Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
HOMETOWN JUICE & CO. - FOOD
i Hometown Juice & Co: 1 Wianno Ave a Ostervill "1 _6 1_ FORMERLY: 3 WIANNO/AMIE BAKERY s r n .' -�r.we..:re.wry...a....�:A��,...�.»J.__.....»,,.. ^. :... Y„ :�. ,.. �' +•w.».++.rm+.+w�'.rw...�w.w,w.`«^w,{+ene+.......w....xny�...�.. �w.we�... ,m—.nn'fw..r= rt" r Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. • RA%NSTABM F.P.(Thomas)Lee,. MAS& Daniel Luczkow,M.D. Alt. �$�, a39• 200 Main Street, Hyannis, MA 02601 r�awsa�° Phone: (508)862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1102 Issue Date: 01/01/2022 DBA: HOMETOWN JUICE & CO. OWNER: ALL IN MODERATION WELLNESS INC. Location of Establishment: 1 WIANNO AVE OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 9 OutdoorSeating: 0 Total Seating: 9 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - — - MOBILE-FOOD: MOBILE-ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Initials:' Town of Barnstable _ Date Paid FaiAmtid$Q� �,S•,B�. ; Inspectional Services Public Health-Division Check# l Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL �•, i NAME OF FOOD•.ESTABLISHMENT:', ; ADDRESS OF FOOD ESTABLISHMENT: f MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: `t tu e Q ��� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 1 - I24 (� �C TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION: /`/ TO 61 '0 � r. = NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** x OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS.' IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE - 1 I • , re' • _ s . RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST + r COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:1Application FormsTOODAPP 2020.doc R, - OWNER INFORMATION•- ^n FULL NAME OF APPLICANT., SOLE OWNER: YES aN OWNER PHONE`• l ADDRESS 25 V1 t C�Z O 1 CORPORATE OWNER: CORPORATE ADDRESS: -D 1 V Z� PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES" The Health Div. will NOT'use past years' records:You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date ` Allergen Awareness Expiration Date y i n 92 s 1. f PN VI J 1�`. 1 _ l �� l 1.�` -2p�, rN'(Q�r�gC/►�t CC// / 2.) �wb�cyiZ ,(mil 1 l c� vj d •kJ It IV , 1G U LICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to scledute yourinspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. c' CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited: NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication Forms700DAPP REV3-2019.doc `oF� rok� TOWN OF BARNS-TABLE HEALTH INSPECTOR's Establishment Name: Dater Page: l of Z- o OFFICE HOURS PUBLIC HEALTH DIVISION e:oo-s:3oA.M. 46 BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e5 9. `0� HYANNIS, MA 02601 MON.-FRL No Reference R-Red.,Item PLEASE PRINT CLEARLY �prFO MPS n 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name V� Date ��2 Tyne of T f Inspection O s outine Address � �- Risk LFood Servic.0 Re-inspection �b Level a ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation JCS' l UlJ Owner HACCP Y/N Temporary Suspect Illness ' Caterer General Complaint Person in Charge(PIC) �J �S Time Bed&Breakfast O HACCP yk�O�J a In: �j b� Inspector �] Out: �� �� '" 'hzg�- -�V Each violation checked req Tres an explanation on the narrative page(s)and a citation of specific provision [A I {_s)violated. � ,G (� v 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 690.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 3 'qU F ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1 2 _ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals w I l r /y l q� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) �t- - ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Z ❑ 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 / \ ) ✓( y CY PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control C ❑ 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 l Critical(C)violations marked must be corrected immediately. (blue&red items) f� t�� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or d 1 within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance Com ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ 9 Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than o 6 non-critical violations von-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to =B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's/S• nature Pri t: 31.Dulmppster screened from public view Permit Posted? V Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI Sign a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ..�-J��:.�'.r.._..-...-.fy_. �- ��� !`,__l.« �.ti�.-' --•�r<-.:-�.'iewti---�.-r-+rw.- w.. �..f.-- � -.�.ti_.... -_- Y- r ..- ." - ���_'...�.- r -. � - �, ..-. .-...1 � - �- :. .- -. -'• -. ..r_-- • a- .. ° x.. .rm. .y._..__ -,_.. -+Aw. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12'_ Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 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-Stara e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G). Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts PackNot age Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 AnimalConsu Foods Tat 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* eff°"ve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * - Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority VII Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * When to Wash* 3-401.11 A 1 6 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )O practices should be debited under#29-Special 3-201.17 Game Animals* 11Good Hygienic Practices 77 Reheating for Hot Holding Requirements. $ Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-50L14 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 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. IMF rpm TOWN OF BARNSTABLE . .. _ HEALTH.INSPECTOR'S Establishment Name: - Date: - Page: ...Z Of, v do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNS'1'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ayq: �• HYANNIS,MA 02601 MO -FRI. 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION �prEo MPS° -RE PORT ' S Name Date / L Tyne of T of Ins a do outiri Address bS Risk =dS.-,!c-V1Re-inspection �/ ( b Level Previous Inspection ( P4_ p�� /-- Id Telephone Residential Kitchen Date: d, �� �g�fa� Mobile Pre-operation -��e a t w Owner HACCP Y/N Temporary Suspect Illness ^ ( &LA4 t Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: p',yt Other Inspector (�� Out: �' ` I•� 'Z �'Ld�V] Y'�G Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ XAv 0 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ( r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 0 /CL. ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures d t`� CJSfi ❑ 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 \ z c /P t k M,aj A, w1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r7 v Gtd464!.y J 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. 1 ❑ 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 B=One critical violation and less than 4non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to.8 non-critical.violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g violatiornonviolations=C.29.Special Requirements (590.009) within 10 days of receipt of this order.30.Other DATE OF RE-INSPECTION• Inspector' Pri31.Dumpster screened from public view Permit Posted? - Y N Grease Trap Previous Pumping Date Grease Rendered Y NPIC' S Print: #Seats Observed-}- Frozen Dessert Machines: Outside Dining Y N Self Service i -Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? L r 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 1S 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 i 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition ofAdulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) Com P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1 I A(I)(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* Elf cnme mnoor 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* in mobile food,temporary and residential Sources* 10 Proper,Adequate Handwashing g' P � Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g 1= 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the.foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 1 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. 574°piME T TOWN OF BARNSTABLE ,HEALTH INSPECTOR'S Establishment Name: - of te- Date: 24 Page: r' Of I OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:MON.-o P.M.MASS. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .639. MO8 -FRI. i <bA �p39,p`0� HYANNIS,MA 02601 sos-as2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY - 'EDN1A" FOOD ESTABLISHMENT INSPECTION REPORT Name Da t 2` Tvae of Tyne of Inspection Routine Address Risk Risk ood Service Re-inspection f Level Retail Previous Inspection MV Telephone Residential Kitchen Da Mobile Pre-operati n Owner HACCP Y/N Temporary Suspec Caterer General Complaint Person in Charge(PIC) Tim Bed&Breakfast HACCP 3. Other Inspector Out: :t "oj ` 1S' G{/'e' b� Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ F.� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 'D Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Q FOOD PROTECTION MANAGEMENT ❑ 12.P ention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties .Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ) O❑ 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) 1(J Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance Com ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo o checked indicate violations of 105 CMR 590.000/Federal Food Code. g ❑ Emergency Closure El Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4nori-critical violations regardless of the number of critical,results in an F. 2 .Water,Plumbing and Waste (FC-5)(590.00 ) establishment permit and cessation of food establishment operations. if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address tical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8rion-critical violations=C. 29.Special Requirements (590.009) 30.Other DATE OF RE-INSPECTION: Ins s�ture Print: 31.Dumpster screened from public view 01, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N ISIC s ignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N zr��..��.�'-"s.^'r..�_�•-......r-r-r.-�^�...�-.�-+..++--`..r-...i-..-^. 'w��'�.-+��+�-- 'r•.`-..s_Y__'�"_ __..-.-.�: .-� ��..r- �-y_ ,. -- _ .-. -�.+-.�.,�. -�-+--+..+�+r'r�^rw+.. � ... ._� ^�h '-r^+s'�^y--- � �...y.s--�,;..s---` .��--Y�w`• �+- .... �..r--.^,.....,z - _ S Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and.Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross contamination 74 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 CoolingMethods for PHFs ± 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* Cooked and Roo Foods.* - -°---� * -- 19 PHF Hot and Cold Holding 2-103.1 f Person-in-Charge Duties - - 3-302.14 Protection"from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* � 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 37302.15 _ 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* 3-30411 Food Contact with Equipment and Utensils. * 7.202.12 Conditions of Use* (590.004 11) Variance Requirements 590.003(G) Reporting by Person in-Charge*- - - - - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 ` Food aiid Water From Regulated Sources -' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law*__ _ - 4-501.111- Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(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 Es-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ _._ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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)(Y)(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,Inject6o Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscap 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 Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 see* 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 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 TagsiRecords: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 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 r6-301.1l Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 * Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 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 1 Specialized Processing Methods* J / 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000, *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. p tNE ro,, TOWN OF BARNSTABLE, - .HEALTH INSPECTOR's Establishment Name: ' �! (..� Date: , 2q1, Page: of OFFICE HOURS PUBLIC HEALTH DIVISION` 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3'MON.-FP.M.RI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MO �p ,aS9• .• HYANNIS,MA 02601 � 508-8 -62-4644 No Reference R-Red Item. PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name , Date i Type of Type of Inspection AM S era • Routine _ Address ////r`2 ® 3 ��,� Risk Food Service Re-inspection �b Level KUM. Previous Inspection Telephone Residential Kitchen D Mobile re-operatio Owner HACCP Y/N Temporary ess � O , Caterer General Complaint _/j� Person in Charge(PIC) Time Bed&Breakfast HACCP .� S �r OS't" n• Other Inspector pt f�,� Out: Z;Lt� h Each violation checked requi es an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) [� i �7U FOOD PROTECTION MANAGEMENT ❑ 12. revention of Contamination from Hands � ❑ 1.PIC Assigned/Knowledgeable/Duties andwash Facilities C�+v 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 MIA ❑ 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 t j� •- j.q w�/ �,,/__ / �Q�� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories If Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations G/ (/ Critical(C)violations marked must be corrected immediately. (blue&red items) �j a 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 ❑ Emergen Suspension dL 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 g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than Orion-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 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 9rion-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8rion-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Si ure Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN Dumpster Screen? Y N 1 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 PHF Hot and c21d Holding - 2-103.11 -Person--in=Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from*IJnapproved Additives* Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods SeparateAom Each 7-101.1 L Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge[o '7-102.11 i 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 orCh __ 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 * ( ) 9 590.003(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* j 590.004 A-B Compliance with Food Law* Stations* 3-801.1](D) Raw or Partially Cooked Animal Food and --- - - - 4-501.111 -Manual Warewashing-Hot Water 7.206.12 Rodent Bait Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and p 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3 202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water*` - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of . ean Utensils and Food Contact Surfaces o * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-60111A( ) Cl Ut a ta f f Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg crave 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.]1(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or ( )-(D) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and in cater- * - - Ratites-165°F IS sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3-40 1.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to. - 3-202.18 Sheltstock 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* f1 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. I 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* 2-01.12 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 PreventingContamination When Tasting* * (Blue Items 23.30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 18 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°17 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 590.004(J) Labeling of Ingredients' SuppldwRli Soep.and hand Drying Devices Within 4$ours 26. Water,Plumbing and Waste FC-5 .006 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;32 a Hand Drying Provision t 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590:000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Town of Barnstable BOARD OF HEALTH o' John T.Norman Board of Health Donald A.Gaudagnoli,M.D. • ¢AWNST BM F.P.(Thomas)Lee MA&q. Daniel Luczkow,M.D.,Alt. jb39. 200 Main Street, Hyannis, MA 02601 &° �a Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590,000 M.G.L. Chapter 94 Sections 30SA, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1102 Issue Date: 06/10/2021 DBA: HOMETOWN JUICE & CO- TEMPORARY PERMIT OWNER: ALL IN MODERATION WELLNESS INC. Location of Establishment: 1 WIANNO AVE OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IncloorSeating: 9 OutcloorSeating: 0 Total Seating: 9 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 07/13/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: I PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I Bellaire, Dianna From: Soto, Kathryn Sent: Thursday, June 10, 2021 10:35 AM To: Bellaire, Dianna Subject: FW: Hometown Juice They are ok to extend another month From: McKean, Thomas Sent: Thursday, June 10, 2021 10:31 AM To: Soto, Kathryn Subject: RE: Hometown Juice Yes From: Soto, Kathryn Sent: Thursday, June 10, 2021 10:24 AM To: McKean, Thomas Subject: FW: Hometown Juice You had allowed me to approve a temporary permit while they waited to get their permit from licensing. I guess they missed the June meeting and are now on for July. Are you ok with extending their temporary permit another month? From: Hartsgrove, Elizabeth Sent: Thursday, June 10, 2021 9:16 AM To: Bellaire, Dianna Cc: Soto, Kathryn Subject: RE: Hometown Juice She actually will be on the July 12t" hearing—as I hadn't heard from her and the application wasn't complete. A new temp FSP will need to be issued from your end of things again so our temp licenses can carry her forward to the hearing. Can you confirm she is allowed up to c seats? Thanks L From: Bellaire, Dianna Sent: Thursday, June 10, 2021 8:55 AM To: Hartsgrove, Elizabeth Cc: Bellaire, Dianna; Soto, Kathryn Subject: RE: Hometown Juice We issued a permit without seating and it was temporary. It expires the day after your meeting in June. Dianna Bellaire Permit Technician Town of Barnstable Health Division 1 I �W Tv Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BMAreIN49TA U- Paul J.Canniff,D.M.D. M 9 39 200 Main Street, Hyannis, MA 02601 IF.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1102 Issue Date: 05/25/2021 DBA: HOMETOWN JUICE & CO- TEMPORARY PERMIT OWNER: ALL IN MODERATION WELLNESS INC. Location of Establishment: 1 WIANNO AVE OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES - - -- - --------- FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 06/15/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE J Restrictions: i Town of Barnstable BOARD OF HEALTHJohnT. Norman Board of Health Donald A.Gaudagnoli,M.D. • aAWNSTAnM Paul J.Canniff,D.M.D. MAS 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1102 Issue Date: 05/13/2021 DBA: HOMETOWN JUICE & CO. OWNER: ALL IN MODERATION WELLNESS INC Location of Establishment: 1 WIANNO AVE OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 9 OutdoorSeating: 0 Total Seating: 9 FEES - - -- - — - -- FOODSERVICEESTABLISHMENT: $250.00 YEAR: 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r °k"'E'b''1. Town of Barnstable r� �_�Imt<als. --- Date Paid Amt_I''d$ J Inspectional Services, Check# ° •` Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 6601 / Office: 508-862-4644 Fax: 508-790-6304 PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLIS111MENT DATE O� ;, NEW OWNERSHIP Lx RENEWAL NAME OF FOOD'ESTABLLSHMENT: ADDRESS OF FOOD ESTABLISHMENT: I CA A V1 n '. klP in V-1 ' Os- ( n V 1 Le IL' Yn V9° C)(cS S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): `' ( "�fiAl Z T 1�r�fwo-� Iran l , Gov► � �3 E-MAIL ADDRESS: (.,� (� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �) - TOTAL NUMBER OF BATHROOMS: WELL WATER:YES�O ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:—' SEASONAL: DATES OF OPERATION/ TO NUMBER OF SEATS: INSIDE: _ OUTSIDE:�TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DkV.`AND LICENSING AND MEET OUTSIDE DINING ' REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) 1 i FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST s CONTINENTAL BREAKFAST ; COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:\Application FormsWOODAPP REV3-2019.doe ��� � . »l � 00 el?� OWNER INFORMATION•' -- FULL NAME OF APPLICANT SOLE OWNER: YES/ i0 OWNER-PHONE#'' - 'ADDRESS (n f Q U r "-,L40 -'O ZFO , 0 f > CORPORATE OWNER: Ptfti lfil( (A � ISCAg CORPORATE ADDRESS:55 I b7 A l— 2d -'1 2 1 �L . X ,( ,C 2 (C Vl YY)A 2 PERSON IN CHARGE OF DAIRY OPERATIONS: •H�CL l` --" -'- �/V 1��?��1--Jv�- 1!ti— LtYJ�GLJ1 Z List(2) Certified Food Protection Managers AND`it least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. . **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. ;, , , 1 : , Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. 6 bO VJ 1 .1_ /23 , t el • SI OF APPLICANT- :DATE --� i Flo, S! ***FOOD POLICY.INFORMATION* SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior,to opening!! Please call Health Div.at 508-8624644 to schedule your inspection; .Please call at least(7)days in advance.,, FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,�`` ' with sample results submitted to the Health Div. Failure to do so will result in the suspension orjevocation of your Frozen Dessert Permit until the above terms are met. r.. r' •� li' .. . t fir. €', ,. ,.y , t,^ CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering , • r '' ' _1 event. You must complete a catering notice found athttp://www.towilolbarnstable.as/healthdivision/apahcations.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. I q'I NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. `' .,1l. tl..¢�:.:li•.- :! It'.- tt c y. ;;1. 1 1, ! , qi• 1, r. 1 r r,T s!a- a} � �� t��e' , " t 1 1,• i 1 1 Q:\Application FormsTOODAPP REV3-2019.doc Quote 04/20/2021 Since 1913 BOSTON SHOWCASE COMPANY Project: From: Hometown Juice Bar Boston Showcase Company 3 Wianno Ave. Mark Cook Heather Wilson-Owner 66 Winchester Street Osterville, MA 02655 PO Box 610254 Newton Highlands, MA 02461 617-965-1100 Job Reference Number:15112 Boston Showcase Company is family owned and operated since 1913. We appreciate the opportunity to earn your business! Please note that as a result of the pandemic, equipment lead times may be longer than normal as a result of shipping delays and materials shortages from manufacturers. Item Qty Description Sell Sell Total 1 1 ea REACH-IN UNDERCOUNTER FREEZER $1,240.00 $1,240.00 Atosa USA, Inc. Model No. MGF8405GR IM"1 Atosa Undercounter Freezer, reach-in,one-section,27-1/2"W x 30"D x 34-1/8"H, rear-mounted self-contained refrigeration,7.15 cu.ft.,(1) right hinged solid door,digital temperature control,-8°to 0°F ® temperature range, (1)adjustable shelf, automatic evaporation, electric defrost,stainless steel interior& exterior,galvanized steel back,2"casters, R290 Hydrocarbon refrigerant, 1/5 HP, 115v/60/1-ph, 1.8 amps,cord, N MA 5-15P,cETLus, ETL-Sanitation 1 ea 2 year labor&parts warranty,5 years warranty on compressor ITEM TOTAL: $1,240.00 2 1 ea ICE MAKER WITH BIN,CUBE-STYLE $1,920.00 $1,920.00 Manitowoc Model No. UDE0065A NEO® Undercounter Ice Maker,cube-style,air-cooled,self contained, 19-11/16"W x 22-11/32"D x 36"H,production capacity up to 57.lb/24 hours at 70°/50"(46 lb at 90°/70%31 lb ice storage capacity,full bin and service indicators,production delay of(4, 12,or 24 hours),Alpha- San anti-microbial protection,forward sliding storage bin for access to refrigeration components, sealed foodzone with removable water trough,distribution tube and damper door,on/off/clean switch,dice size cubes,6"adjustable legs, N,�E,cULus,CE(Replaces QM-30A; CONTACT DISTRIBUTOR FOR AVAILABILITY) 1 ea WARRANTY-SM/QM 3 year parts&labor(Machine),standard 1 ea (-161B)115v/60/1-ph,5.3 amps,cord with NEMA 5-15P ITEM TOTAL: $1,920.00 5 1 ea REFRIGERATED MERCHANDISER $3,554.00 $3,554.00 Initial: Hometown Juice Bar Page 1 of 5 Boston Showcase Company 0412012021 Item City Description Sell Sell Total' True Mfg.-General Foodservice Model No.GDM-49-HC^TSL01 Refrigerated Merchandiser,two-section,True standard look version 01, (8)shelves, (2)double pane thermal insulated glass hinged doors, LED interior lights, powder coated steel exterior,white interior with stainless steel floor, R290 Hydrocarbon refrigerant, 1/2 HP, 115v/60/1- ph,8.5 amps, NEMA 5-15P,cULus, UL EPH Classified, Made in USA, ENERGY STAR® 1 ea NOTE: Commonly stocked model in black exterior, and white exterior; verify availability with factory 1 ea Self-contained refrigeration standard 1 ea Warranty-3 year parts and labor, please visit www.Truemfg.com for specifics 1 ea Warranty-7 year compressor(self-contained only), please visit www.Truemfg.com for specifics 1 ea Left door hinged left, right door hinged right standard 1 ea Exterior: Black powder coated steel, standard 1 ea Interior: White aluminum,with white shelving,standard 1 ea Illuminated sign decal:S-TS-01"TRUE Stripe"graphic,standard 1 ea BSC MA ENERGY STAR REBATE Rebate for purchasing Energy Star $-200.00 $-200.00 equipment. Must complete and sign paperwork and verify eligibility. Qualifying energy companies include Eversource, National Grid, Columbia, Unitil, Berkshire Gas, Cape Light Compact, Liberty Utilities, and Blackstone Gas Company. ITEM TOTAL: $3,354.00 6 1 ea REFRIGERATED MERCHANDISER $2,224.00 $2,224.00 True Mfg.-General Foodservice Model No. GDM-23-HC^TSL01 _ Refrigerated Merchandiser,one-section,True standard look version 01, (4)shelves, (1) Low-E thermal glass hinged door, LED interior lights, powder coated steel exterior,white aluminum interior with stainless steel floor, R290 Hydrocarbon refrigerant, 1/3 HP, 115v/60/1-ph,5.4 amps, NEMA 5-15P,cULus,UL EPH Classified,CE, Made in USA, ENERGY STAR® 1 ea NOTE:Commonly stocked model in black exterior,white exterior, and in right and left hinge;verify availability with factory 1 ea NOTE: Commonly stocked model in right and left hinge;verify availability with factory 1 ea Self-contained refrigeration standard 1 ea Warranty-3 year parts and labor, please visit www.Truemfg.com for specifics 1 ea Warranty-7 year compressor(self-contained only), please visit www.Truemfg.com for specifics 1 ea Door hinged right standard 1 ea Exterior: Black powder coated steel,standard 1 ea Interior: White aluminum, with white shelving, standard 1 ea Illuminated sign decal:S-TS-01 "TRUE Stripe"graphic,standard 1 ea BSC MA ENERGY STAR REBATE Rebate for purchasing Energy Star $-150.00 $-150.00 equipment. Must complete and sign paperwork and verify eligibility. Qualifying energy companies include Eversource, National Grid, Columbia, Unitil, Berkshire Gas, Cape Light Compact, Liberty Utilities, Initial: Hometown Juice Bar Page 2 of 5 Boston Showcase Company 0412012021 `Item City Description Sell Sell Total and Blackstone Gas Company. ITEM TOTAL: $2,074.00 7 1 ea SANDWICH/SALAD PREPARATION REFRIGERATOR $2,021.00 $2,021.00 w Atosa USA, Inc. Model No. MSF8303GR Atosa Sandwich/Salad Top Refrigerator,two-section,60-1/5"W x 30"D x 44-3/10"H, includes(16) 1/6 stainless steel pans, rear-mounted,self- �,':.a contained refrigeration, 17.2 cu.ft., (2)solid hinged self-closing doors, digital temperature control,33°to 40OF temperature range, (2) adjustable shelves, 10" poly cutting board, ventilated refrigeration, automatic evaporation,air defrost,stainless steel interior&exterior, galvanized steel back,5"casters, R290 Hydrocarbon refrigerant, 1/5 HP, 115v/60/1-ph,2.8 amps,cord, NEMA 5-15P,cETLus, ETL-Sanitation 1 ea 2 year labor&parts warranty,5 years warranty on compressor ITEM TOTAL: $2,021.00 8 lea DISPLAY CASE,DIPPING ICE CREAM $1,855.00 $1,855.00 Maxximum Model No. MXDC-8 a+, Maxx Cold X-Series Ice Cream Dipping Cabinet with Glass Canopy, mobile, 14.0 cu.ft.,(8)exposed tubs for scooping&(14)tub storage, flat sliding glass lids, lid lock&keys, interior LED lights,adjustable temperature,white zinc coated, baked on enamel steel exterior, painted white powder coated steel interior,casters, R290 Hydrocarbon refrigerant, 2.0 amps,CE,cETLus, ETL-Sanitation 1 ea 1 year parts&on-site labor with 4 year additional compressor(part only)warranty,standard 1 ea 115v/60/1-ph,2.0 amps,NEMA 5-15P,standard ITEM TOTAL: $1,855.00 10 1 ea BLENDER,BAR $387.32 $387.32 Vitamix Model No.062828 (Formerly 748, 5004) Drink Machine'',64 oz. (2 liter) BPA Free clear Tritan'' standard container with wet blade assembly,two-speed, includes: lid&tamper, black base, 2.3 peak HP, 120v/50/60/1-ph, 11.5 amps, NEMA 5-15P,cULus,NSF 1 ea 3 years warranty on motor base parts& 1 year warranty on labor, standard ITEM TOTAL: $387.32 12 1 ea BLENDER CONTAINER $96.80 $96.80 Vitamix Model No, 1191 STOCK ITEM. Blender Container,64 Oz Vita-Prep A� 13 ITEM TOTAL: $96.80 13 1 ea BLENDER,BAR $1,225.00 $1,225.00 Initial: Hometown Juice Bar Page 3 of 5 1 Boston Showcase Company 0112012021 Item Qty Description Sell Sell Total' Vitamix Model No.036019-ABAB The Quiet One®Twist Lock Blender, countertop,48 oz. (1.4 liter) capacity, clear Tritan"" BPA free Advance®container,24-1/2"H with lid open,stackable, removable compact twist lock cover, (6)touch control buttons with (34) program options, includes:Advance® blade assembly&lid,3-peak HP, 120v/50/60/1-ph, 15.0 amps,NEMA 5-15P, RoHs compliant,CE,WLus,!NSF s 1 ea 3 years warranty on motor base parts& 1 year warranty on labor, standard ITEM TOTAL: $1,225.00 13A 2 ea BLENDER CONTAINER $103.49 $206.98 Vitamix Model No. 15978 - Advance® Complete Blender Container,48 oz. (1.4 liter)capacity,clear j BPA Free,TritanTm container, includes:Advance® blade assembly& lid, ,�ISF(for use with The Quiet One®, Blending Station Advance® & Drink Machine'Advance®) ITEM TOTAL: $206.98 14 R $1,,165.90 R Ref igerateF Merchandiser, b se -con ame re ngera i , c ixe a ec ro empera ure ra , h rs, - anioMn 15 1 ea BSC SERVICES $540.00 $540.00 Boston Showcase Model No. DELIVERY-GOLD Deliver and set equipment. Equipment will be delivered and set into place ready to use in the location where it will be operated or in a designated area at the request of the customer.This includes uncrating,trash removal,adding legs/casters if necessary, peeling stainless steel, etc. Disconnecting existing equipment and final connections, i.e.electrical and plumbing, are by others. ITEM TOTAL: $540.00 16 1 ea SERVICES Boston Showcase Model No.VENDOR-FREIGHT �ft Freight from Vendor Merchandise $16,185.10 Tax $977.82 Total $17,162.92 Initial: Hometown Juice Bar Page 4 of 5 Boston Showcase Company 0412012021 : K i n g,W o o d For more information: L EASING www.KingswoodLeasing.com • - '• ' 888-327-8121 AQC@kingswoodleasing.com Finance-to-Own Click here To Apply 24-month term: $737.30-$775.07* 36-month term: $514.38-$554.13* 48-month term: $403.43-$444.88* 60-month term: $337.25-$380.29* *These examples reflect actual payment ranges that businesses with more than 2 years in business receive. Payments will vary depending on the established business and personal credit. Financing is available for Start-Up restaurants. Pricing is valid for 30 days unless otherwise noted. While we make every effort to ensure this quote is correct, the customer is ultimately responsible to check for errors such as size, gas type, voltage and on-site spacial restrictions. For equipment deliveries or projects, all site prep, permits, plumbing, electrical and mechanical work is not in the scope of our work unless noted.All labor is non-union and performed during our normal work day hours of Monday-Friday 7AM-3:30PM unless otherwise noted. All non-stock/special order items are NOT RETURNABLE unless authorized. If approved for return, all items will be subject to a restocking, re-crating and/or re-packing fee and return shipping charges. Please inspect all packages for damage before accepting delivery. Freight carriers will not accept damage claims and no credit will be issued after delivery has been accepted. When receiving items from common carriers, please indicate, "subject to inspection." If box or item is damaged, please refuse delivery and contact your Account Executive or our office at 617-965-1100. Acceptance: Date: Printed Name: Project Grand Total:$17,162.92 Initial: Hometown Juice Bar Page 5 of 5 I I �77 A Quote 04/20/2021 Since 1913 BOSTON SHOWCASE COMPANY Project: From: Hometown Juice Bar Boston Showcase Company 3 Wianno Ave. Mark Cook Heather Wilson -Owner 66 Winchester Street Osterville, MA 02655 PO Box 610254 Newton Highlands, MA 02461 617-965-1100 Job Reference Number:15112 Boston Showcase Company is family owned and operated since 1913. We appreciate the opportunity to earn your business! Please note that as a result of the pandemic, equipment lead times may be longer than normal as a result of shipping delays and materials shortages from manufacturers. Item City Description Sell Sell Total . .. r 1 1 ea REACH-IN UNDER LINTER FREEZER $1,240.00 $1,240.00 Atosa USA, Inc. Model No. MGF8405GR Atosa Undercounter Freezer, reach-in,one-section,27-1/2"W x 30"D x 34-1/8"H, rear-mounted self-contained refrigeration, 7.15 cu.ft., (1) right hinged solid door,digital temperature control, -8°to 0°F ® temperature range, (1)adjustable shelf,automatic evaporation, electric defrost, stainless steel interior&exterior,galvanized steel back, 2"casters, R290 Hydrocarbon refrigerant, 1/5 HP, 115v/60/1-ph, 1.8 amps,cord, NEMA 5-15P,cETLus, ETL-Sanitation 1 ea 2 year labor&parts warranty,5 years warranty on compressor ITEM TOTAL: $1,240.00 2 1 ea ICE MAKER WITH BIN,CUBE-STYLE $1,920.00 $1,920.00 Manitowoc Model No. UDE0065A NEO® Undercounter Ice Maker, cube-style, air-cooled,self contained, 19-11/16"W x 22-11/32"D x 36"H,production capacity up to 57 Ib/24 hours at 70'/50"(46 lb at 90'/70°),31 lb ice storage capacity,full bin and service indicators,production delay of(4, 12,or 24 hours),Alpha- San anti-microbial protection,forward sliding storage bin for access to refrigeration components, sealed foodzone with removable water trough, distribution tube and damper door, on/off/clean switch,dice size cubes,6"adjustable legs, NSF,cULus,CE(Replaces QM-30A; CONTACT DISTRIBUTOR FOR AVAILABILITY) 1 ea WARRANTY-SM/QM 3 year parts&labor(Machine),standard 1 ea (-161B)115v/60/1-ph,5.3 amps,cord with NEMA 5-15P ITEM TOTAL: $1,920.00 5 1 ea REFRIGERATED MERCHANDISER $3,554.00 $3,554.00 Initial: Hometown Juice Bar Page 1 of 5 Boston Showcase Company 0412012021 Item CRY Description Sell Sell Total True Mfg.-General Foodservice Model No.GDM-49-HC—TSL01 Refrigerated Merchandiser,two-section,True standard look version 01, (8)shelves, (2)double pane thermal insulated glass hinged doors, LED interior lights, powder coated steel exterior, white interior with stainless steel floor, R290 Hydrocarbon refrigerant, 1/2 HP, 115v/60/1- ph,8.5 amps, NEMA 5-15P,cULus, UL EPH Classified, Made in USA, ENERGY STAR® 1 ea NOTE: Commonly stocked model in black exterior, and white exterior; verify availability with factory 1 ea Self-contained refrigeration standard 1 ea Warranty-3 year parts and labor, please visit www.Truemfg.com for specifics 1 ea Warranty-7 year compressor(self-contained only), please visit www.Truemfg.com for specifics 1 ea Left door hinged left, right door hinged right standard 1 ea Exterior: Black powder coated steel,standard 1 ea Interior: White aluminum,with white shelving, standard 1 ea Illuminated sign decal:S-TS-01 "TRUE Stripe"graphic,standard 1 ea BSC MA ENERGY STAR REBATE Rebate for purchasing Energy Star $-200.00 $-200.00 equipment. Must complete and sign paperwork and verify eligibility. Qualifying energy companies include Eversource, National Grid, Columbia, Unitil, Berkshire Gas,Cape Light Compact, Liberty Utilities, and Blackstone Gas Company. ITEM TOTAL: $3,354.00 6 1 ea REFRIGERATED MERCHANDISER $2,224.00 $2,224.00 True Mfg. -General Foodservice Model No. GDM-23-HC—TSL01 Refrigerated Merchandiser, one-section,True standard look version 01, (4)shelves,(1) Low-E thermal glass hinged door, LED interior lights, powder coated steel exterior, white aluminum interior with stainless steel floor, R290 Hydrocarbon refrigerant, 1/3 HP, 115v/60/1-ph,5.4 amps, NEMA 5-15P,cULus,UL EPH Classified,CE, Made in USA, ENERGY STAR® 1 ea NOTE:Commonly stocked model in black exterior,white exterior, and in right and left hinge;verify availability with factory 1 ea NOTE:Commonly stocked model in right and left hinge;verify availability with factory 1 ea Self-contained refrigeration standard 1 ea Warranty-3 year parts and labor,please visit www.Truemfg.com for specifics 1 ea Warranty-7 year compressor(self-contained only), please visit www.Truemfg.com for specifics 1 ea Door hinged right standard 1 ea Exterior: Black powder coated steel,standard 1 ea Interior:White aluminum,with white shelving,standard 1 ea Illuminated sign decal:S-TS-01 "TRUE Stripe"graphic,standard 1 ea BSC MA ENERGY STAR REBATE Rebate for purchasing Energy Star $-150.00 $-150.00 equipment. Must complete and sign paperwork and verify eligibility. Qualifying energy companies include Eversource, National Grid, Columbia, Unitil, Berkshire Gas,Cape Light Compact, Liberty Utilities, Initial: Hometown Juice Bar Page 2 of 5 Boston Showcase Company 0412012021 'Item City Description Sell Sell Total and Blackstone Gas Company. ITEM TOTAL: $2,074.00 7 1 ea SANDWICH/SALAD PREPARATION REFRIGERATOR $2,021.00 $2,021.00 Atosa USA, Inc. Model No. MSF8303GR Atosa Sandwich/Salad Top Refrigerator,two-section,60-1/5"W x 30"D x 44-3/10"H, includes(16) 1/6 stainless steel pans, rear-mounted,self- contained refrigeration, 17.2 cu.ft., (2)solid hinged self-closing doors, digital temperature control,33°to 407 temperature range,(2) adjustable shelves, 10" poly cutting board,ventilated refrigeration, automatic evaporation, air defrost,stainless steel interior&exterior, galvanized steel back,5" casters, R290 Hydrocarbon refrigerant, 1/5 HP, 115v/60/1-ph,2.8 amps,cord, NEMA 5-15P,cETLus, ETL-Sanitation 1 ea 2 year labor&parts warranty,5 years warranty on compressor ITEM TOTAL: $2,021.00 i 8 1 ea DISPLAY CASE,DIPPING ICE CREAM $1,855.00 $1,855.00 Maxximum Model No. MXDC-8 Maxx Cold X-Series Ice Cream Dipping Cabinet with Glass Canopy, mobile, 14.0 cu.ft., (8)exposed tubs for scooping&(14)tub storage, flat sliding glass lids, lid lock&keys, interior LED lights,adjustable temperature,white zinc coated, baked on enamel steel exterior, painted white powder coated steel interior, casters, R290 Hydrocarbon refrigerant, 2.0 amps,CE,cETLus, ETL-Sanitation 1 ea 1 year parts&on-site labor with 4 year additional compressor(part only)warranty,standard 1 ea 115v/60/1-ph,2.0 amps,NEMA 5-15P,standard ITEM TOTAL: $1,855.00 10 1 ea BLENDER,BAR $387.32 $387.32 Vitamix Model No. 062828 (Formerly 748,5004) Drink Machine'',64 oz. (2 liter) BPA Free clear Tritan'' standard container with wet blade assembly,two-speed, includes: lid &tamper, black base,2.3 peak HP, 120v/50/60/1-ph, 11.5 P r`: amps,NEMA 5-15P,cULus,NSF 1 ea 3 years warranty on motor base parts& 1 year warranty on labor, standard ITEM TOTAL: $387.32 12 1 ea BLENDER CONTAINER $96.80 $96.80 Vitamix Model No. 1195 STOCK ITEM. Blender Container,64 Oz Vita-Prep ITEM TOTAL: $96.80 13 1 ea BLENDER,BAR $1,225.00 $1,225.00 Initial: Hometown Juice Bar Page 3 of 5 Boston Showcase Company 0412012021 Item Qty Description Sell Sell Total Vitamix Model No.036019-ABAB i The Quiet One®Twist Lock Blender,countertop,48 oz. (1.4 liter) capacity,clear TritanTm BPA free Advance®container,24-1/2"H with lid open,stackable, removable compact twist lock cover, (6)touch control buttons with (34) program options, includes:Advance® blade assembly&lid,3-peak HP, 120v/50/60/1-ph, 15.0 amps, NEMA 5-15P, RoHs compliant,CE,cULus, NSF 1 ea 3 years warranty on motor base parts&1 year warranty on labor, standard ITEM TOTAL: $1,225.00 13A 2 ea BLENDER CONTAINER $103.49 $206.98 Vitamix Model No. 15978 Advance®Complete Blender Container,48 oz. (1.4 liter)capacity,clear a ` BPA Free,TritanTm container, includes:Advance® blade assembly& lid, NSF(for use with The Quiet One®, Blending Station Advance®& Drink MachineTm Advance®) ITEM TOTAL: $206.98 14 1 ea REFRIGERATED MERCHANDISER $1,265.00 $1,265.00 Atosa USA, Inc. Model No. MCF8725GR 3`r Refrigerator Merchandiser,one-section,24-1/5"W x 24"D x 76-1/5"H, bottom-mounted self-contained refrigeration, 11.1 cu.ft., (1)self- closing hinged glass door with lock, Dixell electronic controller, 33o to 38°F temperature range, (4)shelves, LED interior lighting, lighted header panel, stainless steel interior, black steel exterior, 2" casters, R290 Hydrocarbon refrigerant, 1/7 HP, 115v/60/1-ph,2.1 amps,cord, NEMA 5-15P,cETLus, ETL-Sanitation 1 ea 2 year labor& parts warranty,5 years warranty on compressor ITEM TOTAL: $1,265.00 15 1 ea BSC SERVICES $540.00 $540.00 Boston Showcase Model No. DELIVERY-GOLD Deliver and set equipment. Equipment will be delivered and set into place ready to use in the location where it will be operated or in a designated area at the request of the customer.This includes uncrating,trash removal,adding legs/casters if necessary, peeling stainless steel, etc. Disconnecting existing equipment and final connections, i.e. electrical and plumbing, are by others. ITEM TOTAL: $540.00 16 1 ea SERVICES Boston Showcase Model No.VENDOR-FREIGHT 404== " Freight from Vendor Merchandise $16,185.10 Tax $977.82 Total $17,162.92 Initial: Hometown Juice Bar Page 4 of 5 Boston Showcase Company 0412012021 Kin g swood For more information: L EASING www.KingswoodLeasine.com • " "• = 888-327-8121 AQ(@kingswoodleasing.com Finance-to-Own Click here To Apply 24-month term: $737.30-$775.07* 36-month term: $514.38-$554.13* 48-month term: $403.43-$444.88* 60-month term: $337.25-$380.29* *These examples reflect actual payment ranges that businesses with more than 2 years in business receive. Payments will vary depending on the established business and personal credit. Financing is available for Start-Up restaurants. Pricing is valid for 30 days unless otherwise noted. While we make every effort to ensure this quote is correct,the customer is ultimately responsible to check for errors such as size, gas type, voltage and on-site spacial restrictions. For equipment deliveries or projects, all site prep, permits, plumbing, electrical and mechanical work is not in the scope of our work unless noted.All labor is non-union and performed during our normal work day hours of Monday- Friday 7AM-3:30PM unless otherwise noted. All non-stock/special order items are NOT RETURNABLE unless authorized. If approved for return, all items will be subject to a restocking, re-crating and/or re-packing fee and return shipping charges. Please inspect all packages for damage before accepting delivery. Freight carriers will not accept damage claims and no credit will be issued after delivery has been accepted. When receiving items from common carriers, please indicate, "subject to inspection." If box or item is damaged, please refuse delivery and contact your Account Executive or our office at 617-965-1100. Acceptance: Date: Printed Name: Project Grand Total:$17,162.92 Initial: Hometown Juice Bar Page 5 of 5 l_ Hometown Juice &Co-Osterville Additional Used/ Existing Equipment 3 Bay Washing/Sanitizing Sink Hand Wash Sink Prep Sink Mop Sink Grease Trap Nutrifaster-Juicer 2 Door Reach- In Worktop Refrigerator 14.1 Cubic Foot Chest Freezer r Home Juicers AI9 '` uft* sister History Services (� O 1""r !nr!.if; Buy - Contact N450 Technical, Specifications N460 Specifications: • 1.25 HP Motor • 3450 RPM • 10.8 Amps • 110 Volts/60Hz • 1056 Watts • Stainless Steel Motor Shaft 0 Height 19" • Diameter: 12" • Weight: 61lbs • Two cutter plate configurations available (patented 16 blades or shredder) • 220V, 50Hz Configuration also available 1 Year Limited Manufacturers Warranty UL Listed to Std. 763, UL Sanitation Listed to NSF Std. 8, Certified to CAN/CSA C22.2 NO. 195, CE Approved CL USSf C E Subscribe to our Newsletter! We don't sell or share this information with anyone. Email address _._ © 2021, Nutrifaster Powered by Shopify © 2021, Nutrifaster Powered by Shopify I Bellaire Dianna From: Sota, Kathryn Sent: Friday, May 21, 2021 10:44 AM To: Belleire, Dianna Subject: FW: Contact info From: Soto, Kathryn Sent: Friday, May 21, 2021 10:43 AM To: 'Hometown Juice &Co.' Subject: FW: Contact info Hi Heather, I have not heard back from you since the response I sent on Monday. Also we do not have a floor plan on file, did you not submit one? Please send over a cony asap. Please understand that you are not allowed to open until 1)you send us an order slip for the quartz top 2) supply a floor plan and 3)get a sign off inspection from Health. Reach out to me asap. Regards, Kathryn From: Soto, Kathryn Sent: Monday, May 17, 2021 10:41 AM To: 'Hometown Juice &Co.' Subject: FW: Contact info Hi Heather, Here is the directors response: "Yes if Ms. Wilson can provide us a copy of the order slip for the quartz top." If you can send me that then you will be all set. Thanks, Kathryn From: Soto, Kathryn Sent: Monday, May 17, 2021 10:09 AM To: 'Hometown Juice &Co.' Subject: RE: Contact info Hi Heather, Just an update...I had sent an email to my boss asking for approval and have not heard back yet. As soon as I do I will reach out to you. I finished reviewing your application Friday and everything is all set. I looked over the menu and it looks great! 1 J Take care, Kathryn From: Hometown Juice &Co. [ma ilto:hometownju ice bar@amail.com] Sent: Friday, May 14, 2021 2:53 PM To: Soto, Kathryn Subject: Re: Contact info Hello Kathryn, Question... our quartz for the bar top has been delayed a bit. We do not plan to use the seating right away with COVID and there will not be any food prepared there. Can the bar top be covered so there is no exposed wood until the quartz arrives(possibly a week delay)? Best Regards, Heather Wilson On May 13, 2021, at 11:30 AM, Soto, Kathryn <Kathryn.Soto town.barnstable.ma.us>wrote: Hi Heather, This is my email contact information, plus my direct line is listed below. Feel free to reach out to me with any questions or concerns. Also you can send me any updated equipment information in this email too. I will see you on 5/24 at 2pm. Take care, Kathryn 64 Health inspector Town of Barnstable 200 Main St Hyannis, MA 02601 508-862-4639 <image003.png> The inforrnation 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 Attorneys 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. 2 APTISAN TOASTS ROMETOWNRANDPI-CLED " . Blended fruit with toppings on Pain D'Avignon Multi-Grain.,or Gluten Free Bread (41). ACAIl POWL BLENDED: THE AV® -Acai,. Strawberry, Blueberry Avocado, Tomato, topped TOPPINGS: with 1830 Sea,Salt Herb De D // Banana, Strawberry, Blueberry, Provence ; V Peanut Butter, Chia Seeds PEANUT PUTTED CHOCOLATE PEE ZED Natural Peanut'Butter, Banana, BLENDED: Cocoa Nibs & Cinnamon ' Mango, Banana;Pineapple 0 WN TOPPINGS CUCUMPER$$9,IlIYIlMUS •M g.•_ Banana, Toasted Coconut, Housemade Beet Hummus, Almonds, Local Honey,-. Cucumber, Black Pepper Turmeric, Bee_Pollen } _ Garnished with Cilantro..—TWISTED APPLE .� 'BLENDED: Backwoods AI'-s Twisted Apple Pitaya Strawberry,. Mango —Jelly, pp peed with Red Apple to .x- TOPPINGS: - I Peanut Butter & Chia Seeds r. •. Banana;:Blueberry, ._. ._. .... ..... ----- Toasted Coconut, Local Honey SNACKS - 331 Cotuit Road '.-Suite-27 PANANA 1B®A'Il'. ON ` 41 E CO ' Split Banana with Greek Yogurt - Sandwich, "IvIA�0256'3 - "" TOPPINGS: 774.205.2141 - Blueberry, Strawberry, sandwi,ch@..hometownjuice.6ar.com '.. ]EI�IIIEIl?(�� D�Il'Il'lE� _. Toasted Almond, Local�Honey Chocolate Peanut Butter _.. _ 4 Wianno Avenue . �, - •• Apple Cinnamon - - �.. SIDS Ostervi I Le, MA 02655 VEc�" E STICKS - : 508.419.1240 - � . HOMETOWN'SALAD Carrots & Celery with ostervilteQhometownjui.cebar com �- Natural Peanut Butter p Avocado, Tomato, Cucumber or Housemade Beet Hummus _ - -Arcadian Greens with 1830 herbs- de Provence and a ® hometownjuicebar_,com. Homemade Lemon Vinaigrette MANIC PLACK P EAN PD®WNI ES : . : . . -^ . Tomato, Croutons and MANIC PROTEIN Parmesan Cheese PEANU'Il`Il�U Il D.C..UPS ",' EMU `�'® (�;$$lE(�;V OUT ®�1P:1 OCAL PETA L. SEL1Ec'n®NSI _ JUICES Ito 9_00z. 9-46 SMOOTHIES Kul, Kale, Spinach, Green Apple, Carrot; Orange,.Romaine, Mint, Mango,:::Pineapple,.Lime Peanut Butter...Strawberry„ Cucumber, Parsley; Jalapeno, Cilantro, Lime, . Turmeric, Coconut.Water..-: Banana, Almond Milk,. Bee-Pollen, Lemon, Ginger Turmeric HOMETOWN HULK HOMETOWN REDO CODE HAM ...]EU E (�AND13---. - :_ M .--Coffee, atcha Green Tea -Coffee -Cocoa Nibs Banana Carrot; Red:Beet, Kale, Carrot, Red Apple, Ginger.. _ Avocado,:Loco[.Honey, . Peanut-Butter, Almond Milk _.. . Spinach, Parsley, Celery,' - Banana, Almond Milk _.. Red Apple, Ginger P]EIET VEESWEET _ Beet, Cucumber, Carrot, D®®T CA Strawberry, Blueberry, Adoi i KPLENISH ME Lemon, Orange, Pineapple Ginger, Carrot,. - Local Honey, Greek Yogurt Pineapple, . Banana, Cinnamon Green'Apple, Agave, Almond Milk CDEENVILLE IDl���l Pear, Mint �C� SNAP Beet, Red Apple, Cucumber, I i1( Kale, Spinach; Chia..Seeds, t�rt tt � HT I B L �ll.�ull]E l�ll� Pineapp a Banana;. emo:n Lemon,_Ginger . - - - _._ HLEDATION STATION- = Blueberry, c BI .•berry, Pineapple, V Co onut Water Cucumber, Pear,. ;. a.h&, Banana, Agave, M e 1830 Sea Salt; Mint, �LOVCETTE� µ .:: Lime; Almond Milk Coconut Water _ Blueberry;-Pear, --- - Mint, Coconut Water hoose up to-5 ingredients C DETOX ZINC Banana Strawber Blueberr _ -.. I .. rY .. _ * ��U� AV®CAD® * r)j ®0 Pineapple, Orange; p HOMETOWN LEMONADE Spinach, Granola Chia_Seeds - Spinach - Lemon, Coconut Water, Agave A Agave, Almond Milk ®P ADVA�(OCAD.®,* � XO* -' Cilantro, Romaine, Jalapenog w. S WITC41 rf �, P .. :` SMOOTHIE ]BOOS .CAPE COD COFFEETS - ? Choose from: Greek Yogurt, --- - -i -'`Whey Protein, Plant Sunrise Blend (Hot) WELLNESS . Coconut Milk, Coconut Water, ; protein; Collagen, Green _ Almon d Milk; Whole Milk or Water Cold Brew-(Traditional or Seasonal) Wheatgross Tea Matcha,-Moca, Nitro (Hot or Cold) - - -- Spirulina,.Chia Seeds, Ginger �. Hemp'Seeds, Bee Pollen I Nitro Latte (Hot or Cold) Pineapple - Jalapeno. ORED ONLINE AT Y Granola, Oats, Almonds ��. Coco Nitro Latte (Hot or Cold) Orange -Ginger HOMETOWNJUICEBAR.C-OM Peanut Butter, Almond Keto Coffee $utter; Spinach -Kale;_ Activated - - Avocado,-•Lo:cal Hone ct voted Y.^^a 1E Coconut Water & Lemon - rior�u�wn 7Cold Brew.Coffee, Coconut = W= Mighty Leaf Tea ~ - Ginger, Turmeric, ' � Cacao Nibs,"Cocoa•Nibs (Various Flavors) - Cayenne & Lemon ` - P LEASE.IN FORM,US:OF ANY„ALLERGIES. t S sec IV y LffiA 6 � �cD"I Icy �. � �lP►�v1 S � p � YU7 �E; fk, 0 C) 0 LO-4 Cf- E�ST 0 - 0 &V ry Mov T D S � � E � R m S �1 E 1000- e � 1 y StKvee Ail2�J Gb�a t 'SUS C 5-V'T -7 a b � w � ��� � roc �N�� ►�,� �+ '� c�sz o� aC) a C�Y-T t`NCB Tea AMR MO 9 S{N'K �J D S dY1 S Bellaire, Dianna From: Hartsgrove, Elizabeth Sent: Thursday,June 10, 2021 9:16 AM To: Bellaire, Dianna Cc: Soto, Kathryn Subject: RE: Hometown Juice She actually will be on the July 121h hearing—as I hadn't heard from her and the application wasn't complete. A new temp FSP will need to be issued from your end of things again so our temp licenses can carry her forward to the hearing. Can you confirm she is allowed up to 9 seats? Thanks L From: Bellaire, Dianna Sent: Thursday, June 10, 2021 8:55 AM To: Hartsgrove, Elizabeth Cc: Bellaire, Dianna; Soto, Kathryn Subject: RE: Hometown Juice We issued a permit without seating and it was temporary. It expires the day after your meeting in June. 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-niail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It:is for the addressee only."Phis 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.u.se only.The Infortation 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.J hank you for your cooperation. From: Hartsgrove, Elizabeth Sent: Thursday, June 10, 2021 8:46 AM To: Bellaire, Dianna Subject: FW: Hometown Juice Dianna, Is she all set with her Health requirements that I can issue a temp CV license? Thanks L 1