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HomeMy WebLinkAboutFOUR SEASONS TRATTORIA - FOOD Four Seasons Trattoria 700.Main St. Hyannis e FORMERLY DINA'S FORMERLY KNOWN BISTRO DE SOLEIL . \ ƒ \ � { \ { { / \ \ / � i� ƒ` � }\ }} .¢ Town of Barnstable BOARD OF HEALTH John T. Norman raY Board of Health Donald A.Gaudagnoli,M.D. RARN rABLL F.P.(Thomas)Lee,. P MASA, Daniel Luczkow,M.D. Alt. 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: 252 Issue Date: 01/01/2022 DBA. FOUR SEASONS TRATTORIA OWNER: FOUR SEASONS TRATTORIA HYANNIS INC. Location of Establishment: 700 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 77 OutdoorSeating: 0 Total Seating: 77 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: G. FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: ep Initials: �W'°�'� Town of Barnstable For OM Date Paid lI 15- Amt PA$ _ ,AR,,AM. : Inspectional Services v Mass' Check# (Ol0 l �p i63� Public Health Division Tfn Ma+ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 / Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL �� NAME OF FOOD ESTABLISHMENT: (our Soy � ( ri L�,_ Oy►c1 k yclv"' J` .7()U rn� O ��� �� S s lI y 1 Clvt ki i X ri D Z p ' S � ADDRESS OF FOOD ESTABLISHMENT:�� ,tom I C MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 5_Ym (? E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: CEpb) l- Fees TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 77 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. ,n 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) l 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 1 ,. ra ,.J r OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO D.O.B ff OWNER PHONE I# I 1 LI tq (19 b ADDRESS �j112��.( ICAO CO/�PV` Q✓ n�Ok'I blab} OZ�� CORPORATE OWNER: (fur S C, V\. ecyvt�-- V1 Vl I A e- CORPORATE ADDRESS: --�(> 'K e PERSON IN CHARGE OF DAILY OPERATIONS: P-ed co Ca<;- )`(e4c List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. a(4 e ( TeyKAq vL 2-2 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). 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.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FortnsTOODAPP REV3-2019.doc 1 r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. �a Paul J.Canniff,D.M.D. MA F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; CI-apter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 252 Issue Date: 01/01/2021 DBA: FOUR SEASONS TRATTORIA OWNER: FOUR SEASONS TRATTORIA HYANNIS INC. Location of Establishment: 700 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 77 OutdoorSeating: 0 Total Seating: 77 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use Only: Initials: �t"�'°yti� Town of Barnstable �� � Date Paid � AmI�SI$ = ,,CAB Inspectional Services f_ ( J ' ``� Public Health Division Check# ,�IU Cam a ArFD Mpl s i """" Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE �� NEW OWNS HIP RENEWAL NAME OF FOOD ESTABLISHMENT: �Lur S�1So�,� 1'�M� bYia vtn' ' , R� ADDRESS OF FOOD ESTABLISHMENT: a-54-0- Szp--J�•S rJ00 �VVU�A7�r-kl ""aAj " MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �QWY1 P E-MAIL ADDRESS:�AU r .I-C S oN,S '�Vo Kyi 1�9 F-J, (M\l C + Coy TELEPHONE NUMBER OF FOOD ESTABLISHMENT: lQJ 2Y-BLS .X TOTAL NUMBER OF BATHROOMS: _ WELL WATER:YES vlNO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTU LLER'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? \rP� IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? le-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 FonnsTOODAPP 2020.doc j OWNER INFORMATION: / ,_0,_ FULL NAME OF APPLICANT 1a) �ZS r 4 M _ l� t,�,oY 10, Cl n h1pS SOLE OWNER: YES NO D.O.B OWNER PHONE# T 7"1 ^2-06— l2 `�iO Oe ADDRESS ( 6 t Vj, C Y Uk Lone 0(.Q,;'f L a r/✓t.D 4 14 CORPORATE OWNER: M aliU.Ld fiy---tcmJe,?— CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: jV� Sl►'1 �' ' 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 I. -PeAY0 GAIh do,, �� 07 2c� °�i. �e� e�{lorc{ f! 0 `7 zZ VV 2.Mo;n.uej ( 6 1 o?z W0) SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc r f BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMSTAoU& Paul J.Canniff,D.M.D. esa 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 252 Issue Date: 12/10/2019 DBA: FOUR SEASONS TRATTORIA OWNER: FOUR SEASONS TRATTORIA HYANNIS INC. Location of Establishment: 700 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 77 OutdoorSeating: 0 Total Seating: 77 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gi FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: .� Town of Barnstable • Initials: Date Paia 1 i 1 �$ < BABNSTABLE, : Inspectional Services Public Health Division Thomas McKean,Director x 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 " i �A+PiPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1� 1-1q NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: IVUK ��s � ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF IFFERENT FROM ABOVE): Is � �1�►Lrl`5 E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** 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 D'O'OR(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:1Application FormsWOODAPP 2020.doc ^l � t OWNER INFORMATION: ,�/ FULL NAME OF APPLICANT /"(.imptae C jel'14 Ck Vt LZ SOLE OWNER: YES//NO D.O.B �l—� 75-OWNER PHONE# 177cf-W8 '1 ZU ADDRESS r"to C y I-t-Ot L ('j �' Q��►'l t� !. � l� � CORPORATE OWNER lt;e: P C Q0 CORPORATE ADDRESS: ffyCIAY) S �.x.�--'' U1A0 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. II`(6utit�l �ef^oLvj�e7 r / l 2 Z 1. �Yo 9e0b/d / o 7 /2 ZS3E 2.?C Y0 -92(?CLQY� t ( / D 7 / 7 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 openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). 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 I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsWOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. t 13A MULF John T. Norman i MAS& F.P. Thomas Lee Alternate 6�,9. , 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: 252 Issue Date: 12/20/18 DBA: FOUR SEASONS TRATTORIA OWNER: MANUEL FERNANDEZ Location of Establishment: 700 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IncloorSeating: 77 OutcloorSeating: 0 Total Seating: 77 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: --- - - - - MOBILE- FOOD: MOBILE-ICE CREAM: QAt1�v� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE 4 Restrictions: I PERMIT NO: TOWN OF BARNSTABLE 11/01/2018 252 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter III,Section 5 of the General Laws,a permit is hereby granted to: MANUEL FERNANDEZ D/B/A: FOUR SEASONS TRATTORIA Whose place of business is: 700 MAIN STREET, HYANNIS MA 02601 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 77IN ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Paul J. Canniff, D.M.D, Chairperson FOOD SERVICE ESTABLISHMENT: $300.00 Junichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: Donald A. Guadagnoli, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: Permit expires: a/ �, ) TOBACCO: 12/31/2019 Y� FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE qt Y� cv-*I Oq 3oD Q ' Town of Barnstable , l of tg oFt�r� _ Regulatory Services MASSyq` Public Health Division BARNsTABI '. 4 0 MRNST"LE•cerrwn� WT.1-e as.`. ` i63¢ ♦� KUSM VWosrmvu `iBT e4axsne Eo► ' Thomas McKean,Director 1639-2014 i 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ! �a APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENTrxel DATE: 2q � NT: f)0UV_ - �S0%'x J _ r k�0Yt Ok Qn h c�S 1 n C_ NAME OF FOOD ESTABLISHME ADDRESS OF FOOD ESTABLISHMENT:\e34-0"- -t- T r�.e H y 0r-?17('j MIJ 01491 MAILING ADDRESS (IF DIFFERENT FROM ABOVE): ge 'r 1 f_ E-MAIL ADDRESS: 61 f Seek Jov-S L1 yi n n 14.P Q At0L1t C om TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( b8 ) 771 - F888 NUMBER OF SEATS*: INSIDE: �7 OUTSIDE: 0 TOTAL: 77 * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: _ ANNUAL OR SEASONAL OPERATION: N, Y It L TYPICAL HOURS OF OPERATION MON-FRI: r : D 0 Flvy1 TO I'M DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) ro / T')a y' S IF SEASONAL: APPROXIMATE DATES OF OPERATION: _/_/ TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY VI /FOOD SERVICE RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\Application Formffoodappldoe,.7 ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT Cl h L Te Y'n Ll►i j e Z SOLE OWNER: YES/NO D.O.B PHONE # `7 7 t4 "2.05- 129 6 ADDRESS 9 31 OV-f 5,,yA L-o Sloe. k Ybl rrn o u 4k ✓776 ©z 6j 4[ IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: STATE OF INCORPORATION: FEDERAL IDENTIFICATION NO: F3 —110 7 � 8 FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.*** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) EXPIRATION DATE: 2-2-- 2, erg 0 vi 44e Z EXPIRATION DATE: I D l f 6 / 22. EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST HE NAME OF UR CERTI ED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. 6o^l2Qt'l ON DATE: lo/ 3O/ �✓ SIGNAT OF APPLICANT DATE MAII,-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also,please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. To get a food permit application form, click here. To be able to access this form, your computer must have Acrobat Reader. Most computers have Acrobat Reader, and it will usually activate itself automatically. If your computer does not have Acrobat Reader, you can download a copy of it by going to the Adobe website. For further assistance on any item above, call (508) 862-4644 FEES: Bed &Breakfast Permit=$55; Food Service Permit 0-49 seats=$250; 50 or more seats $300; Continental Breakfast=$30; Retail Food Store—Less than 8,000 S.F. = $100, more than 8,000 S.F. = $285; less than 1,000 S.F. and Incidental to Business= $20; Residential Kitchen= $75;Frozen Dessert License= $30; Tobacco Sales Permit= $85; Additional non-refundable Fee for New Establishment or New Ownership _ $100, Late Fee=$10 Back to Main Public Health Division Page ti P r. n « � 1 y y:. 5 .F, aV, ' p a *e r ,�� �.. � �:. � .•a ..:k�y{+��y.r.*- .����'�'R �d$R,+... �..�,.pm� �.;ySr�,t�..��,�.u"riy� �'�!,�� �'� 1 s' °� �m !".',ash `�` ,.,Y�, a air::""° � .�,;�� a���., '�*+�� �� :�'.. r ca -,,�.,. ,, t�. "�'�+�` ..aS"�_ ,�«r,..,,.,z•, �''� ovOIdz) allsvlld I. LS n I . U T'OINVFtO3TV i l +_ S-9. ..b—.b .N b3•S. 6�L`z i r 'ON NDIS30 3f� , I, a ON11130 HOIH f (m m `I u- , ZZSd ON NJIS34 -in oaf O C?O 1. l 2iY1IlYVIS Q Cz � •bl l �� r. ONf1130 03H011d v I- r, I I, r-•—v i f'�1 sa l RANGE IN �;039WPANCY LIMIT EVENT-IS-FOR NG€N&N -69AR0- : I- 0 E OR ZONING OMPLIANCE �W�M ST COMPLY W/,ALL BUILDIING CODE, C i __ _ C ES BILITY& ZONING REQUIREMENTS �` -=__=----- _ - - '°'� I-•OZ '.� `- - - - --- wC._•_-r.-i'? ,�;\ .. I f.. Y �. ,--�-� .1. �I'`I�Q I, _I• DAT - I! r --- - --- -•�•I'�.�;�7�•-r .l NQ\ I �, KL.I I1.Ln II ^ _. bu - (�` Yt• .._ .�." :�a'I B$ a �_..._— --•- q'I! (sol> r UYl0 .f n ff�lcj 00 [1 ACORO` CERTIFICATE OF LIABILITY INSURANCE 111 IIAM o,8 THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: V the certificate holder Is an ADDITIONAL INSURED, the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone: (978)851-9600 Fax: (978)851.4U8 ccONT Sullivan Insurance Agency SULLIVAN INSURANCE AGENCY ''�;° 978 851.9600 FAX (978)851-4848 885 MAIN STREET E M/ul TEWKSBURY MA 01876 DORESS• INSURERS)AFFORDnaG COVERAGE NA1C# INSURER : XS Brokers Insurance Agency,Inc INsu FOUR SEASONS TRATTORIA OF HYANNIS INC. INSURER B : MA Retail Merchants Workers Comp Group 700 MAIN STREET INSURER To Be Issued 350 STEVENS STREET INSURER O: HYANNIS MA 02601 INSURER.E INSURER F COVERAGES CERTIFICATE NUMBER: 29836 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDS, SUER POLICY EFF POLICY EV LTR POUCY NUMBERIMMMI)ITInmIMMMVIYYYYILIMITS A GENERAL LIABILITY TO BE ISSUED 07103118 07/03/19 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PREMISES ocarD $ 50,000 CLAIMS-MADE FX OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECOT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY ALL OWNED SCHEDULED ��person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (W eeddent) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LmB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B AND�EMPLOYYEERS' LIABILITY ENSATION TO BE ISSUED O7l03N8 07/03/19 X TORYNIS I ER $ ANY PROPRIETORIPARTNERIEXECUTIVE. YIN E.L.EACH ACCIDENT -$ 100,000 OFFICERIMEMSER EXCLUDED? N (Mandatory In NH) NIA E.L.OISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E-L DISEASE-POLICY LIMIT $ C Liquor Liability TO BE ISSUED 07103/18 07/03/19 1,000,000 DESCR[PnON-0F OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Four Seasons Trattoria Of Hyannis Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 700 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Stevens Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE Attention: ACORD 25(2010/05) ©1988-20 0 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t£ G e o O The Education Center, below, verifies that Luis Fernandez has successfully completed the knowledge and skill evaluations for the Emergency Care & Safety Institute Course. Adult,Child,Infant CPR&AED 5Z4LLHSGVLE7 December 18,2016 December 18,2018 Course Name Course Completion Date Recommended Renewal Date Student Authorization Number Cape Cod CPR&First Aid Training 508-364-4750 Lindsey Brown FHC8OV91CPMB Education Center Education Center Phone Number Instructor Name Instructor ID Number info@CapeCPR.com This certificate does not guarantee any future performance or suggest any form of licensure. Skills deteriorate rapidly when not Education Center Email used. Periodic retraining is strongly recommended. 1 Student Authorization#:5Z4LLHSGVLE7 c� i Q^�•�.Cut along the dotted line at the bottom of Education Center: Cape Cod CPR&First Aid Training i the certificate and along the dotted lines around _ _ __ . _ - Education Center Email: info@CapeCPR.com t the course completion card.Fold the card in half. ( Education Center phone#:508-364-4750 t Instructor Name: Lindsey Brown ; Instructor ID# FHC8OV91CPMB i 1 1 The Education Center verifies that the above has successfully ' t 1 completed the knowledge and skill evaluations for the 1 Emergency Care&Safety Institute Course. 1 December 18,2016 December 18,2018 1 Course Completion Date Recommended Renewal Date " � LU ±aF 5 K y 4 k _ 0 �S � � h � t y+ 1 ♦ _ � fl, 1 The Education Center, below, verifies that Manuel Fernandez has successfully completed the knowledge and skill evaluations for the Emergency Care & Safety Institute Course. Adult,Child,Infant CPR&AED 1ARO8M3HGYKC December 18,2016 December 18,2018 Course Name Course Completion Date Recommended Renewal Date Student Authorization Number Cape Cod CPR&First Aid Training 508-364-4750 Lindsey Brown FHC8OV91CPMB Education Center Education Center Phone Number Instructor Name Instructor ID Number info@CapeCPR.com This certificate does not guarantee any future performance or suggest any form of licensure.Skills deteriorate rapidly when not Education Center Email used. Periodic retraining is strongly recommended. - - - - --- - - - -- - - - -- - - - - -- -- -- - - i Student Authorization#:1'ARO8M3HGYKC I 91<Cut along the dotted line at the bottom of Education Centers Cape Cod CPR&First Aid Training t the certificate and along the dotted lines around Education Center Email: info@CapeCPR.com I the course completion card.Fold the card in half. Education Center phone#:508-364-4750 ; Instructor Name: Lindsey Brownkrill i Instructor ID# FHC8OV91CPMB 1 1 L i I t The Education Center verifies that the above has successfu0y x t completed the knovrledge and skill evaluations for the01- 1 Emergency Care&Safety Institute Course. g c3 a i d7� <k b«t E December 18,2016 December 18,2018 r Course Completion Date Recommended Renewal DateZ F_ — .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. — r _. — — ._ _ OF iII IRS INTERNALNREVENUEESERVICE CINCINNATI OH 45999-0023 Date of this notice: 07-03-2018 Employer Identification Number: 83-1107158 Form: SS-4 Number of this notice: CP 575 A FOUR SEASONS TROTTORIA IN HYANNIS % MANUEL T FERNANDEZ 1077 ROUTE 28 For assistance you may call us at: S YARMOUTH, MA 02664 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 83-1107158. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 941 01/31/2019 Form 940 01/31/2019 Form 1120 04/15/2019 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. fur men_� i o� Pasta Polio a vitello Frutti di Mare $24.95 Pollo Scarpariello $18.95 Homemade linguini with shrimp, scalops, Chicken w/sweet Italian sausage in a wine calamari mussels and clams red or white sauce. garlic & herbs sauce.(bone-in or boneless) Fresh Linguine Alfredo $17.95 ADD $3.00w/chicken w1$ 3.50 apiece of shrimp Romano Chicken $17.95 Veal$24.95 Tossed in a creamy parmesan cheese sauce Chicken with baby artichokes and sun . Orecchiette broccoli a salsiccie $18.95 dried tomatoes in white wine and herbs Orecchiette Pasta, Broccoli Rape garlic olive oil Sausage &Pecorino Cheese Alla Napolitano Chicken $17.95 Veal$24.95 Rigatoni Alla Norma Chicken with mushrooms,peppers,fresh Rigatoni Pasta, Eggplants, Fresh Tomatoe tomato white wine garlic and herbs. &Ricotta Linguine con Vongole $ 17.95 Alla Cacciatore Chicken $17.95 Veal$24.95 Linguine in a white or red clam' sauce Chicken with onions, mushrooms, tomatoes herbs Fettuccini Carbonara $17.95 ADD red orwhite sauce(chicken bone-inor boneles) $3.00w/chicken w/$ 3.50 apiece of shrimp Homemade pasta tossed in a pancetta Melanzana Parmigiana bacon cream sauce. Eggplant layered w/cheese and baked in homemade Pasta Primavera $17.95 pomodoro sauce. Seasonal vegetables in choice of marinara sauce, alfredo sauce, or garlic and olive oil. Parmigiana Chicken $18.95 Veal $24.95 Rigatini alla Vodka $16.95 Lightly breaded cutlet topped with mozzarella w/Chichen or salmon$19.95 cheese and pomodoro sauce then baked Pasta tossed in a creamy tomato vodka sauce. Farfale con salmone $17.95 Marsala Chicken $18.95 Veal $24.95 Salmon, mushrooms, asparagus in cream sauce. Pan seared in a marsala wine sauce w/fresh Ravioli pomodoro 16.95 mushrooms Homemade cheese ravioli tossed w/cherry tomatoes, basil, garlic extra virgin olive oil. Piccata Chicken $18.95 Veal $24.95 Pasta alla Bolognese $ 19.95 Pan seared in a lemon, butter and caper sauce House specialty pasta of home-made green fettuccini with a hearty meat sauce Francaise Chicken $18.95 Veal $24.95 and ricotta cheese with herbs and spice. Pan seared in an egg batter with white wine,lemon Lasagna $18.95 and butter Homemade meat Lasagna. Pesce/lsh Saltinbocca Chicken $19.95 Veal $25.95 Layered with proscuitto, spinach and fresh Salmone Mostarda $19.95 mozzarella in a sage white wine demiglaze Salmon fillet finished in a Dijon mustard sauce Tilapia al Forno $ 19.95 Sorrentino Chicken $19.95 Veal $25.95 Baked tilapia fillet with lemon butter& wine sauce. Layered with proscuitto, eggplant and fresh Sole Francaise $19.95 mozzarella topped w/mushroom, shallot& marsala Pan seared sole fillet in an egg batter with white demiglaze. wine, lemon and butter Gamberi Fra Diavlo w/pasta $25.95 Milanese Chicken $18.95 Veal $24.95 Shrimp sauteed in a spicy marinara Lightly breaded and pan fried cutlet served with Gamberi Scampi w/Pasta $25.95 lemon and Toscana salad Shrimp sauteed in garlic, white wine, lemon butter sauce Veal and chicken any style Gamberoni Francaise w/pasta $25.95 Main dishes are served with vegetable of the day Pan seared jumbo shrimp in an egg batter with Or pasta Linguini, angel hear, spaghetti white wine, lemon and butter penne (ziti)-fresh linguini$1.00 Calamari Marinara w/pasta $19.95 Calamari simmered in marinara served over contorno/side dish linguine Fungi sauteed mushrooms 7.95 Zuppa di Pesce $26.95 Mashed Potatoes 6.95 Shrimp, scallops, calamari, clams and salmon Asparagus Gratin 7.95 simmered in a fish fumet with tomato, garlic & Broccoli with garlic and olive oil 6.95 herbs Fried Artichokes 7.95 Sauteed Spinach with Garlic& olive oil 6.95 Before placing your order,please inform Broccoli di rabe garlic&olive oil 7.95 your server if someone in your party has a food allergy Antipasto Insalata La zuppa Del Giomo $6.95 Carpaccio di Manzo $12.95 Made in-house daily. Paper-thin sliced Flet m�non raw with shaved armesan aru ula P � g Calamari $9.95 Insalata di Cesare $79S Lightly Fried ca lama ri tubes served Crisp romaine lettuce with tomato sauce with creamy Caesar dressing i5rodetto di Cozze E VOngole .S».9S [g$h6.ff Ca prese $8.95 cape mussels, manila clams, white wine Ripe tomatoes with fresh mozzarella mild spicy tomato sauce I aril, and red pepper vongole al Forno $99S - InsalataTricolore $79S Baked clams with bread crumbs Endive, arugula, and radicchio in oregano, andgarlic our house dressing Antipasto di verdura $9.95 ' Insalata di cameo $6.95 An assortment ofmarinated Seasonal Field Greens, cherry Tomatoes grilled seasonal vegetables in our House dressing Antipasto Caldo (For Two) $21.95 Insalata di Mare $14.95 Baked stuffed clams, stAed mushrooms, Mixed searood salad ewlant rollantini and crispy baked shrimp. Affettati (Italian cold cuts) 16.95 Cured Meatassorted cold cutPlatter Pizza 10"$If 9S 14"$21.95 Margherita fresh homemade mozzarella, basil with tomato sauce & extra virgin olive oil Bianca combination of our ricotta and mozzarella The Kitchen Sink meatballs, pepperoni. sausage, peppers, mushrooms & onions Chicken Supreme chicken, onion & tomatoes Veggie Lover mixture of garden vegetables *Lasagna Pizza combination with meat sauce, ricotta & mozzarella cheese *Buffalo Pizza chicken with spicy sauce *Milano Pie sausage, red roasted peppers, onions, spinach and mozzarella. Pork King Pie sausage, ham, salami and pepperoni. Roma Pie ham black olives, ricotta and mozzarella. Hawaiian Pie ham and pineapple. House Special Pie ground beef, green peppers, onions, tomatoes and jalapeilo. Dolce Vita Pie chicken, broccoli, tomatoes and mozzarella. Fresca Pie fresh mozzarella,fresh tomato and basil. Best-Seller Pie pepperoni and mushrooms. Italian Pie peppers, sausage and onions. Meat Lover Pie pepperoni, sausage, meatballs and ground beef. EXTRA PIZZA TOPPING S 0.95 -2.95 Sausage, Pepperoni, Peppers garlic ham, onions, anchovies, extra cheese Black olives, mushrooms, broccoli, chicken, ground beef, eggplant,pineapple. Consuming raw or undercooked meats, poultry, seafood, Shellfish or eggs may increase your risk of food borne illness oFtrok� TOWN OF BARNSTABLE..; _ HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. p t639 aim HYANNIS,MA 02601 sos-sz FRI. No Reference R-Red Item PLEASE PRINT CLEARLY r`D"A0y FOOD ESTABLISHMENT INSPECTION REPORT Name C Dat 1.rjA ljlle o Type of Inspection er Routine Address Risk od Service peclion Level ection Telepho Residential Kitchen Date: ' p Mobile Pre-operation C Owne A J o f'�1� wrn�� ,�® HACCP Y/N Temporary Suspect Illness �--t�JI Caterer General Complaint Person in arge(PIC) Time Bed&Breakfast HACCP ( � fvL, . CGti^^ 'In: Other Inspector Out: �- / Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items)) Anti-Choking 590.009(E) ❑ Violations marked may pose an.imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '474 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals en ELI it-I 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 w ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) t' ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP L ❑ 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 f7'-, Critical.(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo Emergency Closure checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g Y ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations re 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view A,4 A^:�j Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen I Y N . _..'-..�:r--._� �..� r.-_i....-w ._...-+�.-..,. ., ��a..._...,...._ -- ...-� -. .�_,-.,-�.s�-r-.., ,.-v-•:-.r-v--`....-.,.s--..:: �v-�. -.-.--'--- -- a.. ,. - �. -..,�-.�...-•---^--`- -��.--•-.r---�. -..mot-- "-Y --"n.�.. .-�.+,. .. -...�-__ ._ _ .. - r. "S„ ,.. .:. _", Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 CoolingMethods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* t _ 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to _ 7-]02.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reportin by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* g Contamination from the Consumer 3 590.063(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* .REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 ' Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-]Ol.l1 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe crier 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 Cough[Molluscan Contact Surf aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * - - Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g, P ar'Y 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands gird 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 practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F ConvenientlyLocated and Accessible Within 2 Hours and From 70*F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF�HE rokti TOWN OF BARNSTABLE p� EALTH-INSPECTOR'S Establishment Name: Date:' age: of �p o i""� " " ""�n � `' OFFICE HOURS PUBLIC HEALTH DIVISION 8:0o=9:30A.M. BARNSrAG�.E. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mA 9. 0$ MON.-FRi. No Reference .R-Red Item PLEASE PRINT CLEARLY �p .e3v a HYANNIS,MA 02601 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT cLlT Name jBat )Tyne of Type of Inspection er Routine id Address Risk Service Re-inspection r Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness C Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast In: O / Inspector Out: G LAY Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ✓ �f 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 _ �S ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 1 F ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) An 195V-(- ❑ 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 I1�7) Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations \� Critical(C)violations marked must be corrected immediately. (blue&red items) v� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4npn-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8npn-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Q j C Dumpster Screen? Y N C l Violations related to Foodborne Illness V16/ations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L114 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se azation-Storage* 3-501.16(A) Roasts Held At or Above 130'F* Applicants* 3-302.11(A) Food Protection* p g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions arid Restrictions g ( ) Disposition of Adulterated or Contaminated Food i 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-'206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - - * 4-501.111 Manual Wazewashing-Ho[Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13- Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective//uzoo/ 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHF's SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P � Game.and Wild Mushrooms Approved By * 3-40i.l l(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 Shelistock Identification Present* 2,301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* practices Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms )O( )( 3-201.17 Game Animals* 11 Good Hygienic Practices 77 • Reheating for Hot Holding Requirem nos ld be debited under#29-Special 5 Receiving/Condition 1 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * Blue Items 23-30) [3-202.18 02.15 Package Integrity ( ) Commercially Processed RTE Food-140°F 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* 01.11 Food Safe and Unadulterated B) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shelistock 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 2 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 03.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8T103.12 I 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. Op THE Tqy TOWN OF BARNSTABLE - - HEALTH.INSPECTOR's Establishment Name: Date: Page: 2-' of ' per' o OFFICE HOURS - ,? PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M63. .•� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �prFD MPS° 508-862-4644 - - - FOOD ESTABLISHMENT INSPECTION REPORT Name ate Type of !Xpacgkinspection ell era to s outine Address Risk Fo ice ection Level ,QEMr Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 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) J14 Led,6 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - �� ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 60P ❑ 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) L ❑ 9.Fooa Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP l ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY c ❑ 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: o ❑ es I P Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled. ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 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 4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,, Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. � 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 1 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN Dumpster Screen? Y N / l ..,��,..,-..-,�-�..-r.... �,.-a�.��.--..-..r,•�_ w--...--_,..... .v_��,.,�r ._....��r- ._ _ . .....L w..... --� .. ._. .. .. ..- ..-... -_- "".'' ram-• r .-. --ti..._.-.......-..._. _ _ _� _ .-.. r.- .y.-.'°.J 1� 'r�'.t., ..... �... •-\�. al.._ _ .. V'.�.!..ti'�.r-•, .sue.i.. .�t..�.�. u ` ._ �.�5`a ✓,--�1'-" f .. . 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.1](A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F)- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) 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 y - Food Contact Surfaces. 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of .11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 4-601 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cme 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- - * - - Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g, P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 - Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* - 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 to 41°F/45°F L6-3O1.11 Numbers and Ca pacifies* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P * 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* 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/ Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-.Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFTHE r TOWN OF BARNSTABLE HEALTH.INSPECTOR's Establishment Name: Date: Page:• of o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �b a; .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 US V Name Date Tvne of of sec ion r All a e on s Address Risk d Service spection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other -V Inspector (�- Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. CS 4 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 Facilitiesok 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 ` q FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) I/(/ ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures W s/ ❑ 5.Receiving/Condition ❑ 17.Reheating r qi ❑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 i ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories VgepL Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Y © C V� Dumpster Screen? N ._� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding. 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(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*7-102.11 Common Name-Working Containers 590.004(F) * P g * 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* Applicants* 7-201.11 Separation-Storage* 20 3-302.11(A)- Food Protection* Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003_ (F) Responsibility o 3-302.15 Washing Fruits and Vegetables f A Food Employee or An 3-501.19 Time as a Public Health Control* _ Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 - Fluid Milk and Milk"Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A Eggs-Immediate Service 145°F 15 sec Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctiw 1112001 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 3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave. the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-101.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11' Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE Tp� TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of OFFICE HOURS PUBLIC 200 MAN STREET 3 DIVISION : 0-- :30 A.M. BARNSTABLE, :30-4 Item Code Item:3oP.M. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3 HYANNIS,MA 02601 MON.-FRL No Reference R-Red Item PLEASE PRINT CLEARLY ,e 508-862-4644 , rEO MA�� FOOD ESTABLISHMENT INSPECTION REPORT - Name l Date Type of Type of Inspection yff er i s Ro Address Risk FFood Service Re-inspection Level Re r ection Telephon 7AA /� /�,t Residential Kitchen Date: Ny e Ck ,� 1 y\ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector LP V Out: j 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) ❑ 91 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i 1] 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) 1714.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) \ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or \ vvV within 90 days as determined b the Board of Health. Overall Rating y yV;, ] ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an ins ection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.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 Print: a Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge 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* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* ! P g 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Lit Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective mnooi 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.tt(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.1 l Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms approved By 2-301.11 Clean Condition-Hands and Aims*Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail practices 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. be debited under#29-Special 5 Receiving/Condition 2-401.11 1 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Packa a Inte ri * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) g g ty Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* F 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F 5-203.11 Numbers and Ca acities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 128. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF`"E'ar TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of PUBLIC HEALTH DIVISION OFFICE HOURS8:00'9:30A.M. BARNSfABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. .e39• `0g HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY lE0 MAC° 508-862-4644 - FOOD ESTABLISHMENT INSPECTION REPORT - Name Dat - e of Type of Insnection Address Risk d Servic Routispection Imu,ne 1T Level ection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness andS L Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: t Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) Clef ` Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F ❑ L Action as determined by the Board of Health. Allergen Awareness 590.009 G) ❑ AA QNC.14- a� 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 Hazar ous Foods) IIISVVI ` ❑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 Roo PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP � 7t/ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer AdvisonestAn Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violati n q\0 A'0 V. Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: 7ffNo Y Non-critical(N)violations must be corrected immediately or Overall Rating1-9 within 90 days as determined by the Board of Health. ® ❑ Voluntary Compliance ❑ Employee Restriction/Excl ion ❑ Re-i spection Scheduled ❑ Emerge OYSuspension C N Official Order for Correction: B sed on an inspection today,the items -- ❑ Embargo Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ ry p ❑ 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 9 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 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. y 29.Special Requirements (590.009) within 10 days of recep i t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: (� 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's • atur Print: } Self Service Wait Service Provided Grease Trap Size .- Variance Letter Posted Y Dumpster Screen? Y N .... �_y..,.._�y.r._...-�-..r..s_. ..--..,.-.,..._.. ...s...-.,. _ _ ��, r - --.+.-. .. r- -- ....__-_. __.v.- -,_. .,.-. -.... ...-._-.,,�..-.. r r..� _- -, - _ __. . . -,s .r--- ,..,-T r- .-..�-»� _..•.r..�...;.+.-..----_.-.. ..- - - +-- .- -+ - y � » 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 1g - 2-103.11 Person-in-Charge Duties - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* PHF Hot and Cold Holding Contamination from Raw 15 Ingredients Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F .. 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 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*s P g - Applicants -- � * 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 3 In Charge* 7.202.12 Conditions of Use =304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions * - Contamination from the Consumer [i 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ - - REQUIREMENTSTOR- 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) • Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 - `Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* * Raw Seed Sprouts Not Served* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 - Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13_ Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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 . A11601- . ean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4 ( ) Cl Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep ctiw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Watef Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* � faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clem Condition-Hands and Arms* r 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* t'oodborne illness interventions and fisk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices j 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition - - 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 - Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 4c 5-204.11 Location and Placement* _ 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,O eration and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention P 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 129. 1 Special Requirements 1 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103. 22 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. oFINErwr TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page of ' per' o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. 3. HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY � 508-862-4644 'E0N1P�� FOOD ESTABLISHMENT INSPECTION REPORT fl Name �/ Date Type of Ty s ecfon e outine Address Risk ood Service on E Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: AA CA IL/ 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 TO 590.009(F) ❑ g '( -�"�. ��: Action as determined by the Board of Health. Allergen Awareness 590.009(G) 01 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties t3.Handwash Facilities EMPLOYEE HEALTH P� R&TECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives y ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) V ❑ 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) NFood Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP `j ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ` 1M ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories L v Y` L Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) E±J Corrective Action Required: V ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating _J within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 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 28;Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29`SpeciaRequirements (590.009) y p within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30-FYY DATE OF RE-INSPECTION: Inspector's Signature Print: 31. ter screened from public view Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Sig ture U,�/,o Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ��� G Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions + Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19.- PHF_Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage Applicants* 3-302.11(A) Food Protection* 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 WashingFruits and Vegetables 3-501.19 Time as a Public Health Control* i Applicant To Report To The Person In Charge* g 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization 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. L16 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. Eggs- mmeateery sec Utensils and Food Contact Surfaces of E Immediate Service 145°F 15 * Animal Foods That are Raw,Undercooked or Equipment 5-IOLI I Drinking Water from an Approved System* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ef/°"°e tiuzooi 4-602.11 _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590:006(B) Watei Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-763.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * - - Ratites-165°F 15 sec* in mobile food,temporary and residential Suufces g P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and.Wild Mushrooms Approved By _ 11 Cle an Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3=202.18 Shellstock Identification Present* 2-301.12_ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-463.11(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) 3-201.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked and Fr from*17 to 1 7/45 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 5203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 - Tags/Records:Fish Products P 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 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. of 114E r TOWN OF BARNSTABLE. HEALTH INSPECTOR-s Establishment Name: Date: .Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. t639• �� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red.Item PLEASE PRINT CLEARLY �Eo MAC° 508-862-4644 - FOOD ESTABLISHMENT INSPECTION REPORT Name Date T e of ns ec io (� Io outine Address Risk ood Servi fiction Level Previous Inspection Telephone Residential Kitchen Date: 1111e SA Mobile Pre-operation 1 Owner HACCP Y/N Temporary Suspect Illness uu Caterer General Complaint ` Person in Charge(PIC) a Bed&Breakfast HACCP Other Inspector Out: aim Alt ­11 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 Itemsi Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ - 60 - 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 ('r PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 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: �- Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restric n/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g y ❑ ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations.. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. y 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature � Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si ture P Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ��kDCcx Dumpster Screen? Y N f Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions r Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*Other* 590.004(F)- - * - - * 590.003(C) Responsibility of the Person-in-Charge-to - --. - 7-102.11 Common Name-WorkingContainers* 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* i * 7-201.11 Separation-Storage Applicants - 3--302.11(A) Fdod 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* 590.003(G) Applicant To Report To The Person In Ch Reporting by Person in Charge* arge* - * 7.202.12 Conditions of Use _ 590:004(11) Variance Requirements - 3-304.11 Food Contact with Equipment and Utensils * _- _ _ Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and _ ( ) t P _ _ _ 4-501�.111 - Manual Wazewashin Ho[Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products*' 4-501.112 Mechanical Warewashiiig-Hot Water - Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202:16 Ice Made From Potable Drinking Water* - ' ' 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* _ _ - gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Efa cri 11112001 4.602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources*' g• P �' 10 Proper,Adequate Handwashing 3-401.1](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 iu a Microwave the appropriate sections above if related to 3-202:18- Shellstock Identification Present* _ 2-301.12 _ Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004 C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 - Receiving/Condition - 2-40.1.11 . Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23.30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F ConvenientlyLocated and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 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 1Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.aEroy TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 94 M 39:s m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508 862 46aa rF°M� FOOD ESTABUSIMENT INSPECTI0.N R. PORT . kaid Name gate of Type of Inspection tz er tion Routine Address /� Risk od Sen/ spection '07 Level L-7 s ns Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint o Person in Charge(PIC) Time Bed&Breakfast HACCPPI In: Other Inspector i Out: C r L. I - / Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items) !� L Anti-Choking 590.009(E) ❑ r Violations marked-may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ /� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14:Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑-7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding T PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR,HIGHLY SUSCEPTIBLE POPULATIONS(HSP) s I ❑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 r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical ViolationstQ r Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: -".:. o Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension 4 C N Official Order for Correction:Based on an i pec on today,the items ❑ Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4npn-critical violations g )( ) cited in this report may result in suspension or revocation the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to.a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8npn-critical violations. If 1 critical refrigeration. within 10 days of receipt t of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y - 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i _ ...--r_..,,.-r.r err----.�....%....--�., ::r.;--,.: .a-� .,--.�:- ..,.r h,��-..- 4-- .-'-�..- ..... - - �..^-�:•.:..N»�-- .- -,.. - . � ..- ...:.i...... - w.,. _ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH,. 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 5 0. Responsibility n-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 9 003 C Res ons brli of the Perso C s( ) P tY 8 7-102.11 Common Name-Working Containers 3-501.16 A Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment ( ) Applicants* me as a Public Health Control 3-302.11(A) Food Protection* P g 7-201.11 Separation-Storage** 20 Ti 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements _ 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions * Contamination from the Consumer 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3 590.003(D) Exclusions and Restrictions ( )(B) 3-306.14 A Returned Food and Rated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1-)) 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. 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* Ejfecnve////tom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 TagsiRecords: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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 57205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 i 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F. ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:,-Of- OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. `• 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M6�9• �0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item - PLEASE PRINT CLEARLY 'rFn MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name 7 DaterL- yDe of T f Ins c ion 49 outine a Address Risk od Service ection .... �f Level Previous Inspection Telephone Residential Kitchen Date: " Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Y- Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ L Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands .sr ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS a / ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives iq f \V/ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals � J FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Frazardous 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 o ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding LA I PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) _ _ F. ❑ 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 �1 Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations W / Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ o ® s ' Non-critical(IV)violations must be corrected immediately or Overall Rating TV within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ E e i E ins e ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e items iF ❑ Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑ Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump er screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N L Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions J Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties � 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45*F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590. 3(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 00 Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 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* effe cnve uuzoor 590.006 B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* ( Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed , Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential _ 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 _Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Crooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requiremenpractices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F (A) g 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 * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.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. oFv�Erow TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: . of OFFICE HOURS - - °_ PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified - ,63q: �0� HYANNIS, MA 02601 MO8 -FRI. No Reference R-Red Item plFc MARS ° 508-N.-F I. PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT - l AA Name r Date a of lysiMnspection n outi _ - Address .' Risk - Servic n Level previous Inspection Telephone / Residential Kitchen Date: Mobile Pre-operation C Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint L Person in Charge(PIC) Time Bed&Breakfast HACCP If In: Other Inspector /►"'" < Out: '` C Each violation checked r quires 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) ❑ iell 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 RA.IAP r 1A ❑ 5.Receiving/Condition ❑ 17.Reheating _ c ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding F PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control n ` ❑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 y ❑ 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 within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4non-critical violations g cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste. (FC-5)(590.006) establishment permit and cessation of food establishment operations. If g p,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have.a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up, be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7j(590.008) 9 � violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order.DATE F RE-INSPECTION; 30.Other Inspector's Signature Print: 31.Dump screened from public view A Permit Posted? N Grease Trap Previous Pumping Date \� Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y IN PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 5 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential Proper,Adequate Handwashing y 10 Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under J129-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) 3-201.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 590.000 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. Op 1NE ram, TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of v` 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. = 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. HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY... rE'D MP�a FOOD ESTABLISHMENT INSPECTION REPORT Name Dal q !Me-of Type of Inspection Rout' c Address Rist ood Servic e-inspectio Level action 67 Telephone Res idential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 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 0•3.,Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 4 Of G/v ` ❑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 + K ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP L ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 0") 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 0 J9 Corrective Action Required: No e tZ 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 FITEmernpncy Suspension C -N Official Order for Correction:Based on an 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 (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6npn-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE f)F RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N PAU,A A Z� 4"4- #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature P t: I l Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dump ster Screen . Y N a: 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours 3-501.15 Cooling 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* g Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH, 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* Time as a Public Health Control 20 590.003(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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(1 )1 Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricints* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS i 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or_ 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game� Pathogens* E/j cave/atom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P arY 10 Proper,Adequate Handwashing Game and Wlld Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PI-1F's 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* (B m(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 PBF's from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp SNE Tom TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of Qyq PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BARNSTARLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MSTA MON.-FRI. �A .a SS `0� HYANNIS,MA 02601 No Reference R,-Red-Item PLEASE PRINT CLEARLY 508-862-4644 M"`° FOOD ESTABLISHMENT INSPECTION REPORT fJVV Name Date Ttoklyne of T e o Inspection I.outine Risk ood Serv' ection Address Previous Inspection '�" -' Level Retal P Telephone Residential Kitchen Date: - LANV (-e,- K`5C�(+eV1 4 L Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) aj(� Time Bed&Breakfast HACCP In: Other L-- 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) ❑ r✓ (.c Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1.PIC Assigned/Knowledgeable/Duties r�(� ❑ g g ❑ 13.Handwash Facilities (/ ` - Q �T� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling w J - / ❑ 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) 41 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 00liq ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices Blue Items) Total Number of Critical Violations t ( t ) Critical(C)violations marked must be corrected immediately. (blue&red items) _ Corrective Action Required: ❑ No ❑ es 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, he items ❑ Embargo 0 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 ardiess of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to 8non-critical violations. If i critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. P q (590.009) Y P I 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N --- - Dumpster Screen o Y N _ Violations related to Foodbome 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 Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* ` Applicants* 3-302.11(A) -Food Protection* 7-201.11 1 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* C J, 590.004 11 Variance Re uirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 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 j Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-201.14 Fish and Recreational) Caught Molluscan * 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec Y g Contact Swiaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15` Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 1=010 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Anunals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. „ 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity Y Critical.dhd-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* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* . Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 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 009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `QF*HE► TOWN OF BARNSTABLE- HEALTH INSPECTOR'S Establishment Name: l�l�L)J" sui+l rN#a^fn Date: � � Page:, � Of " OFFICE HOURS : BAR E. PU62 0 MAN STREEETLIC HEALTH SION - _ - - 3::30-0 4:30 P.M.:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p MASS.a�0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item P EASE PRINT CLEARLY 508-862-4644 'FDM FOOD ESTABLISHMENT INSPECTION REPORT Name w �. rr Date' TYpe of of Inspection It r pG Routine P - Address Risk ood Servic Re--inspection c Q �^ / Level Retail Previous nsp ion t9 Telephone Residential Kitchen Date: )/ /.� �70 Mobile Pre-ope aU'dn Owner HACCP Y/N Temporary Suspect Illness H Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP .p In: Other ° Inspector J`J W_ S` ^ Out: A' Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. j Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 4 Lao.4v Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP 17111 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ! 0 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r M Critical(C)violations marked must be corrected immediately. (blue&red items) l Corrective Action Required: oYes Non-critical(N)violations must be corrected immediately orOverall Rating within 90 days as determined by the Board of Health. Fft ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and.less than 4non-critical violations 9. (FC-4)(590.005) cited in this report may result in suspension or revocation a the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC=6)(590,007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials ( C-7)(590.008) be in writing and submitted'to the Board of Health at the above address violations observed 7 to 8 non-critical violations. If 1 critical refrigeration. F. violati 4 to 8 n- ritical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspe s Sign t re Pri t: \ 31.Dumpster screened from public view 0 l/! Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12. Additives* 3-501.15 Cooling Methods for PHFs 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to __ Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants 7-201.11 Separation-Storage*3-302.11(A) Food Protection* 20 Time as a Public Health Control 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 j 590.003(D) j Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR . 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 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 cmc mnom 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 Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Croper, l Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* ( )O P Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave, the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B). Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402. Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(4(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r Lunch Soups. New England Clam Chowder. 6.99 Soup of The Day. Market Price. Salads Caesar Salad Romaine lettuce,parmigiana cheese, anchovies,"croutons and caesar dressing. 8.99 House Salad Seasonal greens, cherry tomatoes, cucumbers, red onions in our house dressing. 7.99 Beets Salad Roasted beets, caramelized walnuts,gorgonzola cheese, over mix greens, balsamic vinaigrette. 9.25 Kale Salad Raw kale, red onions, caramelized walnuts, dried cranberry,goat cheese, lemon olive oil. 8.99 Salad Additions. Grilled Chicken. 5.99 Grilled Salmon 7.99 Grilled Shrimp. 2.50(each). Appetizers Homemade Coconut Shrimp.Breaded butter flied shrimp with sweet chilly orange. 12.99 Homemade Chicken Tenders.Served with blue cheese and fries. 8.99 Chicken Wings. BBQ sauce and blue cheese. 6piece. 9, 99 Homemade Crab cakes.In a cappers mayo sauce, and muscling greens. 10.99 Fried Calamari.Deep fried calamari served with marinara sauce. 10.99 Burgers All burgers served with lettuce,tomatoes,onions,pickles in a bulkie Roll Tuscan Burger.A peppercorn crusted, roasted red peppers,provolone cheese, with chipotle mayo and fries. 10.99 Hamburger. 8oz char-grilled, with fries. 9.25 Cheeseburger.American cheese, with fries. 9.99 Bacon Cheese Burger. 8oz char-grilled, bacon, swiss cheese, with fries. 10.99 Homemade Veggie Burger. Topped with mushrooms, homemade pesto, with fries. 10.25 Homemade Vegan Quinoa Burger. Wheat bread, avocado, raw kale, served with house salad. 10.99 Sandwich and Paninis Philly Steak Bomb. With peppers, onions, mushrooms, american cheeses, on sub rolled with fries. 11.99 Corned Beef Redben.Sauerkraut, russian dressing, melted swiss cheese, rye bread, with fries. 10.99 Grilled Chicken Sandwich.Lettuce, tomato, sweet chill mayo in a bulkie roll with fries. 9.99 Tuna-Melt.Lettuce, tomato, swiss cheese, wheat bread. with fries. 9.99 Cod Fish Sandwich. Lettuce, tomato, tartar sauce, bulkie roll bread with fries. 10.99 Grill-Cheese.American cheese, white bread, with fries. 8.25 BLT Sandwich.Lettuce, tomato, mayo, toasted white bread crisp, bacon with fries. 8.99 Prosciutto & mozzarella Panini.Italian style ham,fresh mozzarella cheese, sliced tomato, basil pesto. and balsamic glaze. 9.99 Vegetarian delight Panini. Served whitportobello mushrooms, roosted peppers, tomatoes,goat cheese, in a balsamic glaze. 9.99 Pastas Linguini Alfredo. Sauteed with chicken, broccoli and tossed in a rich creamy a�edo sauce. 13.99 Penne ala Vodka. Creamy tomato vodka sauce, tossed with penne pasta. 11.99 Lobster Ravioli. Cherry tomatoes, vodka cream sauce. 14.99 Orecchiette Primavera.Artichokes, cherry, tomatoes, asparagus, kale. roosted peppers,garlic and oil. 12.99 Linguini Vongole. Red or White. 16,99 Seafood Chicken and Veal Shrimp Scampi.Jumbo shrimp in our house scampi sauce, served on linguine pasta. 14.99 Grilled Salmon. Served with mashed potatoes and asparagus 15,99 Frutti di Mare. Sauteed mix seafood over linguini red or withe. 17.99 Fried Whole Belly Clams Plate. With french fries and coleslaw. market price ' Chicken Cacciatore. Sauteed chicken,peppers, onions,fresh mushrooms in a marinara sauce, Tossed with penne pasta. 14.99 Chicken or Veal Parmigiana.Breaded chicken, melted mozzarella in a marinara sauce. Chicken. 13.99 Veal. 15.99 Veal Francaise.Dip in egg them sauteed in a lemon butter and white wine sauce. 17.99 Grilled Lamp Chops. Served with parmesan risotto and vegetables. 18..99 BBQ Ribs. %rack", served with mashed potatoes and coleslaw. 15.99 Consuming raw or uncooked meat,poultry seafood shellfish or eggs may increase your risk of food illness. "Before placing your order please inform service of any food allergies" " f, l New York Sirloin Steak. 120z, served with a peppercorn cognac cream sauce, sauteed broccoli, and mashed Potatoes.25.99 Lamb Chop. Grilled lamb, mint deni glaze sauce,parmesan risotto and green beans. 28.99 112 BBQ Ribs. Served with mashed potatoes and coleslaw. 17.99 Chicken All Plates served with homemade veoetables, or penne, linguini, angel hair pasta. Chicken Marsala. Sauteed mushroon-t.s,shallots, and diced prosciutto in maisala wine sauce. 18.99 Chicken Pieeata. Sauteed shallots, capers, in lemon butterwhite tuine sauce over angel hair pasta 18.99 Chicken Saltimbocca. Layered with prosciutto,spinach, mozzarella cheese, in sage white wine demi glaze.20.99 Chicken Francaise. Pan seared in an egg, butter with white wine, and lemon sauce. 21.99 Chicken Parmesan. Breaded fried, topped with marinas and mozzarella cheese. 18.99 Chicken Cacciatore. Sauteed chicken,peppers, onions, nnlsln•ooms, marinas sauce. 18.99 Lemon Chicken. Sauteed chicken, artichoke,sun dried tomatoes, black oliues, white wine, gcn•lic, basil,and lemon sauce. 19.99 Fish &Seafood Grilled Salmon. Served tu/lemon butter-sauce, mashed potatoes, and sauteed spinach. 21.99 Branzino. PCm seared branzino, shrimp Izsotto,parmesan, and grilled asparagus.22.99 Baked Cod Fish. 8oz, crispy,panko brecid crumbs,garlic mashed potatoes,and sauteed broccoli. 20.99 Cod Francaise. Egg battered scrod, with scampi sauce, silridr•ied tomato, capers and nuishr•00177s. 21.99 Homemade Fish & Chips. Sewed with coleslaw, tartar sauce, and fries. 17.99 Seafood Platter. Fried shrimp, scallops, clams, calamari, codfish, coleslaw, and fries. 27.99 Sides Pizzas $16.00 Sauteed Broccoli. 4.99 Cheese Grilled Asparagus. 6.99 Pepperoni Roasted Artichokes. 5.99 Buffalo Chicken Brussel Sprouts. 5.99 BBQ Chicken Mashed Potatoes. 4.99 Veggies Basket of Onion Rings. 6.99 Bacon Basket of French Fries 4.99 Hawaiian Basket of Sweet Potato Fries. 5-99 Connstiining ray-or tinco ol1 cd meat, poniti-x scaf0x0d, shellfish, or eggs, nim increase your rill:Of f(I(Kl illness. BelOrc 1)1acin",\otir orClCr hlcasC hit'Orin see icr (dcufly Other I'M)d allcr ivs� I p`oFtTowti TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.W BABNSTABLE. ' 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3. HYANNIS, MA 02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY ,erEO MPS p FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 NameAA Date a of Type of Inspection ` / O e Ro ii Address Risk Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 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 J ❑ 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 1❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories V Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 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 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) y p within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N .- - V, C�5 - #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: 0 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A Assignment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* *- 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130"F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* Time as a Public Health Control 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 ConsuAnimal Food That Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg aroe 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 * 3-2-01.14 Fish and Recreational] Caught MolluscanEquipment* 3-401.11(A)(2) Ratites,Injected Meats-I55°F 15 sec Y g Contact Surfaces of Shellfish* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or I' 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g• P �' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When 3-401.11 2-301.14 Wh to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs' following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc -Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Brazillian Food Carnes (Beef CHURRASCO BRASILEIRO $25.00 Picaiiha, costela,frango, tocino, arroz,feijao tropeiro. (Steak, ribs, chicken,pork belly, rice&tropeiro beaiis) PICANHA A MINEIRA $20.00 Picanha,Arroz, Feijao Tropeiro, Maizdioca Frita e Salado. (Rice, tropeiro beans,fried cassava, onions, bacon, egg, ham, kielbosa, &salad) PICANI A COM Q UEIJO $1 S.99 Picanha,Arroz,Feijao, Batata-Frita,Farofa de alho e Vinagrete. (Rice, beads,fries, garlic cassaua crumbs, and Brazilian Salsa) PICANHA COMALHO E CATUPIRY$18.50 Picanha,Arroz com Brocolis,Batata-Frita, e salada. (Rice with broccoli,fries, Brazilian Salsa&salad) Frango (Chicken) FRANGO GRELHADO $15.00 Arroz,feijao,fi•itas e salada. (Grilled Chicken served with rice, beans,fries&salad) FRANGO A PARMEGIANA $16.o0 Arroz,Feijao,Pure de Batata e salada. (Breaded chicken, melted mozzarella, with marbium sauce, served with rice, mashed potato, and salad.) STROGONOFF DE FRANGO $16.o0 Arroz,Fritas e Salado. (sauteed chicken in a cream of ketchup and mustard served with rice,fries, and salad.) Porco (Pork) MEDALHO $16.99 Arroz,Feijao,Fritas,Farofa, de Alho e Salado. (Medallion of Pork with rice, beansfi-ies,garlic, cassava, crumbs, &salad) LOMBO AO BARBECUE$15,00 Arroz, Fritas, e Salado. (Pork loin, with barbecue served with rice,fries, cold salad.) Camarao (Shrimp) CAMARAO AO ALHO E 6LEO $17.00 Arroz, e Vinagrete, batata frita. (Sauteed Shrimp with garlic, olive oil, serued with rice and fries, &Brazilian Salsa) CHICLETE DE CAMARAO $1 7.99 Camarao ao molho de requeijao e pure de batata com batata palha. (Sauteed shrimp with Braziliani cream cheese, with mashed potato and potato sticks.) Consuming rim or uncooked meat, poultry seafood, ,hcllfi."h, m egg.", may increase�our risk of hood illness. L'efi,re placing}'our order please inform serN ice of any other food<111ert;ies Dinner Soups New England Clam Chowder 7.99 Soup Of The Day Market Price Salads Caprese Salad. Served with fresh mozzarella, tomatoes, basil, and balsamic glaze. 10.99 Caesar Salad. Romaine lettuce,parmigiano cheese, anchovies, croutons,and caesar dressing.9.99 House Salad. Seasonal greens, cherry tomatoes, cucumbers, and red onions,in our house dressing.8.99 Beets Salad. Roasted Beets, caramelized walnuts,gorgonzola cheese, over mixed greens, balsamic vinaigrette.10.99 Kale Salads. Raw kale,red onions, caramelized walnuts, dried cranberries,goat cheese, and lemon olive oil. 10.25 Salad Additions. Grilled Chicken.5.99 Grilled Salmon 7.99 Grilled Shrimp 2.50 (each) Appetizer Asparagus &Prosciutto. Roasted Asparagus wrapped with prosciutto,parmigiano cheese, and artichoke. 11.99 Homemade Coconut Shrimp. Breaded butter flied shrimp with sweet chilli orange. 13.99 Homemade Chicken Tenders. Served with blue cheese&fries. 9.99 Chicken Wings. BBQ sauce and blue cheese, 8 pieces. lo.99 Homemade Crab Cakes. In a tappers mayo sauce, and muscling greens.i1.99 Fried Calamari. Deep fried calamari served with marinara sauce.11.99 Pastas Fettucini Carbonara. Tossed in a pancetta with cream sarlce. 16.99 Linguini Alfredo. Sauteed chicken, broccoli, and tossed parmesan cream sauce. 19.99 Penne ala Vodka. Cream tomato vodka sauce. 16.99 Lobster Ravioli. Cherry tomatoes and vodka cream sauce. 20.99 Orecchiette Primavera. Artichokes, cherry tomatoes,asparagus,kale, roasted peppers,garlic, and oil. 16.99 Linguine Vongole. Red or White.18.99 Shrimp Scampi. Jumbo shrimp in our house scampi sauce,served on linguine pasta.22.99 Calamari Fra Diablo. Sauteed calamari, marinara sauce, over linguini pasta. 17.99 Frutti Di Mare. Served with linguini pasta,shrimp,scallops, calamari,mussels, cicnns, red or white. 27.99 Veal All plates served with homemade vegetables or penne, linguini, angel hair pasta. Veal Marsala. Served with sauteed mushrooms,shallots,and diced prosciutto in marsala wine sauce.19.99 Veal Pieatta. Sauteed shallots, capers, in lemon butter white wine sauce.l y.99 Veal Saltimboeea. Layered with prosciutto,spinach&mozzarella cheese, in sage white wine dens glaze. 21.99 Veal Franeaise. Part seared in an egg butter with white wine, and lemon butter sauce.22.99 Veal Paremsan. Breaded fried, topped with marinara and mozzarella cheese. 18.99 (idOidll)Vi1�iSb'11d r, WAM ...r 1:51 L. � n sm' cam^--•` El -_ .� F �. I .,S-.9• ..b-.b .01- g �� fi O NiV� ii )�j IV3-S. ZZ9d I N `� r ON NoIS3a I� f� 0 S 6 (r ONIl130. HOIH `-....� ., c „ Q }. n.al,�;• I aasd ON NOIS30 IN oat - Ol aY-tilFYls cy�. � �- C, -¢t I• -• ' tM130 (13H011d I Y 7 }iANGE IN W-PANCY LIMIT - I -E-M€NT-ISf-F-OR-LAGEN&M-BO AAD7. ES NOT-GERTIFY 11,1-1 0 E OR ZONING OMPLIANCE t �' �d8' �t _ �WoM ST COMPLY W/EALL BUILDING CODEIT` , C ES BILITY 8, ONING REQUIREMENTS J'--==-�__---- -=--_�-__- _-- +'^'1 :.,:,�,, •,,�,•,_:. DAT <<Z ins `'� -- _ - ---- ---- F �. i g .c( � i )dl�ll(1 + X38177 O zZl --- _.=f• J _ --- l NO• C srl. C tot i• @0f r9,L � '. �, ----- -• � L 'ram -�I'..._ .._ � � i Vq l —�`„t F t)v r' T-f if-1,{'� I Sol ©v y ;; 1n Hl4n�d I. _�a / .� o S (e v,-N Q T✓•o r t` '�•b/r-v..,.�.�P CHRISTOPHER KOCABA \ S81.4 OM ZONE #710 MAIN STREET 0 08 E I I W ASSESSORS MAP 308 PARCEL 7 HI/B ZONE I BITUMINOUS SV6 G�EA9ECAL H-20 TRAP PAVEMENT ,�� �1I1'O TANK � I INV IN-2.3.97 INV Out-23.73 65.5' Uj I Z W 40CI I L SHIN 'N NV =137436 �N 6 ap 45,pp' I !� INV b-13.36 n S 11.5 INV-24,35 v J �C) a FULLI io Z m BASEMENT, a N/F ti �+ PETER & � I 7 I C MURRAY E MURRA � I #712 MAIN ST. 20.0 , ASSESSORS W 0 FOUNDATION MAP 308 a TOF=26.6 PARCEL 279 N o LOT 2 I 18,985±S.F. r^ 0.44t ACRES o HVB ZONE 1 24 5' 9 pp. �01 g Qp 6.1 �itk OF 44s o � S 20 1s75' 00 191� 4� MARKBD.DIB tim S 89'36'4 " W 9 VIL NQM93 — —91M 75.16 A�o�fia/STE�``���� — — RN-a s ZSTREET SS��VAL� INV b -1223 MAIN AS-BUILT FOR GREASE TRAP CERTIFICATION ONLY I CERTIFY TO THE BEST OF MY SCALE: 1" = 40' PROFESSIONAL KNOWLEDGE, INFORMATION 0 5 10 20 METERS AND BELIEF THAT THE GREASE TRAP AS-BUILTI CONFORMS WITH ALL LOCAL 0 20 40 80 FEET AND STATE CODE REQUIREMENTS. VERTICAL LOCATION CHANGED ACCORDING TO FINAL BUILDING PLUMBING. BS UeN UFO 349 Main Street, Unit D / 4w W. Yarmouth Massachusetts PROFESSIONAL ENGINEER DATE No. _pf"— Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Yes 3pplicotiou for Oizpozat �bpgtemc Cou5tructiou Vertu Application for a Permit to Construc"V) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System 0 Individual Components Location Address or Lot No. 70-0 MD 51"T° CAA944',S) Owner's Name,Address,and Tel.No. Cl P +WANrJi S L LC_ ZA;4N*'6 (c7W.*, 3v�* I Assessor's Map/Parcel 308 40(ftc-f°i/%4 0Z 164i r7&1 11+8 9'7 0 Installer's Nate,Address,and Tel.No. Rob eF;64., G00SZ. Designer's Name,Address and Tel.No. 1315 C_ " rZ� Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 5EMP _R_ Qj Z00 Number of sheets_ Revision Date till 13 jG� Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) N��'A�f Zsr6b &AL 64Mpse— .rR,,,eip FOR, �I�Al2t't�f'S lC,�'G►.4Gn1. Date last inspected: Agreement: The undersigned agrees to ensure the construction an maintenance oft afor escribed -site sewage disposal system in accordance with the provisions of Title 5 of the Env,' Code and r�qt lac a ste m operation until a Certificate of Compliance has been issued by this Bo d f Health. r Signed Date 4 Application Approved by _Date_ lU U Application Disapproved by: Date fonthe following.reasons Permit No. , Date Issued d / 7 `­ Fee Entered in computer: - _ THE COMMONWEALTH OF MASSACHUSETTS - t t YeS •--PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Digonl �§pgtem Con.5truction Permit ' Application for a Permit to Construct�9) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 7 60 M1) 5T` CAp14—Y'S � Owner's Name,Address,and Tel.No. Cl P WANNi:S L LG L A,Q14MS PL*L9- S ull`ry 1o© Assessor's Map/Parcel 308 QJtr-cy,,jV0, '0Z.1&.9 r781 8 48 5,7 6 o Installer's Name,Address,and Tel.No. {ZGQ ER►UC GU r�S�• Designer's Name,Address and Tel.No. GJ 6izwp 516 R1 VE 2, ` —b ,49 ►-AA O t Sir 5 08 h'78 a-t►q Pv bo-k 3 rlO M'01S PA. R0OT E, z,6 1 Jr+xT6 W iysTNAi7-t"v } Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 51p�t-1:mZSZ$ Z005' Number of sheets Revision Date 111 13jd4 Title a Size of Septic Tank Type of S.A.S. f - Description of Soil Nature of Repairs or Alterations(Answer when applicable) +N 5 11 2•Soa (rAl- 62X--A57-- P- p Date last inspected: f 1 Agreement The undersigned agrees to ensure the construction aV maintenance of the}afore*describeien-site sewage disposal system in accordance with the provisions of Title 5 of the Environmen f Code and of�to 661ace the's stemfin operation until a Certificate of Compliance has been issued by this Board of Health. //J�r Signed [�` Date Application Approved by r Date 67 Application Disapproved by: Date for the following reasons f Permit No. � / "4 1 3 7 Date Issued L� 0 —7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by IZOID - ,r-1G GaNST(2u�Tc�ti? 4 at 9 dd ft'A; ! S\` t4-JANfNv�-S. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Pery .X t No. ( —/3 ? dated Installer R(ObBz lc CONSS2,Jcr("\j Designer L Ci�Gy� #bedrooms Approved desi niflow gpd The issuance of this permit s�h-all/n'ot b aconstrued as a guarantee that the systen(will funclinn s desi ned. Date �/ f �� e � Inspector ------��---/-------- ------------ ----- L— No. Fee V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mtgo5ar *p.5term Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 906 #/A%44-S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions Provided: Construction must be completed within three years of the date of this pe it. Date q >��� Approved by r Town of Barnstable Regulatory Services Thomas F. Geiler,Director { ` Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: /�&41 Sewage Permit# -ZCX)7 /Y7 Assessor's Map\Parcel Designer: 61201)P,2W6 Installer: 9Di:IZii_te— CAA/ST 1tT1d-J Address: ` (-H /1/Ifira✓ST ON.�-rro Address: 5/6 Pt✓s )ZL) W, YN/�r�.OdrN %1'It9 M,n'Xsr0Aus 1A4Lb�, MA OZ61M On /O/0 1Zd0F_,ZrGY CZA/SI, was issued a permit to install a (date) (installer) septie-s s er at 700 10,41-l/ST2 91 i based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. cll' I certify that the sapt-ic�-�teiz referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. lKTIVo/L 41Zo w14&,r ✓i5e776 9L ��Lv��4T1�7<tJ �N OF b9,Is MART( (Ins aller's Signature) DIBB COVIL r; No.45937 &xV oisYE °�,��Q ( esigner's Signature) (Affix De p Here) PLEASE RETURN TO BARNSTABLE PUBLIC • HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc r Rpr x17 2007 12: 02PM HP LRSERJET FAX r e / p- 2 i• RU-GLAZE-WB"" 4406 HIGH MRF*RWMCE Waterborne Epoxy 0 Semi-Gloss Costing . V pewe c°arings is a member of the X1 ftbb ftrld Group Cat. # 4406-XXXXI4408-9999 - - • r - - • - • r , Generic:Waterborne Epoxy Folyamide Color:White&custom colors Fni :Semi-Gloss, 45-60 units minimum @ 600 Genera Oescriptillon:A high performance,two-pack- Clean-up Solvent: Soap and water age,chemically-cured waterborne semi-gloss epoxy WelahVG l (mft10,31bs/gaf.0.23kglL)-varieswith color coating for use as a hard,durable high performance architectural coating(HIPAC).Features easy application, VOC(mixed): 1.67 lbs./gal.(200 g/L)-varies with color low VOC,high flash point, lower odor than solvent- Solids By Volum�(mlxed):45%*1%-varies with color based epoxies,and a hard,tough,stain-resistant finish. Theoretical Coverage at 1.O-Mil 01r:690 sq.ft./gal. ; May be used in areas subject continous high moisture (17 m2/L) • . $ such as shower rooms. Pracii a Apply at 235-324 sq.ft./gal.(6 8 m2/L)on smooth,sealer surfaces.Actual coverage may 7Volcal Uses:_Use on interior property prepared poured vary depending on substrate and application method. (D concrete,concrete block,drywall,metal and wood. May be spray applied at 120-235 sq.ftdgai.(3-6 m2/L). z Ideal for hard usage areas of schools,hospitals, restau- o rants,public buildings and factories. Recommended ilmThick : 2.0-5.0 mils(50-125 microns)dry-5.0-11.0 mils(125-275 microns)wet a Special Qualifications;Suitable for use on structural Systems:Please consult the appropriate system guide, surfaces or surfaces where there Is a possibility of Inc)- -the particular job specification or your ICI,Devoe dental food contact in commarvlal food preparation Coatings' Industrial tings Specialist for proper m establishments,food processing plants and federally systems using this product.Systems must be selected Inspected meat and poultry plants.USDA no longer considering the particular environment Irhvoived. CF) requires or furnishes product c artification letters. temperature Limit: 250°F(121°C)in air.May nc? discolor at temperatures over 140°F(6000). m Flame Sruead Rad1ng,Class A(0-25)over noncombustible ;1-o surltices m FEATURESa0 Figs Point:Over200°F(96°C) Qo Minimum Time D ASTM 1640)At 3 mils a g:dva_ 9 : - Chemical and stain resistant (75 microns)DF &509'°RH: b - Resists splash and spillage of alkalis, salts, moisture, Substrate Tem erature 77°F 25°c m oils,grease,foodstuffs and,detergents Minimum Recast 16 Hours o - Abrasion resistant try Hard 24Hours p - Low odor and a high flash point titttxlmual Hewat o-a - Use over aikyd,latex or epoxy coatings SeH no Limit Ci o - Long lasting this-like finish WarnJM The abovetable prnvidesgeneralguidelinesony.Ahrays eorsuttycU y�3 • Easily Washed and cleaned ICI Devoe Coatings specialist for appropriate recoat Andows since the ma)dmum - Low VOC age recoat time of this product maybe signibcarrtly shortened or lengthened by a In • Perforrhance aftemate for Federal Specifications variety atcondroons,includmg,bur not limited to humldhl,surface temperature, Cs U TT C-550C(Class g) and the use of additives or thinners,The use of aeceleratars or force curing may shorten the aged recoat of individual coatings.The above recoat windows may not Limitations of Use. Not recommended for immersion apply if recoaturg wiM a product other than ttm listed above.If the nadmum o service. Exterior exposure will cause early dulling and aged recoat window Is exceeded,please consult your ICI industrial Coatings v Z loss of gloss,but does not affect protective properties. specialist for appropriate recommendations to enhance adhesion.Failure to n i Epoxy coatings may yellow during application and cure if observe these precautions may resuR in intercoat dalaminatlon. m exposed to the combustion by-products of improperly Shelf.Liie:1 year minimum-unopened o r" ¢ vented fossil fuel burning heaters. Mix Ratio By Volumes 1(base):1(oorverier) Induction:30 minutes-above 70°F(21°C), 2 45 minutes-below 70QF(21°C) 0 of Lit% 6-8 hours @ 77T (25°C) 0 • ' ! - ' DATA PROPERTY TEST METH RESULTS Abrasion Resistance ASTM D 4060,CS-17 wheels, 1 Boring loss 1000g load, 1000 cycles Pencil Hardness ASTM D 3363 l3 Flexibility ASTM D 522, Method B. 1/8" No cracking or flaking Impact Resistance ASTM D 2794 >100 in-lbs Water Resistance ASTM D 2247, 1000 hours, No blistering and 90%glass retention Chemical/Stain Fiesistar t:e ASTM D 1308 Excellent resistance (grape juice,shoe polish,lipstIck,coffee,alIPhatic hydrocarbons,water,motor oil,5014 etharw!solution) Fed Std. No wear through 09800 Washability ASTM D 6142, 141C, 10,00.0 cycles Read Label and Wleterial Safety.Dais Sheet Prior to Use.See other cautions on last page.sFi-0690 4Rpr .17 2007 12: 02PM HP LRSERJET FAX p. 3 — Brack :44Ce-XXXXf440a-099 Ail surfaces must be sound,dry,clean and free of oil,grease, primer GRIPPER 3210.Wood-Prime with this product reduced dirt, mildew,form release agents,curing compounds, efflores- one-half pint per gallon with water or prime with waterbome cence, loose and flaking paint and other foreign substances. primer GRIPPER 3210.Steel- Prime with waterbome epoxy t+iew Sutiat Concrete,Plaster and Masonry-Cure at least primer TRU-GLAZE-WB 4030.Galvanized Metal and Aluminum -Prime with waterborne epoxy primer TRU-GLAZE:-WB 4030. 30 days bebre painting.pH must be 10.0 or lower.F Wove lai- Glazed Brick,Ceramic Tile and Fiberglass-Scuff sand and tance and roughen unusually slick poured or precast I ooncrete by prime with waterbome epoxy primer TRU-GLAZE:-WB 4030. acid etching or sandsweeping.Follow acid manufat+turef's appli- cation and safety instructions.Rinse thoroughly With water and Previo sty_Painted Surfaces.,The waterborne components of allow to dry.Remove loose aggregate.Prime with this product this product generally allow use over most old coatings-Old coat- thinned 8:1 with water or prime with waterborne epoxy primer ings should be tested for lifting.If they lift,remove them.Wash to TRU-GLAZE-WB 4030.Dry overnight to recoat,Fill concrete remove contaminants.Rinse thoroughly with water and allow to block in areas not subject to moisture with latex filler BLOXFIL® dry.Dull glossy areas by light sanding.Remove sanding dust 4000 or ULTRA-HIDE 3010.In moisture prone areas,fill with this Remove loose paint.Prime bare areas with primer specified product or filler TRU-GLAZES 4010.Filters must.dry overnight under New Surfaces. before coating.Drywall-Prime with this product or waterbome • FOR-USE Tintin •Tint the appropriate 4406-XXXX Component A base with orange,pink and red may require multiple coats. ICI Colorants.Mix thoroughly before 4408-9999 Component B Is Application:Maybe applied by brush, roll or spray.No thinning added. required.For airless spray, use.a.015"tip.Adjust pros-sure as Mixing,Slowly aid 44DB-9999 Component B to 4406-XXXX needed.Spray is preferred for appearance and build,For roller Component A in a 1:1 ratio.Stir thoroughly and scrape sides of application, use clean medium nap-synthetic roller(new rollers can to ensure thorough blending.Allow the mixed material to must be free of loose fibers).Brushing is best reserved for small stand 45 minutes at temperatures bolo 70OF(2.1!C)before use. areas of"cutting In".For maximum gloss development,two coats min ind • ime Always restir of this product are recommended.In some cases,one cost may sufficient depending on the application method,color used Mixed material is usable for six to eight hours;if it be s r3p g aPPt m thickens,do not add thinner,but discard and mix fresh material If ands smoothness desired. Do not apply when surface or air tom- Initial thinning is necessary,use up to one-hag pint water,per gal- perature is below 50°F(10°C).Brushing and rolling may require Ion.Do not thin with solvents or solvent thinned coatings.Do-not multiple coats to achieve correct film thickness and/or hiding. add flow-control materials. Drylna Time:Application temperature range is 600-95°F(160- Note-Surfaces coated wilt this Rrodlict may berme slipilm 35`C).At 77OF(25°C)and 50%R.H.,dries to touch in two hours when,mi.For addEra sIh2resistance In of peclegitrian and to recoat overnight.Full cure in seven days.Dries to fight foot traffic add one pound per gallon of pggMe pumice or other tex traffic on concrete floors in 46 hours_Low temperature,high turfing mg humidity,thick films or poor ventilation will increase these times. Lack of ventilation and/or the use of portable fuel buming heaters Spwa ling Rate,Apply.at 235.320 sq.ft./gal.(6-8 m2/L)or 5.0- that produce exhaust gases,during application and Initial stages 7.0 mils wet(2.0-3.0 mills dry)on smooth,sealed surfaces. of curing,may cause yellowing to occur. Actual coverage may vary depending on substrate and applica- tion method.May be spray applied at 120.235 sq.flJgal.(3-6 Clean-urn Clean immediately after use with warm,soapy water. WIL)or 7.0-11.O'rolls wet(3.0.5.0 mils dry).For best hiding,tint Rinse pumps and hoses with xylene after cleaning. prlrriers toward finish coat color. Certain shades of yellow, WARNDIGI CAUSES EYE AND SKIN BURNS.HARMFUL OR FATAL IF SWALLOWED- ASPIRATION HAZARD-CAN ENTER LUNGS AND CAUSE DAMAGE. HARMFUL IF INHALED. MAY CAUSE CENTRAL NERVOUS SYSTEM EFFECTS,INCLUDING DIZZINESS,HEADACHE OR NAUSEA. CAUSES RESPIRATORY TRACT IRRiiA710H. MAY CAUSE ALUMIC SKIN REACTION. MAYBE HARMFUL IF ABSORBED THROUGH SKIN. OVEREXPOSURE MAY CAUSE BLOOD, LIVER,KIDNEY DAMAGE. WHEN TINTED,CONTAINS ETHYLENE GLYCOL WHICH CAN CAUSE SEVERE KIDNEY DAMAGE WHEN INGESTED AND,HAS BEEN SHOWN TO CAUSE BIRTH DEFECTS IN LABORATORY ANIMALS.USE ONLY WITH ADEQUATE VENTILATION. KEEP OUT OF THE REACH OF CHILDREN. NOTICE:Products in this series contain solvents. Reports have associated repeated and prolonged occupational overexposure to sohrents with permanent brain and nervous system damage.Intentional misuse by deliberately concentrating and Inhaling the contents may be harmful or fatal,For emergency informa- tion call(800)545-2643. 1f sanding is done,wear a dust mask to avoid breathing of sanding dust Do not breathe vapors or spray mist 11 you experience eye watering,headaches,or d iiziineK leave the area. If properly used,a respirator may offer additional protection. Obtain protessional advice before using. Close container after each use. FIRST NO: In case of skin contact,wash off quickly with plenty of soap and water,remove contaminated clothing, For eye contact flush Immemately with large amounts of water,for at least 15 minutes. Obtain emergency medical treatment. if swallowed,obtain medical freatmosrt Inune- dlately. tf inhalation causes physical discomfort,remove to fresh air. If discomfort persists or any breathing difficulty occurs,get medical help. KEEP FROM FREEZING. Nate: These warnings encompass the product series. Prior to use,read and follow product-qedfic MSDS and label Information. Wr.•m SHI. .ING Freight Classification: Paint Shipping Weight: 2 gallon kit-23 lbs.(10.4 kg) Flash Point: Over 200OF(96°C) 10 gallon kit-113 lbs. (51.3 kg) Pseltaging: 2 gallon kit(7.571L) 10 gallon kit(37,95L) 1 gallon Component A 5 gallons Component A 1 gallon Component B 5 gallons Component B 4406-xxxx/Ad Stock 460�) Ad Stodt tf6e62rB Cleveland, LIMITATION OF LIABILITY:To the bee,of our knmdedp,the tecbnkal data contained herein are true and Ohio,U.S.A, accuratconforms at the date ol o the specifications contained heruance but are ela.toect change MAKE d OTHER WRRANN OR UAP.A or noti0e.We Guarairtm our product N"Af2 BOO-654-2616 KIND,EXPRESS OR IMPLIED,INCLUDING MERCHANTABILITY AND FITNESS FOR PARTICULAR rPURPOSE, wvuvv.devoecoatitlgS.r�m Liability,if any.is limited to replacErne nt of the product or refund of the purchase price.LABOR OR COST OF 10IX-voe Coa" h a rnerrreer of the ICJ Paints world Group LABOR AND OTHER CON5CiXIENTIAL DAMAGES ARE HEREBY EXCLUDED. j 0„ 40'_ " O U 7RS0 7 $ 007 BASEMENT � 3 � o 300 SQ . 7 Q o 's' - ,, o 20 6 p 0' 0 BASMENT . PLAN. 1 J / ? APR 23 r • 8 • M_ 4l a , r #Arp-15 TOWN F BAR�ISTABL ii � . LOCATION 3 2 Si vow 5�- SEWAGE# — t, VILLAGE % SSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. / SEPTIC TANK CAPACITY 2570 61 (o1 r4-Aje p_ LEACHING FACILITY: (type) I(UWin ice W lz V (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any.wetlands exist within 300 feet of leaching facility) a, Feet /.a�JRNISHED BY "�`j CHRISTOPHEERR KOCABA \ 1 $81.40 08 OM ZONE #710 MAIO STREET 1 W E ASSEORS PARCEL 7P 308 HVB ZONE I BITUMINOUS Nam? GREASE Q IWN-1p '� PAVEMENT I a� 117A'91piEY?XW O2J%.7J 65.5'SUN I r•L,1 Z W 4'QL INV 21V 6-fAJs O /. S ff. UIWZAJS I I ^ I 0 FULL a BASEMENT N/F •� Z ycysi ' Z ' PETER& ¢ CATHERINE �oz W MURRAY I ' 4712 MAIN ASSESSORST W 0 FOUNDATION I MAP SOB N (2 TOF=26.6 ' PARCEL 279 N S LOT 2 v b 18,985tS.F. 0.44t ACRES o HVB ZONE , , 245 9.00' p�?$19 q0 6.1 �HOF A 20.5o' \O. MARK D. G 15.75 9• DIBB S S 89,36'4 W 9 � 75.16 s s wo� B1V 0 R1110-08-1 AI N STREET a+ 2J2 A A IV' AS—BUILT FOR GREASE TRAP CERTIFICATION ONLY I CERTIFY TO THE BEST OF MY SCALE: 1" = 40' PROFESSIONAL KNOWLEDGE, INFORMATION 0 5 10 20 voe"s AND BELIEF THAT THE GREASE TRAP AS—BUILT CONFORMS WITH ALL LOCAL 0 20 40 80 .a. AND STATE CODE REQUIREMENTS. VERTICAL LOCATION CHANGED ACCORDING TO FINAL BUILDING PLUMBING. BSC GROUP 349 Main Street,Unit D Z /0 Y�f1l.� W.Yarmouth Massachusetts PROFESSIONAL ENGINEER DATE A r., ` D057ING SEIRPER CQIrI"EMS LINE TO K- RDA" y smH GREASENMI -.TRAP / --- dw w. IN 20.00 19.75 .4 :6 Vie DROP) ry�I i:,. • , t D �+ M-25. ' INV(1)a1&46 IN 2)-19.80 IN 3)-13.36 r' , t ° SMMRIM- 7 0 2)-1134 _ r <1 800 GALLON v ti GREASE TRAPAll V-20.30 dsg R INV-20.10 `o Y-20.10 IN 2)ii-19.77 + � . IN1/(3)-1286, p Q, DISCONNECT AND p EXISTING SEYdEfi �d PER DPW REGl11RMENTS4X g1� 1 ip r�.. ,J `v d GL.Op, ►� ' ..+' r } TO OG - NA LOCAL UPJ V` y 4 w i < s 1 �\ f � 3 k FSFASONS_ TRATTORIA HYANNIS I t 5 _Q ...�� T+I E� Eih' �00 MAI� _STEET �3 _.}S^ ,TF- iy F� 508 771 --9688TEL - /----- j �-- C C , ' _ =- _ voo 0 0 0 y ci SEATNG <0 0 T 0 / S EATNG �t 3 DISHWASHER handMACNINE SINKP E N IQ T E- 279 S0. FT MAP SINK I _C - C BAR EN ol5 INK TOIL T ! TOILET L ST®GRi WALK INCOCLEA p "� 4- 3CG7 x�}4rs 9 `� p[�tI _ I I 3` C, ( k u t , , I� ' it i cn , I : cn ,- m _ - , 00 FUTURE. ESIDE NTIAL M R LIMIT OF COv E G Al N OF kq S N IN PARK G \ _ � MARK D. ti N V DIBBT Cn O O CIVIL , , fk No.45937 9 Q p F � ,- ST 6 O .c F G _ S i S N ' OIdAL E t j _ , l TP _ t / PROFESSIONAL ENGINEER DATE k• , 01000, , x .0 23. i 4. 0 SITE PLAN . - S N 700MAIN STREET ' N 4.80 s x Ike u HARRYI Su MAIN ST REET - x 24.65 0 24. • IN x2 80 2 4.60 S HYAN NiS , 24 / AS AU M H SETTS ti S C 2 4. S cS 24.80 .-, BARN TABLE COUNTY)S C ( TY1 � X u ._ kc p25. 25:1 _ GRADING DRAINAGEAND � �5.0 PLAN 9 � G S O O O x 24.9 � 26. G _ 5 6 F„ x p, G 24.8 SEP TEMBER 8 5' , 200 f /� i r1 V r / \ L e 1014 61 x 10, x ' O , 5�5 0 2 . 7 6 6.2 2 �25.7 0 5 x 6 cP , 4 REVISIONS: � 5 ; 1 `, 25.8 k _ 26.0 1 N A _ 1 0 D TE DESC. ` x 0 d� 2 5. 1 12 21 05 REV. BUILDING ARCH. 26.0 25.15 , -2 2 C� 25.5 REV. PER TOWN COMMEN - } ti t r Y 2 . 8 0 _ 25 � t t - O oe 2 A� ,} r. Y t. J „ 26.2 r t G , .W PREPARED ED FOR: :..µ a. v a, y . . .. � � & $ DEVELOPMENT, P.O. -) .. .. _ O � z } , 0 c, , { >v , _ �1 R TA 25 agg oil : � �y 0 fir. .�- .....• ., , .,:. .. ....,.. , .. 4 a ,. sd;rx., .:- _ .l'. , -r.y ,. .... .. v_fin , .,.♦ e. - a -. 5 �t Y. .. ..i -.r >.. _ .k , s , 4 �.r, �.t_ ¢ 26 00 6 G r r.. .,., / _ _ _ F2-5. M BSC m ..r G_ k....,._ V W 28 00 0 B23 5 ,H P t r2, > Gkoup 1° ^^ '' r'v \[`^]` . _ S 657 Main Stre et (Route to 2 8 _- W Yarmouth,3- � estMassachusetts� x , , - P -� 4. 8 � u 2 o S �J 02673 .00 CD x 063 F 26 , 125 701 . 26.40 508 :778 8919 �I _ R_2 nn NORTHERN ENTRANC E GRAD ING G DETAIL TW_28.00 OC 2005 The BSC Gro up, Inc. . w BW-25 50 0 SCALE: 1 10 0 25.9 _ A -SC 0 25. 1 LE 1 2 0 10 20 40 FEE-r r <,., GV PR OJ. M M , `i GR.. DIB B 25. 2 � 5 FIELD: A ELD. D. M CARTIN G ZZOLO J. c : G � ` �\ S LC A DES G N C . M._ MD BB P ISSUED FOR P C \ SUE 0 PERMITTIN G DR AWN: M. D BB G S CHECK: M. P IN NOT EC . 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DATE DESCRIPTION �` i�.i;,-.' srFClG� s� HVI:, i/Dl��"G� � 4A,-A-zrz6 t� L DONALD LOCATION: Xv`�� KENNETH � E 20M j 700 M A I O S`C, No.No.20soa TITLE: P f'2o tvo S Io D Sigwra QL c o NJ►J E To Iraw?"1 S0.W11112 SYSTEM AT ao MAIsi ST, WYAtJ►JI $ HASS. _1— SHEETS/SET Drawn: Scale: AS s4ou3 Date: NA AY 3 II 1 9 7 9 Engineering Check K, P, 'cKS71ZOM. DWG. N0. (' Operational Approval FILE NO. SHEET 1 OF