Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 32 PARK STREET 4/30/2018 (3)
CORRESPONDENCE V.F.W. Club 2104 Inc. , � 2 3 � r� THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER RECEIVED .a Massachusetts Department of Public Health SEP 18 2009 Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT TOWN OF NORTH ANDOVER Name V I 1'S �� � 2) �� ,c=� T Food Service Routine VDe n Address 3 2 2�C S 1 Risk ❑ Retail Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint Inspector HACCP O:.t�3 J Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non Cal W"ce wltb: Violations Rolatod to Foodborne Illness Intorventions and Rink Fnctora(Rod Itsms) AndTobacco Violations marked may pose an imminent health hazard and require immediate corrective �009 6110.414111 tFl ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. P ention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM C1atM1C111 s ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.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 TIMElTEMPERATURE CONTROLS(Potenaft Hazardous Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 8. Tags/Reoords/Accuracy of ingredient Statements 17. Reheatin❑ g ❑ 7. Conformance with Approved Procedures/HACCP Pians ❑ 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 HWLY SUSCEPTIBLE POPULATIONS(HSPI ❑ 10. Proper Adequate Handwashing L1 21• Food and Food Preparationfor HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violatad Provisions Rolated Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Intorvontions immediately or within 10 days as determined by the Board and Risk Factors(Rod Itanls3 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 N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc3)(590.004) cit�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 s)(seo.0os) establishment 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)(590.009) 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 R&INSPECTION: Iro Inspector's Sika A Print.'y PIC's Signature: Print: t Page Lof a-pages FORM 734A Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1.22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Goss-contamination 1 590.003(A) signment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowl e* Cooked and RIT Foods* 2-103.11 Person in charge-duties Contaminadon 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.(x)3(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* Contaminadon from the Consumer 590.003(G Reporting by Person in Char e* 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 E s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Water* concentration and hardness. * 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Water.* Utensils Clean* 590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Sheitrtsh and Fish From an Approved Source Contact Surfaces and Utensils* 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 Wild Mushrooms Approved by Regulatory Auth 2-301.11 Clean Condition-Hands and Arms* 3-202:18 Shellstock Identification Present* 2-301.12 Cleaifing 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 Pl 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 Tast' * 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 ShelWock 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 31102.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredlente 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance 1HACCP Plans Suppled with Soap and Hand Drying 3-502.11 S ialized Process' Methods* Deaces 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 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF 1� \� 0�7ov Gti Establishment Name: Vf-_' V'� ?ate 21csy Date: 0) 0 Page: Z of �- Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 3� C_111J�j y S Q_).41 SCIAn AT Z:V) \S 141 �N�;r� l4�ia � V I o C" 6-�7 A\" . S , 2-5 ©, s{-1a = ^�1.-JS, V�� 60:Y) - iL ' S c�X05 -T� �,-��S \�`\.� 1<i 1!✓��C.� T1a 4�ou 7 \ o'er 'T l� �.-� s ►-a , ,0 'N i��R, a w r� LUo sit r-4 00 Discussion With Person in Char 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 Foodbome 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 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* F 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 ° Pathogens.*E"ad'"°"iaoor ( )O Eggs- 155 F 15 Sec. 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 3-401.11(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 3-403.11(B) foodborne illness interventions and risk factors listed above, can be ( ) 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 OF NORTH ANDOVER Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date T e of O eration s T e of Inspection Vf Q 2 )" -1,50 0 Food Service Routine AddressRisk ❑ Retail ElRe-inspection32 I r�2�' Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint I In: ❑HACCP Inspector C -LwP,3 Out. Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Mai-compilaoce wM: Violations Rolatod to Foodborne Illness Interventions and Risk Factors(Red Items) And-ChM" Tobaceo Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 580.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12 revention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases b PROTECTION FROM CHEMICALS Y Food Employee and PIC ❑ 14. 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 TIMEIT'EMPERATURE CONTROLS(PohmUidy Hazardous Foods) ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. 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 ❑ 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQLNREMENTS FOR HIGHLY SUSCEPTIBLE POPUU►TIONs(HSP) ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices tONSUMERADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violatad Provision Rolabd items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions / immediately or within 10 days as determined by the Board and Risk Factors(Rod[tame 122)• 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-z)(sAo.00s)Equi and Food Protection (Fc 3)(590A04) order of the Board of Health. Failure to coned violations 4. Cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4}(se0.o06> the food establishment permit and cessation of food Water, Plumbing and Waste (FC-5)(590.005) establishment operations. If aggrieved by this order,you 27. Physical Facility (Fc-45)(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-iNSPECTION: JA Nq Inspector's Signa Print:1 V) gfL V V PIC'a Signalers: Print �� �✓ Psge4 of ages FORM 734A Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contamination 1 590.0t13(A) signment of Responsibili * 3-302.11(A)(l) Raw Animal Foods Separated from 590.003 B3 Demonstration of Knowledge* Cooked and RTE.Foods* 2-103.11 Person in charge-duties Contamination from Raw/ngrerients 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.(K)3(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) Re rtin 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 Water* concentration and hardness. * 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) and Hsh From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ent* 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 Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 Pl11s 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* 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* Confomnance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Suppled will►Soap and Hand Drying 3-502.11 Specialized Process Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* N 6-301.11 Handwashing 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 NORMH P601 S3\) C4 - t` Establishment Name: Z 10`1 Date: L4 -15 —c-5S Page: of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 5 d Y_ G��SS ��c, '� (-A V\. rA 1A 6,1 C V 3 r-)iN 1 eJ 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 Foodbome 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 11-9 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.*Enedi"1/1,2001 Eggs-Immediate Service 145°Fl5sec• 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 3-403.11B foodborne illness interventions and risk factors listed above, can be ( ) 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 f ) L Date Tvce of Operation(sl Type of Inspection lit/ �6f�lJ°i J D 2T -6�' ❑ Food Service ❑Routine Address 3Z aHe S Risk ❑ Retail ❑Re-inspection TelephoneLevel El Residential Kitchen Previous Inspection Tele P _ /-j ❑ Mobile Date: E] Temporary [IPre-operationOwner V iV 2�0 HACCP Y ❑ serer [I Suspect Illness Person in Charge(PIC) ! Time ❑ Bed&Breakfast ❑General Complaint `, In: '/ Inspector c? ❑HACCP K S/ 0 f d Out: �c> Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Mon-compliance w/lh: Violations Rotated to Foodborne Illness Interventions and Risk FactorsRed Ib3ms Ants-Choking Tobaceo Violations marked may ( ) 00.009(E) ❑ 580.009(F) C]y pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [1 1. PIC Assigned/Knowledgeable/Duties [312. Prevention of Contamination from Hands EMPLOYEE HEALTH ❑13. Handwash Facilities 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 TIME/TEMPERATURE CONTROLS(Potm dally Hazardous Foods) f ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Reoords/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding -Alla ❑ 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 CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑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 immediately or within 10 days as determined by the Board To Foodborne Illnesses Interventions of Health. Non-critical (N)violations must be corrected and Risk Factors(Red!tams 1-22): immediately or within 90 days as determined by the Board Official Orderr for Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C x 590.000/federal Food Code.This report,when signed below 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an Equi and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 24. cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a}(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-Q(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC•7)(590.00B) 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: pyjPrint: 0.91 d PIC's Signature: Print: Page ofZPages FORM 734AUr Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT $ Goss-contamination 1 590.003(A) Assipiment of Responsibility* 3-302.11(AXI) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowledge* Cooke and RTE.Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingreefents ---� 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 Ve eiables 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 590.006(A) Bottled Drinking Water* 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* SheBBsh 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* 1p Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory AuthofiV 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 Anunals* 11 Good Hygienic Practices 5 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PI fr s Received at Pro Temperatures 21101.12 Discharges From the Eyes,Nose and 3-202.15 Package Irate * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Prevent' Contamination When Tasting* 6 FoodTagsSafe e and nada t era 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* Deaces 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availah' 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. THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF �/�`'�� �y �° � ,i Establishment Name: Llll: fw e')r� 2,/d Date: -l�'��' Page: of Item Code c-'Critical.ltem DESCRIPTION.OF VIOLATION/PLANOF CORRECTION Date No. Reference R Red Item Verified _s - .PLEASE-PRINT CLEARLY - & I-A4 /l0 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) FHFs Rec6v6d at'Temperatures n. 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 PHFs 14 Food or Color Additives E19 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* IRaw 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)( ) Eggs- 155°F 15 Sec.2 E Pathogens.*Ell'-'"12001 ( 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 catering,mobile food,temporary and 3-401,11(A)(2) Ratites,Injected Meats-155°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 riskfactors 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. 32 PARK STREET VFW- Club 2104 Of w°Rr" 4North Andover ` Food Est. - Club; Organization - Routine Inspection CWU HACCP: Scoring Type: Additive Score: 0 Failing Score: 50 Item Status Violation Points Critical Urgency Telephone: (978) 687-9614 Owner:---- --- Club 2104, Inc. _ PIC: Inspector: Michele Grant Date Inspected: Correct By: _4/2/20_07_ Risk Level: Permit Number: BHP-2006-0554 Status: FULL COMPLY #of Critical Violations: 0 Time IN: Time OUT: 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 or 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 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2007 ) Page 1 oft THE COMMONWEALTH OF MASSACHUSETTS i TOWN OF NORTH ANDOVER i Massachusetts Department of Public Heal Division of Food and Drugs Q3 FOOD ESTABLISHMENT INSPECTION REPORT Name DvfvO p� Te-6f vaOaerationls) Type-of Inspection v` '�// j ['Food Service outine Address _ Risk [I Retail ElRe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone '7 _ ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In: ❑HACCP Inspector Out: Permit No. ❑Other Each violation checked requires an Axplinatidn on the narrative page(s) and a citation of specific provision(s) violated. Non-compUmm wM: Violations Rolated to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Cho" Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590•009(EI ❑ aso.000(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 12. Prevention of Contamination from Hands ❑ 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 TIMEREMPERATINiE CONTROLS(Potentlally Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans C1 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSPI ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑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 Risk Factors(Red Items 122)• of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an in pection 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 N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-z)(5so.00s) order of the Board of Health. Failure to correct violations 24. Food 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-5)(590.005) establishment 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 REINSPECTION: Inspector's Signature: Print: PIC's Signature: Print: © Page of Pages FORM 734A a Violations 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) signment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003 13Demonstration of Knowledge* Cooked and RTF.Foods* 2-103.11 Person in charge-duties Contamination from Raw°Ingreafents -� 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 horn 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(l)) 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 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* 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 ui ent* 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 Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory AuthOnly 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* 3-301.12 Prevent Contamination When T * 3-101.1 1 Food Safe and Unadulterated* Prevention of Contamination from Hands 6 Tags/Records:Shellstock )Z 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* Conformance with Approved Procedures 5-205.11 Accessibility, tion and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen ,criteria• 6-301.11 Hand Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Provision *Demotes critical item in the federal 1999 Food Code or 105 CMR 590.000. EXAM FORM NO. 1923 CERTIFICATE NO. 5248031 rser!vSiafe- ,, BONN - ServSafe® CerriTa"61"cation TO JOSEPH J LYNCH for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafel Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSA—Conference for Food Protection {CFP). Presented by the National Restaurant Association Educational Foundation 2/26/2007 DATE OF EXAMINATION 2/26/2012 DATE OF EXPIRATION Local lams apoiy Check with your locai regulatory agenoy for requirements. lG National Restaurant Association r ^I Vary M.AdoH EDUCATIONAL FOUNDATION President and Chief Operating 0",cer Nat,onai Restaurant Association EdLIC8t,0nal Fo,,ndat,on www nraef org This document cannot be reproduced or altered. 72007 The National Restaurant Association Educational Foundation 05061402 '10701 i �F�l• 1 Aly P�cTj 0 Zoos---> i e THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Namer Date ae Tvof Oaeration(s1 T e f Ins ection 1- 2 104 i ❑ Food Service NAoutine Address ,��-�� Risk ❑ Retail ❑Re-inspection _ Level ❑ Residential Kitchen Previous Inspection Telephone .� bj �- to (0I ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Time ✓fed&Breakfast ❑❑GeCera Complaint Inspector Out: Permit(N(Jo. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) ) violated. Nmp-c mpl/ance WM: Violations Rolat d to Foodborne 81ness Interventions and Risk Factors(Red Items) Anti•Cholft Tobago Violations marked may pose an imminent health hazard and require immediate corrective 00'009(E) ❑ 00.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned!Knowledgeable/Duties ❑ 12. Prevention of Contamination from Hands ❑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 TIMEITEMPERATURE CONTROLS(Potentially Harardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Reoords/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plebs ❑ 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 HIMIL'Y SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑21• Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑Z2. 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 Risk Factors(Red Items vent): 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 Official 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.0o3) order of the Board of Health. Failure to corned violations Equi by 24. and Food Protection (FC-3)(590.004) order in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a}(s9o.005} the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc s)(seo.00s) establishment 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)(590.008) 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: G PIC's Signature: t Print: S P Page of Pages 9 Lax 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 I 590.003(A) Assignment of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked 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(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* 'Contaminaffon 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 590,003(E)_ 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 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shefrsh and Fish From an Approved Source Contact Surfaces and Utensils 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 Wild Mushrooms Approved by Auth � 2-301.11 Clean Condition-Hands and Arms* Re ulat 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 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 * (, 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 Cities* 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 Plans Suppled with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Dentes 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availabili 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Coda or 105 CMR 590.000. TH/E COMMONWEALTH GF MASSACHUSETTS TOWN OR CITY OF / kvantl_�_E Name: (/ —A2 Date: Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date No. Reference R—Redtem Verified / PLEAS RINT CL RLY _ G�til� /tel f i S '� a,) :.�31. i 117 AJ 7 p_ s _ 1 Discussion With Person in Charge: J _ Corr eve Action Required: ❑ No Yes P (_ V untary Compliance L3 Employee Restriction/ '2 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 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 3-202.12 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) 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 ° Pathogens.*E�r„m"irz°oi ( )(2) Eggs- 155 F 15 Sec. 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 3-403.11(B) foodborne illness interventions and risk factors listed above, can be ( ) 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. 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. f- NORTH ANDOVER BOARD OF HEALTH 682-6483 Pageof2_ FOOD ESTABLISHMENT INSPECTION REPORT Establishment Type Month Day Year Routine od Service ❑ Mobile -' - 2-2_ Qr;� ❑ Re-inspection ❑ Retail ❑ Catering ❑ Complaint ❑ Temporary ❑ Residental Insp. Began ❑ Illness Suspected Kitchen Insp. Ended i 1 ❑ Other Number of Seats Person on Premises Certified in Choke-Saving?: Non-Smoking Seats Provided /I/.,..r1 ❑ Yes ❑ No ESTABLISHMENT NAME 1✓ L-c� LICENSEE NAM -vf.-`- ? �}r ADDRESS _P_423tK LICENSEE PRESENT: ❑ Yes ❑ No TELEPHONE G �/ � - lla-d Based on an inspection today, the items checked below indicate the violated provisions of 105 CMR 590.00. The applicable section of the Massachusetts Regulations follows the item. Critical violations are marked under Column "C"and non-critical violations are marked under Column"N".See back of form for description.Explanation of items is found on Page(s) . This report serves as official notice to violated provisions and official notice to correct said violations. FOOD N C SANITARY FACILITIES N C 1. Food Supply .002 - 29. Water Source .015 2. Food Containers .002 __ 30. Sewage .016 - FOOD PROTECTION 31. Cross-Connection .017 - - 32. Toilets/Handwashing .018/.019 - 3. 018/.019 -3. PHF Temperatures .004 - 33. Insects/Rodents .021 - 4. Facilities, Hot & Cold Storage 004 _ _ 34. Plumbing .017 - 5. PHF Re-service 006 - - 35. Toilet Rooms .018 - 6. Spoiled/Damaged Food .003 _ 36. Handwashing Areas .019 _ 7. Food Protected .003 - 37. Garbage/Refuse .020 - 8. Food Thermometers .004 _ 38. Outside Disposal .020 - 9. Cross Contamination .005 - 39. Outer Openings .021 - 10. PHFs thawed, cooked & cooled .005 - 40. Pesticide/Rodenticide Application .021 - 11. Food Handling .005 - P YSICAL FACILITIES 12. Dispensing Utensils .006 - PERSONNEL 4 . Floors .� 42. Walls, Ceiling 22 _ 13. Employee Infections 008 - 43. Lighting .023 - 14. Employee Hygiene .009 - 44. Ventilation .024 - 15.Employee Clothing .010 - 45. Dressing Rooms .025 _ EQUIPMENT & UTENSILS OTHER 16. Equip/Utensil Clean & Sanitized .013 _ _ 46. Toxics .026 - _. 17. Food Contact Surfaces .013 - 47. Premises .027 - 18. Non-Food Contact Surfaces .013 - 48. Living Areas .027 - 1 ood Contact Surfaces Clean .013 - 49. Linens .027 - on-Food Contact Surfaces Clear .013 - 50. Pets .027 - Wiping Cloths .013 - 51. Bulk Foods .031 _ 22. Dish/Warewashing Facilities 013 52. Salad Bars .032 - 23. Pre-Scraped, Soaked .013 2 ash/Rinse W ter 013 * Any violations of these regulations may be 5 ermometers/Test Kits .01 deemed a critical violation, If In the inion of W. Equipment/Utensil Storage 4 opinion 27. Single Service Articles .014 the inspector, the violation has the potential to 28. Single Service Re-Use .012 - seriously affect public health. COMPLIANCE TIME. days has been granted for the correction of all "critical" violations. Page—z-of—z, ESTABLISHMENT NAME b12F�__Zo ADDRESS ' . Item No. v �f er vim: 4 Discussion with Management: Certified Food Handler e —Signature of Person-in-Charge 9 Health Inspector's Signature ,NORTH ANDOVER BOARD OF HEALTH 682-6483 Pageof .2 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Type Month Day YearY Routine �] Food Service ❑ Mobile l ❑'Re-inspection ❑ Retail ❑ Catering ❑ Complaint ❑ Temporary ❑ Residental Insp. Bega El Illness Suspected � �7 , Kitchen Insp. Ended " S ❑ Other Number of Seats Person on Premises Certified in Choke-Saving?: Non-Smoking Seats Provided ❑ Yes ❑ No ESTABLISHMENT 7E- .// LICENSEE NAME 0�4G ) ADDRESS f LICENSEE PRESENT: ❑ Yes No TELEPHONE b -- ` �►"' -' ��v j G`7a �S Based on an inspection today, the items checked below indicate the violated provisions of 105 CMR 590.00. The applicable section of the Massachusetts Regulations follows the item. Critical violations are marked under Column "C"and non-critical violations are marked under Column"N".See back of form for description.Explanation of items is found on Page(s) . This report serves as official notice to violated provisions and official notice to correct said violations. FOOD N C SANITARY FACILITIES N C 1. Food Supply .002 - 29. Water Source .015 - 2. 015 -2. Food Containers .002 __ 30. Sewage .016 - FOOD PROTECTION 31. Cross-Connection .017 _ - 32. Toil ets/Handwash ing .018/.019 - 3. PHF Temperatures .004 - 33. Insects/Rodents .021 - 4. Facilities, Hot & Cold Storage .004 _ _ 34. Plumbing .017 5. PHF Re-service 006 - - 35. Toilet Rooms .018 _ 6. Spoiled/Damaged Food .003 - 36. Handwashing Areas .019 - 7. Food Protected .003 - 37. Garbage/Refuse .020 - 8. Food Thermometers .004 _ 38. Outside Disposal .020 - 9. Cross Contamination .005 - 39. Outer Openings .021 - 10. PHFs thawed, cooked & cooled .005 - 40. Pesticide/Rodenticide Application .021 - 11. Food Handling .005 - PHYSICAL FACILITIES 12. Dispensing Utensils .006 - PERSONNEL 41. Floors .022 - 42. Walls, Ceiling .022 - 13. Employee Infections .008 - 43. Lighting .023 - 14. Employee Hygiene .009 - 44. Ventilation .024 - 15.Employee Clothing .010 - 45. Dressing Rooms .025 - EQUIPMENT & UTENSILS OTHER 16. Equip/Utensil Clean & Sanitized .013 _ _ 46. Toxics .026 - - 17. Food Contact Surfaces .013 - 47. Premises .027 _ 18. Non-Food Contact Surfaces .013 - 48. Living Areas .027 - d Contact Surfaces Clean .013 - 49. Linens .027 - on-Food Contact Surfaces Clear .013 - 50. Pets 027 - Wiping Cloths 3 51. Bulk Foods .031 - 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 - 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 * Any violations of these regulations may be 25. Thermometers/Test Kits .013 deemed a critical violation, If the opinion of 26. Equipment/Utensil Storage .014 oP 27. Single Service Articles .014 the inspector, the violation has the potential to 28. Single Service Re-Use .012 - seriously affect public health. COMPLIANCE TIME' days has been granted for the correction of all "critical' violations. • _* Page Z ESTABLISHMENT NAME l � -ADDRESS�_ Item No. r v `,17 eS ° Loll— �- - ems.. U �r 07 ��(!f le ve es Discussion with Management: Certified Food Handler Signature of Person-in-Charge Ll Health Inspector's Signature NORTH ANDOVER VFW CLUB 2104, INC. i 32 Park Street • North Andover,MA 01845 978-687-9614 Karen Ann Fitzgibbons May 1, 2015 Assistant Town Clerk for The Licensing Commission 120 Main Street North Andover,Ma. 01845 Dear Karen: Attached please find our application for the extension of our premises to the ABCC. The NAFW board or directors have voted to go non smoking effective 7/1/2015. Therefore to accommodate our members and guest we would like to construct a deck to provide smokers with a sheltered area in which to smoke. The area will be fenced in and only be accessed from the interior of our club. Plans include bushes and shrubs to help buffer noise to our neighbors. No entertainment or speakers will be allowed and beverages can't be purchased out there. But we want to be able to allow our customers to bring a drink out there if desired. Finally attached please find plans for your review Sincerely, Joseph Ly h. Club Manager Cub 2104,Inc. NORTH ANDOVER VFW CLUB 2104, INC. 32 Park Street • North Andover,MA 01845 978-687-9614 Karen Ann Fitzgibbons May 1, 2015 Assistant Town Clerk for The Licensing Commission 120 Main Street North Andover,Ma. 01845 Dear Karen: Attached please find our application for the extension of our premises to the ABCC. The NAFW board or directors have voted to go non smoking effective 7/1/2015. Therefore to accommodate our members and guest we would like to construct a deck to provide smokers with a sheltered area in which to smoke. The area will be fenced in and only be accessed from the interior of our club. Plans include bushes and shrubs to help buffer noise to our neighbors. No entertainment or speakers will be allowed and beverages can't be purchased out there. But we want to be able to allow our customers to bring a drink out there if desired. Finally attached please find plans for your review Sincerely, Joseph Ly h. Club Manager Cub 21.04,Inc. c h` "y r:;tn � y yyh�yy�� Z �h d J� s 'ioy r�`iP t k 1 1 �^ N I t i' ti- l 7/) z f --r h r r Blackis-Ulm, Lisa From: Megan Baldwin <megan@ppsllc-us.com> Sent: Friday,January 30, 2015 10:29 PM To: Grant, Michele; Sawyer, Susan; Grant, Michele; Sawyer, Susan Cc: Bridget Sweet; Kevin Sweet; Blackburn, Lisa; Bridget Sweet; Kevin Sweet; Blackburn, Lisa Subject: Food Safety hand out for VFW Attachments: Food Safety Requirements.pdf Hi Susan and Michele, I put together the attached food safety summary sheet for the VFW to post in their kitchen. I have found they repeatedly struggle with the basics,and so I think a handout with pictures may be helpful. I'd like them to post this,or something similar, in their kitchen.This.way when I say"sanitizer" or"stem thermometer" I will have a picture to point to as a reminder. Let me know if this sounds ok, and also any advised revisions! Best, Megan Baldwin, M.S., R.S. Senior Consultant Public Protection Specialists 1 Top 5 Food Safety Requirements for Serving Safe Food 1) WASH HANDS OFTEN_ • All food handlers shall wash their hands CW ,t o after utilizing the toilet facilities, °o after smoking, eating, changing tasks o before putting on gloves Q any time. hands become contaminated. 2) SANITIZE ALL UTENSILS, CUTTING BOARDS, EQUIPMENT Chlorine Bleach OR Quaternary Sanitizer must be available in spray bottle or a pail marked "Sanitizer". • How to mix Chlorine Sanitizer: ■= o :Mix i TBS Bleach to 1 gallon water L; • Test Sanitizer concentrations with TEST STRIPS k o Chlorine bleach:white papers, 50 ppm OR o Quat: orange papers, 200 ppm 3) COOK FOOD TO SAFE TEMPERATURES • Provide a stem thermometer • Take Internal temperatures to ensure the food is adequately cooked and is:safe to eat o Hot Dogs,Pre-Cooked Sausages: 135°F o Hamburgers: 155°F for 15 seconds o Chicken: 1659F for 15 seconds 4) HOLD FOODS AT SAFE TEMPERATURES • Potentially hazardous food such as cooked Hot Dogs and:hamburgers:must ALWAYS be kept hot or cold o Hot holding: 140'F or more o Cold holding: below 41°F or less 5) USE GLOVES OR UTENSILS, NOT BARE HANDS • Bare hands may not contact ready-to-eat and cooked foods such as hamburgers, salad,or pizza. Use deli tissue, spatulas,tongs,single use gloves. LETTER OF TRANSMITTAL North Andover Health Department o� t%ORTH .�tEq r 400 Osgood Street North Andover, NIA 0.184.5 0 ya V. 978.688.9540 - Phone iL 978.688.8476 - Fax healthdept(a:townofnorthandover.com - E-mail www.townofnorthandover.com - Website Page-/—of sSq�"US�{ TO: DATE: COMPAN FROM:Pamela DelleChiaie, Health Department Assistant Phone: �/ �1//. //� RE: q q J U, Fax: We are sending you: L7 Copy of Letter OPlans ODther ill in below) These are transmitted as checked below: ➢ Mffmved asNoted ➢ rR ' and comment ➢ Muhn* copiesfor ➢ 06 Requested ➢ or Your Use dist O%Requirnd ➢ OResuhmit copiesfor OForApprowd appmwal REMARKS: COPY TO- � COPY TO: COPY TO: SIGNED: REPRESENTATION TO APPLICANT Conditions for applying for club membershi only i I Certify that I am a person of good re p y n Club 2104 repute living within the United States of America; that I a not a member of any organization or group having as its u , o�.erta,ro,�, ry forc Purpose m e of the p rp or one ne o if admitted to membership, I will fulfill the f A nner�� f It s Purposes the � or any ,of it'c nnli ' citizenship and promote the club in apositive obligations andPurposet tial (1 nd that s of Club 2 04, good manner. I AGREE to be bound by the By-Laws of the Board o Manager of Club 2104 along with any directives and f Directors and decisions made by the r ides set forth'"°bey Board of Direc I UNDERST tors. AND that my Club 2104 membership "DOES NOT make me a member of Post 2104 or the Veterans of Foreign Wars. I WILL NOT be granted membership into the L'`eterans of Fo renew my Club 2104 membership on time annually. If I do not en w, I in anyIll be denied 1 will the club. I have No Vote and I Am Not Allowed Into An ed access to Any Metin am not a Club 2104 Member until the Board o<fDirector g of the Board of Directors. I membership application. s has reviewed and approved this I UNDERSTAND that such review may or may not takep lac Board of Directors Meeting. Though in a timely fashion. eat the next regular scheduled Printed Name: - -- -- Date: Signature: Club 2104 Application Form Application Information Applicants Name: Address: Telephone # : City: State:___ Zi p: Date of Birth:__ Email Address: License Plate#: Automobile Make: Model: Color: SPONSOR RECOMMENDATION (For new applicants and To be completed by Sponsor) I. As a member in good standing I hereby support this applicant for club membership and swear that I know of no reason to withhold membership from the Applicant. Printed Name: Signature: Date: 2. Please describe your relation with the Applicant(including Duration) Years For Official Use Only Below This Point Amount: S Check Membership # : •;n;Au TI"iB COMMONW E AI.Ti4 OF MASSACHUSETTS DRFoARTltIXNT or, Coll"IRATIONS AND TAXATION HOW F.LONG,COHYODIONIGI 276 STATE"0119r%- SOSTON +', ARTICLES OF ®RGANaArION t° We, Xaracc T; Dunn , President, X. Ir�Qksoz ., ,' .Cohn I. Willlg .Clerk of RecretAry,and Jawri P. Dew 1traph Crnuglton, Tx. i4artia T. iItl4r, Ix. A T�.mwr W. 3'aoksatt _ a Istr► T. WiIIIS Fduartk C. tiS•Tey r barred of oiilewtt i 3y being a mriorii;/of the di,•er+.urs (or�° with fiAe ,lowexa of rii:r.�torw ,aider tine euinoriti, of velle:xl ?.esws, C�.► tax 180, Eectlosl 4) 1 l,,,b 2104, ins. clacteti t t its i9reL Incetizz ,in rarrp1'=ce MIX the veQulremEnts of (.e*lerai t,aval�, Qu to om Secon 3,ereb,w r fy }yPt the ofollloWinbecrlbers th9eetoof tine agreeanert of cseuciat.Son t0 fOrsa Wit6u : ?Pew whose aatstoe a:a hereto r•% bed, do. by :hies agreement, ,as,ureiAte o'tr�eltme with the ,Y'r; intention of fording a corporation•wider the prav`MnnB of General Lava, Chanter 180. •t. The nyme by whi&the corporation Shall be l:noan ie „^yY Club 2104, :no. r The location of the princioal office of tiln corporation in Massachusatta is to 1>e the jortiu AAdofer at Part �traAt ;., The parpaaas for whichthe corporailon ih foyined are as fOUOWII: v e aad meintai•n social Set..vit To promote, f-star, on tea ureg ' for the Nt`a�xb Ardat _r Past 8:.09 9etaznzta of moo:®ice Vera and to Deus ti+e pass=' to eMuttir® a lircnsc for the ar .A Of alcabo'sia toyexllgara . to Aa say and all acts neceoaarg for dispensing said alaoholio ...4,� bovere+as Under the te2^3>! ani provtgioup of any '1iaeyualA gran tea. �?' 'fie arsaant a4 its r.^pita;ctack ,n.,) in None dOlia?v +lollars v The t yr pnhae et itq gbAres iP '. The number of ira jeliarrm N (rx ,day.'notle,4,ix walMaci,flit ira the!t'i',twing wriver.) ° W10 T.eaive ell reyllizonseuta a'i the(jeneral Lawa of ItFaasaclttlsatte ±For moltiea 11M�e ;• ;�: the Fath .Sap of Movmber , arst meow I for organization,anu appointt' at B:Ou o'eloek p�al.,ar Parx 9trewc, :0orth AUCLOW 7. ?lsra. as tba time and place fol hrddinq such Brat zrenting. s {snvn Pigzz our names, this >�th day of November Y'.�•.AWau ,1i -IT".a'POW-V".% :hw:.w,nc uaB s:.drwri of.wde,o.,.p,ee.wmr la n1• y.Mw.) :., &iCSiDBMOii OF sAOLr . ;x NAKZ Give Number and Street,CNS ar Town atlrtalurRp>i r A>1te8 4 11 .$t.,, NOAi t►davar r]��J 4 :k". '• `ffi: 1'�ai,9lCRnn I7.8 Wfsllle-� St., ha�``��QOvPr I x��' >M. s' t 26 riaunderH 9t., Nov'Axdovetr None -TVk% Jr. Will tSieCYA,' 7"A?. Mi.ddlereez bt., N04610Andover Sono r t t Sr. fl T�ki)lgaeHlohuaRt`A Ave. Zq„r"q�idoYaT lAOili °: .,.,r`h.,.y,9.r l lune ff F`f !4'�J�IM3�I�A1 J,. Lallf�fii'j ?I+. � v !: roveue ;J on A, i-aLI 1w I u'aaarton 8t., a+u uGoroer ` V' ,` d�ggltvn T. Dunw t)li Llnu:ltu .it., tioU Andovor Nope 1 , .':,•,,tea TOWN OF NORTH ANDOVER Fire Department. Central Fire Headquarters 124 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 William V. Dolan Telephone(978) 688-9593 978 Chief of Department FAX� � � + ( )688-9594 z F; wdol�ui()TownofNorthAndover corn William P. Martineau _ wmartineauca)TownofNorthAndover.com Deputy Chief ,......::.:.::.... Joseph Lynch Manager Club 2104 Park Street RECEIVED North Andover MA 01845 MAR 14 2005 TOWN OF NORTH ANDOVER I I March 2005 HEALTH DEPARTMENT Dear Joseph, In November of 2004 the State of Massachusetts enacted the most comprehensive fire protection law upgrades since the Coconut Grove fire in 1942. The enactment of this law, known as Chapter 304 of the Acts of 2004, was the result of a special commission, which was convened after the tragic West Warwick,Rhode Island nightclub fire. Of the 100 people who died in that fire 35 were from Massachusetts. In addition to members of the fire service and building,the parents of those who died where members of the commission. The North Andover licensing Board advised you in December of 2004 that certain provisions requiring the installation of automatic fire protection—fire sprinklers and fire alarm warning systems would not take affect until the 2005 license renewal cycle.as directed ectel Ly the State. Other provisions of the law are in affect now. I am writing to you because your facility will need to initiate fire protection upgrades. The law stipulates that an adequate system of automatic sprinklers shall be installed within three years of the effective date of the law(15 November 2007). The law requires that plans and specifications for a required installation be submitted to the head of the fire department and the local building inspector within eighteen months of the effective date of the law (15 May 2006). These upgrades are required because your facility: • Has a capacity of more that 100 persons • Is designed or used for occupancy as a nightclub, dance hall, discotheque,bar or for similar entertainment purposes. • A portion of your facility meets the criteria and the entire structure must be equipped with fire protection 2 Owners who install an automatic sprinkler system under the provisions of the law are eligible for an accelerated tax depreciation deduction allowance. This law also has specific penalties for violations of occupancy permits. Violation of the maximum capacity two or more times during a twelve month period or a single violation of the maximum capacity by greater than one-half of the maximum, as certified by the building commissioner, will be require the owner to install the fire protection systems within one year of the violation without the benefit of the tax depreciation and they will be subject to a$10,000 fine for the first or second offense. A third offense shall result in the business owner losing his license to operate in the commonwealth and all food, entertainment another licenses associated with his business. These provisions are in affect now and will be enforced for public safety, The principles of fire prevention are education, engineering and enforcement. This letter will initiate the education phase. The engineering is the fire protection systems. Enforcement is needed where voluntary, cooperative compliance cannot be achieved. I have briefly highlighted the provisions of the law to inform you of some of the more significant effects that violation can have on your business. A full copy of the law is attached for your review. You will note that there are provisions for appeal in addition to the requirements. Please review the law and I will call you to schedule a meeting to discuss how it applies to your facility. It is our intent to work with you to attain compliance with the law and prevent any possible reoccurrence of tragedies similar to that,which occurred in Rhode Island. Respectfully, VC William V. Dolan, Fire Chief Cc: Robert Nicetta, Building Commissioner Michael McGuire, Assistant Building Commissioner William P. Martineau, Deputy Fire Chief Lt. Andrew Melnikas, Fire Prevention Officer Donald B. Stewart. Licensing Commission Chair Mark H. Rees, Town Manager Heidi Griffin, Director Community Development&Planning Susan Sawyer,Director North Andover Board of Health