HomeMy WebLinkAboutSUBWAY #12312 - FOOD i
Subway#12312
425 Barnstable Rd
HYANNiS 21�{- 800
i�
I
rSFE BOARD OF HEALTH
Town of Barnstable
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
. 9A1LN9rAB.e. F.P.(Thomas)Lee,.
v � 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt.
Phone: 508 862-4644 Fax: 508 790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 656 Issue Date: 01/01/2022
DBA: SUBWAY #29595
OWNER: SUBFIT LLC,
Location of Establishment: 425 IYANNOUGH RD HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: - -
MOBILE-FOOD:
MOBILE-ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING: i
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
l
11/18/2021 11:04 (FAX) P•008/014
Initials:
Town of Barnstable
Inspectional Services
�. X�Ll
lift Public Health Division Cheer.
Thomas McKean,D rector. U�I yil
200 Main Street,Hyannis,MA 02601 1
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE �'+ NEW OWNERSHIP RENEWAL_
NAME OF FOOD ESTABLISHMENT: &Ml V► C.� e � '
ADDRESS OF FOOD ESTABLISHMENT: Qnn JA�' �..CL•oP�-e
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): I)D 4• 4 6y-.k ("IyG 4'('6�/ - 0al I q
E-MAIL ADDRESS:,&,&^I lG SV7< <d4llw�l.� �Q�q�ic1()IIvlQ.4��a� p.• CoY't Ax
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: aJ ► a - �
TOTAL NUMBER OF BATHROOMS: ?/
WELL WATER7SEASONAL:
" DATES OF OPERATION:NO/...(ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: __
/ / 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
REOUIREMENTS.
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)
_4OD SERVICE
ETAIL FOOD-ONLY required for TCS foods(foods requiring refrlgeration/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:\Applicafion Forma1F00DAPP 2020,doc
f
11/18/2021 11:05 (FAX) P.009/014
OWNER INFORMATION:
i
FULL NAME OF APPLICANT A' Law,•e �VY'
SOLE OWNER: YES I N' D.O.B II t )a OWNER PHONE#
ADDRESS
CORPORATE OWNER:CORPORATE ADDRESS:_
b A Q`� 9 I
PERSON IN CHARGE OF DAILY OPERATIONS: kV10 NJA, -'U"
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'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
s- a�
2 �VVI
(06 O
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 openingll 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 httn://www.townotbarnstable.us/healthdivision/applications ago,
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.31"each calendar year: IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC,Ist,
QAApplieation FonnsTOODAPP RBV3-2019,doe
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Certificate ®f Attendance
This is to verify that - Aunt-
Laurie Turi
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Has attended the following.course
Adult, Child, Infant Choke Saving
which meets the guidelines of the
American Heart-Associatioin
Issue-Date: 1/1012020
This certificate expires 2 years from the issue date
Shawn Lerner,NREMT 1/C
Founder&CEO -
-WN%en Seconds Cownt, Inc.
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FrstAid
TrajWng
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When Seconds Count,Inc.is an Accredited Training Center thmugh the American Heart Association
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r _ Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
w� �rsrxne Paul J.Canniff,D.M.D.
Maw 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: 656 Issue Date: 01/01/2021
DBA: SUBWAY #29595
OWNER: SUBFIT LLC,
Location of Establishment: 425 IYANNOUGH RD HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: Q/
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:
-pa�
For Offi Initials:
Town of Barnstable 76
Date Paid' W Amt Pd$9S-6
BAMMBLE, : Inspectional Services
�
1639. $ArFo��a`` Public Health Division Check# Cash
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE NEW OWNERSHIP RENEWAL I
NAME OF FOOD ESTABLISHMENT: �l� a�1Y11 C Sl�S LU101
ADDRESS OF FOOD ESTABLISHMENT: S 1UG N�O1 aa�DOI
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �1 1YU 'I �i Y� ov YL]� OA I t••;�
E-MAIL ADDRESS: �u� Sl1�JU�taM /A�J� v� \'(� co-W,
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Jvi 1 - �SSS l
TOTAL NUMBER OF BATHROOMS: 0—
WELL WATER: YES NO , . (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO
NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 1X
SEATING: MUST OBTAIN A C MMON 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)
A&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***
REOUIRED 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 100
SOLE OWNER: YES O D.O.B V Aj OWNER PHO nE # b�(y"1'J�
ADDRESS s rl 1 l WY '4V1
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: LaVIA-R
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
/
SIG ti URE 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 openine!! 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 Rnuary 1 st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FonnsTOODAPP REV3-2019.doc
` 5 Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
a�nvsr M + Paul J.Canniff,D.M.D.
b , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 656 . Issue Date: 12/10/2019
DBA: SUBWAY #29595
OWNER: SUBFIT LLC,
Location of Establishment: 425 IYANNOUGH RD HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49
FEES
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: CQA
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
A
For Office U Initials:
Town of Barnstable
Date Paid ADA pa($
BAJWffrAB U. : Inspectional Services
gfDMo+p` 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 ►O L2 I.1_q NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: Hw trtlt_S Sobr, I-LC, DSA 506t,Jaw 2g595
ADDRESS OF FOOD ESTABLISHMENT: t4Z6 Z t,QmaL)%b R-6 t }14cd'%6\S, RA O 2(c O�
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Q?�(� c.Jc�{p�MG(� PN¢ i E..'Przr►, P-k 02-9 1 t-I
E-MAIL ADDRESS: Ct.Netp�' fl�Spup.C°om
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5�u - ,1B- 2 S55
TOTAL NUMBER OF BATHROOMS:WELL WATER: YES NO )( ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL:))< SEASONAL: DATES OF OPERATION:_/_/_ TO
NUMBER OF SEATS: INSIDE: 35 OUTSIDE: _0 _TOTAL: 35
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N I A
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED & BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL, MOBILE & NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q1Application FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANTM2M�C—
SOLE OWNER: YES/ 1@ D.O.B (0 l Zq I LAC[ OWNER PHONE # q(A-4 jtA - 3 3 2.q
ADDRESS 45 'P%r \{',\\ 'fir E . Gpper-\t_ajch,. R\ C)
CORPORATE OWNER:
CORPORATE ADDRESS: q')p t,Jat-ermar\ Ayo , E. • Ra��c�en�� e 1 0Z9lL4
PERSON IN CHARGE OF DAILY OPERATIONS: 1,aUr�e Tv-r1
List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1. Lush e Tvr\ `► / FS / Zo I. Clara.. Ym1 y / 25 / 2-0
2) L�u�`�.fir% •� ( (� l aa�
2. C.1 G.,rq Y�V-�. 2 / \q / 20
SIG ATURE 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 openine!! 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 1st to Dec. 3155 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
-
r Town of Barnstable BOARD OF HEALTH
Paul J Canniff, D.M.D.
} ° Board of Health Donald A.Gaudagnoli, M.D.
¢hrwtisrAa '- John T. Norman
sass. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstablems
Permit to Operate a Food Establishment
In accordance with"regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 656 Issue Date: 12/20/18
DBA: SUBWAY #29595
OWNER: SUBFIT LLC,
Location of Establishment: 425 IYANNOUGH RD HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49
FEES T (�
FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B- FULL BREAKFAST:
CONTINENTAL BREAKFAST: ------ --- - —
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
OF THE toryti For Office Use Only: Initials:
o� Town of Barnstable
Date Paid I� Amt Pd D �
Inspectional Services
]j
�A 16,9 ,0 Check# ��D `a
lEo �A Public Health Division
Thomas McKean,Director f ff ''11
200 Main Street,Hyannis,MA 02601 '�i� W ( ]
Office: 508-862-4644 Fax: 508-790-6304 j
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE I NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: HANN IS SJARS IJZ DBA SqW.4 f.�—)qg'S
ADDRESS OF FOOD ESTABLISHMENT: g2,7 :NA MM046-' k( , 44VA-jjm L ' ,'ntA
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):q30 WATEAMA•I &.E .PW-W f Al DZ-Q( I
E-MAIL ADDRESS:_FAMLIS,ARSR S) , q bJa.6PMg4T6f-0qP(
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (!a`f r7b- �
TOTAL NUMBER OF BATHROO S:
WELL WATE
R: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE: -2� OUTSIDE: 0 TOTAL: 3 J` '
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)? /V
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED)
*** SEASONAL,MOBILE&NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
Q:\Application FormsTOODAPPREV2018.doc
PLEASE CALL 508-862-4644
OWNER INFORMATION:
FULL NAME OF APPLICANT _TPrnCS (�(�• rYI(iYY�]�j SOLE OWNER: YESONO D.O.B �Z q I L4q OWNER PHONE# I- L4,3, f
`,—33ag
ADDRESS_-► PIMC- D ILL bk . 1 E-, CT-1`EE14 .l 04 � M 02-6(E)
CORPORATE OWNER: FEDERAL ID NO. : T�' 1J,5 b4 4
CORPORATE ADDRESS: WRTamkO A)9 E PPW - (Z 02A 1
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 ergen Awareness Expiration Date
7 / l D
U1. ( S
a a / / a /and
2. . ll n / 1� / aoao
SleGTURE 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.townoibarnstable.us/bealthdivision/applications.asp.
OUTDOOR COOIQNG: 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.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st.
QAApplication FormsT00DAPPREV2018.doc
oF�HF ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: U W Date: caha Page: of
OFFICE HOURS
00
eAR Eon PUBLIC
2 0 MAIN STREET DIVISION 3:30-4:30 P.M- Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
3:M - .-FP.M-
g MO8 -FRI.
HYANNIS, MA 02601 sos-ss2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY
'FO1AP� FOOD ESTABLISHMENT INSPECTION REPORT
Name b Date Tvoe o IV=of Ins ec ion
ou me
Address Risk Food S pection C L
Level Retail Previous Inspection �^
Telephone Residential Kitchen Date: �Q/^
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector S Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F)
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 V, 1 q
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 I �/. n
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations .VI
Critical(C)violations marked must be corrected immediately. (blue&red items) ^ � '31aOVeitems
Corrective Action Required: Yes
Non-critical(N)violations must be corrected immediately or Overall Rating O(
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 tod ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the.number of critical,results in an F.
25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations g
)( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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
29.Special quirements (590.009) within 10 days of receipt of this order. viol 'on,4 to 8 non critical violations=C.
30.Other DATE OF RE-INSPECTION: Ins tor' . n to
31.Dum ter screened from public view
�'-r�A �S
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
Signature
Print:
#Seats Observed Frozen Dessert Machines: Outside Dining Y N g
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.* Additives* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)
590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* *
2
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
Require Reporting by Food P g_od Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
7-201.11 Separation-Storage*
Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person in Charge* 7.202.12 Conditions of Use*
3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Resumed 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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* eg Hive rarzooi
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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Ratites-165'F 15 sec*
cater-
Sources* ing,mobile food,temporary and residential
1 o Proper,Adequate Handwashing
Game and Wild Mushrooms Approved By Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
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`17 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
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'17 to 70`17
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'17 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
3-02.12 Records,Creation and Retention �Within,tHours* 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 1.008
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.
°p THE rq TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of
'4 OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
6 SS �0� - HYANNIS,MA 02601 - eoON.-FRI. No Reference R-Red Item. PLEASE PRINT CLEARLY .
N1P`p FOOD ESTABLISHMENT INSPECTION REPORT
Name < Date 1 Tvne of sec ion
ra
Address Risk FQndSapocir Re-inspection
Level Retail Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Char a(PIG} �t4 Bed&Breakfast HACCP
G S In: Other
Inspector \ _ > a Out: t.
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP Ml ^\
i V v
❑ 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 I I
Critical(C)violations marked must be corrected immediately. (blue&red items) I Corrective Action Required: ❑ No I rNIS
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,t items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non=critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspensi on or revocation of the food 6=One critical violation and less than non-critical violations
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
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.Vthe
equirements (590.009) within 10 days of receipt of this order.
violation,4 to 8non-critical violations=C.
30. PATE OF RE-INSPECTION: Inspector' n u 31. screened from public viewPermit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N
PI 's Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ULI/Dumpster Screen o Y INj
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 590.004(F)
590.003(C) Responsibility of the Person-in-Charge to 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* 7-102.11 Common Name-Working Containers* 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* 3-302.11(A) Food Protection* 7-20 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 7-202.11.11 Restriction-Presence and Use*
7.202.12 Cundiuuns of Use* 590.004 3-501.19 Time as a Public Health.Control*
Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
(11) Variance
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 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* 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*
Pe 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate
Equipment* ( )( ) Pathogens
590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game s eg cnve 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) 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 in cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) side
Sources* Ratites-165°F IS sec* ing,mobile food,temporary and residential
1p 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 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
( )( )ro)
3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A& PHFs 165°F 15 sec*
$ Receiving/Condition ( ) (D)
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome
* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk ctors listed above,can be found in the
3-101.11 Food Safe and Unadulterated fa f
8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification Maintained*
Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products
5-203.11 Numbers and Capacities* Within 4 Hours* 23.. Management and Personnel FC-2 .003
5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
.
3-402.11 Parasite Destruction*, Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
5-205.11 Accessibility,Operation and Maintenance
3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and'hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 1Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision F29 I 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
�p IKE►o r, TOWN OF BARNSTABLE - .HEALTH INSPECTOR'S Establishment Name:� � �� Date: ,1 /WOPage: Of
q OFFICE HOURS
PUBLIC HEALTH DIVISION a;06-9:30A.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.a e� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
MP'� 508-862-46" '
FOOD ESTABLISHMENT INSP..CTION REPORT
i-
Name Date Type of sec ion t" 7`
Address isk FoodServi Ei- Pe n
Leveltil ` Prevo s In cf
Telephone ! Residential Kitchen Date: 1l1
Mobile Pre-op�rat /
Owner HACCP Y/N Temporary Suspect Illness _ n
Caterer General Complaint
Person in Charge(PIC) Time B' 8 Breakfast HACCP ef
Other
Inspector r O ��
f specific r visions violated.
r fires a n explanation on the narrative a e s an
d c tation o s ec c o
Each violation checked e u
P P 9 O P P O
q
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) ❑
_ _ r
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r
❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Aft r
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
r
❑ 5.Receiving/Condition ❑ 17.Reheating /
a
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding r
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 FAO
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. Iq ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an i spec ion today,thgms ❑ 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 6von-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
violations observed,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
within 10 days of receipt of this order. v lion,4 to 8non-critical viola ions= -.
w
29.Special Requirements (590.009) y P
30.Other DATE OF RE-INSPECTION: I s for Si na ure C 'nt:
31.Dumpster screened from public view
�f
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N d
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S'g•ature 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,.Il Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* t * _ 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 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 * ( ) 9
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 Rlated 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*
590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) liance P - - - 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
Y P 7-206.13 Tracking Powders,Pest Control and
3-201.13- Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I 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* Effective rrrnoor
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Stuffing Containing Fish,Meat,Poultry or
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*
Sources* ing,mobile food,temporary and residential ,
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.15 Package Integrity* g g 3-003.11(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* Lu 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 29. 1 Special Requirements 009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
°F THE rok• TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: " Date: l Page.: .of
1 J1� OFFICE HOURS A-
PUBLIC HEALTH DIVISION 8:00:9:30A.M.
BARNSTABLE. • lJ 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MAC �' L� HYANNIS,MA 02601 ,. MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
+679• .0 508-862A644
prFO MP'�� F OD ESTABLISHMENT INSPE TI N REPORT
Name Date a of Type of Inspection
+ / Al Routine
Address er
(�ood�Serv' Re-inspection
l3etajt� Previous Inspection � �,� A
Telephone I YMUG�a f� 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 O
Each violation checked requires an explanation on the narra ve ge and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and isk 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) ❑
ar G n
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 OK P
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals - -
a-
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 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 14 -AI '1
PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control J
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) of
�/1 A
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP l /
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY VJ
❑ 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 B=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 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 anon-critical violations. If 1 critical refrigeration.
violations C.
non-critical
29.Special Requirements (590.009) within 10 days of receipt of this order.
lion,4 to 8 =
30.Other DATE OF RE-INSPECTION: p Ct° 991a Prin
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N y
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's at re Print:
Self Service Wait Service Provided Grease Trap.Size Variance Letter Posted Y N
Dumpster Screen? Y N �uf�� /
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 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* Additives*- 19 PHF Hot.and Cold Holding
2-103.11 Person-in-Charge Duties - - 3-302.14 Protection from Unapproved
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
* -
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)-
2 590.003(C} Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
P y7-102.11 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 Se aration-Stora e*
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* - * Z2.02.:12. Conditions of Use* 590.004 11 Valiance Requirements
* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
590.003(G) Reporting by Person in Charge - Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* .-REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � )
-- - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Waming 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 Wazewashing-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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13_ _Shell Eggs* _- _ - - - _ I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1l3 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water-from an Approved System*
4-601.11(A)_ Clean Utensils an Contact Eggs d Food Contt Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
_ _ _
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cave 11112001
4-602.11 _. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS -
Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec*
Sources* 10 Proper,Adequate Handwashing kitc mobile food,temporary and residential
Game and-Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle;Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12_ Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
2-0Ol.11 Eating,Drinking or Using Tobacco* * Requirements.
5 Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
g590.004(E)
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* 12Prevention 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 Preventing Contamination from Employees* 1gProper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13Handwashing 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 1590.000
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 I FC-7 .008
HACCP Plans 6-301.12 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 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.
J14
s6WAV
oF.HE r ° TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page: of
d / OFFICE HOURS
0
PUBLIC HEALTH DIVISION 8:00-9:30A.M.
+ 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
BARNSTABLE.
MASS. MO -FRI.
i6j9• `0 HYANNIS,MA 02691 - 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ,
rFD M 9
F OD ESTABLISHMENT INSPECTION REPORT N Oki
Name l Date , T o T of I s ec ion
�� 011 outme
isku� Fooa'Servi minspeq�ion
Address / !
eve) tail Previou I sp
Telephone Residential Kitchen Date: 1
Mobile Pre-opat�b � / A r
Owner HACCP Y/N Temporary Suspect Illness r
Caterer General Complaint w `
Time d&Breakfast HACCP
Person in Charge(PIC) t Other
f7 In;
Inspector I 1 9ut ,' " r
v 1 A
Each violation checked requires an explanation on the narrativte page(s)and a citation of specific provision(s)violated. re
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 r
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �, )
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l ��
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) I
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
v -
❑ 5.Receiving/Condition ❑ 17.Reheating -
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling . ✓ V `��r/ 6 / I/
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
1
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control > _ >F 's "
8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �
� .�9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP L
Proper AdequateHandwashing CONSUMER ADVISORY fv�/�(�./���
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories C�(� V
r
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t
Critical(C).violations marked must be corrected immediately. blue&red items 1 f
( ) y ( ) �-�'� 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, ms
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo C] 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 mote non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations g
)( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non itical v lations. If 1 critical refrigeration.
vi ,4 to 8 non-critical viol ions. C.
29.Special Requirements (590.009) within 10 days of receipt of this order. e
30.Other Insp cto�'s Signature
DATE OF RE INSPECTION:
i '
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 natur Print:
Self Service Wait Service Provided Grease Trap Size. .. Variance Letter Posted Y N vAQ\
Dumpster Screen? Y N
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.) k
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) [Demonstration
signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives ° _,
Law Cooled to 41'F/45'F Within 4 Hours*
590.003(B) 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.* I - - 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding
Contamination from Poisonous or Toxic Substances Raw Ingredients t 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* 1402.11 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*
_ 7-201.11 Separation-Storage*
Applicants* "- 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control
A
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables *
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*
3-501.19 Time as a Public Health Control
3-304.11 Food Contact with Equipment and Utensils* 590.001(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 Rated 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 Wazewashing-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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
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-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101,11 Drinking Water from an Approved System* Eggs
Not Otherwise Processed to Eliminate
590.006(A) i Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep cti e 1oi2001
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
i 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* 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
3-20L15 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*
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 Identificatibn 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 Anim -als* 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 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
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained
TagsiRecords: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-E
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F r 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved"Procedures/ 6-301.11 - Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .006
HACCP Plans 6-301.12 Hand Drying Provision r
2 29. 1 Special Requirements .009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria* _
8-103.12 Conformance with Approved Procedures* S:590Formback6 2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999'Food Code or 105 CMR 590.000.
TOWN OF BARNSTABLE HEALTH INSPECTOR�s Establishment Name: W/ w 1 / Date:
..i
°F THET Page: of
h OFFICE HOURS L
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BABNWABLE. = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS.
S. HYANNIS,MA 02601 _ MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY.
�A n i^ 508-862-4644
CEOM OOD ESTABLISHMENT INSPECT ON REPORT
Name Date vne of Tvoe of Inspection
Operation(s) RoutineIYKA591 r
Address I l Risk Food Service. Re-inspection I / C
uj
Level, Retail Previous Inspection /_
TelephoneResidential Kitchen Date: /
Mobile Pre-operation i y -
Owner HACCP YIN Temporary Suspect Illness
'Caterer General Complaint u
. U
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector ) Out:
Each violation checked requires a explanation on the narrative page(s)and a citation of specific provisions)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ `A
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) ❑ /n
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands `/ ✓ i
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities -
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS /
❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious,Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures % is
❑ 5.Receiving/Condition ❑ 17.Reheating
/r.
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling "I
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ` ,
PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance . ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items Embargo
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal - ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4non-critical violations
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
violations q 8 non-critical,violations C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspect s Signa ur V Print:
31.Dumpster screened from public view 1
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Vy _PIC's Signat e Print:
/
#Seats Observed Frozen Dessert Machines: Outside Dining Y N I
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N .� r
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.* _ PHF Hot and Cold Holding _
2-103.11- Person-in--Charge Duties - - - - � 3-302.14 Protection from Unapproved Additi4es* 19
Contamination from Raw Ingredients 1 g 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*590.003(C) Responsibility of the Person-in-Charge to •- - t - 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F*
Separation-Storage*
Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An _ 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements
•--
3-304.11 Food Contact with Equipment and Utensils * ( ) 9
590.003(G) Reporting by Person in Charge* _ . _ 7-203.11 Toxic Containers-Prohibitions
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -_- REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS"HSP
590.003(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* _ _ * 3-801.1](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. 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-I55°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* Eff erne 11112001
4-602.1.1 ._ _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Sfandards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
i Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or r
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 10 Proper,Adequate Handwashing g' P mTY
Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority Y 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* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
( )( )ro)
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
2-401.11 Eating,Drinking or Using Tobacco* * Requirements.
5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140*F* (Blue Items 23-30)
3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome
* 12 Prevention of Contamination from Hands 3 403.11 Remaining Unsliced Portions of Beef Roasts*
3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
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(1) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* Sr 590Formba06-2doc
*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.
j � �I�
TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: (,/ Date: Page: of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BABNSTABLE. • 200 MAIN STREET 3:30-a:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
mass. fir. HYANNIS, MA 02601 MON.-FRI.508-862-46aa No Reference R-Red Item PLEASE PRINT CLEARLY
'FDM FOOD ESTABLISHMENT INSP C ION REPORT IL
el- NName Date e o f Ins ection
IWA s Rou i e 1'
Address isk Food-Se pection
Level PreviIm?".
i I/y
Telephone Residential Kitchen Date:Mobile Pre-o
Owner HACCP YIN Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector t:
AV A
Each violation checked requires an explanation on the narra ve 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 re uire immediate corrective Tobacco 590.009(F) ❑
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
OD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
i
�1.PIC Assigned/Knowledgeable/Duties 1�qO ❑ 13.Handwash Facilities �
1,7
EMPLOYEE HEALTH 1 ` PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially 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) Stems
Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Ratingwithin 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 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.
6.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 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 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration.
s receipt violation,4 to 8non-critical violati s
within 10 days of t of this order. =
29.Special Requirements (590.009) y p
30.Other DATE OF RE-INSPECTION: Insp s i to C1 int:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
PIC Sin ture
S Print:
Seats Frozen Dessert Machines: Outside Dining Y N 9
Selfif Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Sereen 9 Y N `^ 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) 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 i 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from EachIdentifying * - 590.004(F)- - -- t - - - - -- -
( )O P 7-101.11 Information- 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) Pood Protection* P g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) R_espon_i -ty 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* i * 7.202.12 Conditions of Use 590.004 11- .Variance Requirements- _
3-304.11 Food Contact with Equipment and Utensils ( ) 4
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 Rlated 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*
F77--4 I 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* _'_ _. _ _ 4-50 1 1 1 1- 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 j Fluid Milk and Milk Products* 4-561.112 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* 3-401.11 A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs. Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 _ Drinking Water from an Approved System*_ _ __. _ _ gg.
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep i-111n001
4-602.1E 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 10 Proper,Adequate Handwashing g' P
-Game and Wild Mushrooms Approved By - - -- * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
_
3-202.18"` Shellstockldentifi"cation Present*- _ _ _ 2,301.12 _ - _Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms*- _ _ _ _ -_ _ 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec
3-201.17 Game Animals* 11 Good Hygienic Practices -17 Reheating for Hot Holding practices should be debited under#29-Special
_
Requirements.
g- - --- -" ` Receiving/Condition ' ' '" - - -- i 2-401-N- _ Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* __ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30)
3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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. 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 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.
�ptME Tom ` '" TOWN OF BARNSTABLE _ HEALTH INSPECTOR,s Establishment Name: Date: i Page:, Of /
ti OFFICE HOURS
P ° PUBLIC HEALTH DIVISION 8:00-9:30A.M.
BARNBTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION(OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS, MA 02601 M 5088- -FRI.62-4644 No Reference R Red Item PLEASE PRINT CLEARLY
Ten Mp+
F.OPVESTABLISHMENT INS EC I- REPORT
Name Date Type of e o c ion
Address Risk ood Se Re-inspection
Level Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP YIN Temporary Suspect Illness
Caterer General Complaint -
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector Out:
Each violation checked requires an a pl ation 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) ❑ Jr
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 9
❑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
0 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 r
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 ❑ 90 Embar
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal Other.❑
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 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 aright 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 8non-critical violations. If 1 critical refrigeration.
violation,4 to 8 non-critical violations=C
within 10 days of receipt of this order. C.
29.Special Requirements (590.009) Y P _
30.Other DATE OF RE-INSPECTION: Inspe _ at Print: j a
31.Dump'ster 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 Signat 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) Assi ent of Responsibility* 8 Cross-contamination _ Law Cooled to 41'F/45°F Within 4 Hours*
( _ gnm _ _ 14 Food or Color Additives •-
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from >3-202.12''' Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* *- 19 PHF Hot and Cold Holding_
2=103.13 - Person-in-Charge Duties - - - - - � - - - - � - 3-302.14 � Protection from ilnapptoved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
E' MPLOYEE 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(G) 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
_ 7-201.11 Separation-Storage*
Applicants* - - - 3-302.1 f(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 _ _ _ 3-501.19 Time as a Public Health Control*
3-302.15__ Washing Fruits and Vegetables *
Applicant To Report`lb'The Person In Charge' * 7.202.12 Conditions of Use _- 590.004 11 Variance-Requirements
3-304.11 Food Contact with Equipment and Utensils ( ) 9
-590.003(G)- rReporting by Person in.Charge* Contamination from the Consumer
- - - 7-203.11 Toxic Containers-Prohibitions*
-
3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS.FOR
_ _. _ _. 3-306.14(A)(B)Returned Food and Rlated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY,SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g � )
Disposition of Adulterated or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4- . Food and Water From-Regulated Sources -9 . - . Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590:004 A-B Com liance with Food Law*__ * 3-801.11(D) Raw or Partially Cooked Animal Food and
� -- ( -) P - - - - - - 4-501.I11- - -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*
37202.13_ . Shell Eggs*_ _ _ _ __ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
s and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. CONSUMER ADVISORY
3-202.14 Eg
gs 16 Proper Cooking Temperatures for PHFs
3-202.16 Ice Made-From Potable Diinkirig 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-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water.from an Approved System* _ Equipment*
gg Not Otherwise Processed to Eliminate
• 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective innoor
4-602.11. _ _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) ` Water Meets�Standards m 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From-an Approved Source-__ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
( - 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish*- `--- - 3-40L11(A)(3) Poultry,Wild Game,Stuffed PHFs .SPECIAL REQUIREMENTS
4-763.11 Methods of Sanitization-Hot Water and Stuffin Containing Fish,Meat,Poultry
3-201.15 Molluscan Shellfish from NSSP Listed_ _ Chemical* Stuffing g or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
Ratites-165°F 15 sec*
Proper,Adequate Handwashing ing,mobile food,temporary and residential
Sources* 10
Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
-, ( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
$ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*17 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.15 Package Integrity*. g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome
* 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions.of Beef Roasts*
3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lis 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 1590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision n'- 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 599., 'Qp. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
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., Especialidade da Casa
Todos os pratos sao servidos com arroz - all dishes served-with rice'`'
Bobo- Shrimp Bobo' ' w {
a x hd' P 1 '.
Shrimp; tomato, cilantro, yucca cream and onion-14 99
a Filet de Peixe com Fritas ° k �"
y' Fish and Chips-9.99
-Mo caeca de - t .�.
F uec'a 1399
5 _ ,Escondidinho - Yucca Pie },
_= Carne ou Frango -,Beef or chicken-9.99
Peito de Frango com Cream, eese - Stuffed Chicken Breast-11 M
Escondidinho`de.Camarao Shrimp Yucca Pie 11 99. '
Prato. a' Casa r
Os pratos abaixo vem acompanhados de arroz ou fritas a salada-
All served with rice�or fries and salad
K: Bife da Casa - Steak r t
Servido com ovo - Served with egg„$11.99
Frango, a Passarinho Fried chunks of Chicken-9.99
Bife a Parmegiana - Beef a Parmagiana-12.99`7
_ - Frango-,a Parmegiana---Chicken Parmagiana-11.99
tP
Strogonoff de Frango ou Carne -.Chicken'' or Beef Strogonoff-11.99
Feijao Tropeiro ou Tutu
Kidney beans, yucca flour, linguica, bacon, eggs, We and fried pork belly or creamed beans
topped with linguica, bacon, eggs�and onions-10.99' 'A ;
Lasanha de Frango ou Carne - ,Chicken or Beef Lasagna-11.99
;Picanha no,'Ch.-- = Prime Cut Sirloin`
Servido com vinagrete a faiofa Served with Vinaigrette and Farofa-17.99 f
0 Feijoada Coinpr eta
47`
-Brazilian Nat�onal-dish served on,Saturdays-11.99
a
Obrigado pela preferencia,{ °;�� ► :i '
A gorjeta do garcon nao esta incluida, no preco?
Preta Cafe Favorite
Pleaset Brazilian
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P {
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Tira Gosto - A etizers
Espetinho -,Kabob,3.99
Salgadinhos - Brazilian Pattie 4
" Coxinha, Empadinha, Esfirra, Quibe, Risole-1.79 r, g
�M,andioquinha Frita - Fried Yucca
r ° s With Chefs sauce-4.99 'y r + ;
Torresmo com Mandioquinha - Fried Pork Belly with Fried Yucca-'6.99
_Linguica com Mandioquinha - Linguica with Fried Yucca-6.99
Carne_com Mandioquinha -,Fried Yucca with Fried,Beef-6.99,,,
Frango`a'Passarinho,=Tried-,Chunks of'Chicken with Botntes-6.99
Camarao a Gregaf=.Greek Shrimp c
Espetinho de Camarao com Queijo Shrimp Kabob with,Cheese-4:99
r
Pastel
Carne Fran o ou uei)o Ground _beef Chicken-or,Cheese-
2.50
Sop.
^as Soups Per unto ao garcon - A k�,your.server
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File Aceboladoa,Palito Steak,Tp,with Onions and Fries-7:99
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Sobremesas-Desserts
:. Brigadeiro Cake-3.50
Alpino-Chocolate branco:e preto White and`Black chocolate-5.00
Marta Rocha Cake-Moran" com Suspiro-
Strawberry Cake with Meringues-4.50
California Cake-Damasco com Ameixa - Plum and Apricot''-'450
Siria Cake-Coco a Ameixa- Toasted Coconut with Plum-4.50
Black Diamond Cake-Chocolate Mousse com Morangos -5.00 .
Chocolate Mousse with Strawberry
Torta Mineira- Abacaxi,coin'Coco Pineapple with Coconut-4:50'
Maracuja Cake-Passion Fruit Cake-3.50
Bobom com Morango Cake-Bobom and Strawberry-4.50 f ,
Pudim ,Brazilian Pudding-2.00 +:, 3
4
nramissu-5.00
Creme Brulee-5.00 's fr t
Cann
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A gorjeta do garcon nao esta`induida no',preco. �}'
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Eggs & Omelettes
All eggs served with toast. Toast substitute: English muffin, raisin-bread or.bagel-.59
Add home fries-.99 Egg-Beater and E W hi - t" �
Egg White add 1:00 i
Omelet Fillings:Diced ham, bacon; sausage;,cheese, onions, ►
- ` peppers,tomatoes, spinach, mushrooms.
Preta Breakfast Sandwich y = Steak & Eggs
ay y..-.� �,�t,� , °��
Two farm fresh fried-eggs4WA choice of meat- 7oz Skillet_ steak with two eggs any.'style,
and cheese served on a_bagel?or'English homefries & toast-9.99 ' „ril
,muffin-with-homefries-6;99`�' + 1
Potato Pancakes tj
Three pancakes served with sour''cre'am and
"Preta Eggs Benny Pp gg
Two farm fresh eggs poached over corned ' '/cho ed scallion.5A Addle s-6.99
beef hash bacon or ham steak on an,Enghsh . ,
' Build Your Own Omelette
muffin topped with hollandaise-andmseryed , 't= }4
-� � = .- ;A three egg omelette with`your'cho ce of
with�homefri6-8-59 �" '
T s, .ed toa three filling sery with st-7.99
Basic Eggs
,Vegetable Omelette
Two Farm fresh eggs served any st le-3.99 ,,r
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- ��•. Filled with peppers;' mush dooms, ,onions,
With choice of meat 4.99
tomato; spinach-7.59 With cheese-7.99
One Egg-2.99 With choice of meat-3 94� 4 ,.' 1 <<
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Preta Scramble - Meat&'Cheese Omelette+;
Choice of meat, scallions tomatoes topped Choice!of ham,-,,,bacon or,sausage. it
with'Hollandaise sauce_.and'servedr.
o pp and cheese-7.59. i>
" 7.99 -
` with homefnes- -�� `" � ,
- _ _ � Western Omelette
Corned Beef Hash Peppers , ham and onions'7.59
-> ___ n ,-- .-- _ . - With',
.choice of cheese-7.99
Crispy"corned beef hash mixed'with'peppers
and :onions with two eggs any style=6.99 e t • �g
Pancakes & French Toast If
Top your pancakes or french toast with blueberries, strawberries or cranberries, or a
combination of.all three-1.00'With choice of meat add-1.59
Preta French Toast Choices all dipped in our '',Two x Four
egg ' Two eggs any style, served with twoi
Thick Cut Texas Toast-5.49 slices of'bacon, two sausage, 2 pancakes-6.99
Cinnamon Bread:French Toast-.6.49 __ __ '`- t ' 'r1
Portuguese Sweet Bread French Toast-6.49 ' Cheese Blintz's � Y� ; * ►
Raisin Bread French Toast-6.49 Four Ricotta and cottage cheese stuffed
'Mintzes=5.99 #
Frenoh Toast Sampler
-One slice of all four breads when you cant
Buttermilk Pancakes
�make,upyour mind-6.49 _ Regular Order (3)=�4.99 Short Stack (2)-3.39
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Preta Cafe favorite
Consuming raw or undercooked meats,seafood,shellfish, poultry or 1 of 1od1•
Appetizers & -Soups
Preti:fibination Platter !' `
Boneless Chicken Tenders ., ,;
A large portion of breaded tenders served Chicken wings (2), chicken tenders (2),
with'a`honey BBQ dipping sauce-7.99 potato and onion rings°8r99
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Buffalo Tenders r . ,' '� Volcano Rings I' r ` ► FE.
�+d,' - � A heaping portion of sweet onion rings
Fried boneless tenders .tossed�in.Buffalo , ;
Sauce. served with blue'ch'eese-dressing and drizzled with petal sauce and rnelted,cheddar
, v cheese-,6.99
v-celery}.sticks,-8.99
a Beef Kabob
Sniffed Potato Skins
Fried potato skins stuffed with bacon bits and aMarinated beef'skewere&!with peppers
and onions-3.99 �
cheddar cheese, served with sour cream-7:99
- Salgadinhos`-Brazilian Pattie,
Mozzarella Sticks ,.,
' Battered mozzarella cheese Coxinha, Empadinha, Esfirra; Ube';
fried golden brown-6.59 4skis le-1'.79 :F ►' +: ►��
-"Anytime- Entrees r #'
Chicken Carbonara Shepherds Pie'
Boneless chicken breast pan:.seared ,,, T .. L Traditional beef,and potato pie-7:99
theri tossed in a rich-cheese_sauce,with
' Chicken Picatta
bacon. Served over.pasta or.rice with a"side t
0 . `.I, - Pan seared chicken 'tossed: in a lemon .and
salad-12.99 _.
'Fish & Chips. - -`�� ��_ � � served-with pasta and side
and mushrooms
- —- saute' with capers
e salad-12:99
A.large hand breaded haddock.filet fried ;
golden brown served with,'French fries, Chicken Alfredo ,
coleslaw, lemon, and tartar.sauce-9.99 Pan seared chicken tossed with a,
creamy Parmesan sauce, served' " �4
i Preta Combo over pasta or rice with side salad-11.99
Grilled beef with onions or grilled chicken "r -
or kabob, served with rice, beans, _ Chicken Marsala
�• a,, Pan seared chicken with mushrooms in a
and green salad-9.99 'Marsala .demi sauce, served over pasta'or
Baked Haddock ,',rice with side.saLad712:99
Filet of haddock topped with buttered crumbs Preta House Salad-4.99
and baked with white wine, served with. ; Add Grilled Chicken=3.00 Steak Tips''5.00
choice of potato or rice and side salad-11:99 I ' I fir''
p ;Shrimp-5.00 s
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Preta Cafe Favorite
Consumingor t- tt et meats,seafood,shellfish,poultry or t of ttttt
Sandwiches
All sandwiches served on choice off;white, wheat, rye,
or pumpernickel bread and homefries.
All burgers served with lettuce; tomato and home fries! '1
Mile High Hot Pastrami Chicken Challenge '�Desafio"F
Black navel pastrami,heated.And Pulled chicken corn, bacon and
served with Swiss cheese-7.99 , ` cheddar cheese-8.99
,Preta.Turkey Stack, r Brazilian Burger 1 ,. i
U° Smoked*turkey, smoky bacon--; lettuce, - 8oz -Angus burger grilled to your.jiking-7.99
tomato and may6`-7.99 - Add choice of cheese-8.59
-_ - B.L.T.
Add mushrooms-.50 Add bacon-1.00
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All time classic of applewood smoked'bacon, preta X-'Burger'
Lettuce tomato and-mayo 6:59 =" " _ Our burger topped,with chicken, fried egg,
4
Monte Chriisto y r
.bacon and cheese-9.99
Ham, turkey, Swiss cheese baked on Reuben }
French toast served with maple syrup-8.5.9 ,Corned beef, sauerkraut, Swiss cheese,
s `1000 Island dressing baked to perfection-7.99
Sides &_Beverages
Side Orders -Coffee
1
Home fries-1.99 Free refill for dine in only-1.69
Choice of Ham,-Sausage; Bacon 2.29a Hot Chocolate-1.79
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HolladaiseSauce-1.29" 1
English Muffin-1.29' Extra tea bag-.99
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Bagel with Cream Cheese-l`.59 Assorted Juices & Milk
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Cold Cereal Milk-1.99 Cranberry, Orange, Seasonal selection 2 /o
Fresh Baked Muffin-1.59 y g
Milk,: Chocolate Milk
Baked Beans-1.59 Small-139 Large-2.59
Side of berries-1.59 '
We Proudly serve Pepsi Products
Coleslaw-1.99 `
_ ,All soda 20 ounce cup-1.99 tj
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Pre . Cafe Favorite
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INSTALLERS NAME&PHONE NO. V�, 1(w wA
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LEACHING FACILITY: (type) (size)
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NO, OF BEDROOMS 6 —
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PERMIT DATE: U A k row,n COMPLIANCE DATE: U,r horkv%
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist ,
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leach facility) Feet
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