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Home My WebLink AboutMIDCAPE SERVICE CENTER- MOBIL MART - FOOD . ......... .....�c?15-��-coal MID CAPE SERVICE CENT. RT.6 & 132, W. BARNS. f Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. nAWNSTAaLL F.P.(Thomas)Lee,. 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. At. ox° Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 489 Issue Date: 01/01/2022 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2145 IYANNOUGH ROAD W. BARNSTABLE„ MA 02668 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2022 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - MOBILE-FOOD: MOBILE-ICE CREAM: C�i FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: I PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For 0Q Initials: "E'°' .� Town of Barnstable — . . � Da -paid MMSTAB Inspectional Services t•heck# MASS. �,L_--_� ;9 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, 1\1A 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE /0, NEW OWNERSHIP RENEWAL 1� NAME OF FOOD ESTABLISHMENT: �V/P ADDRESS OF FOOD ESTABLISHMENT: &22� e ¢ ij3� d" V MAILING ADDRESS(IF DIFFERENT FROM ABOVE): y E-MAIL ADDRESS: �� 3�� D®`C/��i V TELEPHONE NUMBER OF FOOD ESTABLISHMENT: c29) 4D ZJ TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO �/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE: V TOTAL: P 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 �ETAIL 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§08-862-4644 Q:1Application FormsTOODAPP 2020.doc r � OWNER INFORMATION: A FULL NAME OF APPLICANT � SOLE OWNER: YES/NO � OWNER PHONE# �'� O��I ,F/ ADDRESS N� �� 2 �.� CORPORATE OWNER:/1-/V C�� / �.�1C C��y . M_G c CORPORATE ADDRESS: 12ad 6 .��/� �3� ��J�I ,� 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. 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 htti)://iv)vrr townofbarnstable nS/health(IiN-ision/atnnlic ttions.asi). OUTDOOR COOING: 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 APPLICATIONS)AND REQUIRED FEES BY DEC 1st. QApplication FormsTOODAPP REV3-2019.doc i BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Nam =` Paul J.Canniff,D.M.D. MAM 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: 489 Issue Date: 01/01/2021 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2145 IYANNOUGH ROAD W. BARNSTABLE„ MA 02668 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: tsE� r Initials: � � Town of Barnstable Date Paid � �� Apt TA$�. u MASS.tE Inspectional Services �Q � 1639. �0� Check# '35g1� � U ArFo3�a Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLfIC�ATION FOR PERMIT TO OPERATE.A FOOD ESTABLISHMENT DATE ��'��` �`' NEW OWNERSHIP RENEWAL v NAME OF FOOD ESTABLISHMENT: ►�/113 � �/ �C LFi � /yf� �Al ADDRESS OF FOOD ESTABLISHMENT: ,0pi MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �INPl1# Y--5e /&, " /l TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �5—ob - 602 l TOTAL NUMBER OF BATHROOMS: _ WELL WATER: YES NO V ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V/ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: O OUTSIDE: TOTAL: Q 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:\Application FormsTOODAPP 2020.doc I 1' OWNER INFORMATION: /) FULL NAME OF APPLICANT do SOLE OWNER: YES/ i) OWNER PHONE# ADDRESS .iE/� A4 C �j/��J/�F� /7// CORPORATE OWNER: M11) c'I� JL"�� 41(L - C+�� / --- CORPORATE ADDRESS' � AV`a l l� ` PERSON IN CHARGE OF DAILY OPERATIONS: J 56 /- 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 Exliration Date I. 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 htty://www.townofbarnstable.us/heaIthdivision/ai)i)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc f;F BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Guadagnoli,M.D. Ba ISTABM = F.P.(Thomas)Lee 3� , 200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate R Phone: (508) 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 489 Issue Date: 1/1/2021 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2145 IYANNOUGH ROAD WEST BARNSTABLE, MA 02668 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY I `J a G For Office U Initials: . Town of Barnstable �`. Date Paid 1 AmtPd$� �• Inspectional Services ennnaraaLs.. &639. ro ,� . Public Health Division check# - Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT APPLICATION Non-Flavored DATE L� d NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: ADDRESS OF TOBACCO ESTABLISHMENT:�Q�/T/ 6 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: Sc PY L36 OWNER'S NAME: S�G�I��Q OWNER'S PH# -,��-"` OWNER'S ADDRESS: CORPORATE NAME: CORPORATE ADDRESS:beg 6 �it'BD1�1�2 fid1W4&PORATE FID# - ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: v https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: hMs•//male�l.,islature Gov/I,aws/GeneralLaws/PartIV/Titlel/Cha tter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT.THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 3 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 i A' SIGNATURE: PRINTED NAME: , C� // C} �� /�� DATE: Q:1Application FormffOBACCO APP-NonFavor 12-18-19.doox a i Alm ESTABLISHMENT'S NAME TOBACCO SALES, Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section. 371-9. of the Town of Barnstable Board.of Health Regulation: Sales to Minors—S 371 9 Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum.legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. I Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that.the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Hbthibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General haws: - c�Ck)OD Si Pr ed Name Date j Signa Printed Name Date Signa Printed Name Date � 2P JVJ Si ture'1 Printed Name _.. Date Sina re PWN ame Date Printed Name Date Signature Signature Primed Name. Date E. Q\Application Fonns\TOBACCO APP-NonFavor 12-18-19.d6ex A This certifies that the taxpayer named a oy%% :tl 1 6 . fiik 1IIV1,E•:7 Wot, t A("'Of the Massachusetts General LaEvr self at retail at the address shown above, "i.h 41 116t"Y,ti •s, a+.r1+ 1_J�'artcl may be suspended or revoked(or failure to comply with state laws and Te�W#i6l�; � Effective Date: October 1,2020 10.11022 ---------------- ----------------------------------- t ,�,t-it ktER ---------- ---------------------___-__--_-_-__.----_-------------- '`�, MASSACHUSETTS DEPARTMENT OF REVENUE J• Retailer License for Sale of Electronic Nicotine Delivery Systems This license (lust i� Oosted d isibie at all times. The sale of tobacco prod s�lw attvone tinder It years of age is prohibited. MID-CAPE SERVICE CENTER INC account tD: £DL-10240966-f11; MID-CAPE MOBIL SERVICE CENTER& License Number: 1793009664 CONVENfENCE STORE ROUTE 6 & ROUTE 132 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the N14assachusetts General La,.vs to sell electronic nicotine delivery systems at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:May 20, 2020 Expiration Date; September 30, 1022 r - --- ---------------------------- ;-- _--------- Xcxc.sFT MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T J Retailer License for Sale of Cigars and Smoking Tobacco i 1r s This license must be posted and visible at all times. The sate of tobacco �F:47 oY products to anyone under IS years of age is prohibited. MID-CAPE SERVICE CENTER INC :Account®: CRL-10240966-0I0 MID-CAPE MOBIL SERVICE CENTER&CONVENIENCE License Dumber: 1623169024 STORE ROUTE 6 &ROUTE 132 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensee under Chapter 64C of the Massachusetts General Laws to sell at serail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1., 2020 Expiration:Date:September 30, 2022 F s MASSAC'HIJSETTB DRFARTIl�IENT OV REVENUE Ford'CP-3 • _1 Fps Retailer License for Sale of Cigarettes This license must be posted and visible at all times.The.sale of tobacco ` products to anyone under 18 years of age is proibited. MID-CAPE SERVICE CENTER INC Account Ek CGL-10240966-007 MID-CAPE MOBIL SERVICE CENTER&CONVENIENCE License Number: 120-5200896 STORE ROUTE 6 &ROUTE 132 WEST BARNSTABLE MA 02669. This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is.non-transferable and may be suspended or revoked for failure to comply with state laws aud`regulations. Effective Date: October 1,2020 Expiration Date: September 30,2022 .............. r l : . s Town of Barnstable BOARD OF HEALTH Ss John T.Norman Board OI Health Donald A.Gaudagnoli,M.D. R,►RNsr nty. PaulJ.Canniff,D.M.D. esv 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 489 Issue Date: 12/10/2019 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2145 IYANNOUGH ROAD W. BARNSTABLE, MA 02668 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: Indoor5eating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: r r.' FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Initials: °` TOi• Town of Barnstable + �( Date Paid Amt Pd$ 1 f✓U - ; Inspectional Services KAM s6.39. 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�Lz�9 NEW OWNERSHIP RENEWAL v NAME OF FOOD ESTABLISHMENT. &/2 41, � ADDRESS OF FOOD ESTABLISHMENT: !VG r /�CDV�G �%� �'!/�O`�✓/�T✓l /.' �� MAILING ADDRESS(IF DIFFERENT FROM //ABOVE):�/ E-MAIL ADDRESS: C/-WoDt/xy TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (3Of) U�- e>9 7-> TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO ✓I... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: D OUTSIDE: 6 TOTAL: P 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 TAIL 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) ATERING ... (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 n OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES Q OWNER PHONE # ADDRESS � �?c CORPORATE OWNER: Ctt �lC� C�NT,� 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. 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 http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsWOODAPP REV3-2019.,Joc oFIME For Office UsInitials: Town of BarnstableBMWSTABLE _ Inspectional Services Date Paid. Amt Pd$ _ v Mass. $ 1639. Public Health Division ATFO MA'1 a Thomas McKean, Director � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE f! NEW BUSINESS OWNERSHIP s RENEWAL NAME OF TOBACCO ESTABLISHMENT: /�//.y G��` i/('' � � //?/,r ADDRESS OF TOBACCO ESTABLISHMENT: 6A- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: /�� y ��l 4&mo` C TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: (��364� -Do7 OWNER'S NAME: � /� OWNER'S PH# ®g /Q�JD. OWNER'S ADDRESS: (( 4e-r,Q,C"��f CORPORATE ADDRESS:47U, 3,1+ d✓�l7fI��Y1/ CA06f0:RATE ANNUAL: SEASONAL: DATES OF OPERATION:_/ / TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) /V P ✓f TOWN OF BARNSTABLE CODEIMA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https•//male islg ature Gov/Laws/GeneralLaws/PartIV/TitleI/Chgpter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: T PRINTED NAME: ,.5� DATE: Q\Application Fonns\TOBACCO P-NonFavor 11-21-19.doc J ell ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—$371-9. Sale and Distribution of Tobacco Products, 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products, as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Signatu a Printed Name Date x11d41 Signa a Printed Name Date 4�eV�1� 5 � /1/- e Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc I Commonwea@th of Massachusetts Letter[D;L184349$552 � z Department of Revenue Notice Date:Septc.mbcr 4,2018 g4 ;44 Christopher C.Harding,Commissioner ,Account 1D:CGL-10240966-007 FAT t � mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES MID-CAPE SERVICE CENTER INC MID-CAPE MOBIL SERVICE CENTER&C .ROUTE 6&ROUTE 132 WEST BARNSTABLE MA 02668 Attached hvlsw=.i Q la,:- f_C.isa'ett C-(Fo .CT--3T -Cui along-the-dotted-line- and .,_....._�...� -_.��_ display at your business location. At any time,you can log into your MassTaxConnect account:at mass.gov/masstaxconiiect to view and re-print a copy of this license. If you have any questions about your license,call us at(617.) 887-6367 or toll-free in Massachusetts at (800) 392-6089,Monday through Friday, $ 30 a.m..to 4:30 p.m. DETACH HERE NCH rs��a MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes �FVroF�` 'This license must be posted and visible at all times.The sale of tobacco .products to anyone under 18 years of age is prohibited. MID-CAPE SERVICE CENTER INC Account ID: CGL-10240966-007 .MID-CAPE MOBIL SERVICE CENTER& CONVENIENCE License Number: 614246400 STORE ROUTE 6 &ROUTE 132 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell.at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state,laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30,2020 r o �'C.Ht^sFj� Commonwealth of Massachusetts Letter ID:LI 1862391.04 �� r=- s Department of Revenue Notice Date:September 4,2013 ap Christopher C.Harding,Coinmissioncr Account f,D:CRL-10240966-0I0 F4 r 0F mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO MID-CAPE SERVICE CENTER INC o= MID-CAPE MOBIL SERVICE CENTER&C ROUTE 6&ROUTE 132 WEST BARNSTABLE MA 02668 ^. Attached below-is-your Retailer License—for-Salfigars and:Smoking—Tolaacc�jFor�n_CT=3T�..Cut along the dotted line and display at your business location. At any time,you can`log into your MassTaxConnect account.at mass.gov/mmtakconnect to view and re-print a copy of this license. .If you have any questions about your license;call us at(617) 887-6367 or toll.-free in Massachusetts at (800)392-6089, Monday through Friday, 9:30 a.m. to 4:30 P.M. DETACH HERE acYL'sp MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco oYmg p �� This license must be posted and visible at all times.The sale of tobacco :products to anyone under 18 years of age is prohibited. MID-CAPE SERVICE CENTER INC Account ID: CRL-10240966-0 10 MID-CAPE MOBIL SERVICE CENTER& CONVENIENCE License Number: 1770153984 STORE ROUTE 6 &ROUTE 132 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state,laws and regulations.. Effective Date:October 1,2018 Expiration Date:September 30,2020 f BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Guadagnoli,M.D. x�x *�sgr �ae Paul J.Canniff,D.M.D. F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 489 Issue Date: 1/1/2020 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2145 IYANNOUGH ROAD WEST BARNSTABLE, MA 02668 Type of Business Permit: Non-Flavored Annual _�� Seasonal FEES YEAR: 2020 TOBACCO SALES. $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY tKE? Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. A.Ga Board Of Health Donald A.Gaudagnoli,M.D. a RNsrxoLz • John T.Norman MAS& 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 489 . Issue Date: 12/20/18 DBA: MID CAPE SERVICE CENTER, INC.- MOBIL MART OWNER: SAEED A. CHAUDHRY Location of Establishment: 2155 IYANNOUGH ROAD W. BARNSTABLE, MA 02668 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, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: THE Town of Barnstable For Of • Initials: �. a Paid 3 Amt Pd$ Dte CAB , Inspectional Services059. ., Public Health Division h� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 XV ' Office: 508-862-4644 Fax: 508-790-6304 rt APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: //1/p ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: � i�Ul��,a ---t1OO' �D TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: a WELL WATER:YES NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: y OUTSIDE: o TOTAL: o 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 ::�ETAIL 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 FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: �Q� yy FULL NAME OF APPLICANT s SOLE OWNER: YES OWNER PHONE# ADDRESS � i� ��/�� Z, � CORPORATE OWNER: ly SW �/F : CORPORATE ADDRESS: O O V`� �� `''' 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. 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 openinz!! 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.townotbarnstable.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.3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc �114E Town of Barnstable Regulatory Services Department MMUABM ' �m� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT AW/ 74 LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL D/B/A STREET ADDRESS a�7d� TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes V No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided.-on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). / Signature Date Q:\Application Forms\TOBACCO APP2018 dob.docx a: 0 Establishment f t TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood sections VII b. and VII c. of the Barnstable Board of Health Prohibition of Smoking Regulation and the enclosed copy of Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of eighteen(18). Below are sections VII b. and VII c.of the Barnstable Board of Health Regulation: SECTION VII—SALE AND DISTRIBUTION OF TOBACCO PRODUCTS b. Sales To Minors—In conformance with the Massachusetts General Laws Chapter 270, Section 6, no person, firm, corporation, establishment, or agency shall sell tobacco products to. a minor. Each employee working in an establishment licensed to sell tobacco product shall be required to receive a copy of the Board of Health regulations and State Law regarding the sale of tobacco and sign a form indicating that such regulations/laws have been received and understood, a copy of which must be placed on file, in the office of the employer and retained. Such signed forms must be made available for inspection, during the license holders normal business hours upon request of an agent of the Board of Health. c. All distributors/retailers of tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age, the customer present a valid State issued picture identification card or drivers license with appropriate photograph to confirm that the customer is of legal age to purchase the tobacco product. The following employee(s) received and understood Sections VIIb. and VIIc. of the Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Si Printed Name Date Sign a PrintQ Namek Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP2018 dob.docx .x BIKE ti Town of Barnstable • os Regulatory Services Department MAN. �m Public Health Division 1039. 200 Main Street, Hyannis MA 02601 co _0 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Uri Fee: $85.00 MAIL.TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 Al APPLICATION FOR A TOBACCO SALES PERMIT LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL DB/A STREET ADDRESS 9,�, N� , TELEPHONE # FID# Do you curren.ly possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tnha ucts must sign the Employee Signature Form (provided herein). Signature Date Q:\Application Forms\TOBACCO APP2019 dob.docx i,o Establishment TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establish :Went received and understood Chapter 371 of the Town of Barnstable Code and the enclosed Qcopy of giving toba 0 o Section oducts tocf the Massachusetts General Laws which describes the penalties for selling and/w giving p person under the age of•twenty-one (21.). Below are: sections VII b. and c.. of the Barnstable Board of Health Regulation: SE=ALE AND DISTRIBI?'IION OF TOBACCO PRODUCTS �-T b. Sales To Minors--In conformance with the Massachusetts General haws Chapter 270, Section 6, no person, firm, corporation, establishment, or agency shall sell :o6acco products to a moor. Each employee working in an establishm-aPt licensed to sell tobacco product shall be requir, to receive a copy of she Board of Health regulations and State Law regarding the sale of tobacc]- and sign a form indicating that such regulations/laws have been rec{�ived and understood, a co 7 of which must be placed on file, in the office of the employer and retained. Such signed forms must g tl:ce license holder's normal business hours upon request be made available for inspection, durin of an agent of the Board of Health. c. All distributors/retailers f sheet parrs of to products or tobacco merchandise must require that, if a customer appears to possibly be under 2'7 years of age,the cust:on:cer present a valid State. issued picture identification card or driver's license with appropriate p:hotograph to confirm that the customer is of legal age to purchase the tobacco product. table T1'he following employee(s) received and understood Sections VIIb. and vNlassOachus f theBs General Laws: of j Regulation and C:ha.pter 270 Section 6 of the Health P ohibition of Smoking a Date Si Printed.N °e _ _ -- Date , :��: S gna e �Pnt�(teci Name ' Prvlte i Name Date \ R W' Printed Name Date Signature Signature — Printed Name _ w Date - --�— Printed Name Date Signature Signature Pz7nted Name Date Q:\Application Forms\TOBACCO APP2019 dob.doca TOBA("'C:10 SALES TO MINORS Pp:CUBITED BY M.&SSACHUSETTS GENERAL LA.)A%'S Sales to Mirrors—6 371-9. Sale and distribution of tobacco products. 1. No person. shall sell or provide a. tobacco product, as defined herein, to a person under the minimum legal sales age. The minimumm legal sales age in Ba;-nstable is 21. 2. Identification: Each person selling or distributing tobacco products, as defined herein, shall verify the age, of the purchaser by rnea:ns of a valid govemmment-issued photographic: identification containing tl!.e bearer's date of birth that the purchaser is 21 years old or older. Verification is required for zany person under the age of 27. Persons, fllIl1S, corporations, or agencies selling tobacco products to minors or selling tobacco products without a tobacco sales permit shall be punished.as follows: In the case of a first violation, a fine of one hundred dollars($300.00). b. In the case of a second violation within 24 months of the date of the current violation, a fine of two hundred dollars($:300.00) and the Tobacco Product Sales Permit shall be suspended for up to seven(7)consecutive business;days. c. In th.e case of three or more violations within a 24-month period, a fine of three hundred dollars (S300.00)and the Tobacco Product Sales Permit shall be suspended for up to thirty (30)consecutive business clays. In the case of'Four violations or ref-eared, egregious violations of this regulation, as determined by the Board of Health, within a 24-m.onth period, the Board of Health shall hold a hearing in accordance ,,Oh subsection 4 of this ;section and may pennmently revoke a Tobacco Product Sales Permit. Posting Si:ate Law — In confonz;.arace with Massachi:�setts General Laws, Chapter 270, Section 7, a copy of Massachusetts General Laws Chapter 2.70, Section 6 shall be posted conspicuously by the owner or other person in charge thereof in the shop or other place used to sell cigarettes at retail.. The notice to be posted shall be that notice:provided by the Massachusetts Department of Public Health. Such notice shall be at least 48 square inches and shall be posted. at the cash register which receives the greatest volume of single cigarette package sales in such a manner so this may be readily seen by a: person standing at or approaching the cash register. Such notice shall directly face the purchaser and shall not be obstructed from view or place at a height of less than 4 feet or greater than 9 feet. from the floor. For all other cash registers that sell cigarettes, a notice shall be attached which is no smaller than 9 squar-e inches, which is, the size of the sign provided by the Department of Public Health. St:Ech notice must be posted in a manner so that it may be readily sewn by a person standing at or approachin;; t e cash register. such notice shall directly face: the purchaser ancl. shall not be obstructed from view or laced at a height no less than 4 feet or more than 9 I'eet from the floor. Q'ApplicatioF,For+ns\TOBACCO APP2019(Iob.doex °p,NEr _ TOWN OF BARNSTABLE , _ - HEALTH INSPECTOR,s Establishment Name: ( Date: Gi. Page:. of - '•• - 'OFF ICE HOURS PUBLIC HEALTH DIVISION 800-'9:30A.M. BARN�rABLE. 200 MAIN STREET 3 MON. o P.M.FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN-OF CORRECTION Date Verified 5088 -62-4644 MASS. 0g HYANNIS,MA 02601 - M- No Reference R-Red Item - - PLEASE PRINT CLEARLY �,a +s39•a -- ' 'FDN1 FOOP ESTABLISHMENT INSP CTION REPORT. i Name icl ( Date / T e o f Ins ection 1,1L I /`„ - OF Address Gci &AB Risk Food Sery Re-inspection �'t Level a aI Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 1 Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) �� Time1 Bed&Breakfast O herHACCP Inspector �,�j\ `1� Each violation checked 36 equires 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 Temperatureso ❑ 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 Asa 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 1 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations U Critical(C)violations marked must be corrected immediately. (blue&red items) j I ❑ Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes within 90 days as determined by the Board of Health. Overall Rating Voluntary Compliance ❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo❑ ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations g 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 27.Physical Facility (FC-6 590.007 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 y g g' 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 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Si ature -" Print: 31.Diumpslier 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) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202-1i-' Additives* g Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.i4 Protection 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* 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 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 * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions 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 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 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* 4-50T.n2 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment _ * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective innooi _ 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* I 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 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* � 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 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 10 Proper,Adequate Handwashing 2-301.11 Clean Condition-Hands and Arms* 3-401.11(C)(3) Whole--muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under � Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3403.11E Remaining 3-101.11 Food Safe and Unadulterated ( ) g 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 ( ) 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 3-501.14 B Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* ( ) g Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* _ 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8403.12 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. pp 7HE rpm TOWN OF BARNSTABLE ? HEALTH INSPECTOR'S Establishment Name: ; Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. • BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. �'OlFVMn+"0 HYANNIS,MA02601 soa-as2-4saa No Reference R.-Red Item �. PLEASE PRINT CLEARLY F OD ESTABLISHMENT INSP C ON REPORT Name Date Type o Inspection Operation(s) Routin Address Risk eryice -mspecti n Level Retail Previous Telephone ential Kitchen Date: kin 14 /1 Mobile Pre-ope aInoe?]/ ��//Owner HACCP Y/N Temporary Suspec I f Caterer General Complaint Person in Charge(PIC) 6 Time Bed&Breakfast HACCP Other I � InspectorI 2C)N W�z tu (Imw u . Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and 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 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) A ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures .n ❑ 5.Receiving/Condition ❑ 17.Reheating f ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling V . 7.Conformance with Approved Procedures/HACCP Plans '❑ pp ❑ 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 1 , ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY / ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items] Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ` Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately.or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal 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 Orion-critical violations 9 ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order, C=2 critical violations..and less than 9rion-critical. If no critical water,sewage back-up,infestation of rodents or,insects,or lack of 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. 29.Special Requirements (590:009) within 10 days of receipt of this order. ion,4 to 8 non-critical v' lation 30.Other DATE OF RE-INSPECTION: n ecto s Sig at (}ao 2 ri t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Fj #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signature Print. Self Service Wait Service Provided Grease Trap Size Variance Letter Posted:_Y N Dumpster Screen Y N I Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.1-2- 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) * 590.003(C) Responsibility of the Person-in-Charge.to Poisonous or Toxic Substinces 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 _Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* _ Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* .REQUIREMENTS FOR . 3-306.14(A)(B)Returned Food and 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* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 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 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. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb ciive 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 ( )-(D) 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 590.009(A)-(D) Violations of Section temporary and in cater- * Ratites-165°F 15 sec* in mobile food,tern o and residential Sources 10 Proper,Adequate Handwashing g' P mTY Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2-301.11 Clean Condition-Hands and Arms the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 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 1 7 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.11 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* F1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 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 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 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:590For.mback6-2doc *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 INC ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: 1- Itab Date: 7141 lq _Page: 1 of ,perW - OFFICE HOURS 7x eAR"N"sr"�e.o PUBLIC 2 0 MAN SH EETSION - 3: 0- :30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. Mph• g, MON.-FRI. �`rFo MA+"tea HYANNIS,MA 02601 508-862-46" No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name i f 1�� Date 1 impe o f Inspection "/ ),' Operation(s) R �outine C J vkt C V(�('' i .Address 1_0 A iltl h Risk ervice = pection Level Ceta Previous Inspection ��v Telephone ntial Kitchen Date: _ sd i - 16f Mobile Pre-operation J Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint /^ Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Ui A' Out: �. 0a' ,,S ilt 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 L� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations,Relate Blue Items) t d to Good Retail Practices� e ) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary,Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board'of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 aright to.a hearing. Your request must violations observed,7 to 6 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. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y p - 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: �g 31.Dumpster screened from public view (i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #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 IN 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 3-2011�- _ 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 Toxid 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* 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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* Separation-Storage*P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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* Effe°ri°e innooi 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. 4-702.11 Frequency of Sanitization of Utensils and Food 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* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) Ratites-165°F 15 sec* Sources* 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 929-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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained 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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 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 1 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 INE r° TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: - Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 PM. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAss. HYANNIS, MA 02601 5 08-8 62-46-FRi . No Reference R-Red Item PLEASE PRINT CLEARLY �p 639•n�0� .. � 44 � - 'F"""� FOOD ESTABLISHMENT INSPECT]O REPORT Name r� Date *Type , sec ion s outine AddressRisk ectionLlPrevious InspectionTelephone itchen Date: 1 Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: CA 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 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 S 4J fj� within 90 days as determined by the Board of Health. ` o ` ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an insp tion today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F: 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 Physical Facility (FC-6 590.007 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 27.Ph y tY )( ) y y g g 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. violation,4 to 8non-critical violations=C. 29.Special Requirements - (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: F 31.Dumps r 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 Sign re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Cf Dumpster Screen? Y N i Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) w= FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A)±De-. ssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45`F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3=202:f2 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* - 19 PHF Hot and Cold Holding -2-103.11 Person-in-Charge Duties 3-302.14. _. Protection from Unapproved ces 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°E Contamination from Raw Ingredients 15 Poisonous or Toxic Substan 590.004 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-'Original Containers* (F) 2 590.003(C) Responsibility of the Person-in-Charge to - Other* 7-10211 Common Name-Workin 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* 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(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-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 Hermetically Sealed Container* I 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* 3-401.11A(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* e//critic innooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 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 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE r, TOWN OF BARNSTABLE:, .- HEALTH INSPECTOR'S Establishment Name: Date: Page: . of 4 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 mass. MON.-FRI. �p .p3q,p�0 HYANNIS,MA 02601 e08-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'ED"""� FOOD ESTABLISHMENT INSPECTIO REPORT l Name Date a of Type-of Inspection Ooeration(s) n 44103 _FT Address Risk Food Service Re-inspection h Level etas Previous Inspection Telephone esldential Kitchen Date: CA-712Mobile Pre-operation c Ind f Owner HACCP YIN 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) N A 014 1 4 ,k Vaty 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 2 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 14 PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items o Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.E ui merit and Utensils (FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 q P )( ) 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 9rion-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. 29.Special R Y within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. e irements (590.009) P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump er screened from public view &1�-1-1 .. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ig t e Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 1` 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) [Demonstration signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 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* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 2 . Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130 7-201.11 Separation-Storage* °F* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products*' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 Surfaces Utensils and Food Contact Sfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef dive 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)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 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 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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* 3-403.11(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 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 1 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. i. R �;, Retailer License for Sale of Cigarettes y tiF�T 0r. This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. MID-CAPE SERVICE CENTER INC Account ID: CGL-10240966-007 MID-CAPE MOBIL SERVICE CENTER&CON_VENIENCE License Number: 614246400 i STORE 10 ROUTE 6&ROUTE 132 � WEST BARNSTABLE MA 02668 : ice• This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws_to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for 'a failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30, 2020 ,c+rc'SF MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T o Retailer License for Sale of Cigars and Smoking Tobacco Ap'vr 0* This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. MID-CAPE SERVICE CENTER INC Account ID: CRL-10240966-010 MID-CAPE MOBIL SERVICE CENTER& CONVENIENCE License Number: 1770153984 STORE ROUTE 6&ROUTE 132 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1,2018 Expiration Date:September 30,2020 E / � � k T�/ � TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS: PUBLIC HEALTH DIVISION" 8:00-9:30 A.M. 200 MAIN STREET 3:30-4:30 P.M. YbyE .� HYANNIS,MA02601 MON.-FRt.- . Item Code C-Critical Item : DESCRIPTION OF VIOLATION/PLAN.OF CORRECTION DateVenfied' Z 508-B6z-asay No. rReference R-Red Item PLEASE PRINT CLEARLY: .' , Name InO ! ate Type of Type of Ins ection Ad i Oaeration(s) me F,Lmsk F ervice spection Level Retail PrevioX Inection r Telephn� alS�' esidential Kitchen Date: Own r >� �� 1�7 HACCP Y/N Mobile Prepeti n '"'-�` �v,t 6'_2fE � Temporary Suspect Illness Caterer Person in Charge (PIC) Time General Complaint Bed & Breakfast HACCP or In: Other Inspect 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 Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. 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) r ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements Xi 8. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plansg Hot and Cold Holding �j174K3 OW PROTECTION FROM CONTAMINATION 20. Time Asa Public Health Control ' 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) P. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP CiA AA ❑ 10.Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. Overall RatingED ;Corrective Action Required: [❑ No ❑ Yes C N 23.Management and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items ' 24.Food and Food Protection (FC-3)(590.004) checked indicate violations of 105 CM ❑R 590.000/federal Food Code. ❑Voluntary Compliance ❑ Employee Restriction/Exclusion Re-inspection Scheduled ❑ Emergency SuspeIt L) 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physica)Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than anon-critical violations. F= 3 or more critical violations. If no critical violations observed, 28. Poisonous or Toxic Materials (FC-7)(590.008) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations=F. 29.Special Requirements (590.009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation = F is scored automatically if no hot water, 30. Other DATE OF RE-INSPECTION: C= 2 critical violations and less than non-cri"cal. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or observed, 7 to 8 non-critical vi lions no PIC or alternate PIC present. G Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N In t r' S' a rint: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y PI nature Print: .__-_-.:.. - -pa'�r w.r--zr�3.sw-.- ......, f..'14e^r.:+.t'r'5..4�^""�`?i � � �,�+..M,.,7 - � '�-•• � ,„ r-_... _ ��... '� � .V.....-.�,.�+,a.�'^".r`..-+r.a»:s�a.r-;.V�w�.�� ......� •-- i++�,;i.�..:�v.:.t+a.�. '.-^--�.+._..�-sue..-J" �.-... Violations Related to Food, less 3-501.14 PHFs Received at Temperatures Interventions and Risk Factors ed penis 1-22) Violations Related to Foo tyre Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION --.Factors(Red Items 1-22) (Cont.) 411F/45117 Within 4 Hours. FOOD PROTECTION MANAGEMENT 8: Cross-contamination 3-501.15 Cooling Methods for PHFs 1 590.003 A Assi ent ofR nsibili * 3-302.11 A I Raw Animal Foods Separated from PROTECTION FROM CHEMICALS ( x ) epara 19 PHF Hot and Cold Holding„ 590.003 Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives Contamination from Raw In reofients 3-202.12 Additives* 3-501. Cold PI1Fs Maintained at or below 2-103.11 Person in charge-duties 9 S90.004(F)4(F) 41°/45°F* ` 3-30111 A 2 Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* ( x ) eP� t 3-501.16(A) Hot PHFs Maintained at or above EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances « 2 590.003(C) Responsibilityof the person in charge to Contamination from the Environment l 7-101.1 1 Identifying Information-Original 140°F. « require reporting by food employees and 3-302.11 A Food Protection* I Containers* 3-501.16(A) Roasts Held at or above 130°F. a licants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.I I Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.11 Restriction-Presence and Use* 590.004(14) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1.3.1 590.003 D Exclusions and Restrictions* Disposition ofAdu/teratedorContaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.I 1 Incidental Food Contact,Lubricants* 3-801.1 I(B) Use of Pasteurized Eggs* 4:! Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewas -Hot Water « Raw Seed Sprouts Not Served.* 590. A-B Compliance with Food Law' hang 7-206.12 Rodent Bait Stations * Sanitization Temperatures* 3-801.1 1(C) Unopened Food Package Not Re-served. 3-201.12 Food in a Hermeticall Sealed Container 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs Milk Products,Pasteurized* TIME/TEMPERATURE CONTROLS 4-501.114 Chemical Sanitization-temp.,pH 22 3-603.1 I Consumer Advisory Posted for Consumption of - - . Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable concentration and hardness * Water* 16 Proper Cooking Temperatures for 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate 5-101.11 i Water from an Approved System* * Patho ens.*enee;He,n2oo, 590. A Bottled Water* Utensils Clean 3-401.11A(1)(2) Eggs- 155°F 15 Sec. g 590. Water Meets Standards in 310 CMR 22.0* , 4-602.11 Cleaning Frequency of Equipment Food- Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs Sheltrrsh and Fish From an Approved Source Contact Surfaces and Utensils* 3-401.1 I(A)(2) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught MolluscanAnimals- I of R I5 sec. Food Contact Surfaces ofEquipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.11(B)(I)(2) Pork and Beef Roast-130°F 121 min* 4-703.1] Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-401.1 1(A)(2) Ratites,Injected Meats-155°F 15 sec. residential kitchen operations should be Sources* Game and Wild Mushrooms Approved by iU Prope►,Adequate Handwashing * 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Regulatory Auth ' 2-301.11 Clean Condition-Hands and Arms above if related to foodbome illness 2-301.12 Cl Procedure* Stuffing Containing Fish,Meat, 3-202.18 Shellstock Identification Present* * Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash 590.009 violations relating to good retail 3 201.17 Game Animals' Good Hygienic Practices 3-401.1 1(C)(3) Whole-muscle,Intact Beef Steaks Ition 2401.11 Ea i or UsingTobacco* 145°F* practices should be debited under#29- Receivl CO� 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.11 PHFs Received at Pr Temperatures* .2401.12 Discharges From the Eyes,Nose and Mouth* Microwave 1657 3-202.15 Package Integrity* * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 PreventingContamination When Tasting* 3-401.1 1(A)(I)(b) All Other PHFs-145°F 15 sec. 3-101.11 Food Safe and Unadulterated* (Blue Items 23-30) TagsfRecords•Shellstock 12::' Prevention of Contamination from Hands 17 Reheating for Hot Holding 590.004(E) Preventing Contamination from 3-403.1 1(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not re to the 3-202.18 Shellstock Identification* joodborne illness interventions and risk factors listedd above,can be 3-203.12 Shellstock Identification Maintained* Employees* 3-403.11 B ( ) Microwave-165°F 2 Minute Standing found in the following sections ojthe Food Code and 105 CA4R Tags/Records:Fish Products 13 Handwash Facli ties Time* 590.000. 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-403.11 C Commercial) Processed RTE Food- ( ) Y Item Good Retail Practices FC 590.000 3-402,12 Records,Creation and Retention* 5-203.11 Numbo and Capacities* 140°F* 23. Management and Personnel a FC-2 .003 5-204.11 Location and Placement* 3-403.1 1 E Remaining Unsliced Portions of Beef 24. Food and Food Protection I FC-3 .004 590. J Labeling of Ingredients• ( ) g � .. I ConformHACCP Plans ance with Approved Procedures 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 Supplied with Soap and Hand Drying 1g 3-501.14A Proper Cooling of PHFs 26. Water,Plumbing and Waste j FC-5 .006 3-502.11 alized Plans Methods* Devices ( ) Cooling Cooked PHFs from 140°F to 27. Physical Facility +�` FC-6 .007 3-502.12 Reduced oxygen criteria* 6 301.11 Handwashin Cleanser,Availabili 28. Poisonous Toxic Materials .009 70°F Within 2 Hours and From 70°F 29. Special Requirements irements 00 8-103.12 Conformance with Approved Procedures* 6 301.12 Hand Provision to 41°F/451F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient S51W.-pmUb2doc Temperature Ingredients to 41°F/45°F Within 4 Hours* *Dotes 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. s TOWN OF BARNSTABLE BAR_W4 Winance or Regulation i WARNING NOTICE Name of Offender/Manager G t t t" Address of Offender - 1 SS .1-"aA1,A1ktA P.J MV/MB Reg.# Village/State/Zip :"- Wt Sl' 4-rA ,%J-6/j AAA Business Name ";-,1 ; :t2_ n 20_ Business Address 'Miss Signature .of Enforcing Officer Village/State/Zip Vjo.c..h t' . ^A 6615 Location of Offense ''" s�►t�+ os�� fit""Ut l t ' Enforcing Dept/Division Offense >r`410A Facts " , * {7 0 This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. *wn of Barnstable °�t"E'Owti° Regulatory Services Thomas F. Geiler,Director • MUMSTABLE, 1639 MASS. � Public Health Division prED1A0�A Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 18, 2006 Saeed A. Chaudhry Mid Cape Service Center—Mobil 2155 Iyannough Road West Barnstable, MA 02668 NOTICE OF HEARING -BOARD OF HEALTH On 6/27/06, cigarettes were sold to a minor(a person who was under the age of 18 years)by a person employed at your store. According to Section 371-7(B)of the Town of Barnstable Code,no person,firm,corporation, establishment,or agency shall see tobacco products to a minor. According to Section 371-8 of the Town of Barnstable Code,"any proprietor(s)or other person(s) ... who fail(s)to comply with these regulations shall be subject to the following actions for each offense: A warning shall be issued for the first offense. A fine of$100 may be issued for the second offense, $200 for the third offense, $300 for the fourth offense, and$300 for any subsequent offense. You are hereby notified to appear before the Board of Health on Tuesday,August 1,2006,at 3:00 pm to show-cause why your tobacco sales permit should not be suspended and to discuss any future plans you may have to comply with this regulation. The hearing will be held in the Town Hall, Selectmen's Conference Room,367 Main Street,Hyannis,Massachusetts. PER ORDER OF THE B ARD OF HEALTH 9 omas A. McKean,RS, CHO Director of Public Health gAtobacco\wp files\tobacco hearing letter.doc JUN-28-2006 14:39 BARNS COUNTY HEALTH 15083756880 P.13i13 Section 1: EsUblishment .��Q� � Survey Participants Name: 1VIid Cape 5e a Center of . Route 132&Route 6 ° ,�c�as�r Add' - 4 e:;rt 16 Q 1T W Barnstable, MA 02668- et: q Male O emaie Name o Adult Supervisor. City: L Time of Check 3 aniAm Q Type of Establislumervt: Chain Q Indepeadest ❑ Not Known Darn of Check JAI 06 Dav of the Wets: 0 Mon Arats❑Wed p'Ihnrs ❑Fri 13 Sat Q Sun Style ofEzablishmatt(Check Only One): ❑ Convenience Store ❑Grocery Store ❑Bar ❑ Depumnam Store ❑Liouor Store I Q Prh=Club(VFW.Legion_etc.) Q Gas Station Oniv ❑Pbarmacy/Drug Store I ❑Resmuuant ais iwniAlart 0 Other(bowline allev. oif club etc.) ❑Tobacconist Section 2: Was Compliance Check comipleted?Yes t,.No ❑ If Yes please confimre on to the near question, ifIvo please skip This secrion and 3o to section J. H w was tobacco marketed? -the-coun=Youth asks the clak for the produrm ❑ From a vending machine with a lockout device. 0 Other Describe: Was the Purchaser asked for ID? Yes 0 Nql!�— Was this an M-based check? Yes ❑ N004— Was the Parcimser asked hi&(her age? Yes Cl Nop�-- Set of Clerk Maleiemale❑ Apprommare age of clerk: ❑TeenP�yauflg Adult ❑ Adult C7 Older Adult Type of tobacco asked for. gazettes Brnnd of cigarettes asked for: ❑ Matibor�o/-4�r ❑Other. ❑ Chew/Dip ❑ Cigars Cl Other Brand: Was the sale made? Yes ❑ - If"Yes`'how much did the product cost S d t Pnmhaser made payment using; ❑31 bills ❑ SS biU(s) 0 SS bill and 51 bills/or ch2ngoi�-S10 bill(s) ❑ SZ0 bill ❑ change Section 3: If the youth did,not eater the premises or did not attempt to purchase tobacco prodacm please indicate why: I ❑ Our of Business I ❑ Te=. long term closure ❑ gopmutionxiosed at time of visit I ❑ Drive thru oniv ❑ Does not sell tobacco R Unlocatsble ❑ Unsafe to access I ❑ Tobacco out of stock I ! Q Inaccessible by Youth I ❑ Wholesale only/artous ❑ Presence of Wlice ❑ Permit Su coded ❑ Private cittb/petsonal ❑ Machine broken ❑ Yourh inspector knows salesperson ❑ Other raideace ❑ "Don't sell"but tobacco seen in �iz�ios . C.Z0CUME-VGSTL\L0CALS•1\TemoTY 06 MTCP comofranca cheek farm.dcc TOTAL P. 13 f ` Y '+ s e� �� -- r/ � S a t *Town of Barnstable Op THE Tp� Regulatory Services Thomas F. Geiler, Director x BARNSTABLE, 9wA . ,•� Public Health Division TED MA'S A Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 6, 2001 Saeed Chaudry; Manager Mid-Cape Mobil Oil Rt. 6 and Rt. 132 West Barnstable, MA 02668 Order To Appear At The Board Of Health Meeting on March 20, 2001, 7:00 pm On March 1, 2001, cigarettes were sold to a minor (a person under the age of 18 years) by Yagob Khan, who is employed at the Mid-Cape Mobil Oil located at Rt. 6 and Rt..132, West Barnstable, Massachusetts. Mr. Khan received a Warning Notice at the time of the violation. According to Chapter 270, Section 6 of the Massachusetts General Laws "whoever sells a cigarette, chewing tobacco, snuff,or any tobacco in any of its forms to any person under the age of eighteen (18) or, not being his parent or guardian, gives cigarettes, chewing tobacco, snuff, or tobacco in any of its forms to any person under the age of eighteen (18), shall be punished by a fine of not less than one hundred dollars ($100) for the first offense, not less than two hundred dollars ($200) for the second offense, and not less than three hundred dollars ($300) for any third or subsequent offense. Also, Board of Health Regulation Part IX, Section VII specifically states "Persons, firms, corporations, or agencies selling tobacco products to minors (or selling tobacco products without a Tobacco Sales Permit) shall be punished by a fine of not more than $300 per day for each day of such violation and/or suspension of the tobacco sales permit. This letter shall serve as a Warning Notice to you, as you are the manager of this establishment. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules, and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. You are directed to appear before the Board of Health at the Tuesday, March 20, 2001 meeting at 7:00pm. The meeting will be held at the Barnstable Town Hall, 367 Main Street, Hyannis, MA, in the 2nd floor Hearing Room. The reason for the meeting is to provide you an opportunity to present your action plan to prevent sales to minors in the future. PER ORDER OF T BOARD OF HEALTH as A. McKean, RS, CHO Agent of the Board of Health � TOWN OF BARNSTABLE 0 rdinance or Regulation WARNING,;7ICE Name of Offender/Manager C'rN Address of Offender MV/MB Reg.#TESc(' \t7r Village/State/zip 44 U-) f\ k C) Business Name AA 1- 6 "N cA'P:' 26, Business Addressi, Signature of Enforcing Officer Village/State/Zip Location of Offense G n Enforcing Dept/Di'vision Offense /v k C-d Facts Irt -I lk C S W("� V—) r, <�' C) I c-1 '1' This will serve only as a warning. At this time no legal action has b'-6en taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. , Subsequent violations will result in appropriate legal action by the Town. • n r` t pt.x l�` G. FINSHESS ENVIRONMENTAL �� too September 17, 2001 RECEIVED Barnstable Board of Health 367 Main Street OCT 1 �aa, Hyannis, MA 02601 TOWN OF BARNSTABLEi HEALTH DEPT. RE: Class A-1 Response Action Outcome Statement Roadway Spill Route 6 Mid-Cape Highway Entrance#6 Westbound Barnstable,Massachusetts RTN 4-16491 Dear Sir or Madam: Finsness Environmental has recently completed an environmental investigation on the referenced property in accordance with applicable regulations of the Massachusetts Contingency Plan(310 CMR 40.0000). Due to specific soil and groundwater conditions on the property, the response actions performed have met requirements of a Class A-1 Response Action Outcome (RAO), whereby no further action is required. A copy of the completed report can be reviewed and/or copied at the Massachusetts Department of Environmental Protection's (MADEP) Southeast Regional Office in Lakeville, Massachusetts. This letter was submitted to satisfy public notification requirements of the MADEP. Sincerely, =elL. NMENTAL Licensed Site Professional(MA#5156) cc: MADEP-Southeast Regional Office 140 Longhill Avenue o Tel.: (508)679-2002 Somerset,Massachusetts a Fax: (508)679-2205 02726 a E-Mail:finsnesspmeganet.net RECEIVE® �,. 0 C 1r z 12001 TOWN OF BARNSTABLE HEALTH DEPT. Li 2001EPT gLE STORAGE 21--9 1/8.. 1 20' COLD STORAGE 9-ELVNG 8 30- WIDE DOOR COOLER ® FREEZER CLOSEDOOR -- -------------- VALANCE I : to I � N � I AUTO 4 L ollCP� 10 b A REGISTER HIDE r I � Imycs a' X 12- WCE SHELF lM 1N1 6' M 19 h'OC SIELVNC 6'MACAZ1'C RACK -IwMLyrl TTVM1V1S .9 e I FWSH MGH BACK 37'-10 3/4.. PLAN SCALE: 3/I6*'=T-O" ��