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HomeMy WebLinkAboutMiscellaneous - 15 FIRST STREET 4/30/2018 (2) STAT.,. PL IM REVIEWS PLAN RECVD: 10/7/09 PLAN APP. 11/10/09 i i i 'I THE COMMONWEALTH OF MASSACHUSETTS RECEIVED TOWN OF NORTH ANDOVER Massachusetts Department of Public Health SEP 2609 Division of Food and Drugs r TOWN OF NORTH ANDOVER FOOD ESTABLISHMENT INSPECTION REPORT HEALTH DEf'ARTMCNT Name Date TvDe of Operations) Type of Inspection ?N72: -1 -d1S Food Service ❑Routine Address ) 1 `LST Risk ❑ Retail ER Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection P "�g- �3 -�'L ❑ Mobile Date: ❑ Temporary ❑Pre-operation ?w\- Owner ' �� HACCP YM ❑ Caterer ❑Suspect Illness Person in Charge(PIC) S�Y1r. Time ❑ Bed&Breakfast ❑General Complaint In: Inspector Permit No. Other Out: r t out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. p IWO: VioNonn Rolatod to Foodborne Illness Iriftryontions and Rish Fpctorn(Rod llow) AJO-ChokiN Tobw= Violations marked may pose an imminent health hazard and require immediate corrective 590.0091E 690.00!IFI ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned!Knowledgeable/Duties ❑ 12. Prevention of Contamination from Hands [313. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CELS PWNAWNY Haardous Foals) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Reoords/Aocuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSPI ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMERADYISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Intorvontions immediately or within 10 days as determined by the Board and Rialt Factors(Red Items 1-22): of Health. Non-critical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, signed below,when C x Po 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protection (FC3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) Cited in this report may result in suspension or revocation of the food establishment permit and cessation of food Water, Plumbing and Waste (FC-5)(590.006) the operations. If aggrieved by this order,you 27. Physical Facility (FC-0(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-(NSPECTION: Ai� Inspector's Sign ata Print; r .� PIC's Signature: Print: Page of Z-Pages FORM 734A r Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1.22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowledge* CookW and RIM Foods* 2-103.11 Person in charge-duties Contamination hom Raw Ingredients 3-302.11(Ax2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination bom the Environment require reporting by food employees and 3-302.11 A Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination hom the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashmg-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable,Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* She9fish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and VWd Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 Pf 1Fs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Irate * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* - Employees* TagslRecords:Fish Products 13 Handwash Faciltdes 3402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004 J Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Suppled with Soap and Hand Drying 3-502.11 S ialized Process' Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 HandDrying Provision • Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN OR CITY OF a<DZ 1 4 Establishment Name: A p ZZ Date: ('1 Page: Z-- of 2- Item Item Code C—Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �S �i ���/Y► ?9.: _rrAG1--tom 15 ,lJ . F��p4\�— I �.L~", ZO ST,con tr Y e'S rw :> 1 Discussion With Person in Charge: Corrective Action Required: 0 No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion 0 Re-inspection Scheduled 0 Emergency Suspension 0 Embargo ❑ Emergency Closure O Voluntary Disposal O Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures ,e Wo/ations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(RedItems 1-22) (Cont) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11, Identifying Information-Original 140°F. * Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibition's* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* ' Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Funopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Seca Pathogens.*Effect"1/1/2001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.1 I(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(A)(2) Ratites,Injected Meats- 155° catering,mobile food,temporary and F 15 sec. residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry' or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29, Special Requirements 009 to 41°F/45°F Within 4 Hours. * 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41017/451117' Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETT S RECENED TOWN OF NORTH ANDOVER Massachusetts Department of Public Health SEP 18 2009 Division of Food and Drugs TOWN OF NORTM ANDQ,,'F_R FOOD ESTABLISHMENT INSPECTION REPORT HEALTH DEPARTMENT Name nate Tvpe of ODeration(sl Tvce of Ins on FI Z?_ ^2'0 IM Food Service ❑Routine Addressr I Risk [:] Retail ARe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone �,� , 0�-�-Z ❑ Mobile Date: ❑ Temporary [IPre-operationOwner U� �� AoV HACCP YIN ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint -5 In: ❑HACCP Inspector 1 n Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. h w-co p ms„fth: Violations)Rolalt2d to Foodbom Bln n Inbrventiona and Rink Er:ctorss(Red Itzim) Ann-Cho" Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ n0-009(F► ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ ❑ 12. Prevention of Contamination from Hands 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS raterdially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 8. Tags/Reoords/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding 2 "S. Separation/Segregation/Protection ❑20.Time As a Public Health Control &2119. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(i1SP) ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMERADVNMY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violatad Provisions Relatod Items) Critical (C)violations marked must be corrected To Foodborne Illnessoo Intarvontions: immediately or within 10 days as determined by the Board and Risalt Factors(Rod Itrama 1.22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, ned below when signed C x9 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 4. Food and Food Protectionorder of the Board of Health. Failure to correct violations (Fc�>(sso. cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4}(seo.0a)oo51 the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(5W.005) the operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC•7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other ` DATE OF REINSPECTION: q9 0 0� Inspector's Signature Print: ) \�\ l2 rc\ PIC's Signature: Print: _ © Pagel of�, _Pages FORM 734A Yolations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1.22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003 li Demonstration of Knowledge* Cooked and RTE.Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(Ax2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11 A Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shelbsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemicals Sources* 10 Proper,Adequate Handwashing Game and Md Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure* 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PI IFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 TagslRecords:Shellstock 12 Prevention of Contarnination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Suppled with Soap and Hand Drying 3-502.11 Specialized Process' Methods' Devices 3-502.12 Reduced oxygen ng,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6 301.12 Hand Provision •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN OR CITY OF 13°Z_IA A N Do\)Cir--- Establishment Name: S-71-A\`L P� Zti(A Date: 9 .2,p Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Za s S4-Cc 4 »u� �— r�l�—�.. 7�-�' i a�u�--,� tee•► �'►�v • 1.)) � ��. �1�t�; ovo�0 E�-�,�D ..1 �l'� 1L.v����=. tl-�,c.�1L, ta�R, �.: 5 dal T��►`Z-� I LA � a - a�� Ya'�� -> � '` � Discussion rson in Charge: Corrective Action Required: ❑ No ❑ Yes Z O`2 ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion cry ❑ Re-inspection Scheduled ❑ Emergency Suspension CP ' ❑ Embargo ❑ Emergency Closure V, iJ' G ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.7S.lkno.,Bost ,MA 3-501.14(C) PHFs Received at Temperatures V/o/ations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red items 1-22) (Cont) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served. 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* - CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.* Hlediw 1/1/2001 Eggs-Immediate Service 145°FI5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)=(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PRFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.1 l(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 1$ Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours. * 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* 0 Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN, OR CITY OF Establishment Name: 5-7P%, 4 \Z1-` , Date: e► "L�� Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Z� J- 0- l X.' " -I z -s-) ) c- U-L "en- n C1 aSL&�Ch U a cam'' S SC _o�S �)�� A�� �,tt � rJ C✓� UAL Lam%=-tl� v � «S W IVA Discussi Withgers Charge: Corrective Action Required: ❑ No ❑ Yes c' �O ❑ Voluntary Compliance ❑ Employee Restriction/ CP ?tip Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension t.01`� L3 Embargo LI Emergency Closure v� ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(RedItems 1-22) (Cont.) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F. Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1](B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served. 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F IS Sec. Pathogens.*ERelli"1/12001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 2330) 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PRFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-e .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN OR CITY OF— Establishment F Establishment Name: C'S'6l�- `'�1 Z-� Date: Page: of Item Code C-critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 2.s ���5 Z+�= S "(aa 1 r11✓�'r'DS ic� YI vis i�s Pv\,S t--L. q4 tt t^ d'r a v 0 %1 co 'Z L�(;7j-r 1 a S Cci r ey'- Q, yrv,3 S, Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co., Boston,MA 3-501.14(C) PHFs Received at Temperatures Wo/adons Related to Foodborne Illness Intervendons and Risk According to Law Cooled to Factors(Red7tems 1-22) (Cont.) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives h_9 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original 3-501.16 A Roasts Held at or above 130°F. Containers* ( ) 7402.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) [ Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.* MOO-111/2001 Eggs-Immediate Service 145°F15sec* 1 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.1l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and/05 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 113 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements 009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 199.9 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS I TOWN OF NORTH ANDOVER RECEIVED Massachusetts Department of Public Health SEP 1 8 2009 Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT TOWN OF NORTH ANDOVER Name Date T of ' _ Uo ion S) nIZ Y 2,Z)9 Ej Food Service Routine Address 16 F I �LsT, --, Risk ❑ Retail 0 Re-inspection TelephoneLevel ❑ Residential Kitchen Previous Inspection (og ^v� 7� ❑ Mobile Date: [I Temporary ❑.Pre-operaition Owner HACCP YM ❑ Caterer El Suspect Illness Person in Charge(PIC) Sq�� Time ❑ Bed&Breakfast [IGeneral Complaint In: ❑ HACCP Inspector Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-amp/kwme wo: Viot"onsz Rolaftd to Foodb"m 81n=Inturentiona rind Ris h Factors(Rod Ibms3) Anti-Cholft Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 00.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. revention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 3. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMET TEMPERATURE CONTROLS Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Reoords/Aocuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling ��,Separation/ TION FROM CONTAMINATION ❑ 19. Hot and Cold Holding � Segregation/Protection ❑20. Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS It sm ❑ 10�Proper Adequate Handwashing L121. Food and Food Preparation for HSP Good Hygienic Practices CONSUMERADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Rolat*d Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Intorventionst immediately or within 10 days as determined by the Board and Rish Factors(Rod Itomsa 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, ned below when signed C x9 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an Food and Food Protectionorder of the Board of Health. Failure to correct violations (Fc�)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.006) the food establishment permit and cessation of food Water, Plumbing and Waste (Fc s>(5so.00sl establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(5e0.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF REINSPECTION: yaJ L_)_1 2_1 I 'Ilk Inspector's Signa Print. FWi 'D PIC's Signa Print: Pagel ofa Pages FORM 131A Violations Related to Foodbome Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 59().003(A) Assignment of Responsibility* 3-302.11(AXI) Raw Animal Foods Separated from 590.00'1(B) Demonstration of Knowledge* Cooked and R7T Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(AX2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11 A Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306,l4 A B Returned Food and Reservice of Food* 3 590.003(D) INclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fes* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) 4-602.11 Cleaning Frequency of Equipment Food- Water Meets Standards in 310 CMR 22.0' Contact Surfaces and Utensils* Shelllrsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wad Mushrooms Approved by Auth 2-301.1 l Clean Condition-Hands and Arms* Regulatory 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure* 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PIJFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility tion and Maintenance IHACCP Plans Suppled with Soap and Hand Drying 3-502.11 Specialized Process' Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Avadabili ty 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Provision •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN OR CITY OF l�YJ► � Establishment Name: 2 i 0� -- P\2'ti N Date: $ �y^G5 Page: Z of Item Code C—Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date No. Reference R—Red Item Verified oe PLEASE PRINT CLEARLY 2� .00h 1`1 CG- F 1'�i Q')' ` li �G� of 17 v T a -.9 1Qj z v� s G 0.-m\p C.�Lb o r� ► _�' -o r � M0 rs 2'- 5 1�\, 3-' �I`�cfiLG�+ t ti �--� �—• l��sYO v aD. D N r t MO En LDM a1 , i".tJ�1Lbl. -'Cry\ 'F S v 1 r 2 ^0. Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures ' Vlotedons Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red items 1-22) (Cont) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives E19: PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F. Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. Pathogens.* Efledive'111200' Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(8)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(8) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* 0 Denotes critical item in the federal 199.9 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Establishment Name: Date: 44(ss Page: of -7 Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY ra 1a �y c�T +nr rJ DF6®r S77 ' 1/7 e� r '� � YA � 1 1 � D fV z O coo Ri X Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure .. ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures Wo/ations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours. • PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F• 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F. * Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11 A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*E'01-""2001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary and * residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs -26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements 009 to 41°F/45°F Within 4 Hours. * 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41017/450F Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Establishment Name: S �- �2-`L A Date: g - )\A -c>'�L Pager_ Of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 171 lV �cav S tLc� �'�� 1�s� Rte \�.. X54, � r)r1D )P�VA \7 )AA-A-- eves ��- �G,05 Q �C6-� "^�-� �a er�n� u�\�` - '�J ,� � ' C�.✓\ .ice `��� t1-- .-"�, �a'_ cam? �a ' � \ !� �1.. '� � �aJ 1 � ►�' U`�� v � —t�� r-� T Z 51;vae S - �. .lt. 3`� 1 a,U ' v2 rale- 1, C Discussion With Person in Charge: Dz Corrective Action Required: ❑ No ❑ Yes - 0 r-r1 Tz k., 0 LJ Voluntary Compliance Ll Employee Restriction/ o '"' Ill Exclusion r. oa ❑ Re-inspection Scheduled ❑ Emergency Suspension N m ` :iL ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red items 1-22) (Cont) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives h_9 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.* Effedw'"12001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats- 155°F catering,mobile food,temporary and IS sec. residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 199.9 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF ���''►� r3 'Vx O'rti Establishment Name: 1?\`Vt_Pt Date: Page: s of --,-> Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 2v) S � I )-•lv �4--� ��-►�.v1'�S d yl \110 \7�YV \a1 \' � \ (-lS rrc�' . T=A_ v SIR a 14T -7 C� C m z _ A _ r-p w r 6 mn 2 vrs 7))%� �ti V l S 1 `3 Gl�vi m o v �. L.R. m -LS 1 LA Q0 iT MS I'� r�R,vL, -T11 \-/tIV 16-1 � Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures r Wo/at/ons Related to Foodbome Illness Interventions and Risk According to Law Cooled to Factors(Red Items 1-22) (Cont) 41°F/451F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives Fig- PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 41°/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F. * Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* IRaw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11 A(l)(2) Eggs- 155°F 15 Sec. Pathogens.*Ely-firo 1/1/2001 Eggs-Immediate Service 145°Fl5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 10 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 70°F Within 2 Hours and From 70°F 28. Poisonous or Toxic Materials FC-7 .008 29. Special Requirements 009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* *Denotes critical item in the federal 199.9 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF '�� �� Establishment Name: 57r)R- ' 'L'z.a, Date: Page: to of 2 Item Code C—Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 23 �' X051- fi�'4► G'1� '1 del Zvi S 64 VS\ L� GLS tL a j--:9 - b Discussion With Person in Charge: _0 Corrective Action Required: ElNo ❑ Yes ?Q cry s 31 Voluntary Compliance ❑ Employee Restriction/ mv P Exclusion n ` 3 Re-inspection Scheduled ❑ Emergency Suspension ao �• 11 Embargo ❑ Emergency Closure C k D Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures V/o/adons Related to Foodborne Illness/ntervendons and Risk According to Law Cooled to Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives h_9 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers' 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* Z1 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.11A(l)(2) Eggs- 155°F 15 Sec. Pathogens.*Efledh"1/1,2001 Eggs-Immediate Service 1450F15sec* 3-302.13 , Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time' 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH CF MASSACHUSETTS TOWN OR CITY OF N��-�\� 1-.r'00\,7S61_ Establishment Name: 5M�R 4\`L"ti� Date: C,<- wt Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY lA l'�,j-I rA T' '�� bJ l: v> Y`c•Zi } 0---------- MZtat cn J:z -n M� ~ D r� rn ya � z0 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures Woladons Related to Foodbome Illness/ntervendons and Risk According to Law Cooled to Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours.+ PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F. * Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.l 1(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* I Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate • 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*"11111001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations Should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec.' VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements 009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* +Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name y D T of O erdion s bMaof Ins ection Er Food Service EJIRoutine Address 1 1 Risk ❑ Retail ❑ Re-inspection Telephone v Q Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) ❑ Bed&Breakfast ❑General Complaint P_Uffallm MAl-uWff: _� ❑HACCP Inspector Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-_-W-11 nee wa: MoIntionn Roomed to Foodbom Illnonn lnfbirrontions and Rina Fnctorn(Rod Iftmct) AM-ChoMM Tobacco Violations marked may pose an imminent health hazard and require immediate corrective N0.00R NOJM IFI ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Pda0ft Hamdous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Reoords/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling P TION FROM CONTAMINATION ❑ 19. Hot and Cold Holding 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REWIRIEMENTS FOR H!"LY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Rolatbd Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Intorventions I immediately or within 10 days as determined by the Board and Ristt Factors(Red Itomst 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an in pedion immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. C N 590.000/federal Food Code.This repog rt,when signed below 23. Management and Personnel (Fc-2)(590.009) by a Board of Health member or its agent constitutes an 4. Food and Food Protection order of the Board of Health. Failure to corned violations (Fc-3)(99°.0041 cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-4)(5W.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF M4NSPECTION: 42A I 1^fi - �,/? Inspector's Signature: Print: PIC's Signature- Print: Page of Pages FORM 734A Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION ` FOOD PROTECTION MANAGEMENT g Cross-contamination 1 590.003(A) Assi ent of Responsibility* 3-302.11(Axl) Raw Animal Foods Separated from 590.003 l3 Demonstration of Knowledge* Cooked and RIT Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(Ax2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590-003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11 A Food Protection* applicants* 3-302.15 Washing Fnuts and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* - Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 131 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* * 4-501.114 Chemical Sanitization-temp.,pH, - 3-202.14 Eggs and Milk Products,Pasteurized concentration and hardness. * 3-202.16 Ice Made From Potable Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 DrinkingWater from an Approved System* 590.006(A) Bottled DriWater* Utensils Clean* _ 590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils Sheffish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1p Re ulat Ruth 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 ClProcedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 I11lFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock u Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* TagslRecords:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 31302.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Suppled with Soap and Hand Drying 3-502.11 Specialized Process' Methods* Dewces 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision •Dotes critical item in the federal 1999 Food Code or 105 CMR 590.000. T HE'COMMONWEALTH OF MASSACHUSETTS TOWN O � OF Establishment Name: 'ADate: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified -PLEASE PRINT CLtAftbY LIAU t� Jal-VI i L 35 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes i ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled 13Emergency Suspension 4 ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red7tems 1-22) (Cont) 41°F/45°F Within 4 Hours.• PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives h_9 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/450 F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria*- 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*EftcYrve11 Eggs-Immediate Service 1450F15sec• 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted'Fish,Meats&Game Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be 3-401.1 l(A)(3) Poultry, Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Mina ;mint and Personnel FC-2 .003 3-403.11(E) Remaining Unsl iced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27• Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS RECEIVED ° TOWN OF NORTH ANDOVER Massachusetts Department of Public Health MAR 2 6 2008 Division of Food and Drugs IF NORTH FOOD ESTABLISHMENT INSPECTION REPORT T�HEALLTH DEPARTMENTER Name L DateType of Oaerationls) T 9 e Inspection - .0 [ ood Service outine Address Risk ❑ Retail ❑Re-inspection Telephone Level -Z ❑ Residential Kitchen Previous Inspection P 7? - 7'Z ❑ Mobile Date: Owner 0, HACCP YRP ❑ Temporary ❑Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) In: i� ❑ HACCP ` � ❑ Bed 8 Breakfast ❑General Complaint Inspector y,[ CSS/ Ci �0 Out: S`' Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Nm►-compAance wfth: Violationn Ralaltod to Foodborne Illnem Intmuentlons and Rist F€:ctorn(Rod Ibms) Anti-Ch"g Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 5M.09(E) ❑ s0'oog IFI ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 12. Prevention of Contamination from Hands ❑13. Handwesh Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE E] 15.Toxic Chemicals [3 4. Food and Water from Approved Source TiMEITEMPERATURE CONTROLS(Poterrtlatilly Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 8. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION W9. Hot and Cold Holding - a ✓� ?Q 129 Z5 ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REWIFIEMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP El11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Plumber of Violated Provisions Relatad Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Intmentions immediately or within 10 days as determined by the Board and Rich Factors(Red Itoms 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(Seo.000) order of the Board of Health. Failure to corned violations 24. Fond and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.006) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc s>(Sso.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-x(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF REINSPECTION: Inspector's Signature: Print: Ino PIC's Signature: Print: Page�. /Of 2 Pages FORM 734A Violations Related to Foodborne Illness - Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Crass-contamination I 590.003(A) Assipment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003(1;) Demonstration of Knowledge* CookLA and R11 Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients - -� 3-302.11(Ax2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11 A Food Protection* ap licants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* SheCfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Md Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authofity 3-202.18 Shell stock Identification Present* 2-301.12 Procedure* 590.004 C Wild Mushrooms* 2-301.14 When hen to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 21101.11 Eating,Drinking or Using Tobacco* 3-202.11 Pill's Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Irate * Mouth* 3-101.1( Food Safe and Unadulterated* 3-301.12 Preventing Contamination When T * 6 Tags/Records:Shelistock 12 Prevention of Contatrdnation from Hands 3-202.18 Shellstock Identification590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* - Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Suppled with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availabj 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drymg Provision •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS /'l/. ��t/Pf� '• TOWN ORCITY OF � Establishment Name: Date: 3-1- 69— Page: of Z ttem code. G-Critical Item DESCRIPTION OF VIOLATION'.tPLAN OF CORRECTION Date No. Reference. R—Red Item Verified PLEASE PRWT CLEARLY: 2 -4 ZZ C 4 �. d / v 1 i Discussion With Person in Charge: Corrective Action Required: ❑ No �s Voluntary Compliance ❑ Employee Restriction/ CZ0 y Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: Form 734 B A.M.Sulkin Co.,Boston,MA 4 3-501.14(C) PHFs Received affemperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F) 410/450 F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original 140°F. 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*Effe0iveY'12001 Eggs-Immediate Service 145°FI5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary and * residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk factors listed above, can be 3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Time* 590.000. 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 140°F* 23. Management and Personnel FC-2 .003 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Roasts* 25. Equipment and Utensils FC-4 .005 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007 28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 29. Special Requirements .009 to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45°F Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISH INSPECTION REPORT �Name Date TVWrof O enation s T f inspection Food Service [901koutine Address Risk ❑ Retail ❑ Re-inspection Telephone _ m// Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner s ACCP YIN [I Temporary ❑ Pre-operation ❑ Suspect Illness Person in Char (PIC) Time ❑ Bed&Breakfast ❑General Complaint In: ❑HACCP Inspector rw Out: Permit No. ❑Other Each violation checked requires an exp anation on the narrative page(s) and a citation of specific provision(s) violated. Non-compl/ance wm: Violl<itiono Rolatod to Foodbomo lllnws Inttarventionsi and Risk ftctlora Rod Items A" -ChOMM Tobacco Violations marked may pose an imminent health hazard and require immediate corrective "awoog(E) ❑ wo-oeq IFI ❑ action as determined by the Board of Health. 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 Employee and PIC ❑ ❑ 14.Approved Food or Color Additives 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEJTEMPERATURE CONTROLS MotenfWyr Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Reoords/Aocuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Rica Factors(Red Itams 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on anosigned immediately or within 90 days as determined by the Board today,the items checked indicate violations of Health. 590.000/federal Food Code. This report,whow c x Po 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations 24. EquiFooand Food Protection (FC-3)(590.004)C-4)( 90.005 Cited in this report may result in suspension or revocation of 25, Equipment and Utensils (Fc•a>(seo.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc s)(59o.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-&)(5so.0o7) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. er DATE OF RE-INSPECTION: Inspector's Signature: p int: ' PIC'sSignature: Print: e pages FORM 734A Q Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(AXI) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowledge* Cooked and R11 Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredents 3-302.11(Ax2) Raw Animal}bods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11 A Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003E Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* She96sh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Md Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-202.18 Shellstock Identification Present* 2-301.12 Cl Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 ReceivinglCond'ttion 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PIIFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When T * 6 TagslRecords:Shellstock 12 Prevention of Contarnination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3.402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J)_ Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance MACCP Pians Suppied with Soap and Nand Drying 3-502.11 Specialized Process' Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 flandwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision • Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 15 FIRST STREET (::Star Pizza ' iiORTq North Andover ° Food Est. - Restaurant - Food Est. - Routine Inspection 1s�..ss•�jt, �s3'qcKusEt HACCP: L] Scoring Type: Subtractive Max Score: 0 Score: 0 Failing Score: 0 Item Status Violation Points Critical Urgency Telephone: Non-compliance with: (978) 6.8_3-0472 Anti-Choking-590.009(E) PASS 0 Owner: Tobacco-590.009(F) PASS 0 Evros Realty Trust PIC. FOOD PROTECTION MANAGEMENT Alexandra Dedog_lo_u 01. PIC Assigned/Knowledgeable/Duties-590.003(A),590.003(B),2-103.11 PASS 0 fid] RED Inspector: Michele Grant FOOD FROM APPROVED SOURCE Date InS eCted: COrreCt B 04. Food and Water from Approved Source-590.004(A-B),3-201.12,3-201.13,3- PASS 0 FV'] RED p y 202.13,3-202.14,3-202.16,5-101.11,590.006(A),590.006(B),3-201.14,3-201.15,3- 10/20/2006 202.18,590.004(C),3-201.17 Risk Level: 05. Receiving/Condition-3-202.11,3-202.15,3-101.11 PASS 0 [,%7ej RED Permit Number: 06.Tags/Records/Accuracy of Ingredient Statements-3-202.18,3-203.12,3-402.11,3- PASS 0 [d] RED BHP-2005-0404 402.12,590.004(J) _ Status: 07. Conformance with Approved Procedures/HACCP Plans-3-502.11,3-502.12,8- PASS 0 RED FULL COMPLY 103.12 #of Critical Violations: EMPLOYEE HEALTH 0 02. Reporting of Diseases by Food Employee and PIC- PASS 0 [ l RED Time IN: Time OUT: 590.003(C),590.003(F),590.003(G) 03. Personnel with Infections Restricted/Excluded-590.003(D),590.003(E) PASS 0 [Vj RED Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately I'Ior within 90 days) North Andover Board of Health 1600 OSGOOD STREET BUILDING 20;SUITE 2-36 NORTH ANDOVER MA 01845(978)688-9540 healthdept@townofnorthandover.com GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 08,2006 ) Page I of Item Status Violation Points Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to 08.Separation/Segregation/Protection-3-302.11(A)(1),3-302.11(A)(2),3-302.11(A),3- PASS 0 LVI RED Foodborne Illness Interventions 302.15,3-304.11,3-306.14(A)(B),3-701.11 and Risk Factors (Require immediate corrective action) 09. Food Contact Surfaces Cleaning and Sanitizing-4-501.111,4-501.112,4-501.114,4- PASS 0 RED 601.11(A),4-602.11,4-702.11,4-703.11 10. Proper Adequate Handwashing-2-301.11,2-301.12,2-301.14 PASS 0 [dj RED 11.Good Hygienic Practices-2-401.11,2-401.12,3-301.12 PASS 0 [V) RED 12. Prevention of Contamination from Hands-590.004(E) PASS 0 [] RED 13. Handwash Facilities-5-203.11,5-204.11,5-205.11,6-301.11,6-301.12 PASS 0 [] RED PROTECTION FROM CHEMICALS 14.Approved Food or Color Additives-3-202.12,3-302.14 PASS 0 [y) RED 15.Toxic Chemicals-7-101.11,7-102.11,7-201.11,7-202.11,7-202.12,7-203.11,7- PASS 0 [1 RED 204.11,7-204.12,7-204.14,7-205.11,7-206.11,7-206.12,7-206.13 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 16.Cooking Temperatures-3-401.11A(1)(2),3-401.11(A)(2),3-401.11(13)(1)(2),3- PASS 0 [] RED 401.11(A)(2),3-401.1 1(A)(3),3-401.1 1(C)(3),3-401.12,3-401.1 1(A)(1)(b) 17. Reheating-3-403.11(A)&(D),3-403.11(B),3-403.11(C),3-403.11(E) PASS 0 �i%J RED 18.Cooling-3-501.14(A),3-501.14(B),3-501.14(C),3-501.15 PASS 0 [Vj RED 19. Hot and Cold Holding-3-501.16(B)590.004(F),3-501.16(A),3-501.16(A) PASS 0 [� RED 20.Time As a Public Health Control-3-501.19,590.004(H) PASS 0 [d' RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 21. Food and Food Preparation for HSP-3-801.11(A),3-801.11(B),3-801.11(D),3- PASS 0 [Vel RED 801.11(C) CONSUMER ADVISORY 22. Posting of Consumer Advisories-3-603.11,3-302.13 PASS 0 [� RED I North Andover Board of Health 1600 OSGOOD STREET BUILDING 20;SUITE 2-36 NORTH ANDOVER MA 01845(978)688-9540 healthdept@townofnorthandover.com I GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 08,2006 ) Page 2 of3 I w� Item Status Violation Points Critical Urgency Violations Related to Good Retail Practices (Blue Items) .+ 23.Management and Personnel-(FC-2)(590.003) PASS 0 BLUE 24. Food and Food Protection-(FC-3)(590.004) PASS 0 BLUE 25. Equipment and Utensils-(FC-4)(590.005) PASS 0 BLUE 26.Water, Plumbing and Waste-(FC-5)(590.006) PASS 0 BLUE 27. Physical Facility-(FC-6)(590.007) PASS 0 BLUE 28. Poisonous or Toxic Materials-(FC-7)(590.008) PASS 0 BLUE 29. Special Requirements-(590.009),590.009(A)-(D) PASS 0 BLUE 30.Other-See Notes- PASS 0 BLUE North Andover Board of Health 1600 OSGOOD STREET BUILDING 20;SUITE 2-36 NORTH ANDOVER MA 01845(978)688-9540 healthdept@townofnorthandover.com I GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 08,2006 ) Page 3 of I /j (r l to i , oc STAiz "� ►Z,trt SCAM I iI APPROVED BY: DRAWN BY DAiE: ^� U I d - �) REVISED C . F IJ fl h-I I N G DRAWING NUMBER r r • F I r r ' ' i I r I 1, t , , ' 1, �• ..r ' I I~ 1'� ��� ��+ hi'+`k�+��?�r�tt. L��I�fF �•L 1 K;� �1 f:,,.. >,-� r I IN ; ne NK T � gta 1 ! t � r11Y1 'c3.�.lo'_ry;� I �t 'C ' lf"� O O O L...1 C�4M tyh o _'"�, c9.�s t►ti-�'cc,�ean�' `•.O�s �Ow�n O�r1�v'a ca.tna� ���( Prepared For: '-mains �r3�� � S COvvw � M,o Date: lQosC_ Clean Restroom Solutions —Oji Safe Floor Solutions ►1 , - o l m Io , . Essentials Protect Soap Service: Carpet Mat: Type: Size: 3x5 Mat Paper Towel Service: 4x6 Mat Type: ❑Auto ❑Center 3x10 Mat Toilet Paper Service Safety/Logo Mat: Other Size: Protect Artwork Charge Fan Air Freshener: Scraper Mat: Size: Fragrance: Spring Step Mat: Micromist Air Freshener: Size: Fragrance: Message Mat: Automated Flushing System Type: Size: Automated Drip System Dura-lite Mat: Size: Inline Cleaning System Other Feminine Hygiene Service Maintain Urinal Screens Dust Mop: Size: Toilet Seat Cleaner System Wet Mop Other Microfiber Mop: Size: Maintain Mop Handle Dust Mop: Size: Chemical Dispensing Wet Mop Floor Cleaner Microfiber Mop: Size: Disinfectant Cleaner Mop Handle Glass Cleaner Chemical Dispensing Sanitizer Floor Cleaner Other Disinfectant Cleaner Glass Cleaner Sanitizer Other Cintas Bundle Discount: ❑ Gold - 20% ❑ Silver - 15% ❑ Bronze - 10% Deep Clean UltraClean Service Fixtures Restrooms Initial Deep Clean Floors Other Service Charge Notes: This pricing will expire 30 days from date written. Prepared by: !NrAs FS-3101 0.4.09 c (,, t NORTh qw- Q �tLED ,6' "rO 3� 6 h.. OL 0 ~ 1 ey O q. COCMIC K- ��SSAC HUS���y PUBLIC HEALTH DEPARTMENT Community Development Division November 10, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Plan approval; Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009 and reviewed on June 1, 009 and resubmitted on October 7, 2009.The plan has been approved. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe no catering OK 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan OK old existing equipment/ only NSF 3) Page 3 #1 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appears to be close to 1/8 inche=a foot., Please correct scale and size of plan OK 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks OK 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage in back near mop OK 6) Page 4, Food Supplies, blank items. Please complete OK 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. shown OK 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct OK 9) Page 6 #1 Hot/cold holding. Plan shows soup warmers at minimum Please complete submit when decided 10)Page 7 #1 reheating incomplete Please note type and number of reheating units. OK 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer OK 12)Page 8 #4 incomplete Please answer question. Describe policy. Paid sick leave?? OK 13)Page 8 #5 incomplete please answer question OK 14)Page 9 #6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce, tomato etc. will veges come pre-cut?Next door pre-prep 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately OK complete 16)Page 11 questions unanswered:#2, #3, #4, #5, #7, #9, #12 Answer even if it is NO or N/A OK 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached NO softserve b. Pastry—where are you purchasing the pastry?Explain Eddies' in Boston i. Do you have a refrigerated pastry case for items like cannolis, Eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question is there one already? 19)Page 15 #44 question unanswered Please answer OK 20)Page 15 #48 linens Please answer OK 21)Page 16#50 location of clean linen storage Please answer OK 22)Page 17 #62 unanswered Please answer OK 23)Page 18 #75 unanswered Please answer OK 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site will submit The revised plan is significantly different from the first plan reviewed therefore some new items of concern have been identified. 25)The single hand sink is not sufficient to allow access from the ware washing and food areas. (Possibly the plan shows 2 sinks in the corner?) The food service area is greater than 15 feet away from the sink that is hidden in the corner. Also consider there is no hand sink in the actual ware washing area. Moved up wall to accommodate 26)The bathroom is not shown in the first plan and in the second it is open into the food storage area. Toilet rooms opening to the kitchen or dining area shall have adequate ventilation. Ventilation may be provided by window(s) or by mechanical means. yes Be advised that you must address any conditions not identified in the application that are in violation of the food code. Please check to see if the grease trap complies with the following requirement. The Health Department was recently notified of requirements in the plumbing code that may affect you. The language in bold is specific;please do not change it in any way. If you have one or more interior grease traps please note the plumbing code 248 CMR 10.09 (m): 1. A laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one-inch high. The sign shall state the following in exact language: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com _ IMPORTANT This grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis.Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). Prior to receiving your permit to operate you must have 2 inspections; a construction and a final inspection. When all equipment is in place a construction inspection may be requested. Once given approval, you may begin bringing in food. No cooking or serving may be conducted until you receive you final inspection and have your"Food Establishment Permit" given to you by the Health Office. Some items needed to receive the permit to operate are: 1) The establishment will be clean 2) The handsink and bathroom will be stocked with a wall mounted paper towel and soap dispensers 3) The ladies room will have a covered trash can for feminine item disposal 4) Bathroom must have "employee must wash hands before returning to work" signage 5) Handsinks should be labeled"hand wash only" 6) There must be test strips for the Chlorine sanitizer on site. Your application showed "Iodine" as an alternate sanitizer. If it is in use,please have testing capability for the iodine as well. 7) Sanitizer buckets should be set up for review of locations you are keeping them throughout the kitchen. 8) The three-bay should be labeled "wash, rinse, sanitize" in the direction of the intended cleaning procedure. 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10)You must obtain copies of the state and federal food codes and keep them on premises 11)At minimum, employees should be trained on the sick policy and sanitation basics. If you intend to replace any equipment,please contact our office before purchasing the item so that the specification sheets can be approved prior to the order being submitted. We look forward to working with you in the opening of this establishment and its successful operation in North Andover. /SincY, Sa r,REHS�Health Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8476 Web www.townofnorthandover.com NORTFr O�<t►eD 06gti0 �O _ OLAKI RA COCKIC.WK*`y1' 0 Ars 01V SACHI s���y PUBLIC HEALTH DEPARTMENT Community Development Division October 13, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Second Plan review; Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009 and reviewed on June 1, 009 and resubmitted on October 7, 2009. The following items from second review are in BLUE. Please review the letter and then contact the Health Office to set up a meeting. We would like to meet with you to discuss the outstanding items in an attempt to achieve an approvable plan. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe no catering OK 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan still no spec sheetsro-be 3) Page 3 #1 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appearsclose to 1/8 inche=a foot. Please correct scale and size of plan OK 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks OK 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage show location on plan ''i%^ b'Z'L'-LC 6) Page 4, Food Supplies,blank items. Please complete OK 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. show shelving on plan 1 v� r. "-r 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct OK 9) Page 6#1 Hot/cold holding. Plan shows soup warmers at minimum Please complete ?? 10)Page 7#1 reheating incomplete Please note type and number of reheating units. OK 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ' 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer OK 12)Page 8 44 incomplete Please answer question. Describe policy. Paid sick leave?? OK 13)Page 8 #5 incomplete please answer question OK 14)Page 9 46,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce,tomato etc. will veges come pre-cut? more detail, which sink? o 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately incomplete 00"4 16)Page 11 questions unanswered:#2, 43, 44, #5, 47, #9, #12 Answer even if it is NO or N/A OK 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached NO softserve b. Pastry—where are you purchasing the pastry? Explain Explain i. Do you have a refrigerated pastry case for items like cannolis, eclairs etc !� 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question is there one already? 19)Page 15 444 question unanswered Please answer OK 20)Page 15 448 linens Please answer OK 21)Page 16 450 location of clean linen storage Please answer OK 22)Page 17 #62 unanswered Please answer OK 23)Page 18 #75 unanswered Please answer OK 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site no certificates submitted The revised plan is significantly different from the first plan reviewed therefore some new items of concern have been identified. 25)The single hand sink is not sufficient to allow access from the ware washing and food areas. (Possibly the plan shows 2 sinks in the corner?) The food service area is greater than 15 feet away from the sink that is hidden in the corner. Also consider there is no hand sink in the actual ware washing area. L .,Cs�-- 26)The bathroom is not shown in the first plan and in the second it is open into the food storage area. Toilet rooms opening to the kitchen or dining area shall have adequate ventilation. Ventilation may be provided by window(s) or by mechanical means. Sincerely, Susan Sawyer, REHS/RS Public Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com a pORT4 O` .,L!O 16 q� 3'? ae'1- .. 6 OL O � t � O •wM COCMIC {WKw V SAC HUS���� PUBLIC HEALTH DEPARTMENT Community Development Division October 13, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Second Plan review; Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009 and reviewed on June 1, 009 and resubmitted on October 7, 2009. The following items from second review are in BLUE. Please review the letter and then contact the Health Office to set up a meeting. We would like to meet with you to discuss the outstanding items in an attempt to achieve an approvable plan. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe no catering OK 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan still no spec sheets 3) Page 3 #1 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appears to be close to 1/8 inche=a foot. Please correct scale and size of plan OK 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks OK 5) Page 4 k. Noted that no chemicals are.used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage show location on plan 6) Page 4, Food Supplies, blank items. Please complete OK 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. show shelving on plan 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct OK 9) Page 6 #1 Hot/cold holding. Plan shows soup warmers at minimum Please complete ?? 10)Page 7 #1 reheating incomplete Please note type and number of reheating units. OK 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com f y 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer OK 12)Page 8 44 incomplete Please answer question. Describe policy. Paid sick leave?? OK 13)Page 8 #5 incomplete please answer question OK 14)Page 9 #6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce, tomato etc. will veges come pre-cut? more detail, which sink? 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately incomplete 16)Page 11 questions unanswered:42, #3, 44, #5,#7, #9, 412 Answer even if it is NO or N/A OK 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached NO softserve b. Pastry—where are you purchasing the pastry? Explain Explain i. Do you have a refrigerated pastry case for items like cannolis, eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question is there one already? 19)Page 15 444 question unanswered Please answer OK 20)Page 15 #48 linens Please answer OK 21)Page 16 450 location of clean linen storage Please answer OK 22)Page 17 462 unanswered Please answer OK 23 Page 18 #75 unanswered Please answer OK 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site no certificates submitted The revised plan is significantly different from the first plan reviewed therefore some new items of concern have been identified. 25)The single hand sink is not sufficient to allow access from the ware washing and food areas. (Possibly the plan shows 2 sinks in the corner?) The food service area is greater than 15 feet away from the sink that is hidden in the corner. Also consider there is no hand sink in the actual ware washing area. 26)The bathroom is not shown in the first plan and in the second it is open into the food storage area. Toilet rooms opening to the kitchen or dining area shall have adequate ventilation. Ventilation may be provided by window(s) or by mechanical means. Sincerely, Susan Sawyer, REHS/RS Public Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com NORTfi O6q�O 6 OL O A� F- T Coe L M!KM y1 ��SSAC PUBLIC HEALTH DEPARTMENT Community Development Division October 13, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Second Plan review; Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009 and reviewed on June 1, 009 and resubmitted on October 7, 2009. The following items from second review are in BLUE. Please review the letter and then contact the Health Office to set up a meeting. We would like to meet with you to discuss the outstanding items in an attempt to achieve an approvable plan. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe no catering OK 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan still no spec sheets 3) Page 3 #1 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appears to be close to 1/8 inche=a foot. Please correct scale and size of plan OK 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks OK 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage show location on plan 6) Page 4, Food Supplies, blank items. Please complete OK 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. show shelving on plan 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct OK 9) Page 6#1 Hot/cold holding. Plan shows soup warmers at minimum Please complete ?? 10)Page 7 #1 reheating incomplete Please note type and number of reheating units. OK 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer OK 12)Page 8 #4 incomplete Please answer question. Describe policy. Paid sick leave?? OK 13)Page 8 #5 incomplete please answer question OK 14)Page 9#6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce, tomato etc. will veges come pre-cut?more detail, which sink? 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately incomplete 16)Page 11 questions unanswered:#2, #3, #4, #5, #7, #9, #12 Answer even if it is NO or N/A OK 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached NO softserve b. Pastry—where are you purchasing the pastry? Explain Explain i. Do you have a refrigerated pastry case for items like cannolis, Eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question is there one already? 19)Page 15 #44 question unanswered Please answer OK 20)Page 15 #48 linens Please answer OK 21)Page 16 #50 location of clean linen storage Please answer OK 22)Page 17 #62 unanswered Please answer OK 23)Page 18 #75 unanswered Please answer OK 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site no certificates submitted The revised plan is significantly different from the first plan reviewed therefore some new items of concern have been identified. 25)The single hand sink is not sufficient to allow access from the ware washing and food areas. (Possibly the plan shows 2 sinks in the corner?) The food service area is greater than 15 feet away from the sink that is hidden in the corner. Also consider there is no hand sink in the actual ware washing area. 26)The bathroom is not shown in the first plan and in the second it is open into the food storage area. Toilet rooms opening to the kitchen or dining area shall have adequate ventilation. Ventilation may be provided by window(s) or by mechanical means. Sincerely, Susan Sawyer, REHS/RS Public Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r NORTH a O AtLEO ,61 �� O O [u.iu niwcn��• ��AORA7ED SPP` I(5 �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division October 13, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Second Plan review; Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009 and reviewed on June 1, 009 and resubmitted on October 7, 2009. The following items from second review are in BLUE. Please review the letter and then contact the Health Office to set up a meeting. We would like to meet with you to discuss the outstanding items in an attempt to achieve an approvable plan. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe no catering OK 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan still no spec sheets 3) Page 3 #1 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appears to be close to 1/8 inche=a foot. Please correct scale and size of plan OK 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks OK 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage show location on plan 6) Page 4, Food Supplies, blank items. Please complete OK 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. show shelving on plan 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more,please correct OK 9) Page 6 #1 Hot/cold holding. Plan shows soup warmers at minimum Please complete ?? 10)Page 7 #1 reheating incomplete Please note type and number of reheating units. OK 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com A 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer OK 12)Page 8 #4 incomplete Please answer question. Describe policy. Paid sick leave?? OK 13)Page 8 #5 incomplete please answer question OK 14)Page 9 #6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce, tomato etc. will veges come pre-cut? more detail, which sink? 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately incomplete 16)Page 11 questions unanswered:#2, #3, #4, #5, #7, #9, #12 Answer even if it is NO or N/A OK 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached NO softserve b. Pastry—where are you purchasing the pastry? Explain Explain i. Do you have a refrigerated pastry case for items like cannolis, Eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question is there one already? 19)Page 15 #44 question unanswered Please answer OK 20)Page 15 #48 linens Please answer OK 21)Page 16 #50 location of clean linen storage Please answer OK 22)Page 17 #62 unanswered Please answer OK 23)Page 18 #75 unanswered Please answer OK 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site rIo certificates submitted The revised plan is significantly different from the first plan reviewed therefore some new items of concern have been identified. 25)The single hand sink is not sufficient to allow access from the ware washing and food areas. (Possibly the plan shows 2 sinks in the corner?)The food service area is greater than 15 feet away from the sink that is hidden in the corner. Also consider there is no hand sink in the actual ware washing area. 26)The bathroom is not shown in the first plan and in the second it is open into the food storage area. Toilet rooms opening to the kitchen or dining area shall have adequate ventilation. Ventilation may be provided by window(s) or by mechanical means. Sincerely, Susan Sawyer, REHS/RS Public Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Town of North Andover �s HEALTH DEPARTMENT �Ss�cNust� CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: X/ Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Zod ster $ ❑' Service-Type: -- $ '7�• ❑ Funeral Directors <'- ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ r ,aid Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer FDA/CFP: Food Establishment,Plan Review Guide - Sections I Page 1 of 19 t Food and Drug Administration and Conference for Food Protection FOOD ESTABLISHMENT PLAN REVIEW GUIDE FR�cE a, - 2000 c SECTION I �°HEALTH NORTH� f EARMEY FOOD ESTABLISHMENT PLAN REVIEW APPLICATION TO BE COMPLETED BY THE OPERATOR AND SUBMITT THE REGULATORY AUTHORITY Regulatory Authority v y/s Date: o FOOD ESTABLISHMENT PLAN REVIEW APPLICATION /NEW REMQDEL CONVERSION Name of Establishment: 5TPtR- C^ FE )C TE�1 Category: Restaurant ✓, Institution , Daycare , Retail Market , Other Address: _I I 'FI KS;T Sj> Phone if available: C� �1 — 0 � Name of Owner: T A K D RJ� D C—D O U U 0 Mailing Address: G--+-,S ���� 5`r> Telephone: 69 ai) -�5—O n Applicant's Name: LEx4 D R:2B 67u Title (owner,manager, architect, etc.): 0��G Mailing Address: (��S F1STEt�, �J, Telephone: — )6'$ ? I have submitted plans/applications to the following authorities on the following dates: http://www.cfsan.fda.gov/—dms/prev-1.htm1 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide, - Sections I Page 2 of 19 Governing Board of Council Plumbing I Zoning Electric Planning Police Building Fire Conservation Other( ) Hours of Operation: Sun Thurs Mon,5 I I Pori M ! ! TuesM I f%at Weds M 1 I FM Number of Seats: Number of Staff- '(Maximum taff'(Ma ium per shift) Total Square Feet of Facility: 0 517 ` ` 00 s -� Number of Floors on which operations are conducted Maximum Meals to be Served: Breakfast OFEe MSTRI ES (approximate number) Lunch Dinner Projected Date for Start of Project: Projected Date for Completion of Project: Type of Service: Sit Down Meals (check all that apply) Take Out Caterer Mobile Vendor Other_{� Please enclose the follow' g documents: 1/ Proposed Menu (including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment(dumpsters, well, septic system- if applicable) Plan drawn to scale of food establishment showing location of equipment,plumbing, electrical services and mechanical ventilation http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP.: Food Establishment Plan Review Guide- Sections I Page 3 of 19 I Equipment schedule CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan accurately drawn to a minimum scale of 1/4 inch= 1 foot. This is to allow for ease in reading plans. 2. Include: proposed menu, searing capacity, and projected daily meal volume for food service operations. 3. Show the location and when requested, elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common na e. S bmit drawings of self-service hot and cold holding units with sneeze guards. Sf5e P - 4. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and for hot-holding potentially hazardous foods. IVIA 5. Label and locate separate food preparation sinks when t e menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods. /"'A 6. Clearly designate adequate handwashing lavatories for each toilet fixture and in the immediate area of food preparation. 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. 8. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets,basements and/or cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual. 9. Include and provide specifications for: a. Entrances, exits, loading/unloading areas and docks; r b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; t c. Plumbing schedule including location of floor drains; floor sinks, water supply lines, overhead waste-water lines, hot water generating equipment with capacity and recovery rate, backflow r prevention, and wastewater line connections; d. Lighting schedule with protectors; (1)At least 110 lux(10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2)At least 220 lux(20 foot candles): (a)At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption; i http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I � Page 4 of 19 (b) Inside equipment such as reach-in and under-counter refrigerators; (c)At a distance of 75 cm 30 ches) above the floor in areas used for handwashing, warewashing, and equipment and utensil storage, and in toilet rooms; and (3)At least 540 lux (50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders, or saws where employee safety is a factor. e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified fog r saamitatiioon�-b-y an ANSI accredited certification program(when applicable). IM" - I' f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A color coded flow chart demonstrating flow patterns for: -food(receiving, storage,preparation, service); lam -food and dishes (portioning, transport, service); 01,1 -dishes (clean, soiled, cleaning, storage); -utensil (storage,use, cleaning); ' lc_j uY� S -trash and garbage (service area, holding, storage); . rr-p Sh bourzio h. Ventilation schedule for each room; i. A mop sink or curbed cleaning facility with facilities for hanging wet mops; j. Garbage can washing area/facility; k. Cabinets for storing toxic chemicals; PJ) 1. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; Ye-0 m. Completed Section l; n. Site plan (plot plan) FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods (PHF's) to be handled,prepared and served. CATEGORY* (YES) (NO) 1. Thin meats,poultry, fish, eggs (hamburger; sliced meats; fillets) ( ) 2. Thick meats, whole poultry(roast beef, whole turkey, chickens, hams) ( ) 3. Cold processed foods (salads, sandwiches, vegetables) 4. Hot processed foodssoups, tews, rice/noodles, gravy, chowders,tcasseroles) 5. Bakery goods (pies, custards, cream fillings &toppings) P ut' w1 owed 67M�'f�e(t/1 l ) 6. Other * A generic HACCP plan for each category of food may be available from the regulatory authority for reference. http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 ' FDA/CFP: Food Establishment Plan Review Guide- Sections I Page 5 of 19 PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD SUPPLIES: 1. Are all food supplies from inspected and approved sources. YES /NO 2. What are the projected frequencies of deliveries for Frozen foods Wev Refrigerated foods , and Dry goods t 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage 400s.,E- -�- Refrigerated Storage (�- .,�, , and Frozen storage 13: 4. How will dry goods be stored off the floor? LCj 1 COLD STORAGE: 1. Is adequate and approved freezer and refrigViavailable to store frozen foods frozen, and refrigerated foods at 41°F (5°C) and belowO Provide the method used to calculate cold suirements. 2. Will raw meats, poultry and seafood stored in the same refrigerators and freezers with cooked/ready-to-eat foods?YES /(NO If yes,how will cross-contamination be prevented? I � 3. Does each refrigerator/freezer have a thermometer? ES NO Number of refrigeration units: _ Number of freezer units: �C4' of .J 4. Is there a bulk ice machine available? ES /NO THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: Please indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place. Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS RefrigerationOD http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 6 of 19 - y Running Water Less than 70T / (21°C) Microwave(as part of cooking process) Cooked from Frozen state Other(describe) *Frozen foods: approximately one inch or les =t ' , and jnore than an inch=thick. 1� COOKING: L food product thermometers be used to measure final cooking/reheating temperatures of PHF's? YES NO What type of temperature measuring device: �6ejom m x! Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: beef roasts 130°F (121 min) solid seafood pieces 145T (15 sec) other PHF's 145T (15 sec) /V eggs: Immediate service 145T (15 see) pooled* 155T (15 sec) (*pasteurized eggs must be served to a highly susceptible population) pork 1457 (15 sec) comminuted meats/fish 1557 (15 sec) poultry 1657 (15 sec) reheated PHF's 165T (15 sec) 2. List types of cooking equipment. Mcak NaALe, ±4&6n HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 140°F (60°C) or above during holding for service? Indicate type and number of hot holding units. http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 7 of 19 2. How will cold PHF's be maintained at 41'F (5°C) or below during holding for service? Indicate type and number of cold holding units. �-rf 6.1 COOLING: Please indicate by checking the appropriate boxes how PHF's will be cooled to 41°F (5°C) within 6 hours (140°F to 70°F in 2 hours and 70°F to 41'F in 4 hours). Also, indicate where the cooling will take place. COOLING THICK THIN THIN THICK RICE/ METHOD MEATS MEATS SOUPS/ SOUPS/ NOODLES GRAVY GRAVY Shallow Pans Ice Baths Reduce Volume or Size Rapid Chill Other (describe) REHEATING: 1. How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. NArrvmuzAAAeSb S14 4 http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 8 of 19 - 2. How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? PREPARATION: 1. Please list categories of foods prepared more than 12 hours in advance of service. 2. Will food employees be trained in good food sanitation practices?6) S /NO Method of training: Number(s) of employees: t r Yn o nP_ Dates of completion: 3. Will dispo le gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to- eat foods?VE /NO 4. Is ther w 'tten policy to exclude or restrict food workers who are sick or have infected cuts and q lesions?YE NO SSR pb t i� ,1 j �`�"�v�` f ., p la" �S v, �J/q�-e .4 l) Please describe briefly: tmol—e5 Covq TA,,�- Will employees have paid sick leave? ES NO 5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type: (/U� U s - cjo Concentration: t�1 CUM w http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 9 of 19 Test Kit: ES /NO 6. Will ingredients for cold ready-to-eat foods such as tuna, mayonn is and eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled? S O If not, how will ready-to-eat foods be cooled to 41'F? 7. Will all produce be washed on-site prior to use?6NO Is there a planned location used for washing produce?et/NO Describe oL6 � i�l co l d -amu-�► If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. LAJI.+k w sLr ► r eo d, 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (417 - 1407) during preparation. 9. Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared on-site or otherwise required by the regulatory authority. 10. Will the facility be serving food to a highly susceptible population?YES NO If yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area? http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 10 of 19 A. FINISH SCHEDULE Applicant must indicate which materials(quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. Kitchen FLOOR COVING WALLS CEILING Bar C � 1 U Ste- S V1 GT' Food Storage OtheF-StI orage � , k 0�r 6"` 'e, Toilet Rooms S-P-® ( P401".1 L I Dressing Rooms!` \ o _ Garbage& Refuse Storag s1� Mop Service OLC{G e-?Cf Basin Area ,�aY��- ��� ,�� s'¢"'p✓ Warewashin "4< S w �`f g �r d� . � Area 0VLCt Of Walk-in Refrigerators and Freezers http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment.Plan Review Guide - Sections I Page 11 of 19 B.INSECT AND RODENT CONTROL APPLICANT:Please check appropriate boxes. YES NO NA 1. Will all outside doors be self-closing and rodent proof? ( ) ( ) 2. Are screen doors provided on all entrances left open to the outside? 3. Do all openable windows have a minimum#16 mesh screening? ( ) ( ) 4. Is the placement of electrocution devices identified on the plan? 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? ( ( ) ( ) 7. Will air curtains be used? If yes, where? C. GARBAGE AND REFUSE Inside 8. Do all containers have lids? 9. Will refuse be stored inside? If so, where? 10. Is there an area designated for garbage can or floor mat cleaning? Outside 11. Will a dumpster be used? Number—A Size \1 Frequency of pickup Contractor 12. Will a compactor be used? \/ Number_ Size Frequency of pick up http://www.cfsan.fda.gov/–dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 12 of 19 Contractor 13. Will garbage cans be stored outside? 14. Describe surface and location where dumpster/compactor/ga_rbaa ca_n_�arP tc,be—stored 0&de- 15. Describe location of grease storage receptacle P I A 16. Is there an area to store recycled containers? ( ) ( ) ( ) Nh Indicate what materials are required to be recycled; ( ) Glass (, ) Metal ( )Paper u� I ( ) Cardboard ( ) Plastic 17. Is there any area to store returnable damaged goods? ( ) ( ) ( ) D. PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18.Toilet 19. Urinals nI I ' 20. Dishwasher � http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 13 of 19 21. Garbage Grinder 22. Ice machines 23.Ice storage bin 24 inks Mop �. anitor c. Handwash d. 3 Compartment e. 2 Compartment f. l Compartment g.Water Station 25. Steam tables 26.Dipper wells 27. Refrigeration condensate/ drain lines 28. Hose connection 29.Potato peeler http://www.cfsan.fda.gov/—drns/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 14 of 19 30.Beverage Dispenser w/carbonator 31. Other * TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it. An integral trap is one that is built directly into the fixture, e.g., a toilet fixture. A?P?trap is a fixture trap that provides a liquid seal in the shape of the letter?P.? Full ?S?traps are prohibited. 32. Are floor drains provided& easily cleanable, if so, indicate location: E.WATER SUPPLY 33. Is water supply public ( Ior private ( ) ? 34. If private, has source been approved?YES ( )NO ( ) PENDING( ) Please attach copy of written approval and/or permit. 35. Is ice made on premises ) or purchased commercially( ) ? If made on premise, are specifications for the ice machine provided?YES MINO ( ) Describe provision for ice scoop storage: ;� LN0, Provide location of ice maker or bagging operation 36. What is the capacity of the hot water generator? 37. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water(see Part 5 & Part 9 Under Section III in this manual) 38. Is there a water treatment device?YES ( )NO ( ) If yes,how will the device be inspected & serviced? http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment,Plan Review Guide - Sections I Page 15 of 19 39. How are backflow prevention devices inspected & serviced? F. SEWAGE DISPOSAL 40. Is building connected to a municipal sewer?YES (" NO ( ) 41. If no, is private disposal system approved?YES ( )NO ( ) PENDING( ) Please attach copy of written approval and/or permit. 42. Are grease traps provided?YES o O ( ) If so, where? Provide schedule for cleaning &maintenance G.DRESSING ROOMS 43. Are dressing rooms provided?YES ( NO O 44. Describe storage facilities for employees'personal belongings(i.e.,purse, coats,boots,umbrellas,etc.) " low H. GENERAL 45. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES ( NO ( �( Indicate location: 1 " 46. Are all toxics for use on the premise or for retaNsale (this includes personal medications), stored away from food preparation and storage areas?YES (' O ( ) 47. Are all containers of toxics including sanitizing spray bottles clearly labeled? YESM/NO ( ) 48. Will linens be laundered on site?YES O NO http://www.efsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 16 of 19 If yes,what will be laundered and where? If no, how will linens be cleaned? Da kA "Q.A4 C6W MM 49. Is a laundry dryer available?YES ( )NO(J� 50. Location of clean linen storage: 0 PiL,K S 1kE-U 51. Location of dirty linen storage: LAMM cf-VE 'I �n b /(L o<- MIA A\P-m 0u-A--- 52. Are containers constructed of safe materials to store bulk food products?YES ( )NO ( ) Indicate type: �J I R 53. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FIRE AIR AIR &/OR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM DEVICES 54. How is each listed ventilation hood system cleaned? http://www.cfsan.fda.gov/-dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment.Plan Review Guide- Sections I Page 17 of 19 I. SINKS 55. Is a mop sink present?YES MINO ( ) so WO#-" If no,please describe facility for cleaning of mops and other equipment: 56. If the menu dictates, is a food preparation sink present?YES (/O ( ) J.DISHWASHING FACILITIES 57. Will sinks or a dishwasher be used for warewashing? Dishwasher( ) i TvKo compartment sink Three compartment sink(� 58. Dishwasher i Type of sanitization used: 131eaA Hot water(temp.provided) Booster heater Chemical type Is ventilation provided?YES ( NO ( ) 59. Do all dish machines have temp s with operating instructions?YES ( )NO ( ) 60. Do all dish machines have temperature/pressure gauges a required that are accurately working?YES ( )NO ( ) N (\ \ 61. Does the largest pot and pan fit into each compartment of the pot sink?YES (vf'N' O ( ) If no, what is the procedure for manual cleaning and sanitizing? 62. Are there drain boards on both ends of the pot sink? YES JNO ( ) 63. What type of sanitizer is used? \k� http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 18 of 19 Chlorine (") Iodine ( ) Quaternary ammonium ( ) Hot Water (t,)/ Other ( ) 64. Are test papers and/or kits available for checking sanitizer concentration?YES (�O ( ) K. HANDWASHING/TOILET FACILITIES 65. Is there a handwashing sink in each food preparation and warewashing area?YES (,�/NO ( ) 66. Do all handw hi sinks, including those in the restrooms, have a mixing valve or combination faucet?YES (\NO ( ) 67. Do self-closing metering faucetsp vide a flow of water for at least 15 seconds without the need to reactivate the faucet?YES ( )NO (1l 68. Is hand cleanser available at all handwashing sinks?YES MNO ( ) 69. Are hand drying facilities (paper towels, air blowers, etc.) available at all handwashing sinks?YES (� NO ( ) 70. Are covered waste receptacles available in each restroom?YES "/NO ( ) 71. Is hot and cold running water under pressure available at each handwashing sink?YES`�4/NO ( ) 72. Are all toilet room doors self-closing?YES �-4<0 ( ) 73. Are all toilet rooms equipped with adequate ventilation?YES (v,�/N0 ( ) 74. If required, is a handwashing sign posted in each employee restroom?YES (-j/NO ( ) L. SMALL EQUIPMENT REQUIREMENTS 75. Please specify the number, location, and types of each of the following: Slicers p Cutting boards -fnL Can openers W\0 Mixers Nb Floor mats Other http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide- Sections I Page 19 of 19 STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signatures) p owner(s) or responsible representative(s) Date: Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments. Home I Plan Review: Table of Contents Hypertext updated by dms/ces 2000-MAR-30 http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 m` H/O NAME: I CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal ❑ Body Art Establishment `, ❑ Body Art Practitioner er .,•�" rte" ��' Food Service-Type: G " $ r t ❑ Funeral Directors $ I ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler N t $ ' '♦ter. .? ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco Ute` ; ❑ Trash/Solid Waste Hauler ❑ Well Construction $ j SEPTIC Systems: ❑ Septic-Soil Testing $ P 0 ❑ Septic-Design Approval 0 $ W i � ' ❑ Septic Disposal Works Construction(DWQ $ ❑ Septic Disposal Works Installers(DWI) J $ ❑ Title 5Inspector $ ❑ Title 5 Report $ �� ❑ Other:(Indicate) M ;� t � a Ith Agent Initials White Applicant Yellow Health Pink Treasurer t mLL Lteuns are also a vmlLmUc- Lw be-oaf SLwc�le Gs v-esso- Do-wGle Espresso - Joe Coffee Cafe Lane Espresso and steamed milli Caio.�swacLwo Espresso,steamed milli,topped with foam,cocoa, cinnamon and chocolate Cafe Moc(tia. Espresso,steamed milli,chocolate,topped with whipped cream ' CaraHn:el Latte Espresso,steamed milli,caramel,topped with whipped cream =Latte Espresso,steamed milli,caramel,and chocolate fudge, topped with whipped cream ++OT Coffee recd wl a r $1.50 Buono blend,decaf,featured blend Zea (a.va.LLa.GLe,Lw cbecoi f i I }-Fo-t C(n,oco-late CIn aL-Lea Latte Black'tea,honey,vanilla,cinnamon,ginger,steamed milli COLS�iE�R4�E•S mater Sab-a (Re'9' r&-Met) 7cec? -Lea: 3wice . :MLLk r3oz-t�E-n �cwercJ•'2'S�sarkLLwc�.3wLce SysrLwc�. �ater Coca-Co-la asso-rtea sagas �arLety.of e•werca.�. c?riwks Flavorec? U�aters C O FE Iced Drinks ICED GREEN TEA — LEMONADE BOTTLED WATER ORANGE JUICE .JONES NATURALS &ORGANICS JONES SODAS ORGANIC APPLE JUICE ORGANIC MILK OR CHOCOLATE MILK Pepsi-Cola Fountain Drinks and Freshly Brewed Iced Tea also available. Coffee & Tea FRESHLY BREWED COFFEE HOT`REPUBLIC OF TEA'TEAS New Light Roast-.New Dark Roast Hazelnut Ddcaf Espresso Bar Drinks Available iced or hot,with decaf or sldm milk. Additional shots of espresso,flavored syrups or whipped cream available for an additional charge. CAFFE MOCHA CARAMEL LATTE Espresso, foamed milk&chocolate, topped Espresso, foamed milk&caramel, topped with whipped cream&chocolate sauce with whipped cream&caramel sauce CHAT TEA LATTE ICED OR HOT CAPPUCCINO Brewed black tea,honey,.vanilla, Espresso&foamed milk, topped witha cardamom, cinnamon,ginger cap of foam &foamed milk HOT CHOCOLATE GAFFE LATTE Foamed milk&chocolate, topped with Espresso&foamed milk whipped cream &chocolate sauce ESPRESSO s-n v- c., Hot Breakfast Made fres},eyery.morning-Available while.they last! -- — Baked Goods Brownies Mini Bundt Cakes Scones Sweet Rolls. Muffins Muffies san ArtiPastries Cookies & Freshly Bak. ed Bagels. Asia go Cheese Everything Blueberry ; POPPY French Toast Cinnamon CrunchPIain Sesame Dutch Apple&Raisin Whole Grain BAGEL PACK (13,BAGELS, TWO TUBS OF SPREADS) DOZEN&A HALF(18 BAGELS) BAKER'S DOZEN(13 BAGELS) HALF DOZEN BAGELS(6 BAGELS) BAGEL&ANY CREAM CHEESE SPREAD BAGEL Flavorful av orf ul_ Spreads.. Ask about our featured bageland spread: 8 o., Containers PLAIN&REDUCED FAT PLAIN FLAVORED CREAM ORED R CHEESE EDUCED FAT CREAM CHEESE Hazelnut Hon' ey Walnut-Raspberry Sun-Dried To mato= Veggie Ic C � 'L (&7T CK&Pon SANDWICH CHOICES: Brownie Italian Combo Brownies ® Sierra Roast Beef Caramel Pecan,Very Chocolate. Bacon Turkey Bravo Sierra Turkey Smoked Turkey Breast Chicken Salad Cookies Tuna Salad Chocolate Chipper,Nutty Oatmeal Raisin, Smoked Ham&Swiss Roast Beef Shortbread,Chocolate Duet with Walnuts, Nutty Chocolate Chipper. Morning Continental $45.99 An assortment of freshly baked bagels, morning pastries&croissants.Served with cream cheese,butter&preserves plus orange _ juice&coffee.Contains 7 items. Bagels&Morning Pastries $16.99 An assortment of freshly baked bagels& pastries served with cream cheese, butter&preserves.Contains 7 items. Morning Pastries $19.99 An assortment of pastries served with butter &preserves.Contains 7 items. Bagel Pack $13.29 Cinnamon Crunch,Asiago Cheese, Your choice of 13 freshly baked Dutch Apple&Raisin,Blueberry,French Toast, bagels with 2 tubs of spreads. Plain,Sesame,Everything,Whole Grain Plain.&Reduced-Fat Plain Cream Cheese Spread Reduced-Fat Flavored Cream Cheese Spread: Hazelnut,Honey Walnut,Raspberry, Sun-Dried Tomato, Morning Drinks rt/1n Coffee or Hot Tea $14.99 'j''+ RM Orange Juice $14.99 Arasan Pastries:Pecan Braid,Cherry,Cheese, Single-serve containers of orange juice,organic Fresh Apple,Chocolate,Croissant apple juice and organic white and chocolate milks Muffins:Wild Blueberry,Carrot Walnut, also available. Please ask our catering coordinator Reduced Fat Wild Blueberry,Pumpkin for details. Muffles:Chocolate Chip,Pumpkin Scones:Wild Blueberry,Cinnamon Chip,Orange Sweet Rolls:Bear Claw,Cinnamon Roll,Pecan Roll 9/28/2009 1:03 PM FROM: Samel Insurance TO: 1-978-689-4966 PAGE: 001 OF 003 l SAMEL INSURANCE AGENCY, INC. 15 Central Street Andover, MA 01810 Tel (978) 474-0810 Fax (978) 474-0890 FAX COVER SHEET Date/Time: 9/28/2009 1:03:12 PM To: Star Pizza Fax M 1-978-689-4966 From: Patricia A Dietz Number of pages including cover sheet: 3 Message Re: Certificate of Insurance-Town of North Andover Good Afternoon: Per our discussion, please find a copy of a certificate of insurance for Star Pizza. Should you have any questions, please do not hesitate to contact me. Sincerely, Patty Dietz 9/28/2009 1:03 PM FROM: Samel Insurance TO: 1-978-689-4966 PAGE: 002 OF 003 ACORD DATE(MM/DD7YYYY) �M CERTIFICATE OF LIABILITY INSURANCE 09/28/2009 PRODUCER Phone: (978)474-0810 Fax (978)474-0890 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MARSHALL LEINSON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SAMEL INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 15 CENTRAL STREET ALTERT COVERAGE AFFMIED BY THE POLICIES ANDOVER MA 01810 INSURERS AFFORDING COVERAGE NAIC# PHONE: 978474-0810 FAX: 978474-0890 INSURED INSURER A: Commerce Insurance Company EVRO'S REALITY TRUST INSURER B. C/O STAR PIZZA AND FAMILY RESTAURANT INSURER C: 675 FOSTER ST Ihisi IQco n. NORTH ANDOVER MA 01845 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POOLICY EXPIRATION LIMBS LTR INSRDAN IMWODNY1 GENERAL LIABILITY BCLBCG 04/01/09 04/01/10 EACH OCCURRENCE $ 1,0 0,000 P__ MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 PREMISES Ea occurenceCLAIMS MADE[X OCCUR MED.EXP(My one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 PRO- POLICYF—ljFC.TLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es accident) $ ALL OWNED AUTOS BODILY INJURY SCHEOULEDAUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS!UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F�CLAIMS MADE AGGREGATE $ r DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND wC STATLL OTHER EMPLOYERS'LIABILITY roRvuwrs ANY PROPRIETOR/PARTNERIEXECUTIYE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations Usual to a Pizza Restaurant CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 16 Osgood Street WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO North Andover,MA 01845 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � Attention: Marshall Leinson ACORD 25(2001/08) Certificate# 26704 ©ACORD CORPORATION 1988 9/28/2009 1:03 PM FROM: Samel Insurance TO: 1-978-689-4966 PAGE: 003 OF 003 t IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001/08) Certificate#26704 Colleges, Hos'pftals,�-min NES y ENGLAND yF n Corporate Feeders COFFEE Here, There, • •and Everywhere! The New England® Coffee Brand has a strong presence in colleges, hospitals and corporate feeders. This page displays photos of locations that proudly serve our coffee, featuring branded point of purchase materials. NEW ENGLAND COFFEE I i � Staples Headquarters > Framingham, MA Maine Medical Center > Portland, ME . - NEW RELAX IAND ,..s ENJOY! Hellenic College > Brookline, MA Newton-Wellesley Hospital > Newton, MA COFFEE NIV _ � 9 0 UMass Amherst > Amherst, MA Mercy Hospital > Portland, ME 04/05 NEW ENGLAND®COFFEE COMPANY • 100 CHARLES STREET, MALDEN, MA 02148 • 1-800-225-3537 • www.NEwENGLANDCOFFEE.COM NE's Brand Presence4* ENGLAND4 , ft C.-Stores COFFEE Here, There, and Everywhere! The New England.Coffee Brand has a strong presence in the C-Store industry. This page displays a sampling of the locations that proudly serve our coffee and feature branded point of purchase materials. NEv EE ENGLAND �° • • GLAND CUFF COFFEE r � r ``' a•x"' jrM Island Pond Mobil > Derry, NH Town Pantry > Winchester, MA t a � ENGLAND. OFFEE COMPANY tr• � ron _ t i Lake Boon Variety > Hudson, MA Stop & Shoppe > South Portland, ME let r I Y .. • a� `I Kwik Stop Mobil > Portsmouth, NH O'Briens II > Portsmouth, NH 04/05 NEW ENGLAND.COFFEE COMPANY • 100 CHARLES STREET, MALDEN,MA 02148 • 1-800-225-3537 • www.NEwENGLANDCOFFEE.COM j 4 + 64 Ot NORTH o, '14, . L ?Q.r ,• F 41 Town of North Andover HEALTH DEPARTMENT S�CHUSt CHECK#: ( DATE: v -�r LOCATION. C�G� H/O NAME: CONTRACTOR NAME: i Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ Zumpster $ Food Service-Type: $ ❑ Funeral Directors $ i ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report // $ ❑ Other. (Indicate) W $ I �� �IePth Agent Initials White-Applicant Yellow-Health Pink-Treasurer FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 1 of 19 � r k , 'I. Y , Food and Drug Administration and Conference for Food Pr tection FOOD ESTABLISHMENT PL EVIEW GUIDE Z000 1) 1 0 SECTION I T 1/ FOOD ESTABLISHMENT PLAN REVIEW APPLICATION TO BE COMPLETED BY THE OPERATOR AND SUBMITTED TO THE REGULATORY AUTHORITY RECEIVED Regulatory Authoi 'ty MAY 2 0 2009 TOWN OF NORTH ANDOVER Date: '��'O/ HEALTH DEPARTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION EW JREMODEL CONVERSION Name of Establishment: as CARI �yl Category: Restaurant �/, Institution , Daycare , Retail Market , Other Address: Phone if available: Name of Owner: FA 11 L- 14XI9N-bK-+T Mailing Address: G 75 F-o ST�oz � f Telephone: 97R_ t,1783— ® Z/7Z Applicant's Name: �/q() L Title (owner,manager, architect, etc.): owy e Mailing Address: 675;-- rb.. - o Telephone: 97g,- �6 7-- /3® /— q/ 78- 6�9-?-01?72 I have submitted plans/applications to the following authorities on the following dates: http://www.cfsan.fda.gov/-dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 2 of 19 ; Governing Board of Council Plumbing Zoning Electric Planning Police Building Fire Conservation Other( ) Hours of Operation: Sun ✓ d.( � Thurs vim Mon 0 11 Fri opM Tues f M Sat . D.eA7 WedO� Number of Seats: Number of Staff: (Maximum per shift) Total Square Feet of Facility: DD ".�d� ` � � 8co Number of Floors on which operations are conducted_ Maximum Meals to be Served: reakfast (approximate number) Lunch Dinner Projected Date for Start of Project: Projected Date for Completion of Project: Type of Service: Sit Down Meals (check all that apply) Take Out Caterer Mobile Vendor Other Please enclose the following documents: n �� & � A Proposed Menu(including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment(dumpsters, well, septic system- if applicable) Plan drawn to scale of food establishment showing location of equipment,plumbing, electrical services and mechanical ventilation http://www.efsan.fda.gov/—dms/prev-l.html 7/13/2007 i Cl __-- �17"i II 1111111; .Mop sink .3 compartment sink 5 Stairs to get to storage area con 0* A a14 TEN HOLE O M$ DIPPING CABINET )IVIS 61XD _ UNDERCOUNTER '= 1. M REFRIGERq SYRUPS 1PWELL ` 1 FOR [CEGB Q DIPYELL4- IRPOT BREWERS HOT FUDGE DISPENSE A ICE BIOVERSSHE� NDERGOUNTER REFRIGERATOR � fRPDTS FROZEN DRIRK BLENDER CONES i REAMER 20X14 SINK r-WT UP GATE CUP DISPENSER UX14 SINK ! /7/' SUPER AUTOMATIC ESPRESSO MACHINE OUNTERTOP ICKUP SHELF GRAD N• GO ASTRY AND FOR COFFEE DONUT CASE DER AND POS tl FIST ST. zW <, FDA/CFP: Food Establishment Plan Review Guide- Sections I Page 3 of 19 Equipment schedule e NTENTS AND FORMAT OF PLANS AND SPECIFICATIONS Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan urately drawn to a minimum scale of 1/4 inch= 1 foot. This is to allow for ease in reading plans. 2C-,-U roposed menu, seating capacity, and projected daily meal volume for food service operations. 3. Show the location and when requested, elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common name. Submit drawings of self-service hot and cold holding units with sneeze guards. 4. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and for hot-holding potentially hazardous foods. -/'J5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods. 6. Clearly designate adequate handwashing lavatories for each toilet fixture and in the immediate area of food preparation. 116 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. o 8. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets,basements and/or 1 cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual. 9. Include and provide specifications for: a. Entrances, exits, loading/unloading areas and docks; uses;Complete finish schedules for each room including floors, walls, ceilings and coved juncture c. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste-water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; d. Lighting schedule with protectors; (1)At least 110 lux(10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2)At least 220 lux(20 foot candles): (a)At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption; http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections,I Page 4 of 19 (b) Inside equipment such as reach-in and under-counter refrigerators; " (c) At a distance of 75 cm (30 inches) above the floor in areas used for handwashing, warewashing, and equipment and utensil storage, and in toilet rooms; and (3)At least 540 lux(50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders, or saws where employee safety is a factor. e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an ANSI accredited certification program(when applicable). f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A color coded flow chart demonstrating flow patterns for: -food (receiving, storage, preparation, service); -food and dishes (portioning, transport, service); -dishes (clean, soiled, cleaning, storage); -utensil (storage, use, cleaning); -trash and garbage (service area, holding, storage); h. Ventilation schedule for each room; i. A mop sink or curbed cleaning facility with facilities for hanging wet mops; j. Garbage can washing area/facility; k. Cabinets for storing toxic chemicals; �- 1. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; `j tf). m. Completed Section 1; n. Site plan (plot plan) FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods (PHF's)to be handled,prepared and served. CATEGORY* (YES) (NO) 1. Thin meats,poultry, fish, eggs (hamburger; sliced meats; fillets) ( ) ( ) 2. Thick meats,whole poultry(roast beef whole turkey, chickens, hams) ( ) ( ) 3. Cold processed foods (salads, andwic egetables) 4. Hot processed food (soups stews, rice/noodles, gravy, chowders, casseroles) 5. Bakery goods �iescu�s cream fillings &toppings) 6. Other * A generic HACCP plan for each category of food may be available from the regulatory authority for reference. http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide- Sections I Page 5 of 19 PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD SUPPLIES: 1. Are all food supplies from inspected and approved source . YES /NO 2. What are the projected frequencies of deliveries for Frozen foods - f� Refrigerated foods , and Dry goods / Y, 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage _ , Refrigerated Storage , and Frozen storage - e, E, 4. How will dry goods be stored off the floor? COLD STORAGE: 1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen, and refrigerated foods at 417 (5°C) and below?�NO Provide the method used to calculate cold storage requirements. 2. Will raw meats,poultry and seafood e-s ored in the same refrigerators and freezers with cooked/ready-to-eat foods?YES If yes,how will cross-contamination be prevented? 3. Does each refrigerator/freezer have a thermometer. ES NO Number of refrigeration units: Number of freezer units: 0 4. Is there a bulk ice machine available?YE /NO THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: Please indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place. Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS Refrigeration http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections,I Page 6 of 19 Running Water Less than 707 (21°C) Microwave (as part of cooking process) Cooked from Frozen state Other(describe) *Frozen foods: approximately one inch or less thin, and more than an inch=thick. COOKING: 1. Will food product thermometers be used to measure final cooking/reheating temperatures of PHF's? YES /NO What type of temperature measuring device: Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: beef roasts 130°F (121 min) solid seafood pieces 1457 (15 sec) other PHF's 1457 (15 sec) 110 eggs: Immediate service 145°F (15 sec) pooled* 155°F (15 sec) (*pasteurized eggs must be served to a highly susceptible population) pork 145°F (15 sec) comminuted meats/fish 1557 (15 sec) poultry 1657 (15 sec) reheated PHF's 165°F (15 sec) 2. List types of cooking equipment. HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 1407 (60°C) or above during holding for service? Indicate type and number of hot holding units. http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 I)�II�lll I opsin .3 compartment sink a- Stairs to get to storage area =r Ll wb O '0 EN HOLE NNIS 41XD Dn'PMG CABINET UNDettCOUR k RffRIGERAtA SYRUPS O • to ri, tPWELL - 3<- %V 1 `� tCECREAR ` t.,, J*"o DIPVELL 140TFUDGE DISPENSER- IS MOT BREWERS ntsPENSE o ICE DIDDUHLE OVERNE REUIvRIGERA FTOIt r FROZEN IW IRPOTS AND r r r loxia $INKREAmER UP GATE CUP DISPENSER f�/��'� GXt4 SINK UPER + DIT r D'�"�w l AAUUT M TIC I l�I d NACN�INE O UNTERTtiP GRAD N. (w ICKUP SNELF DDNUTYCASE FOR COFFEE DER AND PDS tt Fii ,S'T' ST. -! FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 7 of 19 2. How will cold PHF's be maintained at 417 (5°C) or below during holding for service? Indicate type and number of cold holding units. COOLING: Please indicate by checking the appropriate boxes how PHF's will be cooled to 41°F (5°C) within 6 hours (140°F to 70°F in 2 hours and 70°F to 41°F in 4 hours). Also, indicate where the cooling will take place. COOLING THICK THIN THIN THICK RICE/ METHOD MEATS MEATS SOUPS/ SOUPS/ NOODLES GRAVY GRAVY Shallow Pans Ice Baths ` Reduce Volume or Size Rapid Chill Other (describe) REHEATING: 1. How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 8 of 19 - 2. How will reheating food to 1657 for hot holding be done rapidly and within 2 hours? PREPARATION: 1. Please list categories of foods prepared more than 12 hours in advance of service. 2. Will food employees be trained in good food sanitation practices ' ES NO Method of training: Number(s) of employees: 00- �koY C— Dates of completion: 3. Will dis able gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to- eat foods?n /NO 4. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions?YES /NO Please describe briefly: Will employees have paid sick leave?YES /NO 5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type: Concentration: http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Revi?w Guide - Sections I Page 9 of 19 Test Kit: YES /NO 6. Will ingredients for cold ready-to-eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled?YES/NO If not, how will ready-to-eat foods be cooled to 41'F? 7. Will all produce be washed on-site prior to use?YES /NO Is there a planned location used for washing produce? YES /NO Describe i Fi If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone(41T - 140T) during preparation. 9. Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared on-site or otherwise required by the regulatory authority. 10. Will the facility be serving food to a highly susceptible population? YES O If yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area? http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 10 of 19 A. FINISH SCHEDULE Applicant must indicate which materials(quarry tile, stainless steel, 4"plastic coved molding, etc.) will be used in the following areas. Kitchen FLOOR COVING WALLS CEILING ,Bar Food Storage �' rf Other Storage JG011 Allege- Toilet Rooms cSG Dressing Rooms f V0 Garbage & Refuse Storage /" eadw Mop Service �LC � Basin Areajr 6D� Warewashing v Area YZ/G Walk-in Refrigerators /C'ecrwr and Freezers http://www.cfsan.fda.gov/—chns/Prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 11 of 19�~ B.INSECT AND RODENT CONTROL APPLICANT Please check appropriate boxes. YES NO NA 1. Will all outside doors be self-closing and rodent proof? ) ( ) 2. Are screen doors provided on all entrances left open to the outside? ( ) ( ) ( ) 3. Do all openable windows have a minimum#16 mesh screening? ( ) ( ) ( ) 4. Is the placement of electrocution devices identified on the plan? ( ) ( ) ( ) 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and ( ) ( ) ( ) intakes protected? 6. Is area around building clear of unnecessary brush, litter,boxes and other harborage? (tel ( ) ( ) 7. Will air curtains be used? If yes, where? O O ( ) C. GARBAGE AND REFUSE Inside 8. Do all containers have lids? 9. Will refuse be stored inside? ( ) ( ) ( ) If so, where? 10. Is there an area designated for garbage can or floor mat cleaning? ( ) ( ) ( ) Outside 11. Will a dumpster be used? ( ) ( ) Number Size Frequency of pickup Contractor N 0'e, 12. Will a compactor be used? Number Size ( ) ( ) ( ) Frequency of pick up http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 12 of 19 Contractor 13. Will garbage cans be stored outside? 14. Describe surface and location where dumpster/compactor/garbage cans are to be stored ///k- 1 15. Describe location of grease storage receptacle 16. Is there an area to store recycled containers? l ( ) (4y ( ) Indicate what materials are required to be recycled; (,)/Glass ( Metal (i Paper ( ardboard (0 Plastic 17. Is there any area to store returnable damaged goods? ( ) ( ) ( ) y D. PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18. Toilet i ` / 19. Urinal 20. Dishwasher http://www.efsan.fda.gov/—drns/Prev-l.htinl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 13 of 19 21. Garbage Grinder 22.Ice machines 23.Ice storage bin 24 inks / a Mop Janitor ✓/ Handwash \/ d. / ompartment e. 2 Compartment f. 1 Compartment g. Water Station 25. Steam tables 26.Dipper wells 27. Refrigeration condensate/ drain lines 28. Hose connection 29.Potato peeler http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 14 of 19 30. Beverage Dispenser w/carbonator 31. Other * TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it. An integral trap is one that is built directly into the fixture, e.g., a toilet fixture. A?P?trap is a fixture trap that provides a liquid seal in the shape of the letter?P.? Full ?S?traps are prohibited. 32. Are floor drains provided & easily cleanable, if so, indicate location: E.WATER SUPPLY 33. Is water suppl �p lic C4 private( ) ? 34. If private, has soitrc been approved?YES ( )NO ( ) PENDING( ) Please attach copy of writt n approval and/or permit. 35. Is ice made on premises ( or purchased commercially ( ) ? If made on premise, are specificati ns for the ice machine provided?YES ( )NO ( ) Describe provision for ice scoop storage: Provide location of ice maker o bagging operation 36. What is the capacity of the hot ter generator? 37. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water(see Part 5 &Part 9 Under Section III in this manual) 38. Is there a water treatment device?YES ( )NO If yes, how will the device be inspected &serviced? 1 http://www.cfsan.fda.gov/—dms/Prev-l.html 7/13/2007 Y ll 4 --- �2%4nKI r AAt1 ,ria ;:; . it.. . CONVERT 3-SEASON FORCH TO FINISHED _ q \ .- y BR TENANT sq 680 SF �7 IN NEW PROVIDEE GRAB GRAB BARS, xP ON C!05ET FAFER CISFENSERS, REm0PEA1xG MIRRORS AND FIRE ' A'°5'"°'Dome < BP ALARM STROBE AS y' o REQUIRED. ' 4EPac. 0 accE5BUILD WALL FLUSH TO 51Ef= TzANTa3 _`. COK"" �-- BUMF-OUT. FINISH AS 5r` COOLERREsrw 0PCR<xr SrOR40E o CONTINUOUS SURFACE 10E AND MOUNT NEW CRAB- BAR. RAB- , ~ BAR. 1,, k m<SN 5i<i101 m I EKIST.VAIRE FREP - .- EK15TI10o `In O l `'Y� • 1 �- - _ 1 BATHR0m11 AccEE •� ,l , s's�E P4EP 1 BAixR00M OVEx \ I AcEEwsa F I - BORKSPA[E I ` (' B<1,iR00F I C-9 3/5 PRT i RE.Ewes—/ TiPK;AI \ PRT I i � I I 1 I 1 TENANTa2 386 SF ED I 1 \ TENANT al STAR FIZZ 1,556 SF . I 1 EHEll EHELF eHELF — :HELF_ \ 1 f _.---------------------—-- ND ? REm cats ] EKISING CALLS FRELIMINARY NOT K PLAN-MULTIPLE TENANTS ©2001 GSDAssociatos FOR CONSTRUCTION FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 15 of 19 39. How are backflow prevention devices inspected& serviced? F. SEWAGE DISPOSAL 40. Is building connected to a municipal sewer?YESkj'NO ( ) 41. If no, is private disposal system approved?YES ( )NO ( ) PENDING ( ) Please attach copy of written approval and/or permit. i 42. Are grease traps provided?YES NO O i If so, where? Provide schedule for cleaning &maintenance G.DRESSING ROOMS 43. Are dressing rooms provided?YES (4NO ( } 44. Describe storage facilities for employees'personal belongings(i.e., purse, coats, boots, umbrellas,etc.) H. GENERAL 45. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES--C)NO ( ) Indicat `�'�-� e location: ,. 46. Are all toxics for use on the premise or for retail sale (this includes personal medications), stored away from food preparation and storage areas?YES ( )NO ( ) 47. Are 11 containers of toxics including sanitizing spray bottles clearly labeled? YES( )NO ( ) 48. Will linens be laundered on site?YES ( )NO ( ) http://www.cfsan.fda.gov/—dms/Prev-l.htnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sgctions_I Page 16 of 19 If yes, what will be laundered and where? If no, how will linens be cleaned? 49. Is a laundry dryer available?YES ( )NO ( ) 50. Location of clean linen storage: 51. Location of dirty linen storage: 52. Are containers constructed of safe materials to store bulk food products?YES ( )NO ( ) Indicate type: l 53. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FIRE AIR AIR WOR FEET PROTECTION CAPACITY MAKEUP EXT CTION CFM CFM DEVI S 54. How is each listed ventilation hood system cleaned? http://www.cfsan.fda.gov/—dms/Prev-l.htinl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 17 of 19 I. SINKS 55. Is a mop sink present?YES )NO If no,please describe facility for cleaning of mops and other equipment: 56. If the menu dictates, is a food preparation sink present?YES (/NO ( ) J.DISHWASHING FACILITIES 57. Will sinks or a dishwasher be used for warewashing? Dishwasher( ) Two compartment sink( ) Three compartment sink(v� 58. Dishwasher Type of sanitization used: Hot water(temp.provide Booster heater Chemical type Is ventilation provided?YES ( ) ( ) 59. Do all dish machines have templa with operating instructions?YES ( )NO ( ) 60. Do all dish machines have temperature/pressure gauges as required that are accurately working?YES ( )NO ( ) 61. Does the largest pot and pan fit into each compartment of the pot sink?YES �NO ( ) If no, what is the procedure for manual cleaning and sanitizing? 62. Are there drain boards on both ends of the pot sink? YES ( )NO ( ) 63. What type of sanitizer is used? / �V http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - 'Sections I Page 18 of 19 Chlorine V Iodine ( ) Quaternary ammonium ( ), Hot Water Other ( ) 64. Are test papers and/or kits available for checking sanitizer concentration?YES NV NO( ) K. HANDWASHING/TOILET FACILITIES 65. Is there a handwashing sink in each food preparation and warewashing area?YES V/NO ( ) 66. Do all handw hing sinks, including those in the restrooms, have a mixing valve or combination faucet?YES ( O ( ) 67. Do self-closing metering fauceis provide a flow of water for at least 15 seconds without the need to reactivate the faucet?YES ( )NO( ) 68. Is hand cleanser available at all handwashing sinks?YES (/NO ( ) 69. Are hand drying facilities (paper towels, air blowers, etc.) available at all handwashing sinks?YES (� NO ( ) 70. Are covered waste receptacles available in each restroom?YESNO ( ) 71. Is hot and cold running water under pressure available at each handwashing sink?YES NO ( ) 72. Are all toilet room doors self-closing?YES (V�NO ( ) 73. Are all toilet rooms equipped with adequate ventilation?YES (VNO( ) 74. If required, is a handwashing sign posted in each employee restroom?YES ( NO ( ) L. SMALL EQUIPMENT REQUIREMENTS 75. Please specify the number, location, and types of each of the following: Slicers Cutting boards Can openers Mixers Floor mats Other http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 FDA/CFP: Food Establishment Paan Review Guide - Sections I Page 19 of 19 STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. Signature(s) owner(s) or responsible representative(s) Date: ooD Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments. Home I Plan Review: Table of Contents Hypertext updated by dms/ces 2000-MAR-30 http://www.efsan.fda.gov/—dms/Prev-l.htrnl 7/13/2007 C "PROPOSED EXISTING IL } 30" Collee di P- ���{�t. �r7�0 Ybllis _ i .. _`' �•r+,. ...,w ale 732» Paradise cn P——I i��##�1 ..( e o t e • - Coffee&Pastry • \ i LEFT SIDE FONT.ARRUS BOLD 8' RIGHT SIDE AWNING SIDE AWNING pORTh q ✓ O �t .ED , I� 0 ? �~d _ 'a•6 O O ,R N Are 'r �9SSAC"us���y PUBLIC HEALTH DEPARTMENT Community Development Division June 1, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Plan review of new Food Establishment, Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled.Food Establishment that was received by the Health Department on May 20, 2009. The following items were noted either missing or incomplete from your application. Please revise as needed and resubmit to the Health Department. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan 3) Page 3 #1 Plan is not a minimum 11x14 inches or 1/4 foot= 1 foot. It appears to be close to 1/8 inche= a foot. Please correct scale and size of plan 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach, bathroom cleaner etc. must be stored properly. Show location of storage 6) Page 4, Food Supplies,blank items. Please complete 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct 9) Page 6#1 Hot/cold holding. Plan shows soup warmers at minimum Please complete 10)Page 7#1 reheating incomplete Please note type and number of reheating units. 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer 12)Page 8 #4 incomplete Please answer question. Describe policy. Paid sick leave?? 13)Page 8 #5 incomplete please answer question 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 14)Page 9#6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce, tomato etc. will veges come pre-cut? 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile,walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately 16)Page 11 questions unanswered:#2, #3,#4, #5, #7, #9, #12 Answer even if it is NO or N/A 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached b. Pastry—where are you purchasing the pastry? Explain i. Do you have a refrigerated pastry case for items like cannolis, eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question 19)Page 15 #44 question unanswered Please answer 20)Page 15 #48 linens Please answer 21)Page 16#50 location of clean linen storage Please answer 22)Page 17#62 unanswered Please answer 23)Page 18 #75 unanswered Please answer 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site Other items of concern: The Health Department conducted a walk with you through the business located in the same building. Star Pizza was noted in having numerous code violations in cleanliness and damaged structural elements; ie. Floors, steps, filthy mop sink etc. Although these are 2 separate businesses, it was noted that the Health Department is requiring correction of these items. The front kitchen has become too cluttered with office items; ie desk, files,piles of papers. Etc. These items must be moved to a more appropriate office area. All surfaces must be easily cleanable and uncluttered. Once you review this document we would be happy to meet with you regarding any of the above-mentioned items, otherwise please submit the needed information and plan changes as soon as possible. Sincerely /Susan Sawyer, S/R7/P41ic Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET BUILDING 20; SUITE 2-36 'ss";CM„5 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540-Phone Susan V. Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE:hn://www.townofnorthandover.com APPLICATION FOR LICENSE TO MANUFACTURE FROZEN DESSERTS AND/OR ICE CREAM MIX To the Board of Health of North Andover in accordance with the provisions of Section 65H of Chapter94 of the General Laws, as most recently amended and the regulations made hereunder, the undersigned hereby applies for a license for the WHOLESALEIRETAIL manufacture of frozen desserts and or ice cream mix and submits the following information: Name of Establishment(DBA): Location: Phone: Name of firm: Address of firm: Phone: Owner(s)/Operator(s): Type of business: Corporation ( ) Partnership ( ) Owner( ) Please list licenses,permits or registrations issued by other municipal, state or federal agencies: Names of brands and trade or corporation name, if any,under which the products are to be sold: Freezers: Number and capacity of freezers: Mixing Equipment: Make and Model of mixing equipment: Age: Is the mix purchased? If so, from whom purchased? Is the mix pasteurized? Number of gallons of frozen desserts and/or ice cream mix sold as such in Massachusetts, manufactured during the last calendar year: Regulations: Have you received a copy of the regulation? Is the plant constructed and equipped as provided in the regulations? Dairy: Are you manufacturing dairy products? Please note: Non-dairy frozen desserts no longer require bacterial testing Testing: What is the approved laboratory, which will conduct monthly bacteria testing? Name: Address: Do you understand that the laboratory must submit copies of the results to the Board of Health and the MDPH upon completion of the analysis? Bacteriological limits for frozen desserts are: ➢ Coliform colonies per gram ➢ 50,000 standard plate count per gram I hereby certify that the frozen desserts and/or ice cream mix I sell in Massachusetts will be manufactured in compliance with all laws of the Commonwealth of Massachusetts pertaining thereto and all rules and regulations promulgated by the Massachusetts Department of Public Health made hereunder and will be manufactured under sanitary conditions. Authorized Signature Printed Name FEE: $40 per establishment PAYABLE TO: Town of North Andover LATE FEE AFTER MAY 31"WILL BE DOUBLED TO $80.00 NORTH O O ,L � 1 r ey •� � coc.i�wewc• �• �9SSAC HUS���� I PUBLIC HEALTH DEPARTMENT Community Development Division June 1, 2009 Paul and Alexandra Dedoglou Star Paradise Coffee, Ice Cream and Pastry 9-11 First Street North Andover, MA 01845 Re: Plan review of new Food Establishment, Star Paradise Coffee, Ice Cream and Pastry Dear Mr. and Mrs. Dedoglou, This letter is in response to your application for a New/remodeled Food Establishment that was received by the Health Department on May 20, 2009. The following items were noted either missing or incomplete from your application. Please revise as needed and resubmit to the Health Department. 1) Page 2 Caterer is checked off. What type of catering are you doing? It may need to be permitted separately Please describe 2) Page 2 No specification sheets for each piece of equipment. Please submit detailed specification sheets for all equipment. Identify each piece with the plan by a correlating number on the plan 3) Page 3 41 Plan is not a minimum 11x14 inches or '/4 foot= 1 foot. It appears to be close to 1/8 inche= a foot. Please correct scale and size of plan 4) Page 3 #3 Sinks on plan not designated for type of use Please label sinks 5) Page 4 k. Noted that no chemicals are used all chemicals such as dish detergent, chlorine bleach; bathroom cleaner etc. must be stored properly. Show location of storage 6) Page 4, Food Supplies,blank items. Please complete 7) Storage page 5 #4 How will dry goods be stored? Complete; ie metal shelving etc. 8) Page 5 # 3 Number of refrigerator units 1 —Plan shows more, please correct 9 Page 6 #1 Hot/cold d boldin . Plan shows soup warmers at minimum Please complete 10)Page 7 #1 reheating incomplete Please note type and number of reheating units. 11)Page 8 #1 list foods prepared more than 12 hours in advance Answer question even if zero is the answer 12)Page 8 #4 incomplete Please answer question. Describe policy. Paid sick leave?? 13)Page 8 #5 incomplete please answer question 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 14)Page 9 #6,7 menu shows bacon, sausage, cheese. How will they be stored etc. Any ready to eat, with lettuce,tomato etc. will veges come pre-cut? 15)Page 10 finish schedule Must fill in the type of materials that are being used in each location in the box. Some of the detail provided is not accurate. Ie. Floors-tile, walls - FRP, coving-vinyl, ceiling-washable tiles complete schedule accurately 16)Page 11 questions unanswered:#2,#3,#4, #5, #7, #9, #12 Answer even if it is NO or N/A 17)Menu a. Softserve icecream needs a"frozen dessert Permit"Also Monthly bacteria testing will have to be done on this product by an approved state laboratory. Submit application see attached b. Pastry—where are you purchasing the pastry? Explain i. Do you have a refrigerated pastry case for items like cannolis, Eclairs etc 18)Page 15 #42 is there a grease trap under the 3-bay. Plumbing inspector can answer questions about when you need one. Please complete question 19)Page 15 #44 question unanswered Please answer 20)Page 15 #48 linens Please answer 21)Page 16#50 location of clean linen storage Please answer 22)Page 17#62 unanswered Please answer 23)Page 18 #75 unanswered Please answer 24)Note that you need certified Food Handlers for both businesses submit servsafe certificates of person designated for this site Other items of concern: The Health Department conducted a walk with you through the business located in the same building. Star Pizza was noted in having numerous code violations in cleanliness and damaged structural elements; ie. Floors, steps, filthy mop sink etc. Although these are 2 separate businesses, it was noted that the Health Department is requiring correction of these items. The front kitchen has become too cluttered with office items; ie desk, files,piles of papers. Etc. These items must be moved to a more appropriate office area. All surfaces must be easily cleanable and uncluttered. Once you review this document we would be happy to meet with you regarding any of the above-mentioned items, otherwise please submit the needed information and plan changes as soon as possible. Sincere Y" / Susan Sawyer, S_ P.Alic Health Director Enc: Frozen dessert application 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER ct NORTM 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET _", r•' BUILDING 20; SUITE 2-36 �,SSACMUg t� NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL: healtbdept@tow.nofnorthandover.com WEBSITE: hqp://www.townofnorthandover.com APPLICATION FOR LICENSE TO MANUFACTURE FROZEN DESSERTS AND/OR ICE CREAM MIX To the Board of Health of North Andover in accordance with the provisions of Section 65H of Chapter94 of the General Laws, as most recently amended and the regulations made hereunder, the undersigned hereby applies for a license for the WHOLESALE/RETAIL manufacture of frozen desserts and or ice cream mix and submits the following information: Name of Establishment(DBA): Location: Phone: Name of firm: Address of firm: Phone: Owner(s)/Operator(s): Type of business: Corporation ( ) Partnership ( ) Owner( ) Please list licenses,permits or registrations issued by other municipal, state or federal agencies: Names of brands and trade or corporation name, if any, under which the products are to be sold: Freezers: Number and capacity of freezers: Mixing Equipment: Make and Model of mixing equipment: Age: Is the mix purchased? If so, from whom purchased? Is the mix pasteurized? Number of gallons of frozen desserts and/or ice cream mix sold as such in Massachusetts, manufactured during the last calendar year: Regulations: Have you received a copy of the regulation? Is the plant constructed and equipped as provided in the regulations? Dairy: Are you manufacturing dairy products? Please note: Non-dairy frozen desserts no longer require bacterial testing Testing: What is the approved laboratory, which will conduct monthly bacteria testing? Name: Address: Do you understand that the laboratory must submit copies of the results to the Board of Health and the MDPH upon completion of the analysis? Bacteriological limits for frozen desserts are: ➢ Coliform colonies per gram ➢ 50,000 standard plate count per gram I hereby certify that the frozen desserts and/or ice cream mix I sell in Massachusetts will be manufactured in compliance with all laws of the Commonwealth of Massachusetts pertaining thereto and all rules and regulations promulgated by the Massachusetts Department of Public Health made hereunder and will be manufactured under sanitary conditions. Authorized Signature Printed Name FEE: $40 per establishment PAYABLE TO: Town of North Andover LATE FEE AFTER MAY 31"WILL BE DOUBLED TO $80.00 � ( Page 1 of 1 TU Ippolito, Mary From: John P. Carney ocarney@napd.us] Sent: Monday, March 23, 2009 3:33 PM To: Ippolito, Mary Subject: 11 First Street Mary, The Police Department does not have any public safety concerns with the proposal to add a coffee/ice cream shop next to the existing Star Pizza. Lf. John Carney Operations Division Commander North Andover Police Department 566 Main Street North Andover, MA 01845 978-683-3168 978-686-1212 (fax) 3/23/2009 March 25th TRC Agenda. Page 1 of 1 Ippolito, Mary From: Ellen McIntyre [epmcintyre@comcast.net] Sent: Tuesday, March 17, 2009 6:02 PM To: Ippolito, Mary Subject: RE: March 25th TRC Agenda. Hi Mary— If I remember correctly that property did not have enough parking when they up-dated the pizza shop. The other issue was parking for the tenants. I am sure Jerry has a full handle on this but this was on ZBA a few years back. Ellen From: Ippolito, Mary [mailto:mippolit@townofnorthandover.com] Sent: Tuesday, March 17, 2009 3:41 PM To: Brian Leathe; Brown, Gerald; Curran, Bernadette; Curt Bellavance; Ellen McIntyre; Grant, Michele; Janet Eaton; Jeannine McEvoy; Jennifer Hughes; John Carney; Joyce Bradshaw; Mark Rees; Mary Ippolito; Melnikas, Andrew; Mich Glennon; Pam DelleChiaie; Sawyer, Susan; Thibodeau, Bruce; Tymon, Judy; Willett,Tim; Willis, Gene Subject: March 25th TRC Agenda. Please see attached agenda. Best personal regards, Mary Ippolito, Planning Department Osgood Landing Town of North Andover 1600 Osgood Street Bldg. 20, - Suite 2-36, Planning Department North Andover, MA 01845 P 978-688-9535 F 978-688-9542 mippolito@townofnorthandover.com «TRC Meeting March 25, 2009.doc>> 3/18/2009 -Mff�1crown e • Model: Item #: Quantity: Model HS-9 Model HS-1 Project: • Fabrication: One piece 304 series stainless steel.All seams tig welded and polished. Model HS-2 Model HS-4 • Bowl: Deep drawn with stamped rim on 17" models A .- I to prevent spillage. Wall Mounting Bracket: `�- � -- --t- Offset design for added strength. �--== Faucet: 4"OC faucet supplied (wall or deck). • Drain: Stainless Steel. Model HS-5 Model HS-6 Drain with Overflow: �. Stainless Steel with plastic overflow tube and -- 11 inlet. Plumbing: 1/2" IPS hot and cold water. -T 1 1/2" IPS drain outlet. 1b K Model HS-7 Model HS-8 Model HS-10 Approved By: lgo�wMe Metal Corporation Phone: 800-631-0442 257 Verona Ave. Newark, New Jersey 07104 FAX: 973-485-1424 02/05 www.krowne.com sales@krowne.com 2.1 KFowne Model: Item #: Quantity: Project: HS-9 HS-1 HS-2 ,r �o 12 12 lbs. I" 12 Ibs. 14�4 14 Ibs. 2„ 4„ " II 16-1/4"� t_ 2„ z,. 17-1/4" 15' 10" .-T F-1 �L I-93/4"-a l-�/4'•� f7" ,�„z” 8„ 2„ 12" 8" 2" 10" 8" 2.. 12" 14.. 5" L 1 5 �" 1-1rz•1 I-6" --10,. �6" I--10" 8�B=1 HS-4 11 HS-5 HS-6 ir— II�'�� 14 lbs. r— II_ 151bs. 14 11 lbs. � z^ 10" E z„ 2" L ,5 ,s O L L'L 1 1o•• 8.. �. 18,rr I�{I� 0. � 14" L 1L 2 14„ 1' o"�'n' E 8,• 2., L _ 6,. `1-112'fps " `1-12"P, 8.518„ 8„ I-8-58•, us HS-7 HS-8 HS-10 t-14-1 30 Ibs. 14 II 35 Ibs. 19 lbs. z � �14' 15" 101. tI5" 10" --` I 8.5' (f� 4174" 11 I--r4.1/4" IT 10. IF11 77-1f4" (P 77-1/4" Y � Y r 7 I --1 8.5' i 24" 2" �. � � t8.512� _ 20' 6' T L 1nrz Ivs BSB" arz las 8-W 12' &5/8" Options: check box(es)for required option(s) ❑ H-104 Wall Mount Soap Dispenser ❑ H-109 Faucet Upgrade ❑ H-105 Wall Mounted Towel Dispenser ❑ H-100 1 1/2" IPS Chrome Plated P-Trap ❑ H-106 One Side Splash (specify side) ❑ H-102 Wrist Handle Faucet ❑ H-107 Two Side Splashes ❑ H-103 Wrist Handle Kit ❑ H-108 Stainless Steel Skirt Plumbing Requirements: El H-110 Side Support Brackets Install 36"Working Height Approved By: 1/2"Faucet Supply 12"from Floor 1 1/2"Drain Line 23 1/4"from Floor Due to our commitment to continued product improvement, specifications are subject to change without notice. owne Metal Corporation Phone; 800-631-0442 257 Verona Ave. Newark, New Jersey 07104 FAX: 973-485-1424 02/05 www.krowne.com sales@krowne.com REGULATORY HEALTH AUTHORITY COMPLIANCE REVIEW CHECKLIST Insufficient Satisfactory Unsatisfactory N/A Information 1. Finish Schedule [ ] [ ] [ ] [ ] Kitchen [ ] [ ] [ ) [ ] Warewashing [ ] [ ] ( ] [ ] Food Storage [ ] [ ) [ ] ( ] Other Storage Toilet Rooms [ ] ( ) ( ] [ ] Dressing Rooms [ J [ ] [ ) [ ] Mop Service Area [ ] [ ) [ ] [ 2. Insect&Rodent Harborage 3. Garbage and Refuse 4. Plumbing [ J [ ] [ ] ( J 5. Water Supply 6. Sewage Disposal [ [ ] [ ) [ ] '`. 7. Dressing Booms 8. Separate Toxic Storage 9. Laundry Facilities [ ] [ ] [ [ ] 10. Linen Storage 11. Exhaust Hoods 12. Hand Sinks 13. Dishwashing&Pot Sinks 14. Lighting 15. Ventilation [ ( ] [ ] / [ ] 16. Grease Traps [ [ ] [ ) [ ] 17. Employee Restrooms Location [� Nurnt- ( ] [ ] Soap [ ] [ ] [ J [ ] Hand Drying [ ] [ ] [ ] [ ] Lavatories [ ] [ ] [ ] [ ] Water Closets [ ] [ ] Urinals [ ] [ ] [ ] Waste Receptacles [ ) [ ] [ ) 18. Patron Restrooms Location / Number Soap Hand Drying [ ] [ ) [ ) [ ) Lavatories [ ] [ ) [ ) [ ] Water Closets [ ) [ ) [ ] Urinals [ ) [ ) [ ) Waste Receptacles [ ) [ ] [ ) 19. Kitchen Equipment Space between units or wall closed or adequate space for l easy cleaning [ J [ ] [ ] [ l Aisles sufficient [ [ l [ ] [ ) Storage 6"off floor [ [ ] [ ] [ l Countertops&cutting boards of suitable material [ ) [ ] [ Self serve food area adequately protected ] Built-in extemal temperature gauges or provision for separate internal thermometers noted for each piece of refrigerated equipment [ ] [ Utensil&Kitchen Storage Clean Soiled [ ) L l Counter mounted equipment [ [ ) [ ) Floor mounted equipment [ ] [ ) Vacuum packaging equipment [ ] [ ) [ [ ) Bulk food Self service Salad [ ] [ ) [ Hot/Cold Buffet [ ] [ ] J [ ) 20. Food Preparation Review Raw food prep table(s) [ ] [ ] [ [ ] (as menu dictates) Raw food prep sink(s) (as menu dictates) [ ) Adequate refrigeration [ [ ) [ ) [ ] Adequate cold holding facilities [ ) L ) [ ) Adequate hot holding facilities [✓]� [ ) [ ) [ Adequate hot food preparation equipment [ ] [ ) [ ) Vacuum packaging [ ] [ ) [ L ) HACCP plan COMMENTS: (Explain why any item was noted" nsatisfactory.") / L I 4 11� Sri Reviewer Signature Date Reviewer Title APPROVAL: DATE:_ DISAPPROVAL: DATE: REASONS FOR DISAPPROVAL: nc. lr►T i�1 1J;UV �� � �a� tAJU � LIQ�U icy] L� �.:J iAY� 1N LA1 1J1AJ:U�:� LJ�t� rx Heavy-Duty Drink Mixers COMMERCIAL DMC201DCAMM080DCA Features •High-performance 1 peak input HP " two-speed � � commercial motors r�- 7 •Durable die-castRMIR metal motor housings-quiet operation that's cool to the touch •Optional mixer cup CAC20 stainless steel, 28-oz. capacity fits all standard drink mixers ► •Simple HiAo ��"� speed controls • •Automatic start/stop for hands-free operation •Sealed ball + ' ' bearings are ;. • lubed for life • 120 VAC ' 50/60 HZ • Limited One Year Warranty DMC201 DCA t •cETLus, NSF . .. . .. - .. . ._ ... COUS NSF. DMC 180DCA INCG Heavy-Duty Drink MixersEj us NSF DMC201DCAIDMC180DCA Item Electrical Listings Dimensions Warranty (H" x W" x D") DMC201 DCA 120v, 50/60 Hz cETLus, NSF 16.5" x 14.5" x 8" Limited 1 Year DMC 180DCA 120v, 50/60 Hz cETLus, NSF 14.75" x 4.5" x 8.75" Limited 1 Year Description Catalog # Std Pkg. Ship Wt. Cubic Feet UPC Code (Lbs.) Triple Head Drink Mixer DMC201 DCA 1 37.1 2.6 040072010361 Wall-Mount Drink Mixer DMC 180DCA 1 6.6 0.33 040072010453 --- 14.5" �—_ 4.5" -� r f I 16.5" 14.75" r • 8" 8.75" DMC201DCA - DMC180DCA IAK WaringCommercial • • ( 314 Ella T. Grasso Ave. Torrington • Connecticut 06790 Tel. (800) 492-7464 • Fax (860) 496-9008 • www.waringproducts.com • ©2008 Waring 08WC039 PG-22267 Models Twin FS/FSP, Topping Equipment Twin FSP, Twin FS Hot Topping Date: Project: Quantity: Item Number: Bid Description All stainless steel construction with a brushed (#4) finish. Each dispenses directly from two stainless steel jars or #10 cans. We recommend our NSF approved Stainless Steel Jar #94009. Your local jurisdiction may not permit dispensing from a #10 can. - _ _.... Two adjustable precalibrated thermostats control individual 500 watt heating elements. Temperature settings—marked on thermostat knobs—range from 100° F (38° C) to 200° F (93° C). Power is controlled with two ON/OFF rocker switches. The Twin FS/FSP is designed to pump and ladle hot toppings. Comes complete with a lift-off lid and 1-ounce (30 mL) 10" ' (25.4 cm) Ladle #82561. The pump features a rugged cast J� ✓ valve body and welded construction. Maximum stroke yields 1-ounce (30 mL). Gauging collars are supplied to reduce Twin FS/FSP #81290 yield in 1/4-ounce (7 mL) increments. The Twin FSP is designed to pump two hot toppings. The Twin FS is designed to ladle two hot toppings. Standard Features ..s' 'y"} All stainless steel construction for durability New pump design prevents loss of valve balls Water fill line eliminates overflow accidents Pam e Two 500 watt heating elements for reliable heating and holding Adjustable precalibrated thermostats for accurate heat control e Temperature marks on knobs with protective knob guard Dispense directly from stainless steel jars or #10 cans Twin FS #81220 Pump maximum stroke yields 1-ounce (30 mL) Easy-to-adjust portion control in ' -ounce (7 mL) increments Imo, S�a �� 1/4-ounce cleaning brushes included with pumps for maintenance 'CE Units Available Hot Topping Equipment Accessories Warranty ❑ 1-ounce (30 mL) 10" (25.4 cm) Ladle #82561 Server Products equipment is backed by a ❑ 3-quart (2.8 L) Stainless Steel Jar #94009 two-year limited warranty against defects in materials and workmanship. For our complete warranty statement, see our Website or contact us. Specifications on reverse side Models Twin FS/FSP, Topping Equipment Twin FSP, Twin FS Hot Topping Twin Fudge Server with Pump Specifications and Ladle Construction Brushed (#4) stainless steel units. Pumps 13 1/2" feature a rugged cast valve body and 34.3 cm welded construction. Capacity Two stainless steel jars or #10 cans hold 3-quarts (2.8 L) each; 6-quart (5.7 L) total. dim. A— Models Twin FS/FSP Twin FSP Twin FS 11 7/16" #81290 #81230 #81220 29.1 cm Height in 155/16 155/16 125/16 cm 38.9 38.9 31.3 Width in 17 17 17 cm 43.2 43.2 43.2 9 11/16 , Depth in 13'/2 13'/2 911/16 24.6 cm cm 34.3 34.3 24.6 Dim. A in 43/4 43/4 N/A cm 12.1 12.1 1515/16" Ship Weight 19 Ib 20 Ib 18 Ib 38.9 cm 8.6 kg 9.1 kg 8.2 kg 12 5/16 Electrical 120V, 60Hz, 1000W, 8.3A 31.3 cm 72 in (183 cm) cord set NEMA 5-15P, 15A, 120V PLUG FOB Richfield, Wisconsin 53076 o a CAD Library 17" 43.2 cm We are a member of The KCL CADalog with more than 100 other manufacturers. Our CAD files can be purchased through Kochman Consultants, Ltd. at 847-470-1195, or e-mail sales@kcicad.com. Their website is at www.kcicad.com. • . Server Products, Inc. P.O. Box 530 • Menomonee Falls, WI 53052-0530 Phone: 262-251-7100 Toll Free: 800-558-8722 • Fax: 262-251-2688 • pumpsgexecpc.com e www.server-products.com Server Products,Inc.reserves the right to modify specifications without obligation.Printed in USA 7-2000/10M Stock#02051 i I `LCA �j Ccok- 42CLS -be AW bFuni Lemm C-tovaQ-- `\ C,CLJXX S`cu-,j bta,I e s ccu mk-,u�') Spry �\k GV\CcC)[CLW 5f)(, V\jj eS �3001G � -es crone s 5 r I t &,\r e �C1n va.0-k 1\� r i f S r r �-2�- f ���-�-�--- � I c-e._ 1 I t I t Installation Instructions 00 Section 2 ' I Electrical Service TOTAL CIRCUIT AMPACITY GENERAL The total circuit ampacity is used to help select the wire size of the electrical supply. ®Warning The wire size(or gauge)is also dependent upon All wiring must conform to local,state and national location,materials used,length of run,etc.,so it must be codes. _ determined by a qualified electrician. GROUND FAULT CIRCUIT INTERUPTER VOLTAGE Ground Fault Circuit Interrupter(GFCI/GFI)protection is The maximum allowable voltage variation is± 10%of a system that shuts down the electric circuit(opens it) the rated voltage on the ice machine model/serial when it senses an unexpected loss of power, number plate at start-up(when the electrical load is presumably to ground. Manitowoc Ice, Inc.does not highest). recommend the use of a GFCYGFI circuit protection with The 115/1/60 ice machines are factory pre-wired with a our equipment. If code requires the use of a GFCI/GFI 6'power cord,and NEMA 5-20P-plug configuration. then you must follow the local code.The circuit must be The 208-23011/60 and 230/50/1 ice machines are dedicated,sized properly and there must be a panel factory pre-wired with a 6'power cord only, no plug is GFCI/GFI breaker.We do not recommend GFCI/GFI outlets as they are known for more intermittent nuisance supplied. trips than panel breakers. FUSE/CIRCUIT BREAKER A separate fuse/circuit breaker must be provided for each ice machine.Circuit breakers must be H.A.C.R. rated (does not apply in Canada). A Warning The ice machine must be grounded in accordance with national and local electrical codes. ti Q130IQ210IQ270 ICE MACHINE Voltage Air-Cooled Water Cooled `•1 . Ice Machine Phase Maximum Fuse/ Maximum Fusel _ Cycle Circuit Breaker Total Amps Circuit Breaker Total Amps t Si 115/1/6015 7.0 15 6.3 Q130 208-230/1/60 15 3.6 15 3.1 230/1/50 15 3.6 15 3.1 115/1/60 15 6.5 15 6.1 0210 208-230/1/60 15 3.6 15 3.1 230/1/50 15 3.6 15 3.1 11511/60 15 10.7 15 9.9 Q270 208-230/1/60 15 5.2 15 4.7 230/1/50 15 5.2 15 4.7 i. Model No. 77316-7 77316-10 77316-13 77316-19 A 0 ov 176 a ooffl a r' •o• _C. WELL 14- U- 4'e o (35.6cn) $ cifications: Model 'A' 'B' 'C' Shipping Welght No. Inches Inches Inches inches lbs./(Kg) (6„ 77316.7 7 61/4 4 5718 5 2.3 !© �! 7731610 103/8 61/2 4 5 7/8 6 2.7 77316-13 12 314 6314 4 57/9 7 3.2 3 77316-19 20 518 61/8 6- 774 11.5 5.2 Note:Dimensions are approximate. Typical 5 pecifilwflons Spade Well Ice Cream Spade Cleaning Well has a stainless steel body and is equipped with a rubber bumper- Spade Well models are listed with the National Sanitation Foundation(NSF). s" Food?one:Equipment surfaces intended to be in direct contact with food and equipment surfaces that food or oondcnsate may contact and then drain,drip,or splash back into food of onto surfaces that are intended to be in direct contact with food. For example:directly installed within the ice cream cabinet is a food zone:(REF:NSF STD NSF/ANSI 170-Glossary of food equipment Terminology,Section 3.223.2) r e NEMOO Food Equipment,Ltd 301 mouse Argonne,P.O.Bax 305 -000 GQUIVMCNT Hloksvill&OH 43526 Phone(419)542-7751 Fax(419)542-6690 www.nemcofoodequip-com 3/07 Printed in U.S.A. Item No. ' Quantity • o Mode �-- � 7 77316-10 ; 77316-1 77316-19 FOOD EQUIPMENT pade Well Ice Cream Spade Cleaning Well Standard Features: - Ice Cream Spade Cleaning Well • Well is constructed of 300 series Stainless Steel - 3/8" diameter spigot for running water -Spigot can be installed for left or right side operation • Available one piece Dividers create compartments for holding spades upright and is easily removable for cleaning (except 77316-7) - Overflow Drain Tube is easily removable - Rubber bumper on rim provides protection and sound deadening when removing water from spades •Design incorporates user friendly rounded corners • Available Installation Kit includes plumbing components required for "universal" installation of water supply and drain for easy installation by a Y_ plumber. ** oo Not Install in Food Zone or Sink Compartment. (N;DSF. /o _ Ll Ec..'PC U-) r+i t nv S r4L- te!rr NFMCO Food Equipment, Ltd. 301 Meuse Argonne r (e gccWoopS — P.O. Bo3 Hicksville,05 01143526 Phone (419) 542-7751 FAX (419) 542-EZ90 -- www.nemcofoodequip.com Primed 3IW Prinftd in U.SA DIPWELL WITH DIVIDER You have itghw nate 4Cultarmf," phot} rtee+S c F3s ad 1. . 11 h igt >G i coops end paddlbi uP et In of th"16 d" )ompartrts.Tho-Odnkm.-dwi dlwk w ta:ee emovable fol 01KIVAng>J1120664: I 3P6CiflCATON lengtk IS lnehps r Width:.S lncihas Height b Inches Drain Hole:.'i-1!16" iiat + hito t�tthQ �.f l"D st t r U.S.FOOD &DRUG ADMINISTRATION wtm lhe ms's FoW Semoe sm"011on Mewmi,.Chapter r 3.°104.12;WA se `t aetwea�r►,lfae meq`�= Storage. I!^ s :4 `irl. Iti r1 tiu DfEAN fPir�rs> e� J i 1 I I THREE ® COMPT SINK TEN HOLE DIPPING CABINET UNDERCOUNTER CEMAKER REFRIGERATOR O IPWELL vi SYRUPS O FOR ICECREA11 O IRPOT BREWERS DIPWELL I HOT FUDGE ETJ DISPENSER NDERCOUNTER DOUBLE REFRIGERATOR ICE BI OVERSHELF e i IRPOTS C PS AND FROZEN DRINK CONES O i BLENDERS " REAMER - f 10X14 SINK IFT UP GATE CUP DISPENSERS 0X14 SINK SUPER AUTOMATIC . SUPER EAUTOMATIC ESPRESSO ESPRESSO MACHINE MACHINE JI ICKUP SHELF ICKUP SHELF FOR COFFEE ---COUNTERTOP -PASTRY AND FOR COFFEE OUNTERTO ASTRY Aqn i>[1NUT - GRAB N' GO- . ' GRAB N' G DONUT CASE :1� " ._ � CASE l�W R AND POS 1;_�: - _ -- - ' �•:'.. _ RDER AND POS L; XISTING WINDOW SHELF -POSSIBLE PLACE FOR STOOLS? COUNTERTOP REFRIGERATED GRAB N' G OFFEE PICKUP SHELF IFT GATE I " OPEN TO FLOOR -PASTRY CASE _. _ ___..-. �_r"._�_-w-r.�--��-.. -�� I I t I �� 1 1 1 1¢1 � i , �` J II IIII IIS X12 11 —TE) 4 6 6 6 00 Handicap Plans To Add Coffee Shop f �-YR j o At 11 First St & 13 First St F7 7 I. Coffee machines1 2. Register El 3. Display counter 4. Sinks 8 Tables 5. Stairs to get to storage area 6. Bathrooms 0 7. Refreshments 8. Tables 9. Toaster 10. Refrigerator/under counter L 7 11. 3 compartment sink 12. Mop sink i51 4 f� 3 ST ,57: a i RST& G- S -D ASSOCIATES CONVERT SEASON I —j— G�C O FINISHED ROOM. 1 Q R _R u" ESIDE NTlgi O moo TiVAiVT d) (P,z> b — 7L Q��z d? d IN NEIIJ EAT,ROOri5 N ¢ Q ERcvIDE BRAE EARS, �c r LL CLOSET I — F AF ER D I S F ENEERS , �— 11RROR5 AND TIRE S REEF AS REOUIRED. / \z aCC%51?LE JA-K-IN MCF-SINK COOLER J _ STCRAGc 11" �cSi F,,2_Ni GRAB BARS cFFICE �" NIN _ (TABLE d- 3' _ _ -------------- --------- Y `� InI e I Aw0 ExGT.STAIRS c c nooe _ I!%,.,i=TSTA TIC' ��// TO 6E REMO`/ED \ IN NEW EA ir.. ,. C;RAC EAKs O — _ \O n, _K D -1 �-KS, __ _ _ _ ExI;TING ' ,-- --- MIRRORS AND TIKE BATHROOM I ACCESSIBLE I ' G� ------- FRI EATHRoor --- A_ARr STRGEE ^�� OVENwoRKSFACE V I 6ATHROOM +i REO RED. I I NE'a HAND I q� GRI!L I / LASH SIS\K. Ij <17L EN 11 -RY .NEL FOCTTASH Q CHWRE — FRY I I LL I KE i r`,IL I -NA,N I 2 3186 SF RESTAURANT ENANT »I 1 y STAR FI7/A N y 8 Z) o JFccW 2,0 N Q '- -----------------------— �1 ® CON= a¢� A2 Q o ¢ LEGEND N(L z DATE:03-25-2002 ® N=-m sALu D _xunnG mA.LL REV: 03-26-2002 04-17-2002 TENANT DEMISING IALLB 02-04-2003 FLOOR PLAN-MUL`IPLE TENA NT5 Ca 2003 GSD Associates