Food Establishment Inspection Form The Commonwealth oi Massachusetts Violations City of Newburyport Board of Health . . . . . . 60 Pleasant Street, Newburyport. MA 01950 Prlorlty- Priority foundation- Core- (97'31465-4410 Score (optional) Time Out n" EL 55' "mi? ?3111? . - Le Risk Category of oration nge of inspection L2 a ?ling?! J- Food Service CIRoutine L/?l (L EIRetail L?JReinspection Terephone HACCP WE) DResidential Kitchen Previous Inspection Date: . . DMobile Owner . BEETDDTEW Egre-Opfrl?tion Person-ln-WMPIC} .1 F0 at =ingl a erer uspec ness i It: I I I 5:535; Breakfast : General Complaint inspector DFarmer's Market EIHACCP UOther: DOther: FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designeled compliance status UN. OUT. HID. Mini for each numbered Item IN in compliance OUT not in. compliance Hr? not observed me not Compliance Status l3 ?:3th cos Ft Merit in appropriate bot: for COS andror [:05 corrected on-sito repent Compliance Status COS - - Proper dispostlion of returned, previously SLIPGNISIOH 17 I IN OUT served. reconditioned unsafe food our pegg?z?mhagmm 9" 3" Time-l Temperature Control for Safety 2 NIA Certified Food Protection Manager 18 NIA NIO Proper cooking time 8. temperatures Employee Health 19 NIA NIO Proper reheating procedures for hot holding Management, tood empioyee and conditional 3 employee; knowledge. responsibilities and 20 NIA NIO Proper cooling time and temperature A reporting 4 MW Proper use of restriction and exclusion 21 QNIOUT Nlo Proper hot holding temperature 5 to vom'lmg and 22 NIA NIO Proper cold holding temperature Econ H?gtenlo Practices 23 {gout Proper date marking and disposition (IN OUT HID Proper eating. lasting. drinking. or tobacco use 24 OUT MA MD Time as a Public Health Control lhI UT NIO No dischar eirorn eyes. nose. and mouth l?thISO til - Consumer advisory provided Id-l' row! I I a Preventing Contamination by Hands 25 I IN our? 6 your NIO Hands clean property washed Requirements for Highly Susceptible Populations - 9 @our NIA NIO No bare hand contact with RTE food 25 NIA 23:2?" ??h'b'led "Sinks Properly supp is Food i Color additives and Toxic Substances A Approved?ource 27 J5. OUT ?lthy Food additives: approved 8. property used ?i 1 Food obtained from approved source 28 IN OUT NIA Toxic sub. properly identi?ed, stored 8. used 12 (Iii N10 Food received at proper temperature Confonnancerwith.tApproved .Procedu res Food received In good condition, safe. 8. I 3 I Compliance with variance I specialized process I I 13 UT unadulterated 29 IN GUT IHACCP Pla_n 14 ?om. NIA Required records available: snetlstocI-t lags. Risk Factors are important practices or procedures identi?ed as the most A Protection from Contamination prevalent contributing factors of foodbome illness or injury. Public health 15 WOW NM F??d Pi ?1mm interventions are control measures to prevent foodborne illness orl'njury. 16 NIA Food-contact surfaces: cleaned E. sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventalivo measures to control the oi pathogens. one mrcats. and physical objects this tends. Merl: In epgrom'alo boil: for ('03 Ft (:05 a corrected onrsile during inelastic-n repeat violation Marti in boat ti numb-cred item ts not in compliance Compliance Status cos Compliance Status cos . Safe Food and Water Proper Use of Utensils 30 Pasteurized eggs used where required 43 (In-use utensils properly stored 31 Water 8r ice from approved source 44 t/ Utensils. equipment a linens: properly stored. dried, 8- handled 32 Variance obtained for specialized processing methods 45 Single-use! single-service articles: properly stored used Food Temperature Control 45 v" Gloves used property 33 tori mg?'g?fm ?Wm? ?it Utensils. Equipment and Vending 34 Plant food properly cooked for hot holding 47 surtaces cleanabte. properly 35 [approved thawing methods used 48 ?Warewashing facilities: installed. maintained. used; test strips 35 U4, Thermomelers provided accurate 49 I If! Non-tood contact surfaces clean Food Identi?oation Physical Facilities 3? I I Food properly labeled; original container I I 50 Hot cold water available: adequate pressure .. Prevention of Food Contamination 51 v? Plumbing installed; proper backilow devices 38 1/ Insects. rodents. 8. animals not present 52 Sewage waste water properly disposed 39 E?tSJnIzminetion prevented during food preparation. storage and 53 V?Toilet features: properly constructed. supplied. cleaned 40 y) 1, Personal cleanliness 54 1/r?Garbage 8. refuse property disposed: facilities maintained 41 tMping cloths: properly used a- stored 55 V?Physical facilities installed. maintained. 8: clean 42 Washing fruits 8. vegetables 56 1/ Adequate ventilation 8. lighting. designaled areas used 5? SPECML REQUIREMENTS OTHER EIAnti-choking DAllergen Awareness ElLocal law regulation Elglher and cessation of ten (10) calls n??bm Of?cial Order for Correction: Based on an inspection stobll day-s of receipt oday. the items checked indicate violations of the Board of Health Food Regulation 2013 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 nt 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 this order. 5 er?th Print: IOIMLIA (Ora. LEAK Date:L I Follow-up: YES (circle one) Follow- -up Date, if applicable: IssIlt Food Establishment Ins tion Form at The Commonwealth of Massachusetts City of Newburyport Board of Health Establishment Name: 14? so Pleasant Street, Newburyport. MA 01950 a a 8- 465-4410 57 RA ATIONS Item I Location Tem Item I Lo on ?9.4 OBSERVATIONS ANDIOR CORRECTIVE ACTIONS Violations cited in this must be corrected the time frames or as stated in Section 11 the Food Code PF Foundation 10 Core tem Code . . . . Date Number Section PF. 0 Descr'Pm? Veri?ed 2: Corrective Action Required UYes El Employee Restrict IEchude El Re-ins Scheduled El Emergency Emergency Closure Volunta El Other Date: .2, Signature .1 1EI1B NOTE: This establishment was found to be in compliance with items 30 56. The form was incorrectly completed at the time of inspection. Please contact the Newburyport Health Department for confirmation 978-465-4410. ;tt Food Establishment Inspection Form Page I Date {(52 I onwealth of Massachusetts it Violations uryport Board of Health . . . .Street Newburypo rt A 01950 Priority Priority foundation- Core Time In pvt-4t tars) 465-44113 CitvofNewburvoon con-I Score {optional} Time Out I '3 r?I/l RISK Category 1' 9-hf gratin" 5 la tip?LU . Emmi It} LL Food Service outine 33?; [15-1 {.11 I11 [:IRetail UReinspection Telephone HACCP YIN [:IResidential Kitchen Previous Inspection Date: . EIMobile 0wnar Perm? EITemporary ClPre-Operation Person harge Food Safely TraininglExp Date EICaterer DSUS ect Illness We run rarest-Li?? Inspector .j kiwi/.7 I ElOther: Breakfast Market EIHACCP I:IOther: CIGenerai Complaint FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status llN. OUT N10 for each numbered item - not a =in compliance not In compliance not observed N1 Marti. Jl' In appropriate butt for COS anoror (:05 I: corrected on-siie during inspocoori agent violation licable cos I Compliance Status Com Ifance Status cos . . Proper disposition of returned, previously . SuperVIsmn 17 IN OUT served. reconditioned 8. unsafe food PIC re ent. demo I ates kno I e. and . 1 ?our pe?g?rm: dunes "5 we 9 Time 1 Temperature Control for Safety 2 OUT Certified Food Protection Manager 18 (WOUT N10 Proper cooking time 8. temperatures Employee Health 19 MUT N10 Proper reheating procedures for hot holding Management. food employee and conditional OUT employee: knowledge, responsibilities and 20 OUT N10 Proper cooling time and temperature reporting 4 GI OUT Proper use of restriction and exclusion 21 OUT N10 Proper hot holding temperature ocedure l' res ond? omitin and . 5 OUT dirarrheal straits mg 0 22 N10 Proper cold holding temperature Good Hygienic Practices 23 Hour N10 Proper date marking and disposition 6 IN OUT N10 Proper eating tasting. drinking. or tobacco use 24 EN) OUT N10 Time as a Public Health Control 7 IN our N10 No discharge from eyes. nose. and mouth Consumer Advisory Consumer advisory prowded for rawl Preventing Contamination by Hands 25 I IN OUT undercooked food 8 E11 our N10 Hands clean a properly washed Requirements for Hi Susceptible Populations 6i our N10 No bare hand contact with RTE food 26 I IN our NIA ?sedlied to 6 OUT 311321235511; ??35 5 pm? pp Food 1 Color Additives and Toxic Substances .5 Approved Source 27 qwour NIA Food additives: approved it. properly used 1 1 (Si OUT Food obtained from approved source 28 Toxic sub properly identi?ed stored at used 12 @311 our N10 Food received at proper temperature Conformance with Approved Procedures Food received in good condition. safe. ti II Compliance variancel specialixed process 13 OUT unadulter?ad 29 moose P511 14 N10 Required records available: shellstock tags. Paras? ?Strum? Risk Factors are important practices or procedures identified as the most Protection from Contamination prevalent contributing factors of foodborne illness or injury. Public health 15 OUT 599mm" and 9mm? interventions are control measures to prevent foodborne illness or injury. 16 IN OUT Food-contact surfaces; cleaned 8. sanitized GOOD RETAIL PRACTICES Grind Practices are preventative mes was to control the addition of ?nogons. chemicals. and physical objects into foods. Ma?a In DUI if numbered ?am f?lDl ll'i EDITIPIIEFIDB am 1:05 corrected Ion-silo during inspection Compliance Status Merit in opnato box Ior C05 anal i COS Com pliance Status Ire an! violation COS Safe Food and Water Proper Use of Utensils 30 Pasteurized eggs used where required 43 ln-use utensils properly stored 31 Water a ice from approved source 44 Utensils. equipment linens: properly stored. dried. 8. handled 32 Variance obtained for specialized processing methods 45 Singleuse {single-service articles: properly stored 8. used - Food Temperature Control 46 Gloves used properly 33 aggzg??ngomirads ?sad; adequate equ'pmem for Utensils, Equipment and Vending 34 Plant food properly cooked for not holding 47 3:51: (32310:: :gntact surfaces cleanabls. properly deSIgned. 35 Approved thawing methods used 48 Warewashing facilities: installed, maintained. 8. used: test strips 35 Thermometers provided accurate 49 Non?food contact surfaces clean Food Identi?cation Physical Facilities 37 I I Food properly labeled; original container I I 50 Hot 8. cold water available; adequate pressure Prevention Of Food Cont-minatton 51 Plumbing installed; proper backflow devices 38 insects, rodents, as animals not present 52 Sewage waste water properly disposed 39 dCiZEIzsiination prevented dunng mud preparation. storage and 53 Toilet features: properly constructed. supplied. 8. cleaned 40 Personal cleanliness 54 Garbage refuse properly disposed: facilities maintained 41 Nping cloths: properly used 8. stored 55 Physical facilities installed. maintained. 8. clean 42 Washing fruits 8 vegetables 55 Adequate ventilation 8. lighting: designated areas used 57 SPECIAL OTHER : Anti- choking (590. onsiEl) ElTooacco (590. 009111) Awareness ElLocai law reguiation EIOther a Board at in member or its agent oorislil and cassette of food establishment operatic __t_en cateridor d__e_ys of receipt or this order cud-F?- Dt-l'lctal Ordnr tp'r Correction. Based on an insoemtor today. the items cheated indicate violations of the Board of Health Food Regulation 1 2013 Federal Food Code This report when signed below by 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 II 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 5 Signature? T>gim PrintI?mm 0179/1? 5 Signature: lnspeg. 4.4M 9%xc Follow- -:up YES ?b (circle one) Follow- 5p Date. If applicable r? Food Establishment on Form The of Newburyport Board of Health Establishment Name: 50 Pleasant Street. Newburyport, MA 01950 465-4410 . W3 {lag (L TEMPERATURE OBSERVATIONS lten'i i Location I on OBSERVATIONS CORRECTIVE ACTIONS Violations cited in this must be corrected within the time frames or as stated in Section 8405.11 of the Food Code 2 PF Foundation 10 Core 90 Item Code . . . . . Date Number Section PF 0 Descr'ptm? ?W'matm" Veri?ed 9 J/f Discussron w'th PIC: corrective Action Required EYES Restrict [Exclude Re-inspection Scheduled Em El Closure Other Date: Date: Rev. 12/1 Br' Commonwealth of Massachusetts- C-ity of Newburyport Board of Health .., (978) 465-44100 Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION l? . 1 i" I Food Protection Pr! 305 South Street . Jamaica Plain. MA 0213 Tel. (617) 983-6712 Name Date Ergo-Of Operation(s) Ty Mm.) Mli?l?r- Ctnfifi?!? ?at. FOOdService glitz/tithe Address p. Rislt Retail Re-inspection l. '2 If 5'11. rtr? my Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-Operation Owner HACCP YIN Caterer El Suspect Illness Person-in- Char PIC Bed Breakfast General Complaint HACCP Inspector C-j Out: Permit No. Other Each violation checked reqdires an explanation on the narrative page(s) and a citation of speci?c 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 El 1 PIC AssignedlKnowledgeable/Duties EMPLOYEE HEALTH [3 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 El 5 6 El 7 PROTECTION FROM CONTAMINATION Receiving/Condition Tags/RecordslAccuracy of Ingredient Statements Conformance with Approved Procedures/HACCP Plans I: 8 9. Food Contact Surfaces Cleaning and Sanitizing [j 10 Proper Adequate 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 Of Health. 23. Management and Personnel 24. Food and Food Protection 004) 25, Equipment and Utensils 26 Water, Plumbing and Waste 006) 27. Physical Facility 007) 28. Poisonous or Toxic Materials 008) 29 Special Requirements (590 009) 30. Other if) 003) Non-compliance with: Anti-Choking Tobacco Allergen Awareness 590.009 (E) 590.009 (F) El 590.009 (G) 12. Prevention Of Contamination from Hands El 13 Handwash Facilities PROTECTION FROM CHEMICALS 14 Approved Food or Color Additives El 15 Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures D17 Reheating 18 Cooling 19 Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE- POPULATIONS (HSP) 21. Food and Food Preparatlon 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 590.000/federal 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. DA TE OF RE-INSPECTION: Inspector?s Signature 114$in Mk? Print: .75ng?le retail/6L ?7 some? i 4 (an; as m, a I . Page of? ?Pages Establishment Name: le??/I MUTI1TE ?17.1qu Date: ?Zr/2? Page: a oft Item Code ?Critical Item DESCRIPTION OF PLAN OF CORRECTION Date NO. Reference - Rad item PLEASE PRINT CLEARLY Veri?ed N29 1/13) ?va 5?6: I meow: raw? Ewe mew? m4? ?ail; Discussion With Person in Charge: Corrective Action Required: No Cl Yes Cl Voluntary Compliance Cl Employee Restriction/ Exclusion Q2 ?3 CI Re-inspection Scheduled Cl Emergency Suspension Cl Embargo Cl Emergency Closure 1:1 Voluntary Disposal Other: Food Establishment Inspection Form I . Page of I The Commonwealth of Massachusetts Violations Date [/62 i if City of Newburypoit Board of Health . . . . . . - 60 Pleasant Street. Newburyport. MA 01950 Priority . Priorityfoundation Core TIme In 4 2 ., (973) 465-4410 CitvofNewburvport corn Score (optional) Tlme Out ?ay?M?l Eiahirh iN - - 5 5 me"- eme i QC. (h oration 3 Type of ?we? DFood Servrce DR?outIne past-y. CIRetail CIReinspection Telephone Cf of?; ?g,0 HACCP Y?dy DResidential Kitchen DMobile Owner AM Dl&& Bog- 2010 DTernporary Previous Inspection Date: CIPre-Operation or; -In- her a: .lC] .. Food rely Date ElCaterer DSuspect Illness AA: Eff?) ElBed 8. Breakfast DGeneral Complaint Inspector UFan?ner's Market DHACCP EIOther: DOther: FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN. OUT, for each numbered item Mark d1 appropriate box tor COS and'er COS corrected on-srte during Inspection repeat vtDIellon IN in compliance OUT not in compliance NIO not observed MA not a llcable Compliance Status cos I Compliance Status cos . - I Proper disposition of returned. previously Superwsron 17 OUT served. reconditioned unsafe food PIC present. demonstrates knowledge. and IN UT pc?ms Gum Time Temperature Control for Safety 2 (Di OUT Certified Food Protection Manager 1 8 Mp1? Proper cooking time 8. temperatures Employee Health 19 Ml.? Proper reheating procedures for hot holding Management. food employee and conditronal 3 employee; knowledge. responsibilities and 20 OUT Proper cooling time and temperature n. ?90?an 4 jet/OUT Proper use of restriction and exclusion 21 Proper hot holding temperature Procedures for responding to vomiting and . 5 OUT diarrheal ?ems 22 QOUT NIA Proper cold holding temperature Good Hygienic Practices . 23 tu? OUT Proper date marking and disposition 6 OUT Proper eating. tasting. drinking. or tobacco use . 24 MA MD Time as a Public Health Control 7 IjifI OUT No discharge from eyes. nose. and mouth Consumer Advispry Preventing Contamination by Hands 25I Consumer advtaoty provided for raw 1? I i IN OUT I undercookcdleod 8 OUT mo Hands Clean a. properly washed Rent. inemente tor Highly Susceptible Populations @our No bare hand contact with RTE food 26 @our 52:3?? ?ms ?59d? f??d5 I 10 pa our 3331;353:7335th Pml?e'? '8 Food Color Additives and Toxic Substances .d Approved Source 27 ?it UU-IW Food additives: approved a properly used 1 1 Di OUT Food obtained from approved source 28 will OUT Toxic sub properly identi?ed. stored 8. used 1 2 EOUT MA MD Food received at proper temperature Conformance with Approved Procedures Food received in good condition. safe. 8. Compliance with variance specialized process 13 (B OUT unadulterated 29 I IN OUT Plan Required records available: shellstock tags. 14 IN OUT ER parasite destruction Protection from Contamination 1 5 OUT NIO Food separated and protected Risk Factors are important practices or procedures identi?ed as the most prevalent contributing factors of foodbome illness or injury. Public health interventions are control measures to prevent foodborne illness or injury. 16 {your Food-contact surtaces: cleaned it sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition of pathogens. Chemicals. and physical ob'?cts inlo foods. Mark in not. It numbered Item is not in compliance Mark. or .n tiaie no: tor cos anoint Ft cos negated m-srre during Inspection ereal vlplelion Compliance Status I cos I Compliance Status I COS Safe Food and Water Proper Use of Utensils 30 asteurized eggs used where required 43 In?use utensils properly stored 5/ 31 if Water 8. ice from approved source 44 Utensils. equipment 8. linens: property stored. dried, 8. handled 32 Variance obtained for specialized processing methods 45 Single?use I single-service articles: property stored 8. used . Food Temperature Control 46 Gloves used properly .7 Proper cooling methods used; adequate equmeni for . 33 .emwamre control Utensils. Equipment and Vending . Food 8. non-food contact surfaces cleanable. properly designed. 34 Plant food properly cooked for hot holding 47 constructed 3? used 4 35 Approved thawing methods used 48 Warewashing facilities: installed. maintained. 8. used: test strips 35 Thermometers provided accurate 49 Non-food contact surfaces clean Food Identi?cation Physical Facilities ,z 37 I I Food properly labeled: original container I 50 Hot 8 cold water available. adequate pressure Prevention of Food Contamination 51 Plumbing Installed: proper back?ew devices 33 ?nsects. rodents. 8. animals not present 52 Sewage 8. waste water properly disposed 39 prevented during food preparation. storage and 53 Toilet features: properly constructed. supplied. 8. cleaned a I 40 Personal cleanliness 54 Garbage 8. refuse properly disposed; facilities maintained i/ 41 .r-ig cloths property used 8. stored 55 Physical facilities installed. maintained. 8. clean . . . .x 42 Washing fruits 5 vegetables 56 Adequate ventilation 8. lighting designated areas used 57 SPECIAL REQUIREMENTSIOTHER I DAnti-choking (590 UTobacco (590 DAIIergen Awareness (590 ULocal law it a?iclat Order tor Correction: Based on an inspection today. rho items checked indicate violations of the Board of Health Food Regulation 2013 Federal Food Code This report it a Board of Health member or its agent constitutes an order 0! the Board oi Health Failure to correct violations cited in this report may result in suspensmn or revocation of the food as and cessation of food establishment operations It aggrieved you have a right to a hearing Your request must be in writing and submitted to the Board of Health at the - tart calendar days at of this Eider "x PIC'sSignature' Print. Alf/5341,25 I Date: ?Apr/l, lnspector? SIQRW {if?M Follow- -:up YES Greta one) Follow- -up Date. if applicable: NOTE: This establishment was found to be in compliance with items 30 - 56. The form was incorrectly completed at the time of inspection. Please contact the Newburyport Health Department for confirmation 978-465-4410. Food Form I Page of?? The Colanmonwealth of Massachusetts Violations Date ?City of ?ewburyport Board of Health . . . . . . 60 Pleasant Street, Newburyport. MA 01950 Priority- Priority foundation- Core- Time In If a C1 (978) 465-4410 CitvofNewburvporl com Score (optional) Time Outage; . 45 Establishment Home Risk Category - awaaw mar?4L- we? 4 Weierstrass Maine sa ?955 3 LB UJ E) EIRetail EIReinspection Telephone' HACCF YQJ EResidential Kitchen Previous Inspection Date: . . Mobile owner {a ow yq Perm't#' BTemporary BPre-Operation For -In- Charge (PIC) Food Safety Training i Exp. Date Suspect alga. 11- Lcl-?A? W4 BBed Breakfast EIGeneral Complaint Inspector Farmer's Market DHACCP do 6 itth/L/ Lab EIOther: CIOther: FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN. OUT. NIO, NM) for each numbered item Mark In appropriate box [or (:05 endtor IN in compliance OUT not in compliance N10 not observed NA not a liable ODS corrected during inspection 2! egeei violation Compliance Status I COS I Comp nce Status cos Supervision 17 I UT Prope??dispos?ijtilon oldrlitumed?. pfrevtigousty serve recon none pose co present. demonstrates knowledge. and 1 @qur -. Time iTemperature Control for Safety 2 MUT NIA Certi?ed Food Protection Manager 18 MDUT NIA N10 Proper cooking time 8. temperatures Employee Haaith 19 IWUUT NIO Proper reheating procedures for hot holding Management, food employee and conditional 3 employee; knowledge, responsibilities and 20 IN UT N10 Proper cooling time and temperature A reporting 4 WOUT Proper use of restriction and exclusion 21 N10 Proper hot holding temperature Procedures for res ondi Io omllin and . 5 diarrheal events n?g 9 22 NIA Proper cold holding temperature A Good Hygienic Practices 23 your Nio Proper date marking and disposition 6 at}: OUT NID Proper eatingI tasting. drinking, or tobacco Use 24 NIO Time as a Public Health Control 7 NIO No discharge from eyes. nose. and mouth Graf?ti-mar Advisory . Preventing Contamination by Hands 25 I IN OUT 6k) ?we" I I GROUT N10 Hands clean 8- property washed Requirements tor High_ly Susceptible Populations Wain" me No bare hand contact with RTE food 26 I 9 OUT Nip. ?mm? f??d5 I I 'i Adequate handwashing sinks properly supplled - 10 ?t our Food i Color Additives and Toxic substances and accessible . - .-. Approved Source 27 lg oqurA? Food additives: approved it. properly used 11 WOUT Fond obtained from approved source 28 WOUT NIA Toxic sub. properly identi?ed. stored a used 12 NIA NIO Food received at properlemperature Conformance '11] Approved Procedures Food received in good condition, sale. a 55 Compliance with variance I speclalized process 13 @3111. unadulterated 29 I IN O.UT . I Plan Required records available: sltelistocit tags. 14 IN our l-iio . . . . PEEP 5951mm? . Risk Factors are important practices or procedures identified as the most -- Protectionfrom Contamination prevalent contributing factors of foodborne illness or injury. Public health 15 ?39m F??d ?Pam? and ?mm? interventions are control measures to prevent foodbome illness or injury. 15 OUT Mia Food-eontacl su'taces; cleaned 8. sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition of pathogens. chemicals. and sisal ob'eds into loo-d5. I 1 Mark in box it numbered item I: not in corn Iiance Mark In or rials belt [or [?08 anetpr (:05 corrected cit-site during Inspection re pol visitation Compliance Status I cos Compliance Status cos I Safe Food and Water Proper Use of Utensus 3U ,Pesteurized eggs used where required 43 V, In-use utensils properly stored 31 Water 8. ice from approved source 44 {Utensils equipment linens: properly stored. dried. handled 32 Variance obtained for specialized processing methods 45 5? ?rhgleuse i single?servica articles: properly stored 8. used Food Temperature Control 45 "cloves used proporly Proper cooling methods used; adequate equipment for 33 immamlm comm, Utensils, Equipment and trending 34 i? ant road properly cooked for hot holding 4? ?gm??g?n'm ?Hm: manahle? 35 approved thawing methods used 48 Warewash'ing facilities: installed. maintained. 8. used: test strips 36 Thermometers provided 3. accurate 49 Non-food contact surfaces clean Food identi?cation . Physical Facilities 3? I I Feed properly labeled. original container I I 50 (I Hot 8. cold water available: adequate pressure Prevention of Food Contamination 51 r" lumping installed; prop-erback?ow devices 38 it"Insects. rodents. 8- animals not present 52 Sewage 8. waste water property disposed 39 yf'giggIg?r?nlnatlon prevented during food preparation. storage and 53 V/To?at features: properly constructed, supplied. cleaned 40 l/ Personal cleanliness 54 _Garbage 8. refuse properly disposed; facilities maintained 41 Wit-g cloths: properly used 8. stored 55 r" Physical facilities installed, maintained. 8. clean 42 tor/Washing fruits Br vegetables 56 [rt/Adequate ventilation E. lighting: designated areas used a? SPECIAL REQUIREMENTS i OTHER I EIAnti-choking DTobacco EIAllergen Awareness ElLocaI law regulation DOIher Official Order for 11 an inspection today. the items checked Lndicato violations of the Board at Health Food Regulation Federal Food Code. This reporl. when signed below by a Board of Health l'l'l I'l'tber or its agent nlttilules an order at the Board of Health. Failure to correct violations cited in this report may recult in suspension or revocation of lhe load eslablisl?tmenl permit and cessation of to establishment ope tiorts. If aggrieved by this order. you have a right to a hearing. Your request must be in limling and smmitled lo the Board at Health at the above address within ten {10] calendar ya eireceipi oi this Mag; natu Print: Date: 9 koalov Inspector?s Sit-row I) Follow-up: YE?rolrciaonoi Follow- -up Date, Food Establishment Ins ection Form Pa 9 of Massachusetts City _9f Board of Health Establishment Name: 60 :lefgsagt?gemewburyport. MA 01950 k? 1? Ode/?2 @000 (5 LI TEMPERATURE OBSERVATIONS I Item Item I Location Date: OBSERVATIONS ANDIOR CORRECTIVE ACTIONS must be corrected within the time frames or as stated in Section .11 of the Food Codea PF Foundation 10 Core Item Code . . . . Date Number Section Description of Violation Veri?ed He Discussion with PIC: Corrective Actlon Required Ellie Vol nce El Restrict {Exclude Re-inspection Scheduled Emergency Suspension - El Emergency Closure Voluntary Disposal Other Date: 2? NOTE: This establishment was found to be in compliance with items 30 -56. The form was incorrectly completed at the time of inspection. Please contact the Newburyport Health Department for confirmation 978?465-4410. Food Establishment Inspection Form I TheCommonwealth of Massachusetts Page I of Q. 0' Violations Date 635:3; a 52:? 01950 Priority- Priority foundation- Core- Time In [0 2Q am (978) 465-4410 MMN.CityofNewburvport.com Score (optional) Time Establishment Nome Ali/1:5 r: I I I Risk Category 135le OperationIsI Type of Inspection Establishment Addre'ss DOEI Service Ln ?3 S-l-r, 4 i A gRetarl nspectron Telephone . HACCP YW Residential Kitchen Previous Inspection Date: Owner 1'2 9.- 4/4; 5- 17? 0 Permit if DMUNIE EJITemp-orary BPre-Operation Person-in~Churgu Food Safety Exp. Dal Caterer Suspect Illness Elm k: L3 ?7.13? 4-12 Breakfast EIGeneral Complaint Inspector EIFarmer's Market EIHACCP Pm'i" Mr: A a DOther: UDther: FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN. OUT Nit). for each numbered from Mad: in appropriate box for CBS andlor IN .n oomglrance our not in compliance two a not observed NM. not applicable :05 corrected enrsite during inspection repeer vintaiien Compliance Status I cos I Compliance Status cos - - Proper disposition of returned, previously Supervision 17 I IN OUT I served. reconditioned Er unsafe food PIC rose t. demonstrates knowled e. and . 1 IN OUT pe?gms 51m? 9 Time I Temperature Controlfor Safety 2 IN OUT Certi?ed Food Protection Manager 18 IN OUT Proper cooking time 8. temperatures Employee Health 19 IN our MA MD Proper reheating procedures forhotholding Management. iood employee and conditional 3 IN OUT employee; knowledge. responsibilities and 20 IN OUT Proper cooling time and temperature reporting 4 IN OUT Proper use of restriction and exclusion 21 IN OUT NIO Proper hot holding temperature vomiting and 22 IN OUT Proper cold holding temperature Good Hygienic Practices 23 IN OUT Proper date marking and disposition 5 IN OUT NID Proper eating. lasting. drinking. or tobacco use 24 IN OUT Time as a Public Health Control 7 OUT N10 No discharge from eyes. nose. and mouth Constumer Advisory. . Consumer advisory provided [or raw r? Preventing Contamination by Hands 25 IN our ?Mammal {and El IN GUT NIO Hands clean 8 properly washed Requirements for Ht hly Susceptible Populations 9 our urn mo No bare hand contact with RTE food 26 IN ou-r NIA Et?jfg?m" 10 IN our s'm?s pmpe?y Food 1 Color Additives and Toxic Substances Approved Source 27 IN OUT NIA Food additives: approved a properly used 1 1 IN OUT Food obtained from approved source 28 IN OUT Toxic sub. properly identi?ed. stored 8. used 12 lN OUT Food received at proper temperature Conlormance with Approved Procedures Food received in good condition, sale. 8. Compliance with variance specialized process I I 13 IN OUT unadulterated 29 I OUT I HACCP 14 IN OUT Hoquilredrocords available shelistocit tags. . Risk Factors are important practices or procedures identi?ed as the most Protection from Contamination prevalent contributing factors of foodborne illness or injury. Public health 15 OUT F??d imam? and ?mm? interventions are control measures to prevent foodborne illness or injury. 16 IN OUT NIA Food-contact stresses. cleaned sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventotlve measures to control the ?d?io? or pathogens. chemicals. and physical able-sis late teens. Mark ?it" In box if numbered item is not in compliance Compliance Status Mark ?it? 505 corrected on-srto dunno inspection Ft. 2 repeat violation a to riato bait for COS andlor I COS I Compliance Status local Safe Food and Water Proper Use of Utensils Based on an inspection irons If aggrieved by this order. you have a rightt 3t) Pasteun?zed eggs used where required 43 In-use utensils properly stored 31 Water ice from approved source 44 Utensils. equipment 8. linens: properly stored. dried, 8. handled 32 Variance obtained for specialized processing methods 45 Single-use single-service articles: properly stored used Food Temperature Control 46 Gloves used properly Proper cooling methods used; adequate equipment for 33 temperature control Uten??st Equipment and Vending . Food at non-food contact surfaces cleanable. properly designed. 34 Plant food properly cooked for hot holding it? constructed a used 35 Approved thawing methods used 43 Warewashing facilities: installed. maintained. 8. used; test strips 36 Thermometers provided 8r accurate 49 Non-food contact surfaces clean Food Identification Physical Facilities 3? I Food properly labeled; original container I I St] Hot cold water available; adequate pressure Prevention of Food Contamination 51 Plumbing installed; proper beck?ow devices 38 Insects. rodents. 8. animals not present 52 Sewage waste water properly disposed 39 prevented during food preparation. storage and 53 Toilet features: properly supplied. 81 cleaned 40 Personal cleanliness 54 Garbage 8r refuse properly disposed: facilities maintained 41 iMping cloths: properly used 8. stored 55 Physical facilities installed. maintained, 8. clean 42 Washing fruits a. vegetables 56 Adequate ventilation 8- lighting; designated areas used 5? SPECIAL REQUIREMENTS OTHER DAntI-choking (590.009IE1) CITobacco Awareness EILocal law regulation EIOther Official Order for Corn: odey. the items checked indicate vtoielrens oi the Board oi Health Food Regulation 2013 Federal Food Code This report. when signed below by -nstilulee an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation or the land establishment permit Wow request must be in writing and submitted to the Board of Health at the above address within Date: ty/??f/mlq Inspector's Sight??-r?? a: Print: {1d Follow-up: YES NO (circleone) FollowLp Date. if applicable: - 4 . Food Establishment Ins on Form of The Commonwealth of Massachusetts City of Newburyport Board of Health Establishment Name: A/ock? mo, 5-6?1100] Date' 2/2? E, 9 60 Pleasant Street. Newburyport, MA 01950 5 3?3 465-4410 W. ewbu .co CA 1141* ?1 on. TEMPERATURE OBSERVATIONS item I Location i Tern Item Location OBSERVATIONS CORRECTIVE ACTIONS Violations cited in this must be corrected within the time frames or as stated in Section 8405.11 of the Food Code Pri PF Priori 1 item Code Description of Violation . Date Number Section PF Veri?ed PIC: Corrective Action Required DYea Voluntary Compliance Restrict lExclude Re-inspection Scheduled nsion Embargo Closure Voluntary Disposal 6! lam 9/534/1? Inapecto Rev. 123' Food Establishment Inspection Form I Page 0f__ Tl . of Massachusetts Violations Date 2' I ?7 Board of Health . . . - . Pri ri - i - - ?rm Newburyport. MA 01950 ty . ronty foundation Core Time In (E [gr-Si Itch-44 IU ui?i'ivaitvchewburvoon com Score (Optional) Time Out Establish . Risk Category ?Mt l-?f?L Engla?dlu to erations . 5 act Establishm ddress 00d SEWICE ?31 13 WA Ln .. EIRetail DReinspectiori Telephone EIResidentiaI Kitchen Previous Inspection Date: Owner Permit ill? MObi'e Q: 77?14 EITemporary UPre-Operation Persian?int: Pic]. 7. Food Saiety Training Exp Date EICaterer CISuspect Illness I 8. Breakfast DGeneral Complaint Inspector r7 EIFarmer's Market EIHACCP 10 *3 I DOther: DOther: FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle dos-gnated compliance status (IN OUT Mini tor each numbered item Merit it In appropriate bait for CBS IN in compliance OUT not in compliance Nl? not observed MA not applicable cos a {1.1.3.13 .1..an Inspe?lun p. repeal violatidr Compliance Status I COS I Complt nce Status cos - - Proper disposition of returned. previously 17 UT served reconditioned 8 uns_afe food PIC I. I . . 1 pe?ggiednu?egmTime I Temperature Control for Safety 2 OUT Certified Food Protection Manager 18 MUT NM NM) Proper cooking time 8. temperatures Employee Health 1 9 OUT NIA Proper reheating procedures for hot holding Management. food employee and conditional 3 employee; knowledge. responsibilities and 20 MA MC Proper cooling time and temperature reporting 4 OUT Proper use of restriction and exclusmn 21 QOUT Proper hot holding temperature i i i . 5 6? OUT dlgf??zmia?gesmn ing 0 vomi ing an 22 OUT Proper cold holding temperature A Good 23 OUT Proper date marking and disposition 6 OUT Proper eating. tasting. drinking. or tobacco use 24 OUT NIA Time as a Public Health Control 7 (W OUT N10 No discharge from eyes. nose. and mouth Consumer Advisory - - Consumer advisory provided tor raw Preventing Contamination by Hands (th OUT NIO Hands clean properly washed Requirements for Highly Susceptible Populations (HSP) Call our No hare hand contact With RTE load 26 I OUT Egg?zgr'zed W5 ?59? pmh'b'md I I a Adequate handwashing properly supplied . . 10 our and accessible Food I Color Additives and Toxic Substances Approved Source 23 MUT NIA Food additives: approved properly used 1 1 OUT Food obtained from approved source 28 (9 OUT Toxic sub. properiv identi?ed. stored 8. used 12 OUT Food received at proper temperature Conformance with Approved d? Food received in good condition. sale. 8. :2 variance spemaltzed process 13 J. OUT unadulterated 29 It?! ianci-I Plan Requtred records available: shellstock tagswas? Risk Factors are important practices or procedures identified as the most Prot_ection ontamlnation prevalent contributing factors of foodborne illness or injury. Public health 15 OUT F??d separated and ?meme? interventions are control measures to prevent foodborne illness or injury. 16 Jul OUT Food?contact surfaces; cleaned 8. sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition of pathogens. chemicals. and physical objects into foods. titan: In box it numbered item is not in petunia-ice Mark in naie bot: tor C05 angler C03 corrected tin-site duri in action re al violation Compliance Status I COS I Compliance Status I cos I Safe Food and Water Proper Use of Utensils 30 Pasteurized eggs used where required 43 ln-use utensils properly stored 31 Water 8. ice from approved source 44 Utensils. equipment 8. linens: properly stored. dried. 8. handled 32 Variance obtained for specialized processing methods 45 . Single-use single?service articles: properly stored 8 used Food Temperature Control 45 Gloves used properly Proper cooling methods used: adequate equipment for 33 temperature control Utensils. Equipment and . Food 8. non-food contact surfaces cleanable. properly designed. 34 Plant food properly cooked for hot holding 47 constnicte a used 35 Approved thawing methods used 48 Warawashing iacilities: installed. maintained. 8. used; test strips 35 Thermometers provided 8. accurate 49 Non-food contact surfaces clean Food Identi?cation Physical Facilities 37 I I Food properly labeled; original container I I 50 Hot 8. cold water available; adequate pressure Prevention of Food Contamination 51 Plumbing installed; proper backflow devices 38 Insects. rodents. animals not present 52 Sewage 8. waste water properly disposed 39 prevented during food preparation. storage and 53 Toilet features: properly constructed. supplied. 8. cleaned 40 Personal cleanliness 54 Garbage 8. refuse properly disposed; facilities maintained 41 \Mping cloths: properly used 8. stored 55 Physical facilities installed. maintained. 3- clean 42 Washing fruits 8. vegetables 56 Adequate ventilation 8. lighting; designated areas used 5? SPECIALBEQUIREMENTS OTHER I EIAnti-choking EITobacco (590 IZIAllergen Awareness CILocal law regulation DOther Official Order for Correction: Based on an inspection today the items checked indicate violations at tho- ?oard or Health Food Regulation 2013 Federal Food Code This report. when signed below by a Board of satin member or its agent mnsiilutcs an order or the Board of Health Failure to correct violations cited in this report may result in suspension or revocation of the load establishment permit and cease on of food establishment one one It aggrieved by this order. you have a right to a {hearing Vour request must be in writing and submitted to the Board of Health at the above address within ten gm} grands. days at .aca_.pi at this at PIC's Signature: Print' Iflfl k7, ?74, Data! dz 1'71? Follow- -u:p (circle one) FolIoIv- -up Date, if applicable. 1" Food Establishment Ins ection Form of Massachusetts [:inf of Newburyport Board of Health Establishment Name: . '8 60 Pleasant Street. Newburyport, MA 01950 Date. 7 455-4410 . I MLIL '3 do TEMPERA RE OBSERVATIONS Item I Location To Item I Location I Location OBSERVATIONS CORRECTIVE ACTIONS must be corrected within the time frames or as in Pri PF Foundation 10 Core Item Code P. . . . . Date Number Section PF Description of Vlolatlon Veri?ed Corrective Action Required END El?res nce El Restrict [Exclude Re-ins ction Scheduled El Suspension El El Closure El Voluntary Disposal El Other Date:/ Date: Food Establishment Inspection Form I Page of 1" Thor'Commonwealth of Massachusetts Violations Date City of Newburyport Board of Health . . . . . . 60 Pleasant Street. Newburyport. MA 01950 Priority- . Priority foundation- Core- Time In C9 (are) 455?4410 wvvw.CitvofNe_w_buerort.com Score (optional) Time Out I 1" ?73 Esla?u ishmenl tia 1'15 Risk Category Type of OgerationIsI Type of Inspection 4W 4. EIFood Service EIRoutine I Tu rm AC (j Iggetail DReinspection Telephone . HACCP esidential itchen Previous the action Date: owner Perm? ETemporary BPre-Operation . eraon-ln-Charge Pici Food Date Caterer Suspect illness J:F'ttlieii Ic? odd?L r" 4?44 0 3?1 339d 8. Breakfast DGeneral Complaint tor Farmer?s Market EIHACCP 0 5 [2143 (4?h {?ick I EIOther: IZIOther: FOODBORNE ILLNESS FACTORS AND PUBLIC HEALTH Clrde designated compliance status it". GUT. NIB. Min} tor each numbered ilem int In compliance OUT not in compliance MIG not observed NM net applicable lvlort-i 'it? in appropriate '10:th COS endlor Ft {305 corrected onvsiie during inspection Ft repeal wotatior Compliance Status I COS I Compliance Status 605 - - Proper dlrpoeilion of returned. previously 1? I IN OUT served, reconditioned B. unsaie food PIC rose 1 onslr too knowied e. and . - 1 @?ouT pa?gn? dike? a 9 A Time Temperature Control torSafety 2 HUT NIA Certi?ed Food Protection Manager 18 W0 UT NIO Proper cooking time 8. temperatures Employee Health 19 NIA Proper reheating procedures for hot holding Management. food employee and conditional employee; knowledge. responsibilities and 20 NIO Proper cooling time and temperature reporting 4 Proper use of restriction and exclusion 21 MUT NIO Proper hol holding temperature 5 (in? our ?mm? and 22 dilator Nio Proper cold holding temperature diarrhea! events Good Hygienic Practices 23 lit?OUT Proper date marking and disposition 6 lk?UT NIO Proper eating, tasting. drinking. or tobacco use 24 (QMUT NIA Time as a Public Health Control 7 NIO No discharge from eyes. nose. and mouth Consumer Advis?l?}! Consumer adwsory provided for ranr Preventing Contamination by Hands Hands clean a. properly washed Requirementoror Highly Su_sceptible Populations 9 WOUT No bare hand contact with RTE food 26 ur Pas'eumd f??d5 ?59d: th'b'tec' "ms ml offered Adequate handwashing sinks properly supplied 10 ind accessm Food gator Additives and Toxic Substances Apprd'?ad 27 OUT NIA Food additives: approved properly used 1 1 WOUT Food obtained from approved source 28 (?ithT NIA Toxic sub. properly identi?ed. stored 8. used '12 Food received at proper temperature Confermance With A Procedures Food received in good condition. safe. 8. Compliance With variance specialized process I I 13 unadulterated 29 I IN OUT Plan Required records available; shellstooti tags Wail?? d?t'mc'm" Risk Factors are important practices or procedures identified as the most .rL from Contamination prevalent contributing factors offoodborne illness or injury. Public health 15 mm F??d interventions are control measures to prevent foodborne illness or injury. MIA Food-contact surfaces; cleaned Er sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition of pathogens, chemicals. and physical objects into foods. Mart: "it" "1 hair it numbered item is no: In compliance Marti ?Jt? in approprmte box for I308 andlor 005 corrected on-srle during inapeclion rapeat Violation Compliance Status cos Compliance Status cos I Safe Food and Water Proper Use of Utensils 30 V, Pasteurized eggs used where required 43 vi ln-use utensils Plug-ally stored 31 Water 8. ice from approved source 44 J/Utensils. equipment 8. linens: properly stored. dried. 8. handled 32 Variance obtained for specialized processing methods 45 gingieuse single-service articles; properly stored used Food Temperature Control 46 v? Gloves used properly 33 used; adequate comment for - oils. and Vending 34 ant food Properly cooked for hot holding 47 V, surtaces cleanable, properly designed. 35 Approved thawing methods used 48 Warewashing facilities: installed. maintained, 8. used; test strips 36 l? Thermometers provided 8. accurate 49 g, "Non-food contact surfaces clean Food Identification Physical Facilities 3? I I Food properly labeled; original container I I 50 Vi" Hot 8. cold water available; adequate pressure Prevention of Food Contamination 51 Plumbing installed; proper backflow devices 38 Insects. rodents. 8. animals not present 52 1 4/ Sewage 8. waste water properly disposed 39 l/ Egglt?ZFination prevented preparation, Sim-age and 53 v?Toilet features: properly constructed. supplied. a cleaned 40 In Personal cleanliness 54 . I/Garbage it refuse properly disposed: facilities maintained 41 Wiping cloths: properly used a stored 55 facilities installed, maintained, 8. clean 42 l/ Washing fruits 8. vegetables 56 ul? Adequate ventilation 3. lighting: designated areas used .57 SPECIAL OTHER I ElAnti-choking EITobacco DAllergen Awareness ElLocal law regulation EIOther and cessation a Board of Hoax?! Official r'Corroctioh: Based member of its agent to I food establishment aparal' lei-i IIUI calendar (tors of tecoipt of this and . PlC?s Signature; inspection today. the lien-ls checked indicate violations at the Board oi Food Regulation .1 2013 Federal Food Code. This report. when signed below by Iulod an order of the Board of Health Failure to correct violations cited in this report may result in suspension or revocation of the lood establishment permit a If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to ihe Board of Health at the above address within ?r In. I \t Inspector?s Signature: Follow-up: YES NO (circle one) Follow-UL Date. if applicable: Food Establishment Ins on Form of Massachusetts City . of Newburyport Board of Health Establishment Name: Date' 50 Pl t. 11. MAU1950 9553341665 my? ??va k} a 5 about TEMP RA OBSERVATIONS Item I Location Te Item I Location Item I Location hie/(L11 519 lat. Tic OBSERVATIONS ANDIOR CORRECTIVE ACTIONS Violations must be corrected within the time frames or as stated in . 1 of Food Code PF Foundation 10 Core Item Code P, . . . . Date Number Section PF Description Of V'Olatmn Veri?ed ?55'0" wuth PIC: Corrective Action Required UYes El Volu Restrict lExclude El Scheduled nsion Closure Other Date:L/ (la [7 Signaturw Date: 02 . 12118113 NOTE: This establishment was found to be in compliance with items 30 - 56. The form was incorrectly completed at the time of inspection. Please contact the Newburyport Health Department for confirmation 978-465-4410. Food Establishment Inspection Form I Page 1 of .14 The Commonwealth of Massachusetts Violations ll 1/ Date City of Newburyport Board of Health Prim? Fag?? foundation- I 60 Pleasant Street. Newburyport. MA 01950 5" . 978) 465- 441 Score (optional) Time Out Establishment Name IT, Risk Category f0 rafo Of ?on a? Il?'tilg ?1251 $15.44.th I digits?w Esrabirs anirt 0? IServlce . lne . if; 1 i 9 1,1,9 BRBIHII EIRetnspection Telephone-y (a HACCP YIN Residential Kitchen Previous Inspection Date: Owner E: 5S: 3 Permit 11: DMObile .4 EITemporary EIPre-Operation In ChargeiPlC] Food lety Tr Inin 1Eap DCaterer EISuspect Illness g1. pt '54- E-et/? 1 if 62? Breakfast DGeneral Complaint Inspect EIFarmer's Market EIHACCP 0% (14' Alf) DOther: CIOther: 7? FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN. OUT N10. for each numbered item Mark in appropriate box for COS andior IN in compliance OUT not in compliance N10 not observed MA not applicable C05 corrected on-site during inspection repeat violation Compliance Status COS I Com liance Status 005 . . Proper of returned. prthously 17 served reconcilionsd E. unsate lood PIC present. demonstrates Itnowiedg?. and 1 ?mm: dunes Time 1 Temperature Control for Safety 2 WDUT N1A Certi?ed Food Protection Manager 18 NIA N10 Proper cooking time 8. temperatures Employee Health 1_9 1N OUT N10 Proper reheating procedures for hot holding Management, food employee and conditional 3 6:4ng employee; knowledge. responsibilities and 20 N10 Proper cooling time and temperature re?ning 4 IFJOUT Proper use of restriction and exclusion 21 IN OUT N10 Proper hol holding temperature Pro at res for res ondin to vomitin and . 5 l? ma?a; events 1) 22 OUT N10 Proper cold holding temperature J. Good Hygienic Practices 23 1.11111 our N10 Proper date marking and disposition 6 imbur N10 Proper eating. tasting. drinking. or tobacco use 24 OUT N10 Time as a Public Health Control 7 N10 No discharge from eyes. nose. and mouth Consumer Consumer advisory provided for raw 1 A Preventing Contamination by Hands 25 IN our ta undermokadmm a N10 Hands clean a. properly washed Requirementsuior Highly Susceptible Populations IHSPI 9 rliti?OUT N10 No bare hand contact with RTE food 26 I IN our Egz?zgnzedmds use?; I .h . Adequate handwashing sinks properly supplied . 10 littlour and ?mm? Food 1 Color Agditives and Toxic Substances Approved 27 IN iEItAv? Food additives: approved E. properly used 1 1 69 OUT Food obtained from approved source 28 IN OUT Toxic sub properly identified. stored 81 used 12 9'13 OUT NIA N10 Food received at proper temperature Conformance with Approved Procedures .. Food received in good condition. safe. Compliance variance rspecialized process 13 OUT unadulterated 29 I IN OUT NM Plan Required records available: shellstock tagsparastle destruction Risk Factors are important practices or procedures 1dentrfied as the most - Protection from Contamination prevalent contributing factors of foodbome illness or injury. Public health 15 OUT F??d 591351319? Pm'ec'e? interventions are control measures to prevent foodborne illness or injury. 16 ?rdUT N111 Food-contact surfaces; cleaned 8. sanitized GOOD RETAIL PRACTICES Good Retail Practices are preventative measures to control the addition at pathogens chemicals and pineal; Into tends. Mari-t in box 11 numbered item is not in compliance COS corrected err-site during inspection repeat visitation Edith in a tale bait for (?05 andror Compliance Status I 008 I Compliance Status I cos Safe Food and Water Proper Use of Utensils 30 Pasteurized eggs used where required 4-3 In-use utensils properly stored 31 I Water 8: ice from approved source 44 Utensils. equrprneni 8. linens: properly stored. dead 8. handled 32 Variance obtained for specialized processing methods 45 single-use Mingle-service articles: properly stored a used Food Temperature Control 46 Gloves used properly {Proper cooling methods used; adequate equipment for . 33 comm, - Utensils, Equipment and Vending . Food non-food contact surfaces cleanable. properly designed. 34 Plant food properly cooked for hot holding 47 constructgd 8. used 35 Apgtoved thawing methods used 48 Warewashing facilities installed maintained. 8. used. test strips 35 . A?Fiermomelers provided 8. accurate 49 Non?food contact surfaces clean Food Identification Physical Facilities 37 I I Food properly labeled: original container I I 50 Hot 8. cold water available; adequate pressure Prevention of Food Contamination 51 Plumbing installed; proper back?ow devices 38 Insects. rodents. 8. animals not present 52 Sewage a. waste water properly disposed 39 prevented during food preparation. storage and 53 Toilet features: properly constructed supplied. a cleaned 40 Personal cleanliness 54 Garbage 8. refuse properly disposed: facilities maintained 41 \Mping cloths; properly used 8. stored 55 Physical facilities installed. maintained. a. clean 42 Washing fruits Sr vegetables 56 Adequate ventilation 8. lighting; designated areas used 57 SPECIAL REQUIREMENTS 1 OTHER I EIAnti-choking (590 DTobacco (590. DAIlergen Awareness (590 EILocal law regulation EIOther Of?cial Order tor Correction: 8 an inspocnort today. the items mocked indicate violattoos oi the Board of Health Food Regulation 1 2013 Federal Food Code. This report when signed below by an order or the Board of Health Failure to correct violations cited in this report may result in suspensron or revocation of the food establishment permit ggrievu-d by this order you have a tight to a hearing Your request must be in writing and submitted to the Board of Health at the above address within PlC's Signature: far-MEX Print: (?theft-i? It, 1x111: Follow- -:up N0 (circle one) Follow- -up ne?er. if applicable: Inspf?g?w?; (15/ Qf?f ti- -L i\ Food Establishment Ins tion of Newburyport Board of Health Establishment Name: 60 Pleasant Street. Newburyport. MA 01950 465-4410 Wig:? -L 7 JV TEMP TURE ERVATIO Item I Location Tern Item i Location Tern . Item i Location OBSERVATIONS ANDIOR CORRECTIVE ACTIONS Violations cited in this must be corrected within the time frames or as stated in Section 8405.11 of the Food Code . PF Foundation 10 . Core 90 Description of Violation ,L-mec w. a 4'14; 11%6' Item Code F, Number Section PF Date Verified Drscussron PIC: Corrective Action Required Volunta Compliance Restrict [Exclude El Re- Scheduled nslon El Closure PIC's Sig ?Nil .1 HEM