab[a O-ring. Ease of use compared to the old ball valve drain. Drain is a proven design used in the field for over 5 :'' ears in some of the harshest environments. u PRODUCED FOR: u,. Domino's Pizza Equipment&Supply, Division of Domino's Pizza LLC 3900 Plymouth Road, Livonia, Ml 48150 Exclusive Press---it Gaskets. Easy cleaning and replacement-noscrews,no tools Gaskets 800.248.3325 fax 800.538.1551 are on both drawers and doors. I1II1II'II'II'I III'II'II'II'II' I-11-IN ! l ll Il��t•..I��I.I•I��I.■I��I.•I��III 11���.LI��LI•I��I■■I��I••t��lll 11���.LI��LI•I��I■■I��I••I��III 11��I•ill��l.I•i��l. L ■I��I•.•I II 11���.I•I��I.LI��I•.I�� I��III f. v I ' A) ' _ Roil Pan CU FT _ Model Compre�orF L D H DoorsDrawars* C as Catch Pans �HP��nVoltage� AmNEMAStWt ap ty Storage . I - C ��h ,ti D4MIN0'S�PI �� �b1UIPMENT&SUPPLY �� - � KBE �.� - • • • • DNISIaN QFzDQMINt�!& ZAll � �► , 3900 Plymouth Rogdyuvontq MI r� �� � � �8�-248 3325•Fax 8t�538 1551 � >�x ••• • • Page 1 of 2 SELFTION?% I Washer and Electric Dryer: White 26-61532 i. t i. .... .......... ...... ................ ........... Washer and Gas Dryer: White 26-71532 Basket Volume(Cu.Ft) 3.3 Number of Speeds 1 p i f Cycle Selections 11 s Normal ...- . ......... ;;:�" Casual/Permanent Press E Delicate Ouick Rinse ...... ...... ...................... ._..... t Rinse Spin - 7 '_'.. ......-., ./( F. Spin Only ......... ._..... ._........ ...... ......... ........... ............ _._...................._,;,„,..„.„ Wash/Rinse Temperatures 5 Water Level Selections 5 Soil Level Selections i 4 __..._.....__.................._.........._..._..................... _......................... ....__................ -- Agitator .............. .._..._.__. ....... .......... q......... ............. - Bleach Dispenser Fabric Softener Dispenser Basket Construction € Plastic ..............................._..........................................................................._..._.........................-................. .............. Leveling Legs Motor H.P. /a.._ Sound Insulation Quiet-By-Design" j :. ...__... ..._..._ .:.:+ Capacity(Cu FL) 5.9 ............. .._._........... ___.._ _.___. ..... ............. ___ ....._... Cycle Selections: 9 ... _.. _ ......... ...._...._._.. --..... Kenmore Laundry Center Normal .......... ............... Casual/Permanent Press ............. _....... -..... ............._....._........ O Electric White 26-61532 O Gas White 26-71532 Delicate ....... ...... ....... 27 inches wide Wrinkle Rid Timed Dry 3.3 cu.ft.capacity washer.1-speed motor ...... Quick Fluff 11 wash cycles Air Dry Agitator cleaning system Cool Down ............. Dispensers for abric softener and bleach Temperature Selections 5 _............. Auto Dry •5.9 cu,ft.dryer Push/Turn-To-Start Button .............__.........._._..._......_.........................__...._................................_....__.......................................... 9 drying cycles.5 temperatures Internal/Up Front Lint Filter Auto dry Motor H.P. 4 3-Way Wash and dry at the same time Venting (Bottom,Right,Left) GC ERAL�FEATU ES t .. ............ ... ..._......_ ._.......... __._ e __._. ............... ............. ................. ............_.. Front Serviceable Power Cord Included Gas Only Washer Electric Dryer:Volts/Hz/Amps 240/60/22 24 r Watts(Dryer Heater) 4,500 Electric Dryer Circuit Required(60Hz) 30 Amp Gos t E Washer Gas Dryer:Volts/Hz/Amps 120/60/11 f r i,;n;,c. BTU Per Hour 18,000 0• oo O t LP Gas Conversion.Kit _ ... WE25M74 i Est.Yearly Energy Consumption 289 kWh/yr. .-� —12 ._.. .... _. ....... ._ _ Vcn; ....... . - Est.Yearly Operating Costtt Gas Water Htr/Elec.Water Htr $19/$31 �,9" ,tJ7. .s-+s Item Weight(Approx.Lbs) 247 Shipping Weight(Approx.Lbs) 278 Droil 4IEt 1 Year Limited Warranty— . + f£ .:j Entire Appliance Parts&Labor _ �i—;n• it used for other than private family purposes my apples for only 90 days. Hh=Heater 11All energy$/Yr.figures are calculated at the national average cost and he energy supplier m states where theme.suchprog Energy ams ex sitcriteriones are offered s eased on percentage d by tperr entage of energy cllicicncy attained beyontl the 2007 standard.Dollar amounts may differ. 'Dimension represents door closed including handle and knobs. NOTE:With feet set at mid position.feet can be adjusted 4.375 in. o earS Due to Sears policy of corninuous improvement on its products.Sears reserves •• the right to change materials and packed without notice.Before installing. sears 't suit installation instructions packed with product.For complete warranty �/` Effective 01/09/12 Commercial nformation.conseit the owner's manual or visitwww.managemylife corn. • • s Page 2 of 2 __... .........__. ................ ........._...... .._......... ..._... __. ____. ____ .._._ ._..._ ......... ........... _._.._.. DRYER VENTING RECOMMENDATIONS 4°Clearance Behind the Dryer is Preferred for Best Airflow. Clamps are recommended for wall and dryer connections.Steel clamps 2"Clearance is Achieved With Periscopes, designed to resist stretching,with phillips,/hex head screw are included one each on elbows and periscopes. 4"CLEARANCE BEHIND DRYER ®r 26-49900—Over-The-Top"Kit V 26-98379—Vent Hood Universal solution,8 foot length.Kit includes two 4 lft.a pipe Aluminum body and plastic molded hood with a 4'opening. sections with attached elbows,two close elbows,clamps and wall plate. DRYER EXHAUST LENGTH IMPORTANT NOTE RECOMMENDED MAXIMUM LENGTH 26-49608—Flexible Pipe Exhaust Hood Types 4°x 6'with snap-lock fittings,90°turn takes 1 foot length Do not use non-metal and 6 inch clearance flexible duct.Also.when Recommended Use only for short run installations installing the venting 4'DIA, system,do not exceed 26-49609—Close Elbow WwuwfJ 4"DIA. 4'DIA the specified length for Turns 90'within 4',rotating collars and snap-lock fittings the vent duct.Venting � systems which are longer than specified will 4" 2"CLEARANCE BEHIND DRYER accumulate lint,increase No.of 90" Rigid Rigid drying time and energy Elbows Metal Metal 26-49901—Periscope 0-5° use and shorten the life of 0 56 Feet 42 Feet the dryer. 1 44 Feet 32 Feet 26-49908—Periscope 0-18' ,,,.,,,._. ......_......_.. 2 34 Fee[ zs Fee[ For outlets that overlap or are very close 3 24 Feet 18 Feet 8.18" 26-49904—Periscope 18-29" Periscape POWER CORDS FOR ELECTRIC'DRYERS ONLY Reaches side of most dryers 26-49387,26-49787 All Electric Dryers Require Cord 26-49388,26-49788 3 26-49905—Periscope 29-50' ............ .......... ........................... p Order Wife Length Reaches top of most dryers __.... .._............ o O 26-49387 3 4-t. o - o .......__... .............. 26 49787 3 6-t Gas Dryer Connector Stainless Steel O 26 49388' 4 4.t 26 49590__ '•' .. _ 112' 3/8'Flex 5 ft. 26 49788' 4 6 t 7 26 49585' 3/8' 3/8'Flex 5 ft. 'Complies with 1/l/96 NEC code revision for new construction and remodeling - *Los Angeles only ............... ............. ...... .._..... _....._.. ..___ _ ___ _ ... .._ ,...-..... it Due to Sears policy of continuous impre-dement on its products.Sears reserves [/°' "• t(( "w the rlght to change materials and specifications without notice_Before installing. UL suit installation instructions packed with product.For complete warranty .„ Effective 01/09/12 Commercial "formation,consul the—ors manual or ise managemylife.cwn. THESE V$tA%A WERE CREATED BY AND ARE tRE PROPERTY OF AERO MANt •URING CO.,INC. THEY MAY NO, dt REPRODUCED IN ANY FORM WITHOUT OUR EXPRESS WRITTEN PERMISSION. o w p • co N 0 87.25 ry m o Ol.2 J 10.00 15.00 15.00 — 16.OD 18.fl0 6-27-94 ((]] pp o MR-2!II 16-IM r A J w O O O 21.D0 21.00 w A 1. N AFD\3C\3F21160 430 S/S ODY is � 8.00 n a 7.00 • z 39.50 AD 1' 1B.50 IN S4 H1MlLS THE EflUIPMENT SHOWN ON THIS DRAWING IS MANUFACTURED i0 FABRICATION WILL START ONLY UPON RECEIPT OF SIGNED Y.vmwGS o `HERO SPECIFICATIONS ONLY. AND APPROVED UIRAWINGS UY AUTIIORSZEU AFRO DEALER.- ►"\+ a DRAWINGS ARE MEANT TO INSURE CORRECT DIMENSIONS ONLY. AUT11ORIZED DEALER SIGNITURE: N INDUSTRY DIMENSIONAL TOLERANCES ARE 4 OR -V27. PRINT NAME tIERE: DATE APPROVED: i A- AM Item# Project ECONOMY DELUX AEROSM Quantity M1113 3F3 2F3 Model# Model# Model# — MF3-2116-18LR 3F3-2116-iBLR 2F3-2116-18LR 49 MF3-2116-24LR 3F3-2116-24LR 2F3-2116-24LR MF3-2116-30LR 3F3-2116-30LR 2F3-2116-30LR MF3-2116-36LR 3F3-2116-36LR 2F3-2116-36LR MF3-2118-18LR 3F3-2118-18LR 2F3-2118-18LR MF3-2118-24LR 3F3-2118-24LR 2F3-2118-24LR i MF3-2118-30LR 3F3-2118-30LR 2F3-2118-30LR MF3-2118-36LR 3F3-2118-36LR 2F3-2118-36LR l I = MF3-2020-20LR 3F3-2020-20LR 2F3-2020-20LR MF3-2020-24LR 3F3-2020-24LR 2F3-2020-24LR MF3-2020-30LR 3F3-2020-30LR 2F3-2020-30LR NSF _ MF3-2020-36LR 3F3-2020-36LR 2F3-2020-36LR MF3-2424-18LR 3F3-2424-18LR 2F3-2424-18LR MF3-2424-24LR 3F3-2424-24LR 2F3-2424-24LR _ MF3-2424-30LR 3F3-2424-30LR 2F3-2424-30LR MATERIAL MF3-2424-36LR 3F3-2424-36LR 2F3-2424-36LR BODY ■ MF-16 gauge 304 stainless steel bowl,430 body. ■ 3F -16 gauge 304 stainless steel bowl and body. MF3-3020-20LR 3F3-3020-20LR 2F3-3020-20LR ■ 2F -14 gauge 304 stainless steel bowl and body. MF3-3020-24LR 3F3-3020-24LR 2F3-3020-24LR LEGS MF3-3020-30LR 3F3-3020-30LR 2F3-3020-30LR ■ 15/s"O.D.16 gauge 304 series stainless steel tubing, come MF3-3020-36LR 3F3-3020-36LR 2F3-3020-36LR plete with 1"adjustable impact resistant white metal feet. DESIGN FEATURES ■ All sinks are fully cartoned. ■ Easily assembled. �M SIZES■ AVAILABLE Drainboards pitched 3/4"for positive drainage. EXCLUSIVE AERO SAFETY EDGE ■ Sink hemmed on the roll and backsplash to eliminate cuts HEMMED from rough edges. v—SA IY EDGE CONSTRUCTION I L11/2'DIA.SINK ROLL ■ Exclusive 1411 bosul depeb on all models(consuftmd's spec). ■ Custom style fabrkated bowl for true gauge integrity. ■ All sinks have a 3/4"radius at all intersecting planes (consultant's spec). ■ Stainless steel gusset is machine welded 360 deg to a stainless steel triangular plate. ■ Gusset plate is fully welded directly underneath the sink for support. / ■ Polished to a n4 blended fetish. i Hu ■ All sinks with drainboatds 30"or lonqu equipped with 2 stainless SANITARY LIP. . steel 15/s"O.D.legs with stainless steel gussets and white metal feet PLUMBING 14'DEEP ■ Water supply is 1/2"hot and cold. I ■ Faucet holes are W o.c.(Faucets not included.See accessories). j AEROSPEC f includes aU of the above and the following: CONSULTANT'S SPECS ■Full 10"backsplash instead of standard 7". ■Stainless steel feet in s lieu white metal. AT PRODUCTION PRICES ■Legs have stainless steel crorossbracing with aluminum castings at all intersections. AERO MANUFACTURING COMPANY• 310 ALLWOOD ROAD,CUFTON,NEW JERSEY 07012•VOICE 201.473.5300 FAX 201.473.3794 i Domino's Retrofit Overshelffor 8-foot Work Table : Model: DOM-RETRO84 Item: 320870 'A Ilk 3 i 8419 5411 f x 96"Cut table x 6"overhang on r, k each end !fib fr s %gin%a;...« ..,.,,..:.:.-»w�,r- ..,,..,..;_sr�wan..xw,,,_ -m,.ru.sae»;. ..;,;.,.�.mo.., .... ,.. .,�....:......... .:.-�•,., _,.,;«...T ,.... .. ,,,..,.«M,.�,.,., .. .::?'. • Unit designed to fit on existing 8-foot work table. • Modular design allows flexibility to meet individual • Unit ships knocked-down resulting in freight crew member's preferences and ergonomic needs. savings. • Modifies existing cut tables to make them more • Stainless steel overshelves and backsplash with efficient and more productive. epoxy-coated steel posts and rails. • Accessory rail allows you to customize work station. • Ergonomically designed to maximize productivity • Core accessories for unit include: bins and dividers and minimize excessive movements. All for prepacked sauces, bottle holders, paper holder, accouterments are within arm's reach. cutter holder(minus tub) and screen holders. • Smooth surfaces allow for easy access and • Made in accordance with NSF guidelines. cleaning. • Meets Domino's standards. Contact your Domino's Project Consultant at 1-800-248-3325. N$E 441 EMERSOM. Some assembly required. Storage Solutions THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M i DATA r r ' AM I s _ O U 1 E (L.O.VARIES) 28 EDGE OF PAVEMENT ., 396' 8 IF PROPOSED 4-IN SCH.40 SEWER PIPE PROPOSED H-20 1500 GALLON SEPTIC TANK •" j l INVERT IN EL.=94.00' { M w' :__:�. SLOPE 1% MIN. (TYP.) $ � t EXISTING EDGE OF PAVEMENT - PROPOSED SEWER I Jrant Spindle OBSERVATION EXISTING 3EP,TIC LEACH PIT TO BE PUMPED VV1rE-TYPE CONNECTION (TYP.) INVERT OUT EL.= 96.. v. = 104.89' WELL AND FILL WITH CLEAN SAND (TYP. OF 5) 3umed _ -10% `4 /. D CATCHBASIN RIM EL.=99.81,CD 100.1 O 7 O _ _ INV_OU EXISTING 1000-GAL. = === S iPOSED H-20 2000 GALLON PUMP _ Im .< EL•=97- ± CHAMBER INVERT IN EL.=93.75' GREASE TRAP I� = 0 (CONTRACTOR TO 0 EXISTING 1500-GAL. SEF tiN EXISTING 1500-GAL. SEPTIC VERIFY) 0 -` TANK (CONTRACTOR TC SB/DH �� TANK(CONTRACTOR TO ~,,JNV. OUT EL.= 98.48' VERIFY) INV. OUT EL.= 9 FND MAP57 - - - z - - - - - - - - - - - - N EXISTING 1500-GAL SEPTIC, D 101—PARCEL 3 TANK (CONTRACTOR TO �' --Jo 1 J � ❑ � VERIFY) INV. OUT EL.= 97.61'± -- BLD L1 LOT 2 1 J WINDN 100.7 BLD A �- (219 GI U ^ DUNKIN' DONUTS BLD 5 BLD 6 > N I (459 GPD) QUIK STOP TOF=102.17' PAK MAIL TOF=10: 20 0 TOF=101.93' PROPOSED 80' BY 20' 10.5' (174 GPD) (236 GPD) PRESSURE-DOSED _ 36.5' TOF=102.03' DISPOSAL FIELD L0 TP 1 J 100.60 : :� • CONNECTION INVERT EL.= 96.85' 1��\' r _ MAP 57 EXISTING LEACHING 30.2, PIT AND SPOILED _ PARCEL 4 N ' ` SOIL TO BE BLD 9 REMOVED OFFSITE � 108,109 S.F± PS > sib- 7 _ BLD 3 OFFICEco C PERFORATED = =:~' TANNING, (174 GPD) PVC PIPE .�`r_ :1 "�'' 0 OFFICE, ETC m I TOF= 5 . (160 GPD) TOF=1,01.95' P 101.63 CB/D" EXISTING 1500-GAL. FND _ -:� SEPTIC TANK D (CONTRACTOR TO O 101� , GPS J �/ � , . VERIFY) BLD 10 • - '_ 0 OFFICE -_� 0 r+ SCHEDULES ARE NOT INTENDED TO BE ALL INCLUSIVE. STORE EQUIPMENT SCHEDULE OWNER IS TO BE ULTIMATELY RESPONSIBLE FOR ALL ORDERS. a MARK QTY. DESCRIPTION/MFGR PRODUCT CODE REMARKS FURN.BY INST.BY 00 1 1'STAINLESS STEEL DOUGH SPACER W/LEGS SEE E&S 4"BACKSPLASH/LEG ASSEMBLY 22314D (a:) 1 2'STAINLESS STEEL DOUGH SPACER W/LEGS PC 273160 4"BACKSPLASH/LEG ASSEMBLY 22314D E&S GC 3 &STAINLESS STEEL DOUGH SPACER W/LEGS PC 273161 4"BACKSPLASH/LEG ASSEMBLY 22314D a 4'STAINLESS STEEL DOUGH COUNTER W/LEGS PC 273162 4"BACKSPLASH s S STAINLESS STEEL DOUGH COUNTER W/LEGS PC 273163 4"BACKSPLASH -60 6 6'STAINLESS STEEL DOUGH COUNTER W/LEGS SEE E&S 4"BACKSPLASH r 7 1 7'STAINLESS STEEL DOUGH COUNTER W/LEGS PC 273167 4"BACKSPLASH E&S GC a B 1 UNIVERSAL CORNER STAINLESS STEEL DOUGH COUNTER W/LEGS PC 273165 4"BACKSPLASH E&S GC 490 4'MAKELINE SEE E&S 1 10'-0"MAKELINE RCP(RIGHT SIDE COMPRESSOR) SEE E&S LOW TOP,SEE E&S E&S GC cri 11 1 CORNMEAL CATCHER PC 273021 E&S GC a 12 1 BOFI 3255 DOUBLE STACK CONVEYOR OVEN SEE E&S SPLIT BELT DRIVE ONE OVEN E&S GC JASON D r 13 1 AVI CAP EXHAUST HOOD FOR BOFI 3255 SEE E&S E&S GC 0 14 PULSE TELEPHONE EQUIPMENT BOX W/HINGED ACCESS DOORS PWD W/)WHITE P.LAM 0 15 2 MENU BOARD-37"-55"MONITOR 1080p&HDMI COMPATIBLE SEE POMEROY RECOMMEND LG 43SE3B OR LG 49SE3B POMEROY GC 16 1 1 PIZZA TRACKER-37"-55"MONITOR 1080p&HDMI COMPATIBLE SEE POMEROY WITH HP'T620 THIN CLIENT POMEROY GC -Y GNICH 017a 4 PULSE TELEPHONE/ORDER STATION-WALL MOUNTED SEE PULSE WALL MOUNTED PULSE GC 'J ° E TELEPHONE DRIVER DISPATCH/CUT STATION-WALL MOUNTED SEE PULSE ADDL.DATA FOR PRINTER PULSE GC \\ nl � �r` ARCHITECT ° 17b 2 PULSE / )� �` E 17c 2 1 PULSE TELEPHONE/ORDER STATION-POS COUNTER SEE PULSE POS COUNTER/ADDL.DATA FOR PRINTER PULSE GC a 17d 2 DOUGH/MAKELINE MONITOR-POLE MOUNTED ABOVE SEE PULSE PULSE GC c 17e COUNTER MOUNTED KIOSK SEE PULSE MOUNTING BASE V'� 17f TEAM MEMBER NOTIFICATION(TMN)SYSTEM SEE PULSE MOUNTING ARM,IF NEXT TO POS TERM. - 3 18 1 CALIFORNIA SAFE WITH DIGITAL LOCK/TIME DELAY PC 381811 20"TALL DUE TO ELEC.&CASH DRAWER E&S GC N �✓ 1 - ---- ---- -- _ _ Ul a 19 2 METAL CASH DRAWER W/REMOVABLE TILL PC 312661 MTL.BRACKET KIT REQ'D.-PC 284008 E&S GC - d 20 30"SINGLE DOOR VISI-COOLER SEE COKE 1� 3 �` p�� _tl� - (�(� 2'-10"'CRUST PAINT t \ � n1' L 21 1 54"DOUBLE DOOR VISI COOLER SEE COKE SLIDING DOORS COKE GC n - -- - -- - --- ---- 22 1 COKE COOLER GDM15-RETR(RETRO COKE COOLER) SEE COKE COKE GC 8'0 CRUST PAINT 18'-5"S BWAY TILE L, 3 23 1 T CUT TABLE W/OVERSHELF SEE E&S E&S GC 2a 1 60"ROUTE STAND W/(3)54"HEAT LAMPS(PC320815) PC 320810 E&S GC _ _ IkIll - o ---- ---- , 25 2'DRIVERS TABLE I �, PC 22141 D 15 15 I rz=-----Fp a - Q ° 26 1 3'DRIVERS TABLE PC 22140D E&S GC ABV. ABV. O ZI I 17 w ,1- )C E 27 1 10'x 12'NOMINAL KOLPAK WALK-IN COOLER BOX W/OUT FLR. SEE E&S E&S GC WALL MOUNTED I'; ' c�L z F-I MENU BOARDS 3: - r_-------tr 2 10 17 v Q v w 28 1 SEARS KENMORE ALL-IN-ONE WASHER/DRYER SEE E&S E&S GC m 29 SEARS KENMORE SIDE BY SIDE WASHER SEE E&S z ----- --t- f-- ---- ------- N Q ° L CUSTOMER z of i 11 _ 33 © r a 3o SEARS KENMORE SIDE BY SIDE DRYER SEE E&S SEATING wl Ir I PRODRUECATION - q �1 � 0 31 STAINLESS STEEL 3-COMPARTMENT SINK PC 28102 co 0 3-COMP.SINK,WASTE LEVER PC 383050 AREA w z aw cU L- o o I I 3'6"PART HT.DOUGH 0 3-COMP.SINK,ECONOMY SPRAYER W/ADD-ON FAUCET PC 383011 } o z ml '. WALL W/SNEEZE GLASS v 3-COMP.SINK,WALL BRACKET FOR ECONOMY SPRAYER PC 28108 LLI m z T ' I I 3'-6"PART HT.DOUGH q ° 32 2 COMPLETE 3-COMP.SINK WALL STORAGE SYSTEM PC 411956 E&S GC p / CHILD STEP W/ I WALL W/O SNEEZE GLASS --__-- o o • 33 3 STAINLESS STEEL HANDSINK W/2 WRIST HANDLES&BACKSPLASH PC 383101 W/SPLASSH GUARDS,BOTH SIDES E&S GC w I HAND RAIL N N I g O N N 3 LIQUID SOAP DISPENSERS PC 244006 E&S GC o �I z __--tT1% I w o m 3 HAND SANITIZER DISPENSER SEE E&S E&S GC O z I F- Z a 3 PAPER TOWEL DISPENSER SEE E&S E&S GC w L- • 0 p�o I i'--- 'r co w r Lu / I r- 1:1 w > I r w 3 TRASH CAN W/LID(PC7031) PC 7030 E&S GC U'IL --, �I m l I > z p J 6" a z ° 34 MOLDED STONE MOP SINK PC 28096 N / N �`SOFFIT a _ v o I ABV. ------ w Q N 35 1 WATER HEATER SEE PLUMBING GC GC 0 I 47l'i, ------ C?m co 36 1 4'STAINLESS WORK TABLE PC 326031 E&S GC --- 37 1 5'STAINLESS WORK TABLE PC 22289 E&S GC 22 ADA I I D7 o I r CO o ( ) Os I�j�Ow 4'0" FINISHED r TRANSACTION m I /J m RED TILE 1� J 38 18"x 36"OLYMPIC SHELVING PC 411960 BRUSHED NICKEL IF IN CUSTOMER VIEW I I I ______�, 3cZ„ COUNTER PAN --- FOCAL WALL _ 39 18"x 48"OLYMPIC SHELVING PC 411961 BRUSHED NICKEL IF IN CUSTOMER VIEW ' �q n �&l 18"x 60"OLYMPIC SHELVING PC 411962 BRUSHED NICKEL IF IN CUSTOMER VIEW N_pg ARTU `v TOTAL DOMINOS AREA 2,233 SQ . FT. 4'-0" N ; 418" 1 18"x 72"OLYMPIC SHELVING PC 411963 BRUSHED NICKEL IF IN CUSTOMER VIEW E&S GC 0 =' a2 2 24"x 24"OLYMPIC SHELVING PC 411964 BRUSHED NICKEL IF IN CUSTOMER VIEW E&S GC Q R 43 2 24"x 36"OLYMPIC SHELVING PC 411965 BRUSHED NICKEL IF IN CUSTOMER VIEW E&S GC N F_ W a --- - --- - --- --- ----- t 44 3 24"x 48"OLYMPIC SHELVING PC 411966 BRUSHED NICKELIF IN CUSTOMER VIEW E&S GC I � ,1 it I 11" * �1 � 45 3 24"x 60"OLYMPIC SHELVING PC 411967 BRUSHED NICKEL IF IN CUSTOMER VIEW E&S GC CUSTOMER " I 21 �J 0 BUILDING DATA 0 46 2 20"x 36"HEAVY DUTY DUNNAGE RACK PC 462452 E&S GC AREA � 33 0 47 3 20"x 48"HEAVY DUTY DUNNAGE RACK PC 462453 E&S GC WALL MOUNTED - � ° __--- _-- -- -- - - -- - -- - PIZZA TRACKER MAGNETIC 1! M 48 24"x 36"HEAVY DUTY DUNNAGE RACK PC 462450 r- -- -- -- - - 1 6 ABV. CARTOPPERS - --- NOTE:COKE COOLER y'}� ° a9 1 24"x 48"HEAVY DUTY DUNNAGE RACK PC 462451 E&S GC WIALK-I N _ c6 ________________24 __ W/SLIDING DOORS fl 0 50 16 COMPARTMENT LOCKER PC 26610 OCCUPANT LOAD SUMMARY Q Lo C':OOLERLo 51 1 BUILT-IN MANAGER'S DESK(WITH A.D.A.KNEE CLEARANCE) GC GC 10'x 2' c,? DRIVER'S Q� t 52 5 MODULAR METAL DROP BOX PC 8610A (5)BAYS TO BE ATTACHED TOGETHER E&S GC Q r 27 �I _ N AREA `7 � 53 COKE FOUNTAIN BEVERAGE DISPENSER W/ICE MACHINE ABOVE SEE COKE U `� III N � ----- Z _ N O *10 y NOTE: ONLY ITEMS WITH QUANTITY LISTED ARE APPLICABLE TO THIS PROJECT. ------ --------- o _ ID E&S = DOMINO'S PIZZA EQUIPMENT AND SUPPLY PULSE = DOM INO'S PIZZA POINT OF SALE SYSTEM __ __-__-__ -_- I ! ^ N �52 17a � 17a 142 � O _ 17b r COUNTER CABINET/ SOFFIT SCHEDULE OWNER IS TO BE SCHEDULES ARE ULTIMATELY RES ONSIBLET INTENDED TO BE ALL IFORALLORDERS J - - :5 � / (E) E.P. E E.P. 4'-0" o MARK QTY. DESCRIPTION PRODUCT CODE REMARKS FURN.BY INST.BY > cif „�^ CC-o1 1 TRANSACTION COUNTER(33.5"DEEP) PC 273310 E&S GC p \ c 1 Q I 1 --- --- ---- -- ----- - ---------- rn i 1 L o CC-o 1 18"POS FILLER CABINET(33.5"DEEP) PC 273306 E&S GC __ _ _ __ ___ __ ___ __ _ ___ ___ ________ _ -- -----' - -- -- -- - Q v` CC-o3 1 24"POS FILLER CABINET 33.5"DEEP PC 273307 E&S GC I ___J_____ J ( ) -- ---- - ----- - - -- ----- --- ------ ---- - NT_ CE -- - - --- -� STAIRS CC-o4 30"POS FILLER CABINET(33.5"DEEP) PC 273308 ---- ---- --------- -- -- - ----- - --- ------ ------ VESTIB E I — 0 CC-o5 36"POS FILLER CABINET(33.5"DEEP) PC 273309 CC-O6 WEDGE CABINET(33.5"DEEP) PC 273311 -- ----- - ---------- ______ ___________________J • • 7�'t CC-o7 HOT HOLD CABINET BASE PC 273312 ______ O v CC-os 8'STAINLESS DOUGH TABLE-PIZZA THEATER PC 273100 4"BACKSPLASH j 46 CC-O9 2 POS MOUNTS PC 284007 E&S GC F - 1 DRY ^ •� CV ------------ - CC-10 T CUT TABLE-PIZZA THEATER PC 273117 W/OVERSHELF(PC 273128) ----- ---- - --- - - i STORAGE j`� ly U U - - -- 47 47 47 (� Q CC-1 i SOLID STAINLESS BOX SHELF-3 REQ. PC 273119 W/(4)54"ERECTA POSTS(PC 273166) ------- -- ---- CC-12 BEVERAGE COUNTER PC 284043/PC 284042 TRASH ON RIGHT/TRASH ON LEFT U O CC-13 BEVERAGE COUNTER TOP ORGANIZER SEE E&S nn`` 1� W CC-1a AMENITIES STATION SEE E&S ----- ---- - --- - - `� I o DRY �, W O — CC-t5 2 SNEEZE GUARD POLE END(INDIVIDUAL) PC 284300 G.C.TO PROVIDE GLASS E&S GC FN-01 FN-01 \ z v STORAGE •� c_ T�� O /-� CC-16 35 4 SNEEZE GUARD POLE CENTER/CORNER(INDIVIDUAL) PC 284301 G.C.TO PROVIDE GLASS E&S GC a ABv r �; O •� v �L N CC-17 45'PREFAB MODULAR SOFFIT PC DOM AA 060 PRE-FABRICATED SOFFIT OPTIONAL: (E)MOP ,a 36 33 © � O CV O SEE E&S FOR SOFFIT ACCESSORIES U SINK ��`` '— co O L0 cC-1s 48"x 24"x 8"PREFAB MODULAR SOFFIT PC DOM AA-1 5 010 F 41 ?_ �,J � OUG CC-19 48"x 36"x 8"PREFAB MODULAR SOFFIT PC DOM AA-15 020 T 4 CC-2o 48"x 48"x 8"PREFAB MODULAR SOFFIT PC DOM AA-15030 ---J ---J CUSTOMER N -- u u ---- ----- - --- - -- 51 EXISTING � .� TRAY EQUIPMENT LAYOUT CC-21 48"x 60"x 8"PREFAB MODULAR SOFFIT PC DOM AA-15 040 SEATING 3'-5" CC-22 48"x 96"x 8"PREFAB MODULAR SOFFIT PC DOM AA-15 050 FN-05 AREA �li� OFFICE PHONE I �;, n TRAY n FOR OWNER REVIEW/ CC-23 8 CORIAN LEDGE SUPPORT COLUMN SEE E&S SUPPORT FOR CORIAN WAITING LEDGE E&S GC __-__ ____ __ _ _ r r f 11 DATA z NOT FOR p NOTE: ONLY ITEMS WITH QUANTITY LISTED ARE APPLICABLE TO THIS PROJECT. EXISTING I� ABOVE CLEAN-UP ouG 1� - --- ------ - --- --------- ------- FN-01 FN-01 NOTE: SOFFIT LAYOUT/ACCESSORIES FOR DESIGN INTENT ONLY. FINAL EQUIPMENT ORDER TO BE BASED ON ---- ----- - --- - - WOMEN'S J DESK 0 AREA TRAY CONSTRUCTION: MANUFACTURER'S SPECIFICATIONS. RESTROOMA -� 32 DRY n �EY - 02.27.18 - AB" STO RAG E FURNITURE SCHEDULE 'SCHEDULES ARE NOT INTENDED TO BE ALL INCLUSIVE. STORE FN-01 FN01 4y (�I I N-41/2" OWNER IS TO BE ULTIMATELY RESPONSIBLE FOR ALL ORDERS. Ln REV:DATE: DESCRIPTION: 1 ---1 �t 3'-7" fft WMARK QTY. DESCRIPTION/MFGR PRODUCT CODE REMARKS FURN.BY INST.BY -- ------ ---- - - L --- EXISTING1 03.09.18 OWNER COMMENTS FN-01 12 DINING CHAIR(18"SEAT HEIGHT) PC 318080 DINING ROOM E&S GC N-05 MEN'S 42 " G; 7 FN-02 7 COUNTER STOOL(25"SEAT HEIGHT) PC 318081 WAITING LEDGE E&S GC RESTROOM FN-04 DINING TABLE TOP AND 1 BASE:36"x 24" PC 284015/284016 DINING ROOM rFN-01 rFN-01 FN-05 3 DINING TABLE TOP AND 2 BASES:36"x 48" PC 284017/284018 DINING ROOM E&S GC O O �e 28 M r FN-O6 1 BENCH-3 SEAT PC 284014 WAITING AREA(60"LONG) E&S GC - SHEET NAME: R BENCH-3 SEAT-SECURITY STORE SEE E&S SECURITY STORE(61.25"LONG)1 INTERIOR TRASH CAN-36 GALLON 20"X 20"X40" PC 273030/273031 BASE AND TOP/TOP ONLY FITS(E)BASE E&S GC FN-11 48"SINGLE BOOTH SECTION PC 284011 INTERIOR SEATING AREA 9'-8' 6'-5' 6'-10" (' 16'-4" EQUIPMENT LAYOUT/ FN-12 WALL BOOTH SEATING(SEE PLAN FOR LENGTHS) PC 284013 INTERIOR SEATING AREA 39'-3"' / COUNTER CABINETS/ FN-13 48"DOUBLE BOOTH SEATING PC 284012 INTERIOR SEATING AREA NNN FN-14 EXTERIOR TRASH CAN-55 GALLON PC 273016 EXTERIOR DINING AREA � SCHEDULES FN-15 30"ROUND OUTDOOR TABLE WITH BASE:SEATS 2 PC 318070/318071 EXTERIOR DINING AREA FN-16 36"SQUARE OUTDOOR TABLE WITH BASE:SEATS 4 PC 318072/318073 EXTERIOR DINING AREA 1 EQUIPMENT LAYOUT (`f' FN-18 T RED OUTDOOR TABLE UMBRELLA W/BASE:ADD SMALL LOGO PC 318043/318044 EXTERIOR DINING AREA SHEET NUMBER: FN-19 OUTDOOR PLATINUM CHAIR PC 318074 EXTERIOR DINING AREA SCALE: 1/4"= 1'-0" FN-2o 1 CHILD STEP PC 273300 24W x 18D x 12H E&S GC FN-21 1 HAND RAIL PC 273301 E&S GC A1 . 0 NOTE: ONLY ITEMS WITH QUANTITY LISTED ARE APPLICABLE TO THIS PROJECT. 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