Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name A [55% Etigsgegtion RAARSY ?irrg'7/f'5" DI ?end Service inc Address Risk Retail Re?inspection Q: C- C) (0 Level Residential Kitchen Previous Inspection Telephone 5?0 85 :"80 7 2 (I7 EI Mobile Eats: Temporary Pro-operation Owner 6 8 HACCP YIN CI Caterer El Suspect Illness Person In Charge (PIC) m8: 81% Time Bed Breakfast 3:33.? Complaint . In: Inspector mg?, I 8 Out. Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related IQ Illness and Risk FQQIOE (Red items) Violations marked may pose an imminent health hazard and require Immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Vigiatigns Related to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 0 24. Food and Food Protection 30. Other mils?11.110: 23. Management and Personnel 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) Non compliance with: Anti-choking Tobacco 59030905) Allergens El 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives CI 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating CI 18. Cooling is, Hot and Cold Holding Cl 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting chonsumerAdvIsories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1- 22): Omclal Urge: for gg?ectiog; Based on an inspection today. the Items checked Indicate violations of 105 CMR 590.0001federal 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 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 address within 10 days of receipt of this order. DATE QE I IQN: Signature: WA Print //r/7L a; .. Printrr?m N13 6(1? Page?0f Pages Signature: ?Vulu w- - gok'xool Date: Page: Establishment Name: Hem .- Code Critical lterrl. DESCRIPTION OF- WOLATIDN I PLAN OF: CORRECTION -. Date . Role-hence Red ltem . . .Ven?ed PLEASE PRINT CLEARLY Cb?rUga-Q? (??534an 3. TD awn: \65'5'1? :5 8&ka IA. 6? ?k?\jl p'f?Pu?) chc'} at?? ?61? QHRN ?egi?r? 4- {Zeg?i (1c rm?? Ammo we M90567 Araww s? JWH: l?gppm 69? - a Elf Discussion With Person in Charge: -;Correchve Acton Required El'f- El Voluntary Compliance I CI Employee Rest?o?onl Exclusion CI Re?inspec?on Scheduled El Emergency Suspension CI Embargo El Emergency Closure Voluntary Disposal El Other: SiQONmz?vo??Zdoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfrefrigerators a) wit, F, freezers b)ii1_LF, c} Are thermometers in place in all of the above? Yes_ No_ Potentially Hazardous foods: a) Stored at Yes_?: b) Misbranded/adulterated/ unknown source? Yes_ Nof c) Original, packaging, container in sound condition? Yes cl) Outdated products? Yes_ No? e) PHF at proper temperatures (not/cold)? Yes if No__ Bl Water source: a) Any defects in system? Yes? b) Cross Contamination (check backflow preventers where needed? Yes_ No_[ c} Proper temperatures pressure (check all faucets/fixtures) Yes 41 Sewage?Plumbing -. ls sewage disposal system in good condition? Yes [check drainsfice machinesfbar sinks, air gap, traps/grease traps etc] Yes_ No_ 5) Bathroom, Facilities men?. ladies, employees) a) Is facility vented properly? Yes Yes7 No_ b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? Yes No__ cl) Door closure in place? Yes7- No_ e) Hand washing signs in place in all bathrooms? Yes: No__ 6] Hodentfroach/insect infestation Check behind 8: under all Look for bait boxes/droppings and check extermination reports 7} Worker vaiene-Anv signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? Yes No SlTwo 8t three bay boards a) Sanitizer charts posted? Yes_jo_ b) Sanitizer used? Yes_ No_ c) Chemical test kit on premises? resL/No_ ci) Wiping cloths kept in sanitizer? Yes_?ou e) Sanitizer log kept? Yes_ No_ 9} Facilities l/ a) Are food contact surfaces/equipment clean/sanitized Yes_ No" b) Are non-food contact surfaces clean? (walls/floors/hoods 8i. filters/ stoves/ovens/etc.) Yes No_ 10) Dumpster area clean/tight fitting lids/yard clean Yes_/Nd? Yes7/N 11) Are toxic chemicals labeled and stored prOperiy? o_ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT $O~ooii 5\ Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name . Da 6 1 Ion (3&3 . (Lo-5?s 3&on .5434 It i?'?outine 1' 5 Address RI e-lnspecllon 3&9??ch Level EResldenttal Kitchen ?Previousl spa "i 9 ep 2308 . . Mobile Date: Owner (a HACCP YIN Tammi? ?Egg?! (23.?5 Caterer Susp ct II ass Person In Charge (PIC) Time CI Bed Breakfast General Complaint in; HACCP Inspector Out: Permit No. Other Each violatibn checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Viol ions Rel (Red Items) Anti-Chokinc Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009i?lijij 590-009(Fl CI Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. FIG Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION Ci 8. Separation! Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing CI 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices DUDE Viglatlong Belated tg good Beta]! (Blue Items} Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 95 days as determined by the Board of Health. 0 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. El 17. 18. Cooking Temperatures Reheating Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Qj?gial Order [or Cgrregtlon; Based on an Inspection today, the Items checked Indicate violations of 105 CMR 590.000Ifederal 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 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 address within 10 days of receipt of this order. DATE OF A . a . PICsbigmtm' . lie?T?Slm Print Print: O. Mina?ax) hdsii cSmit/h Brockton 50am on ncuun Estabiishment Name: 3 8 $5602? I Date: 3 {in} \ck Page: 3? of 17mm code. cg; Critical item DESCRIPTION OF 2' PLAN 05 CORRECTION 5; Date ?Reference Red Item . . Ven?ec PLEASE PRINT GLEARLY . Mimr La} 4 (:6er k?A?f-Lb-l at: 6-5831 mtg} E?f?lms Hall? M9. [13,43 Per Hm? mm. 4mm N0 omen foot; Sees-H issues (1cm -, Ammg ?mn .1 .uik ?1?:th 0' (00? Mhl? 190 @954?9. mg: 51"ka mks-v dam 1/ N5 ViaW??o?? 1 609? gift? mg ?6er f?I-In. Discussion With Person in Charge: Corrective Action Reunited . El Voiuntary Compllance Emponee Restriction I Exclusion El ?Re-impaction Scheduled Cl Emergency Suspensio CI Embargo 13 Emergency Closure 0 Voluntary Disposal Other. 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. ?ux? coolers/refrlg rators a) #1233. ?zgfifcrsifr. ragga Wf?T?jf??j?gj freezers banjos WW c] Are thermometers in place in all of the above? Yesfoo? gLPotentially Hazardous foods: a} Stored at b) Misbranded/adulterated/ unknown source? cl Original, packaging, container in sound condition? cl) Outdated products? e) PHF at propertemperatures (not/cold)? 3} Water source: a) Any defects in system? b) Cross Contamination (check backfiow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) ti} Searraeseii Plumbing Is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5i Bathroom, Facilities lmen?. ladies, emoloveeg a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? cl) Door closure in place? e) Hand washing signs in place in all bathrooms? Modent/roachlinsect infestation Check behind 81 under all Look for bait boxes/droppings and check extermination reports 7] Worker Hygiene~Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? SiTwo 8: three bay sinks/dishwashers/drain how; a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities . a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (walls/floors/hoods 8: filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Ye o_ Yes? No Yesl?No Yes Neg Yes Nol/ Yes N035 Yes Yes Yes 7?3 Brockton Board of Health FOOD ESTABLISHMENT REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Nam Date I 13mg of .. ?R?c .tq CI ood Service Ell-Ramos Address . SAN) . Risk Retail Re-inspeotion I .470 QE 9 Rue? Level CI Residential Kitchen Previous Inspection . an on T: <3 580 969 112 lair/ionic Erin; Owner HACCP YIN 6"?me ?We? 0" O) {opt?*0 QacA by . CI Caterer Suspect Illness Person in Charge (PIC) Time Bad Breakfast Sig: Complaint . In: Inspector a (q :5 it IQ) Out: Permit No. ID Other Each violation checked ?r'e'quires an explanation on the narrative page(s) and a citation of specific provision(s) vi action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable.I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedIExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingICondition 6. Tags/Recordsl?Accuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACGP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate 11. Good Hygienic Practices DUDE Viola ion ta I Pr to (Biue Ite ms} Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (FD-EJiSBtmuaj 24. Food and Food Protection 25. Equipment and Utensils (accusations) 26. Water, Plumbing and Waste 27. Physical Facility {Fe?eilsseuriri 2B. Poisonous or Toxic Materials 28. Special Requirements (seams; 30. Other Hates Inspector?s Signatn - I'l?C's Signature: olated. gigiatigns Relateg jg Illness Integegtiggs and Risk (Red Items) Violations marked may pose an Imminent health hazard and require Immediate corrective .J Print: Tl Non-compliance with: Anti-Choking Tobacco 590.com} 590.ceeri El CI Allergens 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures El 17. Rehearing CI 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvlsorIes Number of Violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red Items 1-22): 0 so low Based on an inspection today, the Items checked Indicate violations of 105 CMR 590.000Ifederai 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 the food establishment permit and cessation of food establishment operations. it 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 address within 10 days of receipt of this order. DATE OE . WW .. if board 01' nealm Establishment Name: (5 (AA Date: L?i "l 1 Page: (Duo; sou-r Ito of 13 Qwe- Crcri?callteni 0F VIOLATIONIPLAN QF CORRECTION . .-- - . Date- Reference R?Red?em? wzseml?m?my . - . m; 176/ 3o, 1&1 37 17-2. '1 \n A oec? :9 a ?0 Mfr/1ft? C?ng ?94: A Lfdl?) av? our.? k. (Jew-V . (if? Goff Sxalxmj nf/?xgeaflj 413.; gm bee-g6 4W2 VAX) {Eloise-W.) a Discussion With Person in Charge: Action Requrred No.5 ?D?d-rjIYea-?j it] Voluntary Compliance IlEmploy'ee Restriction Exclusion CI Re?inspection Scheduled Emergency Suspension El Embargo Voluntary Disposal Emergency Closure Other. S?QONzrranve?-' 14:10: 1) Temperatures: record the: Exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerators a) wigs, Migrasl?r, freezers ir4__r, c) Are thermometers in place in all of the above? Yes__ No__n_ Potentially Hazardous foods: 3) Stored at b) Misbranded/aduiterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? a) PHF at proper temperatures (not/cold)? 3 Water 5 rce: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures 8i pressure (check all faucets/fixtures) ii Sewa Plumbln is sewage disposal system in good condition? (check drains/Ice machines/bar sinks, air gap, traps/grease traps etc) 5) Bathroom. Facilities imen?, ladies, amp-levees) a} Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, 8: all holders in place? di Door closure in place? e) Hand washing signs in place in all bathrooms? ?i_ilodent/ roach! insect Infestation Check behind 8: under all Look for bait boxes/droppings and check extermination reports 7) Worker Hvaiene?Anv signs of probierms? Check for hair restraints, clothing etc, any open cuts/sores etc? 8iTwo 3t three hasr sinks/dishwashers/drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities a} Are food contact surfaces/equipment cleanlsanitized b] Are non-food contact surfaces clean? (wails/floors/hoods fliters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Yes? No Yesto Yes 490" Yes? No__ Yes_ No_ Yes No__ Yes No_ Yes? No_ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (503) 530-7175 Fax (500) 580-7179 Name . of 0 Mammalian (broc?LK-ox \My Eff/W?? We. Address . ii: 535? .3 Risk Retail Re?inspection LI 7 0 OF at: Level Residential Kitchen Previous Inspection on one Mobile Date: Temporary El Pro-operation Owner Rb HACCP YIN CI Caterer Suspect Illness Person in Charge (PIC) Time El Bed Breakfast 32%: Complaint In: Li Out: Permit No. Other Each violation ch?ecked?T'equires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: I tie Reiatedt odb rn In rventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009IFI CI Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition 6. Tags/Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation] Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations ted (5 ed il ice (Blue items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 23. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other S: 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods} El 16. Cooking Temperatures 17. Reheating 13. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red items 1-22): Of?QIgi Qrder Qgrregtton; Based on an inspection today. the items checked indicate violations of 105 CMR 590.0imi'federai 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. it 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 address within 10 days of receipt of this order. TE OF E- Inspector?s Print: Signature: Print: . f/ . v?apa?z/?F?g of Pages 5W4 DD'alu I Ice-u Q) CC gi (3AA Establishment Name: Date: LJ Page: of Item?; cpde .. Cri?cal Item .-DESCR1PTION-OF VIOLATION I PLAN OF CORRECTION - -. Date Baference,- Redlltem - WV $6,253.: um km} max 6+ a; \?pee pert?J" 5 (3.5;th QPR K25, Discussion With Person in Charge: Corrective Acton Required?i :rNoh fee CI Voluntary Compliance - - Employee Resmc?on Exclusion CI Re?inspection Scheduled El Emergency Su5pensi: El Embargo El Emergency Closure Voluntary Disposal Other: 5:590Nanw? eS-ldoc Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580-7175 Fax {503) 530-7179 hcxh?g) Q?k will}, ?apsctor .. Name - . [let at coil 5 (C5 (LYLAVCR r, - i\ {flier/jg goalies ouiine I Address 2 i Risk Retail Re-lnspection MT Level RaSldential Kitchen Previous inspection Telephone El] Mobile Eats: Hf Temporary Pro-operation Owner 3 HACCP YIN Caterer Suspect illness Person In Charge (PIC) General Complaint El HACCP El Other A Time El Bed Breakfast in: Out: Permit No. action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and P10 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source [3 5. Receiving/Condition Ci 6. TagisecordslAccuracy of ingredient Statements T. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation] Segregation] Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate 11. Good Hygienic Practices Vto i a state (3 at ii cti a (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. E: 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils (Fc-4llseo.ooe) 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials ?Fr 28. Special Requirements (590.009) 30. Other napauirurmH-lsioe Each violation chedked?requlres an explanation on the narrative pageis) and a citation of specific provision(s) violated. Violations Belated to Illness Interventions and Blair Factors {Red Items) Violations marked may pose an imminent health hazard and require immediate corrective Non-compliance with: Anti-Choking Tobacco 59030002) Cl 590.com) Ci Allergens CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS Ci 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REC-1U IREMENTS FOR HIGHLY SUSCEPTIEILE PDPULATIONS El 21. Food and Food Preparation for CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Red items 1-22): Based on an inspection today, the items checked indicate violations of 105 CMR 590.0tlliifaderal Food Code. This report, when signed taste1 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 revocatior the food establishment permit and cessation of food establishment operations. it 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 within 10 days of receipt of this order. A E- PE 0N- ?1 VVI 'I?vl I IHHILII (sue; sou-n Embargo Emergency Closure Establishment Name: 8/2126 [cl Gm (17/qu Date: Ear" ~44 Page: 1 of 1/ item. Code Critiml item - DESCRIPTION OF VIOLATION PLAN OE CORRECTION Date .Refer?nee Red Item - . PLEASE Wm . . . . Ven?ed Q??xpg? ?23 1V 1' 10?61 if L'l Our yz??ka'a? 1.. 3* #13 a; ark weeneo: Cx?w 9&1 LU an? ex 0 War?: aka? 535(ch Q. )6 Wat-0m Discussion With Person in Charge: Corrective Action Required LYes- CI Volurl?ry Compliance I 0 Employee Rose-Idiom Exclusion El Re-inspection Scheduled El Emergency Suspension El El 0 Voluntary Disposal Olher. SiWra?veS?Z?oc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrige rato rs a) #1315 freezers #2 c) Are the mometers in place in all of the above? Yes__ No? 2i. Potentially Hazardous foods: a) Stored at b) Misbranded/aduiterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3! Water source: a) Any defects in system? b) Cross Contamination (check backfiow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 4i SewagegPiumbing Is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5} Bathroom. Facilities lrnen?, ladies, employees) a) is facility vented properly? b] Proper water temperature? c) Soap, paper towels, toilet tissue, 8: all holders in place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? El Rodent/roach/insect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene-Am! signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo 81 three bay sinks/dishwashers?drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9! Facilities a) Are food contact surfacesfequipment clean/sanitized b) Are non-food contact surfaces clean? (wails/fioors/hoods filters] stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Yesz: No_ Yes_ N05. Yes Yes_ N035 Yes_{No_ Yes_ Nof Yes_ N01 Yes I Yes Ye s_ No__ Yes No Yes7 No_ Yes7No_ Yes Yes: No Yes_ No Yes_ No_ Yes No_ Yes 790? Yes_ No__ Yes_l/liio Yes No_ Yes No_ Yes_ No_ . Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name Dat . of (CC/[km \Xi Nata?) ID-iiuf-iood Service Routine Address Risk Retail Re-lnspection 2 i :3 I Level Residential Kitchen Previous inspection Telephone Mobile Elite: Temporary Pro-operation Owner (6 8 HACCP YIN Caterer El Suspect Illness Person In Charge (PIC) Time Bed Breakfast 323;: Complaint In: Inspectomch rt! 5.. We Out: Permit No. Other Each violation checked requires an explanation on the narrative pagets) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source [3 5. Receiving/Condition CI 6. Tags/RecordslAccuracy of ingredient Statements CI 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. Separation] Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing El 10. ProperAdequate CI 11. Good Hygienic Practices Wisted to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 0 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other :EI?lnIpe ?Form ill-Mine If. Non-compliance with: Anti-Choking Tobacco Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures CI 17. Reheating CI 18. Cooling El 19. Hot and Cold Holding CI 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction; Based on an inspection today, the Items checked indicate violations of 105 CMR 590.0001federal 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 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 address within 10 days of receipt of this order. QE Print . Inspector?s Sigzinturb??w ?We 4/474 Print: Page of Pages rat/9% Signature?FW/W I a UTOOKIOH Doatu Ul ncaun Establishment Name: (?kk Date: Page: Lof 2/ Item, . . - DESCRIPTION OF- VIOLATION I PLAN OF CORRECTION .03! Reference. Rs'Red Item . - . . . _Vc_r 2:49:- 2:2 2 3:22 3:2 HA QT 095?s DR Din-2' 3" Apt ?Him 3 Arm? {Jit- 1? ix in. far 10 Min/I? i} - ?vf% QJL 39H at? 3 49/:qu CRM (kt-515w"! 3 Discussion With Person in Charge: OYes Corrective Action Required El No CI Voluntary Compliance El Re?inspection Scheduled Embargo Voluntaly Disposal El Employee Restriction Exclusion Emergency Suspensi Emergency Closure Other. 5:590Nm' eS-Zdoc 1) Temperatures: record the exact temperature of each refrigerator establishment. coolers/refrigerato a) a2 freezers c) Are thermometers in place in all of the above? Yes_ 2). Potentially Hazardous foods: a} Stored at b) Misbranded/aduiteratedl unknown source? c} Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 31 Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 4} SewaeelPlumbmg Is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5] Bathroom, Facilities imen', ladies. employees} a) Is facility vented properly? in) Proper water temperature? c) Soap, paper towels, toilet tissue, 8: all holders in place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? 6} Rodentfroachfinsect infestation Check behind at under all Look for bait boxes/d and check extermination reports 7) Worker Hygiene-?Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo 81 three hay sinksi?dishwashers/d rain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities a) Are food contact surfaces/equipment cleanfsanitized is} Are non~foocl contact surfaces clean? iwailsffioors/hoods filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11} Are toxic chemicals labeled and stored properly? and freezer in the Kassie tibia {@715 a7__r, Yes_ No_ Yesto_ Yesjfl Yes_, No_ Yesi/N?o Yes ?No Yesto? YesZNo_ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (503) 530-7175 Fax (503) 580-7179 Name - . Date ate a Q) (QR CI and Service utino Address . f? . Risk Retail Re-inspectlon i ?70 A :26, Level Residential Kitchen Previous inspection 9 ep one Mobile Data: 1. El Temporary CI Pro-operation Owner P) HACCP YIN CI Caterer El Suspect Illness Person In Charge (PIC) Time Bed Breakfast 322%? Complaint In: (My t! drips/L Out: Permit No. El Other Each violation cheicited' requires an explanation on the narrative pageis) and a citation of specific provision(s) violated. Violations Related to Egodborng illness lntementiortg and Risk Eactors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and FIG 8. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving/Condition El 6. Tags/RecordslAccuracy of ingredient Statements I: 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related jg Gogg Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. 24. Management and Personnel Food and Food Protection 25. Equipment and Utensils 26. 27. Water, Plumbing and Waste Physical Facility 28. Poisonous or Toxic Materials (Fe-meanness) Non-compliance with: Anti-Choking Tobacco 590.0095) El assassin CI Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or ColorAdditives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures I: 17. Reheating l] 13. Cooling El 19. Hot and Cold Holding CI 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvlsories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red Items 1-22): mm Based on an Inspection today. the items checked Indicate violations of 105 CMR 590.000ifederal 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 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 address 28- Special Requirements (590.009) within 10 days of receipt of this order. 30. Other QF A .r . Inspector?s Signature: A ??717" @577 turn? alumnus.? ff Ken-59f! Print: f/ A I Pace of __Paaes nrocruon poara OI neann (508) 580-7175 Establishment Name: [3ffCt?k?C-M 14A (/le Date: UPKV Page: of ham Code 6- critical Item - DESCRIPTION OF VIOLATION i PLAN OF CORRECTION -- Bats No. Reisrenos~ Reizi Item . MSEPRINT . .-. Venfied ?7 ?ssjgi?" 25/ 0? ,rx. 5435? \oL- i ?31 113x i 2525 {ff-Fi?" {59 301 u~0wto3\ (:3er In $3315} are? . 5 . c) 4? ?Tc? a. gm; is \ong m?eq 267a . Lma?m ?Zs'zz? kg. of? 03?: 3 [ref-p My); i9 Ml a 14,! $555, Discussion With Person in Charge: Corrective Reqmred 01401? 1 a. Yes Ci Voluntary Cornplianoe 0- Employee Restriction!r Exclusion El Re-inspection Scheduled Emergency Suspension Embargo Emergency Closure Voluntary Disposal El Other: 5:59Wv' a?-Zdoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrl crate? a) #123 #2 freezers - his! 1&5 c) Are thermometers in place in all of the above? Yes_ 2i. Potentially Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3] water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures 8: pressure (check all faucets/fixtures) 4 Sewa lumbin ls sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5 Bathroo Facilities men? ladies em lo ees a) Is facility vented properly? b) Proper watertemperature? c) Soap, paper towels, toilet tissue, all holders in place? all Door closure in place? e) Hand washing signs in place in all bathrooms? 6) Rodentfroachfinsect Infestation Check behind at under all Look for bait boxes/droppings and check extermination reports 71 Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? SiTwo 3L three bay sinks/dishwashers/drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 91 Facilities a) Are food contact surfaces/equipment clean/sanitized b) Are non~food contact surfaces clean? (walls/floors/hoods filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/ya rd clean 11) Are toxic chemicals labeled and stored properly? Yes_? Yes__ Yes 5 Yes No_ Yes_ No_ Yes No Yes? No_ Yes.7 F, #51 F, Yese?' No__ Yes_ Nof Yes Yes_ No?' Yes No__ No/ Yes;- No_ Yes_ No Yes_ No Yes_Tj/o_ Yes_ No Yes XML Yes_:90__ Yes_ No_ Yes_vao_ Yes_}, No Yes No_ Yes_ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (503) 580-7175 Fax (508) 580-7179 Name Date a not 5 action 9) (?Cabrera IA lc/i 7?4 #9 fen-rice uI he Address Risk 9 a e-nspec on (17f) Qr?slf'l {:va Level Residential Kitchen Previous Inspection Teleehone Mobile Beta: . Temporary Pro-operation Owner p) 5 I) HACCP YIN Caterer Suspect Illness Person In (marge (PIC) Tlme Bed Breakfast General Complaint In; HACCP Inspector a 444?me (4 Out' Permit No. Other Each violation c?efked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Viglgtiogs Belated to Illness iniementious and Risk (Red Items) Anti'Choki?s Tobacco Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. FIG Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing CI 11. Good Hygienic Practices Vigiatiogs Belated to JRetail Practices (Blue Items) Critical (Ci violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 5H iihljlucIFon?n" 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility (chexeeopor) 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other doc Non-compliance with: 59000002) Allergens CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals EMPERATU RE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvlsorles Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Qi?clal Outer igr Correction: Based on an Inspection today. the items checked indicate violations of 105 CMR 590.000llfederal 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. It 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 address within 10 days of receipt of this order. Inspector? 5 Signature: 1% M. A I Prim: Maw/ear ?pill/f4 PIC ?5 Signature PrinW Page of_P.ages wow J, - Brockton boaru u. . - If, '4 Date: 1 1.. u. 3 Establishment Name: 1/545} ttern- Code G-rCriticaHtem DESCRIPTION OFGORRECTIQN - - .1 Date]: No. Reference . _ive'i?ed Rash-3 '3 (if? 7 3/ 9? ?f Maw?J .r 4? \p (l ?3fo aka 1? 61: I'd?xa'x. 20'2"? Law-1? - ?13 *7/77 Afr1.330 (xii-Ax is; 3? i? If . ugh}. Lula-m?! . I . ?r eriecussion With Person in Charge: Action Requll'ed Cl No CI Yes CI Voiuntary Compliance El Empioyee Resh'ic?on Exclusion El Re?inspection Scheduled El Emergency Suspensu El Embargo Emergency Closure :1 Voluntary Dispose! El Other. S?WZdoc 1) Temperatgres: record the exact temperature of each refrigerator and freezer in the establishment. coolers/ refrigerators a) ow. MELMCF, wife freezers its?F, c) Are thermometers in place in all of the above? Yes_ No_ 2 l. Potentially ?azardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? all Outdated products? a) PHF at proper temperatures (not/cold)? 3 Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures} 4 Sewa lumbln ls sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) mathroom. Facilities imen?, ladies. em pioyeesi a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? all Door closure in place? e) Hand washing signs in place in all bathrooms? 6) Rodent! roach! insect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo 8: three bay sinks/dishwashers/drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? cl) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (walls/floors/hoods filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11} Are toxic chemicals labeled and stored properly? Yes?'No? Yes_ Nof Yes Yes_ No{ Yes No_ Yes_ Yes_ No_/ Yes I No'_ Yes Yes_ No_ Yes No Yes7 No_ Yes-7 No_ Yes Yes: No Yes__ No r?n Yes Yes_ /No_ Yes Yes_ No_ Yes Yes? No_ Yes? YesZNo: !Brockton Board of Health .3. . FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580??175 Fax (508) 580?7179 mme De - ii a to Cd?k aux IA on 1g. at wet Wzgig Food Service Address Risk Retail Re-inspectlon LI 7 0 I Level Residential Kitchen Previous Inspection Telephone (1 Mobile DDate: - Temporary Pro-operation _Owner (333:9 HACCP El Caterer Suspect illness Person In ?c?harge (PIC) Time Bed Breakfast 322%? Complaint . in: inspectorm . i ?2 ca f, ?1 Out: Permit No. Other Each violation cheicked requires an explanation on the narrative pageis) and a citation of specific provision(s) violated. Non-compliance with: Vi it'o at Foo line 5 tervet a s(Reditems} Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require Immediate corrective 590-009(583 590-9119?) CI Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. Receiving/Condition [j 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices iol to Re at Go a ce [Blue items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection iro-sxsecoou 25. Equipment and Utensils 26. Water, Plumbing and Waste (rc-sxseopoa) 27. Physical Facility 28. Poisonous or Toxic Materials (Fc-nrseimoa) 28. Special Requirements (590.009) 30. Other chorm mas: 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS l] 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 1e. Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE FOPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne illnesses interventions 5'6 and Risk Factors (Red items 1-22): 0 fo tion' Based on an inspection today. the items checked indicate violations of 105 CMR 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 oi the food establishment permit and cessation of food establishment operations. if 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 address within 10 days of receipt of this order. El Inspector?s Signatum??: Print: Pics Print: Page of Page . Brockton beam on lice: Establishment Name: 6&7 Egg/L at. if 0123:; Date:__ Vt: . Faun ,Critieal. hem DESCRIPTION OF I- PLAN OE-CQRRECTFONW - - - - .. Reference Redltem - . . . grx?-?xfr if; F, Hg V7) Lu Ace/2C5: SrAec) we? Mr>- ?lm?3t ?aw ?ue. i: DA 00* ?pzxe? LW 2 5L we?d Discussion Person in Charge: CorrechveActIon Requlred 1N0 T: l3- Ye? - I: Voluntary Cornpluanoe CI ?'Eulployee Restrictioln Exclusion CI Re-inSpection Scheduled 0 Emergency Suspensic El Embargo El Emergency Closure El Voluntary Disposal Other. SiBONm?iv?-Zdnc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. a) #1 freezers W125, saws, ss__r, c] Are thermometers in place In all of the above? Yes__ Potentially Hazardous foods: a) Stored at properftempastures/conditions? b) unknown source? c) Original, packaging, container in sound condition? d) Outdated products? a) PHF at proper temperatures {not/cold)? a) Any defects in system? bi Cross Contamination (check backflow preventers where needed? cl Proper temperatures 8: pressure (check all faucets/fixtures) 41 Sewage?Piumbing is sewage disposal system in good condition? {check drains! Ice machines/bar sinks, air gap, traps/grease traps etc) 5} Bathroom, Facilities imen?. ladies. emplovee_si a) is facilltv vented properly? bi Proper water temperature? c) Soap, papertoweis, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs In place in all bathrooms? g} Rodentlroach/ insect infestation Check behind 8: under all Look for bait boxes/?droppings and check extermination reports 2i_ Worker Hireiene-iirnr signs of problem? Check for hair restraints, clothing etc, any open cuts/sores etc? 8iTwo 8: three bav boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? Magma . a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (wails/fioorsfhoods filters/ stoves/ovens/eth 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (503) 530-71r5 Fax (503) 530-7179 Name IKKUJ) Date a eretl Q) (?cabs?ca kit. 7? ?2 and Servlce outine Address 935? Risk Retail Re-lnspection 0 ?0 If (TI Level Residential Kitchen Previous Inspection Telephone Mobile Elana: ?i Temporary Pre-operation Owner ?Qj (Ab HACCP YIN Caterer CI Suspect Illness Person In Charge (PIC) Time Bed 8t Breakfast El General Complaint . . . HACCP Inspectoma [hi g?kgyg Out: Permit No. Other violated. Viola is erve oFob no es Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned lKnowledgeabie I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictediExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. of ingredient Statements CI 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation] Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate CI 11. Good Hygienic Practices tio 5 ate to Practice (Blue items) Critical violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as detennlned by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials (sometimes) 28. Special Requirements (590.009) 30. Other BI ?also Each violation chebked requires an explanation on the narrative page(s) and a citation of specific provisionis} Non-compliance with: Risk actor {Red Items) Anti-Choking Tobacco 59000905) 590.009irl El CI Allergens CI 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 13. Cooling [1 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Red items 1-22): Q?igigl Order for Qg?ectign: Based on an inspection today, the items checked indicate violations of 105 CMR SBD?DOIfederal 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 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 address within 10 days of receipt of this order. QATE QE Inspector?s Signetumjj?/?A? i I Ti C?s Signature: A .. Print: Print: TM Page of - Pages [r 'v-II-v-l I-rvul I [call]! (508) 530?7175 Establishment Name: p) 1/ {?ap Date: Page: ?14? ?Em. Code Item . 0 DESCRIPTION- OF WOLATION i- PLAN OF CORRECTION Date No. Reference Red item . - -- Veri?vz - (2.95% 078% 2?1 1h? 3?1. T445. tit-r r-?xev' in?? E7. *1 Lo mac/tip i1 \Dii'i :3 $1 2 of?LS- ?ag? Claw/L2 4?13?: Da??T?rxi we. R- ?aws? '20er a? ?Fray xvi-1 ix 2y Lu aw \i Leaek ?le we Ayn: Discussion With Person in Charge: Corrective-Action Required D, :Yee El Voluntary Cornoiianoe 1 El Employee Restric?on! Exclusion El Re?inspection Scheduled El Emergency Suspension Embargo 0 Emergency Closure [3 Voluntary Disposal Other: S?mNHn?ve?-ldm 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerate rs a) salt, freezers c) Are thermometers in place In all of the above? Yes__ Potentially Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container In sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 31Wate[source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 41$ewageg?Plumbing ls sewage disposal system in good condition? (check drains/Ice machines/bar sinks, air gap, tra ps/grease traps etc) 51 Bathroom. Facilities (men?, ladiesI employees} a) is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure In place? e) Hand washing signs in place in all bathrooms? 6) Rodentfroaclvr Insect Infestation Check behind under all Look for bait boxes/drOppings and check extermination reports 7) Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? alTwo three bay sinks/dishwashers/drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? modifies a} Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? [wails/floors/hoods fllters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting iidsfyard clean 11) Are toxic chemicals iabeled and stored properly? Inspector?s Signature . I Print: 1. 74% 4; gee? . 3 'Brockton Board of Health 0 FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (503) 5304175 Fax (503) 580-7179 Name 1? Date i tic or: ?j?g CI 00d Service El Routine Address - 31. Retail Re-lnspeotion \3 8 gm 6?06 Level Residential Kitchen Previous Inspection 9-08 ?5-30 #75] Mobile Date: ?3w or ACCP YIN CI Temporary [1 Preoperation [j Caterer Suspect Illness 1' Person In Charge (PICErna Be 81 Breakfast $233621 Complaint . inspector (jigging Out: Permit No. Other Each violation checkTed requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: mutations Belated to Illness lntemegtiogs and 3?)er (Red items) AMI-Choking Tobacco scanners) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1:1 1. FIG Assigned Knowledgeable I Duties EMPLOYEE HEALTH 2. of Diseases by Food Employee and PIC 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. Separation] Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices IZICIDEI yioigtigns gamed to good Beta" Practices (Blue Items) Critical (C) violations merited must be corrected Immediately or within 10 days as determined by the Board of Health. Nonucritical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel {sceeiiseeoosi 24. Food and Food Protection 25. Equipment and Utensils (Fe-431590.505) 26. Water, Plumbing and Waste 27. Physical Facility (Fe-slimmer} 28. Poisonous or Toxic Materials ch-riiseriode) 23. Special Requirements (590.1109) 30. Other 5: ?den Allergens CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardoua Foods) 16. Cooking Temperatures El 17. Reheatlng 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red Items 142}: ?g 0 or 0 ti Based on an inspection today. the Items checked Indicate violations of 105 CMR 590.000lfederai 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 1 the food establishment permit and cessation of food establishment operations. if 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 address within 10 days of receipt of this order. WW #I?i r. gee-[[444 Print: mum/1r Tiara/r '1 Page or a. UURLUI I Dual "Gal? I (508) 580-7175 Establishment Name: \C?ggl? Date: Page: of2?( 1' 3; Item; ,Code C?Cri?callftem DESCRIPTION OF OF CORRECTION *Date' Reference. Item . . 1U?eril?iet:i 0&3? 34%er QMC) 05:92:.) QQ- TH: ?50; 3g 33 WJWL 33- ,w '2 firm ?ns? \O-l My 11? [Alibi/?L? . ?Chas: 03ml 1% ugz'_ a; . gag?! UP 2020 a? [9&7 Q?a?bm/ Pk 35 In 0?17; )1 {3 . . Cgtirh,@ Q: w-C? lngp??kiwv135103043 WW Discussion With Person in Charge: Corrective Action Reqml'ed - nu, Yes Voltmtary Compliance - "Empleyee Restriction] Exclusion 0 Voluntary Disposal Other: Re?inspection Scheduled 0 Emergency Suspension El Embargo CI Emergency Closure 3:590Nalntive6-1doc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coole rs! ref erator a) ti #2256515 aria F, F, freezers 0 1 F, c) Are thermometers In place In all of the above? Yes_ 2 .Potentlall Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3] Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 4 SewagegPiquing ls sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5) Bathroom Facilities lmen?. ladies. employees} a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure In place? e) Hand washing signs in place in all bathrooms? 6i Rodent/roachfinsect infestation Check behind 8: under all stoves/coolers/eq uipment/boxes/paiiets/etc? Look for bait boxes/droppings and check extermination reports 7] Worker vaieneuAny signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo 3t three bau boards a} Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9} Facilities a} Are food contact surfaceslequipment clea n/sanitized b) Are non-food contact surfaces clean? {walls/floorslhoods 84 fliters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/ya rd clean 11) Are toxic chemicals labeled and stored properly? Yes Yes_ No_ Yes_ No_ Yes_ or? Yes No Yes_ No? Yes? No__ Yes?f YesZNo: Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name ?4 0 a 1 Wise fCH/Iir??l g?f/Z?T Hod Service utina Address 331) - Risk Retail Re-Inspection I 3 P/dt 5 IL Level Residential Kitchen Previous Inspection 9 ep 5'79 '5 f0 Mobile Date: +0wner 7 y? a ACCP YIN [3 Temporary Pro-operation Caterer El Suspect Illness Person In Charge (PIC) Time Bed Breakfast 322%? Complaint In: inspector Out: Permit No. Other 26"% org ,5 Each violation ei?cked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Belatgg 19 Foodborne Illness Inlementlells and Risk Factors (Red items) Anti-Choklne Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 59?w??9tElijD 590-009iF) El Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE USED 4. Food and Water from Approved Source 5. Receiving/Condition 6. TagsiRecordslAccuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation:I Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. ProperAdequate El 11. Good Hygienic Practices Violations Related to Good Began Practices (Blue Items) Critical (C) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as detennlned by the Board of Health. 23. 24. 25. Management and Personnel Food and Food Protection Equipment and Utensils 12. Prevention of Contamination from Hands 13. Handwaeh Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures El 17. El 18. Reheatlng Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) [j 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Order for Based on an Inspection today, the items checked Indicate violations of 105 CMR 590.0001federal 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 and cessation of food 26- wate'! P'"mb'"9 and Waste (?3'5?590'00?3) establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be In writing 23- 0" TOXIC Materials and submitted to the Board of Health at the above address 28- Speclal Requirements (590-009) within 10 days of receipt of this order. 30. Other DATE 0E 3g. 1.40, Fjp/ Inspc/or?sSigna re: W/?4x/ Zfages Page? 11le $ng li/ I AK )Pr'lit ?tar ?27.80 Ll DU'dlu I ?Fall. Establishment Name: Vii A00 #Date: ?7 Page: 2' of 4 Item. Cede. . G?Ec??calnem DESCRIPTION - Dz Eeference R-gRedltern- t: . makes Pam-row? Pmr?'?q [i?m 0mg? daw?i??r? 3h M?t?ltim area (?ft-Mm. mnf/ agami?t/ gal-dam? Mm dare-J? A/o (Ar 0/76? 446?? 9/ [safer/Eifwwr/ sang Fr]- ?/dwk nae-pl" ?j [451; Jig/c; Fm u/L? Tag/112m w: 41 we. Discussion With Person in Charge: ?u'culunitary.i Compliarice El Employee Restrictit Exclusion Cl Re?inspection Scheduled El Emergency Susper El Embargo Emergency Closure 0 Voluntary Disposal :1 Other: eG-Zdoc ?4 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/ref i erat a) s1 F, SEWER freezers bieIi-{e c} Are thermometers in place In all of the above? Yes__ No__ 2). Potentially Hazardous foods: a} Stored at Yes:Nvo_ b) Misbrandedfadulterated/ unknown source? Yes_ c) Original, packaging, container in sound condition? d) Outdated products? Yes__ e) PHF at proper temperatures (not/cold)? 3] Water source: a) Any defects in system? Yes__ No: b) Cross Contamination (check backflow preventers where needed? Yes__ No; c) Proper temperatures pressure {check all faucets/fixtures) Yes; 4] SewagefPlumhing is sewage disposal system in good condition? Yes: No__ (check machineslbar sinks, air gap, traps etc) Yes; No__ 5} Bathroom. Facilities imen?. ladies. emplovees] a) Is facility vented properly? No_ b) Proper water temperature? Yes g'No_ c) Soap, paper towels, toilet tissue, all holders in place? Yes No__ d) Door closure in place? Yesi' No_ e) Hand washing signs in place in all bathrooms? Yes No_ El Rodent! roaclui insect infestation Check behind ?t under all Look for bait boxes/droppings and check extermination reports Worker Hygiene-Ana; signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? Yes__ No_ BiTwo 8: three bav boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9! Facilities a} Are food contact surfaces/equipment clean/sanitized 11] Are non-food contact surfaces clean? {walls/floors/hoods fllters/ stovesiovens/etc.) 10} Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? B?roci?tton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 . Tel. (508) 580-7175 Fax (503) 580-7179 Name DOM/gay 536/100 . Warsaw?n gt] 20 outine sir [1 Re all Address . . Re-inspectlon 4/5- 1? 5" I Level Residential Kitchen Previous Inspection Telephone 5'2; {g0 gr 2 21/ Mobile Dljate: . - . Temporary Pie?operation Owner Kr(gr/f; HACCP YIN Caterer Suspect illness Person In Charge {Pie} Time ?325? CI Bed Breakfast General Complalnt In: HACCP ?spector Out: I ?5?7 Permit No. Otiier-??c??if Each violation checked? requires an explanation on the narrative page(s) and a citation of specific provisionte} violated. Non-compliance with: Violations Belated to Egodbor?e Illness Integegtigns and Elsi; Egctors (Red items) Antl-Choklns Tobacco 590.009lE) Ci 590.000lr) El Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT Ci 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH [3 2. Reporting of Diseases by Food Employee and CI 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingICondition 6. Tags/RecordslAccuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing CI 10. Proper Adequate 11. Good Hygienic Practices gioiaglo?? Related to good Beta? Eragtlceg (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. A. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other El Esulmplu anal-Halon i Allergens El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEHEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheeting 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEFTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors {Red items 1?22): a 0 ti n: Based on an inspection today. the items checked indicate violations of 105 CMR 590.0iltlifederai Food Code. This report. when signed hotel 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 the food establishment permit and cessation of food establishment operations. If 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: within 10 days of receipt of this order. I . DI uuntuu v. . .. . c" . Establishment Name: DU kit? 31 [?15 a I Date: 3/ ?2 (17/ ,7 Page: of 4 ?Tern,? Code. - Critical Item DESCRIPTION OF VIOLATION PLAN CORRECTION [335' Nd" Reference; Red Item__ Ven PLEASE PRINT CLEARLY V?rkmm deem 01% ma?a (3n c/ofeaK Qnr'f Gal/?aman?Q??r fez-W3C!? 1451+} mar/7f 61/5) V?t?f AM 00*afa4emuw?odu new Au/ ??wj?hacm UM a?/Ev??ix??ZV fw?f?f?? ?f Awno/?mrg J?f?Err{f?7( ?Mrm.??f 399)} o?j sh?aec74'om- Discussion Person in Charge: .?fConec?veAc?on Reunited jai- El Ya: El Voiuntary Compliance - I - Empl-oyee Restric?or Exclusion Re-inspection Scheduled Emergency Suspens Embargo Emergency Closure 0 Voluntary Disposal omen SISBONanz??VeS-ldoc 1) Iempergtures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refri erator 5 . a) mileage soz?r, sear, freezers a2__,F,ii3 c} Are thermometers in place in all of the above? Yes__ 2). Potentially ?azardous foods: a) Stored at b) Misbranded/aduiteratedl unknown source? ci Original, packaging, container in sound condition? d] Outdated products? e) PHF at proper temperatures (not/cold)? 3) Water source: ai Ans; defects in system? b} Cross Contamination (check backfiow preuenters where needed? ci Proper temperatures 8: pressure (check all faucets/?xtures} is sewage disposal system in good condition? {check drainsfice machinesi?bar sinks, air gap, traps/grease traps etc) 5} Bathroom, Eacllities imen?, ladies, employees} a} is facility vented properly? bi Proper water temperature? c} Soap, paper towels, toilet tissue, 3t all holders in place? d) Door closure In place? e) Hand washing signs in place in all bathrooms? 6} Rodent?roachtinsect infestation Check behind 81. under all Lookfor bait boxes/droppings and check extermination reports 7] Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any: open cuts/sores etc? 3)Two 8t three bay: boards a) Sanitizer charts posted? b] Sanitizer used? c) Chemical test kit on premises? d] Wiping cloths kept in sanitizer? ei Sanitizer log kept? 9 Facilities a} Are food contact surfaces/equipment clean/sanitized b} Are non?food contact surfaces clean? (waiisffioors/hoods filters] stoues/ouens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Veg/?lo, . Nod_ Yes__ Yes__ No Yes Yes? No_ Yes?No?d Yes?NoF Yesjfillow Yes; Noid Yes__, Yes No__ Yes No__ Ya No__ Ye No__ if, No__ No__ lJ-e5__ No__ No__ es__ No__ Brockton Board of Health Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-71?5 Fax (508) 580-7179 eti ESTABLISHMENT INSPECTION REPORT Name (Asst ?9,5 - Address [3 Retail Residentiai Kitchen Mobile Owner HACCP YIN [Saginaw Ci Bed Breakfast Rea-inspection \nsp lion Date: at Pre-oaerati 118' uspect litness General Com aint Telephone ?Person in Char PIC .- Time 9 N, In: ?1154111 DHACCP $23! . coir mot Out. Permit No. Other Each violation checked requires an explanation on the narrative pageisi and a citation of speci?c provision(s) Inspector violatedfree Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board Of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH . 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedIExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. ReceivingICondition 6. TagsIRecordslAccuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 1:1 8. Separation! Segregation! Protection 1:1 9. Food Contact Surfaces Cleaning and Sanitizing Ci 10. Proper Adequate 11. Good Hygienic Practices i to I {Blue Items] Criticai (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physicai Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. 0th - tit rml- - 8 t1 mm? titan in a: A AA .I and Risk Factors (Red items 1-22]: Print: or Firm .. sen Non-compliance with: 5 Fa (Red Items) Anti-Choking Tobacco manuals) Ci scanners) [3 1:1 Allergens 1:1 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 1:1 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling Ci 19. Hot and Cold Hoiding E1 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE FOPULATIONS (HEP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions .2 4-H WW Based on an inspection today, the items checked indicate violations of 105 CMR Food Code. This report, when signed beta 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 revocatioi the food establishment permit and cessation of food establishment operations. It aggrieved by this order. you have a right to a hearing. Your request must be In writing and submitted to the Board of Heaith at the above addre: within 10 days of receipt of this order. Q?g QE -IC own?): i Dual u: ncal I {503) 580-71 75 Establishment Name: 233i awed. 33914. $d~po\ Date: {3,1334% Page: :1 of item Code. . ?Critical Item . . DESCRIPTION OF VIOLATION I- IELAILM 0F CORRECTION . - - .IDate_- . NO. Rad. j- - Fl . LLer Mann?K?arv-cg errata-cu? 4: mm; ?aga Fm fig?? Wv? HOT HOLDING. r; ?f 3 quit {a mm MD '3st 52$ W5 a: 5}an Jnu?lki?} [mrv'mjr \nnk? ML am (MD (was 26:12). HA tame-r OHS i . Discussion With Person in Charge: Ignorrectwe Action Required . - El Yes h? .. . I. ?l?y voluntary Complianee ?mployee Restriction! Exdusion El Rte-inspection Scheduled El Emergency Suspension El Embargo El Emergency Closure :1 Voluntary Disposal El Other: 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfr'efrigerators a) freezers a mafia c) Are thermometers in place in all of the above? Yes?lo_ 21. Potentially Hazardous foods: a) Stored at bl Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3! Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) Is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5 Bathroom, Facilities lmen?. ladies, employees] a) is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs in place In all bathrooms? 6} Rodentfroachlinsect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7] Worker Hygiene-Any slens of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? SiTwo 3t three bay boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (walls/floors/hoods filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? 2355:133th YesXNo_ Yes? No Yes No_ Yes_ Neg Yes%N0_ Yes_ No Yes_ o_ Yes No Yes?g?No Ye No Brockton boaru or Brest-don. MA 02301 Fool) ESTABLISHMENT INSPECTION REPORT Fax (503) 580?7179 743mg?~?ojg od Service Routine Address 9 3 If 2 Risk Retail E1 Fla-inspection Level Residential i?itchen Previous Inspection Telephone qq [511 Mobile Dot Temporary Pro-operation Owner E. HACCP YIN Ci Caterer El Suspect illness Person;ln game (PIC) Time 8r reakiast General Complaint . 2 Cinema ?cur i ?g Q) Out: 0. Ci Other Each violation requ Violations marked may pose an action as determined by the Board ofHeaith. ecco1ancractrl?oii Millicent-gilt; El 1. PlCAssignediKnowledgea 53.545 clDuties lres an explanation on the narrative pagels] and a citation of specific provision(s) Non-compliance with: violated. Vi to ilin to 0 5 (Red Items) Tobacco scanners) El 590.coiitFi imminent health hazard and require immediate corrective Allergens 12.. Prevention of Contamination from Hands 13. Handwash Facilities -- - .- recreation.recalcits'tiicaes by Employee and PIC Cl 14. Approved Food or Color Additives 2. Reporting of Diseases 3. Personnel with infections RestrictedlExciuded 15. Toxic Chemicals roannewnoradrenaline-2:: i 4. Food and Water from Approved Source 16. Cooking Temperatures El 5. ReceivinglCondition 17. Reheating 6. Tags/RecordslAccuracy of ingredient Statements 13. Cooling [3 7. Conformance with Approved Procedures/HACCP Plans 19. Hot and Cold Holding 20. Time As a Public Health Control El 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 21_ Food and Food Preparation for HSP 10. ProperAdequate Handwashing 11. Good Hygienic Practices 0 1 items} Critical (0) viola tions marked must lf? consumes ADvIeOsz 5.. - 22. Posting of Consumer Advisories i {Blue Number of Violated Provisions Related 9 corrected To Foodborne Illnesses interventions immediately or within 10 days as determined by the Board and Risk Factors {Red items 1-22); of Health. Non?critica (N) violations must be corrected Of?cl El iliel: [or . Based on immediately or within 90 days as of Health. coo Signature: Inspector?s Signatureinspection '3"an today. the items checked Indicate violations of 105 CMR 590.000ifederai Food Code. This report, when signed baton by a Board of Health member or its agent constitutes an Print: . . tut-int; 1 1:5 Ll 23' Management and Personnel order of the Board of Health. Failure to correct violations 24' Food and F??d Protection cited in this report may result in suspension or revocation 25' Equipment and Utensils (Fe-411590.005) the food establishment permit and cessation of food 26- Water, Plumbing and Waste (Fc?sil590-006) establishment operations. if aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be In writing 23- POISOWUS or Materials (FC'7il590-005i and submitted to the Board of Health at the above address 28. Special Requirements (690.com within 10 days of receipt of this order. 30. Other .. Page i of Pa: Brockton Board of Health (508) 580-7175 Establishment . Date: 8" 30""{8f Page: of En?wlltem DESCRIPTION OF VIOLATIONIPLAN OF inane ?0 Raf?e {-1.59 RhRed Item PLEASEEHNT . - _Ven?ed ?4145: (5 g; 31;: ?46? 9x 14 Fr?rzyr U7 0 5 b; 7/22/34 Ruggru, 113/ 5-. SS 0 aru{{ \oLx EV 3/ Zr/ 25? Rumba; J: 1 L5 334 15/ \rxomi .6.le Ga (256' Am Keefer?) arc/Quill K) 0:9 ?Al?dls kw? (1pr ?1 U0 ar?gd- 0L 34.3 was?) Byrd-10416 855+ 10 MM, Discussion Person in Charge: El Embargo CI Voluntary Disposal Corrective Action Raqurred El Voluntary Compliance Ernployee Restriction! Exclusion El Rea-inspection Scheduled Emergency Suspension Emergency Closure Other: sewn? ll Temperatures: record the exact temperitgre of each refrigerator establishment. coolerslrefr erators . ai al' #41 as ,rs?r. rr?r, re freezers anti}, ra??ra?a saws, raft, #7 cl Are thermometers inpiace in all of the above? Yes? Potentially Hazardous foods; a) Stored at bi Misbrandediaduiterated! unknown source? cl Original, packaging, container in sound condition? d) Outdated products? e} PHF at proper temperatures inoticoidi? 31 Water source; . a} Any defects in system? . bi Cross Contamination (check 'oacicfiow presenters where needed? c] Proper temperatures at pressure [check all faucets/ fixtures) 4) SewageiPiumbing is sewage disposal system in good condition? [check drains/ice machines/bar sinks, air gap, trapsl'grease traps etc} 5) iB-atiruroonaI Facilities irrien?I ladies, employeesl a} ls facilityf vented properly? bi Proper water temperature? c) Soap, paper towels, toilet tissue, 8: all holders in place? cl) Door closure in place? - ei Hand washing signs in place in all bathrooms? 6} Rodent?roachlinsect infestation Check behind 8: under all Look for bait boxes/droppings and check extermination reports 71 Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores. etc? 8: three bay sinksidishwashersidrain boards a) Sanitizer charts posted? bi Sanitizer used? c) Chemicai test kit on premises? d) Wiping cloths kept in sanitizer? e} Sanitizer log kept? 9} Facilities a] Are food contact surfaces/equipment clean! sanitized - in) Are non-food contact surfaces clean? (walls/floors/hoods stoves/oven slots.) 10) Dumpster area cleanftight ?tting lids/yard clean 11) Are toxic chemicals labeled and stored properly? and freezer in the lad YesW; Yes?wog Yeswo? Yes__, No? Yes/No YestoL/ YesZNo_ Yesd?: Yes a Yes Yes-Zyllio? ?r?es Ye5__No Yes?i~lo Yes )lli: Yes? Yea?)0" Yes__ No Yes?o_ ?r'esL/jilo? Yes__ Yes?to? 'Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name i Date a soil (Th/Iii? i? Z/Z?/t?i Di?ood Service outine Address my? . . Ris?k Retail Re?Inspectlon i. y" Chilton Level El Residential Kitchen Previous Inspection Telephone 55% 76 711/ El Mobile Date: _Owner ACCP YIN Cl Temporary Pro?operation 3P5 CI Caterer El Suspect Illness Person in Charge?(PIC) Time Bed Breakfast 322%": Complaint In: mm 91?? Out: Permit No. Other Each violation c?ecked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: [rotations Related to Egogborne illness Intsmentlons and Elsi-3 Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009(5) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT Cl 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/RecordslAccuracy of Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation! Segregation] Protection El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related 19 599;) Retail Erectiggs (Blue Items) Critical (C) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as detennlned by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other a: A El Allergens 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 19. I-Iotand Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Q?iglgl gas; to: Cgrrectlog; Based on an irfspectlon today. the Items checked Indicate violations of 105 CMR 590.00illfederal 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 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 address within 10 days of receipt of this ordernspec ors gnu. url. 11 AM Z?nges Signature; .- '3 Print: 44!! if?" M?f?fnfif Brockton Board 01 Heann Establishment Name: [Mm?b Q1506 I Date: 3-3115? ?1 Page: v. I?Item- ma- DESCRIPTION OF . -. Date ?1 Beference?li Red-'ltem - WWEMY . ?91'de {on??caun-sr? 3&6 3H0 Bq-l?kmaxS Occu+ :5 1; use clean games?: 3395:} 01w?: in?nite . In? 4N) No Maw: KeghL Pam Fwd. . ?ew NL-?rs, Glam North ?k ?fodcec 35" ?16? 35? Us? WW8 *Sm?aas Germ Uh Duk?eh? ?nal. N8 6% mm a; \sgfig?dsm Discussion Person in Charge: Canec?veAchon Required __No Fl Yes?? :1 Cemplia?ee HEmponee Restriction! Exclusion El Re-inspection Scheduled El Emergency Suspension El Embargo El Emergency Closure an :1 Voluntary Disposal c: Other. SiWeB-ldnc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfrefrigerators a) #113]: F, #2 Agassi F, #4341: F, #5 F, sags, #9 freezers a margin o) Are thermometers in place in all of the above? Yes_ 2i. Potentially Hazardous foods: 3) Stored at Yes Ao_ b) Misbranded/adulterated/ unknown source? N01 c) Original, packaging, container in sound condition? Yes_{ No d) Outdated products? Yes_ No: e) PHF at proper temperatures (not/cold)? Yes?iio_ 3i Water source: a) Any defects in system? Yes? No b) Cross Contamination (check backfiow preventers where needed? Yes_ No_{ c) Proper temperatures pressure (check all faucets/fixtures) Yes 4! SewagegPlumbing is sewage disposal system in good condition? Yes No_ (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) VesZ No_ 5} Bathroom, Facilities imen?. ladies, employees] a) is facility vented properly? Yes "No_ b) Proper water temperature? Yes c) Soap, paper towels, toilet tissue, 8: all holders in place? Yes [No_ d) Door closure in place? Yes Yes No_ e) Hand washing signs in place in all bathrooms? 6} Rodent/roach] insect infestation Check behind 8: under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene-Ami signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo 8: three bay of rain boards a) Sanitizer charts posted? Yes 4? [No_ b) Sanitizer used? Yes No_ c) Chemical test kit on premises? Yes; No_ d) Wiping cloths kept in sanitizer? Yes No_ e) Sanitizer log kept? Yesi?; No_ 9) Facilities a) Are food contact surfaces/equipment clean/sanitized Yes; No_ b) Are non-food contact surfaces clean? (wails/fioors/hoods filters/ stoves/ovens/etc.) Yes,_ No_ 10) Dumpster area clean/tight fitting lids/yard clean Yes No__ Yes 1" 11) Are toxic chemicals labeled and stored properly? Brockton?FBoard of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 I Name . Dat . 0 I #61 Vi 0 Z160 [3/915- /9 D?Food Service 1:1 Routine Address - i . R?Isk Re-inspectlon I P601 f" f? 5 7" Laval Eli Residential Kitchen Previous Inspection ep one a r: Mobile Data: 5:5, El Temporary Pro-operation Owner 5? HACCP YIN Caterer El Suspect Illness Person In Charge (PIC) Time Bed Breakfast General Complaint .s - In: HACCP inspector Out: Permit No. Other??dd Each violatierchecked'requires an explanation on the narrative page(s) and a citation of specific provision(e) violated. Non-compliance with: Violatiggs Belated to Foodpgme illness imement'lons egg Blah factors (Red items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009(533 590-009(Fl Cl Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned!Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/RecordslAccuracy of ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation] Segregation! Protection [1 9. Food Contact Surfaces Cleaning and Sanitizing El 10. ProperAdequate 11. Good Hygienic Practices BEDS 0 etc to (Blue items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (Ni violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils (Po-nilseccos) 26. Water, Plumbing and Waste (chnseccesi 27. Physical Facility {ac?eyseecc?ri 28. Poisonous or Toxic Materials 28. Special Requirements (590.0ch 30. Other 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or ColorAdditives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheatlng El 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP I CONSUMER ADVISORY Cl 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22): WM Based on an inspection today. the items checked indicate violations of 105 CMR 590.000l'federal 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 suapenslon or revocation i the food establishment permit and cessation of food establishment operations. It 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 address within 10 days of receipt of this order. -l 0 Home 1 Inspector?s Show/5'24 ray-? .r-x 'l Kay/>7 . .2 Signature: {Ian l: Print:( PI 68.16 (3mm {in Brockton Boara or rival Establishment Name:__ H?m (a Ck Date: I Item: cec??camem- _Referenceil_ ReRed-ltemf- . 1: - /07? 6/6575: dumyfifr- aha/0R4 :l-Mfa Jana/agamgim 1? Am ?X+da4f?f Afr? imt?aa f?mf (50 {64? Arm-7% 7 1 f? {if} '5 . . wa 01%sz me ef?gec?m AM ?mf ?gammy: 0/6? Discussion With Person in Charge: CorrechveAghonRequsred . T- El ?eluntary'CEmpliance E1 Employee Res?ic?or Exclusion El Re-inSpec?on Scheduled El Emergency Suspens Embargo El Emergency Closure 1 CI Voluntary Disposal CI Other. SSWIM 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrig rotors a) #135: freezers -- . -- - c) Are thermometers in place in all of the above? Potentially Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 31 Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) til is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5) Bathroom, Facilities irnen?. ladies. employees] a) Is facility vented properly? b] Proper water temperature? c) Soap, pa per towels, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? 6} Rodentfroach?nsect infestation Check behind 81 under all Look for bait boxes/droppings and check extermination reports 71 Worker Hygiene?Anv signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? 8lTwo 81 three bay boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9} Facilities a) Are food contact surfacesfequipment clean/sanitized b) Are non~food contact surfaces clean? 8t filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? F, #11, ma?a, Yes?:No_ Yes_ No_ Yes: No__ Yes_ Yes__ No: Yes?'No_ Yes: No_ Yes?: Yes__ No Yes No__ Yes i Yes Yes; No_ - Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 5807179 Name Date action EA 357/ Elig?R cdHService CI ultine it Address sk a a e-nspec on I ?if? ??7774? Level Residential Kitchen Previous Inspection 6 ep Mobile Date: 1 CI Temporary El Pre-operation mis/ Esra .. i Ch PIC rea as enera ompa Person arge( )m 6f ?83291?) "line HACCP inspector Out: Permit No. Other Each violation checke?" requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: V'olatio an Ris Facts 5 (Red items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009(5) I: 590-009lF) I3 Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and El 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/RecordslAccuracy of ingredient Statements CI 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate 11. Good Hygienic Practices Violations Belated to ?god Retaii Erectiges (Blue items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility (Fe-exseocor) 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other Idea El 12. Prevention of Contamination from Hands [3 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of ConsumerAdvisorles Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1?22): We; Based on an impaction today, the items checked indicate violations of 105 CMR 590.0001federai 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 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 address within 10 days of receipt of this order. Q?l OE Inspector?s Signature: . {l Print: m? Page ?ier LPagcejI ?Mtg/[42 ?ies/1% /Va mi. a/ f/{c Alia, =vi impaled. Brockton Board of Health [/2937 wg?mf {Una} woo- - Agra: Establishment Name: ?re/?435; Saga?cv/ Date: - 13/7/57" Page: (9'8 of Herd; Corie I C?Cri?calltem- Reference DESCRIPTION OF VIOLATION f_ OF CORRECTION PLegsE min magi? 176642549 ?rm pk rick/?Af?l? [43?3? /7.:er . frag/J ?ooidj Hzl?c?m .A'H?ca {from 3mg qumni7?? laced 4/944? 5-?ng Macao, 30114010101be J?hvmnaboar 56/739 M?orzrz-A I 9&9 11/941er :5"an .445? 16291;? gar-Q ?911 4! mam/[? Mica? 2' CM We QFAPL r?oiis m?m?c/i Wf? we rem/km 25:5 /Afak ,1 ?lm/?f rim ?41er 22: 45* w; 04/7 cw gh'? mug/4 Discussion With Person in Charge: Correctrve Acton Required :t a El Voluntary Compliance I CI I Employee Restrict Exclusion El Re?inspection Scheduled El Emergency Suspe Embargo Emergency Closur CI Voluntary Disposal Other: 5:590Naxn?ve?dxbc ?whit-?; 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. . coolersjrefrigerators V0554, a) #133}, ragarsa?r, MM, ss?? I freeze rs F, F, ifs?F, c) Are thermometers in place in all of the above? Yes__ No__ 2_i. Potentially Hazardous foods: a) Stored at b} unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures 8i pressure 4} Sewage?Plumbing (check all faucetsr?fixtures} is sewage disposal system in good condition? (check drains/Ice machines/bar sinks, air gap, traps/grease traps etc] iijathroom. Facilities lmen?. ladies, employees} a) Is facility vented properly? b} Proper water temperature? c) Soap, paper towels, toilet tissue, d} Door closure in place? all holders In place? e) Hand washing signs in place in all bathrooms? 61 Rodentlroachf insect infestation Check behind 81 under all Look for bait boxes/droppings and check extermination reports ?Worker vaiene?Any signs of problems? g?w anltizer charts posted? b] Sanitizer used? c} Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9) Facilities hair restraints, clothing etc, any open cuts/sores etc? three bay boards a] Are food contact surfacesfequlprnent clean/sanitized b] Are non-food contact surfaces clean? filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicais labeled and stored properly? gamut; M's-Ace I Ye 5i No__ A ?ak/Q Yes__ No_/ Yes 4 No_ Yes__ Yes-2 No: 11/? (9/2 a Yes _2 Mara Yes No_ Yes?Yes__ No Yes; No_ ?9 185+ 35+ No_ . No__ Yes/_ Yes No_ Yes No_ Yes No_ No_ {/74 i Brockton Board of Health Fool) ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 597175 Fax (508) 580-7179 Name Dte at: 3 gr. - ood Service Month-$5? 1 Address . RI it Retail El Resinspection . ?it? Level Restdential Kitchen Previous i pe "on 9i) one drail-t Mobile Date: El) a? W- I Temporary E1 Pro-(5? gal (H [j Caterer Ci Suspect illness WI, Time Bed Breakfast $123366?! Campiaint In: (13:31.1 Out: Permit No. Other Each violation checked violated. yielatlogs to illness intg?egtiogs and Bis)!1 (Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and 3. Personnel with Infections RestrictedlExoluded FOOD FROM APPROVED SOURCE 1:1 4. Food and Water from Approved Source Ci 5. Receiving/Condition El 6. Tags/RecordslAccurecy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation] Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing Cl 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Viol ti 'i 5 (Blue items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board I of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) . Other requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: Anti-Choking Tobacco sections) scanners) Cl Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding [3 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Red items 1-22): 3 W193: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0iitlifederal Food Code. This report. when signed belol 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 the food establishment permit and cessation of food establishment operations. if 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 within 10 days of receipt of this order. 95'] SE Page Let a El DTOGKIOD OT nealm (508) 580-7175 Establishment Name: 39.11001 Date: MIG Page: ttem- Code-1 C?Cn??cailtem .- DESCRIPTION OF QF CORRECTION . Date No} Reference 'Re?etl-Iternf-Veri?e ?(Broth-rs- oerlrlacey? oiumPS-tcr Enclniulr all. ?1901. l?quc? 1/ if 0' 0 galls U15 spud-kmgk nil-3L, EWW 3-093 ?lial-21.9 (heme. gummy-J?- 2.. aim; 1n?: plot-r; o-C raga-ul? OuJ-Jble? Eva/Q 0 HOT 231.41% F) limit '3 2* {252-2551 ?ap} ?1in {wigs (in 35.0.: umeumh. mam MR seller?; ?1 o3 Ba}; 559k un? I Discussion With Person in Charge: :Can?ectwe Action Required -. 3.: Yes Voluntary Compliance El Ernployee Restriction I Exclusion CI Ree?inspection Scheduled Cl Emergency Suspension El Embargo Cl Emergency Closure Voluntary Disposal El Other: 55mm ldoc 1] Temperatures: record the exact temperature of each refrigerator and establishment. coolers! refrigerators freezer in the a} serializassrasae?i.? "a freezers bi?i?FrW I, ci Are thermometers in place in all of the above? Yesszo? 2). Potentially Hazardous foods: a) Stored at bi Misbrandedfadulterated} unknown source? c) Original, packaging, container in sound condition? Outdated products? e} PHF at proper temperatures (not/cold]? 3} Water source; a} Any defects in system? b} Cross Contamination (check backfiow preventers where needed? cl Proper temperatures Er pressure (check all faucets/fixtures] g} Sewage? Plumbing ls sewage disposal system in good condition? [check drains/ice machinesfbar sinks. air gap, trapsigrease traps etc] 5} Bathroom. Facilities imen?, ladies, employees) ai is facility vented properly? bi Proper water temperature? c] Soap, paper towels, toilet tissue, 8: all holders in place? d} Door closure in place? ei Hand washing signs in place in ailbathrooms? 6i Rodent?roachlinsect infestation Check behind 8i under all Look for and check extermination reports 7} Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? SiTwo 8: three hay boards a) Sanitizer charts posted? bi Sanitizer used? c} Chemical test kit on premises? d} Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9] Facilities ai Are food contact surfaceslequipment clean/sanitized is} Are nonrfood contact surfaces clean? {walls/floors/hoods filters] stovesfo'uensfetc.) 10) Dumpster area clean/tight fitting iidsfyard clean 11) Are toxic chemicals labeled and stored properly? 13W Sara-1?3 hire, 3'09?) N's/cm Yesg?ghlo? Yes__ No Yes?No_ No__ Yes No)% Yes iilo__ #No Yes Yes Yes?io? Yes Ye No? Yes}, Yes No__ Yes__ No__ No__ Yes__, Yes__ Yes__ No__ Yes__ No_ Yes__ No_? No__ Brockton' Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Address Telephone Violations marked may pose an imminent health action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. Assigned i Knowledgeable i Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and Pic [3 3. Personnel with infections RestrictediExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. ReceivingiCondition [j 6. TagsiRecordsiAccuracv of Ingredient Statements Ci Conformance with Approved ProceduresiHAGCP Plans PROTECTION FROM CONTAMINATION B. Separationir Segregation! Protection [3 9. Food Contact Surfaces Cleaning and Sanitizing to. Proper Adequate Handwashing 11. Good Hygienic Practices Vigiatiogs [3 tag! in 9995! Retail Practices [Blue rited must ela items) Critical violations ma be corrected immediately or within 10 days as determined by the Board of Health. Non-critical violations must be corrected immediately or within 90 days as of Health. 23. Management and Personnel 24. Food and Food Protection {FCuSii?iiUDO-ti 25. Equipment and Utensils 26. Water, Plumbing and Waste iroeussecoa 27. Physical Facility irceiissecori 23. Poisonous or Toxic Materials (Fc-riiseiicusi 23. Special Requirements reasons} 30. Other Time In: Out: the narrative pageis] and a citation and require immediate corrective determined by the Board Food Protection i 45 School Street Brochton, MA Tel. ices) 530.7175 Fax (508) 580-7179 ouhne Re-insp action Previous inspection and Service I: Retail CI Residential Kitchen El Mobile ate: Pravoperation [3 Temporary Ci Caterer [3 Suspect illness Ci Bed Breakfast CI General Complaint [Ii HACCP Other of specific provision(si Non-compliance with: Anti-Choking Tobacco assassin) Ci sscsesiri Ci Allergens Permit No. is [Red items} 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS {Potentially Hazardous Foods] El 16. Cooking Temperatures 17. .Reheating is. Cooling El 19. Hot and Cold Holding CI 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS Ci 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violatad Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red items 1-22): Based on an inspection today, the items checked indicate violations of 105 Civil 590.000itederal Food Code. This report, when signed by a Board of Health member or its agent constitutes a order of the Board of Health. Failure to correct vlolatio cited in this report may result in suspension or revoca the food establishment pennit and cessation of food establishment operations. if aggrieved by this order. 3 hava a right to a hearing. Your request must be in vvrii and submitted to the Board of Health at the above ad: within to days of receipt of this order. board or Hjazrr) I (508) 580-7175 Establishment Name: ?5ij ?gig/jg?; <2 110439;: c7 "7 CI Page: dee . inCriticaHte-m DESCRI ION 0F PLAN OF- CORRECTION Rei??n?i . . - I Eiwhm Wear" Lac-{A Hears: ?an/~93 nun-Ire, ?$5,913 h] whims: 4 (wl??fg 1" ?Chill" Hi? Dam .. gerh?rlli ("ht-4w 1? Begin Sunk Afr FMQH Jim 5mm f' 0 $.12!th 9/593? I f5 :3le [edit/id, Clea-mug ?'vduefs? lift! K404 ?i?f Dimmie. Mm (it-(an - Discussion With Person in Charge: :-;Correct1ve Action Required El Voluntary Compliance ME-rnployee Restri??nn Exclusion El Re-inspec?on Scheduled El Emergency Suspensic El Embargo El Emergency Closure CI Voluntary Disposal Other. 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerators a} #191 F, az?iaasyir, #4533: F, freezers c) Are thermometers in place In all of the above? Yes__ No_ 21. Potentially Hazardous foods: a) Stored at Yes b) unknown source? Yes_ Nor: c) Original, packaging, container in sound condition? Yes No_ d) Outdated products? Yes_ No:_ e) PHF at proper temperatures (not/cold)? Yes 31 Water source: a) Any defects in system? Yes_ No bi Cross Contamination (check backfiow preventers where needed? Yes__ No? c) Proper temperatures pressure (check all faucets/fixtures) Yes 4i Sewage/Plum hing Is sewage disposal system In good condition? Yes /No_ (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) Yes__ No_ Si Bathroom, Facilities [men?, ladies, employees} a) Is facility vented properly? Yes I No_ b) Proper water temperature? Yes No__ c) Soap, paper towels, toilet tissue, all holders in place? Yes d) Door closure in place? Yes No_ e) Hand washing signs in place in all bathrooms? 6] Rodentiroach/insect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7) Worker Hygiene?Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? Yes Biiwo 8: three bay boa a) Sanitizer charts posted? Yes No_ b) Sanitizer used? c) Chemical test kit on premises? ire-sf; d} Wiping cloths kept in sanitizer? e) Sanitizer log kept? Yes I No_ 9! Facilities a) Are food contact surfaces/equipment clea n/sanltized Yes: No__ b) Are non-food contact surfaces clean? {walls/floors/hoods filters/ stoves/ovens/etc.) Yes_)vo_ 10) Dumpster area clean/tight fitting lids/yard clean Yes7?o_ 11) Are toxic chemicals labeled and stored properly? No_ 1 Brockton Board of Health Food Protection Program 45 School Street Brockton. MA 02301 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (508) 580??1?5 Fax (508) 530-7179 Name . Date I?s entice outine Address 7? Risk Retail Fla-inspection i 1 I Level Residential Kitchen Previous inepection 503 5' . ACCP YIN EI $3.22:er ?tgievoperation 1-.- sa?j?ca'g ,1 Eli Caterer Suspect Illness Person in Char a FIG Time Bed Breakfast General Compieint I I i In: HACCP Inspector ?zz/wag E, om. opioi- Each violation checked? requires an explanation on the narrative pageis) and a citation of specific provisionis) violated. Non-compliance with(Red items] Anti-Choking Tobacco Violations marked may pose an imminent heaith hazard and require immediate corrective 590-0095ng 590.0095) CI Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned I Knowledgeable i Duties EMPLOYEE HEALTH I: 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections RestrictediExciuded FOOD FROM APPROVED SOURCE 14. Approved Food or Color Additives El 15. Tor-tic Chemicals CONTROLS (Potentially Hazardous Foods) 4. Food and Water from Approved Source 16. Cooking Temperatures [j 5. Receiving/Condition 17, Reheating 6. TagsiRecordslAccuraoy of ingredient Statements 13. Cooling CI 7. Conformance with Approved Procedures/HACCP Plans 19. Hot and Coid Holding PROTECTION FROM CONTAMINATION 20. Time As a Pubiic Health Control 8. Separation! Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing CI 11. Good Hygienic Practices REQUIREMENTS FOR su SCEPTIBLE POPULATIDNS ?21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions i is i {Blue items) Critical [Ci violations marked must be corrected Immediately or within 10 days as determined by the Board and Risk Factors (Red items 1.22}; L. of Health. Non?criticai (N) violations must be corrected MW Based on an ins oil on Immediately or within 90 days as detennlned by the Board today, the items checked indicate violations 0:105 Ci?i'iR ?f Health. 590.00tiifederal Food Code. This report, when signed hole by a Board of Health member or its agent constitutes an 23' Management and Personnel order of the Board of Health. Failure to correct violations 24' F??d and F??d Protection cited in this report may result in suspension or revocatior 25. Equipment and Utensils (F0-4il590-005i the iced establishment permit and cessation of food 26' Water, Plumbing and Waste establishment operations. if aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (PC-7il590-005i and submitted to the Board of Health at the above addres 28- Special Requirements (690.009) within 10 days of receipt or this order. 30. Other 0 BI IpncironnIH-moo Ins cot r? Si nature: .m Print: 5 8 .Wm?dur": -- ?M/Zc?f 1 I I Page Lot 2 "it"s Ripnnturs' Print: 1 BFOCKIOD uoara 01' Establishment Name: yr; 9 sun; saw I no mean I f?A/agl? 5445/ fee-C! Date: 9 Page: pZOf/z Item Code- Refe?r?nce 3 _-Cri_ti_cal "Jam Red ?zErn_ DESCRIPTION OF VIOLATION I PLAN CORRECTION . . 54M .64 2"!er (A 44? 43'ch 47m 7 a, ?g K247i 4.44.1.4/ ?ag? {Arr/p?am ?ew/?/Aci we?vo/ Miac?cflif: ?rst!? 11 sgvaac 43/ An?j/ [Kim 5gb [wry/v42 fm?m I ?z??ar?a/j .1749} ?5?!an not. {522? ??zzled/J gag (.156 114/: @19ch :21; [4,57% j? Leo/@W (5 I I S47 ?weW?V Afte??iaw?za/I/ I a c3) 69/ jjgg?/ Xa?cX/Jw?? but?? A?rf Ir/ern; #If j, A ,1 Discussion With Person in Charge: Correctwe Action Requlred in! No El Voiuntary Compliance CI Employee Restriction I Exclusion Re-inspeciion Scheduled CI Emergency Suspension Cl Embargo El Emergency Closure El Voluntary Disposal Other: establish txcoolers/refrl a) F, #2 freezer? misled c) Are thermometers in place in all of the above 2i. Potentiallv Hazardous foods: a) Stored at hi Misbrandedfaduiterated/ unknown source? gas 3432s, 14425Temperatures: record the exact temperature of each refrig F, sag/gr, mgr, #8 F, Yes_/_ No__ c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3) Water source: a) Any defects in system? hi Cross Contamination (check back c) PrOper temperatures 8; pressure 4 SewageZPlumbing Is sewage disposal system in good condition? {check drains/ice machines?i bar sinks, air gap, flow preventers where needed? [check all faucets/fixtures) tra ps/grease traps etc) ?athroom, Facilities [men?, ladies. employees) a) is facility vented properly? b) Proper water temperature? c] Soap, paper towels, toilet tissue, d} Door closure in place? 31 all holders in place? e} Hand washing signs in place in all bathrooms? 6) Rodentlroach/insect infesta?w Check behind under all stovesfcoolers/equlpm Look for bait boxes/droppings and check extermination reports 7i Worker vaiene-Anv siens of Noble-r1153 Check for hair restraints, clothing etc, any open cuts/sores etc? BiTwo three bag boards a) Sanitizer charts posted? b) Sanitizer used? c} Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities a) Are food contact surfacesfequipment clea b) Are non-food contact surfaces clean? [wal stouesfovens/etc.) n/sanitized ls/fioorslhoods filters/ 10} Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly?:I gum ?5,4 9 99? if . F, entiboxes/pailets/etc? [7?0 I: campy; 5 16/ Af? erator and freezer in the erJ/ 69/0 Yes No__ Yes__ No Yes: No_ Yes__ No: Yes .L No__ No; Yes__ jl/Qf; Yes No__ Yes: No__ YesLNo? Yes No__ Yes; No__ Yes 4_ No__ Yes No__ YesL No_ 0 (. Yes__ No__ Yes No_ Yes No_ Yes - No__ Yes; No__ Yes No__ Yes 1. No_ Yes No_ zes+ 0 5+ 2 84:0 5 arr/?5? 2 Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA {12301 Tel. [503) 5804175 Fax (508) 530-7179 Name Da W101 Wrestler! (0i (380mg D?Focd Service CI outine Address I sk Retail Re-lnspection LEO {The I ?g (7 0r 1 Level El Residential Kitchen Previous Inspection Telephone 757 7 Mobile Dljate: - . Temporary Pro-operation Owner 3 HACCP WN El Caterer El Suspect Illness Person in Charge (PIC) Time Cl Bed Breakfast (11323;? Complaint I . Inspector gut: Permit No. Dther?yf/l 01/ Each violation chezk?ed requires an explanation on the narrative pageis) and a citation of specific provisionls} violated. 'olinReiatdood testis all Violations marked may pose an imminent health hazard and action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. FIG Assigned Knowledgeable I Duties EMPLOYEE HEALTH Cl 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition 6. TagisecordslAccuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing Cl 10. Proper Adequate 11. Good Hygienic Practices ola ions at ac is (Blue Items) Critical violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other Non-compliance with: Is at 5 (Red Items) Anti-Choking Tobacco require immediate corrective 590-009(5) El 590-009(Fl Cl CI Allergens CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) [3 16. Cooking Temperatures CI 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): WEE Based on an Inspection today. the items checked indicate violations of 105 CMR 590.00iilfederal 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 ot the food establishment permit and cessation of food establishment operations. If 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 address within 10 days of receipt of this order. - N- ?Ilspector?s Signatll/re./ Cf. .-. If A 2 Print: Ear?f/ 171.47 1 Page/ 0ta Pages 1:50am 01 neaml '1 . - - - Establishment Name: m?n+L at)? ?214?? Date: 37/ ?2 y/ 15} Page: of 2? 3039 3 DESCRIPTION . - Date Hm' Reference. Fla-Redltem - - - . . -. . . . Veri?ed Varhna 10+ dean GlUmaJ?l?e? l-A" - '94 ol K: an are.? am. an arms/mar: ?0 51 Far 1.559%, We ?rj?v?ir vjm? 3 fit/1k in UH Rajah J4 mesh: 1 m?rs-c m" 0 )c Discussion With Person in Charge: ._cetreg?vgne?gwqug??qgij?ja no El Cornpliance I DI: Employee Restriction] Exclusion Re?inspection Scheduled CI Emergency Suspension Embargo CI Emergency Closure Voluntary Disposal Other: 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment coolers/refri erator 7 a) mi? freezers bl??I?F, sews, c) Are thermometers in place in all of the above? Yes__ 2). Potentially Hazardogs feeds: a] Stored at bl Misbranded/aduiterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e} PHF at proper temperatures {not/cold)? 3) Water source: a} Any defects in system? b} Cross Contamination (check backfiow preventers where needed? c} Proper temperatures 8: pressure {check all faucets/fixtures] 4} Sewage?Piumhing Is sewage disposal system in good condition? {check drainslice machines/bar sinks, air gap, traps/grease traps etc) 5) Bathroom. Facilities imen"I ladies. employees] a) is facility vented properly? Proper water temperature? c} Soap, paper towels, toilet tissue, 8i ail holders in place? all Door closure in place? e} Hand washing signs in place in all bathrooms? 6] Rodentiroachlinsect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7) Worker Hygiene?Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BlTwo 3: three bay boards a] Sanitizer charts posted? is) Sanitizer used? c) Chemical test kit on premises? d] Wiping cloths kept in sanitizer? e} Sanitizer log kept? 91 Facilities a) Are food contact surfaceslequipment clean/sanitized hi Are non?food contact surfaces clean? {walls/floorsfhoods filters/ stoves/ovens/eth 10} Dumpster area cieanltight fitting iidslyard clean 11) Are toxic chemicals labeled and stored properly? F, Yes_ No__f? Yes; No?_ Yes__ No: Yes__ No_f' Yes: No__ Yes; No__ Yes; No__ Yes__ No__ Yes No__ Yes No__ Yes No__ Yes_ No_f Yes No__ Yes No__ Yes No__ Yes No__ No__ Ye No__ Ye:_ No__ Ye No__ Yes? No__ 'i Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel/L508) 580-7175 Fax (508) 80-7179 Name De Mill/VI ij?dt?f Service outine Address I Retail Re-lnspection I I1 . 1,4?ng ng?/fs? Level EResidentlal Kitchen Previous Inspection GOP 0'19 3? - - Mobile Data: Own LII If (8 ACCP YIN CI Temporary CI Pro-operation 6 72105 CI Caterer Suspect illness Person in cli'arge (PIC) Time Bad Breakfast 3:13:66: Complaint In: Inspector be,? ,3 Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Viol tlo sReI cm In ss Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infecilons RestrictediExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation/ Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices DEED Belated 1Q gong nggil ?agtiges (Bins items) Critical violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other [dud Non-compliance with: a (Red Items) Anti-Choking Tobacco 59030905) Cl 500.0095) El Allergens CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or ColorAdditives [Ii 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. El 17. 18. Cooking Temperatures Reheating Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories and Risk Factors (Red Items 1-22): ffic rre . Based on an today, the items checked Indicate violations of 105 CMR 590,000ifederal Food Code. This report1 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. it 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 address within 10 days of receipt of this order. - CTION: Number of Violated Provisions Related To Foodborne Illnesses Interventions Print: ,rf {Ctr/M We 144/17 [of/1o? ft Inspector?s SignsturW . .1 mgW7/ P105 Signature: Wit (IQ, ?741.) l?ageL?i?EE?jI?ages Brockton Board of Heaun Establishment Name: Ehrg - Iggy? . OF: Red item - cede-1.; Reference Date: VIOLATION. PLEASE Ce ?are: CZ/z?cm - ewe Ur??if den, :1 in 11/23" a? n? 6?1 owe-r .2 Ll? it; With Person in Charge: ?correcmehctm?equred No =1 .3 4 El \fcluntary Compliance Re-lnSpection Scheduled Embargo 0 Voluntary Disposal CI Employee Res?iction Exclusion Emergency Su3pensk Emergency Closure El Other: 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfrefrigerators a) indie s9__r freezers c) Are thermometers in place in all of the above? Yes__ No__ 21. Eotentlally Hazardous foods: a} Stored at Yes_ b] unknown source? Yes? No I c) Original, packaging, container ln sound condition? YestoH d) Outdated products? e) PHF at proper temperatures (not/cold}? Yes_ No_ 31 ?ater source: a} Any defects in system? Yes__ No h) Cross Contamination (check backfiow preventers where needed? Yes__ c} Proper temperatures pressure (check all faucets/fixtures) Yes.__ No_ 4 Sewa iumb'n Is sewage disposal system in good condition? Yes /o (check machines/bar sinks, air gap, traps/grease traps etc) Yes_ 5] Bathroom, Facilities imen?, ladies, eleOW?l a) Is facility vented properly? Yes 4/40_ b) Proper water temperature? Yes_ No_ c) Soap, paper towels, toilet tissue, all holders in place? Yes I o_ d) Door closure in place? Yes )lo? e) Hand washing signs in place in all bathrooms? New 6) Rodentfroachfinsect Infestation Check behind 8: under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene?Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? Yes_ No__ aiTwo 8: three bay boards a) Sanitizer charts posted? Yes o_ b) Sanitizer used? Yes No_ c) Chemical test kit on premises? Yes No_ d) Wiping cloths kept in sanitizer? Yes o_ e) Sanitizer log kept? Year No_ 9] Facilities Yes_ Now a) Are food contact surfacesfequipment clean/sanitized b} Are non?food contact surfaces clean? iwails/fioorsfhoods filters/ stoves/ova ns/etc.) o_ 10) Dumpster area clean/tight fitting lids/yard clean Yes 11) Are toxic chemicals labeled and stored properly? Yes_ No__ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 530~7179 Name .. Date WW 0 ?ng gig/?1? ail/Z?f? cod Service lne Address Risk, Retail El Re-lnspection o. . Level El Residential Kitchen Previous Inspection 9 9P 5357 Mobile Date: Owner 9?5? if?? ACCP YIN Temporary El Pre-operation Emec??on which: EC nL. Ci Caterer Suspect Illness Person In Charge (Pica 371ml? - i 3 i? Time Ci Bod Breakfast Smog Complaint In: Inspector Out: Permit No. El Other Each violation chec?fed requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violation to '55: a (Redltemsl Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009(553 590-DDEIFI Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable! Duties EMPLOYEE HEALTH 2. Reporting Of Diseases by Food Employee and PIC CI 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source CI 5. Receiving/Condition 6. Tags/RecordslAccuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation! Segregation] Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing 11. Good Hygienic Practices Violations Related to good Retail Erectices (Blue items) Critical (C) violations marked must be corrected immediatelyr or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 12. Prevention Of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. ApproVed Food or CoiorAddltives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of ConsumerAdvlsorles Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): I rd Based on an Inspection today. the Items checked indicate violations of 105 CMR 590.000lfederal 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. it 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 address within 10 days of receipt of this order. E- Print: J/Ij?f?f. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility _i 28. Poisonous or Toxic Materials 28. Special Requirements (500009) 30. Other I: Ei?lnspi-ltlFurm?-IHJIOG Inspector's Signature: Signature: J. . [?ash/E Binnie ?avid?593w 7 - (Ann's. #146! Brockton Boam on new . Establishment Name: 40/14; $112247 Code Reference I . u. .1 ?l l'aJ Impacts: DESCRIPTION OF M- rZ_ I PLEASE Date? .- Discussion WEI?IPerson in Charge: Ecpmmeaatiunnequipedag?, T1 El Voiuntary Com-plia?oe t3 Re-inspec?on Scheduied Embargo El Voluntary Disposal Emp?loyee Restriction Exclusion Emergency Suspen: Emergency Closure Other: s. Mia/95y 1) Temperatures: record the exact temperature of each refr)gerat rand freezer in the [0?3 ){errlm? 0* establishment. or! 0" coolers/refrigerators a) sugar, raj/kesajgr, sti?e egg. a9_i= freezers .- a4__r, c) Are thermometers in place in all of the above? Yes_ No? Potentiailv Hazardous foods: 3) Stored at Yes b) unknown source? Yes_ No_ c) Original, packaging, container In sound condition? Yes: cl) Outdated products? Yes_ No e) PHF at proper temperatures (not/cold)? Yes; No__ 3! Water source: a) Any defects In system? Yes N04 b) Cross Contamination (check backflow preventers where needed? Yes No c) Proper temperatures 8: pressure (check all faucets/fixtures) Yes No__ 4} Sewage?PIumbing 72?? ls sewage disposal system in good condition? Yes_/No__ 2? c3 0 1? (check drainsfice machines/bar sinks, air gap, traps/grease traps etc) Yes No_ 5i Bathroom. Facilities imen?. ladies, emoioveesi a) Is facility vented properly? Yes No_ b) Proper water temperature? Yes No_ c) Soap, pa per towels, toilet tissue, 8: all holders in place? Yes No_ d) Door closure in place? Yes 4 No_ e) Hand washing signs in place In all bathrooms? Yes 1.. Rodentfroachlinsect Infestation Check behind 8i under all Look for bait boxes/droppings and check extermination reports or: Worker Hveiene?Anv signs of problems? Check for hair restraints, clothing etc, "are,r open cuts/sores etc? Yes_ No; SiTwo three bav boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9i Facilities a) Are food contact surfacesi'equipment clean/sanitized b) Are nonvfood contact surfaces clean? (walisffloors/hoods filters/ stovesfovensfeth 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? 53W :fa/LE 5"??ka ?l i? ??mxzv/?b Yes No Yes: No? j/r/ Yes ?it/{f Yes No__ Yes No__ Yes No_ Yes Yes No__ Yes No_ My MEL. ,i-rr ?if! Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580?7175 Fax (508) 580-7179 4/ if seesaw WM 6A 410/ f/Z 8/9 and Service tine Address Risk CI Retail Reuinspectlon Level Residential Kitchen Previous Inspection Telephone 3 Mobile gm: Temporary Pro?operation Owner Mme/N P?Cl?l?ln'b an?d'ei' Sci/(qt) HACCP Caterer Suspect Illness :frson in Charge (PIC) crises/7. Elite '3 Bed it Breakfast 323%? Complaint Inspector 9 SW Permit No Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisionis} violated. Vi I at ted to Foodh me 551 terven io Violations marked may pose an Imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH l] 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation! Segregation] Protection 9. Food Contact Surfaces Cleaning and Sanitizing CI 10. Proper Adequate Handwashing 11. Good Hygienic Practices Viglgtigug Belated to Good 3912? (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 6 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste (resistances) 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other Non-compliance with: (Red Items) Anti-Choking Tobacco 590.00%) scanners) Allergens El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 6% f? and Risk Factors (Red Items 1-22): Wise; Based on an Inspection today, the Items checked indicate violations of 105 CMR 590.0001federal Food Code. This report, when signed below by a Boardyof 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 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 address within 10 days of receipt of this order. DATE QF Inspector?s Signs 6 Printth ('10 Mannheim Signature?L/IUI I ?77\ Minty/(1W4, Page( of 1% fmr/K No Wei/e WM 5 Brockton Boara on M?w (U61 [an/5 Dan: . Establishment Name: DESCRIPTION 38:11:}l . I . - ??455.th CLEARLY I Discussion With Person in Charge: No i. In ?aiuntaIy-Comp?anee -. Empioyee Ree?ic?or Ii Exclusion '1 E1 Re?inSpec?on Scheduled Emergency Suspens Embargo 0 Emergency Closure I . i Voiuntary Disposal Cl Other: SLSQOWZM u-Il 1" 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfrefrlgerators a) #13? #22 F, #4 F, as? freezers c, merge c) Are thermometers In place In all of the above? Yes? 21. Potentially Hazardous foods: 3) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3i Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 4) Sewage?i?iumbing ls sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5! Bathroom, Facilities imen?. ladies. employees) a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? 6: Rodent?roach?insect infestation Check behind under all Look for bait boxes/droppings and check extermination reports Worker Hygiene?Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? 81Two 3i. three bay sinkdeishwashers?drain boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9! Facilities a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (walls/fioors/hoods 8: fllters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properlyYesZ lilow ae/ Yes Yes__ No_ Yes Yes Yes o_ Yes Yes Yes?:N No: Ye 5 No Yes]! Yes_ if: Yes I No__ Yes cits: Brock?ton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02361 Tel. (503} 580-71'r'5 Fax (503) seer/179 Name 1403/7 Address Date i Food Service Level Residential Kitchen Previous Inspection ?3?9"th 5?9; 55957 I 5 DEIatPIe-operation When ?In ?32 YIN CI caterer 3?15?? ?mass Person in Charge (PIC) . 1:1) Time Bed Breakfast 322%? Complaint in: Inspector 9 ?an-7 Out: Permit No. I Other i WW1 Routine Risk CI Retail Re-lnspection action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections RestrictediExciuded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source [3 5. Receiving/Condition El 6. Tags/Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separationi Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices ati is no 5 (Blue items} Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as detenninsd by the Board of Health. CE 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste ire-sirsecooei 27. Physical Facility trceyesonon 28. Poisonous or Toxic Materials (Fc-riissocoai (590.009) Fr? 28. Special Requirements 30. Other 3: EWIncpuctFem?-tldou Each violation checkMequires an explanation on the narrative pageis) and a citation of specific provisionis) violated. ylgiatiogs Belated 19 illness intgwentiggs and Elsi; Egctors {Red Items) Violations marked may pose an imminent health hazard and require immediate corrective Non-compliance with: Anti-Choking Tobacco 590.00915) El 590.0095) Ij CI Allergens El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling El 19. Hot and Cold Holding CI 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red items 1-22): MW Based on an inspection today. the items checked indicate violations of 105 ClliiR 590.000ifederai 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 the food establishment permit and cessation of food establishment operations. it 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 address within 10 days of receipt of this order. E- HI I HUHI VI I I [?lm my (bus; 560-7175 Establishment Name: J/uim Date: x47, 9; Page: 92 of C71 item .=.Code- Q- --Critioai.item Reference ?'Re'd DESCRIPTION OF VIOLATIOH ELAN. OF CORRECTION 6444.3122- ji??id/??c?q x4964! 5724/; I. Kil?z/?Ai?xp- gym/7i 42/41242- @mff?-h 5; fi??gi-?i apf:? 1/4 edx?cf?' 57?; a/L karma-atgam: c2 {ch hammer (Amy/?cAP?a/f/ Ami-M ?xing-?35- .frr ?sf?rt a" ghf? Mk 1(0de fr?: 441510 I?m?ikel/? [i g?hwa ?414 W/Q/J/f/{ac/ 1 . {Vi HrE/?if??sgg? .17/ Avila-EL. Ihf?f?dkc? If? . Discussion With Person in Charge: Corrective Action .31- z] .- Yes El Voiuntary Compliance 0 - En1pioyee Restrio?on I Exdusion El Re?inspeetion Scheduied CI Emergency Suspension Embargo El Emergency Closure El Voluntary Disposal Other. i- . "ff "v?'ri?e establishment. 1) Temperatures: record Wet temperature of each refrigerator and freezer in the ?we coo le rs/refrige rato freezers em" F, rageae?fr, c) Are thermometers in place in all of the above? Yes__ No__ 2i. Potentially Hazardous foods: al Stored at bl Misbranded/adulterated/ unknown source? cl Original, packaging, container in sound condition? d] Outdated products? e} PHF at proper temperatures (not/cold}? 3} Water source: a} Any defects in system? bl Cross Contamination (check backflow preventers where needed? c) Proper temperatures 3: pressure [check all faucets/fixtures) Sewager?Plumbing Is sewage disposal system in good condition? {check drains/ ice machines/bar sinks, air gap, traps/grease traps etc) 5i Bathroom, Facilities lmen?. ladies. employees} a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders In place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? Rodent/roach! Insect infestation Check behind under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene-riotr signs of problems? Check for hair restraints, ciothing etc, any open cuts/sores etc? 8t three bay boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9) Facilities a) Are food contact surfaces/equipment clean/sanitized b) Are non-food contact surfaces clean? (walls/floors/hoods 8r filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? ?025 After?? a} smart, #516}, Yes No__ Yes__ No: Yes No_ Yes__ No? Yes; No__ Yes__ No_{ Yes__ No__ Ye?r__ No__ YeaNo__ Yes,;_ No_ Yes; No__ No__ 9& Yes__ No__ Yes No__ YESEL No__ Yes No__ Yes_L No__ YesL No__ Yes Yes; No__ Yes 4_ No__ Yes No_ I'd/07? ?grry? (7 Iggy 5' 0Ha??4M-d t" a 3:2 was", .. (Vii? ?fe-?3 I gig? NJ. ZLVAA Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (503) 580-7175 Fax (508) 580-7179 Name - 1 Date . ti [03,19? It? Eli Service ma Address Risk Retail Re-inspection 4! 3 8 Level [1 Residential Kitchen Previous Inspection __el_ep_one 5-5778 '5 3 Eli gtgte-operation 19.4ch scic? El caterer l3 suspect illness Person in Charge (PIC) Time Ci Bed Breakfast General Complaint In: HACGP inspector ,1 Out: Permit No. Other iolated. gigigtigns Belated tg Illness and Blair (Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT II 1. PIC Assigned Knowledgeable i Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedlExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition 6. TagsIRecordslAccuracy of ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION [j 8. Separation! Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices DUDE ol tion I to it (Blue Items} Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected Immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. other at Gualnln-nIFnimi-H.rin1i Each violatio?njchecketi' requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: Anti-Choking Tobacco 590.0090!) CI Allergens CI 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. El 17. 18. Cooking Temperatures Reheattng Cooling El 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red Items I Based on an inspection today, the items checked indicate violations of 105 CMR 590.0iJUi'federai 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 the food establishment permit and cessation of food establishment operations. it aggrieved by this order1 you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. 0 - 1" A :1 Inspector?s Signature: ?g (M Jul/1.1; Page A of leagr h: 1!?er 1A ik Establishment Name ?4 3mm? ?m ."357 5% 5?9 "5.571 Date ?3 #7 page: of mate JaEun DLI _Gritical__lte_m_ 0F PLAN OF CORRECTION Redliern - . pal?p Mic: Taiies. 336?": Glee/V .1 . Amer; SLOWEQE. (a?mmrm era/q Ml??jf/S: Q/cpre?f 441-534. leak/M 49/5 . Jefmimmgj/g?gfg ere/:6: (W4 Jr RA Zr" image/Lab: 53/ @b?r/S - xy?? 3W in"? aria/L r/ 1? Inc- MI. (U If291:: 76.41:: {3.1 aper?$Discussion With Person in Charge: f-CorrectNe Action Reqmred Womhe - El3 El Voluntary Compliance El Employee Ree?etionl Exclusion a Re?inspection Scheduled El Emergency Sugension El Embargo El Emergency (?gure El Voluntary Disposal Other: 17L Harrm raga/?x 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolersfrefri rato rs ., a) re?t #wrsa?r. mgr, #5335 #5315, #7552}. freezers b)#1 7L or?? c] Are thermometers in place in all of the above? Yes__ Zl. Potentially Hazardous foods; ?7483: a) Stored at b] Misbranded/adulterated/ unknown source? Yes_ c) Original, packaging, container in sound condition? YESL d) Outdated products? Yes_ No__ e) PHF at propertemperatures (not/cold)? Yes No__ 3 Water source: a) Any defects in system? No: b) Cross Contamination (check backfiow preventers where needed? Yes__ Nod c) Proper temperatures 8: pressure {check all faucets/fixtures) Yes .4 No__ Ill Sewage?Plumbl?g 49/75], is sewage disposal system in good condition? Yes No__ 5:251 {check drains/?lce machines/bar sinks, air gap, traps/grease traps etc) Yes No__ (W79 5} Bathroom. Facilities fmen?, ladies, employeesl a) is facility yented properly? Yes No_ b) Proper water temperature? Yes No__ c) Soap, paper towels, toilet tissue, 8: all holders in place? Yes cl] Door closure in place? Yes 71, No? 6:6:ng e) Hand washing signs in place in all bathrooms? Yes/L No? All 5 El Rodentr?roach,? insect infestation Check behind 3: under all Look for bait boxesldroppings and check extermination reports 35E 7i Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? Yes__ No__ mo 3: three bay sinks/dishwashers/drain boards a) Sanitizer charts posted? No__ ,3 47 b) Sanitizer used? Yes No_? 5 a, c) Chemical test kit on premises? Yes?r No_ d) Wiping cloths kept in sanitizer? Yes No_ 5 e) Sanitizer log kept? Yes No__ 9] Facilities a) Are food contact surfaces/equipment clean/sanitized Yes No__ b) Are non-food contact surfaces clean? (walls/floors/hoods filters] stoves/ovensfeth Yes No__ 10) Dumpster area cleanftight fitting lids/yard clean Yes i, No__ 11) Are toxic chemicals labeled and stored properly? Yes No__ C?oC/e/ ?176 .1023 Mary 77/! EEK MKC ax/??ag 7, ?3 a may, ?77, mine/f Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Cow) Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 580-7175 Fax (508) 580-7179 Name 0 @5191! too: SMA 951th {q Food Service "It: .- . Retail Re-ins action Exit I: Residential Kitchen Previous IIsp ction gas? - 68st firs ll-i Byline Dam: are FB-G Bi? 0 Owner EXDS HACCP YIN Cateprer ry El Suspect illnelss n/ Person in Charge (PIC) Time Bed Breakfast El General Complal "?1059, HACCP Inspector Out: PermItNo. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with(Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-00958: 590-0090?) Allergens action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and FIG El 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition . 6. Tags/RecordslAccuracy of ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation! Segregation! Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing CI 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices to ii i (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils coarseness) 26. Water, Plumbing and Waste (Fc-sxssocoe) 27. Physical Facility inc-sitesuami 28. Poisonous or Toxic Materials 28. Special Requirements {590.com 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals I TIMENEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures 17. Reheating El 13. Cooling CI 19. Hot and Cold Holding 20. "time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisorle Number of violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red Items 1-22): 0 i tl Based on an inspection today. the items checked indicate violations 590.00tlifederal 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 . the food establishment permit and cessation of food establishment operations. if 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 address within 10 days of receipt of this order. A 0 - 8 TI Enspectoty?gn? 6T . . Win; - Print: 30/77 MM Print: MICK (D, v?I?.vll ?val" Ul ?Gait" (503) 530-7175 $c3nml Date: gllval?blq Page: Establishment Name: at of 3? ltem. . c? . DESCRIPTION OFVIOLATIONIPLAN OF CORRECTION .. . =-Date; Nor ?Reference-15R - - . :Veri?e [Ji?t r?meEr Most-q. 4: Free. law]: IA 4?63le m- Ann 411% range ?nk-aka Balkan-r5 6% N0 mylr?ske) SW9: \er) resell- ?Sam Bum (Peal? 2 m3 agmsas; 99% is linedDiscussion With Person in Cha e: VICorrec?tweActron Requu'ed 1 - ElzVoluntary Compliance Employee Restriction! Exclusion El Ree-inspection Scheduled El Emergency Suspension 0 Embargo El Emergency Closure El Voluntary Disposal Other: 2.ch 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerators I a) mare wafers?e #433}, freezers 5. or 11F, c] Are thermometers in place in all of the above? Potentially Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? cl Proper temperatures pressure (check all faucets/fixtures) 4i SewagefPlumbing ls sewage disposal system In good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5) Bathroom. Facilities lrnen?, ladies, employees} a) Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs in place in all bathrooms? 5} Rodent?roachfinsect infestation Check behind at under all Look for bait boxes/droppings and check extermination reports 7} Worker Hygiene-Any signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? BlTwo 8: three bay boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept In sanitizer? e) Sanitizer log kept? 91 Facilities a) Are food contact surfaces/equipment clean/sanitized b) Are non?food contact surfaces clean? lwalls/floorsfhoods 8t filters/ stoves/ovens/etc.) 10) Dumpster area clean/tight fitting lids/yard clean 11) Are toxic chemicals labeled and stored properly? Yes o_ Yes_ Yam No_ Yes? No_ Yes Yes No_ Yest(N0_ Ye sgNo_ Yes No__ Yes_ No 3 ii A Brockton Board of Health ESTABLISHMENT INSPECTION REPORT A: ww at Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580d7175 Fax (508) 580-7179 Name .CJhM/ijx ?55: Service Routine Address . m3 Retail Ci Pie-inspection . - Residential Kitchen Previousi so ction Telephone EMobiie Eats: agg?bmg Temporary Pro-op rat Owner HACCP YIN Caterer Person in Charge (PIC) Time Bed 8i Breakfast General Complaint . . . -Im E1 HACCP Inspector . . . Out: Permit No. Other . Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: tons to i rv 's 0 (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 599-00905) El 590-009iF) [1 action as determined by the Board of Health. Allergens FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands 1. PIC Assigned! Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM 2. Reporting of Diseases by Food Employee and PIC 14. Approved Food or Cgiur Additives 3. Personnel with infections Restricted/Excluded [j 15_ Toxic Chemicals FOOD FROM APPROVED sconce 4. Food and Water from Approved Source [j 15, Cooking Temperatures Ci 5. Receiving/Condition 17, Rehaating 6. TagelRecordslAccuracy of Ingredient Statements 13. Cooling Ci 7. Conformance with Approved ProcedureslHACCP Plans 4.9. Hot and Cold Holding PROTECTION FROM CONTAMINATION 20. Time As a Public Health Control 8. Separation! Segregation] Protection REQUIREMENTS FOR HIGH Ci 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing Ci 11. Good Hygienic Practices Vi let on Items) Critical (C immediately or of Health. Nonucr immediately or ithin in days as to (Blue Number of Violated Provision ivlelatiene marked must be corrected To Foodborne Illnesses interventions determined by Board and Risk Factors (Red Items 1-22}: itical (N) Vlaia?ons must be corrected ithin 90 days as determined by the Board today, the items checked indi CONTROLS (Potentially Hazardous Foods) LY SUSCEPTIBLE POPULATIDNS (use) 2i. Food and Food Preparation for CONSUMER ADVISORY 22. Posting of Consumer Advisories a Related Based on an inspection cote violations of 105 CMR ofalth. 590.000Ifederai Food Code. This report, when signed help! 23 Management and Personnel 003) by a Board of Health member or Its agent constitutes an 24' ti order of the Board of Health. Failure to correct violations 0? an 0? "3 so on cited in this report may result in suspension or revocatior 25' Equipment and Utensils the food establishment permit and cessation of food 26' Water. Plumbing and Waste (??aw-005} establishment Operations. It aggrieved by this orderI you 27- Physical Facility (Fc'sil590-007) have a right to a hearing. Your request must be in writing 23- Poisonous 0' 1'03?" Materials and submitted to the Board of Health at the above addres 28? Special Requirements (590.009) within 10 days of receipt of this order. - 30. Other DA . IO - Fermi-Mann assign. gnuti?l?j?l l- - I?ri . Lewis (Jill A Structure: ?i Print .. i. i- J. brocxton boara DI neann (508) 580-717, 1-er Establishment Name: E?rsr?nkts QMWL Date: Page: 3? of 39? 0-Cmmal ?em - DESCRIPTION 9F PLAN OF GDRRECTION Date :Nhi'? :Refe'rence Red item ?3 - -. . nmepmm?nw Ven?ed 5M rung-'11: I I %lu? MA 13' Amn?l- {?ll-J {51.9ng flu/9p :76le r?gbfa ,1 My? . Um M1 Discussion With Person in Charge: Commie Act-ion Reqliired: [lo 3 El Yes 31,9 I: Voluntary Compliance El Employee Restric?onl Exclusion El Rte-inspection Scheduled El Emergency Suspension El Embargo Emergency Closure El VOluntary Disposal Other. ldoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerators a) free a Eirafuzww cl Are thermometers inplace in all of the above? Yesig?or_ 2i. Potentially.r Hazardous foods: a) Stored at h) unknown source? c) Original, packaging, container in sound condition? cl) Outdated products? a} PHF at proper temperatures {not/cold)? 31 Water source: a} Any defects in system? . . bi Cross Contamination {check backfiow preventers where needed? c) Proper temperatures at pressure (check all faucets/fixtures) 4i SewaeefPiumhing is sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5i Bathroom, Facilities lmen', ladies. emplOVeesl a} is facility vented properly? in) Proper water temperature? c] Soap, paper towels, toilet tissue, at all holders in piece? d) Door closure in place? e] Hand washing signs in place in all bathrooms? ?Rodentfroachilnsect infestation Check behind at under all Look for bait bOXES/droppings and check extermination reports 71 Worker Hygiene-Am: signs of problems? Check for hair restraints, clothing etc, any open cuts! sores etc? 8: three bav boards a) Sanitizer charts posted? 13) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? ELLE-LIKES. a) Are food contact surfaces/equipment clean/sanitized is} Are non-food contact surfaces clean? [walls/floors/hoods 8: filters] stoues/ovens/ etc.) 10} Dumpster area clean/tight fitting lids/yard clean 11} Are toxic chemicals labeled and stored properly? Ye's?o_ Yes_ N03 Yes?lo? Yes__ Nog Yes 6No__ Yes__ NOS Yes_ Nazi Yes<_ No_ Yoda; No? Yes: No_ Yes}; No? Yes[ No__ Yes No_ Yes No__ YesENo_ 5 yr Yes jNo__ Yes__ No_ Yesngo_ Yes: Yes?_ Yes No_ Yes?o? Yes No? - Yes/ Yes?o_ 1/ i/ i? Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (508) 580-7175 Fax (508) 5807179 Name Date 0 Seem ma?\ KIIFKIIQ Rt'il i 1 Address a e- nspeo ion I ?mul? Level Residential Kitchen Previous I (of?n/ I ?80 HACCP YIN Ig?grary Elalgro-opa a Caterer Suspect Illness Person in Char PIC Time Bed Breakfast General Complaint - Nm In: HACCP inspeetnr__ - EL Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Vi Relate borne Illness Interventions and Risk Factors (Red items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590-009(5) CI 590-009(Fl action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving/Condition 6. Tagszecords/Accuracy of ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation/ Segregation! Protection 9. Food Contact Surfaces Cleaning and Sanitizing I3 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violatio (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as detennlned by the Board of Health. Non-critical (N) violations must be corrected Immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel (Fc-zussonoa) 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility (Fe-exssonon 28. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. 0th S: Mainly-elm ft 1.8L Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating CI 18. Cooling El 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSOEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvisories Fff??K Number of Violated Provisions Related To Foodborne Illnesses Interventions 3/4 and Risk Factors (Red Items 1-22): Based an Inspection today, the items checked indicate violations of 105 CMR 590.0001federal 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. It 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 address within 10 days of receipt of this order. 9E ION: ?spam-yognm Pm?fWiZloL Pidgin] ?fe??Dm? jofal?ages Brockton Boaro nealm Establishment Name: gawk/KR TUNKQR W-gk Sniaoo Date: Page: of 9x Item's; Code. . - - - DESCRIPTION OF g-Daft? . No. :Beferenoeiu n_-_-Red1tem. . . "sahhfuir i. .. . .Ven?ed . earlier; Lax 3*Mf??u we break ?uff} {no MW Wm Q3622. miemmX lee?! WV 0* 3 Elli-ills .. Mi into m?gzedu . - Nerd [rm/wk lmaL tam, @r mgr-Muff) (N No Mani 5.1.99 9N elk-prom QWW Pang-Q -i_IWk-Jb3 antler" Tm? d? wusUL-??y f? Ale . 3* Discussion With Person in Charge: ?0 lw .. 3??th :f :5 - p. . 3953.: El Voluntary Compliance El? Employee R?si?ctionf Exclusion CI Re-inspec?on Scheduled El Emergency Suspension Embargo El Emergency Closure El Voluntary Disposal Other. 55W: ldoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. cooie rs/ refrigerators I a) freezers c) Are thermometers in place in all of the above? YeNo_ 2). Potentially Hazardous foods: a) Stored at b) Misbranded/adulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 31 Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all fa ucets/flxtures) 4} SewaaefPlumblna ls sewage disposal system in good condition? (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) 5} Bathroom, Facilities Intent ladies. emploveesl a} Is facility vented properly? b) Proper water temperature? c) Soap, paper towels, toilet tissue, all holders in place? d) Door closure in place? e) Hand washing signs In place In all bathrooms? 6} Rodentjroachg?lnsect Infestation Check behind 3t under all Look for bait boxes/droppings and check extermination reports 7) Worker Hvalene-Anv siens of problems? Check for hair restraints, clothing etc, anyr open cuts/sores etc? BiTwo 8: three bat: boards a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept In sanitizer? e) Sanitizer log kept? 9 Facilities a} Are food contact surfaces/equipment cieanfsanltized is] Are non-food contact surfaces clean? (walls/floors/hoods filters/ stoves/Ovens/etc.) 10) Dumpster area clean/tight fitting lids/ya rd clean 11) Are toxic chemicals labeled and stored properly? Yes_?gNo_ Yes_ Nag Yes_:gNo__ Yes? Moi 'i'esjg~ No_ Yes_ No! Yes_ Yes_); No_ YemNo_ Yes? No_ Yesg No_ Yes; No__ Yes No_ Ye No_ ll?es No_ Yes No_ Yesy? No Ye Now,? No_ Yes No__ Yex?No_ Yam No_ Yesx No_ Yes No_ Yes_ No_ Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton, MA 02301 Tel. (508) 530-7175 Fax (508) 580-7179 Name to T?gg gt I Uta/er Food Service outine Address 7 - Risk El Retali El Re-inspectlon Level El Residential Kitchen Previous Inspection Telephone Mobile Elite: Temporary Pro-operation All? 9 l? HACCP YIN Caterer Suspect Illness Person in Charge Time Bed 3? Breakfast 322%? Complaint In: Inst-19?? KW i/C Out' Permit No. Other Each violatiort? checked require; an explanation on the narrative page(s) and a citation of specific provision(s) violated. Viglatiogs Belateg to Foggborne Illness Interventions and Risk Factors (Red Items) Non-compliance with: Violations marked may pose an imminent health hazard and require Immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE I: 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuraoy of Ingredient Statements El 7. Conformance with Approved Prooedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation! Segregation/ Protection El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. ProperAdequate Handwashing El 11. Good Hygienic Practices Belated to 09951 Retail (Blue Items) Critical (C) violations marked must be corrected immediately or within 1 0 days as deten'nlned by the Board of Health. Non-critical (N) violations must be corrected Immediately or within 90 days as determined by the Board of Health. 0 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils Anti-Choking Tobacco 590.0095) El 590.00%) El Allergens 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. El 17. El 18. Cooking Temperatures Reheating Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red Items 1-22): 2 We; Based on an Inapection today, the items checked Indicate violations of 105 CMR 590.000lfederal 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 su3pension or revocation of the food establishment permit and cessation of food 25- Water, Plumbing and Waste (Fc'5ll590-005) establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be In writing 28. Poisonous or 1'0le Materials and submitted to the Board of Health at the above address 28- Special Requirements (590.009) within to days of receipt of this order. 30. Other RE- TIDN: ?jot: Inspector?s Signatuy?m? VJ Print. f] it; {73/ 2 PIC i/W? Print: mA If] Cl if 503?] 01' nealm (508) 580-717 EstablishmentName: 7?1?th 717 AC Date: Page: Zlof 2 new; code C__?_C??cajttem_. Refers-nee R'u Red [tam DESCRIPTION OF. VIOLATION I PLAN CORRECTION PLEASE CLEARLY - A D31 - Vet Park.? c/ean mgz'aw?w gnaw and/Ania dear] 'fgm? UK A/a dWWd/aly/ .Jrucfvaf 4 l7 are or} ?nger 7Z?ngf 3316/161? farm?x wean?? Amb? m5! Discussion With Person in Charge: _gCorreotwe Achon Reqmrad Voluntary Compliance Re?inspection Scheduled El El Embargo El Voluntary Disposal El Employee Restriction I Exdusion Emergency SUSpensio Emergency Closure Other. SWeG-Zdoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/ref erator a) sigh sz?ras?r, freezers . bii?? F, ss?r, c) Are thermometers in place in all of the above? Yes__ No_ 2i. Potentiallv Hazardous foods: a) Stored at Yes__ is) Misbranded/aduiterated/ unknown source? Yes__ No_ c) Original, packaging, container in sound condition? YesffNo__ d) Outdated products? e) PHF at proper temperatures (not/cold)? Yes?No_ 3) Water source: a) Any defects in system? Yes No I la) Cross Contamination {check backfiow preventers where needed? Yes No_/ c) Proper temperatures 8: pressure {check all faucets/fixtures) Ye No_ 3) Sewageii?lumbing is'sewage disposal system in good condition? Yes? No_ (check drains/ice machines/bar sinks, air gap, traps/grease traps etc) Yea/{No_ 51_Bathroorn, Facilities iman?. ladies, emolove?l a} is facility vented properly? Yes I No_ b) Proper water temperature? Yes c) Soap, paper towels, toilet tissue, all holders in place? Yes No_ d) Door closure in place? Yes i No_ e] Hand washing signs in place in all bathrooms? Yes No_ Modentfroach/lnsect infestation Check behind 84 under all Look for bait boxes/droppings and check extermination reports 7i Worker Hygiene-Any signs of probiem? Check for hair restraints, clothing etc, any open cuts/sores etc? 8_i1wo Si three hair sinks/dishwashersi?drain boart? a) Sanitizer charts posted? b) Sanitizer used? c) Chemical test kit on premises? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 91 Facilities a} Are food contact surfaces/equipment clean/sanitized bi Are non-food contact surfaces clean? {wails/fioors/hoods filters/ stoveslovensfeth 10} Dumpster area clean/tight fitting lids/yard clean 11] Are toxic chemicals labeled and stored properly? Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brockton. MA 02301 Tel. (505) 580-7175 Fax (508) 530-7179 Name (751% Oh lI?Eood Service El ouilne Address ?rst; Retail Re-inspection i 63 Ward? a? f+f?t? 7L Level Residential Kitchen Previous inspection Dewen:rone I HACCP YIN DEIath?e-Operation 7} 7/41 (a a /r 5' .. [did f' Caterer CI Suspect Illness Person In Charge (PIC) Time Bed Breakfast Sager? Complaint I . Inspector gut: Permit No, El Other violated. V'olatio 5R ate action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned lKnowIedgeable I Duties EMPLOYEE HEALTH I: 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. TagisecordslAccuracy of Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION I:l 8. Separation! Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing I: 10. Proper Adequate Handwashing El 11. Good Hygienic Practices DUDE oatlo 5 dt i a in siBlue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 6 23. Management and Personnel 24. Food and Food Protection (Foeirssonon 25. Equipment and Utensils (Fcayrssecos) 26. Water, Plumbing and Waste {Fc-syssoocs} 27. Physical Facility 2B. Poisonous or Toxic Materials 28. Special Requirements (590.009) 30. Other om i an Vioiations marked may pose an imminent health hazard and require Immediate corrective Each violationcei'i'ecited Feauires? an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: 5 a 3 (Red items) Anti-Choking Tobacco 590.com) El 590.com) El CI Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives I: 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red Items 1-22}: mm Based on an inspection today. the items checked Indicate violations of 105 CMR 590.000ifederal 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 or the iood establishment permit and cessation of food establishment operations. it aggrieved by this order, you have a right to a hearing. Your request most be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. E- - ?do: Inspector?s 51W: WV Signature: 1? I) - A Print: gap? Print: Virgin Page Brockton Board of Healtn j. - Establishment NameDate: 3 7 Page: of item,? So?a Criticalltam . 0F PLAN OF CORRECTION .- .- --. - ._Da_te No.? Reference -. ma?mcww - - -Ve_rified park: A a AWL (/34 Em area 67M 5/ Gram 234/ [Hardy (7L If npw?u ?60 xf 01+ tar??pul? +?3ij 2 3m 5701K 2n a?e ?memf rf/VU 01,4? Ju'mc Min/r}? 5.414??n - Discussion With Person in Charge: Correct-m Requue? -. ti Voiuntary Compliance El I_EmployeeResdeonl Exciusion CI Re-inspection Scheduled El Emergenw Suspension - El Embargo Emergency Closure El Voluntary Disposal Other. Sindoc 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/rem erato a) #125 F, freezers F, c] Are thermometers in place in all of the above? Yes__ No__ Potentially Hazardous foods; ai Stored at b) Misbrandedladulterated/ unknown source? c) Original, packaging, container in sound condition? d) Outdated products? e) PHF at proper temperatures (not/cold)? 3! Water source: a) Any defects in system? b) Cross Contamination (check backflow preventers where needed? c) Proper temperatures pressure (check all faucets/fixtures) 4i Is sewage disposal system in good condition? (check drains/ice machineslbar sinks, air gap, traps/grease traps etc) i?athroom, Facilities imen?, ladies, emplove?l a) Is facility vented properly? b] Proper water temperature? c) Soap, paper towels, toilet tissue, El all holders in place? d) Door closure in place? e} Hand washing signs in place In all bathrooms? 6] Rodentlroachi?lnsect infestation bier! Check behind 84 under all Look for bait boxes/droppings and check extermination reports worker Hygiene-Anti siens of problems? Check for hair restraints, clothing etc, any open cutsfsores etc? gijwo three has: beam a) Sanitizer charts posted? in) Sanitizer used? c) Chemical test kit on premises? d] Wiping cloths kept in sanitizer? e} Sanitizer log kept? gLF_a_c_iLiti?? a} Are food contact surfaces/equipment cleanlsanitized in) Are non-food contact surfaces clean? {walls/floorsfhoods filters] stoves/ovens/eth 10} Dumpster area clean/tight fitting lids/yard clean 11} Are toxic chemicals labeled and stored properly? Yes__ No_ Yes No Ye No__ No__ es_? No es__ No \ies? No No: Brockton Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 45 School Street Brocitton, MA 02301 Tel. (see) sac-r175 Fax (508) 580-7179 - re; - mm Wm- l/ ooze/0.1M ?ip/g #5 ?3541 [j II ?5 I ?9 Address . - Risk a 6- nscectlon I 12;;1/ M545: Level EI Residential Kitchen Previous Inspection 9 ep one Mobile Date' may. 3215/49 . . Temporary El Pie-operation Owner 93/13" HACCP YIN Caterer Suspect Illness p9Breakfast General Complaint 5? I In?? El HACCP Inspector Out: Permit No. c7] 9? 972,4, CI Other Each violation checked requires an explanation on the narrative pageis) and a citation of specific provisionls) violated. Viia'seletF oreins Violations marked mayr pose an imminent health hazard action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tagisecords/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation.i Segregation! Protection El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violations Belated 19 $9051 Beta]! (Blue Items} Critical (C) violations marked must be corrected immediatelyr or within 10 days as determined by the Board and Risk Factors (Red Items 1.22); of Health. Non-critical (N) violations must be corrected Non-compliance with: (1 RI It a 0 (Red Items] Anti-Choking Tobacco and require Immediate corrective 590-00915) 590-009IF) I3 Allergens 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or CoiorAddItives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheatlng 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 'l 'Basedonan Ins action Immediately or within 90 days as determined by the Board today. the Items checked indicate violations of 105 CMR of Health. 30. Other Hull? 590.000lfederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 22' ranggergint ad?: Persannel order of the Board of Health. Faiiure to correct violations 0" an ro 0" cited In this report may result In suspension or revocation oi 25- Equipment ?I?d the food establishment permit and cessation of food 26- Water, Plumbing and Waste establishment operations. if aggrieved by this order, you 27- Facility have a right to a hearing. Your request must be In writing 28- Poisonous or Toxlc Materials realism-008) and submitted to the Board of Health at the above address 28- Special Requlrements 1590-009) within 10 days of receipt of this order. QATE OE I I Print: 4% 40/ (Inspector?s Signature: ?Mg .1419 Page ot?_Z_Pages st l? gnu um: 4195 yfg?/Wj? ?"Z/Zezerfg ?ee Brockton beam 01 new?. Establishment Name: M4195 WW #1111) Date: 51519951 Page: 1:71. of ltem Cede . Nolf Reference 34111111111111, Descmeraou OF. 1110141119151 1131711111.- 1:11= CORRECTION . . . -. 33.15323 PLEASE Pmufc'mm. 41/116151 7,3214% 11: Aft);? PA 49/75? earl-'2- fpr-J 1 .4113 {days/M {9715:3441 . 1a 11 1 #16115! - 3/25?; 23/ M67 [Adair I 1. rig/pm] ??11.51/ 437%. (Firm 157/; aw? g?W Mn?a?; 11? I?wer/ff/?w? 515$ 211,311.04? BZMs?z?rk .2 gN/%xw 4371M 3,45 ?Dar/:9? Q1: 1 mg??m/ ?/1552! 145111117, 15-51:? [Hwy/lava? 14:? Wig/:P/ff- Discussion With Person in Charge: Corrective Action Remind .. Yes :1 Volunte?; Compliance I I - El Employee Restiction I Exclusion E1 Re-inspec?on Scheduled El Emergency Suspension CI Embargo El Emergency Closure Voluntary Disposal El Other: Mfg/?; 1) Temperatures: record the exact temperature of each refrigerator and freezer in the establishment. coolers/refrigerato freezers . 152/}, has: gage r, az??readr, c] Aret ermomet inplace In all of the above? Yes? 2). Potentialhr Hazardous foods; rs . I a] awe, az?sa??s, Wk a) Stored at b] unknown source? Yes_ No cl Original, packaging, container in sound condition? Yes No_ cl) Outdated products? Yes 31 e) PHF at propertemperatures (not/cold)? 31 Water source: a) Any defects in system? . - Yes? No_/ b) Cross Contamination (check backflow preventers where needed? Yes_ No_/ c) Propert?emperatures 8: pressure (check all faucets/fixtures) Yes 41 ls sewage disposal system in good condition? Yes_/_ No_ w?l?w {check drainsfice machines/bar sinks, air gap, traps etc) [26 El Bathroom, Facilities (men', ladies. emoioveesj a) Is facility vented properly? Yes_]_ No_ b) Proper water temperature? . Yes 4_ No_ cl Soap, paper towels, toilet tissue, all holders in place? YEs No_ d) Door closure in place? Yes?f No e) Hand washing signs in place in all bathrooms? Yesjnlo Rodentfroach/insect infestation . Check behind 81 under all Look for bait boxes/droppings and check extermination reports 01K 7i Worker Hygiene-Ami signs of problems? Check for hair restraints, clothing etc, any open cuts/sores etc? No I BlTwo three bay boards a) Sanitizer charts posted? Yes No_ b) Sanitizer used? Yes No__ . c) Chemical test kit on premises? Yes No_ Her?? d) Wiping cloths kept in sanitizer? e) Sanitizer log kept? 9} Facilities a} Are food contact surfaces/equipment clean/sanitized I Yes No__ Yes4_ No_ 46% Yes+ No_ o] Are non-food contact surfaces clean? {walls/floors/hoods filters/ stoves/ovens/etc.) Yes No_ 10} Dumpster area clean/tight fitting lids/yard clean Yes No_ 11) Are toxic chemicals labeled and stored properly? Yes 74 No_ CW ?974.23 Mair/?u?; My? gay/9