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Home My WebLink AboutSEVEN G'S LIQUOR SHOP - RETAIL FOOD SEVEN G'S LIQUOR SHOP NORTHSIDE PLAZ�, e Town of Barnstable BOARD OF HEALTH GJohn T. Norman Board of Health Donald A.Gaudagnoli,M.D. BAMNSTAELL F.P.(Thomas)Lee,. Mnss 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. ,axe 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: 338 Issue Date: 01/01/2022 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location of Establishment: 990 ROUTE 6A 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: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - MOBILE-FOOD: MOBILE-ICE CREAM: ` QA FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use On' • Initials: . 6 Town of Barnstable ° Date Paid Amt_Pd$ „B1E Inspectional Services Public Health Division Check# 'Thomas McKean,Director 200 Main Street,.Hyannis,.MA 02601 Office: 508-862 4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE ,1 `�Z 1 ZaIA NEW OWNERSHIP RENEWAL ✓ i NAME OF FOOD ESTABLISHM J � �s ENT:. &- � L k uo'l ADDRESS OF FOOD ESTABLISIEMIENT: �1 cl 6 .sS*C (a MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS•--- �A�o--J c^ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Z - TOTAL NUMBER OF BATHROOMS. WELL WATER:YES ----NO' ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL "' DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: NIUST OBTAIN A COMMON VICTUALLEWS LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REOUIREIMIENTS. 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 lutehen) 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 PERNUT BEING ISSUED PLEASE CALL 50&862-4644 Q:\Application Fbnw\F00DAPP 2020.doc I � OWNER INFORMATION• (;0,4 C, FULL NAME OF APPLICANT SOLE OWNER: YES NO OWNER PHONE# 150 8 ' - 'I O 9 ADDRESS_ I R pvk-Q K`10c. ( �I.d e CORPORATE OWNER: G5 1.c c] rp CORPORATE ADDRESS: (qC'1 U 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 SHIN. **ATTACH COPIES OF CERTIFICATES**The Health Div. will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified.Food Managers Expiration Date Allergen Awareness Expiration Date 1. 2. ! / tc / rt / 2-024 SIGNATUKUF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/appHeations.asp. OUTDOOR COOIONG: Outdoor cooling,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3 I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIItED FEES BY DEC 1 st. . QMRhcahon FonnsTOODAPP REV3-2019.doc 4 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. •' BARNSTAUM Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 338 Issue Date: 01/01/2021 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location of Establishment: 990 ROUTE 6A 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: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: - s��tKKE rq� Town of Barnstable Office For Use Onlv: Initials: o '" Date Paid i, AIIlt_P(I$ .� RAR ,,CAB Inspectional Services MASS- 9�'i0tf1639.,p � Public Health Division Check# A_Ck�j) Cal-P __M 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 "10 2V NEW OWNERSHIP RENEWAL 5 i NAME OF FOOD ESTABLISHMENT: �&d OE") L\.9 ycs r ©eC ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �y, boyC 7 25's W P—Lk E-MAIL ADDRESS: �&.`Q0�1v TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( yL )3 Z- t-(,s z(,S S� TOTAL NUMBER OF BATHROOMS: WELL WATER: YES ✓NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: `� SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH 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 6WNER INFORMATION- \ FULL NAME OF APPLICANT (:;0 yG SOLE OWNER: YES NO OWNER PHONE # ;50 C� 'J��— G 5 ADDRESS_ ( —1 c�r�'Loj/j - Q ' 7� CORPORATE OWNER: 1 V� CORPORATE ADDRESS: 9 O ° " 6 Z� PERSON IN CHARGE OF DAILY OPERATIONS: C? List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date \iA-- 2. / io / 2a2-, SIGNATURE PPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.aso. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc �piME Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. Z DARNS AOM 3 F.P.(Thomas)Lee MAM 200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate 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: 338 Issue Date: 1/1/2021 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location of Establishment: 990 ROUTE 6A WEST BARNSTABLE, MA 02668 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY r For Office Use Only: Initials: c . J Town of Barnstable f .Date Paidt� � Amt Pd$ao... �} Inspectional Services nwxnerwats :► 1� �'� ae� MAN. 639 Public Health Division s'heck# Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT.:PERMIT.APPLICATION(Non Flavored) DATE!,` _`_a ?.ate NEW BUSINESS OWNERSHIP RENEWAL ci NAME OF TOBACCO ESTABLISHMENT: J � L ADDRESS OF TOBACCO ESTABLISHMENT: . Z 0 C2A (R1 �5...�1Ui�� S � _ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 'G- �J6X .r7 , i�l• -4.1,sS�/��Le O 2(9.� E-MAIL ADDRESS: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT:. 6� ) 3C L OWNER'S NAME: I `1 \ OWNER'S PH#j � �G��• OWNER'S ADDRESS: �\Pr �O Pn_l��asp. �I Prr�t o �c�-+�✓L l CORPORATE NAME: &�c,�� CORPORATE ADDRESS: 53 V �� e^�� CORPORATE FID# 2-2�3 6 0Q� i 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: https://www.ecode360.com/33996392 i MA GENERAL LAW CHAPTER 270/SECTION 6: https:Hmalef,,islature Gov/I,aws/Genera!Taws/PartIV/TitleYChapter270/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 is ! 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4� b. } SIGNATURE: . PRINTED NAME... G61,10 DATE: 11 / 10 / 2-0 2-0 a Q:1Application Forms\TOBACCO APP-NonFavor 12-18-19.docx ---------------------------------------------------------------------------------------------------------------------- 5SNU111SX. MASSACHUSETTS*� DEPARTMENT OF REVENUE Form CT-3T 0 Retailer License for Sale of Cigars and Smoking Tobacco This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. SEVEN GS DISCOUNT LIQUORS INC Account ID: CRL-10469428-009 SEVEN G'S LIQUOR SHOPPE Location ID: 10469428-0007 990 MAIN STREET BLDG 1 License Number: 603695104 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:November 9,2020 Expiration Date:September 30,2022 yyaGlflq�T MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 P A p °, 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 prohibited. SEVEN GS DISCOUNT LIQUORS INC Account ID: CGL-10469428-006 SEVEN G'S LIQUORS Location ID: 10469428-0006 990 MAIN STREET BLDG 1 License Number: 594466816 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: November 9,2020 Expiration Date: September 30,2022 ❑ VOID ❑ CORRECTED PAYER'S name,street address,city or town,state or province,country,ZIP 1 Rents OMB No.1545-0115 ! or foreign postal code,and telephone no. NIiSCeII8ne0US Seven G's Discount Liquors Inc. �oi 9 Income PO Box 2008 2 Royalties $ Form 1099-MISC Dennis, MA 02638 4 Federal income tax withheld Copy C 3 Other income (508) 385-9550 $ $ For Payer PAYER'S TIN RECIPIENT'S TIN 5 Fishing boat proceeds 6 Medical and health care payments 04-2830600 XX-XXX7315 7 Nonemployee compensation 8 Substitute vdendsr payments in lieu of RECIPIENT'S name For Privacy Act Complete Payroll Solutions LLC and Paperwork Street address(including apt.no.) $ 1513.87 $ Reduction Act Drive 9 Payer made direct sales of 10 Crop insu 1 Carando Dr rance proceeds Notice,19 General55,000 or more of consumer products to a buyer Instructions for ((recipient)for resale ► El Certain City or town,state or province,country,and ZIP or foreign postal code a l, f n a' Information h ,;r y =., , Returns. SriSaSection ringfield, MA 01104 t�E� - 8' ': number(see Instructions) FATCA filing 2nd TIN 13 Excessgolden parachute 14 an attorneyGrossproceeds paid to requirement not payments 15b Section 409AAiincoma ❑ 16 State tax withheld 17 State/Payer's state no. 18 State income 409A deferrals $ Department of the Treasury-Internal Revenue Service Form 1099-MISC Jz i zr Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. ➢A1iN$TABLZ John T.Norman 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: 338 Issue Date: 12/20/18 DBA: SEVEN G'S LIQUOR OWNER: PAUL GOVONI Location, of Establishment: 990 ROUTE 6A 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: 2019 RETAIL FOOD: $20.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: ------- ---- - - - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r oFIKE r Initials: o� Town of Barnstable Date Paid Amt Pd$ MAS& Inspectional Services1639. 1 _ ° Public Health Division Check# Thomas McKean, Director 2 I S� 00 Main Street,Hyannis,MA 02601 1 Office: 508-862-4644 Fag: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: S� ADDRESS OF FOOD ESTABLISHMENT: 996 12�((0 0� �Sk DAro-j MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 6 �O'�` �� to OH?tisrP i6 0 24(Qb E-MAIL ADDRESS: !:P4 A�Q co TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ) 3(o2-. TOTAL NUMBER OF BATHROOMS: WELL WATER:YES - NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH 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 DETAIL 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: FULL NAME OF APPLICANT � y ` GOV 6 e1 l SOLE OWNER: YES O OWNER PHONE # :569 ADDRESS &�r�G�� p�n�►-w� uLj 4� � '2��j CORPORATE OWNER: Cj 5 FEDERAL ID NO. : O� 283G(Q-% CORPORATE ADDRESS: Rgt G fZ' 65� PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. I tZ / to ► 2 SIGNATURE O PLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!� Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc lid Town of Barnstable • - Regulatory Services Department BAMSTABM s63q. Public Health Division 9� `�� 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 2. LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL s c BEN G L\ v r D/B/A STREET ADDRESS TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes 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 ' ovi a _on the ext page). Each employee who sells tobacco products must s' n the Em o, - ig ture Form (provided herein). Sig ature Date Q:\Application Forms\TOBACCO APP2018 dob.docx I qfytic ljy As Poll ISO SIAN cut PTA ova Ing A114 t K r % qq �;, �• Bob � g g gGg +� y` gp{ y{ �Fp� p� :�� ! ��1n. L, p� g xrt '� �� Yq♦♦ } g,Y Ef k T � Y 4 �� :c�k'.�. x�. d �� yip IKE Tp� 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 es. `0l HYANNIS, MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY �a ' 508-862-4644 rF°'"Pya FOOD ESTABLISHMENT INSPECTION REPORT Name I S Date.� / Z Tyne of -Type ofInspection 1 Ooeration(s) in Address 7?� P , Xc&vp Risk Food Service Re-i spection C� Level _lT-_ta_ttD Previous Inspection �<f`� Telephone sI ential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness P ry P I I✓1 �Y.sti'�xt Caterer General Complaint Person in Charge(PIC) HACCP Time Bed&Breakfast Other In: Inspector � Out: hv� clL d / - or=,- 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 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. I❑ Embargo g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8 non- cal iolations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatu --- Print: 31.Du m ter 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 Signal-re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* (590.004 11) q 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003 Removal of Exclusions and Restrictions g ( ) �) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) EquipClean Utensils and Food Contact Surfaces of Eggs-Immediate.Service 14$°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * Effective mizooi. 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* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 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 Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 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. LDoFiME TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: -�1 ! ate: ' age: of ti OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified MON9 2639. �0� HYANNIS, MA 02601 508$08-8 -FRI.62-4644 No Reference R-.Red Item, PLEASE PRINT CLEARLY M �iOrFD FOOD ESTABLISHMENT INSP CT ON REPORT Name Dat Tvoe of Ins ection t ODeration(sl Routi Address ' Risk rvice e-Re n � Level Ze al Previous Telephone sl ential Kitchen Date: d` Mobile Pre-oper ti - Owner HACCP Y/N Temporary Suspect IIness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In Other Inspector ut: ,�- - Each violation checked re uires an explanation on the nar ati page(s)and a citation of specific provision(s)violated. r Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSC LYA❑ ' 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 Violatio 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,re 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. B=One critical violation and less than 4non-critical violations g 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to Snon-critical violatio -C. 30.Other In pector's Inr PATE OF RE-INSPECTION: b O? ri�It: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N iif f #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ign ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45`F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 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 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 * 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 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 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. I16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 ConsuAnimal er Food That Pasted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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 A 3401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Cleanon on Cditi -Hands and Arms* Regulatory Authority 3401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-201.11 Package Integrity y Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3�03.11 E 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 * 1 3 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F[0 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 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 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p IM6► TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: �� v J L`�' � Date: I 190 11 Page: !, of q OFFICE HOURS PUBLIC HEALTH DIVISION 6:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A ME7q;s et HYANNIS, MA 02601 M-8 -46FRI 4 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MP'� 506-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT 0 Name �S [�� Date 7/y5/(y Type of TXIRe of Inspection .. L Operation(s) utin r +� Address a� rI 6 A A� �, - Risk Fo ervice spection _ ` <,/a ',O,0(3 C Level tail Previous Inspection 1 f `U Telephone esidential Kitchen Date: _ Q Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness d Q S Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Un �tll n Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY , ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 19 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 6=One critical violation and less than 4nori-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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Ph sical Facilit (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y y 28.Poisonous or Toxic Materials (FC=7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. = 29.Special Requirements (590.009) within 10 days Of receipt of this order. violation,4 to B non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: n / . 31.Dumpster screened from public viewj� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N �� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatul� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM'CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color.Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require t�eporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130'F 1 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as 9 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-13) 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* 4-501.112 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 aid 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* Eggs Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E(f d-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 Substitbte 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* i 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* 3-40I.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* pow, Sources* 10 Proper,Adequate Handwashing ing,mobile food:,[em 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 17. Raw Animal Foods Cooked in a Microwave the appropria[e,sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness'interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 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 foodbore 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3 203.1�2 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 4590 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-r 3-40211 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 O 9 9 27.`roved Physicalfactkty'.. =6 .007 7 Conformance with A 6-301.11 Handwashing Cleanser,Availability - PP Procedures/ 28. ' Poisorfdd� rToXigMatenals FG-7 � .008 HACCP Plans 6-301.12 Hand Drying Provision 29. SpeciaFRegUireeriejits 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. `gyp THE r, TOWN OF BARNSTABLE, HEALTH INSPECTOR'S Establishment Name: Date: _ Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPE TION REPORT Name Date p I6� tDe of T section eration(s) outine -- Address - Risk o Service - � n Level Previous Inspectionov Telephone s, enti it Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP PEI In: Other Inspector ' Out: Each violation checked requires an explanation on the narrative pages)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 ❑ Kl 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 tA 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 VX� ❑ 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) l/ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating U 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 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot i 26.Water,.Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If ' 27.Physical Facility (FC 6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to a non-critical iolat violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumper screened from public view '�w - - AA Permit Posted? `/ Y N Grease Trap Previous Pumping Date Grease Rendered Y N i \ PIC's Si ure #Seats Observed Frozen Dessert Machines: Outside Letter Y N 9 r ; ^ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Ga / x� 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 3-202.12 Additives 2-103.11 Person-in-Charge Duties - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below"41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'P* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P20 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) 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 ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY. 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Pathogens* Ef°'i'11112001 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 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#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3--003.11(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 * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11 E 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* r 18 Proper Cooling of PHFs hollowing 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. 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. Op INC r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of '``QQ'``j��((( OFFICE HOURS : BAR�'15r�1B�.E. PUB2 0 0 MAN STREETLIC HEALTH 3::30-- :30A.M. 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA8 MON.-FRL HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY �A .a39•a e 508-862-4644 rFD MP'� FOOD ESTABLISHMENT INSPECTION REPORT Name .,�-l Date P T 1 s io /�outin �i :V Address Risk %emspection n Level Previous Inspection ` /Telephone Kitchen Date: O V Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness /07 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast H CCP Inspector /V L• l A�Zr✓ - Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 719.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 within 90 days as determined by the Board of Health. Overall Rating12 ❑ 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 no 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 C=2 critical violations and less than 9 non-critical. If If 1 critical refrigeration. critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations. If within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special equirements (590.009) y p 30.0t a DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dum ter 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 Sig tune Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ,__ _ _ ..._ _ _ •/ - ;i.` t/'1.►-,✓V:.�'r'l.r`�c`Y" �ti/' .."" -v�,rrr:,rrr� r"r r ��.,.•u >r.r. r ,_ .. ...�. � _ .. _ _ - t Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous o7 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 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 Requirements 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,PH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F sec* * Animal Foods That are Raw,Undercooked of Equipment 5-101.11 Drinking Water from an Approved System* * - - Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff cmc rnnoor 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 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 l90.0 in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A) �) Violations of Section 5 09(A)-(D) 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* 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 Anirnals* 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 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11 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. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE BAR-w 3427 �. Ordinance or Regulation I WARNING NOTICE C¢ Name of Offender/Manager u { Address of Offender ��-y _�' � MV/MB Reg.# Village/State/Zip Business Name Ise-Ven 41S��, q's p on ;JAc. T7 20 { Business Address I) �it, C,A #a. j `r Signatu=e.of Enforcing Officer Village/State/Zip IAI0SO- AeTCA& ,o6k. Location of Offense (qqn o . t- r,.A f r Enforcing Dept%Division Offense s - R '" /.'. ` # ' -7714.0A Pr� Facts ``' 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. e 1 Town of Barnstable Regulatory Services „ Thomas F. Geiler,Director BAMSTABM Public Health Division QED MA'S A Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 18, 2006 Paul Govoni Seven G's Liquor Shop 990 Route 6A 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 T BOARD OF HEALTH om s A. McKean,RS, C Director of Public Health gAtobacco\wp files\tobacco hearing letter.doc I JUN-28-2006 14:39 BARNS COUNTY HEALTH 15083756880 P.12i13 S"o>sl: 6 s� /tom a Establishmeat__ .--_-.. .- ---- .-------- Survey Participants Seven G's Liquor Shop Name: 99o.Route 6A . W. Barnstable, MA 01668 M Of Purchaser_ Addrms: . . Age. X15 Ct 6 ❑ 17 Sex: ❑Male Female N of Adult upervmr. City. Zip Code: r Time of Check- pm❑ Type ofEsmblisllment: ❑ Cbain ❑ Independent ❑ Not Known Date of Check: (0 7!U �p Dav of the Week: Q Mon XTues Q Wed ❑Thtas ❑Fri ❑ Sat Sun Style ofBsmblishmem (Check Only One): Q Convenience Store 0 Groc =v Store ❑Bar ❑ Deoatrlmm Store ❑Lic=r Store ❑Private Club(VFW,Ledon. etc.) ❑ Cms station Only ❑PhannacyA)m Store ❑Resrmul=t ❑ Gas Mini-)&n ❑Other(bowline allev,golf club etc.) ❑Tobacconist I Section?: Was Compliance Check completed?Yes)(No Q j fYes please connnue onto the nest question. if Yo please slap rhis section and go to section 3. How was tobacco marketed? ❑ Ovet-thacotrnter.,youth asks the clerk for the product. ❑ From a vending machine with a lod=device ❑ Other Describe: Was the Purrlraaer asked for 1D? Yes ❑ No Was this an ID-based check? Yes ❑ No r Was the Purchaser asked his/her age? Yes❑ No Sex of Cleft: Male)R(Female C. Approximate age of cie:IL ❑Tern ❑Young Adult Adult ❑Older Adult Type of tobacco asked for: ❑ Cigarettes Brand of cigarettes asked for. ❑ Marlboro <-Nlewpon Q Other. +' Chew/Dip ❑ Cigars ❑ Other �T Brand: Was the sale made? Yes No ❑If"Yes'how much did the product cost_ S Purchaser made pavmeut using: ❑Sl bills $5 bill(s) ❑ $5 bill and S1 bills/or change ❑ S10 bill(s) Q SZO bill ❑ change Section I. ff the youth did not ewer the premises or did not attempt to purchase tobacco products please indicate why: 0 Out of Business 14 T . long term closure ❑ In operationclosed at time of visit ❑ Drive thru only I ❑ Does not sell tobacco I C3 Unlommble ❑ Unsafe to access Q Tobacco out of stock ❑ Inacc=-ble by vputh EZ Wholesaie onivic utons ❑ Presence of nonce ❑ Permit S usm-nded I l ❑ Private dnb/petsonal ❑ Machine broken ❑ Youth inspector lmows salespe_son ❑ Other rtside= ❑ "Don't sell"but tobacco seen in 5/2&05 C_DOCUME-1ISSTLILOCALS-11Temo1FY 06 MTCP mmpilwm check form.doc . z T NAME OF OFFENDER - s,? Pw frs L;_►, s -� �r ; BAR 65590 TOWN OF ADDRESS OF OFFENDER �( I BARNSTABLE CITY,STATE,ZIP CODE �THE r _ MV/MB REGISTRATION NUMBER.', OFFENSE 'LASS. CL 639 �0 �--• OLIJ efEp MPS s, !�A CGGif ,fr f'.Jt...,r�"✓ I > TIME AND DATE OF VIOLA(A.M./ .M .OfV�/-�' 20 D ION LOCATION 1 VIOLATION � � w NOTICE OF t 9 Ae. SIGNATURE OF N P 6 N ENFORCING DEPT. BADGE NO. w VIOLATION _ _w.__._ ; ,�.. U) , C) OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X \. '� a ORDINANCE El Unable to obtain signature of offender. + ►— THE NONCRIMINAL FINE FOR THIS OFFENSE IS Date mailed' J OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. ILL! REGULATION (f)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. a (2)If you desire to contest this matter in a noncriminal proceeding,you may do so,by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET, BARNSTABLE, MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature Town of Barnstable 114E Tp Regulatory Services • Thomas F.Geiler,Director "* BARNSTABLE, •MASM Public Health Division s 39 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM SECTION I: Establishment Survey Participants Name: Seven G's Liquor Shop Name of purchaser: Age:_i2_ ❑ Male Female Address:_ 990 Rte. 6A /p West Barnstable, MA 02668 Name of Adult Escort/Data Collector: W(M� City: Time of Check: 10 :f I ❑ AM k—PM Type of Establishment: X Chain ❑ Independent ❑ Not Known Date of Check: 4 3 D 2— Style of Establishment(Check Only One): ❑ Convenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store !( Liquor Store ❑ Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) ❑ Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop,etc.) SECTION II: Did the youth enter the premises and attempt to purchase a tobacco product? Yes ❑ No If yes, continue on to the next question, if no,please skip this section and go to Section III. How was tobacco marketed? Over-the-counter:youth asks the clerk for the product. ❑ Over-the-counter:youth selects the product from a self-service display. ❑ From a vending machine with a lockout device. ❑ From a vending machine without a lockout device. Was the purchaser asked for ID? ❑ Yes XNo Was ID accurately checked? ❑ Yes ❑ No N/A Was the purchaser asked his/her age? ❑ Yes KNo Sex of Clerk: Y"ale ❑ Female Approximate age of clerk:__ Did the Clerk say anything to you when the purchase attempt was made? Type of tobacco asked for: Cigarettes ❑ Chew/Dip ❑ Cigars Brand 1 qq � �� ❑ Other Was the sale made? )Yeses ❑ No (if yes,how much did the product cost: $ �� SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products, check here: ❑ and indicate why below: ❑ closed for the day ❑ couldn't locate business ❑ buyer knows clerk/merchant ❑ admission charge ❑ closed for the season ❑ no longer in business ❑ establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment ❑ unsafe area 0 denied admission at door 0 vending machine broken COMPLIANCE CHECK AFFIDAVIT L 2tnA C W YCF( am 1-7 years old. My birthdate is (�,u Q-q q , and I reside at San( ; On ( 10 Q��2 002 ,I participated in a tobacco sales compliance check. Prior to the compliance check,I was instructed by the adult monitor to empty my pockets. I did not carry a backpack'or any other bag. The only thing I carried with me was cash given to me by the adult monitor for the compliance check. The adult monitor also instructed me that I should not dress to look neither older nor dress to look younger; I dressed no different than I would dress to attend school on any typical day. Lastly, the adult monitor also instructed me to tell the truth during the compliance checks. If I was asked my age, I was to tell the truth; if asked if I was carrying identification, I was to say no. I entered 30 yP o'1 G 'j UG Y- Jul Cs p at e_ pm th $_ in cash in my pocket. I attempted to purchase I asked for identification. I gave to the clerk and received$ Z'"J ' in change. I immediately returned to the adult monitor waiting outside, informed him that the sale had been made, and gave him the tobacco I had purchased and the change from the sale. Youth Signature: f Town of Barnstable Regulatory Services t Thomas F.Geiler,Director '"M ' ;I MAS& r Public Health Division s679• ArF p MA't°i Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 pffice: 508-8624644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM ETION I: ;ablishment Survey Participants I. Seven G's Liquor Shop Name of purchaser: idress:_ 990 Rte. 6A Age:- 1'7— ❑ Male WFemale West Barnstable,MA 02668 Name of Adult Escort/Data Collector: Time of Check: 10 - 1 ❑ AM kPM ype of Establishment: '( Chain ❑ Independent ❑ Not Known Date of Check: 13LO2 rle of Establishment(Check Only One): I Convenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart I Gas Station Only ❑ Grocery Store )K Liquor Store I Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) I Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop,etc.) ECTION II: ,d the youth enter the premises and attempt to purchase a tobacco product? Yes 0 No yes, continue on to the next question, if no,please skip this section and go to Section III. ow was tobacco marketed? ,.,Over-the-counter:youth asks the clerk for the product. Over-the-counter:youth selects the product from a self-service display. i From a vending machine with a lockout device. I From a vending machine without a lockout device. Vas the purchaser asked for ID? 0 Yes No Was ID accurately checked? 0 Yes ❑ No XN/A Vas the purchaser asked his/her age? 0 Yes No Iex of Clerk Male ❑ Female Approximate age of clerk:___ )id the Clerk say_anything to you when the purchase attempt was made? type of tobacco asked for: kCigarettes Q Chew/Dip ❑ Cigars Brand NW M-k ❑ Other Was the sale made? Yes 0 No (if yes,how much did the product cost: $ SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products,check here: ❑ and indicate why below: 0 closed for the day 0 couldn't locate business 0 buyer knows clerk/merchant 0 admission charge ❑ closed for the season ❑ no longer in business 0 establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment 0 unsafe area 0 denied admission at door 0 vending machine broken r NAME OF OFFENDER-Sew ,S ` BAR 65590 TOWN OF ADDRESS OF OFFENDER D • BARNSTABLE CITY,STATE,ZIP CODE S � 7 OFFENSE LL NAN\�TABI.L^, t^ 1639. �O I '►eo Nu+• � CL � c 0.000 LL TIME AND DATE OF VIOLATION LOCATION LOCATIONI VIOLATION LL f NOTICE OF A.M.i .M ON —!3 ,20 a Z p .' Ai, VIOLATION SIGNAT EOF 0 EN CINGDEPT„ BADGE NO. LL u. c OF TOWN I I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X a ❑ Unable i Signature of offender.etoobtansg ORDINANCET N a-� ONCRIMINAL FINE FOR THIS OFFENSE IS S lOD —^' Date mailed � u 4 OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL q I` DISPOSITION WITH NO RESULTING CRIMINAL RECORD. LL 'REGULATION (1)You may elect to pa the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LL before:The Bamstable Clerk,23D South Street,Hyannis,MA 02 01,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, n Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 921 If you desire to contest.this matter in a noncriminal proceeding,yyou may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT.COMPOUND,MAIN STREET,BARN ABLE,MA 02630,Attn:21D Noncriminal Hearings and.endose a copy of this (` citation for a hearing. It (3)It you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing I' to be due criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature r COMPLIANCE CHECK.AFFIDAVIT - ` Q am 1� years old. My birthdate is u 'ZOO I q and I reside at ,. t 1 Y_l_Q . 1��2-�CSZ ,I participated in a tobacco sales compliance check. Prior to the compliance check,I was instructed by the adult monitor to empty my pockets. I did not carry a backpack-or any.other bag. The only thing I carried with me was cash given to me by the adult monitor for the compliance check. The adult monitor . also instructed me that I should not dress to look neither older nor dress to look younger; I dressed no different than I would dress to attend school on any typical day. Lastly,the adult monitor also instructed me to tell the truth during the compliance checks. If I was asked my age,I was to tell the.truth;if asked if I was carrying identification, I was to say no. I entered 3e AI'Pn �s (�1�t, r at (- _anfTTyth $-j'D in cash in my pocket. I attempted to purchase Q p I _asked for identification. I gave$ �CQ 'to the clerk and received$6-1-2-13 in change. I immediately returned to the adult monitorwaiting outside, informed him that the sale had been made, and gave him the tobacco I had purchased and the'change from the sale. Youth Signature: Town of Barnstable Regulatory Services Thomas F.Geiler,Director BARNSTABIZ •MAM Public Health Divisi on 039. ♦0 Thomas McKean,Director 367Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-190-6304 TOBACCO COMPLIANCE CHECK FORM Establishm Survey Participants Name: _ Seven G's Liquor Shop Name of Purchaser: or ID# Address: Age: — Sex ❑Mal Female 990 Rte. 6A Did a second person go into.the establishment? Yes ❑-No" West Baimstable,MA 02668 If Yes,what was the second person's: city: Age: Sex: 0 Male ❑Female -j Time of Check: (p %D am 0 pm1Q<1 Date of Check: " Name of Adult Driver/Escort: Type of Establishment Check Only One ❑ Convenience Stoie 0 Pharmacy/Drug Pharmacy/Drug Store 0 Gas Mini-Mart ❑ Gas Station Oily ❑ Grocery Store Li uor.Store ❑ Department Store ❑ Bar ❑ Private Club ,Legion etc. 0 Restaurant(Bar Area) 0 Restaurant Other Area . C1. Other(bowling alley, golf club, etc.): Is this establishment within'/2 mile of a school? Yes 0 No ❑ Don't Know Is this establishment between'/z mile and 1 mile of a school? Yes ❑ No❑ Don't Know Is this establishment between'/Z mile of a youth center(Boy's/Girl's Club)? Yes 0 No ❑ Don't Know Is this establishment between'/2 mile and 1 mile of a youth center(Boy's/Girl's Club)? _ Yes ❑ No 0 Don't Know. Is this establishment within'/z mile of an outdoor recreational site(park,ball field,etc.)? Yes 0 No 0. Don't Know Is this establishment between'/z mile and 1 mile of an outdoor rec.site(park,ball field)? Yes ❑ No ❑ Don't Know l' Tobacco Purchase Attempt: Was the purchase of tobacco attempted: Yes 0 ❑ If No,please explain why not: Was the sale made? Yes No ❑ Brand Purchased: 40-mil � �. Pricer $ X Type of Tobacco purchased attempted. Cigarettes Chew/Dip 0 How was tobacco sold? Clerk was required to select tobacco Purchaser requested..�❑ chaser was able to place tobacco on tke counter. Was.the Purchaser asked for ID? Yes ❑No Was the Purchaser asked his/h age? Yes 0 No. .Was there any tobacco advertising(logos,posters or o er promotional displays?) Yes 0 No� Were any loose(s' gl )cigarettes for sale? Yes 0 NoDon't Know❑ Sex of Clerk: Ma1Female❑ Approximate Age of Clerk: 23 21 Did the Clerk say anyt ' g to you when the urchase atte t r�yyas made? 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'.tn> u �r .�" ?�xax '•�.£ +'G,.,��'�T'�;G'^^s=:t.�4 �nc' 4wg .1 1.,� .�. :�'-`tvi,_t n �t s~I{' � } 7.'fiS .'9. ram 'x .:r3rt .� ev t• yNi' , - �r" �' a:' �-• ,.z. .�,'' d� •o-*�` «-�^r•u4k e� �„ f. k! n f COMPLIANCE CHECK AFFIDAVIT .am. l�p ears old M birthdate T Y Y is , and I reside at C Ile On CON. 4 '?6 artici ated in a tobacco sales compliance P p P check. Prior to the compliance check,I was instructed by the adult monitor to empty my pockets. I did not carry a backpack or any other bag. The only thing I carried with me was cash given to me by the adult monitor for the compliance check. The adult monitor also instructed me that I should not dress to look neither older nor dress to look younger; I dressed no different than I would dress to attend school on any typical day. Lastly, the adult monitor also instructed me to tell the'truth during the compliance checks. If I was asked my age,I was to tell the truth; if asked if I was carrying identification, I was to say no. I enteredSe Ve n C at �:D S am/&m with cash in my pocket. I attempted to purchase I 4 asked for identification. I gave $ to the clerk and received$ .5 in change. I immediately returned to the adult monitor waiting outside, informed him that the sale had been made, and gave him the tobacco I had purchased and the change from the sale. _� Youth Signature: '11ir �oFIMETa1- Tobacco Sales Permit Inspection Report Form Regulatory Services BARNSTABLE, N"S& i639• Public Health Division �0 ATFO��A 367 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Business Name Date Business Telephone Location'- Q Time: In Out _T)o 05 Person in Charge � � ^ Purpose: / Routine Follow-up Inspector's Name '-1t i Complaint VV(M Initial �yy st i rr REGUIr TZON XN GOMPLI�ANCE�� y � Remarks or �� Yes` Nod Recommen a'Rione Signs Posted [MGL 270/61 Permit Posted [VIIa] Tobacco Permit Employee Signed Forms Kept On File [VIIb] Self-service Displays. On Counter and Within 5 Ft. of a Clerk [VIId] No Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] VVV Inspector: Person Interviewed: QAHEALTHUOBACCOWP Files\Tobacco FormffobSalesPermit.doc r OK For 2001 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name Date u i Business Telephone Location Time: In Out , e Person in Charge /_ Purpose Complaint Initial I2EGUFATION caMPLIANCE Re�►tarks or. Yes N0 R common at ?J0 ' A d S, ►a S a Signs Posted [MGL 270/61 �J Permit Posted [VIIa] e-:A—R. License O��tc►� Employee Signed Forms I� I 0y1 ef Kept On File [VIIb] -4Aat w '►'� (Jc. TD v►h AA,-cleok v1A �n i.•tp Air/ Self-service Displays / On Counter and Within J 5 Ft. of a Clerk [VIId] No. Floor Displays [VIId] No Tobacco Products Free of Charge VI1c Inspector: Person Interviewe q:health:tobinsp Town of Barnstable regulatory Services Thomas F.Geiler,Director MASS. Public Health Division ATfo A Thomas McKean,Direcfor 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM Establishm Survey Participants Name of Purchaser: Ma�y or ID# 6ae Seven G's Liquor Shop 990 Rte. 6A Age: Ua Sex: ❑Male )Uemale Did a second person go into the.establishment? Yes ❑ No �- West Barnstable, MA 02668If Yes,what was the second persons: Age: Sex: ❑ Male ❑Female eck: :/.0 am❑ pmjX_ Date of Check: /2—7_1—C)r Name of Adult Driver/Escort: W Q~4 Type of Establishment Check Only One ❑ Convenience Store ❑ Pharmacy/Drug Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store Liquor.Store ❑ Department Store ❑ Bar ❑ Private Club VFW,Legion etc. ❑ Restaurant Bar Area ❑ Restaurant Other Area ❑ Other(bowling alley, golf club,etc. Is this establishment within'/z mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between'/z mile and 1 mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between%z mile of a youth center(Boy's/Girl's Club)? ,Yes ❑ No ❑ Don't Know X Is this establishment between'/2 mile and 1 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't KnowA Is this establishment within'/z mile of an outdoor recreational site(park,ball field, etc.)? Yes ❑ No ❑ Don't•Know A Is this establishment between''/z mile and l mile of an outdoor rec. site(park,ball field)? Yes ❑ No ❑ Don't Know . Tobacco Purchase Attempt: Was the purchase of tobacco attempted: Yes KNo ❑ If No„.please explain why not: Was the sale made? Yes ❑ NOV Brand Purchased: Price: $ Type of Tobacco purchased attempted. Cigarettes Chew/Dip Cl How was tobacco sold? V-Clerk was required to select tobacco Purchaser requested. ❑ Purchaser was able to place tobacco on the co=4,rz ' Was the Purchaser asked for ID? Yes�,:No ❑ Was the.Purchaser asked his/her age? Yes ❑Nok^ Was there any tobacco advertising(logos,posters or other promotional displays?) Yes ❑ No Were any loose(sin le) cigarettes for sale? Yes_❑ .NoVDon't Know❑ Sex of Clerk: M-aleemale❑ Approximate Age of Clerk: 2_67 Did the Clerk say anything to you when the purchase attempt was made? Other Comments:. How was the merchant informed of the results of the.compliance check? ❑ By an adult supervisor immediately after youth hasihave left the premises. ❑ Notified after all compliance checks were complete. Merchan was not notified 0 Other—please specify Town of Barnstable FZHE Regulatory Services O•� Thomas F.Geiler,Director 9' MASS. 'r Public Health Division 1639.arE p t9't 1% Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM SECTION I: Establishment. Survey Participants Name: Seven G's Liquor Shop Name of purchaser: #V5 Age:I_ ❑ Male , Female Address: 990 Rte. 6A �_/,, West Barnstable, NIA 02668 Name of Adult Escort/Data Collector: W� City: Time of Check: Z 'q'S ❑ AM WPM Type of Establishment: X Chain ❑ Independent ❑ Not Known Date of Check: Style of Establishment(Check Only One): ❑ Convenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store )( Liquor Store ❑ Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) ❑ Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop,etc.) SECTION II: Did the youth enter the premises and attempt to purchase a tobacco product? XYes ❑ No If yes, continue on to the next question, if no,please skip this section and go to Section III. A0Vwas tobacco marketed? Over-the-counter:youth asks the clerk for the product. ❑ Over-the-counter:youth selects the product from a self-service display. ❑ From a vending machine with a lockout device. ❑ From a vending machine without a lockout device. Was the purchaser asked for ID? Yes ❑ o Was ID accurately checked? ❑ Yes ❑ No XNIA Was the purchaser asked his/her age? IYes A o Sex of Clerk: ❑ Male Female Approximate age of clerk: Did the Clerk say anything to you when the purchase attempt was made? k Type of tobacco asked for:kCigarettes ❑ Chew/Dip ❑ Cigars Brand ❑ Other Was the sale made? ❑ Yes XNO (if yes,how much did the product cost: $ ) SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products,check here: ❑ and indicate why below: ❑ closed for the day ❑ couldn't locate business ❑ buyer knows clerk/merchant ❑ admission charge ❑ closed for the season ❑ no longer in business ❑ establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment 0 unsafe area 0 denied admission at door 0 vending machine broken OK For 2001 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name IL fe // ✓e ki vk- . �J rrlvo Date Date O C) Business Telephone Location Time: In Out 0 6 v14J�u �I ts-� Person in Charge / Purpose c/ No Reeommendati.ons Signs Posted [MGL 270/61 Permit Posted [VIial D.O.R. License �00 -'0 �. o(i�l O-o Z �✓u�t,-�-�1-- Employee Signed Forms Kept On File [VIIb] / Self-service Displays On Counter and Within �Y 5 Ft. of a Clerk [VIId] No Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] Inspector: II Person Interviewed: 05�\ �. GO Up,/\L q:health:tobinsp oFt► Town of Barnstable Regulatory Services ' BABMSrABM 9 MASS. Thomas F. Geiler,Director 1659. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 3, 2002 Mr. Paul Govoni Seven G's Liquor Shoppe 990 Rte..6A West Barnstable,MA 02668 NOTICE OF SHOW CAUSE HEARING On June 13, 2002 cigarettes.were sold to a minor(a person under the age of 18 years).by an employee of Seven G's.Liquor Shoppe, West Barnstable, Massachuetts. This was the second violation, and resulted in a$100 fine. According to Board of Health Regulation Part IX, Section 1.00, "Following the second offense the.Board of Health may,.after a public hearing,.suspend any license for that public place.for a j period of up to two days for each day of non-compliance or withhold renewal of license. Following a third offense,.the Board of Health may suspend an existing permit/license for a period of time determined by the Board of Health until compliance is achieved." You are hereby notified to appear before the Board of Health on Tuesday,.August 13, 2002 at 7:00 p.m..to show-cause why your tobacco sales.permit should not be suspended and to.discuss. any future plans you may have to comply with the efforts.of the compliance checks. During the hearing,you may present witnesses, documentary evidence,.or any other information relevant to the events which occurred on that date. The hearing will be held in the Basement Conference Room at the.Barnstable School Administration Building, 230 South Street,Hyannis,Massachusetts. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, RS, CHO Director.of Public Health TOWN OF BA.RNSTABLE BAR-WMI'Do' 3832 Ordinance or Regulation WARNING NOTICE rr�Name of Offender/Manager /rVa QQ /Address of Offender � � K W MV/MB Reg.# Village/State/Zip • � ' mh + (A Business Name &vim s`9 avy am/9m on )012 3 20 01 Business Address 910 4 FA jwi i � P (? ( *� Sif'gnatiire of Enforcing Officer Village/State/Zip . ! 'A'''�� 1,;t1 t . . M 6 {3 ' ,r� j Location ofOffense o � . Gk U M. � tt�U1 u 1 111, C. 144 ! �� Enforcing Dept/Division i ` � y Off e n s e [��Y' (Ty1 _ j Facts S,0j11ijW -1�76ACeO +V IL-0-Y Vzgz- fed (�l�i This will serve only as a warning. At thisftime 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. TOWN OF BARNSTABLE W�1 BAR' 2 3832 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager . /Z Address of Offender 41 MV/MB Reg.# Village/State/Zip 0 L on Business Name & Ve't'% (_T jr amPm,, 12 2001 Business Address Sfgn' atute of Enforcing Officer Village/State/Zip- 07 17 ik or.Location of Offense tj Enforcing Dept/Division / Offense Pa,,4 :nx- j Facts 011;tw V(, o /V VIOZA i9tt'r- 0 At I Z Q..'VINNA This wilt serve only as a warning. At this time no legal action has been taken. 9 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. -L Town of Barnstable °&twe'O�R Regulatory Services * Thomas F.Geiler,Director * BARNSPABLE. • . . . . ,0$ Public Health Division 1639. Alfo �a Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM Establishm c ` "_—� Survey Participants Name: ' Seven G's Liquor Shop I Name of Purchaser: or ID# Address: Age: /67 Sex: ❑ Male Female 990 Rte. 6A Did a second person go into the establishment? Yes ❑-No M West Barnstable, A 02668 If Yes,what was the second person's: City: _ Age: Sex: 0 Male ❑ Female Time of Check: m 6 %D am.0 �p _ 1 Date of Check: D Name of Adult Driver/Escort: Type of Establishment Check Only One ❑ Convenience Store 0 Pharmacy/Drug Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store Liquor.Store 0 Department Store ❑ Bar ❑ Private Club VFW,Legion etc.) 0 Restaurant Bar Area ❑ Restaurant Other Area ❑ Other(bowling alley, golf club,etc.): Is this establishment within''/2..mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between'/2 mile and 1 mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between'/2 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No 0 Don't Know Is this establishment between%mile and 1 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't Know Is this establishment within%mile of an outdoor recreational site(park,ball field,etc.)? Yes ❑ No 0. Don't Know Is this establishment between'/z mile and 1 mile of an outdoor rec. site(park,ball field)? Yes ❑ No ❑ Don't Know Tobacco Purchase Attempt: Was the purchase of tobacco attempted: Yes No ❑ If No,please explain why not: Was the sale made? Yes No 0 Brand Purchased: Q+-y WYn (mil _ Price: $ X Type of Tobacco purchased attempted. Cigarettes Chew/Dip 0 How was tobacco sold? Clerk was required to select tobacco Purchaser requested. 0 Purchaser was able to place tobacco on t e counter. Was the Purchaser asked for ID? Yes ❑ No Was the Purchaser asked his/h r age? Yes ❑No Was there any tobacco advertising(logos,posters or o er promotional displays?) Yes 0 No Were any loose(singly cigarettes for sale? Yes ❑ NoDon't Know❑ Sex of Clerk: MalekFemale ❑ Approximate Age of Clerk: Z3- 2,q Did the Clerk say an ' g to you when theyurchase attem t as made? Other Comments: How was.the merchant informed of the results of the compliance check? 0 By an adult supervisor immediately after youth has/have left the premises. ❑ Notified after all compliance checks were complete. 0 Merchan.was not notified ❑ Other-please specify o . HEALTH INSPECTOR'S [a -�Q j �1HE ! TOWN OF BARNSTABLE OFFICE HOURS: 3 . 43 i V10-7, 5040,jpate: *'-'2 Page: of PUBLIC HEALTH DIVISION Establishment Name 4�aiYL r 9n 5:00-9:30A.M. `� T 1:00-2:00 P.M. 367 MAIN STREET MON.-FRI. HYANNIS,MA 02601 862 4644F _p @ rrttliCO( Eti € ok �". - V8 a �. fift x .,s17ef8lel ...< ltt3r «, PtEASHIM�CY ,w� FOOD ESTABLISHMENT INSPECTION REPORT Name ny." .Gs 6,P Date3� Type of Operation(s) T of Ins ection �� ' c ❑ Food Service WRoutine Address Risk Level rr �L Retail ❑ Re-inspection Telephone `❑ Residential Kitchen Previous Inspection ' ❑ Mobile Date: Owner ,4;e HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time/,9/0 ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative s)and a citation of specific provision(s)violated. Non-compliance with: - 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)❑ �� J' � � �� Action as determined by the Board of Health. it17 FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands � ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities f W-,�•�1 r' / l,-v EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ci,� 2 3 J ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14. Approved Food or Color Additives o'Ar ' 0, ❑ 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 El 5.Receiving/Condition ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating G�-' ` ✓ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling * PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑ 20. Time As a Public Health Control ❑ 9.Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10.Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11.Good Hygienic Practices CONSUMER ADVISORY Violations Related to Good Retail Practices(Blue Items) ❑ 22• Posting of Consumer Advisories Critical(C)violations marked must be corrected immediately. Number of Violated Provisions Related Non-critical(N)violations must be corrected immediately or To Foodborne Illnesses Interventions within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22)• CF€ H Official Order for Correction: Based on an inspection today, ;?�J- L r.-� / - g 23. Management and Personnel (FC-2)(590.003) the items checked indicate violations of 105 CMR 590.000/federal 24. Food and Food Protection (FC-3)(590.004) Food Code.This report,when signed below by a Board of Health 25. Equipment and Utensils (FC-4)(590.005) member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in sus , l� y ..��..... ��. ��::.. fix.... ::::.\ :::sa \.:,26. Water,Plumbingand Waste (FGS)(590.006) ,3.„ \ pension r r V n establishment permit and ces .. ::�• .. .\��t ens o o e ocatio of the food !1�� 1 \ ... a P P a 1 \ \ 27. Physical Facility (FC-6)(590.007) sation of food establishment operations. If aggrieved by this or- 28. Poisonous or Toxic Materials (FC-7)(590.008) der,you have a right to a hearing. Your request must be in writ- ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion Re-inspection Scheduled ❑ Emergency Suspension 29. Special Requirements (590.009) ing and submitted to the Board of Health at the above address 30. Other within 10 days of receipt of this order. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: DATE OF RE-INSPECTION: Ins or's Signature ;>^ Prin• 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 1/ N 1 .� _�..:..:,�.....Fyi„�..ytl.�ra,-.r.�.T.�'.�..�r:�3-:-s"=-'�s�'.,�.'`� +-+ain. vF• y.,._�nr.:�.:�c.:-fi+-rt� rs;.-�• --w ...-...4 �-� - - - V10fa6ons Related to Foodbome Illness 3-501.14(C) PHFs Received at Temperatures. Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contaminadon PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 I 590.003 A Assi ent of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003 13 19 Demonstration of Knowledge* Cooked and RTE Foods- 14 Food or Color Additives PHF Hot and Cold Holding 2-103.11 Person in charge-duties Contaminalion from Raw Ingredients 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Una . 3-302.11(Ax2) Raw Animal Foods Separated from Each Unapproved Additives* 590.004(F) 41°/45°F« k EMPLOYEE HEALTH Other` F 15 Poisonous or Toxic Substances 3-501.16(A)' Hot PHFs Maintained at or above 3 590.003(C) Responsibility of the person in charge to Contaminadon from the Environment 7-101.1 1 Identifying Information-Original 140°F.* require reporting by food employees and 3-302.1 I(A)- Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.1 1 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* 7-202.1 1 Restriction-Presence and Use* 590.004(H) - Variance Requirement Charge* Contamination hom 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 3 590.003 D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.1 1 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 I(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 Fes' 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(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 A 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501-111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Samtizatton Temperatures* CONSUMER ADVISORY 4-501.114 Chemical Sanitization-temp.,pH 22 3-603.1 1 Consumer Adviso Posted for Consumption of '3-202.14 E tT P 3-202.76 Ice Made From Potable Drinking Water* Proper Cooking Temperatures concentration and hardness.* Pe g for Animal Foods That are Raw,Undercooked or 16 5-101.1] Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate 590. A Bottled Drinking Water* 3-401.1IA I 2 Utensils Clean* Eggs- 155°F 15 Sec. Pathogens.*E"*-111awl OO gg_ 4 602.11 Cleaning Frequency of Equipment Food- * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590.0 Water Meets Standards in 310 CMR 22.0 Contact Surfaces and Utensils` Eggs-Immediate Service 145°F15sec Shetifish and Fish From an Approved Source 3-401.11(A)(2) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-201:14- Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment*ent* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 4-703.11. Methods of Sanitization-Hot Water and 3-401.1 1(B)(1)(2) Pork and Beef Roast-130°F 121 min* catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. Sources* 10 proper,Adequate Handwashi g + residential kitchen operations should be - Game and Wild Mushrooms Approved byappropriate debited under the a ro riate sections R ula Auth 2-301-11 Clean Condition-Hands and Arms, 3-401.1 l(A.)(3) Wild Game,Stuffed PHFs, Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure* , interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash* Poultry or Ratites 165°F 15 sec. 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 3-201.17 Game Animals* , 145°F« practices should be debited under#29- 5 ReceivlrglConditlon - 2-401.11 Eating,' or Using Tobacco 3-202.11 PHFs Received at Pr Temperatures* 2.401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Mouth* Microwave 165°F* 3-202.15 Package In « 3-401.1 1 A 1 b « VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated` 3-301.12 PreventingContamination When T ( )( )O All Other PHFs-145°F I5 sec. Blue Items 23-30 6' TagslRecords•Shellstock 12 Prevention of Contamination from Hands 17 Reheating for Hot Holding ) 590.004(E) Preventing Contamination fiom 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not relate to the 3-202.18 Shellstock Identification* , foodborne illness interventions and risk factors listed above,can be Em to ees 3-403.11(B) Microwave-165'F 2 Minute Standin found in the following sections of the Food Code and 105 CMR 3-203.12 Tags/ ock Identification Maintained` 13 Hand�sh Facilities , g Tags/Records:Fish Products Time 590.000. Conveniently Located and Accessible 3-403.11(C) Commercially Processed RTE Food- 3�02.11 Parasite Destruction` Item Good Retail Practices FC 390.000 3402.12 Records,Creation and Retention 5-203.11 Numbers and cities* 140°F• 23. Management and Personnel FC-2 .003 590. J Labeling of Ingredients' 5-204.11 Location an 3-403.11(E) Remaining d Placement* Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 8 .. Conformance with Approved Procedures 5-205.11 Accembihty Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 IHACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 Spe6ahzed Processing Methods* Devices 3-501.14 A 27. Physical Facility FC-6 .007 ( ) Cooling Cooked PHFs from 140°F to 6-301.11 Handwas ' Cleanser,Availability28: Poisonous or Toxic Materials It-7 .008 3-502.12 Reduced oxygen ,criteria* 70°F Within 2 Hours and From 70°F 29. Special Requirements 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Provision to 41°F/45°F Within 4 Hours.* P eq .009 30. Other 3-501.14(B) Cooling PHFs Made From Ambient s svor• xbz.*� Temperature Ingredients to 41°F/45°F Within 4 Hours* *Denotes eritiml 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. orIKE rp HEALTH INSPECTOR'S 9. TOWN OF BARNSTABLE OFFICE HOURS: Item No. In the space below describe all violations checked. Page of MWWMAS. ; BOARD OF HEALTH 8:00 9:30 A.M. 367 MAIN STREET MON.-FRI. HYANNIS, MA 02601 790-6265 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name _ S L c,- Date (Z - Clio- O_ 0o` t ( �@ Time,• Address G.l��Gta-.��3 ��6 In0®ut Telephone Type of Establishment Purpose otawo-e.tL Food Service Routin Owner's Name e Retail Food Follow-up Residential Kitchen Complaint Person In Charge Mobile Unit Investigation _ Temporary Food Service Other Inspector's Name y'6- . �v S, Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column'N'and critical violations are marked under column"C'.Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply .002 4 29. Water Source .015 4 2. Food Containers .002 1 30. Sewerage .016 4 Food Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 ` 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 Equipment&Utensils _ 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized 013 i` 2 Other 17. Food Contact Surfaces .013 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean 013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 `" 1 49. Linen .027 1 21. Wiping Cloths .013 1 50. Pets .027 1 Disc ssion w' h Management r ,r_ 22. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 ZY++'W - C �3�w�-. u),4"6✓ -_S4A1'W 23 Pre-Scraped, Soaked .013 1 52. Salad Bars .032 1 P 24. Wash/Rince Water .013 1 S - 25. Thermometerslrest Kits .013 1 No.of 13 Critical Items Violated 26. Equipment/Utensil Storage .014 1 These items require immediate attention. 27. Single Service Articles .014 1 28. Single Service Re-Use .012 1 SCORE Permit Posted? ✓ Y N' Grease Trap Previous Pumping Date Grease Rendered?� Y N _ #Seats Observed? - Frozen Desert Machines:_ V Outside Dining Y N Self Service Wait Service Provided _� Variance Granted Y �/ N Variance Letter Posted Y N Inspected by Received by 13 CRITICAL FOOD HAADLIHG VIOLATI0NS Full Item Descriptions $v 1. Food from an unapproved or unknown source or food which is or may be Food• adulterated, contaminatedC1 Food source, approved, wholesome or otherwise unfit for human consumption ► is found in a food establishment. 2 Containers. properly labelled ' food Protection _ 2. Potentially hazardous food that is held longer than necessary for c3 Potentially hazardous roods proper temparaturess tao°F or .bore, 450F or below, 0°F; rapid cooling of cooked foods within hin a hours preparation or service at a temperature which is greeter than 450 F Ce Facilities to maintain product temperature t' (=70 C) (in the case of cold food) or less than 1400 F (600C) (in CS Unwrapped and potentially hazardous foods not re-served of h. F .:\ 6 Damaged, spoiled, returned foods segregated .. —/• T Food protected during storage, preparation, display, dispensing, service, transportation g Therma.eters provided, conspicuous. accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled i product temperature. 11 Food handling minimized 12 Dispensing utensils stored s, 4. Potentially hazardous food or unwrapped food that has been served to Personnel customers is re—served unless such re—service is allowed under C13 Employees with Infections restricted C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manual methods) '` transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, Installed, maintained, located 1g Non-food contact surfaces: design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dlsh/Werpwashing facilities: designed, constructed, maintained. Installed, located, hygiene which may result in the potential transmission of illness operated aked through food is employed in a food establishment. 23 Pre-flushed, scraped, , temp 24 Wash/Rinse voter clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing � sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure ?� 8. Sewage or liquid waste is not dispobed of in an approved and C30 Sewage and waste water dienosal C31 No cross-connections, back siphonage, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets g Handwashing: number, accessible, design. installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented 3e Plumbing; Installed, maintained areas frequented b customers or employees. sin doors fixtures q yToilet rooms enclosed, self-closing , u es good repair, clean, signs 35 36 Handwashing areas supplied with soap end towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 3T Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency. 8 p r P P y clean installed or designed, accessible or convenient. 38 outside area: dumpster covered. construction, clean g 39 Outer openings protected 9 I 40 Pesticides and rodenticides. proper application j 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, calling, attached equipment; constructed, maintained. clean 43 Lighting provided as required, fixtures shielded as Roams and equipment vented as required 11. A defect exists in the system supplying potable water that may a5 Dressing. locker areas provided used, clean result in the contamination of the water. Other , 12. Insects, rodents or other animals are present on the premises C46 Tories properly stored, labelled, ,sed aT Premises litter-free. unnecesserl articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel ag Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed x 52 Salad bar operations prepared. refrigerated, displayed, protected Note: In sddition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. OK For IaP Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name D to z zon Business Telephone Location Time: In Out 1 r�o ,-¢-- �,+, Person in Charge Purpose Routine Follow-up Complaint Initial REGULATION C.OMPLIpiNCE Remarks or Yes No 'i Recommendations`:.. Signs Posted (MGL 270/61 V Permit Posted [:VIIa] D.O.R. License Employee Signed Forms Fv, Kept On File (VIIb] Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] No Floor Displays [VIId] No Tobacco Products Y� Free of Charge (VIIc] Inspector: E 1J Person Interviewed: < q:health:tobinsp OtIKE7, TOWN OF BARNSTABLE HEALTH INSPECTOR'S OFFICE HOURS: Item No. In the space below describe all violations checked. Page of BOARD OF HEALTH 8:00-9:30 A.M. ,ems 367 MAIN STREET MON.-FRI. 'F0 A"0�• HYANNIS, MA 02601 ' 790-6265 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name 5iLVA4i1 c 5 L y ,/G✓ .S Date /3F � / Time: Address (? Z/✓Bi$ 1,Ccs►� J d+��o In11 Out ;s Telephone �( �, q.rg5- Type of Establishment PUrpo'se Food Service Routine >_ Owner's Name vw,(• Retail Food Follow-up Residential Kitchen Complaint Person in Charge Mobile Unit Investigation Temporary Food Service Other Inspectors Name l� t'd~ � �, Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column"N"and critical violations are marked under column"C".Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply .002 4 29. Water Source .015 4 2. Food Containers .002 1 30. Sewerage .016 ` 4 Food Protection 31. Cross Connections .017 :1 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities, Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 Equipment&Utensils 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized .013 2 Other 17. Food Contact Surfaces .013 .y 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 21. Wiping Cloths .013 1 50. Pets .027 1 Discussion with Management 22. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 L/ 4u 0 -} 4e,_. ZS_ o✓ 23 Pre-Scraped, Soaked .013 1 52. Salad Bars .032 1 24. Wash/Rince Water .013 1 25. Thermometersfrest Kits .013 1 No.of 13 Critical Items Violated 26. Equipment/Utensil Storage .014 1 These items require immediate attention. 27. Single Service Articles .014 1 28. Single Service R - se .012 1 SCORE Permit Posted. Y N Grease Trap Previous Pumping Date Grease Rendered? Y N AA #Seats Observed? /yn Frozen Desert Machines: Outside Dining Y N ✓ Self Service Wait Service Provided Variance Granted Y N Variance Letter Posted Y N Inspected by 'Received by 13 CRITICAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food• i adulterated, contaminated or otherwise unfit for human consumption cI Food Source, approved, wholesome is found in a food establishment. 2 Containers. properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 45OF or below, OOF; 7 rapld cooling of cooked foods within 4 hours 1 preparation or service at a temperature which is greater than 450 F c4 Facillties to maintain product temperature (-70 C) (in the case of cold food) or less than 14O0 F (600C) (in CS Unwrapped and potentially hazardous foods not re-served the Ca Se of hnt f_-.i) 6 Damaged, spoiled, returned foods segregated _ ../ . 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous. accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked. and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored food or unwrapped food that has been served to Personnel Potentially hazardous 4. Po ypp e13 r unless Employees with infections restricted customers is re-served e v d unl s such re-service is allowed under r section 105 CMR 590.0O6(G). c1 Hands washed and clean; good hygienic practices 15 Clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be 06 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, Installed, maintained, located 1g Non-food contact surfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, Installed, located, hygiene which may result in the potential transmission of illness operated . soaked through food is employed in a food establishment. 24 Mash/Rinsedwateraped clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of e equipment/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 2e No re-use of single service articles storage or service. Smeltery Fae111ties. C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 Sewage .nd waste water dir5osal C31 No cross-connections, back siphonage, backflow sanitary manner, or the sewage or liquid waste contaminates or may c32 Toilets 8 Handwashing: number, accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms encaoaed, self-cloning doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, installed or designed, accessible or convenient. 38 outside area: dumpster covered. construction. clean 39 Outer openings protected 40 Pesticides and rodentieides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, calling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and equipment vented as required Y p Y 45 Dressing. locker areas provided used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises C46 Toxics properly stored, labelled, ased ( Y 5 590.027( )(3)) 47 Premises litter-free, unnecessarl articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR F Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, disp:nsed 52 Salad bar operations prepared, refrigerated, displayed, protected q Note: In addition to the items listed above, any other violation of the , Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after+ written notice to the permit holder constitute a critical violation. Q OWN OF BARNSTABLE OFFICE HOURS: - 8:15 - 9:30 A.M. Item No. In the space below describe all violations checked page of OARD OF HEALTH 367 MAIN STREET HYANNIS, MASS. 02601 790-6265 EXT.265: L. FOOD 181tABLISHMENT INSPECTION REPO PT Establishment Name Date - Time: n u Addressr Telephone Type of Establishment: purpose: 0( Food Service Owners Name Retail Food Routine Residential Kitchen Follow-up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation \ Inspectors Nam Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C. Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. CK4 Food N C W-1"Sanitary Facilities N C WT. t. Food Supply 002 i 29. Water Source .015 4 2. Food Containers .002 30. Sewage .016 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .0188 .019 4 3. PHF Temperatures .004 33_ Insects/Rodents 021 2 4. Facilities. Hot 8 Cold Storage .004 2 34. Plumbing .017 1 5 PHF Re-service .006 35, Toilet Rooms 018 2 6. Spoiled/Damaged Foods 003 36. Handwashing Areas .019 2 7 Food Protected .003 37. Garbage/Refuse .020 2 8. Food Thermometers .004 38, Outside Disposal .020 1 9. Cross Contamination .005 39. Outer Openings .02 t 2 10 PHF's thawed,cooked 8 cooled 005 ? 40. Pesticide/Rodenticide Application 021 1 11, Food Handling 005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls, Ceiling 022 2 13. Employee Infections .008 4 43. Lighting .023 1 14. Employee Hygiene .009 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms .025 1 Eg6lpment 8 Utensils Other 16, Equipment/Utensil Clean 8 Sanitized .013 2 46, Toxics 026 4 17. Food Contact Surfaces .013 1 47, Premises .027 1 18 Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19 Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 20 Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths 013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 1 23. Pre-Scraped, Soaked .013 1 24 Wash/Rinse Water .013 1 No. of 13 Critical Items Violated _ 25 Thermometers/Test Kits 013 1 These items require immediate attention. 26 Equipment/Utensil Storage .014 1 t 27 Single Service Articles .014 1 28 Single Service Re-Use .012 1 Grease Trap: In Ground: In Line: Capacity: a&� SCORE Inspected b ed by < Seating: Frozen Dessert Machines: Pumped: 13 CRITICAL FOOD HANDLING VIOLATIONS Full item Descriptions g 1. Food from an unapproved or unknotm source or food which is or may be Food adulterated, contaminated or otherwise unfit for human consumption c1 Food Source, approved, wholesome is found in a food establiahment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 14OOF or above. 45OF or below., ooF; rapid tooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F C4 Facilities to maintain product temperature (`=7o C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served �••�� ..oco of hnt. fn�a� 6 Damaged, spoiled, returned roods segregated - —/ • 7 Food protected during storage, preparation, display, dispensing, service, transportation g Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Perron■el customers is re—served unless such re—service is allowed under C14 lEmDlor was with Infections restricted section 105 CMR 590.006(C). 1 5 C1 Hands washed and clean; good hygienic practices Cean clothes, halt restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food IT Food contact aurfeces: design, constructed. Installed, maintained, located 1g Non-food contact surfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Werewashing facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling or clean equipment/utensils 21 Single service erticles, storage, dispensing sanitized effectively and may contaminate food during preparation, 29 No re-use or single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot3cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 Sewage and waste water dicxsal C31 No cross-connections, back sipnonage, backrlow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets A Handwashingt number, accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented 34 Plumbing; Installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, aelr-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate comber. Insect/rodent resistant, frequency, clean installed or designed, accessible or convenient. 38 a,cside area: dumpster covered, construction, clean 39 outer openings protected e 40 Pesticides and rodenticidea. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed. maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 geo■a and locker equipmear areas as required Y P y 45 Dressing, locker areas provided used, clean result in the contamination of the water. , Other 1 C46 Tories properly stored, labelled, aced 12. Insects, rodents or other animals are present on the premises 47 Premises litter-free, unnecessarl articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 45 Living/sleeping quarters and laundry separate 49 Linen properly stored i 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 5f Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any• other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: `r• °FtNErgr 8:15 - 9:30 A.M. Item No. In the space below describe all violations checked Page of BOARD OF HEALTH 12:45 2:00 P.M. 367 MAIN STREET 'EDA"0y� HYANNIS, MASS. 02601 790-6265 EXT.265: t FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Date Time: in Out Address a Telephone Type of Establishment: Purpose: Food Service .M Owners Name Retail Food Routine.. Residential Kitchen Follow-up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name "� At Caterer Other Ju Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. s r. VVT Food N��C11 Sanitary Facilities N C WT. 1. Food Supply 002 1. 29. Water Source .015 4 `. 2.. Food Containers .0021 30. Sewage .016 4 31. Cross-Connections .017 4 ., Food Protection 4 32. Toilets/Handwashing .018& .019 4 3. PHF Temperatures .004 33. Insects/Rodents .021. 2 +y{ 4. Facilities, Hot&Cold Storage .004 2 34 Plumbing .017 1 5. PHF Re-se vice .006 4 35. Toilet Rooms .018 2 ., 6. Spoiled/Damaged Foods .003 1 36- Handwashing Areas .019 2 t t 7 Food Protected .003 4 37. Garbage/Refuse .020 2 1 8. Food Thermometers .004 2 38, Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings .021 2 10. PHFs thawed,cooked& cooled .005 2 40. Pest icide/Rodent icide Application .02, 1 11. Food.Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls, Ceiling .022 2 ' 13. Employee Infections 008 4 43. Lighting 023 1 .� 14. Employee Hygiene .009 4 44, Ventilation 024 2 15. Employee Clothing .010 1 45. Dressing Rooms 025 1 Equipment& Utensils Other r 16. Equipment/Utensil Clean& Sanitized .013 2 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 t 18. Non-Food Contact Surfaces .013 1 48, Living Areas .027 1 19. Food Contact Surfaces Clean 013 2 49. Linen .027 1 Discussion with Management t 20. Non-Food Contact Surfaces Clean .013 50. Pets 027 1 { 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 1 , / ✓ 23. Pre-Scraped, Soaked .013 1 _ �I 24 Wash/Rinse Water 013 1 No. of 13 Critical Items Violated 25 Thermometers/Test Kits 013 1 These items require immediate attention. 26. Equipment/Utensil Storage 014 1 r ` 27 Single Service Articles - .014 1 t 28. Single Service Re-Use 012�� 1 , Grease Trap: In Qround:` in Line: Capacity: SCORE Inspected by ` Received by -- `� Seating: Frozen Dessert Machines: Pumped: :� _ _- 13 CRITICAL FOOD RANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food• adulterated, contaminated or otherwise unfit for human consumption CI Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous roods at proper temperatures: 140OF or above. 450E or below, ocF; rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F C4 Facilities to maintain product temperature (=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous roods not re-served thC CeSe of hnt f_—A l 6 Damaged, spoiled, returned foods segregated ��• 7 Food protected during storage, preparation, display, dispensing, service, transportation e Thermometers provided, conspicuous, accurate 9 No cross-contemlnation ' 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. /1 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with Infections restricted customers is re-served unless such re-service is allowed under c14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manual methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed. Installed, maintained, located lg Non-food contact surfaces, design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing r■cilitiesi designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-/Rushed, n soaked 24 Wash/Rinse watete tedr clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean equipment/utensils 21 Single service article+, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 sewage and waste water dienosal C31 No cross-connections, back siphonage, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 'Toilets & Handwashing: number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented by customers or employees. 34 ToiletPlumbi r; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handweshing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garb and refuse: containers covered, ..equate number, insect/rodent resistant, rregw.acJ, installed or designed, accessible or convenient. 38 Outside area: aumpscer covered, construction. clean 39 Outer openings protected 40 Pesticides and rodenticidea, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Pbysical Faeilltl'a 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded stem supplyingotable water that may 44 Rooms and equipment rented as required 11. A defect exists in the system P Y 45 Dressing. locker areas prodded used, clean result in the contamination of the water. other 12. /Insects, rodents or other animals are present on the premises c47 tcxics properly stored, labelled, ,sea Y 5 590.02 7( )(3))• 47 Premises ltter-free, unnecessarl articles, cleaning maintenance equipment properly stored, unless allowed b Section 10 CMR F Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, disp,nsed 5f Salad bar operations prepared, refrigerated, displayed, protected Note: . In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: .0t �p 7ME row 8:15 - 9:30 AA, Item No. In the space below describe all violations checked Page"-1 of BOARD OF HEALTH 12:45 2:00 PM. 367 MAIN STREET iOyP 4� HYANNIS, MASS. 02601 790-6265 EXT.265; FOOD ESTABLISHMENT INSPECTION REPORT ` lr q Establishment Name Date��.J3,/y �iMR du Time: In Out Address Telephone Type of Establishment: Purpose: Food Service Owner's Name Retail Food Routine Residential Kitchen Follow-up Person In Charge Mobile Unit Complaint Temporary Food Service Investigation Other inspectors Name Caterer a t Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation :Z checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and `y official notice to correct said violations. N C WT. N C WT. Food Sanitary Facilities ! 1. Food Supply .002�1 1 29. Water Source 015 4 2. Food Containers .002 30. Sewage 016 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8 .019 4 3 3. PHF Temperatures .004 33. Insects/Rodents .021 2 r 4. Facilities, Hot 8 Cold Storage 004 4 34 Plumbing .017 1 } 5. PHF Re-service .006 35. Toilet Rooms .018 2 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas 019 2 4 7 Food Protected 003 37. Garbage/Refuse .020 2 8. Food Thermometers .004 2 38. Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings .021 2 10. PHFs thawed, cooked 8 cooled .005 2 40. Pesticide/Rodent icide Application 021 1 i 11. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42 Walls, Ceiling .022 2 13. Employee Infections .008 4 43. Lighting .023 1 14. Employee Hygiene .009 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms 025 1 Equipment 8 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 2 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises 027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths 013 i 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars 032 1 23. Pre-Scraped, Soaked .013 1 24 Wash/Rinse Water 013 1 NO. Of 13 Critical Items Violated _ 25 Thermometers/Test Kits 013 , 1 These items require immediate attention. 26 Equipment/Utensil Storage 014 1 27 Single Service Articles .014 1 t 28. Single Service Re-Use .012 1 Grease Trap:In Ground: In Line: Capacity: SCORE Inspected by Received by y Seating: Frozen Dessert Machines: Pumped: 13 CRITICAL FOOD RANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food• adulterated, contaminated or otherwise unfit for human consumption c1 Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 1400F or .hove. 450F or below, DoF; rapid cooling of cooked foods within a hours preparation or service at a temperature which is greeter than 450 F Ca Facilities to maintain product temperature (=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served +� e_oso of hr+t fC�a..� 6 Damaged, spoiled, returned foods segregated ) . 7 Food protected during storage, preparation, display, dispensing, service, transportation E Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with Infections restricted customers is re-served unless such re-service is allowed under CC14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, heir restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manull methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed. Installed, maintained, located 1g Non-food contact surfaces, design, constructed, Installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, Installed. located, hygiene which may result in the potential transmission of illness operated pedthrough food is employed in a food establishment. 23 Pre-flushed, scro cle soaked 2a Mash/Dimas water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned d 26 Storage, handling of clean equipment/utensils ac an 21 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hoticold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 sewage •nd wasce water ditoosal C31 No cross-connections, back siphonaae, backrlow sanitary manner, or the sewage or liquid Waste contaminates or may C32 Toilets g Handwashing: number, accessible, design, installed contaminate any food areas used to store or prepare food, or any c33 No insects or rodents; harborage prevented areas frequented b customers or employees. 3a Plumbing; installed, maintained q Y35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing erects supplied with soap and towel dispensers, proper Waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, Insect/rodent resistant, frequency, installed or designed, accessible or convenient. 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not use single service Physical Facilities at Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded stem supplyingotable water that may as Dress and equipment vented as required 11. A defect exists in the system P Y 45 Dressing. locker areas provided used, clean result in the contamination of the water. Other ed 12. Insects, rodents or other animals are present on the premises cub Premises Taxies properly stores, labelled, ,art ( Y 5 590.027( )(3))• a7 Authorizedlltter-free, unneeessarl articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR F personnel ag Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, disp:nsed Note: In addition to the items listed above, any other violation of the si Salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: , pF i�rq'�M 8:15 9:3° A.M. Item No. In the space below describe all violations checked page ! of BOARD OF HEALTH ,2°45 . 2:°° P.M, l 367 MAIN STREET- r1a fe 0 HYANNIS, MASS. 02601 790-6265 EXT.265: - FOOD ESTABLISHMENT. INSPECTION REPORT Establishment Name l y Date/ IF" d �' .�fX.�G��i 7/� 9fAl Address a: In Out Telephone ,,/✓ T pe o t f Establishment: Purpose: ! t ood Service `- .. h Owner's Name Retail Food Routine F� Residential Kitchen Follow-up Person in Charge dYA17-/1/19 ��//)/D Mobile Unit Complaint Temporary Food Service Investigation Inspectors No Caterer Other Based on an inspection today,the items checked below Indic to the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regu ation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation "� checked requires an explanation on the narrative page(s). This report serve as official notice of violated provisions and Lao tt � official notice to correct said violations. WT Food I N C Sanitary Facilities N C WT. 1. Food Supply .002�4 29. Water Source .015 4 / 2. Food Containers .002 30, Sewage 016 4 L 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing `.018& .019 '#4 Zr 3. PHF Temperatures .004 4 33. Insects/Rodents 021 `2 4. Facilities. Hot&Cold Storage .004 234. Plumbing 017 1 5. PHF Re-service 006 35' Toilet Rooms .018 2 6. Spoiled/Damaged Foods .003 4 36. Handwashing Areas .019 2 7. Food Protected 003 37. Garbage/Refuse .020 2 8. Food Thermometers .004 2 38. Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings 021 2 10. PHFs thawed,cooked&cooled .005 2 40. Pesticide/Rodenticide Application 021 1 11. Food Handling .005 .2 12. Dispensing Utensils .006 1 Physical Facilities ' j 41. Floors .022 2 ' Personnel 42. g Walls, Ceiling .022 2 ee 13. Employee Infections .008 4 Lighting P Y 43. L Ung 023 1 14. Employee Hygiene 00911 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms 025 1 Equipment& Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 2 46.t Toxics .026 4y' 17, Food Contact Surfaces .013 1 4T Premises .027 1 18. Non-Food Contact Surfaces .013 1 48.. Living"Areas .027 1 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 20. Non-Food Contact Surfaces Clean .013 1 50_ Pets l 027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Wa rewash Ing Facilities .013 1 52. Salad Bars .032 1 23, Pre-Scraped, Soaked .013 1 24. Wash/Rinse Water 013 1 No. Of 13 Critical Items Violated 25. Thermometers/Test Kits .013 a.1 These items require immediate attention. 26. Equipment/Utensil Storage .014 1 27- Single Service Articles .014 1 28. Single Service Re-Use 012 1 Grease Trap:In Ground: In Line: '' Capacity: Inspecte Eby' Received by Seating: -" Frozen Dessert Machines: Pumped: ' SCORE. x.- V 13 CRITICAL FOOD HANDLING VIOLATIONS 1. Food from an unapproved or unknown source or food which is or may be Food Full item Descriptions adulterated, contatninated or otherwise unfit for human consumption C1 Food source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: MOF or above, 45OF or below, ooF; rapid cooling of cooked foods within M hours preparation or service at a temperature which is greater than 450 F Cr Facilities to maintain product temperature ('=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served th-- _ose of hnt ,r==A) 6 Damaged, spoiled, returned foods segregated T Food protected during storage, preparation, display, dispensing, service, transportation g Thermometers provided, conspicuous, accurate 3. The food establishment's facilities are insufficient to maintain 19 "° cr°"-conc.minatlon 0 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel customers is re-served unless such re-service is allowed under C13 Employees with infections restricted section 105 CMR 590.006(G). Cis ci,� clothes hairnd ean; go restraintaygienic practices Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manual methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, installed, maintained, located establishment. .lg Non-food contact surfaces: design, constructed. Installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths: clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Werpwashing facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 24 Wash/Rlnse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 2e No re-use of Single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of .in an approved and C30 sewage and waste water dienosal sanitary manner, or the sewage or liquid waste contaminates 'or may C31 No cross-connections, back siphonase, backflow y C32 Toilets g Handwashings number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents: harborage prevented areas frequented by customers or employees. 34 Plumbing; Installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Hendweshing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 31 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, clean installed or designed, accessible or convenient. 3e 0utatde area: dumpster covered, construction, clean 39 outer openings protected _ 10. The supply of water is not from an approved source or is not under 40 Pesticides and rodenticides, proper application pressure and the food establishment does not use single service Pbyaieml Facilities articles and/or bottled water from an approved source. 41 Floors constructed, maintained, clean r2 halls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplying potable water that may 44 Rooms and equipment vented as required result in the contamination of the water. 45 Dressing, locker areas provided used, clean Other 12. Insects, rodents or other animals are present on the premises C46 Toxtcs properly stored, labelled, -23ed ( y 5 590.o27(F)(3)). 47 Premises litter-free, unnecesssr) articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR Authorized personnel 46 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, disprnsed Note: In addition to the items listed above, any other violation of the 5; salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftef written notice to the permit holder constitute a critical violation. i Item No. In,the space below describe all violations checked Page of I F a i FOOD ESTABLISHMENT: INSPECTION REPORT ,, 4 Estatgllsh%* t Name> / 1 ' 1� L,7 ' tJ Date/, .,.�e.� j� r F Addresses � ' s• n, Out rr Telephone Type of Establishment: Purpose Food Service s A Owner's Name Retail Food Routine ? sOle Residential Kitchen Follow-upif �' Complaint Person in Charge �✓ I� Mobile Unit Temporary Food Service Investigation ' Inspectors Nam Caterer Other Based on an inspection today,the items checked below indicate th _violated provisions of 105 CMR 590.000. Each item is followed by the applicab4section of the Massachusetts regulation. Noncritical violations are marked under column"N"and ' critical violatioris'aie marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and - �,, official notice to correct said violations. ,r- N C WT. Food 4 Sanitary Facilities N C WT. 1. Food Supply .602' 29. Water Source .015 4 I, 2. Food Containers .002 30 Sewage 016 4 c 31. Cross-Connections 017 4 ,J � Food Protection 32. Toilets%Handwashing .018 8.019 4 3. PHF Temperatures .004 4 33. Insects/Rodents 021 2 4. Facilities. Hot 8 Cold Storage .004 .2 34. Plumbing .017 1 ii 5. PHF Re-service .006 '' 4 35. Toilet Rooms 018 2 ACAV ✓ 6. Spoiled/Damaged Foods .003 4 !36, Handwashing Areas .019 2 7. Food Protected .003 37. Garbage/Refuse .020 2 8. Food Thermometers .004 2 38. Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings .021 2 10. PHFs thawed,cooked 8 cooled 005 2 40. Pest ici de/Rode nticide Application .021 1 F 11. Food Handling 005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls, Ceiling .022 2 13. Employee Infections 008 4 43, Lighting .023 1 z 14. Employee Hygiene 009 4 44. Ventilation .024 2 15. Employee Clothing 010 1 9 45. Dressing Rooms 025 1 t Equipment 3 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 2 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47, Premises .027 1 ' 18. Non-Food Contact Surfaces ,013 • 1 48. Living Areas .027 1 Discussion with Management 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths .013 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities 013 1 52. Salad Bars .032 1 23. Pre-Scraped, Soaked .013 "1 24. Wash/Rinse Water .013 1 No. of 13 Critical Items Violated 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage 014 1 - 27. Single Service Articles .014 1 28. Single Service Re-Use 012 1 Inspected KY01 �� Received by Full Item Descriptions Food C1 Food Source, approved, wholesome 2 Containers, properly labelled Food Protection C3 Potentially- hazardous foods at proper temperatures: 140OF or above, 45OF or below, OOF; rapid cooling of cooked foods within 4 hours C4 Facilities to maintain product temperature C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 11 Food handling minimized 12 Dispensing utensils stored Personnel C13 Employees with infections restricted C14 Hands washed and clean; good hygienic practices 15 Clean clothes, hair restraints Equipment & Utensils C16 Equipment, utensils sanitized (automatic and manual methods) 17 Food contact surfaces: design, constructed, installed, maintained, located 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located, operated 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of cleat equipment/utensils 27 Single service articles, storage, dispensing 28 No re-use of single service articles Sanitary Facilities C29 Water source; approved, hot&cold under pressure C30 Sewage and waste water disposal C31 No cross-connections, back siphonage, backflow C32 Toilets & Handwashing: number, accessible, design, installed C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, ,3ign3 36 Handwashing areas supplied with soap and towel dispensers, proper Waste receptacles 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, clean 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application Physical Facilities, 41 Floors constructed, maintained, clean 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided used, clean other C46 Toxics properly stored, labelled, used 4'7 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. Authorized personnel 48 Living/5!eepi.ng quarters and laundry separate tig Linen properly stored 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected =�'� r a ;fir �fb Item No. In the space below describe all violations checked Page of 4• _ rw 6 It FOOD ESTABLISH MENT:4, INSPECTION' REPORT Establishment Name / Date �Sw f rt t rOgleTim _ Address � + Telephone �� _ .+ Type of Establishment: rpose t r �c � o Food Service _ Owners Name /. etail Food Routine _ Residential Kitchen Follow up ' Complaint Person In Charge Mobile Unit Investigation , sYr Temporary Food Service Inspectors Name Caterer r Other c �• y t - ac c; t Based on an inspectidn today,the items ct>aeck�d tieYow indicate t violated"provisions of 105 CMR 590.000:Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and t f ' critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation / r checked requires an explanation on the narrative page(s). T6,is report serves as official notice of violated provisions and official notice to coerecf said violations t R ' . '. N C Wf. Food EE�11 Sanitary Facilities N G WT. 1. Food Supply 002 4:4 29. Water Source .015 4 'r 2. Food Containers .002 30. Sewage .016 L: 1 4 ' ' 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8.019 4 3. PHF Temperatures .004 4` 33. Insects/Rodents .021 2 4. Facilities. Hot 8 Cold Storage .004 1 34• Plumbing .017 1 ' i 5. PHF Re-servica .006 4. 35' Toilet Rooms .018 2 / 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 2 g"4` 7. Food Protected .003 4! '37. Garbage/Refuse 020 2 8. Food Thermometers .004 2-38. Outside Disposal 020 1 9. Cross Contamination .00 2 39. Outer Openings .021 2 10. PHFs thawed,cooked 8 cooled .005 2; 40. Pest icide/Rode nticide Application 021 1 1.1. Food Handling .005 2 ' 12. Dispensing Utensils .006 1C Physical Facilities ' 41. Floors .022 2 Personnel 42. Walls,Ceiling 022 2 r 13. Employee Infections 008 4 43. Lighting .023 1 14. Employee Hygiene .009 4 44r Ventilation .024 2 15. Employee Clothing .010 (1' 45. Dressing Rooms .025 1 ik9.. N Equipment 8 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 2 46. Toxics .026 ' 4 117. Food Contact Surfaces .013 ;1 47, Premises .027 1 18. Non-Food Contact Surfaces .013 1, 48. Living'Areas .027 1 Discussion with Management 19. Food Contact Surfaces Clean 013 '2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 " 1`;5p. Pets. 027 1 1 21. Wiping Cloths _ .013 - „.j 51. Bulk Foods .031 1 i 22. Dish/Warewashing Facilities l 013 1 52. Salad Bars .032 1 23. Pre-Scraped,Soaked .013 1 24. Wash/Rinse Water 013 1 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits 013 1 These items require immediate attention. 26. Equipment/Utensil Storage .014 1 f 27. Single Service Articles 014 1 28. Single Service Re-Use r ved by Inspected by �. i Full Item Descriptions Food C1 Food Source, approved, wholesome 2 Containers, properly labelled Food Protection C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F oil below, OOF; rapid cooling of cooked foods within 4 hours C4 Facilities to maintain product temperature C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 11 Food handling minimized 12 Dispensing utensils stored Personnel C13 Employees with infections restricted C14 Hands washed and clean; good hygienic practices 15 Clean clothes, hair restraints Equipment & Utensils C16 Equipment, utensils sanitized (automatic and manual methods) 17 Food contact surfaces: design, constructed, installed, maintained, located 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located, operated 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing 28 No re-use of single service articles Sanitary Facilities C29 Water source; approved, hot&cold under pres3dre C30 Sewage and waste water disposal C31, No cross-connections, back siphonage, backflow C32 Toilets & Handwashingi number, accessible, design, installed C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, clean 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application Physical Facilities, 41 Floors constructed, maintained, clean 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided used, clean Other c46 Toxics properly stored, labelled, used 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored., Authorized personnel li3 Living/sleeping quarters and laundr _y-aeparate 49 Linen properly stored 50 4jo pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected tME TOWN OF BARNSTABLE OFFICE HOURS: / pp ♦ - �Wp, 8:30 - 9:30 A.M.BOARD OF HEALTH 12:45 2:00 P.M. Item No. In the space below describe all violations checked 4_ � - �.�I aces.rnni.e a79\ 4 0V, 367 MAIN STREET IpP -- HYANNIS, MASS. 02601 790-6265 EXT.265; �� , � ✓hG ! ^Jr. FOOD ESTABLISHMENT INSPECTION REPORT - Establishment Name Date - y�,� c•�- ..• �f s} �' '�1�.•vt!7ili!,�17Z`�`-x:� Address �� I t\� 1 I� J ` Y //a.I,�) Out Telephone G -2 - `'+ L Type of Establishment: - - 1 Purpose: 1 Food Service 64414 �1H!a9 / yot_k Owner's Name N ot,rv-2- t S Routine r c=�lti./K , �(.� Retail Food � `.�--•��,� Residential Kitchen Follow-up - -•� Person In Charge , �' Mobile Unit Complaint y�� _s Temporary Food Service Investigation Inspectors Name / Caterer Other , Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.060. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and t/ official notice to correct said violations. - Food N C WT'Sanitary Facilities N C WT. 1. Food Supply .002 29. Water Source .015 4 2. Food Containers .002 1 30 Sewage .016 -< 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8 .019 - 2 3. PHF Temperatures .004 4 33. Insects/Rodents .021 2 4. Faci'ities. Hot 8 Cold Storage .004 4 34. Plumbing .017 1 5. PHF Re-service .006 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 2 7, Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 2 9. Cross Contamination .005 2 39. Outer Openings .021 1 10. PHFs thawed,cooked 8 cooled .005 4 40. Pesticide/Rodent icide Application .021 1 11. Food Handling, .005 2 12, Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel 42. Walls,Ceiling .022 1 13. Employee Infections 008�4 43. Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation 024 1 15. Employee Clothing 010 1 45. Dressing Rooms .025 1 Equipment 3 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 J 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 56. Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dlsh/Warewashing Facilities .013 1 52. Salad Bars .032 Lj 2 ` 23. Pre-Scraped, Soaked .013 1 24. Wash/Rinse Water .013 1 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage 014 1 27. Single Service Articles 014 28. Single Service Re-Use 012 1 SCORE Inspected by F Received by 13 CRITICAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food adulterated, contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome 2 containers, properly labelled is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for c3 Potentially hazardous foods at proper temperatures: 140°F or above. YS°F or below, 0°F; rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F c4 Facilities to maintain product temperature (`=70 0 (in the case of cold food) or less than 1400 F (600C) (in c5 Unwrapped and potentially hazardous togas not re-served � 6 Damaged, spoiled, returned foods segregated the case of hot fccdN T Food protected during storage, preparation, display, dispensing, service, transportation 6 Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The. food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to r.raonsel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment i Utensils 5. A person infected with a communicable disease that can be 06 Equipment, utensils sanitized (automatic and manudl methods) transmitted b food is a food handler in a food tT Food contact surfaces: design, constructed. Installed, maintained, located y s working a 18 Non-food contact iurfacest design, constructed, Installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 6. A person not practicing strict standards of cleanliness and personal 21 wiping elfths; glean, use restricted p p $ p 22 Dish/War washing facilitiess 'dealgned, constructed, maintained. Installed. located, hygiene which may result in the potential transmission of illness operated h food is employed in a food establishment. 23 Pre-flushed, scraped, soaked through 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 7. Equipment, utensils and food-contact surfaces are not cleaned and 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No reuse of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not dispo&ed of in = approved and C30 Sewage and waste water dizposal C31 No cross-connections, back 31phonage, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets & Handwashingi number, accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented b customers or employees. 34 Toilet installed, maintained Q y35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles Toilets end facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, Insect/rodent resistant, frequency. 9. $ P • p P y clean installed or designed, accessible or convenient. 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodentieides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not, use single service Physical 1 Floors 4s constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, tailing, attached equipment; constructed, maintained. clean 43 Lighting provided as required, fixtures shielded 44 Booms and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing. locker areas provided used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises C46 Toxics properly stored, labelled, 43ed47 Premises litter-free, unnecessar) articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, d13ptansed si Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: FIE I 8:30 - 9:30 A.M. " BOARD OF HEALTH 12:45 2:00 P.M. Item No. In the space below describe all violations checked '` 367 MAIN STREET e 63�00/ HYANNIS, MASS. 02601 790-6265 EXT.265 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name ty Address 9 7 Tlms: In Out Telephone "2'1,'A-- Li� W ", Type of Establishment: purpofe. `� Retail Food Food Service i / t sh•s-^-^� Owners Name Routine �-}-� j� Residential Kitchen Follow-up Person In Charge [1 LER.Yap Mobile Unit Complaint a r,r Temporary Food Service Investigation Inspectors Name `� Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. i N C NT. Food Sanitary Facilities N C WT. 1. Food Supply .002 4 29. Water Source .015 '` 4 2. Food Containers .002� 1 30. Sewage 016 - 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8.019 2 3. PHF Temperatures .004 4 33. Insects/Rodents .021 2 4. Facilities. Hot 8 Cold Storage .004 4 34. Plumbing .017 1 5. PHF Re-service .006 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 2 9. Cross Contamination .005 2 39. Outer Openings .021 1 10. PHFs thawed,cooked 8 cooled .005 4 40. Pesticide/Rodent icide Application .021 1 11. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel 42. .Walls,Ceiling .022 1 13. Employee Infections .008 4 43. Lighting .023 1 14. Employee Hygiene .009 `> 4 44_ Ventilation .024 1 15. Employee Clothing .010 1 45. Dressing Rooms .025 1 Equipment&Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises 027 I 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 56. Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 2 23. Pre-Scraped.Soaked .013 1 24. Wash/Rinse Water .013 I No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage .014 j' 27. Single Service Articles .014 1 28. Single Service Re-Use .0120 j SCORE Inspected by �^"�^�"-� Received byy� �`t � ��---. t E" i 13 CRITICAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food adulterated, contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, O°F; rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F C4 Facilities to maintain product temperature (=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served the cese of hn+ f��a 6 Damaged, spoiled, returned foods segregated ••i• 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment i Utensils 5. A person infected With a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, installed, maintained, located establishment. 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 6. A person not practicing strict standards of cleanliness and personal 21 Wiping cloths; clean, was restricted 22 Dish/Warpwaahing facilltiesi designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use or single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 Sewage Pnd waste water dievosal sanitarythe liquid . C31 No cross-connections, back siphonage, backflow manner, or e sewage or quid waste contaminates or may C32 Toilets 8 Handwashing: number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented by customers or employees. 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washinghands are not provided, properly Garbage and refuse: containers covered, adequate number. insect/rodent resistant, frequency, P • p P Y 37 clean installed or designed, accessible or convenient. 38 outside area: dumpster covered. construction, clean 39 Outer openings protected 40 Pesticides and rodenticides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities articles and/or bottled water from an approved source. 41 Floors constructed, maintained, clean PP 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and equipment vented as required Y P Y 45 Dressing. locker areas provided used, clean result in the contamination of the water. other 12. Insects, rodents or other animals are present on the premises C46 Toxics properly stored, labelled, ased 47 Premises iet unnecessary articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 46 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 5o No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52' Salad bar operations prepared. refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. 4E rp V -+ TOWN OF BARNS-FABLE OFFICE HOURS: CF( � NPR:.. p� 8:30 - 9:30 A.M. I/,! BOARD OF HEALTH 12:45 - 2:00 P.M. Item No. In the space below describe all violation's checked 367 MAIN STREET HYANNIS, MASS. o26o1 775-1120. EXT. 182 - FOOD ESTABLISHMENT INSPECTION REPORT f � � Establishment Name ( Date �.rt. _ ,c. Address 9y, ...�. ,F Time: In Out Telephone LI Type of Establishment: Purpose- Owners Name _ Food Service Routine Retail Food � Residential Kitchen Follow-up Person In Charge Mobile Unit Complaint Temporary Food Service Investigation inspectors Name - Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s): This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT.sanitary Facilities N C MT. 1. Food Supply .002 4 29. Water Source .015 4 2. Food Containers .002FI, 30. Sewage .016 s: 4 3.1. Cross-Connections .017 4 Food Protection off32. Toilets/Handwashing .018 8 .019 2 3. PHF Temperatures .004 4 33. Insects/Rodents .021 2 4. Facilities. Hot 8 Cold Storage .004 4 34_ Plumbing .017 1 5. PHF Re-servicle .006 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged oods .003 1 36. Handwashing Areas .019 2 7. Food Protected 003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 2 9. Cross Contamination .005 2 39. Outer Openings .021 1 10. PHFs thawed.cooked 8 cooled .005 4 40. Pesticide/Rodent icide Application .021 1 it. Food Handling .005 2 . 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel 42. Walls, Ceiling 022 1 13. Employee Infections 008 M 4 43 Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation - .024 1 15. Employee Clothing 010 1 45. Dressing Rooms .025 1 Equipment 8 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management 19. Food Contact Surfaces Clean- .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 2 23. Pre-Scraped,Soaked .013 1 24. Wash/Rinse Water .013 1 INo.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 I These items require Immediate attention. 26. Equipment/Utensil Storage .014 1 27. Single Service Articles .014 1 } , 28. Single Service Re-Use .012 1. SCORE Inspected by N"'e Received by 13 CRITICAL FOOD HANDLING VIOLATIONS ¢,d Full Item Descriptions '' 1. Food from an unapproved or. unknoi�rn source or food which is or may be Food adulterated, contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled . Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods it proper temperatures: 140°F or above. 450F or below, 0°F; g y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F C4 Facilities to maintain product temperature (a7o C) (in the case of cold food) or less than 1400 F (60°C) (in C5 Unwrapped and potentially hazardous foods not re-nerved �;�� case of hot f��) 7 Foo� 6 Damaged, spoiled, returned foods segregated d protected during storage, preparation, display, dispensing, service, transportation B Thermometers provided, conspicuous, accurate 9 No cross-contamination 3• The- food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel _ C13 Employees with infections restricted customers is re—served unless such re—service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment t Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manual methods) transmitted b food is working as a food handler in a food 17 Food contact surfaces: design, constructed, installed, maintained, located y 18 Non-food'contact surfaces: design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 6. A person not practicing strict standards of cleanliness and personal 21 Wiping cloths; clean, wse restricted p P $ P 22 Dish/War waahin facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated aked through food is employed in a food establishment. 23 Pre-fleshed, scraped, $ 24 Wash/Rinse water clean,g temperature 25 Accurate thermometers, chemical test kits provided; instructions posted Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling or es. s equipment/utensils 7• 27 Single service artlele storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not uinpuaad of in 11i approved and C30 Sewage And waste water ditnosal sanitary manner, or the sewage or liquid waste contaminates or may C31 No cross-connections, back num31pber, accessonage, ble, design, ew g I C32 Toilets 8 Hendwashing: number, accessible, deli n installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets find facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, insect/rodent rasiatant, frequency, $ P ► P P y clean installed or designed, accessible or convenient. 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not, use single service Pb Facilities P 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, rixtures shielded 44 Rooms and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing, locker areas provided used, clean result in the contamination of the water. other c rodents or other animals are resent on the remises 46 Tories properly stored, labelled, ,and 12. Insects, P P 47 Premises litter-free, unnecessar, articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 -CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored,-labelled, dispensed sz salsa bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. 'r i Item No. In the space below describe all violations checked a pa9 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Date "- ,�.�_.---�� J6, �� Time: In Out Addressof J� 1 r �.., S 1rtJ. t� P sr.� A&P *t Telephone I. L/ c7. Type of Establishment: Purpose: Food Service Owners Name � e Retail Food �c Routine en Follow up Residential Kitch Person In Charge Mobile Unit Complaint r Investigation Temporary Food Service Inspectors Name - Caterer Other v Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Noncritical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food t N C Sanitary Facilities N C 1. Food Supply .002 29. Water Source .015 2. Food Containers .002 _30. Sewage .016 ' 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018 8.019 >.( 3. PHF Temperatures .004 m 33. Insects/Rodents .021 4. Facilities..Hot&Cold Storage .004 34. Plumbing .017 5. PHF Re-service .006 35. Toilet Rooms .018 6. Spoiled/Damaged Foods .00336. Handwashing Areas .019 7. Food Protected, .00337. Garbage/Refuse .020 8. Food Thermometers .00438. Outside Disposal .020 9. Cross Contamination .00539. Outer Openings. .021 10. PHFs thawed,cooked&cooled .00540. Pesticide/Rode nticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006TPhysical Facilities 41. Floors .022 r'F Personnel 42. Walls,Ceiling .022 i 13. Employee Infections .008 43. Lighting .023 14. Employee Hygiene .009 `-` 44. Ventilation .024 15. Employee Clothing .010 45. Dressing Rooms .025 Equipment i3 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized, .013 46. Toxics .026 '>! 17. Food Contact Surfaces 013 47. Premises 027 18. Non-Food Contact Surfaces 013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean �.013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. /Salgd Bars .032 i,, 23. Pre-Scraped, Soaked .013 F% . C_ 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items require immediate attention. ` 26. Equipment/Utensil Storage .014 t 27. Single Service Articles .014 /. 28. Single Service Re-Use .012 t Inspected by v r• - Received by �`.r / rt J •`". , TOWN OF BARNSTABLE OFFICE HOURS: OF 1HE p 8:30 - 9:36 A.M _ o. Item No. In the space below describe all violations checked- BOARD 12:45 - 2:00 P.M. BOARD OF HEALTH (IfAN��l AIfI.f: f- 367 MAIN STREET �Gie'a .rL�✓ ice" ( GEC +/71 �°_"%� HYANNIS, MASS. 02601 775-1120• EXT. 182 ', FOOD ESTABLISHMENT. INSPECTION REPORT Establishment NameJ Data7``" Time- In Out Y ," � Address Typo of Establishment: Telephone .Tit' Yp Purpose: Food Service Owners Name �1 L Retail Food Routine �' " S Residential Kitchen Follow up Person in Charge if rte Mobile Unit Complaint �} Temporary Food Service Investigation Inspectors Namee� ` ' f1 ` Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. r Food N C WT.sanitary Facilities N C WT. 1. Food Supply .002� 4 29. Water Source .015 4 2. Food Containers 002 1 30. Sewage .016 - 4 31. Cross-Connections .017 4 Food Protection EVI 32. Toilets/Handwashing .018 8.019 >. 2 3. PHF Temperatures .004 4 33_ Insects/Rodents .021 2 4. Facilities. Hot 8 Cold Storage .004 4 34. Plumbing .017 1 5. PHF Re-service .006 '' 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .021 2 9. Cross Contamination .005 2 39. Outer Openings .02 1 10. PHF's thawed,cooked 8 cooled .005 4 40. Pesticide/Rodenticide Application .021 1 11. Food Handling ' .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 I Personnel 42. Walls,Ceiling .022 I 13. Employee Infections 008 4 43. Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation .024 1 15. Employee Clothing 01 O 1 45. Dressing Rooms .025 I Equipment 8 Utensils Other 16. Equipment/Utensil Clean& Sanitized .013 ` 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management 19, Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 I 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 Lj 2 23. Pre-Scraped, Soaked .013 1 -" 24. Wash/Rinse Water 013 1 No.of 13 Critical Items Violated 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage .014 I 27. Single Service Articles .01 a 1 28. Single Service Re-Use- .012 1 g SCORE Inspected byff `-` �` Received by 13 CRITICAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which is or may be Food• adulterated, contaminated or otherwise unfit for human consumption Ci Food Source, approved, wholesome 2 Containers, properly labelled is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140°F or above, 450F or below, 0°F; y g Y rapid cooling or cooked toads within 4 hours preparation or service at a temperature which is greater than 450 F. C4 Facilities to maintain product temperature (=70 0 (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous roods not re-served the :osn of hot f�C�)• 6 Damaged, spoiled, returned foods segregated T Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination - 3. The- food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food. or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re—served unless such re—service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). .15 Clean clothes, hair restraints Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed. Installed, maintained, located 16 Non-food contact surfaces: design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dlsh/warpwashing facilities: designed, constructed. maintained, installed, located, hygiene which may result in the potential transmission of illness operated h food is employed in a food establishment. scraped, soaked through 23 Pre-flushed, g24 wash/Rinse water clean. temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 7. Equipment, utensils and food—contact surfaces are not cleaned and 27 single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. sanitary Facilities C29 water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in = approved and C30 Sewage Pnd waste water disposal C31 No cross-connections, back siphonage, backflow sanitary manner, or the sewage Or liquid waste contaminates or may C32 Toilets & Handwashing: number, accessible, design. Installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented areas frequented b customers34 Plumbing; installed, maintained Q y cusomers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles Toilets and facilities for washing Hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant. frequency, 9• 8 P • P P y clean installed or designed, accessible or convenient. 36 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticldes. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Ph Facilities P g 41 Floors constructed, maintained, clean articles and/or bottled water from an approved .source. 42 walla, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Roams and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing. locker areas provided used, clean result in the contamination of the water. Other ed 12 Insects rodents Or other animals are resent on the remises c47 PremToliises s properly stored, nnecelabel3ed,lusrt , p properly• f P P 47 Premises 1-:tier-free. unneccssar articles cleaning maintenance equipment ro erly stored: (unles's allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 .Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52' Salad bar operations prepared, refrigerated, displayed, protected ` Note: In addition to the items listed above, any ,other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. . I 1 Item No. In the space below describe all violations checked Page.C_of FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name 1�, /�. Date ,f/ �t / / ,( Time: In .O.g Address 1l/ rI �j �/�� ilfl /JA'.4 ,. r� I-,-P /l At r Telephone - /j�5/ Type of Establishment: ,Purpose- ( } Food Service - �s Owners Name �rl pl �-7F /' Retail Food Routine Residential Kitchen 'Follow-up Person In Charge 'jMobile Unit Complaint ��' # /f )e X i ` Investigation Inspectors Name ) / / /,p Temporary Food Service / >� J(i Pi y ��r(.�YY.(� Caterer Other �9 Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is ! followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation f checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and - official notice to correct said violations. Food N C Sanitary Facilities N C 1. Food Supply .002 29. Water Source .015 2. Food Containers .002 30. Sewage .016 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018 8.019 3. PHF Temperatures .0041111111 33. Insects/Rodents .021 =a`= 4. Facilities. Hot&Cold Storage .004 34. Plumbing .017 5. PHF Re-service .006 35. Toilet Rooms .018 6. Spoiled/Damaged Foods .00336. Handwashing Areas .019 7. Food Protected .00337. Garbage/Refuse .020 8. Food Thermometers .00438. Outside Disposal .020 9. Cross Contamination .00539. Outer Openings .021 10. PHF's thawed,cooked&cooled .00540. Pesticide/Rodenticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006TPhysical Facilities 41. Floors .022 Personnel 42. Walls,Ceiling .022 13. Employee Infections .008 43. Lighting .023 14. Employee Hygiene .009 ' 44. Ventilation .024 15. Employee Clothing .010 45. Dressing Rooms .025 Equipment& Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 /�� lh / f/ »//�'•"Z/ p' J/ ,� 18. Non-Food Contact Surfaces .013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean .013 49. Linen .027 / /.tL �`/v ^'�' Y�, el 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping-Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities •013 52. Salad Bars .032 El 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated 25. Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage .014 27. Single Service Articles .014 28. Single Service Re-Use 012 � P Y� j/i�� r ,_ \' '/r,� 7�,r� , i♦ Inspected b Received by / Y Item No. In the space below describe all violations checked Page of G�� -1 K� __X FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name e � Date Address Time: In Out Telephone 2 is S N S Type of Establishment: Purpose: Food Service Owner's Name Retail Food Routine 4 Residential Kitchen Follow up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation Inspector's Name t Caterer Other v Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C Sanitary Facilities N C 1. Food Supply .002 29. Water Source 015 2. Food Containers .002 30. Sewage .016 31. Cross-Connections .017 z Food Protection 32. Toilets/Handwashing .018&.019< ; 3. PHF Temperatures .004 33. Insects/Rodents .021 4. Facilities,.Hot&Cold Storage .004 34. Plumbing .017 5. PHF Re-servicle .006 35. Toilet Rooms .018 '6. Spoiled/Damaged Foods .003 36. Handwashing Areas .019 7. Food Protected .003 37. Garbage/Refuse .020 8. Food Thermometers .004 38. Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings .021 10. PHFs thawed,cooked&cooled .005 40. Pesticide/Rodenticide Application 021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors 022 Personnel 42. Walls, Ceiling .022 13. Employee Infections 008 43. Lighting .023 14. Employee Hygiene 009 44. Ventilation //.024 x 15. Employee Clothing .010 45. Dressing Rooms fr.025 Equipment& Utensils Other 16. Equipment/Utensil Clean& Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 18. Non-Food Contact Surfaces .013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean .013 49, Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items require'immediate attention. 26. Equipment/Utensil Storage .014 27. Single Service Articles .014 28. Single Service Re-Use .012 ` n Inspected by �., � AReceived by 1 I w! - I J i _ I ? i is W fNq�/'� I/✓ Coo�,�R- rlK. �i �pUNTrGI� r 1 /�O' 1� 0 SENDER: Complete items 1,2,and 3. o Add your address in the"RETURN TO"space on 3 reverse. 1: The following service is requested (check one). g } Show to whom and date delivered. . . .. .. . . .. f Show to whom,date,and address of delivery. ._¢ , n RESTRICTED DELIVERY Show to-whom and date delivered. .. .. . . . . ._¢ RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$_ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. Robert Bearse m Calves Pasture Lane C Barnstable, Ma. 02630 Z 3. ARTICLE DESCRIPTION: m REGISTERED NO. CERTIFIED NO. INSURED NO. m t,6127364 y I (Always obtain signature of addressee or agent) m I have received the article described above. mSIGNATURE Addressee uthorized agent s m C 2 4. rn DA ELIVERY c a m O 2 5. ADDRESS (Complete only if requeste ) +� v 5 V �" . d bq '^ 6. UNABLE TO DELIVER BECAUSE: CE ALS 3 D 5,j` GPO: 1978-272-382 i i 1 UNITED STATES POSTAL SERVICE � OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATE Print your name,address,and ZIP Code in the space below. USE TO AVOID PAYMENT • Complete items 1,2,and 3 on the reverse. OF POSTAGE,$300 • Attach to front of article if space permits.Otherwise U.S.MAIL I affix to back of article. ®pp Endorse article"Return Receipt Requested"adja- cent to number. RETURN TO g 4 BOARD OF HEALTH (Name of Sender) TOWN OF BARNSTABLE P . 0. BOX 534 (Street or 1'.0.Box) HYANNIS MA 02601 (City,State.and ZIP Code) July' 22,0 ,1980 Robert Bearse alves' Pasture.Lane j arestabl.e:,' Ma. .'02630' ear" SKr. s8earse: . r ,., On, December ;26�. 1979,• you wer"e isBued. a .conditional Retail Market f k <`Reliotration'which expired June 1, 1980«" )' a u' were notified by- Letter.'.on:Decemberµ 4; '1979 that'pr�.or. tor e 1, ;1980,, y'ou-woul4,be required :to -install ;toilet °facilitiesa `double tGompaztment sink for;`sanitixng utensils and equip-`' nt,,• You:- were allowed to ,use your existing sink as 'the' regu�.rednd wash.. ��.To ,;date, 'these `violations have ,`not been corrected. allure to'teorr:ect these violations w ll�aresult in.'a hearing be Y .a ore' the",Hoard of Health to show,cause aas ta;`why youz establisY�nent hould mot be` Closed for operatingwithout, a,Retal Market Regis-- 'Pit, ratIon ;. d .`.. � _w H; . Pit• .. ` s. i r ,� , Veit' tzu ,y'yours h , h 3. ohn M.- Kelly _ M ir`ector�of `Public Health JMK rm , • o�z SENT VIA CERTxFED All 11 Y!;4' }t., .. P' �R.r. - _4y - +➢r• 5., .4. .. -p•r ♦ "' - a f Y r x • r r� SENDE?,: Complete items 1,2,and 3. Add your address in the"RETURN TO"space on 3 reverse. ,The following service is requested (check one). n [7�:Show to whom and date delivered. . . .. .. . . . Show to whom,date,and address of delivery. ._¢ RESTRICTED DELIVERY Show to whom and date delivered. . . .. . . . . . RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$_ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED'TO: Mr. Robert E. Bearse • m Calves PastLire Lane C Barnstable, 11A. 02630 x Z 3. ARTICLE DESCRIPTION: z n REGISTERED NO. CERTIFIED NO. INSURED NO. m I1532091 y I (Always obtain signature of addressee or agent) m I have received the article described above. mSIGNATURE ❑ Add r ssee ❑ Authorized agent m Z a. C DATE OF DELIVERY POSTMARK z m v Z 5. ADDRESS (Complete only if requested) v M m 6. UNABLE TO DELIVER BECAUSE: CLERK'S C INITIALS 3 D r x(GPO: 1978-272-382 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS PENALT 'FO TES SENDER INSTRUCTIONS use`To NTT E b Print your name,address,and ZIP Code in the space below. ,0' 011 j • Complete items 1,2,and 3 on the reverse. e • Attach to front of article if space permits.Otherwise = ' U.SJWWL 3 affix to back of article. yl i � 00 • Endorse article"Return Receipt Requested"adia- cent to number. 1 RETURN TO I I BOARD OF HEALTH I TOWN OF(NBA RNSTABLE _ i P. 0. Box 534 I I (Street or P.O.Box) I HYANNIS MA 02601 I (City.State,and ZIP Code) �� I i I ' J • December 4, 13.741 p , W.. Robert. E. Uarse r 'Calves Pasture'"Lane . y $arnstable, MA; 02630 Dear .Mr. Bearse: a` You "will be, issued a 'conditional Retail`Market,e Regisi:ratioin f to expire"junei T 1980. + .. �i Prior to June-' I '.�900,` you will* be,"requ red,x't install toilet facilities t9:es and. a double compartment slink 'kor' sanitiZ3.ng utensils And, e' quipmenti You r ..existing` aink >may� be utili�ed :as the. reclu red hand>wash. If you . have any ,queitidns, 'please call.,. : Very truly youars,•g e John ,M. Kelly Director°of Public Health s, JMK/mm s SENT .VIA, CERTIFIED. M4IL e ,