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Home My WebLink AboutDOLLAR TREE - FOOD - CLOSED j _ DOLLARTRE� 1070 Iyannough Rd. HYA-2q5- Dlq-Jb2 i I . I Bellaire, Dianna From: Desmarais, Donald Sent: Monday, March 21, 2022 9:28 AM To: Bellaire, Dianna Subject: Re: Dollar Tree? No Sent from my Verizon ASUS Tablet -------- Original Message -------- From:"Bellaire, Dianna" Sent:Mon, 21 Mar 2022 08:53:16 -0400 To:"Desmarais, Donald" Cc:"Bellaire, Dianna" Subject:Dollar Tree? I see that you have a note retail food and then "NO PHF" so, do they need a food permit anymore? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The,information contained in this electronic transmission("e:m.ai.l"'),inc:huhing any attachment(the "Infortation"),may be,confidential or otheru•7se exempt from disclosure. It is for the addressee only.Thus Information may be privileged and confidential work product or a privileged and confidential commiuuc:ation.The.Information may also be deliberative and pre decisional in nature.As such,it is for internal use only.The Information may not be disclosed.without the prior written consent of the I)ixector.of.public I l.ea.lth and./o.r. the Town Attorneys Office of the Town of Barnstable.If you have received this e mail by mistake,please notify the sender and delete it from your.system. Please do not copy or forward it.Thank you for your cooperation. a 1 D11 Bellaire, Dianna From: Bellaire, Dianna Sent: Monday, March 21, 2022 9:39 AM To: ma-licensing@dollartree.com Cc: Bellaire, Dianna; rbanks@dollartree.com Subject: Dollar Tree - 1070 Iyannough Road, Hyannis, MA Importance: High Good Morning, Our health inspector went to this location above and found you are not required to have a retail food permit anymore. You must have time/temperature foods, foods that require time and temperature to keep them stable and this store no longer carries these items. You will not receive a renewal for 2023. Sincerely, Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission ("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.`Phis Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature..As such,it is for irntern.al use orrly-The Iriform.ation may riot be disclosed without the prior written consent of the I7.i.recto.r of Public Itealtlr and/or the. Town Attorneys Office of the Town of Barnstable. If you have received this e mail by nistake,please notify the sender anti delete it from your system.Please do not copy or fonva.rd..it.'l.'liank you for your cooperation. 1 F Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. '. BAMSTAoL F.P.(Thomas)Lee,. MAC' Daniel Luczkow,M.D. Alt. °$ rey • ,� 200 Main Street, Hyannis, MA 02601 °tea 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: 943 Issue Date: 01/01/2022 DBA: DOLLAR TREE STORE #4528 OWNER: DOLLAR TREE STORES, INC.. Location of Establishment: 1070 IYANNOUGH 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. 2022 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: CQ� 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: t •� r ' For Office- Initials. `"E'°'yti Town of Barnstable MASSB,E a'7 ; Inspectional Services do81 t 34� v �' q, 039. ,0 Public Health Division AtEp�,�A 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 X NAME OF FOOD ESTABLISHMENT: Dollar Tree#04528 ADDRESS OF FOOD ESTABLISHMENT: 1070 lyannough Road MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 500 Volvo Parkway, Chesapeake Va 23320 K E-MAIL ADDRESS: rbanks@dollartree.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 508 ) 827 - 3156 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER: YES NO X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X 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? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE xRETAIL 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 Q:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT Dollar Tree Stores, Inc. SOLE OWNE YES/ O D.O.B OWNER PHONE# 757-321-5000 or 757-321-5058 ADDRESS 500 Volvo Parkway, Chesapeake Va 23320 CORPORATE OWNER: Same As Above r,X/ CORPORATE ADDRESS: Same As Above v ` PERSON IN CHARGE OF DAILY OPERATIONS: KEVIN EASINGWOOD (Cell) 508-743-5107 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. N/A-Prepackaged Foods / / 1, N/A-Prepackaged Foods 2. N/A-Prepackaged Foods / / h�l AX N511 / 01/ 2021 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.aso. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc — 1 R c Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. DAWN'STAULL. : Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 943 Issue Date: 01/01/2021 DBA: DOLLAR TREE STORE #4528 OWNER: DOLLAR TREE STORES, INC.. Location of Establishment: 1070 IYANNOUGH 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: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: u FINE rp� Town of Barnstable Office For Use Only: Initials: Date Paid ) Amt Pd$ 3p� ,� AS,RB,E : Inspectional Services 'cb ,' ��' Check#�z �C� 'OTe039. 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 1/12/2021, NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: Dollar Tree#04528 ADDRESS OF FOOD ESTABLISHMENT: 1070 Lyamough Rte 132 Road MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 500 Volvo Parkway, Chesapeake VA 23320 E-MAIL ADDRESS: ma-licensing@dollartree.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 775 - 1717 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: Fackage�do�dt7n1 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 FonnsTOODAPP 2020.doc I 1 OWNER INFORMATION: FULL NAME OF APPLICANT Dollar Tree Stores Inc, SOLE OWNE YES/ O D.O.B OWNER PHONE# 757-321-5058 ADDRESS 500 Volvo Parkway Chesapeake VA 23320 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Kevin Easingwood-Store Manager 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. 2. a� 1 , 12/ 2021 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,townolbarn,table.us/healthdivi,ion/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 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:Apphcation FormsTOODAPP REV3-2019.doc Town of Barnstable -- BOARD No HEALTH � John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 943 Issue Date: 12/10/2019 DBA: DOLLAR TREE STORE #4528 OWNER: DOLLAR TREE STORES, INC.. Location of Establishment: 1070 IYANNOUGH 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: $20.00 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: 446 t t For Office Use Only.• Initials: Town of Barnstable _ Date Paid 1 $ /0t Amt Pd$0 - Inspectional Services Mesa � G�� b Fs6 Public Health Division Thomas McKean, Director ti.f 200 Main Street,Hyannis, MA 02601 = , Office: 508-862-4644 Fax: 508-790-6304LJU ��/A�P(PLICATION FOR PERMIT TO OPERATEv/A FOOD ESTABLISHMENT DATE 10 1� NEW OWNERSHIP RENEWAL K NAME OF FOOD ESTABLISHMENT: 1 ADDRESS OF FOOD ESTABLISHMENT: :. 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Snn Volvo Parkway.Chesaaeake.VA 23120 E-MAIL ADDRESS: rbanks@dollarCree.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: z 1-+i TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_)S'... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: I�- 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 WAITS T AFF SERVICE DOOR(S)?140 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 t. OWNER INFORMATION: DollarTree Stores,Inc. FULL NAME OF APPLICANT SOLE OWNE YES/NO D.O.B OWNER PHONE ADDRESS 500 Volvo Parkway,Chesapeake,VA 23320 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 2. / / y SIGNATURE OF A ANT 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 http•//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 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc I Town of Barnstable Inspectional Services = swxxsrABLE, :KAM Public Health Division 059. 1� �fDNM'�A Thomas McKean, Director 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Thursday, October 17,2019 DOLLAR TREE STORES, INC.. DOLLAR TREE STORE#4528 1070 IYANNOUGH ROAD HYANNIS, MA 02601 ATTENTION Your food service/retail permit(s)will be invalid after December 31, 2019 EST BLISIJMENTS FEE Food Service . . . . . . . . . . . . . . . . . Retail Food. . . . . . . . . . . . . . . . . . . . . . . $20.00 Frozen Dessert . . . . . . . . . . . . . . . . . . Mobile Food . . . . . . . . . . . . . . . . . Mobile Ice Cream. . . . . . . . . . . . . . . . . Cottage Food Operation. . . . . . . . . . Continental Breakfast. . . . . . . . . . . B+B-Full Breakfast. . . . . . . . . . . Tobacco . . . . . . . . . . . . . . . . . . . . . . TOTAL DUE $20.00 Food establishment inspections are ongoing by a Health Inspector;therefore, it is not necessary to make an appointment with the Health Division. However, if your establishment is not open during normal working hours(8:30 a.m.—4:30 p.m.), please call 508-862-4644 during these hours to schedule an inspection. Enclosed is a food permit application form. Please complete and sign the form, and mail it along with the required payment on or before December 1, 2019 to the Town of Barnstable, addressed to the Public Health Division, 200 Main Street, Hyannis, MA 02601. Upon satisfactory compliance and receipt of your payment and copies of current Certified Food Manager Certificates for two employees and one Allergen Awareness Certificate you will be sent via mail your food/retail permit(s) for calendar year: 2020 Important: If you are on a Private Well for Drinking Water(not Public Water Service), be sure to have your well test completed prior to our inspection. Reminder to All: 1) Maintain your logs. 2)Establishments with 25+ seats are required to have a person trained in anti-choking procedures on premise while food is being served and to have insurance covering person with training. Failure to renew permit on or before January 1,2019,will result in an additional fee of $10.00 late charge. If you should have any questions,please call 508-862-4644. Q:dbfiles/inspectn.mdb reports Rest Total Fees Annual letter pfrt , Town of Barnstable BOARD OF HEALTH Paul 1 Canniff,D.M.D. ' Board of Health Donald A.Gaudagnoli,M.D. BARNSTA13LL John T.Norman SAW. F.P. Thomas Lee Alternate �a 200 Main Street, Hyannis, MA 02601 wA Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems k 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: 943 Issue Date: 12/20/18 DBA: DOLLAR TREE STORE #4528 OWNER: DOLLAR TREE STORES, INC.. Location of Establishment: 1070 IYANNOUGH 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: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - ---- - - - MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: j PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE j Restrictions: - F'THE Initials: O,^ Town of Barnstable For Office Us Date Paid Amt Pd$ �b MAS& ' Inspectional Services �i°rFo 039. e Check# 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 A 0-2D-I� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: j)O I la 1 TYU =+ 041515 ?(> ADDRESS OF FOOD ESTABLISHMENT: D 61 P? k R I c Rd - MAILING ADDRESS(IF DIFFERENT FROM ABOVE): goo Volvo Peftay,Owapeake,va23340 E-MAIL ADDRESS. Ilomele@dollartree.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Ug—)115 1 7] 1-71 TOTAL NUMBER OF BATHROOMS: 0 WELL WATER:YES NO .:. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_X 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 DO( R )? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE v"RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST -CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED QAApplication FormsTOODAPPREV2018.doe PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT DollarTree Stores,Inc. SOLE OWNER: ES/NO D.O.B OWNER PHONE ADDRESS 500 Volvo Parkway,Chesapeake.VA 2=0 CORPORATE OWNER: DollarTree SoreS,InC. FEDERAL ID NO. : !�4-1-3 8- -7 3 CORPORATE ADDRESS: 500 Volvo Parkway,Chesapeake,VA 23320 PERSON IN CHARGE OF DAILY OPERATIONS: 1�,VIM kL1S J h aye FList (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. 2. Store Uc.Coordinator 2-0 1 � f SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. / TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsT00DAPPREV2018.doc Epp�ME loh� TOWN OF BARNSTAB.LE,; HEALTH INSPECTORS Establishment Name: ,c am-jtgsr �Q�_ Date: e ge .of o OFFICE HOURS PUBLIC HEALTH DIVISION - 600-9:30n.M. BARE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v Mayq: HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name D T e of Ins ection Operation(s) < Routihe .Address /V�� Risk F er oo vice Re-ln pection � ! WAI Level 2MOY Previous 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 In: Other Inspector m_sOut: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ,Q 9- ON, l r Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ " Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness .590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical'Violations ` _n Critical(C)violations marked must be corrected immediately. (blue&red items) !1 \ ,�/ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ 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=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: a or's ' nature 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 Pigognature Print: Self Service Wait Service Provided Grease Trap Size .Variance Letter Posted Y N Dumpster Screen? Y N �' -� Violations related to Foodbonie 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 Law Cooled to 41°F/45°F Within 4 Hours* 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* � g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers** 3-501.16(A) Roasts Held At or Above ontrF* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* 20 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR F590.003(E) Removal of Exclusions and Restrict3-306.14(A)(B)Returned Food and Rted of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ions Disposition of Adulterated orr Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401 11(A)(?) Ratites;Injected Meats-1.55°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Otherpracti 590.009 es violationsd be debited stingunde to g odpeod tail ci 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.1.1(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance 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 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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[liq Op THE ro TOWN OF BARNSTABLE _ HEALTH INSPECTOR,s Establishment Name: Date: Page-: of PUBLIC OFFICE HOURS BARNSTABLE.O` Pu62 0 MAN STREET 3:30 4:30 P.M. DIVISION : 0-- :30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p a3q: HYANNIS,MA 02601 508-862-46" No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P`' FOO ESTABLISHMENT INSP C ION REPORT Name ate Tvoe o Tvoe of Ins ectio Address isk food Sery a-in cti n evel Re ai Previo I s e o[5 Telephone Residential Kitchen Date:' Mobile Pre-o i a Owner HACCP YIN Temporary Suspect Iness Caterer General Complaint Person in Charge(PIC) T'me Bed&Breakfast HACCP Other Inspector Each violation checked requires an explanation on the narrative pa e(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) ❑ n Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures . ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ` ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories i Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ^ ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection tod 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 4 non-critical violations 26.Water,.Plumbing and Waste if no critical violations observed,4 to_6non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot g (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-- itical vi lations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 I 4 to 8non-critical vio 'ons= 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inn n ature ,� Pri 31.Dumpster screened from public view1�/I�L 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 Prl t: Self Service Wart Service Provided Grease Trap Size Variance Letter Posted Y N VU V,-) ( 6 ° Dumpster Screen? Y N Violations related to Foodborne Illness - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L14 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F _ 15 I Poisonous or Toxic Substances t - 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person--in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables ' 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* - Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 590.00411 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 Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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* 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* I 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Battled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//-e-inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-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) Violations of Section 590.009(A)-(D)in cater- Chemical es-Ratites 165°F see* * Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commerciall Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 HandwashingFacilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 500.000. *��)oF. r TOWN OF BARNSTABLE.. HEALTH INSPECTOR•s Establishment Name: / �. Date: �� Page: of OFFICE HOURS PUBLIC HEALTH DIVISION. s:oo-ssoA.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4.30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ASS. �• HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY RFD 39 ° 508-862-4644 FOOD ESTABLISHMENT INSPECTI N REPORT Name _ Date Type of jim ofilospection Operation(s) Ro Address ' Risk rvice Re-inspection Level Food Previous 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 C��\ In: Other - Inspector r 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 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 (v-� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations_ v Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: o ❑ Yes Non-critical(N)violations must be corrected immediately or 1 within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusi Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction.Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other s checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food If no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.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,8 non-critical violations. If 1 critical refrigeration.violatio within 10 days of receipt of this order. n,4 to 8 non-critica4violations=C. 29:Special Requirements (590.009) Y P ,. 30.Other DATE OF RE-INSPECTION: Insp a re P 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si nature Print: (►--k.t C 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) KDem-(nstirationof signment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 7-102.11 Common Name-Working Containers Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45`F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 3-302.11(A) Food Protection* 7-20L11 Se azation-Storage Applicants* p g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened 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 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* El/ctiv 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* Mushrooms Approved By ing,mobile food,temporary and residential Authority eanon on-Hands an Arms*10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and 2-301.11 Cl Condition Hdd 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 Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 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 1 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF. ror TOWN OF BARNSTABLE , HEALTH INSPECTOR's Establishment Name: 1 Date: ✓/7 Page: of ti 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 '659. �0� HYANNIS,MA 02601 soa-s62-4644 No Reference R.-Red Item - _PLEASE PRINT CLEARLY - - �FDM�,p FOOD ESTABLISHMENT INSPFECTJON REPORT Name 1 Dat ,� Type of section Operations) Routine Address �� Risk Food Service - ection Z6,76Level dD7 Previous 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 In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating 44 ❑ 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 I. '�} ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories V Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) C t l Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 1 I 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 o 6 non-critical violations g 26.Water,Plumbingand Waste if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-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 29.Special Requirements (590.009) within 10 days of receipt of this order. lation 4 n-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspec is gnatur Pri 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N Dumpster Screen? Y N 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) JAssignment 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F ( ) P y7-102.11 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* � * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Emits 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 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 05 FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-2 .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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Ho[Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Elt°"Oe 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of fooSecd, temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P ar'Y 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Mid Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.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* 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 * 13 Handwashing Facilities 3-501.14 g 3-202.18 Shellstock Identification (A), Cooling Cooked PHFs from 140°F to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590:000. @1s, DaddAff Tom DOLLAR TREE STORES, INC. August 27, 2010 Town of Barnstable Public Health Division Attn: Donna Miorandi 200 Main St. Hyannis, MA 02601 Re: New Dollar Tree Store #4528 Dear Ms. Miorandi, Dollar Tree Stores, Inc. will be opening a new store location in Hyannis, MA. The new location address will be: 1070 lyannough Route 132 Rd. Hyannis, MA 02601 Estimated opening date: 10-17-10 The new store location will have pre-packaged food and pre-packaged ice cream. Enclosed is the completed Food Establishment Permit Application and fee in the amount of $200.00($100.00 retail fee and $100.00 new establishment fee). I have also provided a store layout, ice cream freezer specification sheet and pre-packaged food list as additional information. Please forward all correspondence and licenses to the Dollar Tree Stores corporate office: Dollar Tree Stores, Inc. Attn: Tennille Gerald 500 Volvo Pkwy Chesapeake, VA 23320 Upon receipt of the license, I will forward it to our store location to be posted. I will call your office to schedule a pre-opening inspection a week before the store opening date. If you have any questions or require any further information, please contact me at (757) .321-5164 or email tgerald �dollartree.com. Thank you in advance for your assistance. Sincerely, tyillle �Id New Store License Coordinator Dollar Tree Stores, Inc. CORPORATE HEADQUARTERS 500 Volvo Parkway Chesapeake, Virginia 23320 Tel 757-321-5000 Fax 757-321-5292 www.dollartree.com r — U PJU, E • Angled front slide top freezer complete with attractive graphics on ' , r all four sides `--� • Ideal for retail and food service — locations such as convenience ores, tourist attractions,stores, , hotels/resorts, stadium concessions, ` '— .= t ._.r- hospitals, business and industry, I '� airports and theatres Isti illII re .. t •��,9 �� 'R}"''�iC��` _.fit '� - Q> 0 Q> 0 0 (o Q 1 y Width 27" 39.5 49" 59" 69" u, E.g Depth 26" 26" 26" 26" 26" e X N o � ` Height Front 30" 30" 30" 30" 30" a a._ , Qom ; Height Back 1 36" 36" 36" 36" 36" - ti Cubic Feet 3.6 6.7 9.1 11.6 14 Baskets 2 4 5 6 single serve 5 pint 1 15 Sections 6 12 15 18 15 Volts 110 110 110 110 110 Amps 4.9 4.9 6 6 5.8 usage Requirements: 100%Dreyer's distributed product Weight(Ibs.) 117 139 157 174 174 Equipment is the sole property of Dreyer's Grand Ice Cream,Inc. Do not rewrap or deface Angled top for easy. NSF,Classified Lock&Key product viewing UL®Sanitation Included On Wheels ©HDIP,Inca ©Dreyer's Grand Ice Cream,Inc. All other trademarks are owned by Societe des Produits Nestle S.A.,Vevey,Switzerland. Dollar Tree Pre-Packaged Food Product List Cookies Crackers Fruit Snacks Pretzels Chips Nuts Popcorn Meat Snacks (Beef Jerky) Canned Vegetables Canned Fruits Canned Meats/Seafood Boxed Dinners (Mac &Cheese, Instant Potatoes, Bagged Rice) Pasta Noodles &Sauce Baking (Cake/Cookie Mixes) Cooking Oils Desserts (Pudding,Apple Sauce) Pickles &Condiments Soups Breakfast Foods (Oatmeal, Syrup, Breakfast Bars, etc.) Bottled/Pre-packaged Drinks (Water, Soda, Juice,Tea, Instant Coffee) Bagged/Boxed Candy(Chocolate, Gum, Fruit Candies, Mints) Freezers &Coolers Ice Cream "All items are pre-packaged "There is no open food preparation or food handling 0 D0«AR TREE STORES, INC., Corporate Officers Bob Sasser President/Chief Executive Officer 500 Volvo Parkway Chesapeake,VA 23320 Gary Philbin Chief Operating Officer 500 Volvo Parkway Chesapeake,VA 23320 James Gorry Corporate Secretary/General Counsel 500 Volvo Parkway Chesapeake,VA 23320 Deborah E. Miller Vice President/Corporate Counsel 500 Volvo Parkway Chesapeake,VA 23320 Street Address: 500 Volvo Parkway, Chesapeake, Virginia 23320 Phone: (757) 321-5000 Fax: (757) 321-5220 WALL CONSTRUCTION TYPES �1 EXTERIOR DEMISING WALL:EXISTING WALL PATCH AND REPAIR WALL AS REQUIRED.FINISH PER FINISH PROVIDE DETACHABLE CHAIN. SCHEDULE,SHEET A4. CONTRACTOR SHALL VERIFY Q Q CONTRACTOR SHALL VERIFY TENANT DEMISING WALL:EXISTING METAL STUDS EXISTING LANDING IS LEVEL WI - EXISTING LANDING IS LEVEL W/ AND FIRECODE GWB.PATCH AND REPAIR AS EXTERIOR FLOOR SLAB.NOTIFY I FXTEBOR FLOOR SLAB.NOTIFY ARCH.,ICI IF VARIES. AAOiffECT ff VARIES. REQUIRED TO MAINTAIN FIRE RATING PER CODE. Pl-LUMINIRdPUTFORM 65TNRS. TACKWEID DOOR SHUTANO Q Q FINISH PER FINISH SCHEDULE,SHEET A4. Q -T-v Q MUST COMPLY WITH ALL STATE AND PROVIDE COVER PLATE AT I ALLUMINUM PLATFORM AREA OF , LOCAL CODES.REFER TO MARUF.DWGS. HARDWARE HOLES. REFUGE.MUST COMPLY WITH GUARD ARID HANDRAIL OWTING WATER METER EXTERIOR DEMISING WALL EXISTING MASONRY WALL I FOR INSTALLATION DETAILS. ALL STATE AND LOCAL CODES.REFER $_z- LOCATION WITH FURRING AND GWB.PATCH AND REPAIR AS OO5TING RAILING. ST LOADING DOCK TO AILS.MANUF DINGS.FOR INSTALLATION REQUIRED.SEE DETAIL 3/A5 FOR ADDITIONAL Q Q Q Q Q DETAILS. REQUIREMENTS.FINISH PER FINISH SCHEDULE. I I TAC1<W13D DOORSHUTAND SHEET A4. ® - PROVIDE COVER PLATE AT HARDWARE HOLES. q PARTITION WALL:6'(20 GA)METAL STUDS @ 16'OC WITH ONE LAYER 518"GWB EACH S1DE TO ROOF DECK —_ —— �1Fl O ON SALES AREA SIDE AND TO l l'-0"AFF ON STOCKROOM SIDE.SEE DETAIL 4/A5 FOR ADDITIONAL REQUIREMENTS AND BRACING.FINISH PER FINISH 8 4 I 3 7 I 1 3 9 1 PLUMBING ROOM 1 7 SCHEDULE,SHEET A4. �. ,`'"` FIRE EXTINGUISHER-SEE NEW 5 PARTITION WALL:3 5/8-(20 GA)METAL STUDS @ 16" �� I +50 ,11,111 I�CTRICAL ROOM W(XM NOTE 2OC WITH ONE LAYER 5/6'GWS EACH SIDETO 6- RffELTOCONCRETEAPXI BIFBL ABOVE FINISH CEI U NG.PLUMBING WALLS ON MOP SINK IDETAIL 3/A/ LOCATON OF ELECTRICALINTERIOR OF TOILETS SHALL HAVE WATER PANELS,EMS,AND PHONE SORESISTANT GWS.FINISH PER FINISH SCHEDULE, HANDICAPPED ACCESSIBLESHEET M. HH.O DRINKING FOUNTAINOCWITH ONE LAPLUMBING IYER 5/8-GINS EACH EXPOSED SIDEVR:T TO FINISHED CEILING.PLUMBING WALLS ON INTERIOR OF TOILETS SHALL HAVE WATER RESISTANT GWS. FINISH PER FINISH SCHEDULE,SHEET A4. � 2 1 N7 INFILL PARTITION:2 lrr(20 GA)METAL STUDS Q 17'OC WITH ONE LAYER 5/8"GINS ON EXPOSED SIDEALIGN EXIST ADJACENT SURFACES.FINISH PERFINISH SCHEDULE,SHEET A4. � 9 m ITPARTITION WALL:6"(20 GAGE)METAL STUDS @ 16' OC VNTH ONE LAYER 5/8'GVVB EACH SIDE TO 6" 94Ip \\�--ddd---A22 I E { ABOVE FINISH CEILING.SEE DETAIL 5/A4.FINISH PER FINISH SCHEDULE SHEET A4. I FIRE EXTINGUISHER-SEE NEW �g PARTITION WALL 3 5/8-(20 GAGE)METAL STUDS @ WORKNOTEZ 16.OC WgTH ONE LAYER 51T GINS TO G'ABOVE FINISHED CEILING.FINISH PER FINISH SCHEDULE SHEETA4. j 17 PARTITION WALL:6-(20 GA)METAL STUDS @ 16'OC — — — — — — — — — — — — SOLES AREA — — — — — — WITH ONE LAYER 51F GWS EACH SIDE TO ROOF DECK ON RESTROOM/OFFICE SIDE AND TO IT-O"AFF ON I GENERAL INFORMATION: STOCKROOM SIDE.SEE DETAIL 5/A5 FOR ADDITIONAL REQUIREMENTS AND BRACING.FINISH PER FINISH SLOPPING CENTER: FESMAL®HYANNIS SCHEDULE,SHEETA4. SHOPPING CFNTEt NISI N 4 U 0 PARTITION WALL EXISTING METAL STUD WATH GOB. C STATE: IttS TTS I.fl e w PATCH AND REPAIR AS REQUIRED.REFER TO 2/A5 FIRE EXTINGUISHER-SEE NEW T4TXTd ENTRY CECEILING L®GHT FOR ADDITIONAL INFORMATION.FINISH PER FINISH WORK NOTE I ,p�INB.CARPET TILE (SALES AREAk 11'-0' pT f SCHEDULE SHEET A4. - 'aO a m n SQUARE FOOTAGES m it F s REE ® t. - a a PARTITION WALL 3 5/(20 GA)METAL STUDS 0 I 4y OC WiTH ONE LAYERR U 5/8'GINS EACH SIDE TO ROOFOF TOTAL SPACE LEASER 7,s15 SF FLOMARU, 6.405 SF DECK FINISH PER FINISH SCHEDULE SHEET A4 B NONSILLES AREA 1,47E SF USABLE STUCIQ2006k 9a1 SF tt% n ,• �,•..Ivl' 1~ •;• � STOCKROOM � W �� r4'I:• 2 TOP OF DECK. �(l'.•• �., _ I t i4'd' I TOP ODECK F I 3 \- A. `2 ® EASTINGCOLUMN-PAINT 314'd• •.,e YE LOW AND PROVIDE BRUSHED ALLUMWUM.COVER TO Ir-W(TYP.) I. 15S ` 7 1 I POWER POLE FOR CHECKOUT � �� _•(� CLEARANCE REGIS ER(WIRWGSUPPLIEDBY 03 i G`T 4./!J!\� p -� w • !v . 2 I TENANT) o 9EC0 RIB*CARPET TILEEMPLOYEEAREA 4FIRE EXTINGUISHER Y-VEW 40 NH � �I PROVIDE NEW STOREFRONT SYSTEM TO MATCH EXIST.INSTALL PER MFG{ '? . SAFE I PUBLISHED STANDARDS. 9'-T INSTALL DECALS ON GLASS PANELS SEE NEW WORK NOTE 5. 71 l 1 AS 11 OFF�E 1 i I m F70ALLUMWUM.STORFFR (`� I O ( I 3 I e SYSTEIA�i PROVIDE NEW STOREFRONT SYSTEM O Z A5 I I I TO MATCH EXIST.INSTALL PER MFG. 3-0]Y sd• TA'! PUBLISHED STANDARDS. . F... N Lu PROVIDE NEW STOREFRONT I. I PROVIDE NEW STOREFRONT SYSTEM DOORS,TRANSOM AN THRESHOLD RESHOLD T. ———————————— ———————————————— I TO MATCH OUST.INSTALL PER MFG. TO MATCH STANDARDS, PER MFG. . PUBLISHED STANDARDS F o@ �•„`� ) PUBLISHED STANDARDS. A FLOOR PLAN y+y 51-ALE: 1N�1'-0' 9 Al NORTH ,� , . Cr. -J'Tw FIXTURE ORDER EXPENSE DEPARTMENT 110--* CITY ITEM x xO O 0 PARKING LOT CART CORRAL 10 WOODEN PALLETS 4 YARD DUMPSTER 1 GRID SPEED TABLE(S) 9 YARD DUMPSTER 8 YARD DUMPSTER TRASH ONLY O O 1 GRID H-UNIT(S) ARDBOARD ONLY CARDBOARD ONLY ARUM PLATFORM O O� AREAEA OF REFUGE. GUARD AND HANDRAIL. O ROUND GIFT FIXTURE MUST COMPLY WITH 4 WRIGLEY'S 4'UMBRELLA MERCHANDISE GUM RACK XIST LOADING DOCK ALLSTATE AND LOCAI. Q O O O O CODES. 0 WRIGLEY'S SIDE CHECKOUT COUNTER GUM RACK LEGGETT AND PLATT _ --- ---- OTY ITEM . . - 11E _ l 36" 36" 10— — 36X72"DOUBLE-SIDED GONDOLA RUN(S) 6'GIFT BAG CONSISTS OF: 6 AT 32 1 AT 04 12'PLASTICS(D30) 8'FRESHENERS-D.G.(D31) n 35'CHEMICALS-D.G.(D31) a 1 AT 24 X AT XX L I V ALL ` ch 2 AT 28 X AT XX \ F L > Q m w fLu — �y - T.11' pr m y CO u7— C7 x _AF WALL 4 �� 0 4 a O U' O d �_` - 0 18"EXTENDERbTS r v m CONSISTS OF: X 18"X 36"STARTER(S) p n n o o n �, `� 4 n n a n n � n n n W N X 18'X 36"ADDON(S) Z U U z Z cz; U �' U 22555�U U~ u' U U U 3 I U U- w `n `� X 18'X 48'STARTER(S) o- s N Q vi a qa F � o ui X 18'X 48'ADDON S nn� n o n� inn � nn n � ann� inn anna it n ( ) �' p �Q I II I ^U U U zo U U $ z CDU U j U U U U ®U 2 36'XCONSISTS OBLESIDAD GONDOLA RUN(S) p 20 aoUU�— a U § w uu �7S C9 g v a �� U a Q �j nn n 4 o nn nn Lenn= nn m nn nno znnQ on Z y ]C Lu n pUUWaU < UU UU �UU;m � UU ^ zUU �Id>UU �UU�� LI p n n n n 0 18'X48'SINGLE SIDED WALL GONDOLA ® ® U a nn n n n nn n n o � _ nn N n n —_ CD n RUN(S)CONSISTS OF: XXATXX ATXX n �uu � " u z Uu� UU � uu� co aUU � UU� �UUcY�� UU� I B 1 z Ci Z c� fr— Ci w $ c3 ! Z5 n 53 U nn m n nnao nn $ 9orTl nn =inn^ a� nn _ � rLn4 ® ® w 4 3 w �� o '_ �> �h 9 18'X96'WALL GONDOLA RUN(S) ¢o UU U CD w U " UU m�UU� o UU �UUw U � U� CONSISTS OF: 1AToe 1ATas F n n nn� nn ^nn� nn �znn� - LLnn w nv=i n 2AT20 1AT18 o + 5 c �' pUU uja = a 2AT04 XATXX ® o U UUo UU Zc� UU� Y UU UU� �v� '� UU� = Z co 1AT27 XATXX n W nn^ n nn� 66nn 3 nn inn onnw zy}nn F > nn wn tAT06 XATXX ib t9+ p w t° 20 36'X 72"ENDCAP(S) n Y UU i? U cwi UU UU s< UU UU _ ,: U F UU a UU 2E 04 36'X54"ENDCAP(S) 4 n r� n n N �nn N nn 0 3'BOOKSHELVES nn n N nn w nn y 4 nn- 4 w T= 5 �y o c� . d„ $ a 12 4'BOOKSHELVES U o U UU UU UU o UUUU U UU N 106 14'X3s'SHELVES LL Q�Q a p n 16 16'X 36"SHELVES STOCKROOM H 'v N 2 io p. CEILING HEIGHT !27o 28 1 'X 48'SHELVES 10,�, 286 166'X 48'SHELVES 0 CANDY MERCHANDIZER wIFEATURE END(R) 4.Wy 4 CANDY MERCHANDIZER wBULK END(R) n *moo ® ® b 0 CANDY MERCHANDIZER wIFEATURE END(L) U 0 CANDY MERCHANDIZER wBULK END(L) TIERED SEA 1 TIERED TABLE('WOW TABLE) 19--y U e�C TABLE IF 20 SO and PROMOTIO a _CLEARANCE W2� J 2a sEAsO and PROMOTI 1 54'4-WAY DISPLAYER(S)WISHELVES WAY 4 STOCKROOM SHELVING(4'SECTIONS) n� _ o� �"nib 12 U-BOATS Y CD CE 'v a"* coKE 1 PALLET JACK LL g TPABLE 18 S and PROMOTION 3PL IV S and PROMOTION 4 X) CD ODI NEW FULL HEIGHT WALL BEHIND 1 BREAKROOM KIT(NEW STORES ONLY) .\RFA 3D CD STOREFRONT SYSTEM, 36 S.D.T.SHOPPING CARTS s o I 0 36'CART RAIL SECTION ra 3 72'CART RAIL SECTION GRID H cRID H 1 STOCKROOM ROLLER SYSTEM y/ BEST/FLEX 200 CONSISTS OF:2.24'SECTIONS(S) 4 GRAND BENEDICTS 1 SLATWALL BRACKETS 2 HELIUM TANK BRACKETS SHOPPING CARTS 1 0 DVDSHELVES(2PKCASE-1-14'1-161 Al'— 2 PICTURE FRAME SHELVES(CARTONS) 5 GRID PANELS )HANG RAILS(CARTONS)2 1 BOOK SHELF BASKETS(CARTONS) 2 MOBILE MERCHANDISER 13 POWER PANEL(2) 16 14'X 36'OPEN END BASKET 192 16"X "OPEN END BASKET(MAX @ 504) 36 8 16"X 36"OPEN END BASKET 50 14'OPEN END BASKET DIVIDER 600 16"OPEN END BASKET DIVIDER(MAX 0 1750) 50 TX 48'PEG FENCE REV DATE REV NO: BY REV DATE REV NO: BY SALES AREA SQUARE— -- - -- — -" TOTAL SPACELEASEDFoorAGE 7825 SF DATE: 7/15/2010 DRAWN BY: JCW STORE N0: 4528 �� DOLLAR TREE STORES,INC. OPERATIONS and PLANNING SALES FLOOR AREA 6,405 SF DOLLARTREE SUPER STORE LAYOUT �► 500 VOLVO PARKWAY FESTIVAL @ HYANNIS USABLE STOCKROOM 920 SF 12 % CEILING HEIGHT 11'-0" CHESAPEAKE,VA23320 HYANNIS, MA F- TOTAL LINEAR FTAGE 803