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Home My WebLink AboutNORTHSIDE MARKET - CLOSED FOOD North side Market 990 Main (6A) St. #2 ' W. Barnstable tMf Town of Barnstable t" 039. Board of Health ♦� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 John Norman,Chaimnan FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 8, 2022 Mr. Joseph Govoni Northside Market 990 Main Street, Unit 2 West Barnstable, MA 02668 RE: Northside Market/ Use of Bottled Water for the Preparation of Coffee Dear Mr. Govoni, You are granted conditional approval to utilize bottled water for the purpose of preparing coffee for public consumption at Northside Market, Unit 2, 990 Main Street, West Barnstable, Massachusetts. This permission is granted with the following conditions: 1) The applicant shall comply with all of the requirements of the MA Food Protection Program - Policies, Procedures, and Guidelines No: FP-05, paragraphs 1 through 6. 2) The applicant shall keep and maintain records of all purchases of bottled water for a minimum of one year. These records shall be made readily available to a health inspector during onsite inspections and/or during other times immediately upon request. Sincerely yours, ohn Norman Chairman Q:WP/Bottled Water forCoffeePrepa ration 990MainStreetWestBarnstable May 2021.docx OF THE DATE: .. $95.00 FEE* ` * r RNSTA + BA LE,MASS. A Town of Barnstable 1639. C.BY: MASS. W v� ♦� Board of Health SCHED.DATE: 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee Daniel Luckowz,M.D.,Alternate VARIANCE REQUEST FORM LOCATION Property Address: 9 U r'l u�i n ( L, i e2 Assessor's Map and Parcel Number: 17g� 00 f-00 8 Size of Lot: 5-,2 . '� Wetlands Within 300 Ft. - 40 Business Name: A o ISAs l ` c Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON J B Name: Name: V0,P— (;-o V,-0 01 G:.oi?11 CC Address: Address: 7 1Q c) mxyl Jt y u , '+ 6 _ l cv-60 Phone: Phone: +,5 0 -R-a f- - O 1 y o-o EMAIL: inct 4 64f, � VARIANCE FROM REGULATION(Incl.Reg.Code u) REASON FOR VARIAN May attach separate sheet if more space nee t /..5 Fe--a5- MA Foqb `169 i ttWt L ..}- Gr21.1(�1J�.I1nPJ3 — NATURE OF WORK: House Addition House Renovation LJ Repair of Failed Septic System _ Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as 5 collated packets. A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters for Innovative/Alternative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health _town.bamstable.ma.us *(Pool Plan-5 hard copies) D. Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1) New construction, 2) Septic repairs with increase in flows, and 3) New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair without an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL F.P.(Thomas)Lee Q:\Application Forms\VARIREQ Rev 2020 1-1-2020.docx Ill (3c4 Crocker, Sharon From: Northside Market WB <info@northsidemarketwb.com> Sent: Friday, April 23, 2021 1:21 PM To: Crocker, Sharon Subject: Fwd: Keurig follow up re: Cleaning and Care Attachments: K35000perationsManual.PDF; ATT00001.htm; K3500CareGuide.pdf;ATT00002.htm Hi Sharon, I'm am also forwarding an email with the info of the keurig machine that we will be using. We will be selling coffee for use in a keurig machine. The coffee will be green mountain coffee. It will be delivered from Sysco foods. Please let me know if you need anything else. Also there will be no inside or outside area for people to drink there coffee. Thanks, Jordan McAdams Sent from my iPhone Begin forwarded message: From: Sharon Palm <Sharon.Palmgkeurig-foodservice.com> Date: April 16, 2021 at 9:40:11 AM EDT To: Northside Market WB <infonnorthsidemarketwb.com> Subject: FW: Keurig follow up re: Cleaning and Care Hi Jordan, I wanted to follow up our recent call on this and email below to see if you wish to order the Keurig coffee system? Thanks, SHARON PALM ACCOUNT SPECIALIST O: 610-365-1352 Sharon.Palmgkeurig-foodservice.com<mailto:Sharon.Palmgkeurig-foodservice.com> Keurig Dr Pepper [cid:imag_e001.RnggO I D71 CA5.CA22D 160] Visit us at www.KeurigDrPepper.com<http://www.keurigdlpepper.com/> https://commercial.keuri From: Sharon Palm Sent: Wednesday, April 7, 2021 12:53 PM To: info(a�northsidemarketwb.com Subject: Keurig follow up re: Cleaning and Care Jordan, It was nice speaking with you again this morning. Per our call, I have attached the K 3500 Operations Manual which shows brewer install and care instructions as well as the Cleaning and Care Guide. System dimensions below. i Here is the link to the Flo Jet device that would connect the system to a portable water tank: https://www,.publickitchensupply.com/p-7772-keurig-floj et-water-pump.aspx Below is a popular cleaning product for the commercial machines: [cid:imae002.png(?01 D7279B.6FOFA770] Thank you again! SHARON PALM ACCOUNT SPECIALIST O: 610-365-1352 Sharon.Palm(a�keuriiz-foodservice.com<mailto:Sharon.Palmna,keurig-foodservice.com> Keurig Dr Pepper [cid:ima eg 001.png@OI D71 CA5.CA22D 160] Visit us at www.KeurigDrPepper.com<http://www.keurigdrpepper.com/> http s://commercial.keurig.com/ CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 I� Crocker, Sharon 7 From: Crocker, Sharon r ( / Sent: Wednesday, April 21, 2021 10:32 AM To: 'info@northsidemarketwb.com' Subject: BOH - Northside Market, WB - Variance Well Water Attachments: VARIREQ Rev 2020 1-1-2020.docx; BOH Sample Variance Letter- Food Estab on well water.pdf Jordan McAdams 508-221-5570 Here you are. Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic transmission("e-mail"),including any attachment(the "Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. � 1 1 _ f�ofy�r`�v Town of Barnstable W MA61.E, tj "�s ' Board of Health �o►aal.s✓ 200 Main Street, Hyannis MA 02601 Office, 508.862 4644 Wayne Mill M.0. rAXi 508.790•634/ Sumner Ka.rman,MSPH Pvul CP.T6 i ,i),M,D May 30,2006 Mr.Junichi Sawayanagi Sushi Distributors,lnc. 1085 Main Street Nest Barnstable,MA _..._ __._.... __..__.... ._..__._._ _._h.... _men_____._................_.._. RE: Sushi Distributors,Incd Operation of a Food Establist Utilizing 3 3 Bottled Water 1 :__....._,..___ _.... __._........._.__ _..... __ __._._..._ __.._..._....__............ -____...___._-------- _..__......_1 Dear Mr. Sawayanagi, You are granted conditional approval to utilize bottled water for the purpose of preparing foods at Sushi Distributors,1085 Main Street Barnstable,Massachusetts. This permission is granted with the following conditions: I t) The applicant shall comply with all of the requirements of the MA Food Protection Program Polices,Procedures,and Guidelines No: FP-05,all paragraphs 1 through 6. I 2) The applicant shall keep and maintain records ofall purchases of bottled water for a minimum of one year. These records shall be made readily available to a health inspector during onsite inspections quid/or during other times immediately upon request. Sincerely, Wayne Miller, M.D. Chairman Q \17'± t?.ci±HuNea1\+,y;er:>ppr(r�rl 1 I rt Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARN,7TABLL Paul J.Canniff,D.M.D. MASS. F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1136 Issue Date: 01/01/2021 DBA: NORTHSIDE MARKET OWNER: NORTHSIDE MARKET LLC Location of Establishment: 990 ROUTE 6A- UNIT#2 WEST BARNSTABLE MA 02668 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES ^� ^� OL FOOD SERVICE ESTABLISHMENT: YEAR. L 1 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qn 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: For+Diflr�L�sc. Initials: own Of Barnstable AM S Inspectional Services Public Health Division �1 0/0- tl3 Thomas McKean,Director l�q Cad l,• 0 b�' 200),bdn Street,Hyannis,iNIA 02601 Office: 508-862-4644 ,Fax: 508-790-6304 APPLICATION FOR PERMITS/TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP Y RENEWAL_ NAME OF FOOD ESTABLISHMENT: (,4h )&P /noon <e7 {� vn 9, ADDRESS OF FOOD ESTABLISHMENT: 9go if M (a��y(� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( } . TOTAL NUMBER OF BATHROOMS: WELL WATER:YFS 1V0_ ...(ANNUAL WATER ANALYSIS REQUIRED) 1 ANNUAL: SEASONAL: DATES OF OPERATION:_/TI TO 1_t NUMBER OF SEATS:INSIDE: OUTSIDE: TOTAL: (� SEATING:MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,_MUST_BE APPROVED BY THE HEALTH DIV.AND.LICEtN�SING,AN E D-MEET OUTSIDE DG REOUIREMENTS:_ 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 , _ERETAIL FOOD-ONLY required for TCS foods(foods'requiring refrigeradonffreezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT"MACHINES...(MONTHLY LAB ANALYSIS REQUMED); CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ***SEASONAL,MOBILE& NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4643 Q:\XppbCA60n hormOOODAPP 2020.doc I, _ t. O'4t4'N Eft:�iFOi2:tMATION.- FULL N AIME OF APPLICAN'T SOLE OWNER: ' 1 NO D.O.B OW1•IER PHONE#'lam �� 9 6 AI)DRE 6 a AL CORPORATE 0WNTER: ��.s�_�PY) ,t �� — C.L,C CORPORATE ADDRESS:31 o A PERSON IN CHARGE OF DAILY OPERATIONS: �10 k e L:>O V O i . List(2)Certified Food Protection Managers AND atleast(I)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I`Certified Food Protection Manager.PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years'records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. I l /. � _ I NA RE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:Al!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 OrBamstable must notify theTowu by fax or mail prior to catering event. You must complete a catering notice found at httu:lhvYrrv&mvnotltarnstabte ttslhcaithdivisiottJanttiicstions asn, OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from.Ianuary I A to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist, Q;Mpplicution Forms DAPP REV3.2019.dac Bellaire, Dianna From: Jordan McAdams <jgmcadams@comcast.net> Sent: Monday, January 25, 2021 12:35 PM To: Bellaire, Dianna Subject: Northsidemarket Attachments: Town of Barnstable.pdf;ATT00001.txt Good afternoon Dianna, My name is Jordan McAdams we spoke awhile back about opening a market in West Barnstable. We are in the process of sending in for a building permit for change of use. I think you said it was ok to send in this paper work when we get close to opening which I hope is soon. Please let me know if you need anything else from us. Thanks,Jordan McAdams Cell number 1-508-221-5570 CAUTION:This email originated from outside of the Town of Barnstable. Do not click links, open attachments or reply, p unless you recognize the sender's email address and know the content is safe! 1 Bellaire, Dianna From: Soto, Kathryn Sent: Thursday, February 04, 20212:30 PM To: 'jgmcadams@comcast.net' Cc: Bellaire, Dianna Subject: FW: Northside market - 990 Route 6A-W. Barnstable- NEW ESTABLISHMENT Hello Jordan, I have not heard from you regarding the store you are hoping to open at 990 Rte 6A in West Barnstable. It is imperative you reach out to me. I need to have a list of the equipment you are planning to use, along with the specs, menu (Ex: breakfast sandwiches, etc...) and detailed floor plan. These must be approved before anything is started. Please contact me right away. Equipment is costly and we do not want you ordering anything that later you must remove and replace because it is not correct. Regards, Kathryn 508-862-4639 -----Original Message----- From: Bellaire, Dianna Sent: Monday,January 25, 2021 12:52 PM To:Jordan McAdams Cc: Bellaire, Dianna;Soto, Kathryn; McKenzie, Marybeth Subject: RE: Northside market-990 Route 6A-W. Barnstable- NEW ESTABLISHMENT Mr. McAdams, I am glad to hear you are working on your permits. You will need to make sure you have your business certificate set up. You will need to contact your Health Inspector regarding what is needed for your store. I've copied them on this email. I have your application and you are retail store. I will need a check made payable to the Town of Barnstable for$200.00. This is comprised of your new review fee and the annual fee of$100.00. Please contact Ms. Kathryn Soto for what is required from.Health Inspector. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and Bellaire, Dianna From: Soto, Kathryn Sent: Monday, February 08, 2021 11:59 AM To: Bellaire, Dianna Subject: FW: FW: Northside market - 990 Route 6A- W. Barnstable- NEW ESTABLISHMENT FYI -----Original Message----- From: 'jgmcadams@comcast.net' [mailto:iRmcadams@comcast.net] Sent: Monday, February 8, 2021 11:59 AM To:Soto, Kathryn Subject: Re: FW: Northside market-990 Route 6A-W. Barnstable- NEW ESTABLISHMENT Good Morning Kathryn, Just responding to your request about North Side Market. We will be selling Retail food items from wholesale companies. we will be more like a small grocery store. Nothing will be prepared on site. We will have no tables,or chairs for customer's to sit at. No grab, and go items, like sandwiches, or salads at this time. If we go that direction, I will reach out to you to see what we need to do so we are complying with the town. I am waiting for my general contractor to send me the store layout,When he does I will forward it to you.in the mean time if you need anything else from me please reach out. Thanks,Jordan McAdams Cell number 1-508-221-5570 > On 02/04/2021 2:29 PM Soto, Kathryn <kathryn.soto@town.barnstable..ma.us>wrote: > I > I > Hello Jordan, > I have not heard from you regarding the store you are hoping to open at 990 Rte 6A in West Barnstable. It is imperative you reach out to me. I need to have a list of the equipment you are planning to use, along with the specs, menu (Ex: breakfast sandwiches, etc...) and detailed floor plan. These must be approved before anything is started. Please contact me right away. Equipment is costly and we do not want you ordering anything that later you must remove and replace because it is not correct. > Regards, > Kathryn >508-862-4639 >-----Original Message----- > From: Bellaire, Dianna >Sent: Monday,January 25, 2021 12:52 PM >To:Jordan McAdams >Cc: Bellaire, Dianna; Soto, Kathryn; McKenzie, Marybeth >Subject: RE: Northside market-990 Route 6A-W. Barnstable- NEW ESTABLISHMENT > Mr. McAdams, i >,�I,am glad to hear you are working on your permits. You will need to make sure you have your business certificate set up.You will need to contact your Health Inspector regarding what is needed for your store. I've copied them on this email. I have your application and you are retail store. I will need a check made payable to the Town of Barnstable for $200.00. This is comprised of your new review fee and the annual fee of$100.00. Please contact Ms. Kathryn Soto for what is required from Health Inspector. >Thank you. > Dianna Bellaire > Permit Technician >Town of Barnstable > Health Division > 200 Main Street > Hyannis, MA 02601 > P:508-862-4643 > Fax:508-790-6304 > Email:Dianna.Bellaire@town.barnstable.ma.us >The information contained in this electronic transmission ("e-mail"), including any attachment (the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature. As such, it is for internal use only.The Vnformation may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. >-----Original Message----- > From:Jordan McAdams [mailto:igmcadams@comcast.net] >Sent: Monday,January 25, 2021 12:35 PM >To: Bellaire, Dianna >Subject: Northsidemarket >Good afternoon Dianna, > My name is Jordan McAdams we spoke awhile back about opening a market in West Barnstable. >We are in the process of sending in for a building permit for change of use. I think you said it was ok to send in this paper work when we get close to opening which I hope is soon. Please let me know if you need anything else from us. > Thanks,Jordan McAdams >Cell number 1-508-221-5570 >CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 `oF IME rgr,F TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ( .. Date �.� 2' Page:._of �P p� 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 MA36. 94 f639.a 0� HYANNIS, MA 02601 508-862 as44 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name G { Date Z Tvoe of Type of Inspection Operation(s) Routine Address �� RCA VA �'-} �� Risk rvice Re-inspection Level Reta' Previous Inspection Telephone esidential Kitchen 2 Mobile Pre-operatio V ✓ Vie ) Owner OCA' � ( HACCP Y/N Temporary spec Illness "� a ,�, Caterer General Complaint Person in Charge(PIC) C � ► Time Bed&Breakfast HACCP ( . I L In: Other Inspector ,I� �b0 v Out: A -29a� b 3 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) ❑ .(,Q�(�, j 2�`_ �- Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ _ 'j' �� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands d� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 3Lip 3 �� 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 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 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 27.Physical Facility aggrieved b this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y ty (FC-6)(590.007) Y Y 9 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 violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signaturd-\, Print: 31.Dumpster screened from public view I � Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 1 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si atu.e /'� f� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N / �/� �V 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* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) P tY7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130'F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* 590. Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) • Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.]IA(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg crEvr rnrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502,12 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. 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