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HomeMy WebLinkAboutEL MARIACHI LOCO - UNIT 12 - FOOD El Mariachi Loco 569 Main St., Ste.. 12 Y. HYAlJNj3 3v8- Iil-6� i FORMERLY � • • I I I ro o� Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAM91rAaLE F.P.(Thomas)Lee M, 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt. . ti 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: 875 Issue Date: 01/01/2022 DBA: EL MARIACHI LOCO OWNER: EL MARIACHI LOCO INCORPORATED Location of Establishment: 569 MAIN STREET- SUITE#12 HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutcloorSeating: 24 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - -— ------- MOBILE-FOOD: MOBILE- ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i For Office Ilse Only: Initials:' p� `% Town of Barnstable �- Date Paid gAnit Pd$ 0101) BARNSTABM ' Inspectional Services r- MAS6. T U P`ublic Health Division `'`� - Thomas McKean,Director: 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Par 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD.ESTABLISHMENT DATE 1/10/2022 NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: El Mariachi Loco ADDRESS OF.FOOD ESTABLISHMENT:569 Unit 12 Main St Hyannis MAILING ADDRESS(IF DIFFERENT FROM ABOVE); E-MAIL ADDRESS: Karinaaahzi@gmaii.com T.F.LEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 508)790 7.188 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION:_/J/_ TO /_/� NUMBER OF SEATS: INSIDE: OUTSIDE: 26 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?No IS AN AIR CURTAIN PROVIDED AT WA.ITSTAFF SERVICE DOOR(S)? Yes TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) XFOOD SERVICE _ requiring refrigeration/freezer) eration/freezer RETAIL FOOD-ONLY required for TCS foods rfy € g ) _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 QAApplicarion PonnsTOODAPP 2020.doc Scanned with CamScannee OWNER INFORMATION: FULL NAME OF WLtCANT Karina Hernandez SOLE OWNER: ES/ O D.O.B Og/10/89 OWNER PHONE# -,,364-49zn Ake ADDRESS 1 ch road west yarmouth 02673 c CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Karina Hernandez List(2)Certified Food Protection Managers AND at least(1.)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS.must have 1 Certified Food Protection Manager:PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date. I. .See atlach / l.✓" edlu.- �2�. g �2<5- v%4 i f�A Cf1�n4ez Li I g /�1 1/10/2022 / f S NATURE OF APP GAT BATE ***FOOD POLICY INFORMATION` S. ASONAL 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. I FROZEN.DAIRY DESSERTS: Frozen.desserts.must be tested by 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 tenn5 are met. CATERING POLICY: Anyone who caters withinth.e Town of Barnstable must notify thcTown by fax or mail prior to catering event. You must complete a catering notice found at http•//www townoLarnstable,.us/healthdiyisi.on/apblications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,.or display of any food product by a food establishment is prohibited.. NOTICE: Permits run annually from January l st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC.Ist. Q9ApPlication rormsTOODAPP RPV3--::019.dm Scanned with CamScanner I I 4� Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. � arxoee Paul J.Canniff,D.M.D. M F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 875 Issue Date: 01/01/2021 DBA: EL MARIACHI LOCO OWNER: MARIA KARINA HERNANDEZ Location of Establishment: 569 MAIN STREET, SUITE#12 HYANNIS„ MA 02601 II Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IncloorSeating: 6 OutdoorSeating: 24 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q/ FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �I For Office Use Only: Initials: � Town of Barnstable Date Paid Amt Pd$� CAB ,MASS : Inspectional Services 1 ,0�' Check# xIJ � A,Eo39�a Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL , p-� NAME OF FOOD ESTABLISHMENT �r(Z T `L��(, l�VCCC) ADDRESS OF FOOD ESTABLISHMENT: S()ck �/tc) cal MAILING ADDRESS(IF DIFFERENT FROM ABOVE): C/` E-MAIL ADDRESS: l►(1 � �1 ` coo1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO -- NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 1 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)?*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 FormsWOODAPP 2020.doc !f OWNER INFORMATION: ^/� FULL NAME OF APPLICANT \ nr I x r—y SOLE OWNERS ES O D.O.BqIL0122 OWNER PHONE# ADDRESS_1� CORPORATE OWNER: �> CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers D 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 \tea -0�T V 6W6 . V249�-26 IGNATURE OF AIQICANT 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/aoplications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc iME ro r, TOWN OF BARNSTABLE, - HEALTH INSPECTORS Establishment Name: Date: Page: of tio� OFFICE HOURS PUBLIC HEALTH DIVISION 6:oo-9i3oA.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,. �0� HYANNIS,MA 02601 MON.-FRi" e No Reference -R.-Red-ltem PLEASE PRINT CLEARLY 508-862-4644 .FOOD ESTABLISHMENT INSPECTION REPORT Name Da lype of Type of Insaection peration(sl Routine 10 Addre*T� -- Risk Food Service Re-inspection Lev Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: 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.ltems) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco " 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ VoluntarY Compliance Employee Restriction/Exclusion ❑ Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If I-criticalrefrigeration. 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: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N /-JAA #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature inY i Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ��f«-_.-__. .-..-. -,_•s. �.r.. - .:... R ...� ....- .-.. - - �r. ti � •^-e.a-.. s. �-. - .1.�. i. 3`-.-•-r � � -�v�.w-a�w++-.� r- -�._-�.- - .... •.. ..•.... ._. rp°+.ti,.r.; .... ° r•' �e -" _. ;-- ..-�--.-,......,. _�.. ._ Violations related to Foodborne Illness i Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) 4 and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302i11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F Applicants* Protection* 7-201.11 Separation-Storage 20 Time as a Public Health Control PP 3-302.11(A) Food O P Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003 F Res onsibili of A Food Em to ee or An 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 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-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg-rme 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 StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g• P 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(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* I 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity � ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 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 ( ) P25. Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities* Within 4 Hours* Management and Personnel FC-2 .003 Tags/Records:Fish Products P I Food and Food Protection FC-3 .004 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance ! Within 4 Hours* Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. oFTHE r TOWN OF BARNSTABLE HEALTH.INSPECTOR`s Establishment Name: Date: age: of 3�•.."�o OFFICE OURS .4 t16i1> PUBLIC HEALTH DIVISION 800-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/P OF CORRECTION Date Verified H b3 9. .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item _ PLEASE PRINT CLEARLY �OlEO MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT -- Name Dat TT De of Type of Inspection Address Risk', Food Service Re-i pE,etiefi Level e a pection Telephone/--,,C) ua� Residential Kitchen Date: �J�� Mobile Pre-operation Owner U 1 HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: s Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. L 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 C- ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities (/ _ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS t 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 f� 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 Holdin ❑ PP ❑ 9 PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIOOP) ❑ 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) U' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined.by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration.. y 29.Special Requirements (590.009) s o within 10 days f receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view q 'I V-�M & --1) Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N I� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' )gnat ri t: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 6� . Dumpster Screen? Y N iav� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 1I Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 � Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 3-501.16(A) Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 ,Food,Contact with Equipment and Utensils * ( ) � 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) _ Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) I 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. 1 g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb�i-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - 3-40L11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - *• Ratites-165°F 15 sec* in mobile food,temporary and residential Sources - - S. P ar>' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 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 n 24. Food and Food Protection FC-3 .004 3-402.1 1 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26: Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:59OFormback6-2doc *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 IME rq TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: e: of o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. ' 200 MAIN STREET 3:30=4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 639. ,�� HYANNIS, MA 02601 MON.-FRi. No Reference R- ej Item PLEASE PRINT CLEARLY �OrED MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORTAq_5 67. Name Date' e of T o ns ec ion era' s b G Address Risk od Service - Re-inspection Level a al Previous Inspection Telephone -- i o Residential Kitchen Date: ov Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness C,n_. '' Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP uAa- In: Other L Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ i ' Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands V ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities LA r 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) r ❑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 C41C Aal-, ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) AM ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ( l ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY \l ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ` V\ Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El N, El Yes Non-critical(N)violations must be corrected immediately or Overall Rating a\ within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 29.Special Requirements _ (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 3 .Other DATE OF RE-INSPECTION: Inspector's Signature Q_ _ Print: 31.Dumpster screened from public vievq 1<7 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' S' ur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ( i Dumpster Screen? Y N t Violation related to Foodbc me 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* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties- - - � - 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to - Other* _ g g 3-501.16(A) Hot PHFs Maintained At or Above 140'F* 7-102.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130`F* Require Reporting by Food Employees and Contamination from the Environment * ( ) 7-201.11 Separation-Storage* Applicants* * P g 20 Time as a Public Health Control - 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables - Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting.by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g' Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* __ 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112" Mechanical Wazewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water*" - - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Clean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ ( ) Eggs-Immediate Service 145'F IS sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg nme 11112001 4-602.11 _Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR'22.0* Contact Surfaces of Equipment*_ * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast 130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* -Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition- 2-40.1.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 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*17 to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45`F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* t S:590Forrnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PyoaIK ►E TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of o y OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 63q: `0 HYANNIS,MA 02601 M°"" FRi' No Reference. R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSP, CTION REPORT Name .L�� ,, - Date T e of T f I s ction - O o outine Address - �. Risk pod Se ', pection Level Previous Inspection AL Telephone ` Residential Kitchen Date: Mobile Pre-operation -, Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP y In: Other Inspector v�1I V�-' .y � � Out: _ I' C 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) ❑ fl I Action as determined by the Board of Health. Allergen Awareness 590.009(G) _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ,+ "" i . ❑ 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 V elIv 10 ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) C. ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures / ❑ 5.Receiving/Condition ❑ 17.Reheating Jk ❑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 LO Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) !%O Corrective Action Required: g ❑ No ® Yes Non-critical(N)violations must be corrected immediately or Overall Ratin within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically la hot C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within P within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Y� Print: 31.Dump ter screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC, Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N d I ( I Y Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions �, y Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS, 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties � 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH_. 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting b Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F q P° g Y7-201.11 Separation-Storage* 20 Time as a Public Health Control Applicants 3-302.11(A) Food Protection* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(]1) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* * Contamination from the Consumer 7-204.11 anitizers,Criteria-Chemicals* REQUIREMENTS FOR 3 590.003(D) Exclusions and Restrictions S 3-306.14(A)(B)Returned Food and Reted or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition ofAduttereted or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y Pe 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg cnw uuzom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* E_ ggs* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F IS sec* 3-201.14 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 3-401.1](C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3 401.12 Raw Animal Foods Cooked in a Microwavebo 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. Other o good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practices 0should.009 �be debited under olations relating t#29 Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(A)&(D) PHFs 165°F 15 sec* * 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11 B Microwave-165°F 2 Minute StandingTime* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.11 PHF's Received at Proper Temperatures ( ) (Blue Items 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 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* i 8 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 5204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 - 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fomrback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p IHE r TOWN OF BARNSTABLE_ _ HEALTH INSPECTOR,s Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 6:00-9:30A.M. BARNSfABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �m HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. 508-862-4644 rED 1A FOOD ESTABLISHMENT INSPECTION REPORT Name Date-7 / Type of TInsr)ection VA G6 l n uti Address Risk spection Level ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC F Time Bed&Breakfast Other In: Inspector ,fin Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. S 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 &57 4 s EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Y" ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑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) 29 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY I�❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Lil Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No [:]..YesNon-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction-Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4�non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 8non-critical violations=C. 29.Special R uirements (590.009) y p - 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump er screened from public view nw Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N (J✓ #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 1 Dumpster Screen? Y N Q 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* _ g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* Separation-Storage*P g 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 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* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water ]Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg c"°e iuiZooi 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 Cough[Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods 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* - Ratites-165°F 15 sec* i_ng,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* ( )( ) p Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave - the appropriate sections above if related to 3-202.18 Shell stock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating, Requirements. 5 Receiving/Condition g,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:Shelistock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs ' following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 ' 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from,Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,O ration and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.N¢roh TOWN OF BARNSTABLE HEATH wsPECTOR s Establishment Name: ,�, G cG 1 �u t d Date: 13 �Page: of ~o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � 679. �•� HYANNIS, MA 02601 - M-8 -PRI. No Reference R-Red Item PLEASE PRINT CLEARLY'rFo MP+° 50862-4644 ° FOOD ESTABLISHMENT INSPECTION REPORT _ Name L Date T e o f Ins ec io ullilg Routi e r i t G Address Risk oo S e-inspection d/ Level Retail Previous I spgction Telephone Residential Kitchen Date: (�j�/'� p Mobile Pre-ope/aGd'n( Owner HACCP Y/N Temporary Suspect Illness 1 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector _ Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items)( Anti-Choking 590.009(E) ❑ , Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) / ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating t (A ❑ 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 r ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATION (HSP) ' ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP G✓ f ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �I < ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations C Critical(C)violations marked must be corrected immediately. (blue&red items) Corre tive Action Required: ❑ No files Non-critical(N)violations must be corrected immediately or Overall Rating ��j within 90 days as determined by the Board of Health. I � oluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency SuspensionC N Official Order for Correction: Basen inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If)01 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the•above address violations observed,7 to anon-critical violations. If-1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe is Si re P n. 31.Dumpster screened from public view i (/� t/1 �� ✓I J Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ign ee Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �l e---_ f Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-1 3-501.16A) Hot PHFs Maintained At or Above 140°F* (02.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* Applicants* � 3-3023 7-201.11 Separation-Storage*1(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 7-202.11 Restriction-Presence and Use*Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* - - - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Roden[Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 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,Meals&Game Pathogens* effe°"°e uuzaoi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F l5 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165'F 15 sec* in mobile food,temporary and residential Sources g� P azY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A g 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 3-402.11 Parasite Destruction * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* i 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. `gyp INE►ok� � TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: f i ('411 Ldc-o Date: o' Page: _of OFFICE HOURS BARNSTABLE. PUBLIC 2 0 MAN STREET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � MASS . `0$ HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY„rF FOOD ESTABLISHMENT INSPECTION REPORT 508-862�644 N� l . Name q rl� o Cd Date c Type of of'Ins ec ion io Routine -4 d Se Address tiro Risk Foo pection Level a ail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation c� Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP L (, In: Other Inspector f/�►rf' ` Out: V" Gi '60 e- 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 ) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11..Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 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 o 6 non-critical violations 9 26.Water,Plumbingand Waste if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food.establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation, 0 8non-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Insp ,tor's 1 - Ig ature nnt: 31.Dumpster screened from public view J 44D 41 N-X Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 144 / Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* _ 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * _ 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) *- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* - '"'" 3-302:11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An _ _ .3-302.15 Washing Fruits Restriction-Presence and Use*its and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements_ _ 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR _ 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. LL6 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective fnrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source -- 3-401.1 I(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-15YF 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section.590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under -Hands and Arms*Condition 11 Clean Co. nn the appropriate Regulatory Authority 2-301 3-401.12 Raw Animal Foods Cooked in a Microwave PPriate sections above if related to P 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23.30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands E * Critical and non-critical violations,,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11( ) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs, following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other r3-502.12 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 Hem in the federal 1999 Food Code or 105 CMR 590.000. pptNE rpw &,-T-OWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: �/Y► �-�J'/ h�"� �te: Page: of v` 10 / ofP OFFICE HOURS J_ .:I1� PUBLIC HEALTH DIVISION � 8:00-9:30A.M. anaNsrne�e. t200 MAIN STREET 9(\� 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1639- ,0� HYANNIS, MA 0260 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY '°rFo MPS a' 508-862-4644 FOOD EST BLISHMENT INSP C 10 REPORT Name Date Type of Type of Inspection r Ro ' Address Risk od Servi e-inspecti Level spection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint a Person in Charge(PIC) Time Bed&Breakfast HACCP ; ) Other Inspector Each violation checked requires an explanation on the narrative ages)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 �MW ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY a ❑ 11:Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical..(C)violations marked must be corrected immediately. (blue&red items) `1� Corrective Action Required: ❑ No ❑ 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 b a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004 P 9 y 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4pon-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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-criti al vio !ions. If 1 critical refrigeration. within 10 da s of recei t of this order. ,4 to 8 non-critical viola' s= 29.Special Requirements Xy (590.009) Y P 30.Other DATE OF RE-INSPECTION: In ctor's Si a Xe /® ,n Print: / 31.Dumpster screened from public view -Z-M k�'; Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N I #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 t Dumpster Screen? Y N Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) +� r FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled[0 41 F Within 4 Hours* for P 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage Time as a Public Health Control Applicants 3-302.11(A) Food Protection* 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * s ecnvr 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155"F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.1 l Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and e ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential ' 10 Proper,Adoquate Handwashing 3-401.11(C)(3) Whole-muscle,Litact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es should be debited under#29-Special violations relating to good retail practic )3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 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. All A F IHE ro l:+ Date: Pa `o cry w OWN OF BARNSTABLE H FF�INSH ECTOR'S Establishment Name: age of p�+ o ��1 CE OURS UBLIC HEALTH DIVISION �1�' 8:30-4:30A.M. BARN ABLE. 200 MAIN STREET �:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified La MASS. i639• ' © 0� HYANNIS, MA 02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY erF p MAy° � 508-862-4644 FOOD ESTABLISHMENT INS CT ON.REPORT b Name , Date a of Type of Inspection Routine 10C NOV Address11 isk Food Servic Re-inspection Level Previous Ins �j�`p Telephone Residential Kitchen r Mobile Pre-operate _r r Owner HACCP YIN Temporary Iness 91, Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP © Other J Inspector Each violation hecked requires an explanation on the narrate a 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 y/ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additivesrlyr)D ` J kftj❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals g FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures FZA S ❑ 5.Receiving/Condition ❑ 17.Reheating I ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 9 ❑ 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) 61 ❑ 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 a Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 1 �� Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating VVV within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo Emergency Closure checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ 9 Y ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below b a Board of Health member or it agent 24.Food and Food Preparation (FC-3)(590.004) P g y s a 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=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- riti cal. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non critica, iolations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical vi atio � C. 29.Special Requirements . (590.009) Y P 30.Other DATE OF RE-INSPECTION: In p or"s Sig a ur a' rin 31.Dumpster scre ed from public view 1 1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N r #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's ignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) * �' FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 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 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 7-201.11 Separation-Storage* 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 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* pP Y Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * Effective inrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.1l(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIALREQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in ca[er- Sources* Ratites-165°F]5 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By L2-301.12 .11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004 C Wild Mushrooms* .14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es shoo violations relating to good retail 3-201.17 ) Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under tY29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/t 6-301.11 lHandwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Ai 4 � k � I pr. Z i ra F• x.r f' 1 Y � •..e K' 1: y: s 4 dT I f 1 y . . 'g y � �.- -� - _ _ -., _ ��::� '�` ,gym ,� • a: k �.. G C Y/)n t w• s+r" h i �y r. J' y x j w r T a v f . All- cp T ) .CeAROS ENCHILADASIf a t. 3 GROUND BEEF HARD 3 corn tortillas smothered in a guajillo salsa or tomatillo 9 � � salsa with cheddar jack cheese,topped with lettuce,sour $ Tyr SHELL TACOS or shredded chicken 12.99 i Cream.and queso fresco,served with rice and beans ry�� With a side of rice or french fries 10.99 92. t BURRITO, AND A j CHEESE SMALL CHIPS AND SALSA 13.99 GROUND BEEF OR CHICKEN 12.99 (steak,chicken.ground beef or carnitas) VEGGIE ENCHILADAS 12.99 ? ;`' 43. 2 STEAK TACOS Any street style Tacos 11.99 i _ a with a side of rice and beans SEAFOOD ENCHILADAS y. `l #a. t ANY BURRITO 12.99 � 3 corn tortillas smothered in salsa verde with sauteed shrimp,crab meat. I with french fries p/� onions,cilantro,sauteed peppers and garlic,served with Rice. #s. a TAQUITOS 11.99 1 and beans 16•95 �y with aside of rice and beans #b. a TACOS 15.99 MOLE ENCHILADAS I �� (steak,chicken,ground beef,carnitas) 3 corn tortillas in a mole sauce filled with chicken.topped #7. CHILAQUILES IN SALSA with sour cream,onion,and queso fresco served with rice 12.99 And beans s j VERDE OR SALSA ROJA 12.99 l with chicken and 1 egg topped with queso fresco and sour cream P LATO S #a. ! served with i flour tortilla or 3 Corn tortillas,rice, ANY BURRITO 13.99 j beans,and a side of guacamole with a side of rice and beans Your choice of 449. 3 EMPANADAS 11.99 f CHICKEN FAJITAS 13.99 with a side of rice and beans s STEAK FAJITAS 14.99 rr' t #to. z TAMALES PORK OR STEAK 9.99 with a side of rice and beans j CARNITAS IN SALSA VERDE 12.99 FREE WATER OR CAN OF SODA WITH ANY COMBO CARNE ASADA (Grill Steak) 14.99 —no substitutions— f i. STEAK SHRIMP FAJITA 15.99 . ., TOSTADAS ' CAMARONES A LA DIABLA 15.99 , s shrimp smothered in our salsa de arbol Crispy corn tortilla•layered with your choice ; served with rice.salad and avocado slices of meat with refried beans,lettuce,salsa, 7� s sour cream,and queso fresco CHICKEN OR GROUND BEEF 8.00 ' r TAMALES " � i STEAK 8.50 f VEGGIE 7.00 RILE ' n C S RELLENOS � - 4 Egg battered roasted chile poblano,stuffed with queso I r ,t•� , fresco on a bed of rice with tomato sauce,topped with 12.99 i ~ CALL AHEAD Queso fresco,side of beans . y 1 w ON: SUMMER HOURS Prices are subject to change _ �� `ri 11 AM TO 10 PM , � f 7m i WINTER HOURS *BEFORE PLACING YOUR ORDER INFORM YOUR � e6nanadu(oco7l LLt SERVER IF A PERSON IN YOUR PARTY j HAS A FOOD ALLERGY 11 AM TO 9 PM oa yAWMQI' q . u � f_ nlm»r�arhilnrolryann�s�c s (\ r r' 508' T7� - 90 71J98� Ak -0 0 its '\569 MAIN STREET HYANNIS, MA APPETIZERS FISH:,.-O.R TUNA TACOS FAJITA TACOS,-- !V -' MEXICAN STREET CORN ON THE B 3.99 6heesu.pica do gatlo,shrodded cabbogP. SaUt4Pd veggies topped with SHAVED CORN SM eoz 4.99 LG„Oz 6.99 Drizzled with special lime sauce ' Guacamole and sour cream CHICKEN TAQUITOS (s) 8.99 FRIED FISH OR FRIED SHRIMP' 4.50 CHICKEN 5.99 RICE OR BEANS 3.00 i; GRILLED TUNA 5.50 I STEAK HOMEMADE GUACAMOLE SM oOZ tG 160Z MARKET PRICE; HARD OR SOFT SHRIMP 5.49 With chips 5.99 CHIPS AND SALSA - 4.99 HANDMADE TAMALES (ea) 2.99 SHELL 3.50f SEAFOOD Pork Chicken or steak GROUND BEEF ! BURRITOS FLOUR EMPANADAS (a) 10.99 i SHREDDED CHICKEN Chicken,ground beef,carnitas,steak and veggies Cheese,salsa and lettuce. CHICKEN TENDERS (4) 10.99 1 Cheese,cabba e,salsa and our ecial lime sauce £ With side of fries VEGGIE TACOS FISH g P 11.99 SIDE OF FRIES 3.50 Sauteed veggie fajita mix, 3•S0 SIDE OF CHIPS 3.00 It Zucchini,cheese and refried beans. SHRIMP 11.99 MEXICAN SHRIMP COCKTAIL large 15.99 It NOPALES (CACTUS) 3.50 Small 11.99 k Tossed with tomatoes,onions,topped DESSERTS CEVICHE TOSTADAS off the day QF THE DAY �I with queso fresco and refried beans. �. FRIED ICE CREAM 8.00 NACHOS QU ESADI LLAS CHURRO 2.99 A stack of corn chips topped with QUESADILOCA 12.99 CHURRO WITH Melted cheddar and jack cheese,salsa ,' (chicken or steak with guacamole,lettuce, f SIDE OF ICE CREAM 6.00 I Beans,black olives,sour cream + Pico de gallo,sour cream and queso fresco) Guacamole,and jalapenos STEAK 1a99 DRINKS CARNITAS, STEAK, GROUND BEEF 1 II OR CHICKEN 12.9Q1 CHICKEN FAJITA (Onion and peppers) 10.99 JARRITOS I�!. 3.00 CHEESE NACHOS 6•ggI# STEAK FAJITA (Onion and peppers) 1 1.99 (mexicdn fruit flavored sad,,) f , ,: i� EXTRA SIDE OF GUAC 2.50 CHIICKEN 9.99 HORCHATA M. �14P 3.50 CHEESE 6.99 ! I.G. 7.00 SALADS ) VEGGIE (Fajita mix and zucchini)) 7.99 1 WATER 2.00 A bed of lettuce.salsa.bell peppers,Cheddar jack ;{j SEAFOOD 12.99 CAN SODA " 1.50 cheese,queso fresco,With a lime vinaigrette. f (shrimp,crab meat sauteed garlic, Choose your Topping Pico de gallo and peppers CHICKEN 8.75 •' ' ? �� N, ::` ,, ` • ••� CARNE ASADA 9.25 �' BURRITOS SHRIMP 12.99 � Your choice of flour tortilla or burrito bowl ® f� • With cheese,beans,rice,lettuce,salsa and sour cream. SrALAD NO MEAT 4.99 STEAK A LA MEXICANA CON JALAPEkOS 11.99 '1 O RTAS I CHICKEN OR GROUND BEEF 8.99 f Your choice of meat on A french roll with i STEAK IN CHILE ROJO 10.99 * ,Lettuce,tomato,onion.Jolapenos,beans, ) CARNITAS IN CHILE VERDE 10.99 ' Mayo,fried cheese and guacamole �} 9.99 I A y g i STEAK CHOICE OF CARNITAS, STEAK, i CARNITAS,VEGGIES OR CACTUS 8.99 � �� t CHORIZO, AL PASTOR OR CHICKEN 11.99 kj CHICKEN MOLE 10.99 '� TACOS STEAK FAJITA WITH JALAPENOS 11.99 f �4 ` � " � � ,; �,; • AL PASTOR - ;P �1 (pineapple pork) 10.9r a°� fis apt t �s Street style tacos served on z soft �, CHORIZO BURRITOS 9.9 ..,} . , , ;. "- ' ' .�. t �� corn tortillas with diced cilantro,onions and slice of lime 3.99 hI ADD EXTRA MEAT 2.00 ' ` •' CHICKEN, CHORIZO, CARNITAS 9 STEAK, AL PASTOR 4.50 �j ADD GUACAMOLE Z50 " 4 CHIMICHANGAS Important:consuming raw or uncooked meats,poultry, V 11�'; 10.99 gnjy (Chicken,steak,carnitas and veggies) ' �� / seafood,shellfish or eggs may increase your risk j of foodbourne illness { B1I,RRITO CALIFORNIA 10.99 { rf (Ste{wk or Chicken) ',Fl DESIGN BY ;j Cheddar cheese,guacamole,F.F.,Pico de gallo and queso fresco W-SUperdesigns.org 401-431-30445J g P g q CHILES RILLINS it �y I Town of Barnstable BOARD OF HEALTH I. John T.Norman + Board Of Health l Donald A.Gaudagnoli,M.D. BARNSr BLF Paul J.Canniff,D.M.D. 1�3q. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ask 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: 875 Issue Date: 12/10/2019 DBA: EL MARIACHI LOCO OWNER: MARIA KARINA HERNANDEZ Location of Establishment: 569 MAIN STREET, SUITE #12 HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutdoorSeating: 24 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qn FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oFIKKE T Initials: Town of Barnstable 12 Y" �' Date Paid 1J Amt Pd$ �,,, �.AB� Inspectional Services Check# � 4 ' Public Health Division `' '°�fo M►.y 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 ! l l NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: &adn1c' ADDRESS OF FOOD ESTABLISHMENT: 7SLq M,1'1'►Q ST- MAILING ADDRES (IF DIFFER�ENT FROM ABOVE): E-MAIL ADDRESS: ( i I \ PA �Ud)o - v TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - v �� TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) f ANNUAL: SEASONAL: DATES OF OPERATION! / /&O NUMBER OF SEATS: INSIDE: OUTSIDE- TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALL R'S LICENSE OM LICENSING DIV. i ***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 APPLI BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc OWNER INFORMATION•FULL NAME OF APPLICANT %f 'f� s SOLE OWNER: YE<GNO D.O.B OWNER PHONE# ADDRESS_ 7slJ"1 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date l r I�- 2. pv i OG 0U_RPLICA T DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsWOODAPP REV3-2019.doc I �*r 7 Town of Barnstable BOARD OF HEALTHPaulJCanniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARN STABLE. John T.Norman Ma&i :$ F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A;. Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 875 Issue Date: 01/25/2019 DBA: EL MARIACHI LOCO OWNER: MARIA KARINA HERNANDEZ Location of Establishment: 569 MAIN STREET, SUITE #12 HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutdoorSeating: 24 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-'FULL BREAKFAST: CONTINENTAL BREAKFAST: — - -- - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Seats: 6 inside, 22 outside -Total 28 seats `d �IKE�y, Only: Initials. Town of Barnstable • Date Paid Amt Pd$ 9 9BARNSTABLE, Inspectional Services �v �. T i639• ♦0 Public Health Division Check Cash 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 I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: I ' ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: QMPA 1 1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: qo TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO K ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION/DJn 170 ADD I NUMBER OF SEATS: INSIDE: AQLOUTSIDE: (O TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENS 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 APPLi BELOW) NE f OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FormsTOODAPPREV2018.doc } y PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/N OWNER PHONE #Sb� ► / ADDRESS �B CORPORATE OWNER: C1 L ID NO. CORPORATE ADDREMAYAS) Vl PERSON IN CHARGE OF DAILY OPERATIONS: Z _ 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 f 2. t SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsTOODAPPREV2018.doc COMBOS o -r CHILES RELLENOS ariachi Egg battered roasted chile poblano, stuffed with ` M LQC #1. 3 ground beef hard shell tacos with a side of queso Chihuahua on a bed of rice with tomato �I Q rice .............................................................13.00 sauce, topped with queso fresco, side of beans #2 1 burrito, and a small chips and salso (steak, 11.99I chicken, ground beef or camitas).............. 14.00 #3. 2 steak tacos with a side of rice and beans t ENCHILADAS t i ....................................................................11.00 3 corn tortillas smothered in a guajillo salsa i #4. 1 fajita sub with a side of fries ............11.00 with chedder jack cheese, topped with lettuce, #5. 5 taquitos with a side of rice and beans sour cream and queso fresco, ....................................................................12.00 served with rice and beans Mexican Restaurant #6.4 tacos (steak, chicken, ground beef, Cheese .......10.99 ...................... camitas) .....................................................15.00 Gound beef 11.99 ............................................... #7. Chilaquiles in salsa verde or salsa roja with Chicken 12.99 CALL AHEAD chicken and 1 egg topped with queso fresco, and sour cream ..........................................13.00 -0 SEAFOOD ENCHILADAS -0 OPEN 11 AM-1 OPM #8. Chicken Mole burrito with a side of rice and 3 corn tortillas smothered in salsa verde with YEAR ROUND beans ..........................................................12.99 sauteed shrimp,crab meat, onions,cilantro,and All combos served with 1 canned coke, garlic, served with a side of rice and beans...16.95 Winter hours Wednesday-Sunday 11-9pm bottled drinks are an additional$1.50 4% MOLE ENCHILADAS - If TOSTADAS -03 corn tortillas in a mole sauce filled with chick- SO8.790.71 gg en, topped with sour cream, onion and queso FACEBOOK.COM/ELMARIACHH.0001 I Crispy corn tortilla, layed with your choice fresco served with rice and beans ............. 12.99 of meat with refried beans, lettuce, salsa, sour cream, and queso fresco t PLATOS -? 569 MAIN STREET HYANNIS MA Chicken ........................................................8.00 Served with 1 flour tortilla or 3 corn tortillas, Came azada .................................................8.50 rice, beans and a side of guacamole, your Kian& El Mariachi Ground beef .................................................7.00 choice of Came azada, chicken fajitas, steak Rylees Loco Veggie .........................................................7.00 fajitas,carnitas in salsa verde or 2 chicken flautas �—Main Street Hyannis — Refried beans 6.50 Katie's Ice Cream t DRINKS -�f DESSERTS -0 Fried ice cream 7.00Facebook -r JARRITOS (mexican fruit flavored soda) ..........2.50 Churro 2.50 HORCHATA ...............................................3.00 Churro with side of ice cream .....................6.00 .WATER .......................................................2.0o Ask About Our Catering PLACING YOUR ORDER INFORM YOUR SERVER IF A PERSON IN YOUR PARTY HAS A FOOD ALLERGY APPETIZERS r TACOS .f BURRITOS v Street style tacos served on a soft corn tortilla Flour tortilla with cheese, beans, rice, lettuce, Chicken Taquitos(5).........................................7.99 with diced cilantro and onion salsa, and sour cream. Cbile ground beef and black bean ...................5.00 Chicken, Chorizo, Camitas 3.99 ............................ Mexican rice(16 oz) 4.00 Steak, Al Pastor .............................................. 4.50 Chicken, ground beef, veggie ..........................8.99 Refried beans(16 oz) .....4.00 Steak in chile rojo ......................................... 10.99 i '"""'""""'""'"""""""""' -�� FISH OR TUNA TACOS -�'� Camitas in chile verde .................................. 10.99 Homemade Guacamole with chips.... Market Price Cod fish or tuna steak with cheese, pico di gallo, Came azada .................................................... 9.99 Chips and Salsa ............................................ 4.99 shredded cabbage, drizzled with our special sauce Camitas ............................................................8.99 Handmade Tamales pork or steak 3.50ea Fish 4.50 Chicken mole .................................................10.99 .............. ................................................................. Flour Empanadas chicken or ground beef... 4 for10.99 Tuna ................................................................ 5.50 Steak Fajita with Jalapenos ............................10.99 Chicken tenders (5) with side of fries ..............9.00 - s GROUND BEEF TACOS Al Pastor ........................................................10.99 Chicken Wings (8) with side of fries .............10.99 1 SEAFOOD BURRITOS -� Served on a hard shell or soft corn tortilla with cheese, salsa, and lettuce ................... 3.50 Cheese, cabbage, salsa, NACHOS V and our special sauce VEGGIE TACOS �'� Fish ................................................................10.50 A stack of corn i chips topped with melted cheddar Tuna ...............................................................13.99 P PP and jack cheese, salsa, beans, black olives, sour Sauteed veggie fajita mix, zucchini, cheese and Shrimp ...........................................................11.00 cream Guacamole, and jalapenos refried beans ....................................................3.50 Extra side of Guac 2.50 1 QUESADILLAS •? -n NOPALES (CACTUS) TACOS V Carnitas, steak, ground beef, or chicken ......12.99 Roasted paddle cactus tossed with peppers, onions, Came azada .....................................................9.99 tomatoes, topped with queso fresco ................3.50 Chicken fajita ................................................10.99 SALADS -�`� „� FAJITA TACOS V Steak fajrta 11.99 - A bed of lettuce, salsa, bell peppers, Chicken ........................................................... 9.99 chedder jack cheese, queso fresco, Sauteed veggies topped with guacamole and sour Cheese ............................................................ 6.99 with a lime vinaigrette. Choose your topping: cream Veggie 7.99 Chicken ................................................. Steak 4.99 Seafood ( shrimp and crab meat sauteed garlic, Ncipales (Cactus) ................... 8.00 ............................................................... ......................... Chicken .......................................................... 8.25 Steak and shrimp ............................................ 5.25 onions, cilantro, and tomatoes) .................... 12.99 Curve azada .................................................... 9.25 Shrimp ...........................................................12.99 TORTAS IMPORTANT Tuna Grilled.....................................................13.99 Your choice of meat on a French roll with lettuce, CONSUMING RAW OR UNCOOKED MEATS, Taco (ground beef) ........................................10.99 tomato, onion, beans, mayo and avocado slices. POULTRY, SEAFOOD, SHELLFISH, OR EGGS MAY Taco other meat .......................................... " ' "" " 11.99 Camitas, steak, chorizo, al pastor .................10.99 INCREASE YOUR RISK OF FOODBORNE ILLNESS ( ) "" Prices are subject to change TOSTA®AS CHOLES RELLENOS Flat corn tortilla with your choice of Battered Chile Poblano on a bed of Rice Cheddar Jack cheese diced tomatoes,onions, meat served with refried beans, lettuce, with tomato sauce,topped with queso fresco black olives,sour cream,guacamole and jalapenos. Shredded pork $12.99 pico de gallo, sour cream and queso fresco Stuffed with Queso Chihuahua $11.99 Gei&ud;Beef d_ ,a A$12 99 Chicken $7.50 ea. St`uffed=with Shredded Beef $1299: steak $12.99 7 hicken $12 °-.99 Carve Az ida r:g _, $8.50 ea. A Ground Beef $6.50 ea. ❑ r ��� OLA®AS � ® �„� S ea Small2.5 3 Corn Tortillas smothered in Guajillo Salsa Mexican Rice Lar e Refried Beans np (�$6.50 ea. with Cheddar Jack cheese,topped with lettuce, 94.50 S�L�.�®SSma11ls$250Ls . sliced tomatoes, sourcream and queso fresco Refried Beansg '� i VC-IJ9, Aso, Iceburg lettuce, tomato wedges,_peppers, with-aside of Mexican Rice and Beans _ ,,,��i..r CliickenA�, 16 95 Mexican c Re rid Beans 2.9 cheddar jack'cheese and quesofresco $ - can I e e e _ �� , Cheese. , , $14.95m, . with our .Iimesauce dressing , � ;PICOdBu,Gallo,Wlth ^ChIpS Chicken „ r ,�$7.25 0 � [ � Nr���~��� � Homemade Guacamole with Chips S`Y'g" $$-5o Lar e $a2.00 Cane�A�zada 8:25y �.. r �. � , x , .. tfSEAF Corn Tortillas smothered in salsatverde MexlcanrCornonithe cob $250= Nogales , ti$6.99;`' -wig sauteed shnmp;crabmeat,onlons` cilantro Shaved Corn Small $7.95 irlJ.* ! 1 �✓ I $ Large $1'1.95 -Tuna � � $7?-99 and garlic vrltha slde.of Mexican Rice and Beans 8{50 * , • , } `� CHURROS ShrimpSauteed with garlic;on top of iceburgiettuce, �-.. � { Fried dou h sorinkled with cinnamon su ii to ato edges,:queso frescol`black beans and �®�E ENCH,H A®AS g P g nr �,5o a �, f ,�, sugar and a side of ice cream ., . croutons with a sdeof bue,cheese dressing. 3 Corn Tortillas iii Sauce filled with MEXICAN HOT CHOCOLATE $4.00 sesame seeds and aside okf Mexican Rice and Beans FRIED icE cREAnn , ; $6.00 ,., Q. �J�� $10:99 > A MEXICAN BOTTLED COKE;SPRITE;ORANGE FANTA $.2:00 Your choice of meat served with one flour tortilla JARR TOs ._ $2 00 (TA MALES AQUA DE,HORCHATA�, AMAICA $1.75 or 3 corn tortillas;MexicanRRic refried beans 2 Homemade Tamale, -•�� �, of Mexican Riceland Beerved ans Borneo„wATeR �� �5�p ���� ��.v $, and a side of Homemade Guacamole 5 Carne AzadaT(� harbroil)d) $12.99 Pork in Salsa Verde $10.5o Bread pudding made with milk, egg whites and cinnamon, topped with strawberry of caramel Steak in Gu $1-1'.50" ChickenTMFajitas $12:99 at�llo�Sauce �,�r :�������wM�,.�.-_ sauce and a side of ice cream. $3_00 Steak Fajitas , $12.99 ► 1 M 0=11® Fz-rAk"-ir TUNAOR SALMON PLATE Consuming raw or undercooked meats poultry,seafood,shellfish Carnitas in Salsa­Verde'---'$1`�•99 t' or eggs may increase your risV of foodborne illness, Your�choice'of Salmon-or Tuna served Mancha ManteleS � especially if you have certain medical conditions. on"a bed of rice with=our Ina le or mango salsa. ,. T� p pp g If you have any food allergies,dietary restrictions or sensitivities (Steak in°Guajillo Salsa► $12•50 I una� $14.95 please let your chef or server know and we will make every effort to accommodate your needs. Please be advised that special requests 2 Flautas (Chicken) $.1 •oo val mon a may require additional time to prepare and additional charges.If you $16 50 have food sensitivities,meats and seafood should be ordered _ .-� ---M `� -- - -- - ___ __ _ :M_.___ _ _.._ thoroughly cooked. 44 - t �A�OO BURR0703 All Tacos Served on a Soft Corn Tortilla Served on a flour tortilla with ' Served with diced cilantro and onion cheese, refried beans, rice, lettuce, AC Chicken I $2.99 ea. I pico de gallo and sour cream Sneak $3.50:e Chicken . Ca h $8 99 Chorizo _ - - $199,ea6, GroandYBee � $8.99 ..4x Ve ie f 3 $8.99 CarnitaS $2.99;ea. g .'. iSn 99tk 9e 0S[1-t1' Q� S � ; Carnita in Chile Verde '$9.99 - t .. Served with cheese, Pico de gallo 1 a cabbage and limesauce cream Caine Azada $9.99 r 4 z , s' f . � ]Q TA CI `� Your choice`of meat on a French roll . Served with cabbage and mango sauce with lettuce;tomato, sliced onion, ' or Pico de galio with limesauciVeream refried_be In rnayo and avocado slices., ,,,, '- i � �Breaded Ch ksn) � Milane�a, $9.99 �.,. � Carnitas-- $10.99 t GROUN���EEF TACOS ; ,teak, � $10 99 Served on a hard shell or soft corn �DSH BUAR070 tortilla with cheese, pico de gallo and lettuce f ,, --. r Served with cheese,,cabbage ea u F '--pico°de gallo-and'limesauce ram,1_ , a Served with cheese, re\fried,beans , sauted peppers,zucchini, onions and cilantro . Carve Azada $9.99 � ®AOLY SPECOALS �" r E _ - Fatita (Chicken) 'L $10:99 i. R Fa,ita (Steak) . $10.99 ®PEN 7 DAYS A WEEK Served with mixed vegetables, Chicken guacamole and sour cream Cheese `mil $6.99 Chicken $3.99 ea. Veggie = $7:99 69 MAIN t S Shrimp ft Crabmeat 1 teak _ - $4.99vea Garlic, onion, cilantro and 5 T Chorizo $5.25 ea. tomatoes sauteed in olive oil $11:99x HYAN N IS, MA 02601 s I Pd $5.00 6/14/85 Map #308110000 TOWN OF BARNSTABLE WATER POLLUTION CONTROL DEPARTXENT APPLICATION FOR SEWERAGE PERMIT Permit NQ 1879 ,ego• ` 0�►Y owner of the Estate hereby Full Name apply for a sewer connection from for the purpose of draining the following: Street and No. Water Closet .___ Shower —__ Urinal Other If Sink Lavatory Bowl __ — Dish Washer _.._------ Other Bath Tub Set Tub .__..... .____ - Washing Machine ___-. Other ---- --- to the common sewer on ...Min_.St....._.....................__ EXPIRES 7/14785 Fixture Rate ❑ Street Meter Rate ❑ INSTALL GREASE TRAP @ FABIO'S a. And the undersigned further agrees to strictly conform to the Laws and ordinances relating to sewers, and to the rules and regulations that are now in force or may be adopted in. relation thereto, and also to the plumbing laws and ordinances so far as they relate thereto. b. And the undersigned further agrees for himself, his heirs, devisees and assigns, that the said Water Pollution.Control Board shall have access at all reasonable hours to the said premises, to see that all the laws, ordinances, rules and regulations relating to the sewer are complied with. / I Owner's Signature '���'�' cJ/� •� Accepted _.__-.___ _....._......._ _ _.. __ .__ _._ ._ Address •-Date By __.___...__.._...___..__ ___r_ ...... Agent/Attorney Contractor's Signature _-- — — ---- B ......... _— .Address water Pollution Control Board White - Office Copy; Canary - Treatment Plant;.Pink - Company; Goldenrod - Owner Tom' From P�. M1 / P Subject 7'�-p? `wsl'W O /o 4 Date WI' WV Message Ce R% T'D MAIN ST, SE4U�2 �X SIGNED `Reply DATE 7.14 r ice -, GA�o 47-223 SIGNED NATIONAL Made to U.S.A. THIS COPY FOR PERSON ADDRESSED of tHE 1 ' DATE: 1 FEE: + BARNSfABLE, • , �$ i3; ,� REC. BY i MPS° Town of Barnstable SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 i Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi - Paul J.Canniff,D.M.D. i, VARIANCE REQUEST FORM LOCATION Property Address: T e44/dv J- r Assessor's Map and Parcel Number: Size of Lot: pp , Wetlands Within 300 Ft. Yes Business Name: C4lf I S !��s i GYMS No Subdivision Name: APPLICANT'S NAME: M, 11iM T /doV19AlY,7^� Phone s-b-e—e10 8—1_ 2?o Did the owner of the property authorize you to represent him or her? Yes tr No PROPERTY OWNER'S NAME CONTACT PERSON Name: Nl IC_(-( ,E L Srgttif TO S Name: Address: I/�JO AT , o/To��' Address:_ Cc d Phone(Srg�ge 35 6 6 Phone: VA. ANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space need el NATURE OF WORK: House Addition House Renovation El Repair of Failed.Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. y� Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) 1 _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) i Variance request application fee collected no fee for lifeguard modification renewals,grease trap variance renewals same owner/lessee only), outside dining variance renewals[same owner'leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC From 9 P Subject r-ea� Ti-�� /testa'/ • Date Message ( ��57e zlra :7 14 Tc" 1-g al;Z a 4/� 904-516 2571 N►A N S sc-W XaST. �X SIGNED Reply DATE tj . N 147-223 SIGNED NAT/ONAL Made h U.S.A. THIS COPY FOR PERSON ADDRESSED 1 - Legend 10 Parcels e _ s « ur , Town Boun dary (382•76 Railroad Track s 568 ings 392 ff Build' PPSx.6utlding #54 �, . ngs Painted Lines 3g89C�Q1 _ #555 � ✓�* � Parking Lots « ' Q��d690, 22 � "w`: ,c" e �� " .�✓,� * .,` "' t Paved / boo- dt #576 � wAl 1 3(Fal36 Unpaved / w: Driveways Paved ;= .` a �• - "' Unpaved Roads P m .� .'- � � .- �,_-.•. � � � � - [3 Paved Road • &' .r` a -? ?.A i�.'":.:: �l *_ . - - Unpaved Road - ar a, � "., i e ,. ^'' - �. ® Bridge i Paved Median Streams ., " 4557 Marsh ,• 93 Water Bodies G; 45Z3 .. 3G8i45 _ •' 134825: A - 4559A s s t - � e r , s k k l J' . 0 , 569 s 3a8t43 308128 I'' 5?7 �� �`' #394 y r 388285 308115 \ #402 308,it4 1.45 Map printed on: 3/15/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26m O 42 83 0 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. gis@town.barnstable.ma.us r t Stanton, David From: Beaudoin, Griffin (Philip) Sent: Friday, March 15, 2019 9:41 AM To: Florence, Brian; Swiniarski, Ellen Cc: Stanton, David; Boule, Andrew; Anderson, Dave; Christopher Reed; Duffy, Robert Subject: FW: 569 Main Street-Grease Trap Dye Test Hi Brian and Ellen, As discussed at the informal site plan review meeting on March 5, 2019,we performed a dye test this morning at the proposed Commercial Kitchen at 569 Main Street, Unit D6 and were able to confirm that the unit's existing 3 bay sink is plumbed to a 1,000 gallon exterior grease trap. The grease trap appeared to be in acceptable condition. ' We reviewed the standard grease trap pumping requirements with Mr. Reed and he acknowledged understanding of the requirements. Thank you, Griffin Griffin Beaudoin, P.E. Interim Assistant Town Engineer Barnstable Department of Public Works 382 Falmouth Road - Hyannis, MA 02601 Cell: 774-487-9663 griffin.beaudoin@town.barnstable.ma.us h�eh°FZHF r°``y�, Town of Barnstable 6AFtNASS ' Board of Health y rIA55. m O° s63q. �0 AIfB MA1 200 Main Street, Hyannis MA 02601 Office: 5.08-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Susan Rask,R.S. April 27, 2007 Michael Santos 4830 Falmouth Road, Rte 28 Cotuit, MA 02635 RE: Freshens Yogurt, 569;Main Street-, Hyannis, Variance = Dear Mr. Santos, You are granted a conditional variance from Section 322-3 of the Town of Barnstable Code, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment at Frozen Yogurt, 569 Main Street, Hyannis with the following conditions: (1) The menu is restricted to yogurt. Cooking or preparation of any other foods is not authorized at this establishment. (2) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. (3) This variance is not transferable to another owner or lessee of this establishment. This variance is granted because only yogurt is proposed at this establishment. Sincerely your �= fI Wayn Miller, M.D. Cha'pr an QAWPFILES\F'rozenYogurt GRDVariance2007.doc �FIHE Tp� DATE: 43hb� FEE: + BARNSfABLE, MASS. 039.� �0 REC. BY Town of Barnstable SCHED. DATE.. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: fy)A-illf 5-1— Assessor's Map and Parcel Number: C� / Size of Lot: Wetlands Within 300 Ft. Yes Business Name: rf!f SkWS yoique+ No �~ Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No $ 'F PROPERTY OWNER'S NAME CONTACT PERSON -- �F AA A 11 __ »sl_ Name:-A41 C h a� /�- SAr1J 7y S Name: Address: $3 O R T a YCo4),'1 IMF Address: Phone: 5'p$—�{a O a Phone: _ VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more Lace needed) G fD X R n NATURE OF WORK: House Addition 1100000 House Renovation ❑ Repair of Failed Septic System-El-- Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL Q:\Application Forms\VARIREQ.DOC MAIL-IN REQUESTS Please mail the completed variance application form to the address below. Also include four copies of engineering plans, house plans, authorization letter, etc (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). _ Make $85.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request form r a Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request t least ten days prior to meeting date at applicant's expense for Title Applicant understands that the abutters must be notified by certified mail a y p g pp p V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests-only) _ $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED,.RE.QUESTS s m Our fax number is (508) 790-6304. Please fax a completed application form. Also, you must mail the required $85.00,fee: Please make the check payable to, :Town of Barnstable. The check must be mailed to the.address listed above. In addition, please mai l four copies of engineered plans, house pla,ns,.authorization letter, etc. (see check-list below): Checklist _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page 0 � 7-1 I I 4 3ZS I ^ � o U gg N P 16 II � I � =Iqc F(D Lj v Z Z O U a a i ment Plan Schedule _ Emu as Equipment Cash Register In z cr is Cone Box 0 CM 3 Refrigerated Cold Pan cn g 4 Glass Guard Fruit Display =� 5 Blender 6 Ice Machine 7 3 bay sink w/ drainboards 8 Stainless shelving REVISIONS 9 Wall mounted touchless hand sink I to Suspended Menu Boards I I Work top cooler Iz Soft serve yogurt machine .13 Storage Cooler 14 Storage freezer 15 Frozen yogurt freezer 16 Dipping well 17 MOD Sink A-1 Hand Dipped Ice Cream 4 ; You Get More Stuff in Freshens New Ice Cream... more candy chunks, richer,thicker syrups, loads of crunchy nuts and scrumptious fruits. In outrageous swirls of flavor! Our newest,trend-setting,micro-batch ice cream is loaded with tons of mix-ins to create the most outrageous,cool combinations ever.Flavors that will have your customers begging for more, like: I Hand In the JarG Berry'd in Red ¢ M i Show Me the Money You the Man Pecan tims With a combination of our latest micro-batch 110 specialties,we will rotate new flavors to keep your customers coming back for more!And our high , profile menu board and flavor descriptions are -- sure to sell. ` i A "Must Have Complement to Our Frozen Treats So"erve Menu - 1 pFSHETp� Town of Barnstable Barnstable Board of Health AIIAmwicaQty * IIA MNSTABLE, r Hass. 200 Main Street,Hyannis MA 02601 , a� dp 039. ATF p MA't°' 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Mr. Marat Hunanyan May 23, 2011 c/o Michael Santos 4830 Route 28 Cotuit, MA RE: Cape's Best Gyros and Grill, 569 Main Street, Grease Trap Variance Dear Mr. Hunanyan, You are granted a temporary conditional variance, contingent upon the approval of the Town Engineer, from Section 322-3 of the Town of Barnstable Code, to continue to utilize a grease recovery device, in lieu of the required inground grease trap. This variance will allow you to operate a food establishment at The Broken Cone, 569 Main Street, Hyannis with the following conditions: (1) A grease recovery device (GRD) shall be installed and maintained in accordance with the MA Plumbing Code. The food establishment manager shall keep records of regular cleaning and maintenance of the grease recovery device. (2) The menu is restricted to the submitted listing of foods which includes gyro wraps, shish kebabs, and cheeseburgers.. (3) Only paper plates and/or plastic utensils shall be utilized. (4) This variance is not transferable to another owner or lessee of this establishment. 5 This variance is temporary. You are required to either (a) install an ( ) inground grease trap within a timeframe as specified by the Town Engineer (approx. six months) or (b) you have the option of submitting documentation from a certified laboratory to the Town Engineer showing that the wastewater effluent contains less than 5 mg/liter of grease. (6) You shall provide both a screen and an electronic air curtain at any service windows provided and associated with outside dining. Q:\WPFILES\GreaseTrapVarianceCapesBestGyros2011 e.doc (7) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. Sincer yours, Wa ne iller, M.D. Q:IWPFILES\GreaseTrapVarianceCapesBestGyros201 te.doc DATE 03 f o>eZFJ OF 1HE Tp� FEE PD. 'own of Barnstable BARNSTABLE, ' CHKLST(I-14) MASS.39. ,m� Regulatory Services Department lEn Mai Al 200 Main Sheet,Hyannis MA 02601 APPLICATION FOR OUTSIDE DINING/ SIDEWALK CAFE LOCATION Name of Establishment: C-41O Y /3t?7- 6YIP0S 6101-1- Establishment Address: S hl 9 MAol -r7 ©2401 APPLICANTSNAME: 1lii/)4AT 'J401,1,4i+/YA1,1 Phone# SOY-//02?-33 ,'G SEATING FACILITIES/EQUIPMENT Total#of Seats Existing #of Restrooms Provided 2 Size of Grease Trap 61Q 0 Total#of Seats Proposed J g Air Curtains(Yes or No) (Total means overall number of seats indoors plus outdoors) Hose Bib (Yes or No) f Screens (Yes or No) 1`140 .0 Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,,Projected / Opening and Closing Dates 0417- 190^r gm GGZ 734ife I c 41-4 A47Cg1--1 hY /;Jek, c�o Pej L ET Ye1V . 694110 AP 4/L IS OI4C^P 7 0 4%1 I/we the undersigned certify that the above information which Uwe provided is correct. Uwe have read and fiilly understand the Town of Barnstable Code Chapter 322 and further understand that failure to comply with said procedures may result in the immediate revocation of this permit. Signature of Applicant(s): Date: 03 /J- // Date: 021151420,11 IMPORTANT-PLEASE REMEM ER A0 INCLUDE: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Division: Licensing Board Approval: Certificate of Insurance: License Agreement: Comments: Q\Application Forms\0UTDINAP.D0C §'752' -5. Ou'.door dining: Qhevklist. Instructions: Please read the following requirements for outdoor dining. Place a checkmark on each line next to the number which you meet the criterion of. If you do not meet the criterion or if you are unsure, leave it blank. A. No person, corporation, or firm shall provide outdoor dining or an outdoor cafe at a food establishment until after all of the following requirements.are met: (1)The applicant shall file a written request for outside dining or for an outside cafe on a form prescribed by the Town and shall submit plans of the proposed dining area.The seating capacity shall be determined by the Board of Health after a determination is made whether requirements of Subsection A(2)through(14)below will be met and after a visual inspection is conducted by an agent of the Board of Health. A replacement food establishment permit.shall be issued by the Board of Health indicating outside dining is permitted and listing the overall seating capacity, only after it is determined by an agent of the Board of Health that all of the requirements Subsection A(2)through(14) of this section are met. (2) A menu shall be submitted to the Board at the time of application. (3)The dining area must be appurtenant and contiguous to the restaurant property. The dining area must be mentioned on the described premises as in the case of a common victualler's license. (4) Sufficient restrooms,both for customers and employees,must be furnished counting the additional outside seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (5) A grease trap shall be of sufficient capacity,based upon 15 gallons per seat, as required by the State Environmental Code,Title V, and Town of Barnstable Health regulations. A grease recovery device may be installed to supplement an existing in-ground grease trap, after receiving the approval of the Board of Health. (6) All entrance and exit doors used by food service personnel and customers must be screened and provided with air curtains meeting National Sanitation Foundation standards. All windows.or openings used for the transfer of food will be screened and provided with air curtains. Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. (7)A drainage system designed to eliminate odors will be required for all outdoor dining areas. Hose bibs with vacuum breakers must be available for washing down the dining area. (8)Trash dumpsters shall be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area, it must be hidden from view..The area around the,dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (9)The patio or other ground surface must be of constructed of material readily cleanable and not susceptible to dust, mud, or debris. (Brick, tile, and concrete are examples of acceptable materials) (10)Table tops must be smooth,nonporous, easily cleanable and durable, and readily maintained in a clean and sanitary condition. (11)Food-service personnel must constantly police the dining area for wastepaper, garbage and other trash. Placement clips, cup holders and other such devices must be utilized to prevent blowing paper. Covered trash receptacles must be provided in close proximity to the dining area and must be emptied as needed to prevent overflowing. (12) Strict cleanup practices must be adhered to.Waitstaff and buspersons must cleanup after each patron as in indoor dining. Each establishment must abide by all regulations contained in Article X,Minimum Sanitation Standards for Food Service Establishments, of the Commonwealth of Massachusetts, Department of Health Sanitary Code. (13) Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities for preparation and disposal of sanitizing solutions must be accessible. (14)Hair nets or other effective hair restraints, such as hats covering exposed hair, shall be worn by all outside food or drink handlers. Beards and mustaches must be neatly trim.med. B. Exemption from doorway air curtain requirement in Subsection A(6) above: The Board of Health may waive the requirement to provide air curtains at the doorways only if no waitstaff services will be provided to the outside dining area(self-service only). QAApplication Forms\OUTDINAPCHECKLIST.doc LR �, �pf THE TQ� DATE: �/ * , FEE• (/I * BARNSPABLE, y MASS. 1639. ♦0 REC. BY Town of Barnstable SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: `T A 41" T!, Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: C/`�!�%I S !� s GY/�-�S oC cwlee No Subdivision Name: APPLICANT'S NAME: M1jP q 1 1-4UiyAAiyiq,1 Phone S-b'g—ei©S—J-s 90 Did the owner of the property authorize you to represent him or her? Yes 1" No PROPERTY OWNER'S NAME CONTACT PERSON `r 1 Name: Nl I C HAE L A• 5�9�` t�S Name: C. ) Address: /M A . Address: Phone(SD8�3 a� — .3 (;, 6 Phone: V ANCE FROM REGULATION(List Reg;.) REASON FOR VARIANCE(May,attach if mor space needed t s't3 NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form . Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicants expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) —� Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC �PSG -)72 G( o�.. � vincc n \I I I � �� II . : . . . .�' ll. T --- r� Page 1 of 1 E pp T �g'2. Model ib NO. $ , 8 -Opec M tMeat - fi��" ° Jj _ .�. Capacity rear a 5 gas ipor a yl��g■ r. as R gas PREssupi ` C.lA�W $. °' vtLK IjEmtal 1 DE FTH ELIECTRICAL TOTAL. 32.6" 17" 1 " 120V J 6ORz d 1AMP 40,000 STU)Hr 75 lbs. 4: .�. a. � .�a e; •� qs.g.. �: �;, .far a"€::t 5�"' � �.� :�� `� p. � ;d,�e€}.:ev,€. �;�:;..�t ��>:, .�,.� http://www.autodoner.com/images/680_Autodoner-G-400-Sell-Back-full.jpg 3/17/201.1 03/12/2013 1,Z.11 FAI I¢�UU1/QUl HYANNIS OAKS CONDOMINIUM TRUST PO Box 6 WEST NYANNISPORTi MA CdG72 508-274.41g5 ! , Approveli.etter , The Board of Trustee's of Hyannis Oaks Condominium Trust grunts dpprovel to Ming Gu and Feng Tao tenants of u nit D•11(owner Susan Glhauslds)to hook up to the grease trap located In the common i 1 i ! area in front of units D-11 and 13-12. i ' r it will be the responsibility of Ming Gu and yang TO to secure any rtecassaty permits from the Town of Barnstable before any work commences, i scam craw p�%vTde e-copy oPthe stops of tfie work and-a'�Itlticatu'uf tnsuwance llstin`g tTie trustees,.and'-{iyarini�-oaics.asJosa=payees _'' '�(tj of ananca of the se tea h chars Del xnd b.bgthunite ! An omMoo area hats isturb .7lnusr�e epulced/rep4a s oriSinality, Neither the trustees nor Hyannis Oaks Condominium Trust will be hold financially and or legally responsible for the maintenance,repair,and repair violations regarding this grease trap. Neither tenants nark ad above may bring suit against the trustee's nor Nydnnia Oaks regarding said ! grease trap. ! Janis Cold,Trustee {tick shechtmart Vk Joanne Moser ® l LO S�acGe, w j W�� (mil , w�.a�vfi� e l,.M.va-ll o 1 - be, o, LnXe l,JMV, L-4- ivD L ) 1 S �3 Bellaire, Dianna From: Bellaire, Dianna Sent: Tuesday, September 18, 2018 10:50 AM To: Flynn, Margaret Cc: Bellaire, Dianna; Crocker, Sharon Subject: RE: El Mariachi Loco-569 Main Street/Ste 12 Hi Maggie; I just spoke to the owner and she said she has 6 inside and 22 outside.She didn't increase the seating.The food permit printed last year is incorrect. Thank you for checking with me. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire @town.barnstable.ma.us From: Flynn, Margaret Sent: Tuesday, September 18, 2018 9:53 AM To: Bellaire, Dianna Subject: RE: El Mariachi Loco-569 Main Street/Ste 12 Perfect,thanks. From: Bellaire, Dianna Sent: Tuesday, September 18, 2018 9:44 AM To: Flynn, Margaret Cc: Bellaire, Dianna Subject: RE: El Mariachi Loco-569 Main Street/Ste 12 Sharon wants me to call them because we need to verify with owner what the actual seating is right now. I am waiting for them to open. I will let you know when I find out for sure. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us 1 ti ■ DATE +' OF THE Tp� ti y RAsrABrE.�* Town of Barnstable FEE PD. MASS. a CHKLST(1-14) 9�A i639• �•� Regulatory Services Department 200 Main Street,Hyannis MA 02601 I APPLICATION FOR OUTSIDE DINING/SIDEWALK CAFE LOCATION ` Name of Establishment: V 0 V a tach l Establishment Address: fk '3 a-IV APPLICANTS NAME: one# 2,� 33 SEATING FACILITIES/EQUIPMENT 2 Total#of Seats Existing #of Restrooms Provided Size of Grease Trap 15m3 C-iQ.lia' Total#of Seats Proposed _ Air Curtains(Yes or No) (Total means overall number of seats indoors plus outdoors) Hose Bib (Yes or No) Screens Yes.or No) Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected Opprung and Closing Dates trs CA- v)ffJnAAM uo k lk nK! -�Co A - PlAnd Ane-nim CIA, 6-� InKh w6 I wAt C I(� nn Uwe e�undcertify that the above information which I/we provided is correct. I/we have read and fully understand the Town of Barnstable Code Chapter 322 and further understand that failure to comply with said procedures may"eiirevo ation of this permit. Signature of Applicant(s) Date: Date: IMPORTANT-PLEASE REMEMBER TO INCLUDE: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Division: Licensing Board Approval: Certificate of Insurance: License Agreement: Comments: Q:Wpplication FormsMTDINAP.DOC c § 32?-5. Outdoor dining: Checklist. Instructions: Please read the following requirements for outdoor dining. Place a checkmark on each line next to the number which you meet the criterion of If you do not meet the criterion or if you are unsure, leave it blank. A. No person, corporation, or firm shall provide outdoor dining or an outdoor cafe at a food establishment until after all of the following requirements are met: (1)The applicant shall file a written request for outside dining or for an outside cafe on a form prescribed by the Town and shall submit plans ofthe proposed dining area. The seating capacity shall be determined by the Board of Health after a detennination is made whether requirements of Subsection A(2)through(14)below will be met and after a visual inspection is conducted by an agent of the Board of Health. A replacement food establishment permit shall be issued by the Board of Health indicating outside dining is permitted and listing the overall seating capacity, only after it is determined by an agent of the Board of Health that all of the requirements Subsection A(2)through(14)of this section are met. (2) A menu shall be submitted to the Board at the time of application. (3)The dining area must be appurtenant and contiguous to the restaurant property. The dining area must be mentioned on the described premises as in the case of a common victualler's license. (4) Sufficient restrooms,both for customers and employees, must be furnished counting the additional outside seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (5) A grease trap shall be of sufficient capacity, based upon 15 gallons per seat, as required by the State Environmental Code,Title V, and Town of Barnstable Health regulations. A grease recovery device may be installed to supplement an existing in-ground grease trap, after receiving the approval of the Board of Health. (6) All entrance and exit doors used by food service personnel and customers must be screened and provided with air curtains meeting National Sanitation Foundation standards. All windows or openings used for the transfer of food will be screened and provided with air curtains.Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. (7)A drainage system designed to eliminate odors will be required for all outdoor dining areas. Hose bibs with vacuum breakers must be available for washing down the dining area. (8)Trash dumpsters shall be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area, it must be hidden from view. The area around the dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (9)The patio or other ground surface must be of constructed of material readily cleanable and not susceptible to dust, mud, or debris. (Brick, tile, and concrete are examples of acceptable materials.) (10)Table tops must be smooth, nonporous,easily cleanable and durable, and readily maintained in a clean and sanitary condition. (11)Food-service personnel must constantly police the dining area for wastepaper,garbage and other trash.Placement clips, cup holders and other such devices must be utilized to prevent blowing paper. Covered trash receptacles must be provided in close proximity to the dining area and must be emptied as needed to prevent overflowing. (12) Strict cleanup practices must be adhered to. Waitstaff and buspersons must clean up after each patron as in indoor dining. Each establishment must abide by all regulations contained in Article X,Minimum Sanitation Standards for Food Service Establishments,of the Commonwealth of Massachusetts,Department of Health Sanitary Code. (13)Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities for preparation and disposal of sanitizing solutions must be accessible. (14)Hair nets or other effective hair restraints, such as hats covering exposed hair, shall be worn by all outside food or drink handlers. Beards and mustaches must be neatly trimmed. B. Exemption from doorway air curtain requirement in Subsection A(6) above: The Board of Health may waive the requirement to provide air curtains,at the doorways only if no waitstaff services will be provided to the outside dining area(self-service only). Q:\Application Forms\OUTDINAPCHECKLIST.doc LA ,Up Oo T 5loJt< Je 3 .R v %_ Staff s� S 0 o 0 0 Q o 0 0 o _ � � o 0 0 0 0 G 0 10/23/2015 12:24 FAX 508 790 6325 WATER POLLUTION CONTROL �001 i' a' TOWN OF BARNSTABLE Date: 04/04/12 DEPARTMENT-OF PUBLIC WORKS. Permit: 4605 SEWER CONNECTION COMPLIANCE Installer: Mike Santos Property Owner: Mike Santos Property Location: 569 Main Street Unit L Village: Hyannis Map a Parcet : 308 - 111 - OOC Plpe Length; 15 ft Pipe Dia&material: 4�' SOO Th a wo as een a in con ormance the u es an egu ations o e epartment o Public or Signature': Date; 17-Sep-12 Depa ent of P Ila Wor yet Map bt Parcet 308 111 569 Main Street Hyannis 2S 573 Main street 561 Main Street i grease trap instaited April 27 , 12 i drop dcan•out locationsp4tainea w . —r-1 US equipment i Sewer Connection Form (Rev; 2010) Page 1 of 4 LEGEND N ' LOCUS o 100 EXISTING CONTOUR r.,. x 100.98 EXISTING :;POT GRADE OVERI-If.Af) WIRES — ° th 3 --- $ EXISTING ";I:; rR °~r :W tiwlN sT �w' y SOu s o BENCHMARK <P� 11 I Goa o o� in Tara HyarinN ( is Golf Club a S FL'Rd Cemelary f s LOCUS MAP NOT.TO SCALE f .... BENCHMARK SET MAGNTIC NAIL(% 0.=34.40 _(ASSUMED DATUM 4,)li PROPOSED GREASE TRAf��� �;r.` (1!,oO ("Al I()N) y r�s f' I�1 oi9+J PROPOSED SEWER --''�: t y i�tl CONNECTION ' 34.711 i, UNIT A ' 33.60 ;lYtl 1�y:�" 7�f y7h >.." 71 w 11i 19'All Jt1 PRDWDE DIRECTLY •` CREASE'TR ,''— 4.. Toni UNIT C 1 2:24 T,AX 508 790 6325 WATER POLLUTION CONTROL Z 004 �^ I i Town of Barnstable ' Department,of public Works and Trench Permit Number Connection . rrerteh Permit e Disconnect ; �P It Par Mad or Repair . c� I / Water Supplier r� i 'tree, : S Village �,.-,• ��j�� 'ewer Account ii , �. �--r— Permit Fee&Check g Septic AbandanrfenC Perpyjt q 1. Residential Bid F 3 ee-$420'00 ; Comm dat Bld - 2, SurGry�far Eac►�Addlpon g Fee 5875.00 el Bldg a159me Service-5200.00 "Surcharge Surcharge for Pump Stattor.-53u0.oo a, /Hiner Rep?ir.or afsconneCt of Exiscin Project Contact Information a S em;c Sso.00 Contractor Name r Owner Name : /J/���J. Contact Name Maillne AddresS Business Address O telephone Spy Lr�d� Contact Phone `/� C6n cact Fax : Prop@My Use Information Residential Commercial ; . mrnercial Use Industrial Standard IndUstriai Code Number of Bldgs ; Site of Parcel {acres) : r Pipe Dla Ed Material ; Before Pipe Length excavating in a Town Wa 0 On Town owned Permit and comply with.the eonst uction Standards Faperty, the S Property, the sewer installer must obtain a Roo 48 hours prior to instaltation. Failure to comply ns outlined d Opening/Trench Fite Sewer it Trenchtherein. Applicant must nc P Y+With the regulations shall be grounds to revoke this permit. . Permit Is valid for 180 calendar days from DPW aDPW that time period. Engineered drawings must be submitted,with this application for industrial installations, approval and the installation , permit. The drawings must be approved before a permit will be isst.led, must be corrt Piet ed within m, to the DPW for all commercial of Contractor Sign ,re a Date DPWAPProval signature&Date Sewer Permit Expires : ,C Sewer CQnnectfOn Forrrr (Rey; 2010, P''V � Big Dipper' Point Source Automatic Thermacoe Grease Removal Systems 0�©0 W-150-IS Specifications DO . . . INSTALLATIONINFORMATION Atlowaminimumof14"clearancefrom top of tank for removal of unit lid. Suggested Minimum Footprint Dimensions READ instruction manual included with system before doing anything. Install unit allowing for the minimum 4" F7 25.5" clearances shown. Make sure the height above the 8.75" Internal Strainer Access Cover is enough to remove the strainer. __ INLET OUTLET Make piping connections with rubber "No Hub"connectors(provided). 8.75" Keep outlet piping as straight as pos- sible.Use only"sweep"connections. Install vent on outlet piping. 6.5" Fill the tank with water before ener- -- -- GC-7 GREASE gizing the power to the motor and 4.5" COLLECTOR heater. ------------------- Set Programmable Time Controllerfor proper operating times. DON'T . . Note: Install"P"trap on outlet connection Reduce pipe size on outlet piping. Installations must comply with of tank.(Note:the unit already has all applicable local, state, and an internal gas trap). national codes for your area. Job Specification: Grease and oils separator(s)shall be Thermaco Big Dipper automatic grease/oil recovery system(s)as manufao- tured by Thermaoo, Inc.,Asheboro, North Carolina as noted on plans. Separator Specifications: Furnish and install _Thermaco Big Dipper Model No. W-150-IS, bright finish type 304 stainless steel exterior, rotationally molded polyethylene interior automatic self- leaning grease and oil recovery separator(s)for floor mounted or partially recessed installation,rated at 15 gallons per minute peak flow,30 pounds of grease capacity and includ- ing as an integral part of the unit, 1 rotating gear hydrophobic wheel assembly for automatic grease/oil removal, an integral flow control device, self-regulating enclosed electric immersion heater, a vessel vent, an integral gas trap, an integral programmable 24-hour multi-event time control, a field reversible motor location, a field reversible grease/oil sump outlet,quick release stainless steel lid damps,a gasketted and fully removable 304 stainless steel lid, a lift-out strainer basket access, an internal stainless steel strainer basket for collection of coarse solids, and a separate grease and oils collection container. Electric assembly shall be tested to comply with pertinent sections of the Standards for Safety ANSI/UL 73 and/or ANSI/UL 1004. Electric motor shall be equipped with thermal overload protection with automatically resettable switch.Two(2)no-hub connectors for plumbing connection provided. @2006 Thermaoo,Inc."All rights reserved"Patented/Patents Pending"Specifications subject to change without notice 2 646 Greensboro St."Asheboro,N.C.27204-2548"Phone(336)629-4651 "North America:(800)633-4204 vos E-mail:info@thermaoo.00m"Online:www.big-dipper.com �. Big Dipper® Point Source Automatic jThermalco� Grease Removal Systems OZZD TH W-200-IS Specifications MOTORMMER 14"CLEARANCE FROM ENCLOSURE TOP OF TANK REQUIRED FOR 23.375• STRAINER BASKET&LID REMOVAL --------------- I � ENRTV G U COOKING qL REOYgJNO CONTAINER INLET AIL OUTLET 0 _ - GREASE n_ � ' =6� GREASE B6= COLLECTOR ei= 8.75" 10.5' =+a CAPACtrV 10.5" - 2"PIPE I --- - --I -- INLET/OUTUT LET I I 1 22.5° 10 17.5" SIDE VIEW END VIEW 25.5" � I FEATURES: •Fully automatic self cleaning cycle. Removes collected grease&oils from tank without any operator assistance. Comes complete with 24-hour timer and Grease Collector. INLET OUTLET •Constructed of corrosion resistant materials suitable for 23.375° Installation in virtually any location. Attractive sanitary Stainless Steel wderlor. • Integrated Motor/Grease OutleVHeaterA-Id enables a fast,do-it-yourself unit operation reversal. •Compact footprint. E I ----------- TOP VIEW •Two(2)No-Hub Connectors provided. CH@TECHNICAL DATA cus Materials: Exterior:304 Stainless Steel, Bright Finish Interior:Rotationally Molded Polyethylene C S NSF Electrical: 115 VAC,60 Hz,520 Watts(4.5 Amps) m Maximum Inlet Flow Rate: 20 GPM Number of Skimming Wheels: 1 Skimming Rate: 20 Pounds Per Hour Grease Retention Capacity: 40+Pounds C E RS�F t E Internal Solids Strainer Capacity: 1.85 Gallons C M6 Thermaco,Inc.•All rights reserved•Patented/Patents Pending•Specifications subject to change without notice 11/061 646 Greensboro St.•Asheboro,N.C.27204-2548•Phone(336)629-4651 •North America:(800)633-4204 3 E-mail:info@thermaoo.com•Online:www.big-dipper.com TOWN OF BARNSTABLE D Cmj4 LOCATION S6�'j /Y1�'� S� SEWAGE #. T7- Z5-�S VILLAGE /Lyq w/ul�C ASSESSOR'S MAP & LOT 00 INSTALLER'S NAME & PHONE NO.?,�1'e-C 6A►•�Pn�i 1i`o�g'IL!6 t SEPTIC TANK CAPACIT r t�N LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL O UBLIC WATE BUILDER OR OWNER �L�b 3Jv rU DATE PERMIT ISSUED: ���T DATE •COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ���� �� h �a � - Town of Barnstable MAM Board of Health �a 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne MDler,M.D.. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul Canniff,D.M.D. March 15, 2006 Mr. Sean Downes 236 Old Town Road West Hyannisport, MA 02672 Dear Mr. Downes, You are granted a conditional variance from the Board of Health.Regulation, PART II SECTION 1.00, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment, utilizing a grease recovery (GRD) device at La Paz Surf Cantina, 573B Main Street Hyannis with the following conditions: (1) A grease recovery device (GRD) shall be installed and maintained in accordance with the MA Plumbing Code. (2) The menu is restricted to the submitted two page listing of foods (submitted February 27, 2006) which includes tacos, soups, sandwiches, and salads. (3) Only paper plates and plastic utensils shall be utilized. (4) A certified laboratory shall be hired to test the wastewater entering and exiting the grease recovery device on a weekly basis (oil, fats, and grease quantities). Results of these tests shall be submitted to the Board at least 14 days before the September 5, 2006 meeting. (5) This variance is not transferable to another owner or leasee of this establishment. (6) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. Q:LaPazSurfCantinaGRDVariance2006 This variance is granted because it has been demonstrated that a grease recovery device (G.R.D.) would be effective in removing grease, fats, and oils. Si4ncey yours, WMiller, M.D. ;'Chai an Q:LaPazSurfCanfinaGRDVariance2006 TOWN OF BARNSTABLE � Ccvl LOCATION -r6r'( /yl A ST— SEWAGE 1# T 7 VILLAGE E��q �U/ur r ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO �e1� L SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 7"be -)rj R,-,oj--, (size) NO. OF BEDROOMS PRIVATE WELL O UBL WATE BUILDER OR OWNER �F-n oe Iry na /,P-- DATE PERMIT ISSUED: ����,��" ,DATE ,CO21PLIANCE ISSUED: G - 9 VARIANCE GRANTED: Yes No j G T _ _ -- �. �_� _r� -- ----- ('..: _ _: I.I�,�iiiII;.II:II�.i1!;i.I�.P�I[�%��I I�I"1 I I:I.I�i��.�i�IIiI�.i.�.I I1 I����II:1I1 I�:I,I I I:�I 1II���I-II��-,I I I I1r 1I1:I,.,II I.L�,I.1I I I II I I�I.,:I,:I'�11I I.I�II I I�I I L I,,II�.",1�-II I�III.1I,I I.��IIII I.I.1 I-.���:I 1-���I"I��I���IIIII--III:.,I1 I11IL:I I:�1II;I...-.�.,I I��F I,I�'.�I�I I.��I I�1',�I 1IL I.�.I�I�I�-.I,I I I..L.�-.I I..-I I1 I.I,.,I�I�'I�I,�.I I1I�.,.-�II�III II�,,�I�.�I II�I�:I.II,I,I�II'1�II.:.I I I III.I II-�I�I,-�..I 1-..I��I1�I I I.I I I��I-I�I�.1I,,I:II-..,I i�11�--II.I I:I I L1I,�I!II1..I I II I,�I/I,��.I.I�I I.i:.'I I�LI,II,.I�I�,I.�.�I I I.I..iI�JI:��I.I1 I:II;I I-1I���I I 1,I,.I�.�I I I II I,�1II�,:,-,���I�I.I I I I�'�I�-�,�..III II�I 1.I.I:�II�.II I I���I�I.I I 4.'I�I�I.II.1��I I.I.,I�IILIII I�I II.�I.I��I I I,I'1.IIII I..I��II,I 1:I'II 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I�-'--'F1I.- - -� � '!�----I'-�' ­I 1 1­�' .­"­­. .-'I'1-I 1--'."'' _. . �.'11__---1____, -"�._---­'­1 1�-I I 1 -L---'-1-1.--�I --,---. 1�1----- I'-------.'!: -----1 -: -----1 -I-- '----I'--- 1 J.. Pd $5.00 6/14/85 Map #308110000 TOWN OF BARNSTABLE WATER POLLUTION CONTROL DEPARTMENT ,a►,n� } APPLICATION FOR SEWERAGE PERMIT Permit NQ 1879 ,ego• ` a ur►. I .._........... _..._. _ _ owner of the Estate hereby Full Name apply for a sewer connection from the purpose of draining the following: Street and No. Water Closet __... Shower __ _ Urinal ...... _ ...._ .._. Other Sink ......................._._ _ _. Lavatory Bowl Dish Washer ._........... _ _ Other Bath Tub _.__ _. Set Tub ._....... .__ _ Washing Machine __ _. ter to the common sewer on ........................... _ _ EXP.IRES 7/14185 Fixture Rate ❑ Street Meter Rate ❑ INSTALL GREASE TRAP @ FABIO'S a. And The undersigned further agrees to strictly conform to the Laws and ordinances relating to sewers, and to the rules and regulations that are now in force or may be adopted in relation thereto, and also to the plumbing laws and ordinances so far as they relate thereto. b. And the undersigned further agrees for himself, his heirs, devisees and assigns, that the said Water Pollution Control Board shall have access at all reasonable hours to the said preMises, to see that all the laws, ordi nances, rules and regulations relating to the sewer are complied with. Owners Signature Accepted _._._ .. ._...._..... ...._._ _..._.. __.—__—._ __..._ Address _._ Date By .._........_ Agent/Attorney Contractor's Signature �_ — _ -••-- --......__ Address .................... _ Water Pollution Control Board White - Office Copy; Canary - Treatment Plant;.Pink - Company; Goldenrod - Owner