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Miscellaneous - 4 MAIN STREET 4/30/2018 (5)
DESIGN LAYOUT Richdale ' s - 4 Main �trAAt i 14ORTFf 16 o T O.Q cocAc NI wK.y1' SAC14US���� PUBLIC HEALTH DEPARTMENT Community Development Division April 23, 2009 Hasina Alam Mohammed Alam Richdale Dairy Store 4 Main Street North Andover,MA 01845 Re: Subway/Richdale Dear Mr. Alam, This letter is in response to your revised application for a New Food Establishment that was received by the Health Department on March 14, 2009. The following items were noted are now complete. The plan has been approved and the Building permit will be signed once this office is presented with a full size plan for the file. 1) Page 8 #2—Two employees must be certified in Safe Food Handling. Please submit either current certifications or proof of enrollment in an approved certification program. OK 2) Page 8#4—No sick policy is referenced. Please submit a written description of your policy. OK 3) Page 9#7—How does produce come into the food establishment? Is it already cut? Lettuce,onions,tomatoes etc.?If produce is managed on site there should be a designated produce sink. No sink is shown on the plan OK 4) Page 10—Please note all coving must have a"curved base".No right angle coving in food areas will be acceptable. No action needed OK 5) Page 14—Please note that the ice scoop used for the ice must be kept in a protected container between uses. No action needed OK 6) Owner will discuss seating with the Building Dept. No seating shown on the plan. Once basic construction is complete and the equipment is in place,please contact the health office for a construction inspection to verify that you have built it to plan. At that time we will sign off the building permit. The final health inspection should be requested approximately 24- 48 hours prior to opening the establishment. At the final pre-operation inspection, it is expected 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com A that the premises will be ready for business.If you have not already done so,please m e sure that all permit fees are paid prior to requesting the final inspection. To receive the approval to begin to operate: 1) The establishment will be clean of all construction materials 2) The hand sinks will be stocked with a wall mounted paper towel and soap dispensers 3) Handsinks should be labeled"hand wash only". With directions of proper techniques. 4) There must be test strips for the sanitizer on site 5) There must be Sanitizer on site.Directions on mixing the sanitizer should be posted. 6) The three-bay should be labeled "wash,rinse, sanitize" 7) Gloves must be on site. Please note that the state DPH does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 8) At minimum, employees should be trained on the sick policy and sanitation basics. 9) Label grease trap per plumbing code 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: 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). You must meet the state code requirements to be allowed to be open for business including,but not limited to the list above. This correspondence is a Health Department plan approval only. Please be advised that other departments may have specific requirements. This approval does not supersede any other department's request regarding other town or state regulations. Please contact this office if you have any questions regarding this correspondence. We look forward to working with you in the continuous effort to provide safe food for the public. Since 1 Y J r� Susan Sawyer, HS/RR "Public Health Director Cc: file 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com z DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, April 17, 2009 10:34 AM To: kiritg2000@aol.com Cc: DelleChiaie, Pamela Subject: RE: subway-4 main st. n andover, ma. Kirit, I just left you a message at your office. If you have all the documents required and a full size copy of the plan, I am ready to approve it. I am satisfied with the plan changes. I am here all day, but please call in advance. If you cannot come today, please note we are closed Monday Susan From: kiritg2000@aol.com [mailto:kiritg2000@aol.com] Sent: Tuesday, April 14, 2009 9:09 AM To: Sawyer, Susan Cc: kiritg2000@aol.com Subject: subway-4 main st. n andover, ma. Town of North Andover Health Department Attn: Ms. Susan Y. Sawyer: Good morning. As per our talk attached is a scan copy of subway at 4 main st.. Thanks for your help. Regards, Kirit Upadhyaya Get the scoop on the live music scene in your area and hit a show tonight. Check out TourTracker.com! 1 � � t DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, April 14, 2009 4:38 PM To: kiritg2000@aol.com Cc: DelleChiaie, Pamela Subject: RE: subway-4 main st. n andover, ma. Thank you I have no time on Wed and Thursday Morning and I am out of the office at a meeting. I will try to get back to you by Thursday with my comments. Feel free to check in with me Thursday afternoon. Thank you Susan From: kiritg2000@aol.com [mailto:kiritg2000@aol.com] Sent: Tuesday, April 14, 2009 9:09 AM To: Sawyer, Susan Cc: kiritg2000@aol.com Subject: subway-4 main st. n andover, ma. Town of North Andover Health Department Attn: Ms. Susan Y. Sawyer: Good morning. As per our talk attached is a scan copy of subway at 4 main st.. Thanks for your help. Regards, Kirit Upadhyaya Get the scoop on the live music scene in your area and hit a show tonight. Check out TourTracker.com! 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, April 03, 2009 4:01 PM To: DelleChiaie, Pamela Subject: Task Completed: Food-Subway/Richdale -----Original Task----- Subject: Food - Subway/Richdale Priority: Normal Start date: Mon 3/30/2009 Due date: Mon 4/6/2009 Status: Completed Complete: 100% Date completed: Fri 4/3/2009 Actual work: 0 hours Requested by: DelleChiaie, Pamela ------------ Hi Susan, Here are some notes re: Richdale/Subway Food Plan Review, P Mon. 3/30/09—Alam coming in to pickup letter. Was scanned and e-mailed on 3/27/09. There is no reference to Subway. There needs to be two distinct businesses: Subway - $185.00 Richdale - $185.00 1. After owner reviews the letter, etc., followup with clarification on business. 2. If they move alcohol—they need to file an Alteration of Premise for Alcohol 3. This should be registered as a DBA with Town Hall—call Joyce or Janet after Alam responds to letter. i 1 DA/Cl P: }ood Establishment Plan Review Guide - Sections I Page I of 19 r Food and` rr 4,dministraticd ana onference for Food Protection FOOD ESTABLISHMENT PLAN REVIEW GUIDE 2000 SECTION I FOOD ESTABLISHMENT PLAN REVIEW APPLICATION TO BE COMPLETED BY THE OPERATOR AND SUBMITTED TO THE REGULATORY AUTHORITY RECEIVED Regulatory Aut ority MARgI�®09 TO(OF NORTH A DOVER Date: _ f l!/� HEALTH DEpq�tTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION NEW ✓ REMODEL CONVERSION Name of Establishment: 6HE ru., Ikes . ABA - RICHD,ILE AA/R-� S`TOK'E- Cate�.;ory: Restaurant , Institution , Daycare , Retail Market , Other $ .Address: 4 y M.419 9Tic€ET 9 koerlt .4mimyrQ o M g �f g4,s- Phone if available: � Name of Owner: t1A-91ffA ALAM \A � O Mailing Address: .3/$'p Sur-701- S/-, Kp4*60p 6€,t? M.4 01fg4S Telephone: 79- ,S Rh - _-4A Applicant's Name: AjyHA1wy b J% !/GAq l� Title (owner, manager, architect, etc.): PRE- 1joEffT• .* (� Mailing .Address: / , S' UT TpN T, /VD, dmDD vj�g f 10o /A7 S' Telephone: 9 79 - 3912- 5 g43 / 9 -3q2- z0g q �«z4j I have submitted plans/applications to the following authorities on the following dates: http:/'/\A7ww.cfsan.fda.gov/-dms/prev-l.html 7/13/?007 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 6-pp&N i`®cvThurs 6.'00 AM - !/900PM Ply MonI.,vpyFri 5°e0-4 Ai !I . d0 PN Tues H-#.a�Pc�at ©o A M -- f` 'p 'IN Wed��ga #,toPH Number of Seats: N Number of Staff: 7— (Maximum (Maximum per shift) Total Square Feet of Facility: Z S ` F Number of Floors on which operations are conducted Maximum Meals to be Served: Breakfast (approximate number) Lunch Dinner Projected Date for Start of Project: MAQe6-2,0-r goq Projected Date,for Completion of Project: 26 7-4 Tukr, Z?00? Type of Service: Sit Down Meals (check all that apply) Take Out Caterer Mobile Vendor Other Please enclose the following documents: Proposed Menu (including seasonal, off-site and banquet menus) Manufacturer Specification sheets for each piece of equipment shown on the plan —%,Z 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.htrnl 7/13/2007 7 II l llA�l rI: rood Establishment Ilan Review Guide - Sections 1 Page 3 of 19 / N/ Equipment schedule CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 1°1 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, 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. 5. 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. 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; b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; 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://,A,,Aw.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 fUA/Cf-l?: 1 ood Establishment flan Review Guide - Sections 1 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. i 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 i 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; 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, sandwiches, vegetables) ( ( ) 4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) (✓r ( ) 5. Bakery goods (pies, custards, cream fillings & toppings) (� 6. Other * A generic HACCP plan for each category of food may be available from the regulatory authority for reference. http://ww-,A,.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 ,c�'AA,r r. r uua Lstaotisnment Plan Keview Uuide - Sections I Page 5 of 19 4 PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS FOOD SUPPLIES: V 1. Are all food supplies from inspected and approved sources? YES /NO 2. What are the projected frequencies of deliveries for Frozen foods4 T �</o/v yttLT Refrigerated foods 4-5mr-TImoNc nd Dry goods 4 &mes �. 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage Refrigerated Storage 2 4,,,- ct V. and Frozen storage T 4. How will d goods be stored ? I/ dry b off the floor. � t-Pt-4 R o.F►= TFPC -rtWK COLD STORAGE: 1. Is adequate and approved freezer and refriger ti n available to store frozen foods frozen, and refrigerated foods at 41'F (5°C) and below? ES)/NO Provide the method used to calculate cold sto ge requirements. 2. Will raw meats, poultry and seafood be stored;in the same refrigerators and freezers with cooked/ready-to-eat foods?YES /NO !_. If yes, how will cross-contamination be prevented? ✓ III 3. Does each refrigerator/freezer have a thermometer? YES /NO Number of refrigeration units: Number of freezer units: 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 FROZE -FOODS *THIN FROZEN FOODS Refrigeration http://www.efsan.fda.gov/—dms/prev-l.html 7/13/2007 i FDA/CFP: Food Establishment Plan Review Guide - Sections 1 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 therm ome rs e 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) eggs: Immediate,,service 1457 (15 sec) pooled* 155T (15 sec) (*past urized eggs must be served to a highly sus<5eptible oapulation) ork 1457 (15 sec) comminuted meats/fish 155°F (15 sec) poultry 165°F (15 sec) reheated PHF's 1657 (15 sec) 2. List types of cooking equipment. i I HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 140T (60°C) or above during holding for service? Indicate type and number of hot holding units. http://ww-w.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 r uou Lstaotisnment nan Keview Uuiae - Jectnons 1 Page 7 of l 9 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. COOLING: Please indicate by checking the appropriate boxes how PHF's will be cooled to 41°F (5°C) within 6 hours (1407 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 i 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 1657 for 15 seconds. Indicate type and number of units used for reheating foods. http://www.cfsan.fda.gov/—dms/prev-1.html 7/13/2007 FDA/CFP: Food hstablishment Plan Review Uuide - Sections 1 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. �4-/rr-t 61 2. Will food employees be trained in good food sanitation practices?YES /NO ` Method of training: Number(s) of employees: '2i Dates of completion: 3. Will dispo_ ble gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to- eat foods? ES /NO 4. 1 there a written policy to exclude or restrict food workers who are sick or have in ec �ut-and lesions? YES /NO Q � G 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? g Chemical Type: Ci1,�,� ' ,. Concentration: ` C) F `w httr://www.cfsan.fda. ov/—dms/ rev-l.html 7/13/2007 � r FDA/CFP: Food Establishment Plan Review 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 nd sandwiches be pre-chilled before being mixed and/or assembled? YES/NO ~ If not, how will ready-to-eat foods be cooled to 417? ✓�'� 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 v �J U If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. i 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 / 0 Ii yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area? http://www.efsan.fda.gov/—dms/prev-l.htrnl 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 i Food Storage tWAS' _4j Other Storage Toilet Rooms l;X 92 Dressing Rooms Garbage & Refuse Storage Mop Service t,�ay�Av�e, Basin Area Warewashing Area + l Walk-in Refrigerators and Freezers http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 ti)Aj(, P: rood hstablishment Plan Review (_iuide - Sections 1 Page 11 of 19 i 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? ( ) ( ) (vY 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? W O O 7. Will air curtains be used? If yes, where? O O � II C. GARBAGE AND REFUSE Inside 8. Do all containers have lids? 9. Will refuse be stored inside? ( ) NY ( ) If so, where. 10. Is there an area designated for garbage can or floor mat cleaning. Outside 11. Will a dumpster be used? (vj ( ) ( ) Number Size Frequency of pickup Contractor V% x"14 12. Will a compactor be used? Number Size Frequency of pick up http://,A,",.cfsan.fda.gov/—dms/prev-l.htrnl 7/13/2007 r1JN/l,rf: roou Csldollsnl11e1]L flan 1CGV1eW UUlue - JCC:LlonS 1 rage 12. 01 lye r \ Contractor 13, Will garbage cans be stored outside? 14, Describe surface and location where dumpster/compactor/garbage cans are to be stored 15. Describe location of grease storage receptacle 16. Is there an area to store recycled containers? Indicate what materials are required to be recycled; O Glass ( ) Metal O Paper O Cardboard O Plastic 17. Is there any area to store returnable damaged goods? O O ( ) D. PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18. Toilet 19. Urinals 20. Dishwasher i http://www.efsan.fda.gov/—dms/prev-l.html 7/13/2007 rlir�i�rr: rooa tstablislhment Plan Review Guide - Sections 1 Page 13 of 19 21. Garbage Grinder 22. Ice machines r l_ i 23. Ice storage bin 24. Sinks ii a. Mop b. Janitor c. Handwash d. 3 Compartment e. 2 Compartment f. 1 Compartment g. Water Station 25. Steam tables 26. Dipper ells 7• Refrigeration condensate/ drain lines 28. Hose connection 29. Potato pee http://www.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 ruAl�,rv: rood tstanstument Plan Keview huide - Sections 1 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 Nor private ( ) ? 34. If private, has source been approved? YES ( )NO ( ) PENDING ( ) v G Please attach copy of written approval and/or permit. 35. Is ice made on premises ( ) or purchased commercially (r� 1 ✓`�� If made on premise, are specifications for the ice machine provided? YES ( )NO ( ) Describe provision for ice scoop storage: Provide location of ice maker or bagging operation 36. What is the capacity of the hot water generator? 5� 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://v;,Aw.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 t•UAC;?: rood 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 (40 ( ) 41. If no, is private disposal system approved? YES ( )NO ( ) PENDING ( ) Pease attach copy of written approval and/or permit. 42. Are grease traps provided? YES (v�NO If so, where? Provide schedule for cleaning & maintenance G. DRESSING ROOMS 43. Are dressing rooms provided? YES ( ) NO (v( 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 ) NO ( ) Indicate location: 46. Are all toxics for use on the premise or for ret it sale (this includes personal medications), stored away from food preparation and storage areas? YES (_ NO ( ) 47. Are all 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.html 7/13/2007 •FDA/CFP: Food Establishment Plan Review Guide - Sections I Page !bot 19\ � 4— d - If yes, what will be laundered and where? If no, how will linens be cleaned? 49. Is a laundry dryer available?YES ( )NO ( ) O/A 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: it 53. Indicate all areas where exhaust hoods are installed: LOCATION FILTERS SQUARE FIRE �R AIR &/OR FEET PROTECTION CAPACITY FM MAKEUPF EXTRACTION DEVICES I I i 54. How is each listed ventilation hood system cleaned? littn://www.efsan.fda.gov/—dms/prev-l.htrnl 7/13/2007 FllA/CfP: Food Establishment Plan Review Guide - Sections I Page 17 of 19 /l I. SINKS 55. Is a mop sink present? YES 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 ( ) SII J. DISHWASHING FACILITIES 57. Will sinks or a dishwasher be used for warewashing? Dishwasher( ) Two compartment sink ( ) Three compartment sink 58. Dishwasher Type of sanitization used: Hot water(temp. provided) Booster heater Chemical type Is ventilation provided? YES (,�'NO ( ) 59. Do all dish machines have templates with operating instructions? YES ( ) NO 60. Do all dish machines have temperature/pressure gauges as required that are accurately working? YES ( ) NO O ti/-Ik w 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 C40 ( ) 63. What type of sanitizer is used? http://vrww.cfsan.fda.gov/—dms/prev-l.html 7/13/2007 FDA/CFP: Food Establishment Plan Review Guide - Sections I Page 18 of 19,E Chlorine X) Iodine ( ) Quaternary ammonium ( ) Hot Water ( ) Other ( ) 64. Are test papers and/or kits available for checking sanitizer concentration?YES (VNO ( ) K. HANDWASHING/TOILET FACILITIES 65. Is there a handwashing sink in each food preparation and warewashing area? YES (v<NO ( ) 66. Do all handwashing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES (y NO O 67. Do self-closing metering faucets 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 (VNO ( ) 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 ((f NO ( ) 71. Is hot and cold running water under pressure available at each handwashing sink? YES (VNO ( ) 72. Are all toilet room doors self-closing?YES (VNO ( ) 73. Are all toilet rooms equipped with adequate ventilation? YES (4NO ( ) 74. If required, is a handwashing sign posted in each employee restroom? YES NO ( ) L. SMALL EQUIPMENT REQUIREMENTS i 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.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. Signature(s) a, o� owner(s) or responsible representative(s) Date: 31 Itto 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 i i I http://www.efsan.fda.gov/—dms/prev-l.html 7/13/2007 MAGEE square-corner utility sinks three compartment r' bowl size drainboard ''`" ' `' .,'; shipping O.A. size (W x L) length €i1 : .......................... 16/4 16/3 . • three compartment—no drainboards 1.8:X:::::.:. .............. ........... ...................... ........... ........... ....... .......... ...................... 16':::::..........Na...........>:::'::1.848-3:::.>::::'::698 1065 90<»: 20.6>:}21 1'/2 x 51 21 x 12 n/a 2136-3 693 1015 85 18.1 24 1/2 x 39 ME mom ,F y .21 x 18 n/a 2154-3 T •::, 4:,, 1185 100 25.7 241/2 x:57:; .................:.: 24 x 16 n/a 2448-3 784 1223 92 25.8 271/2 x 51 0 y� K�•�,� # �y�} o ..:::::: ©.,.::•r :::.>:.>::;u.. ::•::::::::::: :::::•G'!!!VU?; ;:'::::.::::. ::•••ra:R1t7?t;:;.:;a: r:::: S::;t:G127 .......................... 24 x 24 n/a 2472-3* 1051 1627 125 37.1 1/2 x 75 three compartment—double dralnboards 21 x 16 18-L&R 2148-3-18, 2010 2256 127 38.4 27 1/2 x 87 .'::. Y�i?::::::i::iii •::•:::}i^.? "••'r.:::::::i:i :+. +!F �'M 'yl 'el'K'M:i:: 24 x 24 24-L&R 2472-3-24* 2338 2645 175 59.6 27 1/2 x 123 *require two sets of faucet holes four compartment FAUCET • e 14 ' • e I �A • • 111-- SBTO/Z it s9 irr SINK WIDTH A I 18 II ! 21 12 1/2 24 14 shi bowl size drainboard ```' ``'` `. in ** kl ! s pP 9 O.A.size ;. x L) length :::<>.:>::>:: 16/4 16/3 wt. cu.ft. (W x L) (W four compartment—no drainboards --------------- 21 \fit\A..,\w21 x18 n/a 2172-4 ~1463 1530 115 133.3 241/2 x 75 .: tit .:•.wx. ...;?l:;i:::::::T"Rv n.: :::...........:..... +i:.�:nv,•.,, :::::::'pi:•: .. ..... 1�i:.•:��'l:�ii::l��j�:t•Xii�<��:� .............�::.:�:...: •.�?;�}�;�;:}}}}::�viT::i$i{:•... •::::::•K•i:•:ii�i i,;}::v\'+vv;v`::.�•KL.pi}ii:;::v. four compartment—double drainboards 21 x 18 18"L&_R 1 2172-4-18 $2376 $2689L15 5 48.5 24 1/2 x 111 freight class is 150.0 **all shipping weights and cubic feet are approximate all four-compartment sinks require two faucets m Metal Masters Foodservice Equipment Co., Inc. •655 Glenwood Avenue, Smyrna, Delaware 19977. 800/441-8440 • fax 302/653-2065 x Y � f-. I Eterna Cartridge with internal spring a check to prevent cross-flow of water. Used in all T&S Pre-Rinse units and B-270 most faucets.It's replaceable. Double Pantry Faucet B-1400 with Elevated 18" 'Reel Kleen"Retractable Hose Reel Swing Nozzles.V IPS and Spray Head AJI Z _ riser pipe.Ht.261/" above deck./'IPS tail- � Heavy�uty,enclosed type with 35' �I�" � � ' ' hose of Y8 ID.Multi-fit mount for wall, t piece on 4"centers. ceiling or under sink-V IPS female inlet on reel. ( ' Other height and nozzle lengths available. B-1403"Reel Kleen"Open Model Heavy duty-no cover with 35'Y" ID hose B-1205 Glass Filler Push-Back B-1407"Reel Kleen"Open Model Wall-mounted,heavy-duty type—X" Heavy duty-no cover with 15'X IPS male inlet,3'2"long.Volume eg ID hose regulator.Automatic shut off. T&S has 8 models of glass fillers it B-133 �w a Unit _ z Complete unit with mixing faucet for B-1105 proper water temperature.8"center y Workboard Faucet deck faucet with union coupling connec- With 6"Swing Nozzle fions for sink-top installation.Unit is Splashback mounted,shanks on 31/2" 40"high. B-290"Big-Flo"Faucets centers,1'/2"long,1/2"NPS thread. For pot sinks and kettles has 12"swing nozzle, lLr, 8"centers.(adj.7Y4"to 8/ Chrome-plated 61/2"long x 2"wide ) brass escutcheon Available with 18"or 24"swing nozzle Also available with 8",10",or 12"nozzle A�1r V ffi •n" II.j B-190 Combination Kettle Filler and Sprayray use Filler and spray use automatic shutoff ,; valves.Supplied with flexible SS hose- 8'on filler,5'on spray.(Other lengths P to spec.)Assembly 44"high with x w swivel top.k"IPS connections for single 2 { water service at base. 8-1120 Workboard Faucet with 6"Swing Nozzle fz' Deck-mounted,shanks on 8"centers, 1"long.1/2"NPS thread.Chrome-plated 101/2"long 2"wide brass escutcheon. Also available with 8',10",or 12"nozzle ' 5 N DO LAS 100 SEE-THRU I GONDOLA I 11 I II I II I I _-- ! I I I jt SEE THRU TOP GONDOLA I 11�11� WJSLAT WALL BACK � +I s DOUBLE SEMI SEE-THRU GONDOLA W(PANEL BACK FULL BACK GONDOLA with Pegboard Back ■ Strong and durable.construction - 12 ga. Roll formed Steel Uprights. ■ Shoes and uprights are Factory.Pre-Assembled. ■ A variety of available Panel Backs. 23/.n 36" ■ Shelves adjustable on 2" centers. 48" ■ Extenders available to easily change height. 54' 60" ss" ■ Lengthen or shorten a run of gondolas without disturbing entire 72" display. 84" ■ Tough, baked enamel paint finish. 96" 108" ■ 7" mocha kick (front toe). 118" BASE BASE 144" ■ Leveling screws included. SHELF SHELF—+- 168" SIZE SIZE BASE OVERALL BASE OVERALL SHELF DEPTH SHELF DEPTH 7" 101/10" 24" 22"/22" 48' 11 13"/13" 30" 24"/24" 52" r OVERALL 16"/16" 36" 28"/28"C J 60" DEPTH 19"/19" 42" 34"/34" 72" * OFFSET GONDOLAS OFFSET GONDOLAS have one base shelf depth different from the — — — other. To calculate the overall depth.add 2"to each shelf depth. .4280 237 SHERMAN AVE • NEWARK, N. J. 07114- 1201) 242.1600-(800) 631 WALL UNITS 101 a Strong and durable construction - 12 ga. roll formed �I steel uprights. I� © Shoes and uprights are factory pre-assembled. II II a A variety of available panel backs. a Panel just the front ront sin le back or the back also � IIback). (single ) double Ia Shelves adjustable on 2" centers. a Extenders available to easily change height. _1 ■ Lengthen or shorten a run of wall units without disturbing entire display. l II a Tough, baked enamel paint finish. II ■ 7" mocha kick (front toe). II ■ Leveling screws included. I � � WALL UNIT Single Back Pegboard Panel Back 2 1411 36" 42" 48" 54" 60" 66" 72" 84" BASE OVERALL BASE OVERALL 108" SHELF DEPTH SHELF DEPTH " BASE 118 10" 13" 22" 25" --SHELF .168" 13" 16" 24" 27" SIZE 16" 19" 28" 31" 19" 22" 34" 37" oVEHALL� DEPTH E11—m— 1'iiTtTn�1— —==� !`- NO BACK DOUBLE BACK DOUBLE BACK SINGLE BACK SEE-THRU SEMI SEE-THRU SEE-THRU TOP REAR VIEW �. WITH WOOD PANEL BACK WITH SLAT WALL BACK WITH PEGBOARD BACK qWnE M emw MW 337 SHERMAN AVE • NEWARK, N. J. 07114• (201) 242.1600•(800) 631.4280 PACKADED ICE SPECIFICATIONS: ° . • .. MODEL 30 40 65 a _ • Capacity8#Bags 100 140 220 } # • • . . • Approx.Cu.Ft. 30 40 65 i a " • • •. • r; Door Size 27"x46" 27"x46" 27"x46" 4 • • • Outside Height 771/4" 771/4' 771/4" Outside Width 36" 501/2" 641/4" Outside Depth* 30" 30" 341/2" Cold Wall Weightt 288 341 402 Auto Defrost Wtt 298 350 411 Compressor 1/4 HP/115 V 1/4 HP/115 V 1/3 HP/115 V PACKAGED ICE Refrigerant 12 12 12 *Door and handle will add 31/2"to depth.Condensate evaporator,when used on sal auto defrost models,will add TIC depth. tCrated weight. • ' }.:A,",- • • � • • Because of our policy of constant product Improvement,specifications are subject to change without notice and without incurring responsibility to units sold previously. E[! •.• I Vit' • • -lit III r • eta • • • ••• • '• LEER STANDARD FEATURES: • Total steel construction. • Full 2"thick,high efficiency,bonded polyurethane insulation in all walls,tops and bottoms. • Sealed,waterproof seams. • High and low side service valves for easier maintenance. • Medium and low temperature condensing units for balanced refrigeration,high efficiency,and minimum maintenance,regardless of environmental conditions. • Large,embossed,stainless steel doors with welded _ PACKAGED ICE corners. p • Magnetic door gaskets assure a positive and tight seal. m arAa l��j • Cold Wall or Automatic Defrost refrigeration systems 1 • • • • available on all models. •• • •• • Distinctive condenser cover permits efficient operation • . • and protects the unit's cooling fins. .• • Rugged,heavy-duty base easily accepts casters if • • ••• •• • desired. 4• ••• • U.L.and C.S.A.Listed. • • • • • • Finishes:Baked urethane paint to resist graffiti,stains,or j _ • abrasive damage.Personalized colors and silk screening a available. ' ' • • The industry's best warranty,including a full five years •'• • • ••• ' on the compressor. i r �r Model 60, Upright y Indoors or out,this upright c, Model 60 ice merchandiser offers large capacity and N immediate eye appeal.The �• rugged, heavy-duty base, standard on all Leer Merchandisers,easilySPECIFICATIONS: accepts casters for ease in MODEL60 85 100 movement and relocation. Capacity 8#Bags 220 310 355 Approx.Cu.Ft. 60 85 100 Door Size 27"x46" 2rx46" 27"06" OutsideHeight7711e. 77/4" Model 85, Upright Outside Width ® +' This large capacity,high- . 30" ® efficiency ice merchandiser permits easy loading and ColdWallWeightt 440 562 587 access, less filling time,and tremendous consumer Aut' Defrost Wtt 447 597 appeal.Standard on all Leer Compressor 1/3HP/115V1/2HP/115V Ice Merchandisers are Refrigerant ®® 12 sealed,waterproof seams, and the industry's best *Door auto defrost models,will add 3"to depth. warranty. tCrated weight. Because of our policy of constant product Improvement,specifications are subject to change without notice and without Incurring responsibility to units sold previously. Model 100, Upright Here's the ultimate profit center with a full capacity of 355,8# bags of ice.This large capacity ! merchandiser reduces filling trips,yet assures sufficient ` inventory for those peak i demand times.The large metal doors feature Leer's magnetic door gasket,assuring a positive and tight seal. �� o Leer Manufacturing Company,Inc. Box 206 562.3161 206 WAT ' I 206 North Leer Street WATS(800)356-5764 National Form No.04-66-7-85 UO New Lisbon,WI 53950-0206 (800)362-5711 Wisconsin printed in U.S.A. co 0 1985 c Leer Manufacturing Co..Inc..New Lisbon.Wisconsin S-PRE 1 s*.Aae*�eo=o TM IDEAL FOR CONVENIENCE STORE APPLICATION SINGLE-DUTY DELI CASE TSID-48-4 R r` I � I I, HIGH PERFORMANCE REFRIGERATION, SUPERIOR CABINET CONSTRUCTION, UNEQUALLED PRODUCT VIEWING GLASS 1 FOOD SERVICE EQUIPMENT, INC. St. Charles Industrial Center• O'Fallon, Missouri 63366• Plants: O'Fallon, Missouri/St. Louis, Missouri (314) 272-2400 • Toll Free (800) 325-6152 • FAX# (314) 272-2408 • TWX# (910) 997-0662 (TRUE MFG. UD) I TM TSID-48-4 Single-Duty Deli Case FEATURES/BENEFITS • OVERSIZED GRAVITY COIL REFRIGERATION • EXCLUSIVE FRONT AND REAR INTERIOR LIGHTING Oversized and balanced gravity coil refrigeration system is Brighter product illumination with front and rear lighting factory sealed and pre-lubricated for longer life. Gravity coil tubes. Case is egUfpped with two light sources for maxi- provides high humidity to preserve sliced meats and open mum product display. Safety shielded lighting tubes deli products. Capillary tube metering system assures assure longer,brighter,shadow-free product illumination. constant regulation of refrigerant flow, Case will hold 360 to Lighting tubes can be conveniently replaced without 380 under normal ambient conditions. removing product. • INTERIOR WHITE ALUMINUM SIDES&TOP,AND STAINLESS • LARGE PRODUCT VIEWING GLASS STEEL FLOOR WITH COVED CORNERS Glass has been designed with a 130 slant to minimize Easy to clean,non-rust surface will not peel or chip, Appear- reflection from overhead lighting. Three panes of glass ance is bright and sanitary, provide two insulated spaces for twice the insulation value and minimized condensation on glass, • FOAMED-IN-PLACE POLYURETHANE HIGH DENSITY CELL INSULATION • VERSATILE STAINLESS TOP Unsurpassed insulation,extra dense,has highest R factor on Durable stainless steel top provides surface for support the market. Saves energy. equipment such as registers,and point of purchase novelties. • POSITIVE SEAL, ENERGY SAVING,SELF-CLOSING DOOR For quiet consistent closings that preserve the cabinets high • CENTRAL ELECTRICAL CONNECTIONS humidity and low temperature. Condensing unit,lights,and fans terminate in a common junction box. • SIMPLE INSTALLATION Equipped with a 9 foot cord for simple,sole use, 110-115 volt • AUTOMATIC DEFROST SYSTEM plug-in installation. 29"width permits the case to pass Defrost system is time-initiated ,time terminated and through standard 36"wide doors. adjustable. • SPACE SAVING DESIGN • ADJUSTABLE WIRE COATED SHELVES Case design allows for maximum product display in mini- Comes standard with two heavy-duty vinyl coated wire mum retail floor space, Product viewing glass is provided shelves. Easy to clean and durable, front and back,so the case can be used in a traditional case line-up or in an island merchandising scheme. ARCHITECTS CORNER 211/2`1 I 48 1/2" TSID-48-4 1/3 H.P.Compressor 16 Cubic Feet Capacity 2 Wire Shelves Standard ✓ ✓ Plug-in Installation GLASS AREA Shelf Size: 171/2"x 433/4" (1) 19 1/2"x 271/2" 19"x 433/4" (1) EACH li Interior Dimensions: 50 7/16" 441/2"L x 22"D x 331/2"H Exterior Dimensions: 481/2"L x 291/4"D x 507/16"H Voltage/Cycles: 115/60/1 ----- Power Cord Length:9 Feet — — Crated Weight:434 lbs. 29 1 3/4" MADE IN U.S.A. DISTRIBUTED BY WARRANTY rJ One year warranty on all parts and YEAR an additional 4 year warranty on COMPRESSOR ® � compressor.(U.S.A.only) WARRANTY i U o ` > c t o v Ck Tz Ch - o v C Zo Ow,, , 1, z p O Vu 1 V N ,' \ 7QVIIo 1 i to CIS r Ul n ;1' Cil c co to V-00 c V o jsz'Y k ;V �tl 11. V j L� , I A 01coAP10 S R � R F � F A 1' 0 S s v � s 00, PP - 14CRO A .� Mirrored interior surfaces ys improve product display... P Lighted area for product stimulates sales. promotion...cabinets are ® furnished with removable FROZEN FOOD"and 'ICE V CREAM"signage. All models come with a woodgrain PRO plastic laminate cover countertop... standard! Perfect for cash registers or additional non-ref rigerated product displays. „r• ��„ -;.�'�''`��� E A4. 1Vi -- I Greater product visibility with fewer lid tracks to obstruct the customer view ...easier customer access,too! Energy saving radiant heated lids give the shopper a clear view of your products for greater sales...more impulse buys! Brilliant fluorescent full interior lighting shows off your products... speeds selection.Power saver...Light is located above lids, keeps heat out of product area. Full length protective front Big capacity...show more— bumper rail...saves cabinet sell more! appearance.Various woodgrain vinyl accessory coverings available. caPacity 26•$ Co. ft �aPacity MC� Si $ $ co, ft. a�ity it, 18cap M • 5 ,• ...and for service convenience the water y®V� o drain trap is located near the front of the F00 ov FO I? you n cabinet for easier cleaning, if required. M� �O it's perfect for use as a service counter copper drain tube(see permits when you add your cash register K� no-clog draining defrostt water into the can create additional product displays ys for heated condensate pan(see B).A curved Aincreased sales. Because all three MCT trap prevents warm condenser air from A&A models have the same 39"countertop entering the drain tube. ®0& height,you can use the merchandisers Our foamed-in-place insulation features back-to-back,as a wall or aisle line-up or urethane foam...the best available for t as a convenient customer service area. energy y g ' Three models...4/i , 6 and gy efficienc and savings for you. Condenser air flow...in front—out front Our method of insulating unifies the inner 8' lengths. Capacities from is designed for this type of installationand outer walls for extra strength and 2.8 through 26.8 cu. ft. Impulse Sales durability.The result is a thinner wall There's a size just right for construction and more inside � g Illuminated merchandising signs are display space. your needs. Use the MCT 4%z furnished with each model. as an end ca merchandiser t - User Friendly p ` �"`' Easy reading and setting of the defrost ...or an MCT model as a `1 ] -` timer is possible... Y ICS C �� a_, r counter merchandiser! Kelvinator Commercial's MCT line of low temperature horizontal refrigerated r ' cabinets gives you great product displayA , possibilities,energy efficient operation .. and years of proven customer satisfaction. = n The MCT provides a big capacity display that promotes impulse sales. Example... whetheryou use the"FROZEN FOOD" f I 6%Z"high cylindrical cartons can be or"ICE CREAM sign,you'll have a silent stacked two high on compressor step. salesman working for you.The signs are Your customers will appreciate the easy easily interchanged if you decide to vary access of the slide-back radiant heated program. . glass lids and you'll appreciate the added your j sales dollars your MCTcan generate used The full lighted interior and our mirrored with the MCT's"pull out"defrost timer as a counter merchandiser,wall display interior provides an excellent product or end cap. presentation and clear view of the big and "position. more product display area through unobstructed standdinging oon n your head oor r reaching! Nearly any merchandising configuration clear lids.There's even a conveniently The pull out timer box has a mechanical is possible because of the specially stop to guard against accidental electrical designed air flow.The high air intake located light switch to save energy. shocks when setting(see A). position and the bare tube condenser Easy to Service Authorized servicemen can remove minimize dirt and lint build-up and Spring loaded front panels are easy to the stop for electrical service.Front panel increases efficiency. remove without tools... cant be closed until the timer box is Easy Access, Easy Cleaning Lids � ;w_ p returned to its operable position. For easier cleaning, maintenance and Performance Where It Counts stocking,the radiant heated lids are easily The Kelvinator Commercial line of MCT removed... merchandisers has a versatile and adjustable temperature range of-300 to 0°F at 703 ambient.You can insure food .. �/ --,___- quality and customer satisfaction. And you always get great looking and _ f decorator designed cabinetry that s sure ' to compliment any interior decor. r, F � I Accessories...Have It Your Way (See Architectural Drawings... Back Page) simply lift up and pull out panel for O Adjustable shelf superstructure ~ access to the refrigeration components for above cabinet merchandising ` © Extra shelves available compartment.All service through the simply push back—lift up and pull out. cabinet front.right side.permits confining © Rear panel The self closing lids feature nylon front the left end of the cabinet behind counters O Lid lock(one per lid) glides which slide easily in Teflon coated or partitions without restricting access © Bag rack. rear mounting. steel tracks. Lids won't jam...rear center or operating efficiency.There's no need (3;2 x36"/4 x 14;, )speeds glide rides in a Teflon coated steel track to move thecabinet forcleaning orservice. customer service to maintain lid alignment during the O Dual wheel casters offer mobility opening and closing action.A front vinyl Automatic Defrost with Energy and raises cabinet 3" lid gasket helps seal in cold. Efficient Operation O Half-way shelf kit raises deep Versatile Countertop The Kelvinator Commercial MCT storage compartment up to An 18 deep.woodgrain,plastic laminate merchandisers feature automatic electric compressor step level countertop is furnished standard... defrost... O Wire divider ideal for merchandising larger items and maintaining w sly Ig orderly displays 'tf O Step divider for segmenting of the shallow storage compartment r 0 ' located above compressor �. ft _- a 0 Leg Kit is adjustable for additional t 6 height • L-Sha divider divider for more permanent large compartment merchandising segmentation and product flexibility. ., Various woodgrain vinyl covering � kits available for custom look. For economical appearance maintenance, rails,trim,front panels, lid and countertop components are easily replaceable. MODEL MCT 4%2 MCT 6 MCT 8 • ELECTRICAL* 115V,60 Hz. 115V,60 Hz. 115V.60 Hz. • 1 phase** 1 phase** 1 phase** • • Running Amps(700 ' Ambient) 7.0 8.4 11.1 . REFRIGERATION . 0 SYSTEM Condenser Bare Tube Bare Tube Bare Tube • • Compressor 1/3 HP 1/2 HP 3/4 HP • ' Refrigerant R-502 R-502 R-502 • •• Length of Service ' • Cord(inches) 75 e 75 93 CRATE SIZE,VOLUME 58-7/8"Wx36" 76-7/8"Wx36" 100-7/8"Wx36" •- AND APPROX. Dx43-11/16"H Dx43-11/16"H Dx43-11/16"H SHIPPING WEIGHT or 54.2 cu.ft. or 70.7 cu.ft. or 93.6 cu.ft. 525 lbs. 666 lbs. 831 lbs. ARCHITECTURAL i DRAWINGS �� o I 14 I 33 1 II SUPER-II - - rADJUSTABLESHELVES 11-_------'----= 1--------------ii 4".n;=r"s="''e WITH PRICE TAG MLDG. ___ ___-___- IS-____ `I STRUCTURE =,= - :i 171 • "I I I I COUNTER I I I I OPTIONAL"ICE CREAM"SIGN I I 3'hr-18 OP ILLUMINATED I I 11 FURNISHED i 1 FULL WIDTH TIP I I OUT SIGN F R O Z E N F O O 72 S I O /� SLIDE UP LID u - II �I FTI�IID�y I /�1I 41 MIRROR N �I NOSE PLUGP O$ 99 1• LIGHT SWITCH CAB-T.I LOAD LINES HEIGHT I 221fe 1211'(e 3131. RAIL 0-+n /0 0'^I�—24 26-- HEIGHT I_S � �. _.J ---- -- - AIR / q% NL T -- il li L __----_ lyf 28�. -3 lyn I SUPPLY CORD THROUGH l -'1 ZEMOVABLE 2 IS O 33 I/" , : 1"" REAR BASE RAIL 96 SOLID AIR DISCHARGE AT FRONT AND COVER AT REAR OF RIGHT HAND END MCT 8...26.8 cu.ft.capacity—holds 341 halfgallon MACHINERY COMPARTMENT rectangular ice cream cartons.*** S II II 11 "'�1 II 11 I I 11 Il LI --1 I------------- - Z.------ I. 171 Ui I•I I. I I I OPTIONAL"ICE CREAM"SIGN I I I I OPTIONAL"ICE CREAM"SIGN I I 0 II FURNISHED 11 'll FURNISHED II 11 F R O Z E N F O O D. F O O O DI0 I � "o, � ���I LIGHT SWITCH LIGHT SWITCH I� I® II•Ii �I 1 673'• � —�I 1+ 4915 I Ii 1 V "'� ' QI-•��24I ' ' y 0'1 24 -' i__ ILS J 1 I SUPPLY CORD THROUGH lis REAR BASE RAIL lu,-� 1SS, SUPPLY CORD THROUGH 1}(, REAR BASE RAIL 72 54 MCT 6...18.8 cu.ft.capacity—holds 235 half gallon MCT 4%,...12.8 cu.ft.capacity—holds 161 half rectangular ice cream cartons.*** gallon rectangular ice cream cartons.*** ***Carton size 3%2x7x5" COMMERCIALWARRANTY:See Forms 80-0346 or 80-0671 for full text of standard warranty,and optional 4-year compressor warranty(U.S.A.only) UC ® 621 Quay St.,Manitowoc,Wl 54220 :11 -lex 910-260-350 C10 White 0 Consolidated Industries,Inc. COM 377 2188 Litho in the USA Sit SI y Oil, Y_ t i k 8511. r 'll 11 1 - .�. '•_ ^^gym-'- I g i yh 1rr-r T -ate....-.,--�--• 1 �' I 6 t Y � SPECIFICATIONS Low Temperature Cabinets T30 LGP-2 I T50 LGP I T80 LGP 'mm' Compressor Mount Top Top I Top Temp Range 00 to-20°F 0°to-20°F j 0°to=20°F u+ #Doors 1 2 3 Door Construction Triple Pane with Heater Triple Pane with Heater Triple Pane with Heater Hinge Type Torsion Bar Torsion Bar Torsion Bar #Shelves 4 8 ( 12 Shelf Type Cantilever Epoxy Coated Cantilever Epoxy Coated Cantilever Epoxy Coated Shelf Adj. 3/4"a 3/4" j 3/4" Insulation Foam-In-Place Urethane Foam-In-Place Urethane Foam-In-Place Urethane Wall Thickness 23/8' 2 3/8" j 2318' Capacity 27-3 ft' 49.1 W 4 76.2 fN Capacity(1/2 gal.ice cream) 183 366 l 549 Shipping Weight(Approx.) [ 520 lbs ( 760 lbs. j 1010 lbs. Compressor Size 13/4 hp 1 hp a 1 1/2 hp Condenser Type C Fin and Tube Forced Air Fin and Tube Forced Air ( Fin and Tube Forced Air ! Evaporator Type C Fin and Tube Forced Air [ Fin and Tube Forced Air Fin and Tube Forced Air i Refrigerant Type R-502 R-502 R-502 Refrigerant Control Expansion Valve Expansion Valve ) [ Expansion Valve 9 Amp Rating 15812.9 117.8 Electrical Specs(V/Hz/Ph) 115/60/1 115/208-230/60/1 115/208-230/60/1 NSF NSF 7 NSF 7 i NSF 7 9 UL&CSA Listed Yes i Yes I Yes Interior Finish Baked Enamel,Coved Comers ` C Baked Enamel,Coved Corners ; Baked Enamel,Coved Comers Exterior Finish Baked Enamel Baked Enamel p Baked EnamelSign 1 Panel Optional Milliamp Fluor.Lamps l 11 InsulOptional Optional 1500 Milliamp Fluor.Lamp 122ns I Lighting1500 Milliamp Fluor.Lamps Electrical Information 20 Amp Service Cord j Conduit Connected Conduit Connected 1 Max.Fuse Size 20A Max.Fuse Size 30A Min.Circuit Ampacity 20A ; Mih.Circuit Ampacity 25A � 1 T30 LGP-2/730 MGP T50 LGP/T50 MGP 31 52 - �-261/4 47 1/4 INTERIOR r INTERIOR-� 26 3/4 21 5/8 GLASS GLASS TYP. i 83 3/4 61 83 3/4 GL SS GL 1SS TYP, 6 6 Medium Temperature Cabinets 1730 MGP T50 MGP T80 MGP Jompressor Mount Top j Top Top Temp Range 132°to 55-F { 32°to 55-F 32°to 55-F 1 #Doors 1 2 3` ) Door Construction Double Pane Double Pane J Double Pane Hinge Type Torsion Bar j -Torsion Bar Torsion Bar j #Shelves 4 8 r. 112 I Shelf Type Cantilever Epoxy Coated Cantilever Epoxy Coated Cantilever Epoxy Coated Shelf Adj. 3/4" 3/4" I 3/4" Insulation Foam-In-Place Urethane Foam-In-Place Urethane j Foam-In-Place Urethane j Wall Thickness 2 3/4" 2 3/8" ( 2'3/8" Capacity 27.3 ft3 49.1 ft3 76.2 W } Capacity(Six Packs) 108 f '216 324 { Shipping Weight(Approx.) 470 lbs. 640 lbs. j 870 lbs. Compressor Size 1/3 hp 1/2 hp j 1/2 hp i Condenser Type Fin and Tube Forced Air ( Fin and Tube Forced Air j Fin and Tube Forced Air Evaporator Type Fin and Tube Forced Air j d Fin and Tube Forced Air ) Fin and Tube Forced Air i Refrigerant Type R-12 ( r R-502 ) ( R-502 1 Refrigerant Control 'Expansion Valve Expansion Valve j ( Expansion Valve i Amp Rating 11.5 } 13.7 13.7 j Electrical Specs(V/Hz/Ph) ( 115/60/1 ( 115/60/1 j 115/60/1 i NSF-7(Food Storage) ( Yes ; Yes I j Yes UL&CSA Listed Yes ) 1 Yes Yes j Interior Finish Baked Enamel,Coved Corners Baked Enamel,Coved Corners 1 { Baked Enamel,Coved Corners 1 Exterior Finish Baked Enamel Baked Enamel 4 Baked Enamel Sign Panel j Optional ) j Optional ] Optional Lighting 2 Insul.800 Milliamp Fluor.Lamps 1 Insul.800 Milliamp Fluor.Lamp j # 2 Insul.800 Milliamp Fluor.Lamps ) Electrical Information 15 Amp Service Cord ( 20 Amp Service Cord j 20 Amp Service Cord T80 LGP/T80 MGP SIDE VIEW 78 36 1/4 73 1/4 34 3/4 INTERIOR 33 ----------------------- ----------- ----- i i i i i i 29 5/8 21 5/8 I INTERIOR GLASS i TYP. i i i i i 61 60 5/8 i GLASS INTE IOR TYP. i i i i i i i i i ___________ 6 MERCHANDISING PERFORMANCE SERVICE 15% more product visibility in door • Thermostat control allows 00 to –200 • Top-mounted condensing unit area provides much more attractive temperatures on low temp cabinets. provides unobstructed air flow and merchandising and allows product to • Thermostat control allows 320 to 550 easier servicing. "be the star". temperatures on medium temperature . Extra large face area on condenser • Adjustable cantilever shelves can tilt to cabinets. to provides more efficient energy con- 10 degrees and adjust in 3/4' • Expansion valve refrigerant control sumption and reduces cleaning increments. provides quick temperature pull down and maintenance. and reduces compressor run time- 9 Optional lighted sign in top panel can meaning reduced energy consumption. • 2 and 3 door low temperature P be customized to include store locabinets use dual 208/230 volt go or • Exterior switch shuts off freezer cooling compressor. Allows eater merchandise any product fan when doors are open to minimize com P energy consumption. flexibility and reduced inventory • All shelves include a price tag molding requirements. for easier merchandising. • 2 3/8" of foamed-in-place urethane provide maximum insulation. • All cabinets contain a refrigerant • All cabinets meet NSF 7 designations lass for easier maintenance. for merchandising and food service • Discharge mufflers are standard on 2 sight g and 3 door low temperature cabinets to applications. reduce operation noise. . Lighting tem protected by a separate 5 amp fuse. • All doors contain magnetic gaskets to provide a secure tight seal. DETAILS -- i a Gr n `3. >• a,,�' J.i J.L.. ,..,.I - J - Cantilever shelves Low profile,white door frames Large face area on condenser coil Coved corners meet are epoxy coated for increase product viewing area allows for easy cleaning and main- NSF 7 designations beauty and durability. while giving the sensation of tenance while providing efficient for merchandising Can easily be attached being an `open"cabinet. energy consumption. and food service to tilt at a 10 degree applications. angle to create self- feeding racks.Can be adjusted in 3/4" increments. Manufactured By: Sp NSF. FRIGIDAIRE COMMERCIAL PRODUCTS COMPANY 707 Robins St. ■ P.O.Box 4000 ■ Conway,AR 72032 501-327-8945 FAX 501-327.0663 Com 397 4/94 Litho in USA .4 TUE 11:49 FOUNTAIN SERVICES FAX NO. 5087571355 P, 03 D Q Q 3031 ICE/DRINK DISPENSER FEATURES: 31'� Available with six or eight Cornelius SF-1 dispensing valves. All stainless steel counter top model. Adaptable for top mounted ice makers (manual ice fill standard) Lighted tilt-up merchandiser front for: • Easy product identification changeover. s Easy valve brixing. ! Easy access to "up front" control box. J Large rear and side panel areas for product identification, decals, menus and other display advertising. Insulated drip tray. Sealed in cold plate. Rotational molded polyethylene bin liner with foamed urethane insulation. Ice used to cool cold plate is separate from the ice being dispensed into cups. Drink rate of up to 10 drinks/minute at 40°F or less. Anti-bridging mechanism prevents bridging on top surface of cold plate. Mechanical self-closing ice chute door eliminates post dispensing ice drop. SPECIFICATIONS: 19"x 21" Aluminum 11-circuit cold plate Unit comes with one fast flow SF-1 valve 175 lbs. ice bin capacity Requires cubed, cracked or compressed ice (not flaked or crushed) 24 Volt post-mix dispensing valves 115 Volt, 60Hz single phase electrical requirement with separate 20 amp circuit UL and NSF approved Shipping Weight: 282 pounds THE CORNELIUS COMPANY Croz ONE CORNELIUS PLACE C.1 ANOKA, MINNESOTA 55303-1592 TUE 1148 FOUNTAIN SERVICES FAX NO. 5087571355 P. 02 h Q 300 SERIES BACK VIEW Commercial Cube Ice Machine Ice Production Capacity (approximate): Model Number Ambient Incoming Water Temp °F 23 (Condenser) Temp eF 500 700 16310 13% i AC-300-SS-MH 700 243 — C f (Air Cooled) a 121. 900 — 176 AIR _ IN WC-300-SS-MH 700 248 — e (Water Cooled) — � t t 900 186 23% 21: 30 r Model 300 Series BOTTOM VIEW Net Weight: 122 lbs. — gQ _ Shipping Weight: 138 Ibs. 7 -"1 Compressor Z - I FRONT Horsepower: 1/2 Refrigerant: R-22 23 Y, OPENING Electrical --- Freeze Cycle 21 Amps Draw: 8.0 Time Delay Fuse 1 Ratings (amps): 20.0 _H�_ Minimum Circuit A WATER INLET Ampacity (amps): 15.0 B PUMP OUT DRAIN Power Supply C ELECTRICAL CONNECTION (Single Phase): 115V -6OHz D CONDENSATE DRAIN Plumbing Connections Inlet Water i Maximum Pressure 50 PSI Mechanical Data Supply: 3/8 in.SAE Male Flare Fitting 300 Series Bin Drain: Through Bin Cabinet Size: Width 30 In. Waste Water - (from Depth 23 1/2 in. water cooled models): 3/8 in. SAE Male Flare Fitting Height 16 3/8 in. Pump Out t)rnin Cabinet Finish: Stainless Steet Connection: 1/2 In, ID Tubing Note: All air-cooled models require 6 inches clearance on louvered sides and back. SpecificationsSubject To Change Without Notice. IMI CORNELIUS INC. One Cornelius Place • Anoka, Minnesota 55303-1592 (612) 421-6120 • (800) 238-3600 ................................... .......... ........... ................. LE .........., : OF foodservice equipment seneS deep-drawn zoved Corner .......... . .............. ............... sin s .. function .. . value ... economy ... r-� t � t " j O x" µ .. • 412 series all 16 gauge type 430 construction- - . . bowls &aop:assembly deep-drawn;seamless coved corner bowls s legs are braced front, ront to;back functional design ♦ swirlaway drainage X. ♦'legs welded to channels under bowls for maximum weight support and stability " ....... ♦:die-stamped creased drainboards for positive drainage .. " w . " ° .. value price leading the industry through innovation . �. rY•. rEAG �;ta ................. aeiebu .;. ;f. ..........................,.......,..,.......... :_: 412 series coved corner sinks EAGLE all type 430 stainless steel construction 0 W 0 0 0 j I o0 00 00 0o j I L I I L I I L I I L I W 000I I Fol 000 000 j design features w x L arbas length W ' ' (lbs) o a basic sink unit designed for numerous applications one compartment in today's kitchens0 — 22 412=16-1 40 o all bowls have deep-drawn one-piece seamless 1 18 38 412-16-1-18 R or L 58 construction using state-of-the-art hydraulic presses 2 54 412=16-1.18 73 o drainboards,when provided, are integrally welded 19 x 16 1 24 25 12 44 412-16-1-24 R or L 62 o all sink bowls have a generous radius with a mini- 2, 66 41216-1-24 78 mum dimension of 3", and are rectangular for. 1 30 50 412-16-1-30 R or L 75 maximum capacity 2 78 41216-1-30 86 o leg locations fall directly under sink bowls providing two compartments increased stability and maximum weight support 0 40 412-16-2 62 where needed. 1 18 56 412 16-2=18 R Or L 85 o legs are braced front to back for added rigidity 2 72 412-16-2-18 96 19.x 16 1 251/2 62 412-16-2-24 R or L 91 construction features 2 24 84 412-16-2-24 100 o entire assembly is fuse welded and'planished provid- 1 30 68 .412- R 16;2-30 or L 1102 0 ing a one-piece seamless sink unit 2 96 412-16-2-30 119 o welded areas are high-speed belt blended to match three compartments adjacent surfaces with continuity of satin finish 0 — 58 412-16 3 85 o leg gussets are welded to a die-cut heavy-gauge 1 18 74 412-16-3-18 R or L 102 reinforcing channel2 90 412-16-3-18 11,5 o all outside corners of sink assembly are bullnosed to 19 x 16 1 24 25 1fZ 80 412-16-3-24 R or L 106 provide safe, clean edges 2 102 412-16-3-24 120 1 86 412-16-3-30 R or L 116 mechanical 2 30 : 114 412-16-3-30 135,;' o water supply is 1/z' IPS for hot and cold lines o faucet holes are punched on 8" centers 13' o faucets are available as options NSF ♦ basket-type waste drains are 11/z' IPS and included 5"' material sink bowls— 16 gauge type 430 stainless steel 3" top— drainboards, backsplash and rolled rims are 16 gauge type 430 stainless steel 10Y" legs— 15/e"-diameter heavy-gauge galvanized 41Y2" tubing with plated 12-gauge gussets and high-impact corrosion resistant fully adjustable bullet feet—crossbracing is 34" 36Yz" 1"-diameter heavy-gauge galvanized 20Yz"" DL1071 MM122 Rev.8/92 iiKOi.'f • • • . � �%iii�i•� metal � ...fr . . MOO$SRV#GE::0PfV.. P. :�•:�'�;#�lsl",r',: '.� X. .. '•r. {% .f•'ti'f ---------- rr MAY 1, 2002 SALE OF TOBACCO PRODUCTS TO A MINOR RICHDALE (535 CHICKERING RD),NORTH ANDOVER,MA Description of Attached Exhibits EXHIBIT DESCRIPTION A Parental Permission slip provides parental permission for minor to participate in tobacco sale compliance check. Also verifies participant is under the age of 18. Dated 4/30/02. B Tips for Teens form confirms that inspector reviewed compliance check protocol with youth just prior to conducting the compliance checks that day. Dated 5/1/02. C Copy of cigarettes purchased with a label indicating the date,time,place and price of the cigarettes. Dated 5/1/02. D Compliance Check Affidavit, signed under the pains and penalties of perjury by the youth who purchased the cigarettes, verifies that he/she followed compliance check protocol and provides details of the sale of cigarettes by the retailer. Also signed by a witness. Dated 5/1/02. E Tobacco Compliance Check Form providing details of the tobacco sale. F Notice of Violation ) and P Violation) roof of ( payment. This is the ticket issued to the retailer on May 1, 2002, along with proof of payment. G Notice of Violation (Second Violation) and proof of payment. Copy of ticket issued for the violation of May 14, 2001, along with proof of payment H Notice of Violation (First Violation) and proof of payment. Copy of ticket issued for the violation of July 20, 2000, along with proof of payment. Healthy COmmunitieS Tobacco Awareness Program Tobacco Control Program for the Boards of Health in A Andover, Dracut, Methuen, Middleton, North Andover and Topsfield PARENTAL PERMISSION I give permissio m so dau whose birth date is to purchase tobacco products as part o compliance checks being conducted by Healthy Communities Tobacco Awareness Program, which will take place in Na - I verify that my son/daughter is under the age of 18. The purpose of the compliance check is to ascertain whether or not tobacco products are being sold to minors. It is against local and state laws and regulations to sell tobacco products to anyone under the age of 18. I also understand that my child will work in constant and direct supervision of an adult and that all tobacco products obtained during the compliance checks will be taken-from him/her when the compliance check are completed. I also understand that my child may be asked at a later date to participate in follow-up activities such as education, outreach, court testimony and /or Board of Health meetings. TEENAGER'S NAME: PARENT'S NAME: ADDRESS: TELEPHONE: PARENTS SIGNATURE: DATE: o S 20 Main street, Andover, Massachusetts.01810 Tel: 978-749-8999 • Fax: 978-470-8942 • E-M3fl:'hetaoCB8hore.net www.breattiefree.org 0 neratfon.orci Compliance Checks —Tips for Teens You are asked to dress for school. Do not attempt to as you normally do p dress or look older. Do not be disappointed if there is no sale.That is what we want. • If at anytime you feel uncomfortable making the sale,leave the store without g making the purchase. • If the clerk asks your age, tell him/her the truth.Never lie! • If the clerk asks whom you are buying tobacco for, tell him/her it is for you. • Do not bring ID with you. This way if the clerk asks for M,you can honestly say you do not have any. Your pockets should be empty and you should not carry anything else with you except the money we give you. • If you recognize or know the clerk, do not attempt the purchase. • Only purchase tobacco products.The brand you will be requesting is dlaaa, rta Please do not purchase anything else. I • Attempt to purchase from vending machines without seeing a derk/employee. • This is to make sure that all vending machines have a lockout device that works. If the machine is locked, then ask the clerk to unlock it for you. • Do not make conversation with the clerk.Go in attempt a purchase and leave. • When you leave the store, return immediately to the car and report to the Healthy Communities staff person as to whether or not the sale was made. I have gone over the above tips with the undersigned youth prior to conducting a compiianc check on this date. $kalthy o unities Staff Date A staff member of Healthy Communities has gone over these tips with me prior to conducting a compliance check on this date. Mout o unteer Da e !f. HURRY's 1 r ,- -rTT-,'19/30/02 �r { • • • I� Void where prohibited 1. MENTHOL BOX # 4 a -'i- .a-�s �y,�_ ' d.,8t •'N 't "f:'XeF r -�S,ate cy _' '^ ' i'y-.3 ?_$ -ti�,.S j,rkT: "6 jrm_ A :i y E)�;€25 vs ' .1f' w 'K_ 1.45 A� .r'r�-a, .r� ��,t d 'x � '$`�. ...�.Y .�5:�' �y�a_�;i„:. -'� '�y aig��.. ..d,a -._ .Y $_.� f - _ •.'.�, i � '�„R��,'��i�.3�r .� •Ffi 39 •?r1.' i..ti T - Qj �tyyi. 'Pt' ws'.�, �1.+f:'7�� 3 t_: i'F. .gFdi-+„'� cF' ,�ms'�r rtr m g �ai-ix.j �' C '+'a Sc Ary;^� �! a'� ;F. $'`cx � ir. 'Y 'q x,:fi'� w �.; � °- 4 i, .-:�� :' ,�' '"t :�y e► M .�.a - -,{ ��`ta v f. y S a s t � r�.l+ L �� '� �; f 3 2 •'-tiv'�` x rv,,+�' � .� W+..'' _ _ ice, J.v 'NY,,.f .�..'I.; � �.,`.�.. COMPLIANCE CHECK AFMA`VIT W years old. My MEE9 t, birthdate is F�::� and I reside at participated in a tobacco sales 0n Ip Compliance check. Prior to the compliance chcck+I was in�by the adult monitors to empty mti' Pockets. I did not cam a backpack' OT any Other bag. The only thing that I � carried with me was cash given to me by the adult monitors for the compliance check. � c adult monitors also instructed me that I should not dress to look neither older nor Th dre.s s to 1001: vounacn I dressed no different than I WOuld dress to adtend school on any tvPtcal day. Lastly, the adult monitors also instructed me to tell the trade during the �. a,e, I was to tell the truth;if I was asked if I was 1 li:uuc chicks. If 1 was asked m, con P cam ing, identification. I vas to say no. 1 1:11tLT !2etl _ G e • �n cash in my pocket. I attempted to p with S s P $361 ed for identification. I gave QAI ask e I immediately returned to the $ tj•UD to the clerk and received S ng • 0 in change adult monitors ��aitinc outside, informed them that the sale had bees made, and gave to e from the e tobacco I had purchased and the chang � th th cm Y . S►6ned under the pains and penalties of pe&rj this day of ; ' Witnessed bY: �gned: (narn printed) (nine (sign) (tee ) > TOBACCO COMPLIANCE CHECKSORM 0 2002 MTCP ID: 01009 %310 veI" Healthy Communities Tobacco Awareness Pro ram Section 1: ESTABLISHMENT: SURVEY PARTICIPANTS Name:Richdale Name of Purchaser. Address: 535 Chickering Road Age:& Sex: MaleoOf'Female City:North Andover Zip Code:01845 Name of A t Escort/Data ollector r Stele Area(if smaller than city or town please identify) Time of Check: azn_ p _ Type of Establishment: Chain ,,_Independent _Not Known Date of Check: &_/1 TyPp OF ESTABLISHMENT: Gas Mini Mart / Convenience Store _ Pharmacy/Drug Store — _ G Gas Station Only Grocery Store _ Liquor Store —_ Department Store _ Bar _ Private Club Restaurant(Bar Area) _ Restaurant(Other Area) _ Other Section 2: 190-1 remises and attem t to urchase a tobacco product? _YES NO Did you enter the p p p (If yes,please continue on to the next question,if No please skip this section and go to section 3) R o as the tobacco marketed? / Over the counter youth asks the clerk for the product Over the counter:youth selects product from a self-service display _From a vending machine with a lockout device _From a vending machine without a lockout device Was the purchaser asked for ID? _YES Was the purchaser asked his/her age? _YES 110 Sex of Clerk. —MALE FEMALE Approximate age of clerk: /S • 2.� Did the clerk say anything to the youth when the purchase attempt was made? Type of Tobacco asked forte�Cigarettes_Chew/Dip_Cigars Mtn Brand_jW/2 --- Was the sale made? NO (If YES,how much did the product cost:$4P%–" _ Section 3: If the youth did not enter the premises or did not attempt to purchase tobacco products please indicate why: _closed for the day _couldn't locate business —buyer knows clerk/merchant _admission charge —closed for the season —no longer in business _inappropriate for youth -_other ' closed to the public _doesn't sell tobacco _ unsafe establishment denied admission vending machine broken unsafe area 3 �� v1oL -� 0107 TOWN OF NORTH ANDOVER NOTICE OF VIOLATION (Date of this Notice) To: l C_ ,80E1' 'rm.t (Narge of Offender) J (Address oroffender) Ale, (City,State,Zip Code) Ch Sec Fine VIOLATION S C. 'D. TOTAL FINE - at (A.M.)(p.M4 on e of violation (time . _ h �D )F (Signature of Enforcing Person) I HEREBY ACKNOWLEDGE RECEIPT OF THE REGOING CITATION (Signature of 0lfender) offender Unable to obtain signature of of o WITH REGARD YOU HAVE E_THFOLLOWING ALTERNATIVES TO Barin DISPOSITION OF THIS MATTER: in 1. You may elect to pay the above fine,either by s PP g Friar person between 8:30 A.M.and 4:30 P.M.,Monday through : legal holidays excepted. 120 MAIN STREET.NORTH ��before TOWN CLERK,TOWN a cdceck or money order to the ANDOVER,MA 01845 or by rrwil g THIS NOTICE. This will . Town Clerk WITHIN 21 DAYS OF with no resorting operate as a final disposftn of the matter, criminal record. in a non-criminal 2. If you desire to cootestthrs matter a writtenrequest WITHIN proceeding,You may do so by making 21 DAYS OF THIS NOTICE to the Clerk-Magistrate,Lawrence District Court,380 Common SL,Lawrence,MA 01840,ATTN:210 Clerk- non-criminal,for a hearing. A detemdnation ayfinal��on, Magistrate or Assistant Clerk will o atry fine imposed by that with no resulting criminal record,provided office is paid within the time sPOCified• ear as specified,a 3. it you fail to pay the above fine or ta criminal complaint may be issued againstY u. 1 HEREBY ELECT the fist option above,confess to the offense -- charged,and enclose PaYment in the amount of S Signature WHITE:OFFENDER S COPY;YELLOW:DEPT.,PINK:TOW CLERK THE FACE OF THIS DOCUMENT IS LIGHT TAN. EW TATA RMARK EMBEDDED IN PAPER. HOLD TO LIGHT TO VIEW. — - — FIRST ESSEX BANK"IF Andover,Ma 01810 ' 042693950 JULY 26. 2002 56-1968/441 PAY THREE HUNDRED DOLLARS AND NO CENTS*********************** DATE **** ********** TO THE ORDER OF `r�nm l $*******300.00 NOT VALID OVER$1,000 '— I sAte-vicl -&f P-ram Al"poy orliar �3s TELLER #0152 CITY&SD v r-L-L— 11'04 2693950 7nm �• .0 2 9 URE OF ITrER � ISSUFD 13Y AMERICAN EXI ?f:SR Ift "� 0 5118 N\'f'AYAIlf[ I I If :11w451 SII { OTIC.E:b OL ATION ~(Date thle Notlm � I11 Vl�rAn>�t� h t ooa, t r �* (Namsscof O[6eaess�O. T M �^ r= Aof Offender) _' • Y t °: t � 4 � t$y f �.•: , ,erzie VIOLATIONS . F >a ,:. Ch E�Seq g: CA TAL.RINE s i .�� S Ift (S(O��:af:Of tinder), Uha alghature o (offender YOU HAVE. E FOLLCriG81L'TERNATIVES.,. REGARD TQ DISPOSMON'OF ER: 1 You mayeledto paY ro fine,either byappearing in person between 830 A.Wimmi d420 PJM:•.Monda tiro Frill legal holldays excepted,h■s' ' "�" „ 4� _.`" w� =MAIN STREET OWN CLERK;TbN11N _— NORTH. Vii= ANDOVER;MA 01845 ara check or money order to the r.YTown Clerk WITHIN 21 MwEMMF THIS NOTICE.%M- is will 'z operate:as a final dsposii matter,with no`esulling criminal record.ix n-.�= ~,•":3 �4 2. If you desire to Ina non-criminal proceeding,you may do sw=wm =a1dng a written request WITHIN,,°'" 21,DAYS OF THIS NO s Clerk-Magistrate,Lawrence ""I ':District Court,380 Come umom— Lawrence,'MA 01840,ATTN:21 D r mon-criminal,for a hesrerg�. eterminatbn by a Judge, ►:Magistrate or AssistantC�operate as a final disposition, with n 'resulting aimirrat.a,�--:Ivided any fine.impoaed by that;.';; M11ce is paid within the 3,' ff you fall to pay the ab=m or to appear as specified,a",.! 4� Ina(complaint may bares rid against you. .�ii!:tRL'�^F.�ix:�+�l,.'�5.�:;y'�y�„'���'� .�.•ic t r�iLlr.fe ;�.y •t�,:^+ �1���.:' 5 1 HEREBY ELECT the fit t F 11 above,confess tothe offense ;! x�charged,and.enclose of h 3 .4 iF. '. `°'L+ ,i 1 w - - .✓i,.t;."�:f,Ar,rpt .-7.5 y,3^ 6" y.. ,Signature Pi N4 WHITE:OFFENDER S Cts' YELLOW:DEPT„PINK:TOWN CLERK :�- --------. ..;...�K-.. �,.,..+oc.•.a';.:s4'.'°. .. �f 4 3 f a'-'�-....�+.�. .*^cb.+.+u�x .n ..ww•...........a.. .-.w� ..^1r.. Andover Bank 0904510 ,. ANDOVER,MA 01810 53-7047 ®. .JUNE 07 2001 i„3 Arxjon rBank BR# ATE W223351 //►� si00. 00 wo V-A Pay to the �L� order of **ONE HUNDRED DOLLARS AND ZERO CENTS## � RVRE � MEMBER FDIC/DIF PURCHASER'S ADDRESS CITY, TATEANDZIP PERSONAL MONEY ORDER 11'0904 5 LOii' 1: 2 L L 3 704 7 71: 6 5 L 3 0000 20 0��' ._----- ILI'a i �• OF NORTH ANDOVER Z002 �r�;7 Y' ,'�`•;'� 1. fR'!')!.�'1�� ., l7'T`M `,11 i;•• r+�� 'Ii? l V.. . 1���1�;,' ,t,:':7.'.'til:,l:� , Y 'I j';'..:/i, ,t` µi, l,:'t'�'�'S J;:.1'.Ti�S:"�:•:.:.i;r\A�i: r.. 1. .. ,n., •�;i,:. _.;,::,ip.::,.�,., .MWH GF.. RTF4NC IVO CE; ?F: A VIOLgTfON'r 5. 41;1MOLAT 1.•��'''' '�ii+,f'�i43;" ..d': ",S+:S�' - ,i'••�'I�':;:lild�e`�:`l i.'L.': ::I.L14 .C' . :,;ii+:.'.C.,. .,\.Ji i.,:;l.n ''�t'�': '1'/:'•;D:�y t�i,J.�;�`i:k•ll-:�,:.T".�... ::d:'�' t.TWAL PINE _r,' ' ':'.: ;r; '::; s::(Sign- Dept): ACKNOWlDt3E EIPT:OF':TtiE'�OREGOING.;;` }.�;..i5.y+�,,,JI! .'�;.. �ri;'y• :;ll,.y{.':: �YW.:w• - `,:;',,•1`iv::�it,,.7C'":fi: �!,�c�wl�: ;�j:d??.�::!{ti'1,'S,;,I,.:•:•�:'k,i�.'�:!:•�:.::•:4 jr t) �,`•1. .r.�j^�1'T y:��.:�',i.:'•" -I..,�kMYlo'.I�.YHYW��,7+'ga�'���1:1?:eCi.:::...�.::�"•-P�i XQt }IAVrtE�THE;FOLLo1iYINci=A4: Z VK(TH;REGARD- `TQ p Q ;gf;Aimo ; F' r La�.�!° Rho., a s. b'ety eee 0 A Mveirt�'e'r,',ti�ipiaem $,a Rd 44 k19. ay thf0ugh Friday l 1io8da' excepted -:• owNct. :' ;ru: ` x�MAw'sT ET,NORTH es iui�i o y, VFi;. 1895.:ot:by.: ia�np�'clieclf:ocrmocrey.orderto,ttye• it tc'W1THIN'21'DAYS,Q.F; �s.:tvoncE:: ThtsSiviu. .. 1etiLIf,�IiQ-:�•,'•.':'-• tea'a'�11.(i'fi11,fQ04rd;'':,:::<.ii�;,y •s:•';.� '�pa+r�x'�.�,.r,:;-: x.4:5 i.;,'. „-2�;;'�t.jiou iteslr,�;ta,:c4,fi.Epe�thie:ina�l't�a,nom,•�+s)na1;, ='! dln 'You'ii�ay to eo by.ii�ald ";e;wki '04equest WITH{N.'`;' Pie. Br pAYS,.QF;TFitS.NOTICE.Lottie.Clek;M8glatrate ,Ur rence' ?�,A7sfri-cl;Co�;;�R,Com�ti�C.�#•�. en6�r;'i4lAc0'i84Q,:AT'f1i;2i�'.',:� '�r', iiiuiabori'hy a .,:':;non�crUtiintl.tof'.abeaiing�:,A`d.,.et� ea`Judaei��Clerlc=`:-:=:"-.'•�`; [igagietabe of Ai►t ClerkgwN operate d a Ajial.disposition; ;;; w�lC�:'f,►a i ws's�u� goctR+;iiar recoC4;;p�ovrdea ai,r ne.imposed,by that...; if Vol Nip;o�<to appeat,as_specified,'a: •'t:it'jv-�,:F7 nb;f��' :,r;;•;q',rr:i<;:.'?'i yy`'�'�'"! F,. }r� 'I.�}E MSY!$ECT.tlie fMst'o„p.dokw pothe Offense „ .: ►. ';r.;�•chergecl��:atrd•enetose pe``��•s�..N�•in.the,emo�ii�t,af'3”`� ''; °, ;`•'- ''1 ':,��. ;=Yf l`'a;J- •?r `flit::.) � i�;ai.! y'�.SfVFI17' GF E Ek ?;S'COPX,,yf=W.,:DEPT. PINK::T,OWN, TOWN OR NORTH ANDOVER BOARD OF HEALTH 30 SCHOOL STREET NORTSANDOVE.R,-ATASSACHUSRTTS:0.1845 _ 1'ELEPHONB#(97&)?688=8540= FOOD SERVICE" APPLICATION Name. of Establishment._ (C( -,dal21we-V Show C-AV Location-53s Ch,ir�R,ti 1?C1 Telephone#k: t5,o9 -G.P(.-:1'7 9 F Name of Firm:RtcKAoAc b kny -S+0 TZv c Address: at Firm:La6 6A),vuj r 6(,vu . M4- Telephone#[`: 5475=/59s_ owners)/Operator(s) 4 Type of Business Corporation Partnership ( ) Owner ( ) Days: and Hours of Operation: Se '� ay Ho(A1Z5. ue.,.0 twS� Type of Establishment: ' Food Service ( ) Retail O Mobile ( ) Limited Retail ( ) Home Cook ( ) Catering ( ) Farm Stand ( ) Corporation Officers Telephone # President: ArZt-hu m t Treasurer: 5cqoq o,S Clerk: Nickolas Scawa,a Please list licenses, permits, or registrations issued by other municipal,state or federal agencies: kKxLIC +,!c e CR-04►,� Seating Capacity: V Size of Establishment (Square Footage) : 3VD0 so " "pax Names and positions of employees trained and certified in choke saving technique and dates of certification as an certificate (attach copies of certifications) : Names and positions of certified Food Handlers (attach copies of certifications) : know 51„42pe. � Zo) ,N skwepe- Describe your insect/rodent control program, including the name and address of exterminator and how manX times a month _the establishment is serviced: +w,N -Res l- Oo,vtko I sr3elw��„,i- R.d (bille(?L 90 , MA 6IVC C A- wic,.f h Type of Food Sold (check all, that apply) : Bulk Food ( ) Consumed on Premise ( ) Salad Bar ( ) Shell Food ( } Pre-Packaged Take-Out ( ) Baked Goods ( ) I, the undersigned, have obtained and reviewed Article X of the State Sanitary Code. Date: Name f Pe on Completing Form b �!. v •y i s .f r -f �.ky !r'ti tiff++.<".(,� n t �/\ y ,rn.�r •'+,�7, f WIN ,T - P»: w..} r s '.`y °'tdt• �,t t.M Y '. f;•r!.`k ! M 4 i'+ •^'• rj {k t� ,'�1y A `ay t '}k :v r bh�+uhy*SF{ �` 'r'.sM +"'1. .Y`.,r i vi a e 'sti '� ,•✓.�ty`t1 `r�,+^r' i"{ rle R,4,. ^�, ye �4 ''Ri ,kri• - >, R:.:9_. r� IMMUrz ing till Nod AGO Intl / { #�I d ,�- i ,1�" ,VP,V F r Y Yf µ resented gg LL.. 16 e.11 b �s b aving fulfille.b all re uirtm en#s for fs, . fir IL '/», i l\\ _i'y-A R5 f �!`,'",. .•"^nF`* `%` Ysy`" 74. ^` top .t T�+F�K"`*a` �* �y� �" wi s'Y a�' Y '+..a'Yx`�•�,r,�,�y'��i� �'3,����*' ����d'�F., ,1 v�$ r i� �� 'C� n M} IIS wf �aXrr a u+F r s `y'4�� �+is .OK ' nots Jr q yp3, H ,,,"w t.. i r :r✓ y x r .. + yJ � ., Sao rf� (j�^'tt} 14 '� v'•r vt54� � H s4 � r.. } ti .S�' y , '. r«^i ;r ',,,.. f ! . �'Ny$�_,k�, x rr" 4 � ✓ 1 'K.Si OWN . a y` i;g'` .rQ q. ..'T,} T;y "�� t•.r 4,Y-v�' 'r,�F f r F n "f.,?�,'. v , SK 'nw X. 'i v i�, •rr "r`e'f' ��`x i`'x?• F,n? "..Ka '�n` •s ., n� �_._ 't Y P .2` y u4 At5 t e�..• ^t`ti j ` . . rr , ,,, `` �n.},haC. a� ., ?"r" v'•f ,4 fC 'prk ..j C ++ �Fl .l'r - ° i h�jf�� � ....... ._ ",•�w�v,l."sti f �i�vt��., �. K e<.a,.m••.r3:wrr P`�.`�'t` "�'.c .c`--{v4k�.,�''t�xe..c-r .h.'�1_,{,,;�'e. ,,.t y' t.ca..:....+... �w .T d r r! F9 kFydy.� s yy� � �r e' rR <y #i� Mt 4-:,h„y 4 . 5 ;.. d \iRv �� R .*''�' G + t ,+ '� � 'C..�r r 'Fi; a �}rL'� rr fY ..W. r'` .�s:w { t •l ANEW" ,r.� .:"p ..r2,, t{. ? r .,, 4aY>rEs"Or`Ni `t ,a d r ,r .,4r 7„r'-b�rS'�.'1.�j t' '•+.Y'n ., gb j. .Novi. ny�,M�e, ti£ .:{+'..: �7' t ..N+` ;',,, .gk .R..., ,yv`4 'k` •. ..4.�t'"''c 3 ,ear•_"x'k'4u7r f' . "ms`s s. t � •',�s:yn4' � � r 4 F'.x r h.yy. k"fir• p i a C� "'�riiCa• i, i/ . '11% i p�Yf MiP�6 � P egm "as pan A. r iS�"r J � fi 'r,.„S'e s�,... r•`,w'�6'" ,- - "Aware3 Comn :8ox 2029 1 uscaioo'sa, {.3,St03`C34 sf THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OFHEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit#:167-8 In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a permit is hereby granted to: RICHDALE DAIR Y STORE#24, 535 CHICKERING ROAD,NORTH ANDOVER, MA 01845 Permit Expires: December 31, 1998 Type of business and any restrictions.Retail Foods To operate a food establishment in: North Andover,MA Date: December 31, 1997 Board of Health Members: Gayton Osgood, Chairman Francis P. MacMillan,M.D., Member John S. Rizza,D.M.D.,Member FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. **************** Applican � fills out this section***************** r APPLICANT: h' /L , 71 � Phone i ' /mac c v LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) - -Sgtreet St. Number .T�s ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved In j j FeYod Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments i Public Works - sewer/water connections - driveway permit VFire Department Received by Building Inspector Date FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 12 r e. Z-_14 1)4 lry 17e) 5 // .^�J Phone,, S-/�r�s U, OC TION: Assessor' s Map Number Parcel Subdivision Lot(s) Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected j Comments Date Approved �/Z AJ Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit /Fire Department ```' j_Fr i.,, Received by Building Inspector Date , t � �,�'"��" �rS��:`G t� �� •- 1 s �'.j� � , �"t�y�� a�-` ro ,� ���' �� { a x kti �p' We 7x 4 c ffi*ia 7 t -7► r MA K a . itri} MIN Y ,'N� �•�se''��.l�r t a w `x�, i �s� i �+3! Mrd,�, �,�1�,' _ � a�F , �''�9�'S' ,� f � �•` '� '� 75�.i` +�. �:'� �� "�'�� tax R� ,�: '��^ i :5F� ,,It '+ ('lI' .'j1 '� � � ��sz'ry'� -. try i'�m�S�� g�•5�,�? � fi _ � ..y,p +� � 5^ f��ra�9',. MIA 1 v�A.�ry 9" h; 'ts'c'#,U 1, t- � �µ z f+' S• +a�ta;%,��tiL":•:" 5 �}. �yfrr Y. ICEsy, z rvZ!, f �r•'v3:Fhp+ .•rS 2 x� "S >..a s k_ 5` of� M�a �� a �.� � '£ t { ��r „3�' � �f, 8a �W�l•s;.' t f�� at+ t.� r �� t ���p r atria nir °"'�S' a � .a sT �''��`� 8'� ti � c, h '��,-� `� ',�F+`� s'�e,�•,n�'1�,�t",st �a.� �Z� �` ��i;jf�{xf"�JC"a1yl� t�a•',�'( dt'•r���7,^4y` e �'�,£° `'�'� ��� ���F g T7°���•Pry�.�i v1:3�s-�'. + �a t.x £ -.a '"£{°�a •.�^,+ t Y ,�x r t'�_�+ ^ �+�MC.�vl�a� �•� ¢ ,��.,�;y a 2• Y�ttt �,ai �tNS� �, j.x,,5 r '�� 'ro 3F r � ��`�• ;�a�) �.a. b a� a '���^,, �;"; t' � A, y, � 7 , t��5 ` f ? .. ,?;1 t r sp k x > Y5. 4wy°+x{ ��s, tC d•�t r,:« f�+ ��dxxy wF .�:. ,"F:;'-"�' �•,= ..n.. � rW.. , '..:si.:` t 400 SERIES5„ 300 SERIES 5" T 12" 14" 41,, 43" 36„ 38" 34" 36„ On sinks over 54"long faucet holes centered I over each partition. � I General Specifications Specify if drainboards are to be Rolled Rim or ; High Splash • Sinks are drawn from one piece of 16 Ga. When ordering Eagle Cove Corner stainless steel, seamless with 11/2" radii •. Working height—adjustable 34"to 37" 7 Sinks please observe the following: • Splash 8"hiWZ'return to wall on 450 angle Type of Stainless and Depth: with 1"turn up coved corners and bottom for 412-400 Series Stainless-12"deep ease of cleaning and swirlaway drainage 314-300 Series Stainless-14"deep • Faucet Holes-11/e"on 8"centers for sinks up Ordering Information Compartment Sizes to 54"long, 2 sets o holes on longer models • Germ-free seamless nterior Front to Back Left to Right • Rims-1 1/2"diameter rolls front and ends 16 19 16 • Legs--galvanized 1%"tubing 18 24 18 Feet—bullet type,adjustable,completely 22 22 22 enclosed,non-corrosive 24 24 24 • Crumb cup basket strainer included Constructing a Model No. Drainboards Qa 12 21"front to back for 16"size compartment 4=Series of Stainless 24"front to back for 22"size compartment 26"front to back for 18" & 24"size compartment 12=Compartment Depth 16=Compartment Size Welded Integrally 3=No. of Compartment High-Splash 18=Drain Board Size=Right or Left Hand or :18"-24"-30"-36"length. Rolled Rim must be specitied' i THE 314 SERIES IS CONSTRUCTED OF TYPE 300 SERIES STAINLESS STEEL • BOWLS ARE 14"DEEP THE 412 SERIES IS CONSTRUCTED OF TYPE 400 SERIES STAINLESS STEEL • BOWLS ARE 12"DEEP Metal Masters Foodservice Equipment Company, Inc. 655 Glenwood Avenue West—Smyrna, Delaware19977—302-653-5871 t�. "offering the Greatest Number of Bowl Sizes in the Industry A B C D E 412 Sales 400 6/8 314 Series 300 s/s A B C D E 412 Series 400 s/s 314 Series 300 s/s 21 24 Y2 - 18" 19" 41 2--16--1 314-16.1 57 271h 30 22" 22" 412.22.1-30 L or R 314-22-1.30 L or R 39 2192 18 i6" 19" 412.16-1-18 L or R 314.16-1-18 L or R 87 2716 30 22" 22" 412-22-1-30 314.22.1.30 l 57 24% 18 18" 19" 412.16.1.18 314.16.1.18 63 27'2 36 22" 22" 412.22.1.36 L or R 314.22.1-36 L or R 45 2442 24 16" 19" 412-16-1-24 L or R 314-16.1.24 L or R 99 27th 36 22" 22" 412-22.1.36 314.22-1-36 ' 69 2441 24 16" 19" 412-18-1.24 314.16-1.24 29 2916 - 24" 24" 412.24.1 314.24.1 51 2492 30 16" 19" 412-16.1-30 L or R 314.16-1-30 L or R 47 29'6 18 24" 24" 412-24.1.18 L or R 314.24.1.18 L or R 81 2116 18" 19" 412-16-1-30 314-16•1-30 65 29 6 18 24" 24" 412.24.1.18 314.24.1.18 57 24% 36 18" 19" 412.16A-36 L or R 314-16.1-36 L or R 53 2992 24 24" 24" 412.24.1.24 L or R 314-24.1.24 L or R 93 24% 36 16" 19" 412.16.1.36 314-16.1.36 77 291/2 24 24" 24" 412.24.1-24 314.24.1.24 27 27 Y2 - 22" 22" 412.22-1 314.22.1 59 291h 30 24" 24" 412.24.1.30 L or R 314-24.130 L or R 45 27% 18 22" 22" 412.22.1.18 L or R 314.22-1.18 L or R 89 299, 30' 24" 24" 412-24-1.30 314.24-1.30 .63 271/2 18 22" 22" 412.22.1.18 314.22.1.18 65 291h 36 24" 24" 1 412-24-1-36 L or R 314-24.1.36 L or R 51 271h 24 22" 22" 412-22.1-24 L or R 314.22-1-24 L or R 101 29112 36 24" 24" 412.24.1.36 314.24.1.36 75 27th 24 22" 22" 412-22-1-24 314-22.1-24 A B C D E 412 Sena 400 s/s 314 Sales 300 s/s A B C D E- 412 Series 100 s/s 314 Series 300 s/s 39 2416 - 16 19 412.16-2 314-16-2 81 2792 30 22 22 412-22.2.30 L or R 314.22-2-30 L or R 57 24% 18 16 19 412-16.2.18 L or R 314-16-2-18 L or R 111 27'6 30 22 22 412-22-2-30 314-22-2-30 75 2442 18 16 19 412-16-2=18 314-16-2-18 87 271h 36 22 22 412-22-2-36 L or R. 314.22.2.36 L or R 63 24% 24 i6 19 412.16-2.24 L or R 314-16.2-24 L or R 123 271h 36 22 22 412.22.2.36 314.22.2-36 87 24'6 24 16 19 412-16-2.24 314-16 2-24 55 29112 - 24 24 412.24.2 314-24.2 69 14W 30 i6 19 412-16-2-30 L or R 314-16-2-30 L or R 73 291/2 18 24 24 412-24-2-18 L or R 314.24.2.18 L or R 99 2116 30 16 19 412.16.2.30 314.16-2-30 91 291h 18 24 24 412.24-2.18 314-24.2-18 75 241h 36 16. 19 412-16-2-36 L or R 314-16-2.36 L or R 79 29'6 24 24 24 412-24.2.24 L or R 314.24-2-24 L or R 111 24 Y2 36 i6 19 412.16.2-36' 314-16-2-36 103 291h 24 24 24 412-24-2-24 314.24.2.24 51 2714 - 22 22 412.22-2 314.22.2 1 85 291/2 30 24 24 412.24.2-30 L or R 314-24.2-30 L or R 69 2716 18 22 22 412.22.2-18 Lor R 314.22.2-18 L or R ff9129Y2 9'/2 30 24 24 412-24-2-30 314-24.2.30 87 2742 18 22 22 412-22-2-18 314-22-2.18 36 24 24 412.24.2.36 L or R 314.24.2.36 L or R 75 2716 24 22 22 412-22.2-24 L or R. 314-22.2-24 L or R 9'6 36 24 24 412.24-2.36 314.24.2.36 99 27W 24 22 22 412.22.2.24 314-22-2-24 A B C D I E 412 Sala 400 s/s 314 Series 300 s/s kA B C D E 412 Series 400 s/s 314'Serles 300 s/s'57 2492 16 19 412.16-3 314.16-3 271h 24 22 22 412-22-3-24 L or R 314.22.3.24 L or R 75 2442 -18 16 -19_ 412-16-3-18 L or R 314-16-3-18 L or R 274, 24 22 22 412-22.3.24 314-22-3-24 93 241h 18 16 19 412.16.3-18 314.16.3.18 271/2 30 22 22 412-22-3-30 L or R 314.22-3 30 L or R 81- -249r 24 i6 19 412.16-3-24 L or R - 314-16-3-24 L or R 27Y2 30 22 22 412.22-3-30 314.22-3-30 105 24% 24 16 19 412-16-3-24 314-16-3-24 111 2716 36 22 1 22 412-22-3-36 L or R 314-22-3-36 L or R 87, 24th 30 16 19 412-16-3.30 L or R 314-16-3-30 L or R 147 271h 36 22 22 412-22-3-36 314.22.3-36 • 117 2442 30 16 19 412-16-3-30 314-16.3-30 81 291/2 - 24 24 412.24.3 314-24-3 93 2442 36 i6 19 412-16-3-36 L 0r R 314-16-3-36 L or R 99 291h 18 24 24 412-24.3.18 L or R 314-24.3.18 L or R 129 24% 36 i6 19 412-16-3-36 314.16-3.36 117 2942 18 24 24 412-24-3-18 314-24-3.18 63 29% - 18 24 412-18-3 314.18-3 105 291h 24 24 24 412.24-3.24 L or R 314-24-3-24 L or R 81 2916 18 /8 24 412-18.3.18 L or R 314-18-3-18 L or R 129 291h 24 24 24 412.24-3.24 314-24-3-24 99 291h 18 18 24 412-18-3.18 314.18.3.18 111 291h 30 24 1 24 412.24.3.30 L or R 314-24-3-30 L or R 87 29'6 24 18 24 412-18.3-24 L or R 314-18-3-24 L or R 141 291h 30 24 24 1 412-24-3-30 314.24.3.30 111 2914 24 18 24 412.18.3.24 314.18-3-24 117 29th 36 24 24 412.24-3-36 L or R 314.24-3.36 L or R 93 29 V2 30 18 24 412-18.3.30 L or R 314.18.3.30 L or R 153 291h 36 24 24 412.24.3.36 314.24.3.36 123 29 Y2 30 18 24 412.18.3.30 314.18-3-30 99 291, 36 18 24 412.18.3.36 L or R 314.18-3.36 L or R 135 29th 36 1 18 24 412.18.3.36 314-18-3-36 75 27th - 22 22 412-22-3 314.22-3-3 93 2714 16 22 22 41242-3.18 L or R 314.22-3.18 L or R 111 27th 18 .22 22 412.22-3-18 314-22-3-18 AB C D E 412 Series 400 s/s 314 Series 300 s/s A B C D E 412 Series 400 s/s 314 Series 300 s/s 75 2416 - 16 19 412-16-4 314-16-4 129 271/2 30 22 22 412-22-4-30 L or R 314-22-4-30 L or R 93 24'2 18 16 19 412.16.4-18 L or R 314.16-4-18 L or R 159 271/2 30 22 22 412-22-4.30 314-22-4.30 111 24 Y2 18 i6 19 412-16-4-18 314.16-4-18 135 271h 36 22 22 412-22-4-36 L or R 314-22-4-36 L or R 99 2492 24 16 19 412-i6-4-24 L or R 314-16-4-24 L or R 171 271/2 36 22 22 412-22-4-36 314-22.4-36 123 241h 24 16 19 412-16-4-24 314-16-4-24 107 29th - 24 24 412.24-4 314-24-4 105 24 h J2422 9 412.16.4.30 L or R 314-16-4-30 L or R 125 29th 18 24 24 412-24-4-18 L or R 314-24.4.18 L or R 135 24th 9 412-16-4.30 314-16-4.30 143 291/2 18 24 24 412.24.4-18 314-24.4.18 111 24th 9 412.16.4-36 L or R 314-16-4-36 L or R M,12244 24 24 412.24.4-24 L or R 314-24.4.24 L or R 147 2116 9 412-16-4.36 314-16-4-36 4 24 24 412-24-4-24 314.244-24 2716 2 412.22-4 314.22-4 0 24 24 412-24.4-30 L or R 314-24-4.30 L err R 117 27W 2 412-22-4-18 Lor R 314-22-4-18 L or R 0 24 24 412-24-4-30 314-24-4-30 135 27th 2 412-22-4-18 314.22.4-18 - 6 24 24 412-24.4.36 L or.R 31424-4.36 L or R 123 2714 2 412-22-4-24 L or R 314-22-4-24 L Or R 36 24 24 412-24-4-36. 314-24-4.36 147 27% 2 412-22-4-24 314-22-4-24 --Iv)S C I 162 F �Qw V I I O � G ' r t `� ���L� �_ '- z� � _ _I /h� �I ,�aC ��� � �� ����� S-��'�s I I i.. .} I I I A I I I I I I V I I I I 11'CE �'o pop I 6Af3V i , FEM•i IVA ! FI�EEZEI� PIAN _ I I I I I II I � r1 _ _ � II . I i1 � � � 1 , i ' I � ► � � _ I , { I F66D j I P2Q bUcrS ► _1 Au hAq E,... Hous �2Y j PRoc�� j 6odcx5 I I I I f]4 � �'� r • i� t - 1 I I t r t - -�- - 1 T r f 1-r 1 - i 1 - -� I Y I��PtG ,_ LAK Et_PZC?D- 6S i�SS� r)r?_A ES�i I I s i + �� o' I I ; I + + i— 1 + SrJgCV_cp- I i I t, a — 4---i&�-g-I — _Q —'. W -_— S �Q 0 C i 5`i f31<. I COc �E ,C.J-- ICp -al z3bf?)b I UE2 a I El I clef t►�1J1 r~zi��¢ d i I _-1-- - - _.}_ '�__. -�- -r -t_. .+. -.�.. I,. .i r + i � +_ _.t_ -+. ._ t _ * } _t .1 _-1. t i. _T } .� •Py _�•_ , V I I I i Ii II � i � I I I 1 I I I �'(�'�y� �1_._ _• NORTH ANDOVER BOARD OF HEALTH PROCEDURE FOR OPENING A NEW FOOD ESTABLISHMENT 1. Obtain from the Board of Health the following: "New" Food Establishment checklist and Plan Review packet )'"Application for a Food Establishment c) Dumpster Permit Application Glc 3-175L- d) Tobacco Sales Permit Application (when called for) :-"_Submit scaled floor plan of establishment with particular emphasis on kitchen/food prep areas. All equipment must be identified and equipment specification sheets provided. The New Food Establishment Checklist must be filled out in it's entirety and signed by the applicant.�pZan review fee of$50.00 shall accompany this submission. 3. After the floor plan has been reviewed and approved by Board of Health personnel, a Form U may be signed and construction can begin. Any deviations from the plan without the consent of the Board of Health could result in the nullification of the approval. 4. The applications to operate a food establishment, maintain a dumpster and to sell tobacco may be submitted with their associated fees at any time during this process. 5. Prior to certificate of Occupancy sign-off by the Building Department, the Board of Health shall inspect the facility for agreement with the proposed plan with reference to equipment and location, finishes on walls, floors, and ceilings, lighting and any other particular items. / 6. 'After the certificate of occupancy is signed an appointment shall be made with the Aoard of Health for a pre-opening inspection. This inspection must be made and the permit to operate a food establishment signed & presented to management prior to opening the facility. It would be appreciated if the appointment was requested at least 3 days before the targeted opening date. U We certi t ach oms above were discussed a r r aperrwork received. Establishment Applicant !-'� Board of Health fi If — -- - ---- -.- . 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