HomeMy WebLinkAboutFood Inspection Reports - Inspection - 1591 OSGOOD STREET 2/28/2020 R-1 0 Q07! FOOD ESTABLISHMENT INSPECTION REPORT
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NonhAmlowir,iIA 0 1 It 15 Inspection Number Date Time Inspection Type Client Type Inspector
Jimmy's Famous Pizza B1 E513 10130/19 11:17 AM Routine Retail M.Baldwin
1595 Osgood Street Permit Number Person In Charge Variance Priority Priority f Core
North Andover, MA 01845 2 1 3
!I'',''I a I al'I'mim algIIIIIIIIIII I.. ...Ill I'l 1 11 !111111111
IM
MEN=
IN=In compliance OUT=out of compliance N/O=not observed N/A=not applicable COS=corrected on-site during Inspection Repeat Violations Highlited In Yellow
F_ Supervision IN OUT NA NO COS I Protection from Contamination(ConVd) IN OUT NA NO COE
1.PIC present,demonstrates knowledge,and performs duties 15.Food separated and protected
2. Certified Food Protection Manager V 16.Food-contact surfaces;cleaned&sanitized
Employee Health 17.Proper disposition of returned,previously served,
3. Management,food employee and conditional employee
knowledge,responsibilities and reporting V Time/Temperature Control for Safety IN OUT NA NO co
4. Proper use of restriction and exclusion V 18.Proper cooking time&temperatures
5. Procedures for responding to vorniting and diarrheal events 1 V 19.Proper reheating procedures for hot holding V
Good Hygienic Practices IN OUT NA NO COS 20.Proper cooling time and temperature V
6.Proper eating,tasting,drinking,or tobacco use V 21.Proper hot holding temperatures V
7. No discharge from eyes,nose,and mouth V 22.Proper cold holding temperatures
Preventing Contamination by Hands IN OUT NA NO COS 23.Proper date marking and disposition V
8. Hands clean&properly washed V 24.Time as a Public Health Control;procedures&records V
9. No bare hand contact with RTE food or a pre-approved V Consumer Advisory IN OUT NA NO COE
10.Adequate handwashing sinks supplied and accessible 1/ 25,Consumer advisory provided for raw/undercooked food I/
Approved Source IN OUT NA NO COS Highly Susceptible Populations IN OUT NA NO co
11.Food obtained from approved source V 26.Pasteurized foods used;prohibited foods not offered
12.Food received at proper temperature Food/Color Additives and Toxic Substances IN OUT NA NO COS
13.Food in good condition,safe&unadulterated 27.Food additives:approved&properly used V
14.Required records available:shellstock tags,parasite V 28.Toxic substances properly identified,stored&used
Conformance with Approved Procedures IN OUT NA NO co
Repeat Violations Highlighted in Yellow 29.Compliance with variance/specialized process/HACCP V
I ill oll ill IN
............I....................I............................
Safe Food and Water IN OUT NA NO COS Proper Use of Utensils IN OUT NA NO COE
30.Pasteurized eggs used where required V 43.In-use utensils:properly stored
31.Water&ice from approved source 44.Utensils,equip.&linens:property stored,dried&handled
32.Variance obtained for specialized processing methods 45.Single-use/single-service articles:properly stored&used
Food Temperature Control IN OUT NA NO COS 46.Gloves used properly
33.Proper cooling methods used;adequate equip.for temp. Utensils,Equipment and Vending IN OUT NA NO COS
47.All contact surfaces cleanable,properly designed, 3
34.Plant food properly cooked for hot holding
35. Approved thawing methods used 48. Warewashinq facilities:installed,maintained&used;test
49. Non-food contact surfaces clean
36. Thermometers provided&accurate Physical Facilities IN OUT NA NO COS
Food Identification IN OUT NA NO COS 50.Hot&cold water available;adequate pressure
37.Food properly labeled;original container 51.Plumbing installed;proper backflow devices
Prevention of Food Contamination IN OUT NA NO COS 52.Sewage&waste water properly disposed
38.Insects,rodents&animals not present 53.Toilet facilities:properly constructed,supplied,&cleaned
39.Contamination prevented in prep,storage&display 54.Garbage&refuse properly disposed;facilities maintained
40.Personal cleanliness 55.Physical facilities Installed,maintained&clean
41.Wiping cloths;properly used&stored 56.Adequate ventilation&lighting;designated areas use
42.Washing fruits&vegetables
60.105 CMR 590 violations/local regulations
Official Order for Correction:Based on an inspection today,the items marked"OUT"indicated violations of 105 CMR 590.000 and applicable sections of the
2013 FDA Food Code.This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health.Failure to correct
violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations.If you are
subject to a notice of suspension,revocation,or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of healthin accordance
with 105 CMR 590.015(B).
Follow Up Required: Y Follow Up Date:
Inspector PIC
Town of North Andover- Health Department
R-1 0 Page Numbe
FOOD SAFETY INSPECTION REPORT 2
Jimmy's Famous Pizza
1595 Osgood Street Inspection Number Date Time Inspector
North Andover, MA 01845 BIE513 10/30/19 11:17 AM M.Baldwin
EMEMEMEEMM MENNEN= Repeat Violations Highlighted in Yellow
Employee Health
Procedures for Responding to vomiting and diarrheal events
5 2-501.11 Clean-up Vomiting & Diarrheal Events - -
Pf Written plan available. Provide Vomit Spill Kit. Code:A food establishment shall have procedures for
employees to follow when responding to vomiting or diarrheal events that involve the discharge of vomitus
or fecal matter onto surfaces in the food establishment. The procedures shall address the specific actions
employees must take to minimize the spread of contamination and the exposure of employees, consumers,
food, and surfaces to vomitus or fecal matter.
Time / Temperature Control for Safety
Cold Holding Temperature
22 3-501.16 (A)(2) (B) Proper Cold Holding Temps. -Grill area -
Pr Peppers and chicken in front two door exceed 41. Provide 41 deg F or less. Code:All cold TCS foods
shall be held at4l'Forbelow. Eggs that have not been treated to destroy all viable Salmonellae shall be
stored in refrigerated equipment that maintains an ambient air temperature of 450F or less.
Utensils, Equipment and Vending
Town of North Andover- Health Department
R-10 eNumber
FOOD SAFETY INSPECTION REPORT p�g
3
Jimmy's Famous Pizza
1595 Osgood Street Inspection Number Date Time Inspector
North Andover, MA 01845 B1E5B 10/30/ 99 11:17AM M.Baldwin
* ` m Repeat Violations Highlighted in Yellow ail
Food & Nonfood contact surfaces cleanable, properly designed, constructed
47 4-101.11 (B)-(E) Characteristics -Walk in -
C Provide shelves free of rust. Code:Materials that are
used in the construction of utensils and food-contact I,
surfaces of equipment under normal use conditions shall
be:durable, corrosion-resistant, and nonabsorbent,
sufficient in weight and thickness to withstand repeated
warewashing;finished to have a smooth, easily cleanable
surface;and resistant to pitting, chipping, crazing,
scratching, scoring, distortion, and decomposition.
ur, i
i
47 4-201.12 Food Temperature Measuring Devices -Grill area -
Pr Provide food thermometer to confirm chicken cooked to 165 deg F etc. Code:Food temperature
measuring devices may not have sensors or stems constructed of glass, except that thermometers with
glass sensors or stems that are encased in a shatterproof coating such as candy thermometers may be
used.
Town of North Andover- Health Department
R-10 Page Numbe
FOOD SAFETY INSPECTION REPORT 4
Jimmy's Famous Pizza
1595 Osgood Street Inspection Number Date Time Inspector
North Andover, MA 01845 131 E513 I 0/3-0/19 11:17 AM M.Baldwin
� � " � � � " � Repeat Violations Highlighted in Yellow
47 4-501.11 Good Repair and Proper Adjustment-
C Basement case freezer gasket broken. Repair. Code:
Equipment shall be maintained in a state of repair and
condition that meets FDA requirements. Equipment
components such as doors, seals, hinges, fasteners, and
kick plates shall be kept intact, tight, and adjusted in
accordance with manufacturers specifications. Cutting or
piercing parts of can openers shall be kept sharp to
minimize the creation of metal fragments that can
contaminate food when the container is opened.
Physical Facilities
Physical Facilities installed, maintained & cleaned
55 6-501.12 Cleaning. Frequency/Restrictions -Basement -
C Clean floor. Code: The physical facilities shall be cleaned
as often as necessary to keep them clean. Cleaning shall
be done during periods when the least amount of food is
exposed such as after closing. This does not apply to
cleaning that is necessary due to a spill or other accident.
Notes
Town of North Andover- Health Department
R-10 FOOD SAFETY INSPECTION REPORT p�9eNumber
5
Jimmy's Famous Pizza
1595 Osgood Street Inspection Number Date Time Inspector
North Andover, MA 01845 B1E513 10/30/ 99 11:17AM M.Baldwin
Repeat Violations Highlighted in Yellow
Notes
88 Notes -Outside -
N Burrows around dum ster. Have pest control assess for
rats. Clean litter around dumpster. General Notes.
i
y
a
rr
Area Equipment Product Temps
Grill area _ _ Raw chicken 44
Grill area I Cooked peppers 4
Rear prep True refrigerator 38
Temperatures in RED identify items in the temperature danger zone. See the report notes for specific details.
Allergen advisory posted.
Town of North Andover- Health Department
R,10 2mue Nmnbe
�[l[lD ������ |�����T|[�� ������T
FOOD SAFETY^— ' ' ^INSPECTION' '^^'~ REPORT^~' ^ ' 0
Jimmy's Famous Pizza
1G9S Osgood Street Inspection Numberrate-_ _�me _ ��e��__
North Andover, MA 01845 BiE5B 103019 1117AM M.Ba|dwin
- '
Choke saver recently.
TowncfNorthAndovor- Hae|thDepartment
/m`»~,m« FOOD ESTABLISHMENT ||�
n~��a"=wmmo/�
Insoection Numb Time In Time Ou Inspection Type Inspector:
Jimmy's Famous Pizzo 11:01 AM 1 an Baldwin
1595 Osgood Street IPermit Number� _\�l���_
North Andover,
MA O1845 ------- ------Priority ------- -------
' Retail O 0 2
NO iii lit
IN=In compliance OUT=out of compliance wm not observedwm not applicablewu on-site during Inspection violations highlited/ Yellow
Supervision IN OUT NA NO COS I Protection from Contamination (Cont'd) IN OUT NA NO COE
1.PIC present,demonstrates knowledge,and performs duties V 15.Food separated and protected V
2. Certified Food Protection Manager V 16.Food-contact surfaces;cleaned&sanitized V
Employee Health IN OUT NA No COS 17.Proper disposition of returned,previously served,
3. Management,food employee and conditional employee V
knowledge,responsibilities and reporting Time[Temperature Control for Safety IN OUT NA NO GO,'
4. Proper use of restriction and exclusion 18.Proper cooking time&temperatures V
5. Procedures for responding to vomiting and diarrheal events V 19,Proper reheating procedures for hot holding V
Good Hygienic Practices IN OUT NA NO COS 20.Proper cooling time and temperature V
6.Proper eating,tasting,drinking,or tobacco use V 21.Proper hot holding temperatures
7. No discharge from eves,nose,and mouth V 22.Proper cold holding temperatures V
Preventing Contamination by Hands IN OUT NA NO COS_ 23.Proper date marking and disposition V
8. Hands clean&properly washed V 24.Time as a Public Health Control;procedures&records V
9. No bare hand contact with RTE food or a pre-approved V Consumer Advisory IN OUT NA NO COE
10.Adequate handwashing sinks supplied and accessible V 25.Consumer advisory provided for Raw/undercooked food V
Approved Source IN OUT NA NO COS Highly Susceptible Populations IN OUT NA NO CO,1
11.Food obtained from approved source V 26.Pasteurized foods used;prohibited foods not offered V
12.Food received at proper temperature V Food/Color Additives and Toxic Substances IN OUT NA NO COS
13.Food in good condition,safe&unadulterated V 27.Food additives:approved&properly used V
14.Required records available:shellstock tags,parasite V 28,Toxic substances properly identified,stored&used I/
Conformance with Approved Procedures IN OUT NA NO COE
Repeat Violations Highlighted in Yellow 29.Compliance with variance/Specialized process/HACCP It
Safe Food and Water IN OUT NA NO COS Proper Use of Utensils IN OUT NA NO COE
30.Pasteurized eggs used where required 43.In-use utensils:properly stored V
31.Water&ice from approved source 44,Utensils,equip.&linens:property stored,dried&handled V
32.Variance obtained for specialized processing methods V 45.Single-use/single-service articles:properly stored&used V
Food Temperature Control IN OUT NA NO COS 46.Gloves used properly V
33.Proper cooling methods used;adequate equip.for temp. V Utensils,Equipment and Vending IN OUT NA NO COS
47.All contact surfaces cleanable,properly designed, 2
34,Plant food properly cooked for hot holding V
35. Approved thawing methods used V 48. Warewashinq facilities:installed,maintained&used;test
36. Thermometers provided&accurate V 49. Non-food contact surfaces clean
Physical Facilities IN OUT NA NO COS
Food Identification IN OUT NA NO COS 50.Hot&cold water available;adequate pressure I/
37.Food properly labeled;original container V 51.Plumbing installed;proper backflow devices V
Prevention of Food Contamination IN OUT NA NO COS- 52.Sewage&waste water properly disposed V
38.Insects,rodents&animals not present V 53.Toilet facilities:properly constructed,supplied,&cleaned I/
39.Contamination prevented in prep,storage&display 1/ 54.Garbage&refuse properly disposed;facilities maintained V
40.Personal Cleanliness V 55,Physical facilities installed,maintained&clean V
41.Wiping cloths;properly used&stored V 56.Adequate ventilation&lighting;designated areas use V
42.Washing fruits&vegetables V 60.Additional/Local Requirements V
Official Order for Correction:Based on an inspection today,the items marked"OUT"indicated violations of 105 CMR 590.000 and applicable sections of the
2013 FDA Food Code.This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health.Failure to correct
violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. Ifyou are
subject to a notice of suspension,revocation,or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance
22L- -
Follow upRequired: Y Follow Up
Megan Baldwin
Town of North Andover- Health Department �
Page Number
FOOD SAFETY INSPECTION REPORT 2
Jimmy's Famous Pizza
Date� The IMPOdQdU2Y.�
1S95 Osgood Street
4/22/18 11�Ui�5AAK� Megan Baldwin
North Andover, MA 01845 ' '
Utensils, Equipment and Vending
Food & Nonfood contact surfaces cleanable, properly designed, constructed
47 44Q1.19 Nonfood-Contact Surfaces -Grill area
C Clean sides of fry-o-lator. - Nonfood-contact surfaces of equipment that are exposed to splash, spillage, or
other food soiling or that require frequent cleaning shall be constructed of a corrosion-resistant,
nonabaorbmnt. and smooth material.
47 4-1O1.1@ Nonfood-Contact Surfaces -Rear prep
C Floors under shelves soiled. Clean floor. - Nonfood-contact surfaces of equipment that are exposed to
splash, spillage, or other food soiling or that require frequent cleaning shall be constructed of a corrosion-
resistant, nonabsorbent, and smooth material.
Area Equipment P[OdUCf T8DOOS
Good- meat b8US 150 deg F. SCn88n dOOF repaired.
Frank states-
- Painter scheduled to D@iDf rear walls
- new shelving was ordered
- COV8 h@S8 will be installed over new paint
R8-iD8D8C[iOD in 3 weeks, OF send Di[tU[8S OD 8f8ƒUS if completed earlier.
Town of North Andover- Health Department
N01 III AIRI(AcrilvIIIIII I)c111.
12( AtinSIrt-vi FOOD ESTABLISHMENT INSPECTION
Inspection Number Date Time In Time Out Inspection Type Inspector:
Jimmy's Famous Pizza 2889D51C-6CI 4/1/19 11:18 AM 12:02 PM Routine Meqan Baldwin
1595 Osgood Street Permit Number Client Type Variance Priority Priority f Core
North Andover, MA 01845 Retail 1 2 4
IN=In compliance OUT=out of compliance N/O=not observed N/A=not applicable COS=corrected on-site during Inspection Repeat violations highlited In Yellow
F- Supervision IN OUT NA NO COS I Protection from Contamination(Cont'd) IN OUT NA NO COE
1.PIC present,demonstrates knowledge,and performs duties V 15.Food separated and protected V
2. Certified Food Protection Manager 1/ 16.Food-contact surfaces;cleaned&sanitized V
Employee Health IN OUT NA No COS 17.Proper disposition of returned,previously served, V
3. Management,food employee and conditional employee V
knowledge,responsibilities and reporting Time/Temperature Control for Safety IN OUT NA NO CO:
4. Proper use of restriction and exclusion V 18.Proper cooking time&temperatures V
5. Procedures for responding to vomiting and diarrheal events V 19,Proper reheating procedures for hot holding V
Good Hygienic Practices IN OUT NA NO COS 20.Proper cooling time and temperature
6.Proper eating,tasting,drinking,or tobacco use V 21.Proper hot holding temperatures 1 V
7. No discharge from eves,nose,and mouth V 22.Proper cold holding temperatures V
Preventing Contamination by Hands IN OUT NA NO COS_ 23.Proper date marking and disposition V
8. Hands clean&properly washed V 24.Time as a Public Health Control;procedures&records V
9. No bare hand contact with RTE food or a pre-approved V Consumer Advisory IN OUT NA NO COE
10.Adequate handwashing sinks supplied and accessible V 25.Consumer advisory provided for Raw/undercooked food V
Approved Source IN OUT NA NO COS Highly Susceptible Populations IN OUT NA NO COE
11.Food obtained from approved source 26.Pasteurized foods used;prohibited foods not offered V
12.Food received at proper temperature V Food/Color Additives and Toxic Substances IN OUT NA NO COS
13.Food in good condition,safe&unadulterated V 27.Food additives:approved&properly used I/
14.Required records available:shelistock tags,parasite V 28.Toxic substances properly identified,stored&used V
Conformance with Approved Procedures IN OUT NA NO COE
Repeat�Violafi�onsHigh�llghted in�Yellow � 29.Compliance with variance/Specialized process/HACCP
eae
I Safe Food and Water IN OUT NA NO COS Proper Use of Utensils IN OUT NA NO COE
30.Pasteurized eggs used where required V 43.In-use utensils:properly stored V
31.Water&ice from approved source V 44.Utensils,equip.&linens:property stored,dried&handled V
32.Variance obtained for specialized processing methods 45.Single-use/single-service articles:properly stored&used V
Food Temperature Control IN OUT NA NO COS 46.Gloves used properly V
33.Proper cooling methods used;adequate equip,for temp. V Utensils,Equipment and Vending IN OUT NA NO COS
47.All contact surfaces cleanable,propeily designed, 2
34.Plant food properly cooked for hot holding V
35, Approved thawing methods used V 48. Warewashinq facilities:installed,maintained&used;test
49. Non-food contact surfaces clean
36. Thermometers provided&accurate V V
Physical Facilities IN OUT NA NO COS
Food Identification IN OUT NA NO COS 50.Hot&cold water available;adequate pressure V
37.Food properly labeled;original container V 51.Plumbing installed;proper backfiow devices V
Prevention of Food Contamination IN OUT NA NO COS 52.Sewage&waste water properly disposed V
38.Insects,rodents&animals not present V 53.Toilet facilities:properly constructed,supplied,&cleaned V
39.Contamination prevented in prep,storage&display V 54.Garbage&refuse properly disposed;facilities maintained V
40.Personal Cleanliness V 55.PhysVcal facilities lnstalled,maintained&clean 4
41.Wiping cloths;properly used&stored V 56.Adequate ventilation&lighting;designated areas use V
42.Washing fruits&vegetables V 60.Additional/Local Requirements V
Official Order for Correction:Based on an inspection today,the items marked"OUT"indicated violations of 105 CMR 590.000 and applicable sections of the
2013 FDA Food Code.This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health.Failure to correct
violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are
subject to a notice of suspension,revocation,or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance
with 105 CMR 590.015(B).
-6L J - - L, /� Follow Up Required: , Y Follow Up
Megan Baldwin Frank
Town of North Andover- Health Department
£age Number
FOOD SAFETY INSPECTION REPORT 2
Jimmy's Famous Pizza
Date � Time IUamaGtedJ2Yc
1595 Osgood Street
4/1/19 11:18:53AM Megan Baldwin
North Andover, MA 01845
Time / Temperature Control for Safety
Hot Holding Temperature
21 3~501.16(A)(1) Proper Hot Holding Temps. ~Grill area
Pr Red sauce holding at 93 deg F. Reheat to 165 and hold at 135 deg F (or higher). -All hot TCS foods shall
be held at 1350F or above except roasts cooked to a temperature and time as specified in 3-403.11 (B).
Utensils, Equipment and Vending
Food & Nonfood contact surfaces cleanable, properly designed, constructed
47 4'2O2.11 Food-Contact Surfaces -Rear prep
Pf Floor under wire shelving has debris build up. Keep all items 6 in off floor and clean floor. - Multi-use food
contact surfaces shall be smooth; free of breaks; open seams, cracks, chips, inclusions, pits, and similar
imperfections; free of sharp internal angles, corners, and crevices; finished to have smooth welds and
joints; and accessible for cleaning and inspection by one of the following methods: without being
disassembled, by disassembling without the use of tools, by easy disassembling with the use of handheld
tools commonly available to maintenance and cleaning personnel such as screwdrivers, pliers, open-end
wrenches, and Allen wrenches.
47 4-2O2.11 Food-Contact Surfaces -Walk |n
Pf VVina shelving in walk in has peeling rusty surfaces. Repair or replace so shelving is in tact. - Multi-use
food contact surfaces shall be smooth; free of breaks; open seams, cracks, chips, inclusions, pits, and
similar imperfections; free of sharp internal angles, corners, and crevices; finished to have smooth welds
and joints; and accessible for cleaning and inspection by one of the following methods: without being
disassembled, by disassembling without the use of tools, by easy disassembling with the use of handheld
tools commonly available to maintenance and cleaning personnel such as screwdrivers, pliers, open-end
wrenches, and Allen wrenches,
Physical Facilities
Physical Facilities installed, maintained & cleaned
55 G-5O1'12 Cleaning. Frequency/Restrictions -Grill area
C Grease on floor under fry o |ator. -The physical facilities shall bo cleaned am often an necessary tokeep
them clean. Cleaning shall be done during periods when the least amount of food is exposed such as after
closing. This does not apply to cleaning that is necessary due to a spill or other accident.
Town of North Andover- Health Department
' Ea0m Nbuzbe
FOOD SAFETY INSPECTION REPORT 3
Jimmy's Famous Pizza
Date� Time Inapodedbyi
1SyS Osgood Street
4/1/19 11�18'53AM Megan Baldwin
North Andover, MA 01845 � '
55 6-8O1.12 Cleaning. Frequency/Restrictions -Grill area
C Wall next to trash has build up. Clean wall. -The physical facilities shall be cleaned as often as necessary
to keep them clean. Cleaning ahoU be done during periods when the least amount of food is exposed such
aa after closing. This does not apply to cleaning that is necessary due to a spill or other accident.
55 6-501.11 Repairing - Remrpnmp
C Cove base pulled away from vva|| along back wall near back door. Replace. -The physical facilities shall
be maintained in good repair.
55 6-501'12C|een|ng. Frequency/Restrictions - Ftemrpnap
C Gonaen door has ripped screen. Repair screen. 'The physical facilities shall be cleaned as often an
necessary to keep them clean. Cleaning shall be done during periods when the least amount of food is
exposed such ao after closing. This does not apply ho cleaning that is necessary due too spill orother
accident.
Area EOUiDOl8Dt Product T8Dlp8
Front kitchen Deli Refrigerator Low Ham 41
Grill area Red sauce 93
Hood @Dp88[S clean.
S@Difize[ Set Up at DF8p 8[e88.
Health []8D[ advises 3 bay sink DOUS[ be Se[ Up at S[8rf of service.
New M/\ Food Code D8SSed in 2018. See email.
Re-iDSD8Cfi0D in 3 VVe8kS to CUDfirDO cleaning and repairs completed.
Town of North Andover- Health Department
Page Numbe�
FOOD SAFETY INSPECTION REPORT 4
]inomy's Famous Pizza
Date� Time IU=WLIty;
1SA5 Osgood Street
4/1/10 11:18:53AM Megan Baldwin
North Andover, MA 01845
*p,
120lain Sircel FOOD ESTABLISHMENT INSPECTION
North�^~"uumm�
. Inspection Num _I��L�_ _��e�o� �
' ]/mn�ysFannouuRzra 28O8D�1C-0C 11i8A� 12:02PM /NoqanBaldwin
1Sy5Oagood �tree( -------
±����� ��Z�| _���- _��� ��� _�e -
North Andover, MA O184� -------
' Retail 1 2 4
In compliancenoT=out of complianre wm not observed N/A=not applicable COS=corrected on-site during Inspection Repeat violations highilted In Yellow
Supervision IN OUT NA NO COS I Protection from Contamination(Cont'd) IN OUT NA NO COE
1.PIC present,demonstrates knowledge,and performs duties V 15.Food separated and protected V
2. Certified Food Protection Manager V 16.Food-contact surfaces;cleaned&sanitized V
Employee Health IN OUT NA No COS 17.Proper disposition of returned,previously served, V
3. Management,food employee and conditional employee V
knowledge,responsibilities and reporting Time/Temperature Control for Safety IN OUT NA NO GO,'
4. Proper use of restriction and exclusion V 18.Proper Gooking time&temperatures V
5. Procedures for responding to vomiting and dial events V 19.Proper reheating procedures for hot holding V
Good Hygienic Practices IN OUT NA NO COS 20.Proper cooling time and temperature
6.Proper eating,tasting,drinking,or tobacco use V 21 Proper hot holding temperatures
7. No discharge from eves,nose,and mouth V 22.Proper cold holding temperatures
Preventing Contamination by Hands IN OUT NA NO COS 23.Proper date marking and disposition V
8. Hands clean&properly washed V 24.Time as a Public Health Control;procedures&records V
9. No bare hand contact with RTE food or a pre-approved V Consumer Advisory IN OUT NA NO COE
10.Adequate handwashing sinks supplied and accessible V 25.Consumer advisory provided for Raw/undercooked food V
Approved Source IN OUT NA NO COS_ Highly Susceptible Populations IN OUT NA NO CO,1
11.Food obtained from approved source V 26.Pasteurized foods used;prohibited foods not offered V
12.Food received at proper temperature V Food/Color Additives and Toxic Substances IN OUT NA NO COS
13.Food in good condition,safe&unadulterated V 27.Food additives:approved&properly used V
14.Required records available:shellstock tags,parasite V 28.Toxic substances properly identified,stored&used V
Conformance with Approved Procedures IN OUT NA NO COE
Repeat Violations Highlighted in Yellow 29.Compliance with variance/Specialized process/HACCP V
Safe Food and Water IN OUT NA NO COS Proper Use of Utensils IN OUT NA NO COE
30.Pasteurized eggs used where required V 43.In-use utensils:properly stored It
31.Water&ice from approved source V 44.Utensils,equip.&linens:property stored,dried&handled V
32.Variance obtained for specialized processing methods 45.Single-use/single-service articles:properly stored&used V
Food Temperature Control IN OUT NA NO COS 46.Gloves used properly V
33.Proper cooling methods used;adequate equip.for temp. Utensils,Equipment and Vending IN OUT NA NO COS
47.All contact surfaces cleanable,property designed, 2
34.Plant food properly cooked for hot holding V
35. Approved thawing methods used V 48. Warewashinq facilities:installed,maintained&used;test V
36. Thermometers provided&accurate V 49. Non-food contact surfaces clean V
Physical Facilities IN OUT NA NO COS
Food Identification IN OUT NA NO COS 50.Hot&cold water available;adequate pressure V
37.Food properly labeled;original container V 51.Plumbing installed;proper backflow devices V
Prevention of Food Contamination IN OUT NA NO COS 52.Sewage&waste water properly disposed V
38.Insects,rodents&animals not present V 53.Toilet facilities:properly constructed,supplied,&cleaned V
39.Contamination prevented in prep,storage&display V 54.Garbage&refuse properly disposed;facilities maintained V
40.Personal Cleanliness V 55.Physlca�facififies installed,maintained&clean 4
41.Wiping cloths;properly used&stored V 56.Adequate ventilation&lighting;designated areas use V
42.Washing fruits&vegetables V 60.Additional/Local Requirements V
Official Order for Correction:Based on an inspection today,the items marked"OUT"indicated violations of 105 CIVIR 590.000 and applicable sections of the
2013 FDA Food Code.This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health.Failure to correct
violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are
subject to a notice of suspension,revocation,or non-renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance
~ Follow upRequired: v Y Follow Up
Megan Baldwin Frank
TUvvO ofNVrthADdover- Health Department |
Page Nmmbe�
FOOD SAFETY INSPECTION REPORT 2
Jimmy's Famous Pizza
Date� Z�� �p�u�c
159S Osgood Street
North Andover, MA 01845 4/1/18 11�18:b3AK4 Megan Baldwin
NO ON,
Time / Temperature Control for Safety
Hot Holding Temperature
21 3~501.16 (A)(1) Proper Hot HoUding Temps. ~CSri|| area
Pr Red sauce holding at 93 deg F. Reheat to 165 and hold at 135 deg F (or higher). -All hot TCS foods shall
be held at 1351F or above except roasts cooked to a temperature and time as specified in 3-403.11 /B\.
Utensils, Equipment and Vending
Food & Nonfood contact surfaces cleanable, properly designed, constructed
47 4-2O2.11 Food-Contact Surfaces -Rear prep
Pf Floor under wire shelving has debris build up. Keep all items 6 in off floor and clean floor. - Multi-use food
contact surfaces shall bmsmooth; free of breaks; open seams, cracks, chips, inclusions, pits, and similar
imperfections; free of sharp internal angles, corners, and crevices; finished to have smooth welds and
joints; and accessible for cleaning and inspection by one of the following methods: without being
disassembled, by disassembling without the use of tools, by easy disassembling with the use of handheld
tools commonly available to maintenance and cleaning personnel such as screwdrivers, pliers, open-end
wrenches, and Allen wrenches.
47 4-202.11Food-Cmntmct Surfaoee -VVm|kin
Pf Wire shelving in walk in has peeling rusty surfaces. Repair orreplace so shelving is in tact. - Multi-use
food contact surfaces shall besmooth;free of breaks; open seams, cracks, chips, inclusions, pits, and
similar imperfections; free of sharp internal angles, corners, and crevices; finished to have smooth welds
and joints; and accessible for cleaning and inspection by one of the following methods: without being
disassembled, by disassembling without the use of tools, by easy disassembling with the use of handheld
tools commonly available to maintenance and cleaning personnel such as screwdrivers, pliers, open-end
wrenches, and Allen wrenches.
Physical Facilities
Physical Facilities installed, maintained & cleaned
55 8-501.12 Cleaning. Frequency/Restrictions 'Gri|| area
C Grease on floor under fry o |ator. -The physical facilities shall be cleaned as often oa necessary tokeep
them clean. Cleaning shall be done during periods when the least amount of food is exposed such as after
closing. This does not apply to cleaning that is necessary due to a spill or other accident.
Town of North Andover- Health Department
. fao:1Nuumue
FOOD SAFETY INSPECTION REPORT 3
' Now=
�
Jimmy's Famous Pizza
Date � The IUmaQWIU2Yi
15gS Osgood Street
4/1/19 11:18:53AM Megan Baldwin
North Andover, MA 01845
55 6-501.12 Cleaning. Frequency/Restrictions -GrU| area
C Wall next to trash has build up. Clean wall. -The physical facilities shall be cleaned as often as necessary
to keep them clean. Cleaning shall be done during periods when the least amount offood is exposed such
as after closing, This does not apply to cleaning that is necessary due to a spill ur other accident.
55 6'801.11 Repairing -Rear prep
C Cove base pulled away from vvaU along back wall near back door. Replace. -Tho physical facilities shall
be maintained /n good repair.
55 6-501.12 C|aon|nQ' Frequency/Restrictions -Rear prep
C Screen door has ripped screen. Repair screen. -The physical facilities shall be cleaned as often as
necessary to keep them clean. Cleaning shall be done during periods when the least amount offood is
exposed such ao after closing. This does not apply tn cleaning that in necessary due tnm spill orother
accident.
Area EqUiDDleD[ PFOdUCƒ T8OODG
Front kitchen Deli Refrigerator Low Ham 41
Grill area Red sauce �3
Hood appears clean.
S@Oifizer set Up at prep @[88S.
Health Dept 8dViS8S 3 bay sink O0UGf be Se[ UD at start of service.
New M/\ Food Code D@SSed in 2018. See email.
Re-inspection in 3 VVe8kS to COOfi[Dl cleaning and [eD8iB completed.
�
lovvV OfNorthAndover- Health Department
Rage Numbe
FOOD SAFETY INSPECTION REPORT 4
MEEM
]inomy's Famous Pizza Date~� Time�� lmoaXad-huy!
15Q5 Osgood Street 4/1/19 11:18:53AM Megan Baldwin
North Andover, MA 01845
TbwDnfNorthAndover- Hea|thDepartmmnt
THE COMMONWEALTH,10F MASSACHUSETTS
TOWN OF NORTH ANDOVER 120 Main Street
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTIO ORT Fax- 978.688.9542
e-mail: healthdept(Li)northaiidoverma.gov
Name of Establi iment D t Type of Operation(s) Type of Inspection
ae
r�) V 0 LFood Service Routine
Address ctra, S'f Risk Level Lj Retail F]Re-inspection
n Residential Kitchen Previous Inspection
Telephone El Mobile
Owner HACCP: [:] Temporary ❑Pre-operation
Y N F] Caterer ❑Suspect Illness
Person-in-Charge(PIC) f-kVV) 6_S Time ❑F] Bed &Breakfast ❑General Complaint
Fo,v)V) 5 HACCP
Inspector Megetn e In: Year: F1 Other
C, /C/�,v t�k-t Out: - I I
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne iflness,Interventions and Rlsk Fact0 Es jg_ ed jtemll Anti-Choking 590.009(E) [I
Vioiat-io;s-m-'ar-ke,d-",m-a-y,p-os-e"an-im-m-in-en-,t-h-e,-a-lt-h-,-h,,-a-za-;'d and require immediate corrective action as Tobacco 590.009(F) n
determined by the Board of Health. Allergen Awareness 590.009 (G)El
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
1. PIC Assigned/ nowledgeable/Duties
El '13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2 of Diseases by Food Employee and PIC. Reporting 0 14. Approved Food or Color Additives
3. Personnel with infections Restricted/Excluded [_
_1 15.Toxic Chernicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
[_ [-116.Cooking Temperatures
...1 5. Receiving/Condition
El 6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating
ELI 7'. Conformance with Approved Procedures/I-iACCP Plans 18.Cooling
9.
PROTECTION FROM CONTAMINATION 1 Hot and Cold Hoiding
El 20.Time as a Public Health Control
8. Separatioiii/Seg��egation/Protection
9. Food C ontact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
El 21. Food and Food Preparation for HSP
10. Proper Adequate Handwashing CONSUMER ADVISORY
11.Good Hygienic Practices El 22. Posting of Consunner Advisories
Violations Related to Good Retail Practices(Blue Items) Nu,mber of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne 11h7esses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1-22):
Non-critical H violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590,004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
PC 27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28, Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30, Other
Inspector's Signature: ry - Print: )o
_'>0t -
PICS Signature: Print: ,
Page
Violations Related to Foodborne Illness Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION JINIANAGEIN'IENT
1 590.003(A) Assignment of Res)onsibilit * PROTECTION FROM CONTAMINATION
$90.003(B) Demonstration of Knowledge* 8 Cross-contamination
2.103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Coutatnination front Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from the Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590,003(E) Removal of Exclusions and Restrictions 3.306.14 A B Returned Food and Reservice of Food*
Disposition of Adulterated a•
FOOD FROM APPROVED SOURCE Contambnated Food
4 rood and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 rood Contact Surfaces
3-201,13 Fluid Milk and Milk Products* 4-501,11 t Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'Pent eratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warcwashing-Hot Water
3-202.16 1 Ice Made From Potable Drinking Water* Snnitizatioti'fettt eratures*
5-101.l 1 Drinking Water front an Approved System* 4.501.114 Chemical Sanitization-temp.,pH,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590,006(B) Water Meets Standards In 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean
Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and 1I'ild Mushrooms Approved by Chemical*
Re ulato• Atahorit y 10 Proper,Adequate Handwashin
3-202,18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
S Receiving/Condition 11 Good Hygienic Practices
3-202,11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401.12 Discharges From the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
6 Ta s/Records:Shellstock 3-30I.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203,12 Shellstock Identification Maintained* Hands
Togs/Records:Fish Products 590.004(E) Preventing Contamination from
*
oyeesm to ces
3-402.11 Parasite Destruction* 13 I Employees*
Facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590.004(J} 5.203,11 Numbers and Capacities*
Labeling of ingredients* 5-204,11 Location and Placement*
7 Conforn►ance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502.1 t Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser AvailabM
8-103.12 Conformance with Approved Procedures* 6-301,12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
i
Establishment Name: liey1?� c `'1 fnJ3 Date:?S� .S Page: 2 of
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No.p* Reference R—Red Item PLEASE PRINT CLEARLY Veried
�7 CP' // x- I s7 —u
G �ctiYt
rE L
�2r
c f 6 may'r
c — 'd
d t'� —o
Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
❑ Voluntary Compliance ❑ Employee Restriction/
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
c ❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIOnNS LISP
PROTECTION FROA-1 CHEMICALS 21 3-801,11(A) Unpasteurized Pre-packaged Juices and
14 Fbod or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3.801.11( Use of Pasteurized Eggs*
3-302.14 Protection front Unapproved Additives* 3-801.1 I(D) Raw or Partially Cooked Animal Food and
1S Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing I»formation-Original Containers* 3-801.11 C Uno ened Food Package Not Re-served.
7-102,11 Common Name-Working Containers*
7-201,11 -Separation-Storage* CONSUMER ADVISORY
7-202.I 1 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7.202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.I 1 Sanitizers,Criteria--Chemicals* Pathogens.*tecrne P1'Mr
7-204.l2 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590,009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TIME/TEMPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper CookingTemperatures for PHFs practices should be debited under#29--Special
3-401,IIA(1)(2) Eggs- I55°F 15 Sec. Requirements.
Eggs-Immediate Service 145°1315see*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 see,* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 ulna* (Blue Items 23-30)
3.401.1 I(A)(2) Ratites,Injected Meats--l55°F 15 see,* Critical and non-critical violations,which do not relate to the foodborne
3-401.t 1(A)(3) Poultry,Wild Game,Stuffed PHFs, Illness interventions and riskfactors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections ofthe Food Code and 105 CiVR 590,000,
Ratites-165°F 15 see.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* Item I Goorl Retell Practices xFC 5901000
3-401.12 Raw Aninnal Foods Cooked in a 23, Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F15 see,* 25. Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and Waste FC-5 .006
27. Physical Facilit FC--6 .007
3 403.l 1(A)&(D) PHFs [GS°F 15 sec,* 28. Poisonous or Toxic Materials FC-7 .008
3-403.11(B) Microwave-165°F 2 Minute Standing 29. 1 Spec al Requirements .009
Time* 30, Other
3.403.11(C) Commercially Processed RTH Food-
140°F*
3-403.11(E) Remaining Unsticed Portions of Beef 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Roasts*
IS Proper Cooling of PiIFs
3-501.14(A) Cooling Cooked PI•IFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours,*
3-501,l4(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41117/45°17
Within 4 Hours*
3-501.14(C) P1IFs Received at Temperatures
According to Law Cooled to 41°F/451F
Within 4 Hours,
3-501.15 Cooling Methods for PHFs
19 PHF Hot and Cold Holding
3-501,16(B) Cold PHFs Maintained at or below
590.004(F) 41°/45°F*
3-501.16(A) Hot PHFs Maintained at or above 140°F,
3-501,16(A) Roasts Held at or above 130°F.
20 Time as a Public Health Control
3-501,19 Time as a Public Health Control*
590,004(I I) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER le , 120 Main Street
North Andover,Massachusetts 01845
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Division of Food and Drugs (:.vt Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax - 978.688.9542
e-mail: healthdept@northandoverma.gov
Name of Establishment 2 1 Date Type of Operation(s) Type of Inspection
be) Food Service Routine
Address Risk Level ❑ Retail ❑Re-inspection
❑ Residential Kitchen Previous Inspection
Telephone ❑ Mobile Date:
Owner HACCP: ❑ Temporary ❑Pre-operation
Y / N El Caterer El Suspect Illness
Person-in-Charge(PIC) 1�4� Time R Bed&Breakfast F]General Complaint
HACCP
Inspector hl'-e e-4 pr� kl,,Y'-" Out: J!k 1 Year: ❑ Other-
Each violation check requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors.i1jeoltern 1 Anti-Choking 590.009(E) El
Violations"marked may-pose an imminenthealth hazard and require immediate corrective action as Tobacco 590.009(F) 0
determined by the Board of Health. Allergen Awareness 590.009 (G)171
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
I. PIC Assigned/Knowledgeable/Duties
13. HandwasNng Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC [-
_1 14. Approved Food or Color Additives
El 3. Personnel with Infections Restricted/Excluded -115. Toxic Chemicals
FOOD FROM APPROVED SOURCE
4, Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
E-1 5. Receiving/Condition [j 16. Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements Ell 17., Reheating
118, Cooling
7, Conformance with Approved Procedures/HACCP Plans E
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
F El 20. 11me as a Public Health Control
8.Separation/Segregaflon/Pi,otection
9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
E.-] 10. Proper Adequate Handwashing Ej 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
11, Good Hygienic Practices F_] 22m posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses hiterventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1-22):
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
1 cited in this report may result in suspension or revocation of the food
IK 25. Equipment and Utensils (FC-4)(590.005) establishment permit and cessation of food establishment operations.If
26. Water, Plumbing and Waste (FC-5)(590,006) aggrieved by this order,you have a right to a hearing.Your request must
X 27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. P0iS0r10uS or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE,OF RF-lArSPECTION:
30. Other
Inspector's Signature: Pte Print:lerall, JS exie"611
PICs Signature: Print: Page-of J'Pages
Violations Related to Foadborne Illness Interventions and Risk Factors
(Red Iteuns 1-22)
FOOD PROTECTION AMANA.GENTENT
1 590.003(A) Assignment ofRes tonsibilit y* PROTECTION FRO11 CONTAMINATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2-103.11 Person in charge_-duties 3-302.1I(A)(1) RawAnhttal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination front the Environment
590,003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Reporting by Person in Charge* Utensils*
3 590.003(D) Exclusions and Restrictions* Contamination fron the Consumer
590,003(E) Removal of Exclusions and Restrictions 3.306.14 A B Returned Food and Reservice of Food*
Dlsnosillon of,4dalterated or
FOOD FROM APPROVED SOURCE Conlaminated Food
4 rood and water Front Rc mated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.111 Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'l'ett eratures*
3-202,14 Eggs and Milk Products,Pasteurized* 4.501,112 Mechanical Warewashing-Hot Water
3-202.16 1 Ice Made Front Potable Drinking Water* Sanitization Temperatures*
5-101,11 Drinking Water iron an Approved System* 4.501.114 Chemical Sanitization-temp.,PIl,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish Fi-om nit Approved Utensils Clean*
So►n-ce 4-602.11 Cleaning Frequency of Equipment Food-
3-201,14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces ofEquipment*
Sources* 4-703.11 Methods of Sanitization-Hot Witter and
Game and TVild UnshmomsAhproved by Chemical*
Re ulatoqAathorN, 10 Proper,Ade tale Handwashin
3.202,18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Anus*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201,17 Game Animals* 2-301.14 When to Wnsh*
S Receiving/Condition 11 Good Hy ienic Practices
3-202,11 PHFs Received at Proper Temperatures* 2-401.1 l Eating,Drinking or Using Tobacco*
3-202,15 Package Inte ri * 2-401.12 Discharges From the Eyes,Nose and
3-101.11 Food Safe and Unadulterated* Mouth*
6 Tags/Records,Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* I2 Prevention of Contamination from
3-203,12 Shellstock Identification Maintained* Hnnds
Tags/Records:Fish Products 590,004(E) Preventing Contamination from
Enn to yces*
3-402.11 Parasite Destntctiot* 13 Iiandwash Facilities
3-402,12 Records,Creation and Retention*590.004(3) Convenient) Located and Accessible Labeling of Ingredients* 5-203,11 Numbers and Capacities*
5-204,11 Location and Placement*
7 Cott fo�manee with Approved 5-205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plaits Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6301.11 Handwashing Cleanser,Avnilabili
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dr ving Provision
#Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Establishment Name: 2�
Date: 31 Z(; page. of �l
Item Code C—c6fical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION bate
No. Reference R—Red Item PLEASE PRINT CLEARLY Verified�A
"44
t
G AJ t!—ve' VC7\Av"\e�
R kp erg.
rN c.
MPY)�A 0 el-J,e,,Q e'A r
Discussion With Person in Charge: Corrective Action Required: EI No 1(,0,Yes
0-,Voluntary Compliance 0 Employee Restriction!
' M1, "I. "q 0")< Exclusion
11 Re-inspection Scheduled 0 Emergency Suspension
eAVt_
E3 Embargo 0 Emergency Closure
0 Voluntary Disposal E3 Other.
S�e—
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS LISP
PROTECTION FROl isII I CHICALS
21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3-801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection front Unapproved Additives* 3-801.1 I(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.
7-101.I 1 ldenti ,ing Information-Original Containers* 3-801,11 C Unopened Food Package Not Re-served,
7-102.1 i 1 Common Name-Working Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7.202.l2 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.1 l Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.*t7/tr'''"uvmor
7.204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell,Eggs*
7-204.14 Drying Agents,Criteria*
7-205,11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206,1 I Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)hn
7-206.12 Rodent Bait Stations* catering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited tinder the
Monitoring* appropriate sections above if related to
foodborne illness Interventions and risk factors.
TIME CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29--Special
3-401,IIA(i)(2) Eggs- 155°F 15 Sec, Requirements.
Eggs-Ittnnediate Service 145°F15see*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* VIO.LATIONS RELATED TO GOOD REmm PRACTICE'S
3-401.11(B)(1)(2) Pork and Beef Roast-130°F 12i min* (Blue Items 23-30)
3-401.1 I(A)(2) Ratites,Injected Meats--I5S°F 15 see,* Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and riskfactors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 CX/R 590,000,
Ratites-165°F 15 see.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* heat Good Retail Practlees FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23, Mana ement and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25. Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water Plumbing and Waste FC-5 006
3 403.11(A)&(D) PHFs IGS°F i S sec, 27. Physical Facllit FC -6 007
28. Poisonous or Toxic Materials FC-7 .008
3-403,11(B) Microwave-165°F 2 Minute Standing 29, Special Requirements .009
Tine* 30, Other
3-403.11(C) Commercially Processed RTE Food-
l40°F*
3-403.11(E) Remaining Unslieed Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Roasts*
1$ Proper Cooling ofP1IFs
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours,*
3-SO1.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°1?
Within 4 Hours*
3-501.14(C) PHFs Received at Temperatures
According to Law Cooled to 41017/45017
Within 4 Hours.*
3-50115 Cooling Methods for PHFs
t9 P1IFHot and cold Holding
3-501,16(B) Cold PHFs Maintained at or below
590,004(F) 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.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(i i) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 120 Main Street
North Andover,Massachusetts 01845
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Noi
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPO
Fax- 978.688.9542
e-mail: healthdept@northandoverma.gov
Name of Establishment �-)i 2--2-(A. Date Tipe of Operation(s) Type of Inspection
?/ ? //A 0 Food Service R Routine
Address Risk Level R Retail El Re-inspection
R Residential Kitchen Previous Inspection
Telephone El Mobile Date:
Owner HACCP: ❑ Temporary ❑Pre-operation
evrn o.14 Suspect Illness
Y N F] caterer ❑
General Complaint
Person-in-Charge(PIC) (P,^AA.0 Time ❑ Bed&Breakfast
HACCP
Inspector In: ❑ Other
Out: Year:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Vidations Related to Foodborne Byrne ss 4itervenflons and Risk Factors RegAems Anti-Choking 590.009(E) El
'Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590,009(F) El
determined by the Board of Health. Allergen Awareness 590.009 (G)[71
FOOD PROTECTION MANAGEMENT 0 '12. Prevention of Contamination from Hands
1. PIC Assigned/l(noWedgeable/Duties 13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and PlC
[- D 14,Approved Food or Color Additives
3. Personnel with Infections Restricted/Excluded 15, Toxic Chemicals
FOOD FROM APPROVED SOURCE
EJ 4. Food and Water I rorn Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
5. Receiving/Condition E_j 16. Cooking'remperatures
6. Tags/Records/Accuracy of ingredient Statements 17, Reheating
El 7. Conformance with Approved Procedures/HACCP Mans
18, Cooling
PROTECTION FROM CONTAMINATION 19. Hot and ("old Holding
8. Separation/Segregation/Pv,otection E]20.Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
r 9. Food Contact Surfaces Cleaning and SanitiAng 21. Food and Food Preparation for HSP
'10. Proper Adequate Handwashing CONSUMER ADVISORY
11. Good Hygienic Practices 22, Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Ntimber of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodbome Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1-22).
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N
e report,when signed below by a Board of Health member or its agent
_XL 23. Management and Personnel (FC-2)(590,003) constitutes an order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(590�004) cited in this report may result in suspension.or revocation of the food
25. Equipment and Utensils (FC-4)(590.005) establishment permit and cessation of food establishment operations.If
26. Water, Plumbing and Waste (FC-5)(1,90,006) aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE, OF RE-INSPECTION:
30. Other
Inspector's Signature: Print
Aj
n Page of2,Pages
PICs Sig ature: 115�le Print:
Violations Related to Foodboriie Idbiess Interrentions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION NIANAGEMENT
1 590.003(A) Assignment of Res onsibilit y* PROTECTION FROM CONTAMINATION
590.003(B) Demonstration ofKnowledge* 18 Cross-contamination
2-103.11 Person in charge-duties 3-302.1 l(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from the Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.1 I A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590A03((3) Reporting by Person in Charge* Utensils*
3 590A03(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3-306.14 A 8 Returned Food and Reservice of Food*
Disposition of,4didtermed or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-20 L 12 Food in a Henmeticall y Scaled Container* LL Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501,111 Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warowashing-Hot Water
3-202.16 1 lee Made From Potable Drinking Water* Sanitization'l'enn eratares*
5-101.11 Drinking Water from an Approved System* 4-501.114 Chemical Sanitization-temp.,pH,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and.Fish From an Approved Utensils Clean*
Somrce 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of E ui ment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and IPild Mushrooms Approved by Chemical*
Re ulata•vAuthoi,it, 10 Proper,Adequate Handwashin
3-202,18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
5 Reeeivin /Condition 11 Good Hygienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401.12 Discharges From the Byes,Nose and
3-101.I 1 Food Safe and Unadulterated* Mouth*
6 Ta s/Reco•ds:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Ta s/Records:Fish Products 590,004(E) Preventing Contamination from
3-402.11 Parasite Destruction* Em to ces*
3-402,12 Records Creation and Retention* 13 Ilandwash Facilities
590.004(3) Conveniendy Located and Accessible
5.203.11 Numbers and Ca acitics
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5.205,11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Dieing
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
' 3,
Establishment Name, T) Y'Y) Oate: 7— Page: of
Item Code C—Crifical item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY Verified
12Yk C,' 6 q
en /'v-�T141 11 V
A' i")'() "t
0, V ex<w
z' "X P Lf 49ej
e4
C")
IN I
Discussion With Person in Charge: C, Corrective Action Required: 0 No 17—,Y..
13 Voluntary Compliance 0 Employee Restriction
. I
(2 4, 'A C Exclusion
0 Re-inspection Scheduled U Emergency Suspension
lZe"N
C3 Embargo 0 Emergency Closure
0 Voluntary Disposal a Other.
c�
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS LISP
PROTECTION FROM CHE1WICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3.801.1 l(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
IS Poisonous or Toxic Substances Raw Seed Sprouts Not Served.
7-101.l 1 Identi ,ing Information-Original Containers* 3-801.1 t C Unopened Food Package Not Re-served,
7-102.11 Common Name-Working Containers*
7-201,1 l Se arat!on-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.t 1 Consumer Advisory Posted for Consumption of
7.202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.*"ff"'urrmor
7-204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.l3 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above ifrelated to
Foodborne illness interventions and risk factors,
TENIE/TEMPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper CookbngTemperntures for PHFs practices should be debited under#29-Special
3-401.I1A(i)(2) Eggs- 155°F IS Sec.
Requirements.
Eggs-Immediate Service 145°F15sec*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F IS see,* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec,* Critical and nor-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and riskfactors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 Ct-/R 590,000,
Ratites-165°F 15 sec.*
3-401.1 I(C)(3) Whole-muscle,intact Becf Stcaks 145°F* Item Goof Retail Practices FC S901000
3-401.l2 Raw Aninnal Foods Cooked in a 23, Mana ement and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25, Equipment and Utensils 11C-4 .005
17 Rehenting for Hot Holding 26, Water Plumbing and Waste FC-5 .006
27. Physical Facilit FC--6 .007
3 403.t I(A)&(D) PHFs 165°F 15 sec,* 28. Poisonous or Toxic Materials FC-7 1 .008
3-403.1 l(B) Microwave-165°F 2 Minute Standing 29. Special Requirements .009
Time* 30. Other
3.403.11(C) Commercially Processed RTE Food-
l40°F*
3-403.11(E) Remaining Unsliced Portions of Beef ♦Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000,
Roasts*
I$ Proper Cooling of PIIFs
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 hours,*
3-541,14(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 4I°F/45°F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
19 PHF Hot And Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 4 10/4 50 F*
3-501.16(A) Hot PHFs Maintained at or above 140°F,
3-501,16(A) Roasts Held at or above 130°F.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(11) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS 120 Main Street
err TOWN OF NORTH ANDOVER
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax - 978.688.9542
e-mail: healthdept(LDnorthandoverma.gov
Name of Establishment Date Type of Operation(s) Type of Inspection
.J'�YN&VV's rg'107')e"V!� Food Service Routine
Address 5 , P eR IC,�' Risk Level 0 Retail F]Re-inspection
j q c7 El Residential Kitchen Previous Inspection
Telephone 0 Mobile Date:
Owner HACCP: F-1 Temporary El Pre-operation
Y N F] Caterer F-1 Suspect Illness
Person-in-Charge(PIC) Time F-1 Bed &Breakfast ❑ General Complaint
Ab Aojxu�Y1��t�,r)ht� In: / (("5 HACCP
Inspector ke, Il"'A'PN Out: ; �1�0 I Year: F1 Other
Inspectorviolation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violaflons Related to Foodborne lilness hiterventions and Risk Facto Ls_jRel Lqrns -Choking
_j Anti 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) F1
determined by the Board of Health. Allergen Awareness 590.009 (G)0
FOOD PROTECTION MANAGEMENT 12, Prevention of Contamination from Hands
I PIC Assigned/Knowledgeable/Duties
F 113. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC [_
-.114. Approved Food or Color Additives
3. Personnel with infections Restricted/Exciuded
[D 15.Toxic Chernlcals
FOOD FROM APPROVED SOURCE
4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
16.Cooking Temperatures
El
j 5. Receiving/Condition
[-1 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
El 7. Conformance with Approved Procedures/HACCP Plans D 18.Cooling
PROTECTION FROM CONTAMINATION ,4 19, Hot and Cold Holding
Ej 8.Separation/Segregation/Protection El 20.Time as a Public Health Control
9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
21. Food and Food Preparation for HSP
F_ -landwashing 10. Proper Adequate CONSUMER ADVISORY
j 11. Good Hygienic Practices 2Z. Posting of Consurner Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Iterns 1-22):
Non-critical K violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code,This
C N
23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
constitutes an order of the Board of Health. Failure to correct violations
4- 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of the food
25. Equipment and Utensils (FC-4)(590.005) establishment permit and cessation of food establishment operations.If
26. Water, Plumbing and Waste (FC-5)(590.006) aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. P0iS0n0uS or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE,OF RE-INSPE,C77ON:
30. Other
Inspector's Signature: L, Print:
AAef
PICs Signature: Print: Pagej0 fIXTages
Violations Related to Foodborne Illness Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECIJON MANAGEIJUNT
1 590.003(A) Assignment of Res ponsibilit y* PROTECTION FRO\I CONTAMIi\'ATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2-103.11 Person in charge-duties 3-302.1 I(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590.003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from'Each
require reporting by food employees and Other*
applicants* Contamination from(lie Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590.003(0) Re orting by Person in Charge* Utensils*
3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3-306.14 A B Returned Food and Reservice of Food*
Disposition of,4dulterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Re ula(cd Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Coo Hance with Food Law* Food*
3-201.12 Food in a Hermetically Sealed Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501,111 Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.112 Mechanical Narewnshing-Hot Water
3-202.16 Ice Made From Potable Drinking Water* Sanitization'i'enn eratures*
5-101.11 Drinking Water from an Approved System* 4.501,114 Chemical Sanitization-temp.,pI1,
590.006(A) Bottled Drinking\Vater* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4 G01.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602.11 Cleaning Frequency of Equipment Food-
3 201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
sh* 4-702.11 Frequency of Sanitization of Utensils and
Shellfish*a
3-201.I S Molluscan an Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-70111 Methods of Sanitization-Hot Water and
Game and Wild hktshrooms Approved by Chemical*
•yAuthor•it� 10 Proper,Adequate Handwashin
Re alator
3 202.18 Shellstock IAtahoriation,Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301J2 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Nash*
S Receiving/Condition 11 Good HvRienie Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401,11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401,12 Discharges From the Eyes,Nose and
3-10 L I 1 Food Safe and Unadulterated* Month*
6 Ta s/Rcco•ds:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* Prevention of Contamination from
P-1
3-203.12 Shellstock Identification Maintained* Hands
Tags/Records:Fish Products 590,004(E) Preventing Contamination from
EIn to ces*
3-402.11 Parasite Destruction* 13 Ilandwasl►Facilities
3-402.t2 Records,Creation and Retention* Convenient) Located and Accessible
590.004(J) 5-203.11 Numbers and Ca acitics*
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5-205.11 Accessibility,Operation and Maintenance
Procedures/IIACCP Plans Supplied with Soap and Hand D►•5•ing
3-502.11 Specialized Processin Methods* Devices
3-502.12 Reduced o.x gem packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301,12 Hand Drying Provision
#Denotes critical item in tho federal 1999 Food Code or 105 CMR 590.000.
Establishment Name: y"i'yir I wls j'�;1,rY1 O'- �. Date: '7...I Page: ' of
Item Code c—critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY Veried
�� . " a ,....
s
^a e':.- w �" r h r�
iwW,...
( ,
3.` " f
efl
u
�„„u^aq.. ~fin• ,9 a 4''I„ el "„w ) .,. F^ ,., ^","., .." """ ,..„ ,„ ` ..w. ""�✓^ ,�n..d'".
ms v" ._
Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
"J14 e;
w ❑ Voluntary Compliance ❑ Employee Restriction
0-a v Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Reell(ens 1-22) (Cont) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FROl•1 CHEMICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Wnrning Labels*
3-202.12 Additives* 3.801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection front Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal rood and
[5 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-10 L 11 Identi ,ing information-Original Containcrs* 3-801,11 C Unopened Food Package Not Re-served,*
7-102,11 Common Name-Working Containers*
7-201,11 Separation-Storage* CONSUII•IERADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.11 Toxic Containers--Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.*e0"1"rrunoor
7-204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors,
TUNIE/TEMPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29--Special
3-401.IIA(1)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-immediate Service 145°F15sce*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec,* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-40 L1 I(B)(1)(2) Pork and Beef Roast-130°F 12I aria* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec,* Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Gnme,Stuffed PHFs, illness interventions and riskfactors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 CdfR 590,000.
Ratites-165°F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F# Item I Goorl Retail Practices FC S90,000
3-401.12 Raw Animal Foods Cooked in a 23. 1 Mana ement and Personnel FC-2 .003
Microwave 165°F* 2C Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25. Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and waste FC-5 .006
27. PhysicalFacilit FC .007
3-403.l I(A)&(D) PHFs I65°F 15 see.* 28, Poisonous or Toxic Materials FC-7 .008
3-403.1 l(B) Microwave- 165°F 2 Minute Standing 29. spccial Re uirements 009
Time* 30. Other
3.403,11(C) Commercially Processed RTG Food-
140°F*
3-403.t 1(E) Remaining Unsliced Portions of Beef "Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Roasts*
18 Proper Cooling of P1117s
3-501.14(A) Cooling Cooked PHFs from 140°17 to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 hours.*
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 411F/451F
Within 4 Hours*
3-501.14(C) PI11's Received at Temperatures
According to Law Cooled to 411F/451F
Within 4 Hours,*
3-501,15 Cooling Methods for PHFs
l 9 PHF Hot and Cold Holding
3-501,16(B) Cold PHFs Maintained at or below
590,004(F) 410/450 F*
3-501.16(A) Hot PHFs Maintained at or above I401F,
3-501,16(A) Roasts Held at or above 130°F.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(11) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: healtlydept@towrrofnorthandover.com
Name of Establishment Date Type of Operation(s) Type of Inspection
TnIll"A'o 7-16-/6 X Food Service N'Routine
Address W Risk Level El Retail ❑Re-inspection
1 5� n Residential Kitchen Previous Inspection
Telephone F1 Mobile Date:
Owner HACCP: El Temporary ❑Pre-operation
Y N El Caterer ❑ Suspect Illness
Person-in-Charge(PIC) M Time ❑ Bed&Breakfast ❑ General Complaint ovh,VIVI o F1 i-W HACCP
t
Inspector 1\1Le0etr\ Out: Year: Other
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne ftess Interventions and Risk Factors
Anti-Choking 590.009(E) El
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) El
determined by the Board of Health. Allergen Awareness 590,009 (G)[:1
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
1. PIC Assigned/Knowledgeable/Duties 13, Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2, Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives
F__J 3. Personnel with infections Restricted/Exciuded ED 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
0 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
El 5. Receiving/Condition El 16. Cooking'remperatures
)4 6. 'rags/Records/Accuracy of Ingredient Statements Ej 17. Reheating
ED 7. Conformance with Approved Procedures/HACCP Plans ED 18.Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Hoiding
EJ 20,Time as a Public Heafth Control
8. Sepa�,ation/Segregation/Protection
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cleaning and Sanitizing El 21. Food and Food Preparation for HSP
10. Proper Adequate Handwashing CONSUMER ADVISORY
11.Good Hygienic Practices 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Maurer of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses,interventions and Risk
or within 10 days as determined by the Board of Health. r-actors (Red Items 1-22):
Non-critical N violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590,000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26, Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
/V 27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other
Inspector's Signature: L Print:
PICs Signature: Print: 14 Page-f of -- Pages
Violations Related to Foodborne Illness Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION MANAGEMENT
1 590.003(A) Assignment of Res onsibilit * PROTECTION FROM CONTAMINATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2-103.11 Person in charge-duties 3-302.1 I(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
r590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination fro►n the Environment
590,003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Repo (in by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consiuner
590,003(E) Removal of Exclusions and Restrictions 3.306.14 A B Returned Food and Reservice of Food*
Disposition of.4dulterated or
FOOD FROM APPROVED SOURCE Contmninated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590,004 A-13 Conn liance with Food Law* Food*
3-201.12 Food in a hlermeticall y Sealed Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.111 Manual Wnrewashing-Hot Water
3-202.13 Shell Eggs* Sauitization'1'enn eratnres*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Wnrewasbing-Hot Water
3-202.16 1 lee Made From Potable Drinkin Water* Sanitization reran erattlres*
5-101.11 Drinking Water from an Approved System* 4.501.114 Chemical Sanitization-temp.,pll,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602,11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed rood Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and Wild Musluvoms Approved by Chemical*
Regulatory AWhoa-lt, 10 Proper,Adc uatc Handwasbin
3-202.18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
S Receiving/Condition 11 Good Hygienie Practices
3-202,11 PHFs Received at Proper Temperatures* 2-401,11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401,12 Discharges From the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
6 Tags/Records:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.I8 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Tags/Records:Fish Products 590.004(E) Preventing Contamination from
Em to ccs*
3-402.11 Parasite Destruction* 13 Ilandwash Facilities
3-402,12 Records,Creation and Retention*590,004(J) Conveniently Located and Accessible
Labeling of Ingredients* 5-203,11 Numbers and Capacities*
5-204.11 Location and Placement
7 Conformance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6.301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Establishment Name: Jt �h 1�� i- i 2—Z-C,- Date: —A, Page: q- ofC)--
Item code C—Critical Item f DESCRIPTION OF V(Ol.AT10N 1 PLAN OF CORRECTION Date
No. Reference R•-Red Item PLEASE PRINT CLEARLY Verified
'SCS�, i�- ¢ �'� •„ cam' t:C L-- �.. e
tom,/ e1!ti .r r- r
1 _.°
30 ch.ay5.
r r" -
44
G' Pr
_t
Discussion With Person in Charge: j r � ., Corrective Action Required: ❑ No Yes
G� ❑ Voluntary Compliance ❑ Employee Restriction i
Exclusion
❑ Re4nspection Scheduled ❑ Emergency Suspension
G
F illt f �\ is ❑ Embargo El Emergency Closure
UJ WlB
❑ Voluntary Disposal ❑ Other. .
Violations Related to Foodborne Illness Interventions and Risk
Factors(Rent Ifenns 1-22) (Cont) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FROM CHEIMICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3-801.11 Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing Information-Ori iml Containers* 3-801.11C Unopened Food Package Not Re-served.
7-102.11 Common Name-Working Containers*
7-201.11 Se aration-Storage* CONSUNIER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.*P�Jednr uuma
7-204.12 Chemicals for Washing Produce,Criteria` 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* catering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
Foodborne illness interventions and risk factors.
TINIEIFEMPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29--Special
3-401.IIA(1)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-immediate Service 145°1-'15see*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* 1110LATIONS RE,LATTPD TO GOOD RETAIL PRACTICES
3-401.1 I(B)(1)(2) Pork and Beef Roast- 130°F 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,h&cted Meats--155°F 15 sec.* Critical audnon-crificai violations,)vhich do not relate to the Foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, Illness interventions and riskfactors listed above, can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 CGblR 590,000,
Ratites-165°F 15 sec.*
3-401.11(C)(3) Whole-nmscle,Intact Beef Steaks 1450E* Itent Good Recall Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23. Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25. E ui memandUtcmils FC-4 .005
17 ReheAling for Hot Holding 26. 'Water,Plumbing and Waste FC-5 .006
27. Physical Facility FC-6 .007
3-403.11(A)&(D) PHFs 165°F 15 sec.* 28. 1 Poisonous or Toxic Materials FC-7 .008
3-403.11(B) Microwave-165°F 2 Minute Standing 29. Special Requirements 009
Time* 30. Other
3-403.11(C) Commercially Processed RTE Food-
140°F*
3-403.11(6) Remaining Unslieed Portions of Beef Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Roasts*
18 Proper Cooling of P1IFs
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours,*
3-501.l4(B) Cooling PHFs Made From Ambient
'temperature Ingredients to 41°F/450F
Within 4 Hours*
3-501.14(C) P111's Received at Temperatures
According to Law Cooled to 410F/450F
Within 4 Hours.*
E193-501.15 Cooling Methods for PHFs
PIIF Hot And Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/450 F*
3-501.16(A) Hot PHFs Maintained at or above 140*F.
3-501.I6(A) Roasts Held at or above 130°F.
20 1 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
____d
590.004(1I) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: healthdept@t wnotnorthandover.com
Name of Establishment-, Date Type of Operation(s) Type of Inspection
31 Fcxiyy-rQ,,- flu;L2-tN- _7)_-&J-1 [a Food Service Routine
Address 1,50ig 06soock -st Risk Level D Retail 6 Re-inspection
F] Residential Kitchen Previous Inspection
Telephone R Mobile Date:
Owner HACCP: R Temporary El Pre-operation
j C t4,� �C;Nfl.V) A-CW\t,��j S Y N ❑H Caterer El Suspect Illness
Person-in-Charge(PIC) Time El Bed &Breakfast ❑ General Complaint
In: I (q) ❑HACCP
Inspector t0i e3 CA Joed Aw-n/X Out: <6 I Year: ❑Other-
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Vidations Related to Food borne Illness Interventions and Risk F gtLqLs a -LRqd Lems -Choking
_j Anti 590.009(E) n
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) 0
determined by the Board of Health. Allergen Awareness 590,009 (G)El
FOOD PROTECTION MANAGEMENT El 12, Prevention of Contamination from Hands
[:] 1. PIC Assigned/Knowledgeable/Dutles 13, Handw,ashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and PIC
14.Approved Food or Color Additives
E] 3. Personnel with Infections Restricted/E xcluded
15.Toxic ChernicaIs
FOOD FROM APPROVED SOURCE
El 4. Food and Water front Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
j 5. Receiving/Condition El 16,Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding
El 8.Separation/Segregatioui/Protection El 20.'Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
S. Food Contact Surfaces Cleaning and Sanitizing El 21, Food and Food Preparation for HSP
E:1 10. Proper Adequate Handwashing CONSUMER ADVISORY
El 11. Good Hygienic Practices []22. Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related "ro
Critical (C) violations marked must be corrected immediately Foodborne Illnesses interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 122):
Non-critical N violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
41- 27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590,008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other
Inspector's Signature: Print: AA�7-,5
PICs Signature: Print: Page-1 of"a Pages
Violatlons Related to Foodborne Illness Interventlons and Risk Factors
(Red Items 1-22)
FOOD PROTECTION AIANAGENIENT
1 590.003(A) Assignment of Res onsibilit * PROTECTION FROA1 CONTAMINATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2-103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from(lie Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.1 I A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) .,Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(P,) Removal of Fxclusions and Restrictions 3-306,14 A B Returned Food and Reservice of Food*
Disposition of Adultet-ated oi,
FOOD FROM APPROVED SOURCE Contaminated food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Coo liaace with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201,13 Fluid Milk and Milk Products* 4-501.11 l Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitizationt'1'eut eratures*
3-202,14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Wnrewashing-Hot Water
3-202.16 1 Ice Made From Potable Drinking Water* Sanitizatioi'1'ettt eratures*
5-101,11 Drinking Water from an Approved System* 4.501,114 Chemical Sanitization-temp.,pI-1,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602,11 Cleaning Frequency of Equipment Food-
3-201,14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and 1f'ild blushrooms Approved by Chemical*
Regulatory Author,it y 10 Proper,Adequate Handwashin
3-202.18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590X04(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Nash*
S Receiving/Condition 11 Good Hygienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401.12 Discharges From the Eyes,Nose and
3-101.11 Food Safe and Unadulterated* Mouth*
6 Tags/Records:Shellstock 3-30 L 12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hnnds
Tags/Records:Fish Products 590,004(E) Preventing Contamination from
Em to ces*
3-402.11 Parasite Destrnction* 13 llandnvash facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590.004(J) 5-203.11 Numbers and Capacities*
Labeling of Ingredients* 5-204,11 Location and Placement*
7 Conformance with Approved 5.205,11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availabili
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Establishment Name: Trn rfw Date: - Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION p
No. Reference R-Red Item PLEASE PRINT CLEARLY erred
.mI ...
",a G"o M C)", l,- So 5 w .I s' ,-C "?w, ��" � It
pp a
. ' arl I t rA, P' a we
i"7 Q..Pre- <" '46 n
C p
+� . pp k'7e;)d "-� e n �-x.:''' a 'n t
Discussion With Person in Charge: Corrective Action Required: O No Yes
Voluntary Compliance ❑ Employee Restriction!
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items I-22) (Cont) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIOAXS IISP
PROTECTION FROM CHEMICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with\yarning Labels*
3-202.12 Additives* 3-801.1 l(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.1 l(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing Information-Original Containers* I 3-801.1! C Unopened Food Package Not Re-served,
7-102,11 Common Name-Working Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7.202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.I1 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.* ff"'urama
7-204.l2 Chemicals for Washing Produce,Criteria` 3-302,13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590,009(A).(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Past Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TIME/TEMPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PH Fs practices should be debited under#29--Special
3-401.11A(1)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-inunediato Service 145°Fl5see*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 see.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-155*F 15 sec, Critical and non-crilical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Gnme,Stuffed PHFs, illness interventions and riskfactors listed above, can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 CX11?590,000.
Ratites-165°F 15 sec.*
3-401.1 l(C)(3) Whole-niuscle,Intact Beef Steaks 1450E* Item Good Retell Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23, Management and Personnel FC-2 .003
Microwave 165*F* 24, Food and Food Protection FC-3 .004
3-401.1 l(A)(1)(b) All Other PHFs-145OF 15 sec,* 25. Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and Waste FC-5 .006
27. Physical Facilft FC-6 .007
3-403.11(A)&(D) PHFs 165°F 15 sec,* 28. 1 Poisonous or Toxic Materials FC-7 .008
3-403.11(I3) Microwave- 165'F 2 Minute Standing 29. Special Requirements 1 .009
Time* 30. Other
3.403.11(C) Commercially Processed RTE Food-
140°F*
3-403,11(E) Remaining Unsliced Portions of Reef *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590,000.
Roasts*
]8 Proper Cooling of PIIFs
3=501.14(A) Cooling Cooked PI•iFs from l40°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours.*
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45017
Within 4 Hours*
3-501.14(C) PIIFs Received at Temperatures
According to Law Cooled to 41°F/45°F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
i9 PHF Hat and cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/4511 F*
3-501.16(A) Hot PHFs Maintained at or above 140°F.
3-501.16(A) Roasts Held at or above I30°F.
20 Time os a Public Health Control
3-501.19 Time as a Pit lie Henith Control*
_--d
590,004(11) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: heaftlidept@t wriot'northandover.com
Name of Establishment Date Tme of Operation(s) Type of Inspection
Y, Food Service ❑Routine
Address r Risk Level ❑ Retail Re-in ecti
is It spre
Residential P,S colt
r Kitchen -2,
Telephone 0 Mobile Date
Owner HACCP: ❑ Temporary Pre-op
erati
El
Y N Caterer Suspect Illness
Person-in-Charge(PIC) El Bed&Breakfast r❑I General ComplaintF]HACCP
Inspector In: Year: ❑ Other-
Out: 3 1 1
Each violation checkedYequires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne iHness Interventions and Risk Fa tprs 'CL,hems). -Choking Anti 590,009(E) El
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) El
determined by the Board of Health. Allergen Awareness 590.009 (G)Ej
FOOD PROTECTION MANAGEMENT El 12. Prevention of Contarnkiation from Hands
F1 1, PIC Ass igned/KnoWedgeable/Dufies [
EMPLOYEE HEALTH _j 13. Handwashing Facilities
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC 14. Approved Food or Color Additives
3. Personnel with Infections Restricted/Excluded 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
S. Receiving/Condition El 16.Cooking TemperatUres
6. Tags/Records/Accuracy of Ingredient Statements [_1 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling
PROTECTION FROM CONTAMINATION [:119. Hot and Cold Holding
El 20."mime as a Public Health Control
8.Separation/Segregation/Protection
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cleaning and SanftWng El 21. Food and Food Preparation for HSP
E:1 10. Proper Adequate Handwashing CONSUMER ADVISORY
F E]22. Posting of Consumer Advisories
_1 I I. Good Hygienic Practices
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related 7`6
Critical (C) violations marked must be corrected immediately Foodbome Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items I-P.P):
Non-critical H violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code,This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other
Inspector's Signature, Print:
PICs Signature: Print: Page-L of-.2-gages
Violations Related to Foodborne 1/hress Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION)lANAGMMENT
1 590.003(A) Assignnnent of Res ponsibifit,* PROTECTION FRO)1 CONTAMINATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2-103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590.003(C) Responsibility of the person in charge to 3-302,11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from(lie Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.1 t A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590.003(G) Reporting by Person in Chnrgc* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(P,) Removal of Exclusions and Restrictions 3-306,14 A B Returned Food and Reservice of Food*
Disposition of,4dulterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Ilermeticall y Sealed Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.111 Manual Narewashing-Hot Water
3-202.13 Shell Eggs* Sanitizationn'1'eun eratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.112 Mechanical\Narewashing-Hot Water
3-202,l6 Ice Made From Potable Drinking Water* Sauitization'1'eur eratures*
5-101,11 Drinking Water fronn an Approved S ystenn* 4.501,114 Chemical Sanitization-temp.,PIl,
590,006(A) Bottled Drinking Water* concentration and hardness.*
590,006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602,11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Grupe and 111ild Mushrooms,Jpproved by Chemical*
10 Proper,Adequate Handwashin
Re Shellstock
A ntirict 2-301.I 1 Clean Condition-Hands and Arms*
3-202,18 Shellstock Identification Present*
590.004(C) Wild Mushrooms* 2-301,12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
S Receiving/Condition, 11 Good Hy ienie Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3»202.15 Package Inte ri * 2-401.12 Discharges From the Eyes,Nose and
3-101,I 1 Food Safe and Unadulterated* Mouth*
3-301,l2 Preventing Contamination�1Vhen'I'asting*
6 Ta slRccords:Shellstock
3-202.18 Shellstock Identification* IT
Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Ta s/Recm•ds:Fish Products 59UM(E) Preventing Coil tannination from
Em to ces*
3-402.1 t Parasite Destruction* 13 Ilandwash Facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590,004(J} 5-203.11 Numbers and Capacities*
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5.205,11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Doing
3-502,11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6.301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OR CITY OF Ir �r
Establishmefit Name: ZY�1 2c Date: Page: of
ItemCode ii C-Critical Item DESCRIPTION OF VIOLATION J PLAN OF CORRECTION Date
No. Referbnce R—Red Item Verified
�pn P� PLEASE
�,,PRINT CLEARLY
/yy
r f `v'w+6 L'ti l-f; ffi L
—t
t'
1
I
s c O G
— r
Discussion With Person in Charge: Corrective Action Required: No ❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction!
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo O Emergency Closure
O Voluntary Disposal ❑ Other:
Form 734 8 A.M.Sulkin Co.,Boston,MA
Violations Related to Food orne illness
Interventions and Risk Factors(Red Items 1-22)
PROTECTION FROM.CONTAMINATION
FOOD PROTECTION MANAGEMENT _- Gtoss-confarnnaton
1 590.003(A) Assignment of Responsibility* 3-302.11(AX 1) Raw Animal hoods Separated from
590.003(13) Demonstration of Knn, Cooked caul RTE.Foods*
2-103.1 1 Person in char ae-duties Ccan@anWnaficn hum Raw Ingredents
3-302.11(AX2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH _ Othct*
2 590.003(C) Responsibility of the person in charge to Contar,m Lion horn the Environment
require reporting by food employees and 3-302.11 A Fool Protection*
* and
applicants* _ 3-302.15 Waslnn�Fairits nd Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant 'to Report To The Person In Utensils'
Char e* Contarrrn•uon from the Consumer
590.003(G) Person in Charge*� 3-306.14 A B Rettiried Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* Csgxx,rtrarr7 etAduiferatedorContaminated
590.003E Removal of Exclusions and Restrictions Food
3-701.11 Disemcfing or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food`-
4 Food and Water From Regulated Sources 9 � oraxt Suvfaces
590.004 A-B Compliance e with Food Law* 4-501.111 manual Warewashing-Hot Water
3-201.12 Food in HermeticallySealed Container* Sanitization Tem atures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell E s*
- Sanittration Temperatures*
* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.14 E sand Milk Products,Pasteurized concc at r ation and hardness.
3-202.16 Ice Made From Polablc Drirrkirt Water* --m- ---
5-101.11 Drinkm Water from tut A roved S stem* 4-601.11(A) Uensil cttt Faced Contact Surfaces and
Utensils Clean*
590.006 A Bottled l3nukin Water* J
590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
Contact Surfaces and Utensils*
She rrsh and Fish From an Approv®d Source 4-702.11 Faequctacy of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Conl.rct Surfaces of ui ment*
Shellfish*
4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical' _
Sources* �Prigk a A&-Aotate Han aching
Game and Wild Mushrooms Approved by 10 rifi 2-301.11 � Clean Condition-Hands and Arms*
Re alai Autho
�-__-
3-202.18 Shellstock Identification Present* 2-301.12 (leantnnI'xocedure*
3 20104 C Waild rne uslaooms* 2-301.14 When to Wash*
-ls* 11 G Flygic nic Practices
u �
nima
$ ReceivingJCerotitrt 2401.11 Eatin _1 au�._2r Using Tobacco*
3-202.1 1 PH Fs Received at Proper Temptratures* 2401.12 Disc:h rges From the Eyes,Nose and
3-202.15 Packer httegr�ty r Mottth
c
3-101.1 I Food Sale and Unadulterated* 3-301.12 Pacveauu��f ontammation When Tasting*
6 TasdslRecosd�.dl�llcxck lZ Pr va�rtktar of Contamination few Hands
3-202.18 Shellstock Identification * 590.004(E) Prevc r tang Contamination from
3-203.12 Shelistock Identification Maintained* Er"aVlovees*
Tagsl��cerds t•Is1v Fits 13 y�&lasurp�� to t'. cilfitl�s
Cof>vr nr ntiy Located and Accessible
3402.11 Parasite Dc,strnc tion*
3402.12 Records,Creation and Retention* 5-203.11 Nutnbc rs mid Capacities*
- -�- 5-204.11 I ocatiou nd Placement*
590.004(1) Labeling o9 leagnedlt nt - -
- -- -edur 5-205.11 Ac cr s rbciity Olr ration and Maintenance
7 G;;W u roar:s°4tle p o-v Pro educes _ __
iHACCP Plans Sum!ad wilh Soap and Hand Drying
.r.. ivr'os
3-502.11 S rpcialized Processtnm;Methods* - W
° 6-301.11 - Clevr,Availability
3-502.12 Reduced ox ack, il ,citea*Y en 6-301.12 1-land I? nry Provision
8-103.12 Confor"Umce evath"Approved Procedures*Denotes critical item in the federal 1999 Fowl Code o, 105 CM 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: heaithdept@townofnorthandover.com
Name of Establishment S k Date Type of Operation(s) Type of Inspection I'S :j)/() Food Service Routine
Address �-WOA Risk Level El Retail ❑Re-inspection
%J R Residential Kitchen Previous Inspection
Telephone F1 Mobile Date.
Owner HACCP: F] Temporary ❑Pre-operation
A-rCrtN)6_ Y N ❑Lj Caterer El Suspect Illness
Person-in-Charge(PIC) Time HACCP El Bed&Breakfast El General Complaint
E]In: 3 Y6 R Other
Inspector
61 Wi VN Out: Year:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
ftIaflons Related to Foodborne Illness Interventions and Risk FacLorsEqd items -Choking Anti 590.009(E) El
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) F1
determined by the Board of Health. Allergen Awareness 590.009 (G)El
FOOD PROTECTION MANAGEMENT El '12. Prevention of Contamination from Hands
1. PIC Assigned/Knowledgeable/Duties
K13. Handwashing Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC 14. Approved Food or Color Additives
3. Personnel with Infections Restricted/Excluded
15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
Ej 5. Receiving/Condition El 16.Cooking Temperatures
[ 6, Tags/Records/Accuracy of Ingredient Statements E-1 '17. Reheating
El '7. Conformance with Approved Procedures/HACCP Plans 0 18. Cooling
PROTECTION FROM CONTAMINATION K,9., Not and Cold Holding
E] 8.Separation/Segregatioai/Protection D 20.Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cieaning and Sanitizing El 21. Food and Food Preparation for HSP
10. Proper Adequate Handwashing CONSUMER ADVISORY
El 11. Good Hygienic Practices [_1 22. Posting of Consurner Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1-22):
Non-critical H violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C INI report,when signed below by a Board of Health member or its agent
23. Management and Personnel (FC-2)(590.003) constitutes an order of the Board of Health.Failure to correct violations
24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of the food
25. Equipment and Utensils (FC-4)(590.005) establishment permit and cessation of food establishment operations. If
26. Water, Plumbing and Waste (FC-5)(590.006) aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the Bove/Address
28, Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION P41
30. Other
Inspector's Signature: Print: It i
PICS Signature: Print: Page-L of2-Pages
Violations Related to Foodborue lltuess Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION INIANAGE-NIUNT
1 590.003(A) Assignment of Res onsibilit * PROTECTION FROII CONTAMINATION
590.003(B) DenttonstrationofKnota,ledge* 18 Cross-contamination
2-103,11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated front
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from the Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590.003(0) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consinner
590,003(E) Removal of Fxclusions and Restrictions 3.306,14 A 13 Returned Food and Reservice of Food*
Disposition ojAdalterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Rc nlated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-20I.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201,13 Fluid Milk and Milk Products* 4-501.11 t Manual Narewashing-Hot Water
3-202.13 Shell Eggs* Sanitizatiott't'ent eratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.112 Mechanical Warewashing-Hot Water
3-202.16 Ice Made From Potable Drinking Water* Sanitization Tent eratures*
5-101.11 Drinking Water front an Approved System* 4.501,114 Chemical Sanitization-temp.,p11,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish Front nit Approved Utensils Clean*
Source 4-60111 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and 11"ild d-lushrooms Approved by Chemical*
Re ulatoi Anthorit y 10 Proper,Adequate Handtvasbin
3-202.18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Nash*
S Receiving/Condition 11 Good Hygienic Practices
3-202.I 1 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202,15 Package Integrity* 2-401,12 Discharges Front the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
G Tags/Records:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Preventlon of Contamination front
3-203.12 Shellstock Identification Maintained* Hands
Ta s/Records:Fish Products590.004(E) Preventing Contamination front
l m to ces*
3-402.11 Parasite Destruction* 13 Ilandtvflsh Facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590,004(J) 5.203,11 Numbers and Capacities*
Labeling of Ingredients* 5-204,11 Location and Placement*
7 Conformance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6.301.12 1 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Establishment Name: lYLI yam}t'/Pl �' Date: Page: `;" of C7C
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY p Verified
char: vnt'
Q wi yr c,- C ,fi Lc
s c
f
f Nc P ,�>_,- sb.3 ,-.m�, rEr ' ;l,_ ', --] , S
i1 _ L�
Discussion With Person in Charge: G (1 O j Corrective Action Required: ❑ No K Yes
�C / tcS�t^ ❑ Voluntary Compliance ❑ Employee Restriction 1
l /` Exclusion
❑ Re4nspectionScheduled ❑ Emergency Suspension
nrQ ?
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items I-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FRO-NI CHEMICALS 3-801.11(A) Unpasteurized Pre-packaged Juices and
If-
14 Food or Color Additives Bevera es with Warning Labels*
3-202,12 Additives* 3-80 L 11(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing Information-Original Containers* 3-801,11 C Unopened Food Package Not Re-served,
7-102,11 Common Name-Working Containers*
7-201,11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7.202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers--Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.* Mama
7-204.12 Chemicals for Washing Produce,Criteria* 3-302,13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL RE UIREMENTS
7-206,11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness Interventions and risk factors,
'1'INIE/TENIPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHN practices should be debited under 429--Special
3-401.IIA 1 Requirements.
( ){2) Eggs- 155°F 15 Sec.
Eggs-Immediate Service 145°F15seck
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 12I min* (Blue Items 23-30)
3-401.11(A)(2) Rntites,Injected Meats-155°F 15 sec.* Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Gnme,Stuffed PHFs, illness interventions and r1skfactors listed above, can be found in the
Shifting Containing Fish,Meat,Poultry or following sections of the Food Code and 105 Cr61R 590,000.
Ratites-165°F 15 see,*
3-401.1 l(C)(3) Whole-muscle,Intact Beef Steaks 145°F Item Good Retail Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23, Management and Personnel FC-2 .003
Microwave 165°F* N8.
Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* E ui nentandUtensils FC-4 .005
17 Reheating for Hot Holding Water,Phumbin and Wasto FC-5 .006
PhysicalFacilit FC--6 .007
3-403.11(A)&(D) PHFs 165°F 15 sec.* Poisonous or'I'oxicMaterials PC .008
3-403.1 L(B) Microwave-165°F 2 Minute Standing S cial Re uirementsTimer` Other
3-403.1 I(C) Commercially Processed RTE Food-
l40°F*
3-403.I1(E) Remaining Unsliced Portions of Reef 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Roasts*
48 Proper Cooling of PHFs
3-501.14(A) Cooling Cooked P1IFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours,*
3-501.l4(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/450F
Within 4 Hours*
3-501.14(C) PIIFs Received at Temperatures
According to Law Cooled to 410F/450F
Within 4 Hours.*
E193-501.15 Cooling Methods for PHFs
PAR Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/450 F*
3-501.I6(A) Hot PHFs Maintained at or above l40°F.
3-501,16(A) Roasts Held at or above 130°F.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590,004(I I) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: healtlidept@t wrioffiorthandover.com
Name of Establishment Date Type of Operation(s) Tvne of Inspection
�tc(nf-r'lA jEe::�:Mov's :Ec 2_2_c, Food Service
Address 1�61.9 osuA Risk Level El Retail I-ke-inspection
Residential Kitchen Previous lys X4
Telephone El Residential
Mobile CO- CA
Owner HACCP: R Temporary fl"Pre-operafi,n,"
Y / N El Caterer ❑Suspect Illness
Person-in-Charge(PIC) Time Bed&Breakfast HACCP General Complaint
F-1
Inspector El Other
(Aa H ,WI Y-,- Out: 1165 Year:
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations dbo Reiated toil oorne HIness Merventions and_&sXfactors(Red Lto s_ M_j Anti-Choking 590.009(E) M
Violations marked maypose,animminent health hazard and require immediate corrective action as Tobacco 590.009(F) E]
determined by the Board of Health. Allergen Awareness 590.009 (G)F1
FOOD PROTECTION MANAGEMENT EJ_ 12, Prevention of Contamination from Hands
[] 1. PIC Assigned/Knowiedgeable/Duties 0 ,13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
El 2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives
El 3. Personnel with infections Restricted/Excluded 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4, Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
[1 5. Receiving/Condition [�] 16, Cooldng'Temperatures
El 6.. l'ags/Records/Accuracy of Ingredient Statements 17. Reheating
EN 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION E] 19. Hot and Cold Holding
EJ F 20.Tirne as a Public Health Control don/Protection 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cleaning and Sanitizing D 21 W Food and Food Preparation for HSP
10. Proper Adequate Handwashing CONSUMER ADVISORY
11.Good Hygienic Practices ❑22, Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors (Red Items 1-22):
Non-critical N violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590,004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other
Inspector's Signature: Ale Z 14 1 A,11"k Print:
A P
PICs Signature: Print: Page❑
��j L of 0 ages
Violations Related to Foodborue Illness Intert,eirtions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION IMANAGEIMENT
1 590.003(A) Assignment of Res nonsibilit * PROTECTION FROM CONTAMINATION
590.003(Il) Demonstration of Knowledge* 8 Crass-contamination
2-103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated front
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590.003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food eniployces and Other*
applicants* Contamination from the Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590.003(G) Reporting by Person in Charge* Utensils*
3 590.003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3-306.14 A 8 Returned Food and Reservice of Food*
Disposition ofAdulterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590,004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 hood Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.11 t Manual Wnrewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'Pent eratures*
3-202,14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Wnrcwashing-Hot Water
3-202.16 ice Made From Potable Drinking Water* Sanitization'I'em eratures*
5-101.11 Drinking Water front an Approved System* 4.501.114 Chemical Sanitization-temp.,pII,
590.006(A) Bottled Drinking Water* concentration and hardness.
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From nit Approved Utensils Clean*
Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.1 i Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and 1T'ild,1lushrooms Approved by Chemical*
Re ulator Authorii y 10 Proper,Adequate Handwasbin
3-202.18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201,17 Game Animals* 2-301.14 When to Wnsh*
5 Receivin /Condition 11 Good Hygienic Practices
3-202,11 PHFs Received at Proper Temperatures* 2-401,11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401,12 Discharges From the Eyes,Nose and
3-101.11 Food Safe and Unadulterated* Mouth*
6 Togs/Records:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Ta slRecords:Fish Products 590M,I(E) Preventing Contamination from
Em to ces*
3-402.11 Parasite Destruction* 13 Ilandwash Facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590,004(J} 5-203.11 Numbers and Capacities*
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Establishment(dame: raCN,S Date: �_ ��'�S Page: c-. of
Item Code C--Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY Verified
Ail Il4elvis
Discussion With Person in Charge' ` Corrective Action Required: O No Yes
❑ Voluntary Compliance ❑ Employee Restriction
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items I-22) (Cont) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FROM CHE3WICALS 121 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Wanting Labels*
3-202.12 Additives* 3.801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.
7-101.11 Identi ,ing htforntation-Ori inal Containers* 340111 l C Unopened Food Package Not Re-served,
7-102,11 Common Name-Workin Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.*efftaen un'aoar
7-204.12 Chemicals for Washing Produce,Criteria` 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREAIENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* catering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors,
TIt\IEITEMPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29-Special
3-401.11A(1)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-Immediate Service 145°F15see*
3-401,I I(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-401.11(11)(1)(2) Pork and Beef Roast- 130°F 12I thin* (Blue Items 23-30)
3-401.1 l(A)(2) Ratites,Injected Meats-155°F 15 sec,* Critical card non-critical violations,nvhich do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and riskfactom listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or follotving sections of the Food Code and 105 Cd/R 590,000,
Ratites-165°F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* Item I Goort Retail Practices FC 590,000
3-401.12 Raw Animal Foods Cooked in a 23, Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25, Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and Waste FC-5 .006
27. Physical Facilit FC--6 .007
3 403.1 I(A)&(D) PHFs [GS°F 15 sec.* 28, Poisonous or Toxic Materials PC-7 .008
3-403.1 l(B) Microwave- 165°F 2 Minute Standing 29, Special Requirements 009
Time* 30. Other
3.403,11(C) Commercially Processed RTE Food-
140°F*
3-403.11(E) Remaining Unsliced Portions of Beef "Denotes critical item in the federal 1999 Food Code or 105 CMR 590M0.
Roasts'
IS Proper Cooling of PUN
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 hours,*
3-501,14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41 117/450F
Within 4 Hours*
3-501.14(C) P111's Received at Temperatures
According to Law Cooled to 410F/450F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
19 PHF Hot and cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/450 F*
3-501,16(A) Hot PHFs Maintained at or above l40°F.
3-501,16(A) Roasts Held at or above 130°F.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(11) Variance Requirement
fp
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: healthdel)t@t)NvnoftioitliandoN,ei-.com
Name of Establishment Date ape of Operation(s) Type of Inspection
-� i,-h rn Vt 2<U, -. 7d-❑/,-/V [N Food Service El Routine
Address Risk Level F-1 Retail JN Re-inspectlio
❑ Residential Kitchen Previo ?)�,ectioll
Telephone ❑ Mobile Datel . ')
Owner HACCP: El Temporary R Pre-o Inerafion
Y / N El Caterer ❑ Suspect Illness
Time F]General Complaint
•Person-in-Charge(PIC) El Bed &Breakfast F] HACCP
Inspector 36 Year: ❑ Other
Out:// I
Each violation checkedirequires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations Related to Foodborne Illness intervenflons and Risk Factors(Rp
_...... .4!Lq!!Isj Anti-Choking 590.009(E) 171
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590,009(F) []
determined by the Board of Health, Allergen Awareness 590.009 (G)1771
FOOD PROTECTION MANAGEMENT FJ_ 12. Prevention of Contamination from Hands
El is PIC Assigned/KnoMedgeable/DLIfieS D 13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
Ej 2. Reporting of Diseases by Food Employee and PIC F_
El 3. Personnel with infections Restricted/Excluded _1 14,Approved Food or Color Additives
El 15. Toxic Chernicals
FOOD FROM APPROVED SOURCE
4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
S. Receiving/Condition ❑ 16. Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Cold Hddkig
L-1 8,,Separation/Segregation/Protection El 20. Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
El G. Food Contact Surfaces Cleaning and Sanitizing 21. Food and Food Preparation for HSP
10. Proper Adequate Handwashing
CONSUMER ADVISORY
11.Good Hygienic Practices [] 22, Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. "actors(Red Items 1-247):
Non-critical N violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code,This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5) 90,006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility Peo",/onX90.007) be in writing and submitted to the Board of Health at t e abo e address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
(JYJ01111
30. Other
Inspector's Signature: Print:
A ICs Signature: Print: Page of Pages
Violations Related to Foodborne Illness Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION)MANAGENIENT
1 590.003(A) Assignment of Res ionsibilit y* PROTECTION FRObI CONTAMINATION
590.003(B) Demonstration of Kmotvledge* 8 Cross-contamination
2-103.11 Person in charge-duties 3-302.1 I(A)(1) Raw Animal Foods Separated front
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590.003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from fire Envirounient
590,003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3.306.14(A)(B Returned Food and Reservice of Food*
Dlsposltion of Adulterated a•
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701,11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201,13 Fluid Milk and Milk Products* 4-501,111 Manual Wnrewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'1'emn eratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warewashing-Hot Water
3-202,16 Ice Made From Potable Drinking Water* Sanitizatioi'1'enn eratures*
5-101.I 1 Drinking Water from an Approved System* 4-501.114 Chemical Sanitization-temp,,pIl,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and JJ'ild A/ushroomsApproved by Chemical*
Re ulatoi ,AuthoH1, 10 Proper,Adequate Handwasbin
3-202.18 Shellstock Identification Present* 2-301.1 l Clean Condition-Hands and Arms*
590.004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
S Receivin lCordition 11 Good Hygienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401.12 Discharges From the Eyes,Nose and
3-101,11 Food Sate and Unadulterated* Mouth*
6 Ta s/Rcco•ds:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Ta s/Records:Fish Products 590,004(E) Preventing Contamination from
EIn to ees*
3-402.11 Parasite Destruction* 13 IIandwash Facilities
3-402,12 Records,Creation and Retention* ConvenientlyLocated and Accessible
590A04(J) 5-203.11 Numbers and Ca pacifies*
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5-205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plaits Supplied with Soap and Hand Drying
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301,11 Handwashing Cleanser,Avnilabili
8-103.12 Conformance with Approved Procedures* 6-301,12 Hand Drying Provision
*Denotes critical item in the federat 1999 Food Code or 105 CMR 590.000.
Establishment Name: J Date: Page: of�
Item Code C—Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R_Red Item PLEASE PRINT CLEARLY Verified
� t..
_.
� F 1
„r A , daC
,r .> -.Iv.L,.r
'r k.1 r\dm r"-',,r r""r b.J Ili
ry
w B ,.
b F L 4 d 1 C" �d"""
Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
ell le IL94—
❑ Voluntary Compliance ❑ Employee Restriction I
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
9 ❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS
PROTECTION FROM CHICALS IISP
I\I
121 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3-801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing Information-Original Containers* 3-801.11 C Unopened Food Package Not Re-served,*
7-102,11 Common Name-Working Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202,11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.*"0"1 nanooJ
7-204.12 Chemicals for Washing Produce Criterin* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria"
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590.009(A).(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TIME/TENIPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29--Special
3-401.11A(i)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-inunedfato Service 145°FI5sce*
3-401.1 I(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* I/IOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-401.1 I(B)(1)(2) Pork and Beef Roast-130°F 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec." Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and riskfactors listed above, can be found in the
Stu fTfng Containing Fish,Meat,Poultry or following sections of the Food Code and/05 C$IR 590.000.
Ratites-165°F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks l45°F* Items Good Retail Practices FC S901000
3-401.12 Raw Animal Foods Cooked in a 23, Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25. Equipment and Utensils 17C-4 .005
17 Rebenting for Hot Holding 26. water,Plumbing and waste FC-5 .006
) (D) 27. Physical FacilityFC--6 .007
(
3-403.11 A& PHFs 165°F 15 sec.* 28. 1 Poisonous or Toxic Materials FC-7 .008
3-403.1 l(B) Microwave- 165"F 2 Minute Standing 29. Special Requirements 009
Time* 30. Other
3-403.1 I(C) Commercially Processed RTR Food-
l40°F*
3-403.11(E) Remaining Unsliced Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Roasts*
I$ Proper Cooling of PHFs
3-501.14(A) Cooling Cooked PHI s from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 hours.*
3-501.l4(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 4I1F/451F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
19 PIIF Hot and Cold Holding
3-501,16(B) Cold PHFs Maintained at or below
590.004(F) 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.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(11) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood street mite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: ljealthdept@t wnofnorthandover.com
Name of Establishment Date Type of Operation(s) Type of Inspection
t A-NO lb T(Ly x"S ������ 11-10-141 Pq Food Service ®.Routine
Address Y I Risk Level ❑ Retail ❑Re-inspection
Telephone El Residential Kitchen Previous Inspection
❑ Mobile
Owner HACCP: ❑ Temporary ❑pre-operation
Y / N ❑ Caterer ❑ Suspect Illness
General
Person-in-Charge(PIC) tt� , � `- �* Time ❑ Bed&Breakfast El BedComplaint
��1 In: 30 Inspector In:
uw, Out: , Year: ❑ Other
Each violation chec ed requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
flations R i t d to Foodborne Illness Interventionand sk ctors LgT! j Anti-Choking 590.009(E) ❑
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) ❑
determined by the Board of Health. Allergen Awareness 590.009 (G)❑
FOOD PROTECTION MANAGEMENT EJ 12. Prevention of Contamination from Hands
F 1. PIC Assigned/Knowledgeable/Duties
El 13, Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food IEvnpioyee and PIC
F1 14. Approved Food or Color Additives
3n. Personnel with infections Restricted/Excluded
] 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
4 Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
] 5. Receiving/Condition [116.Cooking Temperatures
6. Tags/Records/Accuracy of Ingredient Statements [_1 17. Reheating
7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
..� Su Separa4iouu/Segregatiion/Protect'ion � 20o Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
-..� 9. Food Contact Surfaces Cleaning and Sanitizing 21. Food and Food Preparation folr HSP
10. Proper Adequate Handwashing
CONSUMER ADVISORY
11.good Hygienic Practices -1 22. Posting of Consumer Advisories
Violations Related to Goad Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne I/Inesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1- )e
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N report,when signed below by a Board of Health member or its agent
23. Management and Personnel (FC 2)(59o.aos)
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FG-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION: 1
30. Other C:. ed t 4 G.c4-IS 41CJNel-K
Inspector's Signature: Print:
PICs Signature: Print: a.ca r- Page of ages
' t)
►violations Related to Foodborne Illness Inleri,errllons and Risk Factors
(Red Items 1-22)
FOOD PROTECTION NIANAGENTENT
1 590.003(A) Assignment ofResnonsibilit�* PROTECTION FROM CONTAMINATION
590,003(B) Demonstration of Knowledge* 8 Cross-contanninatiomn
2-103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from the Environment
590,003(F) Responsibility Of A Food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person In 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(G) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590,003(E) Removal of Exclusions and Restrictions 3-306,14 A B Returned Food and Reservice of Food*
Disposition ojAdullerated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501,111 Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'1'eun erattres*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Wnrcwnshing-Hot Water
3-202,16 Ice Made From Potable Drinking Water* Sanitization'Penn eratures*
5-101.11 Drinking Water from an Approved S stern* 4-501,114 Chemical Sanitization-temp.,PH,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.I1(A) Equipment Food Contact Surfaces and
Shellfish and Irish From an Approves! Utensils Clean*
Source 4-602,11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molhiscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and Wild kfushrooms,4pproved by Chemical*
Regidatoijp,4ulhorfly 10 Proper,Adequate Handwashin
3-202,18 Shellstock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590,004(C) Wild Mushrooms* 2-301,12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wnsh*
S Receiving/Condition 11 Good Hy ienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401.12 Discharges From the Eyes,Nose and
3-101.11 Food Safe and Unadulterated* Mouth*
6 Ta s/Records:S11e11stock 3-301.12 Preventing Contamination When'fasting*
3-202,18 Shellstock Identification* I2 Prevention of Contamination from
3-203,12 Shellstock Identification Maintained* Hmids
Tags/Records:Fish Products 590,004(E) Preventing Contamination from
Em to ees*
3-402.11 Parasite Destruction* 13 Ilaindwash Facilities
3-402,12 Records,Creation and Retention*590,004(J) Converflendy Located and Accessible Labeling of Ingredients* 5.203,11 Numbers and Ca pacifies*
5-204,11 Location and Placement*
7 Conformance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Dieing
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packiging,criteria* 6.301.11 Handwa,shing Cleanser,Availabili
8-103.12 Confornnanee with Approved Procedures* 6-301,12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Establishment Name: JC n Date: r ~C Page: a�- of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data
No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
-i g- ass
2 C n d e l r
3 -wa w
4-131
Discussion With Person in Charge: } Corrective Action Required: ❑ No Yes
❑ Voluntary Compliance ❑ Employee Restriction!
Exclusion
ff ❑ Re-inspection Scheduled ❑ Emergency Suspension
a'lt�rl ®44P M
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Relater/to Foodborne Illness Interventions and Risk
Factors(Red Items I-22) (Cont) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FRO1�1 CHT:MICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3.801.1 l(B) Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
IS Poisonous or Toxic Substances Raw Seed Sprouts Not Served.
7-101.11 Identi ,ing Information-Original Containers* 3-801,11 C Unopened food Package Not Re served,
7-102,11 Common Name-Workin Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and User 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.*10"',urnoa
7-204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206,11 Restricted Use Pesticides,Criteria* 590,009(A).(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TI\IE/TEMPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29-Special
3-401,IIA(1)(2) Eggs- 155°F 15 Sec, Requirements.
Eggs lnmediate Service 145°Fl5sec4;
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F I5 sec.* TYIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 12I min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Tn'ccted Meats-155°F 15 sec.* Critical and non-critical violations,iphich do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and risk factors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 CrblR 590.000.
Ratites-165°F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* Item Good Retail Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23. Mann enient and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 25, Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbin and Waste FC-5 .006
27. PhysicalFacilit FC--6 .007
3 403.11(A)&tD) PHFs I65°F 15sec.* 28. Poisonous or Toxic Materials FC-7 .008
3-403.11(13) Microwave-165°F 2 Minute Standing 29. Special Requirements 009
Time* 30. 1 Other
3-403.11(C) Commercially Processed RTE Food-
140°F*
3-403.1 i(E) Remaining Unsliced Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Roasts*
I8 Proper Cooling of PIiFs
3-501,14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 Hours,*
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
3-501.14(C) PHFs Received at Temperatures
According to Law Cooled to 41°F/451F
Within 4 Hours.*
E193-501.15 Cooling Methods for PHFs
PHF Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 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.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(1I) Variance Requirement
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-inail: lietitlidept@t)wiiofnoi-tliaiidover.coni
Name of Establishment Date Type of Operation(s) Type of Inspection
,-K jV'%V'y%.& Food Service
Address Risk Level El Retail Re-inspectilrryl)
el
M Residential Kitchen —Pi rafts--118pection
Telephone F] Mobile Date:
Owner HACCP: F-1 Temporary El Pre-operation
Y / N ❑ Caterer ❑ Suspect Illness
Person-in-Charge(PIC) Bed &Breakfast ❑General Complaint
In: F]HACCP
Inspector Out: It Ize) Year: 1-1 Other
Each violation checldd requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Violations ReWed to Food borne ftess,interventions and Risk Factors Anti-Choking 590.009(E) 0
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) [71
determined by the Board of Health. Allergen Awareness 590.009 (G)E]
FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands
El 1. PIC Ass lgned/Knowledgeab le/Mities E. 13, Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of IDiseases by Food Employee and PIC El 14, Approved Food or Color Additives
3. Personnel with infections Restricted/Excluded
El 15,Toxic Chemicals
FOOD FROM APPROVED SOURCE
El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
El 5, Receiving/Condition 16.Cooking Temperatures
6. Tags/Records/Accuracy of ingredient Statements E,j 17. Re eating
7. Conformance with Approved Procedures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION 19° Hot and Cold Holding
0 8. Sepai°ation/Segregatioi,i/Protection El 20.T'ime as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cleaning and Sanitizing E'] 21. Food and Food Preparaflon for HSP
ll'
El 10., Proper Adequate Flandwashing CONSUMER ADVISORY
11. Good Hygienic Practices 22, Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Relatedro
Critical (C) violations marked must be corrected immediately Foodbome Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. Factors (Red Items 1-22)1:
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590,0001federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other
7
Inspector's Signature: Print: 5,1
PICs Signature: Print: P V A Page/ of",Pages
Violations Related to Foodborue Illness Ititeri entiotrs and Risk Factors
(Red Items 1-22)
FOOD PROTECTION IMANAGMMENT
1 590.003(A) Assignment of Res nonsibilit,* PROTECTION FROi11 CONTAMINATION
590,003(B) Demonstration of Knowledge* 8 Cross-co
2-I03.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods`
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590,003(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
applicants* Contamination from the Environment
590.003(F) Responsibility Of A Food Employee Or An 3-302,11 A Food Protection*
Applicant To Report To The Person In 3-302,15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Reporting by Person in Charge* Utensils*
3 590.003(D) E\cIusioas and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3-306,14 A B Returned Food and Reservice of Food*
Disposition of Multerated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590,004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically Scaled Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.111 Manual Wnrewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'1'em cratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warewashing-Hot Water
3-202.16 1 Ice Made From Potable Drinking Water* Sauitization'1'em eratares*
5-101.11 Drinking Water from an Approved S ystcm* 4.501.114 Chemical Sanitization-temp.,pin,
590.006(A) Bottled Drinking Water* concentration and hardness,*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601,11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602,11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of qui nnent*
Sources* 4-703.11 Methods of Sanitization-Hot Water and
Game and Wild Mushroons.lpproved by Chemical*
Re ulatoiy,4tithoril l0 Proper,Adequate Handrvashin
3-202.18 Shelistock Identification Present* 2-301.11 Clean Condition-Hands and Arms*
590,004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Wash*
S Receiving/Condition 11 Good Hy ienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-401,11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401,12 Discharges From the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
6 Tags/Records:Shelistock 3-301.12 Preventing Contamination When Tasting*
3-202.18 Shelistock Identification* Iz Prevention of Contamination from
3-203.12 Shelistock Identification Maintained* Hnnds
Ta sMecords:Fish Products 590,004(E) Preventing Contamination from
3-402.1 I Parasite Destruction* Em to ces*
13 Ilandwash Facilities
3-402,12 Records,Creation and Retention*590,004(,l) Conveniently Located and Accessible
Labeling of Ingredients* 5.203.11 Numbers and Capacities*
5-204.11 Location and Placement
7 Conformance with Approved 5.205,11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Diving
3-502.11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Avililability
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Establishment Name: v"r V" w_k ""` N✓ l < Date: Page: of `
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY Verged
^
PIC
,r k
ca ,
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction/
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
Violations Related to Faodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS
PROTECTION FRO-NI CHEMICALS IISP
21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3.801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection front Unapproved Additives* 3-801.1 I(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi ,ing Information-Original Containers* 3-801.l I C Unopened Food Package Not Re-served,
7-IO2.11 Common Name-Working Containers*
7-201.11 Separation-Storage* CONSUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions ofUse* Animal Foods That are Raw,Undercooked or
7.203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.*rat°rnp ninnoon
7.204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 incidental Food Contact,Lubricants* SPECIAL REQUIREi1IENTS
7-206.1 t Restricted Use Pesticides,Criteria* 590.009(A).(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.I3 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TINIE/TENIPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHN practices should be debited under#29--Special
3-401.IIA(1)(2) Eggs- 155°F I5 Sec. Requirements,
Eggs-Immediate Service 14501315sec*
3-401.11(A)(2) Comminuted Fish,Meats&Gamc
Animals- 155*F 15 see,* VIOLATIONS RELATED TO GOOD RETAIL PRACTICE'S
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130OF 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats--155°F 15 sec.* Critical and non-critical violations,ivhtch do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuiled PHFs, illness interventions and riskfactois listed above, can be found in Ilia
Stuffing Containing Fish,Meat,Poultry or follosving sections of the Food Code and 105 CrL/R 590,000,
Ratites-165°F 15 see.*
3-401.1 i(C)(3) Whole-muscle,Intact Beef Steaks 145OF* heat Good Retail Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23. Mann anent and Personnel FC-2 .003
Microwave 165*F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFs-145OF 15 sec.* 25. Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbin and Waste FC-5 .006
27. Physical Facility FC-=6 .007
3 403.11(A)&(D) PHFs 165°F 15 sec.* 28. 1 Poisonous or Toxic Materials FC-7 .008
3-403.11(13) Microwave- 165*F 2 Minute Standing 29. 1 Special Re uirements .009
Time* 30. 1 Other
3.403.l 1(C) Commercially Processed RTE Food-
l40°F*
3-403A I(E) Remaining Unsliced Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Roasts*
18 Proper Cooling of P1117s
3-501.14(A) Cooling Cooked PHI s from 140°F to 70°F
Within 2 Hours and From 70°F to
41*F/45°F Within 4 flours,*
3-501.l4(B) Cooling PHFs Made From Ambient
"Temperature Ingredients to 41°F/451F
Within 4 Hours*
3-501.14(C) PIIFs Received at Temperatures
According to Law Cooled to 41012/45017
Within 4 Hours.*
E193-501.15 Cooling Methods for PHFs
PHF Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 41°/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.
20 Time as a Public Health Control
3-501.19 Time as a Public Health Control*
590.004(1I) Variance Ile uirennont
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street Suite 2035
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
Division of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax-978.688.8476
e-mail: healthdept@t wnot'northandovencom
Name of E tablishment Date Type of Operation(s Type of Inspection
Food Service Routine
Address OSS Cho A Risk Level FTRetail ❑Re-inspection
F-1 Residential Kitchen Previous Inspection
Telephone 7 F1 Mobile Date:
Owner HACCP: ❑ Temporary F-1 Pre-operation
Y I N ❑ Caterer F-1 Suspect Illness
QPerson-in-Charge(PIC) Time Out: Y. 0ElBed &Breakfast HACCPComplaint
Inspector In: 30 F1 Other
keaqAA, a)0/lA/J'_ Year:eu 21
Each violation the requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
ftiations Related to Foodborne iflness Intervenflons and ml r or llq�� �j Anti-Choking 590.009(E) ll
n1s [e
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590.009(F) El
determined by the Board of Health. Allergen Awareness 590.009 (G)>�
FOOD PROTECTION MANAGEMENT El 12., Prevention of Contamination from Hands
X 1. PIC Assigned/KnowledgeabWDutles El 13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
2. Reporting of Diseases by Food Employee and PIC
E [_] 14. Approved Food or Color Additives
3. Personnel with hifections Restricted/Excluded 15,Toxic Chemicals
FOOD FROM APPROVED SOURCE
4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
5. Receiving/Condiflon El 16.Cooking Temperatures
6. Tags/Records/A=Uracy of Ingredient Statements Fj_ 17. Reheating
El 7., Conformance with Approved Procedures/HACCP Plans Ej 18. Coofing
PROTECTION FROM CONTAMINATION E] 19. Hot and Cold Holding
8.Separatio:i/Segregation/Protection Ej 20.1"kne as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces Cleaning and Sanitizing El 21. Food and Food Preparation for HSP
El 10. Proper Adequate Handwashing CONSUMER ADVISORY
El 11. Good Hygienic Practices >4 22. Posting of Consurner Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. "actors(Red Items 1-22):
Non-critical H violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations
-:K 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
27. Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing.Your request must
be in writing and submitted to the Board of Health at the above addres
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirements (590.009) DATE OF RE-INSPECTION:
30. Other I
Ad
Inspector's Signature: Print:
PICs Signature: Print: k LA Page-) ofFZPages
FaA(4v-
Violations Related to Foodborne liluess Ititerr,etitiotts and Risk Factors
(Red Items 1-22)
FOOD PROTECTION IMANAGENTENT
1 590.003(A) Assignment ofRes lonsibilit y* PROTECTION FROM CONTAMINATION
590.003(B) Demonstration of Knowledge* 8 Cross-contamination
2.103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
2 590A03(C) Responsibility of the person in charge to 3-302.11(A)(2) Raw Animal Foods Separated from Each
require reporting by food employees and Other*
fl licflnts* Contamination from the Environment
590,003(F) Responsibility Of A food Employee Or An 3-302.11 A Food Protection*
Applicant To Report To The Person 1n 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(3) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590.003(E) Removal of Exclusions and Restrictions 3-306.14 A B Returned Food and Reservice of Food*
Disposition ofAdulterated ar
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Regulated Sources 3-701.11 Discarding or Reconditioning Unsafe
590,004 A-B Compliance with Food Law* Food*
3-201,12 Food in a I-lerneticall y Sealed Container* LL hood Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4.501.111 Manual Narewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'I'enl eratures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warewashing-Hot Water
3-202,16 ice Made From Potable Drinking Water* Sanitization'1'enl eratures*
5-101.11 Drinking Water front an Approved S ystenl* 4.501,114 Chemical Sanitization-temp.,pH,
590,006(A) Bottled Drinking Water* concentration and hardness,*
590,006(B) Water Meets Standards in 310 CMR 22.0* 4-601,11(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702.11 Frequency of Sanitization of Utensils and
3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.11 Methods of Sanitization-Hot Water find
Game and 1Pild Mushrooms Approved by Chemical*
Re ulatogAuthoi-it y 10 Proper,Ade uate Handwashin
3-202,18 Shellstock Identi teat ion Present* 2-301.11 Clean Condition-Hands and Arms*
590,004(C) Wild Mushrooms* 2-301.12 Cleaning Procedure*
3-201.17 Game Animals* 2-301.14 When to Nash*
S Reeeivin /Condition 11 Good Hygienic Practices
3-202,11 PHFs Received at Proper Temperatures* 2-401.11 Eating,Drinking or Using Tobacco*
3-202.15 Package Integrity* 2-401,12 Discharges From the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
G Tags/Records:Shellstock 3-301.12 Preventing Contamination When'1'asting*
3-202.18 Shellstock Identification* 12 Prevention of Contamination from
3-203.12 Shellstock Identification Maintained* Hands
Tags/Records:Fish Products 590,004(E) Preventing Contamination.from
Employees*
3-402.11 Parasite Destnwtlon* 13 Ilandwash Facilities
3-402,12 Records,Creation and Retention* Convenient) Located and Accessible
590,004{,l) 5.203.11 Numbers and Ca pacifies*
Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conformance with Approved 5-205,11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied`with Soap and Hand Drying
3-502,11 Specialized Processing Methods* Devices
3.502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availabili
8.103.12 Conformance with Approved Procedures* 6-301,12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000.
Establishment Name:_ 1 In t5 t e2 C� Date:_ Page:-3--of
Item Code C—Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY Verified
0 1.
r
v
1 _r crz —
� s
ti Oct
5 2
N
r Cie-,
VJ IAJ 420 a -{
Discussion With Person in Charge: "" Corrective Action Required: ❑ No ❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction!
Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
� ❑ Embargo ❑ Emergency Closure
i✓L
❑ Voluntary Disposal ❑ Other
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIRE,MENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS
PROTECTION FRONT C)HAN11CALS LISP
21 3-841.1 I(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3-801.11(B) Use of Pasteurized Eggs*
3-302.14 Protection front Unapproved Additives* 3-801,11(D) Raw or Partially Cooked Animal Food and
15 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 ldenti ,ing Information-Original Containers* 3-801.1 t C Uno ened Food Package Not Re-served,
7-102.11 Common Name-Working Containers*
7-201.11 Separation-Storage* CONSUAIER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.11 Toxic Containers--Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria-Chemicals* Pathogens.*'%""r"1'2001
7.204.12 Chemicals for Washing Produce,Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs!
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590,009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 Rodent Bait Stations* catering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TIAIE/TENIPERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29--Special
3-401.1 iA 1 Requirements.
( )(2) Eggs- 155°F f5 See.
Eggs-hnmediate Service 145°Fl5sec*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* VIOLATIONS RE,LA'1'L*D TO GOOD RETAIL PRACTICES
3-401.11(11)(1)(2) Pork and Beef Roast- 130°F 121 min* (Blue Items 23-30)
3-401.1 I(A)(2) Ratites,ln'ected Meats-155°F 15 sec.* Critical and non-critical violations,which do not relate to tine foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and risk factors listed above, can be found in the
Stuffing Containing Fish,Meat,Poultry or folloiving sections of the Food Code and 105 01l7?590.000,
Ratites-I65°F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* Item Good Retell Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23. Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1)(b) All Other PHFS-145°F 15 sec,* 25, E ai mentand Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and Waste FC-5 .006
27. Physical Facility FC-6 .007
3-403.11(A)&(D) PHFs I65°F 15 sec, 1 28. 1 Poisonous or'foxic Materials HEED
08
3-403.11(B) Microwave-165°F 2 Minute Standing 29. S cial Re uirements 09
Time* 1 30, 1 Other
3.403.11(C) Commercially Processed RTE Food-
l40°F*
3-403.1 l(E) Remaining Unsliced Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000,
Roasts*
18 Proper Cooling of PIIFs
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41°F/45°F Within 4 hours.*
3.501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
3-501.14(C) P1IFs Received at Temperatures
According to Law Cooled to 41°F/451F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
19 PHF Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 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.
20 Time as a Public Health Control
3-501,19 Time as a Public Health Control*
590,004(iI) Variance Reguiremont
Establishment Name: ��tYV `1,4) Z-7-C- Date: i Page: 2- of
Item Code C--Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference
R-Red Item PLEASE PRINT CLEARLY Verged
T
l O P
-�- 1
S4eoFlk
YVI a_
1 f
r a-
i'
h42-x4- r,')-i'
aj
Discussion Wiih Person in Charge: e u --3) r Corrective Action Required: ❑ No ❑ Yes
❑ Voluntary Compliance ❑ Employee Restriction!
-f Exclusion
❑ Re4rispection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
CL-r
q Voluntary Disposal ElOther
Violations Related to Foodborne Illness Interventions and Risk
Factors(Reel Items I-22) (Coat) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FRONT ClIEMICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Beverages with Warning Labels*
3-202.12 Additives* 3-801.ILTL Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
[S Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.1 I Identi ,ing Information-Original Containers* 3-801.1 l C Unopened Food Package Not Re-served,
7-102.11 Common Name-Working Containers*
7-201.11 Separation-Storage* CONi SUMER ADVISORY
7-202.11 Restriction-Presence and Use* 22 3-603.11 Consumer Advisory Posted for Consumption of
7-202.12 Conditions of Use* Animal Foods That are Raw,Undercooked or
7-203.11 Toxic Containers-Prohibitions* Not Otherwise Processed to Eliminate
7-204.11 Sanitizers,Criteria--Chemicals* Pathogens.*4"1"'r/L1 1
7-204.12 Chemicals for Washing Produce Criteria* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* SPECIAL REQUIREMENTS
7-206.11 Restricted Use Pesticides,Criteria* 590,009(A)-(D) Violations of Section 590.009(A)-(D)in
7-206.12 1 Rodent Bait Stations* entering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitoring* appropriate sections above if related to
foodborne illness interventions and risk factors.
TEME/ITAITERATURE CONTROLS Other 590,009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under 429--Special
3-401.IIA(i)(2) Eggs- 155°F 15 Sec. Requirements.
Eggs-Inunediate Service 145°F15scoO
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F IS see,* VIOLATIONS RE,LA'I'TD TO GOOD RETAIL PRACTICES
3-401.1 l(B)(1)(2) Pork and Beef Roast- l30°F 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-l55°F 15 sec.* Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, illness interventions and risltfactors listed above,can be found in the
Stuffing Containing Fish,Meat,Poultry or fallotiving sections of the Food Code and l05 CX/R 590,000.
Ratites-I65°F 15 see.*
3-401.11(C)(3) Whole-musele,Intact Beef Steaks 145*F# Item Good Retail Practices FC S90.000
3-401.12 Raw Animal Foods Cooked in a 23. Management and Personnel FC-2 .003
Microwave 165°F* 24. Food and Food Protection FC-3 .004
3-401.11(A)(1) b) All Other PHFs-145OF15 sec,* 25, Equipment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. Water,Plumbing and Waste FC-5 .006
27. Physical Facility FC--6 .007
3-403.1 t(A)&(D) PHFs 165OF 15 see,* 28. Poisonous or Toxic Materials rC-7 .008
3-403.1 l(B) Microwave-165'F 2 Minute Standing 29. Special Requirements 009
Time* 30. Other
3.403.1 I(C) Commercially Processed RTE Food-
l40°F*
3-403.11(E) Remaining Uns[iced Portions of Beef *Denotes critical item in the federal 1999 Food Code or 105 CMR 590,000,
Roasts*
18 Proper Cooling of PHFs
3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Within 2 Hours and From 70°F to
41*F/45°F Within 4 flours.*
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°17
Within 4 Hours*
3-501.14(C) PHFs Received at Temperatures
According to Law Cooled to 410F/45017
Within 4 Hours.*
i3-501,15 Cooling Methods for PHFs
PHF Hot and Cold Holding
3-501.16(B) Cold PHFs Maintained at or below
590,004(F) 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.
20 Time as a Public Health Control
3-501,19 Time as a Public Health Control*
590.004(1I) Variance Requirement
THE COMMO WEALTH OF MASSACHUSETTS
�rar� TOWN OF NORTH ANDOVER 1600 osgo�d street Suite2o3s
o, Andover,Massachusetts 01845
• MASSACHUSI✓TTS DEPARTMENT OF PUBLIC HEALTH
OI
....."..
Division of Todd and Drugs
Phone-978.6$8.9540
FOOD ESTABLISHMENT INSPECTION REPORT '"'"" °" -" Fax-978.688.8476
c-mail: healthrlept @tawnofnorthandover.conx
Name of Establishme ` Date Type of Operation(s) Type of Inspection
L�"`' '" .^ �d Service ❑Routine
Address 'Risk LA,el ❑ Retail ❑Re-inspection
❑ Residential Kitchen Previous Inspection
Telephone ❑ Mobile Date:
Owner � ) HACCP: ❑Pre-operation
m,,,-��, ❑ Temporary
✓ �..,d .� Y / N ❑ Caterer ❑Suspect Illness
Person-in-Charge(PIC)"''"Wre Time ElBed&Breakfast ❑ General Complaint
p In: Cher ems``
` .
Inspector -, �i4 - �W;:;,,..._ Out: Year:
"-�
Each violation checked requires an explanatin on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
Vldation "R ll ted to Food borne aNw s Interventions and„R V°actors ,Re
Vt is Anti Choking 590.009(E) El
Violations marked may pose an imminent health hazard and require immediate corrective action as Tobacco 590,009(F) ❑
determined by the Board of Health. Allergen Awareness 590.009 (G)[:1
FOOD PROTECTION MANAGEMENT E] 12. Prevention of Contamination from Hands
1. P0C Assigned/knowledgeable/Duties
El 13. Handwashing Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
Ej 2. Reporting of Diseases by Food ErnpIoyee and PIC
D 14.Approved Food or Color Additives
D 3. Personnel with Infections Restricted/Excluded
El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE
F1 4. Food and Water from Approved oaurce TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
Ej 5. Receiving/Condition Ej 16.Cooking'Temperatures
El „ Tags/Records/Accuracy of Ingredient Statements Ej 17. Reheating
7. Conformance with Approved Proceduures/HACCP Plans 18. Cooling
PROTECTION FROM CONTAMINATION 19. Hot and Gold Holding
E 5.Separation/Segregation/Protection E] 20.Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
" 9. Food Contact Surfaces Cleaning and Sanitizing E] 21. Food and Food Preparation for H P
1" F1 10. Proper Adequate Handwvashinq
CONSUMER ADVISORY
11. Good Hygienic Practices � j 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Number of Violated Provisions Related To
Critical (C) violations marked must be corrected immediately Food orne Illnesses h7terventions and Risk
or within 10 days as determined by the Board of Health. Factors(Red Items 1- ).
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N report,when signed below by a Board of Health member or its agent
23. Management and Personnel (FC 2)(590.003) constitutes an order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-3)(590.004)
_y 25. Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days of receipt of this order.
29. Special Requirel nts 90.009) DATE OF RE-INSPECTION:
30. Other !
Inspector's Signature: r Print.
PICs Signature: " "'"" Print: 51. -)g a�" Page O Pages
Violations Related to Foodborue lllttess brterventious and Risk Factors
(Red Items 1-22)
FOOD PROTLCI'ION AMANAGMMENT
1 590.003(A) Assignment of Res tonsibilit y* PROTECTION FROi4I CONTAMINATION
590,003(B) Demonstration of Knowledge* 8 Cross-contamination
2.103.11 Person in charge—duties 3-302.11(A)(1) Raw Animal Foods Separated front
Cooked and RTE Foods*
EMPLOYEE HEALTH Contamination from Raw Ingredients
r590,003(C) Responsibility of the person in charge to 3-302.t 1(A)(2) Raw Animal Foods Separated front Each
require reporting by food employees and Other*
applicants* Contamination front the Envh•onntent
590,003(F) Responsibility Of A Food Employee Or An 3-302.1[(A) Food Protection*
Applicant To Report To The Person lit 3-302.15 Washing Fruits and Vegetables
Charge* 3-304.11 Food Contact with Equipment and
590,003(0) Reporting by Person in Charge* Utensils*
3 590,003(D) Exclusions and Restrictions* Contamination from the Consumer
590,003(E) Removal of Exclusions and Restrictions 3-306,14 A B Returned Food and Reservice of Food*
Disposition ofAdulterated or
FOOD FROM APPROVED SOURCE Contaurinated Food
4 Food and Water Front Regulated Sources 3-70 L I 1 Discarding or Reconditioning Unsafe
590.004 A-B Compliance with Food Law* Food*
3-201.12 Food in a Hermetically y Sealed Container* 9 Food Contact Surfaces
3-201.13 Fluid Milk and Milk Products* 4-501.11 t Manual Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization'l'ett eratures*
3-202,14 Eggs and Milk Products,Pasteurized* 4-501,112 Mechanical Warewashing-Hot Water
3-202,16 Ice Made From Potable Drinking Water* Sanitization'Pent eratures*
5-101,t 1 Drinking Water front an Approved System* 4.501.114 Chemical Sanitization-temp.,PH,
590.006(A) Bottled Drinking Water* concentration and hardness.*
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-601.1I(A) Equipment Food Contact Surfaces and
Shellfish and Fish From an Approved Utensils Clean*
Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces and Utensils*
Shellfish* 4-702,11 Frequency of Sanitization of Utensils and
3-201,15 Molluscan Shellfish front NSSP Listed Food Contact Surfaces of Equipment*
Sources* 4-703.1 l Methods of Sanitization—Hot Water and
Game and Wild kfushroorirs Approved by Chemical*
Regulatory Ardhorit y 10 Proper,Adequate Handwashin
3-202,18 Shellstock Identification Present* 2-301.1 t Clean Condition—Hands and Arms*
590,004(C) Wild Mushrooms* 2-301,12 Cleaning Procedure*
3-201,17 Game Animals* 2-301,14 When to Wnsh*
S Receiving/Condition 11 Good Hygienic Practices
3-202,I 1 PHFs Received at Proper Temperatures* 2-401.1 t Eating,Drinking or Using Tobacco*
3-202,15 Package Integrity* 2-401,12 Discharges Front the Eyes,Nose and
3-101,11 Food Safe and Unadulterated* Mouth*
G Tags/Records:Shellstock 3-301.12 Preventing Contamination When Tasting*
3-202,18 Shellstock Identification* I2 Prevention of Contamination from
3-203,12 Shellstock Identification Maintained* Hands
Ta s/Records:Fish Products 590,004(E) Preventing Contamination from
3-402.11 Parasite Destruction* Bnt to ccs*13 Ilandwash Facilities
3.402,12 Records,Creation and Retention*590,004(,1) Conveniently Located and Accessible
Labeling of Ingredients* 5.203.11 Numbers and Capacities*
5-204,11 Location and Placement
7 Conformance with Approved 5.205.11 Accessibility,Operation and Maintenance
Procedures/HACCP Plans Supplied with Soap and Hand Drying
3-502,11 Specialized Processing Methods* Devices
3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availabili
8-103.12 Conformance with Approved Procedures* 6-301,12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CIF MASSACHUSETTS
V TOWN OR CITY OF Xt"l
Establishment Name: Page: of Date: 7-2z1:1T
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
tz,60 or/ nk
_j
.......... I r
r 1,2 e; f-L_-_-
r__r"
4- iZz.;n
111 .41- P I 2.—L
Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
D Voluntary Compliance El Employee Restriction,e Exclusion
El Re-inspection Scheduled Q Emergency Suspension
Q Embargo Emergency Closure
E) Voluntary Disposal Q Other:
Form 734 B A.M.Sulkin Co.,Boston,MA
Violations Related to Foodborne filness
Interventions and Risk Factors(Red Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
t 590.003(A) Assignment of Responsibility* 3-302A 1(AX 1) Raw Annual Foods Separated from
590.00',L(13j Demonstration of Knowled e* Cooked and RTE Foods*
2-103.11 Person in charge-duties Contamination from Raw Ingredients
3-302.11(Ax2) R<aw Animal Foods Separated from Each
EMPLOYEE HEALTH Othrr'* _
2 590.003(C.) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* _ 3-302.15 Washing_Fmits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils* _
Char e* _ Conta"nation frrom the Consumer
590.003(G) Re rtin by Person in Char e* 3-306.14 A B Retunied Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* DisposiVon of Adulterated or Contaminated
590.003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food'
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.0(A A-B Com liance with Fond Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermeti 2 Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures*
4-501.114 Chemical Sanitization-temp.,
3-202.14 E concentration and • pH,
3-202.16 Ice Made From Potable Drinking Water*
5-101.11 DrinkingWater from an Approved System* 4 601.11(A) Equipment Food Contact Surfaces and
Utensils Clean*
590.006 A Bottled Drinkir Water* -
590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
Contact Surfaces and Utensils*
Shefffish and Fish From an Approved Source
4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish front NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and KNd Mushrooms Approved by -
Re ulata Aulho " 2-301.I I Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Present* 2-301.12 Cleaniij'rocedure*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* lfl fiy+gientc Pra:tices
5 Receiving/Condition 2401.11 Eati DDunkin or Using Tobacco*
3-202.11 PI IFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and
3-202.15 Package Integrity* Mouth*
3-101.11 Food Safe and Unadulterated* 3-301.12 Preventylu-Contarriination When Tastin
6 'fag ecords:Shelistock 12 Prev nflon of Contamination from Hands
3-102.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Em to c_es*
Tag ecords:Fish Products
13 Hat�a3w✓ sh F�cillfies
340111 Parasite Destruction* Convoniently Located and Accessible
3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.004 J Labeling of Ingredients® 5-204.11 Location and
_ Placement*
nee with Approved Procedures 5-205.11 Accessibility',Operation a nd Main tenance
IHACCP Plans Suf gad with Soap and Hand Drying
3-502.1 I S cialized Process Methods* Devicos
3-502.12 Reduced oxygenpackaging,criteria* 6-301.11 IIartdwashitrCle inner,-Avalbihty
8-103.12 Conformance with Approved Procedures* 6 301.12 Hanel DryiProvision
°Denim critical item in the federal 1999 I:ocx(C c&,oT 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OR CITY OF
Establishment Name: Date: Page: of
Item Code C_Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
7-ir' Al 1-1.
A,
Z'r A�
7_ 2=
77477 Discussion With Person in Charge: Corrective Action Required: No Q Yes
Q Voluntary Compliance U Employee Restriction I
Exclusion
El Re-inspection Scheduled 0 Emergency Suspension
U Embargo ❑ Emergency Closure
U Voluntary Disposal 0 Other:
4 Q
Form 734 B A.M.Sulkin Co.,Boston,MA
Violations Related to Foodbome illness
Interventions and Risk Factors(Red Items 1-2 )
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Crass-contamination
1 590.()03(A) Assignment of Res nsibili * 3-302.11(AX 1) Raw Animal Fmi s Separated from
590.003(13 Demonstration of Knowled e* Cooked and RTE Foods*
2-103.1 1 Person in charge-duties Contarranation from Raw Ingroafents
3-302.11(AX2) Raw Anirnal foods Separated from Each
EMPLOYEE HEALTH Other"
2 590.003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* 3-302.15 Washing Fnrits artd Ve etables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils* _
Charge* _ Cantarrtnraton from the Consumer
590.003(G) Re rtin b Person in Char e* .3-306.14 A B Returned Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* Dispasffion of Adulterated or Contaminated
590.003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 t Co Surf aces
590.0(A A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pastem-ized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water*
concentration and hardness. *
5-101.11 Drinkin Water from an A roved S stem* 4-601.11(A) Equipment Food Contact Surfaces and
Utensils Clean*
590.006 A Bottled D ' Water* 4-602.11 Cleaning Frequency of Equipment Food-
590.006 B Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils*
Sheffish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and W/d,Mushrooms Approved by -
Ro ulat Authori 2-301.11 Clean Condition-Hands and Arens*
3-202.18 Shellstock Identification Present* 2-301.12 Cleanin I'rocedrrre*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* 11 G llyglenlc Practices
5 Receiving/Condition 2401.11 Fat in"I na-irr or Usin Tobacco*
3-202.1 1 PIfFs Received at Proper Tem atures* 2401.12 Discharges From the Eyes,Nose and
3-202.15 Packa e Inte tity* Mouth*
3-101.1 l Food Safe and Unadulterated * 3-301.12 Preventing Contamination When Tastin *
6 TagsMecords:Shellstock 12 Prevention of Contamination from Funds
3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Employees*
Tag ecords:Fish Products 13 Pan ash Facilities
3402.11 Parasite Destruction* Y
Convenientl Located and Accessible
--�
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca cities*
590.004 J Labeling of Ingredlents" 5-204.11 Location and Placement*
7 Conforimrice with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance
lHACCP Plans Supl od with Soap and Hand Drying
3-502.11 S cialized Processin Methods* trco
3-502.12 Reduced oxygenpackaging,criteria* 6-301.I 1 Flandwashin Cleanser,Availabili
6-301.12 Hand Ili Provision
8-103.12 Conformance with A oved Procedures* - -
Denim critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
* TOWN OF NORTH ANDOVER 1600 Osgood Street, Building 20, Suite 2-36
* * North Andover, Massachusetts 01845
*'•.-=�-,`* Phone-978.688.9540 Fax-978.688.8476
��ss�cxuse��e FOOD ESTABLISHMENT INSPECTION REPORT e-mail: health dept(&towns fnorthandover.co►tt
Name of Establishment Date Tvpe of Operation(,) Type of InVection
AW a. l'rY�M ►� �t ;-ICA ' 1;� � rood Service � Routine
Address Risk Level ❑ Retail ❑ Re-inspection
Telephone El Residential Kitchen DPrevious Inspection
El Mobile
Owner FIACCP: ❑ Temporary ❑ Pre-operation
I,`-ro,n rM 1 -ta mos y / N ❑ Caterer ❑ Suspect Illness
Person-in-Charge(PIC) ,I Time fled&Breakfast ❑ General Complaint
C9 ❑ ❑ IIACCI
Inspector f" �(` C �, � Out: �(46 Year: ❑Other
' -------._
Each violation ch ed requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
V(.bR Wort iRel��&dd to odtb�Vrne Mines Q»wI�N1k�(VF�"i�4wY�d��s and Riskw..Factt�V�ro(l)p 1,�4("i�"�� Anti-Choking 590.009(E)
Violations marked may pose an imminent health hazard and require immediate Tobacco 590,009(F)
corrective action as determined by the Board of Health. Allergen Awareness 590.009 (G)❑
FOOD PROTECTION MANAGEMENT
�..m1 °62. Prevention of Cot:tai„riiotatlon ffro►mp Hands
E"] 1. PlC Ass igned/ nowledgeable/Dutles
E.1 13" Hantfwashlrtp FaoNlitn►*r
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
E-1 2. Reporting of Diseases by Food Ernployee and PiC
�....� 14.Approved Food or Color Adtluttves
�.... 3, Personnel with infections Restricted/Excluded
15° oxic C'i�etnpc tis
FOOD FROM APPROVED SOURCE �-
..1 4. Food and Water froth Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods)
m1 fs, Receiving/Condition 1 16. Cooking Ierriperatures
6. Tags/Records/Accuracy of ingredient Statements [. .1 17„ Reheating �
.� 7. Confo►°niarice with Approved Procedures/HACCP Flans El 18. CKoolin
PROTECTION FROM CONTAMINATION EX19. Flit and Cold Hoidiinfi
�._.1 8, Separatioiri/taegregation/W roteetpon (_1 20."firer as a Public Hearth Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
1. 1 9. Food Contact Surfat�es CPeai 6►°: and SettitGzi►u9 [] 21, food and Food Preparation for&dCR
�...1 10, Proper Adequate Handwashin
CONSUMER ADVISORY
�..� 11. rood t°lygtentc Practices �� 22. Paastit►a1 of Consutner Advisories
Violations Related to Goad Retail Practices (Blue Items) Number of Violated Provisions Related"fo
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk'
or within 10 days as determined by the Board of Health. 'actors(Red Items 1-22):
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N
23, Management and Personnel (FC-2)(590.003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26, Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27, Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days-of receipt of this order.
29. Special Requirements (590,009) DATE OF RE-INSPEC TION:
30. Other
Inspector's Signature: Print: f A a.0 t, t' 1.-•l✓n
PICs Signature: Print: �(t'Y� Page`of ges
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Red Items 1-22) (Cont.) 41°F/45017 Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
A-Food or Color Additives19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 410/450 F*
15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.
7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served.
Monitoring*
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
[1-6- Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.* Elle11112001
Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* SPECIAL REQUIREMENTS
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590,009(A)-(D) Violations of Section 590.009(A)-(D) in
3-401.11(A)(2) Ratites,Injected Meats- I55°F 15 sec. catering,mobile food,temporary andresidential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-1 650F 15 sec. * interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F
3-401.1 l(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the
3-403.1 i(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
found in the following sections of the Food Code and 105 CUR
Time* 590.000,
3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.006
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsiiced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
lg Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27• 1 Physical Facility FC-6 .007
28. Poisonous or Toxic Materials FC-7 .008
70°F Within 2 Hours and From 70°F 29. 1 Special Requirements .009
to 41017/450F Within 4 Hours. * 30. 1 Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF Oye_'K -
Establishment Name: a ryti ,'S � Date: J' 'tom Page: of �-
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
sin Ke_ e
r CJ rig t —1
f or
ca
r'S
'6a li
V w1
Ja
f� t
Y10-") Y c�
li CI
AYO
EI
1. T 't t-z, o'/-- /a ,
Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
❑ Voluntary Compliance ❑ Employee Restriction
t Lf Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Form 734 B A.M.Sulkin Co..Boston,MA
Violations Related to Foodborne Illness
Interventions and Risk Factors(Red items 1.22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590.003(A) Assignment of Re nsibih * 3-302.11(Ax 1) Raw Animal Foods Separated from
590.003(B) Demonstration of Knowledge* Cooked and WIT.Foods*
2-103.1 1 Person in charge-duties Contamination from Raw Ingredients
3-302.11(Ax2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(C;) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils*
Charge* Contamination from the Consumer
590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Fes*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Tem atures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. *
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and
590.006 A Bottled ' ' Water* Utensils Clean*
590.006 B Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
SheRhsh and Fish From an Approved Source Contact Surfaces and Utensils*
4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of !i ent*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* ip Proper,Adequate Handwashing
Game and tad Mushrooms Approved by
Regulaby Autho' 2-301.11 Clean Condition-Hands and Arms
3-202.18 Shellstock Identification Present* 2-301.12 Cleamn Procedure*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* 11 Good Hygienic Practices
5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202.11 PHFs Received at Pro r Temperatures* 2401.12 Discharges From the Eyes,Nose and
3-202.15 Package Inte * Mouth*
3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tast' *
6 Tags/Records:Shellstock 12 Prevention of Con nation from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Employees*
Tags/Records:Fish Products 13 Handwash Facilities
3402.11 Parasite Destruction* Conveniently Located and Accessible
3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.004 J Labeling of Ingredients* 5-204.11 Location and Placement*
7 Conforrnance with Approved Procedures 5-205.11 Accessibih tion and Maintenance
lHACCP Plans Suppled with Soap and Hand Drying
3-502.11 Specialized Process' Methods* Devices
3-502.12 Reduced oxygen ka ' ,criteria* 6-301.11 Handwashin Cleanser,Availability
8-103.12 Conformance with A oved Procedures* 6-301.12 Hand Provision
*Derides c rtical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street, Building 20; Suite 2-36
North Andover,Massachusetts 01845
Phone-978.688.9540 Fax-978.688.8476
CINU j�yFOOD ESTABLISHMENT INSPECTION REPORT e-mail: liealtli(ler)t(ii)towiioftior•th,,iii(lover.coni
Name offstablishment Date Tilpe of Operation(s) Tjpe of Inspection
(-Kirytienv's F-kvywvsh �P("2,2c.-,. ,217 2Q— Food Service �Routine
IT 12
Address Risk Level ❑ Retail Re-inspection
El Residential Kitchen Previous hispection
Telephone El Mobile Date:
Owner HACCP: E] Temporary El Pre-operation
Y / N El Caterer [:] SLISPCCt 11111CSS
Person-in-Charge(PIC) Time n Bed&Breakfast []General Complaint
)V3 , ,3o E] HACC11
Inspector El Other
et Out: Year:
1,Cia cl
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Non-compliance with:
�holabonrs fa led.to Foodborne Ulness interventions and Risk Factor L�(A! j p s
LC !_[tl�j Anti-Choking 590.009(E)'K
T16iii—io'n'smarked"m"may pose e" "an"'imminent" -- h interventions
-lifi hazard-an,d-require- "'i"mmediate Tobacco 590,009(F),14-
corrective action as determined by the Board of Health. Allergen Awareness 590.009 (G)&
FOOD PROTECTION MANAGEMENT aflon from Hands
] 12. Prevention of Contarnfin,
t. 1. Isla~.Assigned/Knowledgeable/Duties F_"
EMPLOYEE HEALTH -113. Handwashing Facilities
PROTECTION FROM CHEMICALS
EJ 2. Reporting of Mseases by Food Employee and PIC F-_j 14,Approved Food or Color Adriffives
3, Personnel with Infections Restricted/Excluded 16, Toxic Chernica�s
FOOD FROM APPROVED SOURCE
4. Food and Wate,r,from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
5, Receiving/Condition C 16.CookingTernperatures
6. "rags/Records/Accuracy of ingredient Statements, El 17, Reheating
7. Conformance with Approved Procedure sIHACCP Plans Ej 18. Cooling
PROTECTION FROM CONTAMINATION F_] 19, Hot and Cold Holding
F'j 20.Time as,a Pubhe Health Control
8,Separatioii/Seq�egatio�i/Protectiori
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
j 9. Food Contact SUirfaces Cleaning and Sanitizing 21, Food and Food Preparation for HSP
10. Proper Adequate Handwashing
CONSUMER ADVISORY
F E]22g of Consumer Advisories
_] 11. Good Hygienic Practices . Postin
Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions Related ro
Critical (C) violations marked must be corrected immediately r-oodbome illnesses Inteiventions and Risk
or within 10 days as determined by the Board of Health. F-actors ("Red Items 122):
Non-critical N violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23, Management and Personnel (FC-2)(590,003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.th.Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations, If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days-of receipt of this order.
29. Special Requirements (590,009) DA TE OF RE-INSPEC TION:
30. )ther
Inspector's Signature: !, Print: Er a
�,
PICs Signature Print: 7- page-1 of 2ages
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Red Items 9-22) (Cont.) 4l°F/45°F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
14 Food or Color Additives E19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 410/450 F*
15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 1 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.
7-206.13 Tracking Powders,Pest Control and 3-801.11(C) t Unopened Food Package Not Re-served.
Monitoring*
CONSUMER ADVISORY
TIE/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.I IA(1)(2) Eggs- 155°F 15 Sec.
Pathogens.*Eff di-1/11100'
Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.1 I(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS
3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in
3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 sec. catering,mobile food,temporary and
* residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590,009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Slue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the
3-403.1 I B foodborne illness interventions and risk factors listed above, can be
( ) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR
Time* 590.000.
3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590,000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
18 Proper Cooling of PHFs 26, Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. Poisonous or Toxic Materials .008
70°F Within 2 Hours and From 70°F 29. Special Requirements 009
to 41°F/45°F Within 4 Hours. * 30. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
•Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF 4L,+L a o
Establishment Name: '� +a`S `f"cx r n «t ci ..z c Date: 01 �] Page: '2_ of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red item Verified
PLEASE PRINT CLEARLY
@_.fI L G VO
I> r l C
.-7N P't�ee
L 1 €�/ r
aLf
Iw
�w
Discussion With Person' ,Charge: Corrective Action Required: ❑ No J Yes
S
❑ Voluntary Compliance ❑ Employee Restriction/
Exclusion
p
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
D Voluntary Disposal ❑ Other:
Form 734 B A.M.Sulkin Co.,Boston,MA
Violations Related to Foodborne Illness
Interventions and Risk Factors(Red Hems 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT g Cross-contamination
1 590.003(A) Assignment of Re nsibili * 3-302.11(AX 1) Raw Animal Foods Separated from
590.003(13) Demonstration of Knowledge* Cooked and RTE Foods*
2-103.1 1 Person in char e-duties Contamination from Raw Ingredients
V 3-302.11(AX2) Raw Animal Foods Separated from Each.
EMPLOYEE HEALTH Other*
2 590.003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant'ro Report To The Person In Utensils*
Charge* Contamination bon the Consumer
590.003(G) Rep6rtmg by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food*
3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.0(A A-B Compliance with Food Law* ' 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem atums*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,
3-202;16 Ice Made From Potable Drinkin Water* concentration and hardness. *
5-I01..11 DrinkingWater from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and
Utensils Clean*
590.006 A Bottled D ' i' Water* 4-602.11 Cleaning Frequency of Equipment Food-
590.006 B Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils*
Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 10 Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by '
Re ulat Autho . 2-301.11 Clean Condition-Hands and Arms*
3-202.18 Shellstock Identification Present* 2-301.12 Clearing Procedure*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* Good Hygienic Practices
g ReceivinglCondition 2401.11 Eating,Drinkin or Using Tobacco*
3-202.11 PHF-s Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and
3-202A 5 Package Inte 't * Mouth*
3-101.1 1 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tast' *
6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands
3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Employees*
Tags/Records:Fish Products 13 Han ash Facilities
3402.11 Parasite Destruction*
Conveniently Located and Accessible
3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.004 J Labeling of Ingredients' 5-204.11 Location and Placement*
7 Conformance with Approved Procedures 5-205.11 Aceessibili ation and Maintenance
IHACCP Plans Suppled with Soap and Hand Drying
3-502.11 S ialized Process' Methods* Devices
3-502.12 Reduced ongen Eckaging,criteria* 6-301.11 dwashing Cleanser,Availabili
8-103.12 Conformance with A oved Procedures* 6-301.12 Hand Provision
•Denotes critical item in the feral 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER 1600 Osgood Street, Building 20; Suite 2-36
North Andover, Massachusetts 61845
Phone-978.688.9540 Fax-978.688.8476
FOOD ESTABLISHMENT INSPECTION REPORT e-mail: Li ilt�lide)t(a)�to�Niioft�iorthiii�dover.c�otii
Name of Establishment Date Tvpe of Operation(s) Type of hispection
J�ry\m4k�, P j'22D— ),;?— Dtl Food Service F91 Routine
Address /. m Risk Level El Retail El Re-inspection q 60A 5 1 F1 Residential Kitchen Previous Inspection
Telephone lyl�__ ,�R ? 7 El Mobile Date:
[j Pre-operation
Owner HACCP: E] Temporary
MICK F-1 suspect Illness
y N El Caterer El(3c1leral complaint
Person-in-Charge(PIC) Time q e E] Bed& Breakfast E] HACCII
Inspector f-ki, El Other
\&, Out: 1Z 3.5 Year:
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Intervenbons and Risk Factoryffj., j
t !15,1 Anti-Choking 590,009(E)
Violationsmarked� y"—p-o""s-_e,"an'imminent"-—health--hazard''-_and,_, require- immediate Tobacco 590.009(F)
corrective action as determined by the Board of Health. Allergen Awareness 590.009 (G)El
FOOD PROTECTION MANAGEMENT 12. Prevenbon of Contarnination from Hands
El 1. PIC Ass igned/Knowledgea ble/Duties
EMPLOYEE HEALTH 13. Haridwashiing FacUffies
PROTECTION FROM CHEMICALS
2. Repofting of Diseases by,Food Employee and PIC
14,Approved Food or Color Additives
3. Personnel with Infections Restricted/Excluded
0 15,'Toxic Chernicats
❑FOOD FROM APPROVED SOURCE
4. Food and Water frorn Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
El 16.coos(ing ,rernperatures
6. Rec6ving/Coridffion
6. Ta gs/Reco rdslAcc u racy of higredient Statements IT Reheating
E] 7. Conformance with Approved Procedures/HACCP Mans 18. coofing
19, Hot and Cold H0dh,wg
PROTECTION FROM CONTAMINATION
E 120,Thne as a Public Health Control
gaflon/Protection 8. Separaflon/Segre
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. Food Contact Surfaces C eaniing and SanftWng ❑21, Food and Food Preparaflon for HSP
10. Proper Adequate Handwashing CONSUMER ADVISORY
F] 11. Good Hygienic Practices 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions Relatedro
Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk
or within 10 days as determined by the Board of Health. factors (Red Items 1-22):
Non-critical (N) violations must be corrected immediately or Official Order for Correction:Based on an inspection today,the items
within 90 days as determined by the Board of Health. checked indicate violations of 105 CMR 590.000/federal Food Code.This
C N 23. Management and Personnel (FC-2)(590,003) report,when signed below by a Board of Health member or its agent
24. Food and Food Protection (FC-3)(590.004) constitutes an order of the Board of Health.Failure to correct violations
,25. Equipment and Utensils (FC-4)(590,005) cited in this report may result in suspension or revocation of the food
26, Water, Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
aggrieved by this order,you have a right to a hearing.Your request must
27. Physical Facility (FC-6)(590.007) be in writing and submitted to the Board of Health at the above address
28. Poisonous or Toxic Materials (FC-7)(590.008) within 10 days-of receipt of this order.
29. Special Requirements (590.009) DA TE OF RE-INSPECTION:
30. Other
Inspector's Signature. t Print:
PICS Signature: Print: LCA6 9ArAW1JYAV,%N Page- (
Print: Of�Pages
W W V
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
14 Food or Color Additives I 19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/450 F*
3-302.14 Protection from Unapproved Additives*
3-501.16(A) Hot PHFs Maintained at or above
15 Poisonous or Toxic Substances
7-101.11 Identifying Information-Original 140°F.
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. *
7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served.
Monitoring*
CONSUMER ADVISORY
TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.1 lA 1 E Pathogens.* EneIXWe v1rzom
( )(2) Eggs- 155°F 15 Sec.
Eggs-Immediate Service 145°FI5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS
3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.1I(A)(2) Ratites,Injected Meats-I55°F 15 sec, catering,mobile food,temporary andresidential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the
foodborne illness interventions and riskfactors listed above, can be
3-403,11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR
Time* 590.000.
3-403.t 1(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
lg Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. 1 Poisonous or Toxic Materials FC-7 1 .008
70°F Within 2 Hours and From 70°F 29. 1 Special Requirements 009
to 41°F/45°F Within 4 Hours. * 30. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF��--�� /tt0)( /4!L-' ,O -
Establishment Name: L m P Z.2 4,, Date: Jam - 3 _l 2- Page: 2 of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
coo i.11
Ne
k
t 45-le IQ
v i' ri 9
T T
-Q s24p d k
t Jef L^ Kk-',
,
Discussion With Person in Charge: Corrective Action Required: ❑ No ;Ih Yes
❑ Voluntary Compliance ❑ Employee Restriction I
rl± �� Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
& ❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Form 734 B A.M.Sulkio Co.,Boston,MA
3-501.14(C) PHFs Received at Temperatures
Woladons Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Red items 1-22) (Cont.)
41°F/45°F Within 4 Hours. *
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
14 Food or Color Additives El PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 410/450 F*
15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F. *
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Pubic Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 3-801.11(A) Unpasteurized Pre-packaged Juices and
L
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.
7-206.13 Tracking Powders,Pest Control and 3-801.11(C) I Unopened Food Package Not Re-served. *
Monitoring*
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.1IA 1 2)O Eggs- 155°F 15 Sec. Pathogens.* Eftdiva'/'/2001
(
Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec. * SPECIAL REQUIREMENTS
3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.11(A)(2) Ratites,Injected Meats-I55°F IS sec, catering,mobile food, temporary andresidential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. * interventions and risk factors. Other
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590,009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave 165°F*
3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. * VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
17 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the
foodborne illness interventions and risk factors listed above, can be
3-403.11(B) Microwave 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR
Time* 590.000.
3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. Poisonous or Toxic Materials FC-7 .008
70°F Within 2 Hours and From 70°F 29. Special Requirements 03
to 410F/457 Within 4 Hours. * 30. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVE
MassachusettsII
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT
Name�, 7 Date T of Operation(s) TM of Ins ion
) �9 1 2"V 4�")..)c° Food Service ❑ Routine
Address , Risk El Retail Re-inspection
Level ❑ Residential Kitchen Previous Inspection
Telephone , . ❑ Mobile Date:
c
Owner FiACCP YIN ® Temporary El Pre-operation
❑ Caterer ❑Suspect Illness
Person in Charge(PIC) 0)G)L Time ❑ Bed&Breakfast ❑General Complaint
In: ❑HACCP
Ins or ry _ i��°)j Out: Permit No. ❑Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)
violated. pd wa:
ed
Violations marked may pose health hazard and require irnmedi;M(I'7 i r ) Anti-Choking Tobacco
an imminent immediate corrective
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT 12. Pr Lion of C ontsmirvftri frem Hands
) 1. PIC Assigned/Knowledgeable/Duties
. Ha¢r os F-millbes
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
C3 Z Ropofting d(Na °ses by Food Employee and I')It,
14,AppmwedFowl or Coolm Additives
0 3, Personnel wfth Infections Restvicted/Excluded
E) 15. Torok®Clrersr ° fs
FOOD FROM APPROVED SOURCE u K TiM M TtIRE CONTROLS(Potentially rdaus Foods)
4. F and Water from Approved rrurco
) g. Rorwrolving/Conditlon 16. CooWng Temperatures
0 S. Tags/Reoords/Acnuracy rA Irrgu ;/gent Statements Ej 17. ReheeUng
(. T Conformance wfth Approved Procoduros/I IAGCP Plans ❑ 18, CA)oling
PROTECTION FROM CONTAMINATION D 19, Hot and C'crid V*Ading
g. Sepwatiori/Segregationt I roto.fion []20. 7°4ne As a Public HeRith Control
.r�3.. 9. Food Context Surfacos Cleaning and SarAtzingMS FOR HIGHLYSUSCEPTIB L° E (HSP)
tI. Proper p ratr Hcoi vashn i pt. IxA arid Food Pr con forIISP
11, GkYA Hyglenic Pr,„ lces CONSUMER ADVISORY
22. Posting of Consumer Adviv3des
Violations Related to Good Detail Practices-(Blue Number of Violated Provisions Related
Items) Critical (C)violations marked must be corrected To Food borne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(lid Items 1- ):
of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code.This report,when signed below
C N by a Board of Health member or its agent constitutes an
3, Management and Personnel (FC.2)( ) order of the Board of Health. Failure to correct violations
24. Food and Food Protection (FC-a)( ) cited in this report may result in suspension or revocation of
25, Equipment and Utensils (FC-4)( the food establishment permit and cessation of food
25. Water, Plumbing and Waste (FC-a)( ) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC ( .aa7) have a right to a hearing.Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)( ) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other n DATE OF Rg4NSPECTiON:
Inspector's Signa Print:1 )
PIC's Signature: w Prin `` Page of -Pages
FORM 734A
Violations Related to Foodborne Illness
Interventions and Risk Factors(Red items 9-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590.003(A) Assignment of Re nsibih * 3-302.11(AX 1) Raw Animal Foods Separated from
590.003(13 Demonstration of Knowledge* Cooked and RTE.Foods*
2-103.1 1 Person in charge-duties Contamination from Raw Ingredients
3-302.11(Ax2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* 3-302.15 Was ng Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils*
Charge* Contamination from the Consumer
590.003(6) Re rting by Person nt Charge* 3-306.14 A B Returned Food and Reservice of Food*
3 590.003(D) 1 Exclusions and Restrictions* Disposition of Adulterated orContananated
590,003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE FOod*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces
590.004 A-13 Compliance with Foal Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a I lermeticall Sealed Container* Sanitization Tem atures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.]3 Shell E s*
Sanitization Temperatures*
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pl-
3-202.16 Ice Made From Potable DrinkingWater* _ concentration and hardness.
5-101.1] Drinking Water from an A roved S stem* 4-601.11(A) Equipment Food Contact Surfaces and
590.006 A Bottled Drinking Water* Utensils Clean*
4-602.11 Cleaning Frequency of Equipment Food-
590.006 B Water Meets Standards in 310 CUR 22.0* Contact Surfaces and Utensils*
Shetifish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of m ent*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 1® Proper,Adequate aching
Game and Md Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority
3-202.18 Shellstock Identification Present* 2-301.12 Cleanin Procedure*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* 1i Good Hyglenk Practices
5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202.1 1 PHFs Received at Pro r Tem bratures* 2401.12 Discharges From the Eyes,Nose and
3-202.15 Package hite 't * Mouth*
3-101.1 1 Food Sale and unadulterated * 3-301.12 Preventing Contamination When Tasting*
6 Tags/Records:Shellstock 12 Prevention of Can nation from Hands
3-202.19 Shellstock Identification * 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* Employees*
Ha
Tag ecord.:Fish Products 13 ash Facilities
Conveniently Located and Accessible
3-402.1 1 Parasite Destruction*
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities*
590.004 J Labeling of Ingredients*
5-204.11 Location and Placement*
7 Conf nee with Approv Procedur 5-205.11 Accessibility, Lion and Maintenance
IHACCP Plans Suppled with Soap and Hand Drying
3-502.11 Specialized Process' Methods* Devices
3-502.12 Reduced oxy en EEkaging,criteria* 6-301.11 Handwashin Cleanser,Availabili
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Provision
Dotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF '
Establishment Name: `{5 ;C �22 Date: S' _ i Page: of L
Item Code C-Critical Item DESCRIPTION OF VIOLATION d PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
Y.,"l-'.- 4
I
Discussion With Person in Charge: Corrective Action Required: o No ❑ Yes
ee ❑ Voluntary Compliance ❑ Employee Restriction 1
1' Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
�l ❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other:
Form 734 B A.M.Sulkin Co.,Boston,MA
3-55-1.14(C) PHFs Received at Temperatures
Violations Related to dborne Illness Interventions and Risk According to Law Cooled to
Factors(Red items 1-22) (Cont.) 4 I'F/45OF Within 4 Hours.
PROTECTION FROM CHEMICALS F_-3-501.15 Cooling Methods for PHFs
14 Food or Color Additives L19L - PHF Hot and Cold Holding
3-202.12 Additives* _3 501.16(B) -Told-PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 4 V/45°F*
14 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information--Original 140°F. *
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* r 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS (HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 21 3-80 1.1 1(_A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* . 3-801.1 I(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-80 1.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. *
7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served.
Monitoring*
CONSUMER ADVISORY
TIME/TEMPERATURE CONTROLS _12-_3_-603.1 1 Consumer Advisory Posted for Consumption of
1 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-40 1.11 A(l)(2) Eggs- 155°F 15 Sec. - Pathogens.* "-"112001
Eggs-Immediate Service 1450F15sec* 3_-30213 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-40 1.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals- 155°F 15 sec. *
3-40 1.11(13)(1)(2) -Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-40 1.11(A)(2) Ratites,Injected Meats- l55°F 15 sec. catering,mobile food, temporary and
residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. interventions and risk factors. Other
3-40 1.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
1450F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements,
Microwave 165°F*
3-40 1.11(A)(1)(b) All Other PHFs- 145°F 15 sec. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
F 1-7 Reheating for Hot Holding (Blue Items 23-30)
- Critical and non-critical violations, which do not relate to the
3-403.11(A)&(D) PHFs l65°F 15 sec. foodborne illness interventions and risk factors listed above, can be
3-403.11(B) Microwave- 165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR
Time* 590.000.
3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590,000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsl iced Portions of Beef 24. Food and Food Protection FC-3 .0 1 04
Roasts* 25. -Equipment and Utensils FC-4 .005
Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. Poisonous or Toxic Materials FC-7 .008
70°F Within 2 Hours and From 70°F -29. Special Requirements .009
to 4 1 017/450F Within 4 Hours.* 130. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 4 I'F/45'F
Within 4 Hours*
Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER,
Massachusettsli
Division of Food and Drugs
FOOD ESTABLISHMENT INSPECTION REPORT
Name 1 Qpte T of O rations Tyro@ of Ins ion
r \ 5 c -. Jl P, - ram' Food Service Routine
Address C, r Risk Retail Re-inspection
�' � Level ❑ Residential Kitchen Previous Inspection
Telephone (` ❑ Mobile Date:
Owner HACCP YIN ❑ Temporary ❑ Pre-operation
❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint
In: ❑ HACCP
Ins or' , Out: Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)
violated. pt wfa►:
0 marked may pose an imminent health hazard and require immediate( cd l s) Anti-Choking Tobacco
Violations m corrective
6&0.009(E) ❑ 580.009(F) ❑
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT of C try mi n frown Harnds
IPIC Assign if K eeble f Duties
Ll/12revention
. anO h Facilities
EMPLOYEE HEALTH
PROTECTI FRO M CHEMICALS
2, Roporting of Diseases by Food Employee and PIC
(� 14Approved Food or Color Additives
3, Pemonnel wtth Inf diorns Restrktedffixciuded
ut is Cher0 is
FOOD FROM APPROVED SOt1RE S TIM MPERA CONTROLS(Potentially Hazardous Foods)
d. F'onnd and Water from Apinrov Source
S. Re*Wving/CondMon Ell 10. Cookftig TemperWures
❑ 6, Tags/R drfArcunnwy of Ingredient Staterrnennts Ej17. Reinoabng
Ej 7, Conn srrrmarnce with Approved Pr c uresfHACCP Plans ❑ Id ling
PROTECTION FROM CONTAMINATION � 9' tIrA and Cold i"knkhng
Xeparation/Segre ionnf Prot ration E 20, "lime As a Public H Ith Contrd
OR Y SUSCEPTIBLEnsnod ontrte Flauendnvasbinng and dnrtisin(i (�P)
I�.�l y"t, Forere❑rnW iw�„ Bret Prepa ° ion for I�iSP
i. F
�I 0. Proi rat g
❑ tt. Good Hyg6e¢nio Practices
CONSUMER ADVISORY
El 22. P .b ng of Consur'nner Advisodes
Violations Related to Cood stall Frac ices (Blue Numbpf of Violated Provisions Relat9d
items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(lied Itains 1- ):
of Health. Nan-critical (N)violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR
of Health. 590.000Jfederai Food Code.This report,when signed below
C N by a Board of Health member or its agent constitutes an
, Management and Personnel (FC-2)( ) order of the Board of Health. Failure to correct violations
4. Food and Food Protection (Fc-s)( ) cited in this report may result in suspension or revocation of
25, Equipment and Utensils (FC-s)( the food establishment permit and cessation of food
5, ater, Plumbing and Waste (FC-5)( . ) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC- ( .0nr) have a right to a hearing.Your request must be in writing
2& Poisonous or Toxic Materials (FC•7)(, ) and submitted to the Board of Health at the above address
29. Special Requirements ( ) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
Inspector's Print:'
A I n
PIC's Signature , . Print: -h(' A ❑(y) Pagel od Pages
FORM 734A
Violations Related to Foodborne Illness
Interventions and Risk Factors(Red Items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590.003(A) Assignment of Re nsibili * 3-302.11(AX 1) Raw Animal Foods Separated from
590.00300 Demonstration of Knowledge* Cooked and RTT3 Foods*
2-103.1 1 Person in charge-duties Contamination frwn Raw Ingredients
3-302.11(AX2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(C) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.11 A Food Protection*
applicants* 3-302.15 Washing Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Report To The Person In Utensils*
Charge* Contamination from the Consumer
590.003(G) Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food*
u3 590.003 D) Exclusions and Restrictions* Disposition of Adulterated orContar►inated
590,003E Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
q Food and Water From Regulated Sources 9 Food Contact Surfaces
590.0()4 A-B Com liance with Food Law* 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetical) Sealed Container* Sanitization Tem atures*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell Eggs* Sanitization Tem atures*
* 4-501.114 Chemical Sanitization-temp.,pH,
3-202.14 Eggs and Milk Products,Pasteurized concentration and hardness. *
3-202.16 Ice Made From Potable Water* 4-601.11(A) Equipment Food Contact Surfaces and
5-101.1 1 DrinkingWater from an A oved S stem* Utensils Clean*
590.006 A Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food-
590.006 B Water Meets Standards in 310 CUR 22.0* Contact Surfaces and Utensils*
SheAfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* gp Proper,Adequate Ha ashing
Game and Wrld Mushrooms Approved by Authority 2-301.I l Clean Condition-Hands and Arms*
Regulatory
3-202.19 ShelWock Identification Present* 2-301.14 WheClean
Procedure*
590.004 C Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* 11 Hygienic Practices
5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco*
3-202.11 P1I1s Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and
3-202.15 Package Integrity* Mouth*
3-101.1 I Food Sale and Unadulterated *
3-301.12 Preventing Contamination When Tast'
6 Tag ecords:Shellstock 12 Prevention of Con nation from Hands
3-2011 S Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 Shellstock Identification Maintained* r
Ha to
Tag eco►ds:Fish Products 13 Ha asshh
Facilities
Conveniently Located and Accessible
3-402.11 Parasite Destruction*
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca cities*
59(),004 J Labeling of Ingredients* 5-204.11 Location and Placement*
Cont nce 'h Approved Proc ur 5-205.11 Accessibility, lion and Maintenance
Li /HACCP Plans Suppled with Soap and Hand Drying
3-50111 Specialized Process' Methods* Devices
3-502.12 Reduced oxygen paSka ut ,criteria* 6-301.11 Handwashing Cleanser,Availabili
8-103.12 I Conformance with A oved Procedures* 6-301.12 Hand 29±ILProvision
*Donates critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF
Establishment Name ) f�- S j Y---A ? Z, Date: Page: of
Item Code C—Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
? tP
3-fin P -7
Discussion With Person in Charge: Corrective Action Yes
El Voluntary Compliance Ll Employee Restriction
Exclusion
Q Re-inspection Scheduled U Emergency Suspension
LI Embargo U Emergency Closure
EI Voluntary Disposal U Other:
Form 734 B A.M.Sulkin Co..Boston,MA
3-501.14(C) PHFs Received at Temperatures
Vlolations Related to dborne Illness Interventions and Risk According to Law Cooled to
Factors(Red fternsl-22) (Cont.) 4 1'F/45'F Within 4 Hours.
PROTECTION FROM CHEMICALS -50115_�_ -Cooling-Methods for PHFs
14 Color Additives W9 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 4 1'/450 F*
F_15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F. *
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
Separation Storage*7-201.11 3-501.19 Time as a Public Health Control*
7-202.11 _Restriction-Presence and Use* 590,004(H) Variance Requirement
7--262-.12 Conditions of-Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS (HSP)
7-204.12 Chemicals for Washing Produce,Criteria* r21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-80 1.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.
7-206.13 Tracking Powders,Pest Control and L3-801,1 I(C) Unopened Food Package Not Re-served.
Monitoring*
CONSUMER ADVISORY
TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
Pathogens.* ""'11112001
- I.IIA(l)(2) Eggs- 155°F 15 Sec.
Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs
3-401.1 I(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals- 155°F 15 sec. * -
3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.1 I(A)(2) Ratites, Injected Meats- 155°F 15 sec, catering,mobile food,temporary and
residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. interventions and risk factors. Other
3-40 1.11(C)(3) Whole-muscle, Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements,
Microwave 165°F* I
3-401.1 I(A)(1)(b) All Other PHFs- 145°F 15 sec. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
7 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 sec. * Critical and non-critical violations, which do not relate to the
3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
Time* found in the following sections of the Food Code and 105 CUR
590.000,
3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
F,_8 Proper Cooling of PHFs 26. Water, Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28, Poisonous or Toxic Materials I FC-7 .008
70°F Within 2 Hours and From 70°F 29. Special Requirements .009
to 4 1 OF/45017 Within 4 Hours. * 30. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 4 1 OF/45OF
Within 4 Hours*
Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF
Establishment Name:..7 7n� s Date: 6— Page: Of_
Item Code C—Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION bate
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
'�-
77
'D �7
7
Discussion With Person in Charge: Corrective Action Required: 0 No ❑ Yes
• Voluntary Compliance 0 Employee Restriction I
Exclusion
• Re-inspection Scheduled D Emergency Suspension
C) Embargo 0 Emergency Closure
Ll Voluntary Disposal 0 Other:
Form 734 8 A.M.Su!kin Co.,Boston,MA
3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to
Factors(Red Items 1-22) (Cont.) 4 I'F/45'F Within 4 Hours.
PROTECTION FROM CHEMICALS 50115-T-- Cooling-Methods for PHFs
14 Food or Color Additives W9 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Unapproved Additives*
590.004(F) 4 P/45°F*
15 Poisonous or Toxic Substances 3-501.16(A) --Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°F.
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 _Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restrict-ion-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS (HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 2fl 3-80 1.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-80 1.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-80 1.11(D) Raw or-Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* - Raw Seed Sprouts Not Served. *
7-206.13 Tracking Powders,Pest Conti- 3-80 1.11(C) Unopened Food Package Not Re-se
Monitoring* CONSUMER ADVISORY
TIMErTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.1 IA(l)(2) Eggs- 155°F 15 Sec. Pathogens.* 111"'"12001
Eggs-Immediate Service 1450F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.1 I(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS
Animals- 155°F 15 see. *
3-401.11(13)(1)(2) Pork and Beef Roast- 130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 sec. catering,mobile food, temporary and
residential kitchen operations should be
3-40 1.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-165°F 15 sec. interventions and risk factors. Other
3-40 1.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 Raw Animal Foods Cooked in a Special Requirements.
Microwave l65°F* 1
3-40 1.11(A)(1)(b) All Other PHFs- 145°F 15 sec. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
F 1-7 Reheating for Hot Holding (Blue Items 23-30)
3-403.11(A)&(D) PHFs 165°F 15 see. * Critical and non-critical violations, which do not relate to the
foodborne illness interventions and risk factors listed above, can be
3-403.1 I(B) Microwave- 165°F 2 Minute Standing
found in the following sections of the Food Code and 105 CMR
Time*
590.000.
3-403.11(C) Commercially Processed RT_E-Food-
Item Good Retail Practices FC 590.000
140°F* 23. Management and Personnel FC-2 .003
3-403.11(E) Remaining Unsliced Portions of Beef 24.. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. Poisonous or Toxic Materials FC-7 .008
70°F Within 2 Hours and From 70°F29. Special Requirements .009
to 41017/450F Within 4 Hours. * 30. Other
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41*F/45'F
I Within 4 Hours*
0 Denotts critical item in the federal 1999 Food Code or 105 CMR 590,000,
THE COMMONWEALTH CF MASSACHUSETTS
TOWN OR CITY OF V��SE72-
Establishment Date: A4
Page: k of
Item Code C—Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date
No. Reference R—Red Item Verified
PLEASE PRINT CLEARLY
Discussion With Person in Charge: Corrective Action Required: U No Ll Yes
n Voluntary Compliance U Employee Restriction I
Exclusion
0 Re-inspection Scheduled U Emergency Suspension
0 Embargo U Emergency Closure
U Voluntary Disposal Ll Other:
Form 734 B A.M.Sulkin Co..Boston,MA
3-501.14(C) PHFs Received at Temperatures
Vlolations Related to dborne Illness Interventions and Risk According to Law Cooled to
Factors(Red items 1-22) (Cont.) 4 1 OF/45OF Within 4 Hours.
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
14 Food or Color Additives E19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
590.004(F) 410/450 F*
3-302.14 Protection from Unapproved Additives*
r Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at orabove
LEI-
140°F. *
7-101.11 Identifying Information-Original
Containers* 3-501.16(A) Roasts Held at or above 130°F.
7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control
7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement
7-202.12 Conditions of Use*
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Swi�itizem,Criteria-Chemicals* POPULATIONS (HSP)
7-204.12 Chemicals for Washing Produce,Criteria* 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.14 Drying Agents,Criteria* L__ Beverages with Warning Labels*
7-205.11 Incidental Food Contact,Lubricants* 3-80 1.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-80 1.11(D) Raw or Partially Cooked Animal Food and
7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. * i
7-206.13 Tracking Powders,Pest Control and 3-801 1 1(C) Unopened Food Package Not Re-se
Monitoring* _ CONSUMER ADVISORY
TIMEIFTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.1 IA(I)(2_) _ Eggs- 155°F 15 Sec. Pathogens.* Eff"'"2001
Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
3-401.1 I(A)(2) Comminuted Fish,Meats&Game Animals- 155°F 15 sec SPECIAL REQUIREMENTS
. * 590.009(A)-(D) Violations of Section 590.009(A)-(D) in
3-40 1.11(13)(1)(2) Pork and Beef Roast- 130'F 121 min* catering,mobile food,temporary and
3-40 1.11(A)(2) Ratites,Injected Meats- 155°F 15 sec.
residential kitchen operations should be
3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections
Stuffing Containing Fish,Meat, above if related to foodborne illness
Poultry or Ratites-I 65'F 15 sec. interventions and risk factors. Other
3-40 1.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
145°F* practices should be debited under#29-
3-401.12 -Raw-Animal Foods Cooked in a Special Requirements.
Microwave 165°F* 1 1
3-40 1.11(A)(1)(b) All Other PHFs- 145°F 15 sec. VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
F-17 Reheating for Hot Holding (Blue Items 23-30)
3-403.1 I(A)&(D) PHFs 165°F 15 see. * Critical and non-critical violations, which do not relate to the
3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be
Time* 590.000.
in the following sections of the Food Code and 105 CMR
590.000.
3403.1I(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000
140°F* 23. Management and Personnel FC-2 .003
3.403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Roasts* 25. Equipment and Utensils FC-4 .005
F_18 Proper Cooling of PHFs 26. Water, Plumbing and Waste FC-5 .006
-501.14(A) Cooling Cooked PHFs from 140°F to 27. Physical Facility FC-6 .007
28. Poisonous or Toxic Materials FC-7 .008
70°F Within 2 Hours and From 70°F 29. Special Requirements .009
to 4 1 IF/45OF Within 4 Hours. * 30. Other
3-501,14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41'F/45'F
Within 4 Hours*
Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.