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HomeMy WebLinkAboutCENTERVILLE PIE CO. - FOOD zCENTERVILLE PIE CO. 1671 Falmouth Road, Cent. r' a1 pf Town of Barnstable BOARD OF HEALTH $ John T. Norman Board of Health Donald A.Gaudagnoli,M.D. iML14STABM F.P.(Thomas)Lee,. MAS& Daniel Luczkow,M.D. Alt. sag 200 Main Street, Hyannis, MA 02601 p�F 'Mc.Etl 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: 2 Issue Date: 01/01/2022 DBA: CENTERVILLE PIE COMPANY OWNER: KRISTIN BROADLEY Location of Establishment: 1671 FALMOUTH ROAD/UNIT#3 CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent a FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE. Restrictions: 10/14/2021 1 :32PM FAX 7744701407 CentervillePies Ca0001 tie For Office Use Only- Initials: Town of Barnstable Amtsd o . MANi Inspectional Services heck# ';, � Public Health Division t Thomas McKean,Director 200 Main Street,l••I.yannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERA`1'E A FOOD ESTABLISHMENT DATE 10 In I?02 j NEW OWNERSHIP RENEWAL i NAME OF FOOD ESTABi.iSHMENT: L(Tkrv""iI I t 101-e- Omm rtA ADDRESS OF FOOD ESTABLISHMENT: 167 Ou I • (�(o MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ' • i E-MAIL ADDRESS: I TELEPHONE:NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 4 WELL WATER:YES NO-11.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / / TO I / /` I NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMMDEIt*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD i FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE&NEW FOOD ONLYI** REQUIRED TO CALL BEALTIY DIV.FOR INSPECTION i'ItlOR TO PIM TT BEING ISSUED PLEASE CALL 508-862-4644 I• QAApphcu6on ToaasTOODAPP 2020.doe 10/14/2021 1 :32PM FAX 7744701407 CentervillePies 160002 ' I OWNER INFORMATION• )FULL NAME OF APPLICANT SOLE OWNER: YES NO D.O.B G OWNER P'HON # `774 "�$ ADDREss roe anni e2 © i CORPORATE.OWNER: CORPORATE ADDRESS: 11071 QmQtzb �n >vw k /AA Dm2 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Manaaper_s Expiration Date Allergen Awareness Expiration Date i tArCh'i bd Id 515 /.2 I- I /2' I(D2K�1�76 10/-3 / 22- i o / C5 2xi-l SIG T..RE 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 llealth 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.tuivnofbarnstable.uy/healthdivision/aDolications.asn. 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 TIM COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. I Q,\APPlicadon Forms\FOODAPPREV3-2019.doc TOWN OF BARNSTABLE. . HEALTH INSPECTOR-s Establishment Name: �f� Dater Page: Of W OFFICE HOURS PUBLIC HEALTH DIVISION' 8:00-9:30A.M. BARNSTARLE. • 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. ,esq.ego HYANNIS,MA 02601 5oe-86z-asaa No Reference R-Red.Item . PLEASE PRINT CLEARLY tE D P�M FOOD ESTABLISHMENT INSPECTION REPORT i� I In o f 0-f�a �ciud Name 1 (� Date�� ? Type of T s c ion - n outing Address Gl Risk Food Se Re-inspection rr Z '/h X., loe Level Retail Previous Inspection ✓ <^'�� u" Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Igo�I l� Caterer General Complaint Person in Charge(PIC)�r C7�/� I �� Time Bed&Breakfast HACCP �/�1.�%J In: (0-30 Other 1�� �/11.0 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) ❑ f Violations marked may_pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) YA& P:,t /(_ 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 c( y(Y�CfAjCCm ! EMPLOYEE HEALTH PROTECTION FROM CHEMICALS uyu ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals (.�U/`c �� I 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) h ❑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 J Violations Related to Good Retail Practices(Blue Items l 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 d Re- inspection determined b the Board of Health. Voluntary Compliance Employee ee Restriction/Exclusion Re in Emergency Y � ❑ rY P ❑ P Y � ❑ spectlon Scheduled ❑ Emerg y Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 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 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical FacilityFC-6 590.007 aggrieved by this order, have a right to a hearing. q Your re uest must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y ( )( ) you 9 g violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health�at the above address 29.Special Requirements. (590.009) Within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's�tgn re Print: 31.Dumpster screened from public view Permit Posted? �Y N Grease Trap Previous Pumping Date Grease Rendered Y N - - ce:�&� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S' re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202'12v 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 7 5 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) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12. Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR - 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 , Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk.Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/1/2001 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* * 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Shellfish 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail _ 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 40 .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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Ph sical Facility FC-6 .007 590.004(J) 9 9 Y� b 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 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. OF ----------- I ME row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: -�� (ram- Date: Z- Page: l Of `.. OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified 94, 63.>e� HYANNIS,MA 02601 508-8 -FRI.62-4644 NO Reference R-Red Item PLEASE PRINT CLEARLY 8-8 'FDN1�` FOOD ESTABLISHMENT INSP C ION REPORT Name01w4ty-VI, l Date3 ( ` 'Tvoe of T I c ion _ Address C � Risk Food Service Re-inspection eve) Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ,//�(^�� Caterer General Complaint Person in Charge(PIC) �'✓ � Time, Bed&Breakfast HACCP ;In: I d Other Inspector 6tw h So JD out:3` 14H Each violation checked equires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ - Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �� v 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 1717.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 LOOCa ❑ 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) �' _I I Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If water, sly Critical Violation=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. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector' atu � � 30.Other DATE OF RE-INSPECTION: _- 31.Dumpster screened from public view L 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 a/ � Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge[0 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) I 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hat Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undefcooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment ( )( ) Pathogens* 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * e ecrrve irvzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf aces of Equipment* Shellfish* 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 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es shoo 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 2-001.11 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 foodbore 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the g 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[0 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 Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 5-20411 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 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formbackfi-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. pF THE rp TOWN OF BARNSTABLE _ HEALTH INSPECTORS Establishment Name: ( w \ t7 Date: Page: of ry OFFICE HOURS A E' PUBLIC 2 0 MAIN STREET 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MON.-FRI. ate. HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item .. PLEASE PRINT CLEARLY,• . rFO MP'� FOOD TABLISHMENT INSP TI N REPORT - n - e Name Dat of ection f g Routin _ i - Address sk od Servi specti0 evel ai Previou yy � A Telephone Residential Kitchen Date: / Mobile Pre-o or {/ Owner HACCP YIN Temporary Suspect II ness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP ® I Other Inspector fb 5 L= F if O Each violation checked requires an explanation on the narrativ pages)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ - FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS cl ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holdirfg 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 �/'✓ tSi Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations' Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,thd ite s ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal F] Other: checked indicate violations of'105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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 i non-critical: If no critical water,sewage back-up,infestation of rodents or insects,or tack of be in writing and submitted to the Board of Health at the above address violations observed,7 to a non-c ons vi lations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to Snon-critical viol Ions- 29.Special Requirements (590.009) within 10 days of receipt of this order. Sign I Situ e nt: 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N B #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' na re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ( � Dumpster Screen? Y N �S c�V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives r '. - 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'f2'- , 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 frmo Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances i 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) i I i _ * - 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7 102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F 7-202.11 Restriction-Presence and Use*_) 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 3-304.11 Food Contact with Equipment and Utensils In Charge* * 7.202.12 Conditions of Use* 590.004I1 Requirements - Variance 590.003(G) t 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 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 _. Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/I/200/ 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 Surfaces of qui of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* `Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 1 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 * Proper,Adequate Handwashing Ratites-165°F 15 sec* ing' P *aTY mobile food,temporary and residential 10 Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices _ 77 Reheating for Hot Holding Requirements.practices o should be debited under#29-Special 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* C CommerciallyProcessed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity* 3-403.11( ) Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands - 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated a ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'17 to 70`F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-5.01.14(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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision ' 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* Ih 8-103.12 Conformance with Approved Procedures* S:590Fomrback6-2doc *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.xE rof TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: { t"7Page: . of � ti �- • P ° PUBLIC HEALTH DIVISION OFFICE HOURS8.00-9:30A.M. BARN STABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p e3;e m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. 508-862-46" 'FDN1" FOOD ESTABLISHMENT INSPECT ON REPORT Name / dn � Dal of T Inspection O er sFildttine _ Address Risk ervi ction Leve a ai Previous Inspection Telephone ,S' esi ential Kitchen Date: _ Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other n: 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) ❑ s Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ y--� Action as determined by the Board of Health. Allergen Awareness 590.009(G) IF FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ✓1QC ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals i 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 R- _ ❑ 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 • C, ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) C ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HS ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories rL 7t Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations i 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 "1 1 within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order or C ec'on:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate viol ions 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 B=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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.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 i ' 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 8non-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 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 IC's Si!gnatuje Print: Self Service Wait Service Provided Grease.Trap.Size Variance Letter Posted Y N Dumpster Screen? Y N D-Z�r� �6 Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) . Assignment of Responsibility* F 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.*. Additives* 19 PHF Hot and Cold Holding- 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved 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 - Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ` Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* _ Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* _ 590.004 1] Vaziance Re uireme 590.003(G) Reporting by Person in Chargents * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate Animal Foods That are Raw,Undercooked or 5-101.11� .Drinking Water from an Approved System* _ * gg Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg­fi�e uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From.an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Cherriical* g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Mid 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 Requirements. Would be debited under#29-Special 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 * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 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 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 wilt,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 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen.Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590.F6rmback6-2doc *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. , ►r�,ti TOWN OF BARNSTABLE HEA�THINSPECTORs Establishment Name: Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 3:30-4:30 P.M. BARNSTABLE. • ��- 200 MAIN STREET MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MARS. 'gp ,e,m a e� HYANNIS,MA 02601 508-862-4saa No Reference R-Red Item PLEASE PRINT CLEARLY rFDMP, FOOD ESTABLISHMENT INSPECTION REPORT NameC � ` Date l %Retai Type of Inspection Routine CaN of Address l Risk vice Re-inspection Level Previous Inspection Telepho Residential Kitchen gre!oo Mobile peratio Owner HACCP YIN Temporary Me ness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP ;" t In: Other �. L Inspector Out: P'lj Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 3.Personnel with Infectious Restricted/Excluded 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 7 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ' ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ❑ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance [:].Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 B=One critical violation and less than 4npn-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,.4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC76)(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. violation,4 to 8npn-critical violations=C. 29.Special Requirements_ (590.009) within 10 days of receipt of this order. a 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: ►# t V 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' Signatu Pint: 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.) L. .. L FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received atTemperatuiesAccording to 1 590.003(A) Assignment of Responsibility* S Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs - -- - - Cooked and RTE Foods.* - 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved_Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Ori mal Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held AI or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-.Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* - - - - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B).DispReturned 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 Discatding 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* ( ) P 590.004 A-B Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 17.206.12 Rodent Bait Stat ions* 3-801.11(D) Raw or Partially Cooked Animal Food and --3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ * gg Not Otherwise Processed to Eliminate Equipment ( )( ) Pathogens* 590.006(A) Bottled Drinking Water* 3-40L11 A 2 Comminuted Fish,Meats&Game g * e­&e tanoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell _. Shellfish and Fish From.an Approved Source - 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS -� +- 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3--401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 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 CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the g 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[0 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/ i 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. s ..j ' McKenzie, Marybeth To: peggy@centerville.com Cc: Bellaire, Dianna Subject: 1671 Falmouth Rd, new prep area Hello Laurie, Just wanted to give you an update regarding the "old "dining area that has been changed into the new prep area and the hand sink location.You will not be required to have to install a new hand sink with the floor plan submitted because of the distances to the prep areas is approx. 16 feet, and there isn't anything in the way to block the path to the hand sink (partitions, door, and/or work tables etc.) The seats, as we discussed during the meeting, must be removed because the public may not pass through or enter a prep area to get to the bathrooms. If partitions are planned to be installed and the seats to remain then the hand sink issue will have to be looked at again.So, at this point the prep area is approved , but the seats must be removed before the area is utilized. Please let me know what you will be planning on doing and if you have any questions please feel free to contact me. Regards, Marybeth McKenzie R.S. 1 OPTION #2 I 36 36 36 UNIT #4 * A C2n wr t t I e C T SfOR2' i� UNITS.F. 2 A + SG 500 . U N o H - 145.F. z Q Lo 7 r UNIT #6 1.222 5F. T 3 y BAYSIDE DE51GN#RHv10DeLING Nate° Footage is CD 00 o CL TI. O 1665 Unit t4 } U N IT #4 �A��� "W adder a Q Q `! T .`1:. labeled(W and subtr�ctln9 z < #1667 the office space labeled(B). _� uj v o ----------- —nY.w:1 W o i ; atl-7 •' xdr-ter "m�i�o nosemm M ----------- UNIT #5 r way �. AVAILABLE FOR RENT In r r0 k ' { UNIT 5.F. 1,200 S.F. o A - 36 5.F. w )., H + 145.F. 1 � C +2325.F. Z }yQt �* I I.4 I O 5.F. m m i Space r. I ® Nam; 4 o Unit#5 Footage Is ag OO m the ofte spa tided W O add lice addltlonal a� IJNR�4 � � and In9 �p OpF(CE ' I halVbath space labeled(B) t9 / and(C) In wi co UNIT #6 0 U" a DATM ® e HAY51D1_D 4 R fir° 1�5 0[% B1'TMs° UNR 5.F. 1.200 5.F. I<- �ajt` C -232 S.F. a� 0 ro 34 8 S O C eo_ 1 O � 96 .F. o UNR#5 Nff ® a Nobes DAM a` I� STOWAGE FFlCE Unit#G 5qjare Footage n 02 UNR#4 11 UNIT aiE5 ealallataed by subtradang OFFICE IT OMCE sw. halWath space labeled (6'X 149 (C) ua (ICX 141 e'-e• 4•-r UNrr#G + I I ROOM UNR M e� MaCHANlM I wCo�e o a� It001A I ,e_e• a� ,- A2 I I N o s° '— FROF05ED FLOOR FLAN 'm Cri _ ow"Wh Irm 3 SCNLE: imp ,owlerlu10 w a ROOF OVERR co CONCRETE r4M 24.2' 4jk D AREA NIT 2 � ACW 3 T?1 f S.F. -- - P1 573 F. L"T 3S o ' r LA Or . t5'. o c III /A SAr Ll 9 A7M -! U 9 BATH SATM W 7C+RAGE U elfWE aal�o�d tub r C "r"►C .. Rocm RCCM. HIM NONE 0 0 0 No 0 0 MENNo No FT. PREPER moN TABLE ME 0 ME ON NOE ME MEN loom MENNEN ONO ME mom mom mom No MEMNON ME NEES 0 PIE SHOP mom ME MENNEN MENEM 04Si Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aac, s8 PaulJ.Canniff,D.M.D. Mom' F.P. Thomas Lee Alternate ]k 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 2 Issue Date: 01/01/2021 DBA: CENTERVILLE PIE COMPANY OWNER: KRISTIN BROADLEY Location of Establishment: 1671 FALMOUTH ROAD/UNITS C&D CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �tHE tq� For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$ _ + aARNHABLE, : Inspectional Services 9 MASS. � ib3q. ,0�' Check# prE ya Public Health Division D MA 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 ii NAME OF FOOD ESTABLISHMENT: L G wo ADDRESS OF FOOD ESTABLISHMENT: r it Vf I i0 V�17 �- , 0 A MAILING ADDRESS(IF DIFFERENT FRO ABOVE): E-MAIL ADDRESS: TELEPHONE NUMB R OF FOOD ESTABLISHMENT: 11_L_U - TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO " ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: �L/ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSI DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) __,,,FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc �r OWNER INFORMATION: y� FULL NAME OF APPLICANT VEtS—n'� 01 SOLE OWNER: YES NO D.O.B 11J OWNER PHONE# `C (I! ADDRESS �J I CORPORATE OWNER: '/ r CORPORATE ADDRESS: ` W,Ol/1 �'! fl){ cc;ft)[Ult M ©/BUJ O PERSON IN CHARGE OF DAILY OPERATIONS: � W 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 i t your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date L l��` 6 h�YJ 1�1J / I / �2' 1. G�K� IUjlUZ� l 24 110l SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/apylications.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.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc f. . Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. M - + BARNSTABLE. Paul J.Canniff,D.M.D. rMASK , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 2 Issue Date: 12/10/2019 DBA: CENTERVILLE PIE COMPANY OWNER: KRISTIN BROADLEY Location of Establishment: 1671 FALMOUTH ROAD/UNITS C&D CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: 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: 1 - 12/12/2019 2:OOPM FAX 7744701407 CentervillePies 160001 r e For Office Use On Ir Initials; I QED Town of Barnstable Date raid 4 �„�A.�. ; Inspectional Services } a6j9 ► Check# I f Public Health Division _ ,+ Thomas McKean,Director t 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 °4= �y PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 14 NEW OWNERSHIP RENEWAL_ NAME OF FOOD ESTABLISHMENT: Oatm?AijAa-l�- ADDRESS Of FOOD ESTABLISHMENT:, I � l F 0Lt t"[__ ro K cHowwl LL'45 MAILING ADDRESS(IF DIFFERENT FROM ABOVE)• E-MAIL ADDRESS: TELEPHONE NUMBE14 OF FOOD ESTABLISHMENT., TOTAL NUMBER OF BATHROOMS: WELL WATEIt:Y NO ... (ANNUAL.WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO^/ / NUMBER OF SEATS: INSIDE: OUTSIDE. TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** 11TSIDE DINING M 1ST BE APPROVED BY THE HEALTH DIV.AND LICENSING D MEET OUTSIDE DINING REQUIREMENTS. 1S WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPU 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 C017AGE FOOD INDUSTRY(formerly residential kitchen) M•ODILE FOOD FROZEN DAIRY DESSERT MACHINES... (MONTH1..Y LAB ANALYSIS REQUIRED) CA'I'F ICING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** FOOD ONLY*** SEASONAL,MOBILF,&NEW RFOUIRED TO CALL HEALTH DIV. FOR INSPECT)ON PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-862-4644 Q;\Applicauon FortnAr-OODAPP 2020.doc i 12/12/2019 2:OOPM FAX 7744701407 CentervillePies la 002 OWNER INFORMATION: FULL NAME OF APPLICANTLod SOLE OWNER: YES O D.O.B OWNER PHONE#-71 �q 0]� 6, ADDRESS CORPORATE OWNER: �p� ��� }�L r I , �/�/�� CORPORATE ADDRESS:`�n I r 1�t i/f Y I i r1 !`� l��`�� 11 V"f 'UA�PERSON IN CHARGE OF DAILY OPERATIONS: A 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. **ATTACII 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 Ex it tion Date 2(ti 15 20'Z2 i SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE; All seasonal food establishments,including mobile trucks must be inspected by the Health iv. 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 thcrca!ller, 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 catcrs within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htln://www.townofbarnstablc.us/liealthdivision/apglicntions.asn. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establislunent is prohibited. I NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION($)AND REQUIRED FEES BY DrC' Ist. Q%Application FonnsTOODAP RF.V3.2019.doc i Imo_ I rt = , Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNSrARM John T. Norman t 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 2 Issue Date: 12/20/18 DBA: CENTERVILLE PIE COMPANY OWNER: KRISTIN BROADLEY Location of Establishment: 1671 FALMOUTH ROAD/UNITS C&D CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 16 OutdoorSeating: 0 Total Seating: 16 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - -- -- - MOBILE-FOOD: MOBILE-ICE CREAM: 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: Number of seats changed due to recalculation by Engineer of flows and occupancy in complex. r 12/20/2018 1 :39PM FAX 7744701407 CentervillePies 0002 M For Office Usg&A19 u F 4 own of 13arnstable I ` n4 Date Paid j • = spectional Services °'� P lic Health Dxvision �`� omas McKean,Director i 200 ain Street; YXyannis,MA 02601 Office: 50&862-4644 1?= 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT i DATE C NE OWN'E"RSHIP RENEWAL NAME OF FOOD ESTABLIS NT: 1' % I�JU 1V' /�u�% "1 CmPA-11� ADDRESS OF FOOD ESTABLIS NT: J 0 � 11 MAILING ADDRESS(IF DUM ENT FROM ABOVE).. n D F j e1VN -- T-MAIL ADDRESS: TELEPHONE NUM OFF FSTABLISIIMENT: TOTAL NUMBER OF BATHRO MS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: 'i/ ' SFASON I.: DATES OF OPERATION: / / TO NUMBER OF SEATS: INS E: OUTSIDE: TOTAL: SEATING: MUST ORT A COMMON VICTUALLEWS LICENSE FROM LICENSIN DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE PROVED BY THE HEALTH DIV,AND LICENSING AND MEET O'UTSIDJ. DINING RFOUIREW_ff,NTS. IS WAIT STAFF pROVD)ED-FO R OUTSIDE DINING? IS AN AIR CURTAIN PROVIDE AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISkTME T: (PLEASI:CHECK ALL THAT APPLY BELOW) � FOOD SERVICE RETAII.FOOD-ONLY req fired for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKF COTTAGE FOOD INTDUS Y(formerly residential kitchen) —MOBILE FOOD FROZEN DAIRY Dr.SSER MACHINES...(MONTkTLY LAB ANALYSIS REQUIRED) CATERING ... (CATERIN NOTICE REQUIRED BEFORE EVENT(SEF PAGE#2)j TOBACCO SALES... (AN,, UAI,'TOBACCO SALES APPLICATION REQUIRED) ** SEASONAL MOBILE&NEW FOOD ONLY*** RE UIREll TO CALL HEALTH DIV,FOR INSPECTION PRIOR TO PFRMIT 13EING ISSU D Qwp end®FannsT00DA2'PREV2016 ac 12/20/2018 1 :40PM FAX 7744701407 CentervillePies 0006 a.N y owN�R rl�oRMaTro PLEASE CALI.508-862-4644 . FULL NAME OF APPLICAN SOLE OWNER: YES N01 I D.O.D OWNER PRONE# 14 IJ� 4 m ADDRESS 3 0 vF-ITV �� 1: D CORPORATE OWNER: FEDERAL ID NO. : ' F-� 6) .CORPORATE ADDRESS.• A �'�-- I PERSON IN CHARGE OF D Y OPERATIONS: List(2) Certified Food Pro ection Managers AND at Ieast(1)Allergen Awareness CertifijAll k'UOD F.STA$L1Sk NTS must have 1 Certified Food Protection Manager PER SATTACH COPIES OF RTIFICATES" The Ilealth Div, will NOT use past years . You must provide new copies a d POST THE CERTIFICATES at your food establishment. Certified Food Mana ers Expiration Date Allergen Awareness lEx iration Date a ZZ L . � 7�1 /col 1-3 2. A V- JI/ I b- SIGNATURE OF APPLIC DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:J L11 seasonal food establishments,including mobile trucks must be inspected by the H alth Div. prior to opening!! Please call He lh Div.at 508-862-4644 to schedule your inspection. Please call at least(n days in advance. FROZEN DAIRY DESSERTS: I rozen desserts must be tested by a State Certified lab prior to opening and monthly tl,ereaftcr, with sample results submitted to th Health Div. Failure to do so will result in the suspension or revocation of your Fro n Dessert Permit until the above terms are m . CATERING POLICY: Anyone v ho caters within the Town of Barnstable must notify theTown y fax or mail prior to oatering event. You must complete a cater'caterft notice found at htt ://www.townofbarnstable.us/bealthdivision/a lications.as . OUTDOOR COOKING: Outdoo cooking,preparations,or display of any food product by a food establishment is pro dbited. TODACCO ESTABLISHMENT ; All tobacco establishments must complete au Application fol Tobacco Sales Penn t and Employee Signature Form. NOTICE: Permits run annually frmn January Ist to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY T RETURN THE COWLET D APPLICATIO (S)AND REQUIRED FEES BY DEC Ist Q;*pllcadon FomsTF00DAPPREV2018. oc Bellaire, Dianna k From: McKenzie, Marybeth Sent: Friday, December 14, 2018 11:25 AM To: Bellaire, Dianna Cc: McKean, Thomas; Stanton, David Subject: Centerville Pie in Centerville .I know I told you to put a hold on their permit because they had not submitted a revised floor plan for the new prep/ juice bar.They have submitted the plan now, it does need staff approval, but I don't think you should hold their permit at this time. Please check their renewal because they are still showing 4 seats and originally they said they were not going to have any so they may have to.revise it. Thanks Mb a TOWN OF BARNSTABLE LOCATION f s" j C G ��f G� P SEWAGE # ASSESSOR'S MAP Sz LOT INSTALLER'S NAME & PHONE NO. ,��r. SEPTIC TANK CAPACITY V LEACHING FACILITY-(type) �LG'yt� (Size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER r / BUILDER OR OWNA DATE PERMIT ISSUED: .l I / fAff DATE COMPLIANCE ISSUED: VARIA.NCEr GRANTED: Yes _No � i i / C X/7LO x Regulatory oFtHe r Town of Barnstable Service DirectorRichard Scali ti �.� Regulatory Services * � Consumer Affairs Supervisor * BARNSTABLE, * Licensing Division Elizabeth G. Hartsgrove y MASS. 1639. ,0 200 Main Street, Hyannis, MA 02601 ArFD MA't A www.town.barnstable.ma.us Consumer Affairs Administrative Officer Assistant Telephone: 508-862-4674 Fax: 508-778-2412 Stephen O.Estey Margaret Flynn CERTIFIED MAIL: 7003 1680 0004 5456 4694 September 14, 2015 Centerville Pie Company, Inc. Attn: Kristin Broadley 1671 Falmouth Road, Units 3&4 Centerville, MA 02632 RE: UNLICENSED SEATING Dear Ms. Broadley, A visual inspection was conducted of the premise of Centerville Pie Company located at 1671 Falmouth Road in Centerville on Thursday. September 10, 2015 by Consumer Affairs Officer Estey, after this division was notified of a possible discrepancy in town records and a possible increase in the number of seats beyond the allowed and permitted number inside the premise. As you will see in the enclosures, according to • the MGL c. 140 Common Victualler License issued by the Barnstable Licensing Authority and the approved floor plan signed by the Building Commissioner and approved by the Licensing Authority, 12 seats are allowed inside the premise; • the Health Division's Food Service Permit states that only 6 seats are permitted; and • the Building Division Inspection worksheet indicates that there are 12 seats allowed, plus 6 counter seats providing a total of 18 seats in the premise. During the time of the inspection, Officer Estey counted a total of 22 seats made available to patrons. It is unclear as to how and when the records failed to be coordinated or why this error was not corrected prior, however in order to eliminate any confusion in the future we kindly request that before your licenses are renewed for 2016 that you apply to amend both the Common Vicutaller and Food Service Permit to allow the maximum number of 18 allowed seats inside the premise. • Please contact Ellen Wadlington in the Health Division at 508-862-4643 or ell en.wadlington@town.barnstable.ma.us; and • Attached please find all of the necessary paperwork to begin the compliance proces's with the LicensingAuthority. Should you have an questions lease contact Maggie Flynn in q p Y Y Y gg Y the Licensing Division at 508-862-4674 or margaret.flynn@town.barnstable.ma.us. Please be aware that any additional seating beyond the allowed 18 might require additional regulatory review and approvals. Thank you for your immediate attention to this matter and I am available at any time for questions and assistance. 1 � I' agC t Res ectfully, Eliz eth&Hartsgrove,G. Consumer Affairs Supervisor ENCLOSURES CC: Licensing Authority Director of Regulatory Services Richard Scali Consumer Affairs Officer Estey Building Commissioner Thomas Perry Health Director Thomas McKean Eh/1-091115 i McKean, Thomas From: Stanton, David Sent: Friday, February 20, 2015 1:46 PM To: McKean, Thomas Cc: Scali, Richard; Hartsgrove, Elizabeth Subject: Centerville Pie (Centerville location) Tom, I inspected Centerville Pie Company (1671 Falmouth Road, Centerville location). Health permit said 6 seats. Common Victuallers said 12 seats. I observed 18 seats (plus an additional 4 seats were also observed in front by the window, not sure if they are like waiting seats of if they add to the tables if needed.) Thanks, David 1 l `' = O ARNSTABLE INSPECTION WORKSHEET F B �Giose RTIFICATE NO: MAP: D87 OBA: CENTERVILLE PIE COMPANY PARCEL: 001 NAME/MANAGER: ICENTERVILLE F'IE COMPANY INC. STREET: 1 771 FALMOUTH ROAD,UNIT#3 VILLAGE: ICENTERVILLE STATE: FWA7 ZIP: 02632- SEQ NO: 1] BUSINESS TYPE: IRESTAURANT I CONSTRUCTION TYPE: STORY1: CAPACITY: USEi: B Capacity Under 50: ❑ STORY2: CAPACITY: USE2: Outside Seating: ❑ STORY3: CAPACITY: USE3: I I BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 12 LOCI: SEATING CAP8: LOC8: CAP2: 6 LOC2: COUNTER STOOLS CAP9: LOC9: CAP3: 18 LOC3: MAXIMUM SEATING CAPACITY CAP10: LOC1.0: CAP4: LOCO: CAP11: LOCI 1: CAP5: L005: CAP12: LOCI 2: CAP6: LOC6: CAP13: LOC13: CAP7: rl LOCI: CAP14: LOC14: �I =,rinr�hSIS rc M o INSPECT N: DATE ISSUED: EXPIRATION: �.-ti.�.,�-_},`;.5.�,,,-.,;�,._,;�a� 101 /2011 i r � o nttCerti Ica el` ft ns�e��i"o ad ' COMMENTS: ---------------- r 1 V s � 9 ROOF OYERHA COVERED CONCRETE rt71�40 24.2' Q' DMG AREA 'ACANT IT 11 t S.F. T .i. /tic l i N L"T 1tZez � r LA OFFTCE .41 og D HALL N� �l V CiCFRAIN n c� h E7H BATH BATH SAGE s�)o r• tr t -i 0FIF'`iCE CH.. . r- `�� ROM ROGM PERMIT NO: TOWN OF BARNSTABLE September 11, 2015 2 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT .In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: KRISTIN BROADLEY D/BIA: CENTERVILLE PIE CO. Whose place of business is: 1671 FALMOUTH ROAD,UNITS C&D, CENTERVILLE,MA 02632 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 6 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Wayne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: $200.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: ,...--�"-- Paul�.Ganniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Junlchi.Sawavanaal MOBILE FOOD UNIT: Permit expires: TOBACCO: September 1.1, 2015 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE i i i i Town of Barnstable 2-1 oF1Ne roy� Regulatory Services k Richard V. Scali,Director ,AR STABLE, BARNSTABI ru v ti(.try iut rntt n.a MA �. -Public Health Division 9� 039. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ; DATE: NAME OF FOOD ESTABLISHMENT UL � ��FC1/ ADDRESS OF FOOD ESTABLISHMENT: lul ( r�m]UTV �b, � l lu-e t A E-MAIL ADDRESS: C -K�V I�) r 1yl 02`3�— TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (] ) o - ' NUMBER OF SEATS*: INSIDE: L 1p OUTSIDE: -g" TOTAL: Note: If indoor seating provided,see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION & Fez TYPICAL HOURS OF OPERATION MON-FRIt TO CL&) CO i CT I - Pie DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MO AYS) C S. rn D T1,lE�a IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO 'REMINDER " SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED&BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN ✓MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES ✓CATERING OUTSIDE DINING (OVER) ��;,`)i" L, FEE NUMBER THE COMMONWEALTH OF MASSACHUSETTS $100.00 157 TOWN OF IBARNSTABLE Centerville Pie Company, Inc. dlb/a, Centerville Pie Company .. This is to Certify that................ ... ............. 1671 Falmouth Road;.Units#3 .. 4 , Centerville , ................... ........................................... IS HEREBY.GRANTED. A COMMON VICTUALLER'S LICENSE Centerville , MA :...... and'-at that place only and expires insaid................................................. ... ting .unless sooner suspended or revoked for violation of the laws of the Commonwealth respec December 31, 2015 the licensing of common victuallers This license is issued in conf wrtliahe authority granted to the licensing ormity authorities by General Laws,Chapter;140;and amendments thereto: . HOURS: Monday-Saturday 8 am to 6 pm Sunday l I am to 3 pm RESTRICTIONS: 12 seats . In Testimony Whereof,#e undersigned have..hereunto affixed their official signatures. 0 jtf•AIR- .................... NOT VALID unless issued in ................. Licensing Authorities conjunction with a Food Service Permit •-- '��q ................ ...........•-•••'................. ssue Date: January 1, 2015 THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE I PREMISES Lsi-% 36 - 6 OPTION #2 ..; UNIT #4 j L'•21l tt'^v L!I e Z c� UNrr 5.F. 1,200 sty_ m s A + 365.F. U N o 2 � Ell UNIT #G H 145.F. zoo 1SIDE DE5rN+k FOOOM _ t. ?F 1,222 5F. a '.UNIT #4 UNIT #5 N°� ' r % J. 4 $1665 Untt iF4 Fo C 13 �` O 7r ^,. �c1LABl]=FOR RENT) Gata�l�teaaddmc�tie z S s 4 F a s #1 G 7 addetwnal office 5paae — w X labdcd(A)and-,Lbtudmg r ¢ the officeu— ZF2CC hbcicd -------- UNIT#5 m Ld Q k '` F AVA1LABL d t�- , FOR RENT z r`W to N ; UNIT5_F. 1.2005.F. Q A - 36 5_F. Of o �aC e �. 4� C +232 5_F_ 5? t',i s- ¢ z 1.410 5.F. Q m = Not;,-- m r;t r O UNIT Om ; Umt#5 dFoota ge n aMb OFFICE cala the offce apcedeTA and addrng the addtt*rui Llbciod and(C) �) nk v DA'M r UNrr;t6 UNIT #G -u to i o Ln rj aR !Z r° 32 y' UNIT 5.F. 1.200 5.F. °t a C -232 5_F. $ BATH r ° x rr#5 c 9sa 5.F O O 2 5TORAOE FMCS z- 14r05® t UNrr#4 i R#5 iTt Note- a FFit U=#6 lVaneFootage e Vl X 14) r.u (1 d X 149 ,.�. ar ealcUtatcd --Abbacbng U UNrrr4 i uKr05 halVbath 5F2=labeled(() ROOM Zc i n<aou . g-o• 2E rc am NEW � ° A2 PROPOSED FLOOR PLAN Q, SCALE l!4`= I'-0` �°""" ,�, oznazn- a 5 Pa c rFti��a ^.Fl" 1 �i co-5-b et,S vnew, Svc . w y f - www.CentervillePies.com Centerville Pie.Company. : Issue... ... The Centerville Pie company is.located at 1671 Falmouth.Road, Unit 3, Centerville, MA 02632..The customer traffic in the current location is unmanageable. Patrons that are dining in the.restaurant are being disturbed and disrupted because of our tremendous:sales.V6 umes in ordered pies. The customers are standing outside ooihe sidewalk waiting:to get into the facility: The patrons tha:tare conning into dine are deterred by the long lines and we are:losing business. In addition,.the recent popular.ity.of the Chicken Pie through our affiliation with Harry& David has caused our telephones and customer service orders to soar. We are no longer able to service our customers in our current location and:need to expand. The:unit adjacent to the current location is.available. Proposed:Resolution Unit 4 is being acquired:primarily to open a:customer service center and a retail location for customers. and patrons o:pick up frozen pies.and baked goods: The facility is 1260 square feet. Floor plan .... attached. .. . We are not going to prepare food in this location nor are we going to_serve food or have any type of restaurantoffering. Unit4will:house the customer s&.Vice team with offices and cubes for our .... .. .... .. .... ... . telephone staff as well:as a retail store front#or patrons to:pick up:frozen pies and baked goods. We will still prepare:all products in the health department approved facilities and bring them to Unit 4 for customer: ickup and sales.: The facility.contains.4 freezers in total. Two bf the retail merchandise freezers:are new:commercial:True... - freezers that were acquired on October 13th. In addition to the two freezers.is a non refrigerated:display case for our baked goods. The display case was also purchased on.October 13th: Product sheets and receipts.are attached. . _.. In.addition-,the two units, Unit 3 and Unit 4 are attached through a common door located at the front ... . part:of the units. This allows customers to el from the restaurant into the Pie Shop:: This has reduced the;flow of traffic tremendously from the.restaurant. The bathrooms in the Pie Shop are not open to the public::The' are there for the employees of the Pie Shop. .... wo We donate 5%:of our profits to:Cape Abilities to help support people with disabilities'on.Cape Cod. ... .. . .... _. 1671 Falmouth Road/Route 28: 0 Centerville, MA 02632,• Tel: (774)470=4406 • Fax: (774) 470:1407 OPTION #2 _ 86 36 36 UNIT #4 ;, AfbdM CQn Fern l l 2 Z N Oa2jp UNIT 5.F. 1.200 5F. ' Q A + 36 5.F. U N o B 14.5.F. z 1 -7- r UNIT #G Q 'D 71 BAYSIDE DE51GN 4 RZMODEUW NcW. 1,222 SF. w UNIT #4 UNIT #5 �1665 U,,,t, CD o I Nrh Lo (AVAILABLE FOR RENT) calwVteJ a�Q19 z #1667 Wded(A)and bbucdng p z m su p.-°. 2W-o- the offroe space Labeled(B). J v wmaW`mm� W O Ibb ----------- UNIT #5 m Q AVAILABLE FOR RENT LiJ UNIT 5.F. 1.200 S.F. p r 010 dv A 3 — w o of Lo B + 14 5.F. U� w C +2325.F. >- P- w SpX4Ce Q m zo S co X w X z q ® Note. 1.410 S.F. m a O Umt f5 5gmm Footage m UNIT#4 m calculated by w6tracti g the office space landed(A) OFRCE and adding tfie additnal halVbatb space landed(B) c° W-3' L / and(C) UNIT #6 �_ aIT 1 r u�TM ® BAYSIDE D*R a " L.2ge UNIT 5.F. 1.200 S.F.a° C 232 S.F.UNrr#5 968 5.F. i 5TORA�GE OFFICE Note: �BumUNIT#4 i UNIT S5 Umt$6 Footage Isa +er `OFMClax r CalailateJ subdadang t° e• 4•-r halroath space label (C) UN �hgx:R ROOM �4 e r° a° r PROPOSED FLOOR PLAN ,m Qi SCALE: IN P-O' o�mo�ierzoio FEpERAL .Item CURVED GLASS • NON- EF IGE ATE BAKERY CASE MODEL CGD314 CGD3642 CGD3648 CGD5042 CGD5048 CGD5942 CGD598 CGD7742 CGD774 T5 191�3 . N. f s ,,,,ems f�• t �� �' Y 1 z:ZL. 3 «_� " �i. ... Sleek curved-glass styling blends with traditional design elements to rrraximize lrerformance. Cases are available in lengths gf'31". 36", 50 59". and 77". Designed for continuous case line-ups without middle end glass. a -Curved glass styling. - 31" and.36"have two swing doors. -:Adjustable white wire shelves. Shelves are adjustable -Shielded top Eight and shelf lights. up and down and can also be tilted in three positions. -Steel base construction with a choice of six standard j 48"models have three tiers of shelves;42"models laminates on base. Other finishes optional. have two tiers of shelves. - Scratch-resistant,corrosion-proof white vented display -Tempered tilt-out front glass for easy cleaning. Front deck, glass is curved for high visual product.display. -Designed for continuous line-ups. -Tempered glass ends and doors. -Black trim. - Removable sliding rear doors, shelf Lights,shelf Ul.,Safety and UL,Sanitation Listed. i supports, and shelves. : s f � � ROOF OVERHA UNOM C0VERED CONCRETE r01I�OO1�1 24.2' a' D AREA Li t�- q qlT 2 19.7'® ACANT r IT , 11 f S.F. i, a. F. P1573 — 6 r� L"T m 19t E5 :L6 SI r LA .� en io OFF M C o� HALL N:r. AI11/1� SCE s T AGE .9Aa 9 t� BATH S+7H 7;Z Lr"r iC:E S 1. ' 1 J. <<� 36 6 6 OPTION '#2 � ,�, r�(��a��f`�i�`'�,�f� �.Kers.-•.y.Ai•�`'x Y �s� S— 3— b r UNIT #4 ah S 1 S f� ARA� Cen 1e^v l l I e (V ' UNiT S.F. 1,20D 5F. A c4LO v x€ f l 4' + 36 S.F. N o UNIT #G B - 14 S.F. z I Tj P �. - 2 rp'. UNIT 11d '< # 751DE DESfGN*REMODEU I,222 SF. r 7t-T r..:. UNIT #5 s #1665 Note: J n Unttt J4 F la U` J o 1 VAILABLE FOR RENT)s ca►wlateJ ddmgit #16G7 additional office apace — (if Libeled(A)ard sLigractrigQ W X r� 2r-o- Far z�._c the office apace labeled(B), W '-- ---------- Ld — O wru. k G�,rvR UNIT #5 > m Q U AVAILABLE FOR RENT W f UNIT 5.F. 1.200 5.F. 0 >- I co !! �8 � „'� - 36 S.F. o e Kill n BLn � + 14 5.F. w $ g `pa , I f7t C +2325.F. �- >' iii CQx 20 �.L Y ¢ z X Za:fk� 1 v 1.410 S.F. Q m a ,. �O(D Nam: m r7 F UNIT#-4 Urnt 5 Footage is 1 cala�lated aubbwtr%g OFFICE the office Labeled at nxs; z � €i eFaace W and adding the additional halWath apace labeled(6) and(C) v B'� r "� UNIT #G 1.0 UNti/6 N �C� DATH ® — ' 0 0. lie so Z 92 90 UNff 5.F. 1.200 S.F. i % I ' C -232 S.F. $ aa- If on5ATH IT#5 #22 i� 5TOAGt MC RE EE r Nn 5 968 5.F. y o UNIT#4 I N IT ® Note: U CV OFF iF Urnt6 Scpac F e t8%141 calculated by UNrr� 4'-Y L I f uwr alWatfl Spice labeled(C) ROOM 1 l000l 8-0 1 70'-0' G NMY 1 2-• 21 go r 0 o A2 a- F ROPOSED FLOOR PLAN Q, SCALE: IMA ROPE qmi�� _1- .l 0,J �Pal CC Gill K2010 Off C.-5 ems- Ovnor s✓c CURVED GLASS NON-REFRIGERATED BAKERY CASE.......................................................... UP1710N AL M.S.'t'SSORIES: .................................................................. ........................................... • Special Base Finish * Reflective Rear Doors • Glass Shelves * Casters/Cord&Phigincluded • Rear IN'Tappi.ng Board * Legs • Cord &PILL (NENCAL 5-15) * Top Cutting Board, White 9 02 7�m UfRICAL A0­*�S • Fan Kit * Package Shelf • Black... Gold, or Chrome Wire * Light Below Package Shelf Shelves * Front Glass & Rear Door • Reflective Ends Locks • White or Mirrored Interior Joining Kit for Continuous Ends with.I...aminated Exterior Line-LIPS C TIP E —-—----------- --- ............ ......................... ............ .................... ......... ............. .......... H J OPEN SACK H --------- i P1.0000 1S2 )R ROM V,!_ANCE A. 9.. 31%1)—----- rfv._.�iT ;1:.T,w:v ALA J ....... FRON"G!ASS, 0 8S E: .4C'crSs--j Model Dimensions Capacity Electrical L W H (Bakery Pan) (1210,"60/1) CGD3148 31,13" x 35.31" x 48" 4(IS"x 26")&4(9" K 26") I's AMPS CGD3642 36.13" x 35.31" x 42" 3(18"x 26")&3(9"x 26") 1.5 AMPS CGD3648 36.13" x 3 5.31" x 48" 4(18"x 26")&4(91'x 26") 1.5 AMPS CGD5042 50.13" x 35.31" x 42" 6 0 8"x 26")&3(9"x 26") 1.5 AMPS CGD5048 50.1 Y X 35.31" x 48" 8(1811 x 2611)&4(9"x 26") 1.5 AMPS CGD5942 59.13" x 35.3 1," x 42"' 9(18"X 26") 1.5 AMPS CGD5948 59.13" x35.31"x48" 12(IS"x 26") 1.5 AMPS CGD7742 77.13" x 35.31" x 42" 12(18"x_16") 1.5 AMPS CGD77748 77.13" x 35 31" x 48" 16(18"x 26") 1.5 AMPS PANITATiON Due to continuing engineering improvements. UL NUBL` Z, , specifications are subject to change without notice. Look to Federal for Innovative Merchandising Federal Industries A Standex Company 215 Federal Avenue 1Z IFEnEMAL17L& Belleville WI 53508-0290 Phone: 800-356-4206 Fax: 608-424-3234 Email: geninfoCk.,federalind.com `'deb Site: www.federal.i.tid.com TRUE FOOD SERVICE Project Name: A{A# EQUIPMENT, INC. Location: 2001 East Terra Lane•P.O.Box 970.O'Fallon,Missouri 63366 SIS# (636)240-2400•Fax(636)272-2408•(800)325-6152•Intl Fax#(001)636-272-7546 Item #: pry: Parts Dept.(800)424-TRUE•Parts Dept,Fax#(636)272-9471 •www.truemfg.com Model#: Model: T-49FG a agar True's glass door reach-in'c are designed teeth enduring ualrty that prvtects yOur Icngterminvestment. Designed using the highest quality u matenais and components to provide the userxrthcoldeKprvducttemperatures Inwer utility cysts exceptional food safety y and the best v6166 in tod4 s food servi6 €I k marketplace, Extra large evaporator coil,balanced with higher horsepouler compressor and large e condenser maBitains-10'F:(23 3 C)cabinet fs y temperatures.Ideally suited for both frvzen footls and rce cr am. � t� �• Triple pane therrna€ylass door,.: Adjuaable heavy duty PVC coated sheldrs ' § Pcsitiv>scal self dosing door si !r etirne z zx :i m guaranteed door hinges and torsion type �,{ N closure system. t Automatic defrost system time i t tiated t of temperature-teim3nated.Saves energy „ s cons�mpt on and provides.sNortest t ? possible defrost cycl . Bottom mounted.units feature: , Y ® "Nostoop'lowershcIf. storage on top of cabinet. Cvmpre<_sor per"c,rrns 3n coolest,mo>t grease free area of kitchen.: • ��° Easilyaccessible:con den sor.coil forcleaning ti z: is ROB t-IN DAT� Specifications st blec to change without notice. Chart dimensions rounded up to the nearest a .. €. rr.. ar r.unc«d apt,next ovh"-I. nu nher'. Cabinet Dimensions Cord : Crated Capacity (inches) Length Weight (m rn) 9 9 (Cu.Ft. — _ NEM (total ft.) s; ) ;Model Doors (liters', Shelves; L Dt H"* HP Voltage Amps Config. {total tr) 'kbg ....................................................... .................................;............................................... ..............,....................................._............................._!......... _........:........................................................i.......................................................................................:............................. T-49FG 2 49 6 54t/a 2934 783's 1 Yz 115/208-230/60 12.3 14-20P 9 600 1388 1375 756 1991 i 2,74 273 t Depth does not include 13/"(35 rnm)for door handle. Height does not include.5"(12.7 men;for castors or 6"(153 mrn)for optional legs. Requires 115. N,.230r60Hz,single phase,3 pole,4,Nire circuit ..: APPROVALS: AVAILABLE AT u d 1)us �Sf Printed in U.S.A. r + Model: i r, ezer T-49FG Reach-!n Glass , :.. r I S?,4, �L��qWh!? DESIGN • Each door fitted with 15"(381 mm)long extruded J Half door bun tray racks.Each holds up to eleven • r rue's commitment to using the highest quality aluminum handle. , 3"L x 26"D(458 mm x 661 mm)sheet pans(sold materials and oversized refrigeration systems provides • Positive seal self-closing door(s).Lifetime guaranteed separately)(airflow guards need to be removed). the user with colder product temperature_ lower door hinges and torsion type closure system. J Full door bun trayracks.Each holds u to twent riao utility costs,exceptional food safety and the best • Magnetic door gasket(s)of one piece construction, 18"L x 26"D(458 m x 661 mm sheet pans(sold value in today's food service marketplace. removable without tools for ease of cleaning, separately)(airflow guards need to be removed). REFRIGERATION SYSTEM SHELVING J Remote cabinets(condensing unit supplied'oy others; • Factory engineered,self-contained,capillary tube • Six(6)adjustable,heavy duty PVC coated wire shelves system comes standard with 404A expansion valve system using environmentally friendly(CFC free) 20 61 x.22's"D(624 mm x 569 mm,.Four(4)chrome and requires R404A refrigerant).Consult factory R404A refrigerant. plated shelf clips included per shelf: technical service department for BTU information. • Extra large evaporator coil balanced with higher • Shelf support pilasters made of same material as horsepower compressor and large condenser, cabinet interior;shelves are adjustable on!•i°(13 mm) maintains-10'F(-23.3'C1,Ideally suited for both increments. frozen foods and ice cream. LIGHTING Sealed,cast iron,self-lubricating evaporator fan .motor(s)and larger far,blades give True reach in's Fluorescent interior lighting. Each door utilizes full- a more efficient love velocity,high volume airflow length,patented,integrated door light(IDL)system. design.This unique design ensures faster temperature Safety shielded. recovery and shorter run times in the busiest of food MOREL FEATURES _service environments. • Exterior temperature display. • Bottom mounted condensing unit positioned for easy • Evaporator is epoxy coated to eliminate the potential cleaning. Compressor runs in coolest and most grease of corrosion.. free area of the kitchen. Allows for storage area on Rear airflow guards prevent product from blocking top of unit. optimal airflow:. • Automatic defrost system time-initiated,temperature- NSF-7 compliant for open food product. terminated. Saves energy consumption and provides ELECTRICAL Shortest possible defrost cycle. • Unit completely pre-wired at factory arid ready for CABINET CONSTRUCTION final connection to a 115/208-230/601-1z single phase, • Exterior-300 series stainless steel front.Anodized 3 pole,4 wire,20 amp dedicated outlet.Cord and quality aluminum ends,back and top, plug set included. • Interior attractive,NSF approved:white aluminum liner.300 series stainless steel floor with coved corners. 115/208-230/1 i ' NEMA-14-20R • Insulation-entire cabinet structure isfoamed-in-place using high density,CFC free,polyurethane insulation. • Welded.heavy duty steel frame rail,black powder OPTIONAL FEATURES/ACCESSORIES coated for corrosion protection. Upcharge and lead times may apply, • Frame rail fitted with 4"(102 mm)diameter stem J 6"(153 mm)standard legs. castors-locks provided on front set. U 6"(153 mm)seismic:-flanged legs, DOORS J Alternate door hinging(.factory installed). • Tripie pane thermal glass assembly(ies)with extruded J Novelty baskets. aluminum frame(s). a Additional shelves. 'LAN v�t��✓V i 3)°m F* ram ' 3 i s � 83si 3. .S•it3 t�^u 1 usr a) 1.. .saa%rn) i 3imr.,)` :.W gym' 3 a ........... .: 45m!W 027 mm) �'��NTY M�RIC DIMENSIONa ROUNDED JPTC rHE One yearLvarrartty an al!parts NEAREST WHOLE M(LUMETER T — and taborand an additronal 4 �a Mogel iEtevatrort gsght,_, Plan 31). Back 'W KCL year warranty pn compressor ;SPE�iFICATICNS SUBJECT TC CHANGE is T 49FG ;TFEYt7E FEY065••<TFEYO'P' TF°Y1 r3 (U 5 A o..nly) - WITHOUTNQTIt:E, TRUE FOOD SERVICE EQUIPMENT 2001 East Terra Lane=P0.Sox 970.O`Fallon,Missouri 63366•(636)240-2400•Fax(636)272-2408•(800)325-6152•Intl,Fax#(001)636-272-7546=Ww.r,truemfg,corn d No._.L.. Lh6 ,. FEs.....7-�.�..._...= THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH Apphratinn for Uiipniittl Murky Cnnntr iun Ilrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: . ::�..................... .......1. � . ......or I of ....._................___ Ow Address a �... .. � :: ....... .:.... 2------......................... ` !'1!' .............................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......................... .....Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building Ce,& ( )p, yp g ... ......... . No. of ersons............................ Showers — Cafeteria Q. Other fixtures ...................•---................................................................--•---...... P ( ) Q •.................. W Design W Flow............................ per person per day. Total da- 1 flow..............................................................._._._._galons. Septic Tank—Liquid ca aci /8. l-1�lons ' Len hV../....... Width..Y �-.... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..............................................................--•......... Date........................................ 1.1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 06 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ........................................................................... ..........._._......-- --................. ........................... ODescription of Soil..........................................................................•----•----.................................................-------•-•......................... W ----------------------- ---------- --....... --•----------..... -.. .........- -...... .-.--•----•---------- •--•------ --------- -----------.-.-.----------••---•--------------- x ............................•---•--•----•-------•----... ....................-•------.................. .............---... .---------- ..... U Nature of Repairs or Alterations Answer when appli .10C0..... ........ �:�:......t n.�:� .e... !'4 .. Agreement: The undersigned agrees to install the afored scrib d Individual S a e Dispo 1 System in accordance with the provisions of TITLE 5 of the State Sanitary C e The undersi urther ees not to place the system in operation until a Certificate of Compliance has been i ued by tfie b d of th. Sign ...... ......... ............ ....................................... f.� �-'. .... Date Application Approved BY............. ..... .....................a.......... ......... Date Application Disapproved for the following r ons:.........................................................................................................--- .�.$...:..7-��..._........_......................_.------•--.......---Issued................ ----.._........_... ---- .D�........_.._ Permit No...... I No._............ ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. . `... . ..................OF......................................................................................... Appliration for 33isjosttl Works Tonstrnr#ion jiumi# Application is hereby made for a Permit to Construct ( ) or Repair ( )fan Individual Sewage Disposal System at: 1 Location.Address r or Lot No .._t/L " 1:..W?.......... ! C.; .�:l fry........................ ...... /�?` t .... ... r.. z......... !...1. ...........................»...»........._. ++ f a 1�(✓ { / ��i2 /�rnCw k1lA ress................ ............. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......................... ..........Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — a YP g •(d�aC�.f'L`s_--.... P ( ) Cafeteria ( ) 04 Other fixtures . ... W Design Flow............................................gallons"per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity,&A.(Igallons Len h o Width..C/'L..... Diameter..._. .. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. Other Distribution box Dosing tank p ' Total leaching,area................sq. ft. Seepage Pit No.....:........7...... Diameter............... De th below inlet..........., z ( ) g ( ) 0-4 Percolation Test Results Performed by....................... ........................... Date........................................ 0.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to_ground water........................ ....................•-----•-•....................................................................:........................................................... 0 Description of Soil....--•-•--•------------•.........................•--------......-•-•-•-•----....----....................----•-•---..................---..............-•-•••---••----•.. ..---------•.....................•-- --•---....._..........--•----•••--..............•••-•.......•--..........•----........••-•...-••........_..........,.7-.----------_...._.._.... - .... U Nature of Repairs or Alterations—Answer when applicable....:/Q 0 Q.._..__5; A(-.._•.-(v 2&-/I Se •-•••,`i'A . r �......... i C r Y .................,... ... • _ ..----............... ..---....-............. Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary-Code,r The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boardof health. / Signed........r! : /..\.»/.ham................ ........... /-j //:;/?°.... Date Application Approved By.....••....4 e... 'a„! :_ :: .............. ......... w ?=... ••....................... Date Application Disapproved for the following reasons:.............../................---.....---..............--- ........---.»__ .........-•......................•-------.....--•---••-•-----.•.-.......-••••-•-•••-•................._.------------...........---•-•---------------.......---••---....•--........•••.....--••_._.»» Date Peraut No.......Ek- :7 4 /a...»..»....»......� Issued............... --................»--»--...._. Daft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?� .::.-.................OF..... ...:..........-..:.:.:.:................................................. Ta if rate of Tontliliann THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (y,) or Repaired ( ) ►? -O- F �, by........-- .. ......:,.. ......:......_.................................................................................................................................» �7 Installer j/�{j`( at................... !_'7 r ...... �-/a,4--�»a"L h .il (I ,,...p '.: ,- .... •................ .. _ .......--•-•-.......0..............._.. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... ._....7.`?�.(....._. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............................•--........---•---•--............................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO. .:. d (...... �. _ ............................... F . h - .. ............ Disposal Works Tons#rnrtion Vernfit Permission is hereby granted...............►.'_v&4......�._s ._... ... ...................................... _.... to Construct Oc) or Repair ( ) an Individual Sewage DispQs System at No................... ...._ /J_ :k: ( � r :_._. ,.. ---=... . • ................................................. Street as shown on the application for Disposal Works Construction Permit Dated.......................................... ........... .. DATE............. •Board of Health .:..._.?_*a..:. . ................................... FORM 1255 HOBBS 8 WARREN. INC.. PUBLISHERS TOWN OF BAI(NSTABLE LOCATION % �i�L yL� �� r /� SEWAGE # VILLAGE L� ;'' ` ?2 C? f' 'C' _ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY �� �� ! C:4`ti: _. LEACHING FACILITY:(type)_v�Le'✓ " (size) NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER ,/ fJ BUILDER OR OWNE y /l.l 0-vo .r_ DATE PERMIT ISSUED: / DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No ���