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Home My WebLink AboutSTAR MARKET #575 - FOOD Star Market #775 625 West Main St H annis ZqI- dl(o -F�� rt , _ Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. aArataSTAUM S F.P.(Thomas)Lee, KAS399 200 Main Street, Hyannis, MA 02601 Daniel L czkow M.D. Alt. L639 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: 749 Issue Date: 01/01/2022 DBA: STAR MARKET#4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,�� 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 For Office Use Only: Initials: Town of Barnstable Date Paid AmtJM Ss—:M—_ Inspectional Services off, l� 1639. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11/12/21 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Shaw's Supermarket#4595 �5 � ✓lC,�s� ADDRESS OF FOOD ESTABLISHMENT: 625 W Main St, Hyannis MA 02601 MAILING ADDRESS'(IF DIFFERENT FROM ABOVE): 251 Little Falls Drive,Wilmington DE 19808 E-MAIL ADDRESS: Legal.]icensing.team@albertsons.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 775 - 3421 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: N/A OUTSIDE: N/A TOTAL: N/A SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc i OWNER INFORMATION: FULL NAME OF APPLICANT Cody Perdue SOLE OWNER: YES' .:/ - OWNER PHONE# 208-395-3216 ADDRESS : 3026 Crane Creek Road,Boise, ID 83702 CORPORATE OWNER: Shaw's Supermarkets,Inc. CORPORATE ADDRESS: 250 Parkcenter Blvd, Boise ID 83706 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. kerbid 6u� 9 2�C� 2a (cer U 19vcb I z$ 1a-2 2. MkQ1)a-eAl 7AN 'Lc> ( � 01 /2jD--1 2> M. Zap K--b 1z9�2s 12 / 9 /2021 SIGNATURE OF APPLICA DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 I't 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 5-�OL(Z f n CLe '. ,k) ,irvt ct"', DowSign Envelope ID:F699D222-05F9.4786-B597-2D4lA9563653 POWER OF ATTORNEY FOR BUSINESS LICENSE FORMS KNOW ALL MEN BY THESE PRESENTS THAT Albertson Companies,Inc.,a Delaware corporation with offices at 250 Parkcenter Blvd., Boise,ID 83706,on behalf of itself and each of its directly and indirectly-owned subsidiaries(hereinafter referred to collectively as the"Principat")i authorizes Corporation Service Company,a Delaware corporation with offices at 251 Little Falls Drive,Wilmington, DE 19808 and its designated employees(,CSC")to act as its attomey-in-fact for the purpose of signing, stamping;and/or affixing the Principal's signature and filing in the Principal's name any business license applications,tax documents,renewal forms,or related documents(hereinafter referred to collectively as Business License,Forms")as the Principal may request..Principal specifically authorizes CSC to notarize documents on its behalf and perform other necessary acts to fulfill the services requested by Principal. This POA will remain in full force and effect until due notice of its revocation is given by-the Principal to CSC. CSC IS NOT AN ATTORNEY OR LAW FIRM AND DOES NOT PROVIDE LEGAL ADVICE. PRINCIPAL AGREES THAT IT IS RESPONSIBLE FOR REVIEWING LICENSE FORMS AND:SEEKING ADVICE OF COUNSEL WHERE NECESSARY. IN WITNESS WHEREOF,the Principal has caused this instrument to be executed by a duly authorized representative as of the date set forth below. ALBERTSONS COMPANIES,INC. Principal OocuSignedby. By: 3WV NJ" Nam . ?P$iM04br Title: Executive Vice Presioent,General Counsel&Secretary Date: In Sworn to and subscribed before me on this day of-_�tk n L NOTARY PUBLIC Date of Commission Expiration Not too- s. ��aTARY s �••. hNN` i Bellaire, Dianna From: Kegelman, Michael <Michael.Kegelman@cscglobal.com> Sent: Thursday, November 11, 2021 9:59 AM To: Bellaire, Dianna Subject: Shaw's Tobacco Permits Online Account Attachments: Store 4595 Screenshot.PNG; Store 1598 Screenshot.PNG Good Morning, I am writing in regard to the tobacco license/permits for Shaw's 1598 and 4595. Albertsons/Shaw's has partnered with CSC for their license/permit processing and renewals and we are working on the transition.To that end, could you please assist me with the online account set up?When trying to link the account the building information comes up to completely different addresses. I have attached screenshots for reference.This might be the information for the companies that own the physical building but I just want to make sure this is the case before I move forward. If it is the case and I can just move forward please let me know. If needed I can be reached at 302-636-5400 direct extension 66262 to go over this in more detail.When I attempted to contact the number on your email all I got was a busy tone unfortunately. If you need additional information, please contact the following Albertsons email: LegalLicensing.Team@albertsons.com Thank you, Michael Kegelman (He/Hits) What's this? Customer Service Representative ( Business License Team Phone: 302-636-5400 x 66262 Michael.I[egelnian@cscglobal.coni CSC(& 251 Little Falls Drive Wilmington, Delaware 19808-1674 USA cscglobaLcom AVY �: CSC We are the business behind business CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend email coverage from 9 a.m.-6 p.m. ET. To reach a customer service representative, please forward your request to evening team@cscglobal.com. CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! i Bellaire, Dianna From: Kegelman, Michael <Michael.Kegelman@cscglobal.com> Sent: Friday, November 12, 2021 10:22 AM To: Bellaire, Dianna Subject: RE: Shaw's Tobacco Permits Online Account Yes that would most likely speed the process up. I did update the mailing address on the forms as well as the email on there as well.The new address should be 251 Little Falls Drive, Wilmington DE 19808, and email being legal.licensing.team@albertsons.com. Thank You, Michael Kegelman (He/Him) 'what'sthis? Customer Service Representative I Business License Team Phone: 302-636-5400 x 66262 Michael.Kegelman@csc(jlobal.coiri CSCO 251. Little Falls Drive Wilmington, Delaware 1.9808-1.674 USA cscglobal.com CY CSC We are the business behind business CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend email coverage from 9 a.m.-6 p.m. ET. To reach a customer service representative.please forward your request to eveningteam@cscglobal.com. From: Bellaire, Dianna [mailto:Dianna.Bellaire@town.barnstable.ma.us] ; Sent: Friday, November 12, 2021 10:20 AM To: Kegelman, Michael<Michael.Kegelman@cscglobal.com> Cc: Bellaire, Dianna <Dianna.Bellaire @town.barnstable.ma.us> Subject: RE:Shaw's Tobacco Permits Online Account Yes, the POA will work. Thank you. However, will I be changing the contact info for renewals in the future? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us 1 The information contained in this electronic transmission Ce mail"),inchuling any attachment(the"Information"),map be confidential or otherwise exempt from disclosure.It is for the addressee only-.":['his In.forrnation may be privileged and con..fdential work:-product or a privileged and confidential commucucation.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director.of Public Health and/or the 'I'own Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake,please notifi!the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Kegelman, Michael [mailto:Michael.Kegelman@cscglobal.com] Sent: Friday, November 12, 2021 10:18 AM To: Bellaire, Dianna Subject: RE: Shaw's Tobacco Permits Online Account Good Morning, Thank you for getting this form over to me, as well as providing direction for the online process for the tobacco permits. I do have one question about the Food Permits. Since CSC has power of attorney to handle the renewals for Albertson's/Shaw's, are we able to sign on their behalf for the Owner/applicant area of the application? I have also attached our Power of Attorney for your reference if it helps. Thank You, Michael Kegelman (He/Him) What's this? Customer Service Representative ( Business License'Team Phone: 302-636-5400 x 66262 Michael.Kegelman@cscglobal.com CSC® 251 Little halls Drive Wilmington, Delaware 1.9808-1.674 USA. cscalobal.com CSC We are the business behind business CSC is pleased to provide evening email coverage until 11:00 p.m. ET and weekend email coverage From 9 a.m.-6 p.m. ET. To reach a customer service representative; please forward your request to eveningteam@cscglobal.com. From: Bellaire, Dianna [mailto:Dianna.Bellaire@town.barnstable.ma.us] Sent: Friday, November 12, 2021 8:56 AM r : Kegelman, Michael<Michael.Kegelman@cscglobal.com> : Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us> bject: RE: Shaw's Tobacco Permits Online Account portance: High od Morning, 2 II I I am working from home today, but I received email that all phones are down at the office and that is why you received the busy signal.The database uses the owner of the property that pays the tax bills and it will not show your name. You have one address correct and one that needs to be different. 1070 lyannough Road is the correct address for Shaws #1598 625 West Main Street is for Star Market#4595, please choose that address and NOT the 626. Both of your establishments are non-aged restricted category. I have not received the food renewal applications in the mail for either location. I've attached the blank food application which you will need to print one for each. The fee is$535.00 for each establishment for the food. Each market needs 2 food protection managers and one of them needs the 5 year allergen certification. I have the following employees with these certifications on file for each store, if different, I need a copy of those certifications: Star Market#4595 1. Gerald Butts 2. Michael Zajko Shaws#1598 1.Karen Peirce 2.Thomas Cummings Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be conEdential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential comniunication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Info.rm.ation may.not be disclosed without the prior written consent of the Director of Public Health and/`or the. Town Attomev's Office of the Town of Barnstable. If you have received this e-mail b�,mistake,please notify the sender and delete it from wour system.Please do not copy, or forward.i.t. .Fhan.k you for your cooperation.. From: Kegelman, Michael [ma i Ito:Michael.Kegelman@cscgloba1.com] Sent: Thursday, November 11, 2021 9:59 AM To: Bellaire, Dianna Subject: Shaw's Tobacco Permits Online Account Good Morning, I am writing in regard to the tobacco license/permits for Shaw's 1598 and 4595. Albertsons/Shaw's has partnered with CSC for their license/permit processing and renewals and we are working on the transition.To that end, could you please assist me with the online account set up?When trying to link the account the building information comes up to completely different addresses. I have attached screenshots for reference.This might be the information for the companies that own the physical building but I just want to make sure this is the case before I move forward. If it is the case and I can just move forward please let me know. If needed I can be reached at 302-636-5400 direct extension 66262 to go over this in more detail. When I attempted to contact the number on your email all I got was a busy tone unfortunately. 3 BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. =' BARNSTAO :" Paul J.Canniff,D.M.D. MASM& F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 749 Issue Date: 01/01/2021 DBA: STAR MARKET #4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �1tvy THE rpk For Office Initials: Town of Barnstable Date Paid I Amt Pd$, BARNSfABLE, : Inspectional Services 16,39. Public Health Division Check# 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 a a NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: (ORS VV 1— l n S`� . yay1 h (S , M-� 6aCco MAILING ADDRESS(IF DIFFE--RENT FROM ABOVE �D�C 02 !O L'Tibe E-MAIL ADDRESS: )tfSC- /G JC ��VII�V•�DYYIik, Z TELEPHONE NUMBER OF FOOD ESTABLISHMENT: U LSD TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NOX_ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/_/ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: Q 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. l `/ IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? F'1 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? V�f� TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) A 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*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc OWNER INFORMATION: n A �" L ,�;_,. FULL NAME OF APPLICANT 946LY- t4ir --e\J COM D&O V, 'In C SOLE OWNER: YES/NOrr,, OWNER PHONE# �Q'd?j'�(o�"�3 01,1p ADDRESS tj(—E P� ✓ ' (O CORPORATE OWNER: l� t CORPORATE ADDRESS: O , 1 PERSON IN CHARGE OF DAILY OPERATIONS: t rf 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 6 IOU 1.J S SIGNA URE X 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 i p+r�FtET BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Guadagnoli,M.D. BARNSTABM F.P.(Thomas)Lee bSS 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 749 Issue Date: 1/1/2021 DBA: STAR MARKET #4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY FniOffice Initials Imp Town of BarastoMe ' °,Dace Pala i _ s 957 : Ins ect�orial S-earvices.�nrrareete,-a. p T Pubic :,Health Division. Thomas McKean,Director F _ 2001Iain Street;Hyannis,,MA O2601 CQffice:' S08-862-4644 Fag: 508-790 6304 TOBACCO .ESTABL,1$9 !iE,N PERNIIT.A.PPLICA Nair-Flavored DATE ld. .. d� O NEW BUSINESS OWNERSHIP _. RENEWAL .. ... . Ala/� 1VAlYIE'OF 1 UB'ACCO.ESTABLISHMENT „Q{--A r C'((A Y Jc e-E-S �ln�t t,�o�n , (0,C S- a��5�, ADDRESS OF TOBAGCO ESTABLISHMENT I R Q q �,/ � �C� MAILING ADDRESS;(IF',DIFFERENT'.FROM ABOVE) 6_ Boc �-` t�O, �S'lLL7v.� L2� E=1k AI-L ADDRESS VN16LY, COW. _ .. TELEPHONE NUMBER,OF=TOBACCO-,ESTABLISHMEN'T- "(= 1 ' 1.-,31-,2L, s OWNER'S NAME-tiS � Z maz OWN//"PH#t-fu=- 1-te-;.�z OWNER'S ADDRESS:,�2a?Alrk G e✓+Gr ��a • t)lS� ( 83�0 Zv CORPORATE NAME: S6,r t-(,a cue ,6Kn____Da°n`F. (v�� CORPORATE ADDRESS:' UyYGe aS OL60ve CoRp©17ATE Fm#, ��- ANNUAL:- ZC_.. SEASdNAL: DATES OF OPERATION:_.7_/ TO 1_T_ DAYS CLOSED_EXCLUDING HULIdAYS(EX_:MO,NDAYS};_ TOWN OF,BARNSTABLE COI}ElMA.GENERAL I,AW IlNTERN° T LINKS: TOWN..OF BARNSTABLE TOBACCO COMLINK FOR CHAPTER371,.9. h t s //www ecode3 Wcom/3,39963"92 1VIA GENERAL;LAW CHAPTER 2701SECTION E: littps ipa gislah&e Gov/Laws/0eneralLaws/PartIV/Titld4Qga iter270%Section6; *NEW,'BUSINESSES:AND NEW OWNER$ONLY*** REQUIRED TO CALLMEALTH DIVISION.AGENT'FOR AN INSPECTION PRIOR TO PERMLT`BEING ISSUED. ;k PLEASE GALL SO$37S-6621 , ALL A#kICANTS ARE REQUIRED TO SUBMIT THE FOT LOWING REQUIRED DOCUMENTS: I) MA State License to Sell Cigarettes: 3} "IRS Federal Tax ID#Document 2) MA State License to Sell"t✓;gars and Smoking"Totiacco 4)Payment of-Fee(s) see page4 'SIGNATURE 'PRINTEDAAM—E� I any O rco ra n, DATE.', Ul/ O/_' upervJs®r Tax Q=WpplicaO Fo!MAITQBACQp AP.N NonFavor 1248 19.docx ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales:to Minors—4 371-9.:Sale and,:Distributiott of Tobacco Products. l. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-.issued photographic identification containing the bearer's date of birth that the purchaser is 21.years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section.371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laves: Sign tur Printed Name D to Signature Hnto ame Da e Signatttr Printed Name Date 1 . b t ignature Printed Name Date i k4la Signature Panted Name I Date u Si re _ Pri ed'Name Date i. Signature Printed Name Date l t p Q:\Application FonnsITOBACC(J A.PP-NonFavor 1 I-21-19:doc i x. i ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—071-9.Sale:and Distribution of.Tobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town.of Barnstable is 2.1 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older: Verification is required:for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of.Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: - .. } nature Printed Name Date 1 At��`��a T ritittA�Uut� 01 - 1 - tgnature Printed Name Date 1 6 IVC( Signature Printed Name Date d10 Gn, IA C- ticCtF' G+� n1cG0 •42 Q21 ..-::..... 1 Signature Printed Name Date < < VA"n 14 12- - Z10 l tgnature Printed Name Dat $ Signature Printed,Name Date Signature P ted Name Date Q\Application Porms\TOBACCO APP-NonFavor 11-21-19.doc i ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the cmployee(:s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General.Laws which describes the penalties for selling and/or giving tobacco products to.any person under the:age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors— '371-9...Sale a nd-Disiribution of Tobacco.Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales.age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall veri-Py the.age of the purchaser by means of a valid government-.issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person.under the,age of 27. The employee(s)below received and understood'Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270.Section 6 of the Massachusetts General Laws: r � j ' G i- Signature Prin ed Name Date f SICY Printe e Date ; F' Q + '! ure Printed Name Date , 1 ig atur Printed Name Date —signifure Prin d Name Date Sipnatur #, Printed Name Date ^ A i ature Print Name ate Q\Application FormMOBACCO APP-NonFavor 11-21-19.doc ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371, of the.Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the. penalties for selling and/or giving tobacco products to any person under the age of twenty-one(2.1).. Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—_ ,371-9 Sale andDistribution of Tobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein,io a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21,years old or older. Verification is required for any person under the age of 27. I'lie employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section b of the Massachusetts General Laws: Stgnt a Printed Name Date Si ' a r e Pr' ted Name "; 1),iEe ' Signature Printed Nam to 1 Signature Printed Name Date. r x Si atu.a Printed Name Date ko : Signature Printed Namen, Date i'f - ignature ...• Printed Name bate Q:1Application r,orrt&TOBACCOAPP•NonFavor 11-21-19.doc } de,:7� ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the cmployee(s)of this establishment received and understood Chapter371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—§371-9.Sale.and Distribution ofTobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town ofBarnstable is 21 years of age. 2. Identification: .Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means_of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years.old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation andChapter 270 Section 6 of the Massachusetts General Laws: ATrd Signat' e '' Printed Name Date 1r t-1 ....._ 10 , Si- ature Printed Name Date (�Si�gnat _ Printe a e J��/,.. Date '� �� s Nk ' "" '- 1 Signature Feinted Namc Date r S,`na Printed Name Date,/ i n ture Pr d Vme Date , 11 2� Signature Printed Name Date Q\Application FornisMBACCO APP•NonFavor 11-21-19.doc ; r 1]'I❑'] Commonwealth of Massachusetts Letter ID:L1189904704 • '�Jo Department of Revenue Notice Date:November 5,2020 Geoffrey E.Snyder,Commissioner Account ID:CGL-11258835-090 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES Ilyhll�il�ll{��{ui{��'��'Ilil��r�k'I{8'llll�ll�ii�l'I{I'I STAR/SHAW S LICENSING STAR MARKETS COMPANY INC STAR#426 PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3).Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE -------------------------------------------------------------------------------------------------------------------------------------------------- ` `USF MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes �. This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC Account ID: CGL-11258835-090 STAR#4595 Location ID: 11258835-0196 625 W MAIN ST License Number: 1567545344 HYANNIS MA 02601-3420 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: November 5,2020 Expiration Date: September 30,2022 • ctsH�,s Commonwealth of Massachusetts Letter n):L0400824064 � x-- s Department of Revenue Notice Date:February 2,2018 r'^� Christopher C.Harding,Commissioner Account ID:SLS-11258835-045 'F;:iCFf mass.gov/dor SALES AND USE TAX REGISTRATION CERTIFICATE "ll�ll'�"'II��III �IIII'�I��I�IIIII�'��11��1�11tlll � . STAR/SHAW'S LICENSING STAR MARKETS COMPANY INC STAR MARKETS COMPANY INC PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Sales and Use Tax Registration Certificate(Form ST-1). Cut along the dotted line and display at your place of business.You must report any change of name or address to us so that a revised ST-1 can be issued. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this certificate. I DETACH HERE y'XCU(`sF MASSACHUSETTS DEPARTMENT OF REVENUE Form ST-1 r ; -? Sales and Use Tax Registration Certificate ror��~r This registration must be posted and visible at all times. STAR MARKETS COMPANY INC Account ID: SLS-11258835-045 STAR 94595 Location ID: 11258835-0194 625 W MAIN ST Certificate Number: 2066974720 HYANNIS MA 02601-3420 This certifies that the taxpayer named above is registered under Chapters 62C,64H and 64I of the Massachusetts General Laws to sell tangible personal property at retail or for resale at the address shown above. This registration is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: September 8, 1994 ~' BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ILAW- AWY. Paul J.Canniff,D.M.D. av 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate o ice" 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: 749 Issue Date: 12/10/2019 DBA: STAR MARKET#4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: -" c1(- is a.6D For Office Use Only: Initials: Town of Barnstable tt nn�� ' Inspectional Services an�ver,�e,E (�D I MAM 1639. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 �l Office: 508-862-4644 Fag: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE( I S �I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:Star Markets Nwimay, Inc•VIVA -fir 59S ADDRESS OF FOOD ESTABLISHMENT: Malh Sf f jj/Qyiws HP o aw, MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 E-MAIL ADDRESS: NASC.Tax@safeway.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (So 8)7?5- 34 a 1 TOTAL NUMBER OF BATHROOMS: a WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE: 0 TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? N/A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N/A 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 508-8624644 Q:\Application FormsTOODAPP REV3-2019.doe f T OWNER INFORMATION: FULL NAME OF APPLICANT Shaw's Supermarkets,Inc. SOLE OWNER: YES/NO OWNER PHONE# 623-869-4326 ADDRESS PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 CORPORATE OWNER:Shaw's Supermarkets,Inc. CORPORATE ADDRESS: 250 Parkcenter Blvd Boise,ID 83706 PERSON IN CHARGE OF DAILY OPERATIONS: 5 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.Senn fer Hong an (I / 13 / a3 1. &X&n,"ajo 2.A 1tX6Aer-?au t o s / zg- /a! i /N-/ SIGNATURE OF AftLICANT 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 508-8624644 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.asy. OUTDOOR COOING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31 `each cal . IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES B DEC 1st. Q:\Applicadon FormsTOODAPP REV3-2019.doc i ............ .... For Office Use Only. Initials a Town of Barnstable ,Date Paid::�� .Amt_Pd$• . .. - Inspectional Services ' Public Health Division ---- P ex. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Cr Office: 508462-4644 Fax: 508-790-6304µ' T-OBACCO..ESTABLISffi1�NT-PERMIT APPLICATION{Non-Flavoredl' DATE 11/22/1.9..,,...,,.... NEW BUSINESS OWNERSHIP RENEWAL X NAME OF TOBACCO ESTABLISHMENT:, Star Markets Company,..Inc DB/A Star ADDRESS OF TOBACCO ESTABLISHMENT: 625 W Main St. Hyannis,..MA_02601 ' . MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO Box 29096 MS-6531 Phoenix AZ 85038 9096 ........ , E-MAIL ADDRESS:.,.._NASC.Tax@safeway.com ; _ I TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: 508 1 775 _ 3421 OWNER'S NAME: Star Markets Company,Inc. OWNER'S PH#(623)869 _4326 OWNER'S ADDRESS: 750 W Center St. West Bridgewater,MA 02379 __. __ ....-._ . .._........ CORPORATE ADDRESS:250 Parkcenter Blvd Boise,ID 83706 CORPORATE FID# 04-3243710 a s 3 ANNUAL::,..-_X__..:.._ SEASONAL: DATES OF OPERATION: / /_ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) .T,OWN.OF BARNST'ABLE_CODE/MA_GENERAL LAW.INTERNET.:LINKS:: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: ht osa_�vvww.,ecode3,60.com/3399 33.92,:. MA GENERAL LAW CHAPTER 270/SECTION 6: httt s•//mal6ai.slgg ov/LawsLGeneralLaws/Pgii /Titlel/Cha er270/Section6 _... m _... ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE.CALL SQS_ ZS-6621 ._...... . r ALLAPPLICANTS ARE REQUIRED TO,SUBMTf TFiB FOLI&W d REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 �111 fga SIGNATURE. Y�_:_._ ., �._ ,, ....,T� ,, 1 , PRINTED NAME 5 u p e ry ,,g[J� . u DATE: / z� / Q:1Application FormATOBACCO APP•NonFavor 11-21-19.doc _e,..u. .x .✓mom. ,< a_dui�l#5...•' ._ iL�' ,.d. *' ,THE Town of Barnstable For off-, Use on��: Initials: Y Inspectional Services Check#ate a $ • STABLE, * • CBSh 3 ,� Public Health Division �p1 200 Main Street,Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT ESTABLISHMENT NAME (DB/A L� I- -r 44595' ADDRESS OF BUSINESS PO Box 29096,MS-6531 Phoenix,AZ 85038-9096 MAILING ADDRESS (IF DIFFERENT FROM ABOVE) Shays Supermarkets,Inc. Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270,Section 6.00(a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). Signature Date 11 L/5' C:\Users\decollik\AppData\Lucal\Microsoft\Windows\INetCache\Content.Outlook\YZOF4J38\TOBACCO APP2019 dob.docx r sGsfij� Commonwealth of Massachusetts I]1O 1m N Department of Revenue Letter ID:L0688804480 IRA, T� Christopher C.Harding,Commissioner Notice Date:September 17,2018 ' Account ID:CGL-11258835-090 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES �'II'1'1��'�Itti. I� Illl��ltll�'I'��Il�llllllll�llllt��tl�l STAR/SHAW'S LICENSING STAR MARKETS COMPANY INC, STAR MARKET#136-7426 PO BOX 29096 MS#6531 PHOENIX AZ 85038-9096 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. _____________—_ DETACH HERE MASSACHUSETTS DEPARTMENT OF REVENUEt;rg ' Form CT-3T Retailer License for Sale of Cigarettes y t'FNr0e This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC STAR#4595 Account ID: CGL-11258835-090 625 W MAIN ST Location ID: 11258835-0196 HYANNIS MA 02601-3420 License Number: 1971578880 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 30,2020 51! � 'S 1'�STAH1.1SIIi)IF.tYT 1"i4A1H. "TOBACCO S,11.> S Etuployee Sig,nalure Form This form is for offilcial use to indicate that the ctnptuyetio of this cstnlali hmcnt rcecivcd and understood Chapter 371 of the Town or Barnstable Code and Chanter 270 Section 6 of me �fassarltusrrtts ffcneratl I ��c v�hieh dr«ribcs fire M111tics for soling and/or giving tobacco products to art 371-9,of the Town or Bamstabic board of Health Ftrgulat 4,,person tinder the ati!e of rwcn 71 Room is �eeti�ari t}-!,,me ti ) Sales to`minors--4371 9.Sale and Dlslribullon nJ'fnt,urrt�i'rr rtuctj I. No person shall sell or provide a tobaLr-o pr(Ottct,as defined herein,tQ a nets n under The min►tnum legal sales age, The m nitnunt legal sales age in the'rown t f Bam%iMe is 21 years of age. 2, Identification. Each person selling or dimrihmaing tnhic`co products,as d»fined herein, that)vrr fy the age of the purchaser bY means of a valid government-issued photographic identification containing the bearer's date of birth that the pufchaser is 21 years old or older. Vertfication is required for any person under the age of 27: The etrtplOY"(s)below received and understndd Section 371-9(if the Town of ftarnstahle netard of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts Ciencral Law%: ;4 1 GoOLx joiti.0 ZI 1)�- silflduft Printed Name Date Si aturc Printed Vwr D � .a. S gnatU11W Printed N Dalc Aef sign atu Prin cdNnmc I D to Signature Primcd Name Date ca.1 LS k.Cav, I A Signature Printealame date tW Signature Printed Num p;tt a • Qt+J1pp11cafioe 1'ormnTOBAGCo AFF•NonFavar 11.21.19,doc Scanned by CamScanner f NA, ptit"Artl�l5rti►ff:i�1 ` TOBACCO SAI.IrS ;Employee Signature Form Vffonnfficial use to indicate that the cmployce(s)of this establishment received and understood C1,:11latrr 371 of the Town or Barnstable Code and Chaptte 270 Section G of the Massachusetts General t.a%ti,s which dc5crihcs rile penalties for selling andlor giving tobacco products to oily person under the age of twenty-011e t?1�. r3cla"' is Scctiorl 371-9.of the Town of Barnstable Board ofl3caltit Regulation; Sales t0 Minors—6 371-9 Sale and Distributlon of Tobacco [Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person undcr '11te minimum legal sales age. The minimun► legal sales age in the Tol"n or Hnrnsttable Is 21 years of age. 2. Identification: Each person selling or distributing tobacco produces,as depned licrcrn, shall verify the age of the purchaser by means ofa valid govemmrnt-issued trhotograpllic identification containing the bearces date of birth that the purchaser i:s 21}cars old or older. Verification is required for any person undcr the abc of 27. The cmploygc(s)below rmived and understood Section 371.9 of the Town of 130m,5111 ale Board of' Health Prohibidion of Smoking Regulation and Chmptcr270 Section b of tlic;Vtassachusettc C;cnernl l.rus's: Sig nturc ri 4tcdlzaime ��4 Dale Signature Printed Name pate Sig 1'Lit pat4 __1z � j / Printed Nome Bate Sipistture Printed Name Date { 1 - ; qr ' Sign Prinmd ame pate Signature Printed Name Date (1,LAppJ c�li�a rom%AT0BACC0 Ar1%N anFevar t l•2 t•19.doe Scanned by CarnScanner 9 MAMAS 1 ir' ' XSIIrs TOBACCO Sll►LKS EMI)Io),ce Signature Form ,is fonn is for official use to indica'kc that the umpluyce(s)of this establishment received send unt erstrtnd C1t;r'Ptcr 371 the Town of llarnstabte Code and Chapter 270 Section G of the Massac.husetu General t,n%vj which descrihe` the nalt t:s for stlling andfor giving teibjeco products to I1111, person under the age of twenly-one (21), licicr+`' is section r1-9,of tltc Town of I arnsiablc Board ofllealtlt Rcgul;ttiott Sines to Nl linotrs—ki 3TL•9-Sale and.nlstribullon of Tobacco Product$- 1. No person shall sell or provide a tobacco product,as del fined Herein,to a pctscrrl tender 'ilic minimum legal salts age. 'rhe minitnutn legal sales age in the Town of mirnslob1c K 2t years of age, 2. Identification: Each person selling or distributing tobaccn products,as defined herein' shall verify fete age of tilt purchaser by means of a valid gtwernment-issued phologrnphic identification.containing the beater's date of birth that the purchaser is 21 ye3r5 vld err older, Verification is required for any person under tlicagc Cr , 1'he employee(s)below received and understood Sccdon 371-9 of the Town of 13annim lc,Board Of Health prohibition of Smoking Regulation and Chapter 270 Section b of the Massachusetr:, Sign-.urr. Printed l�i� -gate '�sature imed Name Dale c(�aoL e rter , �l 5i�,pat�a-e Printed Name Date 5gna;u a ,r Printed Name Date it e2 r V S"ono . Printed Namt Dste on laic Printed NA me Qaic �.— Signet rem Printed Name !- Dat / A-41 Q.tAppfics�inn>'nrmm�.1'c7D�CCt1/1r't'NnnFgva t I.21-19 dx Scanned by CarnScanner ST ti1,tSTtyiF.NT'S NAIME F. A TOBACCO SAME Employee Signature Form This form is for official use to indicate that the cmplovee(s)ofthis establishment receivers and undcr%tood Chapter 3 I, of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts Ocneral Law., Which dcgcribes the penaltics Tor selling'dndlor giving tobacco prudii-as to any person under the age of twenty-one (21?. Belo' 1s Scccir.n 171-9.of the,Town of Barnstable Board of Health Regulation; Stales to Minors—6 371 4 Sale and Distribution of Tobacco Products, 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age, Z. identification; Each person selling or distributing tobacco products,as de filled herein, shall verify the age of the purchaser by means of a valid government-issued photographic idemif►cation containing the beater's date of birth that the purchaser is 21 tears old or older. Verification is required for any person under tltc rgc of 27, The employee(S)below received and understood Section 371 9 of the Town of Darnstablc Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Mwachuscns General Lasses: 11 Si lure T Prtn cd Name [?atr Printed Name Date ` i t ( \t CA1 Primed, a Ddtr i icnetwc Signa re Printed Name oate L:b2 V l L. a-- I Cj aturc Printed Same Date C gnat c Printed Name t7a:e i Signature Printed Name Uatc t is Q,vtppi.caiwn rornulTQHACCO MIN NonFnvor 11.21-19AM w. Scanned by CamScanner f Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. . STAVe Paul J.Canniff,D.M.D. Mw F.P. Thomas Lee Alternate .� � 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 749 Issue Date: 1/1/2020 DBA: STAR MARKET #4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual —X Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY I rr+ , Town of Barnstable BOARD OF HEALTH 4a Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. R.%RNSrABLF- John T.Norman o �` 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 749 Issue Date: 12/20/18 DBA: STAR MARKET #4595 OWNER: STAR MARKETS COMPANY Location of Establishment: 625 WEST MAIN STREET HYANNIS MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - ------ --- - — MOBILE- FOOD: MOBILE-ICE CREAM: a� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i ti oF�HE roy, For 0 Initials: Town of Barnstable Date Paid '2 ,,BARNgrABLE, Inspectional Services « 9� s6Jq �0� l ArEp `A Public Health Division qq Thomas McKean,Director I + (J 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE t►/2-t ar NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: .S 4-a r llaf-k-&_47 Co A nX , l4G PIP1,4 .S ►�' # YS'9� ADDRESS OF FOOD ESTABLISHMENT: G Z r (y., lvlo-'^ S�- STAR.MARKETS COMP*A-NY's:INC�. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): P.O.8®x 2.9096.MS#6531r E-MAIL ADDRESS: Nasc.tax@Safeway.com Phoenix,AZ 85038-9096 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 2— 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)? IV- 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 QAApplication FormsT00DAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT N%:k r /Yl a, ke h C u,n 12 f -Ell c. SOLE OWNER: /NO OWNER PHONE# ADDRESS_Z5-0 j3 �,a(. , A.�s�. (D 0 37 o C Spar- /4S.'ke tj CORPORATE OWNER: T n c. FEDERAL ID NO. : CORPORATE ADDRESS: Z S'o /�u.-�cc�n,�e. f�d. $a t�, 1 D 8 3-7 o C PERSON IN CHARGE OF DAILY OPERATIONS: n:�e.- o�a g.n S�o J7,1-•e• -� 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 ller en Awareness Expiration Date 1. /�IP ar4 PC, JIG s / z l z . >c�,�:.�� /�•., 1 . tt / 13 /Z- 2. l za : e ►�- i 1 4-1 I SIGNATW 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 b a State Certified lab prior too opening and monthly thereafter, Y P P g Y 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 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 FormsTOODAPPREV2018.doc V .V1 l Town of Barnstable sattxsrns�, « Regulatory Services Department 9� MAW � Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT .S I 7'a r- /�i a.r- Ike 43 Ca,,.� ti n LAST NAME OF APPLICANT ..'FIRST NAME MIDDLE INITIAL ifs-9r D/B/A (ZS STREET ADDRESS sQ8 - 7-7s- 31411 Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided-on the next page). Each employee who sells tobacco products must sign the Emplo ee Signature Form (provided herein). Signature Date Q:\Application Forms\TOBACCO APP2018 dob.docx 4 'rF� Commonwealth of Massachusetts Letter ID:L0688804480 -1 � i{ Im y Department of Revenue Notice Datc:September 17,2018 + 1 Christopher C.Harding,Commissioner Account ID:CGL-I 1258835-090 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES STAR/SHAW'S LICENSING STAR MARKETS COMPANY INC STAR MARKET#136-7426 PO BOX 29096 MS#6531 I PHOENIX AZ 85038-9096 i Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. y f y t 4 90 1 DETACH HERE ------------------------------------------------- ---------------------------------------------------------------------------------------- aCHU MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes ��fihroti�� This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. STAR MARKETS COMPANY INC Account ID: CGL-11258835-090 STAR#4595 Location ID: 11258835-0196 625 W MAIN ST License Number: 1971578880 HYANNIS MA 02601-3420 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to f sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. t t Effective Date:. October 1,2018 , Expiration Date: September 30,2020 A . r. ESTABLISHMENT'S NAMf TOBACCOSALES Employee Signature Form This form .is for official use to indicate that the employees) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270-Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco ` products to any person under the age of twenty-one(21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors—_4 37.1-9.Sale and.Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal.sales age.in the Town of Barnstable .is"21 years of age.. 2. Identification: Each person selling or distributing tobacco products;,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth.that the purchaser is.21 years old or older. Verification is required for any person under the age of 27. The following employees) received and understo d. Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: attire Printed Name f r / Date Signature Printed Name Date Signature Printed Name Date ho I Signature Printed Name Date 1 , ture Printed N e Date ",4 �q enl Sryl O/W Si tore r' ed ame IDate 2� 17-1161 Signature Printed.Name Date Q:\Application FOrrns\TOBACCO APP2019 dob.docx f 57'#7t ,C7' ESTABLISHMENT'S NANT TOBACCO SALES Employee Signature Form This form. is for official use to. indicate that the employee(s) of this establishment received-and understood Chapter 371 of the Town. of Barnstable Code and Chapter 270 Section 6 of the ett Massachuss General Laws which describes the penalties for selling. and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.-of the Town of Barnstable Board of Health.Regulation: Y Sales to Minors— 371-9 Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum-legal sales age in the Town of Barnstable is 21 years of age.. 2. Identification: Each person selling or distributing to products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 2.1 years old or older. Verification is required for any person under the age of 27. i The following employee(s) received and understood Section 371.-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section :6 of the Massachusetts General Laws. Signature Printed Name Date a -- V r,s �. l o I Signature Punted Name Date Signature Printe arise , Date Signature Printed Name Date Signature Printed Name Date Si Pr' ted Name Date gn MePr' ted Name Date Q:\Application Forms TOBACCO APP2019,dob.docx 51rym- WNW kW114WI: Sol. ESTABLISHMENT'S.NAME TOBACCO SALES Employee Signature Form, This form is for official use to indicate.that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270, Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors'—§371-9. Sale and Distribution of Tobacco Products. 1., No person shall.sell or provide atobacco product,as defined herein,to a person under The minimum legal sales age: The minimum legal sales age in.the Town of Barnstable is 21 years of age. 2.. Identification: Each person selling or distributing tobacco products,as defined.herein, shall verify the age of the purchaserby means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age:of 27. The following employee(s) received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of .Smoking Regulation and Chapter 270 Section 6 of the Massachusetts Ge ral Laws:. f Md 1V,-r-2 See kbll ) 1 / S' afore Printed Name Date Signature" Printed Name Date iA AAVI a ? � Signature Printed Name Date ! Signature Printed Name Date Sign re Printed' e Date Sign e Printe Name Dat SignaturefV Printed Name Date Q;.\Application-FormATOBACCO APP2019 dob.doex ESTABLISTZENT�S I�AME TOBACCO SALES' Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 311 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board.of Health Regulation: Sales.to Minors-_371-9. Sale and Distribution of Tobacco Products. l. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21.years of age; 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The following employees) received and understood Section 371,-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 210 Section 61 of the Massachusetts General Laws: S ature Printed Name Date —�— A--- 01 11 Signature Pririt&PNarne Date igna6re Printed Name Date I I i` Signawre Printed Name Date 21WV1az-j.A tore Printed!-lame Date. MY Signaturte Printed Name Date t, 2/15 Signature Printed Name Date Q:1Application FormsU05ACCO APP2019 dob.docx I ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form. This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General. Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21:). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—§371-9..Sale and Distribution of Tobacco Products I. No person shall sell or provide a tobacco product, as defined'herein,.to a person.under The minimum-legal sales age. The minimum-legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling,or distributing:tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid-government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is.required for any person under the age of27. The following employee(s) received and understood Section 311-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 276 Section 6 of the Massachusetts General Laws: 60 of, tore Printed Name Date tae' Printed Name Date PI gre Panted Name Date ignature Printed Marne. Date Signature .rnnted.Name Date Signature Printed Name Date Signature Printed Name Date QilApplicadou FormATOBACCO APP2019 dob.docx `Op IHEr TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: Date: Page:_�ofOFFICE HOURS _ ° PUBLIC HEALTH DIVISION s:ao-ssoA.M. BARNSI-dL. ' 200 MAIN STREET s:so-a:ao P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS..639. �0� HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY �OrEo MPS° 508-862-4644 0,ov !�1 FOOD ESTABLISHMENT INSPECTION REPORT Name yl t Date Type of Inspect o � Routine Address Risk Food Sery -Re--inspection 1 2� V� Level Retail Previous Inspection I �� , Telephone Residential Kitchen Date: Mobile Pre-operation p Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: ✓ Other Inspector Out: 'CaEach 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) ❑ �L�-�i��l✓l Action as determined by the Board of Health. Allergen Awareness 590.009(G) I/ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities SS --? EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �TTV ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals u ` / , - FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods gaAA - 1 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures k �.`abfit l h ❑ 5.Receiving/Condition ❑ 17.Reheating 200c� ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling kj ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 1/t 6 ` /_ PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control j�c �w e � J910� ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �p ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ,j ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories C) (��l✓21 � 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ 9 y ❑ ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 la hot C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signa r Print: 31.Dumpsstter screened from public view I I k�& Permit Posted? 1/ Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign 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) jAssignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and terateReser ice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Ho[Water 7.206.12 Rodent Bait 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs -CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(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* sffe crl-iiiizooi 4-609-11 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 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) 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 StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern o and residential Sources 10 Proper,Adequate Handwashing g' PY 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. Other 590. 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* hould be debited under#29-Special violations relating to good retail practices 590.004(C) Wild Mushrooms* ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 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 * 3-501.14 B Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement ( ) g Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.HE rok TOWN OF.BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: 7 Of o OFFICE HOURS f PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:MON. FP.M.RI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. g MO �'�rFD MP�p 0 HYANNIS,MA 02601 � � � 50e-8 -sz-asaa .No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT - Name 77;7Date jUe of Inspection outine Address f (w f`� Risk ood Service e- ction Level Rea Previous Inspection e Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint q Person in Charge(PIC) Time Bed&Breakfast HACCP 3 11 In: �(y�� Other / Inspector Outa ' (�,[ 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) ❑ l 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) 2 ��l/��.n ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures l 7 C/ ZIP wp ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling - C- ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 01, 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 -F - d dn (�r_ ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories e- r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ' (/ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4 non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Si 'at a Print: . 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si at 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 Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) a�h FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* 7-102.11 Common Name-Working Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g L.2O_ 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 R uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) � Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Ef ctiw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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 (Blu* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* Critical 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 T Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. jPoisonous 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 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `gyp THE rqY TOWN OF BARNSTABLE _ HEALTH INSPECTOR,s Establishment Name: Date: Page: off •^y�+'. �(yj�'� PUBLIC HEALTH DIVISION OFFICE HOURS BARNSTABLE.O•` 2 0 MAN STREET - - 3: - :30A.M. :300-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,6,s9. `0� HYANNIS,MA 02601 MON.-FRI. No Reference .R-Red Item PLEASE PRINT CLEARLY 508-862 4644 °lE0 MPS FOOD ESTABLISHMENT INSPECTION REPORT , -f Name S n Date Type of TInspection c u 6 outine Address 1 e� p_).�, -/ Risk (Food Service Re-inspection c Level Rea Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness V Caterer General Complaint / Person in Charge(PIC) Time Bed&Breakfast HACCP. In: � Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. V 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 l t E- n 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives j W #b 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.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ,/ �j� 7�1 j r / ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding i 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 01061-, ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY E] 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 �p Non-critical(N)violations must be corrected immediately or Overall Rating J within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo Emergency Closure Voluntary Disposal checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g y ❑ ry P Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 (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. . f critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 t on critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. lA�`\ 30.Other DATE OF RE-INSPECTION: Inspect)r ignatur 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' " natur 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 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 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Dying 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* I 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Ef give 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 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 Held Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec* 5 Receiving/Condition ( ) ( ) 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 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 [5-203.11 0.004(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 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 204.I I Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 1 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE ro., TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page:. of "l OFFICE HOURS y ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. �• BARNSfABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item -Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3: �0� HYANNIS,MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY �1°rF0 MA'S° FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 Alt) Name Date Tyne of Tyge of Insil)ection g fine Address �� c�'_V�" Risk ood Servi Re- ection Level Retal Previous Inspection Telephone Residential Kitchen Date: ZL Mobile Pre-operation / Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP / In: ' Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. q Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ t Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ I- �a� (,fif �_y Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands p ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 7� C EMPLOYEE HEALTH PROTECTION FROM CHEMICALS " ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 3-( -(IQ ` 2-• ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) C� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding C(L�x� CLS 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 ° °w~ t/U �p�1�--✓ C`�\ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations _ tY t �- Gr-_ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Actio Re fired: ❑ No ❑ Yes 09 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 ❑ go Other: Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. Emergency Closure Voluntary Disposal ❑ 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 Orion-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 if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements 590.009 within 10 days of receipt of this order. violation,4 to 8 non-critic iolations=C. P q ( ) 30.Other DATE OF RE-INSPECTION: Inspector's Sign lure Print: 31.Dumpster screened from public view Permit Posted? f Y N Grease Trap Previous Pumping Date Grease Rendered Y N � #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted-. Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L4 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.* * 79 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 590.004(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 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* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rea or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) rered Removal of Exclusions and Restrictions Disposition of or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources r9 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* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ) P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait 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* 3-901.11(C) I Unopened Food Package Not Re-Served*.-/ 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * s ecriw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish 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 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requiremenpractices ts 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) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E 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 g 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 5-20411 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 - .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. �F IKE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: � t"lit-�° Date: 1;21( Page: I of wl OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTAHLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MO -FRI. ,6 9. HYANNIS,MA02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 9gp a0 FOOD ESTABLISHMENT INSPECTION REPORT Name S MM Date ,v1 a of Ins ec io O Address �'L� �� -� S Risk Food Serv' Re-insp ion vAA : AIM- Level <� U Retail Previous Inspection / Get` Telephone Residential Kitchen Date: t t Mobile Pre-operation Owner HACCP WIN Temporary 9ll_07 ZLSA - Caterer General Complai or Person in Charge(PIC) )SO� �'l(�y�,`t, Time Bed a Breakfast other 6 f �� In: �I Inspector y� SO-tD Out: rI t m( Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. w� / a�(Qq� 3 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ j�j1 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 1 CL C ✓►' � �f C EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ( lh c o, ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives A10-la-ve &,I ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 1 � LP �G�Q FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) �y�f- ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Ul ❑ 5.Receiving!Condition ❑ 17.Reheating . Li - ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/.Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY of ❑ 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 8t red items) +Z ' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 13 _ I . 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 6=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 ti anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-critical violations=C. " 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signat, Print: i` 31.Dumpster screened from public view j U 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^ f t1 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.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 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 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.I IA(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* Ef ctwe 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 fur Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A - D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) * Ratites-165°F IS sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 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 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70*F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F.KE r TOWN OF BARNSTABLE HEALTH INSPECTOR•s Establishment Name: Date: Page: I of .° ~\ OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ear+NsrAe�e. r 200 MAIN STREET 330-430 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, MONHYANNIS,MA 02601 -FRI. 08-8 508-862�644 No Reference R-Red Item PLEASE PRINT CLEARLY �p +ay9•p. 'FcrA� FOOD ESTABLISHMENT INSPECTION REPORT Name Date imne of TyprQ Inspection p outi / Address Risk Re-inspectionb Level Retail Previous Inspection v" f I Telephone Residential Kitchen Date: 1L/ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness (/ AVf ) Caterer General Complaint Person in Charge(PIC) �/A. /� b Time Bed&Breakfast HACO herCP ' t�L In: (b`t� Inspector V1 9wb OutR-o-tb ' 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) ❑ LLP OP C ��- Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands _v ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities /p �,h i �J�S� A n K�� ` J EMPLOYEE HEALTH PROTECTION FROM CHEMICALS f�lf iv t-Cry �'S ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures V ❑ 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 Is t- ❑8. paration/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP L , wZ,- ". /� h 1-] 10.Proper Adequate Handwashing CONSUMER ADVISORY 1 � 1-ivt h' ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories L LC j_� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations � 4�G[/( 6t �-• Critical(C)violations marked must be corrected immediately. (blue&red items) 3 I� , Corrective Action Required: o• Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically o la hot 27.Physical Facility FC-6(590.007 aggrieved b this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of Y Y ( ) ) 99 Y Y 9 9• q be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8non-Critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Sign t re Print: C\ 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N + Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) �. FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) 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 Hodh* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B). Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables _ * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 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(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR or 7-204.12 Chemicals for Washing 3-306.14(A)(B)Returned Food and Reservi of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg crave 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-20L15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen Game and Wild Mushrooms Approved By * ( )( ) operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-Prevention 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 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. F9E ro. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: ZA Page: Z of �o w� OFFICE HOURS P a PUBLIC HEALTH DIVISION 8:00_9:30A.M. &WNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ASS. �. HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY ��rEO MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date T ype of n e ion _� +/ � �v e 33k/74Routine Address Risk ood S e-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: - e Mobile Pre-operation _ Owner HACCP Y/N Temporary Suspect Illness ?,t;,Q t Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP O lj In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. TIT- 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) ❑ f" � Sr�� 4 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ /p,� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands , ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS S r J .. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives � i,��. ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 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 LS 19.Hot and Cold Holding t 'PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control j ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) l d ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) O Corrective Action Required: ❑ No F[] 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 C] Re-inspectionScheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 (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. . f critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatur Print: / 31.Dumpster screened from public view / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N llliii #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 6�jv j 01 Dumpster Screen? Y N CC//�� - r Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures Accordhig to 1 590.003(A) Assignment of Responsibility* F 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 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 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)Resumed Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 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 4-601.11 A Clean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* ) Equipment* Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective rancor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 2'2.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 590.009(A)-(D) Violations of Section temporary and -ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other es shoo violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11( )( )ro) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the 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* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .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 [3-502.11 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 0.004(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 IF -7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFy(NyE..I TOWN OF BARNSTABLE _ HEALTH INSPECTORS Establishment Name: I"lyV 1 Date: 42,4�2,[Page: of OFFICE HOURS ' � PUBLIC HEALTH DIVISION e:oa-s:soA.M. BARNSrABLE. - 200 MAIN STREET s:so-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �.� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rEo MP-° 508-862A644 FOOD ESTABLISHMENT INSPECTION REPORT Name '"(,� 1I Dat Tyne of T section O n s outiri -ems Address Risk Food Sery Re-inspection L Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness /r �, Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other q' Inspector Out: Li Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. r Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) 10( ❑ t� 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 6 W AL . ❑ 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) f ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18. poling ❑7.Conformance with Approved Procedures/HACCP Plans 9.Hot and Cold Holding a 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 (O r ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 1go P 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: Ll N ❑ 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 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. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4npn-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7)(590.008 9 violation,4 to 8npn-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 pPdnt: 31.Dumpster screened from public view i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature 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 Accordi?ig to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45`F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation 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 Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.]3 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. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ce-umoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* _ 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Sniffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from NSSP Listed + (A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requ'es should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 Matedals FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fomrback6-2doc *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. oFtNE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of °kq OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. HYANNIS,MA 02601 No Reference R-Red Item- ._ LEASE P INT CLEAR �A .639•pie � � � � 508-862-4644 'FON1P� FOOD kSTABLISHMENT INSP TI N REPORT Name Date ype o Insoection s �Irouti Address Risk Sery e-inspectii!, Level Re Previous I _ _4 I Telephone Residential Kitchen Date: Mobile Pre-o. .Owner HACCP Y/N Temporary Suspect IIIss Caterer General Complaint Person in Charge(PIC Time Bed&Breakfast HACCP Other Inspector At Each violation checked requires an explanat on on the nar ativ page(s)and a citation of specific provision(s)violated. Violations Related tc 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 iROTECTION 2.Prevention of Contamination from Hands et ❑ 1.PIC Assigned/Knowledgeable/Duties 3.Handwash Facilities EMPLOYEE HEALTH 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 Q ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP l ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY (�/l�/y_ �� / (Q i ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories (► ` Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations V 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,th ems ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If critical water,sewage back-up,infestation of rodents or insects,or lack of Seriously Critical Violation F is scored automatically if: no hot C=2 critical violations and less than 9non-critical. If no 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no Cal cal viol tions. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC77)(590.008) g ion,4 to 8 non-critical viol' ns 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins or's atu t: Ir31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i . #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y.. N Dumpster Screen? Y N U Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives.. Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 3-501.15 Cooling Methods for P4s 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 41 590.004(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 r 590.003(C) Responsibility of the Person-in-Charge to 7�102.11 Common Name-Working Containers* - * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage*Applicants* 3-302.11(A) Food Protection* P g 2_0_ _ 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 590.00411 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements - 590.003(G) Reporting by Person in Charge y Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ , --REQUIREMENTS.FOR- 3-306.14(A)(B)Resumed Food and Reated or ContamiofFoodnated . 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(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 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 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.l l(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By. 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms _ ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients` Supplied with Soap and hand Drying Devices 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* M 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. ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: !� + I Dateat Page: 4Q- Of3 kq OFFICE HOURS _ PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BA0.NSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified My39, �0� HYANNIS,MA 02601 - M-8 -46 No Reference -R-Red Item PLEASE PRINT CLEARLY .. j0rF0 Mpy n 508-862-4644 O TABLISHMENT INSPEIPTION REPORT Name Date1011 Type of Type of Inspection OReration(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection / Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness vor # - 01 , -( 1 P -_ I W Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other I Inspector Out: Each violation checked requires an xplanation 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) ❑ V V -(.Pi nm 7 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 19 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding - PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP v ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY_ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. is scored au 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F' tomatically if: no hot 27.Physical Facility 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 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 Ins 'or" Si tur Print: RATE OF RE-INSPECTION: 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 P 's Si ff Print:�/j�r Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 7/�1/�� J 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 PHis Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 - Person-in-Charge Duties - 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ 3-302.15 _ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590:003(G) Reporting by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR, 3-306.14(A)(B)Returned Food and 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 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* 4-501.11-1 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 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 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 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces ofP Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Purk and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 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 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 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical'violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .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 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. A/V/oFna ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: 7 Page: Of OFFICE HOURS AR'N"srAB,Eo PUBLIC 200 MAIN STREET 8:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30.P.M. MASS. 3. 508 a m� HYANNIS,MA 02601 M-8 -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY OESTABLISHMENT INSPCI rFD MPy - O N REPORT Name Date Type o Tvoe of Inspection Operation(s) Routine Address=2 Risk Food Service Re-inspection " TT Level Retail Previous Inspection t Telephone Residential Kitchen Date: Mobile Pre-operation _ Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP ,/ In: Other Inspector Out: Each violation checked requires a explan on the narrative page(s)and a citation of specific provision(s)violated. 1, 281 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) V I- 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) ❑ 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. (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 25.Equipment and Utensils )( ) 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=IF is scored automatically if: no hot 27.Physical Facility )( ) aggrieved y y 9 g q 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 y ty (FC-6 590.007 a rieved b 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 within 10 da s of recei t of this order. violation,4 to 8 on-critical violations C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspe is Prin Si re 31.Dumpster screened from public view ` Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si gnat a Print Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N �JJ 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* S Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachIdentifying * 590.004(F) 7-101.11 Identi in Information-Original Containers 2 590.003(C) - Responsibility of the Person-in-Charge to Other* g g 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* Applicants* 3-302.11(A) Food Protection* Separation-Storage*P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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)Resumed Food and Reserted of Food* 7-204.12- Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bai[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 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,Meals&Game Pathogens* Effective innooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-Ql.l l(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( )°�) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* 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* 3A03.11 C Commercially Processed RTE Food-140'F* Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated* ( ) g 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 Cohtamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand�Yin Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °F THE Tpk, TOWN OF BARNSTABLE. - HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION' 8:00-6:30A.M. BARNSTABLE. 3 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified y� mass. MO -FRI. HYANNIS,MA 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ,asq,".qe�' FOOD ESTABLISHMEN7 INSPECTION REPORT Name at Tvpe of -Type of Inspection O s Routine Address Risk/ Food Service Re-inspection Level Previous Inspection I IF Telephone Residential Kitchen Date: Mobile Pre-operation L Owner HACCP Y/N Temporary Caterer eneral Complain Person in Charge(PIC) Time Bed&Breakfast tv_ G In: Other Inspecto Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. c Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 44on4li lot 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) ❑ C-V- 1 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ey ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities _ w 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 I CA ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding d 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 HAP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Ilh ❑ 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) _ (�j� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or b �"I within 90 days as determined by the Board of Health. Overall Rating I A•"�I ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,theme 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. 6=One critical violation and less than Orion-critical violations re 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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t ti is scored automatically if: hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 to Snon-critical violations 29.Special Requirements (590.009) within 10 days of receipt of this order. =C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N t AA .01 #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 P 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 TemperaturekAccording to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 -PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from Each * 590.004(F) ( )O P 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 in the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition 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 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- sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immeme Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff aitiv 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) Poi and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3AOl.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 Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the 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* Ll8 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 Item Good Retail PracticesFC 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 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 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. IeM�..°.R' -'. ,..r,"" �.,.: "*.�,,:' .�..•_. _.'-'^�.-s..�,r a. TOWN OF BARNSTABLE Ordinance or Regulation BAR -W 6101 WARNING NOTICE Name of Offender/Manager ) 4. f{/ Address of Offender W;vxg_ 10,il. P1 MV/MB_ Reg. # Village/State/Zip C�.Y { l ! nI _311 zo J Business Name m; on Business Address 1 l � /I ' r( ✓� Signature of Enforcing Officer r Village/State/Zip Location of Offense 1 dul"e., Wli Enforcing Dept/Division 1 g�,Offense (,'. ��i /ifs 1�� t� —�" 1 ,��1. � � � YJ Facts t�i, Ths;will serve only as a warning. At this time no legal action has been taken.. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE OFFENDER CANARY ORD./REG. PROG. PINK-ENFORCING G)61- -ENFORCING DEPT. TOWN OF BARNSTABLE W .0�.Ordinance or Regulation BAR - WARNING NOTICE e Name of Offender/Manager %,7 ol/t,/ Address of Offender j, i. LA Ih/1 t d MV/M5 Reg. # Village/State/Zip l/;f n i I/� _ Business Name `-s"f/. �` .!f Y_ yam pm; on _ 20 /`�Business Address {/Li/ �, S.ignafiure of Enforcing Officer Village/State/Zip7 Location of Offense :If / [}/ �f ✓ /�I�f 1/ 1 Enforcing beet/Division Offense S1L �° �. Facts Thll serve only as a warning. At this time no legal actin has been taken. It is the goal of-Town agencies.to achieve voluntary-compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. / �- 6 WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING O�FE -. OL - ENFORCING DEPT. 1u y. pFSME- TOWN OF BARNSTABLE , HEALTH INSPECTORs Establishment Name: Date: Page: 1 of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:06-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. �prFD 39- HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY. FOOD ESTABLISHMENT INSP CTI N REPORT 01 Name _ Date �' yoe of e o section O e ou• Y/vL" L !s/ / Address Risk o rvice spection "`� Level Previous Inspection Telephone esidential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Allk 1 L Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other r Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 21 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 ,v0-1 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS V V V ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives iYS/1� 1 ❑ 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 {L ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling t �• `� ❑ 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)(� r ❑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 Violati VA�5 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El 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 . checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or.more.critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the 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 re if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if:;no hot 26.Water,Plumbing and Waste (FC-5)(590:006) establishment permit and cessation of food establishment operations. If 27.Physical Facility aggrieved b 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 y ty (FC-6)(590.007) agg Y Y g g• q violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special equirements (590.009)1 within 10 days of receipt of this order. violation,4 t 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature ature Print: 31.Dump ter screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) y. 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 Houih_* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) 7-102.11 Common Name-Working Containers Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3 30 L11 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`17 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* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef..-/11/1001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F'15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces ofP Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* F 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155' 15 sec* f - Shellfish* - 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chem Stuffing Containing Fish, ical* Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* Proper,Adequate Handwashing ing,mobile food,temporary and residential 10 Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* 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 2-001.11 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity*. g 3-003.11(C) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A). Cooling Cooked PHFs from 140'F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70`F to 41`F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Oth 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 1994 Food Code or 105 CMR 590.000. oFtKE TOWN OF BARNSTABLE, . .HEALTH wsPEcroR,s Establishment Name: Date: Page: .� of OFFICE'HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, MON.-FRI. ,2639- HYANNIS,MA 02601 508-862-4644 No Reference. R-.Red Item PLEASE PRINT CLEARLY 'FD1AP�� FOOD ESTABLISHMENT INSPECTION REPORT < . Name Date / Tapp-of of inspection I ra io s Routi Address Risk ce a-i ection Level et ' Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other' Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM,CHEMICALS U ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �'il `CJ,�r✓L/�,�1/G.iri� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ( -- ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP Nc ❑ 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 o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations g 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 h C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or I ck of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7,to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signat a Print: ] Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN / 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 Houat 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from .3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41 15 Poisonous or Toxic Substances 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 7-102.11 Common Name-Working Containers*2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F p g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* _ 7-201.11 Separation-Storage* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15- _ Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* - _ _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 1590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 _ Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean 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* e�cn,c uuzoo1 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* g 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 m cater- 3-201.15- Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( )-�) Ratites-165°F 15 sec* Proper,Adequate Handwashing ing,mobile food,temporary and residential Sources* 10 Game and W/Id 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* N590.004(E) scharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * eventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12vention of Contamination from Hands 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 eventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13ndwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* nveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S;590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00'-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY MASS. HYANNIS, MA 02601 �A .asv .0 508-862-4644 'F0N1P'' FOOD ESTABLISHMENT INSPECTION EPORT Name Date Tyne of sec 'on O w s outine Address Risk ion 1 C4,)J4 L 0, Level etail Previous Inspection Telephone esidential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an 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) ❑ t 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 44 , ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling L ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ` ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories G Violations Related to Good Retail Practices(Blue Itemsl Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating . within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction,Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: j 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8non-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N jV Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives' * Law Cooled to 41°F/45°F Within 4 Hours;,. 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold-Holding 2=103.T1 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[he-Person-in-Charge to - - - Other* 7-102.11 Common Name-Working Containers* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11) Variance Requirements 590.003(G) Reporting by Person in Charge*- 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 - Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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/TEMPERATURECONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe°"1e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310'CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11' Frequency r f ces of Equipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A Violations of Section 590.009 A in cater- 3-20L15 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail _ _ _ _ 3-401.11( )( )(b) 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 * (Blue Items 23-30) 3-202.15 Package Integrity C( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands g illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* -- 3-003.11(E) Remaining Unsliced Portions of Beef Roasts* 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 10 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 1 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. 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. `pU THE Tqy� TOWN OF BARNSTABLE HEALTH OFFICE HOURSR's Establishment Name: Date: Page: of AR Eon PUBLIC 0HEALTH NSTRETDIVISION 8:00-9:30A.M.P.3:30-4:30 M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.-FRI. HYANNIS, MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY �p ,a39•awe 508-862-4644 FOOD ESTABLISHMENT INSPE TION REPORT e:7j"q, Name D Tyne of Type of Inspection r ` Operafflo 4reo is Address Risk F d Se -inspect;Pr,Level e a evio tion Telephone Residential Kitchen Date: ; `'� Mobile Pre-operation Owner IV HACCP YIN Temporary Suspect Illness f(, n O v Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Y / Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ i Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities LC1/ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS s� ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals /' FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (,, t ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP�� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories � Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �� Critical(C)violations marked must be corrected immediately. (blue&red items) ❑1 Corrective Action Required: No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating 11 v I9 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 (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 l than 9 non-critical. If no critical water,sewage 27.Physical Facility 1 (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must ons and an non cr ga back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If•1 critical refrigeration. 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: I pector's ignature Print: 31.Dumpster screened from public view Pgtmit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y PIC's Sign pre Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N M C Dumpster Screen? Y N Violations related to foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT _ PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C). PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives - . Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to - Other* l,-__ * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At of 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 _ __ 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables. * Applicant To Report'1'o The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 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* eq cew 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 3-401.1l(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f ces of Equipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By Ratites-165°F 15 sec* 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* 17 Reheating for Hot Holding 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 practices should be debited under#29-Special ng 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 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-101.11 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 Tags/Records:s/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cool! of PHFs 6 g P 9 following sections of the Food Code and 105 CMR 590.000 k Identification* 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock ( ) g * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained 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 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. RentoU Proof Of Service Steritech Summary Ehrlich I Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 time in time out customer signature technician signature 09/14/2018 9:13am 09/14/2018 11:09am 9 1 't`$ 11_06 '-,0 AM Pill t.1.8 ) tit Jen with thanks,NICHOLE LOCURTO order number Status service date Description 048874331-000 Completed 09/14/2018 PEST CONTROL MAINT-C open recommendations device Recommendation responsibility Status Date breakroom closet Cracks or damage to wall allowing pest access.Please repair to Open 09/14/2018 prevent pest entry. n Comments Very large hole(about a foot wide)where refridgerant lines come from outside.Seal to prevent rodent entry. Y � device Recommendation responsibility Status Date Sales Floor Cracks or damage to wall allowing pest access.Please repair to Closed 09/13/2018 prevent pest entry. Comments Recommend repairing wall where water main comes into building behind front desk. completed(Previous Status:"PENDING'&Current Status:"Complete") Recommendation Reviewed all voids that were found were sealed by vertec today to prevent rodent entry device Recommendation responsibility Status Date Receiving Cracks or damage to wall allowing pest access.Please repair to Closed 09/13/2018 (beverage/bread prevent pest entry. side) Comments Mice caught on snaps in area near electrical panels raises a concern with in accessible areas.Voids in floor and walls need to be repaired.Boxed in conduit chase to the left of panels needs to be completely repaired of gaps. all cleaning completed(Previous Status:'PENDING'&Current Status:"Complete") Recommendation Reviewed holes in the walls have been permanantly sealed in the janitor cage. device Recommendation responsibility Status Date Bread An accumulation of food product from damaged goods noted. Closed 09/11/2018 Please remove food product to prevent attraction by pests. Comments Bread aisle still has crumbs all over shelves and droppings,looks like it is the same debris that was there at the last service. Cleaning and sanitizing daily in high activity areas will help with controlling rodent problem aisle has been clean and sanitized(Previous Status:'PENDING'&Current Status:"Complete") Recommendation Reviewed Aisle has been thoroughly cleaned,sanitized and voids were sealed. Aisle has been cleaned and sanitized thoroughly device Recommendation responsibility Status Date Receiving Door gap/damage noted that allows pest access.Please repair to Closed 09/06/2018 1/4 Rentokil Proof Of Service Steritech Summary Ehrlich i Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 (beverage/bread prevent pest entry. side) Comments door sweep on the bottom of receiving door does not meet the ground.Repair to prevent pest entry Recommendation Reviewed Recommendation Reviewed Recommendation Reviewed Door gap has been sealed to prevent rodent entry I device Recommendation responsibility Status Date Aisle 8 Pipes extending through wall allowing pest access.Please fill in Closed 08/23/2018 gaps between pipes and wall to prevent pest entry. Comments Pit under freezer units should be filled with stone to prevent rodent access. Service requested. Recommendation Reviewed Voids in this entire area have been completely sealed pest summary Device Pest activity quantity comment Ext.Rbs 004 Rodent Feeding 75%-100% Ext.Rbs 005 Rodent Feeding 75%-100% device summary device type with activity without activity unserviceable total inspected Rodent Bait Station 2 3 0 5 Worksite Inspection Point 0 2 0 2 Inspection Point 0 3 0 3 Materials used u Material Used epa Lot# Dilution% concentrate quantity unit method target !� Rodent/Insect na 0.0 25.00 each Spot Deer mice,House Glueboard mice device Bread equipment used Hand Material Used epa Lot# Dilution% concentrate quantity unit method target Maki Mini Blocks 7173-202 0.005 4.0 4.00 each Containerized Deer mice,House (28grms/block) Station mice,Norway rats device Ext.Rbs 004 equipment used Hand active ingredient Bromadiolone Material Used epa Lot# Dilution% concentrate quantity unit method target Maki Mini Blocks 7173-202 0.005 4.0 4.00 each Containerized Deer mice,House (28grms/block) Station mice,Norway rats device Ext.Rbs 005 equipment used Hand active ingredient Bromadiolone Material Used epa Lot# Dilution% concentrate quantity unit method target Stuff-It na 20.0 20.00 ft Crack and Deer mice,House Crevice mice, Norway rats device Exterior 2/4 f Rentokfl Proof Of Service Steritech Summary Ehrlich I Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 equipment used Foamer comment Sealed several voids around perimeter of the building to monitor rodent activity and determine which area are currently active. Material Used epa Lot# Dilution% concentrate quantity unit method target PT Alpine 499-568 1.0 2.0 2.00 oz Containerized Miscellaneous flies Pressurized Fly Bait Station device Fly Bait 001 (dumpster) equipment used Aerosol active ingredient Dinotefuran Material Used epa Lot# Dilution% concentrate quantity unit method target PT Alpine 499-568 1.0 2.0 2.00 oz Containerized Miscellaneous flies Pressurized Fly Bait Station device Fly Bait 002(dumpster) equipment used Aerosol active ingredient Dinotefuran general comments Today's scheduled service was performed with Ops Manager,Mario Costa.An inspection was done throughout entire store including exterior.Several voids were sealed on the exterior of the building to determine which areas are currently being used for rodent access.Set traps underneath the shelving through entire bread aisle after Vertec sealed off all pits underneath/behind coolers.Recommendation made to seal the very large hole in breakroom closet where refridgerant lines come in to prevent rodent entry.Serviced and rebaited exterior rodent bait stations as needed.Vertec has been here today sealing all areas that we have discovered and recommended to be sealed. Please call with any concerns between now and your next visit.Thank you for your business. 3/4 f Rentokfl Proof Of Service it Steritech Detailed ed Inspection Results Ehrlich ; Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONSLLC ALBERTSONSLLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 inspection results site Star Market West Main St,Exterior,Exterior Device Time pest quantity comment Ext.Rbs 001 10:46am no activity found Ext.Rbs 002 10:47am no activity found Ext.Rbs 004 10:16am Rodent Feeding 75%-100% Ext.Rbs 005 10:18am Rodent Feeding 75%-100% Ext.Rbs 006 10:45am no activity found Exterior 10:28am no activity found Fly Bait 001 (dumpster) 10:42am no activity found Fly Bait 002(dumpster) 10:43am no activity found site Star Market West Main St,Interior,Bread Ailse Device Time pest quantity comment Bread 10:30am no activity found site Star Market West Main St,Interior,breakroom Device Time pest quantity comment breakroom closet 10:38am no activity found 4/4 I l I • t 1 4 " s� t; B 7-t I _ ��'��r", . �-- ,, -.may: -. •� •t�y�-.,,� . - r '� . 3 t ♦.�"" „•.`�'VY.� : _. •rt `, �°k; x 'f��„/7 raE,y�.,I r�.�"yr,1�r8+•f,. � 1 t ,a�,�'ti�)+' � "•`':�.�K ' .` i'y'L1T�' . 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"" ��r r, s �•"s` ?�y�` �,'� ,�j,��'+ �l' lg +yy'r+.af �6 r '1 Y`� t f` y <s�4y��+5 '�!'�• �"^.�aa�'' t' • �y,+' a� .: _ / "a*•""�`11 ^ �'- a.-�`rt,st�wY s '�^ �"�` �' 'Va'��" iili � � .}-`�•`` t•*�fr I r f r s i` x. '��'- ram,;., y� s �•.:�' w :�' y e r s )" • s3 � .� '''��! :� =-tea-� •:x'�;.L,,,. -'`a.`. y t , r �p 114E r TOWN OF BARNSTABLE _. HEALTH INSPECTOR,s Establishment Name: Date: Page:_ of OFFICE HOURS B ARNSfABLE.O'• 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 p ,639,a m HYANNIS,MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY - - lFG MAC 506-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT rill 8 ,0 Name A [ Dat � ` e o TInspection l e en Y')A- AddrerAS6 4,,ZZ Risk e �e-inspection Level e a Previous Inspection Telephone esidential Kitchen Date: - Mobile Pre-operation Owner HACCP Y/N Temporary �-- _ 1L -6> L Caterer General Com int Person in Charge(PIC) Time Bed&Breakfast L y In: Other , J Inspector Out: ` Each violation Checked requires an explanation on the narrative page(s)and a citation of specific provisions)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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 L ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �t ` ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating L ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control A&tf 110 � ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSPl/tk ' El10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) I Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal . ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations l than 9 non-critical. If critical wa g back-up,sewage 27.Physical Facility (FC-6)(590.007)r aggrieved by this order,you have a right to a hearing. Your request must ons and an non-cr no cr p,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to anon-critical violations=C. w 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si ature Print: Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted .Y N Dumpster Screen? Y N I\---��lll l �./' 1 lllJJJ��\ 1 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 Hour* 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%J?/45°F 590. EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-'Original Containers* 004(F) - * . . - - - 2- 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - - - Applicants* 3-302.11(A) Food Protection* - 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An _ 3-3 7-202.11-- Restriction-Presence and Use*02.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 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* ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 'Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3=201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(l)(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* E-ft°rtw uuzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - D in cater- . 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved B 3�01.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )�) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 1129-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 Tune* 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 3403.11E Remaining * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated ( ) g Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF114FIA TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page: of W PUBLIC OFFICE HOURS : B_WL : PuB2 0 MAIN STREET 3:30-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �p a39:p eg HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFD MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date �e of Type of Inspection Operation(s) Routine L V"- Address ' Risk Food Service Re-inspection Level Retail. Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation L w� Owner HACCP Y/N Temporary Sus Caterer ,General Com n Person in Charge(PIC) Time Bed&Breakfast In: Other Ae Inspector Out: `� C Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. f Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ lox Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r S FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ( c EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l,J ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) f ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot,and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP Yl ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP-,' I ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue 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 Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal El Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4npn-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to"6 non:critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements. (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view /�n Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N (/ v #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S" lure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N N Dumpster Screen? Y Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Houft* 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 Holding Cooked and RTE Foods.* Additives* 19, PHF Hot and Cold Holding , 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 Other*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 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P20 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 1 I Variance Requirements 3-304,11 Food Contact with Equipment and Utensils * (--) 9 590.003(G) Reporting by Person in Charge*_ _ _ _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3.306.14(A)(B)Returned Food and terateReser ice of Foam* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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 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 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* Eff.ai-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 I) m 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 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )(b) 3-201.17 Game 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�03.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper TemperatmeO 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 12. Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 8 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 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.148) 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 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 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. Rentokil Proof Of Service ; Steritech Detailed Inspection Results Ehrlich ( Presto-X(Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 inspection results pS'heRUN Star Market West Main St,Interior,Bakery fD®VIcB '.� •vaa�^ s�azstec«.zz,ett '» r ,€zstyr t > 2 x ek �,z 4i . lime pest_ t ,::.,, quantity+. comtrient,.., s .. ��s Mrt 013(bakery) 9:41am no activity found :-:: r,�r .,o x ::. v« ate• ��,¢,z n� Star Market West Main St,Interior,Bread Ailse _ d.DBVICe ;' µ.me.- ----.- +^g;.3 i, ,9'* '<° Time ,.- P.. t " ,.<, fir ,. . ��F ✓, � Mg40' ity commerrt Bread 9:19am no activity found Star Market West Main St,Interior,Meat!Room i•_DeVICB� �` -- y «.,:.-r�`�', u.v." .- - , '',_'-_- .„ ' ".y, "° s �.�«c , �z iTmeuantih+ coat rent. Mrt 006(meat room) 9:36am no activity found Mrt 008(meat room) 9:35am no activity found Star Market West Main St,Interior,Produce DBVtCe;.•��r.� .,�<- ;r, «,��*'�,�::.. '. * '" �" ,.f, fe;;...i. ire .:.:�, ase�z.�, ,»a,� «�.., $TI n@.,. .. pest ,A„` ..,, S :«r«.::: �.'x", i r "pqu ntlt�' Mrt 004(produce) 9:37am no activity found Star Market West Main St,Interior,Receiving �}'- - "� �..,».r..+».;�_� a. cam, �w��Y� #"�f'"R `e3C•N-�' �DBVIC@ ';<e raSSg� r« ��..;, v��,u may. a 'van' .�cA c�� z.�c.e<a,««x . J k, �:•:. Pest r ,, 9uantity Mrt 001 (rec) 9:39am no activity found Mrt 002(rec) 9:39am no activity found ; Mrt 003(rec) 9:38am no activity found Mrt 010(rec) 9:27am no activity found Mrt 011 (rec) 9:23am no activity found Mrt 012(rec) 9:23am no activity found Receiving(beverage/bread side) 9:32am House mice 2 3/3 s� .«, Rentokil Proof Of Service Steritech Summary Ehrlich( Presto-X j Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420- technicit si ftatute � 09/11/2018 8:56am 09/11/2018 9:13am 09/11/2018 9:13am 09/11/2018 9:49am NA with thanks,NICHOLE LOCURTO �,atdernumbe sue.: :Status , service dat8 ,©escri Lion 048874325-000 Completed 09/11/2018 PEST CONTROL MAINT-C open recommendations de ice " Recommendation ._..., responsibiiify..,. •Status., ,, Date Bread An accumulation of food product from damaged goods noted. Open 09/11/2018 Please remove food product to prevent attraction by pests. Comments Bread aisle still has crumbs all over shelves and droppings,looks like it is the same debris that was there at the last service. Cleaning and sanitizing daily in high activity areas will help with controlling rodent problem des, RecQmmendatie5n '"` - _ respousibiHty.. .5'tatLtS."'' -_ Oates Receiving Door gap/damage noted that allows pest access.Please repair to Open 09/06/2018 (beverage/bread prevent pest entry. side) Comments door sweep on the bottom of receiving door does not meet the ground.Repair to prevent pest entry Recommendation Reviewed devices .�,,�� Recommendatton, � ,�j s, ,; �� :•.,,Oats. i bread aisle An accumulation of non-food product from damaged goods noted. Open 08/23/2018 Please remove product to prevent attraction by pests. Comments At both ends of bread aisle on opposite side of bread,the comer behind orange juice coolers is littered with debris which is potential harborage for rodents.There is also a concern that the drain pipe coming from roof and then penetrates the concrete floor is an area that will need to be repaired with concrete to prevent pest entry.This is also a concern at the corner in the front end of the store behind butter cooler&organic frozen goods freezer.This corner also needs to be cleaned and penetrations through wall and floor repaired to prevent pest harborage and entry. Recommendation Reviewed I Damaged product and debris removed from shelves.Dripping pipes in process of being repaired. % Recommendation Reviewed / §'nl" Ky ink .'Y�' , '. �P..+TJ 'i. :• rs,�, ", �W°�,w..�sL'k.F �, .. device `; .,.,, _'", ,Recotrimenclation d „�•• . ; , ,,,,.,��; ,�,.,,.� res, nsibii' .,,,._Status -Q�hs % bread aisle An accumulation of food product from damaged goods noted. Open 08/23/2018 Please remove food product to prevent attraction by pests. Comments . Inspected bread racks for activity from previous nights service.No evidence found in bays that we cleaned,sanitized and trapped last night.Highly recommend bread from all racks from"Panera"brand bread to pastries be,vacuumed of droppings ' and damaged goods not only and top of all shelves but also under bottom shelf and clean and sanitize with a sanitizer to remove the strong scent of rodent urine along this aisle.This recommendation is needed for us to determine the scope of activity moving forward in this area.This also helps us to determine if our control efforts are working.Thank you. Recommendation Reviewed We are sanitizing the entire aisle section by section. Recommendation Reviewed 1/3 e RentokilProof Of Service Summary Steritech Ehrlich { Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 -r�-�w». �.^ n .z ' 6.•Date',M device.:;, Recommendat�onu v<< ,+' , :, ..nresponstbifty Aisle 8 Pipes extending through wall allowing pest access.Please fill in Open 08/23/2018 gaps between pipes and wall to prevent pest entry. �1 ` V Comments Pit under freezer units should be filled with stone to prevent rodent access. " Service requested u a }� Recommen.dation ,. a �,. r@gponsrliiJo .:;Status. Dates a Receiving Water leak/standing water inside.Please remove water and repair Open 07/23/2018 (beverage/bread leak to prevent unsanitary conditions and attraction by pests. side) cc� Comments Pipes running above bread and into walls are leaking accumulating excessive amounts of water on products and Floors VN, 2 recommend repairing pipe issues provides a water source for pest. pipe running above dock and products are directly leaking on products and floor accumulating water creating a water source recommend repairing piping Recommendation Reviewed Recommendation Reviewed Recommendation Reviewed Repairs requested. Recommendation Reviewed L` Recommendation Reviewed pest summary Receiving House mice 2 (beverage/bread side) device summary Sdevic®type n r .. . .yam ,with act+city" ry ..... wiifiout acfiv{ty2unservtceabte,.,_W._.. totatinspecteti� Worksite Inspection Point 1 1 0 2 Mechanical Rodent Trap 0 10 0 10 Materials used ` tiMateHafUsed >" ,epa: Lot# ,sue Dilution°h , concenttata,. puantlty unit ,, me +od •,:" target,, ..,,.., ,: Snaptrap na 0.0 4.00 each Spot Deer mice,House - mice device Receiving(beverage/bread side) equipment used Hand general comments During today's scheduled service I checked in with Jen,two mice were removed from snap traps in bread/drink receiving area.Added more traps.All fresh departments and receiving areas as well as sales floor.Bread aisle has several areas with crumbs and droppings.This area should be cleaned more frequently until rodent issue is under control. Please call with any concerns between now and your next visit.Thank you for your business. 2/3 �p 114E r HEALTH INSPECTOR's Establishment Name: Date: TOWN OF BARN.STABLE Page: of ' OFFICE HOURS AR„�rAB,Eo PUBLIC 2 0 MAIN ALTH DIVISION 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 6 q:s�0 HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY - rFo MAC 508-862 4644 FOOD ES ABLISHMENT INSPECTION REPORT Name D yRe of Tyne of Inspection One '�95 Routine i Address Ris pod Servi Re-inspection Lev a aI Previous Inspection 44 Telephone Residential Kitchen Date: (ti Mobile Pre-operation Owner HACCP Y/N Temporary Sus lit 'E�t� Caterer eneral Complaint Person in Charge(PIC) Time Bed&Breakfast In: Other Inspector Out: ,^ Each violation checked requires an explanation on th arrative page(s)and a citation of specific provision(s)violated. �" 1 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) ❑ 1r1vOI �� /bs FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands l ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Fo ds) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling r( ❑ 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 POPU TIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HS� ❑ 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 &11V _� Critical(C)violations marked must be corrected immediately. (blue&red items) orrective Action Required: ❑ El Yes Non-critical(N)violations must be corrected immediately or Overall Rating I I C� within 90 days as determined by the Board of Health. [ ❑ Voluntary Compliance ❑ Emplo striction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4.non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a.right to a hearing. Your request must violations observed,7 to 8 non-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address tical violations. If 1 critical refrigeration. . within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector'sV!r 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 Sign PrinA(, Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y IN 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 m Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hat and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers*- Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An __ 3-302.15 _ - Washing Fruits and Vegetables 7-202A,1-• Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 -Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q " - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ,, REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - '' Food and Water From Regulated Sources- g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water- 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Continer* 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*. gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff-"9e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Stan M Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ _J Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-70211- - Frequency of Sanitization of Utensils and Food 3 401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish-* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan_Shell_fish from NSSP Listed _ Chemical* Ratites-165°F IS sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202:18 Shellstock Identifrcation 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 6 All Other PHFs-145`F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms _ ( )( )( ) *_ - - - 11� - Good Hygienic Practices � 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals 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 * 3-3b1.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 TagsiRecords:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities ( ) g 3-202.18 Shellstock Identification 3-501.14 A Conlin Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3402.12 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* 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. Rentokil Proof Of Service Summary Steritech Ehrlich ( Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 me i» .uti,.,dine outs customersi natuire= %% �,,:,�., ��.,.• technician 08/16/2018 6:56am 08/16/2018 8:01am - Alex with thanks,DOUGLAS STEEN dice»ses'certifcatio . :: rr A. � d 00-44647 ard,Tr ,number., . <..Status _ �,� sen►ice date°°�"Y"`�Descrrptton ; �� s 3 048527132-000 Completed 08/16/2018 PEST CONTROL MAINT-C open recommendations T-devIce:. „ .: R_k ecommendattion Exterior Debris collecting exterior.Please remove debris to prevent Open 08/16/2018 unsanitary conditions and attraction by pests. Comments highly recommend cleaning under garage shoot and compressor as well as loading dock were organic food barrels stored excessive debris accumulated Recom`m ndatrort�` `' ", _ respdnsibi�i', E £ Status Dae`, g deuce Exterior Pipes extending through wall allowing pest access.Please fill in Open 08/16/2018 gaps between pipes and wall to prevent pest entry. Comments outside bread door man hole cover knocked a foot over water accumulating recommend recovering. tle x uce R T--` ;;, R®commentlaton .., ... a.. r .. .,nsitiilit Sta1 ua ... .:�Qate Receiving Area An accumulation of food product from damaged goods noted. Open 08/14/2018 Please remove food product to prevent attraction by pests. Comments near compactor food debris and other accumulation on floors as well as box crushing area debris and organic build up on floors and under shelving recommend removing device=' ,' 7:Recom em ndatio» res° ns�tiil � 5tatus g �� , �Date- _, ...< Receiving Area Water leak/standing water inside.Please remove water and repair Open 08/14/2018 leak to prevent unsanitary conditions and attraction by pests. Comments Ice machine leaking as well as organic debris building up in drains and sink area recommend repairinf and cleaning area as well as dumping mop buckets that are sitting full pipes still leaking accumulating water highly recommend repairing plumbing creates water source for pest -,�—....,-� --- -,..a.,,��-�-- ,• r �=. r � tea,.. , � a� Receiving Cracks or damage to wall allowing pest access.Please repair to Open 07/23/2018 (beverage/bread prevent pest entry. side) Comments pipe access ways running all of receiving holes in walls pipes running into concrete wide open recommend excluding pipe access ways running through back area making runways for pest recommend removing. 1/3 Page 16 of 21 Shaw's Stores DMB Department: Personnel Coordinator Title Management Career Opportunities Summary Attached to today's DMB are the current Management Career Opportunities. Action: Replace the posting dated 8/14. Action or Action Information https://rxsafeway.sharepoint.com/sites/ABSComPortal/Shaws/Shared%20Documents/DM... 8/16/2018 '` r Rentokil Proof Of Service Steritech Summary Ehrlich C Presto-X I Western The Experts in Pest Control BOSTON PEST 30 POND PARK RD MA 02043-4340 99 800 649-7228 0000 781 331-8321 �.. r nsiti � � Status �, » '�f�Dat®�h.. �Y _ . _ _ ��..... ,�;, Receiving Debris collecting interior.Please remove debris to prevent Open 07/23/2018 (beverage/bread unsanitary conditions and attraction by pests. side) Comments Productts stored on floors against walls allowing harborage and limiting inspection area recommend storing of floors away from walls and removing excessive trash debris products stored on floors in accumulated water under shelving debris build up provides food and harboage recommend a deep cleaning and storing items off floors. �. davrce Rec mo mettdatton Receiving Water leak/standing water inside.Please remove water and repair Open 07/23/2018 (beverage/bread leak to prevent unsanitary conditions and attraction by pests. side) Comments Pipes running above bread and into walls are leaking accumulating excessive amounts of water on products and floors recommend repairing pipe issues provides a water source for pest. pipe running above dock and products are directly leaking on products and floor accumulating water creating a water source recommend repairing piping device summary rd016e,type s 4 with activiiY w..wltt�out,activ3t�r unserv#c ae b,e� total inspected;. Worksite Inspection Point 0 3 0 3 Mechanical Rodent Trap 0 1 0 1 Insect Light Trap 0 2 0 2 Rodent Bait Station 0 4 0 4 Materials used no preparations used during this service general comments During todays service inspected exterior removed two rats near dumpster.Review recommendations made this service located two burrows across from dock dusted.Inspected all ILTs and barcoded in.Excluded seven holes on exterior of building and inspected all exterior devices noting activity. Thank you 2/3 r Rentokil Proof Of Service Steritech Detailed Inspection Results Ehrlich ( Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043.4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 inspection results fSlt@ Star Market West Main St Exterior Exterior t �� r xe Time .St m. os ... ..: Uam p�. ,,.� e , A._ Ext.Rbs 001 7:25am no activity found Ext.Rbs 002 7:17am no activity found Ext.Rbs 003 7:16am no activity found Ext.Rbs 006 7:07am no activity found Exterior 7:40am no activity found ......,-.. . .-.......,„, @ r Star Market West Main St Interior Bakery NSF „lfiT(18 g -^ Q _.. p@St 'XiY - Bakery 7:52am no activity found ILT 004(bakery) 7:53am no activity found Star Market West Main St Interior Deli ly QU8iitltlfCOTnIT1@n kF a r ,db;Gsr,..3e,.z v&F a ILT 003(deli) 7:54am no activity found �SItB .'ems„ h:a�a^✓e,., ,gin ` ,.��a,,�.�,m Star Market West Main St Interior Receiving Mrt 010(rec) 7:39am no activity found Receiving Area 7:48am no activity found 3/3 °FTHE r TOWN OF BARNSTABLE HEALTH INSPECTOR e /V/Page:S Establishment Name: Dat 1 of °kq OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS q MON.-FRI. - t639, `00 HYANNIS,MA b2601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY. A �FOMP'�a FOOD ESTABLISHMENT INSP CTION REPORT cc14 Name Dat vl2e of Type of Inspection O e on s i:�pection Address ` Risk F Level Telephone keswi4tial Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspe lase Caterer era[Complaint Person in Charge(PIC) Time Bed&Breakfast In: Other Inspector Out: I t Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS e ❑ 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 l ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t\ Critical(C)violations marked must be corrected immediately. (blue&red items) �J Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Ratingt--�- 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ g Y ❑ ry p ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(596.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations _ 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=EL 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of no hot 27.Physical Facility .(FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or l 28.Poisonous or Toxic Materials (FC-7)(590.o08) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) PY Within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ,�VW/ I Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: n ' 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 h 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 td" 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives. - Law Cooled to 41°F/45°F Within 4 Hours* - 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection'from Unapproved Additives* 19 - PHF Hot and Cold Holding Contamination from Raw Ingredients F15 Poisonous or Toiilc 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* 7-201.11 S Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* - eparation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* ; Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* ��;rements ' 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590004(1 7) Variancr.Rr 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 Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* t 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A) �)Stuffing Containing Fish,Meat,Poultry or Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* I Sources* 1 p 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. $ 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 I Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* I upplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria*- 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 3 Rentokil Proof Of Service Steritech Summary Ehrlich I Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 - client 016058448/691 service location 016058448/691 ALBERTSONSLLC ALBERTSONSLLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 W. ' �` �clinician 08/17/201811:40am 08/17/201812:41pm Jen with thanks,DOUGLAS STEEN 00-44647 048527136-000 Completed 08/17/2018 PEST CONTROL MAINT-C open recommendations =dev,�ce:�e �„ �, Recornmendafior!,�„ � ,?� ,� ,.< ,�,,��" '� •fie&,,,nsibil[ty�� aStatus' ..=Date'; Trash Shoot An accumulation of food product from damaged goods noted. Open 08/17/2018 Please remove food product to prevent attraction by pests. Comments barrels of produce left in front of trash undcovered condusive for pest activity recommend removing asap. dewce . � Recommendation �� • ', �� esponsrtbfity••• Status`, ,.,�.��?Dat ,,,h,,,,,...� Bread An accumulation of food product from damaged goods noted. Open 08/17/2018 Please remove food product-to prevent attraction by pests. Comments food debris accumulated on shelving and end caps recommend cleaning and removing debris asap__ �ZAA_� device` Recommeridatron responsrbi4ity Status Ddtg Exterior Debris collecting exterior.Please remove debris to prevent Open 08/16/2018 unsanitary conditions and attraction by pests. Comments highly recommend cleaning under garage shoot and compressor as well as loading dock were organic food barrels stored excessive debris accumulated Recommendation Reviewed �devrce� � .' +Recommendatron.: '��9�� 3�.`�. ,..� ,5 . � ,� ,respons�btfiify .,�.•.;>:Statud�s; Exterior Pipes extending through wall allowing pest access.Please fill in Open 08/16/2018 gaps between pipes and wall to prevent pest entry. "iA p Comments outside bread door man hole cover knocked a foot over water accumulating recommend recovering. V Recommendation Reviewed devfc® �gR,ecommeridatron� ,'.., res' nsibiE Status ., _ a........ .. „� � _BQ Receiving Area An accumulation of food product from damaged goods noted. Open 08/14/2018 Please remove food product to prevent attraction by pests. Comments near compactor food debris and other accumulation on floors as well as box crushing area debris and organic build up on floors and under shelving recommend removing food debris and trash build up provides food source and harborage for pest remove asap 1/3 Rentoklel Proof Of Service SteritechSummary Ehrlich ( Presto-X[Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 advice''„ =Recommertdatron Receiving Area Water leak/standing water inside.Please remove water and repair Open 08/14/2018 leak to prevent unsanitary conditions and attraction by pests. Comments Ice machine leaking as well as organic debris building up in drains and sink area recommend repairinf and cleaning area as well as dumping mop buckets that are sitting full pipes still leaking accumulating water highly recommend repairing plumbing creates water source for pest 11 Recommendation Reviewed device .;, .;..Recommendation ..."" € .: „�responslbllity Status Date Receiving Cracks or damage to wall allowing pest access.Please repair to Open 07/23/2018 (beverage/bread prevent pest entry. side) Comments pipe access ways running all of receiving holes in walls pipes running into concrete wide open recommend excluding pipe access ways running through back area making runways for pest recommend removing. Recommendation Reviewed 1.,, r»ic deve•,, Receiving Debris collecting interior.Please remove debris to prevent Open 07/23/2018 (beverage/bread unsanitary conditions and attraction by pests. side) Comments Productts stored on floors against walls allowing harborage and limiting inspection area recommend storing of floors away from walls and removing excessive trash debris products stored on floors in accumulated water under shelving debris build up provides food and harboage recommend a deep cleaning and storing items off floors. Recommendation Reviewed �devrce ' �£ Recommendation ,��K,�,�� ,�� r«.. responslbii�fymStatus� �� $��`�,��flate' -e•y� �� Receiving Water leak/standing water inside.Please remove water and repair Open 07/23/2018 (beverage/bread leak to prevent unsanitary conditions and attraction by pests. side) Comments Pipes running above bread and into walls are leaking accumulating excessive amounts of water on products and floors L recommend repairing pipe issues provides a water source for pest. pipe running above dock and products are directly leaking on products and floor accumulating water creating a ger source �. recommend repairing piping Recommendation Reviewed ` Al 4- � device summary ..c,, y a ;- +� _:ter •� " devfce type with activity .;... vnthout ac#u�tV ,• risen able, petted s., Worksite Inspection Point 0 6 0U 6 Mechanical Rodent Trap 0 2 0 2 Rodent Bait Station 0 4 0 4 Materials used no preparations used during this service general comments During todays service continuted excluding exterior holes and gaps.Receiving doors three sets need new door sweep to exclude activity.Recommend cleaning dock to see areas of exclusion.Inspected all exterior devices rebaited number four.Review recommendations made this service.Thank you 2/3 Rentokil Proof Of Service Detailed Inspection Results Steritech Ehrlich I Presto-X I Western The Experts in Pest Control BOSTON PEST,30 POND PARK RD,MA,02043-4340 99,(800)649-7228 0000,(781)331-8321 client 016058448/691 service location 016058448/691 ALBERTSONS LLC ALBERTSONS LLC 33-7-4595 625 W MAIN ST (508)775-3421 EXT.0000 -1-STORE HYANNIS,MA 02601-3420 inspection results 451t@ r 'rya ar n ? Star Market West Main St,Exterior,Exterior fTime ,pests�. .s g5„ quantit3+,comm nt .. ., Ext.Rbs 002 12:12pm no activity found Ext.Rbs 003 12:16pm no activity found Ext.Rbs 004 12:15pm no activity found Ext.Rbs 006 12:14pm no activity found Exterior 12:18pm no activity found site «- R 777 r r n W� x D q �� m x a>; Star Market West Main St,Interior,Bakery pow HTime pestW tquantity comma. y`' .. „ Bakery 12:33pm no activity found Mrt 013(bakery) 12:32pm no activity found sit@ „ r�� ,�.,; ,��r,; , �� •.., , . Star Market West Main St,Interior,Bread Ailse Device a I Tiro@ r r pest a uant comment Bread 12:31 pm no activity found site �; ,. ,,.> ,e .m�rr ,-,.. ,`.,.�, �� e.zrri � .,,. �-',..��.�.r�: ,�htr ��s�:�F,�;�• .��:,!:'s?' e. � a, Star Market West Main St Interior Receiving 4D@VIc@ :'v x »�a� � Y »�r � w n - �<�� •` a t.rv°f s rTime P®st�,.�:.._ .. quantity�comm@r►t 3 � Mrt 010(rec) 12:30pm no activity found Receiving(beverage/bread side) 12:33pm no activity found Receiving Area 12:30pm no activity found Trash Shoot 12:34pm no activity found 3/3 THE TOWN OF BARNSTABLE. HEALTH INSPECTORS Establishment Name: Date: ,,Lw Page:. lff/ Of off, wiy OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. + BANNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p MASS 0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFD MPS 508-862.4644 FOOD ESTABLISHMENT INSPECTION REPORT 6 5 Name Date Type f Type of Insoection OaeratloAW Routine Address L�l,� Risk 0 ervic Re-inspection Level etal Previous Inspection -71 Telephone esi en Ial Kitchen Date: d Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Caterer neral Com Person in Charge(PIC) Time Bed&Breakfast HACC In: Other Inspector Out: .57j5; / Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned(Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control - ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPU TI S(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 TO 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 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to S non critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature A 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 I PI 's na re Print: Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N /�/" Y �"" 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) jDe-. ssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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) * 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 Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(l l) 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 Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603,11 Consumer Advisory Posted for Consumption of 4-601.11 A) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff crt°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* F2-401.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * When to Wash* 3-0Ol.11 A 1 b All Other PHFs;-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items n3-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and riskfactors listed above,can befound in the 8 Tags/Records:Shellstock Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-501.14(B) Cooling Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* * 5-205.11 Accessibility,Operation and Maintenance TemperatureLure Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 16301.11 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:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp THE r _ TOWN OF BARNSTABLE HEALTH,INSPECTOR'S Establishment Name: Date: 7.Z:) Page: �of a` OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. % BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p MASS..a m MON HYANNIS,MA 02601 8-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFD MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT. Name Datej, of Type of Ins ection v� Operation(s) Rout' .a2 Address Ris Food ervice a-ins ectio Level eta' revious nspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect 1.11nes Caterer eral Complaint, Person in Charge(PIC) Time Bed&Breakfast ACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 y )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements. (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S n tur P'nt: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N , Dumpster Screen? Y N I V l 7 Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g * 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing FruitsUse 7-202.11 Restriction-Presence and its and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff ctiw tarzom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 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 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals* Requirements. 5 i* 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 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsticed Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 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 ki- * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70*F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shells[ock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F , Tags/Records:Fish Products P5-205.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PIlFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 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. °FINE 1'. TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page:. of �q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN57'ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red.ltem PLEASE PRINT CLEARLY�Fp MPS a 508-862�4644 - ' FOOD ESTABLISHMENT INSPECTION REPORT Name _jT� ty�A� � Date 1.411,iv a of Type of Inspection t p Routine Address __ Risk oo Service Re-inspection 44 Level Previous Inspection Telephone tial Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Su Caterer eneral Complaint Person in Charge(PIC) Time Bed&Breakfast In: Other _ Inspector Out: ZIP y� f✓ 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) ❑ f , FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands q ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP..Plans/ ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPUL.ATIONS(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 within 90 days as determined by the Board of Health. Overall Rating GE ❑ Voluntary Compliance Com ❑ 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 6=One critical violation and less than 4non-critical violations. 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations._ If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ' Signatu e Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN }i ,V Dumpster Screen? Y N `/ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-..Original Containers* 590.004(F) * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with 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 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 1 Monitoring* 3-801.11(C) IUnopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-411.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.1](A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145F 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* e//crive ziuzooi 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 Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3A01.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 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* C Commercially Processed RTE Food 140°F* (Blue Items 23-30) 3-202.15 Package Integrity* 3-403.11( ) 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* (E) 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 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers an P d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .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. °F IME Tpk, TOWN OF BARNSTABLE, HEALTH INSPECTOR•s Establishment Name: Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 3:30-4:30 P.M. BARNSTABLE. 200 MAIN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified • �p 639.a mp HYANNIS,MA 02601 • M-8 -46 No Reference R-Red Item PLEASE PRINT CLEARLY tFD MPS 508-862-4644 FOOD ESTABLISHMENT INSP CTION EPORT Name Dat Tvoe of Type of Inspection O e s Routine Address Risk e-inspection Level Ret ' re spection ' Telephone Residential Kitchen Date: t Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP L ( ✓j In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. _ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Ll FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. blue&red items ( ) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure El 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 6=One critical violation and less than Orion-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to Snon-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's S15 Mt i Print: 31.Dumpster screened from public view v 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 Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N re {n �O I . Dumpster Screen? Y N ` @, 6- 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 C TAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contami a'ow, 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 fro 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* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environmen 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables•,� * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipme't and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rese ice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulter `ed 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 Reconditi 'ng 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 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* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff-fi-torzoor 4-602.11 Clcaning 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 3-0Ol.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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 929-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 * (Blue Items 23-30) 3-202.15 Package Integrity Tti ( ) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.12 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 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:590Formback&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. k6oF,„E r TOWN OF BARNSTABLE _HEALTH wSH ECTSR's Establishment Name: Date: age: Of . q OFFICE OUR PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARNSTABLE. �' HYANNIS,MA 02601MON -FRI. 08-8 508-662-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ; �p +a3q•aim �� rF°MA+ VVV FOOD ESTABLISHMENT INSPJECTIO RT . P gggLa Name Date T1tei f T s ectio O� outine - Address a Risk i - ction )off Level Previous InspectionTelephone 1ru ntial Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 04L In: Other It (ILI Inspector Out: _ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ _ Violations marked may pose an imminent health hazard and require immediate corrective. Tobacco 590.009(F) .� Action as determined by the Board of Health. Allergen Awareness 590.009(G ❑ FOOD PROTECTION'MANAGIFMENT ❑ 12.Prevention of Contamination from Hands ! / ❑ 1.PIC Assigned/Knowledgeable/Duties „ ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS jods): /../❑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 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous X4.Food and Water from Approved Source ❑ 16.Cooking Temperatures i5.Receiving/Condition ❑ 17.Reheating i❑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 ` VP l Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 'c Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: Non-critical(N)violations must be corrected immediately or Overall Rating � Basedwithin 90 days as determined by the Board of Health. E ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Off c' I Or a fon inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations: F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address tical violations. If 1 critical refrigeration. violation,4 to Snon-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Ins ctor's Signature Print: 31.Dumpster screened from public view Permit Posted? J Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si ure Print: 'n ' 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.) , r FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives. Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F). 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food=Z! 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed,$proutsNot 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-�Ol °:") I 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* Effective urnoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A) (D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F IS sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash*' 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceRequirements.sshould be debited under 929-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 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) Cooling Cooked PHFs from 140°F to 70°F 3-203.18 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 P 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590,004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 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. a I Town of Barnstable EAR115CA8M ` MASS.. Board of Health g. i67q. ♦� FA r 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D. John T.Norman Tom Lee,Alternate Certified Mail# 7015-1730-0001-4987-5363 July 31, 2018 Jennifer Monihan, Manager Star Market #575/7595 625 West Main Street Hyannis, MA 02601 NOTICE OF HEARING - BOARD OF HEALTH RE: Star Market, 625 West Main Street, Hyannis 1 st Violation On 6/27/18, cigarettes were sold to a minor (a person who was. under the age of 18 years) by a person employed at your store. According to Section 371-7(B) of the Town of Barnstable Code, revised on August 23, 2016, no person, firm, corporation, establishment, or agency shall see tobacco products to a minor. According to Section 371-8 of the Town of Barnstable Code, "any proprietor(s) or other person(s) ... who fail(s) to comply with these regulations shall be subject to the following actions for each offense: A fine of $100 may be issued for the first offense. A fine of $200 along with a 7-day suspension of their tobacco permit may be issued for the second offense, a $300 fine along with a 30-day suspension of their tobacco permit within a three year period may be issued for the third offense, and if a fourth violation occurs during a three year period, they will lose their tobacco license altogether. You are hereby notified to appear before the Board of Health on Tuesday, August 28, 2018 at 3:00 pm to show-cause why your tobacco sales permit should not be suspended and to discuss any future plans you may have to comply with this regulation. The hearing will be held in the Town Hall, Selectmen's Conference Room, 367 Main Street, Hyannis, Massachusetts. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, RS, CHO Director of Public Health Q:\TOBACCO\WP Files\tobacco hearing letter Star Market WMain Jun2018.DOC MTCP ID: 'Tobacco Compliance Check Form 2014-2015. Section 1: Establishment Survey Participants Name: 41 �y ID ofPurchaser: Addres6-5 �1 -el S Age: ❑ 16 tW17 Sex:Male ❑Female 0( Name of A Supervisor: City: /`l y�i'!/�/� Zip Code: d d1Y J6 ,- Time of Check: 3'✓'/ an,❑ pm�d_ Type of Establishment: O—Chain ❑ Independent ❑ Not Known Date of Check: Day of the Week:❑-Mon ❑Tueed ❑Thurs ❑Fri ❑ Sat ❑Sun Style of Establishment(Check Only One): ❑ Convenience Store okmrocery Store ❑Bar ❑ Department Store ❑Liquor Store ❑Private Club(VFW,Legion,etc.) ❑ Gas Station Only ❑Pharmacy/Dru&Store ❑Restaurant ❑ Gas Mini-Mart ❑Other(bowling alloy,golf club etc, ❑Tobacconist Section 2: Was Compliance Check completed' Yeso No Cl If Yes please continue on to the.next question, if No please skip this section and go to section 3. H w was tobacco marketed? Over-the-counter:youth asks the clerk for the product. ❑ From a vending machine with a lookout device. ❑ Othex Describe: Was the Purchaser asked for ID? Yes❑ Nok Was this an ID-based check? Yes❑ Nc� Was the Purchaser asked his/her age? Yes❑ Nog- � AM •Sex of Clerk: Male❑ Femaledi— Approximate age of clerkkeen ❑11Young Adult ❑Adult ❑Older Adult Type of tobacco asked for: cigarettes Brand of cigarettes asked for:.P h Marlboro. ❑Newport ❑Other: ❑ Chew/Dip ❑ Cigars ❑ E-Cigarettes ❑ Other Brand: Was the product requested flavored(NOT Tobacco or menthol)? Yes 0 Nog Was the sale made? Yesdif—No ❑ ¢,(� If"Yes"how much did the product cost: $ lJ / Was a receipt given?Yes❑ Noh Purchaser made payment using- El1 bills ❑ .5 bill(s) ❑ 5 bill an 1 bills/or Chan e 10 ill s ❑ .20 bill ❑ change, Section 3: If the youth did not enter the premises or did not attempt to purchase tobacco products please indicate why: ❑ Out of Business ❑ Temp.long term closure ❑ In o eration,closed at time of visit ❑ Drive thru only ❑ Does not sell tobacco ❑ Unlocatable ❑ Unsafe to access ❑ Tobacco out of stock ❑ Inaccessible by youth ❑ Wholesale only/cartons. ❑ Presence of polico ❑ Permit Suspended ❑ Private club/personal ❑ Machine broken ❑ Other residence ❑ "Don't sell"but tobacco seen in store/Ras erne 4/14/15 NAME OF OFFENDER DAD 4 76 TOWN OF ADDRESS OF'OF ENDER i- BARNSTABLE CITY,STATE.ZIP CODE dFiNE/ MVIMB REGISTRATION NUMBER OFFENSE • HAHNSTAa1.E. .L „y k.r'�- Uj d ASS. g EA Te_. .639• O p+r O LJLI \ Iti r n - v WTIME AN OFVOLATIO LOCATION OMAIOnn NOTICE OF (A.M./tab•)ON 20 P r Nx. . s04 SIGR`ATUAP'OF•fiN CING PERSON'-"' EN „CING DEPT. ° BADGE„O. W VIOLATION a• �' OF TOWN Oo I HERIBY ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE sable to obtain signature of offender. ►,- THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed u+ LU OR. YOU HAVE THE FOLLjil'N8 ALTER ATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a. DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Lu REGULATION , You may elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted Q t ) Y pay Y. PP P Y 9 Y 9 Y P to before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, —.1 Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d R(2)If you desire to contest this matter in a noncriminal proceeding,'you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature �T► r .� Town of Barnstable A8 Board of Health i639• �� '�fa 39.E a 200 Main Street, Hyannis MA 02601 OFFICE: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D. John T.Norman Tom Lee Jennifer Monahan, Manager, Star Market#575/ 7595, 625 West Main, St, Hyannis. EMAIL: Jennifer.monahan@shaws.com ACKNOWLEDGEMENT OF RECEIPT: August 25, 2018 Re: Star:Market# 57517595 at 625 West Main St, Yfyannis _ This is to acknowledge that your tobacco violation hearing has been moved to the September 25, 2018 Board of Yfealth meeting. Thankyou. Your item is scheduled to be heard at the Board of Health Meeting on the: Date of: Tuesdays iseptembe�;2$5;2018 Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room, Second Floor Time: 3:00—6:00 P.M. Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ..."Boards & Committees > Board of Health - or - Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. QAAGENDAS BOHUet Receipt of BOH-Hearing Tobacco 625 W.Main Hy-Star Mkt-Sep252018.doc t 1h� Town of Barnstable o.� B^M'A Board of Health i6g9• `g�' fa ram" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D. John T.Norman Tom Lee,Alternate Certified Mail# 7015-1730-0001-4987-5363 July 31, 2018 Jennifer Monihan, Manager Star Market#575/7595 625 West Main Street Hyannis, MA 02601 NOTICE OF HEARING - BOARD OF HEALTH RE: Star Market, 625 West Main Street, Hyannis 1 st Violation On 6/27/18, cigarettes were sold to a minor (a person who was under the age of 18 years) by a person employed at your store. According to Section 371-7(B) of the Town of Barnstable Code, revised on August 23, 2016, no person, firm, corporation, establishment, or agency shall see tobacco products to a minor. According to Section 371-8 of the Town of Barnstable Code, "any proprietor(s) or other person(s) ... who fail(s) to comply with these regulations shall be subject to the following actions for each offense: A fine of$100 may be issued for the first offense. A fine of$200 along with a 7-day suspension of their tobacco permit may be issued for the second offense, a $300 fine along with a 30-day suspension of their tobacco permit within a three year period may be issued for the third offense, and if a fourth violation occurs during a three year period, they will lose their tobacco license altogether. You are hereby notified to appear before the Board of Health on Tuesday, August 28, 2018 at 3:00 pm to show-cause why your tobacco sales permit should not be suspended and to discuss any future plans you may have to comply with this regulation. The hearing will be held in the Town Hall, Selectmen's Conference Room, 367 Main Street, Hyannis, Massachusetts. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, RS, CHO Director of Public Health Q:\TOBACCO\WP Files\tobacco hearing letter Star Market WMain Jun2018.DOC COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3. A. Sig re B� ■ Print your name and address on the reverse 11';rt so that we can return the card to you. X ❑Addressee ■ Attach this card to the back of the mailplece, B. Rec ived Printed N e) C. Date Welivery or on the front if space permits. C `� 1. Article Addressed to: ,I / A p D. Is delivery ddress different from item 1 Yes %Ic' J Ah Fe A 2 �d AV I rl� 114 r1 If YES,enter delivery address below: ❑No ssq,k- ►n m_kcr Q 3. Service II I'lllll I lII II I II I II II II III II!III III II I III e Adult Signature 0 Registered Signature Delivery 0 Rregistered MMail al ❑Adult 9590 9402 4116 8092 9363 71 Certified Mail® Delivery ❑Certified Mail Restricted Delivery Return Receipt for ❑Collect on Delivery `Merchandise 2._Article_Numher_[?ranafor f.-m�e�,%� %-�- - --� ❑Collect on Delivery Restricted Delivery ❑Signature Confinnation'r" . 7015 1?3 0 f 0 0 01 4 9 8 71 5 3 6-3 t t/ ❑❑insurreedd Mali Restricted Delivery ❑Signature Confirmation Res 'cted Delivery (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domes c Return Receipt I USPS TRACKING# First-Class Mail Postage&FeesPaid I' USPS Permit No.G-10 9590 9402 `' 16 8092 9363 71 I i United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service -�3o 4n-fl o F AEW—.7-hit W13 op 13 nos- rd� zoo i I f { �a.y'J• C;'. m ,'I• • aM Jos.�,�n,. ,✓ �,� II _n m • .. • -• • • �' IM1 c(3 Certified Mail Fee u^ $ SdS/j � Extra Services&Fees(check box,add fee as appropriate) Z(Retum Receipt(hardoopy) $ t� Return Receipt(electronic) $ ; Postm O ((Certified Mail Restricted Delivery $ Here OO ❑Adult Signature Required $ t AUG-3 2018 ❑Adult Signature Restricted Delivery$ Zr O Postage IT,m $ � Total Postage and Fees r $ e 47 v SI� 8®H sue. I.11 sent To<►i v ----- ----------- O Street an-- -Apt.No. r Pd x ra. � r- .. .:.............. Certified Mail service provides the follovying benefits: •A receipt(this portion of the Certified Mail labei). for an electronc return receipt,see a retail •A unique identifier for your mailplece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this , delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(Including the recipient's retail associate. 7 signature)that is retained by the Postal Service- Restricted delivery service,which provides ti for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the + ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). . or Priority Mail®service. Adult signature restricted delivery service,which' ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent.' with Certified Mail service.However,the purchase (not available at retail). G 1 of Certified Mail service does not change the ■7o ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you would like a postmark on r •For an additional fee,and with a proper this Certified Mail receipt,please present your _y endorsement on the mailplece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipients signature). of this label,affix It to the mailpiece,apply 1". You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.�) electronic version.For a hardcopy return receipt, t 1 complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailplece; IMPORTANT:Save this receipt for your records. l Ps Form 38OO,April 2015(Reverse)SN 7530-02.000�7 MTCP ID: Tobacco Compliance Check Form 204-2015 Section 1: stabi%shme>�t Survey Participants Name: Sz/ /"1Arzk-cl, n ��yy ID of Purchaser:, (j Addres (�/ I //� SY Age: ❑ 16 17 Sex: Male ❑Female 0( Name of A Supervisor: City: /7 y�gnli-J- Zip Code: (J d!y j3 J Time of Check: am❑ pm Type of Establishment. 6id'—Chain ❑ Independent ❑ Not Known Date of Check: J/c? Day of the Week:❑-Mon ❑Tues ed ❑Thurs ❑Fri ❑ Sat ❑Sun Style of Establishment(Check Only One): ❑ Convenience Store rote Store ❑Bar ❑ Department Store ❑Liquor Store ❑Private Club(VFW,Legion,etc,) ❑ Gas Station Only ❑Pharmacy/Drag Pharmacy/Drag Store ❑Restaurant ❑ Gas Mini-Mart ❑Other(bowling alley,golf club etc, ❑Tobacconist Section 2: Was Compliance Check completed` -Yosg NO D If Yes please continue on to the.next question, if No please skip this section and ga to section 3, Ii w was tobacco marketed? O�LOver-the-counter:youth asks the clerk for the product, ❑ From a vending machine with a lookout device. ❑ Other Describe: Was the Purchaser asked for ID? Yes❑ Nok Was this an ID-based check? Yes❑ N� Was the Purchaser asked his/her age? Yes❑ No Sex of Clerk: Male❑ Female Approximate age of clerkkeen ❑11Young Adult ❑Adult ❑Older Adult Type of tobacco asked for; cigarettes Brand of cigarettes asked for-4 Marlboro, ❑Newport ❑Other: ❑ Chew/Dip Cl Cigars ❑ E-Cigarettes ❑ Other Brand; Was the product requested flavored(NOT Tobacco or menthol)? Yes ❑ Nog Was the sale made? Yesd 'No ❑ ¢ If"Yes"how much did the product cost: $ i /1 Was a receipt given?Yes IT Noh Purchaser made pgyment using:❑ 1 bills ❑ ,5 billQs ❑ 5 bill an 1 bills/or Change; 10 bill s ❑ ,20 bill ❑ change Section 3-.- If the youth did not enter the premises or did not attempt to purchase tobacco prdducts please indicate why, ❑ Out of Business ❑ Tam .long term closure ❑ In o eration,closed at time of visit ❑ Drive thru only ❑ Does not sell tobacco ❑ Unlocatable ❑ Unsafe to access ❑ Tobacco out of stook ❑ Inaccessible by youth ❑ Wholesale only/cartons ❑ Presence of police ❑ Permit Suspended ❑ Private club/personal ❑ Machine broken ❑ Other residence ❑ "Don't sell"but tobacco seen in ore as permit 4/14/16 No 11,1d � '' Fns............................_ r THE COMMONWEALTH OF MASSACHUSETTS �J BOARD OF HEALTH --•---........._.T�..._........OF........BARNSTABLE Appliration for R-spooal Works Tonotrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 625 Main St. Tedeschi Realt�' C_6?p$&�efion 14 Howard St. , Rockland, MA 02370 ......................--.......................................................................... --••-------•...._.....----......-----......-t-�-d---........._............ •• ..... W Angelo's Supermark , Inc. 14 Howard St. , ROCKjand, MA 02370 ,-1 ....................... ........ Installer Address UType of Building Size Lot----------------------------Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building SuPernarke_L No. -of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------•-----------------------•-•--•-------------------------•-•--------................. W Design Flow...N/A.................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................................... Date a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_.-.----____-_.--_---. rtf Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ a ---•---•--•------------------------•---------••--------------•-----------------------•••--•---------..................................................... 0 Description of Soil.............NIA-................................................................------------------------------------------------------•-----------•-•-•-•-----. . W V -----------------------•--•-----•-•------------•-------------•---------.....---------...---•---•----------------------------•--------------••----------------------------•----•--•--------•---------... W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ To-add a A,004---gal1Qa.grease_.tsa.p....-•---------•-------------------------------------------------------------------••----•--•----•-•--------•---•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b 1 d by the board lth. Signe . ................ ----------- -•August............. _. Date Application Approved By.........................................------•................... • ........................-............... Date Application Disapproved for the following reasons---------- -----•--------------------------------------------------------------•--------------------•-•------••- ----------------------------------------------------------------•-•---------------•-------•-•---------•---------------------------•----------------••--------•-•---------------•--•--------••--•------- Date PermitNo. y...�U---•-••----....._•-----------. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... .....................OF..........4........I............................................................ Trrtif irat of Tontpthata THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--•-----------------•---.....s61 K y' ------------✓ ,I Installer at.............• G�OJ. Qj�r/r ET- -Jr T-•- -------•-------------•--•----•-----------•---------------•----•------------------•--------------- has been instal ed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__�Ie_�.-.4_7G............... dated. .-.�- �-,............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. No...., ...........7. Fim.B.............................. THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH .................................... 0 F........................................................................................... Appliration for Dispaiial Workii Tomitrurtion ramit N-oplicaiion is hereby made for a Permit to Construct or Repair an Individual 'Sewage Disposal System at: ............................................................................................... ................................................................................................. Location-Address or Lot No. ................... ........................................................................ ................................................................................................. Owner- Address Installer Address Type of Building Size 'Lot............................Sq. feet U Dwelling-No. of Bedrooms............................................Expansion Attic Garbage Grinder Other-Type of Building ............................ No. of �ersons............................ Showers Cafeteria aOther fixtures ....................................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank-Liquid capacity............gallons Length................ Width........_._..... Diameter__._--__-_-----. Depth_............... Disposal Trench-No. .................... Width......_............. Total Length.................... Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter..........._._...... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) 1.4 04 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit._...............__. Depth to ground water.._..................... PLI Test Pit No. 2................minutes per inch Depth of Test Pit._.................. Depth to ground water..__._.............._._. P4 ............................................................................................................................................................. 0 Description of Soil...................................................................................................................................... ................................. x U ......................................................................................................................................................................................................... W Z ....................................................................................................................................................................................................... U Nature of Repairs or Alterations-Answer when applicable............................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code- The undersigned further agrees not to place the system in 'L operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo..--- ------------------------------ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......... ............................................ Tntifiratr of Toutplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired'( by...... .��c*,V../ y ..................................................................................................................................................................... Installer at....................... ....................................................................................... *...........*------------- ........................................................... has been insta&d in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works kCVfistruction Permit No...,VV-e.7 ............... dated_, - ------------ --------- ........ THE ISSUANCE OF THIS CERTIFICATE Sk ' -'NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... Inspector.................................................................................... --------------- THE C64 NWEALTH OF MASSACHUSETTS r BOARD a�4EALTH 7Ae1Y4_4- / 41011_1t1_jrd_Z1Z!;V_ _*-, P11- 1/,P0 ...... ....................................OF.............................................., - ....................... No......................... . ..... FEE........................ I,;Bispsa if-E l WorksuRtrudialt prr m Permission is hereby,granted...................................................................................................... ............................... to Construct or Re air an In di ldual Sewage Dispp�al, System atNo...................... ..............................................................................................................................01 V ...................................... Street J *Y- as shown on the application Jr&I =Disposal Works Constrficti Permit No..................._..-Dated.._..... ............................... ............................................. . .................. ........................ Board of Health DATE..............7.................... ...... ................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L VI � r gZe� Commonwea" 7 Daniel S. Greenbaum s� Commissioner ,.t p%e CST/ JLS&��02,Y47 Gilbert T. joly Regional Director March 21, 1991 Purity Supreme RE: ' BARNSTABLE--Cross Connections 101 Billerica Ave. Proposed Backflow Prevention Device No. Billerica, Massachusetts 01822 at Angelo's Supermarket PWS ID# _ 4020004, Trans. #1180, (91-385) ATTENTION: Mr. Thomas McLean Gentlemen: The Department of Environmental Protection, in response to a request submitted on your behalf dated January 18, 1991, has reviewed plans of a proposed backflow prevention device for the subject location. The plans consist of one (1) sheet which is titled: PURITY SUPREME ANGELO'S SUPERMARKET WEST MAIN STREET HYANNIS, MA CANCO FIRE PRQTEC_TION 12-21-90 The Administrative Completeness Review and Technical Review have been completed on the above-referenced submittal'. The plans propose the installation of one 6" Watts 709 double check valve assembly on the water line feeding the fire sprinkler system equipped with siamese connections. The plans are hereby approved with the following provisions: 1. The water lines affected may be -shut down during normal business hours, after reasonable notice and after written permission is received from the local fire department having jurisdiction to permit necessary testing and maintenance. If it is not possible to meet this requirement, it will be necessary to provide a by-pass equipped with an a roved tyDe Backflow prevention device. Original Printed on Recycled Paper I -2- 2. The installation must be readily accessible for testing and maintenance. 3 . A complete set of spare parts for each device must be available for future maintenance. 4. The fire sprinkler system will not be equipped with storage capability. 5. The fire sprinkler system will not have a direct connection to an unapproved source of water. 6. The fire sprinkler system will not be treated with chemicals which includes any type of anti-freeze. In addition, the Department requires that the installation be completed within ninety (90) days after receipt of this communication. After the work has been completed, please notify the Barnstable 'Water Company so that arrangements can, be made for an inspection. The application for a cross connection permit will be issued after the inspection. If you have any questions, please contact Mr. Richard Wiles at (508) 946- 2767. Very truly yours, awrence S. Dayian, Ihief Water Supply Section D/ROW/kan cc: -Barnstable Water Company .P.O. Box 326 Hyannis, MA 02601 Board of Health Town Hall 367 Main Street Hyannis, MA 02601 Plumbing Inspector Town Hall 367 Main Street Hyannis, MA 02601 Fire Dept. Main Street Barnstable, MA 02601 I _3- cc: A & B Canco P.O. Box 999 W. Yarmouth, MA 02673 1 .1 EM.3.02-932709.'F•' s-. + .. M _ - Y ' k + - -` ' ' a THE COMMONWEALTH OF M ASSACHUSETTS - DEPARTMENT OF PUBLIC HEALTH - e - STATE HOUSE, -BOSTON 33 April. 21 1965 ' # Wj* Let Apt* `4 80 um. let- :1XXO ` NS-1 weat y t of P01te �tb# in' nee to V ve3 bVA - ? one of its em s a the ll at thea0�aet ��#��deteviltft., Its matsbulty A loco 81b8 face same s pl � sheeta the first oaf vch �3tle y a , _ - ► exesdmm ft # A ft+ . fob"•"West,Anvosal of i*l,*m vedim amd ftd gmei whitb to wasidered sultiible ftr logal stt 'Fie see du pia 1" per &' vaeb aIU moist or 4 5" on=-pftcwrt roulfbmea 0000te tic $, 3 40lo ftot dog ewer equipped, with a staff 5 Inch oil, 4 distrilv4M bimi and a si ,e �h� bed vh ch ;vro a total at 27� s� � of eels loseb are** y An The blvt,ot(m of OwAtuy ftaizeeruw U of the OvInum that the _ plow eye arm in 04coras ee VM booms prutit a kym thea Vub the rolum I)rovuioaoI 1. l roml is 1wt ed, to a u of M Ono Per ►. ' , 2. ?b chm"e vM— be aaft is thi rl witholit the V*Ior iirittaft, afrroval or this Dvartmmtw , 3. Comtruction Sri. be n' stria acoosrdaacce vith, the."proved p , in acomea-am with the provial ms of Art t ler X1 of .tbe atate Go taxy Code, �t will be aeoeisemT fbr yo to 4*bt a A qo aa Works,CoAstrwUm , ' Pamit from the loca Scud of Rm . ' Whin the dimpoaaa faaMtUa bAv been pIsted, prior to h #y y�+ery,of oee�1 t aaust r notified than ar +it @ to � a field e� t4aaa ' ' A epa of the a°t p+ed approved plus mist be kept,on site i0a lo be used for mmtruetiou purposes, ,. Ca*b a*t►*rA nth District " A I i ,s 8 use ►ts' 023 i" z oao iJae board o Beath Samstable couvtr Co `t E e ' t FJ �l� AR OW � t S-P Angelo's Supermarkets, Inc. 14 HOWARD STREET • ROCKLAND, MASSACHUSETTS 02370 (617) 878-8210 May 5, 1983 Town of Barnstable Office of Board of Health 367 Main St. Hyannis, MA 02601 RE: Angelo's Supermarkets, Inc. 625 Main St. , Hyannis, MA Gentlemen: We agree to install an exterior 1 ,000 gallon grease pit to receive Snack Bar and Bakery waste from the store, before it enters the main sanitary system. It is assumed, since this is an existing establishment, this work will be subject to the discretion of the Plumbing Inspector as to what is feasible in an existing supermarket. ��su•, /fC-��rti '�£�'y'�r"'�"r /)�( Very truly yours, CGy Richard sper RCJ:jm c.c. S. Alan Curtis Star Markets Company,Inc. 625 Mount Auburn Street. Cambridge,MA 02238-9122 (617)528,3449 Gary Collette l (617)528 2349 Fax Project Manager --,,+ ` __ ckEnsL I f� t-e IN-1 VC -63 00 INVf-65.0-( -� o IN iINV=64:81OU-T.).� y4,CLEANOUT(TYP) � , " 4'' INV 65.1 �1 I (EDGE OF CANOPY $ c .I © c 1 i INV.=59.0 INV.'61.9 S RD ' PVC S;0.02 g I B 102 08 SMH 12 WELL L I , :RIM:67.1 I INV.°61.5 (6,) SERVICE PAD- ' I `INV.°61.4 (8 1 Ir b I I TRASH :- COMPACTOR , aNCHOR ;. NI PIV � E ©4 W I (TYPJ A E G ! ©INV.=59. al . L I 1 I -7� 1 1 I :61.5 FOR INTERNAL PLUMBING I 1 3 QJ INV. CQNNECTION TO SANITARY o I INV.--64.7 1 , ro SYSTEM(TYP') ,�� ti /•-� 1 2 0 1 � I 1000 GAL; 1 SIAH 2 GREASE TRAP 1 RIM =67.2 INV -- 6`4�6 ( IN) p _ _INV.=60.7(6 INV:A64.4 (OUT) 1 I INV.=60.5(8 ) O 1 N 1 � 0 11 1 al 62.3 -O- i 6 c INV.63.2 3 J G W G SLEEVING(TYP) STUB FOR FUTURE CONNECTION I -�--IRRIGATION N •.Cf�v, ,1m"r. �".�e..�... %ice ' � - •.. ��; .►/9" _ EXISTING } to N rsyT'�4,i' I RETAIL 4 p Ro 6"PVC 2,500GAL. � �•' '� �� $ -- IN =63 00 GREASE TRP to INV =65.0 (IN) p a S-002 M 0 I r INV.:64.8(OUT) O Qg1E' N G G u 1 I CLEAN OUT(TYP) � , cmm I pravu INV.=651 I EDGE OF CANOPY 1 1 � I S INV:61 9 i I INv.=59.0 6"PVC S=0 O RD 8102 RIM t2 � .I RIM:67.1 40asWEL L. INV.=61.5 (6r�) I I INV :61 4 (8") SERVICE PAD �_ I � � 1 s T I C o I EXISTING TRASH 1. 1 ANCHOR D COMPACTOR U) I 1 (TV > INV=$98-2 '4 ,ir, ;^ x 4 I•+� INv =61.5 FOR INTERNAL PLUMBING +r CONNECTION TO SANITARY G c�Q'L SYSTEM(TYP.) INV.:64.7 1. Z • f o (7)3 2 E (1)2"E pit ` z ¢, ; � 0 004 0r )pLOGIC ` UGClE , T -SMH 2 00 . RIM --67.2 25 GAL �~ _INV.-607(6") GREASE TRAP ` INV.=60518r) INV.: 64.6 (OUT) o INV.-644 ( ' o,• ' • %-CAP `0. AIN CAP- INV.=63.2 INV.=61.0 .. l 3 12 RCP � CLASSY G G �N . f� PURITY SUPREME 2 BILLERICA PARK • 101 BILLERICA AVE. N. BILLERICA, MASSACHUSETT"S 01 BB2-1231 p [617] 663-0750 • [617] 721-0000 t� November 28, 1986 rp, �- _L_ TO: Mr. Stetson Hall ;;'yDEC - "S 1986 Country Board Of Health c/o Barnstable Country Court House. Route 6A Barnstable MA. 02630 �- In accordance with current regulations requiring submittal of plans for store revisions: We plan to replace the existing fish display case with a modern iced fish case at: Hyannis Angelo's 625 W. Main Street Hyannis MA. 02601 I am enclosing a blueprint for your examination. If you have any questions, please contact me at. 721-0000, extension 2133. Installation is scheduled for the week- beginning December 15,. 1986. i . Sincerely, Bob Sturtevant Director Of Sanitation I Encl. /gr „� �� .,.. `:ice b w ...__� �,.�.. �._•._.._,...�..��..�.,,,_...�. --..._,..r._•.�-_ 3 • ��•--4�IE EZE F: GLIAP0 14 L Fib H m _ Y2”vit FL. 2 URA! _r ,�a GANL� �'• �: III G.?IL.E O = ,000 •Q� t� GOLD WAIVAP . 1 2 Lo"x 2= w06, FOOTI Nep 104 12"4 HOLE �o 1 EI,ECfRIG >� WPRER� LIIJ6'S 'tIJRIJ :. . . Ilo'�PIPE 1 � � UP 106WE 04 OF SHE I(#r� _ 4- V'Z''�'f+ ►U P�Ol.1 PIPE guP oP•'t5Ile -/ P ?A'TMLu I REo � •A?'TAG D ?D FISt C-A-5E 'f STANDARD DRAW. NO ,k PURITY SUPREME , INC. DETAILS STITLE SCALE -- 43Pt�� END O O O O i 0 j i FI.Gm UN9: - i I 1 IIlk O� ; i d" I I i� a •g8 i t � I I � I MEAT I I MEAT PREP -- I — u� I PRODUCE! COOLER I — COOLER Il ! I I U - I I ' NI� .+ NW 4 I I frc I i I I AIRG3 RD OW I DD �`---------- �� 00 6 DOOR_ $ RppER —— ^�—_I ——T————— —————————— ——T _ ----- ---------- --r��% Ji a I I i -�- 6TORAGG ------r --------------- °..°'�'w -- -- ----------------------- I ---- - I _ -, I N +--------------------I '----- --- -'- NBIENT I I��-_-_ ws ww 00 I ':�ERT y "'waww'r Ilk R NE 16' ` ---_- ---- - - ''a�°°'""'� I _ W 24 -M/D F OZEN ¢' MOLTI-0 CK MEAT•��+�'L��(�bT'�."'o.nr-' ___ Nn _I ------- — NEW NEW 40'-MULTI-OECK FRESH MEAT --- _----�01fJ( R' z R��CEG DA RYK r J r NEW ' '_ J 711 NSF^) MP T {4 1 C r_____________________ I ---- ----m _ m FROZEN E J4 OCI-pUNC?i7 NEW 10'r1 FISHI I ME T I Ll I \ N S m $�b ROZEN FII2I - I ., I I ®••I I ¢ bA I HARG NG I — I ..., _ NEW 'NEtl 3', I r & 1, r 1`�ny I ��TXN 11 a I -N 6 55 -o°ii'�0°°t�f� {' AMBIENT I I JACK WERI 1 I - - - NEW 1 -SHLVG. '1 IS LVG. 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