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HomeMy WebLinkAboutFOOD MARKET INTERNATIONAL - RETAIL FOOD FOOD"MARKET INTERNATIONAL !. 163 Barnstable Rd.3ij uvn _ Town of Barnstable BOARD OF HEALTH O John T. Norman Board of Health Donald A.Gaudagnoli,M.D. t rsdtaxr rxQuE, F.P.(Thomas)Lee,. 039. 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 957 Issue Date: 01/01/2022 DBA: FOOD MARKET INTERNATIONAL OWNER: RAUL FERNANDEZ Location of Establishment: 163 BARNSTABLE ROAD HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: lhdoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2O2 2 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED- 01/21/2020 - One restroom facility onsite with requirement that Food Market International is responsible for cleaning and maintenance of bathroom. f oF�rqr Town of Barnstable For Office Use Only: Initials: ti �. �` Date Paid AmtPd$ _ BAMSTABLE. Inspectional Services F 39. Public Health Division Check# 7 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 l/ NAME OF FOOD ESTABLISHMENT: GIB !✓JOGt ,,VJk le 1 Y� r�✓hC[ft d Ylc�/. �A✓IC ADDRESS OF FOOD ESTABLISHMENT: W SGllrh g a�GC h�� �c�a�• ,� Rr��+: �f n Z 6ac MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ci E-MAIL ADDRESS: h'?-rood"ra'Y(�rgf�"yt l G 3��M n e c0 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO 1 /_ NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE ,-RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT 90-4� ffr oa n C`C-e— SOLE OWNER: ES/NO OWNER PHONE# 5-0 8- rL]2' Z 6l/ ADDRESS -7 o - ')-e( k( ©e Gd t CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. P A. L. N 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httt)://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. i Q:\Application FormsTOODAPP REV3-2019.doc MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount (see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed & Breakfast Permit= $55; Food Service Permit 0-49 seats= $250; 50 or more seats $300; Continental Breakfast=$30;Retail Food (only TCS Foods) =$20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. = $285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry= $75; Mobile Truck= $50; Mobile Ice Cream Truck= $35; Frozen Dessert License=$30; Additional non-refundable Fee for New Establishment or New Ownership= $100-$500(see staff), Late Fee= $10 QAApplication FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNEMARLE, Paul J.Canniff,D.M.D. 1,539, IL 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 957 Issue Date: 01/01/2021 DBA: FOOD MARKET INTERNATIONAL OWNER: RAUL FERNANDEZ Location of Establishment: 163 BARNSTABLE ROAD HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q/ FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED- 01/21/2020 - One restroom facility onsite with requirement that Food Market International is responsible for cleaning and maintenance of bathroom. IMME Town of Barnstable Office For Use Only: Initials: Date Paid -! Amt Pd$ _ RAMWABLE, : Inspectional Services QL 9cb 1639. ,0� Check# Lj2 t ArFo,AA,a Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11101 Ti° NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��CDp �'VJ.AIff!(t` r�I�e1'nCC t;l)a Cc�- ts7C ADDRESS OF FOOD ESTABLISHMENT: l p 3 - 'Barns-table (U- Fl Y n n "S Hd- a MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 'I—hf:,2ydWni,Keil0-t163 j2 m a "/- �A'3-! TELEPHONE NUMBER OF FOOD ESTABLISHMENT: _0 )53a- -� TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: t/ SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _12ftETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT Terno o 8eZ SOLE OWNER: YES/NO D.O.B OWNER PHONE# ADDRESS_ r7o De+ L— Sf reef- M-4- inz6ol vf' CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: � ,Q 1T-?rpn.yl a(e z List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. /0 /� O SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to oyenin2!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc S BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. • HARN$TAOM t Pauli.Canniff,D.M.D. ,+ 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 18SA; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 957 Issue Date: 01/21/2020 DBA: FOOD MARKET INTERNATIONAL OWNER: RAUL FERNANDEZ Location of Establishment: 163 BARNSTABLE ROAD HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,�A 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: APPROVED- 01/21/2020- One restroom facility onsite with requirement that Food Market International is responsible for cleaning and maintenance of bathroom. r 0 � Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. e,►RNSTABIX PaulJ.Canniff,D.M.D. MASS, , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate i Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 957 Issue Date: ' 11/12/2019 DBA: FOOD MARKET INTERNATIONAL OWNER: RAUL FERNANDEZ Location of Establishment: 163 BARNSTABLE ROAD HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 Outdoor5eating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. - one restroom facility onsite. For Office Initials: <fTown of Barnstable Date paid N l Amt Pd$ [ y' MUMMBLE, ' Inspectional Services Clmeek ' ntnss Public Health Division Thomas McKean, Director 7 2 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE flj12-1?_01J NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Th�fo od' Ma►rke- ADDRESS OF FOOD ESTABLISHMENT: [6's (�m4a Sit G1 Ue R d - H&A'0,S � M'4>0Z 6°( MAILING ADDRESS(IF DIFFERENT FROM ABOVE): C )C�L•�/l—� E-MAIL ADDRESS: I au lr_p_ 22e2 a 1/Q C-0m TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6-OSffV- q 9 414t TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO t ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENS ROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. - IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL.MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc r OWNER INFORMATION: FULL NAME OF APPLICANT Ra1.Q Cerf is n d�P-c— SOLE OWNER: YES/NO D.O.B ' OWNER PHONE# 0 - - ADDRESS 7 b -0P I TCc S':-✓eel tf�«n r .S C:::) 2 G01 - CORPORATE OWNER: CORPORATE ADDRESS: -� PERSON IN CHARGE OF DAILY OPERATIONS: ►� 4.r.� 1---e,i-on a de, List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Manners Expiration Date Allergen Awareness Expiration Date 1. O/A 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http•//www.townofbarnstable.us/healthdivision/api)lications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc f Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. RARNgTABL& John T. Norman MAM 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate 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 305A, 305B, 146, 189 and 189A; Chapter 111,Sections.5 and 127A, a permit is hereby granted to: Permit No: 957 Issue Date: 12/20/18 DBA: FOOD MARKET INTERNATIONAL OWNER: SEGUNDO B. CAMAS & LUIS CALLE Location of Establishment: 163 BARNSTABLE ROAD HYANNIS MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR: 2019 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - -- -- - - -- --- MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. - one restroom facility onsite. t F�"E roy� F9� Initials: o� Town of Barnstable 3//Date Paid Amt Pd 9 KAS& Inspectional Services Ec 9. s`0 Check# Cash Public Health Division Thomas McKean,Director S 106 p J j 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 J NAME OF FOOD ESTABLISHMENT: Ie �� Ef /�tzh�e� I �7�e�h ea ►`i el�i�� 1 ►'� ADDRESS OF FOOD ESTABLISHMENT: T G� • Q aPn rS df b � / ��% rr�//�-Q2(Oc�� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: ® OUTSIDE: 0 TOTAL: CD SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?,Z IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(Sl� - TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FonnsTOODAPPREV2018.doc L�f II r t PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT ,5Qq V;I%.(O Coo 0105 0 r LU Gcct� SOLE OWNER: YES/1 O OWNER PHONE# 50? 3 b 10 Z -7 it ADDRESS_ ��� �ct�-�eti�f S LO loL A . CORPORATE OWNER: FEDERAL ID NO. : Lf b 3`2 CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: © ( Q0. PY 71 h t)C� List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FormsT00DAPPREV2018.doc t 957 BOARD OF HEALTH . 11/06/2017 PERMIT TO OPER ESTABLISHMENT In accordance with �r a RhW4 i' thority of Chapter 94, Section 395A.and Cha er do '"°'G W*� ermit is herebyranted to: �r SEGUNDO B. CAMAS &LUIS CALL S = _ ' /B FOO ' _ III NATIONAL SAF Whose place of business is: s NSTA NN IiVA.4. 1 v Type of business and any reitg' - LISH I R . To operate a food establisifngntt�iin We T BLE RESTRICTIONS IF ANY: MUST PPT�FRIf10E L .O SEATING: 0y �. �4= mom•.� ANNUAL: E jr k.=� s 1, � : SEASONAL: TEMPORAFkA, t r ` = E s FINCIF HEALTH RETAIL FOOD STORE: 00 � k P! ,. .1�Canniff, D.M.D., Chairperson FOOD SERVICE ESTABLISHMENT: is` p _ � J n RESIDENTIAL KITCHEN FOR RETAIL SALE: i I Sawayanagi.�;_ ,� RESIDENTIAL KITCHEN FOR BED+BREAKFAS l F` � ;.: ald A. Guadacgr►oli M.D 4 _^ '�' — r� SL MOBILE FOOD UNIT: = = TOBACCO SALES: ' 30 „1I` FROZEN DESSERT: z Thomas A. McKean, IRS, CHO CATERER: � ,� `' Director of Public Health �. 1He Town of Barnstable &Inv " V oF r Regulatory Services I/ ,A MA BMWSTABLE, * Richard V. Scali Director BARNSTABLE 9�v i639• 19 SARNn�ft A-C u'4 ivy R-WANNISF rEo,,,p�a Public Health Division 1639-2014 Thomas McKean, Director 573 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 FaX 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: ( { �o��� IGid�f' ����r��f/e;lCA � C _ ADDRESS OF FOOD ESTABLISHMENT: ( E :s IZ�I �/�����% 7� OZ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: eo rC-o"P TELEPHONE NUMBER OF FOOD ESTABLISHMENT: G' - NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: A-h/t TYPICAL HOURS OF OPERATION MON-FRI: TO j G1 : ICJ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 1,C� IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE Off'ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY Jam.. OOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:Wpplication Forms\Foodappldoc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: a FULL NAME OF APPLICANT — - -U 1 S 0 SOLE OWNER: YES /'' 0 ADDRESS 113 02era PHONE # /0- 00 j Z IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS:cei '/ IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION: /"' FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1. EXPIRATION DATE: 2. EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF-THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. ✓ XP IRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:\Application Forms\Foodapp3.doc PERMIT 1v0: TOWN OF BARNSTABLE ISSUE DA'[r' 957 BOAR-0Z fiMAt:Ttl 12/28/20 f PERMIT T Q _ _bovss1�ABLISHMENT In accordance witCi ion p cT e`Iga et u er aidli ity of Chapter 94, Section 395A anc}C.Ja ter n: Af ther� ;`aY;s, prmit is hereby granted to: SEGUNDO B. CAMAS & LUIS -AilE' OLD M�Fi) 111TERNATIONAL Whose place of business if iBARNS k16 'R03 [ 5(ANNIS i _ � s ..; ;fr•_ir_;i•' ice;.::_`= - Type of business and any re; trictiobs: I T, - ABLISHMENT To operate a food establishment irt-the ``_'='� i4�aLE RESTRICTIONS IF ANY: MUST�6;ST.VARFAN( _i_5TT nsi SEATING: 0 ANNUAL:`_YES SEASONAL: TEMPORAI'?�%f:`i -1 js S :��i.�,z-� F rr --As = . ,,_ ,�J F< Y:='` OARD OF HEALTH RETAIL FOOD STORE: tn_ y8m�t0`x,i Paul J Canniff, D.M.D., Chairperson FOOD SERVICE ESTABLISHMENT: . c;.- _! ana'Junichi Sawa i RESIDENTIAL KITCHEN FOR RETAIL SALE: z i= _ y g r Donald A.Guadagnoli M.D RESIDENTIAL KITCHEN FOR BED+BREAKFAST -L �_, - _ -.. 't:_•�;�- MOBILE FOOD UNIT: / P.,e.rffil TOBACCO SALES: U 1 7 �/n FROZEN DESSERT:CATERER:' Thomas A. McKean, RS, CHO Director of Public Health 'IKE *wn of Barnstable k"/X Regulatory Services , BAMSTABM Richard V. Scah,.DirectorDIAS& �� J pw BARNSTABLE 1639 0� OSTEM n�rsRs u s�nF s� ie�-Vr e e MU Q �'OrEDMA+p Public Health Division 1639-2014 Thomas McKean, DirectorPa 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 -v x APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT a� DATE: NAME OF FOOD ESTABLISHMENT: �, �� Palo k11 101{0•y y LI-9 1117 ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: C#09031 NUMBER OF SEATS*: INSIDE: 0 OUTSIDE: r6 TOTAL: * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: 48, : `�' TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO 'REMINDER*" SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE / RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) I C• , ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? l)_ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT 63 e U►�O I L S of;o j P o "� tt � SOLE OWNER: YES /NO ADDRESS_/ 6'6 �1.5 PHONE # CIA 9(0 - 0c., IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. t� STATE OF INCORPORATION �;t� �, �'Ic�t•►2,r.' :� i l C` FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) EXPIRATION DATE: / / 2• EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1• EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:\Application Forms\Foodapp2.doc PERMIT NO: TOWN OF BARNSTABLE ISSUE DAT 957 € L January 1, 201 PERMI SHMENT i In accorda a tth a do e r of Chapter 94, » A � Section 395A a e_1 e n f the Gene ,a r it is hereby granted to: SEGUNDO B. CAMAS &LUIS CL , �a4, F MARt1 ATIONAL Whose place of business i `: BARN MNNIS Md0 4 C ...p rY'•-f� A y - Y Type of business and any'Atrietidns: ABLISHM To operate a food establil e# it the '� BLE 4 F RESTRICTIONS IF ANY: MUSTT`�flR11N trpo .- sit SEATING: 0 ANNUAL: SEASONAL: TEMPORAR D OF HEALTH RETAIL FOOD STORE: �. .. a ne Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT: y Paul J.Canniff, D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: 4 z•h� Junichi Sawayanaqi RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: .6�' ���� • TOBACCO SALES: December 31 , 2016 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health ACORD Client#: DATE TM CERTIFICATE OF LIABILITY INSURANCE 05/23/2019 THISS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT RAPHAEL OLIVEIRA PHONE (508)771-4600 DISCOVERY INSURANCE AGENCY LLC (A/C,No,Ext): 668 MAIN ST-UNIT A EMAIL raphaeldiscovery@gmail.com ADDRESS: HYANNIS,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:COLONY INSURANCE COMPANY INSURER B: THE FOOD MARKET INTERNATIONAL, INC. INSURER C: 163 BARNSTABLE ROAD INSURER D: HYANNIS, MA 02601 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL ADDLI SLBR - - - 1 E. ,,.P, ,.,y'. TYPE OF INSURANCE 1 POLICYWLIMBER Llrytltg` r. TR NSR WYD� MMIDDIYYYY �:MMIODIYYYY A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person) $ 5,000.00 101 PKG 0123821-00 5/23/2019 5/23/2020 PERSONAL&ADV INJURY $ 1,000,600.00 GENERAL AGGREGATE $ 2,000,000.00 FE-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000.00 POLICY PROJECT LOC B AUTOMOBILE LIABILITY (EaacccidentSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) C UMBRELLA UAB OCCUR EACH OCCURRENCE EY.CESS LIAR CLAIMS-MADE AGGREGATE O[D RETENTION S D WORKERS COMPENSATION Y N WC STATUTORY OTH AND EMPLOYERS'LIABILITY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? FN E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired'those employees outside of Massachusetts. This certificate of insurance shows the policy it force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance).The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. General Liability:for regular and usual jobs CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY TOWN OF BARNSTABLE, MA CHANGES OR CANCELATIONS. RAPHAEL OLIVEIRA 1 1 ©1988-2010 ACORD CORPORATION.All rights reserved. L Town of Barnstable f f Building Department Q Brian Florence, CB 0 Building Commissioner 200.Main Street,Hyannis, MA 02601 www.towm barmstable.ma.us Pre-application for Business Certificate Date � -Ot' Map Parcel Applicant Information A licants Name r Ila ii( - -PP-. -._._-. ....... . -. ... _. . . Applicants Address. 70 J'^I I e 2 f 1411 o o Email Address I'Q UI CP d d�Q C'�-MO 3 t/V1I'/ Telephone,Number^ Listed❑ Unlisted ❑ Business Information New Business? ----------------------------------------- Yes No/ Business is a registered corporation? ------------------------. Yes No If yes Name of Corporation Does business operate under the registered corporate name? Yes No is the business a sole proprietorship or home occupation? --------- Yes No If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business •—Uh Lod Business Address 1G own S t a V 1 e 'i°f d. Type of Business yr k,� Btul.diag Commissioner Of5ce,Tise Qnly Building Commission Date Clerk Office Use Only pF tME Tp� TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Dater �� `I _ P of 1 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. - 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN O CORRECTION Date Verified 'qp Ma3. �•� HYANNIS, MA 02601 soa-asz as4a No Reference R-Red Item PLEASE PRINT CLEARLY rED MA'�� FOOD ESTABLISHMEN INSP CTION REPORT. Nam Date fArisnection O e ti s outine J. Address Ris 'd Service ei eo�tion �' Lev I rewous Inspection Telephone Residential Kitchen Date: .--- Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP CA i r In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provisions)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Ra"ems) Anti-Choking 590.009(E) r❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) '❑ logo JL Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) "�- ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling rc ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control / T ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ��- Critical(C)violations marked must be corrected immediately. (blue&red items) -YON O Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �- within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B-_ 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 One critical violation and less than 4 non_critical violations re 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: I spector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ---..-..... -.-.. .. �.---r ..r-ter_..-1--•--..r -�^, r �- f -�....--- � .- -.... - - - - -� <- - ,-.....n.� - .� _- ----r.. -. .. .. .s -_- Violations related to Foodboine Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives i 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.* _ 1.9 - _ _ .PH Hot and Cold Holding 2-103.11 - Person-in--Charge Duties - 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 7 5 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) Ho[PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person--in-Charge to _ 7-102.11 Common Name-WorkingContainers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage*Applicants* 3-302.11(A) 'Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 I1 Variance Requirements 590.003(G) Reporting by Person in.Chazge* 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 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 and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P _ 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical) Sealed Container* Saniti'zation 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 76 Proper Cooking Temperatures-for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System _ _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cri� 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 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 Requiremenpractices should be debited under#29-Special _ $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial) Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to.the foodbore 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S: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. °p IKE r°k, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Dat Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified 9 M639. �0� HYANNIS,MA 02601 -FRI.08-8 No Reference R-Red Item PLEASE PRINT CLEARLY �`reu MP'�a 508$62-0644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date e o c io Operation(s) tine 64-t Address 164 Risk Food Service a-i to Level ail Previous Inspection Telephone ✓ idential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint IC Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out:Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. G lf%v L�aJ 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) ❑ CA;fl Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS W / ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control L ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) L ❑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 1 .� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1��'l►!) Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 6T��) within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspeay,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations g )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 a non-critical violations. If 1 critical refrigeration. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. d 30.Other RATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PP PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* PP 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 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* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* ,7-204.11 Sanitizers Criteria-Chemicals* 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* * Raw Seed Sprouts Not Served* Y Sanitization Temperatures 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 3-262.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water*. Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg eye 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals.155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 4-702.11 Frequency of Sanitization of Utensils and Food Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* +, 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- Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing €� P Y Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.1 l 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 g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.t 1(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 18 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 6-301.11 Handwashing Cleanser,Availability 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ t= y 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 1 16-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F\HE Tp TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Dater cLi Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BAaNSTABLt. - 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified 1 b11 : 0� HYANNIS,MA 02601 508-808-8 -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISH MEN .INSPECTION REPORT Name a Type of Type of Inspection Operation(s) Routine Address Risk Fo ervice spection Level revio ction Telephone esidential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspecto Out: ry Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. t \ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ b ` Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives CC �o ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating n I�� within 90 days as determined by the Board of Health. ' l ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on a insp ction today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4ron-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food 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 6ron-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. . f critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8ron-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y {N Dumpster Screen? Y N :_ � �-. „-.� .. :.: , „�.._... _�. _�.:��� `���M rt_ _ s1. 1c .a �.-• ».. a�.+t" • ram-, ,;_. .. :.. a, _ ,..+a+-�w.:::.i`,i{.�.'-.•. _ <v- ,-.. .. _ � _ ,, .. __ .. _ .. .... ., 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)(]) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-101.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11{A) Food Protection* 7-20 .11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * 3-302.15 Washing Fruits and Vegetables 3-SOl.l9 Time as a Public Health Control Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE - 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* ET/cn�e rna001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency rf ces Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009 A ( )-(D)in cater- Chemical ( )-(D) Violations of Section 590.009 A Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing g� P y Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under k29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conven y ient) Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance °F/45°F Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004 J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices ( 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.1 I Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. opiNE roh TOWN OF BARNSTABLE , HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSfABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 6 q.a�0� HYANNIS, MA 02601 MO8 -FRI. No Reference R-Red Item - PLEASE PRINT CLEARLY 50a-asz 4644 'FDN1P' FOOD ESTABLISHMENT INSPECTLON REPORT urow Name Dat e of Type of Inspection Ooeration(s) Routine Address. �ect 74 Lev a nspection Telephone Residential Kitchen Date: Mobile Pre-operation 14 Owner HACCP Y/N Temporary Suspect Illness Caterer I General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ G Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM.CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMErTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY. ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ( 1� 9Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the.Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Eme Closure Voluntary Di checked indicate violations of 105 CMR 590.000/Federal Food Code. 9 rgency ❑ sposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects;or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you Have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8nonscritical violations=C. 29.Special Requirements (59 a0.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's Sig re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT - PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* Additives* - 19 PHF Hot and Cold Holding 3 302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F � po n'EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) P g * 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F - Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours an 590.000 d From 70°F to 41°F/45°F item Good Retail Practices FC 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 I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEATH INSPECTOR•s Establishment Name: Date: Page:, of q. OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 4 BABNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA5 �' HYANNIS,MA 02601 rnoN.-FRI. No Reference R-Red Item - PLEASE PRINT CLEARLY +asq•se 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat ��j/� Type of inspection Operation(s) Address / �� //� Risk Food Service e-Inspection / - Level ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) ✓\ Time Bed&Breakfast HACCP L In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Ald Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS rl i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling l ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold HoldingI-P (/' PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control t ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) OY ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for H P ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ vv 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories i l r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) �a l 1 Corrective Action Required: ❑ No ❑ Yes ❑ Non critical(N)violations must be corrected immediately or Overall Rating t i I, within 90 days as determined by the Board of Health. i// Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N._• Official Order for Correction: Based on an inspection today,tFie items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g y ❑ rY P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by A Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B re9=One critical violation and less than 4 non-critical violations if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1-critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008 9 violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view v`A�L Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / �101 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature _ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N _ Dumpster Screen? Y N __ - e 0,� - �? Violations related to Foodborne Illness ... Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each " 7-101.11 Identifying Information-Original Containers* 590.004(F) *- 2 590.003(C) Responsibility of the Person-in-Charge to- Other* * 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* Storage* - Applicants* 3-302.11(P,) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fm 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Vegetables * * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-263.11 Toxic Containers-Prohibitions* 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,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* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an.Approved Source 3-401.1l(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 Meals-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* . , Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* . Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 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* 3-401.1l(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. $ Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165`F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165`F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity 8 g 3-403.11(C) Commercially Processed RTE Food-140°F 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 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41'F/45°F Item Good Retail Practices FC 590.000 Tags/Records:s: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. DFTME Tpk TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: (� Page: of b OFFICE HOURS / P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. e RNsrneLe. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. �prFD MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT f l C1. Name // f / Date 7� I T of T e-o. Ins section J ' i IICY ' N // l �/ Operation(s) Routine N �. ` . v' Ar// f ✓�' Address h/,o Risk Fond Service RE=insp ction v Level Rem Previous Inspection / r ✓� _ ( ����' �� /��I Telephone Residential Kitchen Date: / Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer. General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP /J /G(� In: Other Inspector ✓��/ v Out: / Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. v �✓ /yam` i V Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ i , / i Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ /�� /V i �J l Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 1 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALSIj- ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) - ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control Al ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) to / A/L •f- ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP �l ` 114 �I / ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories v 1, Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations / l Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating ;tems /,' within 90 days as determined by the Board of Health. E �'f ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, ❑ Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008 9 •violation,4 to Snon-critical violations=C. within 10 days of receipt of this order. 29.Special Requirements (590.009) Inspector's Signature Print: 30.Other / DATE OF RE-INSPECTION: 31.Dumpster 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 PIC's Signature Print: Self Service Wait Service Provided' - _ Grease Trap Size Variance Letter Posted Y N /Q Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH. 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-102.11 Common Name-Working Containers*2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* 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(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an ContactEggs d Food Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff cti a 1/1/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155-F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.1](A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section.590.009 A 3-201.15 Molluscan Shellfish from NSSP Listed * ( )-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential ut 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 Clean Condition-Hands an Arms* d A * Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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. $ Reeeiving/Condition - g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-003.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 13 Handwashing Facilities 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F hem Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE T° TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: pod ma'rkz� aAWnR -,Ot74 Date: i <Ar a-Ol4 Page:�_of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A 639,e�0� HYANNIS,MA 02601 _ MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rfu MPt 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT yaks Name O8 ( +�� n4��a�I Date��(��1 Tvoe of Tyne o section _ p- I L��� _ 100 t Operation(s) out in 13 6 rvs Address f 63 &r(Id7'gb �d Risk d Service spection Level Re Previous Inspection Telephone Idential Kitchen Date: L•II /Floor afori r Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness fl Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP - bjA J0'"f (� In: f(vo Other U1 Inspector qn &(rlS Out: - sc Z 6 >✓ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. SW VA� Violations Related to Foodborne Illness Interventions and Risk Factors Red Items ' "rm rr(7 Gel ( ) 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) ❑ FO D PROTECTION MANAGEMENT [d12.Prevention of Contamination from Hands Gy 1.PIC Assigned/Knowledgeable/Duties 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS .Reporting of Diseases by Food Employees and PIC 74.Approved Food or Color Additives 3.Personnel with Infectious Restricted/Excluded 15. Toxic Chemicals F D FROM APPROVED SOURCE TI EMPERATURE CONTROLS(Potentially Hazardous Foods) VFood and Water from Approved Source Cooking Temperatures 4e 5'Receiving/Condition 17.Reheating 2,e6.Tags/Records/Accuracy of Ingredient Statements [�18.Cooling [17.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding XP TECTION FROM CONTAMINATION 920.Time As a Public Health Control Separation/Segregation/Protection R UIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 2Food Contact Surfaces Cleaning and Sanitizing [/�21.Food and Food Preparation for HS L,40*.Proper Adequate Handwashing C NSUMERADVISORY 1.Good Hygienic Practices e2.Posting of Consumer Advisories V Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations I p Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more.than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the'number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 6 non-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 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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. _ Ifi 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: n `��n S 31.Dumpster screened from public view (•L� I f „ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N _rJ Dumpster Screen? Y N lk� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Subitances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* .� 7-201.11 Separation-Storage* Applicants* � 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-_Presence and Use*its 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 * ( ) 4 590.003(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 for of Food* 7-204.12 _ Chemicals for WashingProduce,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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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* Eggs 3 302.13 Pasteurized E s Substitute for Raw Shell * Shellfish and Fish From an Approved Source 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs 4-702.11 Frequency r f 3- Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS - Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section.590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild-Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 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.l l(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i l °F THE rok, TOWN OF BARNSTABLE HEALTH OFECTTOR'S Establishment Name: �� �G'r" � �^47�h^r� Date:/ - ,Page:�_Of OFFICE H ti Ou S PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSPABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g,� HYANNIS, MA 02601 M-862-4644 N.-FRI. •679• 508-8 No Reference R-Red.-Item PLEASE PRINT CLEARLY p s.0 .. . 'FDN1A' FOOD ESTABLISHMENT INSPECTION REPORT. _ I 00141% 1,C Name i Date I Tvne of T I s e t' n ud� it F Ooeration(s) outine Address ,/ Risk Food-Service eotion Level Previou in ection ✓ Telephone tial Kitchen Date: b//7pp7�� Mobile Pre-op ratioh Owner HACCP Y/N Temporary Suspect Illness all Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: O Each violation the ed requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP- 7 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY V ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories L10 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) v Corrective Action Required: No within 90 days as determined by the Board of Health. ❑ Yes 1 cc.--�� `J Ig ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension Non-critical(N)violations must be corrected immediately or Overall Rating C N Official Order for Correction:Based on an inspection today,the items Checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility ) aggrieved b 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 y y (FC-6)(590.007 Y Y 9 9• q violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violatio to 8 -critical vi lations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspe is Sign n t: J 31.Dumpster screened from public viewwPermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N J. #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N Violations related to Foodborne Illness _ Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*_ 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous 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* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* Variance q 590.004(11) Vari Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 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* F4-6O .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* .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 .11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective faizooi 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 fur Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165°F 15 sec* in mobile food,tempor and residential Sources 10 Proper,Adequate Handwashing g' 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 Requiremenos should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 * 3-501.14 3-202.18 Shellstock Identification 13 Handwashing Facilities A( ) Cooling Cooked and Fr from 140°F to Conveniently Located Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* ted and Accessible Within 2 Hours and From 70°F to 41°F/45 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. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* r8-10312 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. °FINE rok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: o� YV IG�/y�Q{ �LP^y« �� Date: Page: of ti 'OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. s BARN STABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mABs. •� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item. PLEASE P CLEARLY 9$A +eyo•a 508-862-4644 rEDN1P` FOOD ESTABLISHMENT INSPECTION REPORT I-V-/ Name u %un a Date Type of T eo Inspection ff D Ooeration(s) outin v cG. Address a l/ CiMl7/ Risk Food Service e-inspection Level etas Previou Ins ection r 1 27 tic Telephone Residential Kitchen Date: f ' r Ck ) ���p Go Mobile Pre-op ratio I� Owner HACCP Y/N Temporary Suspect Illness yr- '`r d✓ "ZCn Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector 0^V, S Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION.MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Yiolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue 8+red items) Corrective Action Required: JDAilo, ❑ Yes_ Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. lu ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled.. ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the Ite s Embargo Emergency Closure checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ 9 Y 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 4 to 6 = 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed, von-critical violations B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to 8non-critical violations. If 1 critical refrigeration. ` 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address g 29.Special Requirements (ss0.009) within 10 days of receipt of this order. violatio ,4 too - fitical violations=C. 30.Other Inspector ignature Print: DATE OF RE-INSPECTION: , 31.Dumpster screened from public view Pv Permit Posted? Y N 'Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N r V Dumpster Screen? Y N l - 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.) F00 PROTECTION TECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS O 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and.Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41`F/45`F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or Charge* 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* _--. REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sffe cri,e inrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'17 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 3AO1.11(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 Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145`F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands -" 3403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.1 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 `F/45`F 3-402.12 Parasite Destruction*.Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41 25. Equipment and Utensils FC-4 .005 * Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 590.004(J) g 9 y� ty 7 ConfoFinance with Approved Procedures/ 6-301.11 . Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Town of Barnstable M , �tr+F r Board of Health ' URN8TABLL 200 Main Street, Hyannis MA 02601 MASS. 16so. John T.Norman. Office:508-862-4644 Donald A.Guadagnoli,M.D FAX: 508-790-6304 Paul J.Canniff,D.M.D. F.P.(Tom)Lee,P.E.,Alternate BOARD OF HEALTH MEETING RESULTS Tuesday, January 21, 2020 3:00 PM James H. Crocker Jr. Hearing Room, Town Hall 367 Main Street, 2"d Floor, Hyannis, MA I. Variance—Septic (Cont.): Michael McGrath, Holmes and McGrath, representing Michael Valerio, owner—24 Tern Lane, Centerville, Map/Parcel 193-048, repair of failed septic system, requesting multiple variances (continued from December 17, 2019 meeting. CONTINUED TO FEBRUARY 25, 2020. The Board voted to grant a continuation to the February 25, 2020 meeting. II. Variance—Septic: A. Robert Perry, Cape Cod Engineering, representing David and Pamela Leclerc—3920 Main Street, Barnstable, Map/Parcel 335-057, 38,248 square feet parcel, failed septic, requesting two variances. GRANTED WITH NO CONDITIONS. The Board voted to grant the variances with no conditions. A note will be given to the septic installer asking to eliminate as many bends as possible in the pipe installation to improve flow (no adjustment in plans will be necessary. B. David Mason representing Michael and Sara Rabideau, owners — 1837 Main Street, West Barnstable, Map/Parcel 216-033, 0.83 acre parcel, failed septic system, requesting multiple variances. GRANTED WITH NO CONDITIONS. The Board voted to grant the variances with no conditions. III. Informal Discussion: John O'Dea, Sullivan Engineering, and Jeffrey Kaschuluk, owner — 58 Wianno Avenue, Osterville, Map/Parcel 141-003. DISCUSSION. The Board members gave their general comments at this time. Mr. Norman said with the intensive use, if a formal plan comes to the Board, he'd want an Innovative/Alternative (I/A) system. Dr. Canniff and Mr. Lee expressed that they would be interested in having the lot used with the current level of flow. Dr. Guadagnoli, as well, was concerned with the level of flow increase. One suggestion was to utilize nitrogen aggregation using another lot within the same zone. IV. Bedroom Discrepancy (Cont.): Page 1 of 2 BOH 01/21/2020 v Henrique Sousa, new owner, and Maureen Shea - 7 Erin Lane, Hyannis, Map/Parcel 291- 017, 2 versus 4 Bedrooms, continued from December 17, 2019 meeting. GRANTED CLASSIFICATION AS A FOUR BEDROOM WITH CONDITIONS. The Board discussed their concerns. The program which Zenas Crocker is currently accepting applicants for was brought up. The pilot program is for the Nitro system and he would be willing to see if they could get into the pilot program and Mr. Crocker's program would help bridge the gap of cost between what is held in escrow and the cost of this I/A system. Mr. Crocker believes the ongoing maintenance would be very minimal as it is a standard septic system with an additional tank and with the use of wood chips. The Board voted to approve the four bedroom classification pending the submission and permitting of the Nitro I/A system (pilot program) that reduces nitrogen flow less than 10 mg/liter at the downgradient property line and would be maintained in perpetuity with the property through a deed restriction, or must be reduced to a three bedroom. V. Variance — Food: Raul Fernandez, new owner of The Food Market International, - 163 Barnstable Road, Hyannis, requesting variance for one toilet for food service establishment. GRANTED WITH CONDITIONS. The Board voted to grant the food variance for the toilet facilities with the condition that he will be responsible for the cleaning and maintenance of the bathrooms. VI. Update: Tobacco—Smoking Bar: New Sedwick, Inc., owner of bar, is now doing business as 'C.B. Perkins Lounge & Bar', a change from 'Puff the Magic'. VII. Minutes: December 17, 2019 minutes. APPROVED. The Board voted to adopt the minutes with one amendment, Item VI will reflect the motion was seconded by Dr. Guadagnoli. Page 2 of 2 BOH 01/21/2020 f iKE ram, Town of Barnstable a • BARNgrABLE. M"3 16s9. Board of Health �m �fn Sys 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. January 27, 2020 Mr. Raul Fernandez The Food Market International Inc. 163 Barnstable Road Hyannis, MA 02601 RE: 'Variance Decision, 163 Barnstable Road, Hyannis A-310-150. Dear Mr. Camas, You are granted a variance from Section 322-4 of the Town of Barnstable Code, to provide conveniently located restroom facilities for employees onsite. This variance allows you to provide one restroom in a separate building (inside a church) located behind your store. This variance is granted with the following condition: • You are responsible for maintaining and cleaning the restroom. You are also responsible for ensuring there are sufficient quantities of dispenser soap and paper towels the restroom. • Food handling/food preparation is prohibited at this store Only prepackaged foods may be sold at this store. The Board is of the opinion that one restroom onsite should be sufficient for the very few employees at this small retail food store. Sincerely-)yours, John T. Norman Chairman Board of Health Q:\WPFILES\FoodMarketlnternational RestroomVariance 2020.docx a - r� Q op THE 4 DATE: $95.00 FEE*: �S•o� BARNSTABLE, s 9 MASS. : 1 39. it Town of Barnstable BY ' Board of Health SCFIED.DATE: 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Junichi Sawayanagi a VARIANCEasT FORM LOCATION 11 � Property Address: 163 Q n yN s kA b l,,o • (� { ►^'' Assessor's Map and Parcel Number: f� f S� Size of Lot:—® ye,-5- Wetlands Within 300 Ft. Yes Business Name: 'T_;j e Ca>0 &t Key 1,4 f'eykXY Ly 1 No ✓ Subdivision Name: APPLICANT'S NAME: (1r 1 i ,-&✓1 ail "?- - Phone Did the owner of the property authorize you to represent him or her? Yes �No ,:�,auL r-ev_n PROPERTY OWNER'S NAME CONTACT PERSON' -r►e- Toad �Lh4e"N°4"4'4k )� f I ` nr)3 /tU} Name: I Zct vJCC EN "'ft�'yfName:_ / ��6w`►�v ! �^ o Z Address: Address: Phone: �5-D g• 3 61 f- 544 T 9- Phone: n EMAIL: E-'►'1FN� �rV�t'i C� 0A VARIANCE FROM REGULATION(Incl.Reg.Code#) REASON FOR VARIANCE(May attach separate sheet if more space needed)��pm , ji� 1-r� �,,,.b�A�-I�Y�Gvn• ✓lP �Cc Livc�ve�. v�N• S�at<P. Z Z_— C;YL4Ce il• YR4l.�f ci a V> NATURE OF WORK: House Addition LJ House Renovation LJ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as 5 collated packets. X A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters for Innovative/Alternative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health@town.bamstable.ma.us D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu-Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New - -- owner/new lessee applying for food, pool or body art variances. _Exemptions from Variance Fee: 1) Septic repair without an _ increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Paul J.Canniff,Chairman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Junichi Sawayanagi Q:\Application Forms\VARIREQ Rev APR 4-2018.docx r•� to WE .. -M1 Certified Mail Fes $3.50 0630 CO $ on 07 r-I Extra Services&Fees(checktww add tee )� ❑Return Receipt(hardoopy) $ rq ❑Return Receipt(electronic) $ 4- rin Postmark O ❑Certified Mall Restricted Delivery $!' c!p- Here O ❑Adult Signature Required -$ ,;�-- p [:]Adult Signature Restricted Dellvery�R$Y r 1 �+v-vv``i 01 C3 Postage $0.5` :`mb� V (0 Q Total Postage and$6 $� sN cJ /2772019 $ �bs� sent ro pS` it andApt.No.,or P Box IYo: ;Cdy,State,Z/P+4a----, J---------�-------------- ---- ---- --- :rr r rr rrr•r• Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. 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USPS postmark.IFyou would like a postmark on . ■for an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece;you may request Certified Mail Rem at Post Office'"for the following services: postmarkingrlf you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach lire orcoded portion,. of delivery(including the recipient's signature). of this label,affixittollhe.i ilRiece,apply You can request a hardcopy return receipt or an appropriatepostade,and deposiMhe mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt attach PS form 3811 to your mailpiece; IMPORTARi:Save this recelpt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 fU i "I III"rIP4vI.9fft CO- $rwedMauFee $3.5 QpST pc 0630 tE7 ra Extra Services&Fees ICh-1$j,edd(ae Epp - ❑RetumReceipt(hardtop». $ V -�" r—1 ❑Return Receipt(elect»it� $ n Postmark 0 ❑Certified Mail Restrict -Mary $. Here Q ❑Adult Signature Require�N ❑Adult Signature Restricts -M -(T7 Total Postage and Fees 12/27/2019 o $ $6.85 to Sent To 9tieeiand t No.,orP - Q- M------ O City bYate,ZIP+4&------------- --------°-------- n�-- - ---------- ------------ :rr r rr r,r.r rCertified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipierWs retail associate. signature)that is retained by the Postal Service" Restricted delivery service,which provides for a specified period. * A!delivery to,the addressee specified byrname,or dads to the addressee`s authorised agent'r Important Reminders: -Adult signature service,which requires the ■You may purchase'Certified Mail service with signee to be,atieas121 years of age(not First-Class Mail®,First-Class Package Service®; �r available at retail). or Priority Mail®service. "cr4,� Adult signature restricted delivery service,which ■Certified Mall service is notavailable for t�}�• C requires the signee to be at least 21 year;of age international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase• by name,or to the addressee's authorized agent with Certified Mall service.However,the purchaset (not available at retall). of Certified Mail service does not change they• ■To ensure that your Certified Mail receipt is Insurance coverage automatically included withaccepted as legal proof of mailing,It should bear a certain Priority Mail items. USPS postmark If:yoq would like a postmark an ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece;you may request Certified Mail Hemet a Post Office'for the following services: postmarking:If you'don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this Idel,9ftix itto`V mallpiece,apply You can request a hardcepy return receipt or an apptopriato ptietagle,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7s3o-02-0oo-soap I� t.n SE 0 Certified Mail Fee $S.5U 0630 r'I Extra Services&Fees(checkbox,add fee re) Q7 ❑Return Receipt(hardoopy $ UP ❑Return Receipt(electronic) $ / Postmark C ❑Certified Mail Restricted Delivery $ 1111C Here 0 ❑Adult Signature Required $ . ❑Adult Signature ResMcted Delivery .m $ostage $0. 5 A Total Postage and Fge�s �j O O 7 �119 Sent To Y' C3 �ireetandAp£N,oiPl3BoxN ------------ T '"lY"" @Ity,$fate,ZIF+4 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your maiiptece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■ retail associate. V. A record of delivery(including the recipieM's signature)that is retained by the Postal Service'" Restricted delivery service,which provides for a specified period. delivery:to the addressee specified by,name,or a t6the addressee's authorized`agent' Important Reminders; Adult signature service,which requires the ■You may purchase Certified Mail service with signee to 6e at least 21 years of age(not First-Class Mail®,First-Class Package Service®; C available at retail). or Priority Mail®service. `' . Adult signature restricted delivery service,which ■Certified Mail service is notavailable for 0101,64. requires the signee to be at least 21 years of age International mail. OO.Ot and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase Q"1 by name,or to the addressee's authorized agent With Certified Mail service.However,the pure i e (not available at retell). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a- certain Priority Mail items. ��. USPS postmark If you would like a postmark on ■For an additional;fee,and with a proper this Certified Mall you receipt,please present your , endorsement on the mailpiece,you may request y Certified Mail item at a Post Office-for the following services: V postmarking:If.you ddn'tneed a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature)., 'of this label,affix it to the mailpiece,apply ` You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt,•attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Form 38OO,April 2015(Reverse)PSN 7530.02.000.9047 . SECTIONSENDER:' COMPU:TE THISSECTION COMPLETE THIS DELIVERY, wt, A. Signature ■ Complete items 1: ' ;:ard 3. ■ Print your name and address on the reverse X so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) or on the front if space permits. 1. Article Addressed to: D. Is delivery address different fro, If YES,enter delivery addres. �� lJ )�i'J?j02-� 3. Service Type j Prig,.ay Mail Expresso- 0 Adult Sinature 0 'III M II IIIIII Illl IIII111111 IN I I Ill IN I I I III I I III ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 4032 8079 3280 75 ❑Certified Mail® Delivery ❑Certified Mail Restricted Delivery [3 Return Receipt for ❑Collect on Delivery. Merchandise 2. Article Number(transfer from serve e l bel) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation"" G� ❑Insured Mail ❑Signature Confirmation (Jy�� ❑Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt U$PP TRQG. First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 4032 8079 3280 75 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service David Mason 28 Powder Hill Rd. Barnstable,MA 02630 i • sN;: COMPLETE THIS SECTIONON DELIVERY ■ Complete items;l,': � �x� 3. 7,,gna ■ Print your name d address on the reverseIN C ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed e) C. Date of Delivery or on the front if.space permits. 0 S7-VA-&TC. j d""'2 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery ❑address be ow: No p ?j �{ I i/29� II I'IIII III II(11111 IN I I III III I IN I I I III El O Adu3. Mail Express@ lt Service gn turee Restricted Delivery ❑Reg Priority red Mail estricted 9590 9402 4032 8079 3280 99 O Certified MaN Delivery ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Fransfer,from service labeo ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTm Insured Mail El Confirmation 7018 0, fIn,;ured Mail Restricted Delivery Restricted Delivery 3600001 18'70; 573.3_ = ?(over$5oo) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ii r USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 940 4032 8079 3280 99 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service David Mason 28 Powder Hill Rd. Barnstable,MA 02630 I I f��;._am�»•w.=`:� �.flii:f►�.r �fl�'i���l•'lii��til���Ifajil��r�i��r1��r11;r�fl�illli'i I�^. COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Receive by( me Name) C. Date of Delivery or on the front if space permits. lf— X 1. Article Addressed to: D. Is delivery dress different from item 17 ❑Yes If�enter delivery address below: ❑No W 1 �k 1_7C> 9 37 II I IIIIII I'll III I I I I I Il l III II II I II II Il I I I I I III ❑Adu3. lt Signs urece eRestricted Delivery ❑Registered red Mai Mail lRestdcted ❑Adult Signature ❑Registered Mai ITM ❑Certified Mail® Delivery 9590 9403 0727 5196 028163 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service_labeh ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM ❑Insured Mail ❑Signature Confirmation 19 1120 0000 9485 7 914 ❑Insured Mail Restricted Delivery Restricted Delivery i (over$500) r? Ps Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt UNITED STAT!i` -kAL"SER O' E First-Class Mail Postage&Fees Paid ,. USPS F` '�.�"** 0 Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* �auid�asan 28 Powder Hill Rd, I Barnstable;MA 02630 I - - I I LISPS TRACKING# I I }1,111� , l f 11 , rjj ji�i►j:i�tiill�l'i tt+�rl�ii;i,lr ;r I `9590 9403 d7l ( �8 6 COMPLETE • ■ Complete items 1,2,and 3. A Signatu ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by rioted Name) C. Date of Delivery "or on the front if space permits. ic.V 0 U 1. Article Addressed to: D. Is delivery address different from item 17 ❑Yes '20, If YES,enter delivery address elow;, ❑No �. SOX3. Service Type ❑Priority Mail Express® El ❑Adult Signature ❑Registered Ma11TM' ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mail® Delivery - 9590 9403 0727 5196 0281 56 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise _2_Article_Numher_Mransfer_frnm_samiceJahall O Collect on Delivery Restricted Delivery ❑Signature Confirmation*'^ insured Mail ❑Signature Confirmation 7018 0 3 6 0 d o 01i 7 8 7� 57 2 6 ` ',Insured MailRestricted Delivery Restricted Delivery over,$500) PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt j UNITED STATES PO ::�. ss Mail e& d I ! • Sender: Please print your name, address, and ZIP+4®in this box• I)awd Masan 28 Powder Hill Rd. Barnstable,MA 02630 USPS TRACKING# II11(1111_IIII_IIILLL1111L111_Illl.l.11lll_IW1111u , I '�lii�iifii°I �'��'li'�i�i�i' lei`�lfi}I!lllli't1�111'!1''•liii`t?' �'� L The Food Market International Inc. 163 Barnstable Road, Hyannis MA 02601 To Whom it may concern; �— This letter is to verify that I, (,w I I'-ei/Y70Pq C�Z. Will be responsible for the shared bathroom at 163 Barnstable Road, Hyannis MA 02601. The retail location for the cleaning, maintenance and general upkeep of the bathroom. Thank you. Barnstable Town of Barnstable i1£f :I; lll�Ameriea City i ,RAIL NSrAULE,'�'i ASS a,: Board of Health a\�� �fo mA A/ 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 10, 2014 Mr. Segundo Camas The Food Market International Inc. 163 Barnstable Road Hyannis, MA 02601 RE: Variance Decision, 163 Barnstable Road, Hyannis Dear Mr. Camas, You are granted a variance from Section 322-4 of the Town of Barnstable Code, to provide only one restroom facility for employees onsite, in lieu of the required two. The Board of Health Regulation requires two separate toilet facilities for male and female employees. This variance is granted with the following conditions; 1) You are responsible for maintaining and cleaning the restroom. You are also responsible for ensuring there are sufficient quantities of dispenser soap and paper towels the restroom. - 2) A utility/mop sink shall be installed in a conveniently located and easily accessible location within thirty days. The applicant shall submit a proposed plan to the Health Inspector of the proposed utility/mop sink location prior to installation. The Board is of the opinion that one restroom onsite should be sufficient for the very few employees at this small retail food store. 7 Sinc ly yours, W ne filler, M.D. Chair n Board of Health Q:\WPFILES\l63 BarnstableRd Food-RestrooinVarianceFoodMktSep20l4.doe 1 . . Food �'larez+ r(m2 n � P 'THE T` own 'off Barnstable Barnstable T P ti * [�11 1 I1I*�BARiASS. E I 1 Board II oar ®f Health 639• f \TFD MA�a' 200 Main Street,Hyannis MA 02601 22007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 10, 2014 Mr. Segundo Camas The Food Market International Inc. 163 Barnstable Road Hyannis, MA 02601 RE: Variance Decision, 163 Barnstable Road, Hyannis Dear Mr. Camas, You are granted a variance from Section 322-4 of the Town of Barnstable Code,,,. to provide only one restroom facility for employees onsite, in lieu of the required two. The Board of Health Regulation requires two separate toilet facilities for male and female employees. This variance is granted with the following conditions; 1) You are responsible for maintaining and cleaning the restroom. You are also responsible for.ensuring there are sufficient quantities of dispenser soap and paper towels the restroom. ;2) A utility/mop sink shall be installed in a conveniently located and easily accessible location within thirty days. The applicant shall submit a proposed plan to the Health Inspector of the proposed utility/mop sink location prior to installation. The Board is of the opinion that one restroom onsite should be sufficient for the very few employees at this small retail food store. Since ' ly yours, I W' ne ' filler, M.D. Chair n Board of Health Q:\WPFILES\l63 BarnstableRd Food-RestroomVarianceFoodMktSep20l4.doc 1 ' I I t' Op THE 1p� DATE: * FEE: t * BARNSTABLE, • (\'1 Y MASS. 4 c� x63q. ti0 REC. BY prF° Town of Barnstable SCEIED. DATE 7 Bard of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. 1 � VARIANCE REQUEST FORM LOCATION {� I ,/J Property Address: �� /J Q h 5 �� b (C ��i 11a4 h PI/S Assessor's Ma and Parcel Number: p l C) 0 Size of Lot: (DO Wetlands Within 300 Ft. Yes Business Name: ( 4i� 4o;"d �No Subdivision Name: APPLICANT'S NAME: Did the owner of the property autho�'AzeyoiTto represe r her? Yes No r PROPERTY OWNER'S NAME Q�n�S �. � rQ B!CF�� 'AA Name: (�1 �}^a 1�1 / l'��JtQtI'c� :� 9-.e 0' Address: G Ot,p S�a We P—u Address: Phone: , 3 2 Phone: O j�,�•�--�— -T-- t j��� � IA VARNCE FROM REGULATION(Lis Reg.) REASON FOR.VFARLCE May.attach if more space needed) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ "J a Checklist (to be completed by office staff-person receiving variance request.application) Please submit copies iri 4 separate completed sets. — Four(4)copies of the completed variance request form P'fl _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven.(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance.request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and.variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:.\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC MAIL-IN RE UES i Please mail the completed variance application form to the address below. Also include four copies of engineering plans, house plans, authorization letter, etc. (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $95.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request.form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system.plan by submitting'engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicants expense(for Title V and/or local sewage regulation variances only) Full menu submitted.(for grease trap variance requests only) r $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals [same owner/lessee only , and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) t, Variance request submitted at least 15 days prior to meeting date FOR FARE® REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, you must mail the required $95.00 fee. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-fist below): i Checklist Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by the submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals [same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date i i i For further assistance on any item above, call .(508) 862-4644 Back to Main Public Health Division Page i The food Market International INC 163 13arnstable rd Hyannis, MA 02601 To whom it may concern, This letter is to verify that 1, Segundo Camas,Luis Cade Will be responsible for shared bathroom at 163 Barnstable rd , Hyannis Massachusetts; The retail location for the Food Market international INC. We will responsible for the cleaning,maintenance and General upkeep of the bathroom. Thank you, F/ Are.. J 7562108 680415 6 2 pRQSTALNE FRASCO X 0 1,00 1 X 2 02 7 86I109.680366 68019 MULTI?PUNOA X t 1.60 1 X 18 qZ 746210"60372 G8011 IMEGAFIVERFUNDAXIUND _ „ .,, _ 1.501 1 X 18 OZ 746210"W358 66012 COLONL{VE FUNUA X 1 UND _ _ 1.50 1 X _-15 OZ 7.98210b-831881 88020 EUCAMIEL JAR X I UND,-„ _ _ 1,00 1. X •• 15.,••__ OZ UPCMEM CODE CODE OESEWION CASE PACKED CUSICOS ECUATORIANOS 7-B8102S-522242 060011 MARINA YA 25 X I KL l INSTANT WHEAT FLOUR 51.00• T6 k 1 KI. 7.861026. js303 09022 HARINAYA 26X112KL.IINSTANTWHE%1T_FLOUR __ _,. 234Q 23•x• 900 •....GR 7461036.620023 05014 AVENA QUAKER MOUAAX 500 GR I OATMEAL 26.00 28 X 500 GR 748101S520054 03003AVENAQUA!(ER 25XSOOGRlDATS -_• •.•.,_ - V.M.,^_ 25.00 25 X .• 600 GR $61036-620078 05004 AVENA_QUAKfIt 1EX1 KL IOATS __ 25.00 12 X 1 KL -!51018.300006 OS0021 HARINA MAI7.ABROZA I YELLOW CORN FLOUR PRECO0KEO 22.00 20 X. 1 Kl --- PASTA"CQGORNO' 7-752407.001687 01001 PASTASPAGHETn!SPAGHETTI 20.00 20 X 18 OZ 7.752407-001717 03002 PASTA ZI I12TM 20.0.0 20 X �1B OZ 7-752407-GOITOD 03003 PASTA PENNE RIGATEI PENNE RIGATE-- ___._. __ 20.00 20 X•. •__,/8 OZ 7.762407-001894 03004 PASTA EL80W MACARONI I ELBOW 20,0020 X 16 OZ -�' FIDEOSPACA 16001 ILUSI __ 7 862103.1226�t LAZO ON V � _ 20.00 20_X _ 14 OZ 7.882103420121 16002 LAZO PEQUENO _ 20.00 20 X 14 OZ 7-892105-120138 16003 MARGARITAILUSION 20.D0 OD X 14 O2 7.862103.120190 16004 TALIARIN ENROSCADO 20.00 „20 X 14 OZ T862163.120143 16006 MARGARITA N.1 _- 20.00 20 X 14 02 QRDIENTAL-F0)EO8 Y PASTA - 7-86100740629 06041 FIDEOS ORIENTAL!SPAGHETTI _ 2040 24 X 4W GR 7.881007.006689 06040 FIDEOS ORIENTAL ISPAGHETTI _,?0,00 48 X 200 _ OR• 7.861007-800020 0302 SALS 9 A CHINA TAMANQ PEQUENO • „34.00 24 X y200 GR 7.851007.900082 06028 SALSA CHINA TAMANO GRANGE _ 74.00 24 X 520 GR T 88101&I0072� 05316 SALSA OE TOMATE LOS ANOES/KETCHUP .30.00 24 X 316- GR 7048-590226 OSDOS ACHOTE LIQUIDO LA FAVORITA I LIQUID ANNATO 2S.00 30 X S00 ML 7.861048.690812 05010 ACHIOTE LIQUIDO LA FAVORITA I LIQUID ANNAT M • -- _ 25.00 15 X 1 LT T-881045.890133 10604 6 ACSTE LA FAVORITA I OIL _ 26.00 15 X 1 LT 8404092-000124 06310 ACUM.ARBOL ITO „12 X 280 ML 100. r„ _ 10.00 12 X 260 _ML 7-851049412602 05025 AJ{ 4G-MOTO 250 GR X 24 - - _ 16.00 24 X 250 GR 7.85104Ml3D08 05026 AJI-NO MOTO 500 GR X 12 •_.__ _ __,73.D0 12 X _ S00„ ,•• GR 7-861049-510003 06021 AJI-NOMOTO 1 KL X18 40.00 18 X 1 -KL CAF98 TEES 7850-0382 OS00_9 SIC VASQ I COFFEE IN A OLA$S _ _„ _„r 3040 24 X 60 OR 786MB12 0S008 Si CA JARRO I COFFEE IN A JAR __••___ „- 30.00 24 X 100 v GR T451017-931155 08011 CAF EXPRESO I EXPRESS COFFEE _ 1"1 12 X 470 GR _ . 0-17202.20168.2 1604 COLCAFf BARRK:ON 1COFFE2 1200 12 X 8.,• OZ CLEAN=SUPPLIES -702010.380747 06074 AX10N DE LEMON I LEMON SOAP FOR 01SHE$ _ 28.00 24 X 16 OZ 7.702010-38090 05075 A%10N DE ALOE 1 ALOE SOAP FOR DISHES -� 2S.OQ. 24 X �18 OZ 7.702010-381119 060T7 AXOON DE AVENA !OAT SOAP FOR DISHES _ ^ 28.00 24 X 18 OZ 7-702010-380815 05071 AXIOM DE TORONJA I ORAPEFRU1T SOAP FOR DISHES_ 20.00 24 X IIIOz T-YD2010-381294 05079 AXIOM DE MANZANA I APPLE SOAP FOR DISHES _ 28,00 24 X 16 OZ 7.702010.301378 05072 AXIOM DE AJAX 1 AJAX SOAP FOR DISHE8 - 29.00 24 X 16 _ OY 7.88t001-T114Z4 05138 JASON ALES MAOUINADO PARA LAVAR ROPAI BLUE SOAP BAR FOI CLOTHES w 30.00 •48 X -.J8 02 UPCRTEN C006 BESMPTION CASE PACKED 0.61817-8030-3 43005 CHOCO LIS70 FRESA I STAWBERRY_POWDER 1D.00 12 X 10 Ot 0-51817-51610-9 43005 CHOW USTO CHOCOLATE I CHOCOLATE POWDER 10.00 12 X 10 0Z 7.862103.920806 67030 GERMEN DE TRIGO FUNDA I WHEAT GERM 8.00 8 X t4 OZ 7-862103.620906 S7031 SALVADO DE TRIGO FUND_A I WHEAR BRAN 6.00 5 X 14 OZ 7-862109.670B90 09026 GRANOLA NATURAL BANANA 19ANANA GRANOLA 12.00 12 X 14 OZ 7-862100-570020 09026 GRANOLA NATURAL ALMENDRAS IALMONO GRANOLA 12.00 12 X 14 OZ 7.88110WO208 1090271GRANULA NATURAL FRESAS I STRAWBERRY GRANOLA 12,001 12 X 14 OZ 7.882t09.57091J 090Y8 GRANOLA NATURAL MANZANA I APPLE GRANOLA 12.00 12 X 14 OZ SO/E0 39Vd ONI VVS-IgVJ LEZZBZ96LG WdV0:80 VIOZ/60/00 S . S O/-�` Ice Unn a/ Nc2)r '1 a r' - C C r 1 p �I a • � b S C i U-1 LD C6i�r.� h r P�pFtHE rotyy Barnstable Town of Barnstable AHwMcaCfty R,MASS. Board of Health Q D �p 039. ATF0 MAt a. 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 10, 2014 Mr. Segundo Camas The Food Market International Inca 163 Barnstable Road Hyannis, MA 02601 RE: Variance Decision, 163 Barnstable Road, Hyannis Dear Mr. Camas, You are granted a variance from Section 322-4 of the Town of Barnstable Code, to provide only one restroom facility for employees onsite, in lieu of the required two. The Board of Health Regulation requires two separate toilet facilities for male and female employees. This variance is granted with the following conditions; 1) You are responsible for maintaining and cleaning the restroom. You are also responsible for ensuring there are sufficient quantities of dispenser soap and paper towels the restroom. 2) A utility/mop sink shall be installed in a conveniently located and easily accessible location within thirty days. The applicant shall submit a proposed plan to the Health Inspector of the proposed utility/mop sink location prior to installation. The Board is of the opinion that one restroom onsite should be sufficient for the very few employees at this small retail food store. Sincerely yours, Wayne Miller, M.D. Chairman Board of Health Q:\WPFILES\l63 BamstableRd Food-RestroomVarianceFoodMktSep20l4.doc 1 AJ6j .2o:11 6oR dF rqy, Barnstable Town of Barnstable aaxivsr" &4,&Q Board of Health fa 59. 200 Main Street,Hyannis MA 02601 2007 Office: 508=862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sa�vayanagi November 29, 2011 Mr. Steven Hirschberger Arnold Bakery Outlet Store 163 Barnstable Road Hyannis, MA 02601 'RE Variance cis ion Bakery Outlet', 1 -3 Barnstable,'Road, Hyannis Dear Mr. Hirschberger: You are granted a variance from Section 322-4 of the Town of Barnstable Code, to provide one restroom facilities onsite in lieu of the required two. This Board of Health Regulation requires two separate toilet facilities for male and female employees. You testified that there is only one employee who works at this store. The Board is of the opinion that one restroom.onsite should be sufficient for this facility with only one employee. Si ely yours Wayne ; iller, M.D. Chairm n Board of Health Q:\WPFILES\VarianceRestroomAmoldBakeryOutlet2011.doc 1 I r� e CJptME lgfy Town of Barnstable Barnstable AMmedcauy &uuvsraBL& + Board of Health 1 g s639 �� Arfat�A't°i 200 Main Street,Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi November 29, 2011 Mr. Steven Hirschberger Arnold Bakery Outlet Store 163 Barnstable Road Hyannis, MA 02601 RE: Variance Decision, Arnold Bakery Outlet 163 Barnstable Road, Hyannis Dear Mr. Hirschberger: You are granted a variance from Section 322-4 of the Town of Barnstable Code, to provide one irestroom facilities onsite in lieu of the required two. This Board of Health Regulation requires two separate toilet facilities for male and female employees. You testified that there is only one employee who works at this store. The Board is of the opinion that one restroom onsite should be sufficient for this facility with only one employee. Sincerely yours, Wayne Miller, M.D. Chairman Board of Health Q:\WPFILES\VarianceRestroomArnoldBakeryOutlet2011.doc 1 . r Y . �pF THE 1p� DATE: (C�J/ L I FEE: !T6 �y7 + BARNSTABLE, y MASS. �q c 1639• ♦0 REC. BY Town of Barnstable 1 SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. f"0 VARIANCE REQUEST FORM LOCATION Property Address: 1l/ ✓"9 S �j �(S �„�.�J j oa Gy l Assessor's Map and Parcel Number: Size of Lot: ) Wetlands Within 300 Ft. Yes Business Name: AYv10 l 9 No Subdivision Name: APPLICANT'S NAME: Vt-% trJ J40 • Phone Did the owner of the property authorize you to represent or her? Yes No PROPERTY OWNER'S NAMECONTACT PERSON Name: C�Y1�1c�. ► 1�,��0.,d s Name: 4cU"e, Address: i+-ln Address:n_ o l C -B" Phone: So y, 3 6 7 S q - 1 Phone: 7n —� ��rn � 056,6,Y VARIANCE FROM REGULATION(t.ist Reg.) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. 6� Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) s s —� , _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineeor`.registered san.if3rian 1--�. Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) � C Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeiidglidate at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) "? N Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same ownei4l4 see orjl„ outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[my if no expansion 10 e building proposed]) %..1 M Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:.\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC MAIL IN REQUES , Please mail the.completed variance application form to the address below. Also include four copies of engineering plans; house plans, authorization letter, etc. (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $95.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans)', Completed seven(7)page checklist confirming rAew'.of engineered septic system,plan by submitting engineer or registered sanitarian Four(4)'copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals[same owner/lessee only ,and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date .- , FOR (AXED REQUESTS ,, . Our fax number is (508) 790-6304.' Please fax a completed application form. Also, you must'mail the required $95.00 fee. Please make the check payable to: Town of Barnstable: ;The .check must.be,mailed to the address listed above. In addition, please mail four copies of engineered plan"s',house plans,-authorization letter, etc. (see check-list below): Checklist Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by the submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent hin-dher for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page II - , 6 jzq 6 � a 1 � T covj- j, Arnold Bakery Outlet 163 Barnstable Rd. Hyannis, MA 02601 To whom it may concern, This letter is to verify that I, Steven Hirschberger, will be responsible for the shared bathroom at 163 Barnstable Rd. Hyannis, MA the retail location for the Arnold Bakery Outlet. I will be responsible for the cleaning, maintenance and general upkeep of the bathroom. Thank you, Steven M. Hirschberger ct I APPLICATION FOR SITEPLANREVIEW .- --- - ---------------- - -- ----------------- ------- �� Date: LOCATION � �- H�xsiness Name: A ��`(�'��`\- -��4�n� ubdivision Plan Assessor's Map Parcel ANRPlan Property Address: W& o µ Site Plan -VaTER�PxO PTY MPLICANT r yr i �� Name: _�t?-A-i.j2. Address: va, Address:_ l2j", V\ 4 -(VVw C ,L TeIephone: E F C -),6 4 -5-4 'CI, - Telephone: Fax ARCHTIECT/DEVELOFER/CONTRACTORfENGnasR AGENT/ATTORNEY Name: Name: ®1 Address: Address: 'Telephone: _ Telephone: Fax: Fax: C3T6 AGE TANKS MATNM OR WASTE OIL ZONING Dla=CLASSIFICATION Aj Proposed District Overlay(s) Number Number LotArea Sq.Ft -1c 3O L Ac. Size Size Fire District .Above Ground Above.Ground Underground Underground Setbacks ft. Contents Contents Front, Side: Rear. . Number of Baildina:s UTILTT]ES Existing °� Proposed Demolition Sewer ® Public ❑ Private Size Water ❑ Public ❑- Private TOTAf FLOOR AREA BY USE Electac ❑ Aerial ❑ Underground- Exicfitng Proposed Gas0 Natural Propane (sq.fL) s .it Grease Trap ❑Size Basement. SewageDailyFlow *. and Residential- - Restam-a�rt _ *GP or WP areas iestdctwastewat.r discharge to'330 gallans par Retail 00 acre per day into on-&a systet, ' Office tARKIIiGS CES CURB CUTS Medical Office R quired t 13 Existing q Commercial SLifY Provided 3_ Proposed 6 Wholesale(specify) On-Site T�Clare = _ anal ) Off-Site Totals — -Industrial Handicapped_ All Other Uses On S Esfmiated tSject Cost: Fee: Gross FloorA=ea $ 570i SP FORM?IMOC-66/1MOG4 i a Old King's Highway Regional Historic District File 4 Approved? D Yes ©-�/No Hyannis IYWn Street Waterfront IRstoric District File#. Approved? ❑Yes Lo National and/or State Register of Historic Places? Yes Lsd N Listed in o . � ❑ Previous Site Plan Review File# Approved. ❑Yes No Previous Zoning Board of Appeals File 4 Approved? E. Yes ❑No Is the site located in a Flood Area(Section 3-5.1) Yes DN° In Area of Critical Environmental Conee412- ❑Yes o Is the project within 100'of Wetland Resource Area? Uyes Yes UNO No S�slm ea—Mfonnal fires#a�ig ❑No Site Plan prepared,wet stamped and signed by a Registered PE-andlor PLS. El Yes [ yes; ONO Parking and Traffic Circulation Plan Landscape Plan and LightingPlan [l Yes 10 No Drainage Plan with calculations and UtMty Plan 0 Yes ❑No BuildingPlans,(allfloorplans,elevations.and cross sections) [UYes No ate that alt signage must be approved by Code Enforcement rtment Lot area in.sq.ft. r -- sq.ft Total Btn7d'mg(s)footprint sq ft. Ma)d.mi m Lot Coverage as%of Lot GROUND WAMPROTECTIONOVERLAYDISTRICTRF-QUI MMTrS: OVERLAYDISTRICT(S)= Lot.Coverage (%) Required Proposed Site Clearing (!a} Required Proposed pRIl1CIPALBUaD1NG ACCESSORYBU D—IMG(S) Yes. ❑No Number of floors 2� Height: ft. Number of floors `�_Beight: ft. FLOOR AREA: FAR: FLOOR AREA: PAR.- Basement sq.$. Basement sq.ft. First sq.ft. First _sq-ft: Second sq.ft. . Second Attic sq.ft. Attic sq. Other(Specify) sq.ft. Other(Specify) sq.ft Please provide a brief narrative.description of your proposed project: .� . I assert tZiat I have completed(or caused to be completed)this page audthe Site Plan Review Application and tlaaf,to the lest of m 1 e the infnrmatian suhn�ittedhere is true. y� 2 - l✓ Date Name of Applicant SP r-ORM-PZDOC-0611=04 l *+WN OF PROPEA a �l� a y, - `� Legend Road Names T '1�15l "ram rz v� t �i►4wi R1 Map printed on: 5/31/2018 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable UIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026ot O 42 83 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. 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T-0B2109-12D1S8 i6003 Z-U ARIiAD_USION 20.00 20 X 14 02 7-06210312D794 164D4 TALLARIN ENROSCADO 20A0 20 X 14 Oz 7-0d31D3 130145 16006 MARfiARiTA Ni - - - 20.00 20 X ,14 02 ORINENTAL•WEDS Y PASTA 7.861007�W6292 06041 FiDEOSORIENTALISPAGHETTI 7J)AO 24 X 400 _. GR 7.860007$06689 06040RIM SORIENTALISPAGHETTI _ _N _ 20,00 48 X_ 200 GR, 7-861007.900020 Q4D29 SAL3A CHINA TAMANO PEQUENO 3449 24 X_ P60 GR 7.861007.90D082 0502$SALSA CHINA TAMANO GRANDE 74.00 24 X S20 OR 7-861111&200721) 05316 SALSA DE TOMATE LOS ANDES l KETCHUP --_ 30.00 24 X _ 396 GR 71-MO48-890223 06005 ACHOTE L IQUIDO LA FAVORITA I LIQUID ANNATO 25.00 30 X S00 ML - ----- -- r - r.._.._., . .,,_T, 7-861048-690812 05010 ACHK}TE LiQU1DO LA FAVORITA I LIQUID ANNAr µ- 26.D0 13 X 1 LT 7.861048-8013$ 06048 ACEIT£LA FAYdRIITA I OiL _._. 26.00 15 X 1 _ LT 6-004092.OW124 05310 ACEITE ARBOLTPO 12 X 230 ML!00. _ 10.00 12 X 250 ML 7 861049-812d62 06D26 A A-NO-MOTO 230 GR X 24 - 16.00 24 X 330 GR -- T 7.861049.513006 06028 AM-NO MOTO 500 GR X 13 „ _.13.00 12 X _ 500„ ,„ OR 7.861048-510003 06027 AJI-NO MOTQ 1 KL X 10 r 40.00 18 X I _KL _ C 5 TEES _ --7$60-0363 65009 11 C VASO I COFFEE IN A GLASS _ _ - -.....r 30.0 24 X 60_ GR 7850.0812 OWN SI CA JARRO I COFFEE IN A JAR „- - 30.00 24 X 10D __GR 7-0Oi017-931753 05011 CAFE EXPRESO 1 EXPRESS COFFEE ^ - - 42AO 42 X 170 GR 0-17202�0166.2 16004 CULCAFE HARRlGON!COFFEE 72.00 42 X ,$ oz v CLEAN=$0POLIES -702010.3$0747 M74 AAON DE LIMON 1 LEMON SOAP FOR DISHES -M� 28.00 24 X 16 Ox 7.702010.38090T 06078 AMON DE ALOE I ALOE SOAP FOR DISHES _ 2$-00 24 X .'.�10 OZ 7.702010481110 06077 AXiDN DE AVENA _I OAT SOAP FOR DISHES _ 2LOO 24 X 18 DZ 7.702010460616 05071 AMON DE TORONJA I aRAPEFRUIT SOAP FOR DISHES 20.00 14 X 15 03 7-702010-381294 _05076 AXION DE MANZANA 1 APPLE SOAP FOR DISHES - - 2$.00 24 X 16, ,•,_oz 1.702010�87375 05072 AMON DE AJAX !AJAX SOAP FOR DISHES 28.00 34 X i6 or 7.891001•T11424 06138 JABON ALES MAQUINADO PIRA LAVAR ROPAI BLUE SOAP 13AR PO CLOTHES $OJ)0 4$ X $ oz UPCATiB4 CCD€ CASE PACKED 0-51817-60341-3 43005 CHOCO L.ISTO FRESA I STAWRERRY POWDER 10.00. 12 X 10 Oz 0.51817-51610-9 430DO CHOCO L19TO CHOCOLATE I CHOCOLATE POWDER 10.00 12 X 16 oz 7,862163.42080$ 67030 GERMLN DE TRIGO FUNDA I WHEAT GERM 8.00 6 X 14 OZ 7.962103.020005 57031 SALVAOO DE TRIGO FUNDA i WHEAR BRAN U0 6 X 14 oz 7-662109-V0890 49026 GRANOLA NATURAL BANANA 1 BANANA GRANOLA 12.00 12 X 14 oz 7-862109-570920 09026 GRANOLA NATURAL ALMENDRAS[ALMOND GRANOLA 12.00 12 X 14 oz 7-862104�370909 09027 GRNiOLA NATURAL FRESAS 13MVMIERRY GRANOLA 14.001 12 X 14 M- 7-882109.570913 0=8 GRANOLA NA-FUM MANZANA I APPLE GRANOLA 12.00 12 X 14 oz 98/E0 39dd ONI ddS-ISGd LEZZ8Z9EL6 Wdb0:89 VTOZ/69/VO d84683OOOS2 01092tMD 8MNA.F0EtlPASTA/GARLIC PASTE -•- _ - 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