Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
OSTERVILLE FARMERS MARKET - CLOSED TEMP FOOD PERMITS 2021
i FARMERS' MARKET- OSTERVILLE MUSEUM I V 155 Uv V3� y �a� Oster � � lle — � 1 � - og � 'n TEMP FOOD CHECKLIST �dam"` aVL/ EVENT NAME:FARMER'S MARKET OSTERVILLE OT REQUEST: N/A CONTACT NAME: JENNIFER WILLIAMS EVENT ADDRESS: 155 W.BAY RD,OVILLE ICONTACT PH#: 508-280-8882 EVENT DATE: 06-18-20 TO 09-17-21-WEEKLY FRIDAYS CONTACT EMAIL:'williams@ostervillemuseum.or VENDOR TFOOD HANDLERS 5 YR SS 3 YR SS ALLERGENILICENSE EVENT FOOD ARTIS WINER a N/A N/A N/A N/A N/A NO PERMIT NEEDED ` y(/1 SELLING BOTTLED WINES-SHELF STABLE ry Q AUNT DAILIES /A N/A N/A N/A N/A I NO PERMIT NEEDED SELLING DRY BAGGED PASTA-SHELF STABLE BRADFORD FARMHOUSE TOFFLIEE_f, Amy Bradford N/A-APPROVED 3YR X X X NO PERMIT NEEDED PACKAGED TOFFEE-SHELF STABLE (J 0, D SI M Felicia DaSilva N/A N/A N/A X NEEDS PERMIT-FROZEN FOODS ` Josh DaSilva N/A N/A N/A PRE-PACKAGED ASSORTED USDA MEATS AND EGGS ' O S Douglas Foss N/A N/A X X NO PERMIT NEEDED BOTTLED MARINARA-SHELF STABLE C{� FRAULEINS BAKERY Ramona Stuber-Case N/A X X X N„ PAR- WHAT ARE THEY SELLING TO DETERMINE IF THEY NEED A PERMIT?? HALE BONE BROTH Chris Honen N/A N/A N/A l;P .,f NEEb CURRENT:BUSINESS CERTIFICATE.FOR HIS BUSINESS FROZEN BONE BROTH-NEEDS PERMIT FOR FROZEN FOODS XXV V` C Kimchhay Chou X _ N/A N/A X N q Chianna Yu X WHAT ARE THEY SELLING TO DETERMINE IF THEY NEED A PERMIT?? j�C HIPPV PILGRIM Samantha Locketti N/A X X X NO PERMIT NEEDED �t COFFEE RUBS,SALTS,VANILLA SUGAR BOTTLED-SHELF STABLE T HONEY I' HOME Tim Cleland X N/A X X NEEDS PERMIT-SOME ITEMS ARE NOT SHELF STABLE Breads,granola,muffins,scones,biscuits,salads,chilled soups,mac&cheese JAJU PIEROGI &L Case N/A N/A N/A N/A NEEDS PERMIT FOR FROZEN FOODS Frozen Prepacked Pierogis Ax /LARAS CUISINE Lara Ferri KNEED' N/A X X NEEDS 5 YR SERVSAFE/ONLY HAUE-ALLERGEN,,,"I PERMIT"' 4/ a�_. ... o Pre-packaged Pesto Sauces Pfyr MARTHA'S VINEYARD SM KEHOUSE NEED ?�? ?�? ??�.... PdD' yNEEDS'PER NEEDIVII AP,.,PI ICATION MEN ND CERTIFICATES �,SSSQRTED�SMOKED;Iv1EATS AND FISH ---r - R O MONOPAT_I Maria Lemanis I X N/A X X NEEDS PERMITS-SAMPLING ACCORDING TO APPLICATION Olive Oils,Nut butters,olives,baked goods O NATIVE COL MBIAN FOOD LLC' Roberto Pe rmo X N/A X X NO PERMIT IS NEEDED Bagged Coffees-Shelf Stable NUT LADY N,ET D_ ; ?? J 3�? ?�?• NEED NEED APPLICATION-BUSINESS,:CERT SEE IF�NEEDS PERMIT? „p 1' c, tASS(ORTED PRE PACKAGED NUTS . OAKDALE FARMS I Laura Smith IX I N A JX X NO PERMIT NEEDED-SHELF STABLE,NO SAMPLING ' u 4 1 TEMP FOOD CHECKLIST ��'" Assorted Jams an ickles 64 O SANOBE SUPERFOODS Jennifer Beauregard X N/A jX X NO PERMIT NEEDED-SHELF STABLE,NO SAMPLING / Assorted,Peanut Butters (�1 SAVENOR MEATS kqeff Mushin N/A N/A N/A X NEEDS PERMIT-FROZEN MEATS VACUUMED PACKED ASSORTED MEATS O SAY CHEESE Joanie Chipman N/A Ix X X ASSORTED CHEESES PR.3 YEAR PER TM NEEDS PERMIT-REFRIGERATED CHEESE TEKLAS BR AD Janet Mohre / N/A N/A X NO PERMIT NEEDED-SHELF STABLE,NO SAMPLING ��rT (l'-- O TOWNIE FROZEN DESSERTS Robin Flint ? X N/A X X PERMIT NEEDED-FROZEN FOODS PRE-P CKAGED VEGAN-ICE RE MS,SORBETS&TQPPI GS Yl o . ;sue WASHASHORE BAKERY 1 Alexandra McPhersa X N/A X X APPLICATION AS SAMPLES,NEEDS PERMIT EII!jA Vinci i+ N/A X N/A WICKED KETTLE CORN Jeff Paine X N/A X X KETTLE CORN AND SAMPLES Diana Pain N/A NEEDS PERMIT-STATES GIVING OUT SAMPLES VY1 W ���- G��� _ " " � �-�� �.nA Q_ t;�-c-e,y 3 r — �-�' y�ca f Town of Barnstable \ �IoFtHETOwti Inspectional ServicesZ--j 0�1R� Public Health Division BABLEBARNSTABLE, iBAR15TA +(ANIIOY.S0."Cti G4MMPAI" ; Thomas McKean, Director ED"'Dr 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 08/19/2021 Event: FARMERS MARKET - OSTERVILLE Permission is hereby granted to: Artis Winery Name of Person: Jacquelyn Groeper Address: 300 Oak Street, Pembroke, MA 02359(C)617-650-3422 To serve: Wine Sampling ServSafe certified: Jacquelynroeper Allergen: Jacquelynper Only at the following location: Osterville Historical Society, 155 W. Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO'ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Barnstable Public Heal h°Division APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT. DATE N -ME OF SPECIAL EVENT Osterville Farmers' Marked 2021 Season WAS TEAS EVENT APPR©VT.D,BY .THE BOARD A'I'APUBLIC MEETING? x Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAIIS EXECUTIVE .DIRFCTOR' TELEPHONE# 508.428.5861 CELL# 508-2804882 : HOME ADDRESS 155 West j3 Road: VILLAGE Asterville NAME OF ORGANIZATIONV. CON'FACf.PERSON QCr�cr2� - :Y -�t 'TELEPHONE foII -toSO Z� ADDRESS 6ir kS �Cc7~�rcrc 1 cz1 i7r y7a• e, ra:y . :m pZ��� FOOD TorBE SERVED(LIST;EXACT FOODS) +1�' ra5u �� -S�ne NAMES OF TRAINED FOOD HANDLERS(TorBE ONSLTE DURING EVENT): C'lei (ATTACH COPIES OF SERVSAFE&At CERTIFICATES) ADDRESS WHERE TO BE SERVED Os#ervilie Historical Museum.155 West Bav Road,Osferville.l4lA 02655 DATE Tor'B.E'SERVED June 18-Sept 17 TIME 9 an,to 1 pm, WHAT TIME WILL ALL EQUI"PMENT BESET-t3P&READY FORINSPEC TION? �IA HOW WILL FOOD RE KEPT BELOW 4I DEGREES n/A HOW'WILL FOOD BE HELD;AT l40 DEGREES F. 1� HOW IS FOOD COVERED: nJ HOW'IS FOOD SERVED TYPE OF HAND-WASHING FACILITY SIGNATURE: i Town of Barnstable Regulatory Services Department Public Health Division RAIUMABM 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Dt: 1 Date (e Z Table/Cart/Trailer Identification Name T1' s f Telephone Permit Holder's Name Telephone DEW ERMJT PWalid Permit/INFORMATION Displayed & V-4 _ 4L Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite &L4 . (t'^P PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Lo / C _ Foods Covered I�GC u je _ Proper&Adequate Handwashing/Temporary Handwash N Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating Cooling Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print / / ���� $ �'� _ /�� •s Iv' ": n'wi` he�Lhn�es��n, e � 5�afe�A��ctlS 1ain1 ��i�� p a �": � f E,ss" �, r ..s c stb �1�1•,._.,<, ,lysl�. _�n 5nfe�/ OIT I ,r�' ral��,.; ' Lltign£`t€ESE dht, ff/l,T lr "=�, r .<."^ :r/ ,�f fir'- +:r E4 �lia•d - •ry %�'w � % /C/ t Gt ,t3!lt�c3tOf@ L'S r 17t1�SSOCJadOTt }RJUr IS IS.Ufdr nrISI iNS x;. / rJB- '' ,. e valueQur a IL t respond lealLn s ce an app 'ud u car ma I / Y` rrl%9i IBM t G i y �: ;iFrxe �t� Ali a Frestc3en"'�Niitt"`01 Besa rot 'so`'�o S'luhons � ` uryry °�li ID#;3253E34 .tflLa�o ' I r aftgn fey CARD# 1 df 8327818 ServSafe -. - "`' w1w.�a±!ros1>wnne�vnea,a� n[114Y� p .ESftbll5 r8 tR .... ServSafe Alcohol@ CERTIFICATE t�tttp y aurp�G4ssplatt JACQUELYN GROEPER a-•* 3 a p NAME �s a .sizoss / DATE OF EXAMINATION ,a/ray Cord expires three years ham the dote of eaaminafion.local laws apply.. c u%w 4 � r 6' ll[l'A lOBOlILI uog000ssyjumno4Sa8j0u0g0N84110SIMOp64 W i aco u61sap ND 844 ppa®uoy0passry MADISON�00040N'JIUN 041}0 s3mwapml 0`0 0601010SAJOS 841 M., pu0 0810SAJOS POWSW sly6uJIV'(j3v8N)uuipunoi I0u0u0mP3 uogonossy luounalsq 0uou0N L(HP / m suorynlog uoiasioossy auWna18a1 reu0tg8N'3u9pcs0ad=801A aniynoaxS t I K,. - umosg daxxaagg � i •woj6oid 87IAJas IoHoDjo a isuodsai ,.`. 61040311 4DSMaS ey p uoi;aldu3o�SwJ,yuoa ejoaiji a�SNi � ,r, (QS Otl�l'l'l�9��1F7i3'! 'f.�''�CitF�tOf� Ef�a`;�(Im �r� •�� f 5 r v/ t r CERTIFICATE OF ALLERGEN AWARENESS TRAINING i Name of Recipient:=ouErrr GROEM Certificate Number: Date of Completion: onu�o,e Date of Expiration: Issued Br. Be ahove-named penor.is hereby issued this eertXrate L c forromplttingan allergen awarenrsstrainingprogrom ��.... NATIONAL RESTAURANT recognized by the Massachwetts Department of Public Health �—� ASSOCIATION. in accordance with 105 CMR 590.009(C)(3)(a). Masuchusstw Restaurant Auociation 800.765.2122 333 Turnpike Road,Suite 102 www.mtaunnt org Ibis certS*ate will be valid for five(5)years from date ofrompletion. Southborough,MA 01772 508-303-9905 i - wwwtmarestsurantuwe.org WIN i pps mit NO 08te Iss be&21-014 Ju 'The.'Commonwealth of 1l�assflchu ets Ee : �Yuo.uozo xllzv ; TOW OF H<OPEDAL rAu�tioaa Date: June30 26.21 Board)of Health ' 2 78 Hopedale Street'- P.O. Box 7 = HopeAale, Massachusetts 01747 In accordance with regulations promulgated under authority of Chapter 94,.Section 305A and Chapter 111,Section 5 of the Gra1.I:aws a permit is hereby granter)to: A T 'TIE A1.LIE9S ARTISAN DRIEDPASTA, Whose place of business is-7 DEC court,Hopedale, Type of business: RESIDENTIAL KITCHEN TO operate a food establishment in: Towel of Ho nerlale a cvndititrn of this license,in the interest nfpubfic health,the licewee shall not employ or altow,to wvrk on tide ticerrsed prendses any person not present in the Vnited.Slates in compliance with applicable law, Gilliam Fisher, ealth Agent - ♦saaxreM:Pf. NaArA+:RArrxar�e;axsrr a+.JA.i4:ilSrnsA:Hii�exwi'v.N:.rA i+'IRY FtiiiRSAra: .ae wx.•{NARy� irirlTR�h!!`,AlFlti •liar-_rf••f••a;•Tx} R�Rea:YZRt:ArrKxe'agR.f t•x Rr�•.a a.•rruz. y7 - C FART 1 F.1 CAT E OF ' ESS TRAINING AILERG.. ,IN AWAREN N:ttnr<>! 12c°c i�ie�i� ja:dttiYws ('�artificate Number: 28661117 1}itc c t'C`antjticti«ti; '4117M011 • - '.Datc of Ex Expiration: VIM022 i wof Bv- 71� �rrvver/lr,,ann iz r'r472 is wed 111h( rti/irerl. „ /cr rzzlJ!>ir}t allrll et;tzz rrr°ar rera+tt'rrrzrrt�r�,r�{t rrtzzz N A HONA � rq rtr a r/! r(a ;11d+.Ntrhrn,r/t�I)e:�nu/zu.uz o I'tl:/it !/,whlh 1 X ta}it?N,re Jtl elei rl'�laali+. Ord/ 105 C3Jf'''>iJllf�(1�(°t;7j.i)�erl. Ata� nhu� t:�Ie•t.nuant a� ittinn �tHl,i(��",�1'2? 333'llumpOw Rt,M.Nuity lf)e' r�Ei^rs:e.�laurarH.,,r 9€ � �aretlrlutn+it},h, lr� t?iiee;E fli}r Pd1'iilirrfl"will be-Oalifl f rfi/ h`f 4)1'e°tlt:,1P01;1 fkt:e:t'l o/1lplaiDn' _. W\YtY lit;lrt^51dgl,tis61•r�pten'�(' TbyalaxR3f Paflaq}a''RrrrPfTR dR"r♦r•rRxXfYRli9NfrT19+91rifi•PMP'Rilrirr`blr)rYarbxsrR'rOr'ffgYPrsxilpaYrf Rf ArRRkR:Pxrtbabsr+rrrrf.'t.Aa•itr.....W.4........siarris......YrrrirrrRx`aa'ri�TSR�'atgq.p 13 y �� P z zAt ` �a t "k rvsafe CERTIFICATION JOIN HAYN E:S fo;wme%full correlating k w oandords.Sol forth 6 the ScrvSafe":Food Prowicm Mcs.xwr Cerfi(icalion Excimirvation which it accredited 6/16 American National StondL 6133 Institute(ANSI)—Cort(�t 6 Food Protection(CFP) 1,4912620 10551 ` UMBER EXAM FORM NUMBER 4/4/2422 DA11 OF DATE bi EXPIRATI.Qf�i tc>csrllum apply C T qgcrocyfarr¢certilicntion.rmquiramrnta; � x L .. d`a a:.�.'.ta A^ymlrgfl9 tt tti I '� MOP At F _ - � r 4 ¢ � x : � F '� s w'4G{�F,. �' �''i�M>xiv:.,.�RI+��nmu.rce�Ai?.5++$��4.�nE�Sfia17<[h.,��,. Ila��e�U�k�w3}�f .._ _ u Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 >�A OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date Table/Cart/Trailer Identification Name D aj 4(s Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERWT-INFORMATION —"Valid Permit/Displayed n^ P approved p —Iroved Menu Items Offered Only YT l S�Z� '/D� FOOD PROTECTION MANAGEMENT j PIC Assigned/Present Onsite d PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating Cooling _ Hot and Holding ood and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print nP(2,- Barnstable Public Health Divisionf, 2 APPLICATION FOR TEMPORARY FOOD SERVICEPERMI'I' DATE NAME OFSPECIALEVENT Qq r, it a gr, Market 2020 season WAS TIIIS EVENT APPROVED BY THE BOARD AT APUBI IC,MEETING? X Y N NAME OF PERSON(S)REQUESTING PERMTI' JF,NNIFER WII.LIAMS.F.XECITC, DIRECTOR TELEPHONE# S0S.42$.5861 CELL#_508-2804;�2 DOME ADDRESS ISS Nest BuvRoad - VILLAGE fO'sterville QNAREOFORGAATIO7A� �Z CONTACT PERSON 7`ELEI HONE ADDRESS L FOOD TO BE SERVED(LIsT EXACT FOODS) NAMES OF"TRAINED FOOD HANDLERS(TO BE'ONSITE DURING.EVENTy: (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFIexrES) ADDRESS WIIERE-TO BE SERVED Osterville Historical Museum.155 West Bay Rood,0stery lle,MA 02655 'g DATE TO BE SERVED.lute 1.9-Sent IR TIME 9 a.m.to is mm. WHAT TIME WILL'ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? HOW WELL FOOD BE KEPT BELOW 41 DEGREES F HOtiV WELL FOOD.BE HELD AT.140 DEGREES F. IOW IS FOOD.CO`✓ERED HOW IS FOOD SERVED TYPE OF HAND-WASHING FACILITY SIGNATURE: PERMIT NUMBER: FEP-2021-0445 FEE: $75.00 ~� THE COMMONWEALTH OF MASSACHUSETTS Town of Middleborough Board of Health PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General Laws a Permit is hereby grant to: Bradford Farmhouse Toffee Whose place of business is:27 Pleasant Street,Middleboro, MA,02346 Type of business and any restrictions:Home Kitchen To operate a food establishment in.Middleborough Permit Expires on:December 31,2021 Issue Date*.:411t2021 For ttia Board of He€rith..4 Catherine Hassett Health Inspector A�, ill �kuu��w:as�+rxsa:Y�-�s�vxrcc.'�vxa, i:r raaea�.raaw �r..r r C.�,ERTIFICATE OE At IN NkGE AWARENESS T 0 Name.of R 66pknr.,,nnlr 5RADFORD, CereificaieNurnber: b,aa tF Date of Compleaon- IW&20,n j ip2$.2A24. Date of Exxp �ttioi�: C] a him P SriIrr ah —napped per.a hrWy issued tUs rerlilk le �« �arr ,lrt°c anahrP�e ainrr�ttaatrurnin pro rurrr RCIV�l11N, ' ralnivdl tf�,9laa;or n<tt l3 iarrrrzcnt�f°huhlic F rn!!fi _ ,:1 .1 fl{(=sTdl � A1u 333�Turnprkez�Rnui Su e IQ m�.ntcauran snwrcriwretuA1LzCAIR590009G)(4)(n). �¢ W"0,2122 Sant}st>t�rauglx,�tA Ol%i2 ,' Thu errti�rsr�t�c^II ha,a�tid 'Ps,r(.S);yearx/iotn,rlate of�rrr�aJrtipn, p.343-99oS �,�, wYcw.n�s�rreac�urant�w.sz�c,irR �, i'Y3t �.Weik:Mki!'1,i�1�.EfN31'.J�(#Y�lY.1�Y�gl'Y9'.ILY"i'IYY.f]Gi;YKYf9RYt[IY31E'itiiC�l�i"�"1t{yf1�R),}°�atyy,�il1SlT1i3L�iS3Y:fTi!:JYY�$j3,�kyy ��.IfYYY e i� O te f Achievement This certificate is awarded to AMA' BRADFORDI -�" Congrotulafions! You:•have cofn ed ass ervSaHcfee. .rooand er Employee Fond Safety Onfine Course one E Ort' cnrtis t�N 6,. 4985398. 3/3072021 a s National Restaurant Association � 233 J,Wocker Drive,Says 3600 Expiration Date 3/30/2024 � Chjcogo,i�6060&6383 ti 800 765,2122 in Oic3gp area 312.715 1010 Ros�auror.ag 1 SeroSo`e coe' Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 �A OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event O I_ Date Table/Cart/Trailer Identification Name T>ado w d� t� g/(h ,c Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only -P�e* d Clara/>l-.0-4 FOOD PROTECTION MANAGEMENT U��Q PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing 1 Foods Covered (n,�d��I(Ly i yk 4A,,e _ Proper&Adequate Handwashing/Temporary Handwash Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures _ Reheating _ Cooling H old Holding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print a !, v 7, ow / 1 �1 'IPt,I AT C}E�i ()R TE t?I2AR1' Q4 Ekmt Z:EP� fs`" 6,K d t na Sa .p pa e sY V« tl "Season Of SPFCfAL vv r0ste �zlleFscnes' Cet21 \ , Al�f xy 1�A5 TADS El k 3V!Air t V ETA 111�THE BOARD AT LNG? vn C?F PEt2SO�i(S�Ri1S r1rC P1 Rt1IT r+rrrrr `� 'w 1�1sGUri, crow <a_ IiQT4i �ODRFSS; 155 t aysItoad V W CC C stcivtTte H� r� c -77 7 v IN No Ij r O AT' EAL IZAITOE+i Y u t /� ]L t .. 4OI�,rACT PERSON � AW� � jT/C� RJ.�4FCi �y .- ADDRESS I.1.�... 1"°. a, 7 NN Tom— " ' • a ail w ��_ e:t AiNTES OFTRA1'N1;D F(>OI)UANDY S ]E'ONStrili C7TYT�7 )&EN`n: n ° 1 (ATTACK COOP OF SFRV ' &AL A RGEN CMT FIGATFS ` t =r �t� tAM 14'tiER> FU K'S�3L�'1�.k2 �tarica n 5 rat a i 2fi SATE"T BC SERVFM.6-i-ells-SeT1243 51 a m Yo 1 p mIA e YSAT"r M:E%VI'I L ALi-)EQUfPNM T BE SLI U'p&Rk ADY FO111NSP�criOt 7 \\ k H©W WIt L FOOD BE ai*,r BELOW 41 DFO REFS E t r HO i TT.0 FOOD BEF, AT 140 S1EO F \ T.YAC \\ RN a TYPE 6F 1FAND- FACILffY <S\ savv k low 0*1 t � t _jk ill �5 a. � v 3 3 a SIRYs Z \\ \\\ MCI ga kom .. "W- 11 P, s h Rg & 41 `r3 Farm Family Casualty � � �'l�q�� t Insurance Company (�� ; ERIC N A'I'Ar des t Plt�t Cd::f�i e�3t:y NAONAL 344 ROUTE Bw GIENNIONT NEWYORK 1220T-2910 SELECT BUSINESS PACKAGE DECLARATION P%GE s< Policy Number. 2001X218€ Portfolio Number: Account Number: Name and Mailing Address of First Named Insured: JOSHUA DAStLVA CAS'LVA FARM 49R FAiRFiELD ST REHOBOTH, h1k 02769-2032 Agent: 3935 KEVIN J SULUVAN 206 W GROVE ST STE C 14"I;DDLEBOR0 MA 02346-1462 Agent Phone: 508-99"512 Business Description: POULTRY Form of Business:Inaiv,aua►$ve Proprietor P, Trarisaction Type: Renew Policy Period: Frey 07-16-2020 To 07-16-2021 12:01 A.M.Standard Time at your mailing address shown above <z iN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE t3oaiiC n3s $0 Bus�,,ess Persons: Pity $20,000 Business Income&Extra Expense Actual Loss Sustained Not Exceeding 12 Months 01fler Endorsements Bee Schedules LIABILITY COVERAGE Gtrneral Aggregate Lm,t(Griner than Products-Camp!eied Ops) $2,000,000 P�oducts-Completed Operal o ns Aggregate Limit $2,000,000 ftrsonal &Advertising Injury $1,000.000 EACH PERSONIORGAN1 ATION Each Occurrence Limit $1.000,000 Medical Expenses $6,000 EACH PERSON Other Endorsements See Schedules PREMIUM ry t PrIMum shown is Payable at inception Total Pra►niun► $616.00 POLICY SUBJECT TO ANNUAL AUDIT: No The Declarations,Scheciuies and Forms and Endorsements Make Up Your Comptste Pafiriy. Refer to Schedule Of Forms and Endorsements. Pmess Date:05-26-2020 X-3842 010 Page 1 of 6 x>in9 .,.4_. ..,�•. ,„;�- ��., tea.,.,x,• .,>,.,�� ,.�. ,�.�;_ Application Form https://permiteyes.us/rehoboth/boh/printapplication.php?filename=bohis... F08p� Rehoboth Health Department 148 Peck Street Rehoboth, MA 02769 gMvAWPa United States (508)252-3335 TOWN OF REHOBOTH Number F-21-0025 BOARD OF HEALTH Fee$ $100.00 COMMONWEALTH OF DATE ISSUED 12122120 MASSACHUSETTS DaSilva Farm DaSilva Farm 49R FAIRFIELD ST IS HEREBY GRANTED A FOOD ESTABLISHMENT PERMIT This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires 12131121 unless sooner suspended or revoked, Comment: Approved on 12122120 meeting date t4 Rachel Smith Board Chair Signature 1 of 1 4/8/21,7:44 PM Town of Barnstable Regulatory Services Department Public Health Division a� 200 Main Street, Hyannis MA 02601 4 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event ODY \ Date C P I Z Table/Cart/Trailer IdentificatioonpName ��S l (��� `� Telephone Permit Holder's Name i v'1 ��� Telephone DESCRIPTION OF VIOLATION PERJIT INFORMATION _ alid Permit/Displayed q err7 Pre approved Menu Items Offered Only r_ ,)_� FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing ' 1•� �C(/1(JS J Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash I Station Location A n _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) /�,„►®r i s TIME/TEMPERATURE CONTROLS { _ Cooking Temperatures r�M 14 /l 44 _ _ Reheating _ Cooling l(�'X/>y l/o y� d— `'�Ilot and Cold Holding _ Food and Food Protection ���L � CONSUMER ADVISORY e'�- _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print 6dD PIC's Signature Print Town of Barnstable Regulatory Services Department Public Health Division " 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Dr m ( Date b— Table/Cart/Trailer Identification Name �`l VA- "1 wf✓11 Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite aA- PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating _ Cooling _ Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print /L d PIC's Signature Print Town of Barnstable. Regulatory Services Department Public Health Division 0 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event WP v 1;, S Date //2- Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT �� , `. a PIC Assigned/Present Onsite �0 U(�E� .G4a. z PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing -- Foods Covered Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) k ` TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating _ Cooling i/Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print L �l PIC's Signature Print am- stable ub Health Division. NAM OFSPECIAL EVI?., WAS TU S EVENMAPPROVMSYTHE B AT APV$tAC MEETING! v NAME n €RGANIZATio ,,. `4 c .� FOOD TO E SERVED(LOT V(ACT MOOS) 3 NAMES OF TRAINED POW HANDURS(tO K O SITE L3 UNC MINI),AI"TAGtibFSI R `+A# 11 +EE }IFLC�I A DRESS ULRE'TO ESERV@) BAY RoAggalft Hag DATE TO RE SERVED Jm 2j ti.11 �14 4s,n►. l ►'FIAT TV4E WILL AL-L EQIIIP tT I S C'1 $t 'V Ft7tRt3 i'WnON4' I1SV WILL FIIE II- AT.1 DFEE,S F, }# 110W ISPOW COVERED xM � dal �� •. ___ _ � �� .w �' 12/31/2020 Permit#FS-20-184 'rii: Fee: 180 N 4 n O = THE COMMONWEALTH OF MASSACHUSETTS Town of Dartmouth Board of Health This is to certify that Foss Farms Business Name Douglas Foss Licensee Grange 1 Item Type of Establishment agrand oak rd Forestdale MA IS HEREBY GRANTED FOR ANNUAL FOOD ESTABLISHMENT PERMIT Permit Type This permit is granted in conformity with the 105 CMR 590 Minimum Sanitation Standards for Food Establishments State Sanitary Code,Article X and expires December 31,2021 unless sooner suspended or revoked. PERMITS NON-TRANSFERABLE s Conditions: 4— � 3 i Date Issued:January 1,2021 i i I i i I I i I I I i 4 (E+I f 1/1 I iff I!i I' ?}}r�y, � - q�e�'U �j�u f�����q 37k Syr ,� ��' ��r� �� 7x� 3' dfi ���u�51 ����fa�.�6 •A; ' a, arvw �,. a� •n a.� 1� e -"�� 4e f ��t. a�fe tiksx r� jj �ryVv PiafironallRestaurant gssoCtatlon.+ z yF qg ��"a�d i�!xx f �� ���" ✓ �`a � �, =s '� 'y �� " r �,,.�t i Y�i � ': �,� � t s�a�`�55 � 1 �t :: �� ir. r�r�:vv,�5 ,��} l i✓2 �J 1�'!4w,7n4YRffi f� j rt�a i*a k 3v 1 • 7 ffR L 1ACCREOITEO PROGRAM AmerlonNatenetSrandardslnstidrte and,UieCenfe#enceOkF edPfgte tlen�r am Y � '"M M� kl a x y`P� R�4 l ix�t..+."i Kyj ,i'ty Y 3 ^ ksf �3 $ h rn ��,1 �rC,�t�. �+�1�A����+�P,�S� i r�`'����' �i`l`f11 G.,..• .ai raj (j (ti l ,W011�i .+�'Iz l0. 'h �.� f r•le it �r k .i4S'. _ ••tl �J. 5 ufs'� la. .sFwfk � F � ,Ix"�,S,s e 5'�r� ?d I;��1151dk"�7.�.�v�:�A�t:�w..� ,_a.�a�v ,.FS�uk"�x.:s; �.a, IlWiklba�+ rr .�• � .�.o. . ►L, at bd{ af,J CERTIFICATE ®F ALLERGEN AWARE N E S S TRAINING IN G ,�6 4� {► Name of Recipient: DOUGLAS FOSS A� Certificates Number: 2703134 g _ Date of Completion: 12/1012016 Date of Expiration: 12/19/2021. 51 g, Issued By: Die above-nerved fetfon is hereby issued this rerllficelle � ^ � forromplelingan alleig i aeunreness training piogram L f 11a RESITOAURA , ?'dl liized by the Massarbns.11s Departinent o/'Public Health A55OCIATION® in arrordance with 105 GMR 590.009(G)(3)(a). Massachusetts Restaurnni Assoclatlon 800.765.2122 L 3331ivnpike Road,Snitc 102 wtnv.rcsrtutnnt.org Diis rerlirrrale will be valid forgive(.S)yearc`iom date of completion. Southborough,MA 01772 lelion. 508-303-9905 ws�w.marcsiaurmtnasoc.org (�� i I I I a I 1 i I f I \ i i 1 i i Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-79076304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V'r► "I Date Table/Cart/Trailer Identification Name 10- -&fr"A Telephone Permit Holder's Name Telephone itu�e!•DiUTillllT!]�'Vi(1T ATTlll�r i7I7Dvzez r �a�,..�rrz ry PERMIT INFORMATION Valid Permit/Displayed n Pre approved Menu Items Offered Only JWU R tth 4&t,,Ih,e�+'Gr�UQ� IGk y, — FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing live► La•ViGI � _ Foods Covered kj1 &,AA C! fQZd _ Proper&Adequate Handwashing/Temporary Handwash S SUS rRb o4 Station Location � t kfWX*I- WWI S a1 r Good Hygienic Practices(Use of gloves,use of tongs or tissues) ZP/ gym(je TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating _ Cooling _ Hot a Holding _ Food and Food Protection 9 CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Barnstable Public Health Division no 55krn-_,uA APPLICATION FOR TEMPORARYFOOD SER VICEPE T DATE �c NAM OF SPECIAL EVENT Osterville Farmers' Market 2021 Season WAS THIS EVENT APPROVED BY THE:BOARD AT APUBLIC MEETING? X Y tV NAME OF'PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR TELEPHONE#: 508.428»5861 CELL#t 508-280-8882 HOME ADDRESS 155 WestBU Road VILLAGE Osterville NAME OF ORGANIZATION 6ks k.4 7 , CONTACT PERSON a""c�Yl���LGt� TELEPHONE ADDRESS FOOD TO 9BE SERVED(LIST EXACT FOODS)&�Z& NAME j FO DLEMBE ONSITI DURING EVENT): (ATTACH COPIES OF`SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical Museum 155 West Bay Roads Osterville,MA 02655 DATE TO.BE SERVED June 18-Sept 17 _TIME 9 a.m.to.I p.m. WHAT TIME WILL ALL EQUIPMENT BE &READY FORINSPECTIO.N.? 7�1 HOW WILL FOOD BE KEPT BELOW 41 DEGREES,F HOW WILL FOOD BE HELD AT 140 DEGREES:F. /{ T— HOW IS FOOD COVERED17 S � HOW IS:FOOD SERVED TYPE OF HA 1B- 4CILITY r/.SIU IGNATURE: PERMIT NUMBER THE to FEE ,OF MASSACHUSETTS EEE 21-188FC �` tol 100,0 T WN OF KINGSTON } THIS IS TO CERTIFY THAT NAME FRAULEIN'S'BAKERY ADDRESS: 1111 ROCKY WOOD STR. TAUNTON MA 02780 19 HEREBY GRANTED A LICENSE FOR: CATERING PEGGY'S KITCHEN 68 MAIN ST KINGSTON MA 02364 THIS LICENSE IS GRANTED i FORMITY WITH THE ST TUTES AND ORDINANCE RELATING TO THERETO,AND EXPIRES DECEMBER 31, 2021 u ESS SOONER SUSPENDED OR REVOKED, DECEMBER 1,2020 Date Issued v Arthur Boyle, Health Agent J e . i r ME Certifica. te 'Of ie ement This certificate is awarded to RAMO A STUBER=CASE. i Congratulotioasl You have completed ASTM Z" ServiSafem, Food Handler z _ cir� u Employee Food Safety Online.Course and C' xam 4J4899615; 0 a 4/8/2021 No bar National Restaurant Association .233 S.Wocker Drive, Suite 3600 �ExrotiaonD /2024 Chicago,it 60606-6383 , C+# _ 804765.2122 in Chicogo area 312.715,1010 Restoutoni.org i Set Sat,,com �• € a { ti c ��:�S �:: �•.. �.. � i "� �`�' x r.; �.:. �z: � v:� "1,.. 3�.g"`,�., \ � "l \�, � � wily� .'.u" s ��„ ,v:„ ... -,_•. ...�..�aa-...,�<�.'.��o. _....'. � S ..�- �.3"_�S_ .,. ..,. u.. �...v ...... ....�..,'n..�. .�._� :''Q.•r.+�'.,e. _. .., .,.� ..w.>.a. .-� ..3. ..` CERT IrICATE0 F ALLERGEN AWARENESs T RYA 11e of ReC1p3eC11`::.kWdNA STUB€R-CASE } Certificate,.Nurriber: soosaoa ;Date of Completion: d/15/2021 Date of Expiratlon:n </,srzozs ; > ❑ r 7x� Issued By. ( ' 7be aho2 e nan/ed Pierson is hereby isszred thi3 tzrt rate tAT 0NA L�+ for completing an allergen a¢carersesr train irtriro$rRnr RSTtlERAiT recognized by the Masaarhnxetts l.Jeparttrtent o,f Prrhlit lfertltb :,.__...._. "' /ttAl"IQN, tt3 actordance with 105 CAM 590.009(C)f)(a). Massachusetts Restaurant Association. 800,365.2122 333 Turnpike Road,Suite 102 www.restaurantx rg Southborough,I41A 01M ?his cerl�fitatewill he vulirl for five(5)yrart fron►date of romfrletion. 508-303-9905 y wu w.rnarestaurantassoc_org Town of Barnstable Regulatory Services Department Public Health Division DAMffARM 200 Main Street, Hyannis MA 02601 �A OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event © ► l �J f Date Table/Cart/Trailer Identification NameplrQ(J��/�j/��' IJa l�.t y� Telephone Permit Holder's Name I"1���� Telephone PERMIT INFORMATION Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT A � f _ PIC Assigned/Present Onsite 'VV N 6R PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Foods Covered fii t,p� " , ►/)T4 Proper&Adequate Handwashing/Temporary Handwash 4b 6 r� ,(zl 61 Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS — CookingTemeratures Reheating Cooling Hot old Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print (A�Lt—,.4 1 T PIC's Signature Print 921 JW __-) APP LIICAUON FOR TEMPORARY PORARY FOOD S ERVIIC EP ERMIIT DATE ! - 1p-aO1!, NAME OF SPECIAL.EVENT Qjft y q! ]Fglt°lI1YAp, im WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? �Y N NAME, OF PERSON(S)REQUESTING PERMIT ,EN FERR WJLIJAMS.EXE4'U M DYRBCTOR TELEPHONE# 508,428.5b j CELL.#�50&280-8882 HOME ADDRESS I55 West Bay Road VILLAGE O1tetvllle NAME OF ORGANIZATION j 1}C&.I • ,S �'�� .�C� �� 1� CONTACT PERSON Cll)C+JnYIGI ;)Lk f g 3 TELEPHONE y y d ADDRESS `` ( FOOD TO BE SERVED(LIST EXACT FOODS) Q IP NAMES OF TRAINED FOOD HANDLERS(TO BE ONSITE D G EVENT): cbrvn4 4 L ]I- TACI (Al -i&W"%RVSAFE&ALLERGLKCERTUTCATES) Y� ADDRESS WHERE TO BE SERVED.Osteryllle Historical Museum,155 West Bay Road.Osteuille,MA02655 DATE TO BE SERVED,Tune 21-Sept 13 TIME 9-am.to I Q.m. WHAT TIME WILL,ALL EQUIPMENT BE SET-UP do READY FORINSPECTrION? t °-Qcoo fA/r►� HOW WILL FOOD BE KEPT BELOW 41 DEGREES FA t i CC r HOW WELL FOOD BE HELD AT 140 DEGREES F. t" 0d wt 6t ry hd— aft !qr) HOW IS FOOD COVERED eOwed Prl e ap-h- Plc �a-a a rP 5 ca lbp,r d w!-1h• t r d6 . i HOW IS FOOD SERVED RU-Qjjr., TYPE OF HAND-WASHING FACILITY._ s g=e l e.s . SIGNATURE i I i 3 i i i ENO toNgY 4' ` aka 3 THE COMMONWEALTH OF MASSACHUSETTS Torn ofMashpee Business Certificate r: License Number: 2020-013 t _ License Fees; $40.00 F reshrol I 439 Nathan Ellis Highway Type of Business Restaurant i Owner Channa Chou r PO Box 2156, r TgGckel,MA 02536 Dafe'QmWed February 14,2020 t? ►son Dace: Febrtuiry 29,Zt]24 Ip . i f3ebomh F.[Snmi f MaApw Town CICA CERTIFICATE OF LIABILITY INSURANCE DATE / 05/0404/2021 Y) 021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MURRAY&MACDONALD IN SVC INC/PHS 08087259 PHONE (866)467-8730 FAX (888)443-6112 (A/c,No,Ext): (A/c,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Accident and Indemnity Company 22357 Freshroll LLC INSURER B 439 NATHAN ELLIS HWY MASHPEE MA 02649-3132 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L R INSR WVD D (MM/DDNYYYl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE❑OCCUR DAMAGE TO RENTED PR a occurrence MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE JECT POLICY a PRO- ❑LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED I RETENTION$ - WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE E ANY YIN E.L.EACH ACCIDENT $100,000 A PROPRIETOR/PARTNER/EXECUTIVE NIA 08 WEC AE9N3E 02/11/2021 02/11/2022,OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION Osterville Farmers'Market SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PO Box 3 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED OSTERVILLE MA 02655 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I x CERTIFICATION e _ f "U KIMCHHAY CHOU '- A 9 for successfully completing the standards set forth for:the ServSa e� Food Protection Manager Certification Examination, which is accredited by the American National Standardsl'nshtute(ANSI-Conference for-food Protection_(CFP): r 4 -k a � / EXAl E Rv1 FORM NUMBiER 3/7/2019 3/7/2024 � y. 41 DATE OF EX f DATE OF EXPIRATION , = Local laws apply.Che ,' cy.for recertification requirements. ' I \AAA e. Sher #0655.. � E. ClatlOn SOIUtIOnS ■ ServSafe Togo are trademarks of the NRAEF.National Restaurant Association®and the orc design - Contact us with quesfions at 233 S.wacker Drive,Suite 3600,Chicago,IL 60606 6383 or ServSaWrestouront.org L CERTIFICATE OF ALLERGEN AWARENESS TRAINING Name of Recip lent. CHANNA UY 2308829 3,as, Certificate, mber.At ,, � s Date of ai zs'2 is OR Comp° letlan Date of Expiration ^'29'20 ■sir. Issued By: ?he above-named person is hereby issued this certificate r for completing an allergen awareness training program 1! SI '�Ia � _^«... ASSOCIATIONV recognized by the Massachusetts Department of Public Health ...................................................... . in accordance with 105 GMR 590.009(G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 102 www.restaurant.org Southborough,MA 01772 ?his certificate will be valid for five(5)years from date ofcompletion. 508-303-9905 www.mamstauraiitassoc.org fi t+ Town of Barnstable oFt"E�iti Inspectional Services Public Health Division • MANSTABLE, 9 '"" Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Rom,... Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94_Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Healthy Street Food- Fresh Roll Name of Person: Kimchhay Chou Address: 439 Nathan Ellis Hwy Mashpee, MA 02649(C)need To serve: Assorted Spring Rolls, Soups, Noodle Entrees& Rice Entrees-ALL FOODS ***MUST BE KEPT PACKAGED AND KEPT COLD ServSafe certified: Kimchhay Chou Allergen: Channa Uy Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH omas A. McKean Director of Public Health Town of Barnstable Regulatory Services Department Public Health Division MAM 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V�►"` rr Date Table/Cart/Trailer Identification Name Cl Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLA ON PERMIT INFORMATION ry_ �/(� N�'� r C/a 2/i1 — I� --y _ Valid Permit/Displayed 1 / J _ Pre approved Menu Items Offered Only , t V eAAw`, l/U� FOOD PROTECTION MANAGEMENT n� PIC Assigned/Present Onsite c�^P� PROTECTION FROM CONTAMINATION I'1 C:Q Y140 _ Food Contact Surfaces Cleaning and Sanitizing Yllsy ,5m2" Foods Covered Proper&Adequate Handwashing/Temporary Handwash Station Location Ub Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking oologTemeratures 1` n� N I- k; Reheating t� f cowd t` _ Cooling bxp Q _ Hot and Cold Holding 41V11— _ Food and Food Protection (br; (0,I�, CONSUMER ADVISORY Wt—ict �QC S��Q e O F G6U IPA Posting of Consumer Advisories (A-A I 1[.&(Le Fj,1/-t [*d�o 4,�ee /acx/& OTHER REQUIREMENTS p ( J__ Q ; 1 _ Refuse Container(s)Provided/Covered V I/� ,�����'.! , ?/- ,P rslf _ Adequate Toilet Facilities Provided ' """'�^ l 0.Ci�W 0 V t ['f r n,-Ak Inspector's Signature Print PIC's Signature Print i Town of Barnstable Regulatory Services Department Public Health Division HAMMMM 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event i y! Date 1 21 Table/Cart/T railer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing 1 _I _ Foods Covered -t/v.Pivc.� ,(/v"�� C[V��Kwq _ Proper&Adequate Handwashing/Temporary Handwash Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS A 1 Q Cooking Temperatures Reheating _ re A4,I Cooling E _ Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY {I Ce J _ Posting of Consumer Advisories 14 ( ::I� c-n OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Jjr.�Yam{ Adequate Toilet Facilities Provided J Inspector's Signature �/ \ Print PIC's Signature Print Town of Barnstable Regulatory Services Department • s�ru�rsraete. Public Health Division 039. 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event _ �^ Date Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating LA �Iw -(,Mtger ' , Cooling �/�t` C�lX/ (� of and Cold Holding _ Food and Food Protection �Q-- C,,UD` 1 t CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered > Ce- Adequate Toilet Facilities Provided d'►'9�— �1"( )� � /�,} Inspector's Signature Print PIC's Signature Print ( bbyv Barnstable Public Health Division APPLICATION FOR TEMPORARY FOOD SERVICEPERMTT DATE (0 c lz NAME OF SPECIAL EVENT 2sterville Farmers' Market 2021 &ason� NVAS TIRS EVENT APPROVED BY THE BOARD AT APUBLI('.MEETING? x Y N NAME OF PERSON(S)REQLTSTING PERMIT JENNIFER WILLIAMS,EXECUTIVE DIRECTOR TELEPHONE# 5.08.428.5861 CELL# 508-280-8882 HOME ADDRESS 155 West Bay Road VILLAGE Ostervitle NAME OF ORGANIZATION_ CONTACT PERSON L t.S � TELEPHONE ADDRESS "1"o O f Va,-,Jov ✓ kqV) o Z 3 � FOOD TO BE SERVED(LIST EXACT FOODS) 17/D2-11'-� 1-3 U NAMES OF TRAINED FOOD HANDLERS(TO BE ONSITE DURING EVENT)-. /7/ / CT�F?�r�--' (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERETO BE SERVED Osteryille Historical Museum 155 West Bal Road Osterville,MA 02655 DATE TO BE SERVED June 18-Seot 17 TIME 9 a.m.to 1 p.m WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? HOW WILL FOOD BE KEPT BELOW 41 DEGREES F- HOW WILL.FOOD BE HELD AT 140 DEGREES F. HOW IS FOOD COVERED How IS FOOD SERVED_ Oze',-3TYPE OF HAND-WASHING FA f y SIGNATU 6/16/2021 MA Corporations Search Entity Summary Corporations Division AL Business Entity summary ID Number: 001345192 Request certificate New search' Summary for: HALE BONE BROTH COMPANY, INC. The exact name of the.Domestic Profit Corporation: HALE BONE BROTH COMPANY, INC. The name was changed from: GREAT LIFE COMPANY, INC. on 09-16-2019 Entity type: Domestic Profit Corporation Identification Number: 001345192 Date of Organization in Massachusetts: 09- 07-2018 Last date certain: Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day 12/31 The location of the Principal Office: Address: 78 OLD FARM RD. City or town, State, Zip code, HANOVER, MA 02339 USA Country: The name and address of the Registered Agent: Name: CHRISTOPHER HONEN Address: 78 OLD FARM RD. City or town, State, Zip code, HANOVER, MA 02339 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT MELISSA HONEN 78 OLD FARM ROAD HANOVER, MA 02339 USA TREASURER CHRISTOPHER HONEN 78 OLD FARM RD. HANOVER, MA 02339 USA SECRETARY CHRISTOPHER HONEN 78 OLD FARM RD. HANOVER, MA 02339 USA DIRECTOR CHRISTOPHER HONEN 78 OLD FARM RD, HANOVER, MA 02339 USA Business entity stock is publicly traded: The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class or Stock Par value per share outstanding No.of shares Total pay`v aiue No.of shares CNP $ 0.00 10,000 $ 0.00 0 a Consent -_Confidential Data a Merger Allowed .....Manufacturing View filings for this business entity: https://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?sysvaIue=PrOp3KLW3p1jYoOb_OsFXOUAD_2Y1AcG8Xxr3598Ysk- 1/2 "L:l4r t�r. 1 Osterville Farmers' Market: 2021 Application (� Fridays, June 18 to Sept. 17: 9 a.m. to 1 p.m. Rain or Shine Along with this application,please submit a current copy of: ServSafe Certificate • Allergen Training Certificate • Residential or Commercial Kitchen License • Wholesale License • and/or any other paperwork pertinent to the item that you are producing/selling. We will be adhering to all current Covid rules via the Board of Health. THERE IS NO OTHER BARNSTABLE FEE TO PAY CAR BARNSTABLE PERMIT FOR WHICH YOU NEED TO APPLY. $275 enclosed (Checks Payable to Osterville Historical Museum or Venmo @Osterville) Name: (1�, �L,)�J�(Jkj Business Name: Email: 4a1.-1b0Qe 612+2 e2 124""1 eov Cell Phone: /A(- fbgLL f` i Mailing Address:_ -72, QU 671� l�L 1-�a.v0✓4v MA- o2355 Signature Date: Please return via mail (or via email with Venmo payment @Osterville) with all paperwork by April 15 to: Osterville Historical Museum • PO Box 3 • Osterville, MA 02655 Questions?Jennifer Williams@ Jwilliams@OstervilleMuseum.org i s , Ni`y 4 3 KI ........... Yankee Trader Seafood in Pembroke and Hingham Massachusetts is a fully licensed and certified manufacturing company of both USDA and FDA products. Our facility our commercial kitchen space is used by Hale Bone broth for food preparation and storage. If you have any questions please feel free to call Yankee Trader seafood at any time. Very truly yours, Alex Hernan Executive VP of Operations 1610 Corporate Park Drive Pembroke, MA 02359 Tel: (781) 829-4350 x506 Fax: (781) 829-6969 Cell: (781) 724-6468 Email: alex@yankeetraderseafood.com Website: www.yankeetraderseafood.com z' C S,S f 3 N x� w. > k k ,x € r. g x , � c \ z.: a t s a n�5 y /S lt„ z y„ / t h q < o , im po"'g, Fg- j f TV r 6 r _ u b y / r/ v o _ f $ S t M : 3 , w,,.:_M�.- _..... � ..,•��r ..��««.•>�. �, �>;_._�,.«�. ems; � .�. CAM - y ii:. W �; by � ,;,£ � � \\ � �:: �x 1 ':•Fa: �', a �' -��'�\\ r ' .,,��?"- / a� �..Y„,.�. �;•„�«:.. e lobs h9h, '�. a�, mac.:\E� ..i 5 t ,u, '`g,,'.. �a. ::5 B°• i;' E , J a�. r w y � ' "'��\ /r '3 : � /// n ,r4, ./s" � -� yr".= � 4.�+sr`x: 'i i"� y� •� ;a'. ti i @. �''��1. /' y ,/`.' ,� �... -•rs°` x'. O'\ ��. 1 ..\�.x; r ;Era t`•, .� �,. / , Now 0,11- ka f � Y slow c y IN lu Elio �., - �,� wooaea� Town of Barnstable Regulatory Services Department �nnivr�rasc�. Public Health Division Mn39.s. 200 Main Street, Hyannis MA 02601 l� OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V t' "1 n Date Z- Table/Cart/Trailer Identification Name Wd,1_ J�DYLQ IJYDILI� Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only ""PROTECTION MANAGEMENT EPIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION ��, _ Food Contact Surfaces Cleaning and Sanitizing �" AMA I) \ _ Foods Covered c �S S _ Proper&Adequate Handwashing/Temporary Handwash 06k Station Location � Y10 kAl"ZI, iA3/k ox-A _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS f-D � 1 _ inn 11�0k Cooking Temperatures Reheating `� � _ Coo g I itiF _ Hot and Cold Holding Food and Food Protection �^n v� CONSUMER ADVISORY '`'�"� (VAd)G-- la/}yl Pi _ Posting of Consumer Advisories 1 tw l l OTHER REQUIREMENTS 1 I� a I a,&�, _ Refuse Container(s)Provided/Covered Gu��Q,/ 370 F "14, J _ Adequate Toilet Facilities Provided Ct Inspector's Signature Print PIC's Signature Print Town of Barnstable Regulatory Services Department Public Health Division Lx 1"9- 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date Z Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION Valid Permit/Displayed _ Pre approved Menu Items Offered Only Gin" .t-- r,*�r FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Foods Covered ✓Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating �_/Cooling V Hot and Cold Holding S' _ Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print i Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Imo" OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating Cooling . VlV I1 tI-Iot and Cold Holding Food and Food Protection � .aSQ �(/'� CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided , Inspector's Signature -- Print ( Q p PIC's Signature Print I Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean;CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event 14/l.C,f( jz) Date Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed l _ Pre approved Menu Items Offered Only acdapk7LO b — 0-4d FOOD PROTECTION MANAGEMENT C.— . &G{L.R _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered �� Proper&Adequate Handwashing/Temporary Handwash Station Location cc _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating Cooling Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print I .n d�0 �— PIC's Signature °' Print I qy; Y" n Barnstable Public Health Division APPLICATION FOR TEMPORARY FOOD SERVICEPERNIIT DATE 2 NAME OF SPECIAL EVENT OSt rville Farmers' Market 2021 Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X,Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR. TELEPHONE# 508.428.5861 CELL# 508-280-8882 HOME ADDRESS 155 West Bay Road VILLAGE_Osterville NAME OF ORGANIZATION , o2 10,,r I,S-A CONTACT PERSON \ U'1 TELEPHONE Ze g q 7' ADDRESS ]3-. , S'�" _ 1 ` +�j✓�. l y . "� FOOD TO BE SERVED(LIST EXACT FOODS-) f NAMES OF TRAINED FOOD HANDLERS(TO BE ONSTTE DURING EVENT): <�? 1 (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Ostervdle Historical Museum,155 West Bay Road.:Oste"e,MA02655 DATE TO BE SERVED June 18-Sept 17 TIME 9 a:m.to 1 i2 m. WHAT TIME WILL ALL EQUIPMENT BE SET-UP&'READY FORINSPECTION? L { HOW WILL FOOD BE KEPT BELOW 41 DEGREES F HOW WILL FOOD BE HELD AT.140 DEGREES F. i� 1 HOW IS FOOD COVERED C,[: C G, HOW IS FOOD SERVED TYPE OF HAND-WASHN�NG ` SIGNATURE: NUMBER f THE COMMONWEALTH OF MASSACHUSETTS FEE. Board of l#ea'ltff of PERMIT TO OPERATE A FOOD ESTABLISHMENT ' Permit No. L7 r• 20-.�:. In accordance with .Regulations promulgated under authority of Chapter 94, Section 305A and Chapter I It, Section 5 of the General Laws a Permit is hereby granted to, Whose place of business is t7 kt C ......... 3 Type of business and.any restrictions .� -_ s 1'j To operate a food establishment in ......:................ . _ ------ - ' - .......f ---- --------- ,City Permit Expires o Tov ) <............ 20 -- _ s I Board � _ Of ----------- Health t� t�` ,1 `, 1 Health FORM 738.AM.SULK Co.-CHARI ESTOWN,.MA � - - - - ------- :--. E "L N 2 SERVE". AR, TRAIN!Nv I CERTIFICATE I. This certifies that Su nn Lock, is awarded this certificate for L,earn2Serve Food Handler 'Training Course 0\ :100 Hour IE1 Cui11!aleflon Clat� ! l)ircliii311��)�� { ..� ��!tii lC 3t[ !10/12/2020 w 10/12/2023 _� L2s-FH-107490 .:_. . ..:_ ANSI ACCREDITED.PROGRAM officiaj Sig ature CERTIFICATE ISSUER THIS lF l r 1(.rarc Is NOo!.-7R�ai SFC:� ABA 7 1 Cir ui11�7iC!jC?r V i"iflL c1 ion I Elf S f i CiflLi}}'C-Vr3ii{�ICy'.l7lease- end your rC'C�Uh�t.to I CiOil)iailiti�l' ."l[j;S 7?.''1C�!1?iii`?iLt�tf"clltiifli�.CiC)lil C: ii �, i;' Sf `_t(i f t f '� i tx. •tl] i "1� ( ,80-N Capital of Texas Hwy, Bldg i,Suite�_.�_ ( Pustin,TX 7�:'31 , 3-'7.f38..2235 , �. r�ii:r�.t rn� i CERTIFICATE F ALLERGEN AWARENESS TPAINING Name of Recipient:Susannah L.ockettt Date of Completion:April 13, 2017 Date of Expiration:April 13,2022 Issued By: Ze above-named person is hereby issued this rerhficato far ompledi;yT an allergen awatenas training progrMil 6iAHEC Berkshirereenni ed hy.the 1.lassarbrtsetts Department ofPnhlir Health, .irr aa:ordance'soith 105 C.)UR 590.009(G)(3)(a). <htiu Health 8ducatiou Center l ittsQcld,.4Mnssuc11uSe s 17)is rerliyicnte ill be r,nlidfor.five(>J y>em's from.date ofConipletion, s •,„•,Cand llcrcycnduin;sr, � __ tl FARMER'S MARKET MENU kil items will be individually covered and packaged,stored in iced coolers with thermometer for temperature check. STREET FOOD BITES 'an-seared Chive Dumplings 9 'an-seared Vegetable Dumplings 8 land tossed General Tso'Cauliflower Wings 12 FRESH ROLLS Rice paper base with spring mix, basil, and noodles) 3reen Avocado 6 \vocado, green apple, cucumber, coconut. )weet Potato Pineapple 6 sweet potato, pineapple, sweet peppers, cucumber. >ummer Garden 6 3rilled eggplant, zucchini, sweet peppers, carrot. FRESH SALAD MIX (Traditional Asian Street Food Style) i ropical Mango Mix 12 >hredded mango tossed in apple cider vinaigrette and rainbow-colored vegetables. :ape Cod Seaweed Mix 12 flavored tempeh, organic greens, sesame flavored seaweed, cucumber, carrot, corn, cranberry,vegan mayo glazed dressing. douse Ginger Sesame Mix 12 )rganic greens, avocado, chickpeas, corn, grilled zucchini and eggplant, cucumber, red pepper, HONEY ginger dressing. *VEGAN Dressing available! SOUPS he Golden Soup Bowl 12 (served cold for markets) 3randma's recipes! Warm flavor of curry paste, potato, corn, carrots, sweet peas, onions, and coconut milk. Add ice/noodles 2 llama Ramen Soup Bowl 12 (served cold for markets) douse flavored vegetable broth with noodles, crispy tofu, carrot, beansprout. NOODLES BOWLS >picy Noodles 14 lice noodles, hot garlic oil,thin tofu, eggplant, bok choy, beansprout, scallion,jalapeno, lime juice, cilantro.*GF :old Coconut Angel Noodle 14 )oft angel hair noodles with sauteed onions, soy curls in soy vinegar sauce, and fresh cucumber, beansprout, mints, ?ggrolls. ;oba Peanut Noodles 14 >oba noodles tossed with broccoli, carrots, scallion, sesame oil, ginger sauce with soy and peanut glaze. i Town of Barnstable Regulatory Services Department Public Health Division " 200 Main Street, Hyannis MA 02601 MAC OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V I-1 t/1 Date Table/Cart/Trailer Identification Name f f Telephone Permit Holder's Name Telephone PE# IIT INFORMATION Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION C/�% ice'\ �t7— Food Contact Surfaces Cleaning Sanitizing _ Foods Covered p, 941,(,JafY114t ,A Proper&Adequate Handwashing/Temporary HandwashI``"�� � Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating _ Cooling Hot and Co�Hold Food ood Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s),Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print r Barnstable Public health Division % Sw, ox-- APPLICATION FOR TEMPORARY FOOD S.ERVICEPERMIT DATE NAME OF SPECIAL EVENT Osterville Farmers' Market 2021 Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR TELEPHONE# 508A28.5861 CELL# 508-280-8882 HOME ADDRESS 155 West Bav Road VILLAGE Osterville NAME OF ORGANIZATIONr��'� _�L� CONTACT PERSON ^'^ ���'-�` ' TELEPHONE ADDRESS �cCla��C. FOOD TO BE SERVED{(LIST EXACT FOODS) <� ,L_J, '- A " fe.. c C,c ti tic —ty�c�.ti `�c.�\c4is- NAMES OF TRAINED FOOD ANDLERS(TO BE ONSITE DURING EVENT'): C�.1Cti.� (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical Museum,155 West Bay Road,Osterville,MA02655 DATE TO BE SERVED June 18-Scut 17 TIME 9 a.m.to 1 a.m. n/ WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? �IJ`� HOW WILL FOOD BE.KEPT BELOW 41 DECREES F i Qf--A (/� HOW WILL FOOD.BE HELD AT.140:DEGREES F. HOW IS FOOD COVERED 'r<-t r. b�~CSS CV` ,��-�`< x HOWISFOODSERVED �� •�,`�� / TYPE OFHAiVD-WAS .NG F' 1LITY t;:lr-*� �•�' SIGNATURE: 1 , } Low " - i r THE COMMONWEALTH OF MASSACHUSETTS ,ezo••:`iq TOWN OF PLYMOUTH d }n PUBLIC HEALTH DEPARTMENT y, 2021 BUSINESS LICENSE TIMOTHY&LISA CLELAND CLELAND,LISA 8 ATLANTIC ST PLYMOUTH,MA 02360-4302 CID#:46029 DBA:HONEY I'M HOME BL ID#: 101186 LICENSE#:2474 Your 2021 Business License for A LICENSE TO OPERATE A CATERING ESTABLISHMENT is printed below.Please retain a copy for your records. If you have any questions,please call the Public Health Department at 508-747-1620 ext. 10118. THE COMMONWEALTH OF MASSACHUSETTS FEE a. TOWN OF PLYMOUTH $150 a PUBLIC HEALTH DEPARTMENT 6yy 2021 This is to certify that: TIMOTHY&LISA CLELAND HONEY I'M HOME RESIDENTIAL KITCHEN Doing Business In: PLYMOUTH, MA 02360 Has been granted: A LICENSE TO OPERATE A CATERING ESTABLISHMENT In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General Laws and 105 CMR 590.000 Expiration date: December 31,2021 Signature 6A, "4V- LICENSES ARE NOT TRANSFERABLE r N ..e S� ry a e CERTIFICATION TIMOTHY CLELAND " for successfully completing the standards set forth for the ServSafeo Food Protedlor�Manogar Ceitifiwbon Exammahon,_.. which is accredited loy the American National Standards Institute(ANSI}-Conference 19Food.Protection(CFP). �!r F!3 381376 10`5�1831 i,f3 : .� t i:3 UMBER EXAkiFORiiN�UMBERa _. •a..\ r,.. r �zt3t 3 3 3 .3 11/1 11/17/202&1: '3 � DATE OF DATE OF EXPIRATION ,3131u t1 !` 3 :t Local laws apply.C♦ ency for recertif oohon requirements. a „ � xf , 1IN �t #0655 .9 \ \ 02015 Pkrtianol .: : •- hgo om kodarwrks aF Iha NRAEF. ,�....... C W..with q-6 0175 W lad-n Bid.Ste 1500,Chkgp,k.606W.w SenSa(e@rabwmY.ag a. 7 i xi )3 F E E :� s s ti� c - h��,t �/ t t a"lr�•�� > 3 c., ,.; t, ,l�. .;�.s � t`,a `�..s .- �,-�/��±.1,��t _ ,. ,,�rtl s�ti. t,Y k % vv �� � .a.u.ln�c.wma�, L, ,_�.�_...-war�..n..nss. .�..,,�_n,-J:.,,-:s<•;:,x-. >.......:. - - :r«�eaa - - - �r.c x-,,r,;x �,sts�.u.�s y'�.'�./ ( t l I 4 r { • , � '''�a. �. f.,. �, i �%,... .....1 � _. %:i s ga. � f rry. A d '�, � s>. `'�.,. <l ,�6 � �,�. � 1 ��� ��.,..� l 'mac� ► a *i,��« b M v' yyy I� s Y,� �.�b-.i / f),4�� „v.a.Lv,:� ex r.,,rM. . �.Lsas.*. ....w.c:� .ra s, u�sv.r�. eras:n)u -..s .:cu.� - „r en�n•, �.�w - t",,,y,-y [�:..�� .& aC{;?} a" vv ,,1= ' �.a..rsUlk5 `'vKli , i Town of Barnstable Regulatory Services Department * _ Public Health Division ♦ 8.439 SfiABM s a 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date L /�1 Table/Cart/Trailer Identification Name / Yam_ Telephone Permit Holder's Name Telephone PET INFORMATION Valid Permit/Displayed re approved Menu Items Offered Only 1O e 0, WSJ 6616a FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location / �1 n j �� Good Hygienic Practices(Use of gloves,use of tongs or tissues) V 0. 1 1 �-C-C�'171 -41� TIME/TEMPERATURE CONTROLS Cooking Temperaturese�BJ(f� _ Reheating t� r AU( Cool' g _ Hot and Cold Holding 24�i,v i►/ CA t2 Q/ L J� Food and Food Protection ` ✓" �(` CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Barnstable Public Health Division APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT DATE NAME OF SPECIAL EVENT Osterville Farmers' Market 2021 Season _ WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR TELEPHONE`# 508.428S861 CELL# 508:280.8882 HOME ADDRESS 155 West Bay Road VILLAGE Osterville NAME OF ORGANIZATION gy C1 Z LC C-- CONTACT PERSON C GIs TELEPHONE ADDRESS W e3 4 e—!-L f�vC L rh, V NL a I 4 y FOOD TO BE SERVED(LIST EXACT FOODS) ou""LV'cS a ?Ne2a�k NAMES OF TRAINED FOOD HANDLERS(TO BE ONSPPE DURING.EVEN1): (ATTACH OPtES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO.BE SERVED Osterville:Historical Museum,155 West Bay Road Osteryille MA 02655 DATE TO BE SERVED June 18veeot 17 TIME 9 a.m.to l pm. WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? .S :t(6 HOW WILL FOOD BE KEPT BELOW 41 DEGREES F. (GGtt 4t.1 HOW WII L FOOD BE HELD AT 140 DEGREES F. HOW IS FOOD COVERED 1i�N St 6-ntk j�9 F'DILL(L 1e...t HOW IS FOOD SERVED laa jQ,[-- \fl o�ltiChQ TYPE OF HAND-WASHING FACILIT y Cl..A A ef\V I hG SIGNATURE: ,-, =.lf.-. `i, . . a., e -', a •a :'�'_ 3�..-..<,�.-r,. Wk.,,k „r ?i - _ ,r,. Ty�. RW Of MEN qpge.� \w. ' �. s a>�a�4ec „ t Q ; t ..,�TH'J, REAU ��iJUfF2t�h� 1EP.1"fir�;L �"IALT �� \�: i €.��. ,:: -..•: .......-..:. .,:; a t _ MI s +`' �' •^' yy 3ra -x. . < RA Ise Accordan w u ` ce 9th;tUlassactiusetts Gres! Laws Cla ter . etont5 ^„ '� -:.fix, a• _ � - •� .�w• x.;axe.=.. ,11' >..�., .ate.. _. ". .,fE �� -, :. �- r 1 L:,,' Nth:; ;_�_ ,, � .,:-v#, rt t�° s�s� �c, ' . c.,,,a Y+n na,x �. , `s� td a, xsc € \ <z a \ � s v� -,.a: .. .. _,': e. .. ,. .-": :�,a .:. ... i_ '•` x- .�s.,:, 3 a", � 3;' & � ^,b. P'"3� P iYF�,yffe\ Ya, y\ .1�S� �•Y�;� ,�yy�4F�..$ .."& €_-� �ha �.�"{ lilt �xS:-R- c ,...�_"'- ..__._::y <a-' -,:.. ;�---. -..-:,w._- .tea,: r;� -a`.m` ,.&t.,�• ay.'•:> '�\'•u.,,i»< � c � a � *!w, a 4 �.,m,i v> I fftt S 'L .j'CD-%,, `•?> '�'. '�c}S'" .9`Yi,,>g' C "Ta: Y `�u o»`-�\\- `'ad a a �u U UT I WIS Ord � e d t .. ,, A\, 9 � s 3 � � mumtin a t.,• ',, ' s \\ \ Ti .€i? > ;.. .> << a �'�+.I"A; � ,�`'. :., ,,,, .., _c;r-mac- a na,..:: -< r:. �,`.;., �.a,? ,.a,x�.:: ..^"�, •'e �: s? `az-x-'xi < �<^. � , w. » .�„^ _.:,, <<,=. :.. <•.,r.. �< # �. �:a. .,ate.: -. ..� St .-,.,a�,,»w. - ...-.,-� a �+.��i: `�"�°�.,- ,e.,Er •'G.1',x ," -;- I.:x -�:: e,. c�` '... �:: ..� ,-.,��;..^..tea. `yess.� i�ti.X pp}} �.�., ���� 3.,§'y5. k »"5e3 .a..... sc.r 4 e= am. » a�w & E r a ,a r 's � i..t. .,:. „1<...-s �:£f�:, ..:(.,... r { #,.+....,3. ._c.:."h..s—a..... {.,..�.rw.. .._.._.....a..-•---...,_"»�e.N�� -ANEW INK :° 2- .� �,r rk,_ ,.:�. ,^ '� Slc� .^g �ir'�`�$'u a °Bm �". °a- a® r$9s'".•�_... i 4 M1: h" CEM' 7 ASEY WHITE For successfully completing the standards set forth for the Sa I`o Manager Ccrlificafion Examination, _ 4 vAich is accredited by the American National Slandord Sli}JItl N$f tlR rence for Foos!Protection(CFP}.. '£mod 9"733�- 6"f:�' �anff 1 ._ �ER E 8/6/2020 8/6/2025. DATE OF EX 1t Ph'A'l'' " DATE OF EXPIRATION Local Paws upply,ch 1'oadon sD f 9 ,far recerlification requirements_ ® Sher tJ}1awR #0655 8 ciofion Solutions. O O, h was 5�trp®b �dArf 't4� Ser Safe bgo oe sodaaer4s d die,tMAEf Nnad Re+ou�i Av:oridivr?D and the orc Aa,On ., ', ppyygymarhaxsPiont ' �� �. Contrd a r�gmwu.ot 7J9 5 Wade Crt�.Sins 1600,Chcago L 83 w Se.SaFs®rmhurni.ag ...... r :. a-- PWM ON g r z ti M ma mac, �,�, 1y k�c ; � ,, �E� a•r'� r wYK Mr< M, i`3i ysF 3- k a a :� ,�$ y� 4'r kpbA. y y CAa 3 D Ell°z i `f z 33 3 'Ow ow MARSE f a \pr n r'rm rr >•,N' : r . � �r MOPE 4�'t�§ �y✓a•� .nod s~ / » y5 °�tI - i rENIENE z 3 ts'a R�����'a +'d'7,•�'C r - �� � �"�"�'�,a am '��' � }�� � ; ate, g' eke zXa'M $"f» * kx7a �� Em r » a t ;matar�a �a s .r`i�sx was "A IN tow X z2y Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event D h—r v 1 Date --7 21 2 Table/Cart/Trailer Identification Name rr --k 2 Telephone Permit Holder's Name — JJ Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash a ' Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIMEMEMPERATURE CONTROLS Cooking Temperatures Reheating Cooling S "Hot and Cold Holding _ Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS 1 I //�YILG�•� LI. _ Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature / Print PIC's Signature Print 1 r s-S C9 ,tee:, L � of vov,- f e Barnstable Public Health Division 2 APPLICATION FOR TEMPORARY FOOD SERVICEPERIVIIT -' D T ; NAME OF SPECIAL EVENT Osteryille Fai'ITIe ' Mark+ t Z 20 Beacon WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC mEETING? x y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFFR W1LL1AhlS EXECS VF D1RFf"t Qlt__ TELEPHONE# 508 428 ° 1 CELL N. HOME ADDRESS 1.51 1V�st Bav Rva�i VILLAGE to ilte �s Cr�iSti NAME OF ORGANIZATION TELEPHONE - '—�^c CONTACT PERSON VA R ADDRESS , FOOD'I O BE SERVED(MST EXACT•FOODS) To r ja GM t3 tt� Y�SzCi NAMES OF TRAINED FOOD,HANDLE"(TO BE ONSITE DURIMG.EVENT). I• ,. {gTTACIICOPIESOFS£RVSAFE&ALLEItGENCERIIFICAT VED Ostervitte Ittstori pi 1 S Ves B itte d.A' 2 5$ TO BE SER. ADDRESS WHERE. to � TIME a. .m DATE TO BE SERVED June 1945e t 1 UP&READY FORINSPECTIOI ' WHAT"TIME WILL ALL EQUIPhfEiV I BESET- r HOW WILL FOOD BE KEPT BELOW41 DEGREESF�—— 14OW WILL FOOD AT 14Q.DEGREES F: IS.FO{3DCO�., HOW . D SERD WAS, G FACILITY TYPE OF 1AN t 1 SIG[�IA E: f< m cnxvr„ a. CERTIFICATE OF ALLERGEN AWARENESS TRAINING Name diigecip7en�t: RR CertificateNumber: asstsr 4 , Date of Coir7plet on snazoz, Date of Expir�ataon: 3norzozs 3w besucd By: The above-named person is hereby issued this cernfuate all for completing(in allergen c:wareness training program � ' RESTAURANT recognized by the Massacbasetts Department o�f'Pab/ic.1-lealtb Massa husetts Restabsura "Association ASSOCIATION,865.272 in accordance with 105 CMR 590.009(C)(3)(a). 2 333 Turnpike Road,Suite 102 www.restaurant.org This certcate will be ualid for fiv.+(S)years from date of completion Southborough,MA 01772. 508-303-9905 wwwmarestaurantwsoc.org �fx5 rr�-sv�rx asxvxxxxe �ucxrawxx ssw �z«w- �? a PERMIT TO OPERATE A FOOD ESTABLISHMENT TOWN OF ROCKLAND Permit Number:2021 -81 Date: 1/6/2021 FOOD PERMIT (2021) In accordance with Regulations promulgated under authority of Chapter 11, Section 127 A. of the General Laws,a permit granted to: Lara's Cuisine - 90 Reservoir Park Drive,Rockland,MA 02370 Type of Business and any restrictions:Catering The above-named business is hereby permitted to operate as a Food Establishment in the Town of Rockland. This permit may not be transferred to another operator or location. � SSARR a�.,f s+s,crcw+ Pitt rgolis Chafi "`n .. Stephen,a elsoVice Chairman'- Christine Stuart,Member Permit Expires:December 31,2021 �jeotrYoneaYt�j of a��ac�jix�ett20 DEPARTMENT OF,PUBL.0 HEALTH BUREAU OF ENVIRONMENTAL,I IEALTH ' " FOOD PROTECTION PROGRAM 3O5 SOU H STREET .IAMAICA PLAIN ��qyp�� 0 Ns In Accordance wlth,Massachusetts General Laws Chapter 94 Section 305C t NUMBER* ISSUED EXPIRES TYPE' MA 9714 �� 04/22/2021 104d272 022 ' ` Piocess or.Distnbute Foo3d for Sale at Wholesale k ISSUED TO � �� LAMAS CUISINE LLC �1 - � 305�MYLES'STANDISHBLUD " � "�•� TAUNTON,'MA 027.80 � I' ATi N LARA FERRI MMI$SIONER�.OF PUBLIC HEALTH n1 x a ; �,a RECIPIENT S CO:PY a POST IN A CONSPICUOUS PLACEa & �f?l� .tom j=1 e ram ` J.a a.. J.. . ,z: �C.�'-�.... ..1,....+� .L�� -� 5 i ." �. �..R- wx ; Y yr"v. „+� S ,..�1.1� �,- ,� S 3/9l2021 k y Permit Number r COMMONWEALTH OF MASSACHUSETTS FECV 21 14 TOWN O DUXBURY + Board of Health:g 878 Tremont Street k 4 a Duxbu0, MA 0233Z Date Issued o March.9,2021 Laraf's Cu�sln,e k YF # J. ��- 17 Trout Farm Lane Duxbury MA 0232: . .s- :. IS HEREBY GRANTEW LICENSE TO OPERATE A FOOD ESTABLISHMENT ti K r , , �, . Y .,, Less than 10;000 sq"�:ft Retail kr Food °' �� 1-zl 1-4 i 'k a� i f Y : . This perr►if!s granted rn;conform►ty with the,Statutes and orrllnances relating`thereto;;antl i, expires December 31, 2021 unless sooner suspende �_o v yoked. . 2 Heal#h Agenf $ i F 4 y 1 n , T i _ �, - I� .R I� This is an a.permd To team more scan this barcode or vistt duxbu:ryma vtewpointcloud coin/#/records/90408 j , k '. ka e u11 k 1.... tt _ti. d �� i C T i "!1 s f ,, `, ., c > \ � . 4 I IDD/YYYY)E(MM I CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED.BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT THE INSURANCE SHOP LLC/PHS NAMEq 84531599 PHONE (866)467-8730 FAX (888)443-6112 (ac,No,Ext): (A/c,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Fire Insurance Company 19682 LARA'S CUISINE LLC INSURER B: 17 TROUT FARM LN DUXBURY MA 02332 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS D IDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE❑OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE JECT POLICY❑PRO- ❑LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER ANY YIN E.L.EACH ACCIDENT $100,000 A PROPRIETOR/PARTNER/EXECUTIVE NIA 84 WEC BW3140 10/03/2020 10/03/2021 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 OO,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION Quincy Farmers Market SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 79 Coddington Street BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED QUINCY MA 02169 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0E(MMID IYY 20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NUTMEG INSURANCE AGENCY INC/PHS 46508229 PHONE (866)467-8730 FAX (888)443-6112 (ac,No,EXt): (Arc,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Sentinel Insurance Company Ltd. 11000 LARA'S CUISINE LLC INSURER B: 17 TROUT FARM LN DUXBURY MA 02332 wsURERC: INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE D POLICY NUMBER DD I LIMITS T COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE .$1,000,000 CLAIMS-MADE1XIOCCUR DAMAGE TO(Ea e e RENTE $1,000,000 PREMISES X General Liability MED EXP(Any one person) $10,000 A 1 46 SBW UM9324 06/19/2020 06/19/2021 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JECT X POLICY❑PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE R ANY YIN E.L.EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below EMPLOYMENT PRACTICES Each Claim Limit $10,000 A 46 SBW UM9324 06/19/2020 06/19/2021 LIABILITY Aggregate A re ate Limit $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION The Town of Rockland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 242 UNION ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED ROCKLAND MA 02370-1804 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD �F Town of Barnstable Regulatory Services Department Public Health Division A� 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event �Y"1 Date 4 Z Table/Cart/Trailer Identification Name L Cliv s I Telephone Permit Holder's Name 1 PI� � � TT�` Telephone PEI MIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT 1/V /l, ,n Yl PIC Assigned/Present Onsite 1/(,w`� / PROTECTION FROM CONTAMINATION J Food Contact Surfaces Cleaning and Sanitizing --?o�ods Covered ��®® — Proper&Adequate Handwashing/Temporary Handwash � /� J&4-s Station Location ,tl, �- �( d Good Hygienic Practices(Use of gloves,use of tongs or tissues) / TIME/TEMPERATURE CONTROLS _ Cooking Temperatures _ Reheating Cooling Ll of and Cold Holding w17 /1 f Zl Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Town of Barnstable Regulatory Services Department • ea�nlvsr�. Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT P N h D (E WZP6�,`^e ' INSPECTION FORM Name of Special Event C,(,1yrLQ Date 3 Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing Foods Covered y VProper&Adequate Handwashing/Temporary Handwash I ` a�✓ Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating lv TUAL Cooling _ Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signat4 B Print PIC's Signature Print Barnstable Public Health Division i APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT DATE 5 Zo• 2.02-{ NAME OF SPECIAL EVENT OsteryMg Farmers' Market 2021.Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR TELEPHONE# 508.428.5861 CELL# 508-280-8882 HOME ADDRESS.155 West Bay Road VILLAGE Osterville NAMEOFORGANIZATION CONTACT PERSON J« L 7-1 emu, TELEPHONE ADDRESS !� .�kA. �� U.C4- Tip W M - �•�-S� i FOOD TO BE SERVED(LIST EXACT FOODS) SMO ILT-�> r-15 NAVIES OF TRAINED FOOD HANDLERS(TO BE ONSITE DURING EVENT): (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical Museum,155 West Bay Road,Osterville,NIA 02655 DATE TO BE SERVED June 18-Sent 17 TIME 9 a.m.to 1 p.m. �CA WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? HOW WILL FOOD BE KEPT BELOW 41 DEGREES F N COO LF.V-S C®-4 F,9�'J> I t.X X Ct HOW WILL FOOD BE HELD AT 140 DEGREES F. HOW IS FOOD COVERED_CooLf;?,S �� '�A'G�/a'j' �Ot�l,' e��4•t ;�S HOW IS FOOD SERVED () °�A ut s Lao D SE;?,V 47T %�.f,4 TYPE OFHAND-WASHINGFACILITY A�TiIZ�S a 1�L SIGNATURE: V� kk,--c s 0 - OAK BCU FS SCHOOL r I f I i Osterville Farmers' Market: 2021 Application Fridays, June 18 to Sept. 17: 9 a.m. to 1 p.m. Rain or Shine Along with this application,please submit a current 'copy of: ServSafe Certificate Allergen Training Certificate o'Residential or Commercial Kitchen License • Wholesale License and/or any*other paperwork pertinent to the item that you are producing/sel.ling. We will be adhering to all current Covid. rules via-the Board. of,Health. I THERE IS NO OTHER BARNSTABLE FEE TO PAY OR BARNSTABLE PERMIT FOR WHICH YOU NEED TO APPLY. $275 enclosed (Checks Payable to Osterville Historical Museum o enmo @Osterville Name: .J I LL_ _Z1 D L,L, Business Name: MA-V.�� 5 fr`1e�la t> oI�- }�ous�, Email: WSI�I IO t4ou$F 0 0y71 oo1L. Cott Cell Phone: 50$. 57+- 0}3 Mailing Address: pU• 130 X 950 & N OZ5-59 Signature: Date: 5•�.�Oz-( Please return via mail for via email with Venmo payment @Osterville) with all paperwork by April 15 to: �. Osterville Historical Museum • PO Box 3 • Osterville, MA 02655 Questions?Jennifer Williams@ Jwilliams@OstervilleMuseum.org i f Client#: 101041 MVSMOKE ACOW. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONM) F5121/Ml THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES.NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER kA0MN?CT Jessica Townes Martha's Vineyard Ins Agcy A"Ic°Ne E><t,508 693-2800 AIc No):774 487-3128 PO Box 549 E-MAIL townes mvinsurance.com Providence,RI 02901-0549 ADDRESS: jtownes@mvinsurance.com AFFORDING COVERAGE NAIC# 508 693-2800 INSURER A;Mesa Underwriters Specialty Ins Co 36838 INSURED Nils Leaf INSURER 6: INSURER C: dba Martha's Vineyard Smokehouse PO BOX 850 INSURERD: Edgartown,MA 02539 INsuRERE: . INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR Ppp CYEFP POLICY XP i INSR WVD POLICY NUMBER MMIDDIYYYY MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY BINDER1273824 DISIM12021 05/23/2022 EACH OCCURRENCE OECCUR�RENCE $1 00O 000 CLAIMS-MADE �OCCUR PAffi 5 Ea NTEDnce $100 000 X BI/PD Ded:250 MED EXP(Anyone person) s 5 DOD PERSONAL&ADV INJURY $1,000 000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000 00O X POLICY JEC LOC PRODUCTS-COMPIOPAGO $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accide ) $ ANY AUTO BODILY INJURY(Per person)^ s OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY GE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY LITE ER OFFICERMIEMBEREXCLUDED?ECUTIVE� NIA E.L.EACH ACCIDENT $ (Mandatory 1n NH) E.L.DISEASE-EA EMPLOYEE $ li yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES{ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Cured Fish Products CERTIFICATE HOLDER CANCELLATION Osterville Farmer's Market SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, I AUTHORIZED REPRESENTATIVE � ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1731614/M1731612 EJT Client#:A01041 MVSMOKE DATE(MMIOD/YYYY) i ACORD. CERTIFICATE OF LlABtLITY.INSV 0 N-E 5/2112021 THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AN.D.CONFBRS NQ..:RIGHTS UPON THE CERTIFICATE HOLDER'THIS. CERTIFICATE DOES..NOT,AFFIRMATIVE LY..OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGEAFFORDED BY THE,POLICIES BELOW,THjS CERTIFICATE OF:INSURANCE DOES,NOT;CONSTITUTE A:CO.yTRACT,BETYUEEN THE ISSUING INSURER(S),AUTHORIZED, REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT;If the certif)cat®,holder is.an ADDITIONAL.'INSUREI?;the policy.(les).must.haveApDITIONAG.INSURED._provlsions or be endorsed: If SUBROGATION i8 WAIVED,subject to:.the terms and conditions of the.policy,certain policles may;require an endorsement.A statement on this certificate does not confer any rights to the certificate holde�.In lieU of such eridorsement(s):::;;, PRODUCER:. ..:. NAME T Je Martha's Vineyard Ins Agcy E... ssica.Towlnes. PO Box 649 ivc oExt:508693-2800 arc'No 774487-3128' ....... .. ,. - Providence,Rl 02901-0549 . ADDRESS:jtownes@mvinsurance.com.- .• 508 693-2800 lNsuReRA:Mesa UnderWr tens SpRela lty Ins Coo 36838tc ri INSURED Nils Leaf INSURERS dlya Martha's Vineyard Smokehouse INsu�I:Rc: •. PO'Box 860.. ; Edgartown,.MA 02539 INSURER e INSURERF: ' COVERAGES;.:' ;.:,. i ':CERTIFICATENUMBER: REVISION NUMBER: THIS IS.TO CERTIFY THAT:THE POLICIES.OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE:INSURED NAMED ABOVE FOR THE POLICY.PER10D: I INDICATED. NOTWITHSTANDING.ANY REQUIREMENT, TERM.OR CONDITION OF"ANY.CONTRACTOR;:OTHER'DOCUMENT WITH RESPECT TO.INHICH.,THIS. `CERTIFICATE"MAY BE.ISSUED.OR MAY PERTAIN, :THE,INSURANCE AFFORDED.BY°THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL'THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.,;LIMITS SHOWN, MAY.HAVE,BEEN.'REDUCED.BIY.:PAID':CLAIMS. " ' tNSR LTR TYPE OF.INSURANCE: ADD UBR ;:';:) o:_: P LC EFF P LI P.: '.;.-' CCyy EE�X „ . .. - . D ::::..:,;.,,':,.POLICYNUMBER MMIDD MMlDDlYYYY LIMITS :. A X COMMERCIAL cENERAILiABiinY :; ;;.:'` r' B1. DER1273824 5/23/2021 05123120k EACIiOCCURRENCE $1`000`000 CLAIMS-MADE FXVI OCCUR RELATED.P I�FEI Ea ocourrenoa $100 066 X B1/PD Ded:250 MED EXP(Any oneperson) �5 000 PERSONAL&ADV INJURY $1000.000 GEN'LAGGREoATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 00,000 .: r X POLICY a JECT:• -LOC PR60UCTS•COMP/OP AGO s2 OOO OOO OTHER: $ AUTOMOBILE LIABILITY CO B N D SiN L I IT Ea aecidant $ ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED. AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ . HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY.. Perewiden $ $ .. UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LtAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION, PER OTH- AND EMPLOYERS'LIABILITY Y1 N I OFFICER1MEMeERIEXCLUO ECUTIV.E 1 N I A E.L.EACH ACCIDENT $ (Mandatory In NH), E.L.DISEASE•EA EMPLOYEE $ If yyes'describe under DESG�RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) Cured Fish Products i I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Falmouth Board of Health THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 59 Town Hall Square ACCORDANCE W17H THE POLICY PROVISIONS. Falmouth,MA 02540 AUTHORIZED REPRESENTATIVE K. ©1988-2015 ACORD CORPORATION.All rights reserved. 0AK BLOS KNOB -16/03) 1 Of 1 ' The ACORD name and logo are registered marks of ACORD .... 8131M 1731612 EJT 4 .� r ,. ;: i��.�,�.����`_ dtM1 9 L 't itI F dd ibIkI>>t cnf I'vrinit >e�§���,:.� 1':att,tt � ,_: ,���ard`� �' . '� nts-xartr ?iui,�(,ui��u•.r tit p g i Aa M. 4 Per tilt, "NtA I"'o1)d Code. <1 Copy of, Ihc most recent 4 ,tablisho °nt inspection re orl. is "INailable upo re(Ilicsf, e.r v fe CERTIFICATION JILL RIEDELL =- for suooessmly aciwleling the standards set(orih for the SamSafe®Foocl:Frd�ec a�MaroaW CeMi�'fiaation Examinafion, which is aoaedited by the American Isworw)aandardsjrisfivte-[ANSI}{o feream For Food Protedion(CFf). E R E X`AAA€:-.f 4/152019 4/15/2024 DATE OF EX DATE OF EXPIRATION Loeat laws QP* ry for reo"fi«dion requirements Q! ' She 00655 aCron Soluliam p 'tn aoart�rgm . S-mGde bgo an tmdmwAs aF the NRAEF.Narowl Rea mmN AsmdafiwAmW the an:cWsn . .. GonmA a.v�. a 233 S.Waclaer Dri.e,SuAe 3600,Oiwgo,4 606066383 or Serv5afa0mtaumN.ag. J < s , n t i� •`� n < /:uj';a� n ` t /�tT11� s i t �f,T�� s i n c iu:�ws n c.i4. ,� s r �. yu / w F / u u F J C E -,DL..'-Jrl F1 CATE OF 0 AILERGEN AWARENESS TRAINING Name of Recipient: JILL RIEDELL " e Certificate Number: • Date of • • • 4=019 Date of Expiration: 4==4 i Issued Br. 1_ r / . for completing an allergen awareness.train ingpm g :. recognized ly the Mkzacbusetts •,. = NATIONAL ram ASSOCIATION, . • 333 Turnpikz Road,Suite Association 102 www.restaurant.org N y. � a r Southborugh,MA 01772 508-303-9905 C Town of Barnstable Regulatory Services Department Public Health Division = ' 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event " ),L( QL-&— Date Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered .. _ Proper&Adequate Handwashing/Temporary Handwash Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS S-D a� V Cooking Temperatures � �C _ Reheating Vick Cooling 011 V of and Cold Holding Q�L Food and Food Protection CONSUMER ADVISORYQ'`�"�%' Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature/( 4 Print PIC's Signature Print Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event KVj h4"a lw ce,— Date Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered t Proper&Adequate Handwashing/Temporary Handwash Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) —TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating I YL GBV�/ Cooling '�� 6k �Flot and Cold Holding �¢�✓�Q _ �'i _ Food and Food Protection CONSUMER ADVISORY �- _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print —d PIC's Signature Print Barnstable Public Health Division l APPL ICATION FOR TEMPORARY FOOD SERVICEPE DATE< NAME OF SPECIAL EVENT '� m Qt ZOZ WAS THIS EV ENT APPROVED BY THE BOARD AT APUBLIC iNEE1[IVG? ► 1 N NAKE OF PERSON(S)TtEQUESTIING PERMIT JENNI FR WtL1 E tS E�fF�4`7TiVE I)tt ECTl7Tt T!LEPIIONE# S48.428S8Gi CELL#508 2liiT R9$2 HOME ADDRESS 155'Wpy Bap.:Road VILLAGE Ostervllle NAME OF ORGANIZA-110 6^0 {yP CONTACT PERSON G J i t. r/Wlt i J �^t JELEPliUNIt� U g'$ , I OW f ADDRE 5.. -i' E >tt d^(\S WtA(/1.._ M Pr0 L S 7� FDOD TO BE SERVED(LIST EXACT FOODS) , P_ t (tfq't''\ n�*h.0 �� (�L�y^�'t�}{ c,l`xS NAMES OF TRAINED ROOD HANDLE (TO BE ONSITE DURING EVENT): (ATTACH COPIES OF SERVSAFE&tiLLERGEN CERTIF FATES) ADDRESS'WHERE TO BE SERVED Ostemille Eltgtorjca Museum.ISS Nest Bsv RusB Qsterville MAQ�655. DATE TO BE SERVED June/9-Sent 18 TIME to i gsm. WHAT TEME WILL ALL EQUIPMENT HE SET UP':&READY/F�ORMSPECTION? HOW WILL FOOD BE KEPT BELOW 41:DEGREES F. �1J1 t How WILL FOOD BE HELD AT 14tO DEGREES F. A)A HOW IS FOOD COVERED '7'�9 G HOW IS FOOD SERVED i TYPE OF HANDAVASHING FACILITY OGI i SIGNATURE.• COMMONWEALTH OF MASSACHUSETTS Town of Sandwich Board of Health Permit Number: 16 Jan Sebastian Drive 21-112 Sandwich, MA 02563 Fee: j 508-888-4200 $75.00 3 1 E This Residential Kitchen License for 2021 granted to: (Baked goods, nut bars, peanut/almond/peanut butter) 7 Queens Way Sandwich, MA 02563 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111,Section 5 of the General laws This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless suspended or revoked and is non-transferable. 3/25/2021 David B. Mason, RS, CHO Date Issued Director of Public Health This permit/license does not represent nor preclude approval of any other local or state permit granting authority,and does not represent nor preclude compliajwith any other local or state rules or regulations CERTIFICATE OF ALLERGEN AWARENESS TRAINING , Name�f ReClpient ,MARIA LEMANIS I t 1)� Certificate Num-ber.''3asass7 42 Date of Completion,'srzs1zo,s I Date of Ex iraton.;s z rzozs is . ❑ t Bessued By: e above-named person is hereby issued this certificate i j � NATIQNAL for completing an allergen awareness training program RESTAURANT recognized by the Massachusetts Department ofPublic Health .. ..................................... ASSOCIATION, in accordance with,105 CMR 590.009(C)(3)(a). Massachusetts Restaurant Association 800.765'2122 333 Turnpike Road,Suite 102 www.restaurant.org Southborough,MA 01772 This certificate will be valid for five(5)years,from date of completion. 508-303-9905 www.marestauratitassoc.org I I Y 3$ r a AM SAW AV ' 1 3 v5afe'� CERTIFICATION C3. M MARIA LE'MANIS ,= for successfully completing the,standards set forth for the ServSafe®Food Protection Manager Certification Examination w which is accredited by the American National Standards Inst ute f Ah1Sla—Conference for�Food Protection-(CFPL'` 3e w 2 a E X A�'tv� FO�M r x 9/24/2020 9/24/2025 u : DATE OF EX DATE OF EXPIRATION Wa ,. LocaHows apply.Che cy for recertification requirements. ,:. �•, � p......�\'fir., ;: Sher #0655 $ ciation Solutions �.. ,: . HI 'O � ?� ➢ ^ k33� 3 In aaordarce rnt e Se,Safe logo are trademarks of the NRAEF.National Restaurant Associofions and the arc design Cantoct us with questions of 233 S.Wacker Drive,SiiZp u to 3600,Chico,Il 60606 6363 or Sen$afe@resteara n aig i,P, a a ? Town of Barnstable Regulatory Services Department �errsrnsc�, Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event d Date ( Z Table/Cart/Trailer Identification Name 1 l byl 0 Ida , Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT � � 0 PIC Assigned/Present Onsite IVv 1 "t(r(f� PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing (G ^� Foods Covered Proper&Adequate Handwashingi Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating �� _ Cooling O Hot and Cold ding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Barnstable Public Health.Division APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT DATE `a--1G1"Z2)Z. NAME OF.SPECIAL;EVENT OStervil a Farmers' Market 2021 Season i WAS.THIS EVENT APPROVED BY.THE BOARD AT APUBLIC MEETING?. X Y N` NAME OF.PERSON(S)REQUESTING.PERMTT JENNIFER WILLIAMS,EXECUTIVE DIRECTOR TELEPHONE# 508.428.501. CELL# 508-280-8882 I HOME ADDRESS 155 West Bay Road ll VILLAGE.Osterville �. (11 1'n �a'� .NAME OF ORGANIZATION � ��2 L1 c CONTACT PERSON r O&e c� �e.,(A.f jm(3 TELEPHONE �J 0 b, 3t� 'a°V 19 ADDRESS Ab NrG1\� SkY�e V�1Q` �l^� � FOOD TO BE SERVED(LIST EXACT FOODS)l p Ice 05-S se-CAP—'A �s AorV. eAya N`ed,114xr, xocisk deans amcl GrourAc , NAMES OF TRAINED FOOD HANDLERS,(TO BE ONSITE DURING EVENT): t (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERETO BE SERVED Osterville Historical Museum 155 West Bay Road.Osterville.MA 02655 DATE TO BE SERVED June 1840t 17 TIME 9 a.m.to I On, WHAT TIME WILL ALL EQUIPMENTBE SET-UP&READY FORINSPECTION? E HOW WILL FOOD BE INEPT BELOW 41 DEGREES.F 1 HOW WILL FOOD BE HELD AT 140'DEGREES F. HOW IS FOOD COVERED : HOW IS FOOD SERVED-1 TYPE OF HANI ASHING FACILIT R(A na Sa n"\ -z e ` i SIGNATURE: o be.r o e tck-:'f1 0 e, i i i st wills .Ear rs' to 2021 Application Fridays, June 18 to Sept. 17: 9 a.m. to 1 p.m. Rain or Shine } Along with this application,please submit a current copy of: ServSafe Certificate . Allergen Training Certificate Residential or Commercial Kitchen License Wholesale License o and/or any other paperwork pertinent to the item that you are producing/selling. We will be adhering to all .current Covid rules via the Board of Health.. THERE IS NO OTHER. BARNSTABLE FEE TO PAY OR x BARNSTABLE PERMIT FOR WHICH YOU NEED TO APPLY., $27.5 enclosed. (Checks Payable to Osterville Historical Museum or Ven.mo @Osferville) Name: 4beT roqo_�Amlo Business Name.'t-6V«l2 Qo`Qmb�c�n00. Oc Email: r 2MGk 6 6 QN060A.-cnm Cell Phone f dg Z t k 220%i Mailing Address: 4,0 3. 8 Signature: Date: � g-2 Please return via mail (or via email with Venmo payment @Osterville) I ith all paperwork by April 15 to: Osterville Historical Museum PO Box 3 • Osterville, MA 02655 I Questions?Jennifer Williams@ Jwill..iams@OstervilleMuseu.m.org 0 WX qll,A LA r y 'm )MRS Fil 1 .6 CERTIFICATE OF s TRAINING ALLERGEN AWARE,Nra Name of Recipient: Roberto RP Perdomo Date of Coal p1e00n: December 24.1 2019 Date of Exp ratio l Mqe:tuber 23, 2024 IssuedBy;. The above-named person is hereby issued this cert�Tcate r for completing an allergen awareness training program recognized by the Massachusetts Department of Public Health Berkshire in accordance with105 CMR590;009(G)(3)(a). iiAHEQ Area Health Education Center This certt ate will be valid far fi.'z�e(5)years from date of completion. Pittsfield,Massachusetts www.mafoMallergytraining,org "�1t Reg.NO.: :Fee Pd.: $40.00 The com t ith of: tuss chusefts 'SOWN OF WAYLA"M Business Certificate Date Name of Business: ...,\a�,\�12. ...........................................d =Ll, Address ofBusiness:. N Mailing Address if Different; _ • ............................. .............. Nature of Business:........ ...e... os e ..................... by thefollowing named person(s): 'Telephone Number FULL NAME HOME ADDRESS l: b � .. ecdoreo .... 2.. w...::.: ........ ......... ........ ................:...::... ,... ...................,,................... ... ..::....:..:.:... The Commonwc& of mss4chwas Date Personally appeared before me the.above-named person(s)and made oath thatthe.foiegoing:statement is truer 2:. .......... ........... ..(IdemificatioA).. ....... .. ........(Identification).......:........ A certificate issued in accordance with this wttion shall be in force and effect for four years from.the date of issue and shall be conducted and shall Liss e:,and be.void iutless.so renewed. Business Certifirate C`W, . Expiration Date:.. `.: ............. .,..... ���. _ ... ....... ............... {Signature):. . .................... ............................. � (Torun ClmWAssistant Tawn Clerk). THIS CERTIFICATE IS NOT A CERTMCATION THAT Tl CONDUCT OF TSE ABOVE 3VAA'IEJ BUSINESS,AT THE ABOVE'NA3V A ADDRESS;IS IN ACCORDANCE WrM,THE AY LAWS;RULES OR REGULATIONS OR THE TOWN OF WAYLAND 3 i Y h 5 � (M- 1 c .€ 3 f Zn �QCUTICIYCOIT1EA�g��J 4 c �C�ju��Cx � �� x � � DEPARTMENT OF PUBItC HEALTH BUREAU OF ENVIRONMENTAL HEALTH,' FOOD PROTECTION PROGRAM 3O5iS01JTHgSTREETJAMAICAxP1ANV, MAC OZ130 µ� s LICENSE & ' g. �% In Accortlanceawlth Massachusetts,Gen'eral Laws Cnapte�t94 Section 305C, � ,. ;3 NUM$ER ISSUED a EXPIRES M. T1bPE *3 dE Y _ Iv1A 942$, v04f18i2020 £ . 04;,18120114 2I' �` Pracess or'Ditnbute Food for Saleat Wliolesale x INIS IPF x x ' 6 R R U (SSUEDTO NAFIUE COLOMBIAN FOOD LLC£ F 60=MATN S�REET ,AT AllWAYL AND=M?A01778 r 5 ' AT1N ROBE ToPMOSQUERA =t s CO{tMISzsION€R OF FUBLfC;HEt,�LTH §x �:: RECIPIENT'S CQPY POSVIN�A CONSPICUOUS PLACER _ „ s v,� i ' o i CERTIFICATE OF ALLERGEN AWARENESS TRAINING Narne?f Redp IeI1t A USEPPE DE VINCENZO CertifieateNumber, z 1 Date of Completlan Ys1711o9 Date of'xpl atian `artn0z l Issued By: The above-named person is hereby issued this certificate � }r completing an allergen awareness training program RESTAURANT ANT recognized by the Massachusetts Department of Public health ASSOCIATION, in accordance with 105 CMR 590.009('G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 1.02 www:restaurant.org Southhorough,MA 01772 This certificate will be valid for five(5)years from date of completion. 508-303-9905 www rnarestaurantassoc.org '+ w r tis r ti r Town of Barnstable of rati Inspectional Services Public h Health Division w sn MBLE, t 1'"b Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office`. 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under,authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Native Colombian Food Name of Person: Roberto Perdomo Address: 7 Queens Way;-Sandwich, MA 02563(C)508-888-1045 To serve: Bagged Coffee Ground and Whole Bean and brewing samples ***All foods shall originate from an approved source per Section 3-201.11, the Federal Food, Code. Selling and/or'serving of any unauthorized foods from a residential kitchen are prohibited! *** ServSafe certified: Roberto Perdomo Allergen: Roberto Perdomo Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Septa 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health r. } certificatd Number LFzo2loQts Date Issued:01/05l2021 Expiration Date:06/3M021 TOWN OF WAYLAND BOARD OF HEALTH This is to certify that NATIVE COLUMMAN FOOD LLC 160 MAIN ST. WAYLAND,MA 017.78 Isherebygranted a,pernnit. TO OPERATE A RESIDENTIAL KITCHEN TYPE OF BUSINESS AND ANY RESTRICTIONS: WITH COMM 19 RESTRICTIONS This permit is:granted in conformity with the.Statutes and ordinances relating thereto and is valid through the expiration date unless suspended or revoked , RJLIA JUNGHANNS RS CHO/DL Julia Junghanns,RS„C.H.O permitted Entity Copy Director oMblic Health TOWN OF WAYLAND BOARD OF HEALTH This is to certify that NAME COLUMBIAN FOOD LLC 160 MAIN ST. WAYLAND,MA 01778 Is hereby,granted a permit TO OPERATE A RESIDENTIAL KITCHEN TYPE OF RUSWESS AND ANY RESTRICTIONS; WITH COVID 19 RESTRICTIONS This.permit is granted in conformity with the Statutes,and ordinances relating thereto and is valid through the expiration date unless suspended or revoked I r5o''4 mY .1 is F u s �;fi ar't ,"a �a% ,• Zak - a re TIF� C. -io' AT Mir^ U MO 3 ' �RJ L a R'O lo%'E R PER tor:suoasssfully aomplehng-the standards seF forth tnr the FeFoodi Manager Cer66cata ;Examin6fion;. -, which is adcreditecl,by ihe.American Natwal Stgnc}ards�""* rte('A .41ference f or Food Prctect+on;{CFPj; . St ,- T4 FfC ATZ 5t E R: E'X AJ�A 't©$RA tlN°UEM BiE�R' x _ 12/20/201" 12/20/2024 c ` a A DATE OF EX 1�(� ^ �, _ ,R TE; OF EXPIRATION; L•occl-6ws apply.C � Y forrecertiF•iccNon requirements: *✓f' �L z�r �. fl �n � r - -- .. Sher #0655 $fir , tti it5rotia#+r A cia#ion Solutions s ti acawdc��ae Sx�ttxK C�ir » 1� !2@r 3 8�; ServSah 60 as b.!..&of f6"V ff,Ndiond Reskw�arit As�odoliai®and tFie oc deigi beei �,�, , � i •, ,� Caiad us w*,queslioro d 233:$.Wadoer DiireJ:Su 3600;Uiiaa0o1L.6060d�6383.oc SMv6a�ie�lairtsdorg;' ,v ae - �..�,•!,' W '1-�,.:� � �1;,.��.-t: W ':T,�_c,-r (.� -v,f i-:C- (,a '- �.Y..=Y- (�' -,_.��! � �7^,i.,-: W i u' �c ► • o - � • ® - a - a • • L � •7� C1---d-04—C)7,���C�����C��G�J �i Town of Barnstable Regulatory Services Department Public Health Division " Al 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event 07r-76A (( / Date I� Table/Cart/Trailer Identification Name 'Vt 0Y►'1 rd1Gt'-� (7 Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION n, 1 b� / Valid Permit/Displayed l� !'791`,,,,- l Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite c�'►^ !�t` )VI qq � 1 U-CL NfD PROTECTION FROM CONTAMINATIO � I .tt(,C.c OK�pZ� _ Food Contact Surfaces Cleaning and Sanitizing kl( Foods Covered Proper&Adequate Handwashing/Temporary Handwash N�`J �S �Ll1-- ,l Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating _ Cooling Hot and olding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print 6 v PIC's Signature Print Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event o f— \ Date 2 Z Table/Cart/Trailer Identification Name 66 I dYlt L`CA, C 0Oe .Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION (� L Food Contact Surfaces Cleaning and Sanitizingj� _ Foods Covered � 1�,, _( �o ��✓�'_ p per&Adequate Handwashing/Temporary Handwash rtlJ I f'7 Station Location , Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating Cooling (,JCi9t, -f _ Hot and Cold Holding Food and Food Protection ICUy �Ck su5b0 �1 CONSUMER ADVISORY Posting of Consumer Advisories 1 ` OTHER REQUIREMENTS Refuse Container(s)Provided/Covered LAD (7 Adequate Toilet Facilities Provided 7 Inspector's Signature Print lU04" J Oh) PIC's Signature Print 5/29/2021 Application Form 0408�, Rehoboth Health Department �.� 148 Peck Street Rehoboth, MA 02769 f United States (508)252-3335 TOWN OF REHOBOTH plumber F-21-0014 BOARD OF HEALTH Fee$ $50.00 COMMONWEALTH OF DATE ISSUED 12122120 MASSACHUSETTS Oakdale Farms Oakdale Farms 59 WHEATON AVE IS HEREBY GRANTED A FOOD ESTABLISHMENT PERMIT This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires 12131121 unless sooner suspended or revoked. Comment: Approved on 12122120 meeting date Rachel Smith Board Chair Signature https://permiteyes.us/rehoboth/boh/printapplication.php?filename=bohissuepermit.php&application_id=df2da8cc-2e79-11 eb-aeac-122947997c8e&Per... 1/1 W a \ v S:erv,Safe :,::: CERTIFICATION - LAURA SMITH b for successfully completing the.standards set forth for the Serv, "ie-Food Protection Manager Certification Examination, which is accredited by the American National StandardMlw=! te[ANSIa—ConFerence for Food Protection(CFP) ER;.., ,. EX7i'M FORM NUM;BIER ` 3/8/2021 \ M/2026 DATE OF EX DATE OF EXPIRATION . Local laws apply.Che cy for recertification requirements. i A '' ILA Sher N a \\ #0655 p}c k,f �ktt,d ttwflM ° ciahon Solutions, IFI I to oo:ordanca sit e 5-5afe logo are trademarks of the NRAEF.National Restaurant Associefion®and the arc design t\ h \\•. .. -.s Contact us with t at 233 S Wacker.Drive,Suite 3600,Chrc rg. <`ques ions ago,IL 60606�6383 ar5e�rv-$oh>�restauraN.o CA » �, CERTIFICATE OF ALLERGEN AWARENESS TRAINING Z . Name of Recipient enuR',a SMITH Certificate%Number 49 5`3 Date of Completion;aiaizoz, Date of Expiration "diano2s i� ............. Issued By: � The above-named person is hereby issued this cert�ficate .,. NAT�0 for completing an allergen awareness training program ! ,„1� RESTAURANT recognized by the Massachusetts Department of Public Health i.__...._..:...........`°ie"'..:°^....... ASSOCIATION® in accordance with 105 CMR 590.009(G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 102 www.mstaurant.org Southborough,MA 01772 This certificate will be valid for five(5)years from date ofcompletion. 508-303-9905 www.marestauraiitassoc.org / �b r' a., r ^O f�Vj (v �� �`� � ���� ��- �,,9� ��� ���� -�N 2t 7 l� N�`� Town of Barnstable Regulatory Services Department rA�v�aa�tae, Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event QE7L,1 Date G1 1 li Table/Cart/Trailer Identification Name Gl �Ct,(1Q �-12r✓1'1 Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT ' / _ PIC Assigned/Present Onsite Yy�l //Qfs���� PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash Ctt, mod, Station Location Y,77VAd _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) ke TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating _ Cooling Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature -- Print A"W X PIC's Signature Print r 590143 Barnstable Public Health :Division 1PPLIC,A`'CION"F_Olt TEMPORARY FOOD SERVICE;t E !1°1IT RAIL Gf NAME OrSPI:CIAI. Osterville Farmers' M—Arket 2021 Season U'ASTMIS'FVFN"I`r1.FPROVEDBYTHE'BOARD TAl'URLICMEETING? 4 y ,N' NAME OF PERSON(S-)REQUESTU;NG PERMIT JENNIFER WILLIAMS E.VCCL'1V DIRECTOR TCLEPIIONhf3 SW4128.5I361 - CFI.I, ! SDft-284-8RR IIO 1EADDRE-+S 155Nt'est fitIA uod VILLAGE , , NAME OF 0R('2XNIZ,VI'I( FF'Ii0\F ADDRESS >f:l J _ �/1 1/L/�✓�f � FOOD TO 13F.1i�RVED(LIST U XAC7'.'C)0 7 NAMES OF'1' ,INFI<FOOD IIANDUAtS( . 13F ONSITE DU EVENT): (ATTACH COPIES OF SLRt'SAFL&ALLERGEN C.FRTWIC A C4 �� :(�� �!f�t'7/�^t ADDRESS W1I RETO BE SERNU) Osten•ille tiistmira hlusrum t55 iVest-ltFi<<..Aoa(l 0 err{ile `t1 6( ` DATE TO BE S RVED June 18-Sept 17 TIME U:t.m:to I a WHATT'IME X`I U..lLL FQUII'tMENT BF SET-UP F Rt:ADY 'ORIINSPECTION? _ I}OW WILL FCJ)D BL KFI'T'HELOW 41_DEC;RUS F Nd e� r..l-1 / f , 1101t"«JUJU.FCC}D BE HELD A DFGRFFS F. FtC)t1'}ti FOOD SERVED ' Il TYPE 06 HAN FACI.. /? /� tM , servsafe.'�' CERTIFICATION.. JENNIFER BEAU REx for successfv!}y completing the standards set forth far the ServSo{c� F Pr won manager Certification Examination, { which is;?coedited by the American National Sttmdords�nsit}ut� SI �on{erence for Food Protection{� P}; E R E:X z arsr2o2o 1 o/st2.25 DATE -OF EXPIRATION -DATE OF EX • Local lows opply.Ch tray fos rer syi�icatiws Fequ cements. ' Sher 00655 E- dation.Solutions Q•W. ,..5crr$uFai!p�>p=zy Ap>�twka Cf 7ho Ntih[C.hardswwl9asa�;^hri�R'1A'»�P+%'-"mX)d+a urc c�xsSyrr '�t '� .Ccr•rcx?�zn m�� rfca 293.5.,Wa+cbr Give,3a:'?�3�?,Chirugm,d..dUdOd•d381 ar�,v+'. "n"''c*�l � _ x . ;,.sasi�usx,usautuss,eaa..nxx:exu s..a,.a'uraas�sa au a'.IA1.,w.as..:sA,.�u.avexes....:...ara.>uass.aa+e.w.�rosxgr.cvax.urxace.. ..,,,.as.yen aromau.a.®a,+.e.sax seae5*�x: xiwaa t(r: E RT I E I CAS"E OF ALLERGEN AWARENESS RAISIN a a3� i �• Nartte of Recipient:JENNIFEf2lVWREWD •,. Certifit::tre Number:zx.a�se � ra2a,ania � . Date(All"Viration, C lis' s � TPa•a&a� traterr'�` aa✓rrr r h, f r N,e1 rF rt uet: P t e-Vv rrng errr all,at n ,Ft gntfr ta. � c>e;��stsrdAyr/��zlIr<:r�l.r.�weZ7.�rrteu.erty/1'�d�firfl.rrtrp tx a tru aath I0,5 L;mR�fv,R}J(G1(1)f+r1. Mm,.laaw"Rc,c r�,i A..«:grim ow rt?t22 1311v tPAIIjZ,A,UctN ,�rr.rsaxst,ra_urnt�y r,,,rta ut S,rlfL;titrltl of --t ,rw ont trtt:`c ampl,ri0,a>. S•tid,:er a4t,MA(0s 2 t) t f h a:.xssarr�.p..anse¢yt,Kr� nrss4v=axrarsfr rrrr¢r�xvncxa xe r -mn.n ssrtrsa rrars�rr+r�a+¢�-.w+rr�rrrr n„�a+,xrrr<+zvm+aw.�vasrxrv.�cm�'�. °F SEEK°NK Town of Seekonk BUSINESS LICENSE CERTIFICATE 100 Peck St, Seekonk, MA 02771 508-336-2950 Board of Health j}#, PORATEO Business Name: SanoBe Super Foods Business Location: 213 TAUNTON AVE Mailing Address: 213 TAUNTON AVE Seekonk, MA 02771 Seekonk, MA 02771 Owner: SanoBe Super Foods License Number: BOH-000013-2020 License Type: Board of Health Issued Date: Classification: Food Services Expiration Date: 12/31/2020 Fees Paid: $250.00 Asst. Health Agen TO BE POSTED IN A CONSPICUOUS PLACE r ® o • , k .. .:: .; 4 r z z , EL M CE RT I FIC ATIO F . z JENNIFERBEAUAar S ED "',' "M h for successfully completing the standards set forth for the Serti�Fe Food PrbieWtton Manager Certification Examination, which is accredited by the American:National Stdndards lt� tit A�1 €j rence for Food Protection-JUP). .. - - 1 r ER r . E X fl �J _ t � 10/9/2020 U 10/9/2025 DATE OF EX DATE OF EXPIRATION Local laws Opply, Ch cy for recertification requirements. n 1 9Y � F Q w) Sher : „_ #� •,., , T ciation•Solutions, In accordance wi - a ServSafe bgo are trademarks of the NRAEF.National Restaurant Association®and the arc design ' ' Contod us.vMk:questions of 233 5 Wacker Drive,Sate 3600;Chicago,IL 60606-6383 or Se"Safe@re5tourant.org.: A ........—--------------- -—--—-----------------—-- --- ---------- ----- - CERTIFICATE OF ALLERGEN AWARENESS TRAINING , Name of Recipient: JENNIFER BEAUREGARO AD to Certificate Number: 2445368 Date Of Completion: 7r2812016 Date of Expiration: 7'11'2121 'At CIA EUN M Issued By.- The above-namedperson i-,hereby issued this ivrtifirate for completing an alleigen awareness training program Mon _TTI P E S,i,"\U R. N1 recognized by the lWassacbmsew Department of-Public Health t V;S('OAT!Ml in accordance with 105 C,,IYR W0.009(G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 102 %%im.restaurant.org 275iscer�flcate-xillbevalid Southborough,MA 01772 508-303-9905 7 Town of Barnstable Regulatory Services Department Public Health Division MAM 200 Main Street, Hyannis MA 02601 1639.Imo° OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date (� II /Z- Table/Cart/Trailer Identification Name �L� e Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION Valid Permit/Displayed Pre approved Menu Items Offered Only hAIA mk,J `1LkAb-y,5 ow OAV& FOOD OTECTION MANAGEMENT — IC Assigned/Present Onsite PRO Food Contact Surface CleaningAand Sanitizing c� '� S17` - 0� Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash �n t'f QL�ja�-L O - am 1 bV T Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating _ Cooling Hot and Col olding Food nd Food Protection i CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS / _ Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print 11 o� 1 PIC's Signature Print r Barnstable Public Health Division APPLICATION FOR TEMPORARY FOOD SECtVI EY RfMT DATE, NAME OF sPI Ct.1L EVENT OsterA-fle Farmers' Market 2021 Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING' X—Y N NAME OF PERSON(S)REQUESTING PERMIT JF;NNIFER N1,41,1JANI EXECUTIVE DIRECTOR TELEPHONE,# 0K428tc51 CELL# sob-28f►S 2 IIO1N1E ADDRESS ISS WeSt Aay Road VILLAGE O t tc q Ni"W.OF ORGANMATI"ON CONTACT PERSO,Nr,e TELEPHONE -1~W 1 / ADD A(Ls FOOD TO BE SLR) D(LIST EXACT FOODS) �a t'S 1 �� 1("'Pct 4 p tt_ NAlti°tES OF'TRAINED FOOD HANDLERS(TO BE ONSITE DURING EVENT): � y p.,++ G� 00 (ATTACtT:GUPTE5 OF SERVSAFE do ALLERGEN CERTIl IICATE.S) AnDR %1vu9RE TO BE SERVED Oster.ille Histoslca! uxenm 155%N, t Ba Road Oster+itle fit 02ha"5 LATE TO IIR SERVED o Se T tnt t;. .. TIME n 9-M tut rrtq. �. WHAT TT#TE WILL ALL EQUIPMENT BE SET-UI'&READY FpRINSPECTION' ( PL HOW WILI,FOOD RE INCEPT BELOW 41 DEGREES F f Z HOW WILL FOOD BE HELD AT 140 DEGREES F. How IS root)COVERFD_„( rn � t y► irkk� ���o V+`►~C How is FOOD-SERVED 'TYPE OF PLAj A ASHaNG FACILITY SIG ATURE. U" 5„ P Tn t aI AL t�•rx d; w ` t taf. y�� �"q a� "�"✓f".a �', §N'� a�� La �$Yzr � �� zs f� ' r°�„ � � �g..�wsz � �P� a�'� ,v�,q ✓'�,,, u3zg�xC�,,� ra 3 " � "�' � a �"r :. R� 'ate # �.a# a � ., °`� �ad�y�. �". ,�� �`3`�''�� i� ". i "�,}, "'� .. ��«�« ��"s� ;r� ���� � ni i �'� .m r� •6 L���� ash�a w�,,,� ro �` n c:,I� ��t �J.:tnTitvt? w b� z rn rar OF Pi aui H �lttfi�fJ!3", � �j n.. 4�R1r,,R�B+�rr.�nz,at E (,�., � y� FC PfiOTp'Crt v rXtiSia 4A$s NV4R tENthy,�FA.s M.• �y,+�� d a in Acca,'dWice K51h G44ssadw6S CelncrzO UMS C�94$Ocbw� r s :NUMBERISSUED ExFiRE5 TYPE h -70 2 W22/2020 01+,2212021 P ,xr sap,=s; _. ISSUE6 TO SAVr NNORS';UppL Ctl,INC i)l KIRKi A-N'�SIl�1 l t G6u�i13111 CE MA ,u a " »/�.a2aI�7;C?,axI1F[NOR It.lSUlta�T pO57 W d CON PiCUOUS PlACL g y 1PtEN r'copy a ✓� � �r� 3, $ "'� � � as a h 1 • r " ....a, CATION CERTIN JEFFREYol ` MINI hr,: for'svccc w(vily canpWrig;the slondotcls set forth Fo the Sel P oto 00 h4or ogee.Ce6ficotion Exominohon, whi<N{s=,9&ted.by.tho American Notionel 5tondords'n Ai#Si ' wifa eneti for.-Food Protoction JLJ sr��nozi � y �,: .• DATE OF EX DATE OF EXPIRATION laa:opply. farn:acilifimtron:regviFemenk. G3olion solutims t Ra kre�r�:�o+a+z;mti ctb rflA�t•iz&a�R4xa>rnca Am":a.vi� d Am we'd*s�+ 1 p ServSafih CERTIFICATION LINNEA ALLEY "!,=71 . Pr-,�n aM �iN-.mow WIN mot F3ME OF EV., Town of Barnstable Regulatory Services Department Public Health Division saes 200 Main Street, Hyannis MA 02601 63� A1� OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V I' ✓� Date Table/Cart/Trailer Identification Name c�(�AVe Y16-WaA Telephone Permit Holder's Name �� Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed L wa U L*0 _ Pre approved Menu Items Offered Only "� (/ S �p N7M FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash 1! W ItlA, t Ct K"-89, D b Station Location �� _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) zh au i Cl A TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating _ Cooling T6e ✓vl of and Cold Holding _ Food and Food Protection D, D -� CONSUMER ADVISORY ��pp ��O-C-0 � ! Posting of Consumer Advisories S4,L i C OTHER REQUIREMENTS hr I1. 1 Refuse Container(s)Provided/Covered -C 3� F Adequate Toilet Facilities Provided 6( fa)' , Inspector's Signature // / Print f &� ,,,j PIC's Signature Print Town of Barnstable Regulatory Services Department • Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V ( Date Z Table/Cart/Trailer Identification Name f1�,I/e�ta�/ Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD MANAGEMENT PIC Assigned/Present Onsi e PROTECTION FROM CONTAMINATION ;�e (� �D� 3 Clbc�f _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered ��l ✓� I Sl CS I u-e�c c� Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) r'L TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating Cooling Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Town of Barnstable Regulatory Services Department 4 Public Health Division bs� a1� 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event ��� Date -7 49tp Table/Cart/Trailer Identification Name Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing _ Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS _ Cooking Temperatures Reheating Cooling A -'Hot and Cold Holding G"- —AAk-Z,, pl"Hn Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS _ Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature ®- " Print 16+4M, A- PIC's Signature Print f D5 Ion Barnstable Public Health Divls* APPLICATION FOR TEMPORARY FOOD SERVICEPE. IT DATE:4 f NAME OF SPECIAL EVENTQstgmille WAS TIM EVENT APPROVED BY m BOARD AT AP17BLIC MEFTING" Y N NAME OF PERSON(S)REQUESTING PERMIT ENNBFFR Wii I TAMS EECIJTIVF'DiilE-'OR TELEPHONE HOME ADDRESS I sS MLeg Bad Road � _ VILLAGE Ostmilk NAME Of ORGANIZATION @� CONTACT PE RSON T ELE PtIONE AIDLDItESS ,- FoODTO BE SE RV1FD(.LtS'T EXACT FOODS) ._ td� �"�P�Se NAMES OF TRAINED FOOD HANDLERS(T !?ONSTTE DURING EVENT); (AIiTACH COPIESOFSERVSAFE& LLERGENf°i CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical ltkjseum 155 West Illy:Roa4i Qstervfflg,MAQ2655 DATE"I'O BE SERVED leoe#8 5ent 17 rIME 9 a.m.to i m cry:_ WHAT TENlE WILL ALL EQUIPMENT BE SET-If'cS�READY FORiNSPEC°TION? Z ` _77, HOW WILL FOOD BE KEPT BELOW 41 DEGREES F-L L {f/ t, x+ � IOW WILL FOOD BE HELD AT I.o ' t HOW AS FOOD W'IERED HOW IS FOOD SERVED I) TYPE OF HAND- ASHING FACILIMT` i IGNATURE t Adsm Cr to I US Fulbright 4rhni r'"it s=?�Dt t>rlis r�rC Crt :vi<1it'Psa Uj NiA j-tmlic.l':�Ii."y&{,j��?e'.�»rtionc ' g(Y+i'•"f 9�U i.�"�^ i ia•u:�� Er Y�� ?s<+ ,mlin nnn:'�p-3(lt•'� .<.uy F G 11 e =a b q r MServSofelood Handier , F � > y i i w 'a ]ER7, 1RULTE.. "OF -,&*41!f-ULER( N AW-ALREN,,"ESS TRAINING J � lOi►NtE CHIPMAN _� $ f Gk Name o1 Recipient. g l.� � CerCiflcate Nwiiber: sesmas I ' 8. u ' I?-ate of CbjMpl,:tion and© T CM OF MIDDLEBOROUGH ansraou HEALTH DEPARTMENT Date of Expiniti Q s Isauui H;r. �r s . 7hr above-nvmedperson is hereby i"ued tbit reai&ate ' ,gig TtC?1�9A$ + for rompluinti�an all:rgen ewa;vnem trnuringprcgram ,r . ..�'�., STAllANT rrcagn 'byt/te 1Vlassa.huuttsDrzrtmeneafPuhlrHcalltfi _ _..� .. 3CITIONo =n=,,d, ce with 105 OVA 590 009(G)(3)r a), Mazs33 TAwlu. m�o,.,% nt l ft IO2tlon 80L=,7s5 21>a 333Ti�rnI,9RoaSuite,102 www,rstaunIat,org + g Soutlibo�ou$h,AtA 017?2 T},is rertiJicare Ull r valid forfrse(Ss years1ro�n flair o{completion S49-303-9905 �Q www.marsqurn,im�ocot� � s I a.1114 tilttlVlUU01 fxrlquvat U11111tu rApplit:dtiul image '1 01 i .. E " k EIN Assistant ^ Your progress: 9.identity I Authenticate 3.Addresses 4A Details 5.EIN Confirmation Congratufationsl Your EIN has been sucoassfully assigned. Rein Tonics � ! M EIN Assigned: 46-4716427 aco�ssics a rtrinter at the tittta? i.eyai m�[ree: Jtii>�i� .t{ik'[�IRN {(((. Gan i access this iettar at a i ttei_date'?: it PUNtANt; Save anottor print this page and the confirmation imtterbelow for your permanent records The confim-aWn Wetter blow i5 yo w official IRS notice and contains important infvTmal;on regarding your EIN. 11 l j2,,lp atth savdm end printing y0yr CLICK MERE for Your Eiht C nrn atF 3 off k icar Once you have saved or printed your totter.click"Continue"to get additional ,:Continue» Information about u,ing.your new EIN. I i naps use i.www4,rs,govimooieintindiviauaucon irmatiot.isp I o wro 4Ft" .3 _ os YS tr rr c s�, x iDim d�ssT'� f;».»^ .sn .L�fr J:\TC ` IL I r v � a uz Pogo Pis UV gg A,OPWO Forms arid MEN ,qe? ., s HC AV,, B%e9�. +a.Ras�,yoao� £ �1 1(,,1113O{1.1't slit i"� i"�'.-"R; 10N I'LC 1-► 'sI11,4'R.L Y V lI'(MS OF VI'-"R 1ON f 1Z�,ti G)Ct'I1 CENT 4,V O5t)(f] Fxpiroa S''31 2021 AGENCY(tf 1�RICt11TURE>f00n G t"PkEI'S I PC tT,4; !if?1 3 ;; % VIERMONT AGENCY OF AGRAC UI..J`UR..�, FOOD AND MARKETS 11fr 4B,;t�°',cruci _ } 1cEnrpc tEc r,V 1 0,�6'0-790l q Milk Handler Per" it This IICCnw l5 tCi Ccrlif} { NEIGHBORLY 1113CJR1� ' I AR.'vl OF VERB>DON7 Ll,„C.` Randolph Center,Veranont I,hereby Iieense to perl'i�rm tire.btasincss ora milk handler inVcrM0'1t"s set fxln�ill V S r+..6.01a-PICT 1 l Seeliori?72I inchulni be foll'iWinr (X)BuYIScllji)istrbutc(X)"IranSporl W Prk)(C NManufactaare(h)i'a La ti(N ;1 Eff ie x 71 E,f3.Flory t 0ai"v ScCI.iOn CI)iCf' 1,IGI1I30RLY FARMS()I NEIGH[30RI,)' FARMS 01 vt-,R,\o a T 1302 CURTIS RI3 s' „ ..: ��.Q ��{t�8t[.UBti#JZli.11- .� � �d�7.74$&�-tl��d:$.S7 �'x. ���•`'. EpAAWENT OF PUBLIC HEALTH BUREAU u OF ENVIRONarerAL-HEaLTH: l , . FDW PROTECTION PROGRAM,105 SOUTH-STREET JA CA PLAIN, In AccoridanceMth massachusetts s General Laws Chppier 94 ScGGon 305E 4 j "_ . c� V NUMBER ISSUED EXPIRES TYPE40 M 14*#i 11t1$020 l 111812021 Process or Distribute Plod for Sale at Wholesale t” 1SSUED:TO WESTFI EL D FAR]kil INC. 28WORCESTER ROAD I•{L)B RARDSTON,MA 01452 �z ATTN-Robert Stmon Pm-sidcn Got mIsSIONrkO'F PUBLIC HEALTH POST IN A CONSPICUOUS PLACE RECIPIENT'S.COPY i I I I - I l t #:s k 3 v / i FWM: Smith's Country Cheese a#lira rn€i�f�ctaurtir x:*� ,cc3 a 4 5,jvi wt: State license for Smith's Bate: March 26,2021 at4A5 PM To: SoanisChipman 4echIV,1@tjmaet._C0 Here you go,Joaniel Thanks, Allie Smith's Country Cheese Farmstead Gouda,Cheddar,and Havartf since 1985 20 Otter River Road Winchendon,MA01475 978-939.5738 WE— L.�a .fJIlYi110tttut�allI� of 1�t i EI)I&tt �6tvb;l•:Y��P't,u G t§'L'T6,B:JxEw - 'GtY4t1'.i s.:ti.•.xt Frrru„ ,�Lr"ac.V?-fit a.9.,I1.'thi.a Fl,-'LwtQEI In l�sxrtsa-rs tagh Fd't8 GLIunvSk�Gn'»ai Lirar G'hati+rr.lt:im;ri;�17i�C $ �"�`�� _ tll'I Yr. 0.�li<u�trt�z� rate.rS�3natb4acr��c i:;a'LL 9 T 441TT"'tS CTttt1 r�% (;iit. S�-� F _Got t2:t ItI of ROAD .V'EXCEZW1LiN...IA 1.tI s+.4[31T I I1,n,.i� ti"Th I,, E t Al JN P d,IP tdTS Carly POST 114 A CONSPICUOUS PLACE 1 t«x 4 9 E a'w d 4 Y; d':Pr v. �Island anCO C NI 'h od 4 1 9 "Y'T;' a= sN Ai Department OfHealth .. Offwe of Food Proteetion { i " �f M w s pe t�avie :nt etalssaet isaai CO ' a jeAl M� GOD BUSI N-- SS LI.,CE." a � . E t o u e�.f6�the a endin r $€ NMI £ 439 Food ? :� Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Mid OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event LL�I Date Z� Table/Cart/T railer Identification Name Telephone Permit Holder's Name Telephone PERWT INFORMATION _Llfalid Permit/Displayed approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION � Food Contact Surfaces Cleaning and Sanitizing ` 1 t q kj I V1of- Vtiw 0�c _ Foods Covered Proper&Adequate Handwashing/Temporary Handwash 2 Ti����1�'►C 4ov LeT Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS } _ Cooking Temperatures Reheating S�l A 64p (� lQQcjc _ Cooling ' ��,c�G� VHot and Cold Holding ' Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signatur Print I�G h PIC's Signature Print Town of Barnstable Regulatory Services Department Public Health Division a1 ' 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date UI2rF-LY Table/Cart/Trailer Identification Name �gj,,M Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only (.J� FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite oU PROTECTION FROM CONTAMINATION Food Contact Surfaces Cleaning and Sanitizing i hvl Ilk Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating Cooling _ Hot and Cold Holding Food and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT DATE NAME OF SPECIAL EVENT Osterville Farmers' Market 2021 Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING?X Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS,EXECUTIVE DIRECTOR TELEPHONE#508.428.5861 CELL#508-280-8882 HOME ADDRESS 155 West Bay Road VILLAGE Osterville NAME OF ORGANIZATION % ,� l/V� CONTACT PERSON TELEPHONE �/�`}( ADDRESS FOOD TO BE SERVED(LIST EXACT FOODS) � w�S, Su.c�u✓ bu-�tZ✓� s cc.,�.� � �QeCu wS 5" i -tie Cc�vLS �. - CG.vt S, c�4LY NAMES OF TRAIN D FOp D HAN�qLE S(TO BE ONSITE URING EVENT): C01tih a wwa• 1 e%ft K �(�S(✓'CG RO'en (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical Museum,155 West Bay Road,Osterville,MA02655 DATE TO BE SERVED June 18-Sept 17 TIME 9 a.m.to 1 p.m.WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? Vic 5 HOW WILL FOOD BE KEPT BELOW 41 DEGREES IT1 HOW WILL FOOD BE HELD AT 140 DEGREES F. HOW IS FOOD COVERED ��p� (S �n��-� ��, (A G S HOWISFOODSERVED 1I TYPE OF HAND-WASHING FACILITY V v SIGNATURE: z 'Osterville Farmers' Market: 2021 Application Fridays, June 18 to Sept. 17: 9 a.m. to 1 p.m. Rain or Shine Along withthis application,pleasesubmit acurrent copy of: ServSafe Certificate • Allergen TrainingCertificate • Residential or CommercialKitchen License • Wholesale License • and/or any other paperwork pertinent to the item that you are producing/selling. We will be adhering to all current Covid rules via the Board of Health. THERE IS NO OTHER BARNSTABLE FEE TO PAY OR BARNSTABLE PERMIT FOR WHICH YOU NEED TO APPLY. $275 enclosed ✓ (Checks Payable to Osterville Historical Museum or Venmo @Osterville) Name: ���-Gv1 V�,v�'�t3u 1✓_�,`� Business Name: S?",� C- Email: (VA , Cell Phone: LG11 ,Mailing Address: 1 02, U01 Signature: Date: c-� J Please return via mail (or via email with Venmo payment @Osterville) with all paperwork by April 15 to: r Osterville Historical Museum • PO Box 3 • Osterville, MA 02655 Questions?Jennifer Williams@ Jwilliams@OstervilleMuseum.org Barnstable Public Health Division PERMIT NUMBER THE COMMONWEALTH OF MASSACHUSETTS FEE 21 -343FC $100.00 TOWN OF KINGSTON THIS IS TO CERTIFY THAT NAME: SEANUTS ADDRESS: 43 IYANOUGH RD HYANNIS MA 02601 IS HEREBY GRANTED A LICENSE FOR: CATERING FOR USE OF PEGGY'S KITCHEN 68 MAIN ST KINGSTON MA 02364 THIS LICENSE IS GRANTED INCONFORMITY WITH THE STATUTES AND ORDINANCE RELATING TO THERETO, AND EXPIRES ON DECEMBER 31 , 2021 UNLESS SOONER SUSPENDED OR REVOKED. JAN UARY 1 , 2021 ` Date Issued y Arthur Boyle, Health Agent Y 7 x �\ Aa CERTIFICAT,10'N , 2", HELEN VENTO :` ""A x for,successfully completing the standards set forth for:the Se0Ac€f � to non Manager Certification Examination Food , which is accredited by the American National Stanclards lrtstitute(AN5 j Canference for.Food Protectibnr'{CFPJ . k 04 a sM {t ERA EXAM FORM N'U�t $ER 3 ty` 12/8/2020 DATE OF EX DATE OF EXPIRATION �3 •w . • Local laws apply. Che cy for recertification requirements. T 4;42- +a © Sher. #0655, ciafion Solutions, '* k r� •� Via.. _ .,':. In accordance wi y \ tl;' tie ServSa are trademarks of the NRAEF.National Restaurant Association@)an arc design t fe logo Nati � R d the esi n >y „ Contact us with questions at 233 S.Wacker Drive,Suite 3600,Chicago,IL.60606-6383 or Ser'vSafe@restcuront.org.: CERTIFICATE OF ALLERGEN A TRAINING J'j O lame O�R{'.�i�i*eS1� HE�L�EN VENT(U?'u , rs" CertlfieateI urmber4e,63s ' Date of 66mpietl6, , /zozo r Date cif=Exp�ra00n „�vzoz5 0 0 Issued By: The above-named person is hereby issued this certfiiate MID p or completing an allergen awareness train RESTAURANT recognized 1 y the Massachusetts Department of Public.Health ASSOCIATION in accordance with.105 CAM 590.009(G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 102 www.restaurant.org Southborough,MA 01772 This certificate will be valid for five(5)years from date ofcompleti.on. 508-303_9905 www.marestaurantassoc.org r Town of Barnstable Regulatory Services Department �a>at+rsxnlacs. Public Health Division a 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V Date Table/Cart/Trailer Identification Name j f Telephone Permit Holder's Name �-� (' Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite � �"� PROTECTION FROM CONTAMINATION �} -�L !.�^ ' S Mir` _ Food Contact Surfaces Cleaning and Sanitizing J(,(J T >" �1 �l _ Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash th Station Location _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) (A/1 TIME/TEMPERATURECONTROLS �,naLv�C w-Y?�iL _ Cooking Temperatures r _ Reheating 1 _ Cooling CA*-Ir'- P- . _ Hot and Cold Holding Z� �3 6 A�"1 Food and Food Protection CONSUMER ADVISORY ruJ _ Posting of Consumer Advisories lJ OTHER REQUIREMENTS C Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print 6N PIC's Signature Print Barn table Public Health Division APPLICATION FOR TEM'PORARY FOOD.SERVICEPERM:IT NA+EOF rEC1Aldt;V NT -OsterviIle Farmers' Mark t 2021 lea-St-n NVAS THIS F_Vl 1Nq-AYl'1OVLD ltY'lTtil,BOARD Afi:1I'URIAC ME i`!'NG' x 1' N YkltE:IsOFPl,ItSC)N(S)Rl3(2UFSTNG!''LlINTtT TriTNlt°!"RWCrtIAMti i=lift"[fI'ItirT:11t12fW["1C)It ITLU i>UONE,# SOS 4�S SSe t C:'P:E .# �ttfi 2 tt NK#t2 SlC)1lR; IUiTKi^nS lS5 4'ewt ttn�/2e�nel ___ 1 I'll AGEC7stcwvllic NAME OF O►GANIZATiON -k r NYC i� CON VAc r PERSON -ENV 'I�rJ PHONE ADDRESS �5S FOOD To►E siwRr r D(i,ts r ExAr:r FOODS) �. -rec�5 C-0 rncj nit - e V..- � � - ✓ J. ZANIES O �I ttAlhi FC7 1I LERS(TQ.BE ONSITE'DURING E;ViNT): (A rrACIi COMES OF S'ERVSAFE&ALLtNRUN C.1;i21_iFjcA: Es) ,WDRESS W11FRE,TO BE SERVEM 00erville Ii6toricul Museum 155 yV6-t12aY Road.Ooerville,MA02655 DAJT. rO OF SERVED I'M tit-sent 17 TIME 9 an,to 1 n.m: WI:IAI.Ti?iTE WILL ALL EQUIMIENT BE S►:rd1P&IC(sAi)Y FojuNSt,vc-nON? HOW WILL FOOD t1E?.KEPT BELOW 4110GRECS F now Wilaa FOOD BE I( LD AT 140 DEGREES F. How is FOOD COVERED HOW IS FOOD SERVED -iYY:E OF IiA�-ID-WAS£CiNG FACYLITY 1 SIGNA"f�ITRE: � I '� v «a. t!`atp{ l 21-25 $fia.p� This Residential Kitchen License for 2021 gnmed co', JL-h t ... . e a 9 F—marty i<?—e �.st.Sir tivy�ch."t i-0"537 E i met=c,.�3 iaH<. $FD F_ Y.,<,��ta -ame. �.^:�, a:y'33-,.. , .k.�_.,�_.�w�°"n,3 1.��'�.�..eFY.��s.$�+`�• � This lia r t� a:f ri i�r rs,€j �irt�iic.. •� t}a tlzt* t tez ��:* rr�t! ordijmllte�;r�°l tEi'aa�'dli>re i�. tad�r3air�t 21 or ,y y � ✓ ` ,L ,�� "R �r \ servsaf dim, R"r I rpm I C AT I Lt I r z� A JANET MOHRE for successUly completing the standards set Forth for the SerYS* Food Protectwn Mnnager CertiFcotio%Examination, which is accredited by the American National Standards lnshtute[At�lSlj-{A�ference Fo�3Food-Protection�(CFP). 089 36. 5475 ER'R EXAM FORM NUMBER 3/9/2020 k ,� 3/9/2025 r; 5,. DATE OF EX A �I ,�E � __ DATE Of EXPIRATION 4`k Local 6's opply.Che its oii Moto d e cy for recertification requirements. 1. .Oak (' 3 •.a ' ''t"1�#' $her tsdn Brt w� tt0655 x#c twe' c' rg a � o R's q ri ciation Solutions O .D r �` Asic�uk�n 'tlw+�� � _ Rra ,�- � •.' ft so�Wa i'4jq mo trnekrorks b4 t1+tr NRAE.6.t^he�arvl Rrt+azt!W Aar ana±l+n<at dra uee.ekr'n - R .,Stu��n �4 - �% ���. Cwfar m.<;Ih�ywr�m S4'tM 2�00r� fC'BQdObfi393 ar So^Sot���gwrttnr.og7 r. �, "` �___ �.�-.ec.;•>::.�. �,�.,,,.��. . __.m,.a�.�.3,�..,,ate`"'"`` _ - .. J L� ",..�e�+� CE i �. A E O ALLERGEN AWA.RENES.s: ..TRAIN ING .► Name of Re`"cipient: JAN T PnonRrz , Certificate Number: 3723124 Date of Completion: ,,=.412019 Date of Expiration:. 11141202e J�1 Issued By. f Tlie above-named person is hereby isnrd this reret r MR 311t-- ' NATIONAL c _J'ar completing an allergen awareness train ingprogran, � RES 1UR.ANT recognized h%,the Massachusetts D7 portnwnt oyf Pohlic Health °""""" ASSOCIATION, in atr rdante'with 105 CM.R 510,009(G)(3)(4). Nlassachurctos Rcsmurant Associar;nn 800.765.2122 330 Tit€nisikc Rvad,Suitc:102 wwtw-rtstaurant_atg Southborough,NIA 01 i2- 77,tis cert�qrate toill be Valid fr fivr(5)years front slate of completion, 508-303-9905 v.m:veat:uafull tnsloc.org (�'S f Town of Barnstable Regulatory Services Department • Public Health Division 200 Main Street, Hyannis MA 02601 �a OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event Date Z Table/Cart/Trailer Identification Name �j I� Telephone Permit Holder's Name Telephone PERWT INFORMATION —Valid Permit/Displayed _ Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIME/T TURF CONTROLS Sol � Cookinging Temperatures J _ Reheating ] _ Cooling _ Hot old Holding Food and Food Protection CONSUMER ADVISORY _ Posting of Consumer Advisories OTHER REQUIREMENTS Refuse e se Container(s)Provided/Covered _ Adequate Toilet Facilities Provided Inspector's Signature Print n „ � PIC's Signature Print c s Barnstable Public Health division APPLICATION FOR TEMPORARY FOOD SCRVIC EPFRNUT DATE z ' N;%Mf,OF SPECIAL UEN'I' O terville Farmers' Market 2021 Season WAS THIS EVENTAP€DROVE:DBYTUE BOARD ATAPUBLICNIEFTIiNC.? X V N NAME:OF PERSON(S)REQUESTING PERMIT JENNEFFR WILLIAMS.F-NFC'UTIVE DIRECI'OR TELEPHONE 4 508.428.5861 CELL# 508-280-8882 HOhIF Al7DRFSS 1551N'est Ray Road YILL?IC:F, 0stmille NA`IFOPORGANIZATIO11 1 n1 U t rSa CiL {1A{2i Cs �� �Zc?r1 :t j CONTACT PF:R5O ' T1t�b;f1 � t�n. CE'LEI�'ttO\EM ADDRESS' V cJt - ittil} .,I�1?t C�7t� `J �„ FOOD TO Bls SE:RV E D(us I E.tAC`I'FOODS)\kg non �C}1' opLl r 4 t{i 1gr NAMES OF TRAINED'FOOD HANDLERS(TO BE ONSITE DURING EVENT}:, (� U A C" (ATTACH COPIES OF SERVSArE&ALT ERGEN CERTi It ATEs) ADDRESS NNIFIERE TO BE SERVED Osteraille.Historical Museum,155 West BaV Road,Osterville,MA02655 DA TF TO BE.SERVED Juno,18-Sept 17 TIME J a.m.to I P.M. WH 1T'TUNIF NY-LL ALL LQUIPMEENT I3F.SET-UP&R�E,°,.xl�DY FORINS}P—EC I'IO. �K � H:OTV'WILL FOOD BE KEPT BELOW 41;DEGREES I' HONk"WILL FOOD.BIAIIE:I;[)AF 140 DEGREES F. HOW 1S FOOD COVERED ( 0cg 5 HOW IS FOOD SERVER 5tNN - f " TYPE OF IIN14)-4`_. ''.HNC,FACILITY SIGNATURE. '�' � �' ;�► � :'i �` � J: ALLERGEN AWARENESS TRAINING c� rtr: Name of Recipient: ROBIN FLINT Certificate Number: 2118$828 Date of Completion: 51t2617 Date of Expiration: 51112022. : CI' O Issued By: r The above-named person is hereby iswed this artifitateATIO f©r rornpleting an a1krgen awarenets training progrrant � 1�1ESTA RA RSTAUAN'T` ' recognized by the Alassnchuseus.Departrrtrnt o Puhlit Health "�^�".. ASSOCI�T t0NZ � in arrardance with 10S CMR 590.009(C)(3)(a). Masiochusetts Restaurant Association 800,765.2122 333'rurnpike Road,Suite 102 ww%v.rest2ur2rnt.or9 Srruchhornughi\IA U1772 dais t rti u eats u if/b: aalzrz fct�rue(S)y`trars fTorn elate o�tanrple tiara. 508-303-9905 s4 u w.na.trestaunanl�ssoc.or Irk' PERMIT NUMBER THE COMMONWEALTH OF MASSACHUSETTS FEE 21-249FC 100.00_ TOWN OF KINGSTON THIS IS TO CERTIFY THAT NAME: TOWNIE MANUFACTURING dba TOWNIE FROZEN DESSERTS o�R �s: 412 NANTASKET HULL MA 02045 IS HEREBY GRANTED A LICENSE FOR: CATERING PEGGY'S KITCHEN 68 MAIN ST KINGSTON MA.02364 THIS LICENSE IS GRANTED:INCONFORMITY WITH THE STATUTES AND ORDINANCE RELATING TO THERETO,AND EXPIRES ON DECEMBER 31, 2021 UNLESS SOONER SUSPENDED OR REVOKED. DECEMBER 23 2020 Date Issued Arthur Boyle, Health Agent 3'46-, 0 TRAINING LEARN2SERVE FOOD PROTECTION MANAGER CERTIFICATION This certifies that Robin A. Flint has achieved the title of Certified Food Protection Manager with Online Proctor Issue Cate: 03/22./2021 d Certificate number: L2SC-3-009379 1� Test name: Form B21 #0975 Samantha Mont.eibano.CPt f Operating Officer THIS t E RT,?FG I TE IS NtlrY-?"R,AMg Ct�AGi~t-'&Vt7 L/V ztPrO 5 YEARS FROM THE ISSUE 1ATE DEpENt,,r,Vgt jt ),CatlRl ocAt,HEA,THDUARInENTSREOUIREPIENIS i3ft�% :kttaiafrcxas�.ay,C#atgi,u'ulte2�t3ltxastin,T<7�T�i(877.$81.72.35Ivr :v.36f3tra',itinq,cur,? an Th%s ceoifies that RQb n g,Flint naS 3Chle*led the title of Certified Food Protection Manager with Online Proctor kiG'C i,'�3EC:6.3{72P2021 "" -' 40975 CEt afc3xti tL'Ru£b:tZSC•2-Ck?15ZA 7zs',iis�e•-Fs m OLl .,arras.,�ta „.a,nn.d,Li xt OAosrap Ot+iear - w:�-,'+'st'>cx7£&tires .'M'rt£tT_:5VE'tLti`.T. - - r Manager. a Certified Food Protection Congratulations on becoming Learn2Serve also provides training courses in: Food Safety Handler,Alcohol Seller/Server, HACCP, and Sexual Harassment Please contact us today to learn more about how you can take advantage of these quality courses, or visit www,Learn2Serve.com. Vegan•,Unn•Dairr-Allergy'Friendly Ice C"reanis,Sorbets,Topph%s Coffee Chocolate Chip Ice Crea7.A uae�r�,.y,.n r+a s�sYrs y tTee�,..gs SSe�tSm.r�E aaLna.cmmeeerst9 'mf++'Cnra»�a - ..+.�.'Taxn€rt`rnzrnAssczatis.caut - -- TogvJeFraxsnT}r+serts:�yguta?Leoiu Veptt Non-Dairy Allergy Friendly Ice Creams,Sorbets,Tnppinp Strawberry Hill Sorbet Urgrxeie fraxm atraxYiretr�x.gate,,.�c��cnr sa�az: Townic Toppings uutsz�3 szr�han cxtr�: q"g9Y.raYYRiitrtfCAt�e'aferi[,raA1 - TertiYMrFYaf rl91�4SCYL4alit�tt.['aGY Good Old Chocolate Sauce Eujar Ymv�rfe?aM�xt}wtaed rarer Jxasert.,addrd to entlee, §yE asr,I.acoi•tn ndl4 ar Lat m�„ar as a tnut dip, ' $ ipu_q'rar th,p»s!!<ititirm•: y liersaaro rt +.Brat geartiv ar eulaY atr�pht bw,dte Imr1 �' .,,... C7gaak r;.a<.me ax�.r t ryrns raa.po.dre. orbsnc,;re arct.a*..orb, ni7a ratnnr..rich u!t ?!a&mt^,7Sf_'D:YI :tia.-W,�exr nand.aorugrJ,.ttaLv{+�asraR,��pscie�ev.toiaw Leeaa. 8asuees TmrrizFiaztuDecuris�n�rmnil.com �� _ NOTE; These are samples of Townie frozen Dessert labels. Our menu and flavor offerings vary depending on what is available at the market,the time of year,and what flavors our customers request. Each flavor has its own label with the name of the flavor and ingredients listed accordingly. 3 ACC)RV CERTIFICATE OF LIABILITY INSURANCE ,°rEi9 °"`Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORt2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such ondorsement(s'). 10 PRODUCER CONTACT l.T7ry$ II 203 PHONE Pia nssr,Ine das 1L4 ,M»,»....„ .,._-..-..•.-.._..�_...,.,-.F•A-X 1_T_-.$48.9093�� -..— Ca'nPw RISK dianage;.tw:•ad _ E-MAIL Ispilker carnpbelin k.com IJ595 VAfteq DtMt,S¢ke 2a4 - T-„NAIC a Intlialappi7,.IN 482413 INSURER(SI AFFOROINO COVERAGE LatrTSpikerEd293 INSURER A:HANOVER INSURANCE GROUP T 22292 P INSURED INSURER 6 ................. .,,..... ...:........_{.,.,,.. --.._... Townie Manufa_iunng dba Twinie Fier-nn Desserts ....._ 46 G Street 1 SUREST C' <�µ Hurl Massactlusetts0204S INSttRERO; � INSURER E t INSURER➢: C COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .,,,,_.....» ,....,__ �,,... ....... .,.,._..........W�,»». _,,,.,...,.»..._. ... tN1.. — -....^�I: _ POLICY NUMBER i MN1D Pout .. R I ,.... ASSDLaSGiaR� ".» POLIO(EFP PM/DDY`YY LTR; TYPE OF INS i Lltd77!!'S - €X{COMh1ERCIAL GENERAL.LIABILITY g a LEACH OCCURRENCE i S »» ?CLAIA+&MAD£ X€pG UR X € X AA3M3 LHW 0481967 OG101F2019 OW0112020 (tSAIWt EttS R'isYEb L.»�J v PR,{;klic£ .i.gsls?t, el b.. IOO.00D MLD i:Y.3(Anyane rson 15 S,C�70- PERSONAL b ADV INJURY I S 2,OW ODO C !4{,AGvRtGTE A LkUT APPLIES PER: ...._I ggg£ I. ENERAL AGGREGATE S 4,000,_00_0 € X II PwCY Imo_;:P¢ I.fY # (¢ PRL}DifCTS Ct3).tPr'QPAGO S S 4,000,000 AUTOLIO13tLE LIA8UTY 1 ( UhtaV.ED YNL°iLE UMI I »— �E{.SSA+�r�ku�..I..................... {p-�•- AN4•AUT376OpfLY IYJURY{Per person) ;3 1 '£p SC�dEGS°.MED € R ONLY INJURY jP.acodard)AUTOS I S NCxa.cYNEO PROPERTY OAAIAGE teRED AUTOS 7 i AUTOS I_ LPcr at 3dunt) I UMMLLA LtAB i OCCUR ( €EACH OCCURRENCE l 5 -EXCESS UAS I E CLAs,At.5 A0e t. j AGGREGATE S' I 1S CGMF'E*raATR3N AND EIJIPLOY£.47 UXSMJTY �S TtIjE ERN _ a.�.'r; Rac O.'I•"ArsTh"yRrE7TEi,3Tn°E Y!N EL.EACH ACGIptNY C"F,,.xa'U£kr'?2 E,ffi wt3ib2;o7 I El,DISEASE•POLICY Miff S....•...•.••.... .M• „» 3 i DE=ZPTMN OF OPERA.TM31LOCATIONS T VEHICLES(ACORD TOT,AddHienal Remarks Schadule,may ba attached It more&pat*Is squired) Those usual to the Insured's operation.Blanket additional Insured applies per Coverage form 421-2015 0615,Certificate holder, 4 if any,is hearby an additional insured. I w CERTIFICATE HOLDER CANCELLATION Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J�� ©1986.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) -The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services Department I;a>uvsxa�c�. Public Health Division 200 Main Street, Hyannis MA 02601 �a OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event V V"1 Date VkTI Table/Cart/Trailer Identification Name u/�/'� ^✓ Y}C� A�Telephone Permit Holder's Name �-06�A ��` � ��� 60r_ Telephone PERWT INFORMATION _/Valid Permit/Displayed Pre approved Menu Items Offered Only FOO ICD�ROTECTION MANAGEMENT TP Assigned/Present Onsite PROTECTION FROM CONTAMINATION Y _✓Food Contact Surfaces Cleaning and Sanitizing ---'Foods Covered _ Proper&Adequat wtdwashing/Temporary Handwash Statio ation _ Good Hygienic Practices(Use of gloves,use of tongs or tissues) TIMMPERATURE CONTROLS `Tookmg Temperatures 1 za�,- TOO _ Reheating _ Cooling _ Hot and Cold Holding Food and Food Protection CON MER ADVISORY osting of Consumer Advisories OTHER REQUIREMENTS V14 )1 Refuse Container(s)Provided/Covered _ Adequate Toilet Facilities Provided I Inspector's Signature Print S PIC's Signature Print �j�-l✓`� 1 r �^ ; � � g ,. � y -- ; (�{� Y S y. �: .ram •��s ,fin - xk "11 ` s S. a �6 ,k :; " . C3 , .. . ....,. ._ —.:' r ,'. -,: a � _ ` + .. , � � ., � _ : �.:, ,. C r �' � . 1# A� �., i a'•; � �� � d �" �� 1 �, `p F ;, :. .. a,. �. k w J' - ry - N x x ,,y ,a...,...,.,. ._ .-' c ; .tip, 3 x' 5.� - > �. . y . ,• ., 1 AT,-TO V - - � r I . g .. c, ._ .,.". _ ..:. c ,`� j}ww �,g yy,, ^yyy� ,�* fig, ' t ., t318 �:: ._. , _._ -_ _., wM -�. I4 ■ � , � Q �a �, :. ..:.. ...... x , .. ... :: ... c . , .r;. _, .. .,. 3.p:i i - '",`• E - s'..fi i xy`' r . P t. *k1 E� t ,.dF-:ir..,. , - .: �,�. M .:F" .. .., - .. , ,�::a�:.. n:' ..:. - x... ..uc .....-. - ^Gs ,..-:: .... .,.. ,..: I..... .. �. ''i: - .. ..:. ':. .. ....., ........ .. .,... .-... - ,_ ., _. - �, K. .r arm ..,.,.,.-« ....,�.,.,. ,rfr %' :; .� x, �, . �. Wk 0 �. ':'. : F ::: i�. � p "'6 1t, Ei " ,ggy�m,t� yyyly;yyy♦{ },�% p�yyF :+b' t V� TYI Gpb3rk}al"!S'i�1�iyy �, - I _; E — $ kf ,4°J" � '"+A rTry��C"'R �N ��/ . .1 W } LS tr Y.IF,n ZE A .. ' .:: ..� - s .. .. - - .... .... .. ,,.x:. - a., m ... .... h Y 4 .. - ,,4N a d CGflN � � �� v nx } y ,%.. �- a a ' ::. z:' :" .,,"�.?z, r*u K:�: , cam`z*r:.. -�' ., �; �. .. . :.: : .-.:. -. - .:: .i. `> '. .a g r s r' F s ' , .., -� � .kr - : h ,�� �� � ;t I . ,, .. .,. .. - „ �... -- �- -. . . .. � :_ _.. .. . . . _. . . - . ..... car .. ,sue E - 1 m n 4 ...._ -. „° , , 1 , , ..:, a , s , � « ..;�,� y z s ,. 4 - fr . ,. ,,. t ... - - - . ,... - 0 . t �, �� .:-.. .:;-- �� n ' ,,,,,, i ,.,......,,�.,�. s, � x ,. .,.. ...,.,m.�..., ;s .. � ' �I . n � �' .. , .. - .; , ..- .. - _ a W . .. - i .•�;,t v F F „., - E6 _ 'Kvl,S zy w f -_ -: '� ' . ,r .< 1-.d- -: ., �.�,. a .a,t Y Y xh,�:,y „-�, v E „. , ,,, I6 � r D a i 3i k� ' ?tX n �j�d' �s SU "�S�ci s � ib}� a # �#�Ji t i $ T •, 13 __ . M ,.�:.. i .. ..: '_� ., ::,..: C r �51 ��Tlll 1 �N� . . 'n . ,,:,,,� � ,,,4�"��,.,., ,, ....,", ' ' �' '� ��O"' " - ", I- ,�lvn ` �'si -: �' � ,I al,v , , - , �_�,,�� , a 11 g ` 3 ,�,lwv ��_'_',,�� ,,,,,,, ��';'�a";� �,��, �11� � � `' �� s z� u ? �� by $., k +5 a or: ;2a 'F,w.F �,' .fit. �, F 11, �� ,, 9' ,,,.� " v.."',ts ,rd '�` ixa : k. qua f a�s �;o :. fir. s 1 * fl a �o F 9 `'max S _ l �. £ _ < r..r r. .. q, a} . i �< a Sur � �z�' y \ � i x ..: „,:. `,. f a ,,'d'' 7flmn tea.^.;. `� ., xi.,'. �r 11 �I � at c � t> :a <a. .. ss x x :, x � a � - g E , t \ - x k �' s c ,. � :: � ��gW_ �r rawry N' a d r ' � � �� r a I',, ? ' '; a � xa H a 110, �� � - s �. i�,-�,l-',�ll-2l,l,.u,�;,,�-�,,-,"'�7',,,.�'_,,11,i'��11,�`1�",,M 1.;�'l,,1-'1,h"�..U1�4�.`5,`,'W,,,1,- >�:,", � ' '. vx a: ,<xxL i% x rxr ,"„a' Y ikx ')'i `)fin' k XR ,a' Yr 8 "'�zxax \ ix '�:1 4. �dx ,, . . }}��¢ ry^�g ma�cc,, ��yyyy ttdp a', b xx ,,.- ,:xa u�.�u s "a. a xvs_x_"� X�@ �� � \\ b �_ . a ,, ��`s ,x: v. , Si � X., k �S -. Ax x'�<vx aka' d 3 �. ,1� A kax' g CISO - �r Sy 'a> 3x 4Y B �, i3 a , a ' hkx _ _ ire ,-.............. � Y1Nm4alr,��4ewMMm� x�. ��., :'"T n�`, w. :; a',�.,^�"'"".�»^'^e«^w`bx4��fyw�::�X Osterville Farmers Market Food to be Served: Chocolate Chip Cookies Ginger Molasses Cookies Earthquake Cookies Cinnamon Buns Blueberry Scones Raspberry Scones Banana Bread Pumpkin Bread Zucchini Bread Lemon Blueberry Bread PIES Strawberry Rhubarb Blueberry Cherry Mixed Berry Peach / ry t CERTIFICATION y w, r ALEXANDRA MCPfflHalE R N9, for successfully completing the standards set forth for the ServSafe®Food P"c't on Manager Certification Examination, which is accredited by the Amencan National Standards Institute(ANSIKo Terence for.Food Protection (CFP): 4 416 ER EXAM fOR�M NU3MBER 5/13/2019 5/13/2024 DATE OF EX DATE OF EXPIRATION Local laws apply.Che cy for recertification requirements. e / c Sher #0655 ctah on ' 3 s ' 'on Solutions In accordance wi ' e SewSafe logo are trademarks of the NRAEF.National Restaurant Association&and the arc design vbk - / yid? y� Contact us with questions at 233 S.we cker Drive,Suite 36W,Chicago,1L 60606 6383 or SeImSofe@restourant.org `ir CERTIFICATE OF V0 ALLERGEN AWARENESS TRAINING "31", A CM I'q 1 r � Name of Reclpled. ALE, XANDRA MCPHERSON Certificate Nurnber:, 3sos795 Date of Completj6r-I 5/16/� 19 5/16/2024 ❑ / Date of Expiration: . issued By: ! V The above-named person is hereby issued this certfcate or corn letin an alley en awareness training NATIONAL f p g g gAres,� RESTAURANT recognized by the Massachusetts Department of Public Health ASSOCIATION, in accordance with 105 CMR 590.009(G)(3)(a). Massachusetts Restaurant Association 800.765.2122 333 Turnpike Road,Suite 102 www.restaurant.org Southborough,MA 01772 This certificate will be valid forfive(5)years from date ofcompletion. 508-303-9905 � 1 wwwmarestaurantassoc.org u N �� /ice/� � .� i„ // ,i�: ///i i /• //,//,,f//' ` � -i�/ � a � €'�r,,s ;�� , i�l,�/'yi✓//,/, .,, .,_ice%� /, �� ,,, /Gi,iY ili ,_.� ..,./i- / ,,, / •, ,. ✓,.,.,., is r / AW I i i m. y �, 4✓/��.,,. „ _y€e;,;�, xi.'v, /•',f� 7r�U, ,. �, ,, ,,...,_c�%�s• i.. �'%,,,,.., ,,,.,i s� �.s;,,,, us ,�N/iYv, v//i„ ,� /i ',: ?„s sl,,.,< i'L ,,//, �//6„S�-, c;,./, ,,,.,ly i 3 rr K Y e a i}. x a' i T "S k' f, t \ t, x i 5 :E x Er { f y u• u. 3 r r. r r 5. Ceire h I Icute ievel I lul I This certificate is awarded t ELLEN VINCIGUERRA on ratulofiFonsl You hove com 'Ie ed berybare Food Handler . . ' e s. . g NoiiOl a Rest uront As is t, a> to 2�7 33C3 car 'tom y`le .3M 3112t a,ervs as"�. rna f Town of Barnstable Regulatory Services Department >�rrsraaca�, Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event T v l Date �'I Table/Cart/Trailer Identification Name � �" '1 Telephone Permit Holder's Name Telephone DESCRIPTION OF VIOLATION PERMIT INFORMATION _ Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT _ PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION _ Food Contact Surfaces Cleaning and Sanitizing Foods Covered _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use of tongs or tissues TIME/TEMPERATURE CONTROLS Cooking Temperatures Reheating rrI Cooling W\ �k dl — 'f1�✓d �o _ Hot and Holding od and Food Protection CONSUMER ADVISORY Posting of Consumer Advisories OTHER REQUIREMENTS Refuse Container(s)Provided/Covered Adequate Toilet Facilities Provided Inspector's Signature Print PIC's Signature Print Good KRAK�.— S Barnstable Public Health Division APPLICATION FOR TEMPORARY:FOOD SERVICEPERMIT DATE YLI ZI.1) NAME OF SPECIAL EVENT ill F n'1 r ? M Ck t 2Q21 s 11 WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X,_Y N NAME OFPERSON(S)REQUESTING PERMIT iENNU R WILLIAMS..EXECUTIVEbIRECTOR TELEPHONE# SM.428.5861 CELL tt 568-280.8982 HOME ADDRESS 155.West Bay:Road VILLAGE Octerville NAME OF ORGANIZATION Canes (D� '—`j j 6'`-_ /z--IBC 6-,A CONTACT PERSON J pr Yet,K C/� TELEPHONE q-60 - ; V -IM ADDRESS 427. E FOOD TO BE SERVED(LIST EXACT FOODS) NAMES OF TRAINED FOOD HANDLERS(TO BE ONSITE DURING EVENT): ,a,, uc V✓4K4 (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) -- ADDRESS WHERE TO BE SERVED Octerville H&torieal Museum 155 West Bay Road OstervillZ MA 02655 DATE TO BE SERVED June IB-Sent 17 TIME 9 u.m.to I p.m. WHAT TIME WILL ALI,EQUIPMENT BE SET-UP&READY FORINSPECTION? HOW WILL FOOD BE INEPT BELOW 41 DEGREES F HOW WILL FOOD BE HELD AT.140 DEGREES F._ HOW IS FOOD COVERED HOW IS FOOD SERVED 5'c,2 TYPE OF HAND-WASHING FACILITY cw S u d � /4 � /� -,�44 en cc��4 4:4 SIGIYATUEE• c-•�7 ='—"-'-- Permit Number. 33-21 Fee., $50.00 The (COMM011bileattl). of AmoarbU50t.5 Town of Mattaposett Board of Health This is to certify that Cape Cod Wicked Good Kettle Corn 109 Marion Road, Mattapoisett, MA 02739 IS HEREBY GRANTED A PERMIT FOR SEASONAL MOB/LE FOOD SERVICE ESTABLISHMENT PERMIT This permit is granted inclusive of Chapter 94 and Chapter 111 , Section 127A of the General Laws of Massachusetts, and 105,CMR 500 and 590.000: State Sanitary Code Chapter X. This license is granted in conformity with the statutes and ordinances relating thereto, and subject to the applicable rules and regulations of the Massachusetts Department of Public Health and Board of Health issuing this license. This license must be posted in a conspicuous location and. expires on December 3'1 It, 2021 unless sooner suspended, transferred, or revoked. } ayla Davis Date Issued: March 31,2021 Health Agent a" 3 � 9 ,-0 OF Servsafe a (� F 3 g \ CERTIFICATION JEFFREY PAINE for successfully completing the standards set^forth for the SenSafe`-Food Protection Monager Certification Ex=inction, which is accredited by the Arnerican National Standards Institute(ANSO-Conference for Food Protection(CFP), 6138 10550 �5Q4 T NUMBER EXAM FORM NUMBER 4/26/2022 DATE OF E x DATE OF EXPIRATION Local laws apply.Ch" ency for recertification requirements. 9 � 410655 � a --2G15 No k=1 �a �togn o e tra itx ffls of tE a ANA$. Y d 4F -emsServSafee CERTIFICATION DIANA PAINS for smcessMly covpintiny Ow om>dards set forth for 4w SeivSafoe Foot)Protection Morwger Certification Examination, wHich is accredited 6y the American National Stow6cfs InslMe(ANSI}Lanfer*ttco far Food Protection)CFP). „ n 322261 10555 UMBER EXAM FORM N"t);htBER: 7�111 7/11/2022 DATE OFF DATE (7F EXPIRATION t=i{aws apply,Ch nc For recernhcalion'� Y r .!irsinents. \ v >. 80855 y'•... �ISwroaKd � tea.xadnnwl,of d�a Patitf, �. hk�r: cam,„�+w..�.�.®Ae�.x crs w rctY„eta se.esoo,rtac�,,e..vt6fu a s«Vs.,t<aexx�,w�. 1 £ V CERTIFICATE 21, ALLERGEN AwAREN Name of Recipient: JEFFREY PAINE Certificate Number: Date of Completion: Dare of Expiration: 611*01 0 Issued By: 77ie above-named person is hereby issued this certifrah? 1 i RU �j forcompletinga�rrrllesgenawarenesstrrrinirigprogrnnr .z 4 recognized by the Musachuwas Department of Public Realtb in r�rcorrlinue with 105 CMR S90.t10 (G)(3)(a), Massachusetts Restaurant Association 800.765.2122 333 Turnpike Ri,Suite 102 wkvw.re1t2unuat,0rg Southbomugh•MA 01772 Dr is certrPilate will be valid for five(5)yeart f rom date ofcompletion• 509-303-9905 www.mom traurantussoc.ars ` > � �,.�*1^'r�� ',}:.�tA ,, �,�-,--,� �� �" `...aaL►h. As.._�.,...oidi., �af�.�i.�y... "�-M+f,"°�...1.►-�,r.,.sJe.-' ...+.. �t; -sue.;►. ,� ,j.�-. ...,....wM{.�._.......�.1�....,�._...,�.. 1 9 „�- y aT� •R 4K 4.1 i r 1 3 7" i t.? aC/l �l J � fJ. ��►?,' :�' rI "'��� 1�fit.� , rl�` ;J,�.:. ��t� a �:1�t ,� r{� f Town of Barnstable Regulatory Services Department • �anrrsra , Public Health Division 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO TEMPORARY FOOD EVENT INSPECTION FORM Name of Special Event (JM Date Z 1 Table/Cart/Trailer Identification Name `,(f�lC 6fl/lam. Telephone Permit Holder's Name Telephone PERW INFORMATION 'Valid Permit/Displayed Pre approved Menu Items Offered Only FOOD PROTECTION MANAGEMENT PIC Assigned/Present Onsite PROTECTION FROM CONTAMINATION II �," Food Contact Surfaces Cleaning and Sanitizing li - r 'I Vr-—' _ Foods Covered 't`wn1 1/ " , _ Proper&Adequate Handwashing/Temporary Handwash Station Location Good Hygienic Practices(Use of gloves,use'of tongs or tissues) TIME/TEMPERATURE CONTROLS Cooking Temperatures _ Reheating Cooling 1(/� iy-t Hot old Holding S �n _ Food and Food ProtectionQyICj� CONSUMER ADVISORY lnu _ Posting of Consumer Advisories OTHER REQUIREMENTS C 8I( L _ Refuse Container(s)Provided/Covered Adequate Toilet Faciliti Provided Inspector's Signature Print PIC's Signature Print i Town of Barnstable , Inspectional Services . : Public Health Division • 1J►RNeTABLE, • - 9 ,MASSThomas McKean,Director Eo►^^� 200 Main Street,Hyannis,.MA 02601 Office: 508-8624644 Fax: 50&790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws,a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: DaSilva Farms Name of Person: Felicia DaSilva Address: 430 Jepson Lane Portsmouth RI 02871 C 401-528-9442 To serve: Frozen Chicken, Beef&Pork and Eggs ServSafe certified:' Felicia DaSilva Allergen: Felicia DaSilva Only at the following location: 155 W.Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY,:PERMITS,MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas�AMcKean Director of Public Health Town of Barnstable �TMe rati Inspectional Services • Public Health Division saaxsrnai e v� 0 9. �0�' Thomas McKean,Director �F0 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to; DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Fraulein's Bakery Name of Person: Ramona Stuber-Case Address: 1133 Fisher Road, Dartmouth, MA 02748(C)508-930-8604 To serve: European Sweet.& Savory Strudels, Cakes, Pastries, Tarts & Cookies ***All foods shall originate from an approved source per Section 3-201.11, the Federal Food Code. Selling and/or serving of any unauthorized foods from a residential kitchen are prohibited! *** ServSafe certified: Ramona Stuber-Case Allergen: Ramona Stuber-Case Only at the following location: 155 W. Bay Rd, Osier-Ville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-LOOPM. APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Th cKean Director of Public Health I Town of Barnstable ofTME'+ ti� Inspectional Services Public Health Division BARNSTABLE * ■ARMABIX, ' a,wrsresu.umrlc mnnr xrnwa - 1uq.5-rN5 M1,IS• 5'.4'J111E•1YF,r A.Prl!t,¢!i 1a 9. �' Thomas McKean,Director 1639'=014 rFD ,� 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax:. 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94.Secti6n 395A and Chapter 111, Section 5, of the General Laws,a permit is hereby granted to: DATE: 06/01/2021 Event: FARMERS MARKET- OSTERVILLE Permission is hereby granted to: Hale Bone Broth Name of Person: Chris Honen Address: 78 Old Farm Road, Hanover, MA 02339(C)781-844-4418 To serve: Frozen Packaged Bone Broth ServSafe certified:N/A Allergen: N/A Only at the following location: Osterville Historical Society, 155 W.Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:OOAM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH cKean Director of Public Health I I Town of Barnstable Inspectional Services ti Public Health Division r i * BARNBTABLE, v pass Thomas McKean,Director i6gq. Argo ° 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Stir Crazy Healthy Street Food Name of Person: Kimchhay Chou Address: 439 Nathan Ellis Hwy Mashpee, MA 02649, To serve: Assorted Spring Rolls, Soups Noodle Entrees & Rice Entrees=ALL FOODS. ***MUST BE SERVED AND KEPT COLD *** ServSafe certified: Kimchhay Chou Allergen: Channa Uy Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING'DATES: Weekly: June 18-Sept.:17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING"IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH s A. McKean Director of Public Health i I` i Town of Barnstable- Inspectional Services - �": snnxsrnst.�, Public'Health Division • gib ' �� Thomas McKean,Director Argo 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Honey I'm Home Name of Person: Tim Cleland Address: 8 Atlantic Street, Plymouth, MA 02360(C)781-336-7681 To serve: Breads Pies Galettes Scones Muffins Granola Cookies Biscuits Brownies and Bars ***All foods shall originate from an approved source per Section 3-201.11, the Federal Food Code. Selling and/or serving of any unauthorized foods from a residential kitchen.are prohibited! *** ServSafe certified: Tim Cleland Allergen: Tim Cleland Only at the following location: 155 W. Bay Rd,Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept: 17, 2021 FRIDAYS: 9:OOAM-1:OOPM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION,IF SOCIAL GATHERING IS IN TOWN PROPERTY,PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable n+e r�yy Inspectional Services Public Health Division BARNSTABLE • ■ARMABLE, • e,aysrnau-c.onar •mrun•nrieuns 9 MA & � nurnsro.,1639-:11rf•:.S PAPn rlt i639 Thomas McKean,Director ,E� 20t° Fonea+� 200 Main Street,Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws,a permit is hereby granted to: DATE: 06/01/2021 Event: FARMERS MARKET- OSTERVILLE Permission is hereby granted to: JaJu Piero ig_LLC Name of Person: Casey White Address: 271 Western Ave,Lynn, MA 01904(C)413-221-5328 To serve: Frozen Packaged Pierogis ServSafe certified: N/A Allergen:N/A Only at the following location: Osterville Historical Society, 155 W. Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June I&Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING-REGULATIONS IN ADDITION,IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS.MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH / F Thomas.A. McKean Director of Public Health Town of Barnstable. Inspectional Services Public Health Division NAM 9eb 16 9. .0� Thomas McKean,Director A'F0 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790=6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5,of the General Laws,a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Lara's Cuisine LLC. Name of Person: Lara Ferri Address: 17 Trout Farm Lane, Duxbury,MA 02332(C)781-534-8445 To serve: Assorted Pesto Sauces and Relishes ServSafe certified: Lara Ferri Allergen: Lara Ferri Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY,PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH cKean Director of Public Health Town of Barnstable Inspectional Services Public Health Division WNSTABLE } { BhP b16lEK9REiV lE•CDIIIR•Xt/i ilA ' • ■AANSfABLE, r - - cwsms•n mmE•n,-1� ¢E MASS. tf39-i4EV, - 039 `m� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5,of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMERS MARKET- OSTERVILLE Permission is hereby granted to: Martha's Vineyard Smokehouse Name of Person: Jill Riedell Address: 23 Watcha Path, Edgartown, MA. 02655 To-serve: Smoked Bluefish Spread &Filet, Smoked Yellow Fin Tuna Spread, Smoked Mackerel, Bonita & Bass Filet ***All foods shall originate from an approved source per Section 3-201.11, the Federal Food Code. Selling and/or serving of any unauthorized foods from a residential kitchen are prohibited! ServSafe certified:Nathan Gould Allergen:Nathan Gould Only at the following location: Osterville Historical Society, 155 W. Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY,PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable fTME'0 ,� Inspectional Services Public Health Division • BARNSTABLE, MASS. Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 5.08-7.90-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Monopati Name of Person: Maria Lemanis Address: 7 Queens WE, Sandwich, MA 02563(C)508-888-1045 To serve: Olive Oils Olives Peanut,Hazelnut; and Almond Butters, Baklava Greek Baked Goods& Cookies ***All foods shall originate from an approved'source per Section 3-201.11, the Federal Food Code. Selling and/or serving of any unauthorized foods from a residential kitchen are prohibited,! *** ServSafe certified: Maria Lemanis Allergen: Maria Lemanis Only at the following location: 155 W. BU Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Week: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH s A. McKean Director of Public Health Town of Barnstable oFTME tati Inspectional Services Public Health Division ennxsres�.e, ' Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5,of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Savenor Meats Name of Person: Jeff Mushin Address: 65 Black Oak Rd Marstons Mills NM 02648(C)781-476-9352 To serve: Vacuum Packed Assorted Meats ServSafe certified: N/A Allergen: N/A Only at the following location: 155 W. Bay Rd Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY,PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable Inspectional Services 1AItNSTABI!, Public Health Division Thomas McKean,Director j 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 F -Fax: 508 790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and.Chapter 111, Section 5,of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Say Cheese Name of Person: Joanne.Chipman Address: 247 Rounseville Road Rochester MA 02770(C)508-728-1688 To serve: Pre-Packaged-Cheeses-NO SAMPLING ServSafe certified: N/A Allergen:. Joanne Chipman Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17 2021 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION,IF SOCIAL GATHERING IS IN TOWN PROPERTY,PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNST BLE BOARD OF HEALTH McKean Director of Public Health i Town of Barnstable Inspectional Services • �� Public Health Division '► sn�vs'resLe. � gib1639. �� Thomas McKean,Director 20.0 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5,of the General Laws, a permit is hereby granted to: - DATE:06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to; Townie Frozen Desserts Name of Person: Robin Flint Address: 46 G. Street, Hull, MA 02045(C)781-925-6095 To serve: Pre-Packaged Vegan Ice Creams; Sorbets and Toppings ServSafe certified: Robin Flint Allergen: Robin Flint Only at the following location: 155 W. Bay Rd, Osterville,MA'02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-I:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION,IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. . TOWN OF BA STABLE BOARD OF HEALTH T mas A. McKean Director of Public Health I ` Town of Barnstable y Inspectional Services Public Health Division UMMABne MASS.� 0%6. �m� Thomas McKean,Director Ea +� 200 Main Street;Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority-of Chapter 94 Section 395A and Chapter 111, Section 5,of the General Laws, a permit is hereby granted to: . DATE: 06/01/2021 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: .Washashore Bakery Name of Person: Sandy McPherson Address: 14 Central Square Mashpee MA 02649(C)508-419-6835 To serve: Assorted Cookies Pies Quick Breads and Cinnamon Rolls ServSafe certified: Alexandra McPherson Allergen: Alexandra McPherson Only at the following location: 155 W. Bay Rd, Osterville, M.A.02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17, 2021 FRIDAYS: 9:00AM-l:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNST LE BOARD OF HEALTH "-i as . cKean Director of Public Health i Town of:Barnstable Inspectional Services Public Health Division BARNSTABIE /ARMABLE,-' aw,asr"sintm.rs�'mrt-'mi :�esiricnnasir . .,' 9 Thomas McKean,Director i65754 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/01/2021 Event: FARMERS MARKET- OSTERVILLE Permission is hereby granted to: Wicked Good Kettle Corn Name of Person: Jeffrey Paine Address: 109 Marion Road, Mattapoisett, MA 02739 To serve:Kettle Corn ServSafe certified: Jeffrey Paine Allergen: Jeffrey Paine Only at the following location: Osterville Historical Society, 155 W. Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June 18-Sept. 17,2021 FRIDAYS: 9:OOAM-1:OOPM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH o s A. McKean Director of Public Health OS� �=�V � L�-� t= A-� � ��S M �kfz l� E I �5 i� . v�1 . 3 H-y2�0.� � S i i: �� iu� - 1 I �O - b � 2 � zc� TEMP FOOD CHECKLIST Pd t B D - c- k 9 EVENT NAME:FARMER'S MARKET OSTERVILLE OT REQUEST: N/A CONTACT NAME: JENNIFER WILLIAMS "DUE TO COVID/ SAMPLING/COOKING/NO PERMITS FOR SOME EVENT ADDRESS: 155 W.BAY RD,OVILLE CONTACT PH#: 508-790-4200 ext 103 VENDORS THAT HAD PERMITS IN THE PAST. EVENT DATE: 06 26 20 TO 09-18-20-WEEKLY FRIDAYS CONTACT EMAIL:'williamsoostervillemuseum.or VENDOR FOOD HANDLERS 5 YR SS 13 YR SS ALLERGEN LICENSE EVENT FOOD AUNT DAILIES N/A N/A N/A N/A N/A NO PERMIT NEEDED BRADFORD FARMHOUSE TOFFEE Amy Bradford I N/A-APPROVED:X X X NO PERMIT NEEDED DASILVA FARMS FELICIA DASILVA I N/A X X FROZEN CHICKEN,PORK,BEEF AND FRESH EGGS FRAULEINS BAKERY N/A N/A N/A N/A N/A I NO PERMIT NEEDED . HIPPY PILGRIM N/A N/A N/A N/A N/A NO PERMIT NEEDED III HONEY I'M HOME N/A N/A N/A N/A N/A NO PERMIT NEEDED I� LARAS CUISINE N/A N/A N/A N/A N/A NO PERMIT NEEDED MARTHAS VINEYARD SMOKEHOUSE JILL RIEDELL X N/A X X SMOKE SPREADS,BLUEFISH,TUNA,MAHI,MACKEREL,WHITE FISH MONOPATI N/A N/A N/A N/A N/A NO PERMIT NEEDED SAY CHEESE JOANIE CHIPMAN X X X ASSORTED CHEESES APPR.3 YEAR PER TM TEKLAS BRAIDS AND BREADS N/A N/A N/A N/A N A NO PERMIT NEEDED TREASURE BY THE SEA N/A N/A N/A N/A N/A NO PERMIT NEEDED WASHASHORE BAKERY N/A N/A N/A N/A N/A NO PERMIT NEEDED WICKED GOOD KETTLE CORN N/A N/A N/A N/A N/A PRE-BAGGED KETTLE CORN i Bellaire, Dianna From: Jennifer Williams <jwilliams@ostervillemuseum.org> Sent: Friday, June 12, 2020 4:17 PM To: Bellaire, Dianna Cc: Miorandi, Donna Subject: RE:Wicked Good Kettle Corn Great--Thank you! I put the check in the mail today for $180. You should have it by Monday or Tuesday at the latest... We are starting one week from today with those 10 farmers/vendors from your list that don't need additional permits... The temp sensitive permit folks will start the following week on June 26th. With all of the new protocols in place, we just wanted to roll everything out slowly this year to be extra cautious for all. Our staff and volunteers met vesterday to go over our new procedures. All vendors have also been informed. We have all new signage in place for social distancing and masks as well... It is a whole new way,but safety for all is the priority. Have a great weekend! Jen On June 12, 2020 3:27 PM Bellaire, Dianna<dianna.bellairena,town.barnstable.ma.us> wrote: Hi Jennifer; No permit needed for them. Can you please let me know the dates of your market for the few people that need to have permits? I need to get your permits ready. Also,we need to have the payment of $180.00 made out to the Town of Barnstable for the season. I am still missing the current business certificate for Martha's Vineyard Smoke from their town. Can you email that to me. Dianna Bellaire Permit Technician Town of Barnstable Health Division 1 Town of Barnstable Inspectional Services Public Health Division IARNSfABLE HAM. Thomas McKean,Director E0+ 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/26/2020 Event: FARMER'S MARKET-OSTERVILLE` Permission is hereby granted to: DaSilva Farms Name of Person: Felicia DaSilva Address: 430 Jepson Lane, Portsmouth, RI 0201(Q401-528-9442 - To serve: Frozen Chicken, Beef& Pork and Eggs ServSafe certified: Felicia DaSilva Allergen: Felicia DaSilva Only at the following location: 155 W..Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 26-Sept. 18,2020 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Director of Public Health Town of Barnstable Inspectional Services Public Health Division BARNMABLE, 9c 1' ; Thomas McKean, Director �D 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO.OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws,.a permit is hereby granted to: DATE: 06/26/2020 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Jaiu Pierogi" Name of Person: Casey White Address: 271 Western Ave, Lynn, MA 01904(C)413-221-5328` To serve: Assorted Cooked and Frozen Pierogis ***All foods shall originate from an approved source.per Section 3-201.11, the Federal Food Code. Selling and/or serving of any unauthorized foods from a residential kitchen are prohibited! *** ServSafe certified: Casey White Allergen: Casey White Only at the following location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 26-Sept. 18, 2020 FRIDAYS: 9:00AM-I:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH (Gik"i cKean Director of Public Health i u is Town of Barnstable Inspectional Services . Bnxxsrns�, Public Health Division 9c� 039 MAW Thomas McKean,Director rED ► 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance.with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws,;a permit is hereby granted to: DATE: 06/26/2020 Event: FARMERS MARKET - OSTERVILLE Permission is hereby granted to: Martha's Vineyard Smokehouse Name of Person: Jill R.iedell Address: 23 Watcha Path, Edgartown,MA. 02655 To serve: Smoked Bluefish Spread & Filet, Smoked Yellow Fin Tuna Spread, Smoked Mackerel, Bonita & Bass Filet ***All foods shall originate from an approved source per Section 3-201.11, the Federal ood Code. Selling and/or serving of any unauthorized foods from a residential kitchen are prohibited! *** ServSafe certified: Nathan Gould Allergen: Nathan Gould Only at the following location: Osterville Historical Society, 155 W. Bay Rd. Osterville VALID ONLY ON THE FOLLOWING DATES: Weekly: June 26-Sept. 18, 2020 FRIDAYS: 9:0.0AM-I:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH as McKean Director of Public Health Town of Barnstable Inspectional Services Public Health Division v '"AM Thomas McKean,Director F0 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 06/26/2020 Event: FARMER'S MARKET-OSTERVILLE Permission is hereby granted to: Say Cheese Name of Person: Joanne Chipman Address: 247 Rounseville Road, Rochester, MA 02770(C)508-728-1688 To serve: Pre-Packaged Cheeses-NO SAMPLING ServSafe certified: N/A. Allergen: Joanne Chipman Only at the f6llowing location: 155 W. Bay Rd, Osterville, MA 02655 VALID ONLY ON THE FOLLOWING DATES: Weekly: June 26-Sept. 18, 2020 FRIDAYS: 9:00AM-1:00PM APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH omas A. McKean Director of Public Health Bellaire, Dianna From: Jennifer Williams <jwilliams@ostervillemuseum.org> Sent: Monday, June 15, 2020 10:41 AM To: Bellaire, Dianna Cc: Miorandi, Donna Subject: RE: Honey I'm Home Perfect! The market ends on Sept. 18th... And two vendors won't be joining us this summer: Sobe Superfoods (nut butters) and Townie Frozen Desserts...Perhaps next summer... I have three more emails with vendor documents heading your way... Many thanks! Jen On June 15, 2020 10:02 AM Bellaire, Dianna<dianna.bellairega,town.barnstable.ma.us> wrote: No sampling or Cooking, doesn't need a permit. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail"),including any attachment(the"Infonnation"),may be confidential or otherwise exempt frorn disclosure.It is for the addressee only.Plus Information may be privileged. and confidential work-product or a p iN i ged and confidential commwiication.The Infonnatio�.i may also be deliberative and pre-decisional in nature.As such,it is for uiternal use only.The Information may not be disclosed 1 IN HI 1, ING, vnTIN(itrumil C IQ t L V it!i 11000031 il L I UMMAW-- ----------- I'JON, ------------ NN L4 ONO 1 0111 N,MTV g IN 1 5 M 1.. TAII!ll" .74 1 ri-C-if corl v 41 W 6 1 it !!L"- EL47 Ow 1$ -MF%IW; Sol I V& U EAUV FnRm,u F c I v 11, ho"All I I FOOD BE KENT kV", " 41 DFGRU Ilf'tM';17VL FMCP ITV q I I xT I V A F6 Rl ES 7' HOWIS FOOD �.'f T tl !.F'OOD S :R 0 h p— APE OF 11 1 V ME I In nr l t+` Com 114 t1 � ' h �,f lassaChll Ctt-� I.A.Piration Datv., June 30, 20,10 { TOWN OF, HC)pErjAIX Baum of He alt b 1 74 F C���,�+ r �.�-���cila�t��, � rmul��;1:�-�� ��n�.t�r�Erkr�s;ii ; : t i,•� :� ;��. � _ :i i::•r� �����.�x� � ��,f��� 1 1 , �z�L . A=_ � .:t�►t�- Gencmi UAs a pcmi[is tvmby&ni(xi (u: Whfj.w plat rif husini 4 is: 7 DEC. Court flapectal . Ta nperateH fu.o in; t ii ►aa ufg. kde 'Aic� nit a Ucm-se,�the r+�f�.�r`<'�t{�1f�.1lybl�° ����rf1�'�, �lr���r��t� �� s�r�ll��t r'fr"�rarE �. �,•, c�.ix�t►�'It? ��:r.,rA �?rt t���` a"i�r.-rr,ir•% Pt li y � ter � s i�! t} �'t�r`.fe.��,'t.zt �s era �� ; �a rarnce wilj" ap-plic-1.2,w�� � . t fit lla i }��� A It A vM r UP r. ATION HC CERTU7 JON HAYNES i � �•. _~•'� '� i'v'rl4' f tar}4[4C >:yti .�r71:eEC'F:JF4i.� - 6 k, ie'i vlM 14912620, 1 1 414 , 41V222 s DA I MA,f 1 >.i Wu 1,A a.Aa. omy If • � ti aa'� • +x iw-i c.....s. ene„ .>.._"".•..... .... ..• e•. tq,.F c w Y L RT I F I E N 1, ALLFRU AWAREN j" _ F _ e s� t 't• Nil tt�`1. - .. l .l . r.. . 1 �4 [�.] ; : e j`at t �s• i f:t` . , � tr,����rr �h�'!,4', .z.`,�+_ '�E_. �.E�=•mot-war. -. ,'!.. '' a ••sx.�.��,x c■ � �s w. •r.w.l ............ '•Ilk .t`J ' .. .- a• *•.• '•�� ;� `, A 4i '�"� V`), + S``'• ,� w, `.,�,,, ^r_'" �{. 1-«`. ►'�d1''w �"' q,t "' ' f� �` ` ■ ? '` R��t +ate t^.'!.'+ tie �3+ °s�l,!��2�'.;_ .� 14 Jai3i 1 IN I I( F i Fit , I ."aiE'4M,%R FOOD St"A'.s° lt- A- tzm1 f DAXA 1Ins i..v f`;l f01t t kI AN III Al; -�•�.�°Ck l.Mh E FFt-�11�,`'�I,ti1 lt�a�l. .- y. W��.— 1F.i F1111ONk< , .. taws: ,) 11a:3�1t �fVOR} ,ti 1 It _,_.--•, -- 4 _— �-• � 1 �a � °� f fit. ° I.t. 1 I'I kY►C F +,n..J 3.5 �� i I ° ,1 °�°1 •---S �t.k��► [c! 1Yf. •,r �� F.il i €•, f' `1r E'iN)E?*I t . . . Frtd 3[t II " 11. :1I r,'I C► 1?} 1a"."�!13 3' `G EA`}�.'�� [ AIP �>11-11,�"�Ij L;,�'I}_ti,41}���.16� ti•kl �. ��..t1.I,F9tf;I_`rt }^'�) I� 1�'>llcti,<i � �,� �.�`r-«f 1t ati 1 .�.Iri.f1,r�r-�°ilc• "+1.t ri3r � .�•Itiit{•.I;,-,t, �4I�F:[,,1= 'Ci) I t �:- It�'1.I -..' _._ _. It I lei f41` 6�I xp , Il hIT-C Wit. n IWEll; HA.At 1 .t'rt11'.�I.t b I . , I1;'r��r '+,�,'11.1.k•C�rilg ;�h R-aF',�`I F;rt 4 lLr.; _ -_ �� ,_., _d. _ _ �S1C.�`':'�' 1`w k 9)ti:I��1."t h'e $• t�.1= �1 -�__ �.�_,.m. I r ...................... ..... .«.._.esr�.,,�•.,. � CERT - ICATE OF AULERGEN AWARENFSS TRAiNiN Na9T u of Rccc `} r y�, x r _ TWraem k'yMATICNAl an all fro iJr:i;Ig�r.,��..•• f;-edby ' 1�i s�ch�, tu Ihia-r+mw71Ge Y ,. r "k tlb.Il � � 71 �u i off W- i�f l 6 trrr�s irl YSd 4y 't yq THE Co1rllti ONWL1A TH O�: t�Ir..SS;at HU'.'t�TTS- T+o'w n 1.4 f; l a rl to b c-i l o u ji tl d PER-MIT TO OPERA„f'E A row E-STABLlS't- NIENT rt cc rct nce sr4it t a ut ti{�n promut a°e4 and r'nulhOsit�' Of i^t Ch.apt r 11 to t Ian ,5 of the Glonnrnt Laws- a pjvrm t is hmraby r:trat tr,• `L'1, i 7r ll F'ttrrl414�t���a T���n i 'I�ttr r. VI:rp of bualness IS, 27 ple-,isant Stroct, PJA.. 02 b T)pe of burin nt; t ar j,�ton R: Hon. WWI n To op*mLe a food 1'' rrtit Xy� t -on C1a'�"t'iil`+` {" 31, C }v, Fi?F ti'iu f ie T Certificate of Ahiievement ServSafe Fend Handler pl� y e � y �£ Course and Exam r s � b18 33164 w 4k i t� ,np n�hc ��(7blz� �P.tI " At AAIlk I It100It A4 tit IIif INI1111111# VI'I'1 1t Vllf)'A I�i)i, IlVl1'1II�.V�;l lt )t)II tih.ta1'II °l�.l'IIl1II'I m t)t Olt I t1 t \ INV (hic n H It Fill'ilil rs' NIarket 2020 �'ft'aso ll �\ Ay I III♦ I % IN I 1f`1'UM F i) HN I IiE ITH)ARD Al 11'i'1i1M .N1VFTING"' sl t N I i 1�1f tit- PI I:�i)�t��1 RF c)t L51"t\(; 1'FRMI`L JENNIFE.R WILLIAMS ExEt unyE DIRECTOR � i 1 1 E 111'T ION 1.4 S08,428?5fi 1SSM C E;LL# S08-280-9882 H0v11 -�DI)RESS 155AAiaBm R1 :111 VILL.Af;E Ostcr�iilc N AMF OF ORGANIZATION VIA]j/W f/uu IV ('ON LA('I'PERSON 1 L�L) }PAI y I ZL TELEPHONE .ADDRESS FOOD TO BE: (LIST EXACT T FOODS) � ',ry�,S OTI 1 Lill II NAVIES OFTR".,&E;D FOOD HANDLERS(TO BE ONSITE DURING EVENT): H IILSi 1 f Ir.,I I I,GD _ _ T (ATTACH COPIES OFSERVSAFE&ALLERGEN CER"T IFICATE:S} ADDRESS WHERE TO BE SERVED Osten me Hood.1 Mmeuni 155 West Ba% Foad Osty-iHle, VIA02655 DATE.TO BE SERVED,lutae 19 Sept 18 TIME 9 a.m. to t t'.r1i V"1IAT TIME WILL ALL EQUIPMENT BE SVOUP& READY FOROSPFCTIONV IIOVV WILL FOOD BE KEPT BELOW 41 DEf;RE,'FSttF�Jl 11(yw WILL FOOD BE TIELD AT W DEGREFS F. t��i�� -- ---�•— �- LTOW IS FOOL)COVERED I10VN' iS FOOD SERVED, i v Tl"1'E. OF TIAND-1�(1ASITING FACILITY K SIGNATURE: 1,4"I ,?k I 1 i s nIil i,�tfi 11 .}t� d 3 o toll a a , -1o'o Qf A w v�-an.vrcrcx�vw�• Qh CERTIFICATE OF ALLERGEN AWARENESS T'ItAINING � 1 wr' ate Name of Recipient, FELICIA DASIL'VA Certlficate,.,NUrAber 35110.76 ` Date of Completion 7/31i2o18 Date of Exp"tlori� " v`i: . � Issued By: ME The ahove-nantedperson is hereby issued this cert ficate NATIONAL for completing an allergen awareness training program RESTAURANT _. ASSOCIATION ,��. recognized by the Massachusetts Department of public Health ._.._ in accordance with 105 CMR 5gao09(G)(3)(a). Massachusetts Restaurant Association 800365.2122 333 Turnpike Road,Suite 102 www:restaurant.org This certificate will be valid for five(5)years from date of completion. Southborough,MA 01772508-303-9905. l www.marestaurantassoc.org �+ r Barnstable`Public Health Division APPLICATION FOR TEMPORARY FOOD SERVICEPERMIT DATE NAME OF SPECIAL'EVENT Oste vine. Farmers' Market 2020 SeaSOIl WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X Y N NAME OFTERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR'. TELEPHONE# $08.428.5861 CELL# 508-280-8882 HOME ADDRESS 155 West Bay Road VILLAGE Osterville NAME OF ORGANIZATION / !� CONTACT PERSON W &W I ELEPEI NE 744 ADDRESS FOOD TO BE SERVED(LIST EXACT FOODS) '? -j ly NAMES O _ RAINE FOOD HANDLERS(TO BE ONSITE DURING EVENT): (A ACH COPIES O:F SEKVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE.TO BE SERVED Osterville Historical"Museum 155 West Bay Road.Osterville,MA 02655 DATE TO BE SERVED June 19-Sept 18 TIME 2 a.m..to 1 Rim- WHAT TIME WILL ALL.,EQUIPMENT BE SET-UP&.READY FORINSPECTION? HOW WILL FOOD BE KEPT BELOW 41.DEGREES F HOW WILL FOOD BE HELD AT 140 DEGREES F. HOW IS FOOD COVERED / HOW IS FOOD SERVED 40i 6710t�°I TYPE OF HAND-WASHING FACILITY 61 a.. SIGNATURE. i M y ,4 a �,, zF h ro� �. ,i� �, :' ate : , v1.is ,'i ti` a x y ' +,; t k I ;,:. .-. .. .r: . .o.*a. :fir. ,,.:' :.;'W ':- , C..:,-r' ..r .i:: :. 'r i `u E MASSACHU,SETT S . :; I FEE �:� III E ,NUMBER THE CQMMQNVI�EAL TN ) . P RMIT . �: Y r;. . �, � . <_ � x 1. III y ,::. ..: a y : . : 0 00 w, OFC �, �: N� Y,$ 2p ,�Q �, , . . ,, . ., �, ,,,, . ., ... ,. - -- ` ,, _,' _ Y v - 3 < ':n .� g 4 :' r` ,.��'� s �., :.. x ' a i :.. .r t, r :, �..; �, �.• , !kz r h x, :tx: rX Yg z �?'� { 'f �i .A ) , h 'r, .�. . ,. v. '� +:�3x: >', .L l ra', �, „ , AME. �,( �J N `[\E� T. TH1, Tt� CE"FY THAT F RAULEI N S�: BA s y 4 i:i •'' ,, . i <r.;: ..: t �, . . ::ADDRESS .. z: �, �: -,,1I { 1 .RUCKY 1Ji OD ST. .TAUNTC)N:`MA'02780 k �z " s :> I �l - , F S� HtR18 GR NTED '- LI EN{SE , . �� ©,• �+ � , i. 'OR?.i:V/iTd�ISIN.iJ' P " ,i Peg gy,s Kitchen } a , i 4 ! +6 -Main Streetf . , _ . :. ;. f.- m Kin s#tin .11/�A 02 ��# : �; :.. . - ENSE I GRANTE 'INCtJNFORMITY WIT14 THE STATUTES AND ORDINANCE RELATING Tk)THERETO, AND . THIS I�.IC S a;.' - ..< .. EXPIRES pN, December ,8 2020 UNLESS S;40NER SUSPENDED'OR REVOKEDz OCl"OSER 29 2019 Date lssu�d Arthur Bayle; alth Agent , g`,' _ - - s S 3 I,' - - x,�:. v' F; ,. x! y '... .. :�: 3. 0 >. �* . ' �. .. .. :. �w .tern 'e� z '_, ,�� • ,+� N K �x Hwy - 4 r KIM S Salfe ery V�' CERTIFICATION Y S Qa L.IL.L.Y REMPEL for successfully completing the standards set fotih for the ServSofel Food Protection Manager Certification Examination, which is accredited 6y the American National Standards Institute{ANSO-Conference for Food Protection(UP). NsI :. 1 6 ro . 136900 . - , ...,:___... ..._,....r_ __ _ ....._..IS- W-1 (� I I E�N U M B E P._. _.., _, r . EX-AM FORM NUMBER 5/25/202.1. DATE OF E � Na T £ 141, DATE OF EXPIRATION focal laws apply CIS Y4p jaca ul TO r.vcy for recertilicotion requirements.. � � � x � 5Eterrnai�gB ,3� � y �. } SYP rb a1� 5 `` SaC�t ex I t.P#fS ,�r,�� m aacedance:wilt•61,anama Ia6ax- 2d�b x $� Iogo�axufanarSnoftleh' lr. N �� &t201S Naarwl Rrac+.as�nk�lcvnc��+�C.+EdumSotre� t n��(�A� tiq�isc t+t5wa'� N4�saw ctda `�°v «tuicrc ctati :ara� a{ i Mit' uao A�aasia � " % a-SanSale4hes.±csamni. ns c� _l€ � Cuitoet vs win 4oestions�l73 W k?cksan 81a€.Ste 1500 ClticaQa.El.b4dOe °B• M". �• e� � � is o ._�� ��% �>,�.��•• 4 d aS 1,4 1`, 1711% VlF !,*I T AVPRI-.l' VZ> 1,0 1HF Ltj'-, f, ,I,t;sil.:r ;J'A.A ; ifs. x{ yty�!tApT l+:f:A' 3T 4 f1ON' �— k't)t?Ck it1 UF:r-KRVED iLlf ;I _ y t JAI f:1'I"I';1Llitd�I°7 -f}F' FKl`. �.ifF�E? t'YhC:E'• CFvIit t #DDR F.44 vri iF"#,°F, t a i t r, r f f r r;r,-rk sll�;�ttal\ a! s1ui, ,. r��^ t t k 'A P.«'!j TF T97) RF ,";FRI IT P..-'e�,�r SNIMT "I'd'.I,k. INILr- AIJ VQ1 IIIMF: iT BF iSUf=LJ!%& I,i:,JLD krbl ", ,°r'E t._ fit 1%, atr)j4' WILL FIEW P GF �.VVt I5FIXAN aI jJF*GRF,Y.�c, It� �,� J �° � �—' — r I11aF �ti t? _if) f;'i14`F'h�`ii 4 irI VVE OPITAND,W-A nk, G c "fr2-AD-IRL fr IS TI~iL C4 rAMI€!*ol"4YFe" LTH 3 :e �4_s•a1 11 '�` 1. . PERMIT TO OPERATE A. FOOD ESTABLISFImF � 1,;4. St�.l`(L(M ? `9 Crr .1c:curdtnr_c with l?apjioriur'is c F .y q.i91r� .i �7 t�� !� �, �t�,Gt,fi31 �c _ � tali �3_:1 iyy li� �1`tl �s `1vpc of buyil css and a-ay ryt, ►, +.1 �'�... .. ..... ............ .. .se b t � To 1111cfatc I J011d .__.. ... u,r :'cj'Nv n 4 Y l Board to L� 4 ,� Ake E 4 :. f r earn serve ti � at. : 'ri7 Food fiandlerTraining Course Creffit llat tt� 2.0() ,Vvpir.,ilion Date: Fuod Handier Official -Si-griature rtif,cat Issuer °~ M 3. 0 1 ,] Qom:. I €=isi Loa 1`rl".0 Cr7-., r fi _ . s E� t, 1 Q'�: To "is'r" X 787-11 , �,U, �jt i � a13 ���I [IN of �= jr, ii " 7Y t t . ii CEB � � � F 1F r , RG FAWARE,1\1 Ess TRAIN' 11\1 Gi k. Namo of Recip°orit Su onnah Loy kottl � Date cf Covl :Ltic n- ,i4 p ri l 13, 2017 � Date of q on: aril 13, 2022 F i > ^g�`r's C:^T'.:. •q-f i�'dti'E.',:A l+�,la ii:tg ;:ay � i yy2 :� M�6 H�E�..r' .R..... 3 �rssa""wnaw.*..�y�npncannr �tiy'ta - ma�.�+ss7�eis.�a �,�aznr.+��scrrr+w;rs.aar�>•.�t*�:ei�tlt�tria9grYt�PI F'ti"=:��"a�C°`*�u-`�.n`.�. •'*�'"�^� ';.�"fr—�"�.y4'M..� � - 4 �—`, R,F }�.r�l��"��__�.+a,� 1, *- ^'�•a� si 1 Barnstable Public Health Division APPLICATION FOR TEMPORARY FOOD SERVICEP`ERWT DATE NAME OF SPECIAL EVENT Qsterville Farmers' Market 2020 Season WAS THIS EVENT APPROVED BY THE BOARD AT APUBLIC MEETING? X Y N NAME OF PERSON(S)REQUESTING PERMIT JENNIFER WILLIAMS EXECUTIVE DIRECTOR TELEPHONE# 508.428.5861 CELL# 508-280-8882 HOME ADDRESS 155 West Bay Road ` VILLAGE Osterville NAME OF ORGANIZATION ) CONTACT PERSONNt Yr �.�a` "` TELEPHONE ADDRESS S � �L Sk_-{CC FOOD TO BE SERVED(LIST EXACT FOODS) '_NAMES OF TRAINED FOOD HANDLE (TO BE ONSITE DURING EVENT): C.t� U (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Osterville Historical Museum 155 West Bay Road Osterville,MA 02655 DATE TO BE SERVED June 19-Sept 18 TIME 9 a.m.to I p.m. WHAT TIME WILL ALL FQUIPMENT BE SET-UP&READY FORINSPECTION? HOW WILL FOOD BE KEPT BELOW 41 DEGREES HOW WILL FOOD BE HELD AT 140 DEGREES F. tL(\ HOW IS FOOD COVERED r�Qc � 01C HOW IS FOOD SERVED `LXe- ea TYPE OF HAND-WAS NG FA ILITY CCC"\ SIGNATURE: x , I ''-�?F�filitC�tiljllISt 96 L Ac Street T'lyn�ptun;Ma 02367 I ervsn,... fe CERTIFICATION TIMOTHY CLELAND for successfully completing the standards set forth for the ServSafeQ Food Protection Mnnoje r Ca tification Examination, which is accredited 6y the American National Standards Institute(ANSI) Conference for Food Protection(CFP). 14�381376 10518 UMBER EXAM F _)ktA t�!UN"BFR 11/17/2021 DATE F [SATE OF EXPIRATION Local Icrws apPlyECh q X✓r�� � (1 ,.ency for recertification requirements. f S� ���,,4X11t 3��5:AClq�lt� V v : 40655 l ,y •k� — _�� are troden�nrks of the NRAEF s ,.a §-r:si:,.r�cJ-r:e w:'�:?.•n�sirane L�>xR G���,y�� - f�yY4s�.Seiv5i4��:�!+��fi�"7�:.- �r,�° ,.de�,,,,r < f fit,.yt ?. - t�h`.'+KJ.2"t rsx -•,v ksck-r�,'cJ�d Ste Cnn- �:ys ... r ... ;a:Wd oa wrth R�'esuom of 17� Alr� CERTIFICATE OF ALLERGEN AWvtRENESS Name of Recipient: Timothy G Cleland ` 6 , Date of Completion: November 159 2016 Date of Expiration: November 15, 2021 ° g Issued By: �-? i c' 11l177J�.'ll�3cYSaT1 Ys 1wTelly issu'�tI)lS Ct'7L kRtL l Tp. JJ r a- r0�71T3)7 Berksltzrr Qu'c�?"B112sS 1`J"[IZYJ:J1b� •HN!!t'tb jjj� EC nrtcrtt o Publi ?:izeal by Ih AI,"ss,-r:httsct..s L?cp 1r ��i .3 At ea health ucatiuu Center �;�vlx s9o.no. { 1 r X«). ` 10 i'itisficld lItssachusctt5 ;1i rb, lwanl, ii 1t trainin�� ,��y ••- dJTS tI"G?ri llflti.'Or C0117�1� . ewN�.maFood iller��` n � 's �" T Barnstable Public Elea hIitIgiiii'�' z APPLICATION FOR TF-MPORARY FOOD SERVIC`i".f URN11T I re , 1 _ NAMEOFSPECIALEVENT QStel 'HIC F-dr HeI'} �7i11�CC"� 2020 �'2IS(i►i WAS THIS EVENT APPROVED IIV I fit,BOARD AT APUBI 11 MIA,I ING? Sl 1 NAME OF PERSON(S)REQUESI ING 14`10HT JENNUFKWII.LIAAIS,6RFC'1.'"1r14F.11C4tf_t_ltiR._____ TELEPHONE# 5SIS, &5861 C'El.l.N HOME ADDRESS 155 Wesi Rai Road VILLAGE Ostcmifle NAME OF ORGANIZATION���1 CONTAC7PERS-O7N tGC , it/,, TELEPHONE ADDRESS , 7 ( Ckle-fyC' ye_ Z114 FOOD TO BE SERVED(LIST EXACT FOODS) pie-to, I �7rC�ltG �cC cCun /rnM --- NAMES OF TRAINED ?OD HANDLERS([0 BE ONSITE DURING EVENT): i (ATTAC I COPI T F SERVSAFF&ALLERGEN CERTI FICATES) ADDRESS WHERE TO BE SERVED Ostervilk Historical Museum 155 West Bay Bond,Osterv�2bS5 DATE TO BE SERVED June 19-Se t IS TIME 9 m to 1 p.m. WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FORINSPECTION? b� 5 0 HOW WILL WILL FOOD BE KEPT BELOW 41 DEGREES F l U� 11%c HOW WILL FOOD BE HELD AT I40 DEGREES F. HOW IS FOOD COVERED flow IS FOOD SERVED t _-tip TYPE OF HAND-WASHING FACILITY G I70� - S aIq I LI L-C!' , (J itj( LI SI NA JRF ! ply/�f�/ \�__ �CcI�,kf `4411 } CA ik i N 1., N �+ Aik"I ' ' �.L"f' . 1 X /_+ i , ,>, '', :>, s in _. , S ;%„ , 20 f WE annqp A' y 210 :.: d' ..... ". r ' m, � L� x v � x1. 11�: y . :, ;a�: ,,. y o.•., ,, , .. -,:j, ,, ..<, .,> i• ,,x f, *,,, C. y 1 �, :b:,x;: ". #�'. s hY a <,Y,. n.<,;" :�,. ..x 7 Vol,S 1 ,'a,,'� :,r a , ,aT{', y, ,,fin,', .;y ,d,; ,C $ `M �' .:,u�"i 1a 'J' ,;'r Y.::. 9 ": yZO :': <T<, 5 x Y xYrt- :` R i 3 i ', " ,:', , „7 r w r a A 5` y ,�" Itix , .. .r ;. nt /h is y}�J60. r,_ Al .,r.• 4 n' --#„ sx ems, eyx a, "'£.r ,xY >";' 30 Arm, 111111�r ,. -MY -,,My a : ' „x :<a :• ,:a::, M t f .x> '...:,,. .. r;" ,i try;r ....:xgg WO y ..x, x r. f'x.::: .,. ,n ,..< f ,3.,.'_: ;'?..,Y +",,:>: :..x::. d x, «,x, ,x._ ,#; ,::., !fN In_,.x ,"�". ....: , .,.,,,.Yi .s' ,:>i ISSU�.0-4/'Z' /202 ,, +Vail�g �^■ 2Z', .,f.; 5 ? , <':, ,'.'fit .::.4 ::'3 5 x' {r {•a�'. cf� y ;e."1111.<. xif �8 ,., ID '':J .#,x• „x,k:::,;:^�� t=.�I.0 �,-.x�: <x'.. ;:,p &Y:� <':f a'x,,:"} �►71r_ ; VAINPOW MA N *, ., x,f, < .:::.M.. f,,` .,i. :� Is. S`. < .xf •„fin ,:•F.: 53' ?#� 3,,..=,x...h, r...: > q+ \«(r'�'f-:, x .,. ,.' - x �•:-�:. <:. < ' - ?. $< Y s, 1 3 11 ll, in, F: = s AW qjYj, 5 S ;3 ,,gg' Y:. r, gyp �xiE? }�' # -3g "":fit ,c 5+,. a , ,a IF" ' ^Ttt 1 B "', ., t�C��t�1 0 xi K,A,ttt r. OWN I „"gMAMwa, It xi c , - nn ittslcefrd 4 g'.thrretog: tawsi ordlnances'and,re utatons f, ' ' c. , , . .. .<hereb . „Vol Y rstnts a( x .,, oil < ;, : ; fff �" � z -: < ", .If;. yF< 3� I .. uon,r,":r: ,': x. r:<x ':'�e ,:., ", 5, :- 'a;' 11 y;" f ,3 jygy yvm iPl, 'l QFld C :sg :;-tt <,`w'> R.' Y,.,r ,'' �Y• 8 y n5CutO s::; I s r x aM—pyI'vIt, - : 1�a'II11 `': 2 x.,',,% <. c..,CSC , �, Y «ti v r , x ter, i'l11 r F: :: ITC; r f,..r s, .r,.; ,. ra sil , HIS :'v s, k ' .k{:, ,. P �- 4 i ,, �.:,' .�, ,;. ,xt, .: s,. s' `.f, r: .._, f :! r ,''� / c ,tom <11 r-iin q.. , _ btlshment :1 -� .". ROGt:.,, . „ # 27 :f- 1 ,,., . - k SRN A1�E: # ' 11 r,'., , - , fir; 14 �> , t 5.. +� ltrs �.rm halt£ec „ . %,+ on 4/3Q «< x �, ntcss snfner; ���,.. .sus Cncled rur,I �, MI _ .A IJ , ,:, ,z , ::: Von evoke . .1 F r d " * �,-. . I MY AV ,' Rcne�val [aterlals nlusf brtlEimltt ,_, ; ,, � , "A'' ed V. cf,lys �lr to ex it ion** Y 3U Iot' (I At ? � � � i �WM .. r `+�ltler . en,,Bk ' - < Pr4 Eso. c .' a ':� HT ,. . CF �. „ ` Na :Y 5ki� 3- P , '. _ii�s. }, crk t'ti ':' ME,TckxLlc cns6-��c f. , ,t kr. $ 11' .'' PE x t'omm tiC kI .a 1 „ . . c #or'of'Pub c h �,,,. An"MyEl " &IFFa. � �,::. A., ."�;, . so 0 t x Included ifi�C:11ChEf� underhthr aanne tcrtns Rb ¢'•F x ,.. XT,Ala City ,AI'lliz 's. ,,.. d cuad�tlona, IV% 5 -; r imi �,t ,a, - f<ts ;t �P Y t t ':. , tetk Ftntut x ,x, c,. 3, . } Froaca Dz ,Yi,#,:. esxrt,, nufacturcrr' il,E - �f _ r 1 .,xv Icc Gtcaarc "FT; Y ,<'. Truck . <. cn r _ x >, f , £ €, fix' :II ' k. i, I , .a. ..'i ,r, ,. -.kAnn � xr lien Y i _. ..: - x .- x . -41 ., ..a:. q .,r<:.:.', you 3 :._, ..1.... ., ,.,,.1. ,. :L <,r .Zv, ..'k .x, €` ':!."'x K:.. ,3r # J'F< tt:.5 >:,,, :,,,>,,x <::- a % :xxx,,. F, ." - ., �' a # k,i, ikh x d3,.,,.; ,.ssw} ..:>ex. ".x , .yam„ e �>xi.,. .. 3 x a` t s .: Q ?.� „ ,:, 0, 204;, :,x, >. x . ,f» , .... ....:: -. ?k3�x ,,.:..,5 ., , $,. �AA tr ..T+-: W AIM #t:t�� x�x5, %�4? Y''.#c.. 1f "Yw C ,. ::. rx ., " ..,- dr, 3 �:,,. .x,.. " :-: , H, 5'r:,n ,r < a# d f, < 3 d^ - I,,....:.0< ". ,,, ,: t. ,x. "x'�, ,7x x ,, ...r ,i,;: ..- x\'* f'n::, ",' -. '., -r,k'.x,...< ;1 :..._... ,, x ,. ....fix x >,. , <,- >,. f;-.;e.< .. :,,�-Y }. i .,l-_ fi-.. „- AfyAk" „ lnw kv , JUM �. x. 1 ,f <...x..... x. , ,xx.::,x, u.. a , , x „< ,. ii ,,1 ,., r:, ,. .,, x, x.__. ,<..�, ,< . ,.fib. a1 , ,kx, .. ,�,.:„tea. ,r,\ ..$" ... AoiMnW ..:. .,x, ._xx, .r .,_ ,.. r .:: '#xi:.. < :�.,v x r v y.a -. a a- ax.., r .> ,u '. a a ,,, - .% 1 Al �� „, � } ,> a _ ,. , „ n « . „ - ". 11 < 7 da \ x S .. ... ,,.w _.x �'• " .,,:,, ,to _,.. .., �, ,..x ",..... ,,.< ._ .o ,... ,a:., y -:��:' °L v'#t.'.` £'�,'.: �.xi ti � r , / � a i • <t .♦. • • ♦ • f• a •. •.•. • •••. • i► ,Y ��dmn4vi NaHarA S==_: `airN Ua CotthroNce ta'.Fami F'faYctlan: � (/// �� /. ,� No 3^// �.r%/ r, •,lam^ / � '�,!:[` - '.. •_-_-_-.,�-,:�z: _.._ -_� -_ �.. _:. - «"-_ --- _ _..-z-�_.v=__«er:�zo., ............. , ("., ERTIFICATE OF ALLERGEN AWARENESS TRAINING r J .. ' is Name of Recipient: Casey M We Date of Completion: 1 /9/2ox5` Date of Expiration: 11 2020 , 5 y a: x A , r Issued:BV•' � The above-named person is hereby issued this certificate , brcompletin an allergen-awareness trainingprogratn :4 J Berkshire r-eccgnized by the.Massa.cbusetts Dgartrment of Public in accordance with 105 CAYR 590.009(G)(3)(aj. MAHEC Area Health Education Center Pittsfield,Massachusetts � This certi cate will he valid for fiz,e(5j e ars,f rorn elate of completion. _t y • � wvvw.cnafoudall..r 1t -401 - - - - - ..«.... .-...,..,.;.»...�..r..,_«.;».«»._ ..,.« .....r:�n -ram.. Bellaire, Dianna From: Jennifer Williams <jwilliams@ostervillemuseum.org> Sent: Monday,June 15, 2020 2:32 PM To: Bellaire, Dianna Cc: Miorandi, Donna Subject: Re: 2020 Osterville Farmers Market Looks great... One edit: The phone number listed on the spreadsheet...It is not my number...Best contact number for me is my cell phone: 508.280.8882. (Feel free to call any time... Many thanks! Jen On June 15, 2020 2:07 PM Bellaire, Dianna<dianna.bellaire(a�,town.barnstable.ma.us> wrote: Hi Jen; I have everything I need for this year except the $180.00 payment, which I know you are mailing out. I've attached the new Excel Sheet for your review. It looks like only 3 permits for TCS foods. DaSilva Farms Marthas Vineyard Smoke Say Cheese I've notated your two cancellations and I have the permits running from 06-26-2020 to 09-18- 2020. Please let me know if anything is not correct. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street 1 Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.bamstable.ma.us The uiformation 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 I Iealthi and/or the Town Attornec'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.fonva.rd itA.'bank you for your cooperation. r F j 4 Jennifer:Morgan Williams Executive Director, Osterville Historical Museum: Home of the Crosby Boats President, Cape & Islands Historical Association PO Box 3 - Osterville, MA 02655 508.428.5861 www.OstervilleMuseum.ors www.OstervilleFarmersMarket.org CAUTIONThis 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! 2 Ph floorglQW)IC 1,11111h: I' lowlth Division �x ,I I( P N U'( It t V Nl 9,( �I{ %I c It I (I()I I j:v 1( j,V,it's 11 L sir OF I f HI I;-:I A 141 AI A V L H I A V '%11:1'.t LN(," S 1:� k N r rl, I! %1)�N vs cv],t" 0 &4, -----------CjF ORGAN'lZACUMN I PILL cc3NTACT PERSuo"i fAYTHONE APDRESS- lot "TIALIZI -t";y EXACI H.-IONSi To BE SFAVU 0) dd iN I T N D I ARS P 0 rIF ON-,'l I f 1 1 P'l "9I: I %V L I Fit?1, "V SYR\ MUL I Nit. yQjAVNjjSr UV SLI Rr kpf MRINRM A MA 1',,% 41 1#1 _J 1. E ilK ID WK lklt,1 0 A I I 1� K M I 200 V N w. ';4 tri ���1K .9�` � ,.. :?.""z€ .(,.�"Y ,�'Y�.�.s.•� ci` �,�'•�ias�. <��-a 33:�.)a�. �,�L.3�fs�1�-?<,;�.": I'll _C� ! _ - ,'�±.:�.� -77� � 7-1 a. i it C)� r?tlr � .w ., ._ yr * )�, t it 74'.S F—I.,4jl.'0 5 PFv.AC�yr..: C T' e:. / srrs'y q 'fy i� i •� �� �' i ,a �'�'�� f .. �1 i M� Ip T' e S a ry ............. C !" K I; e r ('a' AT r a, .!5 LARA FERRIry 6 41251 v > u �r �, Pa C lot t A�Nk :,[ e� IF-l NIA � OVA <S p Y ti ,�li T E v I L �,p,6e ,tii L AWA R E N F SS �� FRAINING Ism via x 1,71 n Krun OAq Aw 1 4m q k .�. y q: "Y t 04' i� Ire d�, �-' RZo "Amy �,Y f Y i w jv'' i ! TT �5 13.Rr�rt t�ik, i pw lilic t-oalth Division P. RY Ff101) DE R'V Ic1'.�1'�"tL DA I kII-C ;� ILL �d WIN rIV% w,I .til`,?"1+;mF11It' l.t—"--a i ti''� uiz umaiS Yt-t: ' 1 I lit:"�,F. .Si,[�[:;},•,ti t5 a4�k � c�1(„E-,�•..�....—''��C,!_1�:.'r: t7�.t� -+ �_ ,d®e= '� e. Ile IN r r I♦�i t1_143 . X a' 1 • ';31. €7a" 11 .41,'4 _h , . ,�[i, �1 . 4,1,, �v+ g" d`91F. ?tiff11�. 1i. I•:.''I,iVEN1-t _ � _� _ ..�. r"k I'1 f �[ � � �, I 1 +rM �F. ' �h ..'�.5.t.x �'�;i,YN{IM i i h X J Is .... Ewr1 Cur, ir.�wt t,,r �,.. • U,klr foi:' I01 Il Im I nY 4a 11 l l 1111I I I III.WNr y Ni I .1 pat I1& 05'lell11ili)n� I�•! f,IPI1„'I0'G43li1t.d11 ro ..� �' ` �.�__�y,. � .G��"� 3P_-'�+�` �_ .....t;,...r'S..�:3� r•1' �� '.ems- x 1''F. l7} @l,�.'�`])�'r4'_1�I t i'•�[ I ,ry.' i I I `"�.f':i.f�"-�•_��1=�-r''�( � -�-'-=�' '•''j ,��l..�n �` ..:�=�`,�, '.�� III .a rvs CERTINCATION JILL RIEDELL a F x+A is ourfAted by` a Arw un S�x&.1:#r.�t I AT t: , . K i�;dTi E%!5 1 :� ,..'r Et II r� i�!I !�; •k.•ir.a. :.yz,. ,.�a m,�i��" II f ti� Yre m �l t��.i>�.ra 4•i= .. wa„F.v�.,,...°. n f � MEMO" III , ;.+.— .. _ _ s" •,� -_ +ter # 7v`,�f_� _. �' , `S 4',r►'e r , .......... 41 +)''a 111f _..7�31EY�gTra�ra 'p �y.�• .ry ERT I F I AT -F 0 -F Al L E R` G N v. AVVA RE N' t '- RAI N G elf t s n tl K•;� 4 -m-X of AL r. .' y n e r' y �, . a l ~ {$$t}C�Z3•f: � ���7 - � i� & J' F + T+ �•.�f�lr� 4 � w A 4 r :f t 4.r„s ,,,..��.� .. x�a..+{�ytd i'.��. ��i,� i is ��:���r�'�i°r t '�e�.i' r1v r x ,�'�.3,�4,B f:U"H�."Ti� ,.d+.�32"� �4.ke:.:��.P'ie '#A�� �.:;,k r f'• ip 1 h S•} :yk. is .aaS� s f's + r =A • Y•iL�,�A4.1(SYxY�7'R,; 7C#t17R. � —b� � J' ��~ �� 7.f7S.1lg la27Jia�iY.'EA _ �_� ^-� "t ^� _ �r� .ram�T a � �+ ��� '� �� 1• xlzl Bellaire, Dianna From: Jennifer Williams <jwilliams@ostervillemuseum.org> Sent: Friday, June 12, 2020 5:50 PM To: Bellaire, Dianna Cc: Miorandi, Donna Subject: OFM: Smokehouse Edgartown Permit CONIM0:4LALTH OF M ASSACHUSF'I—I'S 13OAM)01:11EAL 11. Food h stahlishnient Pernik Permit No: 38/2020 Date: 3/5/2020 I a a"mdancc-ttiith Regulations I rvnlulgatcd uc,drr uhe a'.4w sty of C;hjptcr 11 127A of dw Citn,r:a Iata��;a 1'cyanit is hereby granted to:Martha's Vineyard Smokehouse Location:2.3 I rtJcnv ay Rd TYpe of bus'ancss&,restrictions; I,i3nitcd Wholcmte Nxid-, To operate iry Edgarloa N a Expires: Mceenbcr 11,2020 Harold 1`.%adch V.(:arrct(Or:azov, DMl); lircran i1�.Laneasfrr�_ 1 '��. �___ Per the NIA Food Code, III COPY Of the 1110st "C"t c' t,lI.)liS lrlr rat I115 )'E'CtiG111 M"t' )t)l't is ,tv lilawe. upon re ue..5t. • Jennifer Morgan Williams J►:II-rl . l WC C'ILlilii � t,_'�ICi I Pi-vision OR` TNIN?RARY 1,(-�101) -Ost OT .�F` N(r tasr.sn YIn 110 U IJATAPA III " *.t!"t �, t CIE I>s lyt'r.�:,t�«�ti�r :�t,;�•<I I��,r��.�k.+ll�" � � � .���� .?�+ w ...I; � �...�'�Ik�Yk�r�: � - I•,?SCR`'.����li "4'+ F.� Iz_�,JI�I..�s'!��t_.e._ �.___...��+� �� ��^a4. ,�.��:,,b t <I•., I :.i � Y°:-s; •,:,:�: 9�'`'.�•.;"• t-. t t �"� � I :9 ! } 1 t t'7t,5"-•!. _ '��� �'� t_r �-17"4�?l'� �f' (•.E� 6h4 t It I�+.I 1' tiCy,. r- v ,' � (r°•a,z.! �' €��� . { b.Alf r.fP-S(Tt,drAr R:, 11I. I.I`,t� 1R'1 4E'a: I taT.V*r1(.{)r^IF'';()r14FRti°'_AVlc5. .ftt_1 VKGF'+I.FI 11d'>4T1F 1 1i.bllh_rt : 'IvJJFRFTOFTF' r0jlr��at�i�G�1,�;7,�3$r+es{� iiOT 1,f) H FF:IV'F 1) I�q .C.°* Pr �r TIC€F:�� 'tali Atc "Al C-r_,V 1. F:f)�_rF".,i-vI EIF.^+F.I`-I-I' a: L;t�_�ti(1'r' p 1,0It.k .11 1)F.(.Iw F h Fi()w l4-"]I.r. :t)(m aF:vP.i.a:ty Ito nt1'; FF-� F- l � ., d(d�`�4`i;k}�HfDD S�'3xL'��i9 " (YFF 0 F}:tA: Ts-WAS II� �`i� �Af'#I 115` a A7v� Per°rmL : M. i tt Dnvc Thgf, Reside-mial Kitchen License for 2020, rantpd N _ t Rai 7 "Qucen5 �Vay g 5aCtctwich, iA 02S63 F�'� - r,t 4"1 tear 1. 3Lf C1140 11 it S 04 qe a � with the �itat"tefl fend ordinances relAting thereto, 2ntl q r�itit,r'e� aK� �t,-rtlk�t�ratt.5` �d �tE* 1 . h,CC. This jai It�c�rt aa�[ eso-lo utdrw;' �u p03ld- or re��e�lced and is icon-tom 31 Ctt, d , fi st z�F r -�91 q► � rA n~$ - ,F� �° � � ��}i •C'%7 p�_ +ti.r•�Y� x. � a s 1TZ',J!3�' ws .c a.s.r w r n A ..�f,^�,� yy �a'ry•`�i Kk wdtt kfi'T 9.f yHiiL.Y�, l*iy _ : - `P'� •a t .. r a'7Sit#�ar a a,a.s, 4 c E E 0 F I N G 4 t � ERGEN_ L L �t �k t Date Date of I.,-'x0rat rI�•! � T •. yyat �$r � J,f w3 1 e r th tF araii L. e a °li3f�t'f .3'� t Y33 ?rd rr� -azna r .4 err rr rrt: l�r r�: Mt NAL_ 1tY 'S� . -1' u {� ! � S+sc Wj 765.21 22 , r-,, t-arzxtsm ` t �' t ,nia.r* � �. .., r ai .y�' tS'`� J �q � - _4#9�rC y '►as��i.a..n e a a r �p k � t Os(r vNilly 1• r(sT1� �Barw�tabt(, Public Health Divi6'm °r .l ,,.;r',l� � y� ':4 ,• ;tj'•. i4 . �."'1 , t!'� tii-;5Tl�,p �,:i�Anesi °:i ; tll: "•h !'ell��,= •� '� �. �7 ai1)1%j iP,)RNw..k rs.,ryrr .,s�°�,.:.. a�t it �..'.+.. ;...:�.d',.".a.'.t. �l.�.r•.a�;�f,fr«d...�l�.�:�a'ia.�� ._ _ _....�.�.. _°,•_� it r rr ° •.. ,.., �. ,, �fr . .g�L.,F. a[t1SPli� �' .fix __ _�+_ ... •I:1;� + ' 'me Win,..._.�`�.h.�J1��f^eLI.�.Awr' �1!C£�,e'� �}°'ad � � le -��.�� .r'� .,f`"?`."ia°:�.••;1�"r.�R.-`ar�fa��s, s.1,. � �.`,'�fr'a-S r _ _�,�,r .L�..f .ti 5���44lF �Fl.hd !"+3{� l .l�#3`6��Alr�.��f"�F7t) �t'w�.I lR. l�'I. ICI tt.11•�t'� 1� a a , Qx lc" b'a..,ULiI',"t G % W,11.�,..�rr l� �. Iu I+� Iii '`•Fl�:°• � l1.I a -i �? $� _..�_..��1i��rl ,m �n.� j' ii.', rp ..��..... !I , i 1`IF '°ail °., i,�l`It".!F7 taj' tl''�'e4 44 ? I i_ '1= .Jt ..} ! � '� e �•`, � ��;J•l�.2' { _, �S t°�-r^--�+� a»,,..,», ..,� /r"}'i' �: ! ° '4y.: t" ♦'1 .;17°�°; °°`.}���e� �. $ �- _, ._._.s.,L_*i..3.-'�..._.. :1.•�a..rr ru,r.•!�.u,,,e<.m�, :I:.'°!. i•tt 1!1�. !.� .... i.lg+Y� °f' d f s �.i 1�f.S ��1',r;w+� —�r�-•i—.t r a o: I� ,I t S'°"��'s I,i',i: ' S I i! 2 i 5 ��rt'.��'"�•°�� � �`��`_� �, ''y 'r,.,�il�� .t�,f g,.���'`�'��L t;e � � tWHO t A ) M -mom, ry S r S Arm maw E,R T I IF C AT I C J El 11 N I FEF: E?EAUREG FIN-1 fit. uasc� r x�r�y p �__vt _! 'e. a. :., r:4s y +n It a9 Awwk,a Nbopj main" I y / W77 8,42872 pxTE or I l fr rf .....--"""„�.,,�� fit•S. - t�i, r � ° �[ *� air CERTIFICATE F NLI- EPGENAWARENESS TRAINING �a 1 Luz ,1 t t. I+y. �fr4 "Avwin r^sRw-wrars i+`taa:t e°4v-/�eT i+a.raR}�•� r*".'4:a�.+ � � + owl �' �.,re.,�r�.+.-r ca,," !�� G.,'P..`v. + �,��,�,f � i�.�� i �Saa*�wt�,.•�r+������rsa=-- "� � ;:'o',•rrrnda r.^r s�en'�'.�r ar,+4,af,a;�r�+r%;,.'w,-,.,�"��ra..�arrr rdr R-�r'+.r:'�„-�. ,�,�..�1,-yy +� 10101c WAR" �j ti ��i�►rl �� . —�`�'�c`r� �a 1 APPI.f A 1 0 !N 11114 I E':"Y"A 'UN $ 1id17l till%1C Vk'`1•:RNII I VAN'. IIN 14!_1+:S hAI %P _, 11 M: 4i • , , ,, i; � " ,...�:`" ^, F:r� ,1 r-.I 4n I'P vi.°lr `4" l '1,�. Ii l-YFP"ffi i�`eit i F I a`.M I a'E,v: .z j,,,'+«:`.o.'.i " F ! 1 �.'�A`�,,.,a�;fi�.1....wh'a�;j�►. ..�.....,..�:.�...... .�,,:.,•.v--- IF:aD 0RVNI, t���V4'r*1R-ayR"W r,l.l.�[>1�. ►»r�yc �i�s ' 6 o mRx l`O"T V'T 1 1 e F t►0TU I I t II E, s&;N"«1:11 I I '=I f N.h(."I t'I�,.^s1.1 ti � 4 "•%MUSOFJ1WUNFD1?0II.�°,at,��I�� yl>aIa��t1%m1}.0(1�E`�d..E4'r,i1;� +,_II?1i1`4ti 4wVT:41;TOt`IE.tit•'1tVED r tr1kY7� T fk:�,iTt.1. at,L Fd►1`'� �tk ur*1 yvp J We",M) E{}rt''. 11F(-l'EO ? ��•�� �� 7 Ar' .5 t , I tote`4s K)00:ti Fu'p 4'1) emu:: . _ `. � '+� a EE� 1 j� r 114.',11 ARIM K c { 3 ;oi. 4 , e e _ -q '' -jz` , - _ =,r �- , J=aim_k �. TN ° ax y `..m`+S e.rMy..s'_ 1 e'l..fx SQ a:VNeW.02 v.T • t `;,�e x�i . "+s•z G. PO 1!NSO3N. 3"3 _e ,Lkl71' ��t��r�3.:1.A ,._ ce 46 s 'ggea. „t CITT i A-' r. z 9 ✓... spa v � t �����������a�,��fa� � � �°1�?7 h��"lh����tkd"T:. �� t b�✓1� i�'�S' ��� a d,� �: a. e € '' IFili7�� �ii ii � ,it��� li�i�li ii �a.z� � � Fri x,"•T��" n w� � 5 5 l�ea.7 .6•t1.�..►..k t • .��N.Y F N i R ,L -V,..1 C..A 1 1.+1 h.e iF S �1 f Ile, ,t I•rr,=4 e�i n•e�.•a 'h. �..si ii�i-t f li"�.�1 �_�i�. Ir c _... y e,. awn •N•z aYA.3.F` � � `� % A �o- . _ i�ir{ >.".�+.: <_'+�>c t}w.!i c�;.�•">4r..� tJt&-fit tl:af.`.a �,�"� .� c 2 c..,VZ 4„,4- NT C..'OFY .. � .,_ .._._.. ., � o " �' 6i(ta .4i1 "Y.R,: )x 1' '.•y,Iil tivvo p V Lo�eytx-f , j: .. r ML > R THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im ^ACC DATA } r e� a m �ryy i � �� ��.k 4:4�� �i�`Y 1 n�4's. �a 4_.. ��� u 4_ A i Y•._�t t. /,S, N t� . w r t MK 4l .Qk� y��sx OW ANON W Certificate of Adniever-nent CHIPMAN is_� :.r.4r ..-3'� �i .•V.-"a't:d dl �.J ervSafe° Food Handier 4 1 fir'a' 2 7 JL fIIE OF ALLIERG _ AvvAL.F,.-ENI- ESS. TRA- INI -N' G i .i'•IF 4J Date of compb�tiqrk� 1.71M OF i _ rt Jk11(H ('sw.6�'9 R-r � 'y t ` i P•YP ' Dalc of f...xpirm-ion: `� s,_ _.gym,.._. ,__.._._._._T��®..:`,.i- P , a IMF ra �ttd ' +m '1'= x r AI �etif.:at; �t�r ra tj� vain T�(1114,415 :: a�, - ,� i` :�I zrr-'am date: .•r3�`�' ti. �i, �+��,�,,I,�Lk q177 50-3434 t } &@*A t4xmlur—z RT 'YLLaar flr - t$u 1`cerr`iL.4 C It ,ml _ 11-arostable Public Health DiN Al"I'LACA-fic"'IN YORAJ."NIPOR.ARY 1,001) QhS1 ' On, IHI PNAWI 11 W "U" loon I 1.q r t bps; I n I v y Mill I I L 1=1 Lon 1 0 1 L P[I t'XIII 11) "i. N;Hit P!, !q, i NA If WP'P-I ...... W• I [RA Uq:!)FX UP I W DL ERS f 10 11"y kl :11 an %I N% it chlmm IWOH"I Muwzljl ME J`J It V I OR I N,,PEC I LON? JR)OMLL Uhln) nr KIN NkLO" U ill "A I I P. wou I(wo Fit.: ;I[,r,!) t 1 14-111 It 1;10.1 % V,yj . i �#.11 ve , —0 Ij Tfii� Res � a + � I{� 1 I -I se for II ' Pitt S,'arrdwic , ''"1A1: t:i55—�-r In x_�'<.Da�r'i 6 T i2i`: ��"4'7y-.i." �'• ;I<Iiti<:'CL It] 4'� [ tr'::� d4 (t 1�11' .a. s, atla��� the+s 4�f+ r s�i�ci e` ��i�^ ` 1 E,r1,Ft�f1unI� or � °.��)car IS pie i i Saf be ry CERTIHCATION JANET MOHRE �'st�� `. ,. �, "•e o5 .9c b t gla I'. 1 i ra. :{1� ".- 4 r� r" i► -'d` ___i��7 fir' _=r's p ._�±� r e. T�CLRT f IFIC 0 . 4 ;rill - ING - --r AWARERom.. � E N E �P Narix. of R 1 OL t.tfor + `°— f r�' r�f•� ' � �'�r�r + zrr.��L-�r',,,ra���,� 1 x�y� r `� r ��-�..�,�.,,? �`v�C[f� rt:,:�r�avtr zl+} af tlt� �; �" ,t J p� 'a ,.ttt I R t1L J h; � e +') , f r• Ka�4'���+1��J9�tf�d���r..� atsr.'�Lc't.h:�ii�'�Ci A; O�.�4D a:$ < .�;• g91a�1 ! "1 't �� y. - srCi�.i 3, �d it �u 3.. a� � 1 'ram fif(,,J �� l�tL �l *��a� W3tVfr.PC#f i mo ; � •s•'.�+'�# {;e" � 6 - n. , e " s. mop . t#` 1 ti r ti^ A 3 ��+� s�� 1 "W. raa 0(7 e.Y � 1' � A ^ j Tel-La's Braids jjt (j j3re V ,I(Is Scandina%rjan, coff(!F,, breads, c -c.5 Fillnish NiSU P, ull,l- wedish Veteb I-ctrj card-wi,---,brat iN yo,,, A I I*,u r,d Crar.but ty 0 r.i O-Inj-;It Focxi.Almund. c:- Lca',Qn Swcdkh Almond Norwegian Apple pie-c-inmamun.applelffAir;! 7'1�0(110013.31 S"WVfti!;h RVL' Ur LiIIIIIa (10:3f] C,are of yo Li r brea ds,- j" fw!"I 1:0 r QI-6L-TN-- 508-364-01- 19 F 13 I'ci kt.a',.-- 11 r-,i id an d Bread; Osterville Rimers Market- Friday- mid jury;:- mid Sept, Chatham Farmers Market- Tues., 3,.00;-6-30, mid May- Med QCX, rEpols, r n s Q 1)1 cc I 4110c; licytIl � ��.o _:s� � � . FOR -j*j_:,Njp()tj.,�jZy 1:()())) ;1��� �� FC�I�Cfi��'C— NAN"!OF MCIAL Evtvv rr �I A BY TUF POAMI AT IV I " IC A—Y h2usk---------------- Y or 01-:6,MN 17 k I t A—if r I IQ ; ki �F QMIPF -'w 14C. NAMFS OF I KAIMP) Mos 11 INWra" 17 1q. 100 1: It; IIIM; FAWN 1 1: f.tri .uw4 .,%rt"mo.,., writ!;, j 4)HE.,'�KRVFD Q2tSlviflsAbKz -�-1 N WMAK ON!" I N I r %vl L 1. ALL EQNPIM&Ar SETA T 111 1 CJ0?4 C 'rt jj()S ' W11J. pf)()t) l*, K}ll.! 14ELIA; 4[ D.lA.HKF HCAV VOLL FOOD BE HELVAT J4U DbfVAKFVX J� HOWIS FOOD CCIVFREDW� 'n*i,E: FAC11,1TY AGNATURP ti., . .. ... -- --.----- Wz 5^Yus Hobo, 7-MIYA& e M e � .. w � ✓ �.���£�' � ..€ � ire ��a � � �� , �� fz r lilt 14�11, sir a 5 1 LR .. �' v 3 f, m w $��i�'a�� w�� 1�"'?Y�+t xn 4 Y �1t$°'°r+�`d'00 � 'sr1 ay i ds w 2'f rS�a* .trf Of +r37�R"n` .4mat Carrrr� " ,arcs �aiv- �rt 'i�� � 1 �t°.rm tc ,hv f + Ott ".tJ�: ir, yw . t .. F !f'A.n. .... •. t.` C�*rl`,.k*3-'+t,r tvt�+r�a'a.?r ��*dust-.«�r'Y �a�-A ,rt, ri�n!s,�rmr; 'i , .. [_ - °,� coy ur I:,;ird WPM Ig r?i]r c. ,;r � .. '�� -• Y , d.a . �cri cv ftor1;C'h':7F'. v abut &1 w thp1r hirds, fro Ok `os3Pt"ipV i it tr -�.) v i .,art :Yi d tor r r tarry a v"tesju d cfi.mmm wx wGh a sprat hard s°==P, p pr�f tc.yaf`" r:r tw WNPAV..= :'.Bf�t?ar'S, r�i`B`;ir�ta°,"t'rY 4�Y'`l>'�i;,'r't7S.2 he'd?Q�1�"a'�•S 4Mh�':E7 Yats 1�.a::`k:. CW scanp;ane C At1.,,' ` itef '�09 Vk-d Wlfeeach v 'of. We farry{'7awple yi1,h i i tK.it jjr ! for !*t?r'r"irv-,11*01 wal4al hi a Lua, ,et 7th twpy water (one for Ice c- anis md, noths,vr f rb 'ts),ri-i"R c jn;!pjji 1 wag r b u OK g Y 0 iO p ed fn another bu6ct hAnd Wul yvatee treated Oft, StebOP,en,and then drat Cut Gra pir ery on a rack. WC brinK t:.AQ'I wi tff w-'th us(cT rcmm- l r,;!wa. h, rinsw, and sAnititir,}K W-Xe(� Me Gwrdt,&C'7f'sailh this° I-,kjw c`_d,'rtlf;bd.d u!�have Lven @X°t errll'S 1 h&lpf4t it)gLAkng p� Iq£i,,!Fitie our<,yskern to be aV1`t43 s. fo`i''V serve the pfAAC. a e are grate ful,for tfi&- r kind assistance and ski G iithnue to implemcm, alt We are happy ELI is1t•si,'3jjtii "`royclrrequim-, L � �v � A v t -s PEF`tVII Nuv,1ALVk THEY MA AC.Htj-F—,, r-T FEE To VN _ IN TON THIS IS TO CERTIFY THAT ��� o; �.�; :. ► ,�a���- � � R ;.� . �— Ainj T �..�I:L 4 G STREET I—LULL MA f-12 4 3 18 HEREBY GRANTEE) A LICENSE FOR : CATERING 68 MAIN ST E SE r5 ,RANTED fF�1CONFs�F;NIITY WITH THE.5TA-TUTES. N1) oRr)l�+1}lNCF REL.d4'�`iNGTO THERETO,A hD THIS LIB — � 22OU2Ou UtiLE.`aS, S0C)h SP o;:C ER SUE4 0R REYQKf-D EXPIRES ON C)E�E�1�E t �I, D,Ite lsst e(i ArthIur jJoy1' , Ro,Ith Agent p m+tt�ea33 F P ServSafe , (.ERTIFICATION ROBIN FLINT d Y Ik i f r t ° ,� t rrxr Aix � n , S 1 y, -.-�,a■�'.-_� � f3'JAlaEcim.��9.'t`aFss TRAINING E N % S . OF CERTIFICATE 4 . tt ALLE AWARERG, ' e, M t,e Nanwc of ,_�.ip'cvtt. Certificate Nuiubcr: Vatc of Completion. t Date of Expiration: s 4' .• u Eli OA r RX ti Lim fd perv,r:is A C,�,�.,�- !' Ff , d _t l 4Asa7m.' E �f5 Yt4tfS1'. !,�."[.` 7r'2itsrti.W N ( t :sS 63°Y=t` tb°ra�tf'��tl+s��f3 5 � sSd,4 4 X1 4J 1i�9 xj REST AU CCANT � Tu. 6�hlw 3i�1�I if i w�Sfi l i � � a� Stdlte W214"+IMY rTA�ttUa�2l3 r�, to { > e � ��- �q y�31�- 'i,�. _a b a i f •9 t a f�Y i l.a M f b l a tl! �MF-& Barnstable 11calth Divis ot, APITIC'AT[ON' VOR TI`:)I 'I R,� RY 1=a:�4)E� Sl:t�� 1r�'��:�'•l:?���C� 'rv" Nlarket 2020 Seas'o'n vPKI.YEDRYI HERO%RDA1 API.BI, CME ;r'"' X �h�4��1}' T' FG`?,!-}°ad'.'�I k?:�;,�"F:tiT�I`tii; PF'>���111 Ih'�'�IF`}'3��'�1 ��F1.1,d,5 '4 h::�sE i l t I'r`�':f.)�I�".$�:�1''1�• tlt"t*4!E-.�.UU}LL'-•`. ���� -,� }� ,, I: ,,,� �®.'`II ; .x�:F. ��r t'�'I��� . _.�_. .. ._ R r fY)`rf3C'1'�'ka'�.'-.f31�v ..1 °. t r +Cr�'�� .: I F I '� f•l1ii".F _-- 1 ?4r tXAa-I i�_ 10h�I H 9i.i T�td3f.:SF:I�'�'�� f: ta.OIF ` {"tF' 11i-1, tiFll f t!�`I]? 11 4'�Ill Fits Il�'4f 1'F:C) �i X..i:��`uiN(,;v.� l s,FRN - xF '.' ." I F1:OFN F.C+ nym kW'! %pC. p[p,w S"571F FtiE I F r. ��.'�. ."'. Iw _. S 44' t a�Stn 1+ i irW,r,til., `1,A��?rw`'• V-)ATV.I...(t 1:F: `,,.R'� 1la f l l"�1t" F4f3 V KIT 0, 4tF'hl�". "arIItl'itiI,V.(``��[f'V�,' QFHF:€.kM =1 I1}];41tA1- .'`Q ; 11CAIM11 I I t}IM HE IIF i.l; :"t-I- IMI 1?:;€;6`F F S F. T _ tii145 15 Ut)f !1 ht JtI r )1 fMMLLIVIIS lrsr. v u s �F '! tI aTIl23g VMN } ram+ i i i, `e�:"�,.t;on offi .�.a ,�` } rcti;-,t:rc by ncc Sc a y.._e _.?od.a.:-�.9 t: l� � ,;.f,.- I.J., . •i�.� �1." i i F t E:t. 1 t`�►' FXPIRf,S- D ecembc r 31� I fl y) tj ! T E "' G7 x; > ALLERGEf ENESS d! NANAAR r { �y1 u r s, l CrZ.1 C t Number: 4 GO rr I FF f�� r i T 7 > i9r�tddF r2 t>r ar'r¢'a, r�.'°, .j��fr.Sf:j��s*3 BIRO _ l ' :c 3ttuC::y}:•ar,1t" . .. :v. r�, t.: ;- � f1 _ ar t f J':t¢ ,�Tt;-.1"�tn �'3 Turn ..tXc �ti�aa+. `•„ ,r, 11�`, �y'`�^ 1 '. 1(prn {t'rt;. t[Y�dlCst� we14 Y� r2!"trfi J `fit fire;,, z {ayy� �'`1�1. Al •r�� � �_t"?_tilt `�`vtil� � r �"�� ��"; FPT ervSafe CERTIFICATION MARIA LEMANIS c vr�ttr}� €S occmd,,;IM by fW,, 1�1 #,xm-� Nc-•xi Sion ch 6-,sa l mi 'f�.�N-40a►on(r-s°pf fit`14d 2 �o 9/14Loor zE R° ay OF 1dE Tpk dARNSTAdLE, + . 9 1639. pp 1639. ,Bo Y Use of Town Property Application Applicant's Name Susan Wilson First Last Applicant's Email Applicant's Cell Phone �suewilson@capecodpride.org ((617) 645-8130 O ganization's Name _ Organization's Website [Cape Cod PRIDE http://capecodpride.org Mailing Address PO Box 246 Address Line 1 (Mashpee J Massachusetts 02649 City State Zip Code Event Name/Title Expected Attendance Admission Fee Cape Cod PRIDE Festival 2020 1,500 1 1$0.00 Location of Event Type of Event 0 Hyannis Village Green ❑Aselton Park 0 Festival/Fair ❑ Charity ❑ Hyannis Harbor ❑ Hyannis Main Street Benefit/Fundraiser Overlook ❑ "A-thon"(run/bike/etc) ❑ Ceremony ❑ Osterville Main Street ❑ Craigville Beach ❑ Farmers Market ❑ Parade 131 ❑ Procession ❑ Rally Please describe your proposed event_ C pea Cod PRIDE Festival is a celebration of the Cape's LGBTQ Community, with music, speakers, entertainers, politicians, raffle, vendors, food trucks, and more. It is free to the public. Is this event public or Is this event reoccuring multiple times throughout a private? single calendar year? O Public O Private 0 Yes O No Set Up Date Set Up Start Time Clean Up Date Clean Up End Time 6/27/2020 -' — 1 8:00 AM ^^m ry � 6/27/2020 y mm m 6:00 PM Event Start Date Event End Date Event Start Time Event End Time j 6/27/2020.. 6/27/2020 112:00 PM ! 5:00 PM Requested Rain Date _ Please attach a copy of your site plan sNone. ._ Public Safety `The Town will notify event organizer if additional permits and approvals are required, based upon information submitted. Will private"security be provided? O Yes O No Will on-site medical services be provided? O Yes O No Will propane be used at event? Will portable heaters be provided at O Yes O No event? O Yes O No Will the event be filmed? O Yes O No Will Media/Press be present at If yes, please describe in more detail (companies, number of your event? people,vehicles, etc) O Yes O No Not known. This event is open to the public, and usually reporters are present. Will the event be promoted through If yes, please list sites and hashtags Social Media? Facebook and Meet Up O Yes O No -- Public Works Will this event require a road closure? Road Closure Form O Yes O No Will vehicles need to be on the Please describe need: property? 3+ Food Trucks will be on the path on the Village O Yes O No Green Will town owned cones/barriers be needed? O Yes O No Are town comfort stations being requested (if Will portable toilets be on site? Number available)? O Yes O No 3 O Yes O No Private Waste Removal #of General Waste #of Recyclable Bins O Yes O No Bins L6____ Will a Portable Generator be on site? Is Town Electricity being requested? O Yes O No O Yes O No Will public art be offered at event? O Yes O No Inspectional Services *The Town will notify event organizer if additional permits are required, based upon information submitted. Tents O Yes O No Will Chairs/Tables be provided by Company Name _ event? Bayside Tent O Yes O No __ _...___...............Will a temporary stage be Will temporary fencing be erected? installed? O Yes O No O Yes O No Signs/Banners # Temporary Sign Permit Temporary Banner Permit O Yes O No Will Inflatables be on site? Company Name and Contact Information O Yes O No [Boston Balloon Factory -rainbow balloon arch at Main St. entrance Jenna Blum 781-956-9836 *The Town will notify event organizer if additional permit is required, based upon information submitted. Health *The Town will notify event organizer if additional permit is required, based upon information submitted. Will food be offered at the Will the food be prepared off Will food be prepared on site? event? Site? O Yes O No O Yes 0 No 0 Yes 0 No Prepackaged food? Will raw shellfish be offered? Will food trucks be at event? O Yes O No O Yes O No O Yes O No How many hand washing stations? _ __. ........................_,__ _,.... Are animals part of the event(petting zoo, pony rides)? O Yes O No Licensing and Town Clerk *The Town will notify event organizer if additional permits are required, based upon information submitted. Will beer/wine be offered at event? If yes, please submit written O Yes O No safety plan Will a raffle/live auction be included in event? Entertainment? Amplification? O Yes O No O Yes O No O Yes O No Will vendors be at event? O Yes O No Parking Will staff/volunteers/vendors need parking Will a shuttle service be provided? permits? O Yes O No O Yes O No Will a public parking lot need to be closed? O Yes O No As a condition of the Use of Town Property approval, the Event Organizer agrees to indemnify, defend and hold harmless the Town of Barnstable and all of its officers and employees against any and all suits, causes of action or claims for injuries, damages, costs and expenses to persons or property, whether public or private, that may arise out of, or be constituting a part of the special event, or any activity constituting a part of the special event, or any act, omission or misconduct of the permit holder or his/her agents, representatives, contractors, employees or volunteers. The permit holder agrees to discharge any and all judgments that may be rendered against the Town of Barnstable or its officers and employees in connection with any suit, cause of action, or claim after the judgment becomes final and unappealable. Applicant Agrees to Indemnification Clause Signature O Yes O No a! ` T7 ff . ............. I I a a a s I:F. I + �1 E� i I� Jill#41.1� 'Shl .�.I I 'Ill II . — — ,4-n,-J1; 5) I R5u`1 Hartsgrove, Elizabeth To: Sue Wilson Subject: RE: CapePride From: Sue Wilson [mailto:suewilson(a)capecodpride.org] Sent: Tuesday, February 4, 2020 1:26 PM To: Hartsgrove, Elizabeth Subject: Re: CapePride Hi Liz -attached is the 2019 final site plan. Last year's food trucks are listed, and there are some different food trucks this year, but otherwise the plan is basically the same. As we get closer, and the food trucks get permitted, and vendors committed, I will send you a detailed 2020 site plan. The basic layout is the same for 2019 and 2020, with one exception-we plan to set up a second Welcome Table at the parking lot end of the Green. i Also, we will have pop tents again, .but no installed tents. i Thanks so much, Sue : { 1 0 YES BUILDING: REVIEWED BY: DATE: ©YES IH EALTH: Temporary food permits are required for all food trucks not d. bellaire 02/04/2020 permitted in the Town of Barnstable and all stand alone food REVIEWED BY: DATE: vendors. Please contact dianna.bellaire@town.barnstable.ma.us for list of food trucks and procedures for food permits. YES LICENSING: REVIEWED BY: DATE: 0 YES POLICE: REVIEWED BY: DATE: ©YES FIRE: Conditional approval... Food trucks cooking with flame will need David Webb 2/4/2020 permits/inspection prior. HyFD will need centralized space to park REVIEWED BY: DATE: pickup truck and 10x10 tent for outreach and EMS equipment. Contact Capt Webb @ 508-775-1300 for further details. 0 YES LIABILITY: REVIEWED BY: DATE: YES ARTS & CULTURE: REVIEWED BY: DATE: Use of Town Property Application Event: Cape PRIDE Festival Location: Hyannis Village GreenDates: June 27, 2020 4 I YEs DPW: REVIEWED BY: DATE: O YEs HARBORMASTER: REVIEWED BY: DATE: YES RECREATION: REVIEWED BY: DATE: YES PARKING: Special Event Parking Permits required for event organizers and vendors in need of parking on town property for longer than 6 hours. Please contact Parking Mgt.at 200 Main St.,in advance of event to S O I m 0 n to 2�4�2020 apply for the$15/day per parking permit.Compliance with Parking Regulations(adherence to posted REVIEWED BY: DATE: signage and pavement markings)will be managed by Town of Barnstable Parking Management. YES TOWN CLERK: REVIEWED BY: DATE e • • OEM Special Event Approved subject to conditions within Section 4. Application Denied, for the following reason: Town Manager's Signature Date Use of Town Property Application Event: Cape PRIDE Festival location: Hyannis Village Greerl�ates: June 27, 2020 5 e i pp IKE,may, TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of OFFICE HOURS p ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 130-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date verified 'gyp ,639•0� HYANNIS,MA 02601 M-8 -464-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY AA 0I lau Mp+ 508 FOOD ESTA LISHMENT INSP CTI N REPORT 1 goo. Name Date ,Type of Type of Inspection Operations) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Pre-operation Owner HACCP Y< Temporary Suspect Illness General Complai t Person in Charge(PIC) Time Bed&Breakfast HACCP In- Other InspectorY9 a/v / _ Each violation checked requires an explanation on the narrative age(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 Ag ❑ 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 r 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 I ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22:Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ® Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g y ❑ ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than it' I violations. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non crifcal violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violati ns= 30.Other DATE OF RE-INSPECTION: Inspe s 'gnature st: 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 Printfolviv Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 r15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 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) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed 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* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources Fg 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 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* 3-40L11A(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 Not Otherwise Processed to Eliminate Equipment ( )O Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g : Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 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 AutWINhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401. 11 Eating,Drinking or Using Tobacco* * Requirements. $ 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 Commerciall 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification r25. 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* Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance3-402.12 Records,Creation and Retention Within 4 HoursWater,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients• Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Y5 6�;S� bAMV °F IKE ram, TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: SA Date: age: Of ti OFFICE HOURS BAR E. PUBS 0 MAW SIC TREET 3:00 30-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified MON3:30-4:30 P.M. HYANNIS,MA02601 sos�08-8 -FRI.s2osaa No Reference R-.Red Item LEASE PRINT CLEA LtY FOOD ES ABLISHMENT INSP TION REPORT Name ate Tyoe of Tvoe of Inspection / Ooeration(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: J Pre-operation Owner ACCP Y/N Tempora Suspect Illness Ca-rer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP _ tn� Other Inspector ut: v Each violation checked requires an explanation on the narrati a pages)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 F VP EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives l /'' ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals V m FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. . (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. O ❑ 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ® g ❑ g _ y ❑ ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 g ) 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. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 t 8 non criti al violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8npn-criical viola)• s= 29.Special Requirements (590.009) y p �- - 30.Other DATE OF RE-INSPECTION: In s ignature 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 IN0 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 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-]03.11 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 1 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System 8g Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 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 Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1] Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 1 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 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. I _ f `OFIKE ro�ry TOWN OF BARNSTABLE . 0 . HEALTH INSPECTOR'S Establishment Name: l U Date: at of �/ v OFFICE HOURS �t�� P �^ PUBLIC HEALTH DIVISION r, 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET /yn s:M N.-FP.M. Item Code C-Critical Item DES RIP I + 10 TION/PLAN OF CORRECTION Date Verified v "'ASS. dg HYANNIS,MA 02601 'Vhbr(��JJJ """ 08-8 -FRi. No Reference R-Red Item PLEASE PRINT CLEARLY �A +a79•p. 508�62�644 'FDN1�' FOOD 9PTAIBLISHMEh T INSPEiCTIjJDN REPORT 4- Af Name Date a of Type of Inspection i woo iOoerationfsl Routine L] Address Risk Food Service Re-inspection t Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N porary Suspect Illness 4 General Complaint Person in Charge(PIC) Time Bed&Breakfast C n� OthHA CP er - f Inspector t.'. Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and isk Factors(Red Items) Anti-Choking 590.009(E) vr �a 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 'py ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives.. ❑ 3.Personnel with Infectious Restricted/Excluded ❑15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [19.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 16.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail 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 y y ❑ Voluntary Compliance ❑ Employee Restrictidn/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. FC-4 590.005 B=One critical violation and less than Orion-critical violations 9 25.Equipment and Utensils ( )( ) 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 or lack of no hot C=2 critical violations and less than 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8rion-critical viol ions=9. 30.Other DATE OF RE-INSPECTION: I sp or i n 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 INSignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N r Dumpster Screen? Y N - 777 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 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH •3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 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 Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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 Reservice of Food* 7-204.12 Chemicals for Washin 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * s nvc 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) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan i Contact Surfaces of Equipment* Shellfish* j 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* ( ) ( ) ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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. violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices shhouou ld be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the 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* g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .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 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. �FAkf`OF IKE roy, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: -6 4SDate: ® age: of 6 ` g OFFICE HOURS P PUBLIC HEALTH DIVISION ' 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET ^ 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified , MASS. g (/ MON.-FRI. q. �+ HYANNIS,MA 02601 508-862-4644 No Reference R-,Red Item PLEASE PRINT CLEARLY 'FDN1"'' FOOD ESTABLISHMENT INSPEfTPkREPORT / J Name Date T e f f In c ion oeration(s) Routine Address Risk i I Food Service pection Level Retail Previous Inspection Telephone Residential Kitchen Date: ✓ Pre-operation itOwner HACCP Y/N Tempora Suspect Illness i" General Complaint Person in Charge(PIC) p Time Bed&Breakfast HACCPOther r In: Inspector VD&N , p Each violation checked requires 6e,p anation 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 ❑ 1.PIC Assigned/,Knowledgeable/Duties ❑ 13.Handwash Facilities j 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 El 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 , 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 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 p suspension critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in sus ension or revocation of the food if no critical violations observed,4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-crit al violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to non-critical violati` s= /� 30.Other DATE OF RE-INSPECTION: Insp cto s ature 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed PIC's Signatu 71 Print: Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N �� V fV/ 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* 8P3-302.11(A)(2) Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 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 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 r 590.003(C) Responsibility of the Pelson-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(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 Chazge* Contamination from the Consumer 3 590.003(D) lExclusions and Restrictions*590.003(E) Removal of Exclusions and Restricti 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP ons Disposition of 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 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened e-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(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* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cd-vinooi 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- s 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 Sources* sec m and residential ing,mobile a food,temporary 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Wild Mushrooms Approved B Game and pp y * 2-301.11 Clean Condition-Hands and Arms al Foods k in a Microwave the appropriate sections above if related to Regulatory Authority 3-401.12 RawAnimal oo Cooked 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* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3 403.11(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* 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 3-501.14(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 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I Bellaire, Dianna From: Miorandi, Donna Sent: Tuesday, August 04, 2020 11:32 AM To: Bellaire, Dianna Cc: Stanton, David Subject: FW: Lobsters at a Farmers' Market Hi David and Dianna: This is what I got from Amy VonHone and it was a great help in addition to what you both have found. I shall forward this onto Jennifer Williams so she can inform the potential vendor for lobsters the whole requirement. Thanks again!!! G. Anna 2. ioranei, A�. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 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. From: Amy von Hone [mai Ito:avonhone@brewster-ma.gov] Sent: Tuesday, August 4, 2020 11:12 AM To: Miorandi, Donna Subject: RE: Lobsters at a Farmers' Market Hi Donna- Yes—we have allowed the sale of fresh lobsters at our Farmers Market. Our local permit is the easy part where we license them through a Farmers Market Retail Food Permit. MA Division of Marine Fisheries requires a dealer permit through the state. The website at the bottom link describes the types of state permits available. If the vendor is catching the lobsters themselves, the Retail Boat Seafood Dealer Permit is probably the permit that fits best for their use. The website also provides the permit package required for the state permitting. We require a copy of all the required DMF permits when they apply for the Farmers Market. https://www.mass.gov/service-details/seafood-dealer- ermits Hopefully this helps. Hope you guys are hanging on in Barnstable. Brewster is busy enough for me—I can't imagine what you are dealing with in Barnstable! Best, Amy Amy L. von Hone, R.S., C.H.O. 1 Brewster Health Director (0) 508.896.3701 X1120 (F) 508.896.4538 From: Miorandi, Donna Sent: Monday, August 3, 2020 4:18 PM To: 'brhealth@brewster.ma.gov' Subject: Lobsters at a Farmers' Market Hi Amy : I hope all is well with you. If you have time I have a question for you regarding selling lobsters at a Farmers' Market. I saw online a story about a couple who are selling lobsters at the Brewster Farmers' Market and they said it was a bit of a process in getting a "special permit". I see nothing in Farmers' Market guidance prohibiting the sale of lobsters. It mentions shellfish but not crustaceans. Any knowledge on this that would be helpful would be greatly appreciated. Thanks and take care. Lbonna.Z. JVGiorandR, �. i Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 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. 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!' 2 �d� ��� ����� --- �-- 6 1 l ` TEMP FOOD CHECKLIST it- EVENT NAME:FARMER'S MARKET HYANNIS OT REQUEST:N CONTACT NAME: LEANNE ANDERSON EVENT ADDRESS: 1336 PHINNEY'S LN,HYANNIS CONTACT PH#: 508-790-4200 ext 103 EVENT DATE: 05 22-2020 TO 09-04-2020 CONTACT EMAIL: leanne@capecodbeer.com VENDOR FOOD HANDLERS S YR SS 3 YR SS ALLERGEN LICENSE EVENT FOOD CAPEABILITIES N/A N/A N/A N/A N/A I NO PERMIT REQUIRED. HIPPY PILGRIM N/A N/A N/A N/A N/A NO PERMIT REQUIRED —zr LITTLE RIVER BEEWORKS N/A N/A N/A N/A N/A NO PERMIT REQUIRED MONOPATI Maria Lemanis X n/a X X OLIVES,OLIVE OIL,HONEY,BAKED GOODS,PEANUT AND ALMOND BUTTER NEOME'S PORTUGUESE STUFFIES Neome Hollis X ix PRE-PACKAGED FROZEN QUAHOGS UNDERGROUND BAKERY Ian Sullivan X n/a X X PRE-PACKAGED BAKED GOODS,FOCCIA BREAD,COOKIES,COFFEE CAKE,PIES Laurie Decost X n/a X WHOOPIE PIES VALCOURT SUGAR SHACK N/A N/A N/A N/A N/A NO PERMIT REQUIRED-PURE MAPLE PRODUCTS WICKED GOOD KETTLE CORN Jeffrey Paine X N/A X X KETTLE CORN f gat` March 1,2020 ; Dianna Bellaire Town of Barnstable U Health Department 200 Main Street Hyannis, MA 02601 Dear Dianna: Attached is the required documentation for the renewal of Cape Cod Beer's Farmers' Market. Our'markets will be every Friday starting.on May 22°d and ending on September 0'.We'will have no more than thirteen vendors each week. The market will begin at 3PM and end at 6PM,our normal closing time.Many of our vendors sell nonfood related products. As in pastyears,we have gathered all the necessary information for all food related vendors for you. This packet includes: • The Cape Cod Beer overall application for the market:: • The Mission and Operational Guidelines of our market. • The floor plan for the market. • Sery Safe and Allergen certification from Cape Cod Beer(Beth Marcus). • Individual Applications for each food related vendor with permit,sery safe and allergen included. • A check for$180(this has been the fee for the last 5 years). Please let me know if this has changed.. 2020 Food Vendors included in application: • MONOPATI: Extra Virgin Olive Oil,Black Olives,Figs, Wine and Spirits, Grapes,Hone.yand many other types of fruit, vegetable,or spices. Sery Safe,Allergen and License included. • NEOME'S PORTUGUESE STUFFIES:Frozen Stuffed Quahogs, Sery Safe,Allergen and License.included. • UNDERGROUND BAKERY: Focaccia Bread, Spent Grain Bread, Cookies;Coffee Cake.and Whoopie Pies, all pre-packaged. Sery Safe,Allergen and License.included. • WICKED GOOD KETTLE CORN:Popping acid Selling Kettle Corn on site, sold in twist tied bags. Sery Safe,Allergen and License included. Below includes the list of exempt food.product vendors:' CAPEABILITIES: Basil,Tomatoes, Cucumbers; Salt,other fr sh vegetables as the season merits.No 1 .additional certificates needed. .— �'�• VALCOURT SUGAR SHACK: Pure maple products.No additional certificates needed. LITTLE RIVER BEEWORKS: Unprocessed and raw honey products.No additional certificates needed: A , .- HIPPY PILL M:Prepackaged spice mixes.No sampling/food handling.No additional certificates needed. U �9 V1( of ylkA If you need anything further, please let me know. Thanking you in advance, Leanne Anderson Cape Cod Beer, Inc. Phone:508-790-4200 Ext 103 leanne. @capecodbeer.coin Cape Cod Beer • 1336 Phinney's Lane • Hyannis, MA 0.2601 508-790-420.0 www.CapeCodBeer.com Town of Barnstable Regulatory Services { ' aA&MABIX p' Richard V. Scali,Director BAMSTABLE 9 MASS. i6 9. `0v Public Health Division Thomas M.McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508=790-6304 MAIL TO:TOWN OF B:ARNSTABLE PUBLIC HEALTH DIVISION 200.1MAMSTREET HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE A CHECK FOR S40.00 ONE DAY;S50.00 (2+DAYS)AND A COPY OF YOUR FOOD SANITATION TRAINING(E.G.ServSaie)CERTIFICATE AND ALLERGEN CERTIFICATE ALLOW SIXTY DAYS TO PROCESS(Piease see instructions on the next page) APPLICATION FOR TEMPORARY FOOD SERVICE PERMIT DATE March 1, 2020 NAME OF SPECIAL EVENT Farmers' Market at Cape Cod Beer WAS THIS EVENT APPROVED BY THE BOARD AT A PUBLIC.MEETING? Y X NT NAME OF PERSONS)REQUESTING PER.Mrr Leanne Anderson, Community Event.Coordinator, Cape Cod Beer TELEPHONE#508-790-4200 z103 CELL# 774-454-1098 HOME ADDRESS 1336.Phinney's Lane VILLAGE Hyannis NAME OF ORGANIZATION Cape Cod Beer CONTACTPERSON Leanne Anderson TELEPHONE 508-790-4200 ADDRESS 1336 Phinney's Lane Hyannis, MA 02601 FOOD TO BE SERVED(LIST EXACT FOODS) See attached. NAMES OF TRAINED FOOD HANDLERS(TO BE O\'SITE DITFJNG EVENT): See attached:. (.ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED Friday 5122-9 NA DATE TO.BE SERVED ✓y TIME 3-6m RAIN AIN DATE WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FOR INSPECTION? 3pm HOW WILL FOOD BE KEPT BELOW 41 DEGREES F Coolers/Freezers/Ice Packs HOW WILL.FOOD BE HELD AT 140 DEGREES F. See attached where applicable HOW IS FOOD COVERED Food will be covered or prepackaged' HOW IS FOOD SERVED See Attached. TYPE OF HAND-WASHING FACILITY On Site. (SIGNATURE OF APPLICANT) p. Farmers Market Meets Happy Hour Mission and Operational Guidelines Dates: Fridays from 3-6 pm starting May22;2020 through September 4,2020. Fees: Due to the high number of last-minute,cancellations in 20.19,we will be charging each vendor,a one-time fee of$50 at the beginning of the season.This fee will ensure that vendors will arrive for their chosen date.This fee will be$50 whether,you participate in a single market or every market.These funds.also go to cover our permitting costs,and the musicians who play weekly. Priorities: • The safety of our visitors • The enhancement of our guest's experience, • The upholding of all applicable town and state regulations • The profitability of the market itself for all participants Goals: • To promote locally made,locally grown,,and local producers. •: To uphold Cape Cod Beer's commitment to Customer Service;Environment;Qualty.and Community—and;hay.e the market reflect these"pillars"in how it is operated and perceived by its visitors. • To educate Cape Cod Beer's visitors on the importance of supporting local producers:&growers. Operational Guidelines Vendor Equipment:Each vendor is responsible for providing and removing,any and all equipment and supplies that he/she requires doing business at the site,including signs;tables,chairs and the like.The use of canopies(i0x10 only)and umbrellas are allowed however,each vendor must provide secure anchoring.of all.canopies and umbrellas using weights and or tie downs. In addition,all vendors are responsible.for removing all.garbage from their site.Recycling is mandatory ask us where to. recycle your stuff if you need to. Signs:All individual vendor signs must remain within the.allotted vendor's exhibit space.and must not block traffic or pedestrian's right of way or interfere with other vendor's displays.All items offered for sale will be clearly labeled and,priced .and each vendor will post a sign of the fare/company name.Source/Origin is required if not grown by your.farm. Scales: In addition,all vendors must utilize legal scales with a.current weights and measures stamp.Ifselling'pre-packed. produce,weight/price must be posted. Permitted Market Items:Vendors shall sell only agricultural,horticultural or food items that they themselves have gro Am, produced or processed.Baked goods and.other processed or specialty foods can be sold with the approval of the Market Manager and require a permit from the Barnstable Board of Health. Please disclose all products when filing your application. with Market Manager. Changes may require additional approval from Board of Health.The Market.Manager will maintain.a. file of all Board of Health Permits.The Market.Manager:has the right to ask that products be removed from stalls by the. vendors if they detract from the overall quality of the:market.Items not produced by the vending farm or business shall,be clearly marked,stating where they are grown or produced and must be approved by the Market Manager: Enforcement of Rules:The Market Manager.is responsible for enforcing the market rules.Possible violations or unresolved issues.will be discussed prior to the next marketdate.If a vendor fails or refuses to adhere to any decision duly made,then the vendor may be expelled for the balance of the market season. Participation:Vendors are expected,to attend all markets that have been assignedto them by the market manager. In. rate case that you must cancel,the vendor must notify the Market Manager by the Wednesday prior to the date of absence.More than two cancellations or a single"no call no show"will.result in loss of participation in the market for the remainder of the season.All vendors are expected to arrive at 2pm. Location of vendor space is assigned first come first served and.based on size requirements. Assignment of Dates:Dates will be assigned on a first come first served.basis with an effort to not overlap productvendom (ie jewelry or signs etc). Invoices will be sent via email upon receipt:of your completed form.Payment is expected by May l if spaces are not paid for by that time they will be surrendered. Link to survey form: https://tinyuri.com/yx4z34on Questions? Contact Market Manager Leanne Anderson LeannegCapeCodBeer.com 508-790-4200 x103 Cape.Cod Beer • 1336 Phinney's Lane ■ Hyannis, MA.■ 02601 508-790-4200 • www.CapeCodBeer.com F RtVI�R'S MARKET LAYOUT Cape Cod Beer—existing building Houses bathrooms,hand washing sinks etc.. X ' 9 10 Beer Garden Went These are cement 1 planters that we have used in past years to define and contain the 2 11 beer garden 12 4 13 D 0 14 :o CES Electric 1 1'p our very fabulous 7 neighbors. F-I 8 We envision this being a r table/station manned by a OT e dotted lines would be`Police staff member to welcome00 style barricades saw horse style guests and"police" to that we would be able to remove make sure people are not befor and after market. departing with.alcohol N yt 9 ServSafe E 2 � CERTIFICATION ELIZABETH. MARC.FIJ a W for successful) completing the standards set forth for the ServSdfe�Food!ProX chon Manager Certification Examination, Y -'ex. which is accredited by the American National Standards lnstltue(ANSI—Conference'for Food Protection(UP), 41 ! & A i405k a ER� EDAM FOR;14 M�PlU�BERy . or h 12/12/201 t 12/12/2023 � n DATE OF EX DATE OF EXPIRATION ' , k"I 6WS UPN y,.Che ry fog teeer.(ection teq utretrtenls. ;•:` ,: 'gym® a I, Sher #0655 _ ciation Solutions., (] ;p f: 14 ■ " 1n dccok�ance wi , ' a SewSafe ago are traderi aM otthe;NRAW Notional Restaurant Association®and d1 w orc design fontod us with uosi'rons oh233 S Wake;< q r, we,Su k 3600,Cl+tagb:IL 60601-6383 w 5erv5 Wrestwraia ora CERTIFICATE OF ALLERGEN AWARENESS TRAINING Name of Recipient; ELVABETH MARCUS Certificate'Number; 4297914 Date of Coiiipletion: 2/28/2020 Date of Expiration `Zrzarzozs Issued By: or completing an alley en awareness tratnm r anr ��, The.above-named erson is hereby issued this certi Cate NATIONAL E ,f p 8 gP 8r' ,aaoa «, RESTAURANT nensunat _.___ +a«n�.p .. recognized by the Massachusetts Departmentof P:iblic Health ASSOCIATION®. in accordance with 105 CMR 590.009(G)(3)(a). Massachusetts Restaurant Association 800.265.2122' 333 Turnpike Road,Suite 102 www.restaurant.org This certificate will be valid for five(S)years from date ofcomfiletioza. SouChborough,MA 01772508-303-9905 1 www marestaurantassoc.org ------------------------------------- 1 . t y Thomm.'NkKcao,Direaor Town of Barnstable. t ReagulatoiT Services = =� .t Rs� d V.scab,�:a�eet�►r } Public Hey tb Division .�:. Office 508-862- 4 Fax; SOS-M-6.304 MAIL TO-UM-N OF TtAMSTABLE 1 N'smm FAXM$1"4W - PMNn. .i%-CL DEACUECKFOR$41� QNC` .1AV::MOO 7`Iiht_'tiF?:�(E�G;�cr+"�v�ft�CE1i�f FCC lfift..l'lt1 it;��ir�E t'ERTIFWkTE A11.ONN SMTV DAVil TO FRO[EIS(Pitau;Sat otr�l b�state�s3 I APPLICATION FOR TEMPORARY FOOD SERVICE PERINJIT fD.An March 1,2 G . .. .. . ... . .. . .. ... : a OFspEcIAL n-F TFamaeW Market at Cape Card Beer WA$YHI E1'Ir:'�T PPROVF,DBY F OOA i1,+�'r �,i'1 [a@ 11E 'fit;' 3' . NA. tF���F, �'uf RE'41 E�7i��E*1tR��[t Leanne Anderson,( �smntatnii}r Evert Goordinamrf gape Cad Bar ROME ADDRS+s�336 PiainWS Lame vtLtAv r yannis . IB:of 01tr. 1t2r1TION Monopa b ro« acr ,-4N Mana LemanisTELEPIRON'E j%DDREss 7 Queens Way, Sandwich,MA MOO TO BESERNID(LIST E.XAC"i rocroc) oUves.olive oil. oney.non- .greek baCed;oocds Peanut fetter,almond batter VAN OF'Tt TRAIN-CI)FOOD itAtiDt.ii RS(To tit;0.\bj,it Dv-RING F-t'g'4"q, Maria,LeES n is >%DD -S: 'WJ4VRt~'TOME 5Ea,►,-F01336 PhInneYs Lane, Ryannis, MA Fri_&2244 Pone I)3TE.T�$E SERVED Fri- �pt.....� k�B�H��1!"E tA`t3:1T TIME WILL.ALL EQ1.tIPMUr7 SE SET-1:P&1RE.A y IFOR t%,pr 3 HOW lk'I:9.B;MOOR KEPT U1,01XI-11 DEGR&E$F CoderslFreezeWi a Packs ELOW'WILL FOOD BEIfEI,i),tT 140iDEGRU, F. et�a flow is FOOiV COVg' EP Food wiH be Covered or prepackaged HOW TS FOOD SERVED GIMS ���E e�>: "a .3a��.�,t1ati�x�t:�Ltr�►� {flf1 SikL e ® i ` ServS fe CERTIFICATION a MARIA LEMANIS a for successfully eompleling the standards set forth for the SenrSafe®Food Protection 1vlartagerCerfifimtian.Examirlcion, which is accredited by the American National Standards Institute(ANSI}Ccnferance=for'Food Protection(CFP). h 773395 507Q� , �r 9 U7v1SfR EXAMQRM NUt�I$ER� 9/14 9/14/2Q20 DATE OF E DATE OF EXPIRATION '�� Local Idws oppl .C ncy for recertification requirements: S 011, R . � ors •❑. #0655 h obcombnce w A�AAarrta+ro M2015 t la5a.w1 lo9oere kodemm6 of&HRAEF: t C road m with questions at 17S W Jo&%on 81vd.Sta 1500;Chicago,flc:dW#a SonSeAaerm rd.arg CIERTIFICATE OF © ALLERGEN AWARENESS TRAINING MARIA"IEMANIS ,, Name of R_ eciplent ` .. Certificate Number: 34645f Date of Co�ipletlon a'6r26/2ot8 Date ofExl211on 6/28/2023� t� 4 Issued By: The ahm)e-named person is hereby issued this certificate NATIONAL farrompleting,an allergen awareness tr:ainingpro�an2 '' �`„: RESTAURANT recognized by the Massachusetts Department of Publu Health i ._ ..__!� �_ ASSOCIATION, in accordance with 105 CUR 590.009(G)(3)(a). 'Massachusetts Restaurant Association 800.765.2122' 333 Turnpike Road,Suite 102 wwwrestiturant.org Southborough,MA 01772 7hiis certificate will be valid for five(5)years from date of completion. 508-303-9905. 's' www.marestaurantassoc.org COMMONWEALTH OF MASSACHUSETTS Town of Sandwich Board of Health © Permit;Number: ._.. 16 Jan Sebastian Drive 20-106aar� O 'K 1639 ,. Sandwich, MA 02563. Fee: _� 1 608-888-4200 $75.00 p F This Residential Kitchen License for 2020 granted toit onop at (Baked goods,nut bars,peanut/almond/hazelnut butter) 7 Queens Way Sandwich, MA 02563 In accordance with Regulations promulgated under authority of Chapter94,section 305A and Chapter 111,Section 5 of the General laws This license.is granted in conformity with the statutes and ordinances relating thereto,and expires December 31, 2020 unless suspende' or revoked and is nontransferable. 1. -�6v_ 2/25/2020 David B..Mason,.RS, CHO Date,Issued Director of Public Health This permlVilcense does not represent nor preclude approval of any other local or state permit grontingauthorlty,and does not represent nor preclude:compliance with.. any other local or state rules or regulations 'HIS SECTION INCLUDES APPLICATION AND PAPERWORK FOR M N PATIO Planning to Sell: Extra Virgin Olive Oil, Black Olives,Figs; Wine and Spirits, Grapes,Honey and many other types of fruit,vegetable,or spices. Certificates: Sery Safe,Allergen, and License included. Thomas NkKesa,Director To n of Barnstable�34ff i Regulatory Services Richard V.Scali,Dirworr Public HealthDivision, O cc:;.504-..862-4 `sac. '509MM-6304 1VUH,:M,TMVN-ODE BkXNSTMWE rust.1c IfFAR TRo DEt'Islo's 'ktA. IrEt L�ti a't 35.NU 0.$01,. E't.EASE INetXVE,A IECK FOR S40.00 ONE @Ail 1 SUM jA.-papa)A-t bACafv(W..YOUR F sA-;'1T%710'% fIAININC(L0iScr>IN-If:P CEIrra .ATXANO AtLFRG:° CtmFICAU ALLOT SAITV W's TO Pit0cm4ptem sea iftgrwfwG so obe ►R pn;i APPLICkTION.FOR TEMPORARY FOOD SERNICE PERMIT DATE March 1.2WG 1.k%ll OF SPECUL V,k 7 I"arn s I�fiark t ai C t COs 3 r ;I t?p�"E>#5@*(Sy S t)l I TI' G ICI��If' Leanne Anderson,Community Event Coordinator.'Cape God Beer '6`Urpu n t 50$-790y4,20O X 102 CELL t 0 7744-454-1098 la UME DDPXSS `1 M Phinneys Lane VILLAGE Ryanrds YXVIEof OftG:ritL7 nON Ne mt e's Portuguese Stuflues. 506-566-M9 , OBI F,$$ 12 Sol n Pond RoW,E San;N%ick 1 4 FOOD TO BE 5XRVE1D(IJ5T EXACT FOODS) PTermade,frWen,.F40nijg a style artssan qua ti.k:MES OF TPLALV ED FWD aL-%N*DL (TORE ONSt DURENG e:VENT)c Neorne 14ciris pre- (ATTACK COPItS OF S « r&LLE:IVCEN GMWICAM) a lwbt"' 1s1� I?rtTl:TO S R3'E& Fri.5122,11q �I$fr 3 -BP r kkgk 4 D Ct O t3 %V'*L-kT TIME WILL ALL EQUIPMENT BE SET-lam$R£--OV FOR t4'sP`F,CnOX! 3 ilk, H:UW VVIL.L E't W,0E:E:UT BELOW-UDEGRM- TF' Irk r �G HOW WILL FOOD BE IIUD AT 140 DECREES F. n/a. I o%v is Eofltl=:CQvER > ftX d wiEt fast sled n t o�ecs HOW iS TOW SERVED 9 r' TYPE OF IL NNDWVUVA.5 J..'G F.kCI LIT' ' ott Sate 4{ Z a; s. . t+ -,-.�`�s, . .. . F., �•. ��q.E ��j��+w'� .5. ,-1...... /ijP 4- & .. _..i- < 5?. -.}T.,Y.. <e _.. >. ,x-g�F� :.;` .6'` ..';F: ,' ._ii ,..<-Y.V' n « y,4..> a.:.,: �•. '2 3. <:.. apt -5 _ `.... ,, <::FS,,.°F °+„i l., �,. -lI,x r ,_ ,+ 5....�..,. ,�y.{ >, k, tt+§ ;: .: <„. 4L I E. _ .<,: S ,,;: >' ? <'a,'v< J, 1{4.SNIN.:.... _s,€-..:_.,EFx. �f 9 .:>., t 3 b. tea,. t: ✓.,<> E a."..xgg � 3 �< ,.>t> r. ( „ .,_ ... < J .M ..., ,F ''e .ice a^ ;`..`•, ,,,,... .. , `�,.<., >M1. .,..,,.. �,rc*o >•.:.: 2a„ .. i`, M %« � ..::.. _,t, ;.. ...\ >� 3. h. ...".;: '...... <_,.....�^: .> ... .. r£ ,. z rs .. <...... ;<� <-__ ..:.v r ... .,n."CS IY;...V.: .,,. �n '� 'tS�•.' � rY ..d ': ,rts'�.... , a........1 .. $' ,....,. ' `x iit�,„.... fi.,. ,-.;5 .......,.� z _ ,.. „-., ..,,I- ,.:.,,x. u w'4r.. t C..,x, °.mow R a'° r£ § : : .., ::. .> .>.: e., < , ,r --t: 't xc,;. {z k':^ -... ,._. ..-. <5..._.-.. :'.;: i>: aq as s, ,L. ,.. t +:. ' ,..>,.. t�. < at¢Y. - .' '». € ,.,<. 6 'yt ,w. ., e<i:,.. e , .. ..,'A,., - E 'Te<: E '.4"F ,. - t ae fr ,x,\} :: -.�..... .. ,.. 1� r„ .:: ,�t,'; x s'q$ d:. ✓ '':=7' ,} g;1..,...l > rc. �' 9 ¢£.£ " !. 3.>:r f ..f. v}* £ , 4., n:y.d.? lr ? �: x.,.:... ... < , ,>,. .y.,. ,r,. -& d;�. 'k: t P �. >'a .,,t. n_ ..,.,,..,. : .....�.. :- *� F ...,..y. s ,r.:.. ., \ ':- ,S° ,fir 1 �g 1. g {�4.,.: �.5.. 'E� i.��: 4 .1.'� § _ ✓ t C•qx;, ::f .....:' - -:.::. +,,:,,+' a, sk'�: .s... `>a, i;:,,.. .... .,e 7 4:.. , ',:. ...„ ,. .,..x'>i° L.- .x{.,a ^V .>,:..< ..... °c... r,. ek Y @'t sq Y •f ryY, "'h � �'t, l�...._ 'a.. ,. _< ..: ,>, ., ,.-: <. ,.t....., S•,,. s: <;.,.. ... ,.f,. a. ..G°,. ,:::.if Y,3. .�.a<`t' �F..-yh::< k �.�, rf -•ee^� �� �'S' h',y'.<�w E£u.4i�a:>, i .. £ P §��{ r�pi g F .. ?` t t£'It � g } , a ?yt e IN r This Is to certify/that 3 Neome` R i € t `cRg3"j{ k. YK M �� �,,,,rr�E d�Q�Y � .�• e x•. � § }bt. �qq�`Ri1 �� F f, 3 has completed MLs z Food Alfer Traifinin 9Y 9 s N � Ij- a,S�i�aa' ra �'w. r<a � « a s : € t € s -�{nee E tl 'x ti ��� {( s Tk Completion Date 10/3112018 � � � , 4 r � i et + ration 1.0 Course Du Ig 360training a r �, Certificate#. 000014828918 rC.?c(I ; t. { �' C� zv 360training corn,�:6801 tJ Capital of Texas Hwy Siqiql uitd 15A♦Austdn TX 78731 ♦ 877.881.2235 www.380training.comE t,: a i� ,�.. -�z` �%�• r� .,�a- '."o �m eta-::M�'+`�a�Y:.r. ��'F:.�. ;i`.k, .�, F;,''^-aa•.> ,..x...... d e� ✓ ;'-1`h+< �'^�. �...t 11 , '4 . .a..x<.epF ... <. ,: r ,,1,'�. F �. ,�.. ,�a,,,. s }.. r,<. >>,,,,5.� „a se .y .. �..e c ,'r.. -" � x � � x ..r ,- .. ;§. ,<.M < ,, �... F £:,: „. ,< - .. ,..< ,3 ,4 FFI v. ^,^ < E.rWINI"', ,1' ..S -� �t:: 1. <2 .A,..`4, �^v.. l ��s• Y,<`u.<.tx' 4/' .sFx 'a`� '�< �- is„k3>" - `�' �i '... �.> ,.: �,.-,y33 x <..>at.:'>.vis I. �� ,"^,�. .,,. . .: o,..-x e. �a, rna ai?< . ..;.�. ......�<., fi. 5 * .t.j��*�� .E ..F. -c ,, -....� .„., {ae<3'�.... r : .< k... ;:S -. .;.:+s`' A -a.>.{{ •<>d' a re:.. '��.7, �s< F , � , ,..,.. E ...... �<�..„ ._ .�:r,,.a _.0 .. y, 4;::-r >. �.... �; ..�` .i - , t ,.. '�„x, s n w <, ..�.,.. .^,�_. .� a ,r r:.:>� t. <J a• <.:•.,.,,,.x Na 'r'.r R •,.., ,S, ..,. A_. .. x., y..'q�.x,r.,.l. Y `� ?'. a „»,:::^ w t_ E::::. •.��. < „... a.. ,. ,,. ,..;�:_�'rFs 'a.... ..y; tSw-. ,�'�e, fir. 3 ..i`'.�.;�r` '.�^, �`�emu... y, _..�.a Sw ty fi 3 �3�. 'e. ..t.�+... .,.. 1' ....> ..4...„ ���, m,<u:. ,.',.,, - �•:;v 3. ,,� €�€�`t; ,-ncv`,g i :::mctEv t 4 r. �<�i... t E {:. 3 .„t,-3 :x ,.,. i 4P s, ?.. ..1.,, .<,.: Fr ,<.. •.".�,,:M=; as at. �q. �.. { ..^ k 2 t .?..2.^ ,..xx.. },: } .. >`..3„.'<:: `z,r £3`:a_�;� i� .e•: x. ,.:,• 7.,e�"-.._.. '.^,'>;.<.>.,,. -,F.`e€ ,:<,.. _,.. ._-- ...� ��x� „:fie' �`?,tx �:t YL.>t, ,:r, "�,: { ,;. ,; ", �t v '.� ;� .-- �gxks f,-�2--;r• `'-��':<`�;v%/ M �, £3i .I.- 1�� 'K'�' ..r .a„ 7�7 € ,. t :C, €r k g1 i{,i ,'ry',c';!> .a ,t E < �-4.P°� �d ��,.s« ": :1< pp Ft R f✓�s yt �,`4,„ i q '3."� i:' Ez "Q:;.:,Y' t,,x•a. <x,, t., `+< €€ <„-�`. E +. � C�•'� I 4 �ae�`.: 9 _ »;za fan 3, •r:, .r >s:;y <..,..... , «,, " .. _ �: �. ,....s-, � < ,a S -.... .. '.:•a .. „_.,. « ,. •x< :a4:< o�tT Y ;}, `'u.. �.<, q �w T. <Z.... t <....�rh. ,1�.. .t ,. €? , ,x{ a4.3 f ;. r. < ,. ,:'a.w G . ,..s ;. . t Se t. .� �,..,t�: '3 §t.,'��,la_-.•�•,«;:>✓ ,e�,.1, � wa'" a.,a ,.,.,B, <,<.,,«., , ._:..,n S,.., '«:4 rc,...,.a' :d-.,E a'.,, <:,.,.. >-: � idq': _s..::�,:.: '._�. "�; yE.'i,a';�..��„.�€ms,�aa:�, nE .�? ,.. •.� >w� .,�"e ,va..`.z ->:•za.<�rx ._ �i k,r ,��j F i �� AIR w ; tl }s.�..�' k yI W, �E �t • SAI � 1 N� l � r This is to certify thMg at s < < ' s E a �3;� i ' t ; has completed: "{ f, h,,aakgkg earnIServe Seafood HACCR` s #`� s a Wl < : e zi Vkz £ � Completion Dater 10/13/2018 _ ��' ^� w € s �t + Course Duration 1.0 , 360t�rainin9 r t,MPI�Il ' _„ 000014656190 l R w Certificate;# ,FF ` < , a . ♦Ain X78731 ♦ 877881-.2235360tra min co m 680N CaPal of Texs Nw 150 ut www.360tranng,comYSuite - v .,... kc» x.. '. ,+'3•. .a,^ -#w.e 4, 'a 1 E�,; a -.,�<' s.. a, ..:r ,� >.« ,�..:"' ,.,<,.. ;a .< •s-.. ,> ..... . �„ ,. l.x :. .z., 7" fra* 1< KIT L> 3 yra �x a..M. _x,,...::'.,.:xfi_.r....t.,:,vx�".,.x,a,x..:.,:,,..::.,x...,aa^g.Y�.+„a:w..».:..�«.....taseae�.!`'t�.S.,'4k�r'<°3<,'.tx*3:.......,.. �P!s.e.xv^.a-J.d.....v,t..i.,.u...'<<.r?>e.>..�'-n.,<<.<.�-:-t:�.v...a:.F...,:+$...`.�.,�}.F`x F2,x<<`:.,,.e,.�..>.0s.„,,�:�.4^w.,..,,,p�,„...<<<....5....-:-.w,,x.e,,d.Y.,.,.xwtF.,e,k..1..f...x,1.-.,.:..i:.....F x:L4.<k�:.a.s....��.�,:3i>I..r..i xf:r�`..,,:.,...:<.�..L�..:v>`t?.,.e.s,Y.,7 e...SYS..<..,aes...�F.,+-:;„,�w.,»."k..r<R.",��....,.,.v.`yr.�'b iii y<<.'«„5?..,c"ti.L+a,vma:.�..Jt.!..:e 3.}.ffir:s«.i.,«:,,..:{�W'`'„.*,El�e.i..,.ac<x,.,..,:�.e.„..<....•,....,-.,..:a..s.'u„,.<..<N,<,•..?..`.',�<,-c."«,..('VI.�,..5..,.e..<.,�.<...<.>..:.:...::._>�..<.,.,..t...<..?,.�.,':.>-,<.'a?�aSe-.F1.F�oxi>....t.i.w...'.;,:...,.....'rv#`»:�r�w an.sVx,>.,r'.>:..,:n.:'„.,„;R,<,�.,.s.„..t�.r.v._•,.">`'>.,.f#x,.p P.,y4,..y�a•ro5.,-..�..�ri.".,.xi f$�.t,C..„...a.�,.4...^,.<sv..,wv..♦«Nq1'C,"x. ,E.._;..ck-:)-aY.,>..:.:�s\vr.5,*-.0 y au�.3.v.',<..x.s.,.�,.f..:f,.^..,'.,�.'.<."`�.5d.Se„?„..1'?tfr,<J.0._.t..<.3.a �3.�!�»—",.`.St<".�i ..`Fpp�.Y,��_.'..?..Pd-y5,Yamx.°hY»4..n E*.3,t.,>..a'.f.o-i;1';6.,S<�"'�'r€"�h``Y.�'��,.c,.�•>r S` ve'a1..a��.1�rX"��•.ta,-<F_`. 9^. ��a.m:'a4 # a 1 ,n 3 +.'..I-i-v t: H �„ tw q1�� �„� � .F �s� l v�<b d i r^ r" w ,� � "a. ,k� .�xF si%s•a ,.5��0.�> � ;'e :a F �a ,§ L.-... ',lax,t, t"' c ,�`�°€ ,,:.. :t € M<r. .. ,.... ��,. -,., �.•....... , ,., r: � ,:,+:k.. ... .a.x, r. .a-... X , �. s :.'€r rr St t X',.•'3.-,-? - > t"t; N ...>.,i & z �: sF. � k i .?,: �.3I, tt �. a� x ,..+ ,,... �, >. �ti„ u,... F,e !....€E },.. �i,.,, ....,, 'h v- <.:.._ ..., t� '.> .,«, '.:3 ,..`.?..c i ,.... �•X}.:::<f ,{+,: e: ,fer �- 1 „€. 1 6 53 A f� ",!: ..;:( i� ..:x.a ?: .r t. 7.'.. �l .x: t ,::<.. .x i.?:, } ,>, ,•...i. S k., .�..d.,.rR, ,',°„ .`tx 3£ .,x1:< -:A., � 1 :"�, i �'i.., .P:: £ S y 'v i :.. I :� :�: n. a°.':, �' �u FI ;�J1if s 4�. S §,�,�• F \. :; <a <E�, ,� ?�T�,'x. � :'ram i<S `� �.�.�'.. �y, 1 v lA PERMIT NUMBER. THE COMMONWEALTH OF MASSACHUSETTS FEE 20-317CA $200.00__ J TOWN OF KINGSTON THIS IS TO CERTIFY THAT NAME: NEOME'S PORTUGUESE STUFFIES ADDRESS: 12 SOLOMON POND RD EAST SANDWICH MA 02537 i --.._. .. ........ U IS HEREBY GRANTED A LICENSE FOR: CATERING PEGGY'S KITCHEN . 68 MAIN ST KINGSTON MA 02364 THIS LICENSE IS GRANTED INCONFORMITY WITH THE STATUTES AND ORDINANCE RELATING TO THERETO,.AND EXPIRES ON DECEMBER 31 , 2020 UNLESS SOONER SUSPENDED OR REVOKED.. h JANUARY 8, 2020 Date Issued.: Arthur Boyle, Health Agent THIS SECTION INCLUDES APPLICATION AND PAPERWORK FOR NEOME'S PORTUGUESE STUFFIES Planning to Sell: Frozen stuffed.quahogs. Certificates: Sery Safe,Allergen, and License'included. To Barnstable --I- ,,- to -Y ricers Richard V,St,,4- Director -Public Realith DiAlsion ,.J . D? .. i4Qq XUAN TRAIMCG�4O. kCMTMCA7Z AND UJZRCvN C k.TION FEAR TE ORAR :FOOD SERVICSTER-WT WAS TMS '-.'A"PROM BY T;ROAn A F L=,3M,E p y NAIS OF _NM Loame Anderso Gommumiv Event. fir: H I ESS tr an i ADD i � ,' nnis:,M 63 F+ aID-ro Tm F lDsy Fbcm bread, spent gMin.biread, cookies,coffee fie and fie pies-ki pre-packagel OF TRALMO FQ=RX D'B Q UTX DL L Y. I n n1lb ntLau e Decbst ADDMSS A:.. TO ,�L;3$ o t Lafte'Myirm,Wx. NA HOW,IrF 9 TIRTE OF EUND-WiSHN0 FA -, ' r 1 d { dX i� Y V COPY Own 3 '£ of €2 Wll� too, "lot A Q. i'�1111�ON TWA AN . Aq 3}: Lr YS'. FIR" t t a .3. Hum" HEY" V, --n� �Q— { z yj ORAb;. :£ y NMI-,q. i, "M SIC TV,MON x r t €6 iRz? a z d JIM put } ASS71,11 VITIs.a a } } "Noi Et 1 {S cad r3 fax. £ c 1 a$ r`�g�RAT 1 k a ASK z BAN Vol *V `vAN doorman. VOWGE 3 ' �';4 j€ AMEM € E : �. Ali Vol for v qRR" �� � i��.Er 'i � ,x•t �.��,s{ ��}�.s€�ka E.,Aaar :''"�� �cxh„t'f��' �� �3 - x e � '_ £f q ; �.�x.ce�ctt iE °;o ..€�i}}€J�'� � c R#it{; ,,...• - ,i �'£s����€��� }F�'� a � �f€7 ��ti�s�SE. ��°£E yx31�}:'� d a RE �; � • }i All" �t sF Y 9 zip a F € } ' kx �Y n Y: .E3 uryr its At S, e,irvsc TAT' . F r.- � ::C E RT I F CA JANN:�:�,'SULLIVAN MR All law MIT tit P it A,02 1 : P S y � r xy � S fS}^ s - a N ... a ,. � ::.:.:• -. '. .,.. .- ., .. F' ;r e - " aCERTIFICATE OF ALLERGEN AWARENESS TRAINING �y 6 nt c Name +M. n 0 t Crt1 t a r>: U' '.a - @04.2 >4 d t I. 9 Date of , , leti 'cJ'' t y� ' Date o :� A Iesuc<l$}n = The above-natned person is bereby issued tl is cent Bate ,,�„„� for totntledng an allergen aw ar-aness trainingprogratn i N I.',(y`j +" n nnoia ° CiV � VN recognized by the Massachusetts Derarn�aesatof Prtblic HerrJth bWn��. e M accordance with 105 CMId 590.009(C)(3)(a). :1 usaciwsetts Restaurant Association 80Q.7G5.2122 3M Urnpikc Road,Suite 102 cvy�nvrestaurnntorg 71tfs ceq ti rcate will be valid for five(5)yours f Bona date of completlon. Southborough,MA. 01772508»303-9905 WWWtllM'e9tautantA$80c.otg Iva IFU A4, _S ... ......... 7 f-17 sun I'l-, J —SA SFITTS, 1V �,o pt k4e P 49n 'lit 1,11 Al ME US N,sf a -S 'n,vft, �, —mmm! eg anq-,,,,'p,rqmanryqj IN Al MES"'i M-11,5,11, ,,No 51 elf Sus "'S VAM C,x ONE Vow Pop M IT Rol mm NMM=If, Evil Ski 21 iml RAJ Elf SAM 0111111 se> Z z`R MR ,:, >._ F _ +, ,s e -• 'xx„ , , <: ., <<. 'mot= s:.,. ' ,a �'f ° m� , - ..d -;,.. c .. ,._ S� k •s .�Ys. xti., >:s';'. .''" ..3. " {r, t.. e$�:'i 1 `a .G; <,F_ 4�'- �'':{; .,�.x. _ „ •� ;"s' -'`F -tee t 3 a ' s: w' k , 5 1 Y fix. $� g�, J >•% :nE: P ,,,;�' � ma's`' t Z ,:t3 \•� e -a h > Y.a t� '� Ea•^ �w c � - t„ x - , >Y s H• « .ss .:.x-✓�� ,,.,;;, ,.. „•: .. :,:o �.. .sx ._,a.. ". .; Eta, :. >r,- ..1' J t / ✓�i 4 » � a hN t$ L • .,,, .., .« r „ .. ..-:,.. ° a ,< •,e T r £ .. �is F" s 4" », x" � h L,. 3* , s > a , _. Us MCI <, \ b r. x,., :' ,..x ra,h ,• ::. a .. � , ...> >w ,fit. ., ., .-..\'.'.:. .. . w NMI :- _ SN 'mot.. ..,_i. < �!. „ ,./ ,,, x. .:..• 14 .,. ,:: nS�.... ., >::.. ........."". -,.. , .. ,», ,. .. >,.. ::. ;:.L •••i r: ... ":.mot tx i, •. ,,, is .:v > '3. y as i K 4t:B, ,•F B i f Y 3 1 i .9 t �> � v sc � z �• � ,� ,�$'��E^:- s^^i:"•�?� _ \ ;_ ^__ �i� h try. ,. p__ ' 4 >K a i s 1 a THIS SECTION INCLUDES APPLICATION AND PAPERWORK FOR UNDERGROUND BAKERY Planning to Sell:Non-Perishable Baked goods,breads,cookies Certificates: Sery Safe,Allergen, and License included. Town of Barnstable Regulatory Services T A � Richard V.Scall,Director BARt'\STr LE : A` Public Health Division Thomas M.McKean,Director 200 Main street,Hyannis,MA 02601 Office: 508-8624644 Fax: '508490-6304. MAIL TO TOWN OF BAWNSTABLE PUBLIaC HEALTH DIVISION 200 MAIN STREF,T IIYANNIS,IIIA 02601: FAX S08 799.63W PLEASE INCLUDEA CHECK FOR$40.00ONE'.DAY;W-00 (2+DAYS)AND A COPY OF YOUR FOOD SANITATION TRAINING(EG.ServSatc)CERTIFICATE AND ALLERGEN CERTII'ICATE ALLOW SIXTY DAYS TO PROCESS(PIMWs e IJWruc6uw on thev=t page) APPLICATION FOR TEMPORARY FOOD SERVICE PERMIT DATE March 1,2020 NAME OF SPECIAL EVENT Farmers'Market at Cape Cod Beer WAS THIS EVENT APPROVED BY THE BOARD AT A PUBLIC MEETING? Y X N NAME OFPERSON(S)REQUESTING PERMIT Leanne Anderson,Community Event Coordinator,Cape.Cod Beer TELEPHONE#508-790-4200 x103 CELL# 774-454-1098 HOME ADDRF 336 Phinneys Lane VILLAGE. Hyannis NAME OF ORGANIZATION C'-a t 0' kc'\ G,0. 14A Care CONTACT PERSON `::S� TELEPHONE ^c) :)'i4!(� ADDRESS Icxk rYtt c;a, I iY►ci+1c' 'Ste - tY)<Q 7 i FOOD TO BE SERVED(LIST EXACT FOODS) .iI� c r n NAMES OF TRAINED FOOD:HANDLERS(TO BE ONSITE DURING EVENT): T roc (ATTACH COPIES OF SERVSAFE&ALLERGEN CERTIFICATES) ADDRESS WHERE TO BE SERVED 1336 Phinney's:.Lane Hyannis,MA 02601 DATE TO BE SERVED Friday 5/22-9/5 TIME 3-6pm RAIN DAB NA WHAT TIME WILL ALL EQUIPMENT BE SET-UP&READY FOR INSPECTION? 3pm HOW WILL FOOD BE KEPT BELOW 41 DEGREES F N);N, HOW WILL FOOD BE HELD AT 140 DEGREES F. AJ I N HOW IS FOOD COVERED ti/A HOW IS FOOD SERVED 3" ._,-"-�%,�y} TYPE OF HAND-WASHING FACILITY On Site SIGNATURE OF APPLICANT) s ServSafe CERTIFICATION JEFFREY PAINE On for successlvify casry)le1"S the standards set forth forifie 5e v5afe®Food K.Cn6pWa cmanager o (CFP). v h;ch is ocaediled by the American NcGor Standards Inst tote ANSI}i s fe+e^w 006138 10550 UMBER EXAM FORM NUMBER. 4t26 4/26/2022 DATE OF EXPIRATION SATE OF E � local las« o ncy fo nKoA(kcatron r requiremenh. ppb'.Ch gig She . ... biomo 6..4 Hauim�id:av 'aw ae tadrmab dd+r9a8: 2D2.15ti.i.w - L6660s.«S.YSde6'saw.a :daedw;,,�,q�vienul7ivl3�wn P}d:5r�1500.Q�caed ... i 's a —75 CERTIFICATE ju TO ALLERGEN AW, ARENESS TRAINING � I Name of Recipient:.JEFFFtEYPAINE Certifie1w Number:.28e2660 Date of Copmpletion- sisnoi sr4 2&2 Date of Fxpir�toon: ■� d C�7 l seuedi By: hrrlhatxM�iarnerlpepsoilishel-jil)�issued this certifr.ntN Logo' NI1f.nt ruing an allergen cigc+nt'euess t►•aining, 1-0gr-<rtrr � 4;,� i2f' 'f t7t�FtN 1 rero ilivvI/I'the Massarhmem D paii neirt ofPublie Health in rrcconlance with 10.5 Gi1•lli s90.009(G)(Aga)• ldussaahu�etcs Reetauraar Ass�cia4 on suo.�b�.i�2z 333'�tmnpilte},toad,Sulfa 1Q www.rC6tautsirtr.org tdt1tt borOVgN MA 0177� 77ris cc:rtlfrrrtt will be a�ctlicl fof fr2e(S).ye li-s fioin elate otiotls�,f #don. 08-303-9903 1+�va!m�msh�urantas6gc.�tg Permit Number. 3420 Fee: $5.0a00 ���� �4IIXIICDIC�1PAYt�� 0� �CtY��rtc�)U�ett Town of Mattapoisett Board of Health This is to certify that Cape Cod Wicked Good Kettle Corn 109 Marion Rd., Mattapoisett MA 02739 lS HEREBY GRANTED A PERMIT FOR SEASONAL MOBILE FOOD SERVICE ESTABLISHMENT PERMIT .1 7A. f Gen r This permit is .granted inclusive of Chapter 94 and Chapter 11 1 , Section2 o the e a Laws of Massachusetts, and 1.05 CMR 500 and 590 000: State Sanitary Code Chapter X. This License is granted in conformity with the statutes and ordinances relating thereto, and subject to the applicable rules and regulations of the Massachusetts Department-of. Public Hearth. and Board of Health issuing this license. This license must be posted in a conspicuous location. and expires on December 31, 202.0 unless sooner suspended, transferred,:or revoked. s L,/ Kayla Davis Date Issued'February 26,2020 Health . gent THIS SECTION INCLUDES APPLICATION AND PAPERWORK FOR WICKED GOOD KETTLE CORN Planning to,Sell: Popping and Selling Kettle Corn on Site.Sold in.twist.tied bags. Certificates:Sery Safe,Allergen,and License included. Town of Barnstable rawti Inspectional Services Public Health Division BARNSTABLE M • 9ARHSrAUaI C'3liFPvtlk•CJ Irl-H n_k AS +' lARNSfABLE, ' n;rt,.ew;ro is•os vrie•�v�s1-11 -F 1E34.I01a 163q. ,0� Thomas McKean, Director � Leo ' s 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Monopati Name of Person: Maria Lemanis Address: 7 Queen's Way, Sandwich, MA 02563(C)508-888-1045 To serve: Olives, Olive Oil, Honey Greek Baked Goods Almond & Peanut Butter. ServSafe certified: Maria Lemanis Allergen Awareness: Maria Lemanis Only at the following location: 1336 Phinng's Lane Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 2y 22—September 4, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable Inspectional Services Public Health Division BARNSTABLE i VAIV/51E•CeJTEW AE-COTUiT•H'VANMS * BARNSTA13 • nAas*cw;M Is.or,wnI,-%V .wH,rw v MAss. Thomas McKean, Director q, 1639. ,0 CEO MA'S A 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Wicked Good Kettle Corn Name of Person: Jeffrey Paine Address: 109 Marion Rd, Mattapoisett, MA 02739(C)508-336-6043 To serve: Kettle Corn ServSafe certified: Jeffrey Paine Allergen Awareness: Jeffrey Paine Only at the following location: 1336 Phinney's Lane Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 22—September 04, 2020 Frida s�Opm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable ,oF"'E rasti Inspectional Services Public Health Division BARNSTABLE IE BMMSTABLE • BARNSTABLE�CEMERV:'lE>COTUIN VAWO cb i63S.9. ���' Thomas McKean, Director p aM.15.O,FJP .1F 0.knSTA^LE � MASS. Tas�-7Gia �FG MAC s 200 Main Street, Hyannis, MA 02601 ��� Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Underground Bakery Name of Person: Ian Sullivan Address: 780 Main St., Dennis, MA 02638(C)774-836-5206 To serve: Pre-packaged Baked Goods, Foccia Bread Cookies, Coffee Cake, Whoopie Pies ServSafe certified: Ian Sullivan & Laura Decost Allergen Awareness: Laurie Decost Only at the following location: 1336 Phinney's Lane, Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: MU 22—September 04, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable oF"'E'a�ti Inspectional Services �. � . .� Public Health Division BARNSTABLE *+Y * HM1R[JSfAtiLE'•tlJf[3Y:1E•f.11F T'I WNFTO5 BARNSTABLE, ' rurt^av>ro:is.ns: :mie.l�:srnrnr�srReie MASS. 1c39-20ta 9� i639. `0� Thomas McKean, Director 5173 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Neome's Portugese Stuffies Name of Person: Neome Hollis Address: 68 Main St, Kingston MA 02364(C)508-566-9399 To serve: Pre-packaged Frozen Stuffed Quahogs ServSafe certified: N/A Allergen Awareness: Neome Hollis Only at the following location: 1336 Phinney's Lane, Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 22—September 04, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable Inspectional Services Public Health Division BARNSTABLE r P4RNS�/5M.1.1 fP3Yi1E•-W-5i.At' 0 r BARNSTABLE, • �u.is.o.39.2ie.�nsracar�1ne:e 16.15.2014 9� 16jft9. `�� Thomas McKean,Director 5751 p'Eo A 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Monopati Name of Person: Maria Lemanis Address: 7Queen's Way, Sandwich MA 02563(C)508-888-1045 To serve: Olives Olive Oil Honey Greek Baked Goods, Almond & Peanut Butter ServSafe certified: Maria Lemanis Allergen Awareness: Maria Lemanis Only at the following location: 1336 Phinney's Lane Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 22—September 4, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable 4 �TME tOwti Inspectional Services Public Health Division BAMSTABLE * a ank;asn�u•ratresvt�x•arrun.inayriu * BABN"ABLE, • ,c-rns ri i.s.o.,�:•e.iF•as;i KPtiS MiF MASS. ieaz-zota �cb i639. � Thomas McKean, Director �1 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Neome's Portugese Stuffies Name of Person: Neome Hollis Address: 68 Main St, Kingston, MA 02364(C)508-566-9399 To serve: Pre-packaged Frozen Stuffed Quahogs ServSafe certified: N/A Allergen Awareness: Neome Hollis Only at the following location: 1336 Phinney's Lane, Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 22—September 04, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable oFTME'arti Inspectional Services Public Health Division WRNS LE * BARNSCABLE, • 5 RSTA6LE•C51TExr1E•GOTurt•Mvr,Nnr cb 16 q; �m� Thomas McKean, Director ,p .. M_s.o., 9 iC•39-7G14 QED�A0� 200 Main Street, Hyannis, MA 02601U5 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Underground Bakery Name of Person: Ian Sullivan Address: 780 Main St., Dennis, MA 02638(C)774-836-5206 To serve: Pre-packaged Baked Goods Foccia Bread, Cookies, Coffee Cake, Whoopie Pies ServSafe certified: Ian Sullivan &Laura Decost Allergen Awareness: Laurie Decost Only at the following location: 1336 Phinney's Lane, Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: Ma 2�ptember 04, 2020 Fridays 3:00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable Inspectional Services Public Health Division BARI'�STABI,E } f B!.R.RME CENTE-IVUE•NTUIT-M'4tN1115 • BAMMBLE. • w;¢;:axs nl ls.o>-n;uiE•InsT xaRN,T+etT 9 MAN. Thomas McKean Director 1639.21014 1639. 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 PERMIT TO OPERATE In accordance with regulations promulgated under authority of Chapter 94 Section 395A and Chapter 111, Section 5, of the General Laws, a permit is hereby granted to: DATE: 03-11-2020 Event: FARMERS MARKET - HYANNIS Permission is hereby granted to: Wicked Good Kettle Corn Name of Person: Jeffrey Paine Address: 109 Marion Rd, Mattapoisett, MA 02739(C)508-336-6043 To serve: Kettle Corn ServSafe certified: Jeffrey Paine Allergen Awareness: Jeffrey Paine Only at the following location: 1336 Phinney's Lane, Hyannis, MA 02601 VALID ONLY ON THE FOLLOWING DATES: May 22—September 04, 2020 Frida sY 3 00pm-6:00pm APPLICANT MUST CONFORM TO ALL ZONING REGULATIONS IN ADDITION, IF SOCIAL GATHERING IS IN TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. TOWN OF BARNSTABLE BOARD OF HEALTH Thomas A. McKean Director of Public Health ST