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Home My WebLink About0760 OST.-W.BARN. RD - Health - WEST VILLAGE ELEM - FRONT BLDG r r FRONT BLDG WEST,VIL'I AGE EI,EM 760 Ost-WB 760109t s 2B° I{_3 L 3 o 'a�l �� 0 f o 'aw Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. . BARNSTABLF- F.P.(Thomas)Lee,. '$ A 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 39 Issue Date: 01/01/2022 DBA: WEST VILLAGES ELEMENTARY SCHOOL (K-3) OWNER: TOWN OF BARNSTABLE Location of Establishment: 760 OSTERVILLE-W.BARNSTABLE RD. MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $5.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use Initials: ..�`"�T°'►�. 'T'own of Barnstable / Date Paid 4 -4Amt Pd$ Inspectional Services j i �w MAS& » Checkbbq Mass. t639. ��$ Public Health Division ��T Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: EI e-mgn+!2 L1 ADDRESS OF FOOD ESTABLISHMENT: 9(aD OS+• VJ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): q44 L3•fYlaln S-E• '1 F00d SVC oc�ce � �4 an 1'5, r ac(- E-MAIL ADDRESS: .1'JaAb — G`Offf-� bps TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (SOK ) 4 AO- I 1 D2 TOTAL NUMBER OF BATHROOMS: I WELL WATER:YES NO i// ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: V DATES OF OPERATION: / I /PTO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FR M LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY FLOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezei) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 QAApplication FormsTOODAPP REV3-2019.doc OVVNER INFORMATION: FULL NAME OF APPLICANT o b� 1 C_ ,Scll l s )(-4-M as-L SOLE OWNER: YES/NO OWNER PHONE # DS �O g ' q 9 b S(o_ ADDRESS_ fj L�'A U3. M G6 r) S-�- A4 0-- GOd �vG 0j�;-C—: tt tj o-n►1 I S. VY\ O Z(o C) CORPORATE OWNER: (-0.VY)Gjf-VL CORPORATE ADDRESS: I9 i o3 Ll PERSON IN CHARGE OF DAILY OPERATIONS: C -D I Ls List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 1\l anc(-1 D i AS H )-q 1. c- G D-las / ,25 2. a.rr)oiS / 5 / a(a Ad Ir? 17 SIGN TURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec. 3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application ForinsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ' EA AHM Paul J.Canniff,D.M.D.MIST MAS& F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us 'Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 39 Issue Date: 01/01/2021 DBA: WEST VILLAGES ELEMENTARY SCHOOL (K-3) OWNER: TOWN OF BARNSTABLE Location of Establishment: 760 OSTERVILLE-W.BARNSTABLE RD. MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE/SCHOOL Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $5.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oF11WEr For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$ � BARNSTABLE, : Inspectional Services 116 . 9 9�'AIEo;�,• Public Health Division `ba 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 3 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Q.7� 1 I IU eS Of-Men IGf ADDRESS OF FOOD ESTABLISHMENT:�� Vs-�• W. Nmsta le PA , mnf*nS M 01c, MIS 7g MAILING ADDRESS(IF DIFFERENT FROM ABOVE): I _T I'V• '"I J' • A ' )oj Svc HyanAl s W ' E-MAIL ADDRESS: ba doh — love. @ M1 bps•as 02� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: C&5 ) 42b _ OU TOTAL NUMBER OF BATHROOMS: I WELL WATER:YES_NO ...(ANNUAL WATER ANALYSIS REQUIRED). ANNUAL: SEASONAL: DATES OF OPERATION: 9 /1(p/240 b, / 30/ 21 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: n SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? n IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ' *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application Forms\FOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANTrnsg- �Ub�i� �jCr100IS 71�r�CrY1lC1'�L SOLE OWNER: YES/NOp�� (� OWNER,PHONE ADDRESS 44 YY • Iwo JT. ATI : food Serve A(P- awls � 020� � , 1 CORPORATE OWNER: -Aran'or IL CORPORATE ADDRESS: -2400 Mark-4 S+• , Ph,10dal ra'11u , Pik q b 3 8n �3� ' 717 PERSON IN CHARGE OF DAILY OPERATIONS: Nancy bias List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new.copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date ►► , .7,1 , ;4 1. q"m s �c.T�ea" � i 2. IGNATURE OF PPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc Y dot Town of Barnstable BOARD OF HEALTH * John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMStA814 Paul J.Canniff,D.M.D. �a � 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590,000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 39 Issue Date: 12/10/2019 DBA: WEST VILLAGES ELEMENTARY SCHOOL K-3 OWNER: TOWN OF BARNSTABLE Location of Establishment: 760 OSTERVI LLE-W.BARNSTABLE RD. MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE/SCHOOL Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $5.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO,Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office • Initials: `I '�"'a� Town of Barnstable Date Paid I I$ ; "f $ RAMWAB I Inspectional Services .39 Public Health Division r Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL_ NAME OF FOOD ESTABLISHMENT: I( V'8M1Adp'V'1 ADDRESS OF FOOD ESTABLISHMENT:l6O O ' Mastons Wls, M# o2 s MAILING ADDRESS(IF DIFFERENT FROM ABOVE):14 V MU.0` S�+ 'Fwd Sic- ACe�awt s1 06EO) E-MAIL ADDRESS: b'"'&' — d oVe@ mybps•uc, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( �) 4� - 1100 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO � ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:&/k I9TO b NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE F OM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? YI a IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? r) v\ TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsWOODAPP 2020.doc f - OWNER INFORMATION: FULL NAME OF APPLICANT— SOLE OWNER: YES/NO. OWNER PHONE ADDRESS ' TGIF Se. O Ice mm ICI o Zbd� CORPORATE OWNER: �1ZlWI(LY�L CORPORATE ADDRESS: M,(tle"� PhOk (phi Pk jq(03 611 ^531 -4111 PERSON IN CHARGE OF DAILY OPERATIONS: Lindt am no List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 24 1. W' lug (�2- / 5 / 2-1 2. 61ymrle, r b / 10 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!!-Please call-Health-Div.of 508=862=4644 t-o-s-cbe-c le-your inspection. Pleas�l at ICast(7)3ays m advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc J BOARD OF HEALTH Town of Barnstable Paul J Canniff,D.M.D. , . Board of Health Donald A.Gaudagnoli,M.D. BAJ%Nsrta�e = John T. Norman 200 Main Street, Hyannis, MA 02601 F.P. Thomas lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: .39 Issue Date: 12/20/18 DBA: WEST VILLAGES ELEMENTARY SCHOOL (K-3) OWNER: TOWN OF BARNSTABLE Location of Establishment: 760 OSTERVILLE-W.BARNSTABLE RD. MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE/SCHOOL Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $5.00 YEAR. 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 09/29/2013 20:51 5087717102 BARNSTABLE LUNCH PAGE 06/19 Town of Barnstable : Initials: g �-- �. Inspectional Services Apitj:d$ �6�9 -- � Public Health Division Thomas McKean.,Director 200 Main Street, Hyannis,MA 02601 Office; 508-862-4644. Fax: 508-790-6304 APPLICATION FOR PXRMIT TO OPERATE A FOOD ESTABLISIWNT, DATE I 1301113 NIrW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ' F ADDRESS OF FOOD ESTABLISHMENT: 'RdWIS S 02W MAILING ADDRESS(IF DIFFERENT FROM ABOVE): r ( �� Ace . E-MAIL ADARES,S: doh--duid 0 1.V[Jul LW k .com OSTIS) MA- V Lam./I TELEPHONE NUMBER OF FOOD ESTABIASI3MENT: &Dj 42b�- 1100 I TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO,� ...(ANNUAL WATER ANALYSTS REQUMM) ANNUAL: SEASONAL: _DATES OF OPERATION:8 A /18TO 6 /27/ (q NU1V,'[(I;.ER OF SEATS: INSIDE: OUTSIDE; TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE hOM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED)-IY 7WE HEALTH DI V AND LICENSTNG,AND MEET OUTSIDE DINING REOUII2EMENTS. IS WAIT STAFF PROVIDED FOR O CITSI.DE D"G? l 1 I LI TS AN ATR CURTAIN PROVIDED AT WA TS'TAFF SERVICE DOOR(S)? TYPE Or ESTABLISHMENT: (PLEASE CIRCK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(roods requiriag refrigerationffivezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAS ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED B)EFORR EVENT(SEE PAGE#.2) TOBACCO SALES ,..(ANNUAL TOBACCO SALES APPLICATION REQUIRED) ***SEASONAL,MOBILE &NEW FOOD ONLY*** IUD ARgu TO CALL HEA LH DIV FOR MPECTION P111OR TO PERMIT BEING„ ,RUED Q: 4plieation Fcnns1F00DAPPR1;Y2016.dac 09/29/2013 20:51 5087717102 BARNSTABLE LUNCH PAGE 07/19 PLEASI CALL 508-862-4644 OM NER INFORMATION: FULL NAIVE OF APPLICANT iW' ttIi? W L(j&1 w1 S SOLE OWNI .- YES/NO $ OWNER PHONE# —( ZS—65(o3 ADDRESS "�'7 7TZ1 �LQS UTTICQ� LS )2W) CORPORATE OWNER: FEDERAL ID NO. CORPORATE ADDRESS: MWO S� ( 4 au—o?� —47 / 7 PERSON IN CHARGE OF DAILY OPERATIONS: R&M .List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will *T_OT use past years' records, You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers EUnirationo Date Aftemea Awareness Expiration Date 6130 /A 2• n. 6 / to , Z2 Of I I 1301 16 SIGNATURE VF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior tr o—pen�ngl! Please call Health Div.at 5118-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS; Frozen desserts must be tested by a State Cerdfiied lab prior to opening and monthly thereafter, with sample results submitted to the Health Div, Paiiure to do so will result in the suspension or revocation of your Frozeo Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httns//www,townofbsrnstable.-us/healthdivision/annlications.asp. OUTDOOR COOKING; Outdoor cooking,preparation,or display of any food product by a food establishment is prohdbited. TOBACCO ESTABLISHMENTS; All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form,. NOTICE: Permits rnm annually from January 1st to Dec.31"each calendar year, IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLB MI)APPLICATION(S)AND AEQUMD FEES BY DEC 1 st. Q:VlpplioeNoa Porn VWDAMEy3018,doc �oFISE TOWN OF BARNSTABLE HEALTH.INSPECTOR•s Establishment Name: Date: Page: of P p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00*-9:30 A.M. BARN57'ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. { MON.-FRI. f63q. �0� 1 HYANNIS, MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 Name l Date e of T of Inspection Operation(s) outi e h t /r✓ Address O�� Risk F ervice ction Level Qetail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation ` � y Owner HACCP YIN Temporary Suspect Illness r7 Caterer General Complaint ` Person in Charge(PIC) ° Time Bed&Breakfast HACCP c 6 In: Other Inspector S Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ,f Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities l may/ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS CL _ C,A ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) cvl u, ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures - - ` VG«I f�. I'I ❑ 5.Receiving/Condition ❑ 17.Reheating 3 - IfQ ❑ 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) 3,wo6i__ 7 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and.Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY k\ p;q ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: Non-critical N violations must be corrected q ❑ No El Yes ( ) u o ected immediately or hi Overall Rating ` within 90 days as determined by the Board of Health. � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g y ❑ ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 p (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 violations observed, violations and lebserved,7 to s sn 9non-critical. If no critical critical violations. If 1 critical refrigeration. ' water,sewage back-up,infestation of rodents or insects,or lack of i than 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 8 non,critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins or' Si e--- P'nt: 31.Dumpste reened from public view C 1 ) H;1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ,� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI `s Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 1 r -- ...--..�..-, _. � � .i. -.rf^;`.....'..-�..1_�y.-...r�.:-..-,....,�..�.w-.r..-.-..,.-.....»,:-...yam,.y_ - .,_ .-. .. �..-.w--.�nA -�- :'T:.aa-'.-.ro..�.,,�ya-.•r�,.^�.. .-•----•^-'w,""+.r..----.-w....o.,r,,r- .,., •- - -r..-t-......-.-...--.�.--•- '-•----.. __.,_..�,_-.. -. -_ .�. .. r•�.�-Y-a" ,....-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* 6 Cross-contamination Liq 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 s 19 PHF Hot and Cold Holding Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45F 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 7-102.11 Common Name-Working Containers 3-501.16 A Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F* Applicants* 1 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-201.11 Separation-Storage**590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(E) Removal of Exclusions and Restrictions' Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202,14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3 401.11A(1)(2) Eggs-155°F IS sec 22 3-603.11 Consumer Advisory Posted for Consumption of .11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 4-601 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff'i"11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources g. P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* Location an Placement* 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 5-204.11 d 3-501.14(B) Cooling PHFs Made from Ambient 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Oheiati nl mud Maintenance 1 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301. 22 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i `oFTiff TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Vv Vl i Date: Z` Page:. of p OFFICE HOURS PUBLIC HEALIH DIVISION 8:UU-9:30A.M. BARN�SrABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3- $ HYANNIS,MA 02601 soa-sz asaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT NameDate 3 q Type of Type 91 Inspection p / s In ( �4 Address -lip b S Q1 Risk t rrood Service e-Inspection Level Previous Inspection Telephone Residential Kitchen Date: 1� . Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP V _ 3)i } -. c44x w In: 10=ZS Other Inspector S Out: C Each violation checked requir s an explanation on the narrative page(s)and a citation of specific provision(s)violated. �fl Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) A d4 T O Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ w° lAtophi to U Action as determined by the Board of Health. Allergen Awareness 590.009(G) p ` e FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities /�� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS yT c,� 9aA,;jrt S' S0q l ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives --_ <_ 6d ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (� ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating `h ❑ 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 `S ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP i O `n t % r. ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY l t�C/f C. ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories l t/J�D D�J Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 3 l 02-' V 4 p Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ o ❑ 'As Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Y Y i , ❑_Voluntary Compliance ❑ Employee-Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,th items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management'and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4nori-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 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 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. , 30.Other DATE OF RE-INSPECTION: Inspector's SignatureR Print��/, 31.Dumpster screened from public view Permit Posted?__1/_Y N Grease Trap Previous Pumping Date Grease Rendered Y N v v #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violation 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 Law Cooled to 41°F/45°F Within 4 Hours* 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 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 1g PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 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 3-501.16(A) Hot PHFs Maintained At or Above 140°F ( ) P yOther* 7-102.11 Common Name-Working Containers* * 3-501.16 A Roasts Held At or Above 130°F Require Reporting by Food Employees and Contamination from the Environment * ( ) * 7-201.11 Separation-Storage 20 Time as a Public Health Control Applicants 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 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 * 3-801.11(B) Use of Pasteurized Eggs* g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef five 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004O Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.1I(A)&(D)_PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items non-critical 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers an P d 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 .00 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .006 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF� roy TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: (_ ' Date: Page: of ti r OFFICE HOURS �• PUBLIC HEAL-TM DIVISION s:nn_a;an a M • BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .e� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 4f, 508-862-4644 'FON1P�p FOOD ESTABLISHMENT INSP CT)IO REPORT 0 Name Dat Type o f73' In ection / ON Routipe ISO Address r rv-isk ' Food.Servc Te-inspectionRetait Telephone Residential Kitchen e:Mobile -op you Owner HACCP Y/N 'Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACOther CP BA n: T Inspector O� :J ' Each violation checked require an explanation on the narrative age(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling P .❑ 7.Conformance with Approved Procedures 1 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.ProperAdequate Handwashing CONSUMER ADVISORY '1 (;`}///J 11.Good Hygienic Practices 22.Posting of Consumer Advisories `/+_ /- ❑ Y9 ❑ 9 L �t Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations~ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: do ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Ord for Correction:Based on an inspection today,t e I ems Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ® g ❑ g y ❑ ry P Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. .25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(596.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la 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 i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n iolati t6S violations. If 1 critical refrigeration. 29.Special Requirements. (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violatio s= 30.Other DATE OF RE-INSPECTION: Ins ecto 's S nat r 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Si nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41*F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140*F 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* 3-302.11(A) Food Protection* 20 7-201.11 Separation-Storage* Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* - 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ery cew rirnooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155"17 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in ca[er- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140*F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140*F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* Temperature Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 590.004(J) 9 9 Y� b 7 Conformance with Approved Procedures/ 6-301.11 1Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. OF INE row _ TOWN OF BARNSTABLE _ HEATH INSPECTOR's Establishment Name: ` ZVate: - Page:. of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. �A te39. .0 HYANNIS, MA 02601 508-862-464a No Reference R-Red Item PLEASE PRINT CLEARLY ,FOM�,• FOOD ESTABLISHMENT INS E�CT ON REPORT137- Name Date e of jyg@=Qf Inspection O er t Routii Address Risk / F o ice a ion Level ( etail Previous Inspection on A i Res n ial Kitchen Date : Telephone Pre-operation Pre-o Mobile P Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires a hxp anation on the narrative page(s)and a citation of specific provision(s)violated. / Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY _ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories., = ' Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be_corrected immediately. (blue&red items) Corrective Action Required: Ti No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ 9 Y ❑ ry P Other: 23..Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zerocritical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC73)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations 26.Water,Plumbing and waste (FC=5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6uon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less.than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed 8 non critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address , to 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 no critic I violations=C. 30.Other DATE OF RE-INSPECTION: Inspe P a Print 31.Dumpster screened from public view # . tvs Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N - #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 9i natur Print: Self Service Wait Service Provided Grease Trap Size Variance.Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. - 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501. Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Time as a Public Health Control Applicants* s 20 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and r 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef crNe 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* - 590.0068) Water Meets Standards in 310 CMR'2'2.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency Sanitization of Utensils and Food 3-401.l l(A)(2) Ratites,Injected Meats-155°F 15 sec* Contact Surr ffaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.l l(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,.Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140'F to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 - 3-402.12 Records,Creation and Retention* - . Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc i *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.' *Denotes critical item in the federal 1999'Food Code or 105 CMR 590.000. `oF, roh TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: 11� ,` �C �� a e: ld Page: -. of . ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. MASS. MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF.CORRECTION Date Verified 'cbA +659.p m HYANNIS,MA 02601 508-862-46" No Reference R-Red Item PLEASE PRINT CLEARLY 'EON1A` FOOD ESTABLISHMENT INSP CTION REPORT Name Date a of f Inspection g Ro ti Address V-�' P Risk -inspection Level Retail Previous Inspection Telephone Residential Kitchen. Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Ch • Caterer General Complaint JVf Person' Charge(PIC) ltt'' Time Bed&Breakfast HACOther CP N In: Inspector Out: t Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. doyiolations Related o Foo orne Illneis Interventions Risk Factors(Red Items Anti-Choking Tobacco lations marked may pose an imminent health hazard and require immediate corrective ction as determined by the Board of Health. 590.009(E) ❑ 590.009(F) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1.PICAssi Assigned/Knowledgeable Duties Gto ❑ 9 g ❑ 13.Handwash Facilities • EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved food or Color Additives 1304oF t ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS,(Potentially Hazardous foods) L ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures • V •Ib/ ❑ 5.Receiving/Condition ❑ 17.Reheating ; � Y t.� ,.. . ❑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„ ka k W ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HS ) ❑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 o ❑lations Related to Good-Retail Practices(Blue Items) Total Number of Critical Violations. Critical C violations marked must be corrected immediately.( ) y (blue&red items) Non-critical(N)violations must be corrected immediately or ® Corrective Action Required: ❑ No Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ 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 3 non-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 03-5)(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.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address refrigeration,or no PIC or alternate PIC present. t of this order.within 10 days of receipt violati served,7 to 8ncn-critical violations=C. 29.Special Requirements_ (590,009) Y P 30.Other DATE OF RE-INSPECTION: Inspe s ig t e 31.Dumpster screened from public view 0 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI Ignature Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N CJ! Dumpster Screen? Y N "r+-�..aw"'�".�,.�'^+c-+ean7•.F k�+RY;, .. .•'^.+#`�Yd"."2..��';w�'-^ortiY" .__ .�.�,� :__-'.-'-�.^.,r�'ear•-'�.^r�-'.+T•.°..a'.•.,.-w-. .'-�.-_._,..-. _ a..-.sr., �. v. r _� � Violations related to Foodborne Illness Violations Related to Foodbome Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41*F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous Identifying Information-Original Containers Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41*F/45*F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 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* 7-102.11 Common Name-WorkingContainers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* i * 7-201.11 Separation-Storage* Time as a Public Health Control 3-302.11(A) Food Protection 20 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) - Variance Requirements 590.003(G) Reporting by Person in Charge*-. Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* _ 3 590.003(D) Exclusion 3-306.14(A)(B)Resumed Food and Reservice of Food* s and Restrictions* 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* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* �? 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(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* Ef mi-1/112001 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 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec 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* t 10 Proper,Adequate Handwashing Ratites-165*F 15 sec* ing,mobile food,temporary and residential C Game and Wild Mushrooms Approved ey 3-401.11( )(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. * 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec ractices should be debited under#29-S ral 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding P Requirements. _ 5 Reeeiving/Condidon 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 r Critical and non-critical violations,which do not relate to the foodboe 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45*F item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* ty• Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 2 Physical Facility FC-8 .00 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. p 0 r _ l a 6�Qyo�TNf Tp`� .�. , The Town of Barnstable HAHI 1B�L, Y1@ B. : Office of Town Manager 7 p0 1677• b� 367 Main Street, Hyannis, MA 02601 Office 508-790-6205 Warren J.Rutherford FAX 508-775-3344 Town Manager TO: Ed Tynan, Supt. of Schools Paul Lebel, Chairman, School Building Committee McKean, Health. Director FROM: Warren J. Rutherford, Town Manager ) ' `6 DATE: June 23, 1993 RE: Groundwater Permit 0-576 Please find enclosed the final permit 0-576 for the was treatment facility located at the site of the Middle School on Osterville/West Barnstable Road. (1 0 Sam, Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of }T0�`�4*L,} R. .PS3-(ASLr Environmental Protection William F. Weld •g3 �,,, Go"mor ,�-; 23 Daniel S.Greenbaum Commisskmr June 16, 1993 Warren J. Rutherford Re: Ground Water Discharge Town of Barnstable Permit No. 0-576 1230 South Street Hyannis, MA 02601 Dear Mr. Rutherford: In response to your application for a permit to discharge into the ground a treated effluent from a wastewater treatment facility located at Osterville, West Barnstable Rd. , Barnstable, MA and after due public notice, I hereby issue the attached final permit. No comments objecting to the issuance or terms of the permit were received by the Division of Water Pollution Control during the public comment period. Therefore, in accordance with 314 CMR 2 . 08, the permit becomes effective upon issuance. Parties aggrieved by the issuance of this permit are hereby advised of their right to request an Adjudicatory Hearing under the provision of Chapter 30A of the Massachusetts General Laws and 314 CMR 1. 00, Rules for the Conduct of Adjudicatory Proceedings. Unless the person requesting the adjudicatory hearing requests and is granted a stay of the terms and conditions of the permit, the permit shall remain fully effective. Very truly yours, Brian Donahoe, Director Division of Water Pollution Control BD/XC/yg 31: 576-1tr cc: DEP, DWPC, SERO DEP, DWS, SERO Board of Health, Superior Court House, Barnstable, MA 02630 One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 DISCHARGE PERMIT Name and Address of Applicant: Town of Barnstable, Barnstable School Bldg. Committee, 1230 South St. , Hyannis, MA 020601 Date of Application: 4-21-92 Application/Permit No. 0-576 Date of Issuance: June 21 , 1993 Date of Expiration: June 21 , 1998 AUTHORITY FOR ISSUANCE Pursuant to authority granted by Chapter 21, Sections 26-53 of the Massachusetts General Laws, as amended, the following permit hereby issued to: Town of Barnstable, Barnstable School Bldg. Committee (hereinafter called "the permittee") authorizing discharges from the on-site advanced sanitary wastewater treatment facility located at Osterville, West Barnstable Rd. , Barnstable such authorization being expressly conditional on compliance by the permittee with all terms and conditions of the permit hereinafter set forth. This permit shall become effective on the date of the Director's signature and shall expire on June 21. 1998 2//fig Brian Donahoe, Director Date Division of Water Pollution Control 2 . I. SPECIAL CONDITIONS A. Effluent Limits The permittee is authorized to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent whose characteristics, within one month after start- up of the facility and continuing thereafter, shall not exceed the following values: Effluent Characteristics Discharge Limitations Flow 32 , 000 gallons per 'day Biochemical Oxygen Demand 5-day, 20 C 30. 0 mg/l Total Suspended Solids 30. 0 mg/1 Total Nitrogen (Organics & Ammonia & Nitrate Annual Daily & Nitirite) avg. max. 5. 0 mg/l 10. 0 mg/l Nitrate-Nitrogen 10. 0 mg/1 a). the pH of the effluent shall not be less than 6. 5 nor greater than 8 .5 at any time. b) The discharge of the effluent shall not result in any demonstrable adverse effect on the ground water or violate any water quality standards that has been promulgated. c) The monthly average concentration of BOD and total suspended solids in the discharge shall not exceed 15 percent of the monthly average concentrations of BOD and total suspended solids in' the influent into the permittee's wastewater treatment facilities. d) When the effluent discharged for a period of 90 consecutive days exceeds 80 percent of the permitted flow limitations, the permittee shall submit to the permitting authorities projected loadings and a program for maintaining satisfactory treatment levels consistent with approved water quality management plans. e) The discharge of the effluent shall not result in a total nitrogen concentration to exceed 5. 0 mg/1 in any of the approved downgradient monitoring wells at any time. *Annual average limitation is imposed only for the purpose of evaluating the ability of the proposed treatment technology to achieve maximum nitrogen reduction when properly operated and maintained and shall be calculated as a 12 month running average. The annual average limitation is not to be applied to the effluent concentration for enforcement action. 3 . t. Monitoring and Reporting 1) The permittee shall monitor and record the quality and quantity of the influent waste stream to the facility. according to the following schedule and other provisions. Minimum Frequency Parameter of Analysis Sample Type BOD5 1 x Monthly 24-hour composite TSS and Total Solids 1 x Monthly 24-hour composite Ammonia-Nitrogen 1 x Monthly 24-hour composite Total Volatile Organic Compounds (USEPA Method # 624) 2 x Annually Grab 2) The permittee shall monitor and record the quality and quantity of effluent at the sampling station prior to discharge to the leaching facility, according to the following schedule and other provisions. Minimum Frequency Parameter of Analysis Sample Type Flow Daily Average pH Daily Grab BOD5 Monthly 24-hour composite TSS and Total Solids Monthly 24-hour composite Total Nitrogen Monthly 24-hour composite Ammonia Nitrogen Monthly 24-hour composite Nitrate-Nitrogen Monthly 24-hour composite Sodium Monthly 24-hour composite Total Volatile Organic Compounds (USEPA Method # 624) 2 x Annually Grab 3) The permittee shall install a minimum of three (3) monitoring wells, one (1) upgradient and two (2) downgradient of the discharge. Detailed plans of the wells, the locations thereof, and the methods and means for sampling therefrom shall be conducted in accordance with the previously approved plan and entitled "Groundwater Monitoring Plan for the Barnstable School Building Site Groundwater Discharge Permit No. 0-576" dated April 8, 1993, submitted by Keyes Associates. The permittee shall install the wells within 90 days of issuance of the permit and monitor, record and report the quality of water in the monitoring wells according to the following schedule and other provisions: Parameter Frequency of Analysis PH 1 x monthly Specific Conductance 1 x monthly Static Water Level 1 x monthly Ammonia-Nitrogen 1 x quarterly Nitrate-Nitrogen 1 x quarterly Total Volatile Organic Compounds (USEPA Method # 624) 2 x annually Fecal Coliform 1 x quarterly 4. 4) Any grab sample or composite sample required to be taken less frequently than daily shall be taken during the period of Monday through Friday inclusive. The permittee shall submit all reports on an acceptable form, properly filled and signed, on the last day of every month, beginning thirty days after the issuance of this permit, to the Regional Director, Department of Environmental Protection, Southeast Regional Office, 20 Riverside Drive, Lakeville, MA 02347, and to the Department of Environmental Protection, Division of Water Pollution Control, One Winter Street, Boston, MA 02108, and to the Board of Health, Superior Court House, Barnstable, MA 02630. C. Supplemental Conditions 1. The permittee shall notify the Director of the Division of Water Pollution Control at least thirty (30) days in advance of the proposed transfer of ownership of the facility for which this permit is written. Said notification shall include a written agreement between the existing and new permittees containing a specific date for transfer of permit, responsibility, coverage and liability between them. 2 . The permittee and any successor shall submit to the Division an annual financial report concerning the sewage treatment system. The report shall include, at a minimum, the following: a. all expenses for operation, maintenance, replacement or repair of the sewage treatment facility within the past year; b. all revenue generated to meet such expenses; C. initial and current balances in the capital reserve account and any other accounts; and d. ` projected means 'of accumulating sufficient capital to replace the sewage treatment facility by 2007 . The report shall be prepared in accordance with generally accepted accounting principles consistently applied. 5. This permit is an action of the Department. Any person aggrieved by this action may request an adjudicatory hearing. A request for a hearing must be made in writing and postmarked within thirty (30) days of the date you received this permit. Under 310 CMR 1. 01 (6) (b) , the request must state clearly and concisely the facts which are the grounds for the request, and the relief sought. The hearing request along with a valid check payable to Commonwealth of Massachusetts in the amount of one hundred dollars ($100. 00) must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency) , county, or district of the Commonwealth of Massa- chusetts, or a municipal housing authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. BD/XC/yg dsk 31: 0-576.gwp PART II GENERAL PERMIT CONDITIONS The following conditions apply to all permits: 1 No discharge authorized in the permit shall result in a violation of the Massachusetts Surface Water Quality Standards (314 CMR 4 . 00) or the Massachusetts Ground Water Quality Standards (314 CMR 6.00) , or any amendments thereto. Upon promulgation of any amended standards, this permit may be revised or amended in accordance with such standard and 314 CMR 2.10 and 3. 12 or 5. 12. For purposes of determining compliance with ground water quality standards, a violation of the ground water quality standards, and the discharge permit, will be determined to occur when any parameter measured in any downgradient well exceeds the applicable criteria listed in 314 CMR 6.06. In those cases where it is shown that a measured parameter exceeds the applicable criteria listed in 314 CMR 6.06 at the upgradient monitoring well, a violation of the ground water quality standards and a measured parameter in any downgradient well exceeds the level of that same measured parameter in the upgradient well for the same sampling period. 2 Duty to comply. The permittee shall comply at all times with the terms and conditions of the permit, 314 CMR, the State Act and all other applicable state and federal statutes and regulations. 3 Standards and prohibitions for toxic pollutants. The permittee shall comply with effluent standards or prohibitions established under Section 307 (a) of the Federal Act for toxic pollutants within the time provided in the regulations that establish these standards or prohibitions, even if the permit has not yet been modified to incorporate the requirement. 4 Proper operation and maintenance. The permittee shall at all times properly operate and maintain all facilities and equipment installed or used to achieve compliance with the terms and conditions of the permit, and in accordance with 314 CMR 12 . 00. 5 Duty to halt or reduce activity. Upon reduction, loss, or failure of the treatment facility, the permittee shall, to the extent necessary to maintain compliance with its permit, control production or discharges or both until the facility is restored or an alternative method of treatment is provided. It shall not be a defense for a . permittee in an enforcement action that it would have been necessary to halt or reduce the permitted activity in order to maintain compliance with the conditions of the permit. page 1 of 7 I continued Records of monitoring information shall include: (a) The date, exact place, and time of sampling or measurements; (b) The individual (s) who performed the sampling or measurement; (c) The date(s) analyses were performed; (d) The individual (s) who performed the analysis; (e) The analytical techniques or methods used; and (f) The results of such analyses. 12 Prohibition of bypassing. Except as provided in 314 CMR 3.19 (13) , bypassing is prohibited and the Director may take enforcement action against a permittee for bypassing, unless the discharge is to a surface water and: (a) The bypass was unavoidable to prevent loss of life, personal injury, or severe property damage; (b) There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities, . retention or untreated wastes, or maintenance during normal periods of equipment downtime. This condition is not satisfied if the permittee could have installed adequate backup equipment to prevent a bypass which occurred during normal periods of equipment downtime or preventive maintenance; and (c) The permittee submitted notice of the bypass to the Director: 1. In the event of an anticipated bypass at least ten (10) days in advance, if possible; or 2. In the event of an unanticipated bypass as soon as the permittee has knowledge of the bypass and no later than twenty-four (24) hours after its first occurrence. 13 Bypass not exceeding limitations. The permittee may allow a bypass to occur which does not cause effluent limitations to be exceeded, but only if necessary for the performance of essential maintenance or to assure efficient operation of treatment facilities. 14 Permit actions. The permit may be modified, suspended, or revoked for cause. The filing of a request by the permittee for a permit modification, reissuance, or termination, or a notification of planned changes or anticipated non-compliance does not stay any permit conditions. is Duty to reapply. If the permittee wishes to continue an activity regulated by the permit after the expiration date of the permit, the permittee must apply for and obtain a new permit. The permittee shall submit a new application at least one hundred and eighty (180) days before the expiration date. of the existing permit, unless permission for a later date has been granted by the Director. page 3 of 7 continued (e) Twenty-four (24) hour reporting. The permittee shall report any non-compliance which may endanger health or the environment. Any information shall be provided orally within twenty-four (24) hours from the time the permittee becomes aware of the circumstances. A written submission shall also be provided within five (5) days of the time the permittee becomes aware of the circumstances. The written submission shall contain a description of the non-compliance, including exact dates and times, and if the non-compliance has not been corrected, the anticipated time it is anticipated to continue; and steps taken or planned to reduce, eliminate, and prevent reoccurrence of the non-compliance. The following shall be included as information which must be reported within twenty-four (24) hours: 1. Any anticipated bypass which exceeds any effluent limitation in the permit. 2. Violation of a maximum daily discharge limitation for any of the pollutants listed by the Director in the permit to be reported within twenty-four (24) hours. (f) Other non-compliance The permittee shall report all instances of non-compliance not reported under 314 CMR 3. 19 (20) (a) , (b) or (e) at the time monitoring reports are submitted. The reports shall contain the information listed in 314 CMR 3 . 19(20) (e) . (g) Toxics. All manufacturing, commercial, mining, or silvicultural dischargers must notify the Director as soon as they know or have reason to believe: 1. That any activity has occurred or will occur which would result in the discharge of any toxic pollutant listed in 314 CMR 3. 16 which is not limited in permit, if that discharge will exceed the highest of the following notification levels: a. One hundred micrograms per liter (100 µg/1) ; b. Two hundred micrograms per liter (200 µg/1) for acrolein and acrylonitrile; five hundred micrograms per liter (500 µg/1) for 2,4-dinitrophenol and for 2- methyl-4, 6-dinitrophenol; and one. milligram per liter 1 mg/1) for antimony; c. . Five (5) times the maximum concentration value reported for that pollutant in the permit application; or 2. That they have begun or expect to begin to use or manufacture as an intermediate or final product or byproduct any toxic pollutant which was not reported in the permit application. page 5 of 7 r continued 25 Transfer of permits. (a) RCRA facilities. Any permit which authorized the operation of a RCRA facility which is subject to the requirements of 314 CMR 8.07 shall be valid only for the person to whom it is issued and may not be transferred. (b) Transfers by modification. Except as provided in 314 CMR 3 . 19 (25) (a) and (c) a permit may be transferred by the permittee to anew owner or operator only if the permit has been modified. or revoked and reissued or a minor modification made to identify the new permittee. (c) Automatic transfers. As an alternative to transfers under 314 CMR 3. 19 (25) (b) , any permit may be automatically transferred to a new permittee if: 1. The current permittee notifies the Director at least thirty (30) days in advance of the proposed transfer date in 314 CMR 3 . 19 (25) (c) 2 . 2 . The notice includes a written agreement between the existing and new permittees containing a specific date for transfer of permit responsibility, coverage, and liability between them; and 3. The Director does not notify the existing permittee and the proposed new permittee of his intent to modify or revoke and reissue the permit. A modification under 314 CMR 3 . 19(25) may also be a minor modification. If this notice is not received, the transfer is effective on the date specified in the agreement mentioned in 314 CMR 3 . 19(25) (c) 2. 26 Permit Fees. (a) Any permittee, other than a public entity, required to obtain a surface water or ground water discharge permit pursuant to M.G.L. c.21, s.43 and 314 CMR 3.00 and 5.00, shall be required annually to obtain an inspection certificate from the Division and submit the information and fee associated therewith in accordance with 314 CMR 2. 12. p:general.gwp i page 7 of 7 TOTAL RECIR. INFL. INFL. INFL. INFL. INFL. RBC EFFL. EFFL. FLOW RATIO pH BOD TSS TS AMMONIA pH pH BOD DATE (GAL) (%) (SU) (MG/L) (MG/L) (MG/L) (MG/L) (SU) (SU) (MG/L) 01-Nov-95 3400 50 7.90 7.80 8.00 02-Nov-95 3700 50 7.90 7.70 7.90 03-Nov-95 3500 50 8.00 7.70 7.60 104-Nov-95 0 50 7.80 7.80 7.90 05-Nov-95 0 50 7.90 7.80 7.90 06-Nov-95 3000 50 7.90 7.80 8.00 07-Nov-95 2700 50 7.80 7.80 8.00 08-Nov-95 3780 50 7.80 7.90 8.10 09-Nov-95 3900 50 7.80 7.90 8.00 10-Nov-95 0 50 7.80 7.90 8.30 11-Nov-95 0 50 7.80 7.90 7.80 12-Nov-95 0 50 7.70 7.90 7.90 13-Nov-95 380C 50 7.90 8.00 7.80 14-Nov-95 3460 50 7.80 8.00 8.40 15-Nov-95 3600 50 7.90 7.50 8.30 16-Nov-95 3300 50 7.80 7.60 8.30 17-Nov-95 3900 50 7.80 101.0 600.00 51.90 7.70 8.20 18-Nov-95 0 50 7.90 7.80 7.80 19-Nov-95 0 50 7.60 7.70 7.90 20-Nov-95 3300 50 7.70 7.80 7.80 21-Nov-95 3400 50 7.70 7.70 8.10 22-Nov-95 1500 50 7.60 7.50 8.00 23-Nov-95 0 50 24-Nov-95 0 50 7.60 7.80 8.30 25-Nov-95 0 50 7.60 7.70 8.40 26-Nov-95 0 50 7.60 7.80 8.40 27-Nov-95 3500 50 7.80 7.80 8.20 28-Nov-95 3400 50 7.90 96.5 7.60 8.30 7.60 29-Nov-95 3800 50 7.80 7.50 8.30 30-Nov-95 4000 50 7.80 7.60 8.40 Total 64,940 Average 2,165 7.79 8 8 r EFFL. EFFL. EFFL. EFFL. - EFFL. EFFL. EFFL. FACILITY TSS TS AMMONIA TKN NITRATE SODIUM VOC BOD REM. DATE (MG/Li (MG/L) (MG/L) (MG/L) (MG/L) (MG/L) (UG/L) (%) 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 19.00 579.00 0.36 2.80 6.10 69.00 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 92.1 29-Nov-95 30-Nov-95 FACILITY FACILITY FACILITY WELL #1 WELL #1 WELL#1 WELL#1 TSS REM. NH4 REM TS REM. H2O LEV. pH COND. NITRATE N DATE N N N (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 81.2 59.5 3.5 23.6 5.3 210 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL #1 WELL #1 WELL #1 WELL#2 WELL#2 WELL#2 WELL#2 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 17.7 5.3 190 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 ------------------------------------------------------------------------------------------------------------------------------- WELL #2 WELL #2 WELL #2 WELL #3 WELL #3 WELL #3 WELL#3 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 18,3 5.5 310 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL #3 WELL #3 WELL #3 WELL #4 WELL #4 WELL#4 WELL#4 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 26.9 5.3 250.0 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL#4 WELL#4 WELL #4 WELL #5 WELL #5 WELL #5 WELL #5 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 34.1 6.0 400 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL #5 WELL #5 WELL #5 WELL #6 WELL#6 WELL#6 WELL#6 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 36.6 6.0 770 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL #6 WELL#6 WELL#6 WELL#7 WELL #7 WELL#7 WELL#7 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 DRY DRY DRY 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 WELL#7 WELL #7 WELL#7 WELL #8 WELL#8 WELL#8 WELL#8 AMMONIA N FECAL COL. VOC/624 H2O LEV. pH COND. NITRATE N DATE MG/L MPN/100 MLS UG/L' (FT) (SU) (uOHLMS) MG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 7-Nov-95 32.5 5.9 120 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 2'9-Nov-95 "1.0-Nov-95 WELL #8 WELL#8 WELL#8 AMMONBA N FECAL COL. VOC/624 DATE MG/L MPN/100 MLS UG/L 01-Nov-95 02-Nov-95 03-Nov-95 04-Nov-95 05-Nov-95 06-Nov-95 07-Nov-95 08-Nov-95 09-Nov-95 10-Nov-95 11-Nov-95 12-Nov-95 13-Nov-95 14-Nov-95 15-Nov-95 16-Nov-95 17-Nov-95 18-Nov-95 19-Nov-95 20-Nov-95 21-Nov-95 22-Nov-95 23-Nov-95 24-Nov-95 25-Nov-95 26-Nov-95 27-Nov-95 28-Nov-95 29-Nov-95 30-Nov-95 oF��Eti Town of Barnstable Regulatory Services swtuasraat.e. / g Thomas F. Geiler,Director �6;q. `0 A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: Sarah Bartholomew, General Manager, Sodexho School Services From: Dale Saad,PhD., Barnstable Health Divisions✓ Date: May 24, 2002 Re: Object found in juice container on May 16, 2002 A 4oz. carton of open apple juice was delivered to the Barnstable Water Pollution Control Lab on May 16, 2002 by Donna , He4lth Inspector for Barnstable Health Division. ldlc.�111.Dj The sample was logged in by Dale Saad, PhD., Barnstable Health Division, and was subjected to a gross visual examination on the same day. The initial gross examination yielded the following: • Sample was received in a small red cooler with cooler packs ("blue ice"). • 4oz.paper juice container was stapled closed. • Container was opened in the lab and was approximately half full (2oz.)with apple juice and a foreign object. • The object was removed from the container and using forceps placed in an examination dish. • Object was placed under a dissecting microscope and examined. •' Further visual examination using a higher-powered microscope indicated a structure lacking plant or animal cells and a structure consistent with a mineral. • Upon visual examination the object was a black,hard,porous material which was non- metallic (magnet test). • The material was easily broken, and crumbled into several pieces similar to the whole except for size. • Visual examination indicated the material was consistent with activated charcoal. On May 21, 2002 additional examination of the sample was conducted as follows: • The object was washed in distilled water and a small section was removed(broken off). • The smaller sample was dried in a low temperature oven(approx. 105°C). • The smaller sample was then weighed and placed in a muffler oven at high temperature (550°C). • The sample retained its size, shape and weight under this regime. • Further examination of the original paper container showed that the apple juice was made using filtered water. • The object found in the container appears consistent with activated charcoal commonly used in beverage filtration processes. I e. �� r=s��.a•_e.Yar�dew9antadsmwaw:ua..,:cv��.er me.4,:wrs,e�caS,�.1r_.= -,_r�.,�.umaw+3a�uw,•svialismivn.�..�..�a.�..m,�s.uav�.s®.nasso�.=_tYa�" �� _ -_•_ ....•m..eta,a�Pi��•r._.�.a,�:e:�•-'—merineian .:.. .,.._a�H„,�:,,_ .s.�•,. .v..+'M-_ 1A)&; KEEPING YOU ORGANIZED No. 10334 2-153L jUMSAI� (ORES y MNlCON:RECYCLED MAIM TENT CoMod Fiber Sourcing 1;08T.`Wwuk" w WshprogfBA•_m �.:.xi-,:^.t�a�-e..i- .a ,'.v�'a" �__ ._,-.Niz�JJL•.�:�_c"..-,Ylivveb.,w,S�.,.emm-_;�;:.:.:hti.e.��:c.__-...�.,a,�.4- _ �..�1,�.:i+r�_,_�_..�a....s�-e......._s;.v.�.o.4 ':�-�z}s*uat,�:� ..rs�.�..�_� ,,..,•..,.vs___.._.. .,__....x�.a+i.,...:�,=., ._.T�.._...�,.,�.�_..._..�..�.n...H...:atmea:�z:e�:..a--'z'a•�e�..vea:v::_.�.:a:�. pi THE l�Y TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 039. .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY ArFD MPy° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT _ Name 1 J Date Toe o Type atinspection v O e tine Address Risk/ Servi etai Re- -tion Level R Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation qZj Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALSbt�� .� ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Ilk f ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals �-- FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardousfoods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling U ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding V' PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9:Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY . ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Q "" `f Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �'g within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction-Based on an inspection today,Me items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ardless of the number of critical,results in an F. B=One critical violation and less than 4 non-critical violations 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations.and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. q (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign lairs Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violation 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 Law Cooled to 41 1 590.003(A) Assignment Responsibility* 8 Cross-contamination 14 Food or Color Additives for P F Within 4 Hours* of 3-501.15 Cooling Methods for PHFs. 590.003(B) Demonstration of Knowledge* 3-302.11(A)(]) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302_.1.4 Protection from Unapproved Additives* Contamination from Raw Ingredients 1 g Poisonous or Toxic Substances 3-501.4(F) Cold PHFs Maintained A[or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C Responsibility of the Person-in-Charge to g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) � h, Other* 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control i 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use - 590.004(11) Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* r 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food 05* 7-2 .11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* I 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eI/cme tnizom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food * 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- * Ratites-165°F IS sec* in mobile food,Lem or and residential Sources g, P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70*F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006. 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 2g, Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. eFt�, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date. l Page: of o OFFICE HOURS PUBLIC HEALTH DIVISION 800-9:30 A.M. BARNSfABLE, 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3: `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p a 508-862-4 A4 'FDN1P� FOOD ESTABLISHMENT INSP C ION REPORT YN Name Dal Type of TyppAftpectionWA(Ye p utine Address ffyRisk ood Service Inspection 4inLevel Retaif Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Lp�� / Time Bed&Breakfast O AC V In: Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items)( Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ L FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities _ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS" L� ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives i L� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals \ FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Ha ous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures oX 1-0 ❑ 5.Receiving/Condition ❑ 17.Reheating VIE ❑ 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) 42 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories I Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations .�' Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating _ 9 within 90 days as determined by the Board of Health.. CCCJJJ ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC 4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 2fir.water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27"Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non critical violations. If 1 critical refrigeration. 28)Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Ins�ect.rlssignature � Print: 30.Other DATE OF RE-INSPECTION: 31.Dump er"screened from public view Permit Posted? ✓ Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N �' ..:�,W,rw td' �.� ._ .ni.^_ _ *;'+,..� � - P.. a 7.. _. i-•'Y.-.�Y +'s�.,.- - -. �4. 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.1](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 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16 A( ) Roasts Held At or Above 130°F* 7-20111 Separation-Storage*Applicants* - - - � P g 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* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Dispgsition of Adulterated or Contaminated ( , - I - 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 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(l)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* _ _ _ gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzooi 4.-602.11. _ Cleaning Frequency of Utensils and Food _ Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food * 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-I55°F 15 sec Shellfish* - 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* • Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 - Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)' 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unshced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 1590.000 3-203.12 Shellstock Identification Maintained* Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying g 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. rT^►o, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS O` PUBLIC HEALTH 8:00-9:30 A.M. BARNSTABLE, 200 MAIN STREET item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 R M. MASS. g. MON.-FRI. a .e39. �0 HYANNIS,MA 02601 sos-8s2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTI N EPORT y c Name C Dat Ve T ec ion s outineAddress isk Re-inspectionLz� eve Previous Inspection V Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness 1. Caterer General Complaint C' HACCP Person in Charge(PIC) ime Bed&Breakfast Other In: Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities e n O EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ` ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Ha ou Fdb C ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Il`/h ❑ 5.Receiving/Condition ❑ 17.Reheating p/ l ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �! ❑ 11 Good Hygienic Practices ❑ 22.Posting of Consumer Advisories, lIlk Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation Critical('C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.VDumpslscreened from public view Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N#Seats Observe Frozen Dessert Machines: Outside Dining Y N PIC's Signature Pr' Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violation related to Foodborne Illness - Violation 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* Law Cooled to 41°F/45°F Within 4 Hours* $ Cross-contamination 14 Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 .- Additives* 2-103:11- - Person-in=Charge Duties - Cooked and RTE Foods.* * 19 .. _ PHF Hot and Cold Holding arg 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients - I 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F 15 Poisonous or•Toxic Substances 590:004(F)- * - -- - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in Charge to Other*- 3-501.16(A) Ho[PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers*Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection** - 3-302.15 Washing Fruits and Vegetables tion* 7-202.7-201.11 Separation-Storage*11 Restriction-Presence and Use 3-501.16 A LIP_ 0 Time as a Public Health Control PP • * 590.003(F) Responsibility of A Food Employee or An - 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food,Con[act with Equipment and Utensils* 7.202.12 Conditions of Use* 590.004(11)- - Variance-Requirements 590.003(G) Reporting by Person in-Charge* ,_ _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food ! 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 IncidentaLFood Contact,Lubricants* Beverages with Warning Labels* 4 _ Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-13) Cotnpliance with Food Law* _ * 3-801.11(D) Raw or Partially Cooked Animal Food and - - 4-501.11.1 - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 - Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHrs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* - - -' - 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* _ r gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ef/cmc mnoor 4-602.11_ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 - Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - _ - - 3-40L11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS _• '�.�� 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and-Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs 145°F 15 * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms_ _ ( )( )( ) er s- sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5- - Receiving/Condition - - 2-401.11___ _Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the:foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E). Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E). Preventing Contamination from Employees* 1$ Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007. 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. Y pFF rO{,„p TOWN OF BARNSTABLE HEALTH OFFICESPECTOR,s Establishment Name: Date: �C Page. - of HOURS RARNSfABLR. PUBLIC 2 0 MAIN STREET i3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MASS. 3. `m� HYANNIS, MA 02601 508-862-4Rs44 I. No Reference R-Red Item PLEASE PRINT CLEARLY �FOMP,a FOOD ESTABLISHMENT INSPECTION REPORT (2,A0 ODD Name Date; �� 1%., Type of section O outine Address -{ Risk oSe ctionLevel Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) me Bed&Breakfast HACCP Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ; 0 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ CSkISIA v` Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ` G FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities La `� � 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 TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures `a- ❑ 5.Receiving/Condition ❑ 17.Reheating ;J VVIrt ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding v✓v PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control � (F(1 ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) L- �t V\,�� 42!) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP �- p , ,„� f f; �- ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY wvt DAL ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories i UJ0- LAWViolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t/ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑Y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations g ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations re 26.water,Plumbing andWaste (FC-5)(590.006) establishment permit and.cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=IF is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If If critical water,sewage back-up,infestatioh of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8nnn-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump r screened from public view ^ /�/� �a4 z Permit Posted? � Y N Grease Trap Previous Pumping Date Grease Rendered Y N V � V v #Seats Observed Frozen Dessert Machines: p Outside Dining Y N PIC's Sig lure Print /% o O �� Self Service Wait Service Provided Grease Tra Size. Variance Letter Posted Y N / G � Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) f FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45*F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 1 y PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130'F* Require Reporting by Food Employees and Contamination from the Environment ( ) * 7-201.11 Separation-Storage* Time as a Public Health Control Applicants * 20 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* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing 590.003(E) Removal of Exclusions and Restrictions g Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* ff 3-801.11(A) _ Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders Raw Seed Sprouts Not Served*,Pest Control and * 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.1](A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"°e rnnoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 4-702.11 Frequency of Sanitization of Utensils and Food Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in ca[er- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential I Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* Good'Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands -•• 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* F 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. o*THE TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: _Page: of bo PUBLIC OFRCE HOURS BARNSTABLE. 2 0 MAN STREEETSION 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �P e3. �0� HYANNIS,MA 02601 eoON. asa4 No Reference R-Red Item PLEASE PRINT C EARLY 'FD MP+� FOOD ESTABLISHMENT INSPECTION REPORT Name .� Dat 124( Tvne ofIMnraflinspection ` _L ro Address isk Re-inspection. evel Retail Previous Inspection 47A Telephone Residential Kitchen Date: , Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness �t Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP tAJ �� In: Other I Inspector Out: i Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items ( ) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ l FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives / ❑ 3:Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) _ ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating >.� ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling r ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control �- ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP _ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories L� Violations Related to Good Retail Practices Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 1,05 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4 non-critical violations 9 p (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other PATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster scre ed from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 111 Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) . FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 _ 590.003(A) Assignment of Responsibility* _ g Cross-contamination 1q Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 1 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 ' Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * _19 ._ _ -_ __ PHF Hot and Cold Holding, 2-103.11 Person-in--Charge Duties -- 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or"Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F-590.003(C) Responsibility of the Person-in-Charge to - - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* - --- - - 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection* 590.003(F) Responsibility of A Food Employee or A Applicant To Report To The n Person In Charge* 3-302.15_ Washing Fruits and Vegetables 7-202.7.202.12 Conditions of Use 3-501.19 Time as a Public Health Control* _ _ * 11 Restriction-Presence and Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - - - - - -- - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of or Contaminated - -- - -- - --• - -3-701.11 Discarding or Reconditioning Unsafe Food* 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE * 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* _ 4_ - " Food a'nd Water From-Regulated Sources ' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ __ - _ 4-501:111 -Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ _._ ____ _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.1ti Ice Made From Potable Drinking Water' - Concentration and Hardness* 3-401.11A(1 j(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*_ _ _ _ _ _ .. gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//°"°e uuzoo1 4.-602.11__ _-Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* I - Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From.an Approved Source __ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* -4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - .' '' Shellfish* - - _ - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15_ _Molluscan Shellfish from NSSP Listed Cherdical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * - Ratites-165°F 15 sec* in mobile food,temporary and residential ' Sources g• P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game-and-WildRegulatory Authority By - "� 2.361.11 Clean Condition'-Hands and Arms* Regulatory Authority I 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* -' 2-301.12 Cleaning Procedure* ( 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to as * Other 590.009 violations relating to good retail 590.004(C) , Wild Mushrooms i- Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition - -- - - 2.401.11 _ . Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3402.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mopth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tas[in * * (Blue Items 23.30) 3.202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible . Within 2 Hours and From 70°F to 41°F/45°F Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen.Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.s 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 17 FOR YOUTH DEVELOPMENT°;;, the FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY May 5,2018 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Attn:Thomas McKean RE:Agreement Number 01-020-5F215 Dear Mr.McKean: This is a formal notification that the following sites will be participating in the Summer Food Service Program for children starting June.25th and ending September 1".The meals will be cooked at the YMCA Camp Lyndon located at 117 Stowe Road,Sandwich, MA. Program Name Approx#Kids - Address Meal Service/Time Served Camp 132 100 2245 lyannough Rd Breakfast:7:30 am-9:30 am West Barnstable, MA Lunch: 11:30 am—1:30 pm Faith Assembly Kiddie 120 154 Bearses Way Breakfast:8:15 am—9:15 am Camp , Hyannis, MA Lunch: 11:30 am—12:30 pm West Villages 50 760 Osterville-W. Barnstable Rd Lunch: 11:00 am—1:00 pm Elementary School Marstons Mills,MA Cromwell Court 50 168 Barnstable Rd Breakfast:8:15 am—9:00 am Apartments Hyannis, MA Lunch: 12:15 pm—1:30 pm Sturgis Library 50 3090 Main St Lunch: 11:45 am—1:15 pm Barnstable,MA A Baby Center 20 81 Willow Ave Lunch:11:00 am—12:00 pm Hyannis, MA Cape Cod Family 50 29 Bassett Ln Lunch: 12:00 pm—1:00 pm Resource Center Hyannis, MA STAR Program 50 418 Bumps Rd Lunch: 11:30 am—1:00 pm Osterville, MA Village Green 50 767 Independence Dr Lunch: 1:00 pm—1:30 am Apartments Hyannis,MA ,,Hyannis West 100 549 West Main St Breakfast:9:00 am—9:30 am Elementary Camp Hyannis, MA Lunch: 11:30 am—12:00 pm Please contact me at(508)362-6500 ext. 142 with any questions. Sincerest Regards, Taylaur Pasquale YMCA Cape Cod Food Service Coordinator P:(508)362-6500 E:taagguale@ymcacapecod.ora I L.L4 6t Sa 6LEA MA 760 Dsf-- W, �► �� ®®a SMEAR KEEPING YOU ORGANIZED No. 10334 2-153L 0S.U,STMNW CONTENT 10%fNUV.RECYCLED WmAT�NE ApL Certified Fiber Sourcing p�a, R wrw .Chprogrem.wo Wq�1o0 'AJ`�e OU6471O AT SUM-CM J a xu`if6rth -Wf�e.-Lra�:.d»t.sii:.;,�....�jlVi.. -.�._ :.�=,,.xSC. ;_. ..,�.✓:ayu.Jbin�'�tiwa,,:.'^r....CW==,-'z.::. .�.�n '_,yam 's:u'--`�c$�-�4i�<ei _ _ .`�SiaS66G.t-="��.ym_ .m.oW..�"c_-_ _ __ __aamrs ��s�-