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Miscellaneous - 733 TURNPIKE STREET 4/30/2018 (7)
.t7 0 COMMONWEALTH OF MASSACHUSETTS NUMBER BHP -2016-0085 North Andover BOARD OF HEALTH FEE $35.00 Dottie's Delights DATE ISSUED NAME May 19, 2016 733 Turnpike Street NORTH ANDOVER, MA 01845 ADDRESS IS HEREBY GRANTED A Food Est. - Temporary - Permit TEMPORARY FOOD PERMIT This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ---------------- May -20,201-6 ----------------- unless sooner suspended or revoked. RESTRICTIONS: Caramels, cookies, brownies, cake pops, penny candy BOARD OF -------- --- HEALTH NOTES: Alyssa Cohen 857-928-4713 -- 7 - - ��i - a HOURS ACTIVE: Shop Til You Drop @ Steven's Estate 5- - 9pm BOARD OF HEALTH CHAIRMAN NORTH ANDOVER HEALTH DEPARTMENT Community Development Division a.........:....x:,.,,:,:....a..........a.,.....,........:........... ..... ,....,..... ...a.,......,..,a,a....... .......... ......x......... .,............. "..".... xx.....a........... a.........a........... XPPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT Fee: $35.00 -This application is to be received at least ten (10) days before the event, with the fee, and a !copy of the Food Service License from the Town of which voce normally operate out of. if app li-able.Pleas hake check payable to: Town of North Andover t,...i...a.................... .a:,.,..i...... ,,,............. u.., .............. a.......,.ux..,x.....a..u..... ,u.,a:.a.,a...».,....:a,.I............... .,..I ..... 1.a, ......... ita.a x.....a.,..Y..aa,ica,i,..a3 4/10/16 ALYSSA COHEN Date: Name of Operator/ Manager: DOTTIE'S DELIGHTS Name of Food Establishment (if applicable)Rc 733 TURNPIKE ST CEIVED Address: APR I y NORTH ANDOVER MA 01845 2016 Town Contact Phone Ws: State: 8579284713 (cell) 471187668 Federal Tax ID Number: Tax Exempt? Include a copy of your State Hawker/Peddler License if applicable: NO Zip:TnMflu HE11.11 O H DEPARTMENT NORTH ER (other) 6***Attach a current ServSafe Certification with every application, even if you think we have one on file"*"' Person in Charge: Name of Event: TRACEY ZYSK SHOP TIL YOU DROP 5/19/16 Contact Phone #: Tf s - cam - L57 \ Date(s) of Event: Time(s) of Event: 723 osgood st north andover ma 01845 Location of Event: 5-9 pm WARE YOU READY?" Checklist - (Guideline for plan review and pre -opening inspection). Have you read these materials YES NO 2. MENU: Attach or list below all items. Any changes must be submitted and approved by the North Andover Health Department at least 5 days prior to the event. 3. FOOD PREPARATION: Will all foods be prepared at the temporary food establishment booth? YES ComnleteLSECTION A below if you answered YES to question 3. North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web http://www.townofnorthandover.com X NO Attach a copy of the permit where the food will be prepared. If food is prepared at a licensed establishment in North nnTT1Ps nFl Ir -.HTS Andover, list name only: Page 1 of 2 4. List each food item prepared, and for each item check which preparation procedure will occur. Please attach a copy of the menu if applicable. SECTION A: At the Booth j 7_� Portion Food Thaw Cut /Assemble Cook Cool I Cold Holding Reheat i Hot Holding I Packaging SECTION B: At the licensed food establishment. F— Portion Food Thaw � Cut / Assemble Cook j Cool Cold Holding Reheat T0tHHoldingPackaging CXQ V, --- — -- - Storage and disposal of wastewater: Please outline your complete sanitation process from start to finish for this event —for example: method(s) of sanitation, such as: using a 10 gallon igloo of bleach & water for sanitation; your procedures for the care and cleaning of utensils, tables; equipment, etc. HANDWASHING FACILITIES AVAILABLE ON SITE SCOOPS FOR PENNY CANDY; EXTRAS ON HAND GLOVES & PAPERS USED TO REMOVE/SERVE BAKED GOODS FROM CASE UNWRAPPED ITEMS PLACED IN BAGS HAIR RESTRAINTS USED 0 0 0 I certify that I am familiar with 105 CMR 590.00 Minimum Sanitation Standards for Food Establishments Article X, and the above described establishment will be operated and maintained in accordance with the regulations. 1ZApplicant's Signature: Date: /Q Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com TEMPORARY FOOD SERVICE — "ARE YOU READY?" Use this guide as a checklist for plan review and pre -opening inspection Application — A completed temporary food service application is to be submitted to the Board of Health Office a minimum of ten (10) days prior to the event. FOOD & UTENSIL STORAGE & HANDLING Dry Storage: All food, equipment, utensils and single service items shall be stored above the floor on pallets or shelving, and protected from contamination. Cold Storage: Refrigeration units shall be provided to keep potentially hazardous foods at 45°F or below. An effectively insulated container with sufficient coolant may be approved by the Health Inspector for storage of less hazardous foods, or use at events of short duration. Hot Storage: Hot food storage units shall be used where necessary to keep potentially hazardous foods at 140° or above. Thermometers: Each refrigeration unit shall have a numerically scaled thermometer to accurately measure the air temperature of the unit. A metal stem thermometer shall be provided where necessary to check the internal temperatures of both hot and cold food. Thermometer must be accurate to +2°F, and have a minimum range of 40°-1650F. Wet Storage: Wet storage of canned or bottled non -potentially hazardous beverages is acceptable when the water contains at least 10 ppm of available chlorine and the water contains at least 10 ppm of available chlorine and the water is changed frequently to keep the water clean. Food Display: All food shall be protected from customer handling, coughing, or sneezing by wrapping, sneeze guards or other effective barriers. Food Preparation: All cooking and serving areas shall be protected from contamination. BBQ areas shall be roped off or otherwise segregated from the public. PERSONNEL Hand washing: A minimum of a two gallon insulated container with a spigot and a basin, soap and dispensed paper towels shall be provided for hand washing. The container shall be filled with hot water. Health: Employees shall not have any open cuts or sores, or diseases transmittable by food. Hygiene: Employees shall have clean outer garments and hair restraints. CLEANING Worth Andover Health Department, 1600 Osgood Street, Suite 2035, Worth Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Bleach: Household bleach or other approved sanitizer shall be provided for dishwashing sanitization and wiping cloths. Wiping Cloths: Wiping cloths shall be rinsed frequently in a clean 100 ppm chlorine solution WATER SUPPLY Water Supply: An adequate supply of potable water shall be on site and obtained from an approved source. Water storage at the booth shall be in approved storage containers. PREMISES Floors: Unless otherwise approved, floors shall be constructed of tight wood, asphalt, or other cleanable material. Floors shall be finished so cleanable. Walls & Ceilings: Walls and ceilings are to be of tight and sound construction to protect from the entrance of the elements, and, where necessary, flying insects. Walls shall be finished so cleanable. Lighting: Adequate lighting by natural or artificial means is to be provided. Bulbs shall be non -breakable or shielded. Counters/Shelving: All food preparation surfaces shall be smooth, easily cleanable, durable and free of seams and difficult to clean areas. All other surfaces shall be finished so cleanable. Garbage: An adequate number of cleanable containers shall be provided inside and outside the booth. Restrooms: An adequate number of approved toilet and hand washing facilities shall be provided at each event. These facilities shall be accessible for employee use. North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com 6 Z L z UJ a U. aLL H F Q X W U u �J' U z I..L.I T- 0 u M M O MJ 0 d E L o- a" o a- a ar dC w O a � c a " Oro upi N a ` C y be � z m a � Z u C O u O C r Q r ? � •3 c E a •9 K t W u w a r T Cl C v O C E, > a � v 3d7 rt x s c W 9 R C O -4 r {� C A E z U C 0 C O ` [ Sawyer, Susan From: Sawyer, Susan Sent: Tuesday, September 15, 2015 10:12 AM To: 'Alyssa Cohen' Subject: RE: heads up Thank you Alyssa, The Health department has received your request to alter the approved floor plan for Dotties Delights, currently under renovation. The change to add a high temperature dishwasher in the location of the prep sink and to relocate the prep sink to an alternate location has been approved. In addition, unless circumstances change that require a shorter time period, it is agreed that this will be done within six months of this approval. Thank you, Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com We are seeking to put in a heat based commercial dishwasher to better ensure proper sanitization and increase cleaning efficiency and therefore productivity. We are installing this unit on the wall of the main kitchen area, in place of the current prep sink, which we intend to relocate to the opposite wall within the next six months. From: Alyssa Cohen[mailto:dottiesdelightsdc@gmail.com] Sent: Monday, September 14, 2015 8:20 PM To: Sawyer, Susan Subject: Re: heads up Good evening! First, thank you for taking today to discuss options and being willing to find a compromise that works for both of us. I truly appreciate it. In terms of the permit, apparently the plumber had a walkthrough the plumbing inspector today, so my guess is the permit is forthcoming. On the topic of what we discussed, here is the requested email statement: We are seeking to put in a heat based commercial dishwasher to better ensure proper sanitization and increase cleaning efficiency and therefore productivity. We are installing this unit on the wall of the main kitchen area, in place of the current prep sink, which we intend to relocate to the opposite wall within the next six months. If there is anything else you need for documentation, please let me know and I will of course provide it. Thank you again for your time. Have a great day! Alyssa On Mon, Sep 14, 2015 at 2:48 PM, Sawyer, Susan <SSa er e,townofnorthandover.com> wrote: Alyssa, I don't think you have needed a plumbing permit yet on your project, so please be sure your contractor pulls a plumbing permit for the new machine. Thank you, Susan From: Alyssa Cohen[mailto:dottiesdelightsdcCaogmail.com] Sent: Friday, September 11, 2015 11:37 AM To: Sawyer, Susan Subject: Re: construction insp tentative 9/18 at 10 AM Will do. I've attached it to this email. With regards to location, it's where on of the sinks used to be. We had a total of 4 sinks, so we swapped the one near the three bay for the dishwasher. (This change will be reflected in the final architectural plans, and I will of course provide a copy to you so that the plans on file are accurate.) We still have 3 remaining sinks, including one designated for hand washing and for food prep. With regards to the three bay, though, since we have the dishwasher, does that still need to be explicitly for rinse, sanitize, and wash? Thank you so much! Have a wonderful day! Alyssa Sawyer, Susan From: Alyssa Cohen <dottiesdelightsdc@gmail.com> Sent: Friday, September 11, 2015 11:37 AM To: Sawyer, Susan Subject: Re: construction insp tentative 9/18 at 10 AM Attachments: Supera_SSUD18-l.pdf Will do. I've attached it to this email. With regards to location, it's where on of the sinks used to be. We had a total of 4 sinks, so we swapped the one near the three bay for the dishwasher. (This change will be reflected in the final architectural plans, and I will of course provide a copy to you so that the plans on file are accurate.) We still have 3 remaining sinks, including one designated for hand washing and for food prep. With regards to the three bay, though, since we have the dishwasher, does that still need to be explicitly for rinse, sanitize, and wash? Thank you so much! Have a wonderful day! Alyssa On Wednesday, September 9, 2015, Sawyer, Susan <SSgMergtownofnorthandover.com> wrote: Yes, please send the spec sheet. Thank you. I assume it is in the same location. Susan From: Alyssa Cohen [mailto:dottiesdelightsdc@gmail.com] Sent: Wednesday, September 09, 2015 9:55 AM To: Sawyer, Susan Subject: Re: construction insp tentative 9/18 at 10 AM Good morning! Thank you so much! 10 am on Friday the 18th sounds great. I'll be sure to update you if anything changes or if Monday looks like a better option. And with regards to that approval letter, I actually printed it out and have used it as a guideline/checklist for preparations. I want to make this as easy as possible for both of us! Also, I'd like to make an amendment to the application to include a heat based dishwasher as opposed to a 3 bay chemical based dishwashing system, complete with appropriate dish tables. We were able to find a unit that worked really well and, since I much prefer heat based sanitization, I'm glad that this was possible. I can send along spec sheets for the unit and anything else you may need. Just let me know and I will of course get it to you. Thank you so much! Alyssa On Tue, Sep 8, 2015 at 9:08 AM, Sawyer, Susan <SSawyer@townofnorthandover.com> wrote: Alyssa, Friday the 18th should be fine. We work 8 —12 only however. I am out of the office Wed and Thursday at a conference. I will put you in the calendar for 10 AM if that is ok, but could you please call the morning of the 18th to confirm if you don't mind. I try not to miss meetings, but sometimes after being out, it can get busy in the office. If you do call Wednesday or Thursday, you can speak with Michele. Also, Please refer to the approval letter for hints on preparing for inspections. Thank you Susan From: Alyssa Cohen [mailto:dottiesdelightsdc@gmail.com] Sent: Saturday, September 05, 2015 6:54 PM To: Sawyer, Susan Subject: Re: checking in Good evening! I hope your holiday weekend is going well! Projected finish date for all construction/space set up is Friday, September 18th. Could we tentatively schedule an inspection for that Friday, with a back up inspection scheduled Monday? (Just in case the space isn't ready, especially given that Friday is a short day for you.) We plan to set up in the following days and have the launch weekend be the last weekend of September. So if we could also schedule a final inspection on Wednesday, September 23rd, that would be great. Thank you so much! This is very exciting to be inching closer to launch and it wouldn't have been possible without your help! Have a great day! Alyssa On Tue, Sep 1, 2015 at 8:32 AM, Sawyer, Susan <SSawyer@townofnorthandover.com> wrote: Hi Alyssa, I am just checking in on you and the progress with the shop. How is your time table for opening looking? Thanks Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawyer@townofnorthandover.com Web www.TownofNorthAndover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma North Andover Health Department (ommunity and Economic Development Division July 24, 2015 Dotties Delights 733 Turnpike Street North Andover 01845 Re: Application approval for Dottie's Delights Dear establishment operator, The Health Department received the plan review application submitted for the establishment to be known as "Dottie's Delights" located at 733 Turnpike Street, North Andover. This application has been approved noting the following items were identified on the May 26th Health inspection. Please address these items prior to your final food inspection. 1) Label grease trap per the plumbing code requirements 2) Post all sign; hand wash, hand sink only etc. 3) Place MSDS sheets in accessible location 4) Ensure all surfaces are in good condition, easily cleanable and non -porous. When all equipment and structural elements are in place, a construction inspection should be requested. It is not expected that the equipment be up and running at this inspection. Please call the Health Department a few days ahead to avoid any delays. At that time, a complete punch list will be provided by the inspector. Once completed, please call the Health Department for re -inspection. The Building permit will be signed off by the Health Inspector when the list is satisfied. Once all other departments are satisfied with the construction, the building department will then grant you occupancy approval. Just prior to issuing the Food Establishment Permit to Operate, the inspector expects to view food properly stored; on shelves, in refrigerators, in storage closets etc. Each establishment opening is unique, so feel free to contact the Health Department at any point in the process. Below are some common pitfalls that can cause delay in opening if not complied with: All lighting over food prep, service and wash areas must be non- breakable. This includes hanging lights or pendants over the bar area. No unprotected glass can be over food areas. Also, any ceiling tiles over food or food prep areas must be washable and all high wash floor areas North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 should have a curved base coving along the walls. Bathroom walls must be non -porous surface behind all fixtures and splash areas; at least 4 feet high and curved base coving along the walls. Some of the items needed to receive the permit to operate are: 1)The establishment will be clean of all construction materials; floors and surfaces all cleaned. All contractors shall be complete. 2)The hand sink(s) and bathroom(s) will have immediate access to wall mounted paper towel and soap dispensers and they must be stocked. 3)The ladies room will have a covered trash can for feminine item disposal 4) Signage: Bathroom(s) must have "employee must wash hands before returning to work" signage; hand sinks must have signage "hand wash only"; 3 -bay labeled "wash, rinse, sanitize"; prep sink "food prep only" 5) Sanitizer bucket should be made up and test strips available. 6) 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): LA 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). 7) Signage for allergens and disclaimers placed as required by law 8) Proper disclaimers on Restaurant menu as needed. 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10) At minimum, employees should be trained on the sick policy and sanitation basic 11) Directions on mixing the sanitizer should be available to the staff. Thank you for your cooperation in this matter. If you have concerns about any of the above conditions; please contact the office. We look forward to working with you in the effort to provide safe food to our citizens. If you have any questions, please contact our office at 1-(978)-688-9540. 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Ns4"mzE C yi7.o a,% $ 2 Ao ChoNho 15 cm E - To a";Et W iilnOnam ]� tMU •iw LL Wx n� °« v nro �d°1A.o :2o ' 9L;E 2 c c e o & m E a N N E E ?, 12 5 � Itll W 12 S J 21 m v O' CD Z) ° z� A C C 70 C'1 N 7 9. ro � M t} ^' a 3 cQ � m T m N Z n ~ r D U ' v m N h^ 0 M r. 0 z 0 jA 0 - 0 z -e a a O a n $ Z o m< p v '� c �' °_ 3 0 o z a a a a o o 3 3 3 fl �' (DES (B > >0 a 0 � C N N � � � � W O. m v O' CD Z) Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) (Cone.) 14 15 16 17 I8 19 20 PROTECTION FROM CHEMICALS TENIENEMPIERATT III R t,n-NTnnr c Food or Color Additives 3-202.12 Additives* 3-302.14 Protection from Unapproved Additives* 3-40 1.1 l(B)(1)(2) Poisonous or Toxic Substances 7-101.11 Identi ,ing Information - Original Containers* 7-102.11 Common Name- Working Containers* 7-201.11 Separation - Storage* 7-202,11 Restriction - Presence and Use* 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-- Prohibitions* 7-204.11 Sanitizers,Criteria - -Chemicals* 7-204.12 Chemicals for Washing Produce Criteria* 7-204.14 Drying Agents, Criteria* 7-205.11 Incidental Food Contact, Lubricants* 7-206.11 Restricted Use Pesticides, Criteria* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders, Pest Control and Monitorin * TENIENEMPIERATT III R t,n-NTnnr c REQUIRE, MENi'S FOR HIGHLY SUSCEPTIBLE POPULATIONS Proper Cooking Temperatures for PHFs 3-401.11A(1)(2) Eggs- 155°F I5 Sec. Eggs- Immediate Service 145°F15sec* 3-401.11(A)(2) Comminuted Fish, Meats & Game Animals - 155°F 15 sec. * 3-40 1.1 l(B)(1)(2) Pork and Beef Roast - 130°F 121 min* 3-401.11(A)(2) Ratites, Iniected Meats -155°F 15 sec. 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, Stuffing Containing Fish, Meat, Poultry or Ratites -165°F 15 sec. * 3-401.11(C)(3) Whole -muscle, Intact Beef Steaks 145°F 3-401.12 Raw Animal Foods Cooked in a Microwave 165°F * 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. FC -5 Reheating for Hot Holding 3-403.11(A)&(D) PHFs 165°F 15 see. * 3-403.11(B) Microwave- 165° F 2 Minute Standing Time* 3-403.11(C) Commercially Processed RTE Food - 140°F* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 29. Proper Cooling of PIIFs 3-501.14(A) Cooling Cooked PI-IFs from 1407 to 70°F Within 2 Hours and From 70°F to 41°F/45°F Within 41lours, * 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 41°F/45*F Within 4 Hours* 3-501.14(C) PIIFs Received at Temperatures According to Law Cooled to 41 °F/451F Within 4 Hours. * 3-501.15 Cooling Methods for PHFs PIIF Hot and Cold Holding 3-501.16(B) 590.004(F) Cold PHFs Maintained at or below 410/450 F* 3-501.16(A) Hot PHFs Maintained at or above 140°F. 3-501.16(A) Roasts Held at or above 130°F. Time as a Public Health Control 3-501.19 Time as a Public Health Control* 590.004 it Variance Requirement REQUIRE, MENi'S FOR HIGHLY SUSCEPTIBLE POPULATIONS IISP 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* Animal Foods That are Raw, Undercooked or 3.801.11 Use of Pasteurized E s* Not Otherwise Processed to Eliminate 3-801.1 l(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. * Patho ens * "I""" ""Of 3-801.11(C) I Unopened Food Package Not Re -served, CONSUMER ADVitnRV 22 1-603.11 Consumer Advisory Posted for Consumption of 590:000 23, Animal Foods That are Raw, Undercooked or FC - 2 .003 Not Otherwise Processed to Eliminate Food and Food Protection FC - 3 Patho ens * "I""" ""Of 25. 3-302.13 1 Pasteurized Eggs Substitute flor Raw Shelf Eggs* JrllulAl, REV UIIZLINIE NTS 590.009(A) -(D) Violations of Section 590.009(A) -(D) in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodborne illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) Critical and non-critical violations rvhiclr do not relate to the foodborne illness interventions and risk factors listed above, can be found in the following sections of the Food Code and 105 CAIR 590.000. Item Good Retall Practices FC 590:000 23, Management and Personnel FC - 2 .003 24. Food and Food Protection FC - 3 .004 25. Equipment and Utensils FC -4 .005 26. Water, Plumbing and Waste FC -5 .006 27. Ph sicalFacilit FC -6 .007 28. Poisonous ar Toxic Materials FC -7008 . 29. Special Requirements 009 30. Other * Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Sawyer, Susan From: Sawyer, Susan Sent: Monday, July 20, 2015 2:59 PM To: dottiesdelightsdc@gmail.com Subject: North Andover shop Hi Alyssa, It has been a few weeks since we saw you at the old "Best of Thymes" and I was wondering where you are in the process of opening your new shop. I checked with the Building department and they said that they had not heard from you either, so I wanted to reach out to you. I also hope your move to MA went alright. Are you still on track to come here? Is there a floor plan forthcoming? I was waiting to see what the actual plan was going to look like before sending you a review letter. Looking forward to hearing from you. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Of MORTN 1 71 62 � 9 Town of North Andover ;'• HEALTH DEPARTMENT 1SS�CHUStt CHECK #: /Q`i i DATE: Z /S LOCATION: ���, H/O NAME: ; , �; CONTRACTOR NAME: Are riovS fin-.., �.►T+�o s Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ -0- Food Service - Type: �'►'� l �-t vi�� $� /❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ c Balt , gent Initials White - Applicant Yellow - Health Pink - Treasurer MSDS 9: RQ0702562-1 Supersedes: RQ0702562 The Procter & Gamble Company P&G Household Care Fabric & Home Care Innovation Center 5299 Spring Grove Avenue Cincinnati, OH 45217-1087 MATERIAL SAFETY DATA SHEET Issue Date: 08104/10 Issue Date: 10/23/07 Identity: LIQUID FLOOR CLEANER FINISHED PRODUCT Brands: MR. CLEAN FINISHED FLOOR CLEANER (AH Variations EXCEPT Mr. Clean Disinfecting Floor Cleaner) PROFESSIONAL PRODUCTS LINE P&G Telephone Number- 1-888-4PG-PROLINE (1-888-474-7765) or call Local Poison Control Center or your physician. Transportation Emergency (24 hour) Telephone Number — CHEMTREC: 1-800-424-9300 — U.S. and Canada; 1-703-527-3887 —for calls originating elsewhere. Potential Health Hazards (Acute and Chronic): (See Section 11 for more information) Ingestion: May cause gastrointestinal irritation. Eye Contact: May cause mild to moderate eye irritation. SkinContact: Mild to moderate skin irritant. Inhalation: N/A Signs and Symptoms of Exposure: Ingestion: Oral ingestion may result in transient nervous system effects (ataxia and muscle weakness) and/or gastrointestinal irritation with nausea, vomiting or diarrhea. This product contains alcohol ethoxylates. Large ingestions (>2rr1/kg) may also cause symptom of alcohol -like intoxications, uncoordination, drowsiness, inarticulateness or ataxia. Alcohol ethoxylates may contribute to central nervous system symptoms. Eye Contact: Instillation into the eye may result in transient superficial effects similar to those produced by mild toilet soaps and detergents. Skin Contact: Use on irritated or extremely dry Skin may aggravate the existing condition. Inhalation: N/A Medical Conditions Generally Known to be Aggravated by Exposure: NK Potential Environmental Effects: (See Section 12 for more information) Hazardous Ingredients as defined by OSHA, 29 CFR 1910.1200 and/or VVHMIS under the HPA: Under normal consumer use, this product would not constitute a hazardous product under US OSHA Hazard Communication. With increased exposure (compared with consumer use), this mixture, when tested as a whole, is considered an inhalation hazard (enzymes) and an eye irritant within the meaning of the OSHA Hazard Communication Standard. Chemical Name Common Name CAS No. Composition LD50/LC50 Range Sodium carbonate Soda ash 497-19-8 0.5-1.5% Oral/rat LD50: 4090 mg/kg Alcohol ethoxylates Non-ionic Confidential 1-5% N/A surfactants First Aid Procedures: Ingestion: Dilute by drinking 1-2 glasses of water. Do NOT induce vomiting. If symptoms persist, consult a physician. Eye Contact: Flush eyes thoroughly with lukewarm water for 15 minutes. If irritation persists, consult a physician Sldn Contact: Thoroughly wash exposed area with soap and water. If irritation persists, consult a physician. Inhalation: Remove to fresh air. If irritation persists, consult a physician Note to Physician: (if applicable): Other. Product package has the following precautionary statement: FRONT LABEL: WARNING: HARMFUL IF SWALLOWED. EYE IRRITANT. KEEP OUT OF REACH OF CHILDREN. (See side panel). SIDE PANEL: EYE IRRITANT: Avoid eye contact and prolonged contact with the skin. If eye contact occurs, flush with water for 15 minutes. If irritation persists, seek medical attention. WARNING: Harmful if swallowed. If swallowed, drink a glass of water and call a physician (product contains alcohol ethoxylates). n �ETIfl i� FiRE )f if;l i(f11F4�'1AF3N Flash Point (Method Used): >93°C/>200'F (closed cup) Flammable Properties: Upper Flammable Limit: N/K Lower Flammable Limit: N/K Explosive Limits: UEL: N/A LEL: N/A Auto -ignition Temperature: N/A Hazardous Combustion Products: N/K Explosion Data (Sensitivity to Mechanical Impact): N/K Explosion Data (Sensitivity to Static Discharge): N/K Extinguishing Media: Suitable: CO2, water, dry chemical or "alcohol' foam Unsuitable: N/K Protection of Firefighters: Specific Hazards Arising from the Material: N/K Protective Equipment and Precautions for Firefighters: Normal fue-fighting gear/equipment. Personal Precautions: N/K Environmental Precautions: DISPOSAL SHOULD BE IN ACCORDANCE WITH FEDERAL, STATE/PROVINCIAL AND LOCAL REGULATIONS. Do not landfill. Small (household) quantities may be disposed of via sewer with large quantities of water. Incineration is preferred where permitted. Methods for Containment: Use water spray to dilute and/or wash away spills. Absorb spilled product onto absorbent material. Methods for Cleanup: Use water spray to dilute and/or wash away spills to avoid exposure and to protect persons worldng to stop/repair leak. Absorb spilled product onto absorbent material. Other Information: (if applicable): SECTION VII - �AIYDII�NC AND STORAGE Precautions To Be Taken in Handling: Avoid direct, prolonged exposure to skin Precautions To B e Taken in Storage: Store in ventilated, cool, dry area. Exposure Guidelines: N/A Engineering Controls: N/A Personal Protective Equipment (PPE): Eye/Face Protection: For splash protection, use chemical goggles. Eye wash fountain is desirable. Skin Protection: Protective gloves (rubber, neoprene) should be used for prolonged direct skin contact Protection: None Appearance (color, physical form, shape): yellow liquid Odor: scented Odor Threshold: N/A Flash Point (Method Used): >93°C/>200°F (closed cup) Reserve Alkalinity: N/A Solubility in Water- completely soluble Physical State: liquid Decomposition Temperature: N/K Vapor Pressure (mm Hg): NIA Evaporation Rate (nBu0Ac=1): N/K Vapor Density (Aix --I): N/A Speck Gravity/Density: 1.023 q/cc Boiling Point: N/A Melting/Freezing Point: N/K Partition Coefficient (n-octanol/water): N/A pH (1% solution): 10.35 Volatile Organic Compound (VOC): Product complies with State and Federal regulations for VOC Content TBIU)fTV AITD RECTNTTY Chemical Stability: Stable Conditions to Avoid: N/K Incompatible Materials: N/K Hazardous Decomposition Products: N/K Possibility of Hazardous Reactions: N/K This product is not expected to be acutely toxic. Emetic properties are not known. If large quantities are ingested, treat symptomatically and do not induce vomiting. If irritant effects are seen, these will be mild to moderate, depending on exposure. If in contact with eyes, flushing with water is recommended. Chronic Effects: No chronic health effects reported. Target Organs: No target organs reported. Carcinogenicity: This finished consumer product is not carcinogenic. NTP: No* IARC: No* * NTP and IARC information confirmed via Ariel Based on ecotoxicity and fate data for the individual ingredients in this specific formulation, and for related consumer household cleaning products formulations, this product is not considered harmful to aquatic organisms or to cause long-term adverse effects in the environment at relevant environmental concentrations. The surfactant(s) used in the formulation biodegrade rapidly and do not accumulate in the environment This product is intended for dispersive use and should not be disposed of directly into the environment $ECTIOI�IXIIIDISPaSAL CQ1�ISiDERA1'IQNS Waste Disposal Method: DISPOSAL IS TO BE PERFORMED IN ACCORDANCE WITH FEDERAL, STATE/PROVINCIAL AND LOCAL REGULATIONS. Non -Household Setting (Federal)• Products covered by this MSDS, in their original form, when disposed as waste, are considered non -hazardous waste according to Federal RCRA regulations (40 CFR 261). Disposal should be in accordance with local, state and federal regulations. Non -Household Setting (California) • Hazardous, in accordance with 22 CCR 66261.20 through 22 CCR 66261.24 Household Use: Consumer may discard empty container in trash, or recycle where facilities exist Consumer produced household solutions may be disposed of down the drain with running water. Product used in household may be disposed of in refuse or in sewer. Products covered by this MSDS, in their original form, are not regulated for transportation. Ground Transport (US DOT): Not regulated Air Transport (IATA): Not regulated Marine/Water Transport (IMDG): Not regulated While the finished product is not considered hazardous as defined by OSHA in 29 CFR 1910.1200(d), this MSDS contains valuable information critical to the safe handling and proper use of the product United States All intentionally added components of this product are listed on the US TSCA Inventory. EPA Registration Number: Not Applicable. SARA 313/302/304/311/312 chemicals: None California: This product has been evaluated and does not require warning labeling under California Proposition 65. California Registration Number. Not Applicable. State Right -to -Know and CERCLA: The following ingredients present in the finished product are listed on state right -to -know lists or state worker exposure lists. Ingredient CAS # Level CERCLA State RQ IL MA NJ PA RI N/A Canada All ingredients are CEPA approved for import to Canada by Procter & Gamble. This product has been classified in accordance with the hazard criteria of the Canadian Controlled Products Regulations (CPR) and this MSDS contains all information required by the Controlled Products Regulations. SECTI©1�F_ XVI OTHER INFORMATION Perfumes contained within the products covered by this MSDS comply with appropriate IFRA guidance. P&G Hazard Rating: Health: 1 4=EXTREME Flammability: 0 3=HIGH Reactivity: 0 2=MODERATE I =SLIGHT 0 --NOT SIGNIFICANT *N/A. - Not Applicable *N/K. - Not Known Data supplied is for use only in connection with occupational safety and health. DISCLAIMER This MSDS is intended to provide a brief summary of our knowledge and guidance regarding the use of this material. The information contained here has been compiled from sources considered by Procter & Gamble to be dependable and is accurate to the best of the Company's knowledge. It is not meant to be an all- inclusive document on worldwide hazard communication regulations. This information is offered in good faith. Each user of this material needs to evaluate the conditions of use and design the appropriate protective mechanisms to prevent employee exposures, property damage or release to the environment. Procter & Gamble assumed no responsibility for injury to the recipient or third persons, or for any damage to any propertyresulting from misuse of the product. SAI-t:I Y UAIA SHttI MA016940 22 MULTI-QUAT SANITIZER Section 1. Chemical product and company identification Product name : 22 MULTI-QUAT SANITIZER Recommended use and : Sanitizer. restrictions Use only for the purpose on the nrndnd fahel Product dilution information Not app6catsie -77777 suppners mtormation Ecolab Inc. Institutional Division 370 N. Wabasha Street St Paul, MN 55102 1-800-352-5326 Code 910787-01 Date of issue 13 Feb 2013 EPA Registration No. 1677-198 EMERGENCY HEALTH INFORMATION: 1-800-328-0026 Outside United States and Canada CALL 1-651-222-5352 (n USA) Section 2. Hazards identification Product AS SOLD GHS Classification CORROSIVE TO METALS - Category 1 ACUTE TOXICITY: ORAL - Category 4 SKIN CORROSIONARRITATION - Category 1 B SERIOUS EYE DAMAGE/ EYE IRRITATION - Category 1 AQUATIC TOXICITY (ACUTE) - Category 2 GHS label elements Signal word : Danger Symbol Hazard statements May be corrosive to metals. Harmful if swallowed. Causes severe sidn bums and eye damage. Toxic to aquatic rife. Precautionary statements Prevention Wear protective gloves. Wear eye or face protection. Wear protective clothing. Keep only in original container. Avoid release to the environment. Wash hands thoroughly after handing. Response Page: 118 Section 3. Compositionlinformation on ingredients 1 Substance/mixture Mixture Product AS SOLD Hazardous ingredients BENZALKONIUM CHLORIDE QUATERNIUM-24 DIDECYLDIMONIUM CHLORIDE 1-octanaminium, n,n-dimethyl-n-octyl-, chloride ALCOHOL Concentration Range (%) CAS number 3 68424-85-1 [Section 2. Hazards identification 1.35 Absorb spillage to prevent material damage. IF 0.9 INHALED: Remove victim to fresh air and keep 1 - 5 at rest in a position comfortable for breathing. Skin contact Immediately call a POISON CENTER or physician. IF SWALLOWED: Immediately call a POISON CENTER or physician. Rinse mouth. Do NOT induce vomiting. IF ON SKIN (or hair): Inhalation Take off immediately all contaminated clothing. Rinse skin with water or shower. Wash contaminated clothing before reuse. Ingestion Immediately calla POISON CENTER or physician. IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. Immediately call a POISON CENTER or physician. Storage : Store in corrosive resistant container with a resistant inner liner. Disposal : See section 13 for waste disposal information. Other hazards : None known. Section 3. Compositionlinformation on ingredients 1 Substance/mixture Mixture Product AS SOLD Hazardous ingredients BENZALKONIUM CHLORIDE QUATERNIUM-24 DIDECYLDIMONIUM CHLORIDE 1-octanaminium, n,n-dimethyl-n-octyl-, chloride ALCOHOL Concentration Range (%) CAS number 3 68424-85-1 2.25 32426-11-2 1.35 7173-51-5 0.9 5538-94-3 1 - 5 64-17-5 Section 4. First aid measures Page: 2/8 Product AS SOLD Eye contact : Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. Get medical attention immediately. Skin contact : Take off immediately all contaminated clothing. Rinse skin with water or shower. Get medical attention immediately. Wash clothing before reuse. Clean shoes thoroughly before reuse. Inhalation : Remove victim to fresh air and keep at rest in a position comfortable for breathing. Get medical attention immediately. Ingestion : Get medical attention immediately. Rinse mouth. Do not induce vomiting. Page: 2/8 Section 4. First aid measures .,__.__._ _r -. U«LLIVIN V1 III -'3-L- NU at;uon snau oe iaKen invoiving any personal nsK or without suitable training. It may be aiders dangerous to the person providing aid to give mouth-to-mouth resuscitation. Wash contaminated clothing thoroughly with water before removing it, or wear gloves. Notes to physician In case of inhalation of decomposition products in a fire, symptoms may be delayed. The exposed person may need to be kept under medical surveillance for 48 hours. See toxicological information (section 11) Section 5. Fire -fighting measures eroauct As timu Suitable fire extinguishing : Use water spray, fog or foam. media Personal Specific hazards arising : In a fire or if heated, a pressure increase will occur and the container may burst. from the chemical This material is toxic to aquatic life. Fire water contaminated with this material must SOLD be contained and prevented from being discharged to any waterway, sewer or drain. Hazardous thermal : Decomposition products may include the following materials: decomposition products carbon dioxide carbon monoxide material. nitrogen oxides Environmental halogenated compounds Specific fire -fighting : Promptly isolate the scene by removing all persons from the vicinity of the incident if methods there is a fire. No action shall be taken involving any personal risk or without Methods for suitable training. Special protective : Fire-fighters should wear appropriate protective equipment and self-contained equipment for fire-fighters breathing apparatus (SCBA) with a full face -piece operated in positive pressure mode. Section 6. Accidental release measures I Product AS SOLD Ptoj cta'F;USE DILUTIOItI Personal Initiate company's spill response procedures Clata toi avatlabfe Refer,to Product AS precautions immediately. Keep people out of area. Put on SOLD appropriate personal protective equipment (see section 8). Do not touch or walk through spilled material. - Environmental Avoid contact of spilled material and runoff with precautions soil and surface waterways. - Methods for Follow company's spill procedures. Keep people cleaning up away from spill. Put on appropriate personal protective equipment (see section 8). Absorb/ neutralize liquid material. Use a tool to scoop up solid or absorbed material and put into appropriate labeled container. Use a tool to scoop up solid or absorbed material and place into appropriate labeled waste container. Use a water rinse for final clears -up. Section 7. Handling and storage Product AS SOLD Handling : Do not ingest. Do not get in eyes or on skin or clothing. Do not breathe vapor or mist. Use only with adequate ventilation. Wash thoroughly after handling. Storage : Keep out of reach of children. Page: 3/8 Section 7. Handling and storage UcuncCn mr, Tunuwrng Temperatures: u and 50°C Section 8. Exposure controls/personal protection 4-UMMI Parameters Ingredient name Exposure limits ALCOHOL ACGIH TLV (United States, 3/2012). engineering controls STEL: 1000 ppm 15 minutes. OSHA PEL (United States, 612010). TWA: 1900 mg/m3 8 hours. TWA: 1000 ppm 8 hours. NIOSH REL (United States, 6/2009). TWA: 1000 ppm 10 hours. TWA: 1900 mg/m310 hours. Skin protection Respiratory protection Hygiene measures : Use suitable protective equipment. A respirator is not needed under normal and intended conditions of product use. Wash hands, forearms and face thoroughly after handling chemical products, before eating, smoking and using the lavatory and at the end of the working period. Appropriate techniques should be used to remove potentially contaminated clothing. Wash contaminated clothing before reusing. (Section 9. Physical and chemical properties Product AS SOLD Physical state Liquid. Color : Red Odor : disinfectant pH : 7.7 (100%) Flash point : > 100°C Explosion limits : Not available. Page: 4/8 FrOauct A5 ZSULD Appropriate Use only with adequate ventilation. If user engineering controls operations generate dust, fumes, gas, vapor or mist, use process enclosures, local exhaust ventilation or other engineering controls to keep worker exposure to airborne contaminants below any recommended or statutory limits. Provide suitable facilities for quick drenching or flushing of the eyes and body in case of contact or splash Personal hazard. protection Eye protection : Use chemical splash goggles. For continued or severe exposure wear a face shield over the goggles. Hand protection : Use chemical -resistant, impervious gloves. Skin protection Respiratory protection Hygiene measures : Use suitable protective equipment. A respirator is not needed under normal and intended conditions of product use. Wash hands, forearms and face thoroughly after handling chemical products, before eating, smoking and using the lavatory and at the end of the working period. Appropriate techniques should be used to remove potentially contaminated clothing. Wash contaminated clothing before reusing. (Section 9. Physical and chemical properties Product AS SOLD Physical state Liquid. Color : Red Odor : disinfectant pH : 7.7 (100%) Flash point : > 100°C Explosion limits : Not available. Page: 4/8 Section 9. Physical and chemical properties gas) Melting point Boiling point Evaporation rate (butyl acetate = 1) Vapor pressure Vapor density Relative density Solubility Partition coefficient: n-octanol/water Auto -ignition temperature Decomposition temperature Odor threshold Viscosity Not availaDie. : Not available. : 100°C (212°F) : Not available. : Not available. : Not available. : 0.998 (Water= 1) : Easily soluble in the following materials: cold water and hot water. Not available. : Not available. : Not available. : Not available. : Not available. Section 10. Stability and reactivity r'lUUMAwQ OVLtJ Stability : The product is stable. Possibility of hazardous : Under normal conditions of storage and use, hazardous reactions will not occur. reactions Conditions to avoid : No specific data. Materials to avoid : Not available. Hazardous decomposition : Under normal conditions of storage and use, hazardous decomposition products products should not be produced. Section 11. Toxicological information MVULe or exposure Sym toms Eye contact Skin contact Inhalation Ingestion Acute toxicity Eye contact Skin contact : sKin contact, tye contact, Inhalation, Ingestion Product AS SOLD : Adverse symptoms may include the following: pain watering redness : Adverse symptoms may include the following: pain or irritation redness blistering may occur : Adverse symptoms may include the following: coughing Respiratory tract irritation : Adverse symptoms may include the following: stomach pains : Causes serious eye damage. Page: 5/8 Section 11. Toxicological information Causes severe burns. Inhalation May give off gas, vapor or dust that is very irritating or corrosive to the respiratory system. Ingestion Harmful if swallowed. May cause bums to mouth, throat and stomach. Toxicity data Product/ingredient name Result Species quaternary ammonium compounds, benzyl- LD50 Dermal Rabbit c12-c16-alkyldimethyl, chlorides 1-decanaminium, n,n- dimethyl-n-octyi-, chloride ethanol didecyldimethylammonium chloride 1-octanaminium, n,n-dimethyl-n-octyl-, chloride Chronic toxicity Carcinogenicity Mutagenicity Teratogenicity Developmental effects Fertility effects LD50 Oral LC50 Inhalation Dusts and mists LD50 Dermal LD50 Oral LC50 Inhalation Vapor LD50 Dermal LD50 Oral LC50 Inhalation Dusts and mists LD50 Dermal LD50 Oral LC50 Inhalation Dusts and mists LD50 Dermal LD50 Oral Rat Rat Rabbit Rat Rat Rabbit Rat Rat Rabbit Rat Rat Rabbit Rat No known significant effects or critical hazards. No known significant effects or critical hazards. No known significant effects or critical hazards. No known significant effects or critical hazards. No known significant effects or critical hazards. Section 12. Ecological information Dose 3340 mg/kg 344 mg/kg 0.07 mg/I 2930 mg/kg 238 mg/kg 117 mg/l 15800 mg/kg 10470 mg/kg 0.07 mg/I 2930 mg/kg 1150 mg/kg 0.07 mg/I 2930 mg/kg 238 mg/kg Product AS SOLD Ecotoxicity This material is toxic to aquatic life. AAguatic and terrestrial toxicity Product/ingredient name Result Species Exposure quaternary ammonium compounds, benzyl- Acute LC50 0.515 mgh Fish 96 hours c12-c16-alkyldimethyl, chlorides 1-decanaminium, n,n-dimethyl-n-octyl-, chloride Acute LC50 <1 mg/I Fish 96 hours ethanol Acute LC50 11000 mg/I Fish 96 hours didecyldimethylammonium chloride Acute LC50 <1 mg/I Fish 96 hours 1-octanaminium, n,n-dimethyl-n-octyl-, chloride Acute EC50 0.1 mg/I Daphnia 48 hours Other adverse effects : No known significant effects or critical hazards. Page: 6/8 I Section 13. Disposal considerations Product AS SOLD Disposal methods : Avoid disposal. Attempt to use product completely in accordance with intended use. Disposal should be in accordance with applicable regional, national and local laws and regulations. Section 14. Transport information Certain shipping modes or package sizes may have exceptions from the transport regulations. The classification provided may not reflect those exceptions and may not apply to all shipping modes or package sizes. oI DOT Classification Not regulated. IMO/IMDG IMO/IMDG Classification Not regulated. For transport in bulk, see shipping documents for specific transportation information. Product AT USS Qli.tl��;©N Not intended fbr i:ranspart Section 15. Regulatory information Product AS SOLD U.S. Federal regulations TSCA 8(b) inventory : All components are listed or exempted. EPA Registration No. : 1677-198 SARA 302/304/3111312 extremely hazardous substances: No listed substance SARA 302/304 emergency planning and notification: No listed substance Form R - Reporting requirements California Prot). 65 Product name No listed substance : No listed substance Section 16. Other information Product AS SOLD Hazardous Material Information System (U.S.A.) National Fire Protection Association (U.S.A.) Page: 718 Section 16. Other information Flammability Health R3" -i 40 Instability/Reactivity Special Date of issue : 13 Feb 2013 Prepared by : Regulatory Affairs 1-800-352-5326 Notice to reader The above information is believed to be correct with respect to the formula used to manufacture the product in the country of origin. As data, standards, and regulations change, and conditions of use and handling are beyond our control, NO WARRANTY, EXPRESS OR IMPLIED, IS MADE AS TO THE COMPLETENESS OR CONTINUING ACCURACY OF THIS INFORMATION. Page: 8/8 Material Safety Data Sheet RAM Cleaner Ramage Enterprises 9219 Gulf Beach Hwy #8 Pensacola, FL 32507 Emergency Tel # 1-800-326-2644 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Product Name: RAM A Fully Concentrated All Purpose Cleaner Synonyms: Liquid non-toxic cleaner Company ID: RAM Enterprises PO Box 790 Elberta, AL 36530 2. COMPOSITION INFORMATION ON INGREDIENTS Component CAS Reg. No. Non -Ionic surfactant 26027-38-3 Sodium metasilicate pentahydrate 6834-92-0 2 methoxyethanol 109-86-4 2 butoxyethanol 111-76-2 cyclohexene 13886-3 potassium hydroxide 1310-58-3 Water 7732-18-5 See Section 8 for Personal Protection (PPE). 3. HAZARDS IDENTIFICATION Emergency Overview: Appearance & Odor: Clear liquid with mild organic odor. Warning Statements: This mixture is basic It is important to avoid contact with strong acids and storage in aluminum containers. The product's main routes of entry are through skin contact, eye contact and inhalation of the mist. Mixture may cause mild irritation to skin, mild irritation to eyes and the gastrointestinal tract if swallowed. Mixture may cause irritation to nasal and respiratory passages. Potential Adverse Health Effects: Eye Contact: May cause irritation. Skin Contact: May cause dryness and irritation of the skin. Ingestion: May irritate the mucous membrane if ingested and be harmful Inhalation: If inhaled may cause irritation to nasal and respiratory passages. 4. FIRST AID MEASURES If in Eyes: Flush with cool water for 15 minutes. Remove contact lenses, if applicable and continue flushing for 15 minutes. Hold eyelids apart to rinse the entire surface of the eyes and lids. Seek medical attention if irritation persists. If on Skin: Wash skin with ample cold water and then with soap and water. Seek medical attention if irritation and/or if redness persists. If Swallowed: Drink 1 to 2 glasses of water and induce vomiting. Never give anything to a person who is unconscious. Seek medical attention immediately if vomiting continues. If Inhaled: Remove to fresh air. If not breathing, call 9-1-1. Seek medical immediately. 5. FIRE FIGHTING MEASURES Flash Point: Not a flammable liquid. Flammable Limits: None established Extinguishing Media: Use appropriate medium for surrounding fire such as alcohol foam, carbon dioxide water spray or fog. Special Fire Fighting Procedures: Provide for the protection of the employees and residents: Notify local authorities that firemen should wear self-contained breathing apparatus with full protecting clothing. If the product gets into a fire situation, it may explode. See section 11 for toxicological data. 6. ACCIDENTAL RELEASE MEASURES In Cases of Spill or Leak: For small spills, ventilate the area and wear proper personal protective equipment. For large spill, contact emergency responders and secure area from anyone. 7. HANDLING AND STORAGE Please keep mixture in a cool, dry place away from everyone such as children, food, feed and domestic animals. Prevent eating, drinking, tobacco usage, and cosmetic application in areas where there is a potential for exposure to the material. Always wash your hands thoroughly after handling., i 8. EXPOSURE CONTROLS / PERSONAL PROTECTION Eye Protection: Chemical goggles. Skin Contact: To avoid skin contact on hands wear chemical resistant gloves along with appropriate work clothing and boots. The concentrated mixture can very slippery to the touch. Use mild detergent and water to dean the PPE. Respiratory Protection: Not required; materials is non-toxic. Ventilation Protection: Not required; if in dose area one may want to provide adequate ventilation. 9. PHYSICAL AND CHEMICAL PROPERTIES Appearance: Clear liquid. Odor: Mild lemon -lime odor. Solubility: Soluble in water. Specific gravity (water=l) 1.05 Boiling point: 208 OF pH. 11.1 Properties: Non-flammable liquid Note: These physical data are typical values based on material tested but may vary from sample to sample. Typical values should not be construed as a guaranteed analysis of any specific lot or as specification items. 10. STABILITY AND REACTIVITY Chemical Stability: Stable at room temperature. Conditions to Avoid: Excessive heat. Materials to avoid: Avoid oxidizers and strong acids. Avoid storage in aluminum. Hazardous Decomposition Products: Oxides of carbon, sulfur and nitrogen. 11. TOXICOLOGICAL INFORMATION Routes of entry: Eye, skin contact, inhalation and ingestion. Eye Irritation: May cause mild irritation to the eyes. Skin Irritation: May cause mild irritation and/or redness to the skin. Inhalation: May cause mild irritation if inhaled. Ingestion: May cause irritation if ingested. Carcinogenicity: Not a carcinogen according to OSHA and IARC 12. ECOLOGICAL INFORMATION This product is biodegradable and contains no phosphates Product is a not a marine pollutant. 13. DISPOSAL CONSIDERATIONS Wear proper PPE found in section 8. A person must be adequately trained by OSHA to deal with a large spill of this mixture. Protect from excessive heat however the product non-flammable. Mixture must be stored in a cool dry place. 14. TRANSPORTATION INFORMATION Follow the precautions indicated in the Handling and Storage Section, Section 7 of this MSDS. US DOT Classification for highway: Not regulated by US DOT in non bulk containers. IATA/ICAO Shipping Description: DO NOT SHIP by AIR unless container and package are authorized for air shipment. Please call for proper packaging. Call to check on proper classification and proper shipping description. IMO Shipping Description: Call for proper classification if shipping by water. 15. REGULATORY INFORMATION SARA Hazard Notification/ Reporting Immediate lY Fire N Sudden Release of Pressure N Delayed N Reactive N SARA Title 313, Toxic chemicals: None Section 302-304 (30 CFR 350): None Extremely hazardous substance (EHS): None SARA/OSHA Hazardous chemical reporting quantity: No RCRA Hazardous waste: No Prop 65 Chemicals: None 16. OTHER National Fire Protection Association (NFPA) Hazardous Materials Identification System (HMIS) NFPA HMIS 1 Health 0 Least 1 Health 0 Flammability i Slight 0 Flammability O Instability 2 Moderate 0 Reactivity 3 High D PPE 4 Severe Prepared by: Dennis E. Belau Reviewed by: Ramage Enterprises, Inc. Although the information and recommendations set forth herein (hereinafter "Information") are presented in good faith and believed to be correct as of the date hereof, RAM Enterprises, Inc. makes no representations as to the completeness or accuracy thereof. Information is supplied upon the condition that the persons receiving same will make their own determination as to its I Stortec HS1012BC Item#:2-Alt TOM STORTECSYSTEMS CO., LLC HAND SINKS STAINLESS STEEL TYPE 304 - 20 GA. MODEL NO. DESCRIPTION BOWL SIZE" O/A SIZE" HS12B W/MT BRACKET 9 X 9 X 5 12 X 16 HS12BC W/MT BRACKET SAME SAME DRAIN, FAUCET HSS12BC SAME AS ABOVE SAME SAME EXCEPT W/2 SIDE SPLASH HS1012B W/MT BRACKET 12 3/ X10 X 5 518 15%X15 51012BC WIMT BRACKET SAME SAME DRAIN, FAUCET HSS1012BC SAME AS ABOVE SAME SAME EXCEPT W2 SIDE SPLASH HS17B W/MT BRACKET 14 X 10 X 5'/ 17 X 15 HS17BC W/MT BRACKET SAME SAME DRAIN, FAUCET HSS17BC SAME AS ABOVE SAME SAME EXCEPT W/2 SIDE SPLASH Stortec Systems Co., LLC 17141 Grand Bay Dr Boca Raton, FL 33496 NSF. P:561-912-1310 F:561-997-0714 The Meat House Andover Alternative Sales Page: 4 Fisher 62677 Item#:3 4" BACKSPLASH FAUCET W/ LEVER HANDLES 4' BACKSPLASH FAUCET W/ WRIST HANDLES 4" [102mm] 4" C/C BACKSPLASH FAUCET 4 1/4"" 5 7/8" [108mm] [149mm] LEVER HANDLES WRIST CONCENTRICS HANDLES SLIP JOINT KIT ROUGH -IN: BACKSPLASH 4' 1102 M] 07/8• [22mm] ANSVA112.18.1-2005 PRODUCT NAME: STAINLESS STEEL 4" BACKSPLASH / ADJ. WALL FAUCET WITH SWIVEL / RIGID GOOSENECK SPOUT MODEL• ❑ 62669 W/ W SWIVEL/RIGID GOOSENECK SPOUT W/ LEVER HANDLES ❑ 62502 W/ 12' SWIVEL/RIGID GOOSENECK SPOUT W/ LEVER HANDLES ❑ 62677 W/ 6' SWNEL/RIGID GOOSENECK SPOUT _ W/ WRIST HANDLES ❑562 10 W/ 12' SWIVEL/RIGID GOOSENECK SPOUT W/ WRIST HANDLES FEATURES CONTROL VALVE 4' C/C BACKSPLASH CONCENTRICS STAINLESS STEEL CONSTRUCTION ` SWIVELLING SEAT DISKS HOT SIDE STEM - RIGHT HAND COLD SIDE STEM - LEFT HAND LEVER HANDLES OR WRIST HANDLES GOOSENECK SPOUT SYSTEM LIMITS `TEMP: 40"F MIN. TO 140'F MAX. ` PRESSURE: 200 PSI MAX. STATIC 2.20 GPM AT 80 PSI SHIPPING WEIGHT 5.0 LBS NSF 61-9 APPROVED $ LISTED www.truesdaii.com MODELS DIM A' DIM "B' DIM'C' 62669 4-1/2' 8 1/16' 3-1/2' 62677 [114.3mm] [204.8mm] [88.90mm] 62502 8-1/4" 12-1/4' 5-1/2' 62510 [209.6mm] [311.2mm] [139.7mm] /SHER FISHER MANUFACTURING COMPANY TOLL FREE: 800-421-6162 - FAX: 800-832-8238 informa6on@fisher-mfg.com - www.fisher-Wg.com The Meat House Andover Alternative Sales Page: 5 Turbo Air TSA -1 -Li Item#A REFR/GER.47ORMAMUFAC7URER i AV Iwr more durable, convenient, beautifu I 1250 Victoria St Carson, CA 90746 Tel. 310-900-1000 Fax. 310-900-1077 www.turboairinc.com Project Model #: Item #: Qty: Available W/H Approval: af1G'�"COI17 j?f`�T�7G'11 117kt`S (One Drain Board) HIGH QUALITY 304 STAINLESS STEEL NSF. Faucet sold seperately Model: TSA -1-12-L1/ TSA -1-1442 TSA -141/ TS11-142 ■ ENTIRE ASSEMBLY IS FUSED, SHIELDED AND POLISHED PROVIDING A ONE-PIECE SEAMLESS SINK UNIT ■ WELDED AREAS ARE HIGH-SPEED BELT BLENDED TO MATCH ADJACENT SURFACES WITH THE CONTINUITY OF A SATIN FINISH ■ ALL SINK COMPARTMENTS ARE COVERED ON A FULL 5/8" RADIUS AND CONSTRUCTED USING STATE OF THE ART SEAMLESS WELDING TECH- NIQUES ■ DIE -STAMPED CREASED DRAIN BOARDS FOR POSITIVE DRAINAGE • SWIRL AWAY BOWL DRAINAGE ■ GALVANIZED LEGS AND GUSSETS ■ ADJUSTABLE ABS BULLET FEET ■ STAINLESS STEEL LEGS AVAILABLE (OPTIONAL) _ t w 0 0 � Q t w (unit: inch) Model Ga. Bowl Size (I x W' x HI Length Width Height # of Faucet Accepted Net Weight ` (lbs.) TSA -1-12-L1 18 18x18x12 39 24 441/2 1 39 TSA -1-14-L2 18 18x18x14 45 24 441/2 1 43 TSA -1 -Ll 18 18x18xll 39 24 1 441/2 1 39 TSB -1-L2 16 24x24xl4 51 30 441/2 1 70 Ver201211 Information and specifications are subject to change without notice. * All net weights are approximated Crafting fee will be added for shipping via common carriers (Please confirm at the time of the purchase). The Meat House Andover Alternative Sales Page: 6 Fisher APPLICATION: JOB NAME: QUANTITY: —12"— [305mm] 8" — [204mm] ITEM NO. 'p' "C" MODEL DIM "A" DIM "B" DIM "C" 34908 2-1/4" 5-7/8" 6' 34924 [57mm] [149mm] [152mm] 34916 SAME AS A 13277 W/ 14" SWING SPOUT ❑ 34932 SAME AS A 13218 W/ 16" SWING SPOUT [2-1/2" 64mm [ 62m ] 162mm [204mm ] 34924 3-1/8' 6-7/8" 10" [79mm] [175mm] [254mm] 29254 3-3/4' 7-3/8' 12" [95mm] [187mm] [305mm] 29238 4-3/8" 8-1/4" 14' [111 mm] [210mm] I [356mm] 34932 5' [127mm] 8-7/8" [225mm] 16' [406mm] ROUGH -IN: FISHER CONCENT &1/2" SLIP (NEW INSI fd7/8' [22mm] 2-1/4' m7mm1 FOR EZ INSTALL ADAPTERS $A ANSI/A112.18.lM The Meat House Andover 34924 PRODUCT NAME: Item#:5 8" CIC BACKSPLASH FAUCET ❑ SPECIAL CONFIGURATION CHECK BASE MODEL AND OPTIONS MODEL: ❑ 34908 SAME AS A 13234 W/ 6'SWING SPOUT ❑ 34916 SAME AS A 13242 W/ 8"SWING SPOUT 34924 SAME AS A 13250 W/ 10" SWING SPOUT 29254 POUT ❑ 29238 SAME AS A 13277 W/ 14" SWING SPOUT ❑ 34932 SAME AS A 13218 W/ 16" SWING SPOUT OPTIONS OR MODIFICATIONS: ❑ SUPPLY LINES (24" OR 36') CIRCLE LENGTH ❑ DJ SUB -ASSY (7-1/4' OR 13") CIRCLE LENGTH ❑ ELBOWS ❑ VANDAL RESISTANT KIT ❑ HANDLES (CROSS OR WRIST) CIRCLE STYLE ■ OTHER EZ INSTALL ADAPTERS, T&S, CHI, CHG FEATURES POP PACKAGING ' WHITE BOX • COLOR PRODUCT LABEL CONTROL VALVE ' 8C/C BACKSPLASH MOUNT • SWIVELLING SEAT DISKS ' HOT SIDE STEM - RIGHT HAND COLD SIDE STEM - LEFT HAND ' STAINLESS STEEL SEATS STAINLESS STEEL SEAT SCREWS ' STAINLESS STEEL HANDLE SCREWS ' 1/2' SLIP JOINT SYSTEM LIMITS ' TEMP: 40°F MIN. TO 140'F MAX. PRESSURE: 200 PSI MAX. STATIC 2.20 GPM AT 80 PSI SHIPPING WEIGHT ' 5.0 LBS ALL 'ER LENT OF STALL) Alternative Sales /SHER FISHER MANUFACTURING COMPANY TOLL FREE: 800-421-6162 - FAX: 800-832-8238 information c0sher-mfq.com - www.fisher-mfq.com Page: 7 Toku Jwlmaf Sink & lk TOIET larew Uk & St m-ge PAZ W O '1D co V ON Ul oP W N O �.o co 14 ON ul �P O d �s NdM CAC C,tZIHHHbH�?O �sa�oaa�= 01' �a�a�oaak� nx m* > +� N ° m o o s o o o"'�,'""ctz (4Ln cn o va ►� rt� o t CA ` S. n w v �m a m* > +� N ° m z m ° -' o� °°- m _D D ;Z m. n w v �m Supera ® imple. Successful. Supera High -Temp Model Numbers: SSUD18-1 Dishwasher: Supera® High -Temp Door -Type Dishwashers Bring your commercial kitchen into the 21 st century and solve your dirty dish dilemma with a Supera® High -Temp Door -Type Dishwasher. Designed for top performance at an economic value these dishwashers will blast through racks of dirty dishes fast and get them squeaky clean and ready for the next customers to keep your restaurant running properly. FEATURES Efficient and Fast You won't be drowning in a never ending sea of dirty dishes when you have a Supera® High -Temp Door -Type Dishwasher. It's durable and reliable stainless steel design makes plates, glasses and flatware clean in a snap, no matter how many dishes you have to get washed during your shift. The 1.2kW pump is highly efficient and assures maximum cleanliness in a short amount of time. And when you find that one rogue fork that escaped the final wash cycle of the night, feel free to open the door and toss it in. The pump power automatically turns off when the door is opened mid cycle. User Friendly Design We know that no one likes to wash the dishes, so let this dishwasher do all the work for you. It comes with built-in programmable automatic chemical dispensers that make dish washing a breeze. The included self - flushing strainer system and removable scrap basket means less work for you and your staff. The booster system keeps water at the optimal high heat rinse temperature ensuring your dishes will always be sparkling clean with no residue. Versatility is Key Supera® knows every kitchen is set up differently and versatility is key. Supera® Dishwashers were designed for installation as a straight -through unit or a corner set up allowing adaptability to fit your kitchens layout that gives your staff more room to work around the unit and get the job done. Features at a Glance: • LED temperature display • Designed for performance at an economic value • Durable stainless steel construction • Adaptable design for straight through or corner set up installation • Easy to use built-in programmable automatic chemical dispensers Ffi • Interior roof cleaning system is included for hard to reach roof area � • Booster keeps optimal rinse temperature SSUD18-1 • Front side accessible for all washer components • Large wash tank holds 10.6 gallons • Wash chamber is fully enclosed • 1.2kW pump is highly efficient and assures maximum cleanliness • Pump power automatically turns off if door opens mid cycle • When the door is opened the wash chamber retains heat • Includes self -flushing stainless steel strainer system with removable scrap basket 4,�S u era® - Simple. Successful. Supera 'i., Model Numbers: SSUD18-1 Plan View Model SSUD18-1 Dimensions 25.6"W x 64.8"H x 29.3"D Dishwasher Type floor -Type Door Location Front Hz. 60 Amps 30 Incoming Water Temperature 120° Phase 3 Rack Included Yes Racks per Hour 55 Rinse Tank Capacity 7.1 gal Rinse Temperature High -Temp Voltage 208 Wash Cycle 60 seconds Wash Tank Capacity 10.6 gal Shipping Weight 205 1 YEAR. PARTS AND LABOR \ I WATER 2s.G- VACCUM E a,txr+l i �r�G.l (LCET m R6[ I'MI'H AC 200V 3PI I (� r RINSE DR/M OALL VALVE I12' Aall DRAM 'AASH MAIN Nd R. i'Pf fTF i qy - s �- ? aQ� G Food Establishment Plan Review Guide FOOD ESTABLISHMENT PLAN REVIEW APPLICATION IS TO BE COMPLETED BY THE OPERATOR AND SUBMITTED TO THE REGULATORY AUTHORITY — at least 60 days in advance before commencement of any food establishment planned openings. TOWN OF NORTH ANDOVER, MA Regulatory Authority 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Date:Qzzz1,5 NEW - New construction, not yet built REMODEL - partial or major renovation of existing establishment CONVERSION — existing establishment that you are purchasing Name of Establishment: \e't N}�\�j Corporate Name: t Category: Restaurant V, Institution , Daycare , Retail Market N _Z, Other Establishment Address: n mffi O`U\AS Phone: (at location if available) E-mail Contacts: Name of Owner: , Mailing Address: Q(01 1!%eC'r\UM �kf*m Mh Oayqa) Telephone: &154—ga5_q,-j Applicant's Name (if different than owner): NA Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 1 of 19 Title (owner, manager, architect, etc.): NA Mailing Address: Telephone:1�. N Date Received: BOH office use only Date Review completed: BOH office use only: Approved / Denied Date Revised application Received: BOH office use only Date Review completed: BOH office use only: Approved / Denied Technical Assistance with,the Permitting Process The Town Planning Department offers the option of attending a Technical Review Committee (TRC) meeting to all applicants. As the applicant, I acknowledge that I have received an explanation and understand that the purpose of the TRC meeting is it to assist me in the various town processes needed to open my establishment. If declined I understand that I have forfeited this opportunity to learn more about the North Andover permitting process. I wish to tten or decline (circle one) participation in the TRC process. Date of TRC (BOH only) General Information Hours of Operation: Sun I k—j!_ ThursA7_4_ Mon Fri_ Tues + Sat 1�—$ Wed \�— 7[ ➢ Number of Seats for customers:__ ➢ Number of Staff: O (Maximum per shift) ➢ Total Square Feet of Facility:Q(P� ➢ Number of Floors on which operations are conducted_ ➢ Maximum Daily Meals to be Served: ➢ Breakfast (approximate number) ➢ Lunch ➢ Dinner Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 2 of 19 Type of Service: Sit Down Meals _ (check all that apply) Take Out NZ Caterer Mobile Vendor Other Please enclose the following documents: Proposed Men (' clu ing seasonal, off-site d banquet menus) COC co&w/ ibc$ C Y) C c 6 ak '-r-5 Manufacturer Specificati sheets for each piece of equipment shown on the p an Q iA S rionp lan showing location of business in building; location of building on site including alleys, streets; and loaof 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 y E , ui ment schedule q p CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan accurately drawn to a minimum scale of 1/4 inch = 1 foot. This is to allow for ease in reading plans. 2. Include: proposed menu, seating capacity, and projected daily meal volume for food service operations. 3. Show the location of each piece of equipment. Each must be clearly labeled on the plan with its common name. Each unit must be sequentially numbered and the numbers must correspond to the equipment specification sheets and an equipment schedule. All self-service hot and cold holding units must have sneeze guards. 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 hand washing lavatories for each toilet fixture and in the immediate area of food preparation, cooking and ware washing, (a hand sink should be located within 10 feet of each area for easy access for all food handlers) 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. 9. Include and provide specifications for: Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 3 of 19 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; (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 hand washing, ware washing, and equipment and utensil storage, and in toilet rooms; and (3) At least 540 lux (50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment such as knives, slicers, grinders, or saws where employee safety is a factor. e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an ANSI accredited certification program (when applicable). f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A mop sink or curbed cleaning facility with facilities for hanging wet mops; h. Garbage can washing area/facility; i. Cabinets for storing toxic chemicals; j. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; k. Site plan (plot plan for new construction) PLEASE CIRCLEIANSWER THE FOLLOWING QUESTIONS FOOD PREPARATION REVIEW Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 4 of 19 Check categories of Potentially Hazardous Foods (PHF's) to be handled, prepared and served. CATEGORY* 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) 5. Bakery goods (pies, custards, cream fillings & toppings) 6. Other FOOD SUPPLIES: 1. Are all food supplies from inspected and approved sources? YES NO 2. What are the projected frequencies (daily, weekly, etc) of deliveries for Frozen foods , Refrigerated foodsg��, and Dry goods 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage , Refrigerated Storage _ , and Frozen storage 4. How will dry goods be stored off the floor? COLD STORAGE: 1. Is adequate and approved fi eezer and refrigeration available to store frozen foods frozen, and refrigerated foods at 41°F (5°C) and below. YES NO 2. Will raw meats,nand seafoo e stored in the same refrigerators and freezers with cooked/ready-to- eat foods? YES 0 If yes, how will cross -contamination be prevented? 3. Does each refrigerator/freezer have a thermometer? YES NO Number of refrigeration units: Number of freezer units: Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 5 of 19 Y 4. Is there a bulk ice machine available? YES / NO Is ice packaged and sold for retail? YES NO THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: NA Please indicate by checking the appropriate boxes how frozen potentifoods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place. Food Thawing Method *Thick or Bulk Frozen *Thin/Portioned Frozen Refrigeration X X Running Water Less than 70°F(21°C) X x Microwave (as part of cooking process) X X Cooked from Frozen state X X Other (describe) �C x *Frozen foods: approximately one inch or less = thin, and more than an inch = thick. PREPARATION: 1. Please list categories of foods prepared more than 12 hours in advance of service. 2. Will food employees be trained in good food sanitation practices. YES NO Method of training: Number(s) of employees: Dates of completion:NA 3. Will di sable gloves and/or utensils and/or food grade paper be used to prevent handling of ready -to -eat foods? YES NO Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 6 of 19 4. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? YES / NO Please describe briefly: Will employees have paid sick leave. YE / NO 9 5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type: Mv `�� Concentration: 2.010 p p,-%— Test Ki YES NO 6. Will ingredients for cold ready -to -eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre -chilled before being mixed and/or assembled? YES/NO If not, how will ready -to -eat foods be cooled to 41'F? 19 X 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 If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 7 of 19 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (417 - 140T) during preparation. 9. Where raw meats, poultry and seafood are prepared in the same work area or using the same equipment as cooled/ready to eat foods, how will cross contamination be prevented? 10. Please list all PHF's you plan to serve which will/may not be cooked to the previously listed minimum temperatures. A proper "consumer advisory" warning notation must be printed on menu or menu boards. 11. Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared on-site or otherwise required by the regulatory authority. x WA 12. Will the facility be serving food to a highly susceptible population? YES NO If yes, List measures taken to comply with code requirements. COOKING: 1. Will food product thermometers be used to measure final cooking/reheating temperatures of PHF's? YES / NO What type of temperature measuring device: NA Minimum cooking time and temperatures of Product utiliziniz convection and conduction heatinr equipment: ➢ beef roasts ➢ 130°F (121min) ➢ solid seafood pieces ➢ 145T (15 sec) ➢ other PHF's ➢ 145°F (15 sec) ➢ eggs: ■ Immediate service 145°F (15 sec) pooled* 1557 (15 sec) (*pasteurized eggs must be served to a highly susceptible population) ➢ pork ➢ 145°F (15 sec) ➢ comminuted meats/fish ➢ 155T (15 sec) ➢ poultry ➢ 165T (15 sec) ➢ reheated PHF's ➢ 165T (15 sec) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 8 of 19 2. List types of cooking equipment. HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 140°F (60°C) or above during holding for service? Indicate type and number of hot holding units. 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: * A Please indicate) by checking the appropriate boxes how PHF's will be cooled to 41 °F (5°C) within 6 hours (140°F to 70°F in 2 hours and 70°F to 41°F in 4 hours). Also, indicate where the cooling will take place. COOLING METHOD THICK MEATS THIN MEATS THIN SOUPS/ GRAVY THICK SOUPS/ GRAVY RICE/ NOODLES Shallow Pans X X X Ice Baths X X X X X Reduce jVolume or Size X x x X Rapid Chill X X X X Other (describe) x Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 9 of 19 REHEATING: 1. How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. 2. How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? A. FINISH SCHEDULE Materials selected must be durable and appropriate to the area and its intended use. High moisture and food splash areas must be non-absorbent, smooth and easily cleanable. All openings must be tight fitting, properly sealed and without voids. Applicant must indicate which materials (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. (please be specific) F Kitchen FLOOR COVING WALLS CEILING Bar rFood Storage . y .PUC Other Storage Toilet Rooms ex��c�t1g Dressing Rooms i NA ��A Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 10 of 19 Kitchen YES NO N/A 1. Will all outside doors be self-closing and rodent proof. Garbage & 2. Are screen doors provided on all entrances left open to the outside? / Refuse Storage I Mop Service 4. Is the placement of electrocution devices identified on the plan? Basin Area I 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? Ware washing 7. Will air curtains be used? If yes, where? Area 8. Do you have a plan to have a contract pest control company? If yes, list company name, describe frequency of inspection and type of service. QAC. cff Walk-in Refrigerators and Freezers W ` B. INSECT & RODENT CONTROL APPLICANT: PLEASE CHECK APPROPRIATE BOXES. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, ��,�,� v"P North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 age 11 of 19 YES NO N/A 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 operable windows have a minimum #16 mesh screening? 4. Is the placement of electrocution devices identified on the plan? 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? 7. Will air curtains be used? If yes, where? 8. Do you have a plan to have a contract pest control company? If yes, list company name, describe frequency of inspection and type of service. QAC. cff Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, ��,�,� v"P North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 age 11 of 19 C. GARBAGE AND REFUSE INSIDE YES NO N/A 9. Do all containers have lids? 10. Will refuse be stored inside? If so, where? / 11. Is there an area designated for a garbage can or floor mat cleaning? OUTSIDE 4 12. Will a dumpster be used? Number: Size of: a. Number: b. Size of: c. Frequency of Pick -Up? Indicate days and how often 13. Will a compactor be used? Number: Size: Frequency of Pick -Up 14. Will garbage cans be stored outside? 15. Describe surface and location where dumpster/compactor/garbage cans are to be stored. bac�, ac -m 16. Describe location of grease storage receptacle 17. Is there an area to store recycled containers? / V 18. Is there any area to store returnable, damaged goods? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 12 of 19 D. PLUMBING CONNECTIONS The FDA Food code and plumbing requirements do not replace or supersede the MA State Plumbing Code, which also must be fully met; instead, it highlights potential hazardous circumstances and particular types of equipment common to food service operations that, if through improper design or installation, could result in contamination of food or water supply. Please indicate proposed properly installed equipment. Equipment Code Confirmed Describe/ Comments Requirements by Operator please initial Dish Machine Backflow prevention +' device i Indirect Waste Steam Jacketed Backflow prevention Kettle device Indirect Waste i I Steamer Backflow prevention device Indirect Waste Garbage Disposals or dish table Backflow prevention device troughs; Submerged inlets At all hose Backflow prevention connections device Garbage can washer Backflow prevention device x [Carbonated I beverage Carbonated Backflow prevention device dispenser Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 13 of 19 Refrigerator Indirect Waste condensate/ drain lines Ice storage bins Indirect Waste � All sinks Air Gap C? Ff Ice Cream dipper Air Gap wells Other I I 19. Are floor drains provided & easily cleanable, if so, indicate location: E. WATER SUPPLY 20. Is water supply public (V<Or private ( )? 21. If private, has source been approved? YES ( ) NO ( ) PENDING ( ) Please attach copy of written approval and/or permit. 22. Is ice made on premises ( ) or purchased commercially ( )? If made on premise, are specifications for the ice machine provided? YES ( ) NO ( ) Describe provision for ice scoop storage: `A Provide location of ice maker or bagging operation M 23. What is the capacity of the hot water generator? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 14 of 19 24. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water / 25. Is there a water treatment device? YES ( ) NO If yes, how will the device be inspected & serviced? 26. How is backflow prevention devices inspected & serviced? F. SEWAGE DISPOSAL 27. Is building connected to a municipal sewer? 28. If no, is private disposal system approved? Please attach copy of written approval and/or permit. 29. Are grease traps provided? If so - where? YES(,40 ( ) YES ( ) NO ( ) PENDING ( ) X YES (�440 ( ) Note: Grease Traps must have the following sign. The language in bold is specific; please do not change it in any way. If you have one or more interior grease traps please note the plumbing code 248 CMR 10.09 (m): 1. A laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one -inch high. The sign shall state the following in exact language: IMPORTANT The 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). G. DRESSING ROOMS 30. Are dressing rooms provided? YES () NO M 11, 31. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas, etc.) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845^ --Phone: 978.688.9540-- Fax: 978.688.8476 Page 15 of 19 H. GENERAL 32. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES ( ) NO ( ) Indicate location: 33. Are all toxics for use on the premise or for retail sale (this includes personal med' ations), stored away from food preparation and storage areas? YES (VENO ( ) 34. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES 0/<NO ( ) Note: Material Safety Data Sheets (MSDS) are required to be kept for all chemicals on the premises. Where the M$DS information be kept on displ#y for easy access in an emergency? 35. Will linens be laundered on site? YES( )NOV If yes, what will be laundered and where? NA If no, how will linens be cleaned?U=-)bec d".0 36. Is a laundry dryer available? 37. Location of clean linen storage: YES( ) NO V 38. Location of dirty linen storage: bw)b n ckobm wcke\ Qa 39. Are containers constructed of safe materials to store bulk food products? YES V40 ( ) Indicate type: 40. Indicate all areas where exhaust hoods are installed: 4\k&on LOCATION FILTERS WOR SQUARE FEET ° FIRE AIR CAPACITY AIR MAKEUP EXTRACTION DEVICES f PROTECTION CFM CFM j P h �JJ L \ Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 16 of 19 41. How is each ventilation hood system that is listed cleaned? I. SINKS 42. Is a mop sink present? YES (v'f10 ( ) If no, please describe facility for cleaning of mops and other equipment: 43. If the menu dictates, is a food preparation sink present? YES VNO ( ) detail answer J. DISHWASHING FACILITIES 44. Will sinks or a dishwasher be used for ware washing? Dishwasher( ) Two compartment sink ( ) Three compartment sink V 45. Dishwasher Type of sanitization used: Hot water (temp. provided) Booster heater Chemical type Is ventilation provided? YES ( ) NO ( ) 46. Do all dish machines have templates with operating instructions? YES( )NO() I A 47. Do dish machines have temperature/pressure gauges as required that are accurate? YES ( ) NO ( ) NA 48. Does the largest pot and pan fit into each compartment of the pot sink? YES VNO ( ) If no, what is the procedure for manual cleaning and sanitizing? 49. Are there drain boards on both ends of the pot sink? Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 17 of 19 YES () NO 50. What type of sanitizer is used? ❑Chlorine ❑Iodine 1plluoaternary ammonium ❑Hot Water ❑Other 51. Are test papers and/or kits available for checking sanitizer concentration? YES M/NO ( ) K. HANDWASHING/TOILET FACILITIES 52. Is there a hand washing sink in each food preparation, cooking and ware washing area? YES V<O ( ) 53. Do a hand washing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES VNO ( ) 54. Do self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES ( ) NO ( ) N 55. Is hand cleanser available at all hand washing sinks? YES VNO ( ) 56. Are hand drying facilities (paper towels, air blowers, etc.) at all hand washing sinks? YES M`N0 ( ) 57. Are covered waste receptacles available in each restroom? YES MNO ( ) 58. Is hot and cold running water under pressure available at each hand washing sink? YES 1 4'NO ( ) 59. Are all toilet room doors self-closing? YES ( ) NO (� 60. Are all toilet rooms equipped with adequate ventilation? YEW(/) NO ( ) 61. Are hand washing signs and instructions posted in each employee restroom? YES(/) NO ( ) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 18 of 19 L. SMALL EQUIPMENT REQUIREMENTS 62. Please specify the number, location, and types of each of the following proposed for on site use: Slicers 0 Cutting boards 0� C Can openers►,L1 YO tV�6t Mixers Floor mats 0 Other 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. A n Signature (s) Print: Owner (s) or responsible representative (s) Date: QAlq /ks 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 preconstruction inspection with equipment in place and a preopening inspection of the establishment will be necessary to determine if it complies with the local and state laws governing food service establishments. Page Last Updated: 1/29/2013 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 19 of 19 � C >, O m E m �T � N mc g Q N E V m m� E ; w: c W Y w m w m U C U a° O .a m c z m E 0 moo o m Iva z m N Q mai � O w C O o 17 q E [I rm? c? 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'''$r N G`p®FL av ro �m01�5 0' Cc 3Ycomtl1�-% o ]o'BArY.��mp r o c nm x m s ' °.m�N�CCEqq • r � u♦ m � N ES. 0 o � c E n U E g ^ p= o z c o z c a d _ E p0 � m � c Q 4 � w� � a E a � 00 V N W � m W cc C K o am G log cm �g7 $' N • Kba' ��� Q ¢ g R� 2 c ad }I as a`uzj S O cE�rm m 2=a 3 Eg • ¢ • C Qy •y. m m s EOLLz z > Z 2 a � a o m m p o 8 E g g� • rmo m�9 E.- Q a -it p z sE m a t t LL :s .:H=i $: =,ie€max 1¢y 0 C VIONEWS AM G S AP With Vitamin E .1 IDENTIFICATION Qanufacturer: Metrex Research Corporation Address: 28210 Wick Road City, State, Zip: Romulus, MI 48174 Telephone: 1-800-841-1428 Emergency: Chemtrec 1- 800-424-9300 Date Prepared: February 2007 2 - COMPOSITION INFORMATION Hazardous In¢redients This product contains no hazardous components as defined in the OSHA Hazard Communication Standard (29 CFR 1910.1200). Other Ineredients Vitamin E, cocamidopropyl betaine, sodium laureth sulfate, polyquatemium-10, polyethylene glycol, cocamide DEA, citric acid, FD&C colorant, fragrance and water 3 - PHYSICAL AND CHEMICAL PROPERTIES Boiling Point: N/A Specific Gravity (H20 =1.0): 1.003 Vapor Pressure (mmHg): N/A Vapor Density (AIR =1): N/A Evaporation Rate: N/A Solubility in Water: 100% pearance and Odor: Clear light pink colored solution with a fruity, ral, sweet fragrance 4 - FIRE AND EXPLOSION HAZARD DATA Flash Point (Method Used): N/A Flammable Limits; LEL: N/A UEL: N/A Extinguishing Media: Water, carbon dioxide, dry chemical Special Fire Fighting Procedures: N/A Unusual Fire or Explosion Hazards: N/A 5 - REACTIVITY DATA Stability: Stable solution. Conditions to Avoid: N/A Incompatibility (Material to Avoid): N/A Hazardous Polymerization: Will not occur. 6 - HEALTH HAZARD DATA Routes of Entry: Skin: N/A Eyes: May be irritating to eyes. Inhalation: N/A Carcinogenicity - NTP: No IARC Monographs: No OSHA Regulated Carcinogen: No MATERIAL SAFETY DATA SHEET 7 - EMERGENCY FIRST AID PROCEDURES Skin: NIA Eyes: Flush eyes with water for at least 15 minutes. Get medical attention if irritation persists. Inhalation: Not expected to occur. Ingestion: Get medical attention. Do not induce vomiting. 8 - PRECAUTIONS FOR SAFE HANDLING & USE Steps to be taken in case material is released or spilled: Flush area with water and dispose to sanitary sewer. Waste Disposal Method: An acceptable method of disposal is to dilute with large amounts of water followed by discharge into a suitable treatment system in accordance with all regulatory agencies. Because acceptable methods of disposal may vary by location and because regulatory requirements may change, the appropriate regulatory agencies should be contacted prior to disposal. Precautions to be taken in handling and storing: Store containers tightly closed and in an upright position at room temperature. 9 - CONTROL MEASURES Respiratory Protection (Specify Type): N/A VENTILATION: Local Exhaust: N/A Mechanical (General): Should be adequate Protective Gloves: N/A Eye Protection: Use goggles if eye exposure is possible. Other Protective Clothing or Equipment: N/A 10 - TRANSPORTATION INFORMATION Not regulated. 11- SPECIAL INFORMATION HMIS (Hazardous Material Identification System) Rating: HO FO RO RI IIS Hazard Index: 4 — Severe Hazard; 3 — Serious Hazard; 2 — Moderate Hazard; 1— Slight Hazard; 0 — Minimum Hazard] Note: This MSDS was prepared in accordance with the requirements of the OSHA Hazard Communication Standard (29 CFR 1910.1200) and is to be used only for this product. The information contained in this MSDS is, to the best of our knowledge, believed to be accurate.