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SUBWAY #53322 - FOOD
SUBWAY#53322 14 West Main St. Hyannis - 2qp-OA4 i OftHEJ Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. awnxgrABLF- 2 F.P.(Thomas)Lee,. sy 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment j 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: 421 Issue Date: 01/01/2022 DBA: SUBWAY #53322 OWNER: SUB FIT, LLC, Location of Establishment: 14 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 32 OutdoorSeating: 0 Total Seating: 32 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED I,N CONJUNCTION WITH A COMMON VICTUALER LICENSE, Restrictions: n, 11/18/2021 11:01 (FAX) P,001/014 Fer Office Use[fniy:P Irtltlals: � ¢ Town Of Barnstable .Date `1 � 21 Amt Rd$ I ,,�eB1� P Inspectional Services �, 1b74�� Public Health Division heck ll 1 ? — - Thomas McKean,Director 3 200 Main Street,Hyannis,NfA 02601 I Office: 508-862-4644 Fix: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: `-��— L, vui ADDRESS OF FOOD ESTABLISHMENT: J? Ik 1V1 n W S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 011116( ) E-MAIL ADDRESS: 11u Laf,��M�l 'c+�C'S�.C6►� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( �) - —1 1 0 TOTAL NUMBER OF BATHROOMS; WELL WATER: _NO—Z.,.(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL:L 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 HEALTII DIV AND LICENSING AND MEET OUTSIDE 121MG REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) _FOOD SERVICE ETA1L 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 FMASE CALL 508-862.4644 QAApplicacion FortnaTOODAPP 2020.doc 11/18/2021 11;01 (FAX) P.002/014 OWNER INFORMATION: FULL NtZ OF APPLICANTUr SOLE OWNER: D.O.B 1 �u r�Q G I OWNER PHONE# 4 O` ' 9> I 5 6 4Z . ' ** ADDRESS_ Ll CORPORATE OWNER: ✓ \ CORPORATE ADDRESS: ?"� y r(ry I t LAUVI it PERSON IN CHARGE OF DAILY OPERATIONS: Ljv ,-LA 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 rood establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 41.0 >--•/ 15 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 openinel I 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: Anyonc who caters within the Town of Barnstable must notify theTown by fix or mail prior to catering event. You must complete a catering notice found at http://www,townoiburnstable.usihealthdivision/applicati2as.aBID. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec,3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:1Application FonnaTOODAPP RBV3.2019.4oc r 0 0 0 a - Certificate of Attendance This is to verify that �V. ' Laurie Turi x . a Has attended the following course Adult, Child, Infant Choke Saving which meets the guidelines of the American Heart Association Issue-Date: 1/1012020 This certificate expires-2 years from the issue date Shawn Lerner.NREMT I/C Founder&CEO When SeCO IdS Covent,Inc .. 1 cP R e. m First-Aid 'j o TraWng -4 LA r r� r When Seconds Count,Inc.is an Accredited Training Gender through the American Heart Association 0 CN \ 00 _ r r r . I St#J" Town of Barnstable BOARD OF HEALTH � John T.Norman Board of Health Donald A.Gaudagnoli,M.D. NSFAI�LE. « Paul J.Canniff,D.M.D. M F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 - Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 421 Issue Date: 01/01/2021 DBA: SUBWAY #53322 OWNER: SUB FIT, LLC, Location of Establishment: 14 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 32 OutdoorSeating: 0 Total Seating: 32 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CtQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: / �� ► Town of Barnstable Only:For Office Use Initials: ti � Date Paid p Amt I'd$^sy BARNSTABLE, : Inspectional Services ��� Check# ArEo �a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE— �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: VVd . p 1" cr 1.0 GLVI O U� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): GM W Af IMG(b1 ANC. E-MAIL ADDRESS: 1 SA_ J TELEPHONE NUMBER OF FOOD ESTABLISHMENT: L TOTAL NUMBER OF BATHROOMS:_ WELL WATER: YES NO/� ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO NUMBER OF SEATS: INSIDE: `t OUTSIDE: TOTAL: 2,0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV. AND LICENSING,AND MEET OUTSIDE DINING REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S). TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc r ` OWNER INFORMATION: FULL NAME OF APPLICANT W SOLE OWNERQ DESNO D.O.B ") OWNER PHONE # LI b1� ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. —�' >' � I ZaZ4. LA VYI� full ��i 13 2. LVA V 7 AAmet n ct f--% SIGNAT 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.townotbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonmsTOODAPP REV3-2019.doc M J• �o- � 5 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNWABLE, Paul J.Canniff,D.M.D. 1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate � # Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 421 Issue Date: 12/10/2019 DBA: SUBWAY #S3322 OWNER: SUB FIT, LLC, Location of Establishment: 14 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 32 OutdoorSeating: 0 Total Seating: 32 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: c�—�►— MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: P 7 ofI rpm For Office • Initials: � Town of Barnstable la �,�� Date Paid Amt Pd$� f'a &MMStABLE. : Inspectional ServicesKAM , - ° 9 1 r Public Health Division check# ' 5 fD N1A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 p, Office: 508-862-4644 Fax: 508-790-6304 M� APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 10 Zy I IQ NEW OWNERSHIP RENEWAL�G NAME OF FOOD ESTABLISHMENT: �JUbtJGu FZT � LLC fl13 A SoNt,! c..S 5 332 Z ADDRESS OF FOOD ESTABLISHMENT: 14 L3 MG:.t-% Sk.,, kj4.Cxntj%S, MA 02(o01 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 9'JO Q wmcpmz Ewe— E.-P�y ieAeMe �2.1 C)I.q 1 y E-MAIL ADDRESS: T-Qrri,I�.jSOIaS @Silber deye�aQrv%er\t pulp. Cc)M TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (50T SI-7 - -1-1(D TOTAL NUMBER OF BATHROOMS:WELL WATER: YES_NO Y. ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: Q_ OUTSIDE: O 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? MIA IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N IA TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) x FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QA\Application FormsTOODAPP 2020.doc 8 OWNER INFORMATION: FULL NAME OF APPLICANT &mes 'tv%'% SOLE OWNER:(Y3E /NO D.O.B (p 12011OWNER PHONE # 4Ol- 4 54- 3329 ADDRESS y S \-k,11 ])r -) E. Grizec'Loi clrh I 9-1 02ZFS1 T CORPORATE OWNER: CORPORATE ADDRESS: q30 L0G.WV nr\ �Xe ., E, PERSON IN CHARGE OF DAILY OPERATIONS: �-LA%Ze- 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.—1—auc�e. Tun -1 / 1 / 22 1. C\Mar KV%C! y / 26 / 2.0 2- 2.0 tO / Zg/ Ig _ SIG ATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinel! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3 1"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 I �tN l Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. ` Board of Health Donald A.Gaudagnoli,M.D. awnxvrABM John T.Norman MAS& F.P. Thomas Lee Alternate +bs 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: 421 Issue Date: 12/20/18 DBA: SUBWAY #53322 OWNER: SUB FIT, LLC, Location of Establishment: 14 WEST MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 32 OutdoorSeating: 0 Total Seating: 32 _ FEES _ FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - - MOBILE- FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: j FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: FINE royti • Initials: o� Town of Barnstable Date PaidT Amt Pd$ grABKAM Inspectional Services ��'F�►�' Public Health Division Check# N—i Thomas McKean,Director Jr�IP 200 Main Street,Hyannis,MA 02601 l-� �> Office: 508-862-4644 Fax: 508-790-6304 ACCPPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: �u1 OW f,I SJOW 3 3 a,3 ADDRESS OF FOOD ESTABLISHMENT: t{ A 1 <S ` U C.crl YItS MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: FA IT I I S U 5c nl�, �or�lrYl2an of YbU(J,G6 T 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: A) OUTSIDE: d 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? N IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) t/FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FormsTOODAPPREV2018.doc w PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT 'ILYy( e.S SOLE OWNER: /NO D.O.B 2.C1 OWNER PHONE# ��I -1�J`C - �j a C) ADDRESS_ LA") P1 W-P VkU"AC " -4 co 1 y CORPORATE OWNER: FEDERAL ID NO. : UMN CORPORATE ADDRESS: �j u W�I� �1� ��11 U� Z 00 / PERSON IN CHARGE OF DAILY OPERATIONS: W ►'� List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. �,. � �� - i1 i ��-1. loin `� i 6R5 i aoao S16NATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. 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 Ist. Q:\Application FormsTOODAPPREV2018.doc yoQ HE t TOWN OF BARNSTABLE , HEALTH INSPECTOR's Establishment Name: Date: Page:_�of 4 'OFFICE HOURS PUBLIC HEALTH DIVISION 6:00-9:30A.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. =A MON.-FRI. A ,e39..m HYANNIS, MA 02601 606-862-464a No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT ED ,f- - . VD Name Dat I e of T of Inspection `' Z-' - g tin Address 1 -� Risk o e-inspection Iq Level Retail Previous Inspection Telephone Residential Kitchen Date: ` JDf /- � �7 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) ff Time Bed&Breakfast HACCP VV ✓`(6tlt Gw� In: Q ✓1 Other Cl i[ �. 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) CV Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �O�, C ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 4 -eq 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 �f�� FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) { d ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures [ t ) o ❑ 5.Receiving/Coridition ❑ 17.Reheating .kr dC _11yo ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding Y ' PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control Q ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 3 't 41f❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP k 91411` r(e ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1 ❑ 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 Lpt 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 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 g violation,4 to 8 n - 'tical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Sig t re 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 Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N r-�,.,�.....,_.r,r- .-,-...- x.�-�._-..-��--�--. n.��-..�..�y--r,,,.-v.,�,..r..�.....�f.a,� -._.-r.-. --�..-_ •--,--,.�..-..._ �,�... �......,+..._.��-_. � ---�.--�-.. •--V - .i.. - w-- -- - �. _- . . .. �.. ..,- -.�_..... -- ti. -.-.ti_ - � -�.-,.,•.ter-..-^----�.�+- . .�..,�-,.--.� _ .. Violations 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* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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 g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* ti * - 20 Time as a Public Health Control 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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 Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 1' TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 76 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.]IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef m-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 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) `Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing kitc mobile food,temporary and residential Game and�Id Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority F2-301.14 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* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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* Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F � 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 * 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 Paiasi[e Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* - 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fomtback6r2doc *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,1METp p TOWN OF BARNSTABLE _ - HEALTH INSPECTOR'S Establishment Name: -- Date:• Page:. Z of L y PUBLIC HEALTH DIVISION 6:00-9:30 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 67q: �0� HYANNIS,MA 02601 506-862-464a No Reference, R=-:Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT lv� 1.S9 � Name Dat /� Tyoe of T f Ins ection Tlaur s outine Address Risk Food servi Re-inspection ` Level Retail Previous Inspection Telephone . Residential Kitchen Date: b .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) 1l Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 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: El ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils 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) s o within 10 days f receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspect 's gn ture Pr" t 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 ig atur 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 T 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) jDD.. ssignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202-1Q- 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Orr 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation 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 i 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* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q _ 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) ` Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9_ Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of g8 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* 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* Effect-1/1r2001 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 3-401.1](A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 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 ni 3-201.17 Game Amals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth*. 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices () 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. `oF�He OFFICE HOURS r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: [T 533 Z-Z. Date: �/l I-LA page: of PUBLIC HEALTH DIVISION 8:00-9,30 A.M. ti s• BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3q MON FRI HYANNIS, MA 02601 .- . No Reference R-Red Item PLEASE PRINT CLEARLY �PrED MPS a, FOOD ESTABLISHMENT INSP TION REPORT 508-862-4644 Name Z Date3 ) 7, Type of ection a/� Routine ek AddressVkr /j vS Risk Food Servi e-inspection �- Level a al Previous Inspection Telephone Residential Kitchen Date: �t " Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness b Caterer General Complaint Person in Charge(PIC) �` Time Bed&Breakfast HACCP In: 2.is- P� Other Inspector A Sc>iv Out:3;5 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 r JtA ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS I ❑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 n I, ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) JA a ❑ ❑ Non-critical(N)violations must be corrected immediately or 3 (J�. within 90 days as determined by the Board of Health. Overall Rating Corrective Action Required: No Yes ❑ Volunta VoluntaryCompliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e 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 9 ardless of the numberof critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations re 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. . f 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. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's i 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 gnature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N C116 d Dumpster Screen? Y N v 0 4__`q__ Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* g Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 * 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* 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) Rep Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q orting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 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 * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 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* 2401.12 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-Q3.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the 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) I 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* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 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. `°FTME r°wti TOWN OF BARNSTABLE HEALTH INSPECTORs Establishment Name: *E3 3 2i7L Date: 3 Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3. `0� HYANNIS,MA 02601 M-8 -46FRI4 e No Reference R-Red Item PLEASE PRINT CLEARLY �DrFD MPS° 50862 644 FOOD ESTABLISHMENT INSPPrjION REPORT Name Z Date3 ( Z Tvoe of ection er Routine Address Risk Food Service Re-inspection ILI Level a al Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint rf ' / /� Person in Charge(PIC) Time Bed&Breakfast HACCP � cT✓Q ^A 6dn ) �f In: Other Inspector Out: i _ ' G��f Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. v / / Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ OL Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ � ) W + �[-C '1'CifiLc Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ I � w Z l • FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �^ I ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals A-tn ®.� In el1 9,Q � FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) > C� ❑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 V PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) q ❑ 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 _ J 1 ��+`4 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. H ❑ 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 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 (FC4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature E.. Print: 31.Dumpster screened from public view / 2 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 ^1 fl 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 ` Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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 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 20 Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rted 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 or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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(I)(2) Eggs- mme is 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* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective I11/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* � P 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 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. Other 590. violations relating to good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23.30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) 8 illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F[0 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers an P d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-002.11 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 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. F.ME r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: "Page of �P� 1 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified MASS. `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �plFD 39.. 50M62-4644 - FOO ESTABLISHMENT INS CT ON REPORT Name Date Tvue of Insoection Routine Address Risk Food Servl Re- n Levert , Previou i if Telephone Residential Kitchen Date: Mobile Pre-op 't Owner HACCP Y/N Temporary Suspect III ess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector d O t: Each violation checked requires an explanation on the narra ve page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 1 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) 4� Action as determined by the Board of Health. Allergen Awareness 590.009(G) 4 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / ❑ 1.PIC Assigned!Knowledgeable/Duties ❑ 13.Handwash Facilities VV EMPLOYEE HEALTH PROTECTION FROM CHEMICALS AA !� ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives n ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ✓f- FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) r ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating C1 ❑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. c ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY qjj ( '7oy El 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations l 1 Critical(C)violations marked must be corrected immediately. (blue&red items) rective Action Require ❑ 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 toda*the,, 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of 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 bads-up,infestation of rodents or insects,or la )( ) be in writing and submitted to the Board of Health at the above address violations observed,7'to 8 non-crit• al violati ns. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8 non-critical violations=C P 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: In or Signatur C Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N y #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI '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 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 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 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 Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 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* 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 4601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 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 Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( )-(D)in cater- Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 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 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )(b) 3-201.17 Gae Animals* u 11 Good Hygienic Practices 17 Reheating for Hot Holding Req rementspractices ]d be debited under It29-Special m 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) 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 TagsiRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 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. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback&2doc *Denotes critical item in thefederal 1999 Food Code or 105 CMR 590.00Q, 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. HEALTH INSPECTOR'S Establishment Name: Date: 1 FTMer TOWN OF BARNSTABLE �`� Page: of • OFFICE HOURS Ane°� PUBLIC 0 MAIN ST HEALTH RETSION 8:00-9:30 A.M. - 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. .. MON.-FRI. No Reference• R Red•Item PLEASE PRINT CLEARLY �p ,679•e�m HYANNIS, MA 02601 508-862-4644 'F FOOD ESTABLISHMENT INSPECT ON REPORT Name Dat Tvoe of Typp&Moection in Address Risk ood S e- spection Level Re ai 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) ❑ t Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities L.Ly EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or ColorAdditives A_VjS V' V ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMElfEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures s ❑ 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 n PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control. U ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) I(� �^ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspensi on or revocation of the food B-One critical violation and less than non-critical violations � 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-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 i non-critical. .-no critical ' water,sewage.back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,Ito anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view. OJ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC' Signature Print: ` / Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y N �""'-�� U �/� 1 V Dumpster Screen? Y N 4Z I _ _ _ 7. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41`F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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 3-501.16A Common Name-Working Containers* ( ) Hot PHFs Maintained At or Above 140 F * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130 F 7-201.11 Separation-Storage* : P g rl Applicants 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 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 AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165'F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.1l(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* 3-003.11(E) Remaining ling of d Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* * 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 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .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 TMET TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS BARN STABLE. PUBLIC 0 MAIN HEALTH DIVISION 3:30-4:30A.M. Item- Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MASS. MON.-FRI. �Dre,63 HYANNIS, MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION EPORT C Name Dat l of Type of Inspection ion Routine IV Address Ris od Service Re-inspection Level - Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary 10thw s Caterer al Complaint Bed&Breakfast PPerson in Charge(PIC) (!/l Time In: 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 requite 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 { l FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) l t F]4.Food and Water from Approved Source:' ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATIO ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 1, Ss ❑ 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: Aj Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employel Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ go Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than Orion-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations ter,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right.to a hearing. Your request must ons and less than 9rion-critical. If no critical water, g back-up,infestation of rodents or insects,or lack of violations observed,7 to 8 non-critical violations: If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8rion-critical violations C. 29.Special Requirements. (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view qL"14 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P s S' ure Pr' f Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N � Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) , FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge[0 Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F , 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202:11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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-Immediate is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) EquiCleapment* is 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 mrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* - 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* �) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-203.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Within 4 Hours* 23. Management and Personnel Tags/Records:Fish Products 5-203.11 Numbers and Capacities* FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Op IKE l TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of. OFFICE HOURS P ° 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. MON.-FRI. '�A ,baq.per• HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY tF0 MPS 508-862-0644 n FOOD ESTABLISHMENT INSPECTION REPORT ` J Name Date Tvne of !Xpe-o-f Inspection '� O ratio utine Ile Address - Risk Food Se-, a=irrs�ection lb j c� Level Previous Inspection § f Telephone .., (� Residential Kitchen Date: t S lS/ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - l 1� Time Bed&Breakfast HACCP Person in Charge(PIC) �'� i`UG V�F�l Other Inspector J 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) ❑ !,0 l Violations marked,may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ j ` [ \ Action as determined'by the Board of Health. Allergen Awareness 590.009(G) n FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands \� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities lJ F EMPLOYEE HEALTH PROTECTION FROM CHEMICALS \ ❑ 2.Reporting of Diseases.by Food Employees and PIC ❑ 14.Approved Food or Color Additives �L \\\0. 1 0 in IV ❑ 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 _ / )6L `^',N _ ❑ 5.Receiving/Condition ❑ 17.Reheating VT Ci} - ❑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 A^, A_V � ❑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 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) Corrective Action Required: ( a No ,Yes Non-critical(N)violations must be corrected immediately or q l.� �° within 90 days as determined b the Board of Health. Overall Rating luna Com liance Employee Rel riction/Exclusion / e-ins ection Scheduled Emergency Suspension Y Y F[:jEE0mbat rY P ❑ P ❑ 9 Y P C N Official Order for Correction:Based on an inspection today,the items rgo ❑ 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 6=One critical violation and less than 6 non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than,9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8nori-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: n 31.Dumpster screenez public view , / ` ,f°�L I /. Permit Posted? Y 'V 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 lJ �j Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions t � . Interventions and Risk Factors(Red Items T-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A)- Assignment of Responsibility* F 8_ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties - _ Cooked and RTE Foods.* .. 3-302.14 Protection from Unapproved'AdditiJes* 79 PHF Hot and.Cold Holding 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* 7-201.11 Separation-Storage* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above IM*F* _ 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 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 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* i 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 -" Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 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 MilkProducts* 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 * 4-501.114 Chemical Sanitization-Temp., H. CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized � P�.P 16 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of g 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-lOLll 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* Ery ctiw 11712001 -- - - - 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.F.ish From an Approved.Source. 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11' Contact S rf Sanitization of Utensils and Food 3-40L11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3=20L14 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 Methqds of Sanitization Hot Water and jStuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfisi.from NS$P Listed. _ Chemical* (A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 -- - - -Game and Wild Mushrooms Approved By- - - -� - ( )O Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 = Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above'if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When'to Wash* * 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 * 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 � Game Animals _ 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 Reyeived 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* i 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 from140°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 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. l: oFt ' TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Ite PLEAE PRI CL RLY a 508-6624644 NT ems. 'FDN1P` FOOD ESTABLISHMENT INSPECT] N REPORT Name r. Dat Type of Tyne of Inspection Operations) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: ,- Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: off i ..r 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) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009( - d Action as determined by the Board of Health. Allergen Awareness 590.009(G)' / � f'1 �.ay FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities / EMPLOYEE HEALTH PROTECTION FROM CHEMICAL ❑ 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) C� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling C t ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control {Vp1QI ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIO^NS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSPO �f ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices' ❑22.Posting of Consumer Advisories S 1 1 11 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations u f/ L 0 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: �„[„ t"N t ❑ Yes TL Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. F 51 ❑ Voluntary Compliance ❑ Employee Restriction/ xclusion e-inspection Scheduled . ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo" ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to.a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8pon-critical violations=C. ' 29.Special.Requirements (590.009) within 10 days of receipt of this order. 30.Other D C Inspector's Signature Print: 31.Dum ter sere ed from p liqo���)e LNn 1 Permit Posted? Y NGT�ase Trap Pre ous Pumping Date Grease Rendered Y N vscso #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S' na ur Prjpi 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 AccoidiLg to 1 590.003(A) Assignment of Responsibility* F 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_Chazge Duties '- 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F) * -' EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 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* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation20 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* Food Contact with Equipment and Utensils*ge* 7.202.12 Conditions of Use* Requirements (11) Variance 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 590.004 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 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*_ * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-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 Warewashing.-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3.-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of i Animal Foods That are Raw,Undercooked or 4-60L11(A)` Clean Utensils and Food Contact Surfaces of 1 Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System*. - _ E ui ment* � gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* q P 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°'19Q 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 ofP 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 I Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* ( ) ( ) * - Ratites-165°F 15 sec* in mobile food,temporaryand residential Sources 10 Proper,Adequate Handwashing g' Game and Wild Mushrooms Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12. Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail _ 590.004(C) Wild Mushrooms* _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°13 Item Good Retail Practices FC 590.0003-203.12 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 an p d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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.Rs ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date l ( Page: of OFFICE HOURS �AR EO) PUBLIC 2 0 MAN SH EET 3:30-4:30 P.M. SION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON MASS g HYANNIS,MA 02601 -FRI. .a3v 508-862-4644 No Reference R-Red-Item PLEASE PRINT CLEARLY. p 08-8 rEO M FOOD ESTABLISHMENT INSPECTION R PORT Lob's* , t� ,l1�� Name Dat e o section e S Routine Address Risk od Se = Level eta'1P'� 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 WEI 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY - - 1 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today, a Items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑,Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than9 -critical. If no critical water,sews 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must non 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 violation,4 to 8non-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view i. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 5 a(ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N v Dumpster Screen? Y N i4 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 TemperaturesAccordingato 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 of Below 41°F/45°F EMPLOYEE 590.004(F) 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 7-102.11 Common Name-Working Containers*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 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 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 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* f 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* .Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source. 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4=702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS _ 4-703.11 Methods of Sanitization-Hot Water and 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 o and residential Sources 10 Proper,Adequate Handwashing g' P rarY 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* 3-401.2-301.14 When to Wash* i 1 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 Ht Holding practices should be debited under#29-Special o g 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. g Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which.do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 13 590.004(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* Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(.f) 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. 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. �p THE Tp� TOWN OF BARNSTABLE .HEALTH INSPECTOR'S Establishment Name: Date: Page: of PUBLIC OFFICE HOURS : BARNSTAR�O' 2 0 MA N ST DIVISION 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. 63 HYANNIS,MA 02601 - MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY - °TFo Mt•�° 508-862-4644 FOOD ESTABLISHMENT INSP CTION REPORT Name Dat Tyne of Tvoe of Inspection OPAEgjton Wgii (% Address Risk ood Service inspeDction Level v 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 Colo�Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22..Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r� Critical(C)violations marked must be corrected immediately. (blue&red items) I�-� Corrective Action Required: ❑ No I'- - , ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A--,Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations, B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view VIA Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 0,( ) #Seats Observed Frozen Dessert Machines: Outside Dining Y N s i tur _ Pn Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �v Dumpster Screen? Y N �C /\ _. ...::'V.:���-•.y_-.�1+-a.+...'.y Y4s� -� L...1�n y'.t...Fr,.,.1,:^}.. , a"C.'i'='�i. -..�".. - . - _..` _ - ^'y. y..v. -- ,.. .. .r c -rr .1�_'te .�.�v-i�.�.L.- -:#--s�+�r^w4.... - .i. .. - Violations related to Foodborne Illness Violations Related to Foodborne Illness Intervention_s 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) [Demonstration ignment of Responsibility* 8 ", Cross-contamination 14 Food or Color Additives _ _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties -_ 3-302.14 Protection from Unapproved Additives - Contamination from Raw Ingredients 15 - ,.,,,- Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-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 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg-r,ve inrzooi 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,tern or and residential Sources 10 Proper,Adequate Handwashing g' p Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004 C) Wild Mushrooms 2-301.14 When to Wash* * Other 590.009 violations relating to good retail ( * 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 Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* illness interventions and risk factors listed above,can be found in the 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°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12. Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotescritical item in the federal 1999 Food Code or 105 CMR 590.000. 14 hlesL Main Street west, end roLpry 'RF 45 deg bend / 1 / 0 1 112 FL dBBP qj : a� W A t f \ D' \ W 4 1 in Q 10 V2 f ti Dairy Queen 4 1/2 f t erg -•9�,� 4 3/4 ft Y a3ft \ �� cle� / Lied - in 8 V2 Ft I June 26. 95 sampling monhole West Main Street s P�vCI i c ' �-5a �'o�L UTILrrr ARM rVIA •r 1® eoanuc ooNv�crloN WIN 6kC'1AuaT PAN ' , •!6 , � 'i�•X�0 8.9,'COUNTh,a W/aN1�P 8F3dUl: - TOUOLSW NAk&".SW blNk 4 9oAP DI131=9NBtla. IO © 9.1")Q4°MOP Mr- WA 4 o k © .STOMOS AAak 1.' Q COVMM,TRABW MIN. e• 1 Q' "• ' `'� � !;:`' "•): am �, � ® ,a°� eAkssr case. 'O 'er `'""") a , ••,. , y COMM AR" -s��• ' !b' COLD DRINK R6'RIQMMATOIl T.ela k AurOMATIC OOFM MAk»i AReA. C`, '• •4� t• M•w�' ® R1�WGtiRAT6D i'OOO PREP 81i.'C-0UM 5"M i 5. 't: �ri ---•�. ,•�;W'�•M ,It�ir�. .Ga ' ®'.b .® �6T PAN. , I-"TOW2l a t1O1J ..y •1-•'c'', ® �cr X r r �. , �'-s°�' w;no>re�lo ® ' r �L' • oel oe . ,� � •�° � � � /' ',�ERVIC8 AR8.4 • iwLL�l'uoiwlt 'i� +• NO ' t• • p4 IN 1 aoALM 1wg Et r. �•'�, •t. , ,• I, ;Tt,-•r r r Jl,,,{•'�II`IIW�•'��.• � � � + �EPRY -svice 6°4p-' 14'-4" i - J J ow DIRECT WIRED '0" X 7'0" 9 r- �tl +toe j t DIRECT i LH 47 $1-5» 48 l' 14'-11" ppil UNDER i 0 9SM ABOVE 45 44 t as > t j j 11 TABLE 40 40 40 40 I\ 1 HEADERWALIL A.F.F. -- +42` +4 °I I '0' X7- " 42 3T 2 ISO ABOVE+ CtT 6*4 8 0 3 ,° PM RH 310" X 6.8.1 - 0" I y +B `'"Nt70D= 30 HIGH SPEED DATA LINE 29 00'-B`A.F.F. - -" &MODEM LINE REQUIRED LH 9 20"X41 dFM 24 --1 REQUIRED Y�JALL tD ®® i( 31 L----- 19 - IL_J1 21 -- - -- 6 6 6A / 6A A �� __ L..,..-._____._-__J 9 8 L . . 6A . . J L . . 6A 6 36"H`H , 89 11 ACE �A'SCfE �1R SP (ffQUUEiD 6 6 ® 8 6 ®¢ 6 3 TVP. 8 6 ( 8 8B 88 88 o 51 6A '.O. 6 6 0• 6 6 +}8 6 6A .Qm 8A O O a 5 P T-1 I` 3'-6" ' 1 " 7- " x ° 0 f a — 14 WesL Main Street. west, end rotary xe 45 deg bend c l 1/2 ft dmp AILL �\ T ru �0 U Dairy Queen 4 V2 ft w � ti �R 4 3/4 ft Alo .Y �, o3fL deep /. Lied - in 8V2ft June 26. 95 sampling manhole West Mein SLreet � 9 foD No..... .... _ Fna..../....................... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiti-Voottl 3Vorki Towitrnr#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. lkl _...!'?tG�2l�il �G�J/ /4'�� Fl ( gTC.11iZ? i ..._. �► _ � v❑ Address Installer Address Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of ersons____________________________ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------- ----------------•----------•----- ------------------- W Design Flow............................................gallons per person per day. Total daily flow.-._........._.__.....__.._....._...........gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet-------------------- Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date----------------.....------------....... Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------_ Depth to ground water........................ 44 Test Pit No. 2................ inutes per inch Depth of Test Pit.................... Depth to ground water........................ ...... -- -•---------- ----- -- --••-••---- ---•---------•--------•-• •-•-- ............ 0 Description of Soil _ W ............................... ....:....__ _._ .__..:_..... _ ---- - .:�� ... ___...... .....--... ..................................................................................................... ............................... U Nature of Repairs or Alterations—Answer wheri applicable............................._.._..._______............_....................____._...........__. -----•----------------------•----------------------------------------------------------•--------•-----•••----•------------------------•-----••-•---------------------------------------.........•....... Agreement: The undersigned agrees to"Install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system-in-operation until a Certificate of Compliance a issued by the board of health. Signed ............. -.............a.......................... .. .................... .. . . Application Approved By ------ .... ------- Application --- - -- ------------------------ ---- .� ....��...... Application Disapproved for the following reason - ------------------------------ ---------------------------------------------------- ---------------------------- ------------- - -- ... ............................ . .. ... .................................................... Permit No. .... .................... ..... Issued ........... .......... .... ............ e ace W/- - -:I-, FE: THE COMMONWEALTH OF MASSACHUSETTS � U � BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiun for Diupu ial World, Tomitrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -----•--- ---••---•---•--------•............. ....••............................... ......................................... Location-Address or Lot No. i _ (..---t-?i�� {f/f�....7iL./J�..7------•--•-•--•--•-- ., .............................................................." l A C O4ner r e Address a .. t..t?� t G 4_.:1-• ( 1<1 eN S:t- ------ is--� - ;�c�C �'.1. lf/f T-4� (e k ................................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow..................................._--------gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter__----___-_.-- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet...._............... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- -----------------------------------------------------------•----- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ �--- D f - escrptonoo -•-----=------• /l � ._._.. ,. _ l�// = x = '� f Gild. % " '� /- •/y //• fA/(/Y l W _ ,/ f> _ v ...............................................................................................................................� .-----..__............_....._._................._............_......... UNature of Repairs or Alterations—Answer when applicable---------...._..._._.......___.__............._..............................f................ -•--•------------------------------------•-----------------------------------------------------•-----------------------------------------------_....•--••-••---•-•••••--••--•---......••--•----•••--•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as�e'`n issued by the board of health. Signed - �`--''" ' ^� ..../..._:.:.... �/� �� / v Application Approved BY � .:........'!'L ........... e'(/ - -------- :../ D'« Application Disapproved for the following reason 6------------------------------------------------------------------------------------------------- ........................... .----- ......................... �GJ I�te Permit No. ..--------------- /-.----f.... ............... Issued .... > e;. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Comylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by --------------------------------------------------------------------------------------------------------._------------------- ------------ - - nstal le S at ..--- -------------------------------------------------------------------------- has been installed in accordance with the provisions�of TITLE 5'01f, he Stat-e.Eavironmental Code as described in the application for Disposal Works Construction Permit No. ..v�4y..�... dated .------ --------t....._- — THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. "----�.....`..- ... Inspector --------X_ _ ....--------------.....-- ----------------------------- ------------------------------------------------------------------- ------ THE COMMONWEALTH OF MASSACHUSETTS n BOARD OF HEALTH — TOWN OF BARNSTABLE ��� No..j.....�.. ......... FEE............ �i��uu�tl Turku �unutr�rtiun �rrmit Permissionis hereby granted----------------------------- --------------- v------------------------ ----•---------------••---•-••---•-.----- to Constru t ) or ,R.epair a !, Individ;ual,S gwage,Disposal System (,,,( k at No. l � 1'1 Iff—,& --........ - ' as shown on the application for Disposal Works Construction Permit No.tl____--- /Dated.._..__��r__ �_..`._�.�?....... ----------•-••-••---•-•----•• .... •...;--........................................................... J Board of Health DATE.. ..."..�..� ,.`.... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Commonwealth of Massachusetts •' ' \ Executive Office of Environmental Affairs Dep.artment of Environmental Protection q� 1, �F® Southeast Regional Office r� L9 99 William F.Weld �. Governor Trudy Coxe Thomasz8 powers t �/idlr�l'iOTT{ielOfMf� March 10, 1994 Sun Company, Inc. RE: BARNSTABLE--WSC/SA-4-1338 Ten Penn Center Sunoco Facility 1801 Market Street 14 West Main Street Philadelphia, Pennsylvania 19103 WAIVER APPLICATION-DENIAL/ PRIORITY DISPOSAL SITE/ ATTENTION: Mr. William Morse TRANSITION STATUS, M.G.L. Chapter 21E and MCP, 310 CMR 40.0000 Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , received a Waiver Application dated July 30, 1993 -for the former Sunoco facility, a disposal site located at 14 West Main Street, Barnstable, Massachusetts. the Department Please be advised that on February 3 1993, h p • P1 Y determined that the site is a confirmed disposal site according to the 1988 version of the Massachusetts Contingency Plan (MCP) . You were previously identified as a "Potentially Responsible Party" (PRP) for this site with liability under MGL c.21E S5. The Department reviewed the Waiver Application and evaluated the previously submitted assessment material pursuant to the 1988 MCP (310 CMR 40.537) . As a result of this review, the Department determined that the site is located within the area designated as an approved Zone II for the 1't7wn of Barnstabl=es wells. T1.14--r4fore, the site is classified as a priority disposal site. Since only non-priority disposal sites are eligible for a waiver, the waiver is hereby denied (310 CMR 40.537 (1) ) . The Department recently redesigned its Waste Site Cleanup Program. The revised MCP (310 CMR 40.0000) and related fee regulations (310 CMR 4 . 00) became effective on October 1, 1993. This site is classified as Tier I pursuant to the provisions of the new MCP. Sites where there is evidence of groundwater contamination at concentrations exceeding the applicable RCGW-1 reportable concentrations set forth in 310 CMR 40.0360 and where the, site is located within a Zone II, are classified as Tier I in accordance with the inclusionary criteria (310 CMR 40.0520(2) (a) ) . 20 Riverside`Drive 9 Lakeville,Massachusetts 02347 9 FAX(508)947-6557 9 Telephone (508) 946-2700 r -2- r As a Tier I site, you are required to submit either a Tier r .� Classification and Permit Application or a Response Action Outcome Statement to the Department in accordance with 310 CMR 40.0500 or 40. 1000 respectively. The deadline for submittal of either of these is one year from the date of this letter. Your submittal must be prepared by and bear the signature of a Licensed Site Professional. In addition, you must evaluate the need or an Immediate f Response Action (IRA) as defined in 310 CMR 40.0410 and notify the Department immediately if an "imminent hazard" exists at the site. IRAs are taken in response-to sudden releases, imminent hazards and conditions of substantial release migration. No IRA may commence without prior Department approval, except as specified in 310 CMR. 40. 0420. This evaluation must continue throughout the remedial response action for this site. We recognize that there may be difficulties and confusion during the transition of existing sites from the 1988 MCP to the new MCP. The new MCP, however, offers many incentives and opportunities for streamlined, timely, and efficient cleanups. It is the Department's intent to provide you with as smooth a transition as possible. Please be aware that failure to comply with any provisions of the revised MCP may result in the Department taking enforcement action against you. Should . you have any questions regarding this waiver determination, please contact--Mark Jablonski of this office at (508) 946-2819 . Any questions regarding the application fee should be directed to the Waiver Unit in the Boston Office at (617) 292- 5545. Very truly yours, Gregg Hunt, Acting Regional Engineer, for Waste Site Camp H/MJ/rr Attachments: Tier I Response Action Permit Fact Sheet Waiver Application Disposition Form CERTIFIED MAIL #P011 216 152 RETURN RECEIPT REQUESTED f n -3- J cc: Town Manager's Office Town Hall 367 Main Street Barnstable, MA 02601 ATTN: Warren Rutherford Board of Health Town Hall 367 Main Street Barnstable, MA 02601 ATTN: Thomas McKean, Chairman DEP - Boston - BWSC ATTN: Waiver Unit DEP - SERO - Administration ATTN: George Crombie Andrea Papadopoulos DEP - SERO - DWS ATTN: Larry Dayian DEP - SERO - Data Entry Commonwealth of Massachusetts Executive Office of Environmental`Affairs Department of Environmental Protection Southeast Regional Office William F.Weld Govemor Trudy Coxe retary,EOFJ1 CA�;_S e m ' ' June 4, 1994 William Morse RE: BARNSTABLE--WSC-4-1338 Sun Company, Inc. Sunoco Facility 35 Terminal Road 14 West Main Street Providence, Rhode Island 02905 Permit # 82645 Tier I Transition Classification and Permit Statement Dear Mr. Morse: The Massachusetts Department of Environmental Protection (DEP) has redesigned the Waste Site Cleanup Program. The revised Massachusetts Contingency Plan ("MCP") and related fee regulations (310 CMR 4 . 00) became effective on October 1, 1993 . The new MCP (310 CMR 40. 0000) includes specific requirements for sites which-- had been classified as "priority disposal sites" under the 1988 version of the MCP in order for them to make the transition into the redesigned program. (See enclosed Transition Fact Sheet #5 for--- more information. ) This letter is being sent to you regarding the above.- referenced site which was previously classified as - a "priority disposal site" and listed as such on DEP's August 1993 Transition List of Confirmed Disposal Sites and Locations to Be Investigated, or Addendum thereto. Sun Company, Inc. has been previously identified as a "Potential Responsible Party" (PRP) for the above referenced site with liability under MGL c.21E §5. TRANSITION CLASSIFICATION Under the new MCP, sites will be classified as either Tier -I or Tier II. All Tier I sites require permits to proceed with assessment and remediation. Sites classified as Tier IA will be managed by a Licensed Site Professional (LSP) under the Department's direct oversight. Tier IB and IC sites will be- managed by LSPs and will not receive direct oversight by DEP, but will be subject to DEP audit. The Transition regulations of the new MCP (310 CMR 40. 0640) , categorically classify all sites which had been listed as "priority disposal sites" as Tier IA sites. The new regulations allow DEP 20 Riverside Drive • . Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 -2- to determine the nature and extent of Departmental oversight required for transition priority disposal sites and, based on the criteria in 310 CMR 40. 0730, classify them as Tier IB sites instead of the categorical Tier . IA. . Using these criteria and existing available information, the Department has determined that the above-referenced site is classified as Tier IB. 4 '" TRANSITION PERMIT .STATEMENT The' new MCP does not require submittal of a new permit:_ application for priority disposal sites. Instead, DEP will issue a "Transition Classification and Permit Statement" (Transition Statement) to those with potential liability under MGL c. 21E §5 which describes the site's classification and the terms of the transition permit. This Statement if signed and dated by the PRP, . or other person performing the response actions; becomes a valid_ Tier I permit for the site effective upon its receipt by the Department. The Transition Statement for the above-referenced . site is attached for .your review ' and action. According to 310 CMR 40. 0640 (3) , you must return the Transition Statement to DEP within 120 days of your receipt of this letter indicating whether you (1) . accept the terms of the Transition Statement, (2) disagree with DEP's classification of the site, or (3) do not accept the terms of the Transition Statement. These options are as follows: (1) .Accept Transition Statement: To accept the terms of the Transition Statement, please sign and date both copies .of , the Statement at Paragraph "1" and return one copy to this office. (Please also send a copy of one of the signed Transition Statements to the Chief Municipal -official and Chairman of the Board of Health. ) Annual Compliance Fees for _ Tier IB will be assessed starting October 1, 1993 . The Tier IB Transition Permit is effective upon the Department's receipt of the signed and dated Transition. Statement f310 CMR 40.0640 (3) (b) l.a] : (2) Disagree with Transition Statement: If you do not agree with the Department's determination that this site should be classified as Tier IB because, in the Opinion of an LSP, the site should be reclassified as IC or Tier�II, sign and date. both copies of the Statement at Paragraph "2" and return one copy to this office within 120 days. (Please also send a copy of one of the signed Transition Statements to the Chief Municipal Official and Chairman of the Board of Health. ) In order to change the site's permit category and in order to continue response actions at the subject site, you must obtain a Major Permit Modification from DEP. To ,do so, you must submit a "Major Permit Modification" application (310 CMR f -3- �.r 40.0707) , which includes an LSP Tier Classification Opinion, and fee of $1200. This. application will then be processed according to the provisions of 310 CMR 40. 0700. The appropriate Annual Compliance Fee will be determined pending the outcome of the permit modification. If you wish to conduct assessment - activities (such as - the : sampling of existing monitoring wells, the sampling of surficial soils, and the monitoring of. vapors inside buildings) within 120 days in an effort to document a -lower-- Tier Classification for the purposes of filing a Major Permit Modification with DEP, you may do so. However, "intrusive" assessment activities (subsurface investigations involving test pits, new monitoring wells, and soil borings, etc. ) , will require prior DEP approval, unless they are being done as part of a response action which already has DEP approval. (3) Do Not Accept Transition Statement: If you do not accept this Transition Statement, you must sign and date the Statement at Paragraph 113-A" or 113-B" and return one copy to this office. (Please also send a copy of one of the signed Transition Statements to the Chief Municipal Official and Chairman of the Board of Health. ) You must .also indicate whether or not you intend to conduct any response actions which were approved by DEP prior to October 1, 1993 . Ifyouu , do not intend to conduct such response actions, you must include an explanation pursuant to 310 CMR 40.0171 and 40.0172. If you do intend to conduct these response actions, you must include a schedule for completing them. Whether or not you intend to complete work previously approved, you must submit a Status Report which includes -an - LSP Opinion as to whether a Temporary or Permanent Solution has been or will be achieved at the site, and if not, the response actions necessary to do so (310 CMR 40. 0640 (3) (b) 3] . Please note that if this site is adjacent to another disposal site where response actions are being conducted, it may be- necessary . to coordinate your response actions with those being undertaken on the adjacent site. All persons authorized to conduct response actions under a Tier I permit must comply at all times with MGL c. 21E, 310 CMR 40. 0000, permit terms and conditions and any . other applicable federal, state, and local' law. Failure to comply with all applicable requirements shall be cause . for the Department to initiate enforcement action, including, without limitation, permit suspension and revocation. If the enclosed Transition Statement is not returned to the Department within 120 days of its receipt, or if the Statement ' indicates that you do not accept the " Transition Permit under paragraph (3) above, the Annual Compliance Fee for Tier IB sites f -4- ($2 , 600) will be assessed, beginning on the day after such Transition Statement is due (310 CMR 40. 0640 (4) ) . In addition, DEP may commence appropriate enforcement actions . to ensure that the required response actions for the above-referenced site are initiated and completed in a timely manner. We recognize that there may be difficulties and confusion during the transition of existing sites from the old MCP to the new MCP. The new MCP, however, offers many . incentives and opportunities for streamlined, timely, and efficient cleanups. It-- is our intent to provide you with as smooth a transition as .. possible. Should you have any questions about -this letter or the Transition Statement, please contact Mark Jablonski at (508) 946 2819 or at the above letterhead address. Very truly yours, Gr gg Ht, Acting Regional Engineer for Waste Site Cleanup. H/DAM/jt Attachments: Summary of Redesigned Program Fact Sheet on LSPs Transition Fact Sheet #5 310 CMR 40. 0730 CERTIFIED MAIL #Z235 539 , 764 RETURN .RECEIPT REQUESTED cc: Barnstable Board of Health Town Hall 367 Main Street , Hyannis, MA 02601 ATTN: Brian R. Grady, Chairman Barnstable Board of Selectmen Town Hall e 367 Main Street Hyannis, .MA 02601 ATTN: Warren J. Rutherford, Town Manager DEP - BOSTON ATTN: Madeline Snow DEP - SERO ATTN: Data Entry w� AOL EGtUI PMENT'. SGHEt7ULE ITEMS FROVIDED.BY;OWNER/TFNNA THRU IDQ-AND INSTALLED BY ,. QTY. No ITEM ANUFAG. R MODEL VOLTAGE PH KW/yP RE DI HOT: GOLD DRAIN GONN. NUMBER 120 I IA FRONT COUNTER :Z BY p R Y • . 2 IAI GASH REGISTER BY LOCALLY I O. 1 VERIF Y IA2: CONDIMENT Y. IDQ:.•• 100011 IA3. TWIN FOOD% R IDQ 100021. 10: 1. IA KW. • . IA4 . FLASH Rc IDQ: 230031 2 1 I:1KW. Y IAS . 35. OG ROLLER 6RILl IDO:.. :.'.. r. 9040211..'. IZO I.."i. Y 2 IAb. PAN DIP.SINK IDQ i3 114° I IAl . BLIZZARD MACHINE I 900100:. . :.: 120...::,..; 1 1.7 Y . IB.. ICE: AM, , RI 1 I I L R VERI I/4". 1. ' IC DRINK H ICEBIN;: ITGO �' '' FF 13 •:.' 120.- SKV4 , T. 12". 1" 1.. ICI. 'GA . TOR VVDRINK Y % I I.: .35 Y; I/Z" . .IG2 DRINKD HO 1 2 I63 3EG.CUPDISP ER ` ID Q 142110.'I: 1 I64 . 4EC CUP ISP E ID 14Z I ID D MENU SY TEM IDQ 2 0040 120 1 6 KW Y 1 . IE 3 DOOR DISPLAY.AG I 0400 120 08 I 1S Y I IEI 4 PANEL M BOARD SYS. IDQ NTEMPD: 12 I .36KW. Y . I IF FREESTANDING CHAIR PK6: IDQ. TE . 2 16 DBL TRASH REGEPTIGA IDQ'. 100166 2 IH HAND DRYERS.. IDQ '10 -150.. 2 IHI CHILD PROTEGTI SEAT IDQ 551-30 2 IH2 BABYGRANGE TATION IDQ 55 - I IJ NEON YOGURT 16N BY OWNER 6.G 120. 1 V FY Y I IK OFFICE BY WN LOCALLY I 2A SOFTS RVE FREEZER IDQ . 9 1GA6-I 2 8 3 •. Y 1 2A1 • DBL TER'LI KIT IDQ 921-2 4 1 2A2 • REGIRGULATIN6 SYSTEM 5 IDQ DQF 1A 2 I 8 KW Y 3/4" 1 2A3 CONE/CUP 15P NSE 1 O 141 1 I 2A4 26'MOUNT RAG 15 IDQ dl4 1 I B 24. IP ST I I I/2 I 1 281 • WATER INE KIT IDQ 911 04 2B2 I M GH ID ." 9001001 l 255. COIF DIP IDQ 4020 1 O. : 1:. I KW Y 1 2 E IDQ: 00 1 Y I . 2G .T ING CABINET Pt¢EEZER IDQ 1114 004 1 I'. 1.5 Y 1 201. TOPPI CABINET BAGK9HE DQ' 6 2 262 BLIZZARD D15PEN5 R IDQ + 2C . MI D! ER IDQ 3•. I 1 Y. 1 20 24 DIP ST ND I Q-I . 2DI • TER I KIT I 1 O 1 . 2D2 BLIZZARD MAGHI ID I 120 I- 1 KW Y 1 203.DOUBLE GO DIP;- IDQ O 12 I. ,I Y 2D4 FUDGE PUMP. IDQ 055100 120 I... .5 Y 1 2E. 50FT5ERYE FREEZER . tDQ,. 9 GAB-l32•.{ 9. • Y I 1 I 2EI •D .WA R LINE.KIT IDQ ;> 421-2 4 2E2 CONE a P DI ... IDQ..> 141501 I 2E3. 26"MOUNT IDO. 141421 2F M15TY I 120. I.. KYV. Y I 3A 5GRUB SINK. IDQ 83 1/2" I 3AI • F ET t DRAIN V IDQ WA 2 3A2 14"X 4'WALL SHELF METRO 1448F5'> 4 3A3 • 14 WALL MOUNT BRACKET IDQ 1 35' 6'CAKE G TER:.. IDQ, i ' ' 100090 1. 3BI . COPY IGAIGE PROJECTOR.: IDQ Q Y. 120 1. .12KW 3B2'.DBL. DIP ER IDQ 03405.0 " 12 1 .15KW. Y 1 - 555 MIXER •.;a IDQ.. DQ SUPPL 120 1 .30KW •Y 1 3G BAG- -BOX BY OWNER. LOCALLY 8 30 AN RACK MBL Iva, +. LOCALLY Y I 3E ICE MACHINE IDQ CM65OA 06. .. 1 .IH/P' 3 8" 3/4' 1. 3EI ICE BIN: IDQ• ' BH500 1 4A 24'X 2'SHELVING ASSEMBLY. IDQ..: :.. 100064 4B DOUBLE FREEZ ID -200 12 l. 1.4KW .. Y . BY OWNER : LOCALLY. 120: I 1.5KW' I 4D DRYE BY OWNER LO Y 120 08 I. R Y .. I 5A 6X8 WALK-I LER ORLAK . K.01 -GL 120'.. SKW Y I 5AI DOOR PANEL CONTROLS NORLAKE A 1.20•':: 1 .2 KW Y 2 6AI .16 X 3'SHELVING ASSEMBLY IDQ : 100064. 6. 6A2 24"X V SHELVIN6 ASSEMBLY.* . ID 1000 1 3 6A3 24"X 4'.SHELVING ASSEMBLY' . IDQ' 100062 .. 2 6A . 24".X 5'SHELVING.A55EMB Y Iva 100066.. bA5.20"X 5'DUNNAGE RACK IDQ.�. 101350 I bB : DOUBLE .R.FREEZER pQ 49. 120 2 1A • ENTER SIGN IDQ . 1664505500. 120.' : 1. 2 1Ai • EXIT 51 O, IDQ '1864505300: O Z2 Y: , 1B ' SXB.SINGLE FACE LOGO IDQ '116000 Y: 8A MANSARD ROOF PK6. I Q TE " DENOTES EQUIPMENT-NOT.SHOWN ON:EQUIPMENT PLAN,.DJT PART.QP EQUIPMENT PACKAGE 5UPPLIEV BY VWNER/TEI 1!!!^1 IIGS►/ci.IT.:CI .A AI f ry 0 _j 0 U � V 1 � 1 vtu `° n wa- O lJ W I ° n � I I t 0 - ------------ - - ° ra pu < a ° 1 a. y 00 ji v;51t e'S+Xk 1 m�s�E t•if e.��r}r a er 1,tirt t. t h. t z �yt� y��Y' �,��,rt•"1 �x1X;q�,j^r le 1 tt-2. .✓ � k+RLa, r ,#9..5{ t�;- IXs ;t -�. .+ .a.-k.:sA.`fi.%< _ A _._ .. �;_. _ z_+Re •o- 's * r�l�a ,r# r R A MURPHY SILVIA PO BOX 976 OSTERVILLE, MA 02655 12$ f, 25-80/440 Y ly PAY'fO'I'HE ORUSR OP y c1i,InRS DEAN WI7TER REYNOLDS INC. A B C1D—TET7G� K L M N P R T U V W Y Z BANK=OWE BANK pNE.COLVAIUUS,NA Food " 'sVablishment Permit MEMO Fro en Dessert License 1:044000804l: 484 1 289 2041I L 28 ,1 1 TRPL swk- m �- =3 0741 P SINK I � � HAN SIIGR-� I r- Of FUTURE SEATING i - o' l -- DAIRY QUEEN �. 14 WEST MAIN STREET HYANNIS, MA 3/8/94 ,y„ NOT TO SCALE EQUIPMENT LIST I Front Serving- Counter W/Accent. Panels 1 Backline Counter 1. Sneezeguard. 1 Laminated Cup Dispenser Panel 1 6' Two-Part Work &. Storage Counter for Cakes 1 Two-Tone Single Laminated Trash Receptacle 1 Drink Lid Holder 2 3E Cup Dispenser 1 . 5E Cup Dispenser , 4 Side Mount Cup 'Dispenser- 2. Side- Mount Cone Dispenser 1 2E Cup Dispenser (coffee) 1 Counter Condiment- Tray Assembly 1. Round. Up. FW115 Food. Steamer 1 Twin Food Warmer' Assembiy 1 APW IDS-lA Hot Dog & Bun Steamer 1 24" Dip Stand (left hand) 1 24" Dip Stand (right hand) 2 Waterline Kit for Dip Stand 2 3/4 HP "Blizzard" Machine 2 "Blizzard" Foot Pedal 1 Double Cone Dip Warmer 3 Hot Fudge Warmer .W/Pump 1 Topping Cabinet Cooler I Triple Cone Dip Warmer 1 Stainless Steel Backshelf for Topping Cabinet 1 Three-Compartment Sink 1 Cecilware Ice Tea Dispenser #S-3 1 Shelving Assembly for Front Serving Counter 1 24" Shelving Assembly - Total to 20 Linear Feet 1 Dunnage Rack 1 2' x 4' Shelving 1 Shelf Mount 2 Duke 957 Soft Serve Cab Freezer Water Cooled/Self Contained, 3 Phase 2. Twin Waterline Kit 4 Adaptor for Waterline Kit 1 T50HSP2 Door Flash Freezer 1 52-1595-04 Pan Rack for Flash Freezer (one side) 10 18" x 26" Sheet. Pans for- Pan Rack Assembly 1 GFISSD- Single Door- Upright Freezer 2 ULG50B0 Two-Door- Disp.lay Freezer w/Casters and 4 Novelty Baskets 1 KLC7 Step-In Cooler, Floorless, Minimum 6' x 8' 1 GY-0404W Water Cooled Ice Cuber w/C400 Bin 1 5-Unit Limited "Brazier" Menu. System (see_ attachedj 1 4-Unit. Cakes & Logs Menu System (see attached) 1 Complete Two-Unit Yogurt Showcase (see attached) 1, Two-Unit Hot Dog Menu_ System (see attached) 1 Novelty Smallwares Package I "Dairy Queen" Smallwares Package 1 Limited "Brazier" Smallwares Package 1 Maintenance Smallwares Package 2.` Cash Registers- -- To Be.- Determined 1 Cash Register Attachment F0129 -2- 1 Time Clock 1. Time Clock Holder 12 "Blizzard" F-lavor' Display/Dispensers (smoke_) 1 KopyKake. Projector 1 Kitchen Aid. Mixer I Menu Board Transparencies Set 2. Child Chairs 1 Outside—Concrete— Trash Receptacle 1 Coffee Maker 2. Malt Powder Dispensers (malt powder/spanish .peanuts) NOTE: Refer- to separate menu board layouts. F0129 —3— f • RECOMMENDED MENU FOR 'BRAZIER' STRIP CENTER STORES "BRAZIER' Hot Dogs Hot Dogs (1/4 lb. "Super, Dog") 4:1 (10" configuration) Hot Dogs 10: 1. (6" configuration) Chili 'N Cheese Dog Cheese Dog Chili Dog Hot Dog The. following is a list of ingredients: 4:1 Hot Dogs Mustard 10: 1 Hot Dogs Sweet. Re.lish 5" Buns Hot Dog Chili Sauce 10" Buns Chopped Onions Ketchup American Cheese Miscellaneous 'Brazier' Items Barbecue sandwich (pork or- beef) with 4" hamburger buns Chips, Assorted (maximum 5 varieties) 'DAIRY QUEEN' ITEMS Cones Small 5 oz. Regular 7 1/2 oz. Dipped Cones Small 5 oz. Regular 7 1/2 oz. Dip Flavors Chocolate and Butterscotch Sundaes Small 5 1/4 oz. Regular 7 1/2 oz.. Shakes/Malts Small 16 oz. Regular 21. oz. Banana Split- 'Peanut Buster' Parfait- "Royal Fudge 'N' Cake" F0129 -4- 'Blizzard' Flavor Treat Small 10 oz. Regular 16 oz.. Soft Drinks Small 16 oz. Regular 21 oz. Large 32 oz. Flavors Coke, Diet Coke, Sprite, Root Beer, Orange (water- based) and. Optional with Soda and Water Buttons. Iced Tea. 16, 21, and 32 oz. Coffee 10 oz. Milk 8 oz.. 100' FROZEN YOGURT Cones Small 5 oz. Regular 7 1/2 oz. Cups Small 5 1/4 oz. Regular 7 1/2 oz. Sundaes Small 5 1/4 oz. Regular 7 1/2 oz. Yogurt Sandwich °Breeze' Flavor Treat Small 10 . oz-. Regular 16 oz. NOVELTIES "Dilly" Bar; individual and 6-packs "Buster Bar"/"Fudge Nut: Bar"; individual and 6-packs "OQ" Sandwich; individual and. 6-packs 1- Optional Manufactured Novelty 000' FROZEN CAKES Sheet. Cake Heart Cake 10" Cake Log 8" Cake F0129 -5- REFRIGERATED TOPPINGS Crushed "Reese-'s Peanut Butter' Cups" Whipped Topping Crushed.. "Heath" Candy Bar Milk- Crushed "Snickers" Candy Bar Option 1. Strawberry Topping Option 2 Pineapple Topping Option 3. Chocolate- Topping. Option 4 REMOTE PUMP TOPPINGS Hot- Chocolate Fudge Hot Butterscotch Fudge Cold.. Chocolate Fudge DRY INGREDIENTS IN, "BLIZZARD° DISPENSERS Crushed "Reese's Pieces" Coconut Crushed "M&M's" Plain Candy Option 1 Crushed "M&M's" Peanut Candy Option 2 Pecans Option-3 Crushed Nuts Option 4 IN MALT POWDER DISPENSERS Malt Powder Spanish Peanuts F0129 -6 ` TOWN OF BARNSTABLE q LOCATION SEWAGE # VILLAGE "� ASSESSOR'S MAP &p LOT��OT -o S INSTALLER'S NAME&PHONE NO. �i�`( aC oJra �v SEPTIC TANK CAPACITY (n A.cJ C trC4 P I -40til1% Se c J Lc LEACHING FACILITY: (type) (size) NO.OF.BEDROOMS , BUILDER OR OWNER SI _y; 4 -�- S�Lyl g / � r 2 y !�J ee%{ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) Feet Furnished by A' �'��. . L A �-°� � <: ,�}-� ��o� �_c 11,E f- References: . t Land Court `s 9 Gr�ea" Tro Case 010 p PA ZONING Land Court se Ca 15133 Take-Out Stations Bush Land Court Certificate 32781 Deed Book 9 0 11 Pae13 Sea — 135 Gals. 5 Spaces/Station:x 2 Sta'ions 10 z 1 ._ 9 Seats x 15 Goi./ tc e _ , Lot NA � sL _ s4 Frontage 200 En'1 /S7�Ift 9 oM D/O LbeB � 0 G i . Required) _ M Use 100 al. (M n q ) :Width NA '. o ace/2 Full Time EmF; .yees - 11 Sp _ 20 14d6Setback S. erd - NA Soots — - Rea rd NA ' s 1 Space/3 `Seats x 9eats 3 at � c«,rss e m Total Spaces R q 1re d 14 • Total Spaces Pro. #ded — 14 ;. r q.; "Scale.. =l 2083 Locus MaR o ' : Project Title k : Ice cream E Sh OP o . • AUNT BETTY S POND , o Wes t End o_ Yr o Ro tary s f —" �. In -_ J ~� Water Lino Feb. 1. 1973 1- \ r of Hyan n Is ., -Y o �o � o t Ma. 0 0 0 Trasho o rep Of *; o Cp• PREPARED f 0 O ,. ReginaSilvia Maus o w c C0 9a*n - . Intlnk FeOc �l 2 C L- 0! O 6 ar X -- p m .o y6 � D 7 .,.p O W O 5 $ \ �`L 911 Main Street �m a paces ,o w (O 1000 Gal. r Proposed Pro osed 4 _ - � r oSteryare, MA r S Grease Trap Sewer Line � " .. .. . U O O / f . ..l.,.+._ .e._ .. + a �u Bike Reek �_ ��` A. ;M. Ison Associates Inc. 36.74• S 60 43 00 E 508 428 1450 4 1856 Proposed 24 3 island FAX 20 Manhole Curb 1�e Catch Basin ; Gran DrawingTitle Granite Curb w • w ' w Catch Basin k Waterline W Existing Wa Exi g S West End Rotor S _ Sewer Line S S _y Existing S Proposed Morn Street _ p West ; Site r� Plan { -,N OF. a : _ i P.,ra � k. . :Scale. 1 20 CML 0 FEET 20 40 50 lE Date: March 3, 1994 Dw No: g - Design: J.V.B. �- o ice-C , Check: 33 Drawn: J.V.B. a i Job No.-2.0662.1 Sheet 1 of 1 i References: Land Court Case 9010 PARKIN ZONING Land Court Case 15133 5�. Land Court Certificate 32781 Gas Station Business Deed Book 1910 Page 113 2 "Bays" ® 3 Spaces/Bdy = 6 Lot Area NA 5t. Frontage 200' Retoii Width - NA Mo,,, ° Setback — 20' LQS�hi 1,600 s.f. ® 1 Space/200 s.f. = 8 Sideyard - NA ab� a Rearyard — NA Total Required 14 ° coo�se Total Provided 14 Scale:1"=2083' Locus Mai Project Title: Sun Oil Company Si e A UNT BETTY'S POND At oQ r' L Q � Wes t Erg d t Ro taryWater Une Feb. 1. 1973 \ 77'f ` sotto In oo o Hyan n is, o o \ ° —° Ma. \\ \ \\ \ \ o --�_TOP Of &OPe w o o — —° o \ \ 8(turnhoua Berra ho o \ \ \ \ \'' \\8 \ (91 \ Chalnllnk Fence 2 cL � a) a .\- aoi :° -H-5 0 \ ,o \ \\ \, ,6� ��� k W m 0 O o \ �, 911 Main Street oP ` _ i� Osterville, MA l° 02655 9 0 1 I (o BAY I (11 L (14 1 � Pump Island ` 6� BAY II ( I =45.1 �s�°I`a A. M. iiison Associates Inc. 136.74. l 3' R=128 s O S 60'43'00" E 508 428 1450 FAX 420 1856 k Island Granite Curb Catch Basin Drawing Title Granite Curb Catch Basin (West End Rotary Exis tin 9 t Main Street Conditions Plan ..^ P. �. Scale: 1"= 20' .�. 0 20 40 50 On FEET ate: March 2, 1994 Dwg No: - n Design: o j Check: �P 313I9 Drawn: J.V.B. Job No: 2.0662.1 Sheet 1 of 1 References: Land Court Case se 90 Gmose Tro 10 pPA ZONING Lan d Court -Case `15133 Take—Out StationsBusinewst Land Court Certificate 32781 f Dee 9 d Book 1 0'P 3 1 Page 11 _ 5 Spaces/Station 2 'Statlo s 9. x n 10 9 Seats x 15 Gal. Seat 135 Gals Lot Area NA f e /S'hIft 200Fronto9e 000 Gal. (Min. Required) En/o.w Use 1 Width NA 1 Space/2 full Time Employees es nw M s 1 Setback 20 P Si a —rd NA d _ 1.QS'dl;i, Y'a a� a Seats Y'a _ , _ ' :Rear rd < NA 1Space/3 Seats 9 Seat 3 Golf � Course Total Spaces Req uired uired 4 p q 1 P ,E m Total Spaces`Provided 14 Scale. al 1 =2083 Locus' Md R Project Title: C Ice ream 0 Sh p o AUNT BETTY'S o . POND Wes t Erg d 0 o. . O .... tea. , , Rot ar --_ In ��, Water Line Feb 1, 1973 \ 77 f i tt Hyan o .o r t Ma. --------- 0 o 0 0 Trash -1 o o Top Of_ dope PREPARED fVR. o 0 x _ 0 k o 0 o B, Re in a Silvia �a 9 o w c B«m Cha(n�in o k Fen ens v► � c A a 6 O V _ f1 ' O "� n� 6 0 �1 O m .o d 7 r+ � 0 �. 5 `L W O' S .o911'Main Street, C] O Spaces 0 i �O b O Co.Proposed 1000 Gal. r P Proposed 4 - � ostern�ie,'MA P o c r s Grease Trap 02655 c Sewer Line ` r T ^ ^ . 8 1 �k a -• 10 a Ra - � � L A. 'M. Wilson Associates '.Inc. 36.74 ' R_.i28.83 at to S 60 43 00 E Proposed 24' Island nh 508 428 1450 FAX 420 1856 / 3 .. Manhole e C� Granite Catch Basin Drawing in Title Granite Cu rb , Existing Waterline W w W w •Catch Basin ` S s S West End Rotary - tin . Line S Existing Sewer i Proposed Street Wes t Main Site Plan CM SH0 . �!q 1 s O Z, w s P. � Scale. 1 20 CMiI .�No.35eU 0 20 _ 40 ` 50 FEET Date: March 3 1994- - Dwr9 No: � Design: J.V.B. Check.-� : 513 9 I Drawn. J.V.B. 1 ob No: 2.0662.1 Sheet 1 of 1 } Re ferences: ces: Land Court Case 9010 PARKIN ZONING Land Court Case 15133 ' • St. land .Court Certificate 32781 Gas SfOtlOn Business and Deed Book 1910 Page 113 f 2 Bays O 3 ;Spaces/Bay = 6 Lot Area — NA �. Frontage 200 Width — NA Refoll M Setback 20' ,e 1,600 s.f. 0 1 Sp s.f. = 8 LOCUS P Sideyard — - NA as Rearyard — NIA Tot,' 'Require' '4 Golf q course Tot._.Provide.�4 Scale:1"=2083' Locus Mai Project Title: i I Sun 01/ Company Site yp` ��`� A UNT BETTY'S POND 4, 0 0. A t 0' Wes t En d - - / Ro tar Water Une Feb. 1. 1973 1 J - pttom In Hyan n is ° — Ma. \ \ \ \ TOP 0 Slope (31\ 1\ \ \ \ v� \ \ — \ (� \ (7-N \ , �\ 9iturmMWa e ern o ��; c \ \ \ \ (8 \ (91 chainlink Fen 2 c _ a G. 00� � X � 50 r0. c \ \ � fig• 911-Main Street 1 W G] O o \ ^cP o� 0 ��' /9 0565511e,,MA C _ I I ai S 2 9 O 1 A v I (o BAY I (11 .: L _ - 1 (4 _ Pump Island .....d..'. ..•....•..• ( � _45.71' A. M. Wilson `Associates Inc. 12 BAY II I i • 136.74• S 60'43'00" E R=128.83 508 428 1450 FAX 420 1856 � Island Granite COO Catch Basin Drawing Title Granite Curb Catch Basin West End Rotary Exis tin 9 Main Street West Conditions Plan i � of Scale: 1 = 20 Oft - 20 40 50 FMT ate: March 2 1994 Dwg No. Design: _ Check. �P Drawn: J.V.B. l Job No: 2.0662.1 Sheet 1 of 1