THE OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT, 1? Name 9% 0a 1} a? Food Service Address Rig Retail Re-lnspection 1? eff Level El Residential Kitchen Previous Inspection elep one -- 1 - Mobile Date: 0 ACCP YIN Temporary (j Pre-operation if? Caterer Suspect Illness Person in Charge (PIC) If? Time Bed Breakfast B?zge?gl Complaint 1? . In: Inspector .M Our: Permit No. CI Other eoflns action Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne illness Intervientions anti 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 El 1. PIC Assigned i Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. ReceivingICondition El 6. Tags/RecordslAccuracy of ingredient Statements El 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Eio_iation? 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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness El Prevention of Contamination from Hands D13 . Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives I315 . Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) D16 I317 [118 D19 D20 . Cooking Temperatures . Reheating . Cooling . Hot and Cold Holding . Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an Inspection today. the Items checked Indicate violations of 105 CMR 590.000IFederaI Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this orderI 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 Inspector?s Signature; 12?? Print: PlC?s Signature: 3/ a {i161 M: [47;?1ub Print: pat/am Nigel?Pages FORM 731A CHARLESTOWNJIAA THE COMMONWEALTH OF TOWN OR CITY OF Massachusetts Department of Public Division of Food and Drugs MASSACHUSETTS I 4-7 Health FOOD ESTABLISHMENT INSPECTION REPORT Name Date ?nge gtfperatlonfs) ecti 4% Hag/?54 -ooc Service Address - . Ris'k Retail Rte-inspection ?e r' Level Residential Kitchen Previous Inspection Te on one :7 - - Mobile Date: 0 '7 7 7757f HACCP YIN Temporary Pro-operation wner ?/Arnnf/r; Caterer Suspect Illness . person in Charge (plc) Time Bed Breakfast Complaint In: Inspector {rid/? Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness interventions anti 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 I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC E) 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. TagisecordsIAccuracy of Ingredient Statements T. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violation_s_ReIateci 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 I 23. 24. 25. 26. 27. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS Approved Food or Color Additives D15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures CI 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control CONSUMER ADVISORY El 22. Posting of Consumer Advisories REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today. the Items checked Indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. W: Inspector?s Signature: Print: Signature: r- Print: {up [(31 ?14434?! I 1' Page745f7A?ages FORM 734A CO. CHARLESTOWN.MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSEECTION REPORT Name Da 9 of0 er lion 5 of ion ?x %4 [3 Food Service Routine Address Risk Retail Flo-inspection . 7/ f/ Level Residential Kitchen Previous Inspection Telephone Mobile Date; 0 a, ACCP YIN Temporary Pre-operation wner 4,1,.56 Caterer El Suspect Illness Person in Charge (PIC) If; Time El 35d Breakfast 32:13:; Complaint r" In: Inspector Out: Permit No. Other Each violation check'ed requires an explanation on the narrative page(s) and a citation of Specific provision(s) violated. Violations Rolgted to Foodborne Illness Interventions and Risk i??actors (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 El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections RestrictediExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 1] 5. ReceivingICondition El 6. TagisecordslAccuracy oi Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing Cl 11. Good Hygienic Practices Violations 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 Immedlately or within 90 days as determined by the Board of 23. Management and Personnel 24. Food and Food Protection (Fc-aussoem) 25. Equipment and Utensils 26. 27. 28. 29. 30. Water, Plumbing and Waste (Fc-sussoeos) Physical Facility Poisonous or Toxic Materials Special Requirements (590.009) Other Non-compliance with: Anti-Choking 590.009 (E) [3 Tobacco Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cl 16. Cooking Temperatures D17. Reheating C118. Cooling El 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of \flolated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be In writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF FIE-INSPECTION: I Inspector?s Signature: 7% Print: Print 0 [gas urc Page?o?Pages Jazz/c2, 204 baa/Mfg FORM 734A CO. CHARLESTOWN.MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Heatlh Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name 7L Dat In I Boy/4% nA/a/? 91.1749 .. we. Address Risk e-inspecli?? 9/5 67: Level Residential Kitchen Prevlous Inspection Telephone Mobile Date: Temporary Pro-operation Owner HACCP YIN Caterer Suspect Illness Person in Charge (PIC) Time Bad 8. Breakfast El] 323%? Complaint - In: Inspector Out: Permit No. Other Each violation checked requires explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require Immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedIExcluded FOOD FROM APPROVED SOURCE Cl 4. Food and Water from Approved Source 5. Receiving/Condition 6. TagisecordslAccuracy of Ingredient Statements El 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Relates! 39 Good Retail Eraotioes (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 23. Management and Personnel (Fc-zuseoboa) 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility (Fc-sxssonon 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other D12. D13. Non-compliance with: Anti-Choking 590.009 (E) [3 Tobacco 590.009 (F) Allergen Awareness 590.009 (G) Prevention of Contamination from Hands Handvvash Facilities PROTECTION FROM CHEMICALS D14. D15. Approved Food or Color Additives Toxic Chemicals CONTROLS (Potentially Hazardous Foods) D16. [31? D18. D19. D20. Cooking Temperatures [flag y? 9/5 Rehea?ng Cooling Hot and Cold Holding Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) D21. D22 Number of Violated Provisions Rel To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Food and Food Preparation for HSP Advisoric Official Order for Correction: Based on an inspection today, the items checked Indicate violations of 105 CMR 590.0001Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited In this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be In writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF HIE-INSPECTION: Inspector? 3 Signature. )Wm ?in? A Hit/ha Am Signature Wager/I Print In M. Pail a nu I PageLofAl?ngcs FORM 734A AM. CHARLESTOWN, MA THE COMMONWEALTH OF MASSACHUSETTS .- rown OR CITY OF Massachusetts Department of Public Heallh Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name new t'O'erations section (oi-V Food Service ouiine Address Risk i Retail URe-inspection #0 '(da Level Residential Previous Inspection Telephone Jj" 7759/ - Mobile Date: Owner [740/ HACCP YIN a Temporary Pro-operation Caterer Suspect Illness Person in Charge (plc) Time Bed 8. Breakfast General Complaint In: El HACCP Inspector My Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned i Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition El 6. TagisecordsIAccuracy of ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices MOW (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 23. Managementand Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials Non-compliance wlm: Anti-Choking 590.009 (E) [1 Tobacco 590.009 (F) Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives U15. Toxic Chemicals CONTROLS [Potential Hazardous Foods} ts?y./ 00 mg ampera ure Jar/i D17. Reheatlng 7 D18. Cooling [319. Hot and Cold Holding a? a a? 20. Time As a Public Health Control CONSUMER ADVISORY 22. Posting of Consumer Advisories REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONs (HSP) El 21. Food and Food Preparation for HSP 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 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29. Special Requirements (500.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector? Signature. Print: 77/ Signature: Mf? u? 14/0441]? A Cir? Samiet/ Page?.41" f_Pages THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF 1mm .725 759/ Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date A?voe of?ceratlongs] Tvoo F61 7 57g KFood Service ?outine Address Risk Retell Re?Inspection :15 ?(Cl 5V Level Residential Kitchen Previous Inspection Telephone Mobile IIgjate: I: Temporary Pre-operation Owner HACCP YIN I: Caterer Suspect Illness person in Char Time Bed Breakfast General Complaint 9 M?rincc/ In: El HACCP InspectorWH Out- Pennlt No. Other Each violation checked requires an ?planation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness lrllowontions and Risk Factors (Red Items) Anti-ehoklng 590.009 (E) Tobacco 500.009 (F) Violations marked may pose an Imminent health hazard and require immediate corrective action as determined by the Board of Health. ?mm" El FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands El 1. PIC AsSIgned I Knowledgeable! Dukes 13. Han dwash Facilities EMPLOYEE HEALTH El 2 Re ortin of Diseases Food Em to es and PIC PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives 3. Personnel with infections RestrictedlExciuded 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cl 16. Cooking Temperatures We! PM owl/r1?" . CI 17. Reheating Tan/2 011$ij 6hr? 53 18. Cooling D19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source [3 5. ReceivingICondition 6. TagisecordsiAccuracy oi Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices yiolgtions Related to (59ch 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 iiclal Order for Correction: Based on an ins so I Immediately or within 90 days as determined by the Board 32am the items checked indicate violations of 135 Craig 590.000IFederal Food Code. This report. when signed below 23 by a Board of Health member or its agent constitutes an 24' order of the Board of Health. Failure to correct violations cited In this report may result in suspension or revocation of 25. the food establishment permit and cessation of food 26' establishment operations. If aggrieved by this order' you 27- have a right to a hearing. Your request must be in writing CONSUMER ADVISORY El 22. Posting of Consumer Advisories WW f55Vo?9 Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red Items 1-22): in Management and Personnel Food and Food Protection Equipment and Utensils Water. Plumbing and Waste Physical Facility (Fe-ensemoor) 28. Poisonous or Toxic Materials (FC-Tii590-008i and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other W: Mace/"2 A. mew/a . PIC's Signature. Am Print. thr?lr?. ?jft El Pugcioi?ilinges FORM 734A AM. CHARLESTOWN. MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF far Publicl-ieatth Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name .. Date CI to oration tion 50/106/ Food Service Routine Address 9 Risk Retail res-Inspection lg [4:3 Level Residential Kitchen Previous Inspection To an one Mobile Date: Temporary Pro-operation Owner HACCP YIN Caterer Suspect illness Person In Charge (PIC) Time El Bed 8: Breakfast General Complaint In: HACCP inspector [Ma/?60 L. #71442?. rm .7 Out: Permit No. EIOther Each violation checked requires anxiaxplanation on the narrative page(s) and a citation of specific provision(s) violated. Non- -compllance with: Violations Related to Foodbome Illness InterventiOns and Risk Factors (Red Items) Anti-Choking 590.0095) Violations marked may pose an Imminent health hazard and require immediate corrective Tob?m 590-0091? action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned Knowledgeabiel Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source CI 5. ReceivinglConditlon 6. TagisecordslAccuracy of Ingredient Statements El 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 1D. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Pragtigeg (Blue ROMS) 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 23. Management and Personnel 24. Food and Food Protection rEEtuipment and Utensils Water, Plumbing and Waste . Physical Facility (Fe-ensemoon 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Allergen Awareness 12. Prevention of Contamination from Hands [1 13. I-landwash Facilities w-F/ Ar ?ag 2 [7114/ PROTECTION FROM CHEMICALS 710mg pr? 8/ [t 5 [4 14. Approved Food or I Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Wolated 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 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. if aggrieved by this orderI 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: W442, if, 784,? l? Print A?mg i PIC'sSignaturet' ML (:10 ?At-{it [if] It Print Pago_Lorl_Pages FORM 734A AM. SULKIN ELI CHARLESTOWN. MA Foor Establishment Inspection Report- City/Town of MM/lfizy Establishment: 0.. Date: Page1ofi Address: W5 9 Time In: Time out: Telephone: Permit No.: Number of Violated Provisions Related to Foodborne illness Risk Factors Owner: and Interventions (Items 1 through 29): to Foodborne Illness Risk Factors W00 1 [sit/V), 65/371] and Interventions (Items 1 through Person- i-n charge' Number of Repeat Violations Related 0 FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed NIA not applicable - corrected on-site during inspection repeat violation Compliance Status I IN Compliance Status I IN cos]? Supervision Protection from Contamination 1 Person-in-charge present, demonstrates GE 15 Food separated and protected knowledge, and performs duties 3?5 .. 16 Food-contact surfaces; cleaned 15'" {Cadet?Food Protection Manager If sanitized . Employee Health Proper disposition of returned, lift! It". Management, food employee and titll?i 17 previously served, reconditioned '5 unsafe food Timsrremperature Control for Safety 3 conditional employee; knowledge, responsibilities and reporting 4 Proper use of restriction and exclusion 1 Proper cooking time temperatures Proper reheating procedures for hot ?Lfl Procedures for responding to vomiting 1% 1 I. 5 and diarrheal events :holding 600d HIIQIGNIG Practices 20 Proper cooling time and temperature 5 Proper eating, tasting, drinking, or E1 21 Proper hot holding temperature tobacco use f; 22 Proper cold holding temperature 7 :tchlIascharge rom eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control Pev nti Contam' i ng Inaton an I ConsumerAdvisory 8 ds clea I washed J-.. Han propery I Consumer advisory provided for raw/ 9 Eggare hand contact with ready-to?eat 25 undercooked food Adequate handwashing sinks properly ET Susceptible PopulatIons 10 supplied and accessible It? 26 PasteurIzed foods used; prothIted foods . not offered A roved Source 11 Food obtained from aZPproved source FoodIColor Additives and Toxic Substances . 1' Food additives: approved properly 12 Food recelved at proper temperature 27 used 13 F003 132:8: 900d condItIon, safe, 8? 5:5 28 Toxic substances properly identified, In: una bl . i stored used 14 :32? Egra?godesstiuitiZn 6' lStOCk Conformance with Approved Procedures Compliance with variance specialized 1 process 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 590. Date of Rel pection: Discussion with Person-in-Charge6&0/ 1c 521'?! M01, SignatureofPerson-l-n -Charge. Date: Signature of Inspector 2? 9d! Data: Form 734A- 1 AM Sulkin Co., Charlestown, MA 29 Food 'Establishment Inspection Report? City/Town of gami?hfw Date: .,.rrsm1 In compliance outofcompllance Nl0= notobserved NIA=notapplicabls COS: corrected on-site during inspection repeat violatIon Status asteurized eggs used where uired 31 ater ice from source 32 ariance obtained for specialized methods a: cooling methods used; equipment for control Plant food properly cooked for hot he 30 33 thawl methods used ermometers rovided accurate Food properly labeled; original ner 38 Insects. rodents, animals not Contamination prevented during food preparation, storage and 39 cleanliness ng cloths: properly used 4O 41 42 ashi fruits . 43 utensils stored 44 Utensils. equipment linens: stored dried, &handled tablets ingle- use single-service articles: stored used 45 46 used er in}: ., 'ns 3 00d non-food contact surfaces 47 able, properly designed, IN OUT NM MO 008 Com Status 48 arewashing facilities: installed. intained. used: test 49 50 Hot cold water available; uate re 51 evices 52 waste water properly oilet features: properly nstructed. ed cleaned arbage refuse properly facilities maintained ical facilities installed, aintained, clean uate ventilation lighting; ed areas used 53 54 55 56 M1 M2 establishment cod 3 awareness M3 M4 ile Food M5 em Food Establishment M6 blic Farmers Market M7 Residential Kitchen; Bed-and- kfast 0 Non M8 Kitchen: Cottage Food Kitchen; USDA Nutrition M9 10 Commercial Kitchen 11 nnovative oration L1 L2 Other law or contact surfaces clean IN OUT NM NIO C03 umbing installed: proper backflow ti-choking procedures in food - - nstructed used of Operationfs]: of Inspection: ?$31 Service Establishment _g8pztine El Retail Food Store Re-lnspection El Residentlal: Cottage Foods Pro-operational El Illness Investigation Residential; Bed Breakfast El General complaint Mobile/Pushcart El HACCP El Temporary Food Estab. Other Other Other Information: {0400/ '55. Signature of Person-In- ?Charge Lag/W Dale; Form 734A-2 A..M Sulkin Charlestown. MA Signature Date: THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF f: 19:2 hr- Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT REPORT 1' Name Date/U Enact Operationis] . My. .r x? Food Service Address g3? Risk Retail I Re-inspection r" Level Residential Kitchen Previous Inspection Telephone 9? 7- ,9 Mobile Dale: . .. Temporary Pre-operation Owner ?HACCP YIN Caterer _Suspect Illness Person in Charge (PIC) Time Bed Breakfast General Complaint In: HACCP Inspector I ?fa, Out: Permit No. Other violated. Violations Related to Foodborne illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable! Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections RestrictedlEchuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingICondltion E) 6. TagsIRecordsiAccuracy of Ingredient Statements T. Conformance with Approved ProcedureslHACCP Plans FROM CONTAMINATION Eff ETC. Food Contact Surfaces Cleaning and Sanitizing CI 10. Proper Adequate Handvvashing Ci 11. Good Hygienic Practices Violations Related to good 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 23. Management and Personnel (Fe-gusseooa) 24. Food and Food Protection (rd-anemone 25. Equipment and Utensils reminiscence) 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: Anti-Choking 590.009 (E) Tobacco Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands r? D13. Handwash Facilities 151;, 44,, PROTECTION FROM CHEMICALS '51'93/1) 14. Approved Food or Color Additives 991' 7f I 4" El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentialiylugurdous Foods} [115. Cooking Temperatures 'r . 1? Reheating . f. L, ID. Cooling .: . CI 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 [fa/4,5 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 on an inspection today. the items checked indicate violations of 105 CMR 590.000iFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submittedto the Board of Health at the above address 29. Special Requirements (590.009) within 10 days Of receipt of this order. {z 30. Other DATE OF RE-INSPECTION{Pr/i Inspector?s Signature: Print: Print PIC?sS'enatW ?Jr . Lei 11.0.0 l??gI-?LOLPagcs i FORM 734A A M. SULKIN CO. CHAN. EETOWN. MA THEC TOWN OR CITY OF i? Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT MMONWEALTH OF MASSACHUSETTS 47/77574/4/ Fm 0/21. kg Swag/M Date/?31? its 24 sag/0W 52;. ep one Owner HACCP YIN Person in Charge (PICK, ?)ka . il'irne VOW ?m/m was 3h: ofO oration uod Sen-ice etall Residential Kitchen El Mobile Temporary Caterer CI Bed 8: Breakfast Permit No. In so Ion til? ne e-inspeclion Previous Inspection Date: Pro-operation Suspect Illness General Complaint HACCP Other Each violation checked requires art/e?irpianatlon on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne illness Interventions and Risk Factors (Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable! Duties EMPLOYEE HEALTH [3 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition El 6. TagisecordslAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresiHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices olatio elated to Good Retail Pr cti 5 (Blue Items) Critical (C) violations marked must be corrected immediately or within 11) 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 23. Managementand Personnel 24. Food and Food Protection 25. Equipmentand Utensils 26. Water. Plumbing and Waste (Fe-summons) 27. Physical Facility (Fe-enseom'n 28. Poisonous or Toxic Materials Non- -compllance with: Anti-Choking 590.009 (E) [3 Tobacco 590.009 (F) Allergen Awareness 590.009 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) D16. Cooking Temperatures gagged It?d 3 D17. Reheating MO gm?: 18. Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation Ior HSP O??ih" 155w? 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 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 CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTIQN: r" Print: 1' (I71 Bat/168m}. Inspector? SiFnafrWW??/I I Signatu MW o\\xi>ewL FORM 734A AM. SULKIN CO. CHARLESTOWN. MA COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusettsneparbnentof Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date 9 oration a of tie D/h 13 SC had/ Food Service outine Address (1 Risk Retail gas-inspection 5 [0 Level Residential Kitchen Previous Inapection Telephone Mobile Date: Temporary Pro-Operation Owner HACCP Caterer Suspect Illness person in Charge (plc) Time El Bed 8. Breakfast Generai Complaint . In: HACCP Inspector Mama/2h 7 Out: Permit No. EIOther Each violation checked req'ulre an planatlon on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodhorne illness Interventions and Risk Factors (Red Items) Antl-Choklng 590.0095) Violations marked may pose an imminent health hazard and require Immediate corrective Tobawo 590-009 (F) action as determined by the Board of Health. We! ?9'80? "mm? 590-009 (til [3 FOOD PROTECTION MANAGEMENT 12. Prevention of Conta mina ion from Hands 1. PIC Assignadi? dgaable i Duties 459% 6/9 in? fat-V [j 13. Handwash Facilities ?9165772; EMPLOYEE HEALTH #31092! a PROTECTION FROM CHEMICALS MM 3?84sporting of Diseases by oo in: eyes and PIC D14- Approved Food or Color AddItIves 3. I t' I . CI ersonne WIth ectIons Res nc IExc ed CI 15' Toxic Chemi Is 4 7(0 5/ FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 5. ReceivingiCondition 6. TagsiRecordsiAccuracy of ingredient Statements [317' Reheating 7. Conformance with Approved ProceduresIHACCP Plans 18' Cooling PROTECTION FROM CONTAMINATION El 19' H?t and c?'d ??de 8. 20 Time As a Public Health Control - - - - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 9. Food Contact Surfaces Cleaning and Sanitizmg CI 21. Food and cod Preparation for HSP 10. ProperAdequate Handwashing in . . . CONSUMER ADVISORY 11' 600d HygIenIc Practices 22. Posting of Consumer Advisories Related 1 i ractices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses nterventions 9 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 Official Order for one show Based on an ins . pection immediately or within 90 days as determined by th? Board today. the items checked indicate violations of 105 CMR 590.000iFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23' 523::33'232 order of the Board of Health. Failure to correct violations cited In this report may result in suspension or revocation of 25' Equipment and Utensils the food establishment and cessation of food 26- Water . Plumbing and Waste establishment Operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF Inspector?s Signature: MW Print. mil/1&3 L, O. maze ?am; wife FORM 734?! AM. SULKIN 00. MA. I I Pagc_Loi?_LPages Food. Establishment Inspection Report? City/Town of iga/W/ Establishment: Date: 6 Page 1 of 9_ iddress ?25 IrchG/Oroi Time in: Time out: Telephone: I Permit No.: Owner: Number of Violated Provisions Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): Person- in- charge?um? inspector: Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): C7 FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO- not observed NIA- - not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN Compliance Status I IN Supervision Protection from Contamination knowledge, and performs duties Person-in-charge present, demonstrates Certified Food Protection Manager 15 Food separated and protected 16 Food-contact surfaces; cleaned sanitized Employee Health Management. food employee and 3 conditional employee; knowledge, responsibilities and reporting Proper disposition of returned, previously served, reconditioned unsafe food 1 TimeiTemperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures Procedures for responding to vomiting and diarrheal events 1 Proper reheating procedures for hot holding (.0 Good Hygienic Practices Proper eating, tasting, drinking, or tobacco use 0 2 Preper cooling time and temperature 2 Proper hot holding temperature No discharge from eyes, nose, and mouth 22 Proper cold holding temperature 23 Proper date marking and disposition Preventing Contamination by Hands 24 Time as a Public Health Control 8 Hands clean properly washed Consumer Advisory No bare hand contact with ready-to-eat food Consumer advisory provided for raw/ 25 undercooked food I. Adequate handwashing sinks properly supplied and accessible Highly Susceptible Populations Approved Source 2 0) not offered Pasteurized foods used; prohibited foods 11 Food obtained from approved source FoodiCoior Additives and Toxic Substances 12 Food received at proper temperature 1 (.0 unad ulte rated Food received in good condition, safe, Required records available: shellstock 14 tags, parasite destruction Food additives: approved prOperly 27 used Toxic substances prOperly identified, 2 stored used 03 Conformance with Approved Procedures 29 Compliance with variance specialized process 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 590. Date 07mins?: Discussion with Person- win?Charge bails-46?? Uii-?iL. fr dam at- 7613 Ad iffy/mg my eyed/33a 04% we Batm? Date: 6 /y Form 734A- 1 AM. Sulkin Co., Chariestown, MA Food Establishment Report? City/T own of Compliance Status Compliance Status it: our NM mo cos 48 Warewashing facilities: installed, 30 Pasteurized eggs used where maintained, 8t. test strips required 49 Non-food contact surfaces clean 31 Water& ice from approved source hyiicti .?Eitcililie?tf; 32 Variance obtained for specialized 50 [Hot cold water available; processing methods adequate pressure 1' TF3 . i 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 property 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 gang?m? . an 55 Physical facilities installed. 37 Food properly labeled; original maintained, &clean . container 56 Adequate ventilatlon lighting; 9? "r . desrgnated areas ursed . i'nsects, rodents animals not .. ?54193 7" Jill W?mii??d tin" 38 present M1 Anti-choking procedures in food Contamination prevented during service establishment 39 food preparation, storage and Food alter awareness display {Reit?wr?ftii??t?a FL tifltl Anti 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment 42 Washing fEEitS stables M6 Public Market; Farmers Market 3.3 M7 Residential Kitchen; Bed-and- 43 ln?use utensils prqgerly stored Breakfast Operation 44 Utensils. equipment linens: M8 Residential Kitchen: Cottage Food pr0perly stored, dried, handled Operation 45 Single-use I single-service articles: M9 School Kitchen: USDA Nutrition properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen ?2"?77 7: Equipment and Vending?! ill?{2; M11 In novative Operation Food non-food contact surfaces "-14 tiff 47 cleanable. properly designed, L1 Local law or regulation constructed used L2 Other Ty Operation(s): Service Establishment Retail Food Store El Residential: Cottage Foods El Residential; Bed 8. Pro-operational El illness Investigation Inspection: we Re-lnspectlon Gther?nfzmatio: Breakfast General complaint Mobile/Pushcart El HACCP El Temporary Food Estab. El Other El Other A A .a Signature of Person-in-Charg . Dam: .- Signature ?atm? . .l . - f, Form 734A-2 A.M. Sulkin Co., Charlestown, MA ?7 THE LTH OF MASSACHUSETTS TOWN OR CITY OF mom a; Massachusetts Departnent of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date/f, eofo stations eoflns action (7 A4 a Wren: Food Service I I Routine Address '1 Ri?k Retail El Re-Inspectlon ?e Level Residential Kitchen Previous Inspection Telephone El Mobile Date: . Temporary Pre-Operation Owner . 120.1 HACCP Caterer Suspect Illness Person in Charge (PIC) Time El Bad 8- Breakfast B32263 Complaint In: Inspector 4. Out' Permit No. Other. Each violation checked requires an explanation on the narrative pageIs) and a citation of specific provision(s) violated. Non- -compiiance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective 590.009 (F) a action as determined by the Board of Health. A'le'ge" 590909 FOOD PROTECTION MANAGEMENT [j 12. Minion of Contamination from Hands 1. PIC AssignedlKnowledgeabIeI Duties 3. Handwash Facilities EMPLOYEE HEALTH 2 Re ortin of Diseases Food Em Io ee and PIC PROTECTION FROM CHEMICALS . 9 El 14. Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded 15' Toxic Chemicals FOOD FROM APPROVED SOURCE 4_ Food and Water from Approved Source TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 5 Receiving/Condition Cooking Temperatures 19TagsIRecordsiAccuracy of Ingredient Statements E117- Reheating . El 7. Conformance with Approved ProceduresIHACCP Plans 18' Cooling 4?52; 19. Hot and Cold Holding 20. Time As a Public Health Control . . . . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS IHSP) El 9. Food Contact Surfaces Cleaning and Sanitizmg El 21' Food and Food Preparation for HSP 10. ProperAdequate Handwashing PROTECTION FROM CONTAMINATION 8. . . . CONSUMER ADVISORY 11' G??d Hygienic Practices El 22. Posting of Consumer Advisories VIOI-EIUDHS t0 600d Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Food borne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22}: ?f Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the Items checked Indicate violations of 105 CMR fc 590.000IFederal Food Code. This reportl when signed below by a Board of Health member or its agent constitutes an 22' ii": PerEnnel (Eggusgg'gg?e) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25' EqUIpment and UtenSIls the food establishment permit and cessation of food 26. Water, Plum bing and Waste establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be In writing 28. Poisonous or Toxic Materials (FC-7li590-008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector?s Signature: ?if, Print: .. r?Z- Signature??r) . 17763:)? Print: C3. :stkimlf ?"an03 FORM 734A AM. SULKIN CO. MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name . Date ?1 BC 0" (at, . 7' Food Service Rou' Address '7 Risk Retail Mpeclion/?/j/f; Level Residential Kitchen Previous Inspection Telephone [3 Mobile Date: Temporary Pre-cperation Owner HACCP Caterer Suspect Illness Person in Charge (PIC) Time Bed Breakfast General Complaint In. El HACCP Inspector om: 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 Related to Foodborne iliness interventions and Mel: Factors (Red Items) Anti-choklng 590.009 (E) Violations marked may pose an imminent health hazard and require Immediate corrective Tobacco 590-009tF) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedIExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. ReceivinglCondition 6. TagsIRecordsiAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violatigng 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 23. Management and Personnel 24. Food and Food Protection (Fe-cusses?) 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility .28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or ColorAdditives CI 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures CI 17. Reheatlng [j 18. Cooling l?r?ipflf o- [319. Hot and Cold Holding M/yr 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) CI 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22): Of?cial Order for Correction: Based on an inspection today. the items checked indicate violations of105 CMR 590. ODD/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 ord/ner DATE OF ?4/7 Inspector's Signature: -7, 2 Print: PIC?sSignature: I I. i I, . JPrint: Puge..-_ rJ-f/ Pages . In v. 1r - - FORM 734A AM. SULKIN CO. FWIESTOWN, LIA r' THE COMMONWEALTH OF MASSACHUSETTS TOWN 0R CITY Massachusetts Deparlment of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name 5 Date a ?3 re i \?i?vce MW 5?06? jijl/g and Service cutine Address Retail Re-Inepecticn We. M4 ?07 5" Level Residential Kitchen Previous Inspection Mobile D:ete Temporary Pre- -operation Owner HACCP YIN Caterer Suspect Illness person in Charge (Plc? Tlme CI Bed Breakfast General Complaint In. HACCP lnspectoquM/yy L. 3%4/14 7 Out: Permit No. 1: Other Each vloiatiun che?c'ked re'q'uires?a?n explanation on the narrative page(s) and a citation of specific provision(s) ViolatOd. Non-compliance with: Violations Related to Foodborne Illness interventions and Risk Factors (Red Items) Anti-choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Wham 590-009 (F) action as determined by the Board of Health. 590-099 FOOD PROTECTION MANAGEMENT . 12. Prevention of Contamination from Hands 1. PIC Assigned i Knowledgeable I Duties El 13. Han dwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures C117. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictediExcluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. ReceivingICondition 6. TagsiRecordsiAccuracy of Ingredient Statements [3 7. Conformance with Approved ProceduresiHACCP Plans PROTECTION FROM CONTAMINATION El 8. :1 622m? Stur'ECe: Clezlilling and Sanitizmg 21. Food and Food Preparation for . roper aqua CONSUMER ADVISORY ?/73 155.9 65 rac 22. Posting of Consumer Advisories VI 1 i I Retail pram 5' (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses interventions Immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22); of Health. Non-critical (N) violations must be corrected Of?cial Order for Canadian Based on an ins . . pechon Immediately or within 90 days as determined by the Board today, the Items checked indicate violations of 105 CMR 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23' order of the Board of Health. Failure to correct violations cited in this report may result In suspension or revocation of 25' Equipment and Utensils the food establishment permit and cessation of food 26- Water, Plumbing and Waste establishment operations. If aggrieved by this order, you 27- Facility (Fa-?li590-007) 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. Special Requirements (690.009) within 10 days of receipt of this order. 30- Other W: Pm?j9?34r?0 Bang/a '7 Signalilrel?mM My Print: CA 5kmbf Pngc7tof+Pagcs FORM 734A AM. BULKIN CO. CHARLESTOWN. MA Food Establishment Inspection Report City/Town of Establishment. l/ W?/??ffM [(16/205/ Date: 3 Time in: Time out: Page 1 of; Address. ?795 ,1 Telephone. Permit No.: Owner: Number of Violated Provisions Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): Person-in-charge: Inspector: Meg/6&4? Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): FOODBORNE RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN Compliance Status I IN Supervision Protection from Contamination Person-in-charge present, demonstrates knowledge. and performs duties 1 U1 Food separated and protected 2_ Certified Food Protection Manager Food-contact surfaces; cleaned saaned _x O) Employee Health Management, food employee and 3 conditional employee; knowledge, responsibilities and reporting Proper disposition of returned, 17 previously served, reconditioned unsafe food TImeITemperature Control for Safety 4 Proper use of restriction and exclusion Procedures for responding to vomiting and diarrheal events 1 Proper cooking time temperatures Proper reheating procedures for hot 1 holding to Good Hygienic Practices Proper eating, tasting, drinking. or tobacco use 20 Proper cooling time and temperature 2 Proper hot holding temperature No discharge from eyes, nose, and mouth PO 2 Proper cold holding temperature 23 Proper date marking and disposition Preventing Contamination by Han 24 Time as a Public Health Control 8 Hands clean properly washed Consumer Advisory No bare hand contact with ready?to-eat food Consumer advisory provided for raw 25 undercooked food Adequate handwashing sinks properly 10 supplied and accessible Highly Susceptible Populations Approved Source 2 not offered Pasteurized foods used; prohibited foods 11 Food obtained from approved source FoodiColor Additives and Toxic Substances 12 Food received at proper temperature 1 Food received in good condition, safe, unadulterated (9 Food additives: approved properly 2 used -.I Required records available: shellstock tags, parasite destruction 4: 1 Toxic substances properly identified, 28 stored used Conformance with Approved Procedures 29 Compliance with variance specialized 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- renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR Date of Reinspection: Discussion with Person-in-Charge: Signature of Person- In- Charge. 777 Signature 7m 5 /f Date: Form 734A- 1 AM. Sulkin Co., Charlestown, MA Food Establishment Inspection Report City/Town of iw/W/j7??ey? Establishment: Jt?C?A??t?y? #449766?ch iDate: 2 La} /j7 Page 2 ofi oboe PRACTICES AND MASSACHUSETTS- ONLY ssc?dns IN in compliance out of compliance NIO- not observed NIA- - not applicable COS corrected on-site during inspection repeat violation Compliance Status IN lwolcosl Compliance Status IN OUT MIA cos Safe Food and Water 48 Walrewashing facilities: installed, 30 Pasteurized eggs used where maintained, used; test strips reqUIred 49 Non-food contact surfaces clean 31 Water ice from approved source Physical Facilities 32 Variance obtained for specialized 50 Hot cold water available; methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow 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 facilities maintained Food Identification 55 Physical facilities installed, maintained, clean Food properly labeled; original 37 container 56 Adequate ventilation lighting; Prevention of Food Contamination deSIQnated areas used 38 Insects, rodents, 8, animals not Additional Requirements listed' In 105 CMR 590. 011 present M1 Anti- -choking procedures' In food service establishment Contamination prevented during 39 food preparation, storage and M2 allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 Caterer M4 Mobile Food Operation 41 Wiping cloths: properly used stored M5 Temporary Food Establishment 42 Washing fruits vegetables M6 Public Market; Farmers Market 0f Utensils M7 Residential Kitchen; Bed?and? 43 In-use utensils properly stored Breakfast Operation Utensils, equipment linens: Residential Kitchen: Cottage Food 44 properly stored, dried, handled M8 Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly . M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 Innovative Operation Food non? -food contact surfaces Local Requirements 47 cleanable, properly designed, L1 Local law or regulation constructed used L2 Other ofOperation(s): Otherlnformation: cod Service Establishment outine Retail Food Store e-inspection El Residential: Cottage Foods Pre-operational El Residential; Bed El Illness investigation Breakfast Ci General complaint Ci MobilelPushcart HACCP El Temporary Food Estab. Other El Other 1 Signature of Person-in-Charge a] Date: (Jr/1 If 5 Form A.M. Sulkin Co., Charlestown MA Signature of Inspector WWL m?y/ Data: (1,4:ch Food Establishment Inspection Repo?rt City/Town of @Wg7/f7?g/r lEstablishmenti jig/WW7 gag? lDate' 3 pageiof 2 Te re Observations Item I Location Item Location Item I Location Observations and/or Corrective Actions Viotations must correcLed within 1115 tlma or in Sect Item Number Sectlon of Code of Violatlon Date to Correct By 77 M52 a?r? ::Qna:ure 0: Tumor:- -in- mimmz SEWW EST: gna ure 0 nspac or: a 9' AM- Form 7343 AM Sulkin Co., Charlestown, MA TOWN OR CITY OF THE COMMOWOF MASSACHUSETTS z. Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT JNSPECTION REPORT Name Dat fT so 0 eretions fl eci KW . @474 Food Service I ilB?l ine Address Risk Retail Rte-inspection Jig/7 i r?ru- 0 J) - Level Residential Kitchen eep one {237: y?fl 4% 1Moblle Datg: i' Owner 1 HACCP YIN 9??me - c- ae/Lz/ at Caterer Suspect Illness Person in Charge (PIC) . Time Bad at Breakfast 3:25;? Complaint . . In: Inspector oi, if? Out: Permit No. DOther Each violation checked reguires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable! Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC [j 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. ReceivingiCondltion 6. TagsiRecords/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Ggog Retail Practiges (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 Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands D13. Handwaeh Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) [:119. Hot and Cold Holding 20. Time As a Public Health Control 9? 7/ /7 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP 16. Cooking Temperatures D17. Reheating El 18. Cooling CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of \flolated 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 590.000l'Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in 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 addres within 10 days of receipt of this order DATE OF RE-INSPECTION: 9 Print: glam. MQUC A Pam?Pages of Health. 0 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste (Fe-silseonosi /27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.000) 30. Other Inspector?s Signature: Print: Signature: 7 FORM 734A AM. SULKIN CO. MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF 725 mil MassachusetlsDepar-lmentof PublicHeatth Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date - eratio "Ce-111g, Address Risk Retail Level Residential Kitchen Previous Inspection Telephone Mobile gte: Temporary Pre-operation Owner HACCP YIN El Caterer DSuspectlilness Person in Charge (PIC) Time Bed Breakfast General Complaint In: HACCP Inspector ?ulsn. Out: Permit No. DOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Rotated to Foodborne illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Tobacco 590.009 (F) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable i Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictediExcluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. TagsIRecordsiAccuracy of Ingredient Statements [3 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violations Related to Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of 23. Management and Personnel (Fc-zuseocos) 24. Food and Food Protection 25. Equipment and Utensils 36. Water, Plumbing and Waste '22. Physical Facility 28. Poisonous or Toxic Materials (Fe-mseopoe) 29. Special Requirements (590.009) 30. Other,? All argon Awareness 590.009 (6) [:112. Prevention of Contamination from Hands [113. Hantivailsh Facilities r?r- t? real lift-h; Jolie Min PROTECTION FROM CHEMICALS ?r 14. Approved Food or Color Additives El 15. Toxic Chemicals farm L/wz [fl L1 thr: - CONTROLS (PotenlIal'ly Hazardous Foods) C116. Cooking Temperatures fax? (yum; 7 E117. Reheating l?r?ezj?ce/ .4. +16% . More as. (Lime; (?Rama?s/5 D19. Hota nd Cold Holding (I 20. Time As a Public Health Control" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0{IIJIFederal 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 FIE-INSPECTION: 5 >30e/5" Inspector?s Signature: I Print: 0/ Z, 2274 PlC?s Signature: Print: . PngeLoIHLPagcs Emaun- rn'rnI-nl .- COMMONWEALTH OF MASSACHUSETTS TOWN 0R CITY OF 67?s?" Massachusetts Deparhnent of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date 3i Operatignisl . i#5 El ood Service outine Address i ?7 Risk Retail tag i Re-inspection 1' "rm 31- 727? Level Residential Kitchen Previous Inspection Telephone El Mobile Eve: Temporary Pro-operation Owner HACCP YIN Caterer Suspect Illness Person in Charge (PIC) Time El Bed 8: Breakfast C) General Complaint I In. El HACCP Inspector W3- Out: Permit No. Other Each violation checked requires an efplanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Facims (Red Items) Anti-choklng 590.0095) Violations marked may pose an imminent health hazard and require immediate corrective Wham 590-009IF) action as determined by the Board of Health. ?mg? 590-009 FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands Cl 1. PIC Assigned I Knowledgeable I Duties 13. Handwash Facilities PROTECTION FROM CHEMICALS [j 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondltion 6. TagisecordsIAccuracy of Ingredient Statements 16. Cooking Temperatures D17. Reheating 7. Conformance with Approved ProceduresiHACCP Plans [318' Cooling PROTECTION FROM CONTAMINATION 19- and 8. 20- Time As a Public Health Control . - - REQUIREMENTS FOR HIGHLT SUSCEPTIBLE POPULATIONS (HSP) 9. Food Contact Surfaces Cleaning and SanItIzIng CI 21 Food and Food Preparation 10', HSP El 10. Proper Adequate Handwashing 5., 7L . . CONSUMER ADVISORY 11' Good Hyglemc Practices 22. Posting of Consumer Advisories Violations Belated to Ggod Reg? Eractlces (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must b9 corrected To Foodborne "Inesses Interventions 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?cial Order tor Correction: Based on an inspection Immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report' when signed below by a Board of Health member or its agent constitutes an 32' $2333.23: order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25' Eqmpment 39d Utensils the food establishment permit and cessation of food 26- Water. Plumbing and Waste (Fc'5ii59o-005) establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be in writing 28- or Tom: Materials (PC-7il590-003) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF r-u 23am. mumSignature: fl, Print: FORM 734A AM. SULKIN 00. i it MA of _r . - . Food Establishment Inspection Report City/Town Establishment: 3-3-5 ,1 . . . Date: - Page 1 of Address: I . Jr: Time in: Timeout: Telephone: I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: and Interventions (Items 1 through 29): Person?in-Charge: 3U L. 2? Number of Repeat Violations Related i ., to Foodborne Illness Risk Factors - . and Interventions (items 1 through 29]: FOODBORNE ILLNESS Factoas AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance N10 not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I Compliance Status iom ~mlmo cos Supervision Protection from Contamination Person-in-charge present, demonstrates knowledge, and performs duties 2 Certified Food Protection Manager 15 Food separated and protected 16 Food-contact surfaces; cleaned sanitized Employee Health Management, food employee and 3 conditional employee; knowledge. responsibilities and reporting Proper disposition of returned, 17 previously served, reconditioned unsafe food Timel'l'emperature Control for Safety 4 Proper use of restriction and exclusion CD 1 Proper cooking time temperatures Procedures for responding to vomiting and diarrheal events Proper reheating procedures for hot 19 holding Good Hygienic Practices Proper eating, tasting, drinking, or tobacco use No discharge from eyes, nose, and mouth Preventing Contamination by Hands 8 Hands clean properly washed No bare hand contact with ready-to-eat food Adequate handwashing sinks properly 1O supplied and accessible Approved Source 11 Food obtained from approved source 12 Food received at proper temperature 13 Food received in good condition, safe, unadulterated Required records available: shelistock 14 tags, parasite destruction 20 Proper cooling time and temperature 2 Proper hot holding temperature 2 PrOper cold holding temperature ml 2 Proper date marking and disposition 24 Time as a Public Health Control Consumer Advisory Consumer advisory provided for raw/ 2 undercooked food (I1 Highly Susceptible Populations Pasteurized foods used; prohibited foods 26 not offered Foo'dIColor Additives and Toxic Substances Food additives: approved properly 27 used Toxic substances properly identified, 2 stored used 03 Conformance with Approved Procedures Compliance with variance specialized 29 process 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 Reinspection: .. - .- f. I Discussion with Person-in-ChargeSignature of PersOn-lmCharge: -- Signature of inspector: I Form 734A-1 AM. Sulkin Charlestown, MA Food Establishment Inspection Report? City/Town of Establishment: . r?urfr 3? Date: . v" PageZof .. .. -1 . in compliance outofcompliance NIO: notobserved corrected on- Sitedunng Inspection R=repeatv olation Compliance Status IN OUT NM N10 cos Com iance Status arewashing facilities: installed, 30 Pasteurized eggs used where aintained, used; test Strips required 49 on-food contact surfaces clean 31 Water ice from approved source 32 Variance obtained for specialized 50 Hot cold water available; roceasing methods uate ure Si. 5 a . a 51 Plumbing installed; proper backflow Proper cooling methods used; 33 adequate equipment for 52 ge waste water preperly temperature control 34 Piantfood properly cooked for hot 5 oilet features: properly holding nstructed, su ied, cleaned 35 Approved thawing methods used 54 arbage refuse properly 36 Thermometers provided accurate i faC'lltieS maintained g- . - 5 ysical facilities Installed, Food properly labeled; original aIntaIned 8? container 56 is ventilatlon I - . areas used .353Insects, rodents. animals not . - present M1 king procedures In food Contamination prevented during establishment 39 food preparation. storage and M2 all awareness 40 Personal cleanliness M3 41 Wiping cloths: properly used M4 bile Food tion Jstored M5 em ra Food Establishment 42 Washin fruits yo etabies M6 blic Market; Farmers Market .. .11 M7 dential Kitchen: Bed-and- 43 ln-use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored. dried. handled 45 Single-use single-service articles: M9 Kitchen; USDA Nutrition properly stored used 46 Gloves used properly Commercial Kitchen .?ni'gi 1' .V?l'ItlII?ilr. I ve 0 Food non-food contact surfaces 47 cleanable. properly designed, . law or ulation censtructed used L2 Type, of Operationts}: Type/d Inspection: Other Information: _Fo?od Service Establishment ,Eigpuline D'Retall Food Store He- -inspectlon El Residential: Cottage Foods El Pre- -operatlonal Residential: Bed Illness Investigation Breakfast El General complaint El Mobile/Pushcalt Temporary Food Estab: Other El Other Signature of Person-in-Chargn: Date: Signature i . DateForm 734A-2 AM. Suikin Co}; 'Charlestown, MA THE OF MASSACHUSETTS TOWN OR CITY OF we Massachusetts Deparlment of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date eration f-In and Service outine Address Risk Retail Re-inSpectIon far/41 (a Level Residential Kitchen Telephone gig/3%, El Mobile Date: Ow er HACCP YIN Temporary Pro-operation f/ El Caterer Suspect Illness Person in Char Time Bed 8. Breakfast General Complaint 9 I I In. . UHACCP Inspector 3M Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventlons and 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 El 1. PIC Assigned i Knowledgeable i Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. ReceivingiCondition 6. TagsiRecordsiAccuracy of Ingredient Statements 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (BIue 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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils (Po-anemone) 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials (Fc-7u590.oos) 29. Special Requirements (590.009) 30. Other Non-compliance with: AntI-cnoklng 590.009 (E) E) Tobacco 550.005 (F) AllergenAwareness EWDOMG) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) D16. Cooking Temperatures U17. Reheating [118. Cooling D19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an Inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited In this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: 2577/ .. Inspector?s Slgnaturcf Print: ?in" pried/lo . Pagevlo/[LPages Signature: 1% [If FORM 734A AM. SULKIN LID CHARLESTOWN. MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY hir- Massaohusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name - Date 1' are oration fins Ion 11./55 TL 5624 (91.9 #3 Food Service #eutine Address Risk Retail Rte-Inspection 75 f'?c?fh 6 ?t?t?i Level Residential Kitchen PreviDUs inspection Telephone Mobile ?le: Temporary Pre-operatlon Owner . HACCP YIN Caterer Suspect Illness - . . 11 Bed Breakfast General Complaint Person in Charge (PIC) TibCi QUQ A Innie Ci HACCP Out: PermitNO- UOther Each violation checked requiresr?a?h explanation on the narrative pagels) and a citation of specific provision(s) Violated. Non-compliance with: Violations Related to Foodburne Illness interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations ntarked may pose an imminent health hazard and require immediate corrective ??000 5909091") action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I KnoWledgeabIe I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingICondition 6. TagsIRecordsIAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Wham to Good Retail Hm (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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils g5: Water, Plumbing and Waste 7. Physical Facility (Fc-sirssopor) 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Allergen Awareness scanners) 12. Prevention of Contamination from Hands El 13. Handwash Facilities $035+ fat/"5' PROTECTION FROM CHEMICALS ?7 5 fa?f-j' mam/VI a D14. Approved Food or Color Additives G'?ugr 5:25;: 5 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) Ci 16. Cooking Temperatures ?C/z90m (9:731 5412?5/ 1:117. Reheatlng (?#0er [j 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 4/0 - El 22. Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): O?icia?rder for Correction: Based on an inspection today. the Items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result In suspension or revocation of the food establishment 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: Inspector?s Signature: WIW A . I MM Own?? Q99 FORM 734A AM. BULKIN CO. CHARLESTOWN. MA -lE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT ?/orf/q war 5mm ?ft/41; . Risers?? . 32:31:23"? ?52 g5! 524% 31:. ?Acc" 353.? Person in charge (plc) rirne Bed 8. Breakfast 3:33;: Complaint InSpectosz/Zg/Zv? EIOther Each violation checked req-uires 4n explanation on the narrative pagets) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Antl-Choklng 590.0095) Tobacco 590.009 (F) Violations marked may pose an Imminent health hazard and require immediate corrective action as determined by the Board of Health. 590-009(3) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives D15. Toxic Chemicals TIMEHEMPERATURE CONTROLS [Potentially Hazardous Foods] D16. Cooking Temperature. Rehearing W5 U/ff?b??y?h 5 if} Cooling . 19. Hot and Cold Holding FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedIExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Ap rovecISource 5. Receiving/Condition 6. TagSIRecordslAccuracy oi gredient's atoments Cl 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION PROM CONTAMINATION El 8. Tim! 0,4 :17 I 9. Food ContactSurfaces Cleaning and Sam El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 11? 600d Hygienic Practices El 22. Posting of Consumer Advisories Violations Related to 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 21. Food and Food Preparation for HSP 10. ProperAdequate Handwashing 6m 6 v7 CONSUMERADVISORY (.6 Number of Vioiated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today. the Items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF Prim/KW . jaw/w I Print: (5:)qu q?l 23. 24. 25. 26. 27. 28. 29. 30. Inspector?s Signat?y}! W2 #1 VJJ 7 FORM 734A AM. SULKIN CO. CHARLESTOWN. MA Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility (Fe-cusseoo'r) Poisonous or Toxic Materials Special Requirements (590.009) Other "x Foo?d Establishment Inspection Report - City/Town of ?aw/7i Establishment: fl/d??yggf (9&5me Date: 6 . - Address: 4/ f-Xea/w ?yg Time in: Time out: Telephone: 1 Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors 0 Owner: and Interventions (items 1 through 29): to Foodborne Illness Risk Factors - .. . Person-in-charge: KT Prl?gu?uq Number of Repeat Violations Related Inspector: WW2, and Interventions (items 1 through 29): it'iSK?cmRs AND PUBLIC HEALTH IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during Inspection repeat violation Compliance Status I Compliance Status IN Supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected knowledge, and performs duties 16 Food-contact surfaces; cleaned . ?Certified Food Protection Manager sanitized Employee Health Proper disposition of returned. L: Management, food employee and 9" a 17 previously served, reconditioned if; 12.5 3 conditional employee; knowledge, unsafe fOOd responsibilities and reporting TlmelTemperature Control for Safety 4 Proper use of restriction and exclusion i; 18 Proper cooking time temperatures 5 Procedures for responding to vomiting Hi 19 Proper reheating procedures for hot and diarrheal events _5_vi 9.1: holding Good Hygienic Practices 20 Proper cooling time and temperature 5 prer eating, tasting, drinking, or 21 Proper hot holding temperature :3 8900 use 22 Proper cold holding temperature 7 0 discharge rom eyes, nose. and 3' 23 Proper date marking and disposition mouth . . . 24 Time as a Public Health Control Preventing Contamination by Hands . .. Consumer Adwsory 8 Hands clean properly washed . . No bare hand contact with read -to-eat 2 Consumer advrsory provrded for raw/ 9 undercooked food food Hi hl Susce tible Po ulations 10 Adequate handwashing sinks properly . supplied and accessible - 26 Pasteurized foods used, prohibited foods Approved Source not offered . . k. Food/Color Additives and Toxic Substances 11 Food obtained from approved source a- . Food additives: approved properly . 12 Food received at proper temperature 27 used 1 13 F003 2:02:31 900d condition, safe. 8? 28 Toxic substances properly identified, una er stored used 14 Requrred records available. shellstock Conformance with Approved Procedures tags, paraSIte destruction . . . . . . - 29 Compliance With variance speCialized process HACCP Plan :i?ii 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 Reinspection: Discussion with Person-in?Charge: 716,190 Check; ?ood 5/5334? MK ail :11] c?ecfs 9000/ 72? . Signature of Person-in-Charge: Date: ?31 .- Form 734A-1 AM. Sulkin Charlestown, MA 001W Signature of Inspector. W1 Datai? Food Establishment Inspection Report- City/T own of I74. 3142?,? Date: v? o/y Page 2 of: Intestine Rem?: ?Ecnori81 ?tel-Ir in compliance OUT: out ofcompliance NIO not observed - not applicable corrected on-site during Inspection 12- repeat violation Compliance Status IN our NM Nto cos Compliance Status Warewashing facilities: installed, 30 steurized eggs used where maintained. test strips ed 49 Non-food contact surfaces clean 31 ater ice from approved source ?151153330 - 32 ariance obtained for specialized 50 Hot cold water available; rocessi methods adequate pressure I i 4 . 51 Plumbing installed; proper backflow cooling methods used; devices 33 uate equipment for 52 Sewage 8t waste water properly rature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holdin constructed. supplied. 8. cleaned 35 thawi methods used 54 Garbage refuse properly 35 ometers 3; accurate disposed; facilities maintained . 55 Physical facilities installed, 37 Food properly labeled; original maintained. 8? clean ntainer 55 Adequate ventilation lighting; .., - designated areas used - th?md?itieftaII-?teq?lra af?liated 3131.13" 2:1" Anti- -choking procedures in food Insects. rodents. animals not 38 sent M1 . . ntamination prevented during serVIce establishment 39 preparation. storage and M2 allergy awareness - ,T?Frr 'Itt'a'te 40 al cleanliness M3 Caterer 41 ng cloths: properly used M4 Mobile Food Operation tored M5 Temporary Food Establishment 42 ashi fruits bles M6 Public Market; Farmers Market t? I: of: I M7 Residential Kitchen; Bed-and? 43 In- -use utensils stored Breakfast Operation 44 sils. equipment linens: M3 Residential Kitchen: Cottage Food stored. dried. 8t handled Operation 45 ingIe-use single-service articles: M9 School Kitchen; USDA Nutrition stored used Program 46 Gloves used M10 Leased Commercial Kitchen . Inf-,3. - and 3- M11 Innovative Operation Food non-food contact surfaces Tr?: at UEII 47 enable. PFOPBFIY designed, L1 Local law or regulation structed used L2 Other Type of Operation(s): goofinspection: Otherlnformation: ?fnort Service Establishment uilnB 4 Retail Food Store e-inspecllon gahoa .- ?/??twmy Residential: Cottage Foods El Pre-operational Residential; Bed Illness investigation Breakfast El General complaint El Mobile/Pushcart El HACCP Temporary Food Estab. Other Other fl I I I - Signature ofPerson- Irl- -Charg5HM {Vim/? Date: 4; .Al ~00 signature I /J,r Form 734A-2 A..M Sutkin Co.. Charlestown, MA Food Establishment Inspection Report City/Town of ??og/7727119? 7422/ [Establishment ?/Mm?y [Data @113 Page lofi Tem ra item 1 Location Tern item I Location Item! Location Observations and/or Corrective Actions Violations he stated below or 3 r1 8-405. 1 of the Food Section of Code Description of Violation Date to Correct By Item Number 1" Signature ofPerson-ln-Ch 1 Data: - Signature . Data: 4 I Form 7343 AM. guitar? (20., CharlestownfMA ?or THE OF MASSACHUSETTS TOWN 0R CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT-JINSPECTION REPORT i" Name Date T?pe of Ogerationte} of Ins ec ion 1: 54/ i/Yg Food Service I i Routine Address 0' Risk? Retail El Rea-Inspection r" Level Residential Kitchen Previous Inspection 6 OP one *2/37 Datlite-operation Owner Mag/w? HACCP YIN Caterer Suspect Illness Person in Charge (PIC) Time Bad Breakfast El] 332%? Complaint In: Inspector 115% Out: Permit No. Other Each violation checited requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne illness interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) (j 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 El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. TagsIRecordsiAccuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. [j 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board Of Ith. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other tr Tobacco 590.009 (F) Allergen Awareness 590.009 (0) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) [3 16. Cooking Temperatures D17. Reheating [318. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of ConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: Inspector?s Signature: 74/2/41; Prim; (?La 73$? j? r?ii A PlC?s Signature: Print: Vl-Y?f -. W?M/fml? Page?iyLPages FORM 734A AM.SULKIN CO. CHARLESTOWN.MA THE OF MASSACHUSETTS TOWN OR CITY OF 4974'; 2,1 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT IHSEECTION REPORT Name 3% Dat/ a oil '3 action .4, . IRoutine Address or? Risk El Retail El Re-Inspection ~57? Level Residential Kitchen Previous Inspection Telephone Mobile Eire: Temporary Pre-operation Owner (4 11%? 4,,If'yd HACCP YIN Caterer El Suspect Illness Person in Charge (PIC) - Time El Bed Breakfast 322%? Complaint In: Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an Imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD ROTECTION MANAGEMENT . EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedIExciuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. ReceivingICondItion 6. Tags/RecordsIACcuracy of Ingredient Statements El 7. Conformance with Approved ProcedureslI-lACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations 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 . 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) [j [112. Prevention of Contamination from Hands D13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures "3 g; If 17. Reheatlng a/ El 18. Cooling .. D19. Hot and Cold Holding #77" a A 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an Inspection today. the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report. when signed below by a Board of Health member or Its agent constitutes an order of the Board of Health. Failure to correct violations Cited In this report may result In suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: it: CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related Inspector?s Signature: Print: PlC?s Signature? ,r 1 Ext/?3; Lam: Pagefdgi?Pages 'i FORM 734A AM. SULKIN CO. CHARLESTOWH .393 Print?n r6341 Elm laui THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date eofO oration of Ins ecio I i Food Service I ii Routine Address Risk Retail Rte-inspection Level Residential Kitchen Previous Inspection Telephone 8 Mobile Elsie: Temporary Pro-operation Owner HACCP YIN CI Caterer Suspect Illness Person in Charge (PIC) Time El Bed 8. Breakfast General Complaint In: HACCP Inspector Out: Permit No. Other violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingICondition El 6. TagsIRecordsIAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violations 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 ofHe Food Contact Surfaces Cleaning and Sanitizing 23. 24. 25. 26. 27. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste (Fc-silsso.0os) Physical Facility Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (0) D12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or ColorAdditives U15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures D17. Reheating I, 1 - D10. Cooling I19. Hot and Cold Holding . 20. Time As a Public Health Control CONSUMER ADVISORY 22. Posting of Consumer Advisories REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP 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 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other one OF . Inspector?s Signature: Print: Signature: Print: annu "run A ll Elli VIM r?n Dunn] :c'l'niluu IIA Food Establishment Inspection Report City/Town of Establishment: Pf,??f Address: Fry?g??; 53/- 93313:.? __i;age1of_g_ Time in: Time out: Telephone; Permit No.1 Owner: Number of Violated Provisions Related to Foodborne Illness Risk Factors and Interventions (items 1 through 29): Person-in-charge: Inspectorz??lW 2W Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): FOODBORNE RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN Compliance Status IN Supervision Protection from Contamination 1 Person-in-charge present, demonstrates a 15 Food separated and protected k00W edge. and performs dUtieS 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, . Management food employee and 17 previously reconditioned 8i "1 3 conditional employee; knowledge. unsafe fOOd responsibilities and reporting TimelTemperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures 5 Procedures for responding to vomiting 19 Proper reheating procedures for hot and diarrheal events holding 900d Hygienic Practices 20 Proper cooling time and temperature 5 Pr?iper eating, tasting, drinking, or 21 Proper hot holding temperature :3 :ccohuse 22 Proper cold holding temperature 7 mgutlrsic arge rom eyes, nose, an 23 Proper date marking and disposition . . 24 Time as a Public Health Control Preventing Contamination by Hands Consumer Adwsory 8 Hands clean properly washed . . No bare hand contact with read -to-eat 25 Consumer adVIsory prowded for raw/ 9 food undercooked food 10 Adequate handwashing sinks properly . Highly SusceptibriebPoiZjuicatiodns supplied and accessible 26 Pasteurized foods used, pro I ite 00 [l Approved Source not offered . FoodlColor Additives and Toxic Substances 11 Food obtained from approved source . . . Food additives: approved properly 12 Food received at proper temperature 27 used 13 F203 900d condition, safe, 8? 28 Toxic substances properly identified. a a stored used 14 Reqwred records available. Conformance with Approved Procedures tags. paraSIte destruction . . . . . 29 Compliance With variance speCIalized process] 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 Reinspectlon: Discussion with Person-in-Charge: Signature of Person- in- ?Charge J, 7/4 ,5 Date: 2 Signature of Inspector: /f Date: Form 734A-1 A..M Sulkin Co., Charlestown, MA Food Establishment Inspection Report? City/Town of 150/7474 5735/ Establishment: Jyf/%7L lDate: 2 Page 2 MA GOOD RETAIL PRACTICES AND MASSACHUSETTS- ONLY SECTIONS IN- - in compliance out of compliance NIO- - not observed not applicable COS- corrected on-site during inspection repeat violation Compliance Status I Compliance Status Lil lN llour cos Safe Food and Water Warewashing facilities: installed, 30 Pasteurized eggs used where .. 48 maintained. test strips required 49 Non?food contact surfaces clean 31 Water ice from approved source Physical Facilities Variance obtained for specialized Hot cold water available; 32 processing methods 50 adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage 8. waste water properly temperature control disposed 34 Elag't food properly cooked for hot 53 Toilet featujres: 0 mg cons ruc ,supple . ceane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; faCIlItIes maintalned Food Identification 55 Physical facilities installed. 37 Footd properly labeled; original lighting' con ainer Prevention of Food Contamination 56 designated areas ?59d Insects rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present 1 M1 Anti-choking procedures in food Contamination prevented during M2 39 food preparation, storage and 00 a ergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 [Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment 42 Washing fruits vegetables M6 Public Market; Farmers Market Proper U59 0f Utensils M7 Residential Kitchen; Bed-and- 43 ln-use utensils properly stored Breakfast Operation 44 Utensils, equipment 8. 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 properly M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 Innovative Operation Food non-food contact surfaces Local Requirements 47 cleanable, properly designed, L1 Local law or regulation constructed used L2 Other Cl Retail Food Store '1 -inspection 1670 until/'6' El Residential: Cottage Foods El Pre-operational a/ Cl Residential; Bed Illness investigation 5/00/ 6 Mfg/?f Mar Breakfast General complaint CI Mobile/Pushcart [j HACCP Tipfof Operation(s): Igpection: Other information: I I -ood Service Establishment #17 W/ace 717/6) S?r/ Cl Te orary cod Eslab El other ther Signature ofPerson In Charge?.714 I Date: 3%7/f7 Form 734A-2 AM. Sulkin Co., Charlestown, MA THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF rib 0' 5 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tiger of2Og"eration(sl T?ge gt Inspection -22 - "Food Service tirre Address Risk Retail E?R?e?nspectioMX/? '7 Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner .2 HACCP YIN Caterer DSUSpect Illness Person in Charge (PIC) 27 Time Bed 8. Breakfast General Complaint In: El HACCP Inspector Out: Permit No. Other violated. Violations Related to Foodborne Itlness 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 I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictediExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivingiCondition El 6. TagsIRecordsiAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Viol 5 ate ed to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 23. 24. 25. 26. 27. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste (Fc-eiiseopoe) Physical Facility Each violation checked requires an explanation on the arrative page(s) and a citation of specific provision(s) Non-compliance with: Anti-Choking 590.009 (E) 590.009 (F) Allergen Awareness El [:112. Prevention of Contamination from Hands 1. 3. Henri-Nash Facilities ,2 PROTECTION FROM CHEMICALS I . I I If, .r 14. Approved Food or Color Additives I: "3 42.2 Ci 15. Toxic Chemicals 29:7 ?4 TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods] 242% (A 16. Cooking Temperatures 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 Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or Its agent constitutes an order of the Board of Health. Failure to correct violations cited In this report may result i?nsuspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this orderI you have a right to a hearing. Your request must be In writing 28. Poisonous or Toxic Materials IFC-TII590-008) and submitted to the Board of Health at the above address 29. Special Require ants (590.009) within 10 days of receipt of this order. - 2 30. Other W: Rafe/7 Inspector?s SignetiIi-e': Print: PlC?s Signature: Print: Pagc;of4Pagcs ("I?ll?fled COMMONWEALTH OF MASSACHUSETTS TH TOWN OR CITY OF i??mrhs??f massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date ot?O eratlon I 5 action jot/Mair? 5 227 Food Service MEI Routine Address Di Risk Retail Ree?inspection (961560 Level [3 Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pro-operation Owner . HACCP YIN Ca?erer Eguspect Illness pe In Char p33,. - . Time Be Breakfast eneral Complaint '30 ge (- 28? In. HACCP Inspector Out, Permit No. Other Each violation checked requ-ii'es an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Food borne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590-009 (F) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned i Knowledgeable I Duties EMPLOYEE HEALTH [3 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. ReceivingICondition El 6. TagsiRecordslAccu racy of ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing CI 10. ProperAdequate Handwashing 11. Good Hygienic Practices Violations 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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste '27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. l-landwash Facilities Ef?iw/g ?7 may/?? PROTECTION FROM CHEMICALS ?/czm {2,113 14. Approved Food or Color Additives D15. Toxic Chemicals tic/c; 4?76 Wee TIMEITEMFERATURE shy I?zgfe?. teat/r?. [116. Cooking Temperatures I Edi-H /A/p?f 3/4; 11; D17. Reheating 171/ Mitt/ti waite?aa/a?. D18. Cooling E119. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSPI 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. lf 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: Inspector?s Siglinth/Qvfj Mg? [Iv 11/. I I FORM 734A AM SULKIN CO. CHARLESTOWN. MA (z i \b?C/rcm COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date 010 oration in 3 oodlService Sardine Address a Risk IT Retai e~inspeciion 6/35 (9 (/9f I [/14 Level Residential Kitchen Previoua Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACOP YIN Caterer DSuspect Illness person in Charge (plc) Time Bed Breakfast General Complaint Inspector 7/ A '27/ Out Permit No. El Other Each violation checked requires an efplanation on the narrative page(s) and a citation of specific provision(s) VIolated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective T0b80?? 590-009IFI action as determined by the Board of Health. mamm? 590-009 FOOD PROTECTION MANAGEMENT 1. PIC Assigned i Knowledgeable! Duties EMPLOYEE HEALTH 2 Reporting of Diseases by Food Employee and FIG 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source El 5. ReceivinglCondition 6. TagisecordslAccuracy oi Ingredient Statements El 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Ggod Re?ll (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 23. Management and Personnel 24. Food and Food Protection (PC-summon) 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials tremendous) 29. Special Requirements (590.009) 30. Other 12. Prevention of Contamination from Hands fr? 13. Handwash .3 {ti/Ir It? Cit/"Jas- ?.7437. PROTECTION FROM CHEMICALS +417) ran? E114. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures D17. Reheating 18. Cooling 19. Hot and Cold Holding ymt?f 112W 20. Time As a Public Health Control 9 74 Twp?? REQUIREMENTS FOR HIGHLY SUSCEFTIBLE POPULATIONS (HSPI 21 Food and Food Preparation for HSP CI 22. Posting of Consumer Adwsones Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result In suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be In writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. OF RE-INSPECTION: Inspector?s Signature. it! ?in? 1, {Dz/1444 PngeLolLZiPn gee FORM 734A A..M SW66. MAN. Food Establishment Inspection Report City/Town of 180/272 12 57V Date: - 5.. [9 Page1ofi Establishmer?il: 95% Zn 650 Time in: Time out: [m 994;.ch pin. Telephone: Permit No.: Number of Violated Provisions Related Owner: to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): Number of Repeat Violations Related .. Person-in-charge: - 4 - to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): FOCDBORNE m??K FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during Inspection- repeat violation Compliance Status IN I IN Compliance Status Supervision Protection from Contamination 1 Person-in-charge present, demonstrates Ill; lg 15 Food separated and protected knowledge. and performs duties ll 16 Food-contact surfaces; cleaned 8. p. 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, at Management, food employee and 11:7 in} 17 previously served, reconditioned 8. {it 3 conditional employee; knowledge, unsafe food ,4 responsibilities and reporting 13$ Timerl'emperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures 5 Procedures for responding to vomiting 33? I 19 Proper reheating procedures for hot and diarrheal events in} i2? holding 900d Hygienic Practices 20 Proper cooling time and temperature 6 Pigper eating, tasting, drinking, or an? 21 Proper hot holding temperature :3 :9Cohuse 22 Proper cold holding temperature 7 minut?c arge rom eyes, nose, and 23 Proper date marking and disposition . . . 24 Time as a Public Health Control Preventing Contamination by Hands . Consumer Advisory 8 Hands clean properly washed . . . No bare hand contact with read ?to?eat 25 Consumer adVIsory rowded for raw/ 9 undercooked food food Highly Susceptible Populations Adequate handwashing sinks properly . . . . 10 supplied and accessible 26 Pasteurized foods used, prohibited foods Approved Source not offered c: . . Food/Color Additives and Toxic Substances 11 Food obtained from approved source av . .. . Food additives: approved properly 12 Food received at proper temperature 27 used (2 - - 1i," . 13 F003 1:06:16: 900d condition, safe, 8? 28 Toxic substances properly identified, 2? una era stored used 14 Reqwred records available. Conformance with Approved Procedures tags, parasue destruction 2 (0 Compliance with variance specialized process HACCP Plan Of?cial 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 Relnspectlon: Discussion with Person-in-Charge: 3 a. /9 . Signature of Porso Signature of Inspector: Form AM. Sulkin Co., Charlestown, MA .2 .. Datez? Food Establishment Inspection Report? City/T own of 150/41 Establishment: Date. 7136 PageZof: ?gammy raw: in compliance outof compliance not observed NiA-notappilcable corrected on-slte during inspection R- - repeelvlolation Compliance Status IN our mo cos Com StatUS airewlashing facilities: installed, 30 Pasteurized eggs used where aintained used; t95t required 49 contact surfaces clean 31 Water ice from approved source fl 32 Variance obtained for specialized 50 cold water available; processing methods ure EST 51 umbing installed; proper backflow Proper cooling methods used; BVICGS 33 adequate equipment for 52 waste water properly temperature control 34 Plant food properly cooked for hot 53 oiiet features: properly holding . su ied, cleaned 35 Approved thawing methods used 54 ge refuse properly 36 Thermometers provided accurate i facilities maintained . 55 Physical facilities installed, 37 Food properly labeled; original aintained, 8? . container 56 uate ventilation lighting; {33 ?1 areas used 38 Insects rodents, animals not . present M1 procedures in food Contamination prevented during establishment 39 food preparation, storage and M2 3 awareness display 40 Personal cleanliness M3 rer 41 Wiping cloths: properly used obiie Food Operation M5 em Food Establishment 42 Washin fruits vegetables M6 ublic Market; Farmers Market aili?'m??i . x. . 3 M7 Kitchen; Bed-and- 43 In-use utensils properly stored 44 Utensils, equipment linens: M8 Kitchen: Cottage Food properly stored, dried, handled 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used 46 Gloves used properly 1 Leased Commercial Kitchen Equipment F, Jim: Mi1 innovative on Food 8. non-food contact surfaces - 47 cleanabie. properly designed. L1 Local law or ulation constructed used L2 golf Operationis): gem Inspection: Other Information: nod Service Establishment outine Retail Food Store Re-inspection ;Wd( Residential: Cottage Foods Pre-operational Residential; Bed 8. illness Investigation Breakfast El General complaint El MobIIeIPushcart El HACCP El Temporary Food Estab. Other Ei Other 11/? Signature ofPerson-IW/ Date: BignetureoiinspectW [ii y??X Datez? /j Form mSulkin Co. Charlestown, MA Food Establishment Inspection Report - City/Town of wM/hf??/ [Establishment Samoggyl JDale: Q?s .. Pageiofi .- u? I Tern re Obser?Vations Item! Location Tem Item I Location Tern Item I Location Tern Observations and/or Corrective Actions Vloi 5 must a or 05.11 the Code item Section of Code Description of Violation Date to Correct By Number :2 Signature of Person-in-C nature of Form 7348 Suit-tin Co., Char! THE COMMONWEALTH (if: MASSACHUSETTS TOWN OR CITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date - eofO stations eo.. ns? ction 1 I I F600 Service 'Ro Address Risk Cl Retail M57 -- . Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pro-Operation Owner HACCP YIN Caterer EISuspect Illness Person in Charge (PIC) Time El Bed&Breakfast General Complaint In. HACCP Inspector - Out. Permit No. EIOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an Imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE E) 4. Food and Water from Approved Source El 5. Receiving/Condition 6. TagisecordslAccuracy of Ingredient Statements El 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. ProperAdequate Handwashing El 11. Good Hygienic Practices Violations 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 a 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous 0r Toxic Materials Non-compliance with: Anti-Choking Tobacco 590.009 (F) Allergen Awareness 590.009 (3) 12. PJeventIon of Contamination from Hands D23. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures :1 U17. Reheating I, El ,18. Cooling . 19. Hot and Cold Holding 41/; 20. Time As a Public Health Control 5,477 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP 47.31am? -r/r VJ- CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the Items checked indicate violations of 105 CMR 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be In writing and submitted to_the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF . . (M, . .- Inspector?s Signature: - ?ff: Print: . 1 I . Signature: I Print: FORM 734A AMSULKIN CO. CHARLESTOWN.MA THE COMMONWEALTH OF MASSACHUSETTS .2 TOWN ORCITY OF Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name Date of eration fins action - 02'6 ?Ig and Service =1gimme Address Risk Retail Rte-inepeclion Level Residential Kitchen Previous Inspection Telephone Mobile Data: Temporary Pre- -operation Owner HACCP YIN Caterer E'Suspect Illness Bed Breakfast General Corn Iaint Person In Charge (PIC) {/21 A TIme HACCP In: Inspector Out? Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Antl-choklng 590.009 (E) El Violations marked may pose an imminent health hazard and require Immediate corrective 590-009IFI action as determined by the Board of Health. ?awn? 590-009 El FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands . - I . El 1. PIC I Knowledgeable I Duties CI 13' Han dwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS C114. Approved Food or Color Additives - .r D15. Toxic Chemicals ,2 464% .. TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition El 6. TagsIRecordslAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 16. Cooking Temperatures D17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control - . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONs (HSP) 9. Food Contact Surfaces Cleaning and 21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing . . . CONSUMER ADVISORY 11' G??d HygienIc PractIces 22. Posting of Consumer Advisories ?mam? 331%th to Retail Pra__1Lc__?c 5? (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22); of Health. Non-critical (N) violations must be corrected Of?cial Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, that Items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an ranzger?tint ad": order of the Board of Health. Failure to correct violations 0? an r0 9? on (F '3?590'004) cited in this report may result In suspension or revocation of 25. Equipment and Utensils the food establishment permit and cessation of food 26- Water, Plumbing and Waste establishment operations. If aggrieved by this order, you 27- Faculty have a right to a hearing. Your request must be In writing 28. Poisonous or Toxic Materials IFC-7II590-008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF Inspector's Signature: Print: Signature: I Print: Page_Lof_/_Pages Tun A RI II In? (?11 I?l-lnDI curl-nun: un HE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF /h .11 5743/? Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Namaf?/ Da amt! a fin W154 5? and Service Routine Address 7Q) .. Risk Retall e-lnspeciion I Level Residential Kitchen Previous Inspection eep one Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness Person in Charge (PIC) Time Bed Breakfast 3:22? Complaint . In: Inspectoer/Ka l. 5 4? m1 Out: Permit No. El Other Each violation checked requifes an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) [j Violations marked may pose an imminent health hazard and require immediate corrective 590-009iF) action as determined by the Board of Health. Allergen Awareness 590.009 El [112. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) Cl 16. Cooking Temperatures El 17. Reheating D18. Cooling D19. Hot and Cold Holding 550:5 El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation Ior HSP FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictediEchuded FOOD FROM APPROVED SOURCE Cl 4. Food and Water from Approved Source El 5. ReceivingIConditicn [j 6. TagsIRecordsiAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Eggs]! (Blue CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected immediately or within 10 days as detennlned by the Board of Health. Non-critical (N) violations must be corrected Immediately or within 90 days as determined by the Board 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility (Fe-sussomr) 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Of?cial Order for Correction: Based on an Inspection today, the items checked indicate violations of 105 CMR 590.000IFederaI Food Code. This report, when signed below by a Board of Health member or Its agent constitutes an order of the Board of Health. Failure to correct violations cited In this report may result in suspension or revocation 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 RE-INSPECTION: Inspector?s Signature: Signature: . Print: x1 I. 3 ?12/ Am ?in" ?0M/??lm i I?acheLLPa chI FORM 734A AM. CHARLESTOWN. MA Food Establishment Inspection Report City/Town of @5102? 557/? gablishment: Skl/ Date: 2 Pagel of: Address: Dr? Time in' 2O Timeout: /5 Telephone: I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: and Interventions (items 1 through 29): Person-in-charge:\ )3 Po" fr; Number of Repeat Violations Related to Foodborne Illness Risk Factors Inspector: W2 /Wf and Interventions (items 1 through 29): FOODBORNE AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status Compliance Status IN 0Ln ~m ~ro cos Supervision Protection from Contamination 1 Person-in-charge present. demonstrates 15 Food separated and protected knowledge. and performs duties 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned. Management food employee and 17 served. 8r. 3 conditional employee; knowledge. unsafe fOOd responsibilities and reporting TimelTemperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures 5 Procedures for responding to vomiting 19 Proper reheating procedures for hot and diarrheal events holding Good Hygienic Practices 20 Proper cooling time and temperature 5 prer eatlng. drInkIng, or 21 Proper hot holding temperature to 3960 use 22 Proper cold holding temperature 7 from eyes. ?059? and 23 Proper date marking and disposition . . 24 Time as a Public Health Control PreventIng Contaminatlon by Hands . Consumer AdVIsory 8 Hands clean properly washed . . No bare hand contact with read -to-eat 25 Consumer advrsory prowded for raw/ 9 undercooked food fOOd hl tible Po ulations 10 Adequate handwashing sinks properly . If; udcep h'b?t 2f supplied and accessible 26 asteurIzed foo Approved Source not offered . FoodfColor Additives and Toxic Substances 11 Food obtaIned from approved source . . . Food addItIves: approved properly 12 Food recered at proper temperature 27 used 13 F003 rlecelrecd 900d condItIon. safe. 8? 28 Toxic substances properly identified. una era . stored used 14 ReqUIred records avaIlable. Conformance with Approved Procedures tags. paraSIte destruction . . . . . 29 CompIIance WIth varIance speCIalIzed process 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 Reinspection: Discussion with Person-in-Charge: Signature of Person-in-Charge: Date: - 1 (MW - 6 Igna ureo Inspector: MW 7 a e. 2:20- Form 734A- 1 AM Sulkin Co., Charlestown, MA Food Establishment Inspection Report City/Town of 1160/74/4sz Establishment: Sly/V lDate: 3 Page2 of; [2 GOOD RETAIL PRACTICES AND MASSACHUSETTS- ONLY SECTIONS IN in compliance out of compliance not observed NIA not applicable corrected on- site during inspection repeat violation Compliance Status IN lourlumlulolcos] a Compliance Status IN OUT MA M0 cos Safe Food and Water 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 Physical Facilities 32 Variance obtained for specialized 50 Hot cold water available; processmg methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backfiow Proper cooling methods used; themes 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, suppIIed, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained Food Identification I 55 Physical facilities installed, maintained, clean Food properly labeled; original Adequate ventilation 8. lighting; container 37 56 designated areas used Additional Requirements listed in 105 CMR 590011 M1 Anti-choking procedures in food service establishment Insects, rodents, animals not 38 present Contamination prevented during 39 food preparation, storage and display M2 Food allergy awareness Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 [Caterer M4 Mobile Food Operation M5 Temporary Food Establishment 41 Wiping cloths: properly used stored 42 Washing fruits vegetables M6 Public Market: Farmers Market Proper Use of Utensils 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 Single?use/ single-service articles: School Kitchen; USDA Nutrition 45 M9 properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen UtensilsI Equipment and Vending .. M11 innovative Operation Local Requirements Li Local law or regulation Food non-food contact surfaces 47 cleanable. properly designed, constructed used L2 Other ype of 0peration(s): of Inspection: Other Information: and Service Establishment oullne El Retail Food Store e?inspection . El Residential: Cottage Foods Pre-operational 5/ . HM 91 k? IZI Residential; Bed 8. Illness investigation Breakfast General complaint Mobile/Pushcart El HACCP Te pore Esl b. Other r?x Signature of Person-in-Clt Date: Signature mm/ Dat e: '5 0223/9; Form 734A-2 AM. Sulkin Charlestown. MA Food Establishment Inspection Report? City/Town of M/?z/h 533/? [Estabiishment 0/54/ f/l/FJ/ ?Date: 3 910 ./57 Pageiofi] Tem ure Obsewat Item I Location Item I Location Tem Item I Location Observations and/or Corrective Actions must be corrected [he or .1 the Food 3 Item Number Section of Code Description of Violation Date to Correct By a I Signature of Person-In Charge%1 r} Date: .M Signature ofinapactor: Wim Date: 5 1720 Form 7348 AM. Sutkin Co., Charlestown, MA