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HomeMy WebLinkAbout2095 MAIN STREET (M.MILLS) - Health - MARSTONS MILLS ELEMENTARY Marstons Mills Elementary 2095 Main St. - M.M. rA 0 PERMIT NO: TOWN Q.F--BARN�&TA&LkISSUE DATE 86 December 28, 2009 PERMI ` ' �D '43 .� ENT In accordan reg i` only#ated u it f hapter 94, Section 395A an a ecti � General La rmisereby granted to: TOWN OF BARNSTABLE x "` " LAGE RY SCHOOL Whose place of business is:1 9 209 MAIN STR - ; . MILLS, 026q I Type of business and any r is n ME J g X To operate a food establish r tag tF� z T 4 T. f t ., RESTRICTIONS IF ANY: p yA SEATING: ANNUAL: YES SEASONAL: TEMPORARY: � OFHEALTH RETAIL FOOD STORE: � "' �° ne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT 5. s RESIDENTIAL KITCHEN FOR RETAIL SALE M.-;. aul J.Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST .IUnIChI$aWayanaQl MOBILE FOOD UNIT: �^`n TOBACCO SALES: December 31 , 2 0.10 FROZEN DESSERT: Thomas A. McKean, IRS, CHO CATERER: Director of Public Health Town of Barnstable oF ZHE T P °'�.y Regulatory Services Barnstable Thomas F. Geiler, Director /l8-America It BARNSTABLE, q$A MASS. Public Health Division 2007 - Thomas McKean, Director q/Q p 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 5687790-6304 APPLICATION FOR PE RMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: y ADDRESS OF FOOD ESTABLISHME ao9 rMkmn 6A.LU, 6d6 MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: { ) LM - o'�O9d NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: TOTAL.NUMBER OF BATHROOMS. ANNUAL OR SEASONAL OPERATION: l�bM TYPICAL HOURS OF OPERATION MON-FRI: : TO USJ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) S �-�. -} S0► , IF SEASONAL: APPROXIMATE DATES OF OPERATION: F"l ,9,'1 / CG —To 'REMINDER*" SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ' RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES j CATERING I OUTSIDE DINING (OVER) QAHealthWpplication FormsToodappl.doc d ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT C � SOLE OWNER: Y,EnS/NO ADDRESS PHONE # ( SU )�_77 - 656 IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1• CY Q,..��� EXPIRATION DATE: Y 2. CNSI�CWtcj EXPIRATION DATE: 3. EXPIRATION DATE: )a/ 4. EXPIRATION DATE: SIGNATURE OF APP CANT AND DATE QAHealth\Application Forms\Foodappl.doc ERiVIIT NO: TOWN OF BARNSTABLE 12/20/2007 86 BOARD OF HEALTH PERMIT TO OI?E &EQ1 'ST BLISHMENT In accordance wit#rI �►ns��rtet �traty of Chapter 94, Section 395A and C�p 1 hod�wo �eGnIsare> it is hereby granted to: . 1 < , TOWN OF BARNST MARS1 I11,SELEMENTARY SCHOOL Whose place of business.is: � AIN S MILL 6 - fir � a Type of business and any r st,., � BLISHM NT' A' z3 F { To operate a food establisl4n n�& p e RESTRICTIONS IF ANY: $$ SEATING: . ANNUAL: w SEASONAL: TEMPORAR= - S �F HEALTH' RETAIL FOOD STORE: a FOOD SERVICE ESTABLISHMENT: $S n filler, M.D.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: k a 'J. Canniff,D.M.D.. RESIDENTIAL KITCHEN FOR BED_+BREAKFAST: ."' nlChl Sawavanagi. MOBILE FOOD UNIT: I. TOBACCO SALES: �n FROZEN DESSERT: - Thomas A. McKean, IRS,CHO CATERER: Director of Public Health f Town of Barnstabl 0 e Regulatory Services Barnstable Thomas F. Geiler,Director 9$ '1 ,.�' Public Health Division 2007 p'ED'" s Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: ..A±—,Li 46 NAME OF FOOD ESTABLISHMENT: N -a7 ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: �S� OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: / ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: ?,6( : P.,vt TO P30 :_ m DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 5��. 4 Sv,ti IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / 'REMINDER' SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TQ OPENING: TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY `' s FOOD SERVICE RETAIL FOOD �. BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING R�.= Q\HealthWpplication Forms\Foodappl.doc $r ***REMINDER*** • IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: r� n ^ n FULL NAME OF APPLICANT cXlJy x � s SOLE OWNER: YES/NO c� ADDRESS_ PHONE # CLOD 7 7'T -pS6 3. IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O Galo7� STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REOUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1• )Yl i1 rr��� � EXPIRATION DATE:- �9 / y / "?G I �. 2. 1. �ncwL EXPIRATION DATE:)/ /9 / ?6JZ. 3• �1�.' � J ��- EXPIRATION DATE:/ /J�lG10 4. EXP RATION DATE: . \ SIGNAT& OF APPL CANT AND DATE Q:\HealthWpplication Forms\Foodappl.doc PERIYIIT NO: TOWN OF'BARNSTABLE ISSUE DATE 86 :OF HEALTFt '` 12/28/2006 PERMIT TO'QPERAT A FOOD EStABLISHMENT In accordance,-with regulattnso promulgated underIithor><yof Chapter 94, Section 39�A and Qhapte�``l'I,Section 5 of the General La s,,a permit>s hereby granted to: 3 � . TOWN OF BARNSTABLE 'D%B/A •MARSTONS MILLSELEMENTARY SCHOOL haw g Aa , '2' Whose place of business is, 2035 MAIN STREET;~MARSTQI+iS MILLS,MA 02649, Type of business and any restrictions: FOOD`,SEXRVICE�ESTA61LISHMAT To operate a food establishmentxn the TOflVI+M OF BARf�SiBLE RESTRICTIONS IF ANY: SEATING: ANNUAL: YES � '44PIN, 01 SEASONAL: TEMPORARY y 'r % s F E E S BOARD OF HEALTH RETAIL FOOD STORE: � �a x.� � Wayne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: '= $5:UQs � ' RESIDENTIAL KITCHEN FOR RETAIL SALE: :w Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: �,,. " ` Paul J. Canniff, D.M.D. MOBILE FOOD UNIT: f��srnlitXplreS ��-- Q� TOBACCO SALES: 1 2 / 3 1 / 2 0 0 7 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health Town of Barnstable y�P�oFTHE toy�� Regulatory Services t Thomas F. Geiler, Director antwsrnBLE. 9� ';S. � Public Health Division pTED 1"P�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: f`'I c+r� ,S ,� �It'w�e �. Arz►1 ADDRESS OF FOOD ESTABLISHMENT: ao9S �1po WLS' Kla.W69'F MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (SO W') yd F - ace 90. NUMBER OF SEATS: INSIDE: 0 0 OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: C(�n TYPICAL HOURS OF OPERATION MON-FRI: !.1)6: 0. TO G .w1 DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) ,S P-, 4 :�ojy IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY XFOOD SERVICE RETAIL FOOD - BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING Q:1HealthUpplication Foanffoodappl.doc . ` ***REMINDER*** . 0 AW1, IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANTL- SOLE OWNER: YES/NO ADDRESS 7yy 1UcS� 1�1r�1>tiS�. � wpi ;tj; j44• CU-g6C f PHONE # csaT, -osb IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. E (,66 7 9 STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** I. s N Hti�Y� 1�i0Yv�e lRU( S i►u��+�()ti EXPIRATION DATE:-5- / q / aG // 2. S f)vL,DA SI OSf k CS0-0 EXPIRATION DATE: la /-J�- /1016- 3. ')e ruk se. T1 oyr4 EXPIRATION DATE: I / �7/ oqG/� 4. `. EXPIRATION DATE: l x '114�' Vtlo / 3 6 � SIGNATtE OF AP ICANT AND DATE Q:\iealthWpplication Forms\Foodappl.doc � t 1 YEItMI Ask- TOWN OF BARNSTABLE s 86 12/28/05 BOARD.(? AEA.LTH PERMIT TO Q 00 aATE A 000, S'F/kPLISHMENT > In accordance with regrijaLt s On g$ted>lry c r,a tho of chapter 94 _ Section 395A and Ch ter iL � �ty P e�t1o1T 5 of t1 CCe k�era#]f�yy Wper nit is hereby r . � Y granted to:0-1 t: TOWN OF BARNSTABOV �� = �8/A MARSTNSiVII,LS� LEMENTARY SCHOOL Whose place of business is s '761 � � W7 ' MAIN STEE , , Nt1R' ' } IS MILLS&W1lIA p2s r Type of business and any r stictlons: � To operate a food establis � en Y.Z F teTO� ( FiISBL, v RESTRICTIONS IF ANYvv Ile j SEATING: . .ANNUAL: * § SEASONAL:. TEMPORAR RETAIL FOOD STORE: QOF H F FOOD SERVICE ESTABLISHMENT * `� s RESIDENTIAL KITCHEN FOR RETAIL SALE ot� aYRe Miller, M.D., Chairperson 5" RESIDENTIAL KITCHEN FOR BED,+BREAKFAST �= ' rSu�iner Kaufman, M.S.P.H. ' MOBILE FOOD UNIT:. Paul J. Canniff, D.M.D. > TOBACCO SALES ' FROZEN DESSERT: CATERER: Thomas A. McKean, RS, CHO Director of Public Health *. EY' R f A AW- Orown of Barnstable r � L Regulatory Services 6 , ° Thomas F. Geiler,Director BAMSTLABUX'$ 639. Public Health Division .n �e QED MA'�� Thomas McKean",Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERNUT TO OPERATE A FOOD ESTABLISHMENT DATE: 00M..C1,06 NAME OF FOOD ESTABLISHMENT: 'BC yalco"��;. ADDRESS OF FOOD ESTABLISHMENT cS� %*t y. S4, MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 9096 NUMBER OF SEATS: INSIDE: 10 OUTSIDE: TOTAL:. / TOTAL NUMBER OF BATHROOMS: - �► : �SC�ao-e. ANNUAL OR SEASONAL OPERATION: '�t&Aer� TYPICAL HOURS OF OPERATION MON-FRI: Sy - TO 0 DAYS CLOSED EXCLUDING HOLIDAYS (I.E.MONDAYS) S iq-' 4 SU w IF SEASONAL: APPROXIMATE DATES OF OPERATION: C /_3 f`/ O.�TO ***REIVIINDER** .SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY �OOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER °) QAHea1di\App1icafim FormsToodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO ADDRESS PHONE# IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): , LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 20049 EACH FOOD SERVICE.ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION'CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE- NAME _OF THE ESTABLISHMENT ON. THE CERTIFICATE*** /1 L. EXPIRATION DATE: �o / 2. EXPIRATION DATE: 1 / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE:_ / SIGNATUA OF AP CANT,AND DATE. . Q:\Health\Application Fc=\Foodappl.doc . °F.t�4E r TOWN OFBARNSTABLE HEALTH INSPECTOR,s Establishment Name: �Y*� � Date: w �'t Page: of OFFICE HOURS °^ PUBLIC HEALTH DIVISION 8:00-9:30A.M. _= BARNSTABLE, ` 200 MAIN STREET 3:M N.- P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 63q. �0� HYANNIS,MA02601 08-8 -FRI. �`reo Mp+, soe-ssz asaa No Reference R-Red Item : PLEASE PRINT C RLY ' FOOD ESTABLISHMENT INSPECTION REPORT Name .��\� 1 S Date C� Tvne ofjyj)&Qf Inspection , lion(s) . O e Rout Address.r�95 tom -- Risk ood Servl Re-inspection Level Retal Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer GeneraLComplaint ob Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other e% Inspector - Out: : ch violation checked requires an:explanation on the narrative page(s)and a citation of specific provision(s)violated. - lations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco Violations marked may pose an.iniminent health hazard and require immediate corrective Action as determined by the Board of Health_ 90.009(F) ❑ -590.009(E) ❑ 5 FOOD PROTECTION MANAGEMENT _ Q 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.Personnelwith'Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 1 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 . Q 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved.Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION 17120.Time As a Public Health Control ❑ &.Separation PSegregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation f&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 r� Critical(C)violations marked must be corrected Immediately. (blue&red items) Corrective Action Required: Yes Non-critical(N)violations must be corrected immediately or .- Lay, q ❑ • Overall Rating within 90 days as determined by the Board of Health. VoluntaryCompliance Employee Restriction/Exclusion Re-inspection Scheduled Emerge Sus ension C N Official Order for Correction:Based on a s the items ❑ p ❑ ❑ p g y _. p checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. '26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-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 4 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,lack of 28.Poiso ous 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=C. refrigeration,or no PIC or alternate PIC present. 29.Spec I Requirements (590.009) within 10 days of receipt of this order. 30,Oth DATE OF RE-INSPECTION: �n� 31.Du pster screened from public view Permit Posted? Y N. Grease Trap Previous Pumping Date Grease Rendered Y N Fi�f t #Seats Observed Frozen Dessert Machines: Outside Dining Y N j Signatur � Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y NDumpster Screen? Y N ���1///��V// ffh64�iro Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) - FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 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.* 19 PHF Hot and Cold Holding 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 EMPLOYEE HEALTH 590.004(F) 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance-Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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) 1 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. 15 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed . Stuffing Containing Fish,Meat,Poultry or 590.009 A D) Violations of Section 5W009 A D m cater- Chemical ( )-( ( )-( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential Flo Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk facto 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 r 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Spe Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* - 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the 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 5 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 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 590.0 Records,Creation and Retention*90.004( Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27, Physical Facility FC-6 .007 Conformance with A 6-301.11 Handwashin Cleanser,Availability 28. Poisonous or Toxic Materials FC'•7 .008 7 Approved Procedures/ g t3 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements t .009 3-502.11 Specialized Processing Methods* _ 30. Other 1 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. W1 HEALTH INSPECTOR'S dF."E TOWN OF BARNSTABLF_ Establishment Name: t ate: 10-7Page: _� of OFFICE HOURS: St, PUBLIC HEALTH DIVISION 8:00-9:30 A.M. _ 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item KAM HYANNIS,MA 02601 MON.-FRI. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 6sA�� 508-862-4644 No. Reference R-Red PLEASEPRINTCLEARLY �eJ�v- .Sa Name M M l Date Type of a of Inspection v� Routine 0 G Address �p fi)� Risk Food Servi nspection Level ear Previous Inspection - U Telephone Residential Kitchen Date: Mobile Pre-operation • Owner HACCP Y/N Temporary Suspect Illness I Person in Charge (P C) Time Caterer HACCP General Complaint C d ` In: Bed 8 Breakfast Other Inspector ) ,0/I W- Out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. 4, c Ir Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items)Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. 0p- FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands I ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases b Food Employees and PIC �. 6" a Gr r Po 9 Y ❑ 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 115. 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 ` ❑ 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. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. c N Overall Rating 23.Management and Personnel Official Order for Correction: Based on an inspection today,the items Corrective Action Required: ❑ No Yes g (FC-2)(590.003) 24.Food and Food Protection (Fc-3)(590.004) checked indicate violations of 105 CMR 590.000/federal Food Code. This report,when signed below by a Board of Health member or its Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-inspection Scheduled ❑ Emergency Suspension 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of to Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment 28. Poisonous or Toxic Materials (FC-7)(590.008) operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than 3 non-critical violations. F= 3 or more critical violations. If no critical violations observed, 29.Special Requirements (590.009) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations=F. the above address within 10 days of receipt of this order. 30. Other If no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if no hot water, 31. Dumpster screened from public view DATE OF RE-INSPECTION: C= 2 cri cal viola ns a d less than non-critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N obs rved,7 to n n ritical viol ins=C. no PIC or alternate PIC present. #Seats Observed Frozen Dessert Machines: Outside Dining Y N Inspecto .Sign ure Print: ' S vV • J C+ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N PIC' i to Print: Dumpster Screen? Y N Yoladons 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-contamination 1 590.003 A Assignment ofR nsibili * 3-302.11(Axl) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 590.003 B Demonstration ofKnowledge* t * 14 Food or Color Additives 19 PHF Hot and Cold Holding . Cooked and RTE Foods 3-501.16(B) Cold PHFs Maintained at or below 2-103.1 1 Person in charge-duties Contamination htxn Raw Ingredients 3-202.12 Additives* 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 590.004(F) 4I0/450 F* - EMPLOYEE HEALTH Other` 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment 7-101.1 1 Identifying Information-Original 140°F.* require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control I 590.003(F) Responsibility Of Food Employee Or An 3-304.11 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* Contarninabon from the Consumer 7-202.12 Conditions of Use* 590.003 G R rtin b Person in Charge* 3-306.14 A B Returned Food and Resemce of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3. 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Fes* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 I(B) Use of Pasteurized Eggs* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-80 L1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.1 1 1 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Samtizabon Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(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* Sanitization Temperatures* CONSUMER ADVISORY * 4-501.114 Chemical Sanitization-temp.,pH 22 3-603.1 1 Consumer Advisory Posted for Consumption of 3-202.14 Eggs and Milk Products,Pasteurized TIME/TEMPERATURE CONTROLS concentration and hardness.* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable Water` 16 Proper Cooking Temperatures for 5-101.11 Dnnking Water from an Approved S stem* 4-i01.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate * Utensils Clean* 3-401.11A 1 2 Pathogens.*Enea<,nrz000 590. A Bottled Water OO Eggs- I55°F 15 Sec. 4-602.11 Cleaning Frequency s Substitute for Raw Shell 590. B Water Meets Standards in 310 CMR 22.0* �uenc y of Equipment Food- 3-30213 Past Eggs-Immediate Service 145°F I Ssec• id Eggs Eggs* Contact Surfaces and Utensils` She�frslt and Fish From an Approved Source 3-401.1 I(A)(2) Comminuted Fish,Meats&Game 4-702.11 Frequency ofSanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Animals-155°F I5 sec. Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 3-201.15 Molluscan Shellfish from NSSP Listed 4-703.1 1 Methods of Sanitization-Hot Water and 3-401.1 I A 2 catering,mobile food,temporary and Chemical ( )O Ratites,Injected Meats-155°F 15 sec. Sources* 10 Proper,AdequateHandwashing * residential kitchen operations should be Game and Wlid Mushrooms Approved by * 3-401.1 1 A 3 Poultry, debited under the appropriate sections Regulatory Authority2-301.11 Clean Condition-Hands and Arms ( )O ry,Wild Game,Stuffed PHPs, Stuffing Containing Fish,Meat, above if related to foodbome illness 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure g g , interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash* Poultry or Ratites-165°F 15 sec. 3-201.17 Game Attimals : 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 5 Receiving/Condition 2401.11 Eating,Drinking or Unng Tobacco* 145°F* practices should be debited under 029- 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.15 Package hit * Mouth* Microwave 165°F' 3-101.11 Food Safe and Unadulterated` 3-301.12 Preventing Contamination When Tasting* 3-401.1 l(A)(1)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES Blue Items 23-30 6 Tags/Records:Shellstock 12 Prevention of Contarrtinatlon from Hands 17 Reheating for Hot Holding ( ) 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate to the 3-203.12.1 Shellstock Identification Maintained* Employees* 3-20 Shellstock Identification* 3-403.1 I(B) Microwave-165°F 2 Minute Standing r foodboe illness interventions and risk factors listed above,can be 13 Haridwash Facilities found in the following sections of the Food Code and 105 CA4R Tags/Records:Fish Products Time* 590.000. ConveniendyLocatedandAccessible C Commercially Processed 3-002.11 Parasite Destruction* 3-403.1I( ) ommerc yrocesse Food- Item I Good Retail Practices FC 590.000 * 5-203.11 Numbers and Capacities* 140°F* 3�02.12 Records,Creation and Retention 23. Management and Personnel FC-2 .003 590 J Labeling of Ingredients* 5-204"11 Location and Placement* 3-403.1 1(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 1HACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 Specialized Processing Methods* Devices 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 70°F Within 2 Hours and From 70°F 28. Poisonous or Toxic Materials FC-7 .008 8-103.12 Conformance with Approved Procedures* 6 301.12 Hand Drying Provision to 41°F/451F Within 4 Hours.• 29. Special Requirements 009 3-501.14(B) Cooling PHFs Made From Ambient Sswrc°,,,,war."2ne Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 1999 Food Code m 105 CMR 590.000. •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r ' - 7 aft TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: b L - ,j I v vl 'df MTh /1, Date: id "'4,Page:,�_of o G HOURS PUBLIC HEALTH DIVISION 8:00:00-9:30A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. MASS. MON.-FRS. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A +679• .e HYANNIS,MA 02601 rFU MP'�p 508-862�644 No Reference - R-Red.Item � PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT - Name_ / n i Date e o o Inspection jlv- - O s e 1 P Address Risk o d e e Re-inspection I . Level Previous Inspection �t) pq 0 �jj i7 Telephone . Residential Kitchen Date: Mobile Pre-operation - (� Kk f Owner .. HACCP Y/N Temporary Suspect Illness Caterer General Complaint !A C - 7 Person in Charge(PIC) Time Bed&Breakfast HACCP• Other J . . .. In: . Inspector Out: r » Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated: , Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco Violations marked may,pose an imminent health hazard and require immediate corrective Action as determined by the Board.of Health.• 590.009(E) ❑ 590.009(F) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands !...PIC Assigned/Knowled eable/Duties ❑ 9 9 ❑ 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 Q 16.Cooking Temperatures ❑ 5:Receiving/Condition ❑ 17.Reheating Q 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/Se' regation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE *OPULATIOS(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)Non-critical(N)violations must be corrected immediatelyor �� Corrective Action Required: No ❑ Yes. I Ir,� 'within 90 days as determined by the Board of Health. Overall Rating_ vJ `J`"\ ❑ 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. ❑ Embargo.. ❑ Emergency Closure ❑ Voluntary Disposal ' ❑.Other. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an'order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. If no critical violations observed, 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 Mess than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (F,C-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-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 cr' I violati ns and less an 4 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,lack of be in writing and submitted to the Board of Health at the above address refrigeration,or no PIC or alternate PIC present. 28.Poisonous or Toxic Materials (FC-7)(590.008) Iations b ed,7 to 8 -critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins ector's Sig toe in. 31.Dumpster screened from public view 20 L/t j 5;/7 Permit Posted? Y N. Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P1 gnature Pr Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N L ���JJJ ^ram.. .-...F _� -_._.. _ -.,..� _ _...��•r.-�r.-.- ^.'�,,�...-- r.� ._�„cr,r,._. __ _ -.,. .. ..°'rx+` .s _ ... _� _ _. , __ _ �•tY `"q'."y" r+- - � ..-n.-F �'1r's^.7tr".._w""ti'A'�v�n.ih$7"y'-..�-'Y�v'�,�-� '•a!- .. -a.+ -�.-..� n v � r 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* g 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.* 19 PHF Hot and Cold Holding g - 3-302.14 Protection from Unapproved Additives* Contamination from 15 Poisonous or Toxic Substances Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A)- Food Protection 590.003 Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * (� P ty3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions - . Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food And 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* - Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EJ/eawv 1/1/2001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f cesSanitizationquof Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By ( 3-401.11 C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* - 17. Reheating for Hot Holding 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating togood retail 3-201.17 Game Animals* 11 Good Hygienic Practices practices should be debited under#29-Special ng Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the.Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 5 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 18 Handwashin 9 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 4.11 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* 5-20 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5, .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 590.004(J) 9 9 27. Physical Facility FC-6 .007 Conformance with A 6-301.11 Handwashin Cleanser,Availability 28. Poisonous or Toxic Materials T Approved Procedures/ 8 tY 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. � C �� j�� '�M.'-��p�,.: .-C-� F! -^^f 1"'-.2 rrtlP� """:.-"a ��.�e�-.. ^'�:..s S" -.n.�..�..d,..,.,.z.�, -"�'~"�"" .,.w.„�.:v ' '+�...,i.-..:...�,�.^'^^.�.r"'Ay,4-+'.."'^5'"•"-�''`@ �'t+w�u�.�'^.�� a,�m.,._:tr�."�'^�„ +� «� .� - ''"^^'-.. .�...,... _ _ _ ._ .,. - r.... _ .�. ... _ .. - _ _ ,. ... ���...._.,... __:.;- �.�.....,:r,.c:a.:,.�...�..�:.,.,.:�.a,...,�a,.��,m:;a�:.,_w�. ;.,:�_:�...�.....,.t�_..���.�:...:._.s.�,.,. .iz.;�.:�:...::�.�i,.�i�,,..���_�,.,,.,t...,�.�.....y.._�M...�..�.y_w��,..,�__�.y-_�.��..��:.N:w�.:e..-..,•.�w-� - — ------ — '--'� -- � _- s 1 Fss............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........0 F� ..� .``................................................ ,X.V.Ptiratinn -for m,ivnoal luorkii Tnnitrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst �----- ...... .. . .. .... .......)212 Z V 6 e ocation-Ad ss 7 1 Ot - ...- wner Address a •-•............. � ----------------------------- Insf er Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.. .. ____Expansion Attic ( ) Garbage Grinder ( ) �,� , - p, Other—Type of Building . ........... ............. No. of persons.....__.--------- Showers ( ) — Cafeteria ( ) dOther fi_ a es "- W Design Flow-------- .................. .. .gallons per person per day. Total daily, flow................... .....-................gallons. WSeptic Tank—Liquid capacity- d-gallons Length................ Width................ Diameter.........__..._ Depth.__..._........ x Disposal Trench—No............. ....... Width------------ed... Total Length...._-_.-.--_----- Total leaching area-------------.------sq. ft. Seepage Pit No....I.............. Diameter./ �f�- --- Depth below inlet-_---_--.--__-_.-_ Total leaching area------------------sq. fi. z Other Distribution box ( ) Dosing tank ( ) '-, Percolation Test Results Performed bY.......................................................................... Date.---•---------------------------------- aTest Pit No. 1................minutes per inch Depth of "Pest Pit-----------------... Depth to ground water_..._...._......._..__.. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............._......... 9 ------------------- -------------•••---••-•..._.........•••-•-•---••-----------••-•-••......--•-•---....................................................... ODescription of Soil----------------- -------------------------------------•---•-------...------------------------------------------------------------------------------------------------- x --------- --- W Q .. x -- ,., - -- V N tur of P.epairs or ter ons A Answer wh air . ' b4e .. .- . - --- -- ........ .... . I? A reement. g The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned furtl 'r agrees not to place the system in operation until a Certificate of Compliance has ee issuedly the boar o h �i i/ Sign -- ---��--� �L.� �.- ---�- -- --- N���---------• ----- ----'"Date ..-- .. Application^Approved BY ....--- ..................................................................... Date Application Disapproved for the following reasons--------------------------------------------------------'-----------------------------.....---••-----•---------- --•-•--------•-------•-•......-•--•--•••-•�-•••-----------•--•••••----•--•--•---•-•--•-••-••----•----------------------------------------------• -------------------------------------------------- � Date 74 Permit No. ... Issued = �� =`y = ----- Date No.......31 Fmc............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD ,PF HEALTH /.0 ........................................................ Appliration -for Bhipaiial Works Tonstrurtion Vautil Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst .......... .. . .....C�.. ..............)..................../ .................. ----io dd s _7 ------- ...... .......... .. ........ . cation A s 1 ­1� 0 ...... .. .. ... ... .......... . .... ..... ................. ... .. er Address Inst er Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms 'AY --Expansion Attic Garbage Grinder ( ) Other—Type of Building f�._Aol- ------------- No. of persons.....__.______.__ Showers Cafeteria ( ) PL4 : - Other j#ges ---------- .................................................... -------- ---------------------------------------------------------------------- Design Flow..._.......: ----- gallons per person per day. Total daily flow_________-��T ......................gallons. 9 Septic Tank—Liquid capacity.A.5--a- ..gallons Length................ Width.._.........._.. Diameter__..._..___._.. Depth._....___._..... Disposal Trench—No- -------------------- Width.? ?(---------M--- Total Length__...__.___.....__.. Total leaching area--------------------*sq. f t. r- _!�'Seepage Pit No..../-------------- Diamet e / -------- -- Depth below inlet_........_._._..._.. Total leaching area------------------Sq. it. Other Distribution box Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit..._____._______-_-- Depth to ground water...____-___.__.._.__._.. L� Test Pit No. 2----_----------minutes per inch Depth of Test Pit.__...._............ Depth to ground water...._....__.____..__.... ...............I................................................................................................................ ---------------------------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------- x ................................................................................................................. U .................................. ----------------------------------------------------- 11 ---------------- -----­--------------- ----------------------------------------------------------------------------t ------ —_------- ----- U N tu�r of R/Ze airr��;e.,r Ob ns/-7 Answer wh oh ble. ___11n11 S o --j------ - --­------------------------------------------------------ ------- greement �� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned furt) agrees not to place the system in operation until a Certificate of Compliance hpasee issued A the boar he ign Date ApplicationApproved By-------- ............................................. ............................ ---------------------------------------- Date Application Disapproved for the following reasons:.--------------------------------------------------------------------------------------------------------------- ................................. ------------------------------------------- ............................................................................---------------------------------------------- Date Permit ... ...................................... .................No.........�Z7..6 Issued-------- Date THE COMMONWEALTH OF MASSACHUSETTS t, BOARD OF HEALTH hr ..................7DA l7...OF....... ....... ............. ............ ........................... IT Qwrtifirate of Tourphattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed X) or Repaired by.....................# j ------------------------------* -------------------------------------------------------------------------------------------------- at.... /-0 6L- 14 4 0 & Installer ...................................... ---------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Codes as described in the application for Disposal Works Construction Permit No...__._ -------------------- dated-------- ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . ..... . ........ ... OF.......... ...... . . . ........ t No........V .... FEE.................. Permission ys hereby granted----_------------ ------ &.............. -es--------------------------------- ..................... to Construct or Repair ar� Individual Sewage Disposal System 1 0 .... at No-------------4-C. 4mp�--------- - ..........1// ----------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No._.X?i----- Dated___,w4 ............. -------------------------------------------------- ------.-.-4 e . ... ..................... G 3.176 - i1" Boar f Health DATE. -------- .... ------ . FORM 1255 H0813S & WARREN. INC.. PUBLISHERS j • • BA BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE G BARNSTABLE, MASSACHUSETTS 02630 0 o ' �lA 55 PHONE: 362-2511 EXT.330 LAB 337 CLINIC 340 April 26, 1989 Mr. Harold Renzi, Supervisor Buildings and Grounds Maintenance Barnstable Public Schools 835 Falmouth Road Hyannis, MA 02601 Dear Mr. Renzi: Enclosed are the lead in drinking water results for the Martstons Mills East Elementary School. and a copy of the Lead in Water Advisory. Of the five locations sampled, four had lead levels above the proposed EPA recommended limit of 20 ppb. The first area of concern is the sink in the kitchen dishroom. This site had a lead level of 55 ppb on the first draw, a level above the current EPA recommended limit of 50 ppb. The five minute flush sample and the sample after A-3 had lead levels of 26 ppb and 25 ppb respectively. Both samples were above the proposed EPA recommended limit. The second area of concern is the two bay kitchen sink by the dish room entrance. This sink had a first draw lead level of 56 ppb, a level higher than the current EPA recommended limit. The last two areas of concern were the water cooler by the custodians office and the right sink in room 14. These locations had first draw lead levels of 26 ppb and 94 ppb respectively. The cooler was above the proposed EPA recommended limit and the sink in room 14 was above the current EPA recommended limit. The Massachusetts Department of Public Health and this Department recommend that for those schools with one or more samples above 20 ppb, all water bubblers, coolers and sinks used for food preparation be flushed for two minutes each morning. Additional recommendations are in the Lead in Water Advisory. These samples were also analyzed for copper. This data may be utilized for any corrosion control programs. If there are any questions regarding these results please don 't hesitate to call. Sincerely, Sean M. O'Brien xc: Thomas McKean - Barnstable BOH Registered Sanitarian Alfred Menesale - Marstons Mills Elementary Donald Rugg - Centerville-Osterville Water Co. BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 v MAss ° DRINKING WATER ANALYSIS PHONE:362-2511 ,_ --- -- EXT. 330 LAB 337 METALS ANALYSIS - PUBLIC WATER SUPPLIES CLINIC 340 CLIENT: Marstons Mills East Elementary School COLLECTOR: Sean O'Brien . • . . • MAILING ADDRESS: Old East Osterville Road AFFILIATION: BCHED Marstons Mills , MA 02648 DATE OF COLLECTION- 4/7/89 DATE OF ANALYSIS: 4/7/89 SAMPLE LOCATION. Marstons Mills East Elementary School SAMPLE PARAMETER RESULTS RECOMMENDED LIMITS LEAD(ppb) COPPER(ppm) LEAD(ppb) COPPER(ppm A Sink in Kitchen Dish Room Al First Draw 55 7.6 50 1.0 A2 Temperature Change <20 3.8 A3 5 Min. Flush 26 2.6 A4 After 5 Min. Flush 25 4.2 B Kitchen Sink Floor (2Bay). B1 First Draw 56 9.6 B2 2 Min. Flush 20 7.2 C Water Cooler by Custodians Office C1 First Draw 26 7.6 C2 2 Min. Flush <20 9.9 D Bubbler by Room 9 D1 First Draw <20 8.4 D2 2 Min. Flush <20 7.4 E Sink Room 14 right E1 First Draw 94 9.0 E2 2 Min. Flush <20 6.2 E3 10 Min. Flush <20 7.0 REMARKS: cc: Barnstable Board of Health cc: 4 BaR ems,, BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE O BARNSTABLE, MASSACHUSETTS 02630 V 0 0 A S S PHONE:362-2511 EXT. 330 LAB 337 CLINIC 340 LEAD IN WATER ADVISORY RECOMMENDATIONS The data in this survey provide a basis for applying recommendations of EPA and the Massachusetts Department of Quality Engineering with regard to management of lead in school drinking water. This report provides interim recommendations that can be implemented immediately by all schools to reduce exposure to lead from drinking water. School Superintendents should contact their local health agents and local water supplier for assistance. The Massachusetts Department of Public Health will provide additional advice and guidance as needed, as will the Barnstable County Health and Environmental Department. Surveyed Schools Those schools that had lead levels below 20 ug/L: # Use of bubblers, faucets and sinks may continue as usual . . Only cold water taps should be used for cooking, beverages and food preparation. # Develop a plumbing profile of your schools (detailed information will be mailed out by the Department of Education) . # Further testing may be necessary depending on the findings from the plumbing profile. Those schools that had one or more samples above 20 ug/L: Flush water bubblers and coolers, and sinks used for food preparation each morning for two minutes. A more detailed flushing protocol that is recommended by EPA will be sent to all schools. # Take out of service any bubbler, cooler or sink that had levels that did not fall below 20 ug/L after flushing as indicated in the survey. Other bubblers, sinks and coolers may be used. � cr • (Lead in Water Advisory continued - Page 2) # Coolers and bubblersthat had lead levels above 100 ug/L at first flush should be taken out of service, even if the lead levels are reduced below 20 ug/L after one flushing. Only cold water taps should be used for food preparation. # Develop a plumbing profile of the school. Conduct further testing if indicated by the plumbing profile. Schools Not Surveyed Schools that were not surveyed should adopt the following interim measures until they can complete a plumbing survey and have testing done for . lead in water. # Begin now to flush for two minutes at bubblers, coolers and sinks each morning. Follow EPA flushing protocol that will be sent to each school district within the next two weeks. # Use cold water taps for all food preparation. # Develop a plumbing profile. # Test water at a minimum number of sites as in the statewide survey, and at other sites as indicated by the plumbing profile. 0 BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE a0 BARNSTABLE, MASSACHUSETTS 02630 o .AIA, DRINKING WATER ANALYSIS PHONE:38Y-2b11 _: -- --------- - — EXT. 330 LAB 337 METALS ANALYSIS - PUBLIC WATER SUPPLIES CLINIC340 CLIENT: Marstons Mills Elementary School COLLECTOR: Sean M. O'Brien MAILING ADDRESS: 2095 Main Street AFFILIATION: BCHED Marstons Mills ,MA 02648 DATE OF COLLECTION. 4,/4/89 7:00 a:m: DATE OF ANALYSIS: 4/4../89 SAMPLE LOCATION: Marstons Mills Elementary School SAMPLE PARAMETER RESULTS RECOMMENDED LIMITS LEAD(ppb) COPPER(ppm) LEAD(ppb) COPPER(ppm) A Sink in Custodians Office Al First Draw <20 2.4 50 1.0 A2 Temperature Change <20 0.3 A3 5 Min. Flush <20 0.2 A4 After 5 Min. Flush <20 0.2 B Sink Front Kitchen Wall B1 First Draw <20 2.5 _ B2 2 Min. Flush <20 0.2 C Bubbler in Gym C1 First Draw <20 0.4 C2 2 Min. Flush <20 0.2 D Cooler by Front Entrance D1 First Draw 39 2. 1 D2 2 Min. Flush <20 1 .8 E Boys Room Sink Portable Class Room E1 First Draw <20 2.6 E2 2 Min. Flush <20 1.9 E3 10 Min. Flush <20 0.8 ANALYST REMARKS: cc: Barnstable Board of Health cc: • /,f-Cy�g Item No. In the spa low describe all violations checked Page /of I 6 l ��7 a�� G!_7!�5�Y a-1�` ! �i4`' i//,.Sv ,/,pia t',!�•-7 FOOD ESTABLISHMENT INSPECTION REPORT ,.�s� ,.� �"9`�'" Jill Establishment Name / '! a4�oee� 9 j� o s^" Date/q�/,J �,`,q�r-7'1- f%p►to �vA ,r ' /0,,s Address /'!, r�r�. - Time: In Out .�"'r '40 Telephone -er T'v Type of Establishment: purpose. Food Service 4 Owners Name � Retail Food Routine Follow-up r ' Residential Kitchen W Person in Charge V ofiv'w , Complaint f /,..f`y.A" Mobile Unit 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. N C Food Sanitary Facilities N C 1. Food Supply .002 29. Water Source .015 <7 2. Food Containers .002 30. Sewage .016 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018&.019 3. PHF Temperatures .004 33. Insects/Rodents .021 f--" 4. Facilities..Hot&Cold Storage .004 34. Plumbing .017 5. PHF Re-servicje .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. PHF's thawed..cooked&cooled .005 40. Pesticide/Rode nticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 Personnel 42. Walls,Ceiling .022 13. Employee Infections .008 y 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& 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 Inspected by' a, � ��G�G��/yf�I/fa Received by I Massachusetts Department of Public Health Division of Food & Drugs FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Date- �. Address U - Time: In Out hi Telephone n '�.,� �`,*a Type of Establishment: Purpose: Owner's Name Food Service Routine %' Retail Food Follow-up Person In Charge '��`� 751" Residential Kitchen Complaint Mobile Unit Investigation Inspector's Name p Temporary Food Service 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. N C Food WT Sanitary Facilities N C 1V 1. Food Supply 4 .002M 29. Water Source .015 2. Food Containers 002 30. Sewage .016 4 31. Cross-Connections .017 4 Food Protection 777 32. Toilets/Handwashing .018 8 .019 2 3. PHF Temperatures .004 : 33. Insects/Rodents .021 2 4. Facilities. Hot 8 Cold Storage 4 .004 34, Plumbing 017 1 5. PHF Re-service 4 1.006 ;:>' 35. Toilet Rooms 018 6. Spoiled/Damaged Foods 1.003 36. Handwashing Areas .019 7. Food Protected 4 .003 37. Garbage/Refuse .020 8. Food Thermometers 1 .004 38. Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings .021 10. PHF's thawed, cooked 8 cooled 4 .005 40. Pesticide/Rodenticide Application .021 11. Food Handling 2 .005 Li 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 11 Personnel 42. Walls, Ceiling ..022 i.I 13. Employee Infections 4 .008 43. Lighting .023 i 1 14. Employee Hygiene 4 .000 " 44. Ventilation .024 �! 15. Employee Clothing 1 .01 ! 45. Dressing Rooms 025 1 �. y Equipment& Utensils r7 Other 16. Equipment/Utensil Clean 8 Sanitized 4 .013 46. Toxics .026 4 '17. Food Contact Surfaces 1 .013 47. Premises .027 1 18. Non-Food Contact Surfaces 1 .013 48. Living Areas .027 1 19. Food Contact Surfaces Clean 2 .013 49. Linen .027 20. Non-Food Contact Surfaces Clean 1 013 50. Pets 027 1 21 Wiping Cloths 1 013 . 51. Bulk Foods .03111171 22. Dish/Warewashing Facilities 1 013 52. Salad Bars .032 Lj L2 23. Pre-Scraped, Soaked 1 .013 ti 24. Wash/Rinse Water 013 No-of 13 Critical Items Violated t 25. Thermometers/Test Kits 1 .013 These items require immediate attention. 26. Equipment/Utensil Storage 1 .014 27. Single Service Articles 014 Received by: ,-- Inspected by: ti 28 Single Service Re-Use 012 V J s 0 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 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/Warp washing 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 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, 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 48 .Living/sleeping quarters and laundry separate 49 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 Establishment Name Date c Address w 8 Page of Item No. In the space below describe all violations checked on front page. c f jI 6 r Discussion with Management 13 CRITICAL FOOD HANDLING VIOLATIONS 1. Food from an unapproved or unknown ,source or -food which is or may be adulterated, contaminated or otherwise unfit for human consumption is found in a food establishment. 2. Potentially hazardous food that is held longer than necessary for preparation or service at a temperature which is greater than 450 F (=70 C) (in the case of cold food) or less than 1400 F (600C) (in the case of hot food) . 3. The food establishment's facilities are insufficient to maintain product temperature. 4. Potentially hazardous food or unwrapped food that has been served to customers is re-served unless such re-service is allowed under section 105 CMR 590.006(G). 5. A person infected with a communicable disease that can be transmitted by food is working as a food handler in a food establishment. 6. A person not practicing strict standards of cleanliness and personal hygiene which may result in the potential transmission of illness through food is employed in a food establishment. 7. Equipment, utensils and food-contact surfaces are not cleaned and sanitized effectively and may contaminate ' food during preparation, storage or service. 8. Sewage or liquid waste is not disposed of in an approved and sanitary manner, or the sewage or liquid waste contaminates 'or may contaminate any food areas used to store or prepare food, or any areas frequented by customers or employees. 9. Toilets and facilities for washing hands are not provided, properly installed or designed, accessible or convenient. 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 articles and/or bottled water from an approved source. 11. A defect exists in the system supplying potable water that may result in the contamination of the water. 12. Insects, rodents or other animals are present on the premises (unless allowed by Section 105 CMR 590.027(F)(3)) . 13. Toxic items are improperly labeled, stored or used. 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 noti.ce .to the permit holder constitute a critical violation. sa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT Z SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 V ° �lASs ° PHONE:362-2511 EXT.330 LAB 337 CLINIC 340 May 1, 1989 Mr. Harold Renzi, Supervisor Buildings & Grounds Maintenance Barnstable Public Schools 835 Falmouth Road Hyannis, MA 02601 Dear Mr. Renzi: Enclosed are the lead in drinking water results for the Marstons Mills Elementary School on route 28 and a copy of the Lead in Water Advisory. Of the five locations sampled in this school, only one site had an elevated lead level. The cooler in the entrance hallway had a first draw lead level of 39 ppb. Though this level is below the current EPA recommended limit of 50 ppb, it is above the proposed EPA recommended limit of 20 ppb. This Department and the Department of Public Health recommend that for those schools with one or more samples above 20 ppb flushing all water bubblers, coolers, and sinks used for food preparation each morning for two minutes. These samples were also analyzed for copper. This data may be utilized by the Water Department for any corrosion control programs. If there are any questions regarding these results, please don't hesitate to call me. Sincerely, f /7 Sean M. O'Brilen Registered Sanitarian xc: Thomas McKean, Director Barnstable Health Dept. Jane Sheckells, Principal Cotuit-Marstons Mills Schools Donald Rugg, Superintendent Centerville-Osterville Water Dept. I w BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE C" BARNSTABLE, MASSACHUSETTS 02630 PHONE:362.2511 IA S DRINKING WATER ANALYSIS __ ------- --- --- ---- ---- EXT. 330 LAB 337 METALS ANALYSIS - PUBLIC WATER SUPPLIES CLINIC 340 CLIENT: Marstons Mills Elementary School COLLECTOR: Sean M. O'Brien MAILING ADDRESS: 2095 Main Street AFFILIATION: BCHED Marstons Mills ,MA 02648 DATE OF COLLECTION: 4J_4/89 7:00 a.m. DATE OF ANALYSIS: 4/4. /89 SAMPLE LOCATION: Marstons Mills Elementary School SAMPLE PARAMETER RESULTS RECOMMENDED LIMITS LEAD(ppb) COPPER(ppm) LEAD(ppb) COPPER(ppm) A Sink in Custodians Office Al First Draw <20 2.4 50 1.0 A2 Temperature Change <20 0.3 A3 5 Min. Flush <20 0.2 A4 After 5 Min. Flush <20 0.2 B Sink Front Kitchen Wall B1 First Draw <20 2.5 B2 2 Min. Flush <20 0.2 C Bubbler in Gym C1 First Draw <20 0.4 C2 2 Min. Flush <20 0.2 D . Cooler by Front Entrance D1 First Draw 39 2.1 D2 2 Min. Flush <20 1 .8 E Boys Room Sink Portable Class Room E1 First Draw <20 2.6 E2 2 Min. Flush <20 1 .9 E3 10 Min. Flush <20 0.8 11 ANALYST REMARKS: cc: Barnstable Board of Health cc: BARNSTABLE COUNTY HEALTH AND ENVIRONMEN L DEPARTMENT —A 3 SUPERIOR COURT HOUSE z p BARNSTABLE, MASSACHUSETTS 02630 v AIAss DRINKING WATER ANALYSIS PHONE:362-2511 ._ EXT. 330 LAB 337 METALS ANALYSIS - PUBLIC WATER SUPPLIES CLINIC340 CLIENT: Marstons Mills East Elementary School COLLECTOR: Sean O'Brien MAILING ADDRESS: a F�LI BCHED Marstons Mills , MA 02648 DATE OF COLLECTION: 4/7/89 DATE OF ANALYSIS: 4/7/89 SAMPLE LOCATION. Marstons Mills East Elementary School SAMPLE PARAMETER RESULTS RECOMMENDED LIMITS LEAD(ppb) COPPER(ppm) LEAD(ppb) COPPER(ppm) A Sink in Kitchen Dish Room Al First Draw 55 7.6 50 1.0 A2 Temperature Change <20 3.8 A3 5 Min. Flush 26 2.6 A4 After 5 Min. Flush 25 4.2 B Kitchen Sink Floor (2Bay) B1 First Draw 56 9.6 B2 2 Min. Flush 20 7.2 C Water Cooler by Custodians Office C1 First Draw 26 7.6 C2 2 Min. Flush <20 9.9 D Bubbler by Room 9 D1 First Draw <20 8.4 D2- 2 Min. Flush 1120 7.4 E Sink Room 14 right El First Draw 94 9.0 E2 2 Min. Flush <20 6.2 E3 10 Min. Flush <20 7.0 REMARKS: cc: Barnstable Board of Health cc: Centerville-Osterville-Marstons Mills Water Department P.O.BOX 369- 1138 MAIN STREET OSTERVILLE,MASSACHUSETTS 02655 %,�F- o Sr�4L OFFICE OF WATER BOARD OF WATER COMMISSIONERS �i DEPT. WATER SUPERINTENDENT q TEL.No.508-428-6691 �STONS�� FAX No.508-428-3508 LEAD AND COPPER COMPLIANCE SAMPLING PROGRAM SCHOOL RESULTS City/Town:Barnstable PWS Name:C-O-MM Water Department PWS ID#:4020002 Date:October 17 2007 Naine.of School:Vlarstons Mills Elementary Schools Sampling Address: 2095 Main Street,Marstons Mills,MA 02648 Date Sample Collected 09/12/2007 Sampling period: Third quarter 2007 Name of Sample Provider:COMM Telephone No:508-428-6691 Email address:ccrocker@commfiredisrict.com Dear School Superintendent: Thank you very much for your participation in the C-O-MM Water Department Lead and Copper Sampling Program. The lead and copper levels in your school water samples are as follows: KITCHEN: LEAD: 0.017 milligrams per liter(mg/1) COPPER: .099 mg/l FOUNTAIN: LEAD: 0.0032 milligrams per liter(mg/1) COPPER: 1_5 mg/1 For schools,the.Massachusetts,Department of Environmental Protection,Drinking Water Program(MassDEP/DWP)Action Level for Lead in school drinking water is 0.015 mg/l.The MassDEP/DWP action level is more stringent than the federal Lead Action Level.The standard for.Copper is 1.3.mg/l. Even though the lead level in the water at your school is above the MassDEP/DWP Lead Action Level,C-O-MM Water Department recommends,the following tips to keep any potential lead out of the water in your school: • Most importantly—Daily before the school is open,please flush all the taps and drinking water fountains at your school until after the water feels cold. The flushing of the taps ensures the best quality water.The water in the pipe in the street has no lead. c%' • Never use hot water from the faucet for drinking or cooking. • Never boil water to remove lead.Boiling water for an extended time may make the lead more concentrated. • If your results were above the lead or copper action Level,follow the guidance in MassDEP/DVVT uocutnecit titicu "Recommended Remediation Actions to Reduce or Eliminate Lead Exposure from Drinking Water in Schools".A copy of this document is located at the website address listed below. If you have any questions regarding lead or copper in drinking water or your sampling results,please feel free to contact:Craig Crocker at 508428-6691. For more information on lead or copper in school drinking water visit the following website: http://Ni,w�v.mass.gov/dep/water/drinkin¢/leadothe.htm. cc:MassDEP regional Office . PWS File . http://wwl,,.epa.gov/safewater/contaminants/index.html k Last updated on Monday, September 10th, 2007. Drinking 'water Contaminants 43s- �rG`a You are here: EPA Home Water Safewater Drinking Water-Contaminants On this page National Primary Drinking Water Regulations • List of Drinking Water Contaminants & their MCLs National Secondary Drinking Water Regulations • List of Secondary Drinking Water Regulations r " • Unregulated Contaminants �aY National Primary Drinking Water Regulations y / a�, ail r National Primary Drinking Water Regulations (NPDWRs or primary standards) are legally enforceable standards that apply to public water systems. Primary standards protect public health by limiting the levels of contaminants in drinking water. Visit the list of regulated contaminants with links for more details. • List of Contaminants & their Maximum Contaminant Level (MCLs) • Setting Standards for Safe Drinking Water to learn about EPA's standard-setting process • EPA's Regulated Contaminant Timeline (PDF_ (1 pp, 86 K ) (About PDF) • National Primary Drinking Water Regulations- The complete regulations regarding these contaminants availible from the Code of Federal Regulations Website List of Contaminants & their MCLs Information on this section • Microorganisms Alphabetical List (PDF) • Disinfectants (6 pp, 396 K) (About PDF) • Disinfection Byproducts EPA 816-F-03-016, June • Inorganic Chemicals 2003 • Organic Chemicals The links provided below • Radionuclides are to either Consumer Fact Sheet, Rule Implementation web sites, or PDF files. (About PDF) Microorganisms MCL or Sources of MCLG1 i Potential Health Effects from Contaminant (mg/L) TT1 Contaminant in 2 (mg/L) Ingestion of Water Drinking Water 2 Cryptosporidium zero 77 3 (pdf file) Gastrointestinal illness (e.g., Human and fecal animal diarrhea, vomiting, cramps) waste Giardia lamblia zero 1 T Gastrointestinal illness (e.g., Human and animal fecal diarrhea, vomiting, cramps) waste r Heterotrophic plate n/a TT3 count HPC has no health effects; it is an HPC measures a range of analytic method used to measure bacteria that are the variety of bacteria that are naturally present in the common in water. The lower the environment concentration of bacteria in drinking water, the better maintained the water system is. Legionella zero TT3 Legionnaire's Disease, a type of Found naturally in water; pneumonia multiplies in heating systems Total Coliforms zero 5.0%4 (including fecal Not a health threat in itself; it is Coliforms are naturally coliform and E. used to indicate whether other present in the Cvii) potentially harmful bacteria may be environment; as well as presents feces; fecal coliforms and E. coii only come from human and animal fecal waste. ................................ ..... __ ........ .......... ........ ......... Turbidity n/a TT3 Turbidity is a measure of the Soil runoff cloudiness of water. It is used to indicate water quality and filtration effectiveness (e.g., whether disease-causing organisms are present). Higher turbidity levels are often associated with higher levels of disease-causing microorganisms such as viruses, parasites and some bacteria. These organisms can cause symptoms such as nausea, cramps, diarrhea, and associated headaches. Viruses (enteric) zero TT3 Gastrointestinal illness (e.g., Human and animal fecal diarrhea, vomiting, cramps) waste Disinfection Byproducts MCL or MCLG1 1 Potential Health Effects from Sources of Contaminant (mg/L) TT— Contaminant in 2 (mg/L) Ingestion of Water Drinking Water z Bromate zero 0.010 Increased risk of cancer Byproduct of drinking water disinfection Chlorite 0.8 1.0 Anemia; infants & young children: Byproduct of drinking nervous system effects water disinfection Haloacetic acids n/a5 0.060 HAA5) Increased risk of cancer Byproduct of drinking water disinfection i Total noneZ 0.10 Trihalomethanes ---------- ---------- Liver, kidneyor central nervous Byproduct yproduct of drinking (TTHMs) n/a6 0.080 system problems; increased risk of water disinfection cancer Disinfectants Contaminant MRDLG-1 MRDLI Potential Health Effects Sources of Contaminant 2 2 from Ingestion of Water in (mg/L) (mg/L) Drinking g Water i Chloramines as MRDLG=41 MRDL=4.01 Cl2.1 Eye/nose irritation; stomach Water additive used to discomfort, anemia control microbes Chlorine as MRDLG=41 MRDL=4.01 CI.) Eye/nose irritation; stomach Water additive used to discomfort control microbes Chlorine dioxide MRDLG=0.81 MRDL=0.81 as CIO.) Anemia; infants & young Water additive used to children: nervous system control microbes effects Inorganic Chemicals MCLG1 i ` Potential Health Effects Sources of Contaminant in Contaminant m MCL or TT— ( 9/L) (mg/L)? from Ingestion of Water Drinking Water i Antimony_ 0.006 0.006 Increase in blood cholesterol; Discharge from petroleum decrease in blood sugar refineries; fire retardants; ceramics; electronics; solder Arsenic 02 0.010 as of Skin damage or problems with Erosion of natural deposits; 01/23/06 circulatory systems, and may runoff from orchards, runoff have increased risk of getting from glass & cancer electron icsproduction wastes Asbestos 7 7 MFL (fiber >10 million Increased risk of developing Decay of asbestos cement in micrometers) fibers benign intestinal of per liter g polyps water mains; erosion of natural deposits Bal.rium 2 2 Increase in blood pressure Discharge of drilling wastes; discharge from metal refineries; erosion of natural deposits . .... ........ ........ ..... _.._ __.... ......... ......... _. Beryllium 0.004 0.004 Intestinal lesions Discharge from metal refineries and coal-burning factories; discharge from electrical, aerospace, and defense industries ......... ......... ......... .. Cadmium 0.005 0.005 Kidney damage Corrosion of galvanized pipes; erosion of natural deposits; discharge from metal refineries; runoff from waste batteries and paints Chiromium total 0.1 0.1 Allergic dermatitis Discharge from steel and pulp mills; erosion of natural deposits ......... ......... ......... ...... _ ....... .............. ......... Copper 1.3 TT8; Action Short term exposure: Corrosion of household Level=1.3 Gastrointestinal distress plumbing systems; erosion of natural deposits Long term exposure: Liver.or kidney damage People with Wilson's Disease should consult their personal doctor if the amount of copper in their water exceeds the action level Cyanide (as free 0.2 0.2 cyanide] Nerve damage or thyroid Discharge from steel/metal problems factories; discharge from plastic and fertilizer factories Fluoride 4„0 4.0 Bone disease (pain and Water additive which tenderness of the bones); promotes strong teeth; Children may get mottled teeth erosion of natural deposits; discharge from fertilizer and aluminum factories Lead zero TT-1; Action Infants and children: Delays in Corrosion of household Level=0.015 physical or mental plumbing systems; erosion of development; children could natural deposits show slight deficits in attention span and learning abilities Adults: Kidney problems; high blood pressure Mercury_ 0.002 0.002 (inorganic Kidney damage Erosion of natural deposits; discharge from refineries and factories; runoff from landfills and croplands Nitrate 10 10 (measured as Infants below the age of six Runoff from fertilizer use; Nitrogen)_ months who drink water leaching from septic tanks, containing nitrate in excess of sewage; erosion of natural the MCL could become deposits seriously ill and, if untreated, may die. Symptoms include shortness of breath and blue- baby syndrome. Nitrite 1 1 measured as Nitrogen)- Infants below the age of six Runoff from fertilizer use; months who drink water leaching from septic tanks, containing nitrite in excess of sewage; erosion of natural the MCL could become deposits seriously ill and, if untreated, may die. Symptoms include shortness of breath and blue- baby syndrome. _ _ ......... ........ Selenium 0.05 0.05 Hair or fingernail loss; Discharge from petroleum numbness in fingers or toes; refineries; erosion of natural circulatory problems deposits; discharge from mines Thallium 0.0005 0.002 Hair loss; changes in blood; Leaching from ore-processing kidney, intestine, or liver sites; discharge from problems electronics, glass, and drug factories Organic Chemicals 1 MCL or Sources of MCLG1 Contaminant m L Potential Health Effects Contaminant in i from Ingestion of Water ( 2 ) (mg/L)Z g Drinking Water Acrylamide zero TT9 Nervous system or blood Added to water during problems; increased risk of sewage/wastewater cancer treatment Alachlor zero 0.002 Eye, liver, kidney or spleen Runoff from herbicide problems; anemia; increased used on row crops risk of cancer Atrazine 0.003 0.003 Cardiovascular system or Runoff from herbicide reproductive problems used on row crops Benzene zero 0.005 Anemia; decrease in blood Discharge from platelets; increased risk of factories; leaching cancer from gas storage tanks and landfills Benzo(a)pyrene (PAHs) zero 0.0002 Reproductive difficulties; Leaching from linings increased risk of cancer of water storage tanks and distribution lines Ca rbofu ra n 0.04 0.04 Problems with blood, nervous Leaching of soil system, or reproductive fumigant used on rice system and alfalfa Carbon zero 0.005 tetrachloride Liver problems; increased risk Discharge from of cancer chemical plants and other industrial activities Chlordane zero 0.002 Liver or nervous system Residue of banned problems; increased risk of termiticide cancer ...._............ ....... .......... ................................................................................. ......... ......... ...................... ......... .... ........................................ Chlorobenzene 0.1 0.1 Liver or kidney problems Discharge from chemical and agricultural chemical factories 2,4-D 0.07 0.07 Kidney, liver, or adrenal gland Runoff from herbicide problems used on row crops Dala oon 0.2 0.2 Minor kidney changes Runoff from herbicide used on rights of way ......................... . .................... ........ .. ...... . .......................................................................................................-.-....................._....................................................................................-.......................................................................................................................................................................................... 1,2-Dibromo-3- zero 0.0002 chlc+ropropane (DBCP� Reproductive difficulties; Runoff/leaching from increased risk of cancer soil fumigant used on soybeans, cotton, pineapples, and orchards o-Dichlorobenzene 0.6 0.6 Liver, kidney, or circulatory Discharge from system problems industrial chemical factories p-Dichlorobenzene 0.075 0.075 Anemia; liver, kidney or Discharge from spleen damage; changes in industrial chemical blood factories 1,2-Dichloroethane zero 0.005 Increased risk of cancer Discharge from industrial chemical factories 1,1-Dichloroethylene 0.007 0.007 Liver problems Discharge from industrial chemical factories cis-1,2-Dichloroethylene 0.07 0.07 Liver problems Discharge from industrial chemical factories �. ....... �. . ...._... ......... . . ..__ ...... trans-1,2-Dichloroethylene 0.1 0.1 Liver problems Discharge from industrial chemical factories Dic',hloromethane zero 0.005 Liver problems; increased risk Discharge from drug of cancer and chemical factories 12-Dichloropropane zero 0.005 Increased risk of cancer Discharge from industrial chemical factories Di(2-ethylhexyl) adipate 0.4 0.4 Weight loss, liver problems, or Discharge from possible reproductive chemical factories difficulties. Di(2-ethylhexyl) phthalate zero 0.006 Reproductive difficulties; liver Discharge from problems; increased risk of rubber and chemical cancer factories Dinoseb 0.007 0.007 Reproductive difficulties Runoff from herbicide used on soybeans and vegetables Dioxin 2,3 7,8-TCDD) zero 0.00000003 Reproductive difficulties; Emissions from waste increased risk of cancer incineration and other combustion; discharge from chemical factories Di uat 0.02 0.02 Cataracts Runoff from herbicide use Endothall 0.1 0.1 Stomach and intestinal Runoff from herbicide problems use Endrin 0.002 0.002 Liver problems Residue of banned insecticide ....... ......... ............... ........ .... ... ......... ........ Epichlorohydrin zero TT9 Increased cancer risk, and Discharge from over a long period of time, industrial chemical stomach problems factories; an impurity of some water treatment chemicals Ethylbenzene 0.7 0.7 Liver or kidneys problems Discharge from petroleum refineries Ethvlene dibromide zero 0.00005 Problems with liver, stomach, Discharge from reproductive system, or petroleum refineries kidneys; increased risk of cancer Gly_phosate 0.7 0.7 Kidney problems; reproductive Runoff from herbicide difficulties use _... . ........ ......... ......... ......... ......... Heptachlor zero 0.0004 Liver damage; increased risk Residue of banned of cancer termiticide Heptachlor epoxide zero 0.0002 Liver damage; increased risk Breakdown of of cancer heptachlor Hexachlorobenzene zero 0.001 Liver or kidney problems; Discharge from metal reproductive difficulties; refineries and increased risk of cancer agricultural chemical factories Hexachlorocyclo pentad iene 0.05 0.05 Kidney or stomach problems Discharge from chemical factories Lindane 0.0002 0.0002 Liver or kidney problems Runoff/leaching from insecticide used on cattle, lumber, gardens Methoxychlor 0.04 0.04 Reproductive difficulties Runoff/leaching from insecticide used on fruits, vegetables, alfalfa, livestock Oxamyl (Vydate) 0.2 0.2 Slight nervous system effects Runoff/leaching from insecticide used on apples, potatoes, and tomatoes Polychlorinated zero 0.0005 biphenyls (PCBs) Skin changes; thymus gland Runoff from landfills; problems; immune discharge of waste deficiencies; reproductive or chemicals nervous system difficulties; increased risk of cancer Pentachlorophenol zero 0.001 Liver or kidney problems; Discharge from wood increased cancer risk preserving factories ...... ... ........ ..................................................... ........ ...- ......... ......... ......... ............... .... ........... ............ Picloram 0.5 0.5 Liver problems Herbicide runoff Simazine 0.004 0.004 Problems with blood Herbicide runoff Styrene 0.1 0.1 Liver, kidney, or circulatory Discharge from system problems rubber and plastic factories; leaching from landfills Tetrachloroethylene zero 0.005 Liver problems; increased risk Discharge from of cancer factories and dry cleaners Toluene 1 1 Nervous system, kidney, or Discharge from liver problems petroleum factories Toxaphene zero 0.003 Kidney, liver, or thyroid Runoff/leaching from problems; increased risk of insecticide used on cancer cotton and cattle 2,4,5-TP (Silvex) 0.05 0.05 Liver problems Residue of banned herbicide 1 2 4-Trichlorobenzene 0.07 0.07 Changes in adrenal glands Discharge from textile finishing factories 11,1-Trichloroethane 0.20 0.2 Liver, nervous system, or Discharge from metal circulatory problems degreasing sites and other factories 112-Tr ichloroethane 0.003 0.005 Liver, kidney, or immune Discharge from system problems industrial chemical factories Triclhloroethylene zero 0.005 Liver problems; increased risk Discharge from metal of cancer degreasing sites and other factories Vinyl chloride zero 0.002 Increased risk of cancer Leaching from PVC pipes; discharge from plastic factories Xylenes (totals 10 10 Nervous system damage Discharge from petroleum factories; discharge from chemical factories Radionuclides MCLGi MCL or potential Health Effects from Sources of Contaminant (mg/L) ! TT1 Contaminant in Z m L z Ingestion of Water Drinking Water ( g/ )— Alpha particles nonez 15 ---------- picocuries Increased risk of cancer Erosion of natural zero per Liter deposits of certain (pCi/L) minerals that are radioactive and may emit a form of radiation known as alpha radiation Beta particles and none? 4 photon emitters ---------- millirems Increased risk of cancer Decay of natural and zero per year man-made deposits of certain minerals that are radioactive and may emit forms of radiation known as photons and beta radiation Radium 226 and nonez 5 pCi/L Radium 228 ---------- Increased risk of cancer Erosion of natural (combined) zero deposits Uranium zero Increased risk of cancer, kidney Erosion of natural 30 ug/L toxicity deposits as of 12/08/03 Notes 1 Definitions: Maximum Contaminant Level (MCL) - The highest level of a contaminant that is allowed in drinking water. MCLs are set as close to MCLGs as feasible using the best available treatment technology and taking cost into consideration. MCLs are enforceable standards. Maximum Contaminant Level Goal (MCLG) - The level of a contaminant in drinking water below which there is no known or expected risk to health. MCLGs allow for a margin of safety and are non-enforceable public health goals. Maximum Residual Disinfectant Level (MRDL) - The highest level of a disinfectant allowed in drinking water. There is convincing evidence that addition of a disinfectant is necessary for control of microbial contaminants. Maximum Residual Disinfectant Level Goal (MRDLG) - The level of a drinking water disinfectant below which there is no known or expected risk to health. MRDLGs do not reflect the benefits of the use of disinfectants to control microbial contaminants. Treatment Technique - A required process intended to reduce the level of a contaminant in drinking water. 2 Units are in milligrams per liter (mg/L) unless otherwise noted. Milligrams per liter are equivalent to parts per million. 3 EPA's surface water treatment rules require systems using surface water or ground water under the direct influence of surface water to (1) disinfect their water, and (2) filter their water or meet criteria for avoiding filtration so that the following contaminants are controlled at the following levels: • Cryptosporidium: (as of1/1/02 for systems serving >10,000 and 1/14/05 for systems serving <10,000) 99% removal. • Giardia lamblia: 99.9% removal/inactivation • Viruses: 99.99% removal/inactivation • Legionella: No limit, but EPA believes that if Giardia and viruses are removed/inactivated, Legioneiia will also be controlled. • Turbidity: At no time can turbidity (cloudiness of water) go above 5 nephelolometric turbidity units (NTU); systems that filter must ensure that the turbidity go no higher than 1 NTU (0.5 NTU for conventional or direct filtration) in at least 95% of the daily samples in any month. As of January 1, 2002, turbidity may never exceed 1 NTU, and must not exceed 0.3 NTU in 95% of daily samples in any month. • HPC: No more than 500 bacterial colonies per milliliter. • Long Term 1 Enhanced Surface Water Treatment (Effective Date: January 14, 2005); Surface water systems or (GWUDI) systems serving fewer than 10,000 people must comply with the applicable Long Term 1 Enhanced Surface Water Treatment Rule provisions (e.g. turbidity standards, individual filter monitoring, Cryptosporidium removal requirements, updated watershed control requirements for unfiltered systems). • Filter Backwash Recycling; The Filter Backwash Recycling Rule requires systems that recycle to return specific recycle flows through all processes of the system's existing conventional or direct filtration system or at an alternate location approved by the state. 4.more than 5.0% samples total coliform-positive in a month. (For water systems that collect fewer than 40 routine samples per month, no more than one sample can be total coliform-positive per month.) Every sample that has total coliform must be analyzed for either fecal coliforms or E. coli if two consecutive TC- positive samples, and one is also positive for E.coli fecal coliforms, system has an acute MCL violation. 5 Fecal coliform and E. coli are bacteria whose presence indicates that the water may be contaminated with human or animal wastes. Disease-causing microbes (pathogens) in these wastes can cause diarrhea, cram1ps, nausea, headaches, or other symptoms. These pathogens may pose a special health risk for infants, young children, and people with severely compromised immune systems. 6 Although there is no collective MCLG for this contaminant group, there are individual MCLGs for some of the individual contaminants: • Trihalomethanes: bromodichloromethane (zero); bromoform (zero); dibromochloromethane (0.06 mg/Q. Chloroform is regulated with this group but has no MCLG. • Haloacetic acids: dichloroacetic acid (zero); trichloroacetic acid (0.3 mg/Q. Monochloroacetic acid, bromoacetic acid, and dibromoacetic acid are regulated with this group but have no MCLGs. 7 MCLGs were not established before the 1986 Amendments to the Safe Drinking Water Act. Therefore, there is no MCLG for this contaminant. 8 Lead and copper are regulated by a Treatment Technique that requires systems to control the '~ corrosiveness of their water. If more than 10% of tap water samples exceed the action level, water systems must take additional steps. For copper, the action level is 1.3 mg/L, and for lead is 0.015 mg/L. 9 Each water system must certify, in writing, to the state (using third-party or manufacturer's certification) that when acrylamide and epichlorohydrin are used in drinking water systems, the combination (or product) of dose and monomer level does not exceed the levels specified, as follows: • Acrylamide = 0.05% dosed at 1 mg/L (or equivalent) • Epichlorohydrin = 0.01% dosed at 20 mg/L (or equivalent) National Secondary Drinking Water Regulations National Secondary Drinking Water Regulations (NSDWRs or secondary standards) are non-enforceable guidelines regulating contaminants that may cause cosmetic effects (such as skin or tooth discoloration) or aesthetic effects (such as taste, odor, or color) in drinking water. EPA recommends secondary standards to water systems but does not require systems to comply. However, states may choose to adopt them as enforceable standards. • National Secondary Drinking Water Regulations - The complete regulations regarding these contaminants available from the Code of Federal Regulations Web Site. • For more information, read Secondary Drinking Water Regulations: Guidance for Nuisance Chemicals. List of National Secondary Drinking Water Regulations Contaminant Secondary Standard Aluminum 0.05 to 0.2 mg/L Chloride 250 mg/L Color 15 (color units) Copper 1.0 mg/L Corrosivity noncorrosive Fluoride 2.0 mg/L Foaming Agents 0.5 mg/L Iron 0.3 mg/L Manganese 0.05 mg/L Odor 3 threshold odor number pH 6.5-8.5 ........ ......... _...._ ......... ..... .... ......... ......... .......... Silver 0.10 mg/L Sulfate 250 mg/L Total Dissolved Solids 500 mg/L Zinc 5 mg/L Unregulated Contaminants This list of contaminants which, at the time of publication, are not subject to any proposed or promulgated national primary drinking water regulation (NPDWR), are known or anticipated to occur in public water systems, and may require regulations under SDWA. For more information check out the list, or vist the Drinking Water Contaminant Candidate List (CCL) web site. • Drinking Water Contaminant Candidate List 2 • Drinking Water Contaminant Candidate List (CCL) Web Site • Unregulated Contaminant Monitoring Program (UCM) • Information on specific unregulated contaminants • MTBE (methyl-t-butyl ether) in drinking water t TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION Marstons I%1ills Elementar School ADDRESS: Rt. 28, main Street �9 S MAP NO. PARCEL NO.� OWNER NAME: Barnstable Public Schools VILLAGE: Marstnns mills INSTALLATION DATE: 7/25/88 BY: Alan Corporation ADDRESS: 290 W. Boylston St. , Worcester, MA CERT. NO. 01606 TANK INFORMATION LOCATION OF TANK: On Rt. 28 side nf. Rnhnnl in front. of gvmnacinm 000 Double wall 10 CAPACITY TYPE ibar,;jla-ss AGE e 0 - FUEL/CHEMICAL #4. oil TESTING CERTIFICATION C A PASS E ] FAIL DATE 7/25/88 LEAK DETECTION E 7 CHECK IF N/A TYPE/BRAND Polluiert FD102 ZONE OF CONTRIBUTION E ] YES EX ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED QXX1 YES 1 J NO DATE 7/25/88 UUNSERVATION E ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. E105(JE ]E ]E ]E J DATE \ `7 �L a� c� S� LoA� r pock ym 40 - TOWN OF BARNSTABLE AlAj"G VAL1119 14a RUNDERGROUND FUEL AND CHEMICAL STORAGE SY TEMS . � � � J ASSESS ORS MAP NO. PARCEL NO. (� , ADDRESS! 14ain grrr.Pt, VILLAGE% Maroons MUIR NAME;..... ..._ 2�iarstot�:i.Mi11s..Elementary School_ CONTACT PERSON Jack Renzi PHONE NUMBER 771-4828 LOCATION OF TANKS;. . CAPACITY: ..TYPE.-OF' FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM 8,000 #4 1959 H�loa& UPOP 120 AL 3# 0 #2 1959 r ono ©FIDW CN S-AU,6D S'Ro 9 DATE OF PURCHASE OF EACH: 1. 1959 21959 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS od By cyawfz"' PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. 7 _..--- -- ----- - (THIS PERMIT MUST 6E CONS�ICUOYiI� ►wucu vrv^ .— i ,- Ind'� � !� e Iz ........................... N � i - rnl c CENTERVILLE - OSTERVILLE FIRE DEPARTMENT PERMIT FOR STORAGE OF FUEL OIL In accordance with made under authority Prnvisions 148.ther . L., and Regulations Ma.rstons Mill ElemenA6-qv_....•..••J..A..JM rinq.............. Nome...................................................... (Installer) (owner or occupant). Route 28 205' South St. � Address .................................. Address ................................................ Jamaica Plain i Burner toraps Make Indust rial.,_C,ombus;�iP#e of Tank .......�=0-ta.21g............ ..................... •' gals. (or) Size...... Ind. C omb....Mf .. Capacity .............. Manufacturer ••�'............................ Model No. or Size .......... 3.Q............. location .................................................. TYPe•A T...at4j).jn4jjgApprovol No. ...1QQ2.... I .► � Chief J.M. Far.rin gtQA epaPermit issued , ea I Fire D rtment.......................... BY c (THIS PERMIT MUST SE CONSPICUOUSLY POSTED UPON THE PREMISES) TOWN OF BARNSTABLE VA UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS A Gf � ASSESSORS MAP NO. PARCEL NO. ' ADDRESS: VILLAGE: Marst-nns Mills NAME;._ l4arstona.Mi11s.Elementary School CONTACT PERSON Jack Renzi PHONE NUMBER 771-4828 ' LOCATION OF TANKS:. . CAPACITY: ..TYPE•01' FUEL AGE: TYPE: LEAK \ OR CHEMICAL: DETECTION SYSTFAX ` 8,000 #4 1959 ` 275 #2 1959 DATE OF PURCHASE OF EACH: 1. 1959 21959 3. 4. 5. _ DATE OF FIRE DEPARTMENT PERMIT: ' ! TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS • PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. —..........._.......... ._. - (THIS PERMIT MUST 6E CONSPICUOUSLY POSTED UPON THE PREMISES) ���2/ j CENTERVILLE • WERVILLE FIRE DEPARTMENT / PERMIT FOR STORAGE OF FUEL OIL ions of Chapter 148. and Regulations In accoidance with prmis made under authority thereof. Eleme J.A. .............. Marstons Mill .............n+Aey.................. .. rino Name................... (Installer (ow or occupant) ....... 205' South S . Route 28 Address n ............ jamai Flai Address ..................................... J maica storage Sumer Ton .Exist ing• ........ v i e of o b .� ' Make .....Industri........�. g C city gals. (or) Size............ Ind. Com o _ Manufacturer .. ... .......................... Q............. Location ............... Model No. or Size .......... . Type.A13Z...4:t 011-. if► RgApprovol No. ...lQQ2.... �`vc� � Chief J.r?..DFarrng .off. J ... a artment ................ ..............i...ea t Fire P Permit Issued ... ....... ; t -1 ........................................................... ..................�........... BY .I. ' IS PERMIT MUST of CONSPICUOUSLY POSTED UPON 7NE PREMISES) . G lie AMA