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Home My WebLink AboutCASH MARKET - FOOD (2) CASH MARIET'c' '105°Rte 14 MR e1-9- ©4MMills i Town of Barnstable BOARD OF HEALTH John T.Norman -� Board of Health Donald A.Gaudagnoli, M.D. +' MARN rA L'E F.P.(Thomas)Lee, Daniel Luczkow,M.D. Alt. $� ��s4• ,� 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: 114 Issue Date: 01/01/2022 DBA: CASH MARKET OWNER: PURBELI INC. Location of Establishment: 105 ROUTE 149 MARSTONS MILLS„ MA 02648 Type of Business Permit: RETAIL WITH FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SEATING AUTHORIZED d For Office Use Only Initials: ,' " '�'`�� Town of Barnstable Date Paid (e ( &itld$ 2� • AHD Inspectional Services 1639. Public Health Division Thomas McKean, Director O ( Z( 200 Main Street, Hyannis, NLk 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 0��' 0� NEW OWNERSHIP RENEWAL✓ NAME OF FOOD ESTABLISHMENT: Cas�� 'M-aoq ADDRESS OF FOOD ESTABLISHMENT: 0 ( �� Wlgr iM ;l 1!S/Mho O:Q6 qF3 MAILING ADDRESS(IF DIFFERENT FROM,ABOVE): 1 E-MAIL ADDRESS: pgrb>� I K '(. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATI ON: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V' FOOD SERVICE VRETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT tkdltl1. 1 ► ,atVcf) Q 1�4i SOLE OWNER: YES NO OWNER PHONE # ��~ �'��eS � ADDRESS_ � , f`��"I �` Px-e 1 / H Yq n y N A,f S D I CORPORATE OWNER: � I L � CORPORATE ADDRESS: �6 OAT" ,"1 j! M Qr ° , 2 l 0a,6 L{a r 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. VA60,01 C*%c �lxJ�� "/3 0 l 1. 2. 4Z AX- SIGNATURE O A PL CANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townoft)arnstable.us/healtlidivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc Epp THE ro TOWN OF BARNSTABLE - HEALTH INSPECTOR,s Establishment Name: Date: Page: _of v o OFFICE HOURS PUBLIC HEALTH DIVISION 8:06-9:30A.M. BARNSTABLE, ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �r. MON.-FRI. E.639. tee HYANNIS, MA 02601 sos-as24644 No Reference R.-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSP CT)ON REPORT _ I l a C� C 1/2, vne oName ," ` Nl Date T of Inspection Address P Risk outine 3 h b FoS e-Inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness f lL Caterer General Complaint Person in Charge(PIC) �� Bi�� Time Bed&Breakfast HACCP , In: Other I �� Inspector ( Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ C•( 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 L /� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ++// ,n -/ ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures Ce C1' � 422 KI /'C 1"t � r ❑ 5.Receiving/Condition ❑ 17.Reheating - (� ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling - lb ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold HoldingAAJ �l.t�kCT 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 f\ ,l"� I"`^� e f� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations vv �[JJ Q�rl Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El ElYes 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. ❑ 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 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 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 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signa e Prit:��/ 31.Dumps r screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N _ ,...�.. �. -. .,..-....:: ..�. ....-�../�..w...-•.-_.-�",....._ 'a,.�-.._•+-.r�.'�,• ...r1`.%..:,....,„..r----`.'-v'..r`...�..u%-:-w...a ,-t-.L...�_�>..; ,. ,. .._..-..'�......-- _ -. • _. -. �. .. .--`. a .... _. .. � � - .. �.. a 'a" +^'yr�.- 1_. -f ..� ,-^„ ...... - .• .. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) e FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - 3-302.14 Protection from Unapproved Additives* 19 Contamination from Raw Ingredients r 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* 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 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q _ Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Warewashin Hat Water 7.206.12 Roden[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 Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater,from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * e e�nve uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 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. $ 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 ( ) Y Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 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[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. P`pF ME Tpk� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: -.Page: --?--. of 1 OFFICE HOURS PUBLIC HEALTH DIVISION e:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:MON. FP.M.RI Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MO HYANNIS,MA 02601 508-8 -s2�sa.a No Reference R-Red Item - PLEASE PRINT CLEARLY . 'E0N1P� FOOD ESTABLISHMENT INSPE TION REPORT ( S o Name l Date 1 Z T e o T of Ins a lion O ine- c`l ll Y Address Risk ood Se e-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness 1 VJA Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other 2 Inspector S Out: l Each violation checked require an explanation on the narrative page(s)and a citation of specific provision(s)violated. Aa 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) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) V 1p , Cl FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities Ail" EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Aa L� 1 �e/.5'/ l" ❑ 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) till ❑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 ¢ i Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes Overall Rating within 90 days as determined by the Board of Health. Com❑ 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. ❑ 9 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 B=One critical violation and less.than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility 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 8non-critical lations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Sign re Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N �. M1.-: i•-.r:r '+-r.-_.'�_..•.._ ,-"„'.l..r+..,. .-ri-...t.1.r...,: ..� Y><�,.y.ew+`...r ,.-ter.^J'Yy-.-1..r _��._-�_� -�-• -w�.-.. - ._. - r-�.---�..-��r�..� -..� -1 y._.- . ...�..-�. Y �-_r�r�.:, vr•.n. w_�}- � Yr�sr'\" �_. ��.. ...�.�..-.�'.^.w-. .ram r��-•`�-?w-n'K+..rY+•s•r-r•.r ., v.-.. �.aS' w. -vim•-4-yw.-� - Violations related to Foodborne Illness '_ Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302:11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils* f 7-203.11 Toxic Containers-Prohibitions* 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)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(ArB) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) ' Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs*_ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec Not Otherwise Processed to Eliminate * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg . Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e//cn-riuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whale-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* p 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms ( )( )( ) * 2-301.14 When to Wash* 3--`401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices 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 * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from.Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105.CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F 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 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 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. °p v4E Tp� TOWN OF BARNSTABLE , HEALTH INSPECTORS Establishment Name: Date: / Page: of qf OFFICE HOURS PUBLIC HEALTH DIVISION 8.00-930A.M. /// 3:30-4:30 P.M. BARNSrABLE. ` 200 MAIN STREET ] Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. ( / MON.-FRI. HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY TFDN`"� FOOD ES ABLISH,MEN7 INSP C I N REPORT Name )/ Dat Tvne of Se-inspe i Type of Inspection � � O I Address ZRisk ood Servl R Level Btal re rous`Inspectlon Telephone Residential Kitchen e: Mobile ;Pre-ot a Owner HACCP YIN Temporary S supct-Illness i Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP LA 14 Other '00� U7q ZA Inspector Each violation checked requires an explanation on the narrativ 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) ❑ 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 9 G-71 / ❑ 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 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 , 202�0� 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 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 than3 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 n-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation�of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical: If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to S non- ritical iolations. If 1 critical refrigeration. 29.Special Requirements - (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical vio lion n tor' G tint: t.._ 30.Other � DATE OF RE-INSPECTION: "Pre� - 7 31.Dumpster screened from public view... 7 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC'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(Q) 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 * 590.004(F) ( ) 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 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 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 Rted 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 or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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 d-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 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* Mushrooms Approved By ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec* Authority 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and . 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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 Receiving/Condition 2-401.1.1 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs'165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18. Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling 3-202.18 Shellstock Identification. ( ) g 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/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I � i / °p1NE To,," TOWN OF BARNSTABLE "TH INSPECTOR'S Establishment Name: Nil � Date: age:�of ry t1� OFFICE HOURS C4 I/ P I � 11 y I I PUBLIC HEALTH DIVISION 8:00-9:30A.M. • BARNS'1'ABLE. • 200 MAIN STREET � 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �' HYANNIS, MA 02601 b MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 2e39• N508-862-4644 ' F 0D E§TA_RWSHMENT INSP T N REPORT n Name Date a of Type of Insuection g Routine Address % Risk Food Se Re-inspection 0 el Previous Inspection Telephone Residential Kitchen / Mobile Pre-operation.. _ , Owner HACCP YIN Temporary S-u-sr6ffIllness Caterer General Complaint Person in Charge(PIC) TL'm a Bed 8 Breakfast HACCP Other InspectorLZ , Each violation checked requires A explanation on the narrative Ae(s)and a citation of specific provision(s)violated. 71/7 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((3) ❑ 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) Ddl ❑ 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 S' ao Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Y 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 (FC4)(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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If If no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical viol ions. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation, non-critical violations= 29.Special Requirements (590.009) within 10 days of receipt of this order. IJ 30.Other DATE OF RE-INSPECTION: Inspector' natur' 31.Dumpster screened from public view . Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Froien 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) [Demonstration gnment of Responsibility* 8 Cross-contamination 1q 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`tJnappioved 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: 590.004(F) 7-102.11 Common Name-Working Containers*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 Se azation-Storage*-Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* I1_- 590.004 Variance Requirements 590.003(G) Reporting by Person in Charge* _ 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 Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 3-80 L 11(C) Ud Fd P N R * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* nopene oo ackage ot e-Served 3-202.13 Shell Eggs* - _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 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* Elf cri�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-l30°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-Ho[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* in mobile food,tempor and residential Sources 10 Proper,Adequate Handwashing g' Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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 practiRequices should be debited under 1/29-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* C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity* 3-403.11( ) ommerc y Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions_of Beef Roasts* illness interventions and risk factofs listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification*. ( ) Cooling Cooked PHFs from 1407F[0 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 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. Wef � 42�;age: HEALTH INSPECTOR'S Establishment Name: ate: of THE rp TOWN OF BARNSTABLE. & -1 � do,/ - 1 OFFICE HOURS 4 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. �p .639. ,m HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'EOM y, FOOD ESTABLISHMENT INSP ION REPORT Name � ate e o ns ection V4 � 0eration(s) Boutin Address is ice sped n J evel Retai ' Previo p i Telephone sidential Kitchen Date: Mobile Pre-op Owner HACCP YIN Temporary Suspe I Wes Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector MOM 111W Each violation checked requires an explanation on th narrat pa and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions an 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 J 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 i ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations_ Critical(C)violations marked must be corrected immediately. (blue&red items) ?J �aD 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 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 6=One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6 Won-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 S Wort critical violati s. If 1 critical refrigeration. .. 29.Special Requirements (590.009) y receipt within 10 days of i t of this order. violation,4 to 8 non-critical violation =C. r 30.Other DATE OF RE-INSPECTION: Ins a Signatur f 31.Dumpster screened from public view ® /j Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ig ure Print: Self Service Wait Service Provided Grease.Trap Size. Variance Letter Posted Y N Dumpster Screen? Y N �/ :>s Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* Cross-contamination 14 Food or Color Additives _ ,, Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) JDerr onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to- Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-'102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* - 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting-by-Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 52490.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ ,, - ° ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 3 590.003(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* 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 1 g3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eli ti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590-006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 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 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* COProper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* y. 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) 3-202.11 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 3-403.11E 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 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 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. 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 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. HEALTH INSPECTOR'S Establishment Name: ( I �p THE Tpk, TOWN OF BARNSTABLE�.. .. ��nS �I�f� (NLa� Date: Page: � of ti 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. g. - MON.-FRI. p�m HYANNIS,MA 02601 sob-8s2 as4a No Reference R Red Item PLEASE PRINT CLEARLY 'FON1P' FOOD ESTABLISHMENT INSPECTION REPORT Name MQlrafors mills Datel/�/(q lype-o jyj2e of Inspection Operation(s) outine `b Address `q Risk Fo .Service ection 1 v5 r- i m Level _tail Previous Inspection S �I� Telephone ential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary - Suspect Illness _ �.� ✓ Caterer General Complaint L Person in Charge(PIC) Time Bed&Breakfast HACCP - �- bo r riwze`S -oe In: Other Inspector � qn ( J�� Out: - itrr0�✓�(t^�v/ 1 V - Bum wr ar 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 SUSCEPTIE)LE 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 ry p [:],Employee ❑ p ❑ Y Y ❑ Voluntary Compliance Em to ee 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 )( ) 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 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. w 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: n 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 IN Dumpster Screen? Y N .c 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 LU Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 1 Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)( ) p 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 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* 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*590.003(E) Removal of Exclusions and Restrictions 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reser of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP Disposition of Adulterated or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 ConsuAnimal er Food That Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzoor 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 _ _ 3-101.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 590.009(A)-(D) Violations of Section temporary and a ide in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* 3-201.17 Game Animals* Other 590.009 violations relating to good retail 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 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Ins 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°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. T Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. "• BaNrxnce Paul J.Canniff,D.M.D. MkS& 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: 114 Issue Date: 1/01/2021 DBA: CASH MARKET OWNER: PURBELI INC. Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IncloorSeating: 0 OutcloorSeating; 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent ? FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE f Restrictions: NO SEATING AUTHORIZED I_ oFTHE rFor Office UsInitials: Town of Barnstable Date Paid Amt -d$A5tr— BABNSTABLE, ; Inspectional Services Public Health Division cne�k# 9199to 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 III rO NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: Pu6e-&�IPtc ->BA ADDRESS OF FOOD ESTABLISHMENT: 1 � ko — 19 -I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): NIA . I_ E-MAIL ADDRESS: Por" gK4 �� 0 jh q S(A M i r WM' � TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO`✓w ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE:X OUTSIDE: 'e 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 W AITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANTf�� rt �'1(�� Q SOLE OWNER: YES/U ( ( �� QO�WNER PHONE# 11 75(43— 8. ADDRESS O�f- I ' CORPORATE OWNER: �� e°� I t4 / CORPORATE ADDRESS: 1,05 R PQ+-e-., q PERSON IN CHARGE OF DAILY OPERATIONS: Qj 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 It 01" 1 ^ U7-3 4e` 3VV,-h 14- � 30 26�3 0 mod SIG AT E OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/aPplications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 V 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 y s -BA Wr t ¢f J y z ¢F , SAMIF 10 Z Z, 01114) a} �Z� �� ¢w 3a+r ° x '`' 4 per' z �s ✓ s r 4 & r ' s g � ari570 RE't"{� # Rj/ C3nYrrr'� C1r Cl�t7C� rfJtE4ICl�I `� s � 17 e� � 01370-i ,. �, x0 ✓ sr Y4t � 07180l8k 0� ti �a xy a Y '0�4 r �; t: c�de 6233570 airs 071013 .x as Yf g9ita€4t€�l5� 1Fhtsai xa Pro :. „� �„<..?•� ,o,.. ems. 9 r�` ,r�,s �Nu�� ,, aX .Ef k . c Score Report .Congratulations' You passed the Certified Professional FoOd Manager examination, Your Score is as follows', ore Status Exam Date 87 PASS 071*2018' VI. t � y ( "MAMbOOl € 0 � N h 8 NORTH'STREET HYANNIS, MA 060�9 warn 70 tc�c gr�iz d 3y Gcr r na Apr oo l o ration A" �k 071301, ' i 071301 Gra.ater Lowell Tech.-5arasin ,,ate � X � •C .;5 ervSa. ivi, -CE PlIF, "ICATIO '.. JUAN PACHAN for wcc Jell c-omplefing the standards set frsA for the Sera s �' er Certification Exominotion, wl ie ss raccredit d'by the nergcran N&tioncal Standardsg e #� rance for Food Prc�tec ion( FPS;- r .:. nw• �, £ � ';. - �s G�ra„ '��a Pik,��y'a _ '� s- �k � a � 8/1 12 8113/2023 SATE QF EX RATE OF EXP17RATIQN loccl`'la�vsF .' etficnticire requirements.: - 6 iotron-S��vtr�na ,, � ncv"�C to q.pr fat#t i6a aF the tdRt1€F:Nir ce Rasta uv�i Assx atio, onj the OX ensign -. r ;;, Cr�agi us wyh r{ fistna aI23�S.Yti°ac�nr t3rcva,�#fis 3600,Ct�ec6go,R..�66_�389�5erv5ad5�ra +ra� -v, 9 rj r .Y �rF�r �., r er , .r r1 •.s zzr 5,14 .F� ilk tr ry y 7* r x , ,ts^t�, 'l' f x sxK�"l�il ' � i �� t 'Clt1 eeiYlC@ or L7tYi� tt$l � a, � ,f� .f,.� ��I ass � h ', Y�'v r E•�v C�''y,�x�� fi��Y 'r !F qs.�•�'��°.�' •'� ett�i �t+ 0137,b2 31" V 5 ., r � y »t '�"'" �8 '�*� vw,yx� d �' Y.'� r • t�� K 'Yaa x �r��M._ s n #yn"R iallEzt: lr7k 6+rr� hti € f rJ @304 M � �j `rSas° T �,.. . Pi W C"ut et(" GJ Prometric Score Report on r bul tions! You passed the Certified Professional od Manager examination. Y6ur Score is as follows: Score StAUGExam Date 80 PASS 074012018 ARK t : � � � F i•aj r g T� � f R,-2 3 f 4* J .HAR�,y}}�� y'j��y} }�p,�jryR py�wr y��q � i SSt.xf`�x�F�w� nJA f tR= ild`VLAS Kl'°i:ItlWf°97tlG Y9 �ys y,y E��wy" �,;y LE�j py � - C7 HR#Y*7 10 iS1l Y K HYAI NlS, M A 02601 i F arn6{ t cognrzedy''.Co�afairr�e �r.Fbpii t�epan Ir i txrt $ Greater Dwell Tech-Sarasin 2617 2 x, Es012 j ,� 'Y�.Y.'��e, W 7��.Yi�a," �, '' ..Xf.�r' bJ 'r-..Ci'e" tq� 'v-;k� y.S 'b-�Y.�.-r' W '?v-��.r,' kj Y.^;XMv .tee.� ��C' �l f ., ,. . A � ��c�' :� - ., :�_� .; �� u y ;. j ... y '. ::: �... ... -. r . + ,, t +. 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'�,,'�. � -' "ir�."� �Wit:,". �y!'"'''r....'w....,.�+0`5.:."..r'`"p�Crq`' �"A°r 4....,..-�'r�P�;r�.'' ��(,�`��(,'J «'~t"'/^ �� '`' I/�' ,�q�(�yf � ^.�:,•,;., ' \. � �a �1[,,,I•�' F!r I.1-I'.r,1.rli,.(.l..i.,l.l'.tI.1.1.t.r-.I..a l.I�lt '('1..1 1 I.1 t'.- ��Y C �! r Y� '1 F f G 11 ��r' rryye� �r• ,n �r r�'�n r�� r f^► r� ��r^ �y ti,, �� f../• .,ilk.-`"`•,,,..,„A.w�.�'�,�i*l;i'' �``� .�a ..•:"��.�.,�,'�!.�'�'.�`,.-.J i..�" ''r,..' C.��.'"LJw6..✓"� �^C!��l7,��"~y."�";o:./.f.�, ""�'°,!+^: I� 7,w�.'�%./'...,.��r'A 17�'."�^7'�I�J�„'.."'� C�, `� °'*� ,I` / (:y�� {) •/,. .� '� � ! yik•.,1�'T.. (t 1 Ca F `' \ �/: �>:'��/� `'�� /'' �l..l,1'1:�..� .:, � �V :. t 1• '�;�". ,�,��' i 1�1.. "��y, �•, �� ,,, �.,s, ,t�. �.-* `�+4 M a-��'�4, N2 .�' �•d:; tx7 .►� `�, �'P ►-r `,.�x� tr'1 ,' t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. aARNgrAiRL& f F.P.(Thomas)Lee 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: 114 Issue Date: 1/1/2021 DBA: CASH MARKET OWNER: PURBELI INC. Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 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: ,NO SEATING AUTHORIZED PLEASE POST CONSPICUOUSLY t For Office Use • Initials: . Town of Barnstable Date PaidL $_ �: enRnerwars,.: Inspectional Services R4 (4 Pu blic Health DivisionThomas McKean, Dixector 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT_ PERMIT APPLICATION(Non Flavored) DATE. _I� �o�� NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: rIke,, �✓� �� . '� �'CI ADDRESS OF TOBACCO ESTABLISHMENT: . MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �+� a� E-MAIL ADDRESS: U wrh Q t f TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: ( L- _ ►_ns OWNER'S NAME: �C44WI OWNER'S PH# '�! t A � OWNER'S ADDRESS �� r( Y 110 ,n/ I�'1 At CAM I CORPORATE NAME . %I'uY'�` 1.k(2— q CORPORATE ADDRESS: �®E'f'+e" �� l CORPORATE FID# 8 -1-;1- 1q 1 h ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS).. TOWN OF BARNSTABLE.COMMA GENERAL.LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: httgs://malegislature.r!o v/Laws/GeneralLa,ws/Pe.rtI"'J/Titlel!Cl a ter270/Sec(on6, ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 t ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document i 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: P PRINTED NAME: DATE:. ( / 10 LOYO 0 t Q:\Application FormsJOBACCO APP-NonFavor 12-18-19.docx :1 9: f C ash 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 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 Laws: Signatu Printed Name Date 2. Si azure Printed Name Date Signature Pnnte Name Date Signature Printed Name Date 1 Signature Printed Name Date F Signature Printed Name Date t. Signature Printed Name Date Q:\Application Forms\TOBACCO APP-NonFavor 12-18-19.docx Commonwealth of Massachusetts Letter ID:L1721065792 • �� Department of Revenue Notice Date:November 13,2020 C. s y P Geoffrey E.Snyder,Commissioner oner Account ID:CGL-18505101-003 vTOF mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES o= PURBELI INC A— CASH MARKET 105 ROUTE 149 Mom MARSTONS MILLS MA 02648-1839 Attached below is your Retailer License for Sale of Cigarettes_ _ g (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 � as�TTr MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 v' •s+ Retailer License for Sale of Cigarettes �FqZ ok This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. PURBELI INC Account ID: CGL-18505101-003 CASH MARKET License Number: 1852246016 105 ROUTE 149 MARSTONSMILLAS MA 02648 . 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 13, 2020 Expiration Date: September 30, 2022 I Ij • ss�` itsF Commonwealth of Massachusetts Letter ID:L0445205056 Department of Revenue Notice Date:May 12,2020 IS • .i J Geoffrey E.Snyder,Commissioner Account ID:EDL-18505101-013 &VT V, mass.gov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS II�� 1 �1�11� 111��11111�1� �111� 11111�11��"II�'ll�l�llll�'�� o= PURBELI INC S CASH MARKET 105 ROUTE 149 MARSTONS MILLS MA 02648-l 839 Attached below is your Retailer License for Sale of Electronic Nicotine Delivery Systems.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. I DETACH HERE ------------------------------------------------------------------------------------------------------------------------------------------------ ScH�'S�T MASSACHUSETTS DEPARTMENT OF REVENUE Retailer License for Sale of Electronic Nicotine:Delivery Systems yF �� This license must be posted and visible at all times. The sale of pro* tobacco products to anyone under 21. years of age is prohibited. PURBELI [NC Account tD: EDL-18505101-013 CASH MARKET License Number: 1789118464 105 ROUTE 149 MARSTONSMILLAS MA 02648 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell electronic nicotine delivery systems 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: May 12, 2020 Expiration Date: September 30, 2022 ,'$yam 11 DEPARTMENT OF THE TREASURY i�►7 INTERNAL REVENUE SERVICE ' CINCINNATI OH 45999-0023 Date of this notice: 08-30-2016 Employer Identification Number: Form: SS-4 Number of this notice: CP 575 A PURBELI INC CASH MARKET % HARKALAS KANDANGWA For assistance you may call us at: 105 ROUTE 149 1-800-829-4933 MARSTONS MLS, MA 02648 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIiFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 81-3709935. This EIN will identify you, your.'� business accounts, tax returns, and documents, even if you have no employees. Please: keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1120 04/15/2017 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If vou .intend to elect to file your return a'.s a small business corporation, an election to file a Form 1120-5 must be made within certain timeframes and the corporation must meet certain tests. All of thisinformation is included in the instructions for Form 2553, Election by a Small Business Corporation. t c�� .�- ago _ coluitionwealth to massachusett Lettar,ID LtGG.Efi0.i28 IO rl� r-- �* 'Department of Revenue I'�otice Datt December 14.,2020 Cieol'frey L.snyder,Commissioner Account ID,C`RL-1'1505101-01Q z mass.gavldor RETAILER LICENSE FOR SALE OF CIGARS AND SMO ING TOBACCO E�l��111�11t1�1�1lhllF�l�I1�hl��I��1h�lll��lill��ilhl�li��l Pt.1RBEL1 INC:. CASH MARKET 1 W ROUTE 1.49 MARSTO.NS MILLS MA 02648-1839 Attached below is your Retailer license for Sale of Cigars and Smoking Tobacco(Fonn CT-3T). Cur along;the dotted line and display at your business location..At any t.itue,you can log into your MassTaxConn.ect.aceount at,rnass.gov/n..iasstaxcoilnect to view and:re-print a:eopy of this license. If you have any questions about your license;call us at(C 17) 857-6367 or to ll-free in Massachusetts at (800) 392-6089,Monday through Friday,8.30 a.m. to 4:30 p.m. DETACH t1.ERE �trua M.ASSACHUSET`I'S.DEPARTMEN7'OF.R.EVENUC Farm CT-3T Retailer License. for Sale of Cigars and Smoking Tobacco This license inust.be posted and visible at all times.The sale of tobacco products to anyone under 21 .,years of age is prohibited. PURBELI INC Account.Ii): CRI_ 18505101-010 CASH;MARKET License Number: 12895.91360 105 .ROUTE 149 MARSTONSMILLAS MA 0.2648 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 reguWions. Effective Date:.Decertiber 14.2020 Expiration Date:.September 30 2022 I G Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSt`ABM 2 Paul J.Canniff,D.M.D. 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: 114 Issue Date: 04/28/2020 DBA: CASH MARKET OWNER: PUREBELI INC. Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: — - MOBILE-FOOD: MOBILE-ICE CREAM: C�iA FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE f Restrictions: NO SEATING AUTHORIZED For Office Use Onlv: Initials: Town of Barnstable / Date Paid / Z�� Amt Pd$Zb BA MAM4 * Inspectional Services � -0:19. `� Public Health Division cne�k# P 114 rfD MA<p Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE ©�/ NEW OWNERSHIP V1 RENEWAL NAME OF FOOD ESTABLISHMENT: Mft�rOW C/5 0 �Z—T ADDRESS OF FOOD ESTABLISHMENT: 1(0 FZ RO`44-e- 9 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: prb 0/ w TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NOX ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:'-_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: V 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 REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?�� IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 00 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*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP REV3-2019.doc I OVVNtR INFORMATION: Row o qL FULL NAME OF APPLICANTg1� 'J�\ W I � `" SOLE OWNER: YES NOS OWNER PHONE # �� ADDRESS 16 N4 CORPORATE OWNER: u>4,�) tI� CORPORATE ADDRESS: you I '1 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 ti 1. i y" n M e /ao /90 1. 1190WW1 n� Imo/ I)g lgq 2. -TU DLO 0 , ) /cA-? SIGNAT A PL CANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to ovenina!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townotbarnstable.us/healthdivision/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation, or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January i st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doe e M HI A " t Rsl GRILLED STBAK g CARNT 'i�l Dili � f i GRILLEDwCHICKEN .. .. �. A ARBACfJA f t +LLo 3� FRIES H IICD bE+ = � FISH"& HIP vAC At7LE X E DNIONS � . f3LIES CIICKRN'I`IICTCAR0 NELESS) CIZA1VTItDY „ CHICKEN CURRY 9.93 HOiVIEADE ALEPENC3S ., BCt7CTER CHICKEN 9. LE CE C TCKEN BIRYANY ' QXJESU FRESCtJ GREEN�'EPPER SITES � ITALIAN,AMERICAN,RG F, AST BEE TINA,TiJR KEY, HAW w. CHIPS S2.00. CLIPS +SALSA: ►3.5Q _v SHIPS+ GTTAC .5.5Q: ; kEA11S13 tt QU spot" 4s° ' 1 ` aN1 s l- i a tv x f 4 ROASTED TQMATO,Q1VI(�NTV WITS xi GARLIC,JAL�EPEN( AND ; R r - now 1144'. CHILE VERDE (ME 4) ,F$ eIZAN�3zo ... � i. Ji I ° JALEFENG, lJNION,GARLIC AND 3 GLANTR(J " - GIE 7 99 t z AEG SHELL TACOS CHILE DE ARBOL (HOT) A MIX OF,' ABANERCkC,HILE DE B O ARB L,;�WAL111UT,�GARLICAND MEATa ygyy TXTRA lY EAT M1 IN rEx ;.. - " VEGGIE EXTRA G�TAC Elm k ( pieces) $10 99 or fines ' s // with vice or Irieb z: i F MEAT$3 72 (each) VEGGIE'$2"{each} a„ FISH$3 9'N beach} =-.1 Greek Avocado 8c..... ed Ch �l�en Salad' II V ° aesar5alad Green Salad,Garden Salad , MEAT$8 47 ;' yEGGIE�7 7a • . MEAT$13 25. VEGGIE$1125 Marston mills Cash : Market Marston i i 1 I .r tf I n" �- s =r i GRILLED STEAK- _ r ARNITAS GRILLED CHICKEN LAM BARBACQA SaR?UND BEEF FRESH PICO'DE.GALLQ FISH&:CHIPS GUACAMOLE � u ONIONS:; - ^' OLIVES CHICKEN TTKKA(BONELESS)$4.99 : CTLANTRQ CHICKEN CURRY 9. ` 99 � _. a� HOMEMADE TALEPENOS BUI TER CHICKEN$9.99 LETTUCEn QUESt3 FRESCO CHICKEN:BIRYANY$9.99 5 F GREEN PEPPER SIDES ITAUAN,1 AMERICAN,ROAST BEEF, f � � ";�� p��` - ' TUNA,TURKEY, CHIPS $2.04 CHIPS+SALSA $3.50 CHIPS+GUAC RI+*E " BEANS $3.00= i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. iSTABM '+ Paul J.Canniff,D.M.D. 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: 114 Issue Date: 12/10/2019 DBA: CASH MARKET OWNER: HARKALAS KANDANGWA Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gin FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SEATING AUTHORIZED �IMMEr Only:For Office Use Initials: lu ®u Town of Barnstable Date Paidi Amt Pd$J snRNsrnBL6. SM 9ce q • Inspectional Services r., Public Health Division - Thomas McKean,Director Lg 200 Main Street, Hyannis,MA 02601 I ; Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE_Nu I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ca , _ P' ` ' ADDRESS OF FOOD ESTABLISHMENT: 1 O S RWAbe If`4 9 &Id hM j (�AM> MPtleul MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 'M E-MAIL ADDRESS: �UX)291AI"( M -I�- C 0 ' 1 ,Q TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES NO `y ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc ) a, OWNER INFORMATION: FULL NAME OF APPLICANT [(f4 am v > Q SOLE OWNER: YES/NO ) OWNER PHONE � � �('iJ � / q 7 ADDRESS 6 NO-A-41 S L'-- ��n",�/f n M4 J CORPORATE OWNER: 1-��a� J CORPORATE ADDRESS: �� . _ ma.:j� 1'Yt., O-A mA- . PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. a SIG T O A PLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.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. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc e Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. R11 STA M Paul J.Canniff,D.M.D. MAn 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: 114 Issue Date: 1/1/2020 DBA: CASH MARKET OWNER: HARKALAS KANDANGWA Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: Non-Flavored Annual . Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY 4 OpTME For Office Use Only: Initials: ' Town of Barnstable j Date Paid 1 Amt Pd$ BARNSTABLE, : Inspectional Services F.& Public Health Division Check# Cash Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: C A S H M A`I`y I ,�2-r, ADDRESS OF TOBACCO ESTABLISHMENT: I Q 1 1 A 1 ' ICCl'cS 0 TU 6 LKLI� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: PLLgL`1'� 1j�L/ hC 9 -a-ma &' cQ yn TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: G�= `� 1 OWNER'S NAME: � ��_ ka 1(f., WfbWNER'S PH#?8'j%tf- 7 q 5 OWNER'S ADDRESS: fy OY141J U CORPORATE ADDRESS: �I.lQ�� C. CORPORATE FID# ANNUAL:_ a SEASONAL: DATES OF OPERATION: _/ / TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: https://male isle ature..gov/Laws/GeneralLaws/PartIV/Titlel/Chgpter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING 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 SIGNATURE: 1A PRINTED NAME: C � C r � DATE: ,) -/l%�' / I °i Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc i �U MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco 9 � of This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. PURBELI INC Account ID: CRL-18505 10 1-0 10 CASH MARKET License Number: 2074007552 105 ROUTE 149 MARSTONSMILLAS MA 02648 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 ma fkd- 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 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 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: gn Printed Name Date gnature Printed Name Date c cIv v, czf 131 L `I Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc z MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T 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. PURBELI INC Account ID: CGL-18505101-003 CASH MARKET License Number: 959105024 105 ROUTE 149 MARSTONSMILLAS MA 02648 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 i Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. a� Board of Health Donald A.Gaudagnoli,M.D. MRNSTABLE, : John T. Norman MA F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 114 Issue Date: 12/20/18 DBA: CASH MARKET OWNER: HARKALAS KANDANGWA Location of Establishment: 105 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2019 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: --- - ----------- — --- MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SEATING AUTHORIZED 1 oFt►�tom, For Office Use Only: Initials: Town of Barnstable ��*��Q� �tr �&MMSTADate Paid 1 Amt I'd $ _ MAM. $ Inspectional Services i6Jq �0 ArEp `A Public Health Division Check# Thomas McKean, Director U a 119 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE` �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: c a 1'l n 0., i-k\o f- ADDRESS OF FOOD ESTABLISHMENT: pG; 9joui-2 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): < YVe. E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 6 S l?- 1-0 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO )( ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: - OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS:, IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?--4)lf TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FonnsTOODAPPREV2018.doc s PLEASE CALL 508-862-4644 OWNER INFORMATION: + 1 FULL NAME OF APPLICANT ROI 0� GV� SOLE OWNER: YES NO OWNER PHONE # S(9 Lf _ n Z ! I 0 ADDRESS JOS Q(LkU I.q 1 o fop OZ 6LIY CORPORATE OWNER: EDERAL ID NO. : CORPORATE ADDRESS: 10 S Y \yI I , 1 ' Gms. M R G 2—C L-4 PERSON IN CHARGE OF DAILY OPERATIONS: �kw-yvc 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 Diva will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIGNA OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec. 3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc :110 �114Eh, Town of Barnstable For Office Use Only: Initials: o,. Date Paid Inspectional Services Check# Amt Pd$Cash BA 1639. 6 9`��ek Public Health Division Fp MpY 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 Cl,, n o v ESTABLISHMENT NAME (DB/A) ADDRESS OF BUSINESS MwY-S Y.S — � t .M Pr t C,LA S? MAILING ADDRESS (IF DIFFERENT FROM ABOVE) axe © Sog��8'710� _ ° Inc Y M61 oC0y� EMAIL PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes 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 I who sells tobacco ppoducts must sign the Employee Signature Form (provided herein). Signature Date 1 2 /—A U 9 Q:\Application Forms\TOBACCO APP2019 dob.docx I n 3r 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 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 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: S"VIY Printed Name Date .ul�1Cct,QAS n 12-)S� Si Printed Name Date S a 6v, Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date I Signature Printed Name Date Signature Printed Name Date QA\Application Forms\TOBACCO APP2019 dob.docx May 26 , 1987 Town of Barnstable Board of Health Attn: Tom McKeon Barnstable, MA 02630 Dear Sir: We have closed the cooking operation after Mr. Tom McKeon visited our store on a complaint regarding a grease trap. As you are aware that this store has been in existence for over fifty years and we are trying to update our entire store to meet state and local codes. Presently, we do have plans to remodel the store and install an in-ground grease trap. We ask your permission to allow us the installation of a temporary under the sink grease trap and continue operation through the Summer at which time we shall commence with our new plans which will include new sewage system and grease trap. We have employed John Maffei of Cammett Construction to install the grease and Baxter & Nye to design it. Sincerely, Antoine & Maria Madkour Marstons Mills Cash Market I p OA v � R� v�R Z �. a R A I A.- I,pjr �q-6MrQbT 30 -A W ' LS Tian M V Woo a 3 /1[Gw_ CoTLjIT cowl. �• Frz.4,..C3 F%OA i b 5 roa a �"' I 4600 - S cl13 VAFIADES ' No.9109 w ' COTO/7 PROA D NOTE:THIS PLAN WAS DRAWN FOR MORTGAGE PURPOSES ONLY AND IS NOT TO BE RECORDED.OR CONSTRUED AS AN INSTRUMENT SURVEY. MORTGAGE LOAN INSPECTION DEED REFERENCE BK.3246 PG.320 IN 4 PLAN REFERENCE PLAN BOOK 295 PG. 99 �Q I CERTIFY THAT THE STRUCTURE ON THIS PLAN IS LOCATED AS SHOWN AND THE " , MASS. _ LOCATION CONFORMED TO THE ZONING LAWS OF THE CITY OR TOWN OF BARNSTABLE WHEN CONSTRUCTED. aA RA/-S7-A E5/--E COUNTY 1 HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN DOES NOT LIE SCALE: 1 APR 1 t- 6, 1986 WITHIN THE SPECIAL FLOOD HAZARD AREA AS SHOWN ON THE F.I.S.MAPS FOR THE CITY OR TOWN OF BARNSTABLE DATED APRIL 3, 1 978. I CERTIFY THAT THIS INSPECTION WAS PERFORMED IN ACCORDANCE WITH THE TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS ADOPTED BY JAMES C. VAFIADES—REG..LAND SURVEYOR THE MASSACHUSETTS'ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS. 256 WORCESTER LANE, WALTHAM, MASS. INC. No......................... FEs...Aa�U THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...TO.W99...........0F....40 Y. . .. !��... .............................. Appliration for BWVasal lVarkii Tatuitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (4+mn Individual Sewage Disposal systL1/.�_- .1. 1r..... .................................................... ------------------------------------------- - -----....------------------... JE .... y_�h_ , ...... �` ec- ........................ .....9�2 Y � '��C---..-.....------•---...-----• G.... ..... .✓•i... �,fL�.,,dress.....................•-•-•----•----•--..._. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............... ••------------- ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................:.. Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit._.____._....___.... Depth to ground water........................ a ••••----•--- ......... t 0 Description of Soil_.... 1 ?. /.. - ..........:..... - - X U ...-------•---•--•---•------------------•--•--------•-------------._....._........_...----._..._._.............-----------...._..----•---------•-•._...-----------------..._...-----•-••-•--•----.......- ----------------------------------•------------•------------.•--•-•----•-------•-•-•--•-•-----------------------• :----------------------...._•---- ---•----------•-•-•---....._•-•--_.... U Nature of Repairs or Alterations—Answer when applicable......... ...: 7-__ �__T-------------------------------- --------••----•---•---------••-•----------------------•----•-•-•-•..._...._.._..--•••••-•••--•------------------•-••------•-•-•----•---•-•-----------•-•-----•-----•--------------------••---•----...__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board health. Signed.._ 1�._._.__ .v./.:�.d. ._ ,e > D e Application Approved By............... -1 y/ ............................... �f J -`•'-.------••-•---- Date Application Disapproved for the following reasons---------------••----....---••-•-----._...-------------.._..--•------------------•---•----• ---........._•---.. ---------------------------------•----•-----•------•--••---...._...---...-------•-----.........._...._.........................._..-••--•------•-------------------- ••----•... . ----•-----•--- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Diopoial Warkii Tonitrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( 4-)-a Individual Sewage Disposal Systen)At: ................................................... ........•---••---•-•--............---••-•-- ••. ......•-••....-•-.........__.. 1 ion Address ----'k�,-4 �. l 1.. ...... j.................. ....... .......� ._� .. . ' r. ............................... Owder r ; 1 ' Ad.dress ....................... ------------------- Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms...............:................. .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............................ No, of ersons._...............•_........_ Showers — yp g p ( ) Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............. ..............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................_- ti, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......... .-----.---_--. Descriptionof Soil .. . . - '.J -•------------------------------•----------------- ............................ x c., x ------•-------- -.....................................................................................................................--.. ... ------------ - 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 TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board o iealth. Signed A:- `........ �_. .: ........... . ';_ ♦ ll Da Application Approved By.................. ........................ ,l..----- .......... Date Application Disapproved for the f ollot6ing reasons:•----•-----------•--••••--•--••-•-•--•••---••-•-•---••-•---•-••------•-----•-•------------- ------------------- f Date i� PermitNo.................................................... Issued.................•. { Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....� ..........OF........ .......................... Trr#if irate of Toutphatta THIS IS T ,.CERTIFY That tie Ind vidual Sewage Di Posal System constructed ( ) or Repaired y ire .... .-. ......... % w at --1 � f .. ----- -Sd- j --------------------------------------- ' �'��... . / has been in tailed in acckdarice with the provisions of TITLE r of The State Sanitary Code as described in the application for Disp sal Works Construction Permit No............ .. _.. , _... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM WIL FUN TION SATISFACTORY. d 3 � DATE---..1.. 1.. Inspector....... ... - - THE COMMONWEALTH OF MASSACHUSETTS ..... BOARD OF HEALTH No......... �'r � ............ J .......OF.......�..ti ll.5AP'1, ............................. Permission is hereby granted--------- t_ .._.. -��'1� ''' ?.... to Constrtt or e air -n In Sewage Dis o S stem yy�/ at Street as shown on the application for Disposal Works Construction Permit No....... Dated.......................................... rd of Health DATE ...........................-• ' FORM 1255 A. M. SULKIN, INC_BOSTON Ate, BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WHI IAM C.NYE R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering July 2, 1987 Town of Barnstable Board of Health P.O. Box 534 Hyannis, Ma. 02601 Dear Mr. Kelly: This is to inform you that we have been engaged by Cammett Builders to design a new septic system for the Marstons Mills Cash Market. The percolation test has been done and the design will be completed in a week or two. If you have any further questions please do not hesitate tto,,.call . VeryAAN y yours, William C. e, R.L.S. WCNlljp MEMEERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACXUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS i I I ' I� j l y I I I . I I Town of II Barnstable Board of Health r I. Attn: To m McKeon Barnstable MA �0264 9 I II RE: r Marstons Mills Cash Market Dear Sirs: vi We have c I. closed the cooking operation ait6r!Mt,'sited our store on a Tom .McKeon complaint regarding a grease' trap. . As you are aware that this store has been in, existe,nce for over fifty years and we are ' trying to ,update our entire store to meet State and local codes, . Presently, we do have plans 'to remodlellthe, atore and install an inground grease trap. We, have employed Cammett 'Con to do thew s work true. • We tion ask Your permission to allow us the installation of a temporary under the sink grease trap and ;continu'e operation , through the Summer at which time we 'shall commence with our new plans which will include a new sewage system and gt ease trap. f I Sincerely, 1 . I I I Antoine and Maria Madkour Marstons Mills Cash Market' I, I j I , I ' I y i. j i JOSEPH P. MACOMBER & SON, INC. BOX 66 - CENTERVILLE, MASS. 02632 - PHONE 775-6412 775-3338 Town of Barnstable Board of Health South Street ` Hyannis, Mass . 02601 February 21, 1986 RE : Marstons Mills Cash Mkt . Route 149 Attention: John Kelly Marstons Mills, Mass . Dear Mr. Kelly, In reference to the above place of business, Mr. Crosby has agreed to pump the existing sewage system twice a year . The reason for this is that there is not enough land area to expand the system and meet the Title - V code . The main problem is that there is a catch basin on the property which feed into Mill Pond on Route 149 . This catch basin handles the water from the gas station, restaurant and the apartments,/.-on Route 149. We could not install a leaching area far enough away from the catch basin which empties into Mill Pond without sewage seeping into the catch basin and traveling to Mill Pond . At this time there isn ' t a problem with the present septic system. Sincerely, Joseph P. Macomber & Son Inc . Joseph P. Macomber Jr. cc : Town of Barnstable Board Of Health Marstons Mills Cash Market October 19, 1983 Mr. Richard Crosby Marstons Mills Cash Market, Inc. Box 425 Marstons Mills, Ma. 02648 Dear Mr. .Crosby: You are granted an extension of time to expire January 1, 1985, to install an onsite sewage disposal system conforming to Title 5, of the State Environmental Code, and ehe 'town of Barnstable Health Regulations at the Marstons Mills Cash Market property, Route 149, Marstons Mills. This extension was granted because a 600 gallon leaching pit was installed recently to alleviate problems caused by an inadequate system. This extension is invalid in the event you have furthr problems with your existing system. If problems occur, you will be required to immedi- ately upgrade the system to conform to all State and local regulations. Very truly ours, Ro ert L. -1716s, Chairman An a Lsi ugh H. F. inge, M. D ' BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm '-MARSTONS MILLS CASH MARKET INC. DBA-CASH MARKET ROUTE 149 BOX 425, MARSTONS MILLS, MA 02648 TEL.(617)428-6620 d94 1 ✓�'�t 0 � vC3GtRh J /��/L . 3 v(AK p� old 7✓4a /9 Dl r of l t sit") � �N. �K��` ,�„�^ f...i•! �3�J per+►!/ Cis. c9 vim•. ��.,... �� H"Opt rJ a �•�`� �� J^0 w �a K �o•.� ��`� C k /V/G h, u,•,. J* eo 0 6% 40%V 61AW' i-r- Oft S , THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A , 1- I m / IL DATA TOWN OF BARNSTABLE LOCATION _ f ��C l9`9 �art� 'n�S ! .�' SEWAGE # VILLAGE)% . ZAB ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.j2g g k7,7-eo E6/s-r 3y SEPTIC TANK CAPACITY o2 0,00 LEACHING FACILITY:(type) (size) ./000 6AL NO. OF BEDROOMS PRIVATE WELL OK iUBLI6 WATER BUILDER OR OWNER Xk-�� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRAN ED: Yes No 0 + � k4� S LOCATION SEWAGE PER IT NO. VILLAGE INSTALLER'S NAME i ADDRESS t U I L 0 E R OR OWNER -es DATE PERMIT ISSUED _�� DATE COMPLIANCE ISSUED j la rs f'3 � 6 h7 P' � 1 71 Bellaire, Dianna From: Cash Matket <purbeliinc@gmail.com> Sent: Monday, December 07, 2020 10:46 AM To: Bellaire, Dianna Subject: Re: 20211 Food/Tobacco Permit- Cash Market Good morning Dianna State did not send me cigar license they said we can sell small cigar on the cigarette license I have send ocean street market application 2 days late so it might be on the way Bhakti still one of the serve manager With best regards Harkalas On Mon, Dec 7, 2020 at 10:41 AM Bellaire, Dianna<Dianna.Bellaire@town.barnstable.ma.us>wrote: r This is confirmation I have received your renewal for Cash Market. Can you please verify a couple of things . for me. Do you sell cigars? You didn't send me the license for cigars. If not, please reply to this email and I will make a note on the account. ? Also, I didn't receive the renewal application for Ocean Street Market. Did you mail or drop that off yet? .Please confirm if Bhakti Sitaula is still one of your Servsafe Food Managers. I have that certificate on file. If not, when you send in your Ocean Street Market application, you will need another Servsafe Food Manager. . i �1 Thank you. ' b Dianna Bellaite F i - Permit Technician Town of Barnstable r I Health Division 200 Main Street �µ ¢ Hyannis. MA 02601 . ' P508-862-4643 Fax508-790-6304 i Email:Dianna.Bellaire@,town.barnstable.ma.us NORTHWEST CORNER RANGE GUARD pq FIREN UISHER NET SPRINKLER EXT G SYSTEM CANISTER 24"'xb7" 24'" 2" 3-COMP M j 51NK SINK DN FRYOLA rip. 16nx30" I 4'"XS5' FRYOLA I fR SWELVES FLOOR DRAIN 36inx30n GRILL w i —HOOD ' - Z I2410X30n in i ® COOK TOP 24NT 0 AD _ J UP GAS—FIRED —� �uJ 44 X78 DOUBLE Q PIZZAOVEN 141_ " 10'—4n SODA 23'_Oln I REF. Q DROP CEILING I W 0 J -" TILED FLOOR I I SINKD BE w Q E J v I I Y Qo (L Ily32"xq6" - I Imo—DROPPED Z f LOW SOFFIT p[ v CASE I I ABOVE LL, J FRZR. } 24"x60" Q Q COUNTER 2"x32" 3011X84" V ELECTRIC MEAT MEAT REF. STEAM TABU SLICER RIND SHEET I OF I STORE I I DROP CEILING FLOOR FLAN WALK-IN I TICJLE STORE SCALE. 114" = V-01' G� obis DRAWN SY: KW DATE: 3/7/0fu 1 i NORTHWEST r �� CORNERcl —� RANGE GUARD I (/' \ EX I FIRE WET SPRINKLER EXTINGUISHER SYSTEM x Ili CANISTER 24"'x6711 2410 22" 3-COMP. MOD SINK I SIN D-N r—� I D 16"x3oll FRYOLA 4R 1(o"x30" I 241"xSSO Z FRYOLA lK FLOOR SHELVES z DRAIN GRILL HOOD 1t.IL� ,ux�n ,"TOUNT , �yL ® CO24OK TOP 24 O _ J EF UP U GAS-FIRED Q ul z 44"x7$" DOUBLE PIZZAOVE 10'—411 SODA 23'-pl11 I REF. Q DROP CEILING I W DELI HAND o Q J ZQ TILE FLOOR I I SINK w Q 1 I Y O N IL 32"xq6" I I<DROPPED Q Z OQC LOW CAS SOFFIT ID V FRZR. _ I i ABOVE > LL tIC� 24"x6O" Q Q COUNTER 211x32" 30"x84" U 1 ELECTRIC MEAT MEAT R F.DA E+TEAM TABLE SLICER GRIND II I SHEET I OF I STORE DROP CEILING FLOOR PLAN WALK-IN S I I COOLER I TILE OR R All SCALE: 1/4" = 1'-011 Al .�oB: obn DRAWN BY, KW DATE: 3/7/O(n y NORTHWEST CORNERDL RANGE GUARD 7EXIFIREWET SPRINKLER XTINGUISHER SYSTEM CANISTER 241"X57u 24"' 22" �` } 3-COMP. M SINK I SINK DN 1611x�11 I �_ � FRYOLA !ER 16°x3011 I 41tlx551 FRYOLA fR FLOOR ELVE 3(ornx3011 I DRAIN GRILL I n— HOOD 24 x30 ' 2410x601 � ® COOK TOP COUNTERO II o (0 - - UP. DOUBLE PIZZA OVENS 14°_ a [ T 101-411 SODA REF. • Q A. DROP CEILING I W DELI HAND BE ° d TILE FLOOR( I SINK W Q c I I � N (L 32"xg611 DROPPED Z (_ LOW SOFFIT 13 09 CASE I I ABOVE Lu - FRZR. > UJ to — W 24"x60" V COUNTER 2"x32" 301lx8411 ELECTRIC MEAT FrZIEAT REF $TEAM TABLE SLIGER IND , SWEET I OF 1 STORE I DROP CEILING FLOOR FLAN WALK-IN STORE : i/4" = i°—C7" /��J COOLER I TILE FLOOR SCALE � mil DRAWN SY: KW DATE- 2=0 Imo— j