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HomeMy WebLinkAboutFRATERNAL LODGE AF & AM - FOOD FRATERNAL LODGE 1939 r alm. Rd. Geri. Fraternal bodge AF & AM Falmouth 1989 F . uth Rd. Cville FORMERLY: MASONIC LODGE a IW► Town of Barnstable BOARD OF HEALTH ' a John T. Norman Board of Health Donald A.Gaudagnoli,M.D. awWNIT BLE F.P.(Thomas)Lee, z 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. ra •�� 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: 48 Issue Date: 01/01/2022 DBA: FRATERNAL LODGE AF & AM OWNER: CENTERVILLE BUILDING CORP. Location of Establishment: 1989 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $50.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: a� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oFtwe t� For Office Use Only. Initials: ti Town of Barnstable Q` 11 Date Paid AIIl Psl$ _ &MMSPABLE, : Inspectional Services Public Health Division _ 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 12/07/2021 NEW OWNERSHIP RENEWAL x NAME OF FOOD ESTABLISHMENT: Fraternal Lodge ADDRESS OF FOOD ESTABLISHMENT: 1989 Faulmouth Rd, Certerville, MA, 02632 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): P.O. Box 595, Centerville, MA, 02632 ' E-MAIL ADDRESS: leotatara@gmail.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 815 - 7887 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER: YES NO x ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: x SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 130 OUTSIDE: TOTAL: 130 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 REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? NA IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? NA TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) x 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 • OWNER INFORMATION: FULL NAME OF APPLICANT Centervill Building Corp SOLE OWNER: VVES/NO OWNER PHONE#508-8015-7887 ADDRESS 1989 Faulmouth Rd, Centerville, MA, 02632 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS. Leo Tatara 508-815-7887 List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.Josiane Aquino n5/ 4/ n 6 1. Josiane Aquino 10/31/2024 2,Jose Sobrinho 02/25/2024 C- �' 12 /07 /2021 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/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2919.doc r Bellaire, Dianna From: Leo Tatara <leotatara@gmail.com> Sent: Tuesday, December 07, 2021 12:15 PM To: Bellaire, Dianna Cc: Soto, Kathryn; Leonardo Burri Subject: Re: Fw: 2022 Food Permit Fraternal Lodge AF &AM - Centerville Attachments: FOODAPP2022.pdf, FOOD AND ALERGENT CERTIFICATES.pdf Good Morning All, I apologize for my tardiness in getting this ready, please find the application, ServSafe and allergen certifications attached. Chef Fabiano, is working on getting his certifications ready to register his business and have his own permit, if he does not provide us with the proper certification and permit we will no longer rent the facility to him. Please let me know if there is anything else I need to do, and when you would like to stop by. Best Regards Leo Tatara\ 508-815-7887 On Mon,Nov 15, 2021 at 6:16 PM Bellaire, Dianna<Dianna.Bellaire(a�town.barnstable.ma.us> wrote: Please be aware that AM + Fraternal Lodge has to have a current kitchen food permit in order to let them rent it out as a commissary kitchen. Then the person who has their own business and is renting the kitchen will need their own permit. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 1 Email:Dianna.Bella ire @town.barnstable.ma.us 'Elie information contained.in this electronic transmission ("e-mail"),including any attachment(the"Itiformation"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work..product or a -id confidential communication.The Information may also be deliberative and pre-decisional in nat-ure..As such,it is for. privileged a internal use only.The Information may not be disclosed without the prior written consent of the Director of Public health and/or the Town.Attorneys Office of the.Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it."Thank you for your cooperation. From: Leo Tatara [mailto:leotatara@,gmail.com] Sent: Monday, November 15, 2021 4:19 PM To: Bellaire, Dianna ` Subject: Re: Fw: 2022 Food Permit Fraternal Lodge AF &AM - Centerville Hi Dianna, Thank you for clarifying what is needed, I am working on getting the allergen certificate. The person renting is getting his food safe and allergen certification, also I gave him the Food Application, As soon I get all together I will submit it to you. On Tue,Nov 9, 2021 at 10:22 AM Erich Horgan <ehorgangmocness.com> wrote: Good morning Leonid and Leo, I hope all is well with you and your families. I am forwarding you this message to make sure you received it. 2 Fraternally, Erich 'i 's jFrom: Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us> } Sent:Tuesday, November 9, 20219:19 AM To: Fraternal@MassFreemasonry.net<Fraternal@MassFreemasonry.net> Cc: Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us> Subject: 2022 Food Permit Fraternal Lodge AF&AM -Centerville Good Morning, it has been brought to my attention by the health inspector that Jerry Pass is no longer the contact for this jestablishment and there are new people in the commercial kitchen. I received a check but, no application and no food protection Manager's or Allergen Certificates. When the health inspector went to inspect, she found there is a person renting the kitchen w/o a permit. Please complete the application attached and email back to me with certifications. The health inspector has spoken to the person renting the kitchen and they need to take of their business permit. However, if you are their kitchen,you need to have a valid permit. If you have any questions,you may call me today or Friday. You may also email me. Please notate the allergen person expires at the end of the year. I need one food manager to take the attached allergen training. p Y g I currently have the following people as the Servsafe/allergen on file below: 3 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTAULL, PaulJ.Canniff,D.M.D. MAIM, F.P. Thomas Lee Alternate z � 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, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 48 Issue Date: 01/01/2021 DBA: FRATERNAL LODGE AF & AM OWNER: CENTERVILLE BUILDING CORP. Location of Establishment: 1989 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $50.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.h 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: C-)� �tNKE r Initials: Town of Barnstable Date id Amt Pd lARN3rABLE, : Inspectional Services Pa / 9 MA9S g' Public Health Division pTED MA't h 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/ / t0 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��Icrn a L 1e a�oi �,eti cr v� a GCW 4JL�/� ADDRESS OF FOOD ESTABLISHMENT: /q" MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS:��g �/a G'a in c a sr /Al TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (f 3.4" TOTAL NUMBER OF BATHROOMS: Z WELL WATER: YES NO '✓ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 13, OUTSIDE: TOTAL: /3 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? r a 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 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 FottnsTOODAPP 2020.doc i , OWNER INFORMATION: FULL NAME OF APPLICANT ZQ 90as.S SOLE OWNER: YES/NO OWNER PHONE# 6 O.V Jr ADDRESS /98Q CORPORATE OWNER: CORPORATE ADDRESS: 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 nesv copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.,6ve e a,tdo Sop..,en= j I. brih ho a /�.s /z�7y �vets �.- S4 vho&. '424 "el / �6/ 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/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc ti F, p4 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ". aAPNSTABM Paul J.Canniff,D.M.D. 14 F.P. Thomas Lee Alternate 1s� 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: 48 Issue Date: 12/10/2019 DBA: FRATERNAL LODGE AF & AM OWNER: CENTERVILLE BUILDING CORP. Location of Establishment: 1989 FALMOUTH ROAD CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $50.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,?� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: • } 44 e j 19-00,;t—®I For Off • Initials: LL Town of Barnstable Q` Date Paid L' ' Amt Pd$�— BAIMSTABLE, : Inspectional Services ta' Public Health Division Thomas McKean Director Y 200 Main Street,Hyannis,MA 02601 lu Office: 508-862-4644 Fax: 508-790-6304 ' APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE /% O NEW OWNERSHIP RENEWAL 1,-' - NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: h MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �b E-MAIL ADDRESS: a ASS G��+r+Qlsr. tied TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ^j- TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO v ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: r/ SEASONAL:, DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? _ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) XOOD 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 FormffOODAPP 2020.doc f 4 �1 i OWNER INFORMATION: T �7 FULL NAME OF APPLICANT p/ e it r X T ZLV_S" SOLE OWNER: YE NO p�OWNER PHONE# ADDRESS 229� , ,�,t���� '� 1/0f= p � q -�'3^`' / >✓� -��J CORPORATE OWNER: l /C�i^=4�,yard Q 1��UlY h C&uh NO CORPORATE ADDRESS: 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 Managers Expiration Date Allergen Awareness Expiration Date 2-1 l,-Ag 1� IGNATURE 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. CATE'•RING 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/heaIthdivision/api)lications.as1). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc P`oFTHE row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of _ OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .A- v. �0� HYANNIS,MA 02601 MON.-FRI. No Reference R Red Item p 508-862-4644 PLEASE PRINT CLEARLY - FOOD ESTABLISHMENT INSPECTION REPORT Name Date jyge of Ivoe of I s ection / l- Rou' �� CL Address Risk e-inspectio Level Retail cz Previous nspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) i Time Bed&Breakfast HACCP In: ,,,/� Other Inspector Out: Each violation checked requ' es 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 F EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPU NS(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) I Corrective Action Required: El 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 Order for Correction: Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g y ❑ ry p Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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 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 obs ed,7 to 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation, 0 8 n n-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspecto ' re _ Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i #Seats Observed Frozen Dessert Machines: Outside Dining Y N Signature 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 Law Cooled to 41°F/45°F Within 4 Hours* 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 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 A[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* 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Other* g g 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* Applicants* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111. Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg crave urnoor 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* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Shellfish* - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section porary and - ide in cater * Ratites-165°F IS sec* in mobile food,temporary and residential Sources g• P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When 3-401.11 2-301.14 Wh to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail practices( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 3-203.12 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 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 3AO2.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *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. PyoFt rortio TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTA9L6. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1639. �0� HYANNIS,MA 02601 MON.-FRi. No Reference R-Red Item- PLEASE PRINT CLEARLY �PrFo MAC° 508-8624644 ' FOOD ESTABLISHMENT INSPECTION REPORT w 1(kzxl�4 IdeGe�ct Name r Date Type of Type of Inspection ` s Routine � Address Risk Se e-inspectio 1„ f u ' Level Retail ction 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: Other Inspector b Out: Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. d Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ to fl "old Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 1 ( �(�� 0 7//�� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �� Yl�W 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 �� I ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) t 06 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 147-AQ 10.Proper Adequate Handwashing CONSUMER ADVISORY 7 �-e"'"'I r!i( L. . ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories k C1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I�l.� (n Critical(C)violations marked must be corrected immediately. (blue&red items) \ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating _` within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations g (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. . f 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 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Si ature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 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* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Foam* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cave////aoo/ 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* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Contact Surfaces of Equipment 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* Shellfish and Fish From an Approved Source gg 4-702.11 Frequency rf 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 Chemical* g 590.009(A)-(ll) violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tam or and residential Sources g, P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 ( ) m 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature.Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 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 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. P�pTME TpN,� TOWN OF BARNSTABLE HEALTH_NSPECTOR's Establishment Name: Date:' Page: of Z. o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. RARE, 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. m HYANNIS, MA 02601 MON.-FRI. NO Reference R-,Red Item 3 a. Spg_gg�� PLEASE PRINT CLEARLY TEDN1P` FOOD ESTABLISHMENT INSP CTION REPORT Name Date Z Tvoe of Type of Inspection V(/ Rou Address Risk "Food Se e-inspect on Level etail o s nspection `� �� CCU Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint / h Person in Charge(PIC) �� ��, �� Time Bed 8 Breakfast HACCP Ei` kJ ✓'� ' I r � , / In: Other Inspector �, J� Out: / -2-6 wlq 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) ❑ Q4-'-O-�S Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands A )� yr e ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities S� ✓ IV ! t� /n /+ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS I "SF' CL (mot e. j�/LI ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives '� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 11 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 Z� 12 ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) U_ ❑ 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 Violation Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. 3 � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 g 29.Special Requirements (590:009) within 10 days of receipt of this order. violation,4 to 8von-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumps screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign ur 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 1q 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 75 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* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage*Applicants* * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* g g 7.202.12 Conditions of Use* ' 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and R of Food* Wa Produce,Criteria HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated ated o or r Contaminated 7-204.12 Chemicals for shin g * HSP� ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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 A 11-601. ) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4 ( Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Egecri-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Park and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf 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* I Shellfish* 4-703.11 Methods of Sanitization-Ho[Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* 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. radicsshould 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 foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from.Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 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 P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. „<t row TOWN OF BARNS_TABLE . HEALTH INSPECTOR'S Establishment Name: Date: Page: 2 of ' `2--- hp c� OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. SARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.. �m� HYANNIS,MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY MP FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 Name Date L Tyne of Type of Inspection ' O Roa-uitnin Address dSe Level aai s pe io ection 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: /�_ Other Inspector ` Out: �CIfI,M. Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ��� e� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Itemsl Anti-Choking 590.009(E) ❑ hr 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 ZIP ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ^ ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 6=One critical violation and less than 4npn-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violatid l than 9 -critical. If critical water, a 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations.and an non no cr er,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address i4 anon-critical violations. If 1 critical refrigeration. '�H 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-c ca v ol�tions=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 PIC's Signature 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* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 79 PHF Hot and Cold Holding 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) 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 3-501.16 A Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment * ( ) 7-201.11 Separation-Storage* Applicants* * P g - 20 Time as a Public Health Control 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 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 390.003(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 ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* ' 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ef/cane vrnoor 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 8. P �' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 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 ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 3-203.18 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 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* _ 3-501.14(B) Cooling PHFs Made from Ambient Temperature In to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Ivlaintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand"Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of, OFFICE HOURS ' •` PUBLIC HEALTH DIVISION .. 8:00-9:30 A.M. RARNSTARLE. - - - 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A MASS.9. `0$ HYANNIS,MA 02601 MON.-FRI. No Reference .R-Red Item PLEASE PRINT CLEARLY 508 rFo Ma+° -862-4644 FOOD ESTABLISHMENT INSPECTION REPORT � tf{27S (S. (/ ► / Name � � Date �� T e o T Inspection � ^ Routine `'4� Glmf°/�S Address �� Risk Fo e-Inspection S �. Level Retail Previous Inspection Telephone Residential Kitchen Date: P Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) ` � f Time Bed&Breakfast HACCP Other Inspector �� Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 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 Zug ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives l! ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals $Z - FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) f/dv( C� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures r "/Y 5E7 ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 9 1 L,� �A I ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding C� d°V I[CJD U YV 7 t� PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control -pa 6uiir h7i1 Mg Ac I f ❑ 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 )vl(), y Critical(C)violations marked must be corrected immediately. (blue&red items) Z Non-critical'(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes es within 90 days as determined b the Board of Health. Overall Rating Y Y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g y ❑ rY P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (F6-3)(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. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspec o ' Si nature Print: n 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 PI ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N .. .-.. _- •.?.-^- - .r .-'rti- -._ .._....-.`_...�.- �_: � '.. ... - ..-. �. v .-.._, -.. -_ -- -.� __ ._ _, ° '-----+.. •-•--v-.� .. .r-.. -- - w s. r_ --.w. .i .- �-.r ...,. y fe f.- T .-. _ ��_. �. .x�'4^-Y ry __ .. ._.� ._- 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 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 EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C). Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F* Applicants*- 7-201.11 Separation g oration-Storage* 3-501.16A- - 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 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) i Reporting by.Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reservior 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 j Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11 A Cl Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or Equipment( ) Clean oo on * Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe critic 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-I55°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 Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P aTY 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 Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.1.1- Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formbackfr2doc *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.�E r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page:. Z of Z W OFFICE HOURS P ° PUBLIC HEALTH DIVISION 800-'9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3.3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 MON.-FRI. No Reference R-.Red Item. PLEASE PRINT CLEARLY . p'EDN1Pvp FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 Name !'D Date'I 2 T e o Type of Inspection � O er ions outine Address Risk ood S e e-inspection tvO (j el Level Retail Previous Inspection �� r Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) ' � ��uQilTl� Time Bed&Breakfast HACCP t v In: Other kr Inspector �� Out: , �� r Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. •/ i A �� ��J� 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) ❑ /2f.,4 or- 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) n M ` I I ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures cr(J - "- ❑ 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 El Yes; Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ZI #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(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 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* * Applicants* 3-302.11(A) Food Protection* 20 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 7-201.11 Separation-Storage* Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting.by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* - Contamination from the Consumer F-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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* " ' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601. Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 11A 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cq-1i1n001 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 rf Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-]55°F 15 sec* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutWildhority 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 Requirepractices 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* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F[0 70°F Convenient/ 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* y * 23. Mana ement 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 3-402.11 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* 2 . Water,Plumbing and Waste FC-5 .00 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc '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. L%5� 8 oF.K�Er TOWN OF BARNSTABLE HEALTH INSPECTOR, Establishment Name: / Date: Page: of °j� v yo OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, = 200 MAIN STREET io 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. .65q. �� �, HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSP ICTION REPORT Name 1 Date j IT-ype of Tyne of Inspection l✓ / n Rp Address Risk Food Servic e-inspec'o- Level Telephone 4 Residential Kitchen Date: Mobile Pre-opL t Owner HACCP Y/N Temporary Suspect III�31 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector N A V� 'Zo MA / Each violation checked requires an explanation on the narrati a page(,)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) ❑ 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 AdditivesLC ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP❑ 10.ProperAdequate Handwashing CONSUMER ADVISORY Ltl* ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories N 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 i mg ❑ ❑ ❑ checked indicate violations of 105 CMR 590.000/Federal Food od . 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 it agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more criticaf 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 (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 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 c itical (olations. If 1 critical refrigeration. within 10 days of receipt of this order. to a' ,4 to 8 non-critical viol io C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: In ctor's a e d Print: j 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 Sign ture Print:, Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A Assignment 14 Food or Color Additives Law Cooled to 41°F/45`F Within 4 Hours* ( ) gnment of Responsibility* 8 Cross-contamination 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-]03.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7- Common Name-Working Containers 7-202.11 01.11 Separationg-Storage* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and grated 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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* efff cnvc uuzoor 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 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* 3-401.11 2-301.14 When to Wash* 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. radicsshould 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.0m HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical.item.in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ff _ oFt r TOWN OF BARNSTABLE gg9yyyp / HEALTH INSPECTOR'S Establishment Name: e ,,, II ; Date: Page: of v� c I ,h \p OFFICE HOURS / PUBLIC HEALTH DIVISION 444✓✓✓ VVV 8:00-9:30 A.M. snnNsrneLE. 200 MAIN STREET 3:30-a:3o F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/ ;�1 O RECTION Date Verified MASS. g. MON.-FRI. ,63q. o HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPE 1 EPORT ® 5osssz.4s4n Name D e e o of Inspection - O Routine f Address 11 fli �tisk ood Servic a Re-inspection C ° Level Retailer Previous Ins i ` Telephone v p i Residential KitchenJQ D Mobile re-operati0 V Owner HACCP Y/N Temporary Sus nes d Caterer General Complaint i Person in Charge(PIC) Time Bed&Breakfast HACCP Other , � � � 4! Inspector lk�lc ' f aIIir a Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. ; Violations Related to Foodborne Illness Interventions and isk Factors Red Items ( 1 Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 'Skxxt,` Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding A 61 �• PROTECTION FROM CONTAMINATION WOW ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) j ❑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 L"(� Violations Related to Good Retail Practices(Blue Items). Total Number of Critical Violations IV > Critical(C)violations marked must be corrected immediately. (blue&red items) ` I 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 it s ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food dode. 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 4von-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 g p,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up, 28.Poisonous or Toxic Materials (FC-7)(590.008 g violations observed,7 to 8 non-c itical v lations. If 1 critical refrigeration. be in writing and submitted to the Board of Health at the above address vl �on,4 to 8non-critical viol ions-) 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: In tor's i nat re PriVt. 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature P Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health ConVol 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*its 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* 590.00411 uirements 3-304.11 Food Contact with Equipment and Utensils * ( ) Variance Re q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 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 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 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) Corruniuuted Fish,Meats&Game Pathogens* cf<<..z 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3 g01.11(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 Chemical* 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 Wild Mushrooms Approved By 2-301.11 Clean an 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* 3ADI.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 practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity i= g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 - 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ------------ TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:_�of �P do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABt:u: ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 'cbA OS•a�0� HYANNIS,MA 02601 5MON.-FRI.08-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY reD MPS FOOD ESTABLISHMENT INSPJAECTJON REPORT Name %-V'AIA Da a of Imill o s ectio O on utin Address Risk od.Serv' e-inspection 0 Level a Previous Inspection Telephone Residential Kitchen Date: L Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ® ,� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: U(f IC t.o Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ti Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ a FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1.PIC Assigned/Knowledgeable/Duties ❑ g g ❑ 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 )Vj FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Fo❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Y V ❑ 5.Receiving/Condition ❑ 17.Reheating q ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.CoolingV /"\{J ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding / , PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control "� oe ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / _ zT-yajJa i'ir ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY p ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories LO Vv y Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue 8r red items) Corrective Action Required: ❑ Ye Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employ / I R s f -ins tion.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 B=One critical violation and less than 4 non-critical 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 if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC75)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations ob served,7 to anon-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 within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. p q (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view r 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 ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i . _ - - -_- '��ro"�+�-M�`..I�--+ems+�YWC'.'.^�'4�+Aen`^.�.i J`Yi'.�'a""Ym. . Z,.-♦. .. _ _ .. _ _ __ ... - _- Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 . Additives* g ; 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 A 15 590.004(F)- - *- Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16( ) 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* 7-20L P g I1 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits. 7-202.11 Restriction-Presence and Use*and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) 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* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) d Fd P N R * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* Unopene oo ackage ot e-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 Pasted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101,11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg°t"'e umooi 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P �' 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* 3-401.11 )( )( ) 2-301.14 When to Wash* 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. radicsshould 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) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-102.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g 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 ( ) 3-203.12 Tags/Records:Fish Products Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to o 41°F/45°F Item Good Retail Practices FC 590.000 5-203.11 Numbers and Capacities* Within 4 Hours* - 23. Management and Personnel FC-2 .003 3402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 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. Rp(NE T TOWN OF BARNSTA.BLE. :HEALTH.INSPECTOR-s Establishment Name: Date Page:_�of PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. s BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/P AN OF CORRECTION Date Verified �b "�9 0� HYANNIS,MA 02601 soe-s2 aR t639• s4a No Reference R-.Red Item PLEASE PRINT CLEARLY & FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tyne of sec ion Address Risk Rod Sery e-Inspection Level i 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: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. U � 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 Ar 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 q ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ax 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. ❑ 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 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 (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,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 within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009 Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump er screened from public view . Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ign 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-) r_ 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 of Toxic Substances 3-501.16(B) Cold PHFs Maintained A[or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) � Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 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 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-I55°F 15 sec CONSUMER ADVISORY Concentration and Hardness* 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* Anima]Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E11°tire 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf ces 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590..009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*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 Tastin * * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 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 690.000. TOWN OF BARNSTABLE HEALTH INSPECTOR•s Establishment Name: Date: Page: of � oyo OFFICE HOURS BARNSTABLE. `; PU62 0 MAN STREEETLIC HEALTH SION 3::30-4:30 P.M.0-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p39, `0 HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �b 608-ssz 4sad p FOOD ESTABLISHMENT INSPECTION REPORT RAddre Dat Type of Tvoe of Inspection O e s Risk od Service =Re-inspectio Level nspection Telephone Residential Kitchen Da e. Mobile Pre-operation `� Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on.the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco -590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM 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 G FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP 4 ❑ 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 ❑ Emergency Closure ❑ Voluntary Disposal ❑-Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number,of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 pop-critical violations if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no.critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within p 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 PI 's Signa re ^ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N CrJC✓//� Dumpster Screen? Y N Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures Acco.�ding 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* * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 590.003(C) Responsibility of the Person-in-Charge to - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation g aration-Storage 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* 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 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* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Tem eratures* 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* - Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/12001 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 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* 8 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P rY 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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. radicsshould 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* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RT'E Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F[0 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* I 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 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE I TOWN OF BARNSTABLE." > HEALTH INSPECTOR's Establishment Name: Date: ,\Y Page: of OFFICE HOURS PUBLIC HEALTH DIVISION s:oii-9:30A.M. s BARNSTABLE. = 0 MAIN STREET 3:MO N.'-FRI P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 Soe-ssz-asa.a No Reference R-Red Item PLEASE PRINT CLEARLY �EON1P'' FOOD ESTABLISHMENT INSPECTION REPORT of , Name Dat Re of TypeoUnspection Ooeration(s) R Address ` ` _ Risk Fo ervice ction a Level etail Previous Inspection E Telephone esidential Kitchen Date: Mobile Pre-operation d Owner HACCP YIN Temporary. Suspect Illness Caterer General Complaint Person in Charge(PIC) I Time Bed&Breakfast HACCP In: Other Inspecto Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands d ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or-Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations `C %�r 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. L// I ❑ 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 re ardless of the number of critical,results in an F. 590.005 B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC 4 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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. within 10 days of receipt of this order. violation,4 to 8von-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ji Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 111 1 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) 1 FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to -1-590.003(A).._Assignment of Responsibility* _ 8 Cross contamination 14 Food or Color Additives. Law Cooled to 41°F/45°F Within 4 Hours* " 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3=202:-L2 Additives* • ' '� Cooked and RTE Foods.* * 19 _ PHF Hot and Cold-Holding_ 2-103.11 Person-in-Charge Duties 3-302.14'-V Protection from Unapproved Additives - - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to - - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 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 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*its and Vegetables * 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11)- - - Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual-Wazewashing-Ho[Water 7.206.12 Rodent Bait Stations Raw Seed S routs Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Ware-washing-Hot Water Monitoring* 3-801.11(C) I Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe c"1e 11112001 'I 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) I 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* in mobile food,temporary and residential Sources g. P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and 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 929-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashin Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* 9 ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70*17 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 3402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility, an Operation Maintenance Temperature Ingredients to 41°F/45`F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* Within 4Hours* 26. Water,Plumbing and Waste FC-5 U06 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 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. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THEE 2do.," TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of '4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00 9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.9. `0� HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY �F�� FOOD ESTABLISHMENT INSPECTION REPORT Name ) Date T e o Type of Inspection O erat'on s Rout' 1 o. O _ Address'ice isk ' reams Itlsnection r el I"`- P Telephone Residential Kitchen ' Date: Mobile Pre-operation Owner ACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector ;/ij,� ` • Out: c Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and lisk Factors Red Items Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and re ire immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �� FOOD PROTECTION MANAGEMENT ❑ 1 Prevention of Contamination from Hands f, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.He wash Facilities EMPLOYEE HEALTH PROTECTION OM CHEMICALS r _ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Fo or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals - FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CON OLS(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 P) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY L L, v ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations -� Lj Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: o ❑ 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 B=One critical violation and less than 4 non-critical 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 if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically 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 If critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed;7 to anon-critical violations. If 1 critical refrigeration. C. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations= e Inspector's Signature Print: 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view /� `' e, , Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N I #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Violations related to Foodborne illness 1.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* I 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) � Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from •- 3-202.12 Additives Cooked and RTE Foods.* * 19_,___ _ PHF Hot and Cold Holding 2-103.11 ' Person-in_Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or'Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE-HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers _ _ - Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separationg-Storage* Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* { 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * _ 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) .,Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated orce,of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g _ � ) Disposition of Adulterated or Contaminated -- - - - - Food --- 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law*_ 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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* TIMEITEMPERATURE CONTROLS •' 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made Frum Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food:Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* * gg __- Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathugeiis* Fg'r'°P uuzoot 590.006 B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* ( Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source � 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.I1 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g to 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 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.1 t Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007_ 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °PIKE r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: /4SI(�age: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARN STABLE.A 11 `,�Q/ / ��/' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Mbs �00 �� V`� Lf/Y HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY & � FOOD ESTA LISHMENT INSPECTION REPORT01 506-662 4644 + t Name Da%W l Tvne of sec ion O e tine Address q Risk F Servl Re-inspection Level Previous Inspection Telephone Residential Kitchen Date: C Mobile Pre-operation Owner �7 �� HACCP Y/N Temporary Suspectlllness 6 v� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other � l K .r Inspector yv\ Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ l Z 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 r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS -T G ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 10 ❑ 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) c Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating V I. 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 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster scre ed from public view s Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signature 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* F 8 Cross-contamination 14 Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 - Additives* 3-501.15 Cooling Methods for PHFs 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachContainers* -590.004(F) 7-101.11 Identifying Information-Original x * 2 590.003 C).: Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140 F ( P y - - -' '' �" 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 590.00 7-202.11 Restriction-Presence and Use*.3(F) Responsibility of A Food Employee or An _ 3-302.15 - .Washing Fruits and Vegetables _ 3-501.19 Time as a Public Health Control* an Applict To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils*Contamination from the Consumer * 590.004(11) Variance Requirements _ __ - 7-203.11 Toxic Containers-Prohibitions 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition of Adulterated or Contaminated - - - - -- - --- - - Food --- 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.11 1 MandalW✓azewashing-Hot Water- 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-20f.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 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 E s-Irumediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5.-101-11_ Drinking Water from an Approved System*. _ . . _ - * _ _gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/IR001 _ 4-602.11 ..Cleaning-Frequency ontact Surfaces e of of Utensils and Food - _ Animals-155°F 15 sec* 590.006(B) �Water Meets Standards iti310 CMR 22.0* Contact Surfaces of Equipment* � * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* -4-702:11 Frequency of Sanitization of Utensils and Food * 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec Shellfish*- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 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* in mobile food,temporary and residential Sources g, P mrY 10 Proper,Adequate Handwashing � , Game and Wild Mushrooms-Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.19 I Shellstock'Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 Whe to as I * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* q Wash* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices - 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition - 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* 3-501.14( ) ° Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41 F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003-- 3-402.11 Parasite Destruction* Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 e 3 402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006_;. 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 _ 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6 2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °F� ►oh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: 7)/ 2 05 Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. • BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MARA e,. �0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY A'FOMA,a FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 Name- ��' ems`\ Da Tvoe of T of Inspection -LockOperation(s) Address n�/ r Risk FoqA.SLervice Re-inspection Nin Q ` OV Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 1 Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP `bIFQ In: Other ex Vro 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) ❑ CNN Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ C Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. untary Compliance Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items IF❑ 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 b a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004 p g y A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-critical 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 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 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Speci I Requirements (590.009) within 10 days of receipt of this order. ion 4 8 olat non-critical violations=C. 30.Oth DATE OF RE-INSPECTION: Insp 'tor Sign to r 31.D Aster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig nr Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N - Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 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* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti° 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g * 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590. 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 y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°Fro 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: !`vt t'�jr A o6 T Date: -2- b Page: of OFFICE HOURS p ° PUBLIC ("HEALTH DIVISION 8:00-9:30 A.M. BABNSTABLE. • 200 MAIN STREET 3:MON. FRI.P.M. Item Code. C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified s639. ,0� HYANNIS,MA 02601 - 'rFOMa�° 'FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY - Name L /� Et Date Tvoe of I s ec ion r r r v M A l 0y, I f P✓)t� o Ro I M t Address �� Risk ood Service Re-inspection ` - r. M V 'e'� °' Level Previous I sp ction & Telephone Residential Kitchen Date: p 1 Z0, Mobile Pre-o�ergfio7 /Z d o-IF Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint r� Person in Charge(PIC) Time Bed&Breakfast HACCP A ' In: Other Inspector � w H S Out: c Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. s Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ,�q� _C /�U Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 6 c, Jml- CktA ❑ 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 I r r 1 u n 01{' - FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures i ❑ 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) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes within 90 days as determined by the Board of Health. Overall Rating Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed, 25.Equipment and Utensils FC-4 590.005 9 or more non-critical violations=F. ( )( ) 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 Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 C=2 critical violations and less than 4 non-critical. If no critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violatio erve to 8non-critical violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector' Signat Print: 31.OtherDump p DATE OF RE-INSPECTION: ✓i 31.Dum ster screened from public view to Permit Posted? @l N Grease Trap Previous Pumping Date Grease Rendered Y N V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 0117* Dumpster Screen? Y N d�_ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 CoolingMethods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* L 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) RawAnimal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate . 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb"""e uuzooi 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 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and 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. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail * 3-401.11 A 1 b All Other PHFs-145°F 15 sec 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities Cooked P]HF's from 140°F to 70°F 3-50L14(A) Cooling 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient P 24. Food and Food Protection FC-3 .004 3-402.11 Records, Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Recordt s,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590ForTnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of �q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` '� 200 MAIN STREET 3:M N. FRI.P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �639• 508-8 -62-4644 No Reference R-Red Item MASS. 0� HYANNIS,MA 02601 PLEASE PRINT CLEARLY '4A � 08-8 'FON1P`p FOOD ESTABLISHMENT INSP C ON REPORT Name Date �e of o Tve of Inspection Routine 1 Address Risk od Servic Re-inspection Level Rea Previous Inspection Telephone Residential Kitchen !:Ms Mobile Owner ACCP YIN Temporary Caterer General Complaint rson in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector - t: .I ch violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ iolations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awarencss 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ( ' EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 10 ❑ 5.Receiving/Condition ❑ 17.Reheating o+ A ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling P7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control [_I 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.P_roperAdequate Handwashing CONSUMER ADVISORY A 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) A�iw I I Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility FC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of y ty ( )( ) C=2 critical violations and less tha 4non-critical. If no 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 violations observed,7 to 8 no -criti al violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I ct rs Signat Q' �+ Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N � / Dumpster Screen? Y N ,.."."'_^-._--"a^•-•-^__v-..n.....,r`.'^.v-.tir..r-"':�+'� �-v--'-`'A--�----"--"'-'_'^-•+emu__.-.T-'+*vr1[ter.-J'��,,...-...�+•�-'.'--4..-�-c'�.rrt--..•,..:-�-^+-'_"--r.----r..-.e.-�: w�...-___ .... ..-.'^r..,.+^`r.-Y--.»-..c--�•'_'.o. _.___-`--_---�----�^-•-'+.-,,•-a-..d---Arr•-�sy.�.-"`'-�_"^-+`�..s'<`r.FJY.H�•.�r--.....�..�.,.. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 37501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19- PHF-Hot and Cold Holding _ 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachIdentifying * 590.004(F) * ' ' - - P 7-101.11 Identi m Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* 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 1-1 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* - 7-204.11 Sanitizers,Criteria-Chemicals* -- • • REQUIREMENTS FOR• ' 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 -F.00dand Water From Regulated Sources -9 - Fodd 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 Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* - 4=501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 7 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 AnimalConsu Fooer d That 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"r" gg Equipment* - -- Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 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* j 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)- 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 Game and Wild Mushrooms Approved By _ _ A 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 IS sec* Other 590.009 violations relating to good retAft 11' Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Speci 3-201.17 Game Animals* Requirements. 5 - Receiving/Condition- _ 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i i pp THE Tpk, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: f ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-a:3o . Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI 'cbA +639• �0� HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'F� FOOD ESTABLISHMENT INSP T N REPORT Name �, Date Typeofof Type of Inspection -01 Operation(s) Routine Address Risk LI Food Service Re-inspection Level Retail Previous Inspection A e-N In 4,0 Telephone /` Residential Kitchen Date: Mobile Pre-operation Owner _ HACCP Y/N Temporary Suspect Illness Caterer General Complaint on in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector r Out: ch violation checked requires In explanation on the narrative page(s)and a citation of specific provision(s)violated. IN ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) Iolations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) A 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 ' uly - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 167.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ROTECTION FROM CONTAMINATION ❑20.Time Asa 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 160.Proper Adequate Handwashing CONSUMER ADVISORY 1.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: No ❑ Yes Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violations and less than 4non-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address viol serve to non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe S' Print: 31.Dumpster screened from public view AW9 )e:5�) Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' S" Print: ) Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �C J hf-2t/f/1/ ✓ Dumpster Screen? Y N ! v `I 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 Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g1q Food or Color Additives * - - * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives _ Cooked and RTE Foods.* * - - 99 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 15 Poisonous or Toxic Substances 590.004(F) *�• ' -,EMPLOYEE HEALTH, 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* 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 AReport Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fmits and Vegetables * Applicant To Report To'The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -REQUIREMENTS FOR 3-306.14(A)(B)l Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP ` 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food V 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources - g - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* _ Concentration and Hardness* 3 401.11A(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 - Fgnipmrnr* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Cuimruuuted Fislr,Mcals&G-me Pathogens* 011i.l 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* - Chemical*Methods of Sanitization-Hot Water and ffi3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed 4-70 Stung Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources*' 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,-Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 - Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 reta' 3-201.17 Game Animals* - 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Speci Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remainin Unsliced Portions of Beef Roasts* g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590,000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45`F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices _ 27. Physical Facility FC-6 007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* - 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc *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. THE• HEALTH INSPECTOR'S Establishment Name: Date: Page: of TOWN OF BARNSTABLE, __ OFFICE HOURS: K) P BLIC HEALTH DIVISIONa 8:00-9:30 A.M. 2 Q 3:30-4.30 P.M. • ruRt+srwetg � 200 MAIN STREET ,,,,� $ � � � MON.-FRI. Item Code C-Critical'Item DESCRIPTION OF VIOLATION I'PLAN OF CORRECTION Date Verified' i639• �e .]V � HYANNIS,MA02601 508-862-4644 No; Reference R-Red Item � PLEASEPRINTCLEARLY D N1tl�6 Name - Date Type of Inspection Routine Address Risk Food Servlc ion Level Previo s n pec}ion�/ Telephone Residential Kitchen Date:�d �a`Z Mobile Pre-oper Owner HACCP Y/N Temporary Suspect Illness O Caterer General Complaint Person in Charge (PIC) Time Bed & Breakfast HACCP Other Inspecto t: violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco / Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ C Action as determined by the Board of Health. 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 TIMFTEMPERATURECONTROLS(Potentially Hazardous oods) - ❑ 4. Food and Water from roved Source Approved in Temperatures res ❑ 16. Cooking P 115. Receiving/Condition ❑ 17. Reheating Q" ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑'7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and.Cold Holding - Tm 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 Proper Adequate Handwashing - .Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations < / ' I critical(N)violations must be corrected immediately o (blue&red items)r. -� } within 90 days as determined by the Board of Health. Overall Rating Corrective Action Required: ❑.No ' ❑ Yes c N _ 23.Management and Personnel -(F�z)(sso.003) Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/federal Food Code. ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-Inspection Scheduled ❑ Emergency Suspension j 24.Food and Food Protection "(FC-3)(590.004) This report,when signed below by a Board of Health member or its _ 25. Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste_ ---(FC-5)(5s0.o06) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: - 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment A= Zero critical violations and no more than anon-critical violations. F= 3 or more critical violations. n no critical violations observed, operations. If aggrieved by this order,you have a right to a hearing. 28. Poisonous or Toxic Materials _ (FC-7)(590.008) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. s or more non-critical violations= F. 29. Special Requirements (590.009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation= F is scored.automatically if no hot water, 30. Other C= 2 critical violations and lesRth n 4 no -critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or DATE OF REANSPECTION: no PIC or alternate PIC present. bserved, 7 to 8 non-criticlatio =C. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N In at Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N ' IC Signature Pr• t: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y / l -.._._.; .. - ,.-.-,.;}a--M"-�..�t�-�✓w...� ,r-. _ r"1-w rw r«c+�'r,.....-. 7+„ '� ..v,. --�--�-^v-� :3.+ti«w...�.r4.,.,.w-:��.`Pw-"`ter .,�•ari,.-•...r.a.,✓+v.y---r+-�.�--s�� -,--�=s- =-;y. ..«ram-.a:r.... �••�i.�:!" �"L�,+-K�..r".t dt.-`..-..��,..._-'Wr^' Violations Related to Foodborne Illness 3-501.14(C) PHFs Received at Temperatures Interventions and Risk Factors(Red items 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 411F/45117 Within 4 Hours.` FOOD PROTECTION MANAGEMENT 8 Cross-contarnination PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 590.003 A Assignment of R 3-302.11(Ax1) Raw Animal Foods Separated from 19 PHF Hot and Cold Holdinlding- 590.003 Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives Contamination from Raw In redrents 3-202.12 Additives* 3-501. Cold PHFs Maintained at or below 2-103.11 Person in charge-duties 9 590.004(F)4(F) 410/450 p• 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances Contamination from the Environment 7-101.1 1 Identifying Information-Original mat 140st 2 590.003(C) Responsibility of the person in charge to h' g g * require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-5(I1.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(H) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590. D003 G R in b Person in Charge* 3-306.14 A II Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3. 590.003 Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs* Food and Water R ulated Sources 9 Food Contact Surfaces * 3-801.1 I(D) Raw or Partially Cooked Animal Food and 4' e9 7-206.I I Restricted Use Pesticides,Criteria 590. A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* Sanitization Temperatures* 3-801.1 1(C) Unopened Food Package Not Re-served. 3-201.12 Food in a Hermetically Sealed Container* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 4-501.114 Chemical Sanitization-temp., H, 22 3-603.1 1 Consumer Advisory Posted for Consumption of 3-202.14 Eggs and Milk Products,Pasteurized* p TIME/TEMPERATURE CONTROLS ry p 3-202.16 Ice Made From Potable Drinking Water* Proper Cooking Temperatures for concentration and hardness.* Animal Foods That are Raw,Undercooked or 16 5-101.11 Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean* Pathogens.*e" �'"R0°' 590. A Bottled Drinking Water* 3-401.I IA(1)(2) Eggs- I55°F IS Sec. 4-602.11 Cleaning Frequency of Equipment Food- 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590. Water Meets Standards in 310 CMR 22.0* * Eggs-Immediate Service 145°F I Ssec• Contact Surfaces and Utensils 3-401.1 I A She9fish and Fish From an Approved Source ( )(2) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 1(B)(1)(2) Pork and Beef Roast-130°F 121 min* 4-"103.11 Methods of Sanilizatiutt-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-40I A I(A)(2) Ratites,Injected Meats-155°F 15 sec. residential kitchen operations should be Sources 10 . proper,Adequate Handwashing Game and Wild Mushrooms Approved by , 3-401.11 A 3 Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Regulatory AuM 2-301.11 Clean Condition-Hands and Arms ( )O 2-301.12 Cl Procedure* Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202.18 Shellstock Identification Present * interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash* Poultry or Ratites-165°F 15 sec. a 11 Good Hygienic Practices 3-401.1 I(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 3-201.17 Game Animals * 1450E* practices should be debited under#29- 5 ReceivinglCondftlon 2401.11 Ea i or Using Tobacco 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. , Mouth* Microwave 165°F 3-202.15 Package In , 3-401.11 A 1 b , VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated` 3-301.12 Preventing Contamination When Tasting* ( )( )O All Other PHFs-1450E 15 sec. 6 (Blue Items 23-30) Tags/Recwds:Shellstock u ,, Prevention of Contamination from Hands 17 Reheating for Hot Holding 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-403.1 1(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate the Employees* 3-403.1 IB °( ) Microwave-165 F 2 Minute Standing foodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained* g found in the following sections of the Food Code and 105 CA4R 13 Handwash Facilities Time* TagsRtecords:Fish Products 590.000. Conveniently Located and Accessible 3-403.1 1(C) Commercially Processed RTE Food- 3�02.11 Parasite Destruction` Item Good Retail Practices FC 590.000 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 140°F* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement` 3-403.1 1 E Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 590. J Labeling of Ingredients* ( ) g Conformance with Approved Procedures 5-205.11 Accessibility, lion and_Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 IHACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 Devices 27. Physical Facility FC-6 .007 3-502.11 S alized Processing Methods 3-501.14(A) Cooling Cooked PHFs from 1400E to 6-301.11 Handwashin Cleanser,Availability28. Poisonous or Toxic Materials FC-7 .008 3-502.12 Reduced oxygenpackaging, 2g. Special Requirements 009 6-301.12 Hand Provision P q 8-103.12 Conformance with Approved Procedures* to 41°F/451F Within 4 Hours.* 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient 5:51XKI Ikr 2.Mc Temperature Ingredients to 41°F/45°F Within 4 Hours* *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. �1NE TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: a OFFICE HOURS: CT PUBLIC HEALTH DIVISION 8:00-9:30 A.M. = a►nrrsTwaie 200 MAIN STREET 3:30-4:30 P.M. MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA02601 508-862-4644 No. Reference R-Red Item PLEASE PRINT CLEARLY Name Date Tvpe of f Inspection Routine Address Risk Food Se pection Level ai Previous Inspection If Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint 6 Person in Charge (PIC) Time Bed & Breakfast HACCP In: Other Inspector Out: rviolation checked requires aA explanation on the narrative page(s)and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. jkA FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities �-- m� EMPLOYEEHEALTH 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/TEM PERATU RE 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 Asa Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 4 ,,60. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP I.Good Hygienic Practices CONSUMER ADVISORY W ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. Overall Rating rn Corrective.Action Required: ❑ No ❑ Yes C N 23.Management and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/federal Food Code. ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-inspection Scheduled ❑ Emergency Suspension j 24.Food and Food Protection (Fc 3)(sso.00a) This report,when signed below by a Board of Health member or its 25. Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than 3 non-critical violations. F= 3 or more critical violations. If no critical violations observed, 28. Poisonous or Toxic Materials (FC-7)(590.008) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations= F. 29. Special Requirements (590.009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation = F is scored automatically if no hot water, 30. Other C= 2 critical violations and less than 4 non-critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or DATE OF RE-INSPECTION: observed, 7 o 8 non-critical violations=C. no PIC or alternate PIC present. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Insp Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y PIC s ig at a Print: . ".��..,-.:,.ter---- "�-,-_.�..�.-.w--v=�•-....:�<aF:.r--:--=+"-'=s-s..r�'-ry,._,.,,:_ "'k''y'w w y.--*w .t-.''.--` x�� -.r- ...c"�-.`--i-�..::- -•-,z � .-� - ,,,n,.,r=-` •ti,..;�✓-�^--^-.+...`,,::�.«r--'.:.._ Violations Related to Foodbome Illness 3-50 1.1 a(c) PHFs Received at Temperatures Interventions and Msk Factors(Red helms 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/451F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-eontarnination 3-501.15 Cooling Methods for PHFs 1 I 590.003 A Assignment of Responsibility* 3-302.11 A ] Raw Animal Foods Separated from PROTECTION FROM CHEMICALS ( x ) S�"d 19 PHF Hot and Cold Holding * 14 - Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 590.003 B Demonstration oCKnowled a Cooked and RTTi Foods � 2-103.11 Person in charge-duties Contamination hom Raw Ingredients 3-202.12 Additives* 590.004(F) 41°/45°F* 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above Contamination tram the Environment 7-101.1 1 Identifying Information-Original 140°ts 2 590.003(C) Responsibility of the person in charge to fy g g * require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 13ont applicants* 3-302.15 Was Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of Food Employee Or An 3-304.11 t, Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(H) Variance Requirement Charge* Contamnation from the Consumer 7-202.12 Conditions of Use* 590.003 G R rting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 31 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* Fond* * 3-801.1 1(B) Use of Pasteurized Eggs* FOOD FROM APPROVED SOURCE 7-205.11 Incidental Food Contact,Lubricants 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.1 11 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* Sanitization Temperatures* 3-801.1 I(C) Unopened Food Package Not Re-served. 3-201.12 Food in a Hermetically Sealed Container* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products` 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 1 Eggs and Milk Products,Pasteurized TIME/TEMPERATURE CONTROLS 4-501.114 Chemical Sanitization-temp.,pH, 22 3-603.1 1 Consumer Advisory Posted for Consumption of concentration and hardness.* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable Water* 16 Proper Cooking Temperatures for 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean` 3-401.11A(1)(2) E s 155°F 15 Sec. Pathogens.*E"e'"�" " 590. Water Meets Standards in 310 CMR 22.0* 590. A Bottled Water` 4-6i02.11 Cleaning Frequency of Equipment Food- gg Eggs-Immediate Service 145°F I Ssec* 3-302,13 Pasteurized Eggs Substitute for Raw Shell Eggs* ShelUish and Fish From an Approved Source Contact Surfaces and Utensils, 3-401.1 I(A)( )2 Comminuted Fish,Meats&Game 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and Animals-155°P 15 sec.* SPECIAL REQUIREMENTS Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min* 4-703.11 .Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical, 3-401.11(A)(2) Ratitcs,Injected Meats-I559'15 sec. residential kitchen operations should be Sources 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by , 3-401.I I(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections R u/a Auih 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cl Procedure* Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202.18 Shellstock Identification Present , Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks g 2401.11 Eating, or Using Tobacco* 145°F* practices should be debited under#29- 5 RecelvinWCondidon Special Requirements. 3-202.11 PHFs Received at Temperatures* 2-401.12 Discharges From the Eyes;Nose and 3-401.12 Raw Animal Foods Cooked in a P 9 * Mouth* Microwave 165°F* 3-202.15 Package In * 3-401.1 1 A 1 b * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated* 3-301.12 Prevent Contamination When Tasting* ( )( )O All Other PHFs-14S°F 15 sec. 12 Prevention of Contamination from Hands 17 Reheating for Hot Holding (Blue Items 23-30) 6',', TagsfReeords:Shellstock Critical and non-critical violations, which do not relate to the 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec.* 3-202.18 Shellstock Identification* joodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained` Employees* 3-403.11(B) Microwave-165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR 1me Tags/Records:Fish Products 3 Handwash Facilities Ti " 590.000. 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 140°F* 23. Management and Personnel FC-2 .003 590. J Labeling otingredlents' ( ) Remaining 5-204 3-403.1 1E.11 Location and Placement* inin Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Conformance with Approved Procedures 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 /HACCP Plans Suppled with Soap and Hand Drying ]g Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 Devices 27. Physical Facility FC-6 .007 3-502.11 Specialized Proses Methods 3-501.14(A) Cooling Cooked PHFs from 140°F to 11 Handwashin 6-301. Cleanser, 28. Poisonous or Toxic Materials FC-7 .008 3-502.12 Reduced oxygen packaging,criteria* Availability 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 8-103.12 Conformance with Approved Procedures* 6 301.12 Hand Provision to 41°F/451F Within 4 Hours.* 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient S 59of,. M,kb.E Temperature Ingredients to 41°F/45°F Within 4 Hours* *Datats 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. HEALTH INSPECTOR'S r � TOWN OF BARNSTABLE OFFICE HOURS: Establishment Name: Date: Page: of PUBLIC HEALTH DIVISION 8:00-9:30 A.M. _ •� 200 MAIN STREET 3:30-4:30 P.M. .� HYANNIS MA02601 MON,-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Verified , � y• 508-862-4644 N0. Reference R-Red ItemPLEASE P I CLEARLY Q Name Date Type of Ins ection NOW- 6(ANVL;1M) IN s Routine" Address Risk Food Servi , -inspection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation d Owner HACCP Y/N Temporary Suspect Illness Person in Charge (PIC) Time Caterer HACCP General Complaint Bed & Breakfast In: Other Inspector Out: violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. AMA) LIWGALS fly Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands Q ❑ 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 S ❑ 3. Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures 115. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding ( � PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing 10. 1121. Food and Food Preparation for HSP Proper Adequate Handwashing .Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. Overall Rating Corrective Action Required: ❑C N No ❑ Yes 23.Management and Personnel Official Order for Correction: Based on an inspection today,the items g (FC 2)(590.003) ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-ins 24.Food and Food Protection (FC-3)(590.004) checked indicate violations of 105 CMR 590.000/federal Food Code. rY PRe-inspection Scheduled ❑ Emergency Suspension j This report,when signed below by a Board of Health member or its 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to Correct 26.Water, Plumbingand Waste P y p ❑Embar o ❑ Emergency Closure ❑Voluntary Disposal(FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of 9 9 Y ry p sal ❑Other: i the food establishment permit and ces-sation of food establishment - - --- 27. Physical Facility (FC�)(590.007) P A= Zero critical violations and no more than 3 non-critical violations. F= 3 or more critical violations. If no critical violations observed, 28. Poisonous or Toxic Materials (FC-7)(590.008) operations. If aggrieved by this order,you have a right to a hearing. 9 or more non-critical violations= F. Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4von-critical violations. 29. Special Requirements (590,009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation = F is scored automatically if no hot water, 30. Other C= 2 critical violations and less than 4 non-critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or DATE OF RE-INSPECTION: no PIC or alternate PIC present. observed, 7 to 8non-critical violations=C. -A 191M Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Ins ctor' I e Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N _ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y P i at a Print: :.,�,.-.�:,., ... ,�,` ::'..�,._,.�:.,..5��.✓,.tL+`i-:Z•••;r:�=' e1• ..--e.� Te. r,'.,�,.. �'- �.�.*«. .,��.- _;�,..�yt„�- �...��;[,,Ya:s�•i�:s;; •t,� s:>> �y::�,..y--v Violations Related to Foodbome Illness 3-501.14(C) PHFs Received at Temperatures Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-501.15 Cooling Methods for PHFs 1 590.003 A Assi ent of R nsibili * 3-302.11(AXI) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 590.003 B Demonstration of Knowledge* Cooked and RTE-Foods* 14 Food or Color Additives 2-103.11 Person in charge-duties Contamination Ilium 590.00 om Raw Ingredients 3-202.12 Additives* 3-501.16(B 4(F) Cold PHFs Maintained at or below 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 41°/45°F" EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above Contamination from the Environment 7-101.1 1 Identifying Information-Original 140sts' 2 590.003(C) Responsibility of the person in charge to Y g g require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.11 Restriction-Presence and Use* 590.004(14) Variance Requirement Charge* Contarrnabon from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3.1 590.003D Exclusions and Restrictions* Disposition of Adulterated orContaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 21 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.1 1 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. 3-201.12 Food in a Hermetically Sealed Container* Sar itization Temperalures* 7-206.13 Tracking Powders,Pest Control and I3-801.1 1(C) I Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 4-501.114 Chemical Sanitization-temp., H, 22 3-603.1 1 Consumer Advisory Posted Consumption 3-202.14 Eggs and Milk Products,Pasteurized* p TIME/TEMPERATURE CONTROLS ty td f C tion of p 3-202.16 Ice Made From Potable Water* Proper Cooking Temperatures for concentration and hardness.* Animal Foods That are Raw,Undercooked or ' 16 5-101.11 Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean* Pathogens.*EeWry 111 oWl 590. A Bottled Water* 3-401.1 I A(1)(2) Eggs- 155°F 15 Sec. 590. Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Contact Surfaces and Utensils* She®6sh and Fish From an Approved Source 3-401.1 I(A)(2) Comminuted Fish,Meats&Game 4 702.11 Frequency of Sanitization of Utensils and Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui bent* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 I(B)(1)(2) Pork and Beef Roast-130°F 121 min*4 703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemicals residential 1(A)(2) Ratites,Injected Meats-155°P 15 sec. catering,mobile food,temporary and Sources* s residential kitchen operations should be i0 Game and Audi Mushroom Proper,Adequate Handwashing s Approved by debited under the appropriate sections R ula Auth 3 2-301.11 C1eanCondition-Hands and Arms* -401.11(A)(3) Poultry,Wild Game, 3-202.18 Shellstock Identification Present* 2-301.12 Cleatting Procedure* Stuffing Containing Fish,Meat, above if related to foodborne illness s 2-301.14 When to Wash* Poultry or Ratites-165°P 15 sec.* interventions and risk factors. Other 590. C Wild Mushrooms 3-401.1 I(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail ` 3-201.17 Game Animals* lI Good Hygienic Practices 5 RecelvinglConditiou 2-401.11 Eating,Drinking or Using Tobacco* 145°F* practices should be debited under#29- 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.15 Package Integrity* Mouth* Microwave 165°F" 3-101.11 Food Safe and Unadulterated* 3-301.12 Prevent Contamination When Tasting* 3-401.1 1(A)(1)(b) All Other PHFs-145°F 15 sec.• VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 12 „ Prevention of Contamination from Hands 17 Reheating for Hot Holding (Blue Items 23-30) 3-202.18 Shellstock Identification 6' TagslRecord Shellstock 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sea* Critical and non-critical violations, which do not relate to the * Em to ees* Joodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained* 3-403.1 I(B) Microwave-165°F 2 Minute Standing 13 Handwash Facilities * Sound in the following sections of the Food Code and 105 CA4R TagslReeords:Fish Products Time 590.000, Conveniently Located and Accessible 3-402.1 I Parasite Destruction* 3-403.1 1(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 11 Numbers and Capacities*3402.12 Records,Creation and Retention* 5-203. 140°F 23. ,Management and Personnel FC-2 .003 590. J Labeling of Ingredlente 5-204.11 Location and Placement* 3-403.1 1(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Confortnance with Approved Procedures 5-205.1 I Accembility,Operation and Maintenance Roasts" 25. Equipment and Utensils FC-4 .005 IHACCP Plans Suppled with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 S 'alized Processing Methods Devices 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 6-301.12 Hand Provision 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 8-103.12 Conformance with Approved Procedures* to 41°F/451F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient S 51W mW&�-2.a.< Temperature Ingredients to 41°F/45°F Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. •Denotes critical item in the federal)999 Food Code or 105 CMR 590.000. ; r Wt a , w r i r 2 � k e i A' N der W x.w d r'h E' " x 4 a • � r Y , F , w r= a a:. , a 1� f r 9 77 � s s s t� x 3, r « ell f a rN�$ •w a. v e � j t f e � � a y k " �w at °a a gYdA e 1 bA G 44 fl a, 8 �, ry a n P � t d tx va k k d +, � § RAM y ��? .„.�{'p•#" 1 p. �7 f m e , f n x , i t, i n J Ii . ws -z IT c w., f 5 s k t k� i J �i. w .. _ m n: f w 5. 3 n _ . n t iE r< r"— �: h 6 . r � e LL T k f } 4 �'a ~i u Yj +4+ax L sa s ' _v a r , k K � r� N a $ rT a „ CN " a a r � � y ra 4 14I F a y li il� A n 9+. r t k d � Xt. m r ) ' py, t M � a k k k } 9 d i I bIi s {' 9 r y 3 4 s iry3 uk -m ,roh,Y f o �. � .. a �. � � � '�+' ( _ �,n "�"��� •"�_ '�. a ' e F �,•. a „ "� n. � �, Y � ` �S.�', ,"l Rt C S �W, .. � r t� F � •r ey i e�” a t � u n 4. ia` a , I , 3 a r n: y , il f s . s . 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I h It c J� + � � � ,.��'� i sn a� k Y*cam - � * .:•. d h nV 7l x '• V XX� F m t av'i r y.� t MK 22 , lE ram. - r ^ k r , %y 1 R Y a i v s , v� E + S " , .. z i� :tee a ` M r.=n a v � � s �`,•� _� - _ a v ti F s i.F. }i ""' S .'4..A P Mom'"•" ,a. WIN OF BARNSTABLE HEALTH INSPECTOR'S aT • OFFICE HOURS: Item No. In topace below describe all violations the Page of . �„„�,.o,• : O -ARD OF HEALTH 8:00-9:30A.M. T4, •= 367 MAIN STREET MON.-FRI. HYANNIS, MA 02601 790-6265 FOOD ESTABLISHMENT INSPECTION REPORT 613 /30 Establishment Name Ld4K AE Date Address / $ ��p- � v o'� In I ut ®Z 3 L l _ K- Telephone Type of Establishment Purpose / Food Service Routine Owners Name f '6 Retail Food Follow-up Residential Kitchen Complaint Person in Charge Mobile Unit Investigation s Temporary Food Service Other Inspectors Name o'(/� �iis� � Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column°N'and critical violations are marked under column'C°.Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply .002 4 29. Water Source .015 4 2. Food Containers .002 IR, 1 30. Sewerage .016 4 Food Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas ✓ .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse 1,6 A,VA 505 .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 Equipment&Utensils _ 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized .013 2 Other 17. Food Contact Surfaces .013 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 (5- 21. Wiping Cloths .013 1 50. Pets .027 1 Discussion with Mana�Qe,,rpent b l..i /� 22. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 �,.uzv c ati...> lVL�C-W d I1 t�- c✓ �/�i, / j } 23 Pre-Scraped, Soaked .013 1 52. Salad Bars 032 1 vl J 24. Wash/Rince Water .013 1 25. Thermometers/Test Kits .013 1 No.of 13 Critical Items Violated 26. Equipment/Utensil Storage .014 1 These items require immediate attention. 27. Single Service Articles .014 1 28. Single Service Re-Use .012 1 SCORE Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N #Seats Observed? Frozen Desert Machines: /1/ Outside Dining Y-�N Self Service /r WaiPService Provided _y__ Variance Granted Y ✓ N Variance Letter Posted TY N Inspected by'AA&6�� 4 ' Received 13 CRITICAL 7: OD HANDLING VIOLATIONS ky Full Item Descriptions w1. Food from an unapproved or unknon source or food which is be Food- adulterated, contaminated or otherwise unfit for human consumption CI Food source, approved, wholesomeAl is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for c3 Potentially hazardous rooms proper temperatures: 140°F or above, 45°F or below, 0°F; , rapid cooling of cooked foods within hin 4 hours preparation or service at a temperature which is greeter than 450 1 w Facilities to maintain product temperature (`=70 C) (in the case Of cold food) Or less than 1400 F (600C) (in CS unwrapped and potentially hazardous foods not re-served �;;� _neo of hr,t f_vAl 6 Damaged, spoiled, returned foods segregated /• 7 Food protected during storage, preparation, display. dispensing, service, transportation ' S Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C1e Hands washed and clean; good hygienic practices section 105 CMR 590.006(G)• 15 Clean clothes. hair restraints Equipment & utesslls 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) 17 Food contact surfaces: design, constructed, Installed, maintained, located transmitted by food is working as a food handler in a foofl tg Non-food contact 'surfaces design, constructed, installed. maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Yarpwashing facllitiest designed, constructed, maintained. Installed. located. hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked g24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 29 No reuse of single service articles storage or service. Saeitary Facilities C29 Water source; approved, hoticold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 sewage and waste water die"sal C31 No cross-connections, back siphonese, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets & Handwashingi number, accessible, design. Installed contaminate any food areas used to store or prepare food, or any C3i No Insects or rodents; harborage prevented 35 Plumbing; installed. maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors. fixtures good repair, clean, signs 36 Handwashing areas supplied with soap end towel dispensers, proper waste receptacles 9. Toilets and facilities for washinghands are not provided, properly 37 Garbage and refuse: containers covered, adequate number. Insect/rodent resistant. frequency. P m P P Y clean installed or designed, accessible or convenient. 3e out area: Oumpster covered. construction. clean 39 Outer openings protected e0 Pesticides and rodentieides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not, use single service Pbysical Facilities a1 Floors constructed, maintained, clean articles and/or bottled water from an approved source. r2 Walls, ceiling. attached equipment; constructed, maintained. clean 43 Lighting provided es required, fixtures shielded stem supplyingotable water that may eM Rooms and equipment .anted as required 11. A defect exists in the at Y P Y �5 Dressing. locker areas provided used. clean result in the contamination of the water. other 12. Insects, rodents or other animals are present on the premises cq6 Tories properly stored. labelled, used (unless allowed b Section 10 Cl1R590.027(F)(3)). �7 Premises litter-free, unnecessarl articles, cleaning maintenance equipment properly stored. ( Y 5 . 590.027(F)(3)). Authorized personnel 46 Living/sleeping quarters and laundry separate 9. e9 Linen properly stored 13. Toxic items are improperly labeled, stored or used. So No pets or other live animals except guide dogs 51 Bulk foods stored. labelled, dispi•nsed Note: In addition to the items listed above, any other violation of the 52' Salad bar operations prepared. refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftef written notice to the permit holder constitute a critical violation. OIKE!I Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. 4 Board of Health Donald A.Gaudagnoli,M.D. r RNSThos.e. : John T. Norman M¢ ` F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 48 Issue Date: 01/09/2019 DBA: FRATERNAL LODGE AF & AM OWNER: CENTERVILLE BUILDING CORP. Location of Establishment: 1989 FALMOUTH ROAD CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES - FOODSERVICEESTABLISHMENT: $50.00 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, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Town of Barnstable BOARD OF HEALTH 8 r Paul J Canniff,D.M.D. Board OI Health Donald A.Gaudagnoli,M.D. RAWNSTABLL =" John T.Norman M1" +ens , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate eor ° Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment An accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chanter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 48 Issue Date: 12/20/18 DBA: FRATERNAL LODGE MASONIC LODGE OWNER: CENTERVILLE BUILDING CORP. Location of Establishment: 1989 FALMOUTH ROAD CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 _ FEES FOOD SERVICE ESTABLISHMENT: $50.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - --- --- - - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: I : PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: (19 t oFIKE r Town of Barnstable For Office Use Only: Initials: o„ � • Date Paid i fo Apt$� 9MMAS" $ Inspectional Services s67q. �0 rEDMA'�a Public Health Division Check# \ Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT LZ( �C, j4p' DATE / JJ9 NEW OWNERSHIP RENEWAL .tl� ral-?v�-C 11 t-4. NAME OF FOOD ESTABLISHMENT: G Q*j7001r yy i4y �lhL��y� ea rb ADDRESS OF FOOD ESTABLISHMENT: /p�j' - a7Lir,�®•.��� 14d •»X�i�- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �� J E-MAIL ADDRESS:�r �.,�5 @ CCU•+ �Gr TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (,-f -�9 TOTAL NUMBER OF BATHROOMS: �- WELL WATER: YES NO Z.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO N 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. Na IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 00 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? HO TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V 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) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED QQV\pplication FormsTOODAPPREV2018.doc i PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT_ SOLE OWNER: /NO D.O.B HONE # :S `—OWNER P ADDRESS_-- 2 2—:0 gda 0-C..— CORPORATE OWNER: FEDERAL ID NO. : Oy 143.2du CORPORATE ADDRESS: 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 Managers Expiration Date Allergen Awareness Expiration Date 1./"� V 1 11 2. 1 IGNATURE 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 a4 a met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/ai)plications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc 1 PERMIT NO: TOWN OF BARNSTABLE 03/16/2018 48 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: CENTERVILLE BUILDING CORP. D/B/A: CENTERVILLE BUILDING CORP Whose place of business is: P.O. BOX 61/1989 FALMOUTH ROAD , 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: ANNUAL: YES SEASONAL: TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: Paul J. Canniff, D.M.D,Chairperson FOOD SERVICE ESTABLISHMENT: $50.00 Junichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: Donald A.Guadagnoli, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: 1 MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: 12/31/2018 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health f PERMIT NO: TOWN OF BARNSTABLE. 02/06/2018 48 BOARD OF HEALTH PERMIT TO OPERAT,—E A'FOOD.E TABLISHMENT In accordance with regulattoTi�-p-P M l ated„untfe�au`fhprity of Chapter 94, { s _ Fx Section 395A and Chapter,Y k tiorr 5-OVIR.L-Geieral ws;-a.'permit is hereby granted to: s = n CENTERVILLE BUILDIRid 1`03FirEN` 1 /ItsLE.BUILDING CORP Whose place of business is: 61/ 1 �i. A{# °AD , 105)V RVii_.LE, MA 02632 ,zg_ r Type of business and any re tr cf l F D' I RV BLISHME' ems+ .'S-+' l * To operate a food establishment in tie TO fIBLE f RESTRICTIONS IF ANY: K 'r. aLF.' t SEATING: ANNUAL JET. �� x .�y.2 k ; SEASONAL: TEMPORARY v s � k s � '.:: _ s� A fi3bF HEALTH RETAIL FOOD STORE: F W J anniff, D.M.D Chairperson FOOD SERVICE ESTABLISHMENT: ''� �. 4510` 'NAY � � ,� ,,^'r- � uiiofi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: `s 3 gE, 7' ° � o iald A.Guadagnoli, M.D RESIDENTIAL KITCHEN FOR BED+BREAKFAS?4 �� x '� :� �� ' MOBILE FOOD UNIT: 'TOBACCO SALES: FROZEN DESSERT: .. Thomas A. McKean, RS, CHO CATERER: ,�,�.�.v-,>...,:.:.�,.�xc- ~� Director of Public Health 'THE Town of Barnstable Zt!:�>� Regulatory Services j Aay-ch Ij U 's sMWsr,BLE. Richardli Director .V. ScaBAB TABLE i639. 10WAM � �waes:a i `dos u ors eai QLE Public Health Division 1639-2014 m McKean, Director ��� 'Thomas o 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: ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS:_ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �r NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: AO.;5 ' * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: 02 ANNUAL OR SEASONAL OPERATION: 'Yl n TYPICAL HOURS OF OPERATION MON-FRI: � TO DAYS CLOSED EXCLUDING HOLIDAYS .E. MONDAYS 2_0 Weditt Cdat 311dsofv reja� 2 ww�� �Q h� .� 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 *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT— SOLE OWNER: YES/� ADDRESS 7�7 1 Ham, , � r �9a� /i��.� a , �trT! ®��8✓ PHONE # (.gTj&2 ,? IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. (� STATE OF INCORPORATION2��.. FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1. 1L ZYI�� I�.1 �j•�I Ir"a EXPIRATION DATE: / Dla/ 2• I1I1,a n yul pf . y,. ' ►h V ✓a1 EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1• EXPIRATION DATE: Tvm ff SIGNATURE OF APPLICANT AND DATE Q application Forms\Foodapp2.doc - ' Town of Barnstable � �- � Regulatory Services BIZ "A� snar,sr,►sLe, Richard V. Scali, Director BARNSTABLE p en p <wr°�" Ir r=-osmnUE w�aaa s u Public Health Division 1639-2014 Thomas McKean, Director �Dg 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: J NAME OF FOOD ESTABLISHMENT: (Ale Na� �`� fff T ADDRESS OF FOOD ESTABLISHMENT: C`7 � / Meg 0 ✓ E-MAIL ADDRESS: C�4 Q 0 1 `-'- �0.�� / 0 7r[ - WS'ho ✓TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( �) 1 7 Y aq5�� /NUMBER OF SEATS*: INSIDE: I 1-0 OUTSIDE: TOTAL: A* Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: >Gt . TYPICAL HOURS OF OPERATION MON FRI: 1 TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 1/1 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 AOODSERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT � ' i�I�C I At Uo A Cevl V �j SOLE OWNER: YES/NO ADDRESS J(AI MLA+ CO3j /l Utz PHONE # Z I�v- 6 f9bX-lei v ~ 35Y Y IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1• EXPIRATION DATE: 2• EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1• EXPIRATION DATE:61 /20,-/� SIGNATURE OF APPLICANT AND DATE QAApplication Forms\Foodapp2.doc r PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 48 January 1, 2016 PERMI Rq,. ftop, F941M SHMENT l In accorda afith lrg %tio 'd' r of Chapter 94, Section 395A ao a 1 ec n -.#if the Gene a r it is hereby granted to: CENTERVILLE BUILDING CORFf f RNAL . &A.M.( MASON) Whose place of business I `� t�. BOX b' ar. OAD , I T V LE, MA 02632 W: Type of business and any 4tr ticths: � F �,A ~TABLISHR*NT � 2 r To operate a food establis� er*-Wthe x T A13LE ' RESTRICTIONS IF ANY: r - ._ a� s. r, .c:.�:�: �.��`�-.� i`a„5' -,. i^r f= SEATING: ANNUAL: XE SEASONAL: TEMPORARX- _ 4 ' D OF HEALTH d:fsr RETAIL FOOD STORE: ' u .k yne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: QUO , 4' RESIDENTIAL KITCHEN FOR RETAIL SALE: Paul J. Canniff, D.M.D. �` i-•r,��:. 5� RESIDENTIAL KITCHEN FOR BED+BREAKFAST - � e Junichi Sawayanagi�- � 77 MOBILE FOOD UNIT: TOBACCO SALES: December 31 , 2016 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health II PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 48 BOARD.A.FHEAL:�Tk January 1, 2014 ,r PERMIT TO .O � ►TE A'FO`O;Dt,ESTA ISHMENT In accordance w th a Ala t ns prop►► IL aced t der nthorit,y of Chapter 94, Section 395A and Cbapter 114.gecioa� of'£fie G� rat97 ,.aertn.it is hereby granted to: a CENTERVILLE BUILDING CORP. - FRATER NAL-LQ13GE A F? &A.M.( MASON) Whose place of business Is =k OX 6If-14 , Lf?lft AD , O£fF1• f2 /IC LE, MA 02632 E _ Type of business and any rest I HMENT To operate a food establishtnlnf pit theT "C1 - _ RESTRICTIONS IF ANY: r SEATING: ANNUAL: YES; SEASONAL: TEMPORARIY� 3'sxz x x r < ES �.. �; 1Al2 OF HEALTH RETAIL FOODSTORE: FOOD SERVICE ESTABLISHMENT: yte Miller, M.D., Chairperson t 4 Pill RESIDENTIAL KITCHEN FOR RETAIL SALE: y, �� x J. Canniff, D.M.D.r ,v �z _ :lunichi Sawayanagi RESIDENTIAL KITCHEN FOR BED+BREAKFAST: g MOBILE FOOD UNIT: � iI� S TOBACCO SALES: 14 FROZEN DESSERT: CATERER: Thomas A. McKean, RS, CHO Director of Public Health v 4W Town of Barnstable 5 Regulatory Services Barnstable Richard V. Scali,Interim Director MASS Health Division 63 14• 1 Thomas McKean,Director Zoe, 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: ADDRESS OF FOOD ESTABLISHMENT: KO �f l�'a 26 MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: CEO�) NUMBER OF SEATS: INSIDE: 1 Z ) OUTSIDE: TOTAL: 0 TOTAL NUMBER OF BATHROOMS: 2-- ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 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 ZFOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST C) RESIDENTIAL KITCHEN MOBILE FOODZZZ _ TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING , rn OUTSIDE DINING (OVER) I ***"MINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: �? FULL NAME OF APPLICANT2�/ � -!� j�l.�-� ��� t.��' SOLE OWNER: YES/NO ADDRESS 7 9 PHONE# 7791 ��SV IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0Ysz 3 79 9 l STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES .RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERVSAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REOUIRED ONSITE_ DURING ALL HOURS OF . OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1. � EXPIRATION DATE: 2. /� � Tl EXPIRATION DATE: 1f l 2-rll _46 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: maft_"�Ilel /4 / -:s SIGNATURE OF APPLICANT AND DATE f :. Town of Barnstable _. 1I?l P ti Regulatory Services Barnstable al Thomas F. Geiler, Director AWAniedcaClty ,(r//��/,_1 BARNSTABLE, �$ MASS. 16.39. ,Q Public Health Division �� 2007 6 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: ]-N ADDRESS OF FOOD ESTABLISHMENT: ,"► Q ��ui „. ►= C �so'v� v.7eeC MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Sb 2Z NUMBER OF SEATS: INSIDE: 3D OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: eZ ANNUAL OR SEASONAL OPERATION: uA L TYPICAL HOURS OF OPERATION MON-FRI sty TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) a ft 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 SERVICEi2 ' " �UruC�ON� RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN - �� vays; MOBILE FOOD _ TOBACCO SALES ROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) QAHealth\Application Forms\Foodappl.doc '1 • ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT b DE 13&-,>, av? SOLE OWNER: YES /NO ADDRESS28f /�uC�T.4�S/� �cl a�lS�� ( r�U'► 120TV_c: l C3Z652 PHONE IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: A IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. o y79-7 j STATE OF INCORPORATION 4�A FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS RE( tIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4: EXPIRATION DATE: 2 / 2Z /L SIGNATURE OF APPLICANT AND DATE QAHealth4Application Forms\Foodappl.doc — PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2004 48 ' BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, 1 Section 395A and Chapter 111,Section 5 of the General Laws, a permit is hereby granted to: CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE A.F. &A.M. Whose place of business is: 1989 FALMOUTH RD., P.O. BOX 61 , 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: ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Wayne Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT $50.00 RESIDENTIAL KITCHEN FOR RETAIL SALE Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires:TOBACCO �/n l FROZEN DESSERT: December 31, 2004 FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: CATERER: Director of Public Health I Town of BarnstabliO , Ft"E' Regulato ,Services 0 �„ � ,a d �:. -,Vd:. : . � ..� Thomas r.Geiler'Director * saartsrasi.E, � . � ,,� Public Health Division DEC 2 6 2003 Thomas McKean,Director TOWN OF BARNSTABLE 200 Main Street, Hyannis,MA 02601 HEALTH DEPT. Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: lp NAME OFF OD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) ' TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: ✓OUTSIDE: TOTAL:� TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: : TYPICAL HOURS OF OPERATION MON-FRI: � , To " DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) � IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OFISTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACS CATERING OUTSIDE DINING i y `mil QAHealth\AppUcation Forms\Foodappl.doc • ***REMINDER*** IF OUTSIDE DINING,-YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE PTEIDE DINING CRITERIA x IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS 1 PHONE# ��� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS, A J IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3 7q 7 STATE OF INCORPORATION ul FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: 3. EXPIRATION DATE: 4. EXPIRATION DATE: SIGNAT OF APPLICANT AND DATE QAHealth'Application Forms\Foodappl.doc I 0 ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND kO LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? � IS.AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT GCZ� � SOLE OWNER: YES NO ADDRESS PHONE # IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: _ IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION 0 r FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Health\Application Forms\Foodappl.doc PERMIT NO TOWN OF BARNSTABLE JJAANUARY 1,2003 48 BOARD OF HEALTH `4'"11 PERMIT TO OPERATEeA 0013 ESTABLISHMENT o In accordance with regn1 fd' s promul,gated under authority of Chapter 94, Section 395A and Chapter 111,S¢ciion'5 of the General Laws,a permit is hereby granted to: CENTERVILLE BUILDING CORP. r q/R/A a FRATERNA,, L.QDGE A.F. &A.M. Whose place of business is: �98 ALMOUTEI RQ,'P O gW61 , CEUTEFt, LLE, MA 02632 Type of business and any restric ionq; FOOD SARI ESTABLISHMENT To operate a food establishment trr the r: TOWN OF BpRI $`CABLE RESTRICTIONS IF ANY • 7 SEATING: ANNUAL YtS " € SEASONAL: TEMPORARY: a. ....,.:- BOARD OF HEALTH RETAIL FOOD STORE: z Susan G.Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE Ralph A.Murphy,M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST ' Sumner Kaufman,M.S.P.H. MOBILE FOOD UNIT: Permit expires TOBACCO SALES: December 31 2003Q FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: y • Town of Barnstable °FINE T° Regulatory Services ti Thomas F. Geer, Director a" MASS. . ' Public Health Division Qj .i639 �0 ArEo 39 Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Renewal: No Fee SEATING ANNUAL SEASONA �770;t,,.� ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT nn NAME OF FOOD ESTABLISHMENT Y� AJ �c�C_ ." - _ ADDRESS OF FOOD ESTABLISHMENT E4z o0k. TELEPHONE NUMBER / TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD MILK BED AND BREAKFAST CONT.BR. RES.KITCHEN M BIO LE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER:jZYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. � STATE OF INCORPORATION , FULL NAME AND HONE ADDR SS OF: - PRESIDENT TREASUR CIO, CLERK SIGNATURE APPLICANT RESTRICTIONS: HOME ADDRESS �( - e - �- �✓e. HOME TELEPHONE#, ;g VQ II_ Foodest/wp/q PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2000 48 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: CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE A.F. &A.M. Whose place of business is: 1989 FALMOUTH RD., P.O. BOX 61 , 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: ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G.Rask,R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: $50.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE i o E Town of,Barnstable Department of Health, Safety, and Environmental Services sAMSTABLE, 9� 039. Public Health Division �FDN'0�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT F'uLL idAME OF APPLICANT NAME OF FOOD ESTABLISHMENT `� �/2/l/-/,,'-& &:�2496A,- ADDRESS OF FOOD ESTABLISHMENT Cvf Y `S O/v+ cgc3_C-0 LM 0 TELEPHONE NUMBER Sd7 7'9_�4'15 �-- TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. � � STATE OF INCORPORATION IM.S-5 FULL NAME AND HOME ADDRESS OF: 5-5- 092,4Lt4 Y ii QVK1A,.S A o PRESIDENT,FA4/Itl,-/, /Ye- C2A�7--ef,11c.C-e , /V I :9R6,5--;L TREASURER AVIYA IL-le-x , 1WIt- CLERK �13b G� �lPsy. .g a' L/rt�Yi 0';7 /W' ® �v C/ SIGNA RE OF APPL+IC RESTRICTIONS: HOME ADDRESS I/S-,91s/&,-,-::;).s 7x,,z - HOME TELEPHONE# `7>:`- y, <46 � foodest/db/q FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $50.00 RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST SEATING: MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OFF BARNSTABLE OFFiEA, H PERMIT TO OPERATE A FOODESAELISHMENT PERMIT NO: 48b JANUARY 1, 1999 q . In accordancewth regulations-prombl�gatedunder authority of Chapter 94, Section 395A an Chapter 11'1;5ectiM 5'-"of the General Laws,�a permit is hereby granted to: V D f CENTERVILLE BUILDING CORP. D/B/A• FRATERNAL LODGE A F &A M A 3 YEP tf,,7� e f Whose place of business is- 1989, FALMO�UTH I�,RD_ O,. BOX 61 . CENTTERVILLE, MA 02632 Type of business and anyestrw<ct� ns: FOOD SERVICE ESTABLISHMENT To operate a food establishimnt iitth` TO , O e BARNSTABLE Permit expires: December 3'I1=999 BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P.H. Thomas A. McKean, RS, CHO Director of Public Health FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $50.00 RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TQWt °OF'9ARNSTABLE-1.. ARD-OF 'EALk PERMIT TO OPERATE A FOOD ESTABLISHMENT � � � �? 5 b04 RA.PERMIT NO: 48 JANUARY 1� r N , 1998 r 4 .} x�k �+ ;underauth � y oIn accordancd, ith regulatQn�,promtlgated of Chapter 94, Section 396A and Chapter 11 Section S of the General Laws, a permit is hereby geante�d to: n , CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE A F.°�� A►.M: � . . ` �` - NTERVILLE, MA 02632 Whose place of business rs��989 FALMQTkl�D P�..,O: BOX 61 , �- Type of business and any= ct s• FOOD�SERVICE ESTABLISHMENT ' f_ OWN OFPBA6R To operate a food establishment � -" NST�4BLE , Permit expires: December 1998 ' BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S. H. Thomas A. McKean, RS,CH Director of Public Health .s c� s Town of Barnstable • Department of Health, Safety, and Environmental Services • BAt2N9TABLE. • NSTA Public Health Division i639• ,eTFD A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT CLIQ7T)Zk1l I- CO/z'/� NAME OF FOOD ESTABLISHMENT 4- A5 �o % ��•/�) ADDRESS OF FOOD ESTABLISHMENT 9$C/ '1�41M ^4ix- j0, 60X &/ /fYIWA14S/ A4,4 o�©� TELEPHONE NUMBER 5-0,F" 72 3 -c�L`IS- TYPE OF ESTABLISHMENT: L- FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION No.6�� STATE OF INCORPORATION ;I GIs GS ✓ FULL NAME AND HOME ADDRESS OF: PRESIDENT OVAIA1 39- T/SQy�.t�,Tv►--� ,o�,,•� TREASURER /1t1W C'A �/✓��✓9� / Y/�i/�t/fs /`o✓,q .0,-7e,0 J CLERK Iz0�2.. '��� ��T /4,7* "all y SIGNAnIE OF APPLICANT RESTRICTIONS: HOME ADDRESS //5—,&/s1tP i /yy/9N�V".S , /'l/-7 0-'�L60-;r HOME TELEPHONE# 3-- yslo6, foodest/db/q FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $50.00 RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OE-BARNSTABLE BOARDQF M'EATFFq PERMIT TO O�ERATE_A FOOD ESTABLISHMENT J % PERMIT NO: 484 y - JANUARY 1 1997 a a . In accordance wlth%�egulations promulgated under authority'ofrChapter 94, .m , Section 395A and chapter 111, Sectiorr5 of-the General Laws, a permit is hereby granted to: CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE F.A A.M Whose place of businesis: 1989 FALMOJT .,RL BOA 61 , CENTERVILLE, MA 02632 v.re� f ;�.. Type of business and any°restfidbons: FO�OD,SE ESTABLISHMENT To operate a food establishment In the, TOWN`O F4, 'PTABLE; o Jj Permit expires: December " BOARD OF HEALTH " - Susan G. Rask, R.S.,Chairperson Brian R.Grady, R.S. RESTRICTIONS IF ANY: Ralph A.Murphy, M.D. Thomas A. McKean, R.S.,CHO ;a, Director of Public Health FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: $S0.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST: MOBILE FOOD UNIT: ANNUAL: Yes TEMPORARY FOOD ESTABLISHMENT: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 48 JANUARY 1, 1996 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: CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE A.F. &A.M. Whose place of business is: 1989 FALMOUTH RD., P.O. BOX 61 , CENTERVILLE, MA 02632 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit expires: December 31, 1996. • BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Brian R. Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. Thomas A. McKean, R.S.,CHO Director of Public Health SEATING: UNKNOWN FEE SEASONAL: NO RETAIL: FOOD: $50.00 MILK: DESSERT: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 48 JANUARY 1, 1995 In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General laws, a Permit is hereby granted to: CENTERVILLE BUILDING CORP. D/B/A: FRATERNAL LODGE A.F. &A.M. Whose place of business is: 1989 FALMOUTH RD. , CENTERVILLE. MA 02632 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires: December 31, 1995. BOARD OF HEALTH Brian R. Grady, RS, Chairman Susan G. Rask, RS Joseph C. Snow, MD Thomas A. McKean Director of Public Health t` 4 SEATING: UNKN FEE RETAIL• FOOD: $50.00 MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 49 JANUARY 1, 1994 In accordance with Regulations promulgated under authority •of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit Is hereby granted to: , D/B/A FRATERNAL LODGE A.F. & A.M. Whose place of business is at 1989 FALMOUTH RD. , CENTERVILLE, MA Type of business and any restrictions FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1994 BOARD OF HEALTH. Brian R. Grady, RS, Chairman Susan G. Rask, RS Joseph C. Sn M.D. Thomas A. McKean Director of Public Health SEATING: UNKN FEE RETAIL: FOOD: _$50.00 MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 56 JANUARY 1, 1993 In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: D/B/A FRATERNAL LODGE A.F. & A.M. Whose place of business is at 1989 FALMOUTH RD. , CENTERVILLE, MA Type of business and any restrictions FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1993 BOARD OF HEALTH Susan G. Rask, Chairman Joseph C. Snow, M.D. Brian R. Grady Thomas A. McKean Director of Public Health r ANI'MAL NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 172 $50.00 TOWN of BARNSTABLE Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 172 JANUlkE.Y1, 19 92 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: HUCH C. FINDLAY D/B/A FRATERNAL LODGE A.F. & A.1,01. Whose place of business is 1989 FALMOUTH ROAD, CENTERMLE Type of business and any restrictions FOOD SERVICE ESTABLISH.PIM To operate a food establishment in TOVTIN OF BAR:ISTABLE (City or Town) Permit Expires DEC EMBER 31, 19 Board of p Health FORM 738 Rev.7986 AGENT tt�Ipq 1 i,r17 NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 2�5 $50.00 ... .. .. .. . `"I, . of .. BARNSTAIII,F. .. .. .. .... ..... .... . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. ..276.. .. .. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: . .... ........ ..HUGH C. FM'1DT YA'Y . ..d/b/a.. ... .FEtA�Ia LODE MASONS............ Whose place of business is .. .. .... .. .. .. .... .. ... 1989 Falmouth Road, f� 2xville Type of business and any restrictions FOOD SI ��,�'ALISID U To operate a food establishment in .... . .... .. ... . .'irjt�I 0 'B�dtN� LE (City or Town) Permit Expires .. .. . r�''.IV-. 19 T JANEF ES UGH,t C iAIPu�iAI Copy StJS tV RmS' . ...... .. .. .. .. .. .. .. .. . Board This Copy To Be Retained By Local , , .jPSW (',te r. Mg t. .. .. .. ,, .. , of Board of Health. Health FORM 738 HOBBS&WARREN,INC.-1986 ��LTlt . .. .. .. .. - TOWN OF BARNSTABLE OFFICE HOURS: OF TNF Ipw 8:30 - 9:30 A.M. - :i •BOARD OF HEALTH • 12:45 . 2:00 P.M. Item No. In the spiwelow describe all violations checked o ,s(0` ��_ �Jd 367 MAIN STREET v,:- CI HYANNIS, MASS. 02601 790-6265 EXT 265 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name F 10- t �0,, t (; �.`.�'7PfJ� r•, 1 �} ^�-� /�,� Date r2.-�$� Address J� 7 )` /�f�Lrt.e+!., P ( ��I: vo !"1rc. p/) Time: In Out Telephone --� --� �, `i Type of Establishment: Purpose: Erb Food Service �'` Routine <, Retail Food _ '! �1!� Residential Kitchen Follow-up f r^ Person In Charge Mobile Unit Complaint1,2 Investigation Inspectors Name \ n J Temporary Food Service Other Caterer O .fre Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT.Sanitary Facilities N C WT. 1. Food Supply .002 4 29. Water Source .015 '=' 4 2. Food Containers .002 1 30. Sewage .016 "' 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8.019 2 3. PHF Temperatures .004 4 33. Insects/Rodents .021 1 4. Facilities. Hot 8 Cold Storage .004 4 34. Plumbing .01 7 1 5. PHF Re-servicie .006 " 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged Foods .003 1 36. Handwashin Areas .019 9 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside i Ou s de Disposal 020 2 9. Cross Contamination .005 2 39. Outer Openings .021 ] 10. PHFs thawed,cooked 8 cooled 005 4 40. Pesticide/Rode nticide Application .021 ] 11. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel rqr42. Walls. Ceiling .022 ] 13. Employee Infections 008 4 43. Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation .024 1 15. Employee Clothing 0t0 1 45. Dressing Rooms .025 1 Equipment& Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 4 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management, 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 .1 ' 52. Salad Bars .032 Li 2 23. Pre-Scraped. Soaked .013 1 24. Wash/Rinse Water .013 1 No. of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage .014 ] 27. Single Service Articles .014 ] tt 28. Single Service Re-Use 012 ] 1 SCORE Inspected by / + -•�+� '� Received by 13 CRIJUCAL FOOD HANDLING VIOLATIONS t G"' • • Full Item Descriptions • J 1. Food from an unapproved or unknown source or food which is or may be Food- adulterated, contafainated or otherwise unfit for human consumption ci Food Source, approved, wholesome 2 Containers. properly labelled is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for c3 Potentially hazardous roods at proper temperatures: 1uO°F or above, 45°F or below, 0°F; rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F c4 Facilities to maintain product temperature (=7° C) (in the case of cold food) or less than 1400 F (600C) (in c5 Unwrapped and potentially hazardous foods not re-served e. case of hat the f_Oal 6 Damaged, spoiled, returned foods segregated .. .-i. 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with Infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 clean clothes, hair restraints Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed. Installed, maintained, located establishment. Non-foodjS contact surfacessurfaces: Clean. free ofdesign. all cleansers constructed, installed. maintained. located 19 Food contact 20 Non-food contact surfaces clean, free of all cleansers 6. A person not practicing strict standards of cleanliness and personal 21 Wiping cloths; clean, use restricted P F g P 22 Dish/Warpwashing fae111iiess designed, constructed, maintained, installed. located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked g24 Wash/blase voter clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean equipment/utensils 21 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 26 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C3O Sewage xnd waste water dienosal sanitarylow manner, or the sewage or liquid waste contaminates 'or may C31 No cross-connections, back er. accessible, ble,back design.f g q Y C32 Toilets 8 Handwaahingi number. eecessible, des! n. installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented b customers or employees. 34 ToiletPlumbi r; is enclosed. maintained , q Y35 toilet rooms enclosed, self-closing doors, fixtures good repair, clean signs 36 Handvashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number. insect/rodent resistant, frequency. .installed or designed, accessible or convenient. 38 outside area: dumpster covered. construction, clean 39 Outer openings protected 40 Pesticides and rodenticidea, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service physical Flo rs contias 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained. clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and locker at vents as required Y P Y 45 Dressing. locker areas provided used. clean result in the contamination of the water. other 12. Insects, rodents or other animals are present on the premises cub PremToxiises s properly -Cored, nnecelabel ed,yaara g p properly ( y 5 590.027(F)(3)). 47 Preaisrs ltter-free, unnecessar articles, cleaning maintenance equipment ro erly stored. unless allowed b Section 10 CMR Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52' Salad bar operations prepared. refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. NU,,4BER FEE THE COMMONWEALTH OF MASSACHUSETTS 419 . . . .O%V.p . . . . . .. . of .. . .Daw sable. . . . . . . . . .. .. .. . . . . . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. . . . . . . . a3ecela.be.11r. 19. . . In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: . . .. . . . . . . .. . 143's ur . . . .. .. .. . . . . . . . . . . . . . . .. . . . . .. . Whose place of business is . . . . . .1.9189.Falm niu-th. toad, . .. . . . . . . .. .. . . ... Type of business and any restrictions �r�r .i? ,�: >; �X . .. . . . . . .. .. . . . . . . . . . . .. . . . . ... To operate a food establishment in ;a� ff��� .,. `.. . . . . . . . . .. .. .. . . . . . . . . . . . . . . .. .. . .. (City or Town) Permit Expires s`l e, 3 ; . . . . . . . 19q.0 . . � "Pro;tfem a • t.ro"�. Fgs.i'Fa as 4%t ' 'i Copy Ana.bane. 'hbaug1h. . . . . . . . .. .. .. .. .. . Board This Copy To Be Retained By Local r, , ,, ,, ,, ,, , , ,, , of Board of Health. Health I FORM 738 HOBBS&WARREN,INC.-1986 �- �.: s (� f' . • V Item No. In the sp below describe all violations checked Page_bf / a�•�A Q..�.�-"' l 'r7 7 FOOD - ESTABLISHMENT INSPECTION REPORT Establishment Name 410-, -I s0 �/�f Date �r Address �} Time: In Out Telephone _ 2- '1 7 F Type of Establishment: purpose: Food Service [ Owner's Name Retail Food Routine ' Residential Kitchen Follow-up Person In Charge H Al" � � Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name * Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation. checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food �NC-777 Sanitary Facilities N C 1. Food Supply •0021 29. Water Source 2. Food Containers .002 30. Sewage 01016 6 .:�' 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018 8 .019 3. PHF Temperatures 004 33. Insects/Rodents .021 -` 4. Facilities. Hot 8 Cold Storage .004 34. Plumbing .01 7 5. PHF Re-servicle .0060 1 35. Toilet Rooms .018 6. Spoiled/Damaged Foods .003 36. Handwashing Areas .019 7. Food Protected .003 37. Garbage/Refuse .020 8. Food Thermometers .004 38. Outside Disposal .020 ar 9. Cross Contamination .005 39. Outer Openings 021 10. PHFs thawed,cooked 8 cooled .005 40. Pesticide/Rodenticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 Personnel 42' Walls, Ceiling .022 13. Employee Infections 008 43, Lighting 023 14. Employee Hygiene 009 44. Ventilation .024 15. Employee Clothing 010 45. Dressing Rooms .025 Equipment& Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises 027 18. Non-Food Contact Surfaces 013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52, Salad Bars .032 23. Pre-Scraped, Soaked .013 24, Wash/Rinse Water .013 No. of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage 014 27. Single'Service Articles .014 28. Single Service Re-Use .012 Inspected by 1 Received by �1 �? r,i� `(f i FA Al �� `" }....� a-M.',.�.,,. z.., .�, + r '� '., n _ _ 1 }a_ 4 ¢. rya a ✓ w_'iG { n � R•y ` a�,ty � g t o"� x.F' A . �. •� • r t t • r •�.a _s i '�0 � `�°, '� 4 3,kr a,�d. y.��jc '� �,�' kt '_ C1 f•' � N � ,• '� ,� I� .y`'�' . >•ti ^ -+}. f st"F .r a K 'q e y +7'+N°+ h w, 4..7`r i ri._yr^ •E""v. r• : t v',. .+ _ ... .,,,ti' , " of•!rt}g ..S-.Qy.ri.3 K tC ti'+�£ s S "r«.•. { 'c F . } ! �� � 3, 'r "`.*° `�' '".r .�. r -•'I .s w t - r ; ix 15�ttyi•' ;a r 2 J ''`'I-*.� k'� • G j 4s'a. •'.'' %gi S r�� §� �'b�'j � } �� }' *l { �� •„ r t g 'r h ••+" r r i `f r ? $f. ; {. e .r� i « r 4 bR } rr,A 7 ',ara •. s pr t ;�'i-o w �j e :4 a . ' t f r #3 + v s4''. t "P.•, ra .(t 4 . �L. :sE r. ' .r 'a a r r .. �'Y "- r f j✓'F }•r•,a''er..L, G'y .r1� a.; •�. �w`i' �`,� a 77`r`-'9 { A +I r, 5 - � +. r �S'r1. r.• ''tir 3 ^6 � .c 5#. � �.�E .:t + :+f y ;F„'` 4 '`�, t February 18:. IL983 k 1� '" .,� �� r,,k �. �Jw}1, �.•"'"�`4'! tFY7' e+po..,i,, bar k''Aj' ?t' .xrr.` 'a+ +'.5 yP` • ��, }<' �'' '"� °'r a,`f,�'#4'•i' •« ''•'c"'"'P • ;. t l �J S• rs j"�. t, '?fi 7' .' t r ; r y/"Y "73 rp^ ri ,.k i'? .'' �A M*.s L ..y rT.;t t.-sa •^'^f r. r.�. ,yf r Y,.^ �•�,:,.¢4 7i�t i'f:+�. _r'ir.f ° { ,a a nad. 5:1 +'!,J.}` •'s6;r .r:E:ty' '+' �jw y-r�, r ',�,F.Sk'F *±Fes'. ,r. ir. h },•' a s, C 44, . r ' is 1Tt� �' 4:.} ,• , i i:,:' Fraternal•. Odge 4"a`�'.. c".Ki Mit+ r M350A1C.•LO(.icle A. 7 Mi.,� Kenyon . air'{ y, ,�.': � jr. 4 ; ,.; ; .,a'., .. ri. 5 +ry a*' C {}•t�' . •.} > Y} r ,.°�.'+.ld°'° ':".+l' ".} t, •F.$ r 422 Main'., treet Hyannis_t E'SCl�r ,. •- r � r"' .7" .:3"' r ,a,t x r 1' +�� e Y A'� F "�' .� % 5r Dear-Mr arr �v : p f„"'.� }c., y" v ;iti M+1 ~ •,..r.t.< + s' {+.,•$T.� _,�,wit..,.t;,'+c t�. .� •e.* }r + � 71.r;. tt r.� '.a d§�., ',r• .a �- r}. Enclosed' .'a copy - ' i wh am s o y (of;,ar Board tr�f;.,Health Requlat on ch hec e e€fective'P`ebruary :24, .18f3,;:;gcver`niaic yunc3�rground €ue1� andt chemi f ' ' r � cal�stdrage,t .•.a� ����} a'�-�. 1 tti s f e' Sr'`,j'f r` � � +, .`.� .a}f. .ri �y� 4"-� 4 �� C r .. • 1 I i•..a.^, f ,+ «. P �.� -: � r•r �.� s =a x.. : r r ;•' *T k�5' .� t'r,r c '4 •- ,.,."� _ ..� e r"i' { •-' � ':,p •.'*.art� a, � 'r a ':.� 3'f,yP�+�r�{,..'a 'g r' 4E., + .J• w+'-C?. plea a ,f Il gout ',the"tc 3 3osed.wcard, and•return it tt>' us`•.3ist ng'.any uiiderraund storagetans located at ,the' Mastiizic I�c�dge ubuldirig,r ~ x Main;Street, � s..r.,, � { y'dr"9,ij +-, 4{'�� ry `t'�y:� « 'I• Nf _,r rn. �. Yrfi ,�1'_... Fi-a a �. c � .�,. •`.. Y r r, ` •: -� .. E . " •t .. �+ r �,... rf • 'rG`7 .r. +g •yt + v •.r . a , . .-., Fire .Department :records► 'in 'cate; ur_ ,tank"- thi --one t •Undergrouhd 'fuel` tanks,' twenty years o€";age ©r older,'<that have�a {:capacity of Jover 5fl4i^gallons�must be.•tested" each°,;.year foz•'leaks: .r, r} , ' 'The Kent'.Moore -Pressure aTest- is the pkeferred' test- he wever`''an ti_ `{.° ' }' ' P y tank:4,can 'be .tested°by* ' S PSIr'A r'Press re T+est�helyd;far�'a m�i.n3.mum of twc� ours. . For`your:�Yconvenience y' �e have enclosed` : list ri af` c rfo m h • a• i g otRl 3nieS`Whq,' r ,,t is testing �y r 6xi,,rmay r also�ut1- lize any othdr°'concerns qualified toy perform this .testing` 'z Yau are dace®cted to;'h�aVe,the'-tank tested by May`I,7` i983 'le se a ,'. ; -. b 4 , ♦ f a�y�.'yw }��•_ , '�.�, subrmit`�ft�estinxg{ .res/u�(its andhear' interpretation -to"..`this �o€fice° 'TL r ,� J riar YY Ma L {L' •�9V � rJ�• ''< r a 4 3. .. !.' v7 i. ,ti 4 l �. `r r"� y #' .�r r F;atifure, t6.,,d0.rsd{,could'"resul.t� n,lpg•al�actioh- and='the�`,penal,ty'.c�€ i r a separate ;day s..f inure to comply with. an, order shall;r constitute a<`separ�te vol:at 4n. �,. r, � 3 .. � FP c•, p , . I r ;.x � 4. G� a ' Your mays request .a blearing jbefore'*'the: Board of• Health .3€ 'written; `` .��' {petit%on�recuestingr same'+is?`yrecea.ved wi.tYn,seven .{7} da s,4f t•,. `` "6' pt of this" order. `' +� •4 r x r`: a u c '; ` v r, a '; J r'n F , ". r L.`.r i ^ r .� r .,tyrs f {i. 7 ! s�.%k' fi v " +' r',Y. + r v"•3•r '�':, i +, C �r �,}' r.`� 4 i � r r,�, ��. '•' r`�x.v�• !,r fr••.`-. L �' :. �, If you-'havw any:questions,�''please call 7,5-lilfl.� extension;18Z 1 " r i F .,... - v. _ .� � �� � ,. ` ; ,pif f. �r w, °f�� r ,:} Y{ � .k_*r' ° YGr {.� « � �•, �lery "truly yours,, , tz ,� a r tr�'ti .� �?, s '•..': y r 1 � i .� ?� _;. �,�• �, ',,JohnF M,`. Keilly t', s_Director 'of Public Rea"Ith t w ti 1 s•'`r.!�Y m , '4 3 3'7 .,. Y i. ` ,t4, 't Y r encl♦ r �} L • t r r "hr }S 1 }. ' � r • � '- kr, * ,,., s 1 J.r� +fir „ ir 41 yrgt•"'tJ' F } A .4' i J` ♦ '+Z 2 i. w 4"'., Jt L }1u l,.{ LtJ .. 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X: M,ry , ., ,. i J,� `t^ r r'*r r•S •'SYt�.� '2.' f •'-'t 4 s 'r'?F e e -#•„� ,r , -, Zhe owrik'of" Barnstable .Seia- �Plantt-7collt'l-nues toj'havei pr"obk,6s r c, ,s,•if r,. x :wi th.i s ti .A fi� }. , ��r + _ 'k 4 `rr .,gre`asel �'� You: are rem nd c� tk at�,all Food Se v1�41�ee, Establ `sfi {..��` I.=� " f tments ,with small nsic e greasTO tr ps must ainstallr larger,,'ou.tsi,c�e`.t ;, , ` f ' ;:, a t , ,;grease fi' ter'cept"ors by' the' riext�U1 icen`s n, .erio'd ` ins accordance,, 1. � ^' ,1,,. -f4fth;,-Town Health= Regulati'onsF rr % ..' " ► :_ W - ,'era 1 �1 g r - ',. ,,,q L. • , t k.+- s 3;.. f .. #♦ + T 4 4k, 1"a .'�• '.r. s 7-.' ty: KFr I, ty 4�ty sa 4. t:. + uk K Sc C.. 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'4, ; 4. ,. a _rN . i t.... 2t':. r: „ .',}4, tt F 7. teaFi- THE COMMONWEALTH OF MASSACHUSETTS BOARD H Ap, i tion is hereby made for a Per it to Construct or Repair an Individual Sewage Disposal ..........W ---eA Location-1 eres No. Owner Dwelling—No. of Bedroo --Gartage Grinder Type of Building Other—Type of Buildi, p._4rs ------------------4 ria (7�� ----------------------------- Other Distribution box Dosi z b?I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'JITLE 5 of the State Sanitary Code h n d further agrees not to place the yste in operation until a Certificate of Compliance has been issue f hea 09 Date Date � Application Disapproved for the follo. vning reasons:.............................................................................................................. Date Daft yam, THE COMMONWEALTH OF MASSACHUSETTS BOARD FS H 1T ........................OF................... ..... . Appliration' for Disposal Works Tonstrnr#iun rumi# AVli tion is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage isposal syst �? _ � / 2— ....!:. .................................. --•-• - ......... ! - --.................-•-- ............ Location-Address` �r Lot N. .5 .......... �..._� .._/_ Ca2< iQ = .............. ...-- . ------........----..... ............................................... - Owner Address ......................^---•--...------.....------........................... ................----------.........---•--....------....................7--5�...................... Installer Address //J/✓ .J Type of Building /,,— size Lot..........i.................Sq. Ie�� U Dwelling—No. of Bedrooms.........................................., Expansion Attic ( v)' Garbage Grinder a Other—Type of Building(-.'? ' �No. of per 4t ------------------------ Showers ( ) — Cafeteria ( ) Other fixtures . .off..._... ' }t tl� fA/� _ . , W -�� Design Flow.........................................gallons per person day. Total (�Py flow....' _......._.__.......__.._......Zallons. Septic Tank—Liquid capacity. O.gallons Length................ Width................ Diameter................ Depth.... x Disposal Trench—No..................... Width....... Total Length.................... Total leaching area...... sq. ft. Seepage Pit No...fml,!t __.. is eter..../Y_.._......Depth Blow inlet.._.v..-.�� Total 1` hing area.'�'...�.sq. ft. Z Other Distribution box ( Dosing to ( �'� V 1� '-' Percolation Test Results Performed b :f._.../' _.{....................... , _ a / f,.y Date ;,�G i a Test Pit No. L.f __�ariinutes per in�h Depth of Test Pit.•.................. Depth to ground water........................ (T4 Test Pit No. 2................minutes me h Depth of Test Pit.................... Depth to ground water........................ x ......• ----------------------------------------• •-•-••_... •---••......•----•---••-.......................................................... ----- --=-- ----- 0 Description of Soil..........................................................................................------------•--------------------------...---------------..............--.••- W V --------- --------------- -------------------------------- •-------------------------------------- ......------------------------------.-----------.------•-----------------........------------ •----------- W ••-•--•------------•----•---••--••••••••-••••••••••---•••••••-----....•••••••••••••-•-••---••-•--..._....•••••-•---••••-••-•••••-•••-••••••-•-•-•••....•--••••••••..................••••----..._......-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..............................................--•-•---------•-•-----------------------------._....••-••-.-•••••--••••--••••••••.......••••••••••••••••-•••••••-••--........................---••--•-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— signed further agrees not to place the system in operation until a Certificate of Compliance has been is ed b t rd o ealth. Signed- ---- --- ------------------•-- --- •----........._.... Application Approved By....................1...."........... . 2 Application Disapproved for the following reasons----------------------------•--••------------•----------------------------------•----......•................... -----------•-------------------•-•---...............---------------------•--......--.•..•.....-----------•.--•-----....------------. Permit No. - I -_._.. Issued ................... t..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD /OF HEALTTH l <..........................O F...... ............. Trrtifirate of Tomplittnrr THIS IS TO CERTIFY, That the In ividual Sewage Disposal System constructed ( ) or Repaired ( ) In W at.11 `� .cl: ....- er ..:............ has been installed in accordance w• i the provisions of TI IP') oL_Th Sate Sanitary Code as described in the application for Disposal Works Construction Permit No....................•--_.._._.._._....... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTI N SATI FACTORY. DATE.....................-t...r--��v---- ---------------- Inspector------------ ....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................`t-' FEE... -....... ..OF..................................................................................... �'-•-7 �6_ No......`................ Disposal Works Illustr ion rrntit Permissionis hereby granted........................................................................................................................................ to Construct or P air ��a�n Ind Se a e o y P � stem f � --t.�t Street // as shown on the application for Disposal Works Construction Permit No.�..�.�.. Dated. . ....... ............... ..... DATE................................................................................. FORM 1255 A. M, SULKIN, INC., BOSTON AsBuilt Page 1 of 1 ASSESSOR'S MAP NO. � PARCEL �A` D©� L0 C A L ION SEWAGE PE MI r"o. V I L L A G .INSTALLER'S NAME & ADDRESS LC -4• UILDER 00 0WNER DATE PERMIT ISSUED a�_ ( DATE COMPLIANCE ISSUED q �4 ` http://issgl2/intranet/propdataJprebuilt.aspx?mappar=l 89002001&seq=1 9/5/2012 CONSTRUCTION ir: LiAncr: &CO CORPORATION 34 Mill Street P.O. Box 498 Assonet, MA 02702 (617) 644-2291 Sept . 14 , 1987 Town of Barnstable Board Of Health P .O . Box 534 Hyannis , Mass . 02601 Attn: Mr . Dunning Re : Fraternal Lodge Masonic Hall Fuller Road Dear Mr. Dunning : This is to inform your office that we inspected the installation of the septic system at the above location , and in my opinion this was installed as per the proposed plan . Yours truly , Robert M. Davidson , P .E . cc : Fraternal Lodge c/o Hugh Findlay RMD/ad _ a , AsBuilt Page 1 of 1 MtSSOR'S MAP N0. •� PARCEL LOCATION SEWAGE PERMI ,XO. " -� INSTALLER'S NAME A ADDRESS -!' MILDER OR OWNER DATE PERMIT ISSUED l DATE COMPLIANCE IS $UED 1 4 _ _ �7�,Tl If N. , . http://issgl2/intranet/propdata/prebuilt.aspx?mappar=189002001&seq=1 9/14/2012 A ,...+.....rw.« «w...+w.,...,.....-•.,sw..,.. u,..�:.r aw:....,_Nx...,-..w,-..-r -....."..e..va. r...:..:;r..+,+� .-. 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