Food Report? City/Town of mm Dale: IL [00 Page 1 big; Address: Men Time inch (.60 Time out: Telephone: I Permit No.: Number of Vlolated Provisions Related to Foodborne Illness Risk Factors and Interventions (items 1 through Person- In- charge: Karin Number of Repeat Violations Reiatr?id OW?3?:met[ I s?hthf Vii nt?sir' Inspector: .. ease. assesses . Waitresses Compliance Status ?.ch Person- in-charge present demonstrates knowledge. and performs duties 2 Certified Food Protection Manager i. .- Management, food employee and conditional employee; knowledge, responsibilities and reporting Proper use of restriction and exclusion Procedures for responding to vomiting Iv and diarrheai events . 0.) Proper eating, tasting, drinking, or .. tobacco use No discharge from eyes. nose, and mouth 7 Hands clean properly washed iv 9 No bare hand contact with ready-to-eat .. food Adequate handwashing sinks properly I sup lied and accessible 11 Food obtained from approved source 12 Food received at proper temperature 13 Food received in good condition, safe, Eur/I, unadulterated Required records available: shellstock tags, parasite destruction 1 J: In compliance 0U'l'= outofcompilence NIO=noIobserved NM: notappiicable corrected on-site during inspection R=repeatviolation ood ocd~contact surfaces; cleaned to oodborne Illness Risk Factors . and Interventions {lIeIns 1 through 29): . I . Put?" .- - Compliance StaIus NIP. Contamination rated and otecied 305 nitized er disposition of returned, iy served . reconditioned food time tern ures er reheating procedures for hot i oper cooling time and temperature or hot holdl tern re cold hold tern oper date mar and dis as a Public Health Control mar advisory provided for raw ndercooked food prized foods used; prohibited food offered cod additives: approved properly sod oxic substances properly identified. used ompliance with variance specialized ass I Plan Official Order for Correction: Based on an inspection today. the Items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are subject to a notice of suspension, revocation, or non- renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR Date of Reinspeotlon: _ELsgussion with Person-ln-Charge: mi /l f) . ?rear/rs l/I Mei. 7b are version pas/I Food Establishment Inspection Report City/Town of NM i Establishment: .Date 59;, I55 l? Page 2 Pf? IN: In compliance outofcompllance not observed NIA not applicable COS =corrected? on- s-lte ?durlng Inspection repeatvlolatlon Compliance Status IN OUT No COS Compliance Status Warewashing facilities: installed. 30 pasteurized eggs used where maintained used: test strips required 49 Non-food contact surfaces clean 31 Water ice from approved source 31-35 Essay: 13' 32 Variance obtained for specialized 50 Hot 8 cold water available; processing methods adequate pressure E79 . ii, 51 Plumbing installed; proper backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed: facilities maintained . . 55 Physical facilities installed. 37 Food properly labeled; original maIntaIned, 8? clean . . . container 56 Adequate ventilation IIghtIng. a . esignated areiusw": Elnsects, rodents, &anlmals not - present M1 Anti- choking procedures In food Contamination prevented during service establishment as food preparation, storage and Food allergy awareness display Personal cleanliness Wiping cloths: properly used 8. stored 40 41 42 Washing fruits vegetables I ln-use utensils properly stored Utensils. equipment linens: properly stored. dried, handled Single-use I single?service articles: properly stored used 43 44 45 46 Gloves used properly Food non?food contact surfaces cleanable, properly designed, constructed at used 47 Mobile Food Operation Temporary Food Establishment Public Market; Farmers Market Residential Kitchen; Bed-and- Breakfast Operation Residential Kitchen: Cottage Food M8 Operation School Kitchen; USDA Nutrition M9 Program M10 Leased Commercial Kitchen M11 Innovative Operation L1 Local law or regulation L2 Other Food Service Establishment Ci Retail Food Store El Residential: Cottage Foods El Residential: Bed 8: Breakfast El Mobile/Pushcart Temporary Food Estab. El Other . pe of Operationts}: pe of Inspection: 7&4 yig?oullne El Rel-inspection Pro-operational Illness investigation Cl General complaint El HACCP El Other OFSMM capital I6, men (er .i 5% axe/Mr . IN jg?naWerson In Chabyf i'drsna x, mil/V THE COMMONWEALTH OF MASSACHUSETTS in; go .3me a Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Dale II 1? <9 ?scal ?31350? Series ?Emeline Address Risk Retail Fla-inspection Level [3 Residential Kitchen Previous Inspection Telephone Mobile Data: . Temporary Pro-operation - Owner I vhnU? HACCP Caterer Suspect Illness Person in Charge (PIC) Time Bed 81 Breakfast General Complaint KARE ENTIRE In: (0110 HACCP Inspector?WM WC 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: Violations t_o_ Foodborne Intervention iaiiti Risk I ac tt_11s [Red Items} Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) El 590.009 (F) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [j 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH [3 2. Reporting of Dis eases by Food Employee and PIC [3 3. Personnel with lnlections Restricted Excluded FOOD FROM APPROVED SOURCE [j 4. Food and Water from Approved Source CI 5. Receiving Condition 6. Tags 1' Records lAccuracy of Ingredient Statements 7. Conformance with Approved ProcedUIes/ I-IACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation Segregation Protection [3 9. Food Contact Surfaces Cleaning and Sanitizing 10. ProperAdequate Handwashing 11. Good Hygienic Practices I?litlj (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board 01 Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. . Management and Personnel 003) . Food and Food Protection . Equipment and Utensils . Water. Plumbing and Waste . Physical Facility IFc-cltseoom) . Poisonous or Toxic Materials . Special Requirements (590,009) . Other Local Law Allergen Awareness 590.009 (G) 12. Prevention of Contamination lrom Hands 13. l-landwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or CotorAdditives I3 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling [3 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 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 an inspection today, the items checked indicate viol trans of 105 CMR 590.000/Federal Food Code. This rep rt. 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 QF Inspector )igit ?11% 1'y/M? Plint: WW WWO as New Wig/i 7/iV lie/a} FORM A (REV. HOBBS B: WARREN -BOSTON This Form Approved by the of Public Health BOARD OF/f-l EALTH Establishment Name: Mdi?'? Date: Page: of Item Code C-Criticailtem DESCRIPTION 0F CORRECTION Date No. Reference - Red Item PLEASE PRINT CLEARLY Verified 040% l, rail? 43% Lu: alt)? vi lilthmoj?h? ADDS nor coat? Writs Is balm; ha bl??jib (Al-1f 3 xi dismaeolf si-rmis 61min s?mw 23 Quinlan/ill. SiDCbol Zme 819% Discussion With Person in Charge: Corrective Action Required: Yes j, Mluntary Compliance Cl Fla?inspection Scheduled Cl Embargo Cl Voluntary Disposal #D/Employee Restriction Exclusion 1:1 Emergency Suspension CI Emergency Closure Other FORM 7343 (REV. 7/2000) HOBBS WARREN, - BOSTON This Form Approved by the Department of Public Health Food Establishment Inspection Report Citleown of Mime?; Establishment: Date: I th? 3 Pagei Address: QJNJ ??nk-6L Time ?1153130451 Mom: Telephone: I Permit No.1 Number of Violated Provisions Related to illness Risk Factors Owner and Interventions {itemsi through 29): Persondn charge: Li mat [17th Number of Repeat Violations Related to Foodborne illness Risk Factors and interventions (?items 1 through .29): a . . - fili?f - we as iN=lnc cmpilance N10: not observed not applicable COS=corrected on- s-lte during inspection repeal violation Compliance Status in our Hill we cos a Compliance Status in NM 003 W?s: . .3: e; entanilh?ation?ff'3 1 Person- in-charge present. demonstrates 15 5 rated and start knowledge and performs dUtiBS 15 Food-contact surfaces; cleaned 2 Certified Food Protection Manager tized Fag-egg; . - it PT . oper disposition of returned. Management food employee and xi 1? iousiy Served, reconditioned 3 conditional employee; knowledge t/ nsafe fOOd responsibilities and reporting 3? 4 Proper use of restriction and exclusion 18 time res Procedures for responding to vomiting reheating procedures for hot 5 v? 19 and diarrheal events 11:3? u. '3 20 cooling time and temperature 6 Proper eating, tasting, drinking, or 21 hot hold tem tobacco use 22 cold tem rature 7 mm eyes" ?059' and 23 Pro date and sition Public Health Control B?Hands clean properly washed . i - . . No bare hand contact with ready-to-eat 25 nsumer advrsory provnded for raw/ 9 food ed food [ah 10 Adequate handwashing sinks properly 26 esteurized foods used; prohibited lied and accessible supp . offered 11 Food obtained from approved source 12 Food received at proper temperature 2? 1 Food received in good condition, safe, unadulterated Required records available: shelistock tags, parasite destruction additives: approved 8; properly sad oxic substances properly identified, red used 28 14 pliance with variance i specialized HACCP Plan Official Order for Correction: Based on an inspection today, the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA Food Code. This report. when signed below by a Board of Health member or Its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are subject to a notice of suspension, revocation, or non- renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR Date of Reins m-a-?iscussion with Pershn-in-Charge: Date?? . /rl .M S'Werwra/ {if Food Establishment Inspection Report? City/Town of \UyS/iu?s Establishment .4 ?f . Date: i9. ., ?9 QPageZof_ is i if its In in; gait; e?t'?me: In compliance OUT: out of compliance N110: not observed not applicable COS corrected during inspection repeat violation Com Itance Status IN OUT NM N10 cos Compliance Status Warewashing facilities: installed, 30 Pasteurized eggs used where maintained, used; test strips required Non-food contact surfaces clean 31 Water ice from approved source 32 Variance obtained for specialized 50 Hot cold water available: processing methods adequate pressure - . - Plumbing installed; proper backflow sea 51 . Proper cooling methods used; dewces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained . - 55 Physical facilities installed, 37 Food properly labeled; original malntalned, 8? clean container 56 Adequate ventilation lighting; - . designated areas used - - - - . c; -. i . 38 Insects, rodents, animals not shift. present Anti-choking procedures in food Contamination prevented during service 39 food preparation. storage and M2 FOOG allergy awareness - . display it, i [It i??ns ail-Li hill? 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment '42 Washin fruits ve etabies M6 Public Market; Farmers Market M7 Residential Kitchen; Bed?and- 43 ln-use utensils properly stored Breakfast Operation 44 Utensils, equipment& linens: M8 Residential Kitchen: Cottage Food properly stored. dried. handled Operation 1. 45 Single-use l? single?service articles: M9 School Kitchen; USDA Nutrition V, properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen I.- . M11 Innovative Operation Food 8. non-food contact surfaces - . 47 cleanable. properly designed. L1 Local law or regulation constructed used L2 Other pa of Operationis): of Inspection: Other Information: ood Service Establishment outlne Retail Food Store Re-lnspectlon El Residential: Cottage Foods 3' El Pro-operational El Residential; Bed Illness Investigation Breakfast General complaint El Mobile/Pushcart El HACCP El Temporary Food Estab. El Other El Other l?qffr'g/ gne - -on- n- argeunit so .620 . Data: MPPH Wrt??rm If Food Establishment Inspection Report City/Town of lDate: 124' [6/16 Page_of__ .5 3.: .. Item-Located? I. I. I litemiLocation ?ItemiLocatlon' - oriG' n3 - Violations cited In this it or In Section Section of Code Description of Violation Date to Correct By g. Number THE COMMONWEALTH OF MASSACHUSETTS 173% Wr 0 Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Na - Dale MWQIFI (mm! 57 mood Service ?outine Address Risk Retail Fla-inspection Level Residential Kitchen Previous inspection Telephone Mobile Data: . Temporary El Pro-operation - Owner UII Iif pnhQ/I HACCP CI Caterer El Suspect Illness In ChargetPlC} Time Bed Breakfast General Complaint 8 so i IEIQIELJ c?qo HACCP Inventor-Wu I i Permit No. Other Each violation checked requires anbesplanatlon on the narrative page(s) and a citation of specific provision(s) violated. .VIQIUIIMEJIEIBIQKI Illness Interventions a?d?IE-ka?tors (I?ted Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [j 1. Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and FIG I: 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source CI 5. ReceivinglCondition 6. Tags Records /Accuracy 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. Proper Adequate Handwashing CI 11. Good Hygienic Practices ?otation; (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. Poisor or Toxic Materials 007) Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law Allergen Awareness 590.009 (G) CI 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives I: 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods19. 20. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting oi Consumer Advisories Cooking Temperatures Rehealing Cooling Hot and Cold Holding Time as a Public Health Control Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Otticlal Order tor Correction: Based an inspection today. the items checked indicate violations of 105 CMR 590.000/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. 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 29. Spar (590.009) within 10 days of receipt of this order. 30' 0" DATE OF RE-INSPECTION: Inspector?s wr?tu?le: I Print: If 1de ltd/(Ax Page of Pages c. ram ORM T3 IREV. 9120101 DEBS Br WARREN -BOSTON . ?TTit KM Kigali This Form Approved by the Massachusetts ol? Public chith Establishment Name: mid Fin/W I OF MLTH Date: Page: :3 of Item No. Code Reference - Critical Item Fl Red Item DESCRIPTION OF VIOLATION PLEASE PRINT CL IAN OF CORRECTION ELY Date Verified I quqa? QJQ. I b?nmac/hiu mosh 4.0% OWK Woes. mm 0 (CinocQ ELMMh-?ccf ?oodsmk m3 $00.40 x: 0W erl. ratio A new Jr's gODsmm Maul \oe? QQM I MUM: WW Wick?) May-.24 Him @36th Discussion With Person in Charge: Corrective Action Required: . DYes Voluntary Compliance Cl Pie?inspection Scheduled CI Embargo Cl Voluntary Disposal Other Employee Restriction Exclusion Emergency Suspension Emergency Closure FORM 734B (REV. 7/2000) HOBBS 8: WARREN, BOSTON This Form Approved by the Department of Public Health Food Establishment Inspection Report - CityITown of Establishment. ?g {n+8 Date: i2,? Page 1 or_ Address: {3?1?ng Time in. [61 Time out: I, Telephone: I, Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner ., ,5 and interventions [Items 1 through 29]: Person- -in- charge: I: hf V?n? Number of Repeat Violations Fteiated? to Foodborne Illness Risk Factors . .- Interventionsiltems lthmugh 29)1_ Compliance Status IN our MIA no cos Compliance Status IIN louriwt micosi - Protection tron] Contamination .. 1 Person-in-charge present, demonstrates 15 Food separated and protected V, I knowledge. and performs duties I 16 Food- contact surfaces; cleaned 2 Certified Food Protection Manager sanitized . - . I Proper disposition of returned. Mariagementl fond empbyee and 1? DFBVIDUSIV served, reconditioned i/ 3 conditional employee; knowledge, unsafe food responsibilities and reporting a. - 4 Proper use of restriction and exclusion 13 Proper cooking time temperatures v? 5 Procedures for responding to vomiting v/ 19 Proper reheating procedures for hot and diarrheal events holding Proper cooling time and temperature 5 Proper eating. tasting: drinking. or 21 Proper hot holding temperature 1 r, tobacco use 22 Proper cold holding temperature 7 nN1ichll?charge from eyes, nose, and 23 Proper date marking and disposition V, I, . 1 24 Time as a Public Halth Control Hands ole ro erl 9 food ?undercood food. ?if" 10 properly v/ 6 Pasteurized foods used; prohibited foods . not offered 11 Food obtained from approved source . x" Food 1 12 Food received at proper temperature 2? used . 13 Esggurl?i?ggiglj 900d condition, safe, 8? 23 Toxic substances properly identified. - stored &used_ Required records available: shellstock 1 tags. parasite destruction A Compliance with vari I sialzed" _process I HACCP Plan Official Order for Correction: Based on an inspection today, the items marked indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FDA Food Code. This report. when signed below by a Board of Health member or Its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result In suspension or revocation of the food establishment permit and cessation of food establishment operations. if you are subject to a notice of suspension. revocation, or non- renewai pursuant}; 05 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR DWectlon:? Discussion wit Person-ln-Charge: ?ier A Sig alure of n-i- D:ato Signature/91 l?dftor/ Mm [Metric/1;;r ?f MDPH ropty?l [omit-51mm? version Food Establishment Inspection Report? City/Town of \Ugm Establishment Compliance Status OUT NM ?10 508 ii Compliance Status IN OUT NJA Nlo cos is?! 1-: - ea' 48 Warewashing facilities: installed, 30 Pasteurized eggs used where maintained, used: test strips required 49 Non-food contact surfaces clean 31 Water& ice from approved source .-. - - . - ?j?ij 32 Variance obtained for specialized 50 Hot cold water available; processing methods adequate pressure [31 - - . . 51 Plumbing installed; proper backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage 8i. refuse properly 36 Thermometers provided accurate disposed; facilities maintained . . 55 Physical facilities installed, 37 Food properly labeled; original 8? container 56 Adequate ventilation 8t lighting; m- -, (165! nated areas used 38 insects, rodents, &animals not - ?49 -- - ,i mat-.21 present M1 Anti-choking procedures In food Contamination prevented during serwce 39 food preparation, storage and M2 F0051 allergy awareness display ?giggle I - . a . 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment 42 Washing fruits vs stables M6 Public Market: Farmers Market M7 Residential Kitchen; Bed?and- 43 In-use utensils properly stored Breakfast Operation 44 Utensils, equipment& linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used pro erly M10 Leased Commercial Kitchen ?e M11 Innovative Operation Food non-food contact surfaces 5 47 cieanable, properly designed, L1 Local law or regulation constructed used L2 Other cod Service Establishment Retail Food Store Breakfast El General complaint Mobile/Pushcart [3 HACCP Type of Operation(s): [Spot of Inspection: Other Information: 5 s. 80%- itmi We El Residential: Cottage Foods El Prooperational '9 itkm 301d? to Residential: Bed a El Illness investigation Aw We ecOlQ We .. 5g El Temporary Food Estab. 0 er a [ZlOlher fig chicken 53?? trolls an. 11 nit-Lil. L4 60+] otlnbi r? v1.0 \lMibluk/lni Irv-nu Date: n?hJ" 5! nature 0 o??ln- hares/337V f?t/ Wt) [NEIL/fair! 5 pecttr i Jul??l'i? crane THE OF MASSACHUSETTS OF Mhd?r?x?m? FOOD ESTABLISHMENT INSPECTION REPORT Tel. Board of Health arm I Address :31 m, Telephone A . )nmr WWII Person In Charge (PICflue/f w/ ?Food Service Retail CI Re-Inspection Level Residential Kitchen Previous Inspection El Mobile Data: HACCP VIN Temporary El Pro-operation Caterer Suspect Illness Time [3 Bed 8. Breakiast General Complaint 0 El HACCP IOut: Permit No. Other Each violation checked? reqLIires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: _ated to IllIIr; ~55 Item Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590009 (E) El 590.009 (F) El action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [j 1. PIC Assigned 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 Irom Approved Source 5. Receiving/Condition 6. Tags I Records rAccuracy oi Ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION [j 8. Separation Segregation Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing [j 11. Good Hygienic Practices Viol}. _;_rI_rII_l tanner. (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. . Management and Personnel 003) . Food and Food Protection Equipment and Utensils 005) . Water, Plumbing and Waste (Fc-sriseocoe) . Physical Facility . Poisonous or Toxic Materials 008) . /77Rrequirements (590.009) . Otl/ f. Local Law El Allergen AWareness 590.009 (G) [3 CI 12. Prevention oI Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or ColorAdditives CI 15. Toxic Chemicals I CONTROLS (Potentlally Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling Fl 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 Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Order to: Correegign: Based on an "Inspection today. the items checked indicate Violation, of 105 CMR 590.000/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 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. DATE QF EE-INSPEC I Wrasse new. web. rebel l?ne?or?Pages FOF (REV. 9/20l0l HOBBS (.II WARREN - BOSTON II This Form Approved by the Massachusetts Department of Public HenltII Establishment Name: 93 ff" HEALTH Date: {Di/i Page: of Item No. 0? Critical Item Reference Red Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION PLEASE PRINT Date Verified IL (DIP remix 4; minim Wtbu?wa} 63?; Him/Ii QM: Moan}? DI animal at; mid arid WIWIISMIK LU @351?) tL OKUDU OFI GOSH), an I: {19% not mic/L EMU (kc/gun {4/1 Discussion With Person in Charge: Action Required: NO SgLD/(loluntary Compliance CI Fla-inspection Scheduled CI Embargo CI Voluntary Disposal D/Employee Restriction .1 Exclusion Emergency Suspension Cl Emergency Closure Other FORM 73 45 (REV. 7/2000) HOBBS WARREN, BOSTON This Form Approved by the Department of Public Health