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HomeMy WebLinkAboutMISAKI JAPANESE - FOOD OLD OWNERS a"q_ 'Co MISAKI JAPANESE 379 W...Main St.,HY - FORMERLY: SUSHI BY YOSHI • SEE 16 SUOMI ROAD – UNIT 1 • ADDRESS CORRECTED WITH NEW OWNERS IN 2024. Town of Barnstable BOARD OF HEALTH Y 8 John T. Norman Board of Health Donald A.Gaudagnoli,M.D. DAW,NSTAPUL F.P.(Thomas)Lee,. 3q 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. ra Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnsta'blems 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: 496 Issue Date: 01/01/2022 DBA: MISAKI JAPANESE RESTAURANT OWNER: WKC, INC. Location of Establishment: 379 W. MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: `�— MOBILE-ICE CREAM: c= Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: � For Office Use Onlv: Initials: '' �. "'E�o Town of Barnstable Date Paid �Amt Pd$ ca lsb ��AB�. ; Inspectional Services ii -,MARr, '�FD►�•+� Public Health Division Thomas McKean, Director 2IA 200 Main Street, Hyannis,MA 02601 1 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE < NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: . W4, C ADDRESS OF FOOD ESTABLISHMENT: 5J9 r I U/4 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ),5 ir1r i,9(2 COMMA,, a-c, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( J L )-37/ -,377/V TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO — ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: `-' SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: � OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT rrl I9 I v SOLE OWNER: YES/qNO OWNER PHONE #ADDRESS CORPORATE OWNER: 2z ��,fCORPORATE ADDRESS: U o a� C�b n 8-C/� 3x, i"�.�il Y Y�/t,/� l�, mo-' b" / PERSON IN CHARGE OF DAILY OPERATIONS: � .n - 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. / A1. I �� / a /90po' �— ` / 2. Ej �i ��i��,Q. I® l 0 /a /� T /xj/ SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 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 `w Rom: Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. nx��srxss� w Paul J.Canniff,D.M.D. #As, 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: 496 Issue Date: 01/01/2021 DBA: MISAKI JAPANESE RESTAURANT OWNER: WKC, INC. Location of Establishment: 379 W. MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I i � SI NE T Town of Barnstable For Office Use Only: Initials: 90 � Date Pd I Amt Pd$ ✓ 96AMSfABLEss ,p Inspectional Services ai �a,�l 1p Ma Check# 1639. s Public Health Division ArFD MA'S 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 UeFO .. NAME OF FOOD ESTABLISHMENT: /nc—, d,19o, iflt�b, ADDRESS OF FOOD ESTABLISHMENT: )-Wan i3 coo MAILING ADDRESS(IF DIFFERENT FROM ABOVE): r^E-MAIL ADDRESS: { 1S�i r-P Su sh) core aj t tv--� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( SAY) (- ' TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc I i' OWNER INFORMATION: �p FULL NAME OF APPLICANTi (. V ' SOLE OWNER: YE /NO OWNER PHONE# 0 ADDRESS , 'o t nn, CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date / 1. an I an '11 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc I Gin, Town of Barnstable tF4� BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aA STABL& Paul J.Canniff,D.M.D. e 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 496 Issue Date: 12/10/2019 DBA: MISAKI JAPANESE RESTAURANT OWNER: WKC, INC. Location of Establishment: 379 W. MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: GQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I i E� n Initials: Town of Barnstable - Date Paid 1 Amt PdPd$ BARMABLE. ; Inspectional Services "US&' heck# s639. , Public Health Division �EDMA�a in Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 1 1 Office: 508-862-4644 Fax: 508-790-6304 `r. j�APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE V NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:- G )Y1 f ADDRESS OF FOOD ESTABLISHMENT: Uwi'Ianv +3 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: A ( ' s1 c�! •(7F'A i)� (LQ�� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES �NO L ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ✓ SEASONAL: DATES OF OPERATION: /�/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE.OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsT00DAPP 2020.doc I _ � tf i OWNER INFORMATION: FULL NAME OF APPLICANT / �,gyp f SOLE OWNER: YES/NO OWNER PHONE# 73 / ADDRESS 3 lJ� l� & clyavnih yv o-OV�(DG 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 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc Cw �y rtx Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. MRIN'S ABLE. John T.Norman �$ 1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate a 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: 496 Issue Date: 12/20/18 DBA: MISAKI JAPANESE RESTAURANT OWNER: KAREN TERRIO Location of Establishment: 379 W. MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - — - ------- - - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: f PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: ... .. ......... .. .. ___-..__. _._..__. .. . .- ..... .. .. ._ FTokti For Office Use Only. Initials: . o� Town of Barnstable Date Paid Amt Pd$ * M Inspectional Services 059. `0� A'E Public Health Division Check# Thomas McKean,Director S" / 18 200 Main Street, Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: MlO'% (� ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): !c�► E-MAIL ADDRESS: 1 1 G( I'di 162 CO}VLC TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - _ TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:—, � SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE 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) 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: kpplication FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT Ln ) b SOLE OWNER: YES/NO a OWNER PHONE# �-3 �ADDRESS VOL+ G / k mwo MA A CORPORATE OWNER: FEDERAL ID NO. : � CORPORATE ADDRESS: �4A PERSON IN CHARGE OF DAILY OPERATIONS: Q�/�n List (2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. rl lu SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc HEALTH INSPECTOR'S Establishment Name: Date y°FtHE rqY TOWN OF BARNSTABLE.: Page: of,, _. P ° PUBLIC HEALTH DIVISION 3 30 4:3o P.M. ti _ OFFICE'WOURS BARNSTABLE 200 MAIN STREET Item Code C Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. t6}y. .� HYANNIS, MA 021i01 soe-asz 4644 No Reference R-Red Item , PLEASE PRINT CLEARLY rFD MPy p .. FOOD ESTABLISHMENT INSPECTION REPORT 9, 1 _ UDF Name ( � Date'n ,- Tyne of Ins ectio ..Address p� J Risk + ood Servic Re-inspection - �' l / (� Level ar Previous.lnspection 142 Telephone Residential Kitchen Date: _ Mobile..' Pre-operation _. _ r (-f . Owner HACCP YIN Temporary Suspect)Ilnes 3 Caterer' General Comps laint Person in Charge(PIC) C Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked re uires-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 y p health hazard and require immediate corrective Tobacco 590.009(F) ❑ 3 �- �� Action as determined by the Boa d of Health. Allergen Awareness 590.009(G) -. FOOD PROTECTION MANAGEMENT ❑ 12.Prevention ofContamination from Hands (� J 0 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 Re$tricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE . . TIME/TEMPERATURE CONTROLS(Potentially,Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Ive - ❑ 5.Receiving/Condition ❑ 17.Reheating. ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ,j. PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 3 �( ' : 6 ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP (,l ❑ 10.Proper Adequate Handwashing' CONSUMER ADVISORY j� �l�y� El 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories t U^� + ` - 14 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 IN)violations must be corrected immediately or Overall Rating \`C within 90 days as determined by the Board.of Health. - 1 ❑ Voluntary Compliance . ❑.Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension fF- C N Official Order for Correction: Based.on an inspection today,the items checked indicate violations of 165 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 mo 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. B=One critical violation and less than Orion-critical violations re 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 6rion-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 writin and submitted to the Board of Health at the above address violations:observed 7 to 8rion-critical violations. If 1 critical refrigeration. 9 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8 n-criU al violations=C: within 10 days of receipt of this order. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's g ature Prin 31.Dumpste�Greened from public view . Permit Posted? w y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIs � a re Pri nt: Self Service Wait Service Provided Grease Trap Size: Variance Letter Posted Y- N Dumpster Screen? Y N .. � � -�.__ „' -•�-*�-�-•--Y'- �--"--,r. ---_. - -. ,..�•.._- ...-.�- _. �-.ti..-.,.-`..-.......�-�_-+,.-,.._ -..r+--r r.-�'C�'.-,-+-r....--.•.•--+;•-:•--..-�.�.r-+---•ti"--".1..�--_..-...--..�..-.- �-,._..�...-. _ .. - .._�-.,--- .-.�s,. -,.• _ . .-ti er""._"". 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 Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to. Other* --..-:: „ ., .. . .7-102.11 % Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation Storage** 3-501.16(A) Roasts Held At or Above 130°F* - Applicants* 3-302.11(A) Food Protection* p g 7-202.11 Restriction-Presence and 20 Use* Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effect-turzoor 4-602.11 Cleaning Frequency of Uleusils 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* i 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 41.i 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 40L11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2 401.11 Eating.,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute 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 non-critical 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 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* g illness interventions and risk factors listed above,can be found in the 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs 8 Tags/Records:Shellstock following sections of the Food Code and 105 CMR 590:000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) g Coolin Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2: .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste F.C.-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices -- -- - --- 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 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. IKE, TOWN OF BARNS TABLE; __ -. , .,HEALTH wsPEcroR's Establishment Name: Date: Page: �. of `oF OFFICE HOURS �R Eo PUBLIC 2 0 MAIN STREET 6 30 4:30,P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date Verified MASS. HYANNIS, MA 02601 - - s MON.3FRI. No Reference R.,-Red Item - PLEASE PRINT CLEARLY.;.. 039•p 0�' .-..,. -. 508-862-4644 FOOD ESTABLISHMENT,INSP CTION REPORT, Name _ / Date Type of f Inspection ov iris `` d �j p / L Address. !1 J' Risk - ... Food e-inspection 1"vim^ f Level Retail Previous Inspection Telephone Re sidential sidential Kitchen Dated Mobile Pre operation Owner HACCP YIN Temporary Suspect Illness ' - Caterer- General Complaint �- Person in Charge(PIC) � Time Bed&'Breakfast HACCP. In: . Other .-Inspector 1 _ Out: . Each violation checked requires an explanation on the narrative page(s)and a citation-of specific provision(s)violated tv. Violations Related to Foodborna Illness Interventions and Risk Factors(Red Items) -Anti-Choking 590.009(E) ❑ Violations_marked7nniay 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) ❑ tea 0192, FOOD PROTECTION MANAGEMENT, ❑ 12.Prevention of Contamination from Hands ev ❑ 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.- - �-{ C � ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals4/2 �T 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 8 O. ❑ 7.Conformance with Approved Procedures/HACCP Plan_s ❑ 19.Hot and Cold Holding. PROTECTION FROM:CONTAMINATION ❑ 20.Time As a Public Health Control n 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) !/Jj Zqn w ❑ 9.-Food Contact Surfaces Cleaning.and Sanitizing ❑ 21.Food and Food Preparation for HSP! ^� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY d 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories w� 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 ❑'Yet Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. � ❑ Volunta VoluntaryCompliance Employee Restriction/Exclusion Re-inspection Scheduled ❑ Emergency.Suspension C N Official Order for Correction Based on an inspection today,the items F] 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.. 6=One Critical violation and less than 4,non-critical violations 9 - 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. Seriously Critical Violation=F is scored automatically-if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9rion-critical. If no critical ' water,sewage back-up, 27.Physical Facility (FCr6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 9 p,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 non- '' violations=C. 29.Special Requirements. (590.009) within 10 days of receipt of this order. Inspector's Signat re Print: 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view �c" Permit Posted? ease Trap Previous Pumping Date Grease Rendered Y N N PIC's Signatur Print: Y N Grease #Seats Observed Frozen Dessert Machines: Outside Dining Y 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 Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in=Charge . � 3-302.14 Protection from Unapproved Additives r 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 * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-.Charge to Other*, 3-50116(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130'F* Applicants* - 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Rest 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*590.003(E) Removal of Exclusions and Restrictions 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reser or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP Disposition ofAdultereted or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 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* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cnvc mrzoor 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* r. 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 nSPECIAL`REQUIREMENTS'4° 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145"F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140`F* (Blue Items 23-30) 3-202.15 Package Integrity Y 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3=202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'F 3-203.12 _ Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3.402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°.F 25. Equipment and Utensils FC-4 .005 3-402.4( Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page:. of 'y 'Y OFFICE HOURS 7x BAR E. PUBLIC 2 0 MAIN STREET - - - 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MASS. MON.-FRI. p ,639,e m HYANNIS,MA 02601 508-862-4644 No Reference R-.Red Item PLEASE PRINT CLEARLY 'FD1A�' FOOD ESTABLISHMENT INSPECTION REPORT / CAit-IA br cal Name Date Type o TyRo,,of Inspection O i s outine d v Z h Address '� '��� Risk Re-Inspection Level Retail Previous Inspection Telephone Residential Kitchen Date:. Mobile Pre-operation t Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP loll^ In: Other I\_ Inspector Out: 1 -L A, 4 fftloz�: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. rf Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ v 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 ` ( to-DE 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 I ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP 1 ❑ 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 �1 �_. 1'L2cl h );<k Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils - 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signa re int, 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 Sign u Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N -..-, --. ._..- �.-. .. -'ir_-.. . ...,. "...�-�...Y..- �s,:-`..... ..., ...- .. .. - -• �r�'vati..r`. �... .r.-�__.�- ...,�-..�-..r^•'��...-•-•-_�--- '�' ..-r:ti:1:.-� .,- -.�.ra'Z�r.' ..�. .-r�'.-'i. ,- -.... _-+.t......,..,._ _ _.-i�,t...t ..f..f'-:'."l s�.s'--�. �.�. ._.�. 1 Ah. 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* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *. 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 2 590.003(C) Responsibility of the Person-in-Charge to - 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se * 3-501.16(A) Roasts Held At or Above 130°F Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 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 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 ( ) P 4-501.111 Manual Warewashing-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 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 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 scc* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitutc for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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 practiceRequirements.sshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 9-203.12 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF,HE rqr TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page: V\ of OFFICE HOURS ' BARNSTABLE. PUBLIC 2 0 MAN STREET 3:30-4:30 P.M. DIVISION - - - - : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. ,639.sum HYANNIS,MA 02601 soa-asz 4644 No Reference R-Red Item .. PLEASE PRINT CLEARLY 'EON1�` .. FOOD ESTABLISHMENT INSPECTION REPORT Name" Date Tvne of _Ty9Lgf Inspection g outine /L lit Address G� K �� Risk Se utn pection Level Retail Previous Inspection cv? Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time , I Bed&Breakfast HACCP In: ly Other Inspector I 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 Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red,items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �--- within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension Official Order for Correction: Based on an ins the items inspection today,C N p y ❑ checked indicate violations of 105 CMR 590.000/Federal Food Code ❑ Embargo ❑ Emergency Closure El Voluntary Disposal O ther.- 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 4von-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility C=2 critical violations and less than 9non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of y y (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Si In ?re Pri 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 Sign re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Screen"Dumpster Y N Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * - 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original:Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - - 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils*- tensils 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 Rlated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 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 AnimalConsu Fooer d That Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff 0-1112001 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 r f ces of qui of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 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 590.009(A)-(D)in cater- Sources* Proper,Adequate Handwashing 10 Ratites-165°F 15 sec* ing'mobile food,temporaryand residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity ( ) 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 ( ) 1': 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 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t `pptNE T TOWN OF BARNSTABLE. ,. _ HEALTH INSPECTOR'S Establishment Name: f t � Date: .Page; of "l OFFICE HOURS BAR E.o PUBLIC 2 0 MAN STREET 3:30-430 P.M. DIVISION : 0-9:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Tq� .MASS. �e� HYANNIS,MA 02601 508 862-4W No Reference R-Red-Item PLEASE PRINT CLEARLY p'EO"" " FOOD ESTABLISHMENT INSPFECTION REPORT Name M It Date ,,21 e of Type of Inspection Ix Address Risk Food Service =.-inspec G�J � nf_ I Io - `� ll of°�r Level ection � x Q Telephone Residential Kitchen Date: Mobile Pre-operation c� Owner - HACCP Y/N Temporary Suspect Illness Caterer General Complaint -Person in Charge(PIC) Time Bed&Breakfast HACCP 6e42,, usl 7 Z / In: 3: (b a p Other / Inspector 1Al J Out:3:10 P Each violation checked requ'es an explanation on the narrative page(s)and a citation of specific provision(s)violated. k L Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ e if Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ a- Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands f, ❑ 1.PICA ssigned/Knowledgeable/Duties ❑ 13.Handwash Facilities P1 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 V ❑ 5.Receiving/Condition ❑ 17.Reheating - Q191 V ❑ 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 HSR ❑ 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) 9- Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating 1 Y y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items 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 re ardless 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 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) 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 viol tion, 8npn-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe tor' nature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap.Size Variance Letter Posted Y N Dumpster Screen? Y N �� �-�"_."_. ..�.-�._.r_. .�+�-.._..+.-.,.�..___r....�----- '-ram....----�� •-r-�-•.• '� -i+-' ' - "' r ...-�._ ., .�- ...r- _ r--r' ,-� ....._-v-. -. -. .. __ .` a __•_ ...-� -' � Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* s 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'Unapprdved Additives Contamination from Raw Ingredients 1� _ 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F _ ___,_._ 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 _ _ _ _-_ 7-102.1] Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302'11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ 3 302.15_ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* - Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) 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 4 Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources - 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-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 Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13_ - Shell Eggs*_ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 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 E ui ment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source q P 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 m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )_( ) ( )'( ) * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ 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 Remainin Unsliced Portions of Beef Roasts* [3-203.12 01.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 02.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°FTags/Records:Fish Products E5-205.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 -402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 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 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE. HEALTH INSPECTOR�s Establishment Name: 1"`�"- Date: Z j Page: l of do< PUBLIC HEALTH DIVISION OFFICE`HOURSaoo 6-. A.M. BARNSTABLE. ` 200 MAIN STREET s:ao-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. �p ,e,q.�. HYANNIS,MA 02601 sob-862-4saa No Reference R-Red Item- PLEASE PRINT CLEARLY 'FDN1 FOOD ESTABLISHMENT INSPECTION REPORT Name I`s Date Z TO_ype of ns ection ✓ �� Routirie ` Address 2? �� Risk ('Food Service Re-inspection a Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) �� �e Time Bed&Breakfast HACCP V G� In:2;Ls­Py'( Other R Inspector y� �I�fiD Out: n� %ems? Each violation checked req Tres 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) at'iC FOOD PROTECTION MANAGEMENT . ❑ 12.Prevention of Contamination from Hands j Q ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �G EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ; kt ",.e�- ❑ 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.Aceiving/Condition ❑ 17.Reheating .Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling d 1 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding r PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ex(O O&L ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) d ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ry ❑ 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 8�red items) la I iI Corrective Action Required: ❑ No -Yes-- Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other:. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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' Signature Print: � 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Siggnat�u/re 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 .►•z� 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 L14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) IDemonstration 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 fr6m Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F -- 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to ' 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separationg-Storage* Applicants* - 3-302.11(A) Food Protection* * 20 Time as a Public Health Control ( ) Responsibility Employee _ _ _ 3-302.15 _ Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use 590.003 F Res onsibilit of A Food Em to ee or An 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) I 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 Reaervior 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 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=501.1-12' Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* - 3-401.11A(1)(2) Eggs-155*F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System*_ Eggs 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 Equipment* Not Otherwise Processed to Eliminate 59W.006(A) : Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef criw 11112001 3K.006(B) Water Meets Standards in 3 10 CMR 22."0* _ 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* - - Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and g g try 590.009 A D Violations of Section 590.009 A D m cater- ,��', Stuffing Containing Fish,Meat,Poultry or ( )_( ) ( )_( ) 3-201.15 Molluscan from NSSP Listed_ Chemical* Ratites-165'F 15 sec* Sources* 10 P ing,mobile food,temporary and residential 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 11 - - Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 17 Reheating for Hot Holding Requirements. Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* a. 3-202.1-f" PHF's Received at Proper Temperatures* 3 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 o' * 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 t ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101'.11 Food Safe and Unadulterated �) g - illness interventions and risk factors listed above,can be found in the g,- Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs P 9 following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities *. Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products ' 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* l Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance * 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' V 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 37-502.12 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 n Oq,IKE rok, TOWN OF BARNSTABLE; .. - ,. HEALTH INSPECTORS Establishment Name: Date: Page:, 2- OFFICE HOURS = r PUBLIC HEALTH DIVISION 80o=9:30A.M. BARNSTABLE. ` 200 MAIN STREET 33o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Y 639. �0� HYANNIS, MA 02601 M -FRI. No Reference R-Red-Item - PLEASE PRINT CLEARLY - �p � 506-8-862-4644 'FON1P'' FOOD ESTABLISHMENT INSPECTION REPORT Name I Dat -Type o Type 21 Inspection `'' -u ine `! /,)-t � Address Risk*04 e-inspection i 1 eYej yl _ �� Level Retail Previous Inspection !J J J�- Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness l A� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector 1 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) ❑ /ryat /j_ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 1_ / I- �-/1- FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands Cl ❑ 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 Alf 2 ❑ 5.Receiving/Condition ❑ 17.Reheating Q ❑ 6. gs/Records/Accuracy of Ingredient Statements ❑ 18. (]C ling / -FM 7.Conformance with Approved Procedures/HACCP Plans 9.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 _ We Wd ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t ll iy dw -mil_ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No es Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance 4 Y Y ❑ ry p� ❑ 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 n n-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 4non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automaticallytion of rodents or insects,or lack of 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 9non-critical. If no critical water,sewage back-up,infestation 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 'goat Print: �,�✓' " 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Signaaturree(� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted - Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) -' FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202-12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* __ -� ' *- 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 1S 590.004(F)Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* i Applicants* - - - 3-30211(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 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* (11) 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 Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F 9 -- Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111-- Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - -- -4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 _ Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or _5-]Ol.l1 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate - Equipment - 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Utensils and Food 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effect-1/1/2001 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F 15 sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Shellfish and Fish From an Approved Source Eggs 4-702.11 -- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F IS sec* 3-201.14 1 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 StuffingContainin Fish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* g Proper,Adequate Handwashing 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 � 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 1 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* ( )( )( ) * 11 Good Hygienic Practices 1.7 Reheating for Hot Holding practices should be debited under#29-Special i 3-201.17 � Game Animals Requirements. 5 - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* - 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.1I(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package-Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006. 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 :007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590�R0�0. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. l sh,� �oaISE rokti E V. TOWN OF BARNSTABLE ��OFFICE LTH INSPECTOR'S Establishment Name: Date: Page: of HOURS P ° PUBLIC HEALTH DIVISION00 8:00-9,30A.M. BARNSfABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION`/PLAN OF CORRECTION Date Verified �b ,6!j q: `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY prEDM�, FOOD EATAP ISHMENT INSPEJPCTIIDN REPORT Irk�p808-862-4644 Name Date o Tyoe of Inspection " Operation(s) Routine Address Risk j 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 AA Other Inspector � Each violation checked requires an explanation on the narrativ'page and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items ( 1 Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 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 A , ❑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) C� ❑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 Advisoriest�flifla Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations tr Critical(C)violations marked must be corrected immediately. (blue 8 red items) 1 I� Corrective Action Required: ❑ No E] Yes Non-critical(N)Violations must be corrected immediately or Ewithin 90 days as determined by the Board of Health. Overall Rating Volunta Com liance.❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled E] Emergency Suspension C N Official Order for Correction:Based on an inspection today,th ite s Embargo checked indicate violations of 105 CMR 590.000/Federal Food Co e. ® g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food 4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed, Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 on-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-cri cal violations. If 1 critical refrigeration. within 10 days of receipt of this order. viola n,4 to 8 non-critical viol ns= 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Ins or's nature rint: 31.Dumpster screened from public view 7 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's g ture- Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N r Dumpster Screen? Y N �� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 CoolingMethods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH„ 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 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 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 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 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- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ery cave 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* 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 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* 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* practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 13 Handwashing Facilities Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 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. pF THE 1pk, � i TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page:. of q OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ? BARNSrAe,E. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF COk'RECTION Date Verified - aw .0� HYANNIS,MA 02601 soa-862-4644 No Reference- R-Red Item PLEASE PRINT E LY ' FOOD ESTABLISHMENT INSPE I N REPORT. IRS h)in Name ki- Date a of Type of Inspection Ooeration(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness 'A -41711 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other 19 1 Inspector Out: Each violation checked requird 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 y1d ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 4 ,v� 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 ev PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal . ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) 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 g violiOrms.4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. - 30.Other PATE OF RE-INSPECTION: Inspe Si 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 PIGS a r Print: r Self Service Wait Service Provided Grease Trap Size Vaiiance:Letter.Posted• - Y Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions :d 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* * 3-501.16(A) Hot PHFs Maintained At orilbove 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 Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * *7.202.12 Conditions of Use 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P - 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* Eggs 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(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* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-40 1.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 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* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority � 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11(2-301.14 When to Wash* A)( )( ) 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y 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* F 11i Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 4 13 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved,Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE Tpk, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: _ Page:_ of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. i BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified y mass. g MON.-FRI. �b, .a3s•p�m HYANNIS, MA 02601 50e-862-4644 No Reference R-Red Item. PLEASE PRINT CLEARLY FOOD ESTABLIStIMENT INSPECTI N REPORT - Name 3ape of T o section Ae r utine Address ,. Risk Servi ection <� Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer QgpamlZomplaint 01 - Person in Charge(PIC) Time Bed&Breakfast HACCP 141 Si In: r il 4 A� Inspector Out: J Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. i 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) ❑ 'AJ# ^' 1 Action as determined by the Board of Health. Allergen Awareness 590.009(G) p, FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands a- ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities tOL EMPLOYEE HEALTH PROTECTION FROM CHEMICALS s- i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives v ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 1� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures TnWk I -7 b ❑ 5.Receiving/Condition ❑ 17.Reheating 1 ❑ 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) _. IV ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �o❑ 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) v Corrective Action Required: o El Non-critical(N)violations must be corrected immediately or Overall Rating 111 k ic within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical-violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non-critical violations 9 if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water;Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 g.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 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature/- n�J 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 IC' Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination F 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 _ Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions �j] 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. 1g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective rnnoor 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)incater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* in mobile food,temporary and residential Sources* 10 Proper,Adequate Handwashing g' PoY Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceRequires should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C 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* L18 Proper Cooling of PHFs fallowing sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 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 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. V ♦vl 2 pieces (orSasFiimi 3 pc add$2.00) �- JKisal�i • Toro Fatty Tuna Mkt •' Shiro Maguro White Tuna 4.75 379 West Main Street • Maguro Tuna 5.25 Hyannis, Massachusetts 02601 • Sake Salmon 4.75 (508) 771-3771 • Ebi Shrimp 4.75 • Ama Ebi Sweet Shrimp 6.75 �. � V �. SUSHI • Hamachi Yellowtail 5.50 • Tako Octopus 4.75 Misakl • Tobiko Flying Fish Roe 4.95 • Saba Mackerel 3.95 -�- • Ikura Salmon Roe 5.75 • Kaibashira Scallop 5.95 . • Uni Sea Urchin 6.50 • Anago Sea Eel 4.95 • U n a g i Fresh Water Eel 4.95 " • Kan Crab Stick 4.50 + • 99 Tama9 o E 3.95 Ca 0 . • Ika Squid 4.50 m • Inari Tofu Skin 3.95 _ Wakivmo Sushi 6 pieces orIfandRod Appetizers s Shumai 6 • Tekka Tuna Roll 5.50 Steamed shrimp dumpling with ponzu sauce • Sake Maki Salmon Roll 5.25 ❖ Gyoza 6 • Kappa Cucumber Roll 4.75 Pork dumpling&vegetables deep fried • Negihamachi Yellowtail roll with scallion 5.75 with ponzu sauce • Kan pyo Seasoned Japanese Squash 3.50 Agedashi Tofu 6 • Oshinko Pickled Radish Roll 3.50 Deep fried, seasoned w/our special dashi sauce • Avocado Avocado Roll 3.50 Mixed Tempura 8 Delicately fried shrimp and vegetables f s• Vegetable Tempura 7 Inside Out (.qa Delicately fried vegetables and tofu :• Yakitori 8 6 pieces Grilled chicken teriyaki skewers ❖Tatsuta Age 8 • California Kani, cucumber,avocado 5.50 Deep fried seasoned chicken • California with Fish Roe 5.95 s Edamame 5 • Spicy Tuna or Salmon with Spicy Sauce 6.95 Fresh boiled soy beans • Nantucket Tuna or Salmon 6.50 Soft Shell Crab 10 with avocado&scallion Deep fried crispy soft shell crab with citrus sauce :•Tuna Carpaccio 11 • Rhoda Tuna,avocado&fish roe 6.75 Tuna sashimi topped with tomato, red onion,capers, • Mitchell Tuna,avocado,asparagus, 7.50 Scallions and EV olive oil. cucumber, fish roe ❖ Sushi Sample 9 • Dynamite Tuna,salmon,avocado, 8.95 Assortment of chefs choice from today's catch cucumber, fish roe with dynamite sauce ❖ Sashimi Sample 11 • Salmon Skin scallions&fish roe 5.70 Chefs selection of sliced fresh fish • King E.S. Roll Tuna,salmon&yellowtail 8.50 :• Rainbow of steamed vegetables 7 with spicy sauce Mixed vegetables with special sauce • Una-Kyu Fresh water eel&cucumber 6.00 • Una-Avo Fresh water eel&avocado 6.25 J(Tara d (Soup • Vegatables Avocado,cucumber, 5.75 J asparagus,kanpyoyamagobo&oshinko Salad small 5 large 6 • Tempura Asparagus with avocado 6.00 with house ginger dressing • Ebi Kyu Cooked shrimp with cucumber 5.75 Tofu Salad 7 • Ebi Avo Cooked shrimp with avocado 6.00 Fresh vegetables and tofu with house ginger dressing • Cape Cod white fish,scallions and spicy sauce 5.75 Wakame Salad 6 • Spicy Scallop fresh scallop with spicy sauce 6.75 Mixed green seaweed • Crunchy Salmon Salmon, cucumber and 6.50 Ika Sansai 8 tempura crunch Marinated squid salad • Philadelphia Salmon, cucumber and cream 6.95 Hijiki and Edamame Salad 6 cheese Cooked seaweed and edamame • Alaskam cookedsalmon, cucumberand 7.95 Sunomono Salad 7 avocado Seafood, vegetables with vinegar sauce Seafood Sumiso 7 Consuming raw or undercooked meats,poultry,seafood, Seafood and vegetables with miso sauce shellfish or eggs may increase your risk of food home illness. Miso Soup 2 "Before placing your order,please inform your server Soy Bean Soup if a person in your party has a food allergy" Misaki Soup 7 Seafood and vegetables soybean soup Japanese Steamed Rice 2 www.misakisushi.com ................................................................................................... .................................................................................................... Entrees sushiBar Servedwith rice e�miso soup or smaCCsalad Served with miso Soup d�Sushi Regular...1 roll &8 pieces 20 Assortment of chefs choice from today's catch 4-Chicken Teriyaki 15 0 Sushi Deluxe...I roll&10 pieces 25 Marinated chicken grilled and topped with Assortment of chef's choice from today's catch sauteed onions, mushroom and teriyaki sauce o�Sashimi 26 Chefs selection of sliced fresh fish -.*-Beef Teriyaki 17 Marinated sirloin grilled and topped with sauteed o� Sushi&Sashimi Combo 29 onions, mushroom and teriyaki sauce- Chefs selection of nigiri and sliced fresh fish 6• Chirashi 22 :• Atlantic Salmon Teriyaki 18 Chefs selection of fish served over sushi rice Marinated salmon grilled and topped with o�Tekka Donburi 20 sauteed onions, mushroom and teriyaki sauce Sliced fresh tuna served over rice Tiger Prawn Shrimp Teriyaki 19 0 Sake Donburi 17 Sauteed in garlic butter&teriyaki sauce Sliced fresh salmon served over rice ob Unaju 19 s• Tempura Mixed 16 Cooked eel served over rice with eel sauce Deep fried shrimp&vegetables in light batter 66 Dynamite Combo 15 Dynamite roll and California roll with fish roe ❖ Chicken Tempura 16 Deep fried chicken&vegetables in light batter apeciaC�lrs 4• Vegetable Tempura 15 8 pieces Deep fried vegetables and tofu in light batter ❖ Yaki Soba 15 Maui Onion 13.95 Stir fried soba noodles&vegetables with choice Tempura sweet onion,avocado,asparagus inside of chicken, beef or shrimp out rolled topped with Cajun seared tuna, wasabi mayo and sriracha. :• Yaki Udon 15 Spicy Crary 13.95 Stir fried Udon noodles&vegetables Shrimp tempura,avocado,and cucumber inside served with choice of chicken, beef or shrimp out roll topped with spicy tuna,dynamite sauce, tempura crunch and wasabi tobeko. ❖ Nabeyaki Udon 20 - Caterpillar 12.95 Japanese udon noodles w/chicken, egg, ? Una kyu topped with avocado and eel sauce. vegetables&shrimp tempura in fish broth Naruto 11.95 Tuna, salmon,white fish and vegetables wrapped d•Chicken KatSu 15 in cucumber and finished with miso sauce and Panko fried chicken sliced and served with sesame seeds. Tonkatsu sauce. Dragon 12.95 California roll topped with eel, avocado and eel sauce. Misaki 12.95 Tuna, salmon,whitefish and vegetables wrapped in soy paper topped with mild sauce. Rainbow 12.95 t California roll topped with tuna, salmon,white isaki fish and shrimp. Soft Shell Crab 12.95 Tempura soft shell crab,cucumbers and fish roe. Shrimp Tempura 9.95 Tempura shrimp, cucumber and fish roe. Futomaki 10.95 Take Out Kani kama, egg custard and vegetables. (5 0 8) 7 71-3 7 71 Consuming raw or undercooked meats,poultry,seafood, shellfish or eggs may increase your risk of food home illness Salad and Souu l. Back to top of Menu Small Salad 2. small fresh salad with special dressing 95 Large Salad 3 large fresh salad with special dressing 95 Tofu Salad 4, fresh vegetables and tofu with special dressing 95 Wakame Salad 4, homemade mixed green seaweed 25 Sunomono 5. seafood,vegetables with vinegar sauce 75 Seafood Sumiso 4, seafood, vegetables with miso sauce 75 Miso Soup 1 soy bean soup 50 Misaki Soup 3, seafood, vegetables with soybean soup 50 Rice 1. Japanese steamed rice 25 r t ' Appetizers Back to top of Menu Shumai 4 steamed dumpling with special sauce 25 Gyoza beef dumpling and vegetables deep fried 4' with special sauce 5 Agedashi Tofu 4. deep fried tofu seasoned with our special dashi sauce 25 Tempura 6. delicately fried shrimp and vegetables 75 Vegetable Tempura 5. delicately deep fried vegetables 75 Yakitori 5. broiled chicken on a skewer 25 Tatsuta Age 4. deep fried seasoned chicken 25 Edamame 3. boiled fresh soy beans 75 Soft Shell Crab 8. deep fried crispy soft shell crab served with 50 tasty lemon sauce Sushi 7. assortment of chef's choice from today's catch 251 Sashimi 9. chef s selection of sliced fresh fish 75 Rainbow Steamed Vegetables 5. steamed mixed vegetables with special sauce Back to top of Menu A la Carte These items may be ordered as; Nigiri/Sashimi Makimono Rolls Inside out rolls BIG Rolls Back to top of Menu Nigiri (2 Pieces) Sashimi Back to top of Menu Tuna(Maguro) $3.85 Salmon (Saki) $3.85 Shrimp(Ebi) $3.75 Yellow Tail(Hamachi) $4.25 Whitefish (Shiromi) $3.85 Octopus (Tako) $3.85 Masago $3.85 Flying Fish Row $4.50 Mackerel(Saba) $3.50 Salmon Roe(Ikura) $4.95 Scallop (Kaibashira) $4.25 Sea Urchin(Uni) $5.95 Fresh Water Eel(Unagi) $4.50 Crab Stick(Kani) $3.50 EX(Tamago) $2.95 Squid (Ika) $3.85 Surf Clam (Hokki) $3.85 Inari $2.75 Makimono Rolls Inside out rolls BIG Rolls I Makimono Rolls (6 Pieces) Back to top of Menu Tekka (Tuna Roll) $3.95 Kappa (Cucumber Roll) $3.25 Negihama (Yellow Tail Roll with Scallions) $4.50 Ka, navo (Seasoned Japanese Squash) $3.25 Oshinko (Pickled Radish Roll) $3.25 Avacado Roll $3.50 Nigiri/Sashimi Inside out rolls BIG Rolls Back to top of Menu Inside out Rolls (6 Pieces) Back to top of Menu California (Crabstick, Cucumber,Avacado) $3.95 California with Fish Roe $4.95 Saicy Tuna or Salmon $4.5 Nantucket: Tuna or Salmon (Avacado and Scallion) $5.50 Rhoda (Tuna, Avacado,and Fish Roe) $5.75 Mitchell (Tuna,Avacado,Asparagus, Cucumber and Fish Roe) $6.25 L)ynamfte (Tuna, Salmon,Avacado,Cucumber, Fish Roe with Dynamite $7.25 Sauce) Salmon Skin (Salmon Skin, Scallions, and Fish Roe) $4.50 King_E.S.Roll (Tuna, Salmon, Yellowtail with spicy sauce) $6.75 Una-Kyu (Fresh Water Eel and Cucumber) $5.25 Una-Avo (Fresh Water Eel and Avacado) $5.25 Vegetables $4.75 Avacado Cucumber Asparagus, Kam o f Tempura Asparagus (Asparagus and Avacado) $4.75 Ebi Kvu (Cooked Shrimp with Cucumber) $4.75 Ebi Avo (Cooked Shrimp with Avacado) 4.75 Nigiri/Sashimi Makimono Rolls BIG Rolls Back to top of Menu Big Rolls (8 Pieces) Back to top of Menu Shrimp Tempura (Vegetables and Fish Roe) 7.2 Soft Shell Crab $9.951 Futomaki (Variety of Vegetables, Crab, and Egg Custard Rolled in Rice 8.95 Nigiri/Sashimi Makimono Rolls Inside out rolls Back to top of Menu r Sushi Dinners Served with soup and rice some exceptions apply Back to top of Menu Sushi Regular ( 1 roll & 8 pc. sushi ) assortment of chef s choice from today's 16.50 catch Sushi Deluxe 19.50 (1 roll & 10 pc. sushi) Sashimi ( chefs selection of fish ) sashimi is a variety of sliced fresh 19.95 raw fish Sushi and Sashimi Combo 24.95 chef s selection of fresh fish Chirashi 15.95 chefs selection of fish served over sushi rice Tekka Donburi 15.95 sliced fresh tuna served over sushi rice Unaju 17.95 cooked eel served over rice, with eel sauce Dynamite Combo 11.95 dynamite roll and california roll with fish roe Sushi Bibinppa 15.95 fresh fish and vegetables served over plain rice with spicy sauce Omakase Sushi or Sashimi or Combination Dinn assortment of fresh fish sushi sashimi or sushi and er for sashimi combinations. two Chefs selection of the day $40 up Back to top of Menu Cooked Dinners Back to top of Menu Teriyaki Chicken broiled chicken with teriyaki sauce 12.95 served with rice and miso soup or small salad Teriyaki Beef broiled beef with teriyaki sauce 15.95 served with rice and miso soup or small salad Atlantic Salmon Teriyaki broiled salmon with teriyaki sauce 14.95 served with rice and miso soup or small salad Tiger Prawn ShrimpTeriyaki juicy tiger shrimp sauteed in garlic butter 18.95 and teriyaki sauce served with rice and miso soup or small salad Tempura Mixed deep fried shrimp and vegetables in light batter 14.95 Chicken Tempura deep fried chicken and vegetables in light batter 14.95 Vegetable Tempura deep fried vegetables in light batter 11.95 Yaki Soba stir fried egg noodles and vegetables with choice of chicken, 11.95 beef or seafood Yaki Udon stir fried japanese wheat noodles and vegetables 11.95 with choice of chicken, beef or seafood Nabeyaki Udon Japanese wheat noodles served with chicken, 11.95 egg, vegetables and shrimp tempura in fish broth Chicken Katsu or Pork Katsu breaded chicken or pork, deep fried 12.95 Beef Negimayaki beef and vegetable roll-up in teriyaki sauce 16.95 Sukiyaki choice of sliced beef or chicken and vegetables 17.95 with sukiyaki sauce cooked in stew style Omakase Kaiseki 35 u includes appetizer, soup, sunomono, yakimono per a emono sushi sashimi and more 1persol (two person minimum/reserve in advance) Back to top of Menu Misaki Home Page Desserts Ice Cream 2.50 Fried Banana deep fried banana in light batter 2.75 Back to top of Menu Misaki Home Pale r %DCOf . .StbA%r) Misaki HACCCP Plan: Categorization of Potentially Hazardous Foods: Sushi Rice Ingredients: Nishiki Medium, Graiih White Rice � '( Mizkan KD 39-Sushi Vinegar V ga Flow Diagram: ice . ' `Gd Owk k1fik r runs ck 1p lw 8 qv s o rt cle d It . o �a*or to ft" Cftkhr C4S i►ftl ol`ci tiri I UDY- K(4f rice iv� w 1tv 49 .* T a2ed TEfr. TULODS INdS'IWXdd 13rd3Sd3 dH WdST :i, �,TOZ DT daS i i Em to ee and Sube ,,visory Trainin Plan: I, Sean Terrio, own and operate Misaki Japanese Cusinine and Sushi. I have made ne of my everyday responsibilities making each and every bate of sushi dice for restaurant service. I am fully aware of all th dangers associated with holding rice at room temperature r an extended period of time. I am HACCP certified as ell as ServSafe certified. When I cannot be there to make the sushi rice, my head sushi chef, Makoto �.. Hamada, will handl the respcinsibility. My sushi chef, Eric Fenner, who has ovi ir 8 years Qf experience in this business, and is ServSafe qual ifled, is also extremely knowledgeable of the rice making pro ess. We all follow a strict standard operating procedur 1 according to the HACCP guidelines that were taught during ny training. Standard ODerating Procedures SOP : Critical Control Poin {CCP) pH testing is a CCP f r the acid jification of sushi rice and the pH tested each time a b tch of rice is made at Misaki. Testing is conducted with a pF tester made by Hanna Instruments, model #HI 9810 ph- C-TDs Meter. Eight quarts of Nishiki rice are washed for appr ximately!12 minutes until the water is clear. The cooked rice is then placed in large stainless-steel" bowl and 2 quarts o KD-39 sushi vinegar is added. After cooling for one half our the rice is pH tested using the Hanna .Z 92ed TEiabTLLB[]S TMHSTWWH4 1 'af`?dgRW1 AW WACT :b 4Tfl7 nT daC i instrument. I make rice slurry, using distilled water and the cooked sushi rice. I nash the rice into equal parts water with a teaspoon and then est it. Thel average daily pH is 3.9. Critical Limits( i The target level pH for the acidified rice is 4.1. It should never ' exceed 4.6. The pH of the instrument is tested prior to use. According to MDPH Guidance RF 3-3 Usina Acidification to k Make Cooked Rice a Non-Pote'intially Hazardous Food and the Evaluation Tool the CL is: k � PH shall not exceed 4.6 (PH meter) ) Method and Fre u encv for IVIdnitoring and Controllin each C— I, Sean Terrio, test a 3ch batch of sushi rice that is made and routinely verify all S P's are being followed and monitored. If I am not present, ell her chef Makoto Hamada or chef Eric Fenner, makes sure that all SOP's are being followed and monitored. Corrective Action: If the CL for any CCP is not met, we take immediate action. We discard any sushi rice tested that is over 4.3 to be extra cautious. P 92ed TP-6-6TIiAnC TVWQTWWW4 1grM'1cu7 au LIACT :i, 4Tna nT dac i Scientific Data and ecords: We consider record keeping one of the most important parts of our HACCP plan. Attached is an example of our record keeping procedure. .6 92ed TO-.-.TI Irma TMUCT LIVUJ I '3PM3CU-1 JU I.I JCT 'l iTn nT ear PH LOG Ingredient name DATE OF USE PH LEVEL >P&NATURE 8/1/14: 8/2/14' 8/3/l4 8/4/14 U 8/5/14 8/6/14 W114 8/8/14 8/9114 8J10/14 •� 8/11/14 L,f 8/12/14 1 8113/l4 8/14A4 8/15/14 V16,114 3 8/17/14 8/l8l14 'i 8/19/14 8120/14 8121/14 8/22/14 8123/14. 8/24/14 1 9125114 &'26/14 G 8/27/14 8/28/14 8/29/14 8/30/14 8/31/14 C 222al T CLl T t 1 Onn i Categorization of Potentially Hazardous Foods Sushi Rice Ingredients are as follows: Nishiki Medium Grain Rice Mizkan KD-39 Sushi Rice Vinegar Materials used are as follows: Large Stainless Steel Rice Mixing Bowl 17% Anti-bacterial Plastic Rice Mixing Spatula (2) Large Sheet Pans wrapped in plastic (for cooling) Standard Operating Procedure (SOP) for the daily preparation of Sushi Rice: 1. (8)Eight quarts of Nishiki rice is washed for approximately 12 minutes in a • large stainless steel bowl until water is clear. A half batch of rice (4)four quarts is often times cooked using the same procedure with the exception of sushi vinegar added. 2. The uncooked rice is then placed in a gas powered rice cooker to be cooked for approximately 45 minutes. 3. After the cooking process, the rice is then placed in a mixing bowl and mixed with approx. (2)two quarts of KD-39 Sushi Vinegar. Half batch=1 quart. 4. The rice is then transferred to the sheet trays to cool for % hour. S. After cooling the pH of the sushi rice is then tested pH tester made by Hanna Instruments (model #HI 9810 pH-EC-TDs Meter,or by using pH paper specifically designed for Sushi Rice. 6. After testing, if the pH of the rice is <4.1, the rice is then placed in a rice warmer for no more than 4 hours. Uu� • 1 it Hazard Analysis If the pH level of the sushi rice exceeds 4.6 and is not brought down below 4.6, it may be able to support the growth of pathogens including Bacillus cereus, Salmonella, Staphylococcus aureus, and some types of Vibrio species when stored at room temperature. vae'u� +0 V_�/ Critical Control Point (CCP) The pH testing is a CCP for the acidification of our sushi rice and the pH is tested each time a batch of rice is prepared at Misaki. The test is conducted by making a slurry of distilled water and the prepared or cooked sushi rice. Using either the pH tester or the pH tester strips, they are dipped into the slurry for 1-2 seconds for a proper reading. The target pH level is between 3.8 and 4.3. The pH level should never exceed 4.6. I. Critical Limits (CL) T�� According to the MDHP Guidance RF 3-3 Using Acidification to Make Cooked Rice a Non-Potentially Hazardous Food and the Evaluation Tool, the Critical Limit(CL) is: pH shall not exceed 4.6 If the CRITICAL LIMIT is exceeded CORRECTIVE ACTION is taken by the sushi chef and/or designated employees. v Monitoring Procedures and Frequency 1. What: pH of cooked Sushi Rice 2. How: Mix sushi rice with distilled water to make a slurry, and test with pH paper.or,pH t st r. 3. Fre uenc�:�� �3 k q y very batch of acidified coo ed rice intended to be used for • sushi. 2 r - i Corrective Action Procedures Decision Model; �ioIA3 U9(%j9'aVn v � E S 4 i� �or ec,Ve u5ec YF S . a Y\d qw-ts4- r to OV) +ke cafy-ec� C'ff�'*c �e i • Corrective Action Procedures Decision Model Oec,urf m e- ES 4 - +3 . �JO b i�ect'pe u5eGk o� YES .00 �H 44.3 YES a QIN11 y- 5VSW iGe rt INTERNATIONAL INC *INVOICE* CUSTOMER COPY 0735314 INVOICE NO. INVOICE DATE SHIP DATE PAGE 55 wildcat way REMIT TO: Linden, NJ 07036 80-2251531 11/30/2017 11/30/2017 1/1 (908) 525-4400 CUSTOMER#. DEPT. SECT. TERMS r HIP SAME N-5726 7 NET 30 DAYS 00 CUSTOMER P.O.# ORDER DATE 11/29/2017 SHIP VIA SHIPPING POINT BROKER 508-771-3771 B #4 - 30 FREIGHT TRUCK ROUTE .y ..WHSE SALESMAN B21 n '4 NAEA SOLD MISAKI JAPANESE CUISINE UNPAID ACCOUNTS OVER 30 DAYS SUBJECTTO1.5%PER MONTH SERVICE CHARGE. _ TO 379 WEST MAIN ST. HYANNIS, MA 02601 rt. 12251531011005093A UPC OR CUSTOMER i SLOT ! ITEM QTY. I QTY. ITEM CODE NO. CODE I CASE EACH DESCRIPTION SRP EACH ! UNIT AMOUNT i PRICE PRICE FROZEN ITEM — 0 11152 20425 3 �.'F00 1 20425 I 4.0#IKURE GEIKO BOILED OCTOPUS 5P 22.00 # I 13.00/#I 52.00* 0 11152 2as59 i _F641A Z4559 UOGASHI HAMACHI FILLET 2KG UP FRM JPN 1#_r�I I 8.20/#1 289.46* MESSAGE: Tuesday 1 case Hamachi 1 pc Octopus V ir•hirir*iirir*{r it it it it it it ir*4 it ir*ir it ir•k+t it it it it it ir'str*7 it it it it it it it it ir*ir it it it it it�4 it it it ir*ir * l PARASITE DESTRUCTION i ✓ * SEAFOOD PRODUCTS SUBJECT TO FOOD CODE REGULATION 3-402.,a1 * (ITEMS LISTED BELOW) WERE STORED AT A TEMPERATURE OF -4 * DEGREES FAHRENHEIT OR BELOW FOR 7 DAYS, t�R 731 DEGREES * FAHRENHEIT OR BELOW FOR 15 HOURS. 1" * t. * #24559 ! 1I►�5 it it it it it it eY it*ir it tr*ir it ir*ir it it it t,it it it it it it it it it it it it it it i:ir•k tr it frA•ir�ir it it it Yr*ir�tr ir*ir•fr it it it it .. a f f i CASE COUNT DELIVERED BY RECEWf0 BY DAJE ALL CLAIMS ON THIS INVOICE WEIGHT CS/EA: 0/393 Fm ST BE MADE WITH 5 DAYS AFTER INVOICE 341.46 RECEIPT OF MERCHANDISE. 40.11# TOTAL ���:. �i\r� '- .-[ &, .•..e �' ,< "3., n n X ,y ra t" url,.�aN"r ,n.n�, M 1.i 'in� l e�:� mC vn,l'rry`.,M�hr iy,y'�,.'. ..,�T i,�la$.V�:L• >ew> � x.":1: W� #.w N ,.o:n.w :.Wi.S,. a fWUR`: ,µ ,. u, ,yo wn�MnS`aryM. driii�: wW°• # �JL � h � �....M., `1 .. •. 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',k'v„.`DATE e� " F . . R ER, WINE SP,tR(TS s , - SIGN(NORA�;CEf'fiNGt71=1Nt#Y,PL'EASESEEBtCKO (NVOtGEFOR4t?DPItONAITRMSANDCQNDt�IONS.a �} a cusronnERc m::, owa,a ' 4 „ �, . .rsm urv,.,yT�t , ' .y t'''�ci _ „gym w�.M,F„ wr'I'• ^.f m z m¢�. r _. +'q:ua k M ,. „?� •. . ,,:- .,i »m ms 'amx,rom=a a ""a ali'a:v::d 4 •, I INTERNATIONAL INC *INVOICE* CUSTOMER COPY 0735313 5"s"-wi i ucat way INVOICE NO. INVOICE DATE SHIP DATE PAGE ' REMIT TO: Linden, NJ 07036 80-2251530 111/30/2017 11/30/2617 1/1 (908) 525-4400 CUSTOMER#. DEPT. SECT. TERMS 10HIP SAME N-5726 NET 30 DAYS TO CUSTOMER P.O.# ORDER DATE 11/29/2017 SHIP VIA SHIPPING POINT BROKER 508-771-3771 B #4 - 30 FREIGHT TRUCK ROUTE WNSE . SALESMAN S B21 AT iT t NAEA SOLD MISAKI JAPANESE CUISINE UNPAID ACCOUNTS OVER 30 DAYS SUBJECT TO1.5%PER MONTH SERVICECHARGE. TO 379 WEST MAIN ST. �, s HYANNIS, MA 02601 j 12251530011005023 UPC OR CUSTOMER SLOT ' ITEM ( QTY. j QTY. ' EACH ITEM CODE I NO. ± CODE j CASE EACH DESCRIPTION SRP ` I UNIT I AMOUNT PRICE PRICE I __ -- ----1- - �_---- FROZEN ITEM ----- _ �- 0 11152 07126 8 FA23A 07126 i 3�IYOYA CRAWFISH S LAd r'FzN :12/1 A # 40.001 40.00 120.00* 69 45365 2ooz8 0 �,fA59A 1 14745 1 j AED UNAGI KABAYA I,.„NO MSG 9Z CHN - 2/11# 105.00 105.00 105.00* 0 11152 26302 1 FA63A f 26302 j -- I- 1 J YAMAFUKU SASA NO HA BARAN /100 PC 4.501 -4.501 4.50* - rBo3A f 29307 1 IZCREST YFIN TUNA ROUND WILD I' 0 2/11 # 99.00 99.00 99.00* =' -I- - - I_-� AZ_UMA FD T_0_BIKq U MI WASA . 24/1.10 #� 19.00 19.00 1 38.00 FD66D6 43756 2 1 -= -r--- ----- 7 45329 82012 9 --- REFREGIR� EM ---- _--� -49.70333 01002 0 -- �? _--'_--_ i ISHINO SAIKYO Sp 10/2.20 #1 11.50I 11.50 23.00* � CB32C 11445 i 2 - DRY ITENb-:. FULL CASE) - --- 11152 04034 9 '@AB22A 04034 ; j 1 ;WPHIJIKI-SEAWEED K _ 12/1.00 #I -11.001 11.001 11.00* 0 85696 608-04 4 �AC107A 06223 -^3 j 1MORI-NU-SILKEN TOFU FIRM BLUE.12/12.30 Z 0.88� 10.50 31.50 0 73575 64333 0 AC39A j 17833 2 i MIZKAN S'SND VINEGAR KD-39 _ 5.28 GAL 37.201 37.20�- 74.40* 7 93573 86689 9 AB03A 120341 1 I_- - WANER POWDERED WASABI V-lA USA 10/2.20 #1 1 8.50 85.001 85.00* i - - -- -- 0 11152 25556 9 S AB50A ; 25556 I 1 1 I JFC W-BASHI W/BAG TENSOGE-CH ' 100/40 PR I 1-001 100.00 100.00* 0 41390 00175 8-\l AA23A ! 26073 ' 1 J KKM SOY SCE L-SODIUM TUB 5.00 GAL 45.001 45.00 45.00* 0 11152 28580 1 ' A001 i 28580 ; 4 I_NISHIKI PREM RICE 7 50.00 # ; 42.001 42.00 168.00* 0 41390 00278 6 AA07A 1 68292 i 3 I KKM SOY SCE PKT 500/6 MLA- 1 13.801 13.80 41.40* MESSAGE: Tuesday 1 case Hamachi 1 pc Octopus it it it is fe it is it is is is it{{r it{r it it i4 M it it Yc is it it tr is it it is is iY is is it it eM it it it it it it it*it it is it it it it is it{r{r{r{r it * PARASITE DESTRUCTION * SEAFOOD PRODUCTS SUBJECT TO FOOD CODE REGULATION 3-402.11* * (ITEMS LISTED BELOW) WERE STORED AT A TEMPERATURE OF -4 * DEGREES FAHRENHEIT OR BELOW FOR 7 DAYS, OR -31 DEGREES * FAHRENHEIT OR BELOW FOR 15 HOURS. * #43756 it it it it it{r is is it it it it it it it is it it sY it it it it it{<tr it it it it{r it it is it it{r{r{r is it it it Yr it k it*•k it it it it is is it{r it it•* - CASE COUNT DELIVERED BY R VEO BY�. ""� DATE ALL CLAIMS ON THIS INVOICE WEIGHT CS/EA: 16/10 T. MUST BE MADE WITH 5 DAYS AFTER INVOICE 945.80 RECEIPT OF MERCHANDISE. 560.32# TOTAL 4=; x z • ` "-+ pH Log �f. Manager Verification: �Gl(/��C►��I Q Date: (Keep Log for 60 Days) Date Time pH Corrective Action Staffs) Signature l! Z c 5 % �. N/k, - I a��)- 1 f to 3- ck id 5e 4¢ 1 IJ tj /* • ; � 3 OA 3 je) 1012,0 2 � 3O i 23 �� '� f PH Log Manager Verification: � V�r( 0 Date: lZ Z b i (Keep Log for 60 Days) Date Time pH Corrective Action(s) StaffSignature IZ z 3;P �. 12 Z -i- • { F 4 1 1 L + Y Categorization of Potentially Hazardous Foods Sushi Rice Ingredients are as follows: Nishiki Medium Grain Rice Mizkan KD-39 Sushi Rice Vinegar Materials used are as follows: Large Stainless Steel Rice Mixing Bowl 17% Anti-bacterial Plastic Rice Mixing Spatula (2) Large Sheet Pans wrapped in plastic (for cooling) Standard Operating Procedure (SOP) for'the daily preparation of Sushi Rice: 1. (8)Eight quarts of Nishiki rice is washed for approximately 12 minutes in a • large stainless steel bowl until water is clear. A half batch of rice (4)four quarts is often times cooked using the same procedure with the exception of sushi vinegar added. 2. The uncooked rice is then placed in a gas powered rice cooker to be cooked for approximately 45 minutes. 3. After the cooking process, the rice is then placed in a mixing bowl and mixed with approx. (2)two quarts of KD-39 Sushi Vinegar. Half batch=1 quart. 4. The rice is then transferred to the sheet trays to cool for % hour. 5. After cooling the pH of the sushi rice is then tested pH tester made by Hanna Instruments (model #HI 9810 pH-EC-TDs Meter, or by using pH paper specifically designed for Sushi Rice. 6. After testing, if the pH of the rice is <4.1, the rice is.then placed in a rice warmer for no more than 4 hours. Jr S 1 • Hazard Analysis If the pH level of the sushi rice exceeds 4.6 and is not brought down below 4.6, it may be able to support the growth of pathogens including Bacillus cereus, Salmonella, Staphylococcus aureus, and some types of Vibrio species when stored at room temperature. The product (sushi rice) is discarded. Critical Control Point (CCP) The pH testing is a CCP for the acidification of our sushi rice and the pH is tested each time a batch of rice is prepared at Misaki. The test is conducted by making a slurry of distilled water and the prepared or cooked sushi rice. Using either the pH tester or the pH tester strips, they are dipped into the slurry for 1-2 seconds for a proper reading. The target pH level is between 3.8 and 4.3. The pH level should never exceed 4.6 if tested after two hours of preparation. Critical Limits (CL) According to the MDHP Guidance RF 3-3 Using Acidification to Make Cooked Rice a Non-Potentially Hazardous Food and the Evaluation Tool, the Critical Limit(CL) is: pH shall not exceed 4.6 If the CRITICAL LIMIT is exceeded CORRECTIVE ACTION is taken by the sushi chef and/or designated employees. The sushi rice is discarded. Monitoring Procedures and Freguency 1. What: pH of cooked Sushi Rice 2. How: Mix sushi rice with distilled water to make a slurry, and test with pH paper. 3. Frequency: Every batch of acidified cooked rice intended to be used for sushi. ,y A 2 e . 4. Who: Sushi chef and/or designated employees • Corrective Action CA 1. Any sushi rice that exceeds the CL that has been made in <1 hour, we immediately add additional sushi vinegar and retest the pH. 2. Any sushi rice that exceeds the CL that has been made in >1 hour, we immediately discard the rice. 3. Proper records are carefully maintained as to when sushi rice is discarded strictly adhering to SOP's to ensure safety. Employee Training 1. The sushi chef and/or designated employees are trained in the proper use of the pH paper and/or the pH tester, including its calibration. 2. The sushi chef and/or designated employees are trained in how to properly use the pH log. 3. The sushi chef and/or designated employees are trained in proper • preparation of the sushi rice recipe with emphasis on the precise and consistent measurement of the ingredients. 4. All sushi employees are trained in proper employee hygiene which specifically includes: a. Proper handwashing b. Proper attire c. Proper hair restraints d. Prohibition of jewelry S. All sushi employees are trained in the proper use of foodservice gloves. Gloves are only used for one continuous task and then discarded. Gloves are regularly changed to avoid cross-contamination, especially when changing from preparing raw ingredients to handling ready-to-eat foods. 6. All sushi employees are informed of their duty to report to the Person-in- Charge i.e. SeanTerrio or Karen Terrio when they are experiencing symptoms of foodborne illness or have been diagnosed with specific a diseases. An updated blank Employee Reporting Form is provided. 3 7. All sushi employees are trained in proper cleaning and sanitizing of equipment, utensils, and the physical facilities. If using bamboo mats or maki-su they must be cleaned and sanitized daily, as well as, they must be covered in clean cling wrap and the cling wrap must be changed regularly i.e. every (4)four hours. If using a non-covered bamboo mat, the product being prepared must be covered in clean cling wrap and the cling wrap discarded after each use. Mats must be stored in a clean and sanitized area before and after use. 8. All sushi employees are trained in the proper procedures for preventing cross-conta m i nation. 4 i Training Steps to Testing Sushi Rice To attain a pH reading, prepare a rice slurry by combining % cup sample of the acidified rice taken from the batch and % cup distilled water in a clear cup. Ensure uniformity by blending the slurry for approximately 20 seconds. Insert the pH paper strip into the liquid portion of the slurry. Record the measurement. In the event the target pH is above 4.6, add more vinegar • and adjust the recipe accordingly, i.e. to meet proper pH requirements. I, , - have been properly trained to test the pH of sushi rice made on the premises of Misaki as of -�l� • 5 . 1 In Employee Injury/Illness Report Form Instructions: Complete this form as soon as possible in the event of an employee injury or illness. Employees must use this form to report all work-related injuries, illnesses and incidents of"potential danger" in which an employee may have become seriously injured. This aids in identifying and correcting hazards before they cause serious injuries. When completed, give this form to a supervisor for further action. This report is for a work-related: ❑ Injury ❑ Illness ❑ Potential Danger Your name: Job title: Supervisor: Have you told your supervisor about this injury/potential danger? ❑Yes ❑No Date of injury/potential danger: Time of injury/potential danger: Names of witnesses (if any): Where did it happen? • What were you doing at the time? Describe the steps that led up to the injury/potential danger, if they apply. (continue on the back if necessary): What could have been done to prevent this injury/potential danger? What parts of your body were injured? If a potential danger,how could you have been hurt? Did you see a doctor about this injury/illness? ❑ Yes ❑No If yes, whom did you see? Doctor's phone number and address: Date of doctor's visit: Time of doctor's visit: Has this part of your body been injured before? ❑ Yes ❑No If yes,when? Current employer/company name: • Your signature (optional): Date: �v Evaluation Tool for Acidified Rice HACCP Plans Last Updalad 3116ID4 ❑ Standard Operating Procedures (SOP) Most recent inspection report indicates compliance with 105 CMR 590,000. Any pre- existing violations,which may result in biological,physical or chemical contamination of this product, have been corrected. ❑ SOP for pH measurement Manufacturer specs and calibration instructions for pH meter or pH paper(.3 or less scale) used provided Instruction for measuring pH of rice slurry made with distilled water provided If a pH meter is used: ■ Buffer solution,which has not passed expiration date, used ■ 4.0 Buffer solution (unless manufacturer recommends otherwise)used ❑ Recipe/Formulation Provided — Strength of vinegar identified(%by volume) Preparation steps identified Recipe/formulation (target pH at or below 4.1)validated, signed and dated by a food.laboratory ❑ Preparation Steps Identified Hazard Analysis Included Growth of B.cereus and production of toxins identified ❑ CCP Identified Acidifying step (addition of vinegar to rice) ❑ Critical Limit Identified pH of acidified rice must be tested prior to use. If using pH paper,the pH shall not exceed 4.3. If using a pH meter, the pH shall not exceed: ■ 4.3 if tested within 2 hours of preparation, or ■ 4.6 if tested after 2 hours of-preparation. ❑ Monitoring Procedures Identified. — Calibrated pH meter or pH papers used to measure each batch of acidified rice — Person(s) identified for testing pH of rice , ❑ Corrective Actions and Documentation Procedures Identified If rice not tested, do not use until tested. If rice is above 4.6 (07 4.3 using pH papers), — Discard if rice not made within the hour If rice made within the hour, cool immediately or add additional vinegar,re-mix and re-test pH — Verify use of correct recipe and procedures — Verify calibration and proper use of ph meter or ph papers ❑ Verification (Short Term/I ong Term) Process Identified pH meter calibrated daily when used Monitoring records reviewed daily or as needed by PIC Recipe/formulation (target pH at or below 4.1) validated, signed and dated by a food laboratory ■ lab validation updated annually or when recipe is modified, ■ when daily pH levels are consistently higher than the laboratory validated pH measurement — Signed and dated HACCP plan reviewed and modified at least annually or as gn P Y needed by PIC. &�❑ Records to be Maintained Identified — pH log for each batch of rice (sample page included) maintained for 30 days — Corrective actions recorded in log (sample page included) — Daily calibration Iog maintained for pH meter Laboratory test results maintained for one year ❑ Employee Training Plan Documented (sample of training log provided) — Employee Health and Hygiene — Cleaning and Sanitizing Procedures — Cross-contamination Prevention Procedures — Monitoring Procedures for Acidified Rice — Use of pH meter or pH papers — Corrective Actions — Recordkeeping Requirements i t. f ENVIROTECHLABORATORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Misaki Sushi Restrauantldba Sean Terrio Location: rice Address: 379 West Main St Hyannis,MA Lab Number: DW-182098 Collected By: Client Date Received: 07/13/18 Sample Type: Rice Well Specs �,� Localro7i our'ce � � DateCollecfell' Trme Collected ' ' Cpmmenls�,�- � ��"'` ,� � ' Analysts Requested Uults Recommended Limits Analysis Result I Alethod Date Analyzed Analyzed By pH sushi rice pH units <4.6 3.89 SM 4500-H-13 07/13/2018 RL Comments: t 1 f1 f L I 1 Date 7/16/2018 Ronald J.Saari Laboratory Director r BRL=Beloit,Reportable Limits "'See Anached Page 1 of 1 : aCertifrcation is not available for this analyze for potable water samples.. 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I Alc let —I -V�6+— VffT7i j T • 4-1 - o r I _ I 14 Se!T a�f rs 3 ' <o �— MM1MMM MENNOMEN r mommmom SEEM 1111100111110111111 MEN No MINNISEEM MEN lmM=MMM IN mmommomom mom IN mommoommmommimimmoom MIN ON mom MEMEN m ON �a�'� ���iC■� alloCSC■��■�n■�■m■■■�■il NEON INERM ■�■■ ommo MOON ommommoolommom mmoommommommommom No IN No mommoommumom ONES mommommoommoom . ....... ............ . 'ii' ' I�iii°■■■ s"iiiiC■e iEiOiiie■E mom ■ . ............ ................. 1111111 . CARL F. RIEDELL & SON, INC. 778 MAIN STREET INVOICE # OS;ERVILLE, MA 02655-2046 TEL. (508) 428-6365 CONTACT: CUSTOMER: C"/ l 'k S G ram; i3�� WORK ORDER CONTRACT: CALL#: I�yay/i(yt i�/ P�'4_►--• D/�c� / RECEIVED: BY: TECH(S): CIA QUANTITY MATERIAL AMOUNT PROBLEM/TASK �P�a Socc'�7 �t�k v✓, 2 " coAou—' �.�C'��,� I-K e-r /7,V AA 1c..--ic k fh 'A 15-i( A 0�, -L ���G:.,�r� v eA4 I,-^67- /Le fl-cc-n g-;,s iecf S ��:,,��A- le c9 lea ,- civ-jv&,-- Misaki Japanese Cuisine,Sushi Bar 379 West Main St. Hyannis,M.Asachusetts 02601 MAT DESCRIPTION TAX PERMIT DUMP TOTAL .. COMPLETED R:TURN CAFIL F. ,RIEDELL & SON, INC. 778 MAIN STREET ^�j� INVOICE # OSTERVILLE, MA 02655-2046 TEL. (508)428-6365 CCNTACr. CUSTOMER: S'4 r /3� Dot n� � l�'l4r�G�ir �, X ' RACr 379 W. 01"-k,n sf, WORK ORDER `�" L#: CALL /uY�r7n, l, dYy4 - o/G v . RECEIVED: C1 i BY: QUANTITY MATERIAL AMOUNT PROBLEM/TASK Aej q :Aen Ire-A, oo ? 0 A;n 1:.,.4C IV- Aot *,--fc A eee ;A 6RQ4A 0Aa:nEn 01A4 1,"Af- e f/AeC7 h4f/fLf S'IAa:.e , r• f�oa;Aeco �fa ,� 4.e veA- Miecald Jape m O i*w &m Bar 3-0 West MWn St Flyanrrs,M.'rea�plaetts B2601 MAT DESCRIPTION TAX PERMIT Old TOTAL C spLum pLRURN fof Minki mum Q Iq, imin St. ��QI OV 7�A 141 s Y � 1 . eo� SA fl to sG ace CP PA� <.,� ?o�,,.,e s P a.,se All g, 6L-T— _1 �.SfR / row (v � M 5ik►..%a 2-e.Q .mot9 VAV It I r I i i .. ��` • ,��}'d t *� � .�tit }{1�� a d,��C� � #• �,�;t ;� a; ^^4�1iY icy:..._-.:.�..r,�..+-�..--r...-ram-..-+ •..�;a.�..,ll:��...r...- - - ,�:^- � �+14�`tK�'..�A .� +�'�