HomeMy WebLinkAboutNACC - Food - Routine & Re-Inspection - Inspection - 500 GREAT POND ROAD 12/29/2022 THE COMMONWEALTH OF 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 INSPECTION REPORT Fax- 978.688.9542
e-mail: healthdeptC�northandoverma.gov
Name of Establishment /O Date 12�29 2t T e o O Aeration s T o Ins pection
Ar� Wovu C&"f J� Food Service Routine
Address 00 G(?fil� "P0n& Risk Level ❑ Retail ❑Re-inspection
❑ Residential Kitchen Previous Inspection
Telephone
(14$ 605-4- 3yIy ❑ Mobile Date:
Owner HACCP: ❑ Temporary ❑Pre-operation
NO(AI N11040-t C c" Y / N ❑ Caterer ❑ Suspect Illness
Person-in-Charge(PIC) �� Time ❑ Bed&Breakfast ❑ HACCP General Complaint
In: f*tj0,::"_
Inspector S. Out: :'' Year: ?.cTL-- ElOther
Each violation chec equires 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(Red Items) 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 ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
®„13. Handwashing Facilities C(:UJ�
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
❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling
PROTECTION FROM CONTAMINATION 0,19. Hot and Cold Holding
❑ 20. Time as a Public Health Control
❑ 8. Separation/Segregation/Protection
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
9. 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. Factors(Red Items 1-22): L/
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. 1243o jLz S Il`k,,
29. Special Requirements (590.009) DATEOFRE-INSPECTION: -b
30. Other
Inspector's Signature: Print: S
PICs Signature U, 1i I Print: Pagel of Pages
Violations Related to Foodborne Illness Interventions and Risk Factors
(Red Items 1-22)
FOOD PROTECTION i1IANAGEi1IENT
I 590.003(A) Assi nment of Res onsibilit * PROTECTION FRODI CONTAMINATION
590.003(B) Demonstration of Knowledge* 18 Cross-contamination
2-103.11 Person in charge-duties 3-302.11(A)(I) Raw Animal Foods Separated from
Cooked and RTE.- Foods*
EMPLOYEE HEALTH Contamination from Raw Li redients
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
590.003(0) Re rting 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 ojAdulterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From 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 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 Temperatures*
3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.112 Mechanical Warewashing-Hot Water
3-202.16 ice Made From Potable Drinking Water* Sanitization Tenn eratures*
5-101.11 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
Utensils Clean*
Shellfish and Fish From an Approved Source 4-602.11 Cleaning Frequency of Equipment Food-
Contact Surfaces and Utensils*
3-201.14 Fish and Recreationally Caught Molluscan Shellfish 4-702.11 Frequency of Sanitization of Utensils and 3-201.15 Molluscan Shellfish from NSSP Listed Food Contact Surfaces of Equipment*
4-703.11 Methods of Sanitization-Hot Water and
Sources*
Game and INN Mushrooms Approved by Chemical*
Regulatoiy Authorit, 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 Ganre Animals* 2-301.14 When to Wash*
5 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* Hands
Tags/Records:Fish Products 590.004(E) Preventing Contamination from
Employees*
3-402.11 Parasite Destruction* 13 Ilandwash Facilities
3-402,l2 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 Conrornnance 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 packiging,criteria* 6-301.11 1 Handwashing Cleanser,Availabili
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision
*Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000.
11 I l
2
Establishment Name: /VO��h VCy V�b Date: 1�1 Z l Z.Z Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
` G(t4 No. Reference R-Red Item PLEASE PRINT CLEARLY Verified
ito..,n
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Lj
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00H'- �r s1..�! nS z s, a�rlU�c� -�v.r��J A�1-w-,Osi1LC, C�b�
Discussion With Person in Charge: Corrective Action Required: Cl No ❑ Yes
— I.00G � c,1. tSSv� D,(j <faf fsr�t r ev -I"�/� El Voluntary Compliance ❑ Exclusion ployee Restriction/
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
l ! 6 13 Voluntary Disposal ❑ Other.
Violations Related to Foodborne Illness Intervenntions and Risk
Factors(Red Items 1-22) (Cont.) REQUIRE'MEN'rS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FRO' I CHEMICALS 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 I Use of Pasteurized Eggs*
3-302.14 Protection from Unapproved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
15 Polsonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-10I.t 1 Identi6,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* 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 Sanilizers,Criteria--Chemicals* Pathogens.*4"mr"
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* catering,mobile food,temporary and residential
7-206.13 Tracking Powders,Pest Control and kitchen operations should be debited under the
Monitorin * 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 PHFs practices should be debited under#29--Special
3-40 1.1 IA(1)(2) Eggs- 155°F 15 Sec. Requirements.
E s-immediate Service 145°F15sec*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
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-critical violations,ivhicl 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 follosving sections oftle Food Code and 105 CdIR 590.000.
Ratites-165°F 15 sec.*
3-401.1 I(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. 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
27. Physical Facilit FC-6 .007
3 403.11(A)&(D) PHFs I65°F 15 sec.* 28. Poisonous or Toxic Materials FC-7 1 .008
3-403.11(B) Microwave- 165°F 2 Minute Standing 29. 1 Special Requirements .009
Time* 30. 1 Other
3-403.11(C) Commercially Processed RTE Food-
140°F*
3-403.l 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 NIB
3-501.14(A) Cooling Cooked PIiFs from 140°F to 70°F
Within 2 Hours and From 70°F to
4I*F/45°F Within 4 Hours.*
3-501.14(B) Cooling PHFs Made From Ambient
Temperature Ingredients to 41°P/45*F
Within 4 Hours*
3-50I.14(C) PIIFs Received at Temperatures
According to Law Cooled to 41 1F/451F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
11-9 PIN 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
Establishment Name: AA, �` �" `/ l�W Date: /2/ Page: 3 of
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
/ No. Reference R—Red Item PLEASE PRINT CLEARLY Verified
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Discussion With Person in Charge: Corrective Action Required: ❑ No Yes
�(] � Slt" 5 { i`�for� �ss.�cs El Voluntary Compliance ❑ Employee Restriction I
Exclusion
�3t �-i0 s� �-� El Re-inspection Scheduled ❑ Emergency Suspension
L '� 1 �u��
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
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THE COMMONWEALTH OF MASSACHUSETTS
••t"'`"'• TOWN OF NORTH ANDOVER 120 Main Street
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH North Andover,Massachusetts 01845
STDivision of Food and Drugs Phone-978.688.9540
FOOD ESTABLISHMENT INSPECTION REPORT Fax- 978.688.9542
mail: healthdept@northandoverma.gov
Name of Establishment l /� ff Dater T e o Operation(s) Tyne of Inspection
NOCd� f-t�itX� �t� � /6�t3 Food Service ❑ outine
Address �� Gf-� �� �J� Risk Level ❑ Retail [�Re-inspection
1 ❑ Residential Kitchen Previous Inspection
Telephone Date: I z Zq z1_
Q4Y 6�. -�,`{1 ❑ Mobile
Owner HACCP: ❑ Temporary ❑ Pre-operation
��� El Suspect Illness
y / N ❑ Caterer ❑ General Complaint
Person-in-Charge(PIC) � Time Bed&Breakfast ❑ HACCP
Inspector c, In. 0 ElOther
p �.6 Out: : '>r Year:
Each violation the d 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(Red Items) 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 ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
❑ 13. 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
❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans rr❑v 18.Cooling
PROTECTION FROM CONTAMINATION ra 19. Hot and Cold Holding
❑ 8.Separation/Segregation/Protection ❑ 20.Time as a Public Health Control
REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS(HSP)
❑ 9. 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. 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: 'L
30. Other '
Inspector's Signature: Print: C.
PICs Signatu Print: 1 J Page!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 FROT%I CONTAMINATION
590.003(B) DemonstrationofKnowled e* 18 Cross-contamination
2-103.11 Person in charge-duties 3-302.11(A)(1) Raw Animal Foods Separated from
Cooked and RTH 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[(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 ojAdulterated or
FOOD FROM APPROVED SOURCE Contaminated Food
4 Food and Water From Rc ulatcd 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 Temperatures*
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* Sanitization Tem eratures*
5-101.11 Drinking Water from an Approved System* 4-501.114 Chemical Sanitization-temp.,pli,
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
Utensils Clean*
Shellfish and Fish From an Approved Source 4-602.11 Cleaning Frequency of Equipment Food-
3-201.14 Fish and Recreationally Caught MolluscanContact Surfaces and Utensils*
Shellfish* 4-702.1 l 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 IVild Uushrooms Approved by Chemical*
Regulatory Regulatoiy Anthorit 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*
5 Receiving/Condition I1 Good Hygienic Practices
3-202.11 PHFs Received at Proper Temperatures* 2-40 L l 1 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/Rccor•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
590.004(E) Preventing Contamination from
Tags/Records:Fish Products
Employees*
3-402.11 Parasite Destruction* 13 Ilandwash Facilities
3-402.12 Records,Creation and Retention* Conveniently Located and Accessible
590.004(J) 5-203.11 Numbers and Ca acilies*
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* I 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 t05 CMR 590.000.
Q�o, , K 'y � Date: �-�Establishment Name: (�6 I Page: Z_ of
Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R—Red Item PLEASE PRINT CLEARLY t Verified
(; •tl s
'{ q-.66 v,I k%11 e,•,tt.-- iv1(
Lk O1 -6a Cobl,0 ri r cm,..,- e%4eV AW CLZA-
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(s � j S c cry 4AS-6i M-st_,,
✓a1 Lf s., vr�(.f + wC.Q i, - lj-L ,
Discussion With Person in Charge: _ �/f_ N t 24 � 1 LLA3
w Corr tive Action Required: ❑ No yes
Z C(•¢ Voluntary Compliance ❑ Employee Restriction
n" ay-\ '$ ZZ►® J<J1M Exclusion
❑ Re-inspection Scheduled ❑ Emergency Suspension
❑ Embargo ❑ Emergency Closure
❑ Voluntary Disposal ❑ Other.
a
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Rents 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS IISP
PROTECTION FROM CHE\IICALS 21 3-801.11(A) Unpasteurized Pre-packaged Juices and
14 Food or Color Additives Bevera es with 1Varnin Labels*
3-202,12 Additives* 3-80l.jL(j!L Use of Pasteurized Eggs*
3-302.14 Protection from Una roved Additives* 3-801.11(D) Raw or Partially Cooked Animal Food and
l5 Poisonous or Toxic Substances Raw Seed Sprouts Not Served.*
7-101.11 Identi6,ing Information-Original Containers* 3-801.1 I C Unopened Food Package Not Re-served.
7-102.11 Common Name-Working Containers*
7-201.11 Separation-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
7-204.1 1 Sanilizers,Criteria-Chemicals* Pathogens.*EJ"'"'"01
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 UIREi1IENTS
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.
'I'LNIE/TE1%,IPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under 429-Special
3-401.1IA(1)(2) Eggs- 155°F 15 Sec. Requirements.
E s-Immediate Service 145°F15sec*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals-155°F 15 see.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-401.1 I(B)(1)(2) Pork and Beef Roast- 130'17 121 min* (Blue Items 23-30)
3-401.11(A)(2) Ratites,Injected Meats-155OF 15 sec.* Critical and non-critical violations,Witch 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 CilIR 590.000.
Ratites-165'F 15 sec.*
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 1457* Itent 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-145*F 15 sec.* 25. E ui ment and Utensils FC-4 .005
17 Reheating for Hot Holding 26. water,Plumbing and Waste FC-5 .006
27. Physical Facility FC--6 .007
3-403.11(A)&(D) PHFs 165°F 15 see.* 28. Poisonousor'foxicMaterials 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(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 MIN
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) PllFs Received at Temperatures
According to Law Cooled to 41°F/45°F
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.I6(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
,� n � 1
Establishment Name: 1t/O�`t t,A• �ry Cwl- Date: /i?'/23 Page: ' of
Item Code C—Critical Item DESCRIPTION OF VIOLATION!PLAN OF CORRECTION pate
No. Reference R—Red Item PLEASE PRINT CLEARLY Verged
110 4 A vj i un r ce n- ,l� ja 'e 3 4 •�2� - ct•o i c� �l ri•�c,441,
Pt, J (a �,✓,;J(�e s ✓',c /•,t n v� .,i. Y, .n tiy2_ ^v� v- �/V, 1 0'
n;
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.
OC
Violations Related to Foodborne Illness Interventions and Risk
Factors(Red Items 1-22) (Cont.) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
POPULATIONS I ISP
PROTECTION FROM CHEMICALS 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 Identi6,ing Information-Original Containers* 3-801.1 I 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.*t�Jcane rii�zoor
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 REQUIRENIENTS
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* 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.
TINIE/TEMPERATURE CONTROLS Other 590.009 violations relating to good retail
16 Proper Cooking Temperatures for PHFs practices should be debited under#29-Special
3-401.11A(1)(2) Eggs- 155°F IS Sec.
Requirements.
E s-luunediate Service 145°F15sec*
3-401.11(A)(2) Comminuted Fish,Meats&Game
Animals- 155°F 15 see.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* (Blue Items 23-30)
3-401.1 I(A)(2) Ratites,Injected Meats-155°F 15 see.' Critical and non-critical violations,which do not relate to the foodborne
3-401.11(A)(3) Poultry,Wild Ganne,Stuffed PHFs, illness interventions and r•iskfactors listed above, can be found in the
Stuffing Containing Fish,Meat,Poultry or following sections of the Food Code and 105 011?590,000.
Ratites-165°F 15 sec.*
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-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. Ph ical Facility FC-6 .007
3-403.11(A)&(D) PHFs 165°F 15 sec.* 28. 1 Poisonousor'toxic Materials FC-7 .008
3-403.11(B) Microwve- 165°F 2 Minute Standing 29. SpecialRequirements 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 Code or 105 CMR 590.000.
Roasts*
18 Proper Cooling of PUN
3-501.14(A) Cooling Cooked PIIFs 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) PIlFs Received at Temperatures
According to Law Cooled to 4I°F/45°F
Within 4 Hours.*
3-501.15 Cooling Methods for PHFs
19 PAF 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