HomeMy WebLinkAboutWENDY'S RESTAURANT - FOOD a
;WENDY'S RESTAURA
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4
Town of Barnstable BOARD OF HEALTH.
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
BAR
N,TAB F.P.(Thomas)Lee,.
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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 176 Issue Date: 01/01/2022
DBA: WENDY'S OLD FASHIONED HAMBURGERS
OWNER: FASHION FOOD LLC.
Location of Establishment: 554 IYANNOUGH ROAD HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 65 OutdoorSeating: 16 Total Seating: 81
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: --
MOBILE-FOOD:
MOBILE-ICE CREAM: C,��
FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
i
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
Town of Barnstable For Office Use 19W.Initials:
Date Paid Amt Pd$
Inspectional Services
F1639.
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 mod �'✓ NEW OWNERSHIP RENEWAL v
NAME OF FOOD ESTABLISHMENT: ��� / �. �-►� sGC� �'"� v '�.� y�
ADDRESS OF FOOD ESTABLISHMENT: Sq /V
MAILING ADDRESS(IF DIFFE FROM ABOVE):
E-MAIL ADDRESS:
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (3® ) 77/
TOTAL NUMBER OF BATHROOMS:
WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: v SEASONAL: DATES OF OPERATION: ^/ • / TO
NUMBER OF SEATS: INSIDE: 92 OUTSIDE: TOTAL: 9z
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? /./
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
JFOOD 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 508-8624644
Q:\Application FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANT .1'4x,-/4A7
SOLE OWNER: YES/NO D.O.B '�-.,^ ,�' OWNER PHONE# S,0 2a 7 63�
ADDRESS �� /� �,s?�.�' = Ly,��c. - /�A �2� A\,
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: �"�/ %L. ✓"`'C t.S/
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
CwF oOt*�' 64e vze 121 /7 /2coz y z g�" Zas' ,:ze /aX 9 .27�
SIG ATURE OF APPLICA DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FormsT00DAPP REV3-2019.doc
a
Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
WiRNSTAH , Paul J.Canniff,D.M.D.
'\ r H MA 02601 F.P. Thomas Lee Alternate
�.. � 200 Main Street, Hyannis,
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 176 Issue Date: 01/01/2021
DBA: WENDY'S OLD FASHIONED HAMBURGERS
OWNER: FASHION FOOD LLC.
Location of Establishment: 554 IYANNOUGH ROAD HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 65 OutdoorSeating: 16 Total Seating: 81
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: G�
FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
oFTHE r For Off • Initials:\`
° . Town of Barnstable �j �j
Q Date Paid I 1 A5 AmLBd S J�
BMMSTABL6. : Inspectional Services �] �� (M 1-
MASS.
' Check#� �� `
1639. ,. Public Health Division 7e-
ArFD
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE �! ZU NEW OWNERSHIP RENEWAL �/
NAME OF FOOD ESTABLISHMENT:�/����'✓� � \" "'�`�y S
ADDRESS OF FOOD ESTABLISHMENT: 7%S:* 7 e32
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS:
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (Sag) 771- oe✓3 a
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO V. (ANNUAL WATER ANALYSIS REQUIRED) '
ANNUAL: V SEASONAL: DATES OF OPERATION: /_/_ TO
NUMBER OF SEATS: INSIDE: 9Z OUTSIDE: TOTAL: �2
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? �
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL,MOBILE & NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:\Application FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANT /2N,637 '�y'�
SOLE OWNER: YES/NO D.O.B�®�' 38 OWNER PHONE# 56$ —26 7 -95r3 2Z `
ADDRESS
CORPORATE OWNER:
CORPORATE ADDRESS: e y im'X�� O-Z6�2
PERSON IN CHARGE OF DAILY OPERATIONS:
List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
s6 /2 0M3 1. / f,�Jp y�.->.z�y 3 / sG /R 0z-:3
2 e2 / �f�S rvC.E /Z ,2 3
SIGNATURE OF APPLICA DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi).
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st.
Q:\Application FormsTOODAPP REV3-2019.doc
f
" pf Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
L1itY 1ADM : Paul J.Canniff,D.M.D.
CAM F.P. Thomas Lee Alternate
16196 .� 200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 176 Issue Date: 12/10/2019
DBA: -WENDY'S OLD FASHIONED HAMBURGERS
OWNER: FASHION FOOD LLC.
Location of Establishment: 554 IYANNOUGH ROAD HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 65 OutdoorSeating: 16 Total Seating: 81
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: ��
FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
i
1
of1t tqy For Office Use Only: Initials_
Town of Barnstable
Date Paid �� o`�� I—I Amt pd$
Inspectional Services
nxn,srnei e. :
KAss.
i639 ,� Public Health Division Check#
�fD MA'S A
Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
PPLICATION FOR PERMIT TO OPERATE AA FOOD ESTABLISHMENT
DATE / Z® NEW OWNERSHIP RENEWAL V
NAME OF FOOD ESTABLISHMENT: / �'�-�� �/ �7� iV ✓- ����
ADDRESS OF FOOD ESTABLISHMENT: .5S / ' �3d vr,-K�•�s T1f� ���G�
MAILING ADDRESS(IF DIFFERENT FROM A13 E):
E-MAIL ADDRESS:
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (-iEZ� 771- / v
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO Y ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE: 5?�? OUTSIDE: — TOTAL: 9a
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/�
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S) '
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
QAApplication FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANT
SOLE OWNER: YES/N�O D.O.B 7Q4 /� � OWNER PHONE#
ADDRESS
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS:
List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1. 7I.n�
, loll
2�Z.�•r��' �� � /2 />9 /�oz� �. a �G�- �i�v� >z�i��dz 3 ,
SIGNA 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 opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist.
Q:Wpplication FormsTOODAPP REV3-2019.doc
TIME r TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date:311s/,? Page: of
`o °k1 OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
200 MAIN STREET 3: - FRI.P.M.
M
BARN5rARLE. OH..- Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
` M
HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT.CLEARLY
�A 0-19.p�0
rFOMP+ FOOD ESTABLISHMENT INSPECTION REPORT
Name Dated �!, a of Tvue of Inspection
✓ O s outin
Address Risk 4 Food Service e-inspection
Level Retai Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
HACCP Y/N Temporary Suspect Illness ,...,
Owner Caterer General Complaint
Person in Charge(PIC) , Bed&Breakfast HACCP �� -- - Q J
.-Time Other u
Inspector Out: /
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations,marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
In
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) d f�
❑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 �J
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
E38.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 L/f�
Critical(C)violations marked must be corrected immediately. (blue&red items) �' / �''� I
Non-critical(N)violations must be corrected immediately or (, pt ra Corrective Action Required: ❑ No es
within 90 days as determined b the Board of Health. Overall Rating
Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection tdl6ay,the items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed,
25.Equipment and Utensils FC-4 590.005 9 or more non-critical violations=F.
( )( ) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations
6.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 non-critical. If no critical `Hater,sewage back-up,infestation of rodents or insects,or lack of
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations=C. refrigeration.
29.Special Requirements (590.009) within 10 days of receipt of this order.
nspector re t:
30.Other DATE OF RE-INSPECTION:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
PIC's Signature Print:
#Seats Observed
Frozen Dessert Machines: Outside Dining Y N
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N V1 l,
Dumpster Screen? Y N V _ ..
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 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
7-102.11 Common Name-Working Containers 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* p g 20 Time as a Public Health Control
3-302.11(A) Food Protection*
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use
3-304.11 Food Contact with Equipment and Utensils* 590.004(I1) Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetically Sealed Container* - Sanitization Temperatures* Raw Seed Sprouts Not Served*
7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment
5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff-"we trozooi
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 Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A
3-201.15 Molluscan Shellfish from NSSP Listed ( )-(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 t 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.
* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )( )
* 11 Good Hygienic Practices 17 r + Reheatin for Hot Holdin practices should be debited under#29-Special
3-201.17 Game Animals 9 9 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)I Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3 403.11(E) ' Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 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* * Within 4 Hours* 23. Management and Personnel FC-2 .003
Tags/Records:Fish Products 5-203.11 Numbers and Capacities
* 3-501.14 B Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* 5-204.11 Location and Placement ( ) g
* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009
3-502.11 Specialized Processing Methods* 130. Other
3-502.12 1 Reduced-Oxygen Packaging Criteria*
8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc
`Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: / Page: . of
4 OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSfABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS. MON.-FRI.
�p ,639,sum HYANNIS, MA 02601 soe-e62 asaa No Reference R-Red Item PLEASE RINT CLEARLY
1p°MP( - FOOD ESTABLISHMENT INSPECTION REPORT
Name Date Type of Type of Inspection
S)perajifMou
Address Risk ood Se e-inspection
Level Retal Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP Y/N Temporary IHACCP
spect Illness
Caterer n -
Person in Charge(PIC) Time Bed&Breakfast In: er \
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ .
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities \
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
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 t
❑ O
11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories LL
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) (� I I I Corrective Action Required: o Yes
Non-critical(N)violations must be corrected immediately or Overall Rating I v ll
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,th 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.
obs
if no critical violations observry
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 e than o 6 non-critical violations
than
4 to 6von-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 8non-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C_
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspe at
31.Dumps r screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature -mnt:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N /�
Dumpster Screen? Y N � ' '` u+` "�`
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) [De-.
signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours*
590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)
2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
* 7-201.11 Separation-Storage*
Applicants 3-302.11(A) Food Protection 3-302.15 Washing Fruits and Vegetables* 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use*
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements -- -
590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions*
3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals*
( ) ( )(B) REQUIREMENTS FOR-
3-306.14 A Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 1 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
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* * gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective iirnooi
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*
F
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155' 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
Chemical Stuffing Containing Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed * 8 g 590.009(A)-(D) Violations of Section 590.009(A);(D)in cater-
Ratites-165°F IS sec*
Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors.
2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )(b)
3-201.17 Game Ammals* 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.
$ 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 Stan me Standing Ti * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F*
12 Blue Items 23-30)
Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* F18 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
Supplied with Soap and hand Drying Devices thin 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 _
590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28, 1 Poisonous or Toxic Materials FC-7 .008.
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* I 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.
N
oFI�E ram, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: � �d�� Page: of
q OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSrABLE, • 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 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
-862-4644
M FOOD ESTABLISHMENT INSPECTION REPORT 508
Name Date �} e of Inspection
Routin
Address 5 Risk od Se e-inspection
') Level Previous Inspection
Telephone Residential Kitchen Date: � � g
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint 10
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector Out:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Qz-j� A
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands \�
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities \ '! i
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS w v Q
❑ 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)
_3
❑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) V �(
❑ 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 �11pJ1
j
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items)Overall Rating ��j Corrective Action Required: ❑ No Yes
Non-critical(N)violations must be corrected immediately or -{`
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, he items ❑ Embargo Emergency Closure El-voluntary Disposal El Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
violations observed,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
o �tic violation,4 tal violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order. t
30.Other DATE OF RE-INSPECTION: Inspector' ' na Pr
91 31.VDurner screened from public viewPermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
- - v.. r's.��e'..�.y...`:.pt�.....i1_--'Y.,e4..ti_,-:.•.JSr:iA,....e.R• r �... .. -.._ . _ _
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C)- PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination U Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202'12-"• Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)
7-102.11 Common Name-Working Containers*2 590.003(C) Responsibility of the Person-in-Charge to
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
* 7-201.11 Separation-Storage*
Applicants 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control 20 Time as a Public Health Control
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* 590.004 11 Variance Re uirements
590.003(G) Reporting by Person in Charge -
* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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*
q 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
y P 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 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* 3-401.1](A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/I2001
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 r f ces of Equipment*
of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( (A Stuffing Containing Fish,Meat,Poultry or 590.009 A)-(D) Violations of Section 590.009 cater-
)-(D)
in
-165°F 15 sec*
Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30)
3-201A1 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne
* 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
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. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc
*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 590.600.
Op THE ToH, TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: want Date. Page: of
q OFFICE HOURS TT��
AHN�rAa�eo PUB2 0 LIC HE N ST ALTH RETSION 8:00-9:30A.M.
3:30-4:30 P.M. Item Code C-Critical Item DES RIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
M" HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item. P A*PR)
E RLY
.a3v �0 -862-4644dy,
10rF0 MP�� FOOD ESTABLISHMENT INSP ION REPORT SOB
Name Dat Type of Type of Inspection
Absamk" Routine
Address Sk Food Servi Re-inspe on
vel Pr t : s�
Telephone Residential Kitchen Date:
Mobile Pre-ope at o
Owner HACCP YIN Temporary
Caterer eral Compl '
Person in Charge(PI ) Time Bed&Breakfast
n, Other
Inspector
Each violation checked requires an expla ation on the narrative gels)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 5900009(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 My
❑ 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 OPULATIONS(HSP) 9
❑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 n inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal El 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 (F6-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 6 non-critical violations non-critical violations
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 =B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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- ritical violations. If 1 critical refrigeration.
)( n,4 to 8 non-critical vi " ions/4-A.,
29.Special Requirements (590.009) within 10 days of receipt of this order. A
' re
30.Other DATE OF RE-INSPECTION: In ctor
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted- Y. N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PBFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 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 Cooked and RTE Foods.* * 3-501.15 Cooling Methods for PHFs
19
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* PHF Hot and Cold Holding
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances i 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* 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 * 590.004 11
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 ) Variance Requirements -
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
(
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ ._ _ .REQUIREMENTS FOR,
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � )
Food 7.204.14 1 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*
q 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* TIMEITEMPERATURE CONTROLS '
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
* - Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water 3-401.11A(l)(2) Eggs-155'F 15 sec Animal Foods That are Raw,Undercooked or
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* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep cti°e 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 Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surf of Equipment*
j Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in.cater-
Ratites-165°F 15 sec*
Sources* Mushrooms Approved By ing,mobile food,temporary and residential
Authority
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
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 Requirements.
radicsshould be debited under#29-Special
$ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package.Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)
12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 '
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
5-205.11 Accessibility,Operation and Maintenance *
3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices _ 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ - 6-301.11 Handwashing Cleanser,Availability
28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009
3-502.11- Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 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 1909 Food Code or 105 CMR 590.000.
pptME Tq," TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page:J of.
'4 OFFICE HOURS
AR E. PUBLIC 0 HE N STREET
DIVISION 8:00-9:30A.M.
3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS, p MON.-FRI.
�p ,639.p HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PR I-T CLEARLY
'FON1 FOOD ESTABLISHMENT INSP T O REPORT
Name C' Date Type o Tyne of Inspection
Routine
x Address Ocii isk Food Servi Re-inspects n
F
evel Previou pg n)
Telephone Residential Kitchen Date: f�{{` J
Mobile Pr -
Owner HACCP YIN Temporary uspect Illness
Caterer Genera omplaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
Other
e-j Al
Inspector t:
Each violation checked requires an explanation on the narrative pa (s) Ration 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 4.eh an
❑ 5.Receiving/Condition ❑ 17.Reheating F;
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding f V1,-A
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLP POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
i
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY /
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) I� + Corrective Action Required: ❑ No ❑ Yes y
Non-critical(N)violations must be corrected immediately or Overall Rating L 1 )q
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 ems ❑ Embargo El 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 4.non-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 Vio s observed,7 to 8 non critic I 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' lati to 8 non-critical violatio =C
29.Special Requirements (590.009) y p
30.Other DATE OF RE-INSPECTION: Ins s S tur Ppnt:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s ignature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N LA ni
Dumpster Screen? Y N
Violations related to Foodborne Illness - - Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT _ PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* _ 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties - - - - 3-302.14 Protection-from Unapproved Additives* o
Contamination from Raw Ingredients 1 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
15-. Poisonous or Toxic Substances 590.004(F.) - * -
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Other Identifying Information-Original Containers*
590.003(C) Responsibility of the Person-in-Charge to * - 3-501.16(A) Hot PHFs Maintained At or Above 140°F
- - - - - - �7-102.11 Common Name-Working Containers*
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
7-201.11 Separation-Storage*
Applicants 3-31)2.11(A) Food Protection* 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An_ 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance 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* s _REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g ( )
Disposition of Adulterated or Contaminated
Food - 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
q Food and Water From Regu/atedsources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004 A-B). Compliance with Food Law* _ * 3-801.11(D) Raw or Partially Cooked Animal Food and
( P 4-501.111 Manual Wazewashing--Hat�yater -- 7.206.12 Roden[Bait Stations
3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* ! Raw Seed Sprouts Not Served*
� Y P 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 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* 4-602.11 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef c ire 11112001
_ .Cleaning Frequency of Utensils and Food -590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F 15 sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 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 ContainingFish,Meat,Poultryor
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and a ide in cater-
- - Ratites-165°F 15 sec*
Sources* ing,mobile food,temporary and residential
1 o 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(A)(1)(b) All Other PHFs-145°F 15 sec
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 - Good Hygienic Practices -17 eat Hot Reheating for H Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 - Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140'F* Blue Items 23-30)
12 Prevention of Contamination from Hands - Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers 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°f Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans '` 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 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* Sr 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.
7
°p VIE I , TOWN OF BARNSTABLE .. HEAD?H INSPECTOR�s Establishment Name: Date: � Page: of
4 OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
;}9. � HYANNIS,MA 02601 506-62-46" No Reference R-Red Item PLEASE PRINT CLEARLY
1% OOD ESTABLISHMENT INSPrWTOON REPORT
Name Dat pe of jype of Inspection
Routine
Address Risk Foo Service Re-inspection
Level Previous Inspection
Telephone Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP YIN Temporary Suspect Illness A.
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other . i
Inspector Out:
Each violation checked requires a /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 _ 9
� � Anti-Choking 590.009 E
9 O
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 0
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) i Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating.
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other:.
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ardless of the number of critical,results in an F.
6=One critical violation and less than 4non-critical violations 9
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26.Water,Plumbing and Waste ) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
g (FC-5)(590.006 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 8non-critical violations. If 1 critical refrigeration.
- violo 8 n -criti I violations C.
29.SpeciaLRequirements - (590.009) within 10 days of receipt of this order.
=
30.Other DATE OF RE-INSPECTION:
Inspe is Si ur Print:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat a Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y . N
Dumpster Screen Y N
Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives th
* 3-501.15 Cooling Meods for PHR
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* 3-501.16A 7-102.11 Common Name-Working Containers* ( ) *
Hot PHFs Maintained At or Above 140°F
Require Reporting by Food Employees and ; Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F
Applicants* 3-302:11(?,) - Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control
590.003(R) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements
590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
- Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* .REQUIREMENTS FOR..
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law*. _ * 3-801.11(D) Raw or Partially Cooked Animal Food and
4-501.111 - Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 i Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
Y P 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System*
4-601.11(A) Clean Eggs Utensils and Food Contact 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* Effective 11112001
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
' Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS ',�,
4-703.11 Methods of Sanitization-Hot Water and Stuffi
ng Containing Fish,Meat,Poultry or 590009(A)-(D) Violations 3-201.15 Molluscan Shellfish from"NSSP Listed Chemical* Ratites-165°F 15 sec* . o ons of Section 590.009(A)-(D)in cater-
Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential
Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle;Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 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) Commerciall 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 foodborne
* 12 Prevention of Contamination from Hands 3 403.11(E) 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* 1 S 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 =p 29. Special Requirements 009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
3153-DMC-Fashion Food-3153 Page 3 of 4
554 Route 132 PMIX Report - All Terminals 9
Hyannis,MA 02601 07/09/201 8 07/10/2018-- 2:47 PM
14.2.32.0
Printed by:Tracey Rudlin
«,
Item Num Price Food %
Rank Category Num Item Name Sold Sold Amount Cost Profit Cost% Sales
106 29171 LG StrawMel 2.00 3.64 7.27 0.00 + 7.27 0.00 0.09
107 24081 MD Choc Fros 4.00 1.80 7.21 0.00 7.21 0.00 0.09
108 10050 Bcntr Triple 1.00 7.21 7.21 0.00 7.21 0.00 0.09
109 32033 Regular Coffe 7.00 0.99 6.93 0.00 6.93 0.00 0.08
110 24130 MD Van Frost 4.00 1.67 6.68 0.00 6.68 0.00 0.08
111 24091 LG Choc Fros 3.00 2.20 6.59 0.00 6.59 0.00 0.08
112 22028 Cheese Fry 3.00 2.19 6.56 0.00 6.56 0.00 0.08
113 21100 Kids Fries 21.00 0.66 13.79 7.35 6.44 53.30 0.17
114 20201 Chili Chz Pot 2.00 2.99 5.98 0.00 5.98 0.00 0.07
115 10425 Cheesy Chdb 4.00 1.49 5.96 0.00 5.96 0.00 0.07
116 19100 KidsChzburge 3.00 1.98 5.94 0.00 5.94 0.00 0.07
117 27229 MD Iced Tea 3.00 1.89 5.67 0.00 5.67 0.00 0.07
118 19250 Kids Hamburg 3.00 1.86 5.59 0.00 5.59 0.00 0.07
119 11210 Grilled Asiago 1AO 5.41 5.41 0.00 5.41 0.00 0.07
120 72101 Cheese\nSau' 0 0.30 5.40 0.00 5.40 0.00 0.07
121 79025 Shredded\nC 18.00 0.30 5.40 0.00 5.40 0.00 0.07
122 29116 MD Cherry Te 2.00 2.69 5.38 0.00 5.38 0.00 0.06
123 10325 Double JBC 2.00 2.59 5.18 0.00 5.18 0.00 0.06
124 78210 Add Spicy 2.00 2.50 5.00 0.00 5.00 0.00 0.06
125 23045 Dbl Chc Cooki 5.00 0.99 4.95 0.00 4.95 0.00 0.06
126 21502 Strwbry&Blub 6.00 0.80 4.81 0.00 4.81 0.00 0.06
127 30053 Milk .5.00 0.96 4.79 0.00 4.79 0.00 0.06
128 10000 Bcntr Single 1.00 4.79 4.79 0.00 4.79 0.00 0.06
129 22027 Cheese Fry 2.00 2.39 4.78 0.00 4.78 0.00 0.06
130 11456 Homestyle Wr 2.00 2.18 4.36 0.00 4.36 0.00 0.05
131 24140 LG Van Frosty 2.00 2.16 4.32 0.00 4.32 0.00 0.05
132 26825 KM FREESTY 7.00 0.61 4.25 0.00 4.25 0'.00 0.05
133 78060 Bacon 2pc 4.00 1.00 4.00 0.00 4.00 0.00 0.05
134 29110 SM StrawMel 2.00 1.99 3.98 0.00 3.98 0.00 0.05
135 29115 SM Cherry Te 2.00 1.99 3.98 0.00 3.98 0.00 0.05
136 20352 SrCrm&Chv 3.00 1.33 3.98 0.00 3.98 0.00 0.05
137 23015 Sugar Cookie 4.00 0.99 3.96 0.00 3.96-- 0.00 0.05
138 24100 JR Van Frosty 4.00 0.95 3.80 0.00 3.80 0.00 0.05
139 29173 LG Cherry Te 1.00 3.71 3.71 0.00 3.71 0.00 0.04
140 29070 LG Stwbry Le 1.00 3.70 3.70 0.00 3.70 0.00 0.04
141 29155 LG Limeade 1.00 3.29 3.29 0.00 3.29 0.00 0.04
142 29172 LG Cherry Te 1.00 3.19 3.19 0.00 3.19 0.00 0.04
143 29158 MD Limeade 1.00 3.18 3.18 0.00 3.18 0.00 0.04
144 30050 Milk 2.00 1.59 3.18 0.00 3.18 0.00 0.04
145 20152 Cheese Potat 1.00 3.02 3.02 0.00 3.02 0.00 0.04
146 31250 English Hot T 3.00 0.99 2.97 0.00 2.97 0.00 0.04
147 21500 Strwbry&Blub 2.00 1.39 2.78 0.00 2.78 0.00 0.03
148 29079 MD Green Te 1.00 2.74 2.74 0.00 2.74 0.00 0.03
149 72001 American\nCh 9.00 0.30 2.70 0.00 2.70 0.00 0.03
150 29076 LG Green Tea 1.00 2.69 2.69 0.00 2.69 0.00 0.03
151 17308 Side Salad 2.00 1.34 2.68 0.00 2.68 0.00 0.03
152 11450 Homestyle Wr 2.00 33 2.66 0.00 2.66 0.00 0.03
153 78150 �1dd Grilled 1.00 2.59- 2.50 0.00 2.50 0.00 0.03
154 29075 MD Green Te 1.00 2.39 2.39 0.00 2.39 0.00 0.03
155 27230 LG Iced Tea 0 2.29 2.29 0.00 2.29 0.00 0.03
156 12656 Grilled Wrap 1.�0 2.18 2.18 0.00 2.18 0.00 0.03
157 30021 HK Fruit Punc 2.00' 1.06 2.12 0.00 2.12 0.00 0.03
158 30020 HK Fruit Punc 2.00 0.99 1.98 0.00 1.98 0.00 0.02
159 30026 Choc Milk 2.00 0.98 1.96 0.00 1.96 0.00 0.02
3153-DMC-Fashion Food-3153 554 Route 132 PMIX Report - All Terminals Page 1 of 4
Hyannis,MA 02601 07/09/201 8 07/10/2018-- 2:47 PM
14.2.32.0
Printed by:Tracey Rudlin
A .
Revenue Centers Selected:ALL
Item Num Price Food %
Rank Category Num Item Name Sold Sold Amount Cost Profit Cost% Sales
1 FOOD 21151 Small Fries 385.0 1.30 499.56 0.00 499.56 0.00 6.03
2 10150 Double Chees 89.00 5.61 499.02 0.00 499.02 0.00 6.02
3 10200 Single Chees 101.0 4.49 453.95 0.00 453.95 0.00 5.48
4 21201 Medium Fries 168.0 2.13 357.26 0.00 357.26 0.00 4.31
5 26828 CMB SM FRS 308.0 1.16 355.95 0.00 355.95 0.00 4.29
6 10025 Bcntr Double 54.00 6.40 345.66 0.00 345.66 0.00 4.17
7 10300 JBC 216.0 1.51 325.32 0.00 325.32 0.00 3.92
8 11500 Spicy Chicken 63.00 4.69 295.31 0.00 295.31 0.00 3.56
9 26830 CMB MD FRS 133.0 1.77 235.44 0.00 235.44 0.00 2.84
10 14150 10 pc Nugget 68.00 2.93 198.95 0.00 198.95 0.00 2.40
11 20510 4 pc Nuggets 311.0 0.61 188.91 0.00 188.91 0.00 2.28
12 21251 Large Fries 69.00 2.45 168.84 0.00 168.84 0.00 2.04
13 11400 Homestyle 34.00 4.80 163.12 0.00 163.12 0.00 1.97
14 10060 Son Baconato 33.00 4.75 156.89 0.00 156.89 0.00 1.89
15 21150 Small Fries 80.00 1.89 151.20 0.00 151.20 0.00 1.82
16 11215 Home Asiago 26.00 5.42 140.88 0.00 140.88 0.00 1.70
17 17675 SW Avocado ,9 6.69 133.80 0.00 133.80 0.00 1.61
18 26835 CMB LG FRS 5 2.11 116.21 0.00 116.21 0.00 1.40
19 17440 Berry Burst FL 17.00° 6.79 115.43 0.00 115.43 0.00 1.39
20 21200 Medium Fries 0' 2.29 112.21 0.00 112.21 0.00 1.35
21 10175 Double Stack 65.00 1.72 111.52 0.00 111.52 0.00 1.35
22 12724 6 PC Tenders 16.00 6.31 101.03 0.00 101.03 0.00 1.22
23 11601 Buff Rnch Ch 94.00 1.00 94.00 0.00 94.00 0.00 1.13
24 11300 Crispy Chk 76.00 1.15 87.37 0.00 87.37 0.00 1.05
25 10375 Jr Cheesebur 74.00 1.15 84.92 0.00 84.92 0.00 1.02
26 21250 Large Fries 31.00 2.69 83.39 0.00 83.39 0.00 1.01
27 21351 LG Chili 33.00 2.49 82.17 0.00 82.17 0.00 0.99
28 17450 ApplePecanF (IM 6.69 80.28 0.00 80.28 0.00 0.97
29 10400 Jr Chz Deluxe 55.00 1.46 80.14 0.00 80.14 0.00 0.97
30 29068 SM Stwbry Le 39.00 2.04 79.39 0.00 79.39 0.00 0.96
31 12716 4 PC Tenders 20.00 3.91 78.16 0.00 78.16 0.00 0.94
32 22045 Baconator Fri 28.00 2.59 72.52 0.00 72.52 0.00 0.87
33 11350 BLT Crispy C 61.00 1.18 71.88 0.00 71.88 0.00 0.87
34 26810 SM FREESTY 41.00 1.69 69.29 0.00 69.29 0.00 0.84
35 14052 6 pc Nuggets 35.00 1.89 66.15 0.00 66.15 0.00 0.80
36 11550 Spicy Wrap 280 2.26 63.16 0.00 63.16 0.00 0.76
37 17455 AppPecan Hal 3.0 4.69 60.97 0.00 60.97 0.00 0.74
38 24070 SM Choc Fros 4 1.39 59.77 0.00 59.77 0.00 0.72
39 11404 Grilled Chicke 1.2.00 4.95 59.37 0.00 59.37 0.00 0.72
40 17442 Berry Burst H 1 4.79 57.48 0.00 57.48 0.00 0.69
41 26815 MD FREESTY 30.00 1.89 56.70 0.00 56.70 0.00 0.68
42 21303 SM Chili 29.00 1.89 54.81 0.00 54.81 0.00 0.66
43 12715 3 PC Tenders 19.00 2.86 54.36 0.00 54.36 0.00 0.66
r
44 17460 SpicyCaesarF 8.00 6.69 53.52 0.00 53.52 0.00 0.65
45 10250 Triple Cheese 8.00 6.34 50.70 0.00 50.70 0.00 0.61
46 24090 LG Choc Fros 20.00 2.49 49.80 0.00 49.80 0.00 0.60
47 17677- SW Avocado 10.00-- 4.69 46.90 0.00 46.90 0.00 0.57
48 22046 Baconator Fri 0 2.51 42.69 0.00 42.69 0.00 0.51
49 24120- SM Van Frost 30.00 1.39 41.70 0.00 41.70 0.00 0.50
50 19050 Kids Nuggets 17.00 2.34 39.74 0.00 39.74 0.00 0.48
51 24080 MD Choc Fros 21.00 1.89 39.69 0.00 39.69 0.00 0.48
554 Roue 13 Fashion Food-3153 P A I V Report - /�All Terminals Page : Of 4
Hyannis,MA 02601 f_tVt /� R 07/09/20�$ 07/10/2018 2:4. PM
14.2.32.0
Printed by:Tracey Rudlin
Y�
Item Num Price Food %
Rank Category Num Item Name Sold Sold Amount Cost Profit Cost% Sales
52 24129 MD Van Frost 21.00 1.89 39.69 0.00 39.69 0.00 0.48
53 14051 4 pc Nuggets 30.00 1.29 38.70 0.00 38.70 0.00 0.47
54 26820 LG FREESTY 16.00 2.29 36.64 0.00 36.64 0.00 0.44
55 17462 SpcyCaesar H 8.00 4.49 35.92 0.00 35.92 0.00 0.43
56 29069 MD Stwbry Le 10.00 3.23 32.28 0.00 32.28 0.00 0.39
57 21125 Junior Fries 24.00 1.29 30.96 0.00 30.96 0.00 0.37
58 29064 SM Stwbry Le 12.00 2.29 27.48 0.00 27.48 0.00 0.33
59 27295 SM Natl Lemo 16.00 1.62 25.99 0.00 25.99 0.00 0.31
60 17660 Taco Salad F 4.00 6.39 25.56 0.00 25.56 0.00 0.31
61 12650 Grilled Wrap 0 1.80 25.26 0.00 25.26 0.00 0.30
62 29065 MD Stwbry Le 9.00 2.79 25.11 0.00 25.11 0.00 0.30
63 17307 Side Salad 14.00 1.79 25.06 0.00 25.06 0.00 0.30
64 23010 Choc Chnk C 23.00 0.99 22.77 0.00 22.77 0.00 0.27
65 13000 Fish 5.00 4.27 21.36 0.00 21.36 0.00 0.26
66 20050 Bacon Chz Po 7.00 2.99 20.93 0.00 20.93 0.00 0.25
67 10450 Jr Hamburger 17.00 1.19 20.23 0.00 20.23 0.00 0.24
68 24071 SM Choc Fros 19.00 1.04 19.71 0.00 19.71 0.00 0.24
69 20350 SrCrm&Chv 12.00 1.59 19.08 0.00 19.08 0.00 0.23
70 30002 Bottled Water 13.00 1.41 18.31 0.00 18.31 0.00 0.22
71 22022 Chili Chz Fry 6.00 2.86 17.14 0.00 17.14 0.00 0.21
72 11205 Spicy Asiago 3.00 5.50 16.51 0.00 16.51 0.00 0.20
73 29066 LG Stwbry Le 5.00 3.29 16.45 0.00 16.45 0.00 0.20
74 11263 SW Grilled 3.00 5.33 15.99 0.00 15.99 0.00 0.19
75 29118 MD Cherry Te 5.00 3.10 15.51 0.00 15.51 0.00 0.19
76 24050 JR Choc Frost 16.00 0.95 15.20 0.00 15.20 0.00 0.18
77 22021 Chili Chz Fry 5.00 2.99 14.95 0.00 14.95 0.00 .0.18
78 29113 MD StrawMel 4.00 3.14 12.54 0.00 12.54 0.00 0.15
79 24139 LG Van Frosty 5.00 2.49 12.45 0.00 12.45 0.00 0.15
80 27296 MD Natl Lemo 5.00 2.44 12.18 0.00 12.18 0.00 0.15
81 27287 SM Natl Lemo 6.00 1.99 11.94 0.00 11.94 0.00 0.14
82 20300 Plain Potato 7.00 1.59 11.13 0.00 11.13 0.00 0.13
83 20052 Bacon Chz Po 4.00 2.73 10.91 0.00 10.91 0.00 0.13
84 29157 SM Limeade 5.00 2.18 10.90 0.00 10.90 0.00 0.13
85 27277 SM Iced Tea 8.00 1.34 10.74 0.00 10.74 0.00 0.13
86 17054 Side Caesar 6.00 1.79 10.74 0.00 10.74 0.00 0.13
87 11262 SW Homestyl 2.00 5.28 10.56 0.00 10.56 0.00 0.13
88 11261 SW Spicy 2.00 5.28 10.56 0.00 10.56 0.00 0.13
89 30001 Bottled Water 6.00 1.69 10.14 0.00 10.14 0.00 0.12
90 30022 HK Fruit Punc• 12.00 0.82 9.85 0.00 9.85 0.00 0.12
91 27288 MD Natl Lemo 4.00 2.39 9.56 0.00 9.56 0.00 0.12
92 17661 Taco Salad H 2.00 4.69 9.38 0.00 9.38 0.00 0.11
93 29153 SM Limeade 4.00 2.29 9.16 0.00 9.16 0.00 0.11
94 78070 Bacon 3pc 9.00 1.00 9.00 0.00 9.00 0.00 0.11
95 20100 BroccoliChz P 3.00 2.99 8.97 0.00 8.97 0.00 0.11
96 27.297 LG Natl Lemo 3.00 2.97 8.91 0.00 8.91 0.00 0.11
97 29112 SM StrawMel 5.00 . 1.77 8.84 0.00 8.84 0.00 0.11
98 13005 Fish Cheese 2.00 4.39 8.77 0.00 8.77 0.00 0.11
99 30308 SM Plain Iced 5.00 1.69 8.45 0.00 8.45 0.00 0.10
100 29154 MD Limeade 3.00 2.79 8.37 0.00 8.37 0.00 0.10
101 27289 LG Natl Lemo 3.00 2.79 8.37 0.00 8.37 0.00 0.10
102 24121 SM Van Frost 8.00 1.02 8.18 0.00 8.18 0.00 0.10
103 29111 MD StrawMel 3.00 2.69 8.07 0.00 8.07 0.00 0.10
104 12720 Kids 2PC Ten 4.00 2.01 8.03 0.00 8.03 0.00 0.10
105 29074 SM Green Te 4.00 1.99 7.96 0.00 7.96 0.00 0.10
Superiors Brand Meats
RC Sugardale Foods
January 5, 2015
To: Larry Burke, Wendy's Quality Assurance
From: Bill Eisel, Fresh Mark Technical Services
Wendy's Applewood Bacon cooking procedure of placing half slices on baking sheets in
the Wendy's Oven for minimum of 9 minutes on medium (350 degrees) results is a shelf
stable bacon product.
Data was collected on Wendy's Applewood Bacon cooked in the Fresh Mark Massillon
QA Lab using the above Wendy's procedure in an actual Wendy's restaurant oven.
• Bacon Temperature reached ranged from 280 F to 305 F.
• Water Activity ranged from .51 to .84
These parameters meet the shelf stable classification. The bacon was cooked to a
temperature resulting in a lethality treatment that meets USDA Appendix A requirements
and provides a water activity of not more than 0.84, which is more stringent than USDA
published limits (0.92) for shelf stability of even higher risk products.
Please contact me if you have any questions.
t
1888 Southway, S.E. • P.O. Box 571 • Massillon, Ohio 44646.330.832-7491
G
s
Town of Barnstableoi,,,ys,&
9 $ Board of Health
r'`� fa Mai 206 Main Street, Hyannis MA 02601 C�Z y � 2007
Office: 508-8624644 Wayne Miller,M:D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
November 24, 2014
Mr. Robert Goldman and
Mr. Usama Elsehraway
Wendy's Restaurant
554 lyannough Road
Hyannis, MA 02601
RE Uanan:ce to Operate with Two;Restroorn Facilities Wendy's Restaurant
Dear Mr. Marion,
You are granted a variance to construct two toilet facilities to be shared by patrons and
employees at Wendy's Restaurant, 554 lyannough Road, Hyannis.
The variance granted is as follows:
Section 322-4 Toilet Facilities To construct two restrooms to be shared by patrons
and employees, in lieu of the requirement to provide separate employees' male and
female toilet. facilities and separate patrons' male and female toilet facilities whenever
more than 50 seats are provided.
The applicant testified that there is no additional space within the existing building layout
to construct additional. bathrooms. The two new restrooms will be much larger replacing
the original two, and will be constructed in conformance with ADA requirements. The
new bathrooms will consist of separate stalls within each bathroom. Also, the number
of seats will be reduced from 92 to 65 during the renovation. Although this is
considered a major renovation, the number of seats will be significantly reduced and the
existing building layout will remain the same. There haven't been any complaints in
regards to the restrooms at this location in the past. Therefore based upon all of the
above, the Board is of the opinion that this variance should be granted.
LC
ncer ly yours,
ayne Miller, M.D.
hairman
Q:\WPFILES\WendysToiletVariance2Ol4.doc
;ioA
,� 1
DATE:
FEE: q
1�' + BARNSTABLE, �
MASS. /
1639.A�� REC. BY — ✓'�f��d�r
" Town of Barnstable
SCHED. DATE:
Board of Health
206 Main Street, Hyannis MA 02601
Office: 508-862-4644 Wayne A.Miller,M.D.
FAX: 508-790-6304 Junichi Sawayanagi
rr bilk,
J.Canniff,D.M.D.
l � VARIANCE REQUEST FORM
LOCATION to,-
5 , � Q
Property Address: C�VY1 N 1 S
Assessor's Map and Parcel Number: 10Size of Lot: l�
n
Wetlands Within 300 Ft. Yes Business Name: lJ�� 1.5 ,(,t,,,�Q4�4
iiN,,o— f�Q�Z Subdivision Name: )
APPLICANT'S NAME: l SO-I '� Phone ,q3 q—
Did the owner of the property authorize you to represent him or hert Yes No
PROPERTY OWNER'S NAME lQ CONTACT PERSON
Name: .� � � ti `liW Name:
Address: Address:
Phone: <° Phone: e�
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
w t ec
NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑
Checklist (to be completed by office staff-person receiving variance request application)
Please submit copies in 4 separate completed sets.
_ Four(4)copies of the completed variance request form
— Four(4)copies of engineered plan submitted(e.g.septic system plans)
— Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian
— Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
— Signed letter stating that the property owner authorized you to represent him/her for this request -
- Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title
V and/or local sewage regulation variances only)
_ Full menu submitted(for grease trap variance requests only)
Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only],
outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the
building proposed])
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Wayne Miller,Chairman
NOT APPROVED Junichi Sawayanagi
REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet
Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC
October 29 2014
J
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Town of Barnstable—Public Health Division
200 Main St
Hyannis, MA 02601
Re: Wendy's Renovations
554 lyannough Rd
Hyannis, MA
Variance Request—Reason for Variance
To Whom It May Concern:
This restaurant was constructed prior to this requirement—Article 1 of town code#322-4. As art of this
P q p
remodel, we are actually reducing the seating capacity, thus reducing occupant load (we are still over 50).
During peak operating times (12:00 pm to 1:30 pm), our dining room is only at approximately 60%
maximum occupancy, and 64% of all business to this restaurant is from drive-thru customers. This
remodel includes completing remodeling our current restrooms, bringing them up to accessible standards,
which is taking up more square footage than the current existing toilet rooms. Providing an employee
facility is not feasible given our operation need for storage and food prep area. Currently, the staff is
required to wash their hands every time they enter the kitchen area. The manager monitors this, and it
would be difficult to monitor hand washing in a remote toilet room.We therefore respectively request a
waiver from this regulation and believe our current condition provides proper sanitization standards.
Sincerely,
Usama EI-Sehraway
508-237-7717
o 2-6 3z
i
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WOMEN
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THE COMMONWEALTH OF MASS CHUSETTS
BOARD,,,OF HEALTH G�.W ,,,,�,,A . _ Y J 77.
CJLtJ/� 0F....Xc I MI.G- .......................................
Appliratiun -fur Uiipuutt1 Workii Cnunutrnrtiun PPrutit
Application is herebymade for a Permit to Construct ( A or Repair (X an Individual Sewage Disposal
System at
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ocation.Addreo.
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..........
1 o -- •-•------•----- - ....
O�wyner -•••-------•----•--..•..------Ad ress
W {/-�-5-•. --•------•--- --•-•----------•---------------------------
6" Installer Address
U Type of Building Size Lot..3 2.v0 0....Sq. feet�--
�-, Dwelling—No. of Bedroom__.._.... �____________________Expansion Attic ( ) Garbage Grinder ( )
PL4 Other ' Type of Building .--_ 71?�?............ No. of persons..._.....``..A--........ Showers ( ) — Cafeteria ( )
a' Other fixtures -__
¢ "0 ------------------------------------ --------•---•------------------------..._..........---....--------------..._------........------
W Design Flow'..�� ........gallons per person per day. Total daily flow------- ---.-..--.---gallons.
WSeptic Tank—Liquid capacity ____gallons Length...<_7.-.... Width-----9..._.. Diameter................ Depth----------------
x Disposal Trench—No- ____________________ Width..--_---__--__--_--- Total Length....... Total leaching area--------------------sq. ft.
Seepage Pit No . Diameter........ r......-- dal----- Depth below inlet........F....... Total leaching are, ___&.a16_sq. ft.
Z Other Distribution box (,A) Dosing tank ( )
Percolation Test Results Performed by _____________ '9'd��` 7
o Date------------- - - - --- --- -._..
Test Pit No. L:..-�.._____-minutes per inch Depth of Test Pit.....6......: Depth to ground water.---�AFZyMd
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
9 ---------------------------- •---•-•-•----••---------•-----------•...--•-••---•••----------------------------------------------------
O Description of Soil------i��AU Y 06-7— = _T.
x - -------•------------------••--•-------•------•---•-••-----
U -------------------•-•----------------------------------------------------------------------------------•---------------------- ----------------------------------------- - ---
W ---L(i�l� ��------------------- ---------------------- ------•------•----•------------------•
x A*
U Nature of Repairs or Alterations—Answer when applicable.............. ------- ----------------- �-----..._.__-.-.---.-___..
----------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedes i ndividual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitar, Cod e undersigned further agrees not to place the'system in
operation until a Certificate of Compliance has e i y he]ward of health.
(
Signed --- --------------•---- ------------------------------------------------------
---------- ---------------------
Date
ApplicationApproved BY � = ------------------ -------------------------------------- ---------------• ... --------------
Date
Application Disapproved for the ollowing reasons-------------------•-----.._._...-----------------._._.......----------------------------------------------------
--__- E -------- - - � ------------------- � --------------
)41
PermitNo. .y! ... ............. Issued.---•----------------- .................................
Date
_ __1__ Ito
-No..*,
-No > .ire-' „ `' 1�' f ; "EE...1,/.. •h. ,'`
..
THE COMMO.NWEALT:H OE 'MASS CHUSETTS �-
-BOARD P�HEALTH
ppliration 'fnr' Uiii nottl lgoikii Toulltr rt��gt Pr��it
iIN it
Q
Agplicafion is hereby made for a Permit to Construct ( or Repair ( an Individual Sewage Disposal
System at
v
..._....--•-•-• - - -- -
oeation- re / Lot o
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.•'". .........
' �`_ caner � Add ess, -
a --- -- --- --- ..=----•-- .. .._.... ------------------------------ ----- --- ------
eo. Installer � ; Address y ;
l 60,___Sq. feet Q Type of Building � - - • � � ,Size Lot. _- ¢- ,
U Dwelling—, No.—No. of Bedroom Ex ansion Attic Garbage Grinder
a g P ( ) g ( ),
p, Other Type of Building No. of persons......L-9�-------_ Showers ( ) — Cafeteria (s
Wp, ;Other fixtures ----',.- ------ ----------------------------------------- ----------------- - s...................
Design Flow..` -- ..-gallons per person er day. Total dail 'flow .. '. - --.-.-gallon
WSeptic ank—Liquid- capacity!,.gallons Length_=��-__-_- Width.. _-. ..... Diameter---.- ------ Depth:_ --.-.
x Disposal Trench No. ...:................ Width -..---- Total Length--_.__-._ - Total leaching area..... ;_� sq ft.
3 Seepage Pit Noa-_:-... :.-._._ Diameter._--_ �---- Depth below inlet-....:.. ._.-___ Total'ieaching area. - sq ft:
Z Other Distribution box O Dosing tank
Percolation Test Results Performed,by. } '�'f f
d"--; ---=------- Date-- '
Test Pit No. 1---- -__-minutes per inch Depth of "hest Pit..-- __-,-. Depth to ground water-,.. - boA#40
f� T' st Pit No. 2................minutes per.,inch Depth 'of Test Pit,...................... Depth to ground water--.--.---_-_--.-----. -
`
O Description of Soil------= - - !� '"*--� ---------- ----- -I- ---C - ------- - ---
V - `---------------- -..-
W P_..... rs s i
U p' when applicable - .�+�^`'r" ..............
- ;r -:.y
Naure of Repairs or Alterations--Answer
-•----------------------------- - -- j---------------- --------- -----•-------------------------•------ --------
Agreement:
tle undersigned agrees to install the aforedesc r'' ydividual Sewage Disposal System in accordanEwith
the provisions of Article XI of the State Sanitar, Cod e.undersigned further agrees not to place the system in
operation until a Certificate of Compliance has e i y the�oar`d;of health aY <
Signed.....- .. I,,t :. x'"`^ ,
J --- ---- g.
A G
- ,w
ApplicatiorYa+ApBroed BY k,
- ....:.:. ...... .....
r
„ t Dater s
Application Disapproved for the (1011owing reasons-------------........................................................ ---.--•- -------•- ------ -------
.•.-..•....--•----------•---•-------•---------------------------•._....-----------------------------•----------------------------------------------•---------------------------------------------------
Date
Q_ 2 7- 7 7. .
Permit No......� ---------- Issued----- --------------------------------= ,
Date -
u
<y THE COTMONWEALTHt-OF MASSACHUSETTS M
.�_ BOARD OF `HEALTH
OF..... .... ........ ...... . . ........ . .........................
Tntifiratr of f 1,11mplianrr
.� THI S TO C IFY Th e Individual Sewage Disposal System constructed O or'Repaired -( )
a. b �� -------------------------------- ------------------------------- ------
Y_•_
nst
$ �4 --I -,I�er ------- -•- J-......--- -
has been installed'in accordance with the revisions of Article XI-of The State Sanitary C de t. � p• ode as described in the
for Disposal Works Construction Permity'�10 -.: dated ---- .a_-------------------------------------
application
THE.4SWANCE OF THIS
CERTIFICATE SHALL IdOT`jBEWCONSTRUED AS A.,G�JARAPITt E THAT THE ; 'A
SYSTEM Hall L FUNCTION SATISFACTORY.
DATE . 2 2� 77 --- Inspector ... .. . y {`
THE COMMONWE4. TH OF MASSACHUSETTS -
BOARD OF° HEALTHe� '
X •
1GG rGC OF (r
No �---------•_.... FEE ----•-.
Permission is hereby granted ... ------------------------ ....................................................------------
to Construct ( ) or Repair ( ) an Individual'Sew age Qisposa} System
at No. l�X c r -
r T;e.; r Street . ,t xa ,t:, Ay
as shown on the application for Disposal Works Construction mit ...- '�...... Dated.... -_..'.� .....
tl
�.K.� oar o H -
f
DATE.-- ----�-�-�----�.... -----------------------------------
�
r �
r FORM 1255 HOBdS & WARREN. INC.. PUBLISHERS
-,ter I .;.t..: ! � ,. .� t �'�^+'''tA '�tZd"'�w"ly r7 J n.^�:dY', '�;•
y. t
ALAN W. JONES & ASSOCIATES
CONSULTING ENGINEERS
6 CARLETON DRIVE WEST
EAST SANDWICH, MASS.02537
TELEPHONE 888-3154
26 September 1977
Board of Health
Town of Barnstable
Town Hall
Main Street
Hyannis, Mass.
Res Wendy's Restaurant
Iyanough Rd. & Barnstable
Rd. , Hyannis, Mass.
Gentlemen:
This is to certify that the sewage disposal system for
the subject project was installed in accordance with the
design drawing #76181 prepared by Baxter and Nye, Inc. ,
Land Surveyors, Osterville, Mass. , dated 6/3/77 and
revised 8/30/77. .
Your ruly,
AWJspmj Alan W. J es
ccs Baxter and Nye, Inc.
I
c• 341,
/3 7
7
6975 CONSTITUTION PLACE • WORTHINGTON, OHIO 43085 • (614) 846-5017
May 4, 1977
Mr. Fred DeFeo
Department of Environmental Quality Engineering
Southeast Region
Lakeville Hospital
Lakeville, Massachusetts 02346
Re: Septic Tank Capacity
• Wendy' s Old Fashioned Hamburgers/Hyannis
Dear Mr. DeFeo:
In response to our recent telephone conversation, I have taken weekend
water meter readings at a very successful Wendy' s Restaurant located
at 2226 Henderson Road, Columbus, Ohio. Incidently, this store was
one of the three stores that Mr. Sherowski of Wendy' s International ,
Inc. used in computing the average water consumption; it is one of the
higher volume stores in the Wendy' s operation.
Water meter readings were taken as follows:
Friday, April 29, 1977 8:15 a.m. Meter Reading: 2084 .88
Monday, May 2 , 1977 8 : 35 a.m. Meter Reading: 2089 . 76
4 . 88 x 100 CF
488 CF x 7.48 gal/CF f 3 days = 1216.7 gal/day
As you will note above, the water consumption per day over the weekend
was 1216. 7 gallons which compares with the company established average
of 650 gallons per day. We have alluded to the company established.
average of 650 per day and believe the weekend numbers are consistent
with that average. While the company has requested that their sales
volume remain confidential, we did compare their weekend sales volume
with their average sales. We found the weekend water consumption to be
reasonably' consistent and proportional to sales.
Mr. Sherowski, who is Vice President of Engineering . for Wendy's Inter-
national, has .further analyzed their water consumption and determined
that 55% of their water consumption is consumed in making of ice, soft
drinks, and miscellaneous uses with 45% of the water consumption resulting
in sewage discharge.
Our purpose in writing this letter is to, hopefully, reduce the
size of the septic tank required for Hyannis and offer the following
comparisons for your review:
f
t[t
S
' 1
S
r
Mr. Fred DeFeo -2 May 4, 1977
Existing Formula
92 seats x 35 gal/seat x 1.5 (retention factor) = 483Q gallons (required septic
system capacity)
Using Wendy's Average Consumption
650 GPD x .45 (discharge factor) x 2.0 (for design flout x 1.5 (retention factor) _
877.5 gallons (required septic
system capacity)
Using Wendy's Actual Weekend Meter Readings
1216.7 GPD x .45 (discharge factor) x 1.5 (retention factor) = 821.3 gallons
(required septic
system capacity)
We are asking your approval for a 2 ,000 gallon septic system installation
based on the above data. This would accommodate a daily water consumption
of approximately 3,000 gallons when taking the 45% discharge factor into
consideration along with a 36-hour retention time.
As a further consideration when comparing Wendy 's water consumption with .
other fast food operations, we wish to call to your attention that the
nature of the operation contributes to the reduction of water consumption
i.e. the use of frozen french fries which requires no water in the
preparation process .
If you should have any questions regarding this letter or the data
contained herein, please feel free to contact me at (614) 846-5017.
Ye t 1 ly burs,
1 o n D. � arne-
Ohio Registered Profs ion, Engineer
JDB:d lm '
cc: Mr. Henry Sherowski
Mr. William Eagan
Mr. Kelley
��i�ltl4�_l+i l�t�•✓
'A'
n ` r
1 v
M
y
* •A _ - R. 'f' ,' '* � x �af- °'mow{` Zt.
March
14
Mr. William• Eagan
c/o Rene L° `P€sy nt Real' 'Estate `
° 79 Barnstable -Read S k
I yannie,r Massa att€�
Y - Dear. Mr. Eaqan tNY x x
a
The` Health -Department fill illow~'an Ron *slate �iewage system for
a Food :Service 4Establieh`aent; off .,cyan®ugh;R6.a -annis;
c��osite tie Red `Gaiach. rill with,the follow ng, conditi ons s `. .
Seating capacl. y .cannot exceed
Site must pass -pe�rec latiori tests and sewage pans
submitted °bar. a` Registered Engineer"mus meet¶ all
`•i® t Qua Y conta '.d+n T.7itlS,i v�., V.L.*.y hii i.4ate a -
Envikanmental,' , Code ;wind` To" of Barnstable,.Health
Regu lat i.bne;:
• �Sewage.,stub must be provided" for conneetsan'LLwhen
Townr39eWt°x' is available.,,
EStabli.shment .must Gonn,eat 'to `'own°sewer. as on
,as; $t becaes =available°
} Very,truly, yours; . E
Jahn 'M Kelly r `
` Director of 'Public'Health
rZ
An
It
i
I
,
THE TO� TOWN OF BARNSTABLE
OFFICE OF
BAfl7-9TAM BOARD OF HEALTH
�00 163q. 397 MAIN STREET
HYANNIS, MASS. 02601
Date �� 1927
I agree as a condition of my Frozen Dessert License
to have my products tested bacteriologically on a monthly
basis by an approved laboratory.
I understand that if my products have a standard
plate count in excess of 50,000 bacteria or exceed 0 for
Coliform, I must obtain a re-test within seventy-two (72 )
hours. If the count exceeds 50,000 on the standard plate
count or over 0 on the Coliform I will stop the sale of
the contaminated product until counts are obtained that
fall within the prescribed limits.
In addition, I agree to conform to all of the State
Health regulations contained in Article X, of the State
Sanitary Code, and Town of Barnstable Health regulations
and understand that failure to do so will result in the
closing of my establishment.
Signature
Name of Establ shment
VU C t6(1P9'S
Witnessed: _!
CUSTOM WINDOW TRIM n P.U.W. CORNER & WALL TRIM GENERAL NOTES SEATING CHART EQUIPMENT & CONNECTIONS SITE NUMBER: 03153
�✓ BASE MODEL: 3076
m " I. 6.G.5HALL GOORDINATEREQUIREMENT5 OF MILLWORK,5PEGIALTIE5,EG JIPMENT, 3076 STANDARD IA DESCRIPTION OF EQUIPMENT REMARKS m m
'I^ AND FURNI5HIN65 WITH OWNER PRIOR TO 5TART OF WORK. W o ASSET TYPE: FRANCHISE
ye �• sz ULTRA—MODERN REMODEL QOr Z Q CLASSIFICATION: REMODEL
L11
;t — 2. ELEGTRIGAL 4 PLUMBING�REQUIREMENT5 FOR THE IN5TALLATION OF MILLWORK, � z
" 5PEGIALTIE5,EQUIPMENT,AND F"15HIN65 15 THE RE5PON51BILITY OF THE 6.G. STOOLS (WI-FI BAR)ES SETS OWNER: USAMA EL SEHRAWEY
CORNER T1ZIM
STANDARD L 4 A0200' BEVERAGE SYSTEM SELF—SERVE DINING ROOM (FREESTYLE) 0 0
3. EQUIPMENT L15TED 15 TO BE FURNISHED BY THE KITCHEN EQUIPMENT SUPPLIER
UNLESS NOTED OTHERV415E. 2 - TOP BOOTH 0 BASE VERSION: 2014 JULY 03 R1
2" 4. KITCHEN EQUIPMENT SUPPLIER PROVIOE5 LABOR FOR MRATIN6,A55EMBLY AND A0502 ICED TEA DISPENSER-ROUNDED FRONT (3 GALLLON) ES ES UPGRADE CLASSIFICATION:
5ETTIN6 OF EQUIPMENT. 4 = TOP BOOTH 4
L.�2 5 TOP BOOTH (ROUND) 5 CO20# SOAP DISPENSERS - CUSTOMER RESTROOM *OWNER TO VERIFY ACTUAL EQUIPMENT/MODEL TO BE USED 0 0 FRAN FLAG
5. KITCHEN EQUIPMENT SUPPLIER WILL 5UPPLY CRITICAL DIMEN510%,PLUMBIN6 AND
END WALL TRIM `r ELEGIRIGAL 5PEGIFIGATION5 FOR EQUIPMENT 5UPPLIED BY THE KITCHEN BANQUETTE 0 C030# TOWEL DISPENSER - CUSTOMER RESTROOM *OWNER TO VERIFY ACTUAL EQUIPMENT/MODEL TO BE USED 0 0 PROJECT YEAR: 2014
2x4 EQUIPMENT SUPPLIER
02" BANQUETTE "ISLAND" 16 C0401 NAPKIN DISPENSER ES ES FURNITURE PACKAGE: 2014
b. ELECTRICAL AND PLUMBIN6 GONTRAGTOR TO MAKE FINAL CONNECTION TO 2 TOP TABLE - LOW 8
EQUIPMENT
ALL CORNERS DESIGN BULLETINS: THRU DB 01
�2" I" 4 TOP TABLE — LOW 4 C1502' KETCHUP PUMP ES ES
CONTINUOUS WELD5 m 7I 1. 5EE INTERIOR ELEVATION5 FOR A�RTPACK GRAPHIC,LOGATION5. 2 TOP TABLE — HIGH 16 C1801 LID/STRAW DISPENSER ES ES
1 14
L— J S. 516NA6E TO BE 5UBMITTED UNDER 5EPARATE PERMIT.
END WALL MM ;r 5 TOP TABLE — FAMILY 5
2xb 4. THE GENERAL IS 5HALL PROVIDE A GONTIN6ENGY BID FOR WORK IN D0200 POS TERMINAL 0 0 I
2" L THE BACK OF HOU5E/KITGHEN AREA BEYOND THE 5GOPE OF TH15REMODEL LOUNGE CHAIRS 4 t
5HOWN ON THESE DOGUMENT5.COORDINATE ANWALL WORK BID,PROPOSED,OR
r
� 'REQUIRED WITH THE INENDY'S CONSTRUCTION 1<:E:RE5ENTATIVE PRIOR TO E1405 FRONT COUNTER ES ES
PURCHASING OR BEGINNING ANY WORK BEYOND THE LIMITED SCOPE SHOWN ON E4402' WIFI'BAR =KITCHEN EOUIP�IENT SUPPLIER TO VERIFY ACTUAL EQUIP ENT/MODEL/FINISH ES ES The Chesapeake Design Group
`�- THESE CON5TWTION DOGUMENT5. ro BE USED
Architects, Incorporated
2014 DINING TOTAL 66
Q u� LU 10. THE CONTRACTOR SHALL PROVIDE AND INSTALL SOLID P4000 BLOGKIN6 FOR L1130 STAINLESS STEEL CORNER TRIM STND "L" (99" LONG) SEE DETAIL "Lit' IN DETAIL 02/EQ1.1 ES GC
ALL WALL MOUTNED ITEMS,516NA6E,EQUIPMENT,MILLWORK,ETC.. COORDINATE ADA SEATING (X REQUIRED) 4
/ 18 6A. ' ' LOCATIONS WITH OWNER'S GON5TRUGTION'REPRE5ENTATIVE A5 NEGE55A1RY. LI#30 STAINLESS STEEL END WALL TRIM 2x4 (99" LONG) SEE DETAIL "L12" OR "L13" IN DETAIL 02/EQ1.1 ES GC 419 North Charles Street
5TAINLE55 STEEL ~ ORIGINAL DINING TOTAL
TYPICAL DOWN z — CORNER 6UA�RD rz LU
11. EXI5TIN6 EQUIPMENT TO REMIAN UNLE55 NOTED OTHERWISE. Baltimore, Maryland 21201
FEATHER N0202 CASH DROP BOX ES ES t: 410.837.3622 f: 410.837.3621
CU5TOM 5TAINLE55 5TEEL TRIM "-
MOUNT 5TAINLE55 w
Q01## REMOTE CONDENSING UNIT — DINING ROOM (ROOF) #KITCHEN EQUIPMENT SUPPLIER To VERIFY ACTUAL EQUIPIJEENr/�1ODEL/FlMSF1 ES ES
FOR DRIVE-THRU WINDOW UNIT TIGHT TO TO BE USED SEAL
Ul CONCRETE SLAB 4 Q02## ICE MACHINE - DINING ROOM *OUANTITY WILL VARY DEPENDING ON EXACT BEVERAGE SYSTEM)CONRGURAnoN ES ES
R0102 TRASH RECEPTACLE ES ES D ARr✓+�T
CORNER TRIM END WALL TRIM R0201 QUAD BOOTH WALL ES ES ��`' �S F�
NOTE: 55 STEEL GA5ED OPENING OF FULLY YELDED AND LII LI2/LI3
MITERED GORNER5,PROVIDED BY KE5,IN5TALLED R0302, CONDIMENT STAND (w/ DRAIN} ES ES c,
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BY G.G.,G.G.TO SHIM OPENING AS'REQUhRED. R04s1 SELF SERVE CHASE ASSEMBLY I _ ES ES .7i?47
cv R0503i LOUNGE CHAIR ES ES t d "LTID E
NOTE: SUPPLIED BY OWNER ,
R0505' CHAIR — STANDARD HEIGHT 'e ES ES
R0506 CHAIR — CAFE HEIGHT ES ES �C7HOF°AI'�'�'�
R1116 BOOTH WALL — STANDARD E5 ES
R1202 CANTILEVER BRACKET FOR TABLES ES ES
R1301 SINGLE BOOTH (23"x42") ES ES PROFESSIONAL CERTIFICATION:
R1302 SINGLE BOOTH w/ FINISHED BACK (23"x42") ES ES I HEREBY CERTIFY THAT THESE
R1321 DOUBLE BOOTH (44-1/2"x42') ES ES DOCUMENTS WERE PREPARED OR
APPROVED BY ME, AND THAT
R1352 CORNER BOOTH (w/o SINGLE BOOTH ATTACHED) ES ES AWN A DULY LICENSED ARCHITECT
R1603 HIGH CHAIRS ES ES UNDER THE LAWS OF THE STATE
OF MA
R1705 BOOSTER CHAIR ES ES
LICENSE N0. 7647
R1802 CHANGING TABLE ES ES EXPIRATION DATE 8/31/15
R1901 TABLE BASE(30'x3O') — STANDARD HEIGHT ES ES
TANKLE55 R1902' TABLE BASE (22"x22") STANDARD HEIGHT ES ES
NATE'R HEATER R1903 TABLE BASE (20%20") — LOUNGE TABLE ES ES O
R1904 TABLE BASE (22"X22') - BAR HEIGHT ES ES PROJECT TYPE:
76
00 0 o R1906' TABLE BASE (HANDICAP) — STANDARD HEIGHT 2 BASES REQUIRED PER TABLE ES ES REMODEL
METER5�BR615ER5
GEYGLE G EANIN o R1907' TABLE BASE (36%36") STANDARD HEIGHT ES ES
TANK ISPEN5ER5 R2008 TABLE TOP 22"x42" (w/4 EASED CORNERS) LAMINATE ES ES
SUPPORT 5INK MOP
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1�AGK 103 VESTIBULE TABLE TOP 22"x42" — CORIAN ES ES
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R1�05 R2014'
WATEiZ DRINK � WOMEN'S •
5Y5TEM N IOIA R20J8 a 1 R2103 TABLE TOP 36" ROUND CORIAN ES ES
" R'902 R2105 TABLE TOP 24" ROUND CUPPED '= LAMINATE ES ES
R'202 Q
R2106 TABLE TOP 36" ROUND — LAMINATE ES ES
R'32'
U050# DIGITAL MENU BOARDS *OWNER TO VERIFY ACTUAL EQUIPMENT/MODEL TO BE USED 0 0
OFFICE i CORRIDOR R�01- �A R3505 U050# DIGITAL QUEUING BOARDS *OWNER TO VERIFY ACTUAL EQUIPMENT/MODEL TO BE USED 0 0
GENTER L_ DRY STO IOIG R20J8 ON ROOF U060 *OWNER TO VERIFY ACTUAL EQUIPMENT/MODEL TO BE USED 0 0
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