THE COMMONWEALTH OFIIJAASSAC HUSETTS 7wa OF F?WKoti Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. 9033? Name . Dale Wm Vid 9? Food Service I: Routine Add . . I I I Risk Retail CI Flo-inspection ress I ?51 Level Residential Kitchen Previous Inspection Telephone \5?0 57 - .512 0-3 [3 Mobile Date: 0 HACCP YIN Temporary Pro-operation wner CI Caterer Suspect illness Person In Charge (Pic) Time CI Bed Breaklast General Complaint 1 In: El HACCP Inspector MON II Out: Permit No. LI Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: ngtatigns Related to Eogglborne illness 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. Local Law Allergen Awareness 590.009 (G) F309 PROTECTION MANAGEMENT 12. Prevention of Contamination lrom Hands 1. PIC Assi ned/Knowled sable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) LI 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Inlections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water lrorn A roved Source pp 16. Cooking Temperatures ., 5. Receiv'n [Condition I 17. Reheating 6. Tags I Records Accuracy of Ingredient Statements . A HACC 18. Cooling 7. Contormance with roved Proce ures/ Ians pp CI 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION . . 20. Time as a Public Health Control 8. aration/Se re ation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 9. Food Contact Surfaces Cleaning and Sanitizing . 21. Food and Food Preparatton Ior HSP 10. Proper Adequate CONSUMER ADVISORY Hygienic Practices CI 22. Posting of Consumer Advisories Violatignjs Related to Good Retail Practices (Blue Number of Vlolated Provisions Related Items) Critical (0) violations marked must be corrected To Foodborne Illnesses Interventions 6/ immediately 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 Of?cia 9mg- Based on an inspection immediately or within 90 days as determined by the Board today. the items checked indicate violations of 105 CMR GI Health. 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an 23- Managemenl and Personnel (PC-216900031 order of the Board of Health. Failure to correct violations 24 Food and Food Protection (FC-311590 004) cited in this report may result in suspension or revocation of 25 Equipment and Utensils tFC-4lt5909005) the food establishment permit and cessation of iced 25- Walel- Plumbing and Waste establishment operations. If aggrieved by this order, you 27 007] have a right to a hearing. Your request must be in writing 28 Poisonous or Toxic Materials and submitted to the Board of Health at the above address 29- Requirements (590 0091 within 10 days of receipt of this order. 30 Ollie DATE OF FIE-INSPECTION: . l?rlnIKTZ-ny?x someway P?""Lil This Form Approved hy the Mnssacltuxults Department of Public Health Page of c?{Pages Him}. BOARD OF HEALTH Establishment Name: DDIVTS WPNEJC. Date: 61?7"? Page: =2 of Item Code Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference Red Item PLE ASE PRINT CLEARLY Veri?ed Jemima: batter Wm Sam/we 3, EM SINK Witt/.1 Marga? A (mag; lfl? - Lott: Kari? - @04me W771 Haw: Karma/x7 4 we: PM Medea vaay 459141933va P?oreac gee {5009 i? r: warty Kai b??i {Boob PKoFaicgg imKe?) 61x} 58va Dream Dewar/o] Kris?n mm Lice/m) 6429/ Discussion With Person in Charge: Corrective Action Required: El?n Voluntary Compliance . i" . Wee em?? will? Pie-inspection Scheduled Cl Embargo CI Voluntary Disposal Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other This Form Approved by the Dcpanment of Public Health THE COMMONWEALTH OF MASSACHUSETTS OF prii??l/I Board of Health fit-?0 6/905 FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Date large of Operallgu?] b?wi I (f 3'13'1 9 gFood Service If Routine Add a I RISK I: Retail Re-inspeclion ress I I I gI Level Residential Kitchen Previous Inspection Telephone yr? . -51 . ?7 1] Mobile Dale: Owner J03 at ..I HACCP VIN Temporary Pro-operation CI Caterer Suspect Illness Person In Charge (PIC) irlme CI Bed til Breaklast 3:21:95: Complaint - . n: Inapecior (vill?m?ll GNP I I 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: ?otation; R. eta. ted toEoedbeLnelltness interventions and lir-ms] Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) El 590.009 (F) l: 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 lnlections Restricted! Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags Records 1 Accuracy of Ingredient Statements 7. Coniormance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation/Segregation Protection [3 9. Food Contact Surlaces Cleaning and Sanitizing CI 10. Proper Adequate Handwashing 11. Good Hygienic Practices Vlelailens Belated in. Good Retell fireciices (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 003) 24 Food and Food Protection 004) 25 Equipment and Utensils 005) 26. Water, Plumbing and Waste 27. Physical Facility 007) 28 Poisonous or Toxic Materials 29. Special Requirements (590 009i 30. Other Local Law (3 Allergen Awareness 590.009 (G) I 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) 16. Cooking Temperatures El 17. Rehearing 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 CONSUMER ADVISORY CI 22. Posting 01 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 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board oi 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. DAIE Print: PIC?saIiiv?al??LGPI-?qdj/ PrInl: L1H PugeLnfjages This Form Approved by the Massachusetts of Public Health FfanII/i BOARD OF HEALTH 4' . - - '9 Establishment Name: hair-"i3 I Artur,? Date: 0'1 Page: 01 item Code C- Critical Item I DESCRIPTION OF VIOLATION i' PLAN OF CORRECTION Date No. Reference - Red Item PLEASE pm," Verified Him? x: m: elem.) 5WD (get Jaw 9 'Tr? Ice-am n: 3 i 51? - 22A, Few ?fe ?aw ?yr?a) a Em b, ?ne?M - a w; coat/gm 3 ,2 3?1- is ?if?c-M lit/? (1)119.? H769 My Katrina Mm rm est-:3 m; ?35,2, are: gay harem-vi?) J94 L. Him [m g, #bECJ?af 5 /x 3 1:102- 1 ($35.33 was me M714 Mower. Haifa? Ha?z-m 4 Discussion With Person in Charge: Corrective Action Required: 9440 El Yes 1 CI Voluntary Compliance Employee Restriction! Mimi/L? WW 375:5 Exclusion Fie-inspection Scheduled Emergency Suspension Embargo Cl Emergency Closure CI Voluntary Disposal Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS Fianna/U OF FOOD ESTABLISHMENT INSPECTION REPORT Board of Health T9I., 1.51.90? [7?405_? Name Date We] _Fl :oiilina . Address . etai e-inspection (9 Hi I Level [3 Residential Kitchen Previous Inspection Telephone - Mobile DateHACCP YIN Temporary Pro-operation wner Caterer Suspect Illness Person In Charge (PIC) Tlme Bed Breakfast General Complaint In: HACCP Ins ctor - . . Oh P9 maid?!) Out. er Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Iatecl IQ t'Qdeang Intervention Factors (I 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 I I 2. Reporting oi Diseases by Food Employee and PIC 3. Personnel with lnlections Restricted I Excluded FOOD FROM APPROVED SOURCE 4. Food and Water irom Approved Source [1 5. Receiving I Condition 6. Tags Records I Accuracy of Ingredient Statements LI 7. Conlormance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation Protection 9. Food Contact Surlaces Cleaning and Sanitizing Ct] 10. Proper Adequate Handwashing Nan-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law Allergen Awareness 590.009 (G) I3 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATUFIE CONTROLS (Potentially Hazardous Foods) [3 16. Cooking Temperatures 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 11. Good Hygienic Practices Migiatiens?eiam?co? Retailfwreslicss (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 004) Equipment and Utensils 005) . Water. Plumbing and Waste 006) . Physical Facility 007) Poisonous or Toxic Materials DOB) . Special Requirements (590 009) . Other CONSUMER ADVISORY 0046651433 22. Posting of Consumer Advisories i0 Number of Violated Provisions Related To Foodborne Illnesses Interventions I and Risk Factors (Red Items 1-22): Qrder for Based on an inspection today. the items checked indicate violations 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. 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 In. :8 W7 Pit: 3' WWII PIE-Is SignuluyIu/or Print: (901/4 ?g'hx $3131: CI This Form Approved by the Massachusetts Department of Public Health BOARD OF HEALTH Establishment Name: Hi (m 6 Mali; Date: i0 Page: a] of Item Code Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference Fled Item Pam-r CLEARLY Verified 45 Wins 1N1: FR: Mex (m we?) Li; 66131? 4' ?aps; Tow-w cram um) wa Moria? Dam? Win/c5 mini/HMS (99.9? 6?53: {Silt/1'6 12115724 Ma?a; 1280 ova/U mze?zw- Mgr/mm 016and ?oor. 4 Cele/M: ?37 Focm rmmy 671232639 ?My mW may log mew/ME. coax! mm 0006?!? Mar-War from) 2% (ML 55:; Jame Jar/Pr); perm?. gimp-Maj 12/ memv 4m 242; pg re 23465 mew-yea mm Mimi mam (?s?im *7 Chow: U545, (3M mum-m 0114;: km . v? A xi?mi a} ir?WL/die: I5 mama, jar?i716; (M1034 011T mama Discussion With Person in Charge: Corrective Action RequiredVolunta Corn liance Baguio-U; OUR Exclusion Re-inspection Scheduled Embargo CI Voluntary Disposal Emergency Suspension Emergency Closure ODD Other This Form Approved by the Depanment of Public Health TEE COMMONWEALTH OF MASSACHUSETTS IOui?n OF FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. 530 Name Date ammonia} Wise FY00 H. a Iq Sat) 00 (I I. Food Service I- Routine Address . Risk Retail Re-inspection (2 I l? 0 II . Level [3 Residential Kitchen Previous Inspection Telephone 6L) I ii CO Mobile Data: . 0 HACCP vm Temporary Ci Pre-operalion wner Caterer Suspect Illness Person In Charge (PIC) Time Bed 8. Breaklast General Complaint Inspector .. I - I my?! I Out. Permit No. OI er Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Fgg?bgrne Illness "Emil Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590009 (E) 590.009 (F) El action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [j 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH [ii 2 Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted I Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water trom Approved Source [j 5. Receiving Condition 6. Tags:? Records I Accuracy of Ingredient Statements 7. Coniormance with Approved Procedures/ HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection [3 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Vic?atjm Related 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. . Management and Personnel 003) Food and Food Protection 004) . Equipment and Utensils . Water. Plumbing and Waste . Physical Faculty 007) Poisonous or Toxic Materials Special Requirements (590.009) . Other Local Law Allergen Awareness 590.009 (G) [j 12. Prevention of Contamination irom Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures Cl 17. Reheating 18. 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 ConsumerAdvlsories Number oi Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22): Official Order for Carrection: Based on an inspection today. the items checked indicate violations 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 OF FIE-INSPECTION: t' ?731.11 Ir?chtur's Signilty'r'?y C?ll/L/ Print: (192/4717 ?y ?i?i .. - . . I-IL .I. Sigrli?IurL. J.-L .Lwi/ Print. C0 (Sargved Inf I. 'jrll'ml This Form Approved by the Massachusetts ni' Public Health Fara/151m BOARD OF HEALTH Establishment Name: Fra.-1Klm if: i" SCI1 Date: - 9} page; 53 of 92, Item No. Code Reference Critical Item - Red Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Mimi-m; mew er?a?D Joe? ?7 M?ab "Tb My 53??an 477639 We %0 Moriarty Mij?i) c: 1h?: mm; m; 2 ME Or} more -4r; Diwmemw: in? ~?wi Liv; 1 2-521, ?lm?s? Li} rm F?ofil? 5 PM 2:6? WW 4LT waiiag??-WME :Lg? aggm tum/i <3?ch I??C-i?a?cy? n/ 3?77 it: h?ff??4?gi $5533; air Eu ll' (Z 6 Hi?ni? fibe?rlifv 151% 292i Priob?'ETL/ Disks?; c946 3? HRMDAENL hum 50/319 Pm me Discussion With Person in Charge: Corrective Action Required: (G440 CI Yes We :1 i :13: 1755 9/ Voluntary Compliance Pie-inspection Scheduled Embargo [30130 Voluntary Disposal Other Employee Restriction Exclusion Emergency Suspension Emergency Closure This Form Approved by the Depanment of Public Health THE COMMONWEALTH OF MASSACHUSETTS lawn} OF F'rimixiilLl Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Te. .5 ch}? ?il flrl5 me . Date Wilt] B?ltihi 09 (ST i 3/ Food Service [3 outlne Add Risk Retail Flo-inspection ress 6?2 .Q Li CORK k; Level [3 Residential Kitchen Previous inspection Telephone .. Mobile Date: Owner ?6-0 51? (P ACCP YIN Temporary Pro-operation Caterer Suspect illness Person in Charge (PIC) Time [3 Bed Breakfast 3 General Complaint In: HACCP Inspector K: t?i?lU Out: Permit No. l_l Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non- -compiiance with: Violations, fetuses (Hod lie..m..s_i AMI-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) El 590.009 (F) [3 action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT lj 1. PIC Assigned [Knowledgeable l' Duties EMPLOYEE HEALTH Li 2. Fleporting oi Diseases by Food Employee and FIG i :l 3. Personnel with Iniections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source i 5. Receiving Condition Cl 6. Tags Records lAccuracy oi ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION if] 8. Separation I Segregation I Protection if] 9. Food Contact Surlaces Cleaning and Sanitizing i3 10 Proper Adequate Cl 11. Good Hygienic Practices Violajiens?eiated (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. Local Law Allergen Awareness 590.009 (G) 12. Prevention of Contamination irom Hands . Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives woos Chemicals TIMEITEMPERATUHE CONTROLS (Potentially Hazardous Foods) [3 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 consumes ADVISORY Ce 1r: 445541 '13 Cl 22. Posting of Consumer Advisories Number of Vtoiated Provisions Related To Foodborne illnesses interventions 0L and Fiisk Factors (Fied items 1-22): Qitlciai Order for Cgrregtign: Based on 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 23 Management and Personnel (PC-3690.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (PC-31690 004) cited in this report may result in suspension or revocation of 25. Equipmenl and Utensils (PC-41690005) the food establishment permit and cessation of food 26. Water. Plumbing and Waste (FC-Sli590.006i establishment operations. It aggrieved by this order, you 27- Physical FaCi'ilY 007) have a right to a hearing. Your request must be in writing ?nder-lining or Toxic Materials 716910.008) and submitted to the Board of Health at the above address 9'74 Special Heqwremems (590.009) within 10 days of receipt of this order. 30- Other oars CF - i' ?ii. fillinrilinrfiv?iw Print. 9(9) tan/V on?, 9i?? ?4 Twin? Pagei?f_Pagcs )33/ Print: This Form Approved by the of Public Health 9 . Plath; ii L: BOARD OF HEALTH Establishment Name: 1:53:41; Date: Page: 91 of a) Item Code C-Criticalltem DESCRIPTION OF OF Date No. Reference Fted Item pm,? CLEARLY Verified (taming: (I?m axioms hm; mm; mm ?lm? i3: @069 -- l6: [Mum/? waJ Mm dwor 6,3: 59f L463) MLL oi: Fm?i?lr 7114,09: 6h} ?radar mum KG STOKES) M) f; Jammy for-?ea, avatar m: ?were 4% 1772/57;- . Umugm Elias?wag: wm/ Mam Haw-9 game-NT? ?7 (Mr: (main/Pa 0. 0735? 6445,33 Mm Hal 3?1" 3 +3ch TL ?1:573 0" I NV 3,9 $07) J71 5 ?73 0 0? )iv?d A [?ask-m, ?mg/4v; go We [xv/171mm f?ef?ewz 4295624 4% 2? Ru/ ?mu?imw? PIT mm: Wrifetew ?ts PM, ?rJTl/exv fem! (573-621) Discussion With Person in Charge: Co/u?ctive Action Required: Ci No ??ves Voluntary Compliance CI Pie-inspection Scheduled CI Embargo CI Voluntary Disposal Cl Employee Restriction Exclusion Emergency Suspension Emergency Closure ODD Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS OF FViir?i Ki) 0 Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. 5.10" 4960? Name HUN (6, MONA Address 3 Li 0 If; ti Jr Telephone 513 I - [0330 Owner Person In Charge (PIC) Giana Ui?iit \i to t? i Hegel .6: I?l Ci Food Service Routine Risk Ci Fielail Ci Re-inspection Level Residential Kitchen Previous Inspection [3 Mobile Data: HACCP YIN Temporary Pro-operation Caterer Suspect Illness Time Bed 8. Breakfast General Complaint In: El HACCP Out: Permit No. Other Each violation cheicked requires an explanation on the narrative page(s) and a citation of specific provisionis) violated. Non-compliance with: Violations Foodborne Illness BiaLFactgis {Pied Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) 590.009 (F) El action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT i] i. PIC Assigned i Knowledgeable Dulles EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections Restricted I Excluded FOOD FROM APPROVED SOURCE Ci 4. Food and Water from Approved Source Li 5 Receiving I Condition 6. Tags/ Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Suriaces Cleaning and Sanitizing [j 10. Proper Adequate Handwashing 11. Good Hygienic Practices Pelagic. {load Beta! 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. . Management and Personnel 003) . Food and Food Protection 004) . Equipment and Utensils 005) . Water. Plumbing and Waste . Physical Facility 007) Poisonous or Toxic Materials (PCT/used 003) . Special Requirements (590 009) . Olher Local Law Allergen Awareness 590.009 (G) 1 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) [3 16. Cooking Temperatures El 17. Reheating Ci 18. Cooling [3 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?iglai Qrger for Based on an inspection today. the items checked indicate violations 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. 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 FRE-IN PE TI N: hw?z?l??mm?i Print: 63/0 01/ "Might ?17/ [Ma ?07 This Form Approved hy the Massachusetts Department nl? Public Health Frat?) 0 BOARD OF HEALTH Establishment Name: ?ller?. Alden Date: 3' I 9 Page: 91 of Item Code C?Criticalltern DESCRIPTION OF 0F CORRECTION Date No. Reference Red Item PLEASE Palm. CLEARLY Verified 14me m4 6';th ?7 S?Tocr?ab MSW. viper A Fare-IQ ?Tow-?M mm?? - agave/Arr owe-:7? .32" 'Jpg rm own/? WJ ohm ASE-cor) ?73667) . Eamon/mg; ?gs-pet memzm $25 jam/40mm? gauge: Jammie IN: 112:: Cm, Am; cum; 1 Favfm'?; Atom-2AA: firm?AA 337/16 [/0917le HAI- - pages [/2333 Wanna/2:13 LIm?nl?? We) ?71; CMD N. {dc-T? may Map pg [7 mcs?r? oe @5er QLmer-u? 4.x! WrcatY- ~50 - ELL Foch; D?yts??cme ?m?m ALA. F000 ?oral?; ATE-ran Cm" Goa??w? 54/) A 1135' A JETM a; {are wk I7 (an; cit-Emt?mf?~ Mimi; x: 1914/ sz?Kff (77?67762) Discussion With Person in Charge: Corrective Action Required: )Z/Yes Cl oluntary Compliance Cl Pie-inspection Scheduled Embargo Voluntary Disposal Employee Restriction I Exclusion BUD Emergency Suspension Emergency Closure Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS iJ OF FOOD ESTABLISHMENT INSPECTION REPORT Board of Health ?530- 4905 Name DBIB r1 I 0 Km l/t] 071Food Service [j Routine Address . . Risk Retail Fie-inspection hr .25Level Residential Kitchen Previous Inspection Telephone 0 0 Mobile Date: Owner 53] (2 ?30 HACCP YIN El Temporary El Pro-operation Caterer Suspect Illness Person In Charge (PIC) Time Bed Breakiast General Complaint In: HACCP (Tl i Out: Permit No. Other Each violation chiacked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. to, Fooritggiirie Illness interventions and Risk EMIQLE itisdliwal 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 Duties EMPLOYEE HEALTH 2. Reporting oi Diseases by Food Employee and PIC 3. Personnel with infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water irom Approved Source 5. Receiving I Condition 6. Tags 1 Records lAccuracy of ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing i3 11. Good Hygienic Practices MIMRelatedto Good I'Ielail 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. Management and Personnel 003) . Food and Food Protection 004) . Equipment and Utensils 005) . Water. Plumbing and Waste 006) . Physical Facility 007) . Poisonous or Toxic Materials 008) . Special Requirements {590 009) . Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) Local Law Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Appluvud Food or Color Additives Ci 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures CI 17. Heheating 18. Cooling Ci 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 Cl 22. Posting of Consumer Advisories 61:9 r35?) 3:9 3' 1 Jr Number of Violated Provisions Related To Foodborne Illnesses Interventions I and Risk Factors (Bed Items 1-22): WM Based on an inspection today. the items checked indicate violations of 105 CMFI 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. 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 OF FIE-INSPECTION: lnspe tt?-is Signature: .2. (Am; Print: 4:00? a Pugejfil?ages (11% This Form Approved by the Massachusetts Department at Public Health {:th at, m1 BOARD OF HEALTH Establishment Name: Date: Page: 9. of 32.. Item Code Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Fled Item pmSE PRINT CLEARLY Verified - HEW: ?mug, 9m '4 Mac crab u: my 63M a: H, ?T?ix??i?w :53? i? Mfr, rum/l fits-Fe): ?393,17: Zen .meza/Jm?y x. mm: m; a? '7 pm, 42m; roast? $333122? m3 My more": M313: ?rf?gP-?ciou Lax-la (mug - 66 mm/ fair??- Lil" mum, Ki?fi?? lJ rim" owl/l m?mc-p?. (Hi/ff: Mo 1? amt/5343? 0853i we no em l?i Hort-a1 Limo ?a?WPwm Ugl?' I - ?said/M 54mm Dam/m War/Joan Discussion With Person in Charge: Corrective Action Required: Cl No {fl Yes Voluntary Compliance Cl Pie-inspection Scheduled Cl Embargo Voluntary Disposal Cl Employee Restriction I Exclusion DUB Other Emergency Suspension Emergency Closure This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS Mum 0F Fran/I711) FOOD ESTABLISHMENT INSPECTION REPORT Board of Health 501 9/ 6105/ Name?? . Dir-ate 6 It! i If: 53 1 Fill {1 VI 1' ?3 I Food Servrce Routine Address IL) I . i 4 . 8.1. Risk Retail . Re-Inspectlon (P J57 I35 II ?t 1 Level CI Fiesrdeniiai Kitchen Previous Inspection Telephone \fV/ ?y 910 Mobile Data: Owner HACCP YIN Temporary Pro-operation CI Caterer I3 Suspect Illness Person In Charge (pic) Time CI Bed 8: Breakfast General Complaint In: El HACCP Inapector 6112001! Out: Permit No. Other Each violation che?ked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Nan-compliance with: dl Ins} Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) 590.009 (F) El action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting oi Diseases by Food Employee and PIC 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE [j 4. Food and Water from Approved Source LEI 5. Receiving Condition 6. Tags I Records Accuracy of Ingredient Statements LI 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation I Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing [j 10. Proper Adequate Handwashing 11. Good Hygienic Practices yiolattogsfielated Logged 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. . Management and Personnel 003) . Food and Food Protection :Fc-atiseo 004) . Equipment and Utensils . Water, Plumbing and Waste Physical Facility 007) Poisonous or Toxic Materials 008) Requirements (590 009) Other Local Law Allergen Awareness 590.009 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures [j 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 Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): gffigial Based on an inspection today, the items checked indicate violations 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 OF IRE-INSPECTION: 1:2 .4227 cam MW '5 Slant/m @3de Print: L- Pageiofj?iPages This Form Approved by the Massachusetts Department of' Public Health BOARD OF HEALTH rI?l? f? I Establishment Name: JP. f1?? JCAUCU Date: L/?f?l 7 Page: 02? of ?9 Item Code 0- Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference Ft Red Item PLEASE PRINT CLEARLY Verified Him/D NV Lz?fW 14guy pom mngemv 51mg? 3/ Apia/en - . JMmZ?e/t- 5mm; Meme/face mu QEPM/aim'i: 9.9% KY Gian-?E notes Pm:- F132. r'??ff?lr' f: 514573 CA5 @453?? 5 as: LU 2 in," 20; - Rousseau ~25 (law ?15;ch Mirna}, in; /f"2?5 (Joy) 1 (mm LED lax, atria-av 67:5? La." . 323' war/1:: Hml? ?7 Discussion With Person in Charge: Corrective Action RequiredVoluntary Compliance Cl Employee Restriction! Illa;- tax-?17" ?36 f] Exclusion Cl Re-inspection Scheduled Cl Emergency Suspension Embargo Emergency Closure Voluntary Disposal CI Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS '?wd 0F mekuni Board of Health 5g0-deo5 FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Date . mildew Elimination 8? If ?36 1:401; Ll l0 OOH L-I/Routine Address' . i . Risk Retail Re-inspection .5730 lebN ?57 Level El Residential Kitchen Previous Inspection Telephone r- . 7 - . - Mobile Data: Owner 5.3 k) 0 A 3O 7'2 HACCP YIN El Temporary Pro-operation Caterer Suspect Illness Person In Charge (PIC) Time Bad Breakfast General Complaint In: El HACCP Inspector Alarm? I Out: Permit No. Other Each violation checked requires an explanation on the narrative pageis) and a citation of specific provisionIs) violated. Illness Interventions and RISK Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT i. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and PIC 3 Personnel with Iniectlons Restricted I Excluded FOOD FROM APPROVED SOURCE 4 Food and Water from Approved Source 5. Receiving Condition 6 Tags Records I Accuracy 01 Ingredient Statements 7. Coniormance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Suriaces Cleaning and Sanitizing Cl 10. Proper Adequate Handwashing Cl 11. Good Hygienic Practices stateless. Belated it P. realises (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 003) 24 Food and Food Protection 25. Equipment and Utensils a Water. Plumbing and Waste 27?. Phy5lca Facility (chnseo 007) 28 Poisonous or Toxic Materials 008) 29. Special Requirements (590 009) 30. Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 El Local Law Allergen Awareness 590.009 (G) 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) 16. Cooking Temperatures [j 17. Reheating 13. 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 CI 22. Posting ol ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions 6? and Risk Factors (Red Items 1-22): . glticiaI Order Igr Qgrrecilgn: Based on an inspection today. the items checked indicate violations 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 lood 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. DATEOF E-l PE Pm": (Flo/ii,? .Aff?y/ Ringgit-Pm: 1:1? Pit: Sb?jg??lu trio-n EDret?t?ilP Page ol' (Level This Form Approved hy the Massachusetts of Public Health Establishment Name: Kai/57: I 5.41m 511 BOARD OF HEALTH Date: Page: .3 of Item Code Critical Item I DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference - Red Item PLEASE PRINT CLEARLY Veri?ed Hyman/dc: (?me '31 my ?e?v mama) m4 we? '9 WWEA 35:93: 1311:; mm r31; 5 ?tting: 94673} 2/31/11 If?f I 0.585 m?f? We? VIWMSWU . pm.- 1 :77 m3 3-5115; @1th 35 i 4n 0 55ft m) ICE ?air/D (MI Pew .3 . c??dj #777: [.415 D?b?i COUI H'X'piqc. I Ur?? p53,- I I 35:17 mew m: 59/111; mr? @033 <7 [#13 Karen?! .. .411 mama rm?? (In) 11" UIWC (1 Rae-L lids auras Jar/634%? 7? 01 1?1 LED ?zz, EWwVe?as 1724 mar/a; Him; ??maxo?? 9? Discussion With Person in Charge: Corrective Action Required: No Ef?e-rs Voluntary Compliance CI Employee Restriction I my Exclusion Pie-inspection Scheduled Cl Emergency Suspension Embargo Emergency Closure CI Voluntary Disposal Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS locum OF k/Iii Board of Health .faaee/ (105? FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name . . . De - . KrIIer .So Wt) .fr- 1743-11 5 Feel Se-e Add i . Risk Retail Re-inspecllon rose 600 i7( SII Level [3 Residential Kitchen Previous Inspection Telephone Mobile Data: 0 3 03?) I) 7 HACCP YIN Temporary Pro-operation wner Caterer Suspect Illness Person In Charge (PIC) Time [j Bed 8. Breakiast general Complaint . In: ACCP Inspector (<1th I I Cut: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of speci?c provision(s) violated. Non-compliance with: Rigiated to illness and Blah Items} Anti-Choking Tobacco Violations marked may pose an imminent health hazard and requre immediate corrective 590.009 (E) El 590.009 (F) 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 irom Approved Source i. i 5. Receiving I Condition [3 6. Tags Records Accuracy oi ingredient Statements 7. Contormance with Approved Procedures! HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection CI 9. Food Contact Surlaces Cleaning and Sanitizing 10. ProperAdequate Handwashing 11. Good Hygienic Practices tasteless Belatedge?e ed?etajlfraetms (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 (PC-2irseo 003) Food and Food Protection tquipment and Utensils 005) .- Water, Plumbing and Waste (FC-Sltseocosl . Physical Facility 007) Porsonous or TOXIC Materials (PC-71690 008) .. Special Requirements (590 009) . . Other Local Law Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands CI 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 19. Hot and Cold Holding El 20. Time as a Public Health Controi REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConsumerAdvisories To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correctloa: Based on an inspection today. the items checked indicate violations 01 105 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 01 receipt oi this order. DATE OF Number of Violated Provisions Related 1'77 I. .4 'l 'r PrintPrlm' (You Page /of PLl?agcs This Form Approved by the Massachusetts Department of Public Health VIC-ham BOARD OF HEALTH K/m?l KEMP: Establishment Name: I Mu Date: Page: of 2? item Code C- Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item PLEASE PRINT CLEARLY Verified QLI 'ij ?IFIId-il'er ?frlr .111 I: ?t Idili?r' kWh/?Ll? . gum \f-er J?NmZ/erc Mr {?1014 ,r l? I )r . A5 093;: u' (if) I r, (in; I 5'1, 3? f? (I: {7/ka Jan/(f i I. a - 5 4'3 0:"on i was) ?ll-ML {furlI?z?i?c??xcv was? al'i IL, 59% UKQM i, 15 1 Jimgg?? 7? /7w '7 137? 65516;?) ?212? 351? -- Mr? Inf r' {aha-i}: Hag.) ., a, stem . L151. u? {in} 7-"3 .17 I [74, J, 1/393Jig? :14 r/ I Dr: Llama ?44w - ?ll 450; -. diff; Jrir' If! I CBIEKIQQD flit/s EMFQJ ya: ?0.71 ?it: {7671/ fir-EH area-M'U? 7 Discussion With Person in Charge: Corrective Action Required: CI No KI Yes 0 Voluntary Compliance El Employee Restriction! Exclusion CI Pie-inspection Scheduled CI Emergency Suspension 0 Embargo 0 Emergency Closure CI Voluntary Disposal Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS ITOLJ hi FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. 3,5030 ?/905? Name Dari WW Wow KENNED .SCHDO L. (/49 . i? Food Service Routine Address . Risk Retail [3 Flo-inspection . POND Level Residential Kitchen Previous Inspection Telephone 53 020 ("If a) 03 Ci Mobile Date: Owner HACCP YIN [3 Temporary [3 Pre-operation Caterer i:i Suspect Illness Person in Charge (PIC) Time Ci Bed Breaklast General Complaint In: HACCP Inspector I) m, Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisionts) violated. violations Related E?etm?s?l?t?i?t?i 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 Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC i] 3. Personnel with Inleclions Restricted I Excluded FOOD FROM APPROVED SOUFICE 4. Food and Water lrom Approved Source 5. Receiving I Condition 6. Tags I Records [Accuracy of Ingredient Statements 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION Ci 8. Separation I Segregation I Protection Ci 9. Food Contact Surtaces Cleaning and Sanitizing i3 10, Proper Adequate Handwashing [j 11. Good Hygienic Practices ed (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. Hit. Management and Personnel 24 Food and Food Protection Equipment and Utensils (Fe-4x590 005) 26. Water, Plumbing and Waste 27 Physical Facility i?FC-slrsee 007) 28 Poisonous or Toxic Materials tFC-Vltseo 008) 29. SpeClal Requirements (590.009) 30 Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law Allergen Awareness 590.009 (G) fj 12. Prevention ol Contamination from Hands [3 13. Handwash Facilities PROTECTION FROM CHEMICALS i:i 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures Ci 17. Reheating i3 18. Cooling Cl 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 01 Consumer Advisories Number of Vtolated Provisions Related To Foodborne illnesses lnterventlons and Risk Factors (Red Items 1-22): gray to: Correction; Based on an inspection today, the items checked indicate violations 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 01 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 01 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. DEFEPrint. Print: Kay/3:; U61, hill DICE. I?age/ ofil?agcs This Form Approved by the Massachusetts Department of Public Health BOARD OF HEALTH Establishment Name: 3511 ?uff?17> i} Cir-100 L. Date: - 5? Page: c1 of Item Code 0? Critical item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference Fl - Fled Item PLEASE PRINT CLEARLY Verified Lira/A5: 21141: .J i :7 W60 FEEL 1' [?aw rj 0:419 4 Elf!) 1.5 9.71? 55.163: mam um BE 6 Til/?13 ?ux 0.90 sex - zi'az/r? (may) i Mic/1C Qatar, 1650191112? 212? F??o ?at feywa ?76me #an Ff mr? ?14MEX: 1W I c876 .15 Gal." win. lrn-?iai-r. 7-.1. ?Yb-130 Kf' 127,. 5 if [j {Al?s/K157 ir-r {a I 3-1-7? rain Ira!"- .l - I - is}: 95711771 #13le ii 1771.13: '77 {32743 .1175 i la) rig/<1 dam of?? 77a?: 17%} 17;; hi? 92/1. r790 03 Pm; raw ?ts-fa Discussion With Person in Charge: E/orrective Action Required: No 16 Yes {Cl Voluntary Compliance CI Employee Restriction I Exclusion El Pie-inspection Scheduled Cl Emergency Suspension 0 Embargo '3 Emergency Closure '3 Voluntary Disposal Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS -- 0F ?rst?) Uh; FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. \fa?O? Name - I Dare . Imm L. i -i Food Servrcu B?Routine Address Riak Retail Ci Re-inspection J5 Level Residential Kitchen Previous inspection Telephone 6,17? 29 030 Mobile Data: Owner HACCP YIN Temporary Pro-operation Caterer Suspect Illness Person in Charge (PIC) Time Bed 8. Breakfast General Complaint I In: HACCP Ins actor . . Aria/1U Out. Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation oi specific provision(s) violated. Non-compliance with: Niel-aliens .?eiateitto?eqcthorne Liaise-s interventions Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) El 590.009 (F) El action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable I Duties EMPLOYEE HEALTH Ci 2. Reporting oi Diseases by Food Employee and PIC 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE Ci 4. Food and Water irom Approved Source ij 5. Receiving Condition Ci 6. Tags I Records/Accuracy oi Ingredient Statements 7. Coniormance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices VJQiaians Rela?iqfiugd?riaii Prag?g (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 003) 24 Food and Food Protection 004) 1, :1 Equipment and Utensils 26 Water. Plumbing and Waste 006) 27. Physical Facility 007) 28 Poisonous or Toxic Materials 008) 29. Special Requnements (590 009) 30 Other r7 Local Law Allergen Awareness 590.009 (G) 12. Prevention oi Contamination irom Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (POIBniially Hazardous Foods) Ci 16. Cooking Temperatures Cl 17. Rehealing [j 18. Cooling Cl 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 oi ConsumerAdvisorles Number oi Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Red Items 1-22): Qrger [gr Based on an inspection today. the items checked indicate violations 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. 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 orderPrint: (?ngh/ Pji?iwtxm? Pm" . Vkitc/errsz' ?Deli-filters This Form Approved hy the Massachusetts ni? Public Health Establishment Name: kin/far)? Date: 5'5? 1 9 BOARD OF HEALTH A Page: 5?2" of 02"? Item Code C?Criticalltem DESCRIPTION OF CORRECTION Date No. Reference Red Item pm," CLEARLY Veri?ed -- Mama-mt my 4 Paopuwy ?3wa mm cram" ?3 KW 5 (W Room 54(522/ new 7 5m Maui/m 69mm aux/Lama) amen/5D mm; {gr-mm,? 6? WW or: {erecm? 93/? (e?umez fwmz-ayz, Wexunmc? when manna?! inf-75,204: {Murat-{N Maumrrl . meet my? Ne gem?1 P: cert; 6 My :37 1%sz 29552; :4 3113?; may d? 73/113713 0M Jazz; Mia aux/ML: w/m Peg/aw (Ma . ?r ?5453 ?vwvge: Mi?/ fife/96 Mimi ?es??mw 4 @yr 3/ DiscussionWith Person in Charge: Corr live Action Required: a/Yes Voluntary Compliance Employee Restrictionf El Re-inspection Scheduled Cl Embargo CI Voluntary Disposal Cl Exclusion Emergency Suspension Emergency Closure Other This Form Approved by the Department of Public Health THE COMMONWEALTH MASSACHUSETTS 01: "1 Board of Health FOOD ESTABLISHMENT INSPECTION REPORT f?o?q 405? Name Be a I met ?in. Goa SCH 00(? ii memes omin- . Risk Retail Re-inspectlon Address I {7 POMD \5 I Level Residential Kitchen Previous Inspection Telephone Mobile Date: Owner 6?06) 50? ACCP YIN Temporary Pro?operation Caterer Ci Suspect Illness I Ch Time Bed 8. Breaklast General Complaint Person erg? In: HACCP (27.1.1.1 mi .1 Each violation checked 'requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. 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 Ci 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted I Excluded FOOD FROM APPROVED SOURCE 4. Food and Water Irom Approved Source 5. Receiving/Condition 6. Tags/ Records IAccuracy of Ingredient Statements 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation I Segregation I Protection 9. Food Contact Surlaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Hiplatiens Belated 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. Non-compiiance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law Allergen Awareness 590.009 (G) 12. Prevention oi Contamination from Hands 13. Hanriwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or ColorAdditives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. El 17. El 18. Cooking Temperatures Reheating 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 Consumer Advisories Number oI Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Oitlcial Order for Correction: Based on an inspection today. the Items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an -L - Management and Personnel 003) order of the Board oi Health. Failure to correct violations . and Food Protection (FC-3IISQO 004) cited in this report may result in suspension or revocation of - arid the food establishment permit and cessation of food Water, Plumbing and Waste 006i establishment operations. It aggrieved by this order, you - (FC-GIISQO 007) have a right to a hearing. Your request must be in writing Porsonous or Toxic Materials (FC-7it590 008) and submitted to the Board of Health at the above address Special Requirements (590.0091 within 10 days of receipt of this order. . Other DAT OF FIE-IN PE on- -. 2/ Inst :Wur 5' Signature: Print: I it" Hi} am 2 {3122/ (gnaw ?fr r/ a) PI 55mm rt: I'nle of - Pa 05 . (411.146. t? 3-- . ii i This Form Approved 1y the Massachusetts Department of Public Health 1K) BOARD OF HEALTH Establishment Name: IR i? (3420} 3 Date: - 1?31 5? Page: 03? of re" Item Code 0- Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference - Red Item pm," CLEARLY Verified '12-le 4' F60 @121 n?vi ?Tl?wl?i/i EEK A) u?o? WONT 190$ .a Aim-g; ?lings-1:7 335? $1 .13 or out L714 We (new 572Foul-c. Jail; II: .- u?v?zp I Ml! Kim H, 441,: -i [2 - eel - 3.33; ?7 ?ll/1295b? - MT rem, i (aw/hm: FIT @0931; magm??a? agate? no at I?m/gag m: Fem 14/371?to of: Discussion With Person in Charge: Corrective Action Required: No DYes . - an?, - 5 Cl Voluntary Compliance Employee Restriction/ CHAIM 4 :51 lb Exclusion Pie-inspection Scheduled CI Embargo Voluntary Disposal Other Emergency Suspension Emergency Closure This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS "Town or: Fem K'Il?r?l Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. 3790" 5/905 Name Date I 1y 1 TN - CounIV 3c. Ila OI 33;}le res is Retail Fla-ins action Add 9 I LI (I LI Level [3 Residential Kitchen Previous IrFIspection CI Mobile Date: Telephone 5713? 5-0} 5) Owner HACCP YIN CI Temporary Person In Charge (PIC) 10m} I I) Caterer Suspect Illness Time Bed 8. Breaklast CI General Complaint in: CI HACCP Out: Permit No. Other Pro-operation Linn) Each vioIation chIs-cked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: to Foodborne Illness Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (E) El 590.009 (F) [3 action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned! Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting ol Diseases by Food Employee and PIC 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving Condition CI 6. Tags Records I Accuracy 01 Ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION B. Separation/Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Belated (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 Local Law C) Allergen Awareness 590.009 (G) I CI 12. Prevention oi Contamination Irom Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures I7. Reheating El 18. Cooling [3 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 Cl 22. Posting of Consumer Advisories Number of Vlolated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Qiticial Order Correction: Based on an inspection today. the items checked indicate violations 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 - Equipmenl and Utensils (FC-4lt590.005) the food establishment permit and cessation of food . Water, Plumbing and Waste lFC-Sltseo 006) establishment operations. It aggrieved by this order. you WIS-611590.007) have a right to a hearing. Your request must be in writing Potsonous or Toxic Materials 008) and submitted to the Board of Health at the above address Special Hequiremenls (590 009) within 10 days of receipt of this order. - Other DATE OF Framer-gallon; 010Sirn tu . PI t: i? '41?!er AL Eternal we.? r? . This Form Approved by the nl? Public Health In; E?iJk?b-J BOARD OF HEALTH Establishment Name: Date: Page: of 32+ Item Code Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference Fied Item PLEASE pm,? CLEARLY Verified ?Mimi; C5371 Li 5 $736593 Li?iuflu. am Mo. VERLIV ?swam smart/cg M6391 5' rf'i L. 5775 ft 3 rim; 'u'rkifi 5%3? FTLL. 5: i {new :3 5t 01%" Kai?5#15: 6-59. if ?55m Wm 5315,? 5.355531" {in-1+5 FF +55% 5571/5172 5? 62A 'f vrifnw H. R1333- LU ici?V in?ll/H?, 5 (L ,Lr/J?x? 551:1" . . . i 1 ?55/ Q15, Foam {To/(ti) 4 07773626? W. an .-. a. Heads ii 3? ig- pi; 52/5/5- 5. .53, 2 My? 21 ,5 - Discussion With Person in Charge: Corrective Action Required: za/No Cl Yes 1 3 . Voluntary Compliance Employee Restriction] ?rm-r .273"; I Exclusion CI Fie?inspection Scheduled Embargo GOOD [3 Voluntary Disposal Emergency Suspension Emergency Closure Other This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS IDLLIYI OF FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. . 5.690" 905 Name Date W15) P0 1? l?l'li?rl?l ~11; j? ?2 i Food Service ii? Routine Adm? a 1+ .4 Risk [3 Retail El Fla-inspection I L) 7-) Wt?: I?ll) Level Residential Kitchen Previous Inspection Tele hone . . 508? A 54] 50} I71 Mobile Date. . 0 er HACCP WM Temporary CI Pro-operatlon wn 1 Caterer Suspect Illness .1 - I Bed 8. Breaklast Gene al i Person In Charge (PIC) ?(if/f ?tJ Ens HAccgp ompant Ins actor Out. Permit No. Other__ Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Reta ted 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 I'?l 2. Reporting oi Diseases by Food Employee and PIC [j 3. Personnel with Inlections Restricted I Excluded FOOD FROM APPROVED SOURCE 4. Food and Water irom Approved Source 5. Receiving/Condition 6. Tags Records I Accuracy 01 Ingredient Statements 7. Coniormance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation Protection 9. Food Contact Suriaces Cleaning and Sanitizing Lj 10. Proper Adequate Handwashing 11. Good Hygienic Practices ligation; Relation to (234 0L1_?r_ttai_l_lir_el?l_ilze_s (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. (3 . Management and Personnel 003) Food and Food Protection (FC-Stisgo 004) . Equipment and Utensils 005) . Water. Plumbing and Waste . Physical Facility (FC-sllseo 007) Poisonous or Toxic Materials 008) Special Requirements (590 009) Other with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) El Local Law Allergen Awareness 590.009 (G) 12. Prevention oi Contamination from Hands Ci 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) [3 16. Cooking Temperatures El 17. Reheating CI 18. Cooling Cl 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): Of?cial Order igr Correction: Based on an inspection today, the items checked indicate violations oi 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 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. DATE OF RE-INSPECTION: (??gmaturem (sax/J Signatur?: Print: granite. 404.1?, if will I This Form Approved by tile Massachusetts Department 01' Public Health Ran K?l'Vl BOARD OF HEALTH "x -. ?0 1 Establishment Name: l'?riw?wrer? BIT-E06 0319: ?0 I (I Page: ?1 0" Item Code c? Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference - Red Item PLEASE PRINT CLEARLY Verified 1mm SW: com) it mew amt?? ill mi Ff) ?s?c ?Tcixm a NJ .2 {hr Foam FE $717653 1 95513? A Racer: 111/ 4.7.1 my i?T- i 5m .215 Jim 0 misc LC rm air-?rms r?f?i?jm?? cm Writ/W26 1 [um-La; 4 7 T) I in {ii/31mm? Alicia Ski;- ri? MEL Air?r'e? fans/mag My o- my, Fear) Wei-?acct \m 59 m! {Meow/fut Ffikd. rt}? NH r75. ti.J Db?r? ?57 It?? 5 90? Ti?iuiiT For: means?) (at? C- ym?: Discussion With Person in Charge: Corrective Action Required: No Wes D/Voluntary Compliance Cl Employee Restriction I Exclusion Cl Re-inspection Scheduled 0 Emergency Suspension Cl Embargo Emergency Closure Cl Voluntary Disposal CI Other This Form Approved by the Department of Public Health HE COMMONWEALTH MASSACHUSETTS mitt-N 0F A) FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. 590? git/w Name Date i mm pn? q? 1" 'li Food Service I Routine Addmg?s . '8 Risk {3 Retail [3 Fla-inspection I 3-5 ?Ti' 6T Level Ftesidential Kitchen Previous Inspection Telephone 8,51? 31 Mobile Data: 0 er 50 5'0? HACCP YIN Ci Temporary Pro-operation wn Caterer Ci Suspect Illness Person In Charge (PIC) Time Bed 81 Breaklast General Complaint In: HACCP Ins ector - . (.31 We (I Cut. Permit No. Other Each violation chebked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. yiglptinns Estatedt and Risk fiGlQEiiHedieatsj 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 Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with inlections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water irom Approved Source 5. Receiving Condition 6. Tags I Records Accuracy 01 Ingredient Statements 7. Conlormance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION [Li 8. Separation Segregation Protection Li] 9 Food Contact Surfaces Cleaning and Sanitizing i3 10. Proper Adequate Handwashing 11. Good Hygienic Practices \ttolatioas?eiated loiteed Be.tal.i_Presti_css (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. 23 Management and Personnel 24 Food and Food Protection 004) Equipment and Utensils 26. Water, Plumbing and Waste ti-sitssocos) 27. Physical Facility (Fosusso 007) 28 P0lsonous or Toxic Materials th-ritsso 008) 29 Special Requirements (590.009) 30. Other Non-compliance with: Amt-Choking Tobacco 500.009 El 590.009 (F) El LocaILaw Allergen Awareness 590.009 (G) i/ 12. Prevention oi Contamination from Hands Cl 13. Handwash Facilities PROTECTION FROM CHEMICALS Cl 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPEFIATUFIE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Rehearing (tooling lt-t. iiot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Cl 21. Food and Food Preparation tor HSP CONSUMER ADVISORY 22. Posting 01 Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Ftisk Factors (Red Items 1-22): Q?lgial for Cgrreglion; Based on an inspection today. the items checked indicate violations of 105 CMFI 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 01 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 01 receipt of this order. DATE OF FIE-INSPECTIQE I?tor a Si 'rtatu?? (JIM Print: 6;?ny W/i/ i7 fl '1 (am; Page of "Z?Pagcs This Form Approved by the Massachusetts Department of Public Health Establishment Name: PPIK lil?NTEi?, Saucer, thwiuu BOARD OF HEALTH CHI-157 Date: Page: of 91/ Code Reference Item No. - Red Item Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION PLEASE PRINT Date Veri?ed .6: Hmong, Guam) 9310176140? (ma?a) aroma mam gym: in! 3'1? mp; Mama, 5/ J77: gem as" jc? 7?24? Pair/a M?f 533% an; em, F525- my - ?172: 4 \f 1w? <3 5464*? Jilin: 2TH Ff? WEE 5'77 2?91: EEMM NJ 39? gel, 56633 f?nf?tff MR3) Dim int/tune Kim. 1-: a. Manes: ?f/bz 1 9% 37% pre?x; '11 fair?" at] ?1771 fW Page W42 @5611?? {?313 .21? {er/am fmgce? gm? ?Ml/E?b no, M1734 FKDFEL Hm: def?6 1511/1 we cc; WM/?lfc? In" r' - ?v?u 17-_ fm?EW 5m 5% 5W mes-2' 9714? 070/ 5,5414? Discussion With Person in Charge: Corrective Action Required: 134% 9? Voluntary Compliance Cl Employee Restriction! Exclusion Pie-inspection Scheduled CI Emergency Suspension Embargo CI Emergency Closure Voluntary Disposal Other This Form Approved by the Department of Public Health