Food Establishment Inspection Report City/Town of 1 [Establishment 71ft. I Date: 9 jq/ /g Page 1 of; Address: 8? No I (C AV Time in: Time out: Telephone: W391 999?317? Permit No: Number of Violated Provisions Related - I to Foodborne illness Risk Factors Owner: and interventions (items 1 through 29): Person-in-Charge: 0! a $4 WC 711.,55 Number of Repeat Violations Related . to Foodborne illness Risk Factors inspector - up dingo and interventions {Items 1 through 29): 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 low] NIAINIOICOSI 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 1/ sanitized Employee Health Preper disposition of returned, Management, food employee and 17 previously served, reconditioned 8. 3 conditional employee; knowledge, unsafe f00d responsibilities and reporting . Timerremperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures )0 5 Procedures for responding to vomiting 1 Proper reheating procedures for hot and diarrheal events holding 600d Hygienic Practices 20 Proper cooling time and temperature l0 5 Proper eating, tasting, drinking, or 21 Proper hot holding temperature )0 tobacco use 22 Proper cold holding temperature 7 charge from eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control Pre ntin Conta t' Hands ve 9 mm ion ConsumerAdvisory Ch 9 No bare hand contact with ready-to-eat 2 undercooked food 00 . Highly Susceptible Populations Adequate handwashing sinks properly 8 Hands clean ro eri wash Consumeradvisory provided for raw/ )0 10 supplied and accessible J: 26 Pasteurized foods used; prohibited foods )6 Approved Source ?Ct offered . 1 FoodIColor Additives and Toxic Substances 11 Food obtained from approved source . . 0d add't' ro i 12 Food received at proper temperature 27 uged I ives. approve pery :3 13 5:23 2:02:de 900d condition, safe, 8? ?t 28 Toxic substances properly identified, ff. i stored used 1: 14 eqUIred records availab e. shelistock Conformance with Approved Procedures 1tags, paraSite destruction . . . . . . 29 Compliance With variance speCIaiized 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- renewai 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-ChargeDate- Signature of Person-in- {7/329 (264 i I Signature ?/Wv/grz Date: ?i report form 10i5f1B version 'Food Establishment Inspection Report City/Town of Quit/lite} W7 ?it: Establishment: ?out: Jckw/ Date. SECTIONS in compliance out of compliance - not observed not applicable COS: corrected on- site during inspection R- repeat violation Compliance Status I IN NIAINIOICOSI Compliance Status IN OUT COS SafeFood 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 backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained Food Identification 55 Physical facilities installed, 37 Food properly labeled; original maintained, 8? container 56 Adequate ventilation lighting, Prevention of Food Contamination deSIgnated areas used Insects rodents animals not Additional Requirements listed In 105 CMR 590. 011 38 present I M1 Anti- -choking procedures in food Contamination prevented during service establishment . 39 food preparation. storage and M2 allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 JCaterer 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment )0 42 Washing fruits vegetables . M6 Public Market; Farmers Market Proper Use of Utensils M7 Residential Kitchen; Bed-and- 43 ln-use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food )f properly stored, dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition property stored used Program 46 Gloves used properly -, M10 Leased Commercial Kitchen )6 Utensils, Equipment and Vending M11 Innovative Operation )5 Food non- food contact surfaces .- '7 Local Requirements 47 Cleanablei properly L1 Local law or regulation constructed used L2 Other Type of 0peration(s): Type of Inspection: Other Information: Weutine El Re-inspection Pre-operational Illness investigation General complaint HACCP mower Hg. JF ?food Service Establishment Retail cod Store Residential: Cottage Foods Residential; Bed Breakfast El Mobile/Pushcart Temporary Food Esta . Winter 2 6/1 ill: I Sig atom of Person-ln-Cl?rgezl Signature of Inspector: MDPH report form 10I5f13 version 9mm We ?Food Establishment Inspection Report City/Town of (DUI Establishment: A {an Ml ycj/Vb?" lDate: Page__3_of_?3_I Observations Item! Location Item I Location Item I Location mm hm? Observations and/or Corrective Actions Violations cited in be the time frames or in 11 of the Food Code Item Section of Description of Violation Date to Correct 0 AA Wobll\ 41% I 35-}th Slgnature of Person- WV SignatumonnsW7ML Date report form? Food Establishment Inspection Report City/Town of 69?"va Establishment: ?4!?me i251 Gal Date: 61/5 I Page 1 of; Time out: Address: ?0 5 L1 3 5 Time in: Telephone: a gl?? ?37 ?57 Permit N0.: Number of Violated Provisions Related to Foodborne Illness Risk Factors 5 Owner: 6Q .. '0 and Interventions (Items 1 through 29): Person-in-charge: Liz kin? Number of Repeat Violations Related Inspector: girl} 0(6ch Liv to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 1 IN luroi cos] 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 f? 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, Management, food employee and 17 previously served, reconditioned 3 conditional employee; knowledge, unsafe fOOd responsibilities and reporting Timel'l'emperature 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 6 Proper eating, tasting, drinking, or 21 Proper hot holding temperature use 22 Proper cold holding temperature 7 No discharge rom eyes, nose, an 23 Proper date marking and disposition mouth . . . . . 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 prowded for raw/ 9 undercooked food fOOd - Highly Susceptible Populations Adequate handwashing sinks properly . . . 10 supplied and accessible Ago :ch 26 Pasteurized foods used; prohibited foods Approved Source not offered . as ea FoodICoIor Additives and Toxic Substances 11 Food obtained from approved source -. . . . Food additives: approved properly 12 Food received at proper temperature 27 used 13 F303 90"" safe' 3? 23 Toxic substances properly identified, a. a era stored used 14 Requued records available. sheilstock 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 Reinspection: Discussion with Person-in-Charge: tomes Signature of Person-in-Ch ?/snat??l 25.1,ny MDPH report form ware?m ?1 Food Establishment Inspection Report? City/Town of Sella/t mw??ut Establishment. 29?} Lid-2L!? econ RETAIL Pam-amiss AND MAssAcnuserrs-ONL? s?j'chI Page 2 of; in compliance out of compliance not observed not applicable - corrected on- site during inspection repeat violation IN Compliance Status I Compliance Status lN our NIA N10 cos Safe Food and Water Warewashing facilities: installed 30 Pasteurized eggs used where 48 maintained, 8. 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; processing methods adequate pressure Food Ternperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; deVIces 33 adequate eqmpment for 52 Sewage waste water properly temperature control disposed 34 Slag-t food properly cooked for hot 53 Toilett featitujres: props-rt: 0 mg cons ruc supple same 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate ?utilities maintained Food Identi?cation 55 fSCIgtiels Installed, 37 Food properly labeled; original main aIne cean . container 56 Adequate ventilation lighting, Prevention of Food Contamination . designated areas used Insects, rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present M1 [Anti-choking procedures in food Contamination prevented during servrce establishment 39 M2 IFood allergy awareness food preparation. storage and display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 Caterer 41 42 Wiping cloths: properly used stored [Washing fruits vegetables Proper Use of Utensils M4 Mobile Food Operation M5 Temporary Food Establishment M6 V, Public Market; Farmers Market M7 Residential Kitchen; Bed-and- Breakfast Operation 43 In?use utensils properly stored 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 property M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 innovative Operation 47 Food non-food contact surfaces cteanable, properly designed, constructed used Local Requirements L1 Local law or regulation L2 Other ?Ia/h: Type of Operation(s): El Residential: Cottage Foods El Residential; Bed El Mobile/Pushcart El Temporary Food Estab. ?QOther and Service Establishment Retail Food Store reakfast ELHACCP pe ?yRoutine Re-inspection El Pre?operational El illness investigation 12] General complaint ?Dther lu?l 519mg? Other Information: Signature of Person-in-Charge: Signature of Inspector: ?mf??r ?mi/J/I7 MDPH report loan - 11161113 versmn Food Establishment Inspection Report City/Town of 620%.: Eabushment: Mgr-31114 [Jamal ?clwa I {Date Pagegof?j 1' re Observations Item] Location Item I Location Item I Location I Observations andlor Corrective Actions in this must be corrected within the time frames stated below or Section of Code Description of Violation Date to Correct Item Palm I a in a .h with :Ignature :aiy/g I . ?7 ignatureo nspec orMDPH report form 10l5i'18 version Food Establishment Inspection Report City/Town of OLA Establishment: gtethNet-abj KIN) Date: 9] g} [It 1 Page1ofL Address: 13?5- ff?nnm 51? Time in: Time out: Telephone: (c gnu (ML/apt; 131.7! LPermit No.: Owner: Number of Violated Provisions Related to Foodborne Illness Risk Factors 9 and Interventions (Items 1 through 29): Person-in-charge: 015th Dang. i {n inspector: [3/4 A a 14 Number of Repeat Violations Related to Foodborne illness Risk Factors and interventions (Items 1 through 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH iti?r?EmEuTrons IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status In louTlNrAINiolcosl Compliance Status low] NIAthol cos Supervision Protection from Contamination Person-in-charge present, demonstrates 15 Food separated and protected I knowledge, 300' performs duties 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized Empiqyee Health 1 Proper disposition of returned, Management, food employee and 17 previously served, reconditioned 8t 3 conditional employee; knowledge, unsafe fOOd responsibilities and reporting 1 TituelTemperature 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 diarrheai events holding 1 Good Practices 20 Proper cooling time and temperature 5 Proper eating, tasting, drinking, or 21 Proper hot holding temperature tobacco use 22 Proper cold holding temperature 7 $23: charge from eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control Preventing Contamination by Hands 8 Hands clean properly washed No bare hand contact with ready-to-eat food Adequate handwashing sinks properly 10isuppiied and accessible Consumer Advisory 2 01 Consumer advisory provided for raw/ undercooked food Highly Susceptible Populations Approved Source 11 Food obtained from approved source 12 Food received at prOper temperature Ka?h?s 0? Food received in good condition, safe, 13 unadulterated Required records available: sheilstock 14 tags, parasite destruction 26 Pasteurized foods used; prohibited foods not offered FoodIColor Additives and Toxic Substances 27 Food additives: approved properly used 28 Toxic substances properly identified, stored used Conformance with Approved Procedures 29 Compliance with variance specialized process HACCP Plan ta" 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: AW 5/qu Signature ofF?erson-in-Charge 1580? If, lLSignature of Inspector: [2&1ng MDPH roman lorn'l 10i5/18 version Date: Date: 9 Food Establishment Inspection Report City/Town of Out/id Establishment: GGCCAUQ wU/a/ [gnoll I Date. (N S/l?t I Page 2 of coon RETAIL PRACTICES massacitusertsc? sections lN= in compliance out of compliance NIO- not observed not applicable corrected on- site during inspection - repeat violation Compliance Status fouthmINiolcosl Compliance Status IN OUT NM N10 005 . 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 backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, 8r cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; maintained Food Identi?cation 55 Physical facilities installed, 37 Food properly labeled; original maintained, 8? . . container 56 Adequate ventilation lighting, Prevention of Food Contamination deSIgnated areas used - Insects rodents animals not Additional Requirements listed' In 105 CMR 590. 011 38 present M1 Anti- -choking procedures In food ?y Contamination prevented during service establishment 39 food preparation, storage and M2 allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 [Caterer IX M4 Mobile Food Operation Wiping cloths: properly used 41 stored M5 Temporary Food Establishment A 42 Washing fruits vegetables . . . - M6 Public Market; Farmers Market Proper Use of Utensils M7 Residential Kitchen; Bed?and- 43 ln?use utensils properly stored Breakfast Operation A 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food )6 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 x. Utensils, Equipment and Vending M11 Innovative Operation PC Food non-food contact surfaces tire; Local Requirements u-w - -.- 47 cleanable. properly designed, 91' L1 Local law or regulation )c constructed used it? L2 Other )0 pe of Operationls): of Inspection: Other Information: flood Service Establishment B?R?tutine Retail Food Store Re- -inspection Residential: Cottage Foods El Pre-operational El Residential; Bed 8. El Illness investigation Breakfast General complaint Mobile/Pushcart HACCP El Temporary od Esta. that 33! mg n; 12 Other foam Slgnature ofPerson In -Charge: Date: [ff/J Signature of Inspector MW Date. [76 MDPH report form - mane verston ?Food Establishment Inspection Report City/Town of Or] 1 V) (LU [Establishment BfEaKW-Boib lDate: Pagelofl . i 5 Item I Location Item I Location Item I Location 6 ILA Observations andior Corrective Actions :3 cited in be corrected within the time stated ow or 8405.11 of the Food Code Ngrim Section Of Description of Violation Date to Correct 1/ Signature of Person-in-Charge: bb an: Date: QXfr/I/?v Signature of inspector: L?wl/ CL Date: MDPH report form 10l5rla version Food Establishment Inspection Report City/Town of (901 mm, Establishment: Bean A '7 7 c, ,4 215/20: Page 1 of?? Address: [Gk-Wk! Time in: Time out: Telephone: 1., hr) . I Permit No.: Owner: to Foodborne Illness Risk Factors and interventions (Items 1 through 29): Number of Violated Provisions Related 9? Person?in?charge: :nAm?Q Wm (as, Inspector: pf} UL Mn M014 Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 Iowhu?wolcos? Compliance Status I IN 008} Supervision Protection from Contamination Person-in-charge present, demonstrates knowledge, and performs duties 1 01 Food separated and protected Food-contact surfaces; cleaned 125-2" 2 Certified Food Protection Manager 16 sanitized Employee Health Proper disposition of returned, Management, food employee and )0 17 previously served, reconditioned 3 conditional employee; knowledge, unsafe fOOd responsibilities and reporting Timel'l'emperature 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 6 Proper eating, tasting, drinking, or 21 Proper hot holding temperature use 22 Proper cold holding temperature 7 223;: charge from eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control 8 Hands clean properly washed )0 No bare hand contact with ready?to-eat food )0 Adequate handwashing sinks properly II )0 10 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: shellstock tags, parasite destruction .X Preventing Contamination by Hands 14 Consumer Advisory Consumer advisory provided for raw/ process HACCP Plan 25 undercooked food Highly Susceptible Populations 26 Pasteurized foods used; prohibited foods not offered FoodIColor Additives and Toxic Substances 27 Food additives: approved properly used 28 Toxic substances properly identified, stored used tiff. Conformance with Approved Procedures 29 Compliance with variance specialized if 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 Ere-inspection: Discussion with Person?in-Charge: lift/?2 Signature of Person-in-Ch [a/M Date: cur/? Signature Date: 22/; 4} f} report Iorm ?35:15 version Food Establishment Inspection Report City/Town of mtuiLl/WQ Establishment: Date: 9125/?? IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN IOUTI ?leol?l Compliance Status IN OUT NIA me 008 Safe Food and Water - 48 Warewashing facilities: installed, 30 Pasteurized eggs used where maintained, used; test strips requred 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 backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed. supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained Food Identi?cation 55 Physical facilities installed, 37 Food properly labeled; original maintained, 8? clean . container 56 Adequate ventilation lighting, Prevention of Food Contamination de3ignated areas used Insects rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present M1 nti-choking procedures in food Contamination prevented during service establishment 39 food preparation, storage and I allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness I M3 Caterer 41 Wiping cloths: properly used I M4 Mobile Food Operation .79 stored it M5 Temporary Food Establishment )0 42 Washing fruits vegetables .3. M6 Public Market; Farmers Market to Pruner Use of Utensils . M7 Residential Kitchen; Bed-and- 43 In-use utensils properly stored j; j. Breakfast Operation 44 Utensils, equipment linens: 3.5; M8 Residential Kitchen: Cottage Food properly stored, dried, handled . .- Operation 45 Single-use single-service articles: I M9 School Kitchen; USDA Nutrition properly stored used i. Program /1 46 Gloves used properly raj-?2 . 5 M10 Leased Commercial Kitchen Utensils. Equipment and Vending M11 Innovative Operation 5.: Food non-food contact surfaces in Local Requirements 47 cleanabie, properly deSignedi L1 Local law or regulation )5 constructed used L- L2 Other 99 of Operation(s): gyps- of Inspection: as it end Sarvice Establishment outine Retail Food Store Re?inspeclion El Residential: Cottage Foods El Pre-operational El Residential; Bed El Illness investigation Breakfast El General complaint Mobile/Pushcart El HACCP El Temporary and Esta b. E?Gther .. QOlher dd 90 Other Information: Slgnature of Person-tn-Chargs: E?x. Date: Signature of Inspector: WM 1/ Daniel/51A!? MDPH report form 10l5l1B version Food Establishment Inspection Report City/Town of (Du Lu? [Establishment or 2 MM II lDate: [q PageLof; I Item I Location Item I Location Item I Location Observations andior Corrective Actions Violations cited In re be the time stated or .1 the Food Code Item Section of Code Description of Violation Date to Correct rod: SM - ae' :gnature o: IF'ersont-Inl-Crh-rarge. I: 9 If 9? Ignatureo nspec 01%: ate. q/f MUPH report form - on QUINCY DEPARTMENT, 440 EAST SQUANTUM STREET QUINCY, MA 02171 FOOD ESTABLISHMENT INSPECTION REPORT Food Protection Program 305 South Street Jamaica Plain. MA 02130 Tel. (617) 983-6712 Name Date eration i? Ins eetion QWVAW 3131 18 1: Food Service lg Routine Address SQ 01,111} 11% la 1 E/?otai] 'Re-inspection Telephone rev10usInspect10n 9 977 El Mobile Date: Owner HACCP Ci Temporary Pre-operatlon Person 1n Charge (PIC) Time I: Caterer El Suspect Illness jui?tl? e, map/ti 111: Tobacco General Complaint Inspector Out: E, HACCP HQ A WW Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of speci?c provisions violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) An?- Choking Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation/ Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Rotated to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Non-compliance with. Tobacco 5911111191111; 599.1309 I: 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives I: 15. Toxic Chemicals PERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time As a Public Health Control REQUIRENIENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an Number of Violated Provisions Related 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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste (F 27. Physical Facility 28. Poisonous or Toxic Materials (F :3 gg?dal Requirements (5901109) within 10 days of receipt of this order. Inspector?s MW Print: H4 a: . aim/13' Prim-u!" Page of Pages Sig? ?P/twdz/ I Establishment Name: Date: I R5 Page: Item Code - Critical Item No. Reference - Red Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION mu Date VerIfIad Al 7Aj//g .. '70 C/iym Discussion With Person in Charge: Corrective Action Required: No Yes El Voluntary Compliance jayRe-inspection Scheduled I, Embargo ll El Voluntary Disposal El Employee Restriction Exclusion Emergency Suspension Emergency Closure Other: 0 Food Establishment Inspection Report City/Town of ?Qu may? Establishment: 8pm? $.mgqrio 9:05 Date: It] I Page1 Address 50 Colum Rani Time in: Time out: Telephone. I Ll7 - If}? 97 7 3? Permit No.: Owner: Number of Violated Provisions Related . to Foodborne Illness Risk Factors 9 and Interventions (Items 1 through 29): Person-in-charge: A A ELM be in Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions {items 1 through 29): Inspector: at, 1AA 641!?ij 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 Compliance Status IIN Supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected I 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 previously served, reconditioned 3 conditional employee; knowledge, unsafe f00d TimelTemperature Control for Safety responsibilities and reporting 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures 5 Procedures for responding to vomiting 1g Proper reheating procedures for hot and diarrheal events holding Good Hygienic Practices 20 Proper cooling time and temperature 6 eating, tasting, drinking, or 21 Proper hot holding temperature to aFCOhuse 22 Proper cold holding temperature 7 No (me arge rom eyes, nose, and 23 Proper date marking and disposition mouth . . ,z . . . 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 prowded for raw/ 9 undercooked food f??d Highly Susceptible Populations Adequate handwashing sinks properly . . . 10 supplied and accessible . 26 foods used; prohibited foodsJ Approved Source 11 Food obtained from approved source FoodIColor Additives and Toxic Substances 12 Food received at proper temperature 1 Food received in good condition, safe, ,1 unadulterated "4 Q.) .3: . Food additives: approved properly 27 used Required records available: shellstock tags, parasite destruction 14 Toxic substances properly identified, 2 stored used CD 0 Conformance with Approved Procedures 2 Compliance with variance specialized (O 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. 015(8). Date of Reinspection: Discussion with Person-in-Charge: Signature of Person in-Charge: 3T1 Date. 47/6 Signature of Inspector: [if/?j i d% Dalm9/j/f?l MDPH report lorrn? 1015113 version Food Establishment Inspection Report City/Town of (Du ?er \t Establishment: Kg, Manolo we: Date. Page 2 of f3_ lN= in compliance outofcompliance not observed notapplicable corrected on- s?ite duringinspection R=repeatviolation Compliance Status Comp iance Status IN OUT cos Safe Food and Water 48 Warewashing facilities: installed, 30 Pasteurized eggs used where required maintained, used; test strips 49 Non-food contact surfaces clean 31 Water ice from approved source Physical Facilities 32 Variance obtained for specialized processing methods 50 Hot cold water available; adequate pressure Food Temperature Control . 51 Plumbing installed; proper backflow Proper cooling methods used; deV'CeS 33 adequate equipment for . 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained Food Identi?cation 55 Physical facilities installed, Food properly labeled; original maintained, clean Adequate ventilation lighting; 56 . de3lgnated areas used 37 . contalner Prevention of Food contamination insects rodents animals not Additional Requirements listed in 105 CMR 590. 011 38 present M1 Anti-choking procedures in food . Contamination prevented during serwce establishment 39 food preparation, storage and M2 allergy awareness display Review of Retail Operations listed in 105 cm??ssomo 40 Personal cleanliness M3 Caterer >5 41 Wiping cloths: properly used M4 Mobile Food Operation stored M5 Temporary Food Establishment 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 )6 Single-use single-service articles: School Kitchen; USDA Nutrition 45 M9 properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 innovative Operation Food non?food contact surfaces i: Local Requirements 47 ole-enable. properly designed, $14:ng L1 Local law or regulation )6 constructed used it? . L2 Other Type of Operation(s): pe of Inspection: Other Information: El Food Service Establishment Routine El Retail Food Store Re-inspection El Residential: Cottage Foods El Pre-operational Residential; Bed El illness investigation Breakfast El General complaint El Mobile/Pushcart El HACCP 1] Temporary cod Estab. gother 12?; \g 935 Other on Signature of Person-in-Charge; Date: 2 i 9 Signature of Inspecto? Date: I I9 WU MDPH rspon Iotrn t?i?l?i? versidni' 5?5? Food Establishment Inspection Report - City/Town of Quint at lEstablishment: Brogwm dmr. <3 lDate: 0? I I I PagegofL I Item I Location Tem Item I Location Item I Location r. Observations andior Corrective Actions this must be corrected within the time stated below or in 11 oi the Food Code Item Section of Description of Violation Date to Correct AW :Igna:ure 0::ersorl-ini-Chaijle: 2 MAM 1::an ?1 Ignaureo nspecor. MDPH report form IDISHB version? Food Establishment Inspection Report f1 City/Town of ?Ma, Establishment: C691 z-I-V?n I MIFCIAIC Seam; I Date: Page1 of Address: 7 3' ?m s; Time in: Time out: Telephone: '3 7 6 5'11) I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: a f) and Interventions [Items 1 through 29}: Person-in-charge: a I) I-em Pyd? Number of Repeat Violations Related Inspector: (5.1 I 0164! to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 IN Compliance Status I Supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected knowledge, 80d performs duties 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized EmployeeHealth Proper disposition of returned, Managen'IentI food employee and 17 previously reconditioned 3 conditional employee; knowledge, unsafe food . and reporting Tlma?entperatiire 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 G00d Hygienic Practices 20 Proper cooling time and temperature 6 Proper eating, taSth. drinking, 0" I 21 Proper hot holding temperature use 22 Proper cold holding temperature 7 No discharge rom eyes, nose, and 23 Proper date marking and disposition mouth . . . . . 24 Time as a Public Health Control Preventing Contamination by Hands . Consumer Advrsory 8 Hands clean properly washed No bare hand contact with read -to-eat 25 Consumer adwsory prowded for raw/ z? 9 undercooked food fOOd Highly Susceptible Populations Adequate handwashing sinks properly 10 supplied and accessible I 26 Pasteurized foods used, prohibited foods Approved Source not offered . FoodIColor Additives and Toxic Substances 11 Food obtained from approved source . additive 'a I 12 Food received at preper temperature 27 5' pprove F003 900d condition, safe, 8? ., l. 28 Toxic substances properly identified, una era 9 . stored used I 14 Reqwred records available. shellstoc 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 ofsuspension, 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: (DEMOS i'Ii Signature of Person-in-C ge: 01 Signature of Inspector: My iuioPH report form 10/5/18 version Date: ?7 a Food Establishment Inspection Report City/Town of Quinn?? i-J/ Establishment: (leash-7," If ch/I Date: a I I ?1 Page2 of_: IN in compliance out of compliance NIO not observed NIA not applicable 008 corrected on-site during inspection repeat violation Compliance Status I IN iomlumlmolcosl Compliance Status OUT NIA N10 cos Safe Food and Water Warewashing facilities: installed, 30 Pasteurized eggs used where 48 maintained, 81 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; processing methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; devrces 33 adequate equnpment for 52 Sewage waste water properly temperature control disposed 34 :lagt food properly cooked for hot 53 Toile: featt?res: prrlopgrl? i 0 mg cons ruc supp ie eane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; fa?l'ltle? maintained Food Identification 55 Phys:cal taught-is installed, 37 Food properly labeled; original I. \fent?aetfonn lighting" container . Prevention of Food Contamination 56 designated areas used - insects rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present 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 ll M3 Caterer \g 41 Wiping cloths: properly used M4 Mobile Food Operation stored in} M5 Temporary Food Establishment 74 42 Washing fTUilS vegetables n. . . M6 Public Market; Farmers Market r7? Proper use Of UIEHSHS . . M7 Residential Kitchen; Bed-and- 43 In-use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation 45 Single-use I single-service articles: - M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly ~37 M10 Leased Commercial Kitchen Utensils, Equipment and trend ng M11 innovative Operation ?t Food non-food contact surfaces 3? Local Requirements 47 cleanable, properly designed, - 13;} . L1 Local law or regulation 54 constructed used 1 L2 Other 74 pe of Operation(s): pe of Inspection: Other Information: ood Service Establishment gRouline ?sts" Food Store IZJ Re-inspection H009 It)? (V I +7 71C Residential: Cottage Foods El Pro-operational El Residential; Bed El Illness investigation Breakfast El General complaint El Mobile/Pushcart HACCP El emporary ood Estab. Other 56,139?" Milepmm 2%1her 35E .23! 3 . Signature of Person-l harge: Date: Ci 5? 1 Signature ?MDPH report form - means r~ Food Establishment Inspection Report City/Town of (1)01 KC EstablishmentDate: ?7 Page of Tern erature Observations item I Location item I Location Item I Location I 2'7 I 0 Observations andior Corrective Actions lotions cited in this must be corrected within the time or in Section 3495.1 Section of Code Description of Violation Date to Correct Olwv Wet, ?1r an.? Item gna ureo erson-tn-t?lrge. {?1an a i P3101 I i 6 Signature Date?7/ r/ I (I MDPH rep-m farm - icons version Food'Establishment Inspection Report City/Town of Y1 Establishment: Ch I f: Cm Date: (Hf/19 Page1 of 2 Address: L50 GM 1; ?21va Time in: Time out: Telephone: .l Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors 2\ Owner 3 and Interventions (Items 1 through 29): Person-in-Charge: 539? {4 kg Number of Repeat Violations Related tr to Foodborne Illness Risk Factors Inspector: VA (Al/[011: {33% and Interventions [Items-1 through 29): 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 In Compliance Status liN omlNIAINi0 cos Supervision Protection from Contamination 1 Person?in-charge present, demonstrates 15 Food separated and protected knowledge, and performs duties 1" 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager 3} sanitized Employee Health Proper disposition of returned, 17 previously served, reconditioned )0 Management, food employee and unsafe food 3 conditional employee; knowledge, responsibilities and reporting ?mef?l?ernperature Control fer Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures \n 5 Procedures for responding to vomiting 19 Proper reheating procedures for hot [v and diarrheal events holding .50 500d Hygienic Practices 20 Proper cooling time and temperature )0 6 Proper eating, tasting, drinking. or 21 Proper hot holding temperature tobacco use 22 Proper cold holding temperature .P. 7 mggtirscharge from eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control t' t' reven mg on aminaion an Consumer Advisory 8 Hands clean a properly washed No bare hand contact with ready-to?eat Consumer adVIsory provrded for aw/ undercooked food 25 9 food 10 Adequate handwashing sinks properly supplied and accessible Highly Suscemible Populations Pasteurized foods used; prohibited foods not offered Mir Approved Source FoodIColor Additives and Toxic Substances 11 Food obtained from approved source Food additives: approved properly Yd 12 Food received at proper temperature 27 used 13 F003 rleceiyedd 900d condition, safe, 8? :5 :5 28 Toxic substances properly identified, 1 una era . stored used 1 ReqUired records available. shellstock Conformance with Approved Procedures I tags, parasrte destruction . . . . . o. 29 Compliance With variance speCIaIized process HACCP Plan 'i 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: 1 Signature of Person-in-Charge: WW Date: 9/ 9? Signature of Inspector: My Date: 01/ MDPH report form 105113 varsrori Food Establishmelit Inspection Report City/Town of oi Establishment: i?ihc 5 co 9K 0L Date. g?il?i soon RETAIL- PRAcrIces Arie usertsonur stamens in compliance outofcompllance not observed NIA=notappIicabIe corrected on-site durIng Inspection R=repeatviolation Compliance Status I IN Compliance Status IN Page 2 of 3_ OUT COS Safe Food and Water Warewashing facilities: installed, 30 Pasteurized eggs used where )0 48 maintained. used; test strips required 49 Non-food contact surfaces clean 31 Water at ice from approved source Physical Facilities 32 Variance obtained for specialized 50 Hot cold water available; processing methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 :Iagt food properly cooked for hot 53 Toilei feetitujres: propzrl? I 0 mg cons ruc ,suppIe . ceane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; faellitlee maintained Food Identi?cation . 55 Egi?ig?iggcgit?zgi?stalled. Food ro erly labeled; ori inal 37 contaifierp 56 Adequate ventilation lighting; Prevention of Food Contamination deSFSIIated areas used Insects rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present, M1 Anti-choking procedures in food )i Contamination prevented during M2 :ervcilceuestablishment 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 Vilipindg cloths: properly used M4 Mobile Food Operation )0 ore M5 Temporary Food Establishment go 42 Washing fruits vegetables M6 Public Market; Farmers Market )0 Proper Use Of Utensiis M7 Residential Kitchen; Bed-and- A) 43 ln-use utensils properly stored Breakfast Operation 44 Utensils. equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen )4 Utensils, Equipment and Vending M11 Innovative Operation >0 Food non-food contact surfaces .51. LIJ Local Requirements 47 cleanable, properly designed, if; L1 Local law or regulation constructed used Irx L2 Other Type of Operation(s): Food Service Establishment El Retail Food Store Residential: Cottage Foods Residential; Bed El Mobile/Pushcart mporary Food Estab. of of Inspection: Rutine Re- -inspection Pre-operaiional El Illness investigation El General complaint El HACCP FLther ile- I reakfast Other Other Information: I Signature of Person-in-Charge: A Signature of Inspector: I [7331/ 77m Date: cl/f//4 MDPH report form Im?f?l? version Food Establishment inspection Report City/Town of I Ulrika/1 [Establishment ?e/ng 05:133.? Date: RUBEN 1' Item I Location Item Section of Tem erature bservatlons Item I Location Item I Location Observations andior Corrective Actions must be ames stated below or in Section Description of Violation Date to Correct Signature of Person-in-Charge: MW Signature of Inspector: Jay/i 67/37/13 MDPH report form 10mm version . Food Establishment Inspection Report City/Town of QJM Establishment: Lthh?dlh H?Mact, 1 $1 Date MI Page 1 of Address: 300 Time In: Time out: Telephone: C(?irL?h 3?7 6 3/ I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors 2 Owner: PI 5 and Interventions (Items 1 through 29): Person-in-Charge: WufNumber of Repeat Violations Related . to Foodborne Illness Risk Factors Inspector. DI I Diets? and Interventions (Items 1 through 29]: Foopao??'E ILLNESS met moronsmrueuc HEIIL mf?li, - =1 rj In compliance out of compliance not observed NIA- - not applicable COS- corrected on-site during inspection R- - repeat violation Compliance Status IIN OUTINIAINIOICOS Compliance Status IIN [omlmalmolcos stinger-eon I. Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected knowledge and performs duties 1 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized . Employee H?ath. 5.31% Proper disposition of returned, Management, food employee and 17 previously served, reconditioned 3 conditional employee; knowledge, unsafe 1?90? reaponsibilities and reporting '4 1" 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 Grim! '2 - .J, I 20 Proper cooling time and temperature 5 Pr?ipereatmg, tastIng, dr??k'?9 or 21 Proper hot holding temperature to ?3930 use 22 Preper cold holding temperature 7 N0 dIscharge from eyes, nose, and 23 Proper date marking and disposition . [mouth . . .Time as a PubIIc Health Control Preventing Contamination by Hands 55;: . . . - Consumer- Advisory 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 Susceptible Populations supplied and accessible 26 foods used, prothIted foods I rovod Source . App FoodiCotorAdditIvos and Toxic Substances 11 Food obtaIned from approved source Food additives a roved ro erI 12 Food received at proper temperature 27 used pp . . . . 13 F003 rlecelre: 900d condItIon, safe, 8? 28 Toxic substances properly identified, una era . I stored 8. used 14 ReqUIred records avaIIabIe. She Conformance with Approved Procedures tags, paraSIte destructIon . . . . . 29 CompIIance WIth varIance speCIalIzed l' . 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 c0rrect 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: l7 mow?) Signature of Inspector: Signature of Person In-Charge A j/ MDPH report form - Iot?t?i? iN= in compliance out of compliance not observed notappiicabie COS: corrected on- site dunng inspection repeat VIoiatIon _Compliance Status IN [our] NIAlNIolcos R Compliance Status iN our NIA mo cos 7. E.- S?f?m 3? 13,4 - Warewashing facilities: installed $0 Pasteurized eggs used where I 48 maintained, test strips required 49__No_n-_food contact surfaces clean 31 Water& ice from approved source -. I PIES-TERM 3' . >511 32 Variance obtained for specialized 50 Hot cold water available; processing methods adequate pressure . . .- .. 5 . . 51 Ego/$239 Installed, proper backfiow roper coo Ing me use 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 :iagt food properly cooked for hot 53 Toiie: feattiares: propgrii i 0 mg cons ruc . supp Ie ceane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate dIsposed; faCIIitieS maintaIned if?? .53, $123; .fp??d?i?i in} 55 Physical facilities installed. 37 Food properly labeled; original maIntaIned, 8? clean container 56 Adequate ventilation lighting; :1 :fvr ??Pre?nt?an f' - designated areas used . insects, rodents. animals not '4 33 present Anti-choking procedures In food Contamination prevented during serVIce estabiIshment (If 39 food preparation, storage and allergy awareness .. . display Will? mapem?om "?at in mm_mslo 40 Personaicleaniiness M3 Caterer 41 Vllipindg cloths: properly used 8. M4 Mobile Food Operation ore M5 Temporary Food Establishment 42 Washing fruits vegetables I. . M6 Public Market; Farmers Market Properties ofUtsn'sils? M7 Residential Kitchen; Bed-and- 43 In-use utensils properly stored Breakfast Operation 44 Utensils. equipment& linens: M8 Residential Kitchen: Cottage Food properly stored. dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen 4" Utensils, Equipment and Vending M11 innovative Operation Food non-food contact surfaces Local Requirements 47 cieenabie properly designed, L1 Local law or regulation constructed used L2 Other I pe of Operationis): Ty of inspection: Other information: szood Service Establishment B?fnine [3 Retail Food Store El Re-inspection El Residential: Cottage Foods 1] Pre-operationai El Residential; Bed El Illness investigation Breakfast El General complaint El Moine/Pushcart HACCP i3 Temporary and Estab. ?omer Oiher 2 3341 gig-7464 A I Signature of Person-ln-Charge' ta: 41' 4 Signature of Inspector: magi/q If? MDPH report iorrn - 1Ur5i1El version Food Establishment Inspection Report City/Town of ?u [but [y {Establishment Lthdo'm Date: a (q Pagelofl I 'erature Observations Item I Location Item I Location Tern Item I Location I I 1 Observations andior Corrective Actions in this must be corrected within the time frames stated below or In Section 5405.11 of the Food Code Item Section of Code Description of Violation Date to Correct By I adj/9 ?Mi Mann?t UJ- Signature of Person-in-Charge: ?54 LL (767 Ditty If Signature W4 Datel l1 I MDPH repon form - 105?!) verso-an Food Establishment Inspection Report City/Town of er'fm?ly Establishment: 1? i 3011004 Date: 7/6/14? Page 1 of; Address: 6; 51. Time im? Time out: Telephone: 53/9? 87;] IPermitNo: Number of Violated Provisions Related Owner: a 5 to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 3 conditional employee; knowledge, responsibilities and reporting Person-in-Charge: Dram t. DCa?i Number of Repeat Violations Related to Foodborne Illness Risk Factors Inspector: r511! 13ch and Interventions (Items 1 through 29): ?1 . - j. 1? regenerate-levees: hisrtrecroes elegance? 3 IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN UT we we cos Compliance Status IourlNIA ~e cos . ?zj' T'fi?irer?vieienr Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected and performs duties 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized 11?? 7 Proper disposition of returned, Management, food employee and 17 previously served, reconditioned unsafe food f; r, "1 4 Proper use of restriction and exclusion '1 Procedures for responding to vomiting and diarrheal events is 7' heed Realtor: Erectioes' - . Eta Proper eating, tasting, drinking, or tobacco use No discharge from eyes, nose. and mouth Preventing Contamination by Han CD iHands clean pr0perly washed No bare hand contact with ready-to-eat food Adequate handwashing sinks properly 10 supplied and accessible Approved Source 11 Food obtained from approved source T, 12 Food received at proper temperature Food received in good condition, safe, 1 unadulterated 14 Required records available: shellstock tags, parasite destruction 8 Proper cooking time temperatures 19 Proper reheating procedures for hot I holding 20 Proper cooling time and temperature 21 Proper hot holding temperature 22 Proper cold holding temperature 23 Proper date marking and disposition .- 24 Time as a Public Health Control I consummate-e . I . 25 Consumer advisory provided for raw/ I undercooked food Highly Susceptible Populations 26 Pasteurized foods used; prohibited foods not offered 1 FoodJCoIor Additives and Toxic Substances 27 Food additives: approved properly used 28 Toxic substances properly identified, stored used 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 Date of Reinspection: Discussion with Person-in-Charge: (9 Signature of Inspector: . .i /7 r? . Signature of Person-in-Charmg MM 7?ij[7 g4 arr/r7 MDPH report form 105le verslon Food Establishment Inspection Report? City/Town of Ifif Establishment: maul-IT?5,333" ?:94 ii?! 1" I in compliance out of compliance Ni0= not observed not applicable COS corrected on -site during?inspection R=repeatviolation Page 2 Complyance Status 1 IN [our] Compliance Status IN our NIA mo cos 7531': Hill]! and Wife! 48 Warewashing facilities: installed, 30 Pasteurized eggs where maintained, 81 used' test strips required 49 Non- food contact surfaces clean 31 Water 8. ice from approved source A, A PhysichFaifli?gs I 32 Variance obtained for specialized 50 Hot cold water available; processing methods adequate pressure Fond'l'qmperatura Can . .7 51 Plumbing installed; proper backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed Plant food properly cooked for hot Toilet features: properly 34 . 53 . holdIng constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate facilities maintained . Foodldenti?catibn .21: .1 55 Physical facilities installed, 3? Food properly labeled; original maIntaIned, 8? clean container 56 Adequate ventilation lighting; rerun-Iran ofFiIod'C'cil'ltiirii ., 956d Insects. rodents. animals not - 050 R- 33 present M1 Anti-choking procedures in food Contamination prevented during servuce establIshment 39 food preparation, storage and M2 F0051. allergy awareness .. display Raviaw of Retail Operations listed In 105 CMR GEMINI 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation lstored M5 Temporary Food Establishment 42 IWashing fruits vegetables M6 Public Market; Farmers Market Proper Use of Utensils M7 Residential Kitchen; Bed-and- 43 ln-use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation Single-use single-service articles: School Kitchen; USDA Nutrition . 45 M9 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 OlperatioMs): Type of Inspection: Other Information: Food Service Establishment Routine Retail Food Store Re-inspection El Residential: Cottage Foods Pre-operational Residential; Bed El Illness investigation Breakfast General complaint Mobile/Pushcart HA yours Esfb. MIW j?kU/\ Other it, 1211? I?j i 1' I naureo arson-n- are: 5 ae' i a:ura :lps tl-GI1 I jig/J Bit 0 npecor. w?t/ MDPH repon form - t?i?it? version Food Establishment Inspection Report City/Town of <0th9; j/ Establishment: lDate: 7/6/ Page of re Item I Location Item I Location Item I Location ll bf 5 I Observations andIor Corrective Actions Violations cited in this 011 must within the time below or in Section E-4CI5.11 of the Item Section of Description of Violation Date to Correct . Signature of Person-ln-Charg/EW 1 7' Signature of Inspector: 0' Date: [a MDPH report mime version Food Establishment Inspection Report City/Town of 6?20ng Establishment: Date: $167 I 9 Page Address: LI New NJ Time in: 1 Time out: Telephone: a 6L I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: P. and Interventions (Items 1 through 29): Person-in-charge: 0:61?, Pom Number of Repeat Violations Related 1- . to Foodborne illness Risk Factors Inspector Br II flea-J? and Interventions (Items 1 through 29): 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 lom ~mi~ro cos Supervision Protection from Contamination 1 iPerson-in-charge present, demonstrates 15 Food separated and protected knowledge, 30d performs duties . 1 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, Management, food employee and 17 previously served, reconditioned 3 conditional employee; knowledge, unsafe 1r00d responsibilities and reporting Ttmarrarnparature Control for Safety, 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures 5 Procedures for responding to vomiting I 19 Proper reheating procedures for hot and diarrheai events holding 600d Hygienic Practices ., 20 Proper cooling time and temperature 6 Proper eating, tasting, dr'nk'?9: or 21 Proper hot holding temperature ??900 use 22 Proper cold holding temperature 7 N0 discharge from eyes, nose, and 23 Proper date marking and disposition mouth . . . . . 24 Time as a Public Health Control Preventing Contamination by Hands . Consumer Advrsory 8 Hands clean properly washed . . No bare hand contact with read -to-eat 25 Consumer advrsory rovrded for raw/ 9 undercooked food food Highly Susceptible Populations Adequate handwashing sinks properly - . . . 10 supplied and accessible 26 Pasteurized foods used, prohibited foods .4. Approved Source not offered . 7, 7.: FoodiCoIor Additives and Toxic Substances 11 Food obtained from approved source as. Food addit'ves a roved I 12 Food received at proper temperature 27 used I pp oper F003 nice'fe: 900d condition, safe, 1' 28 Toxic substances properly identified, una era I stored used -. 14 Requrred records avaiiab e. sheiistock Conformance with Approved Procedures tags, parasrte destruction . . . . 29 Compliance variance specrailzed - process HACCP Plan I Official Order for Correction: Based on an inspection today, the items marked indicated violations of 105 CMR 590.000 and applicable sections ofthe 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: Comp; I to Signature of Person-m-Chargexw r} Ar Signature h? MDPH report form - tartar-EB version Food Establishment Inspection Report? City/Town of Game Establishment. 7L Sci?[?ail Date. {761 Page 2 of; ?6601: 35ml; essences AND MASSACHUSETTS-ONLY seerIONs in compliance out of compliance - not observed not applicable corrected on- -site during inspectim R- repeat violation Compliance Status I IN Compliance Status IN OUT NIA mo cos saferood andti'later, 48 Wa-rewashing 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 backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control dIsposed 34 Plant food properly cooked for hot 53 Toilet features: properly holdIng constructed, suppIIed. cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate dIsposed; maIntained Food Identifibatien 55 Physical facilities installed, maintained. clean 37 Food properly labeled; original I . . container 56 Adequate ventIIatIon IIghtIng; designated areas used Prevention of 7 Additional Requirements IiStEd in 105 CMR 590.011 38 Insects, rodents, animals not present M1 procedures In food Contamination prevented during servIce estabIIshment 39 food preparation, storage and M2 Food-allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 [Caterer 41 JWiping cloths: properly used M4 'Mobile Food Operation stored M5 Temporary Food Establishment 42 {Washing fruits vegetables . M6 Public Market; Farmers Market Proper Use Of M7 Residential Kitchen; Bed-and- 43 In-use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen A Utensils, Equipment and Vending M11 Innovative Operation Food non-food contact surfaces {1,13 Local Requirements 47 cleanable, properly designed, KIT 33?, L1 Local law or regulation 7C: constructed used r? L2 Other If pe of Operation(s): pe of Inspection: Other Information: 2304mm Service Establishment )gRoutine Retail Food Store El Rte-inspection Residential: Cottage Foods El Pre-operational El Residential; Bed El Illness investigation Breakfast General complaint Mobile/Pushcart ACCP Egemperaryfo dEstab. gather Rd ther Signature of A 7/425??! "1 SIgnature of Inspector: MM 6? /l:3ste:/ I a) MDPH report form 1015118 verslon Food Establishment Inspection Report City/Town of Glut Etablishment: Schot/ IDate: ?i I Pagelofll Observations Item I Location Tem Item I Location Item I I 646 Observations andtor Corrective Actions in is re must be corrected within the time frames stated or Food Code Section of Code Description of Violation Date to Correct M.) 14? 5 1m: Foa?i )4 e43 ?u/q MS Item Signature of Person-ln-Charge: 4 Signature ?atfd a, MDPH repan term - 1015318 versmn Food Establishment Inspection Report City/Town of MAI Establishment: Wow?! 0, it" Date: Page 1 of Address: 1? mm m1? Sims-er Time in: Time out: 41,? 7 93?71 P70 I Permit No.: Owner: to Foodborne illness Risk Factors Number of Violated Provisions Related and Interventions (Items 1 through 29): Person-in-charge: inspector: Add (from Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions [Items 1 through 29): FOODBORNE ILLNES's 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 JOUTINIAINIOICOSI Compliance Status I IN COSI Supervision Protection from Contamination 13 Food received in good condition, safe, unadulterated L14 Required records available: sheiistock tags, parasite destruction Toxic substances properly identified, 2 stored used CD 1 IPerson-in-charge present, demonstrates 15 Food separated and protected knowledge, and performs duties 16 Food-contact surfaces; cleaned 8. 2 Certified Food Protection Manager sanitized Ei?playe?e Health Proper disposition of returned, [managementI food emp 0yee and 17 DFEVIOUSIY reconditioned 3 conditional employee; knowledge, ?unsafe f00d responsibilities and reporting Ilme?emgeraturo 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 hoiding 500d Hygienic Practices 20 Proper cooling time and temperature 6 Proper eating, tastIng, drInkIng, or 21 proper hot holding temperature use 22 Proper coid holding temperature 7 N0 dIscharge from eyes, nose, an I 23 Proper date marking and disposition mouth Time as a PubIIc Health Control PreventIng Contamination by Hands Consumer Advisory 8 Hands clean properly washed . . No bare hand contact with read -to-eat 25 Consumer adVIsory prowded for raw/ 5/ 9 undercooked food Hi hl Suscs tibie Po ulations 10 Adequate handwashing sinks properly . . no I) supplied and accessible as eurIze 00 5 used, pro I Ited 00 Approved Source not offered . FoodICoIor Additives and Toxic Substances 11 Food obtaIned from approved source Food additives a roved 12 Food received at proper temperature 27 pp prop use ?1 Conformance with Approved Procedures Official Order for Correction: Based on an inspection today, the items marked applicable sections of the 2013 FDA Food Code. This report, when signed below by a an order of the Board of Health. Failure to correct violations cited in this report may re establishment permit and cessation of food establishment operations. if you are subje renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of Date of Reinspection: WW I Signature 6! WM VM Discussion with Person-in-Charge: Z?l/f?mf Signature of Inspector: MDPH repon F?fmv 1015f13 verSIon 29 Compliance with variance I specialized process HACCP Plan VP: Date: indicated violations of 105 CMR 590.000 and Board of Health member or its agent constitutes suit in suspension or revocation of the food ct to a notice of suspension, revocation, or non- health in accordance with 105 CMR 7? 4 Food Establishment Inspection Report? City/Town of Qdmeu?i Establishment: Date: filb?ll't Page 2 of 3 WenthOII?r coop RETAIE raincoat?is AND MASSAGHUSE rrs-oiiLv seerious lN= in compliance out of compliance Nl0= not observed NIA- - not applicable corrected on- site during inspection - repeat violation Compliance Status I ?4 OUT COS Compliance Status I IN JOUTJ Safe Food and Water Warewashing facilities: installed, 3O Pasteu-rjzed eggs used where 48 maintained, 8: 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; 33 adequate equipment for t/ 52 Sewage waste water properly temperature control disposed 34 :leli?'it food properly cooked for hot 53 Toilett feattujres: 0 ing cons ruc supp ie eane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate maintained Food Identification . 55 Physical facilities installed, 37 Food properly labeled; original maintained, 8? container 56 Adequate ventilation lighting; Prevention of Food Contamination designated areas used Insects rodents animals not - Additional Requirements listed in 105 CMR 590.011 38 pr es ent' M1 in food Contamination prevented during M2 :ervtijcenes a '3 men .- 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 )6 41 Wiping cloths: properly used M4 Mobile Food Operation ,p stored M5 Temporary Food Establishment Pg 42 Washing fruits vegetables M6 Public Market; Farmers Market go Proper Use of Utensils Residential Kitchen; Bed-and- 43 ln? ?use utensils properly stored Breakfast Operation 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation Single-use single?service articles: School Kitchen; USDA Nutrition 45 properly stored used M9 Program 46 Gloves used properly M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 innovative Operation )0 Food non-food contact surfaces {?55 Local Requirements 47 cleanable, properly designed, ?Ej- L1 Local law or regulation Y3 constructed used L2 Other )0 pe of Operation(s): #Eood Service Establishment El Retail Food Store Residential: Cottage Foods El Residential; Bed El Mobile/Pushcart l3 Temp ore and Esao. JE/Other Egg: 1 pe of Inspection: Routine El Re~inspection El Pro-operational El Illness investigation El General complaint El VOther My rea kfast Other Information: Signature of Person-in-Charge: W69 MW ?at? El 9? Signature ?air/UM f/J he MDPH report form roisrie um?l?n Food Establishment Inspection Report City/Town of (put me, Establishment: Won/Mia Y?r lDate: 1 PageLofi ons item! Location Item I Location Item I Location Observations andior Corrective Actions cited in this must be corrected below or in Section Item Section of Description of Violation Date to Correct :gnature f'l} 23:9 g! 7 gnatureo nspector. as. (i [f/Iq MDPH repon form - 101518 varsioi'f' Food Establishment Inspection Report City/Town of a . .. . Establ'sment Moore Ow neJi Ht KIA TM no Pater CI i bl I Page Address: 1 if? Time in: Time out: TelephonePermit No.: Number of Violated Provisions Related 1 7 9 If I to Foodborne Illness Risk Factors 9., Owner: and Interventions (Items 1 through 29): Person in charge. (3r) F1 3'11 4L gr Number of Repeat Violations Related to Foodborne Illness Risk Factors [0/3 Vi? [All (i and Interventions (Items 1 through 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS IN in compliance out of compliance NIO not observed MA not applicable COS corrected on-site during inspection repeat violation Compliance Status IJN ?ourlN/AlNiolcos] Compliance Status I IN Iomj NIAINIOJCOSI Supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected y, knowledge, and performs duties 16 Food-contact surfaces; cleaned 8. 2 Certified Food Protection Manager sanitized )4 Employee Health Proper disposition of returned, Management, food employee and 17 previously served, reconditioned unsafe food 3 conditional employee; knowledge, . Timerremperature Control for Safety responsibilities and reporting 3?33? 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures r, 5 Procedures for responding to vomiting 19 Proper reheating procedures for hot and diarrheal events holding )0 300d Hy?i??ic Practices 20 Proper cooling time and temperature )5 5 Proper eating, taSt'?9- drinking, or 21 Proper hot holding temperature tobacco use 22 Proper cold holding temperature 2), 7 mfgma?ge from eyes" ?059' and 23 Proper date marking and disposition )0 . . . 24 Time as a Public Health Control Preventing Contamination by Hands Consumer Advisory I 8 :ande Cl: an Wipe: y-mashed 96 25 Consumer advisory provided for raw/ A) 9 ratio are an con ac wr rea y- o-ea )0 undercooked food 10 Adequate handwashing sinks properly 3? i? . SusceptibllebPopulations supplied and accessible 26 00 3 used, pro ited foods )1 re . App ?d ourc FoodICoIor Additives and Toxic Substances 11 Food obtained from approved source )6 .. Food additives approved properl 12 Food received at proper temperature \0 27 used )0 13 In 900d CONdItlon. safe, 28 properly identified, It :21: 14 shellstock Xi Conformance with Approved Procedures 9 29 Compliance with variance specialized process HACCP Plan )5 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. It 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 ageinSpection: Discussion with Person-in-ChargeSignature of Date: ?at/y/jl; Signature of Inspector: Date: MDPH rancid form - version Food Establishment Inspection Report City/Town of 0W i?m u?l Establishment: Date ?iH/I?i Page 2 of 3_ laws @ul Hm 511.39 i 6000 RETAIL PRACTICES: AND SECTIONS in compliance out ofcompliance notobserved not applicable COS: corrected on- -site during inspection repeat violation IN Compliance Status I IN IOUTI NIAINIOICOSI Compliance Status lN OUT MIA Nio cos 5319 Food and Water Warewashing facilities: installed, 30 Pasteurized eggs used where )0 4B 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 Contfol 51 Plumbing installed; proper backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 :lagt food properly cooked for hot 53 Toilet featujres: pro-ping 0 mg cons ructe supp Ie ceane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate facilities maintained Food identification . 55 installed, 37 Food properly labeled; original $1233: dentist?? lighting container I Prevention of Food Contamination . 56 designated areas ?59d insects, rodents animals not Additional Requirements listed in 105 CMR 590.011 . 38 present M1 Anti-choking procedures in food Contamination prevented during M2 :ervcijceuestablishment 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 y. stored M5 Temporary Food Establishment 42 Washing fruits vegetables M6 Public Market; Farmers Market Proper Use of Utensils M7 Residential Kitchen; Bed-and? 43 ln-use utensils properly stored Breakfast Operation k, 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation Single-use single-service articles: School Kitchen; USDA Nutrition 45 properly stored used M9 Program 46 Gloves used properly M10 Leased Commercial Kitchen . )c Utensils, Equipment and Vending M11 Innovative Operation )c Food non- -food contact surfaces {33' Local Requirements 47 cleanable properly designed, l-j ye L1 Local law or regulation )1 constructed used 'ji-f . L2 Other Weutine Re-inspection El Pre-operational El Illness investigation El General complaint HACCP pe of 0peration(s): ?ood Service Establishment Retail Food Store El Residential: Cottage Foods El Residential; Bed Breakfast El Mobile/Pushcart Tempora od tab. 121? Other ?90 I I 1 Type of Inspection: Other information: . 1' tilt}! Signature of Person~in-Chargo: Signature of lnspecto .: Date. MDPH report form t?f??a version Food Establishment Inspection Report City/Town of w. (L . Establishment: 1U 0M Qumran! All (I: S2: Date: ?9 17] 9 bageiofii Item I Location Item I Location Item I Location Observations andior Corrective Actions rt must time beiow or in Section 8-405.? of the Food Code Item Section of Code Description of Violation Date to Correct By .41 :ignature of Person-I? r95; Date': 9/ 9 ignaturo It Date. 1; MDPH recon form IDISHS match? 1" Food Establishment Inspection Report City/Town of Q0 Mp 9/81/79 Page1of_1 Establishment: I45 ?aking! mam Date: Owner: Address. I I, fwd?d: g1 Time in: Time out: Telephone. I KI 7- 917? ff? 51 Permit No: (I Number of Violated Provisions Related to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): Number of Repeat Violations Related Person-in-charge: f/C ?i?ffq Ana/mew Inspector: to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 momjmlalcosl Compliance Status IDUTINIAINIOICOSI Supervision Protection from Contamination Management, food employee and 3 conditional employee; knowledge, responsibilities and reporting 1 Person-in-charge present, demonstrates 15 Food separated and protected I knowledge, and performs duties 16 Food-contact surfaces; cleaned 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, 17 previously served, reconditioned unsafe food TimeITemperature 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 600d Hygienic Practices 20 Proper cooling time and temperature 5 Proper eating, tasting, drinking, or 21 Proper hot holding temperature tobacco use 22 Proper cold holding temperature .1 7 from eyes, nose, and 23 Proper date marking and disposition 24 Time as a Public Health Control Preventing Contamination by Hands 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 1 . . supplied and acceSSIble :1 0 Highly Susceptible Papulations Approved Source Pasteurized foods used; prohibited foods I not offered 26 11 Food obtained from approved source ,7 FoodlCoIor Additives and Toxic Substances 12 Food received at proper temperature 13 Food received in good condition, safe, unadulterated Food additives: approved properly ,4 27 used Lt. Required records available: shellstock Toxic substances properly identified, 5 2 stored used .2 CD Conformance with Approved Procedures tags, parasite destruction 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 applicabIe 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 Reinspecti n: Discussion with Person-in-Charge: Signature of Person- in- Charge. Signature of Inspe 9mm Date: q/IL/I/fg? MDPH report form 31'5" versiort Food Establishment Inspection Report City/Town of QI/inevji Establishment: NQII: [oedema (200m Date: 5 If GOOD RETAIL AND MASSACHUSETTS-ONLY in compliance outofcompliance not observed not applicable corrected on-site during Inspection R=repeatviolation Compliance Status INJEUTJ Compliance Status IN OUT NIA Nio COS Safe Food and Water 43 Wa-rew-ashing facilities: installed, 30 Pasteurized eggs used where maintained, test Stl'lpS reqUIred 49 Non-food contact surfaces clean 31 Water ice from approved source Mimi Facilities 32 Variance obtained for specialized 50 Hot cold water available; processmg methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 35 Thermometers provided accurate faCIIltleS maintained Food Identi?cation 55 Physical facilities installed, 37 Food properly labeled; original container maintained. clean Prevention of Food Contamination 56 Adequate ventilation lighting; designated areas used 38 Insects, rodents, animals not present Additional Requirements listed in 105 CMR 590.011 39 Contamination prevented during food preparation, storage and display Anti-choking procedures in food service establishment M2 Food allergy awareness Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used M4 Mobile Food Operation j, stored M5 Temporary Food Establishment 42 Washing fruits vegetables -- M6 Public Market; Farmers Market )6 Proper Use of Utensils Residential Kitchen; Bed-and? X, 43 In?use utensils properly stored - ?1 Breakfast Operation 44 Utensils, equipment linens: ?g M8 Residential Kitchen: Cottage Food properly stored, dried, handled 4 . Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program 46 Gloves used properly M10 Leased Commercial Kitchen 3, Utensils, Equipment and Vending M11 Innovative Operation >e Food non-food contact surfaces Local Requirements 47 Cleanablei properly designed, LI Local law or regulation >4 constructed used . ., L2 Other )6 Type of Operation(s): Filigod Service Establishment Retail Food Store Residential: Cottage Foods Residential; Bed Breakfast Mobile/Pushcart mpnrary Esiab - of Inspection: ?utine e-Inspecticn Pre-operational Illness investigation General complaint IZI HACCP Mr 'l IQ?iSlliS ther JAE-LL Other Information: Signature of Person-in-Charge: Date: Signature of lnspectoE Dt: 9/9/25 MDPH report ruim - IDIEIIB versioL/ 21M gag/u Food Establishment lnspection Report City/Town of Go ?It Establishment: ?tk?q?1 [Cm lDate: It] fl 01 1? Pagegof; I re Observations Item I Location Item I Location Item I Location Observations andlor Corrective Actions Violations cited in this time below or in Section 8405.11 of the Food Code Item Number Section of Code Description of Violation Date to Correct By f? 3:9 9/999 at?! 9 f9 MDPH report form version In? Food Establishment Inspection Report City/Town of nevi Establishment: Par ,v fact?? Date: (H 1 Page 1 of 3 Address: I LI ?ti/l n?cq Time in: I Time out: Telephone: I . {?93k} (H) F6116 i Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors an Owner: and Interventions (Items 1 through 20}: Person-in-charge: f) mail t? 3' Number of Repeat Violations Related to Foodborne illness Risk Factors Inspector: Mil Anti/We BI and Interventions (Items 1 through 29}: ILLNESS RISK FACTORS AND PUBLIC IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status IN [curlnmiwo?cosl Compliance Status I IN lourlniiAlN/oicosl Supervision Protection from Contamination 1 Person-in-charge present, demonstratesi 15 Food separated and protected 300' performs duties Food-contact surfaces; cleaned 2 Certified Food Protection Manager 16 sanitized Health . Proper disposition of returned, Management, feed employee and 17 previously served, reconditioned 3 conditional employee; knowledge, unsafe f00d responsibilities and reporting . Timel'l'emperature 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 diarrheai events holding (300d Hygienic Practices 20 Proper cooling time and temperature 6 Proper eating, tasting, drinking, or 21 Proper hot holding temperature tobacco use 22 Proper cold holding temperature 7 :23; charge from eyes, nose, and 23 Proper date marking and disposition . . . 24 Time as a Public Health Control Preventing Contamination by Hands, 8 Hands clean properIy washed - . Consumer Advrsory 9 No bare hand contact with ready-to-eat 25 provrded for raw] 1 food . . . 10 Adequate handwashing sinks properly I U. I Pasteurized supplied and accessrbie - ., not offered 11 Food obtained i" 13} FoodIColor Additives and Toxic Substances 12 Food received at proper temperature 27 additives. approved 8? properly 13 received In 900d condition, safe, Toxic substances properly Identified, unadulterated 28 stored used 14 shellstock Conformance with Approved Procedures . 29 Compliance with variance specialized Vi" 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 ofthe 2013 FDA Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are subject to a notice of suspension, revocation, or non- renewai pursuant 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: (em Signature of Person-in-Charge' Date: Signature of Inspector: Date: c/ I [f MDPH report form 1015/18 versi?n Food Establishment Inspection Report? City/Town of Our m4 Establishment: I JW-kgfr 56k Date: Ll Page20fi GOQD RETAIL PRAcricEs AND sections I in compliance out ofcornpliance not observed not applicable COS: corrected on-site duringinspection R=repeat violation Compliance Status JIM IOUTI Compliance Status iN OUT N10 cos Safe Food and Water; 48 Wa-rewashing 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; processing methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used deVIces 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed. supplied, cleaned 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate disposed; facilities maintained Food identi?cation 55 Physical facilities installed, 37 Food properly labeled; original maintained, 8? clean container 56 Adequate ventilation lighting; Prevention of Food Contamination de5ignated areas used - Insects rodents, animals not Additional Requirements listed in 105 Chili-590.011 38 present M1 Anti-choking procedures in food i Contamination prevented during service establishment 39 food preparation. storage and M2 allergy awareness . display Review of Retail Operations listed in 105 CHE 590.010 40 Personal cleanliness M3 ICaterer 41 Wiping cloths: properly used M4 rMobile Food Operation )0 stored M5 Temporary Food Establishment )0 42 Washing ?'UitS vegetables ., M6 Public Market; Farmers Market )0 Proper Use of Utensils M7 Residential Kitchen; Bed?and- 43 ln-use utensils properly stored Breakfast Operation )6 44 Utensils, equipment linens: M8 Residential Kitchen: Cottage Food A pr0perly stored, dried, handled Operation 45 Single?use single-service articles: ,5 3! M9 School Kitchen; USDA Nutrition 6? {a properly stored used Program k? 46 Gloves used properly M10 Leased Commercial Kitchen )0 Utensils, Equipmentand Vending M11 Innovative Operation )6 Food non- f-ood contact surfaces 13'5? If Local Requirements 47 cleanable, properly designed, L1 Local law or regulation constructed used L2 Other 4% pe of Operation(s): Ty of Inspection: Other information: Ended Service Establishment E??iutine Retail Food Store El Re-inspection El Residential: Cottage Foods El Pre-operalional El Residential; Bed El Illness investigation Breakfast El General complaint El Mobile/Pushcart HACCPM El Temporary ood Eslab gOther?L?W yt 3 p?blher (g Signature of Person-in-Char ,gzar i/?/Iq Signature of Inspector: report form 10i5i'1l3 version Food Establishment Inspection Report - City/Town of Item I Location cited in this ?em Section of I Establishment: 31L 50?, ?Date: 3 of_?3_ em rature Observations Item I Location Tem Item I Location Observations andlor Corrective Actions must corrected within the time frames stated below or Description of Violation Date to Correct 0 Ctr?" but)? 2 Signature of Person-invCharge Signature of Inspector: of 54/ Ballet 9/ 4mm MDPH report Iorm - 10mm; version Food Establishment Inspection Report City/Town of Qui new! Establishment: I?lciltv? M?siq Date: 5) I3 I Page1of?_I Address: go 51? Time in: Time out: TelephonePermit No.: Owner: Number of Violated Provisions Related to Foodborne Illness Risk Factors 6? and Interventions (Items 1 through 29): Number of Repeat Violations Related Person-in-charge: Debbi?t, ?uff!" Inspector: Ito/I JL A to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 Compliance Status I IN Supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected 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 served, reconditioned 3 conditional employee; knowledge, unsafe f00d responsibilities and reporting 4 Proper use of restriction and exclusion Procedures for responding to vomiting TimeiTemperature Control for Safety I 18 Proper cooking time temperatures Proper reheating procedures for hot 5 and diarrheal events Good Hygienic Practices 6 Proper eating, tasting, drinking, or tobacco use 7 No discharge from eyes, nose, and mouth Preventing Contamination by Hands 23 Proper date marking and disposition 1?9 holding 20 Proper cooling time and temperature 21 Proper hot holding temperature ?ti 22 Proper cold holding temperature ?ve 24 Time as a Public Health Control 8 Hands clean properly washed Consumer Advisory No bare hand contact with ready-to-eat food Adequate handwashing sinks properly 10 supplied and accessible 2 U1 Consumer advisory provided for raw undercooked food Highly Susceptible Populations Approved Source Pasteurized foods used; prohibited foods 26 not offered 11 Food obtained from approved source k\ 12 Food received at proper temperature 13 Food received in good condition, safe, I unadulterated Required records available: shellstock tags, parasite destruction 14 FoodIColor Additives and Toxic Substances Food additives: approved properly 27 used 28 Toxic substances properly identified, stored used I 3; 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 #574 Date of Reinspection: Discussion with Person-in-Charge: Signature of Person-in-Charg% Date: Signature i L- - MDPH report form 10151118 version ?Food Establishment Inspection Report City/Town of CL) [v10 Pet?r?' \Ndo S?Jrcr? Establishment: Date: qu?? Page 2 of 5 Goon? Remit. enhances sEc?nons IN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status I IN JOUTI MA I N10 ICOSI Compliance Status IN 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; processing methods adequate pressure Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; dEViceS 33 adequate equipment for 52 Sewage waste water properly temperature control disposed 34 Elagt food properly cooked for hot 53 Toilet feetIthIjres: prepgrl? 0 mg cons ruc ,supp Ie ceane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate . maIntained Food Identi?c?a?nn 55 fielghels Installed, 37 Footd properly labeled; original 21:;233: vent?aiiann lighting" con aIner Prevention of Food Contamination 56 deSIgnated areas ?59d - Insects rodents animals not Additional Ratiuirsments listed' In 105 CMR R590. 011 38 present M1 Anti- -choking procedures' In food Contamination prevented during serVIce estabIIshment 39 food preparation; storage and M2 allergy awareness 1 display 40 Personal cleanliness 41 Wiping cloths: properly used stored 42JWashing fruits vegetables Proper Use of Utensils 43 ln?use utensils properly stored OUT NIO COS Review of Retail Operations listed in 105 MR 590.010- M3 [Caterer M4 Mobile Food Operation M5 Temporary Food Establishment M6 Public Market; Farmers Market M7 Residential Kitchen; Bed-and- Breakfast Operation Residential Kitchen: Cottage Food 44 Utensils, equipment& linens: M8 . 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 f-?gI .915 Local Requirements 47 cteanable, properly designed, ~52" "gt: L1 Local law or regulation constructed used L2 Other we of 0peration(s): Me of Inspection: ?z?d Service Establishment utine El Retail Food Store Re- inspection Residential: Cottage Foods El Pre-operational Residential; Bed Illness investigation Breakfast General complaint El Mobile/Pushcan HACCP El Tempora Food Est b. Egolher? fir-L U. (mg D?Other (A 2 Other Information: Signature of Porson-ln-Charge: DO Date: Signature of Inspector: Date: MDPH report form 1015MB version Food Establishment Inspection Report City/Town of I 1A1 I lEstablishment: P?t?)f Wth?'l?rf Date: PageLofi Item I Location Item I Location Observations andi?or Corrective Actions Violations cited In this must be or in 8405.11 of the Food Code Item Section of Description of Violation Date to Correct 1/ A Signature of Person in .c'hE 925m Ignatureo Inspector. ate. (5/5 report form towns version Food Establishment Inspection Report City/Town of 62a; nagi/ Establishment: ?5 Date: Page 1 of Jordrciemv? (?1-th 3/31?? . Address: 5?92 Co M5 7L, 5 71 Time In: Time out: Telephone: 37 351 5K 7 Permit N0.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: a - and Interventions (Items 1 through 29): Person-in-charge: ii Number of Repeat Violations Related r~ i? ?r to Foodborne Illness Risk Factors Inspector: (3. ii 0 and Interventions (Items 1 through 29): 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 Compliance Status iN supervision Protection from Contamination 1 Person-in-charge present, demonstrates 15 Food separated and protected i knowledge, and performs duties 16 Food-contact surfaces; cleaned f. 2 Certified Food Protection Manager sanitized Employee Health Proper disposition of returned, ManagementI food emp'oyee and 17 preViOUSiy reconditioned 8L 3 conditional employee; knowledge, unsafe fOOd responsibilities and reporting 'Timen'emperature 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 diarrhea! events holding 300d Hygienic Practices 20 Proper cooling time and temperature 5 Proper eating, tasting, dr'?k'?9v 0" 21 Proper hot holding temperature use 22 Proper cold holding temperature j, 7 N0 discharge from eyes, nose, and 23 Proper date marking and disposition mouth . . . . 24 Time as a Health Control Preventing Contamination by Hands 1 8 Hands clean properly washed . . No bare hand contact with read ?to-eat 25 Consumer advrsory provrded for raw/ 9 undercooked food fOOd Highly Susceptible Populations Ade uate handwashing sinks ro erly . . . 10 suppcaiied and accessible 26 Pasteurized foods used; prohibited foods A roved Source not offered . pp FoodIColor Additives and Toxic Substances 11 Food obtained from approved source Food additives a roved ro erl L, 12 Food received at proper temperature 27 used pp 13 F003 fear? 900d condition, safe, 8? i: if; 28 Toxic substances properly identified. Rna era . . stored used 14 equrred records available. shellstock Conformance with Approved Procedures tags, parasne destruction . . . . . ?1 29 Compliance With variance spec1alized 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: Con/Mb Signature of Person-in-Charge: Date: Signature of Inspector: i I I tux/J MM 4/ 7f xi MDPH report form - versron Food Establishment Inspection Report? City/Town of QJIPM Establishment: (3 {25.3.34 71.} 6651 Date: ?7 I Page 2 of__ RETAIL enemas Ano MASSACHUSETTS-ONLY sEct one _r in compliance out of compliance not observed not applicable corrected on- sile during inspection repeat VIolation Compliance Status I IN Comp?ance Status IN OUT Nio cos Safe Food and Water . 48 Warewashing facilities: installed, 30 Pasteurized eggs used where maintained, used; test strips requned 49 Non-food contact surfaces clean 31 Water 8. ice from approved source Physical Facilities 32 Variance obtained for Specialized 50 Hot cold water available; processing methods adequate pressure Food Temperature Control 7 51 Plumbing installed; proper backflow Proper cooling methods used; 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 Identi?cation 3 55 Physical facilities installed, Food properly labeled; original maintained, 8? clean 37 container 56 Adequate ventilation lighting; Prevention of Food Contamination designated areas used . . . . Insects. rodents animals not Additional Requirements listed in 105 38 present M1 Anti-choking procedures in food V7 Contamination prevented during service establishment 39 food preparation, storage and M2 allergy 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 7 42 WaShan fruits vegetables M6 Public Market; Farmers Market Proper Use Of Utensils M7 Residential Kitchen; Bed?and- 43 ln-use utensils pr0perly stored -.J Breakfast Operation 44 Utensils, equipment linens: . M8 Residential Kitchen: Cottage Food properly stored, dried, handled Operation 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used Program (I 46 Gloves used properly 3? - M10 Leased Commercial Kitchen A Utensils Equipment and Vending M11 Innovative Operation 54 Food non-food contact surfaces 3 if] - Local Requirements 47 cleanable, properly designed, U7. . L1 Local law or regulation constructed used . . 2 L2 Other *1 pe of 0peration(s): Tape of Inspection: Other Information: Re?ggection gvob 71 St, (ff +9 (kg Residential: Cottage Foods El Pre-operational El Residential; Bed 8. El Illness investigation Breakfast General complaint El Mobile/Pushcart HACCP Cl Temporary Food Estab. QROlher i? will Ida gum my Signature of Person-In-Charge: f; A A Bluff/5% .7 MD PH report form 113t5i13 version Signature utinapeetar; ?5 l?ff/ f? Food Establishment Inspection Report City/Town of @0515er Establishment: '3 Date: I 4; Page of am re Item I Location Item I Location Item I Location If Observations andfor Corrective Actions Violations must acted within the time frames or in .11 of the Food Code Item Section of Description of Violation Date to Correct Signature of Parson-inoCharga: Date: Signature ofinspector: 435733. c5 1 I I I report form version Food Establishment Inspection Report City/Town of Queue 7 Sc Act)! Establishment: @drnatL {Jig I Date: ?iZ/s?hq Page1of__3_ Address: {00 8.71 Time in: Time out: Telephone: 37 33 5.2 I Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors 1 Owner: a and Interventions {Items 1 through 29}: Person-in?charge: K: ?vf SJt?inx 91" JG. 2? Number of Repeat Violations Related 0M - Dear If Inspector: to Foodborne Illness Risk Factors and interventions (Items 1 through 29): FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH . lN in compliance out of compliance NIO not observed NIA not applicable COS corrected on-site during inspection repeat violation Compliance Status IN lourl NIAINIOI cos i Compliance Status IN 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 previously served, reconditioned 3 conditional employee; knowledge, unsafe f00d responsibilities and reporting Timel?l'emperature 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 300d Hygienic Practices . 20 Proper cooling time and temperature 6 Proper eating, tasting, drinking, or 21 Proper hot holding temperature tobacco use - 22 Proper cold holding temperature 7 2:23;: charge from eyes, nose, and 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 ready?to-eat 25 Consumer adVIsory prowded for raw/ 9 undercooked food food I-li hi Susce tible Po ulations 10 Adequate handwashing sinks properly i . . . supplied and acceSSible 26 Pasteurized foods used, prohibited foods/ Approved Source 11 Food obtained from approved source 12 Food received at proper temperature 1 Food received in good condition, safe, Egg unadulterated Required records available: shellstock tags, parasite destruction Ca) 1 .h not offered FoodlColor Additives and Toxic Substances 27 Food additives: approved properly used .N Toxic substances properly identified, 13" 28 stored used if" 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 Date of Reinspection: Discussion with Person-in-Charge: (w/ms .95.. Signature of Person-tn-Cha e! ?if/in 1 Signature Elatffr/l ?1 report form iorms uersinr?u Food Establishment Inspection Report? City/Town of dbib?Q/i/ Establishment: Quiw/ ?fe-1L) Date- W's/re Page 2 of; sect) RETAIL PRACTIC Ska; EQA AND 3 in compliance out ofcomplIance not observed not appIIcabIe corrected on- s-ite duringinspection R=repeatviolation Compliance Status I IN IOUTI NIA I Compliance Status Safe Food and Water Warewashing facilities: installedPasteurized eggs used where 48 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; processingmethods . 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 Elagt food properly cooked for hot 53 Toilett featujres: I 0 mg cons ruc supp Ie eane 35 Approved thawing methods used 54 Garbage refuse properly 36 Thermometers provided accurate faCilltie? maintaIned Food Identi?cation 55 37 Food properly labeled; original . . container 56 Adequate ventIIatIon lIghtIng, Prevention of Food Cont'aminatiOn designated areas used . Insects rodents animals not Additional Requirements listed in 105 CMR 590.011 38 present M1 Anti-Ichoking 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 ICaterer 41 Wiping cloths: properly used M4 [Mobile Food Operation stored M5 Temporary Food Establishment 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 properly stored used .- M9 Program 46 Gloves used properly M10 Leased Commercial Kitchen Utensils, Equipment and Vending M11 Innovative Operation Food non- food contact surfaces 2?3: .. Local Raqulrements 47 cleanable, properly designed, LI Local law or regulation constructed used . L2 Other Type of 0peration(s): Type of Inspection: Other Information: El Food Service Establishment El Retail Food Store Residential: Cottage Foods El Residential; Bed Breakfast El Mobile/PushcaIt Tempura Other ?60 bi EIIRoutine Re-inspection El Pre-operational Illness investigation General complaint El HACCP CI Other Hood 1 lat/I30! S/Slx (43-h: 1)?le A Signature of Person- in- -Charg?/: {j Date?/r/I? Signature of Inspector: 77?r/I?7 MDPH repon form - Iorsrie vars-or: Food Establishment Inspection Report City/Town of 3/ [Establishment 620:? fa]! SCLM Date: a I Page_10f 3 1 - I re Observations Item I Location Item I Location c-l a. a Observations andlor Corrective Actions Violations cited in this the time frames or 11 of the Food Code Section of Code Description of Violation Date to Correct I U6 - 44? 5/ Item Signature of Person tn-Charaf giwj 4i .9 Signature of?? report form-1015118 version Food Establishment Inspection Report City/Town of Qdim Establishment: Sit/dew HM 6? School Date: 6/9/49 51/ g: Page 1 of; Address: ?3 3; 105., lm ?r g} Time in: Time out: Telephone: 6, 84-] Y7 Permit No.: Number of Violated Provisions Related to Foodborne Illness Risk Factors Owner: . 5 and Interventions (Items 1 through 29): Person?in-charge: {MG?Item Number of Repeat Violations Related inspector: (5'31 De?atir to Foodborne Illness Risk Factors and Interventions (Items 1 through 29): 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 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, ManagementI food emp 0yee and 17 reconditioned 8: 3 conditional employee; knowledge, unsafe f00d responsibilities and reporting Timel'l'emperature Control for Safety 4 Proper use of restriction and exclusion 18 Proper cooking time temperatures Procedures for responding to vomiting Proper reheating procedures for hot 5 . 19 . and diarrheai events holding 500d Hygienic Practices 20 Proper cooling time and temperature 6 ffPer eating, tasting, drinking, or 21 Proper hot holding temperature 29??huse 22 Proper cold holding temperature 7 NO '50 arge rom eyes, nose, an 23 Proper date marking and disposition mouth . . ,r . . . 24 Time as a Public Health Control Preventing Contamination by Hands . Consumer Advrsory 8 Hands clean properly washed . . . No bare hand contact with read -to-eat 25 Consumer adVIsory provrded 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 . I - FoodlColor Additives and Toxic Substances 11 Food obtained from approved source 0d add't' I 12 Food received at proper temperature 27 used I ives. approve propery 13 Fogguriigreaiifg 'n 900d condition, safe, 8? I: 28 Toxic substances properly identified, if" un II stored used 24". 14 ReqUIred records avaiiable. she Conformance with Approved Procedures tags, paraSIte destruction 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: Discussion with Person-in-Charge: (90105 A 1 Signature of Pa E-Ec-Eharge: f? Signature ofinspector: i (Vi MDPH report form 10/5118 version Food Establishment Inspection Report_? City/Town of Gains Establishment. Snug {7146f Date: Oilblr?i Page 2 of; GOOD RETAIL PRACTICES AND MASSACHUSETTS-ON LY SEGTIONS in compliance out of compliance - not observed not applicable -: corrected on- site during inspection repeat violation Compliance Status I IN Compliance Status IN OUT COS Safe Food and Water 30 Pasteurized eggs used where required 31 Water ice from approved source 32 Variance obtained for specialized processing methods 48 Warewashing facilities: installed, maintained, used; test strips 49 Non-food contact surfaces clean Physical Facilities Hot cold water available; 50 adequate pressure Food Temperature Control Proper cooling methods used; 33 adequate equipment for temperature control Plumbing installed; proper backflow 51 devices Sewage waste water properly 52 disposed 34 Plant food properly cooked for hot holding Toilet features: properly 53 constructed, supplied, cleaned 35 Approved thawing methods used 36 Thermometers provided accurate Food Identi?cation Food properly labeled; original 37 container Prevention of Food Contamination Insects, rodents, animals not 38 present Contamination prevented during 39 food preparation, storage and display 40 Personal cleanliness 41 Wiping cloths: properly used stored 42 Washing fruits 8: vegetables Garbage refuse properly 54 disposed; facilities maintained Physical facilities installed, 55 maintained, clean Adequate ventilation lighting; 56 designated areas used Additional Requirements listed' In 105 CMR 590. 011 nti- -choking procedures In food service establishment M2 Food allergy awareness Review of Retail Operations listed in 105 CMR 590.010 M3 Caterer M4 Mobile Food Operation M5 Temporary Food Establishment Proper Use of Utensils M7 Residential Kitchen; Bed-and- Breakfast Operation 7C. M6 Public Market; Farmers Market 43 In-use utensils properly stored 44 Utensils, equipment linens: *3 M8 Residential Kitchen: Cottage Food properly stored, drIed, handled . OperatIon 45 Single-use single-service articles: M9 School Kitchen; USDA Nutrition properly stored used I Program 46 Gloves used properly y: 3" M10 Leased Commercial Kitchen Utensils, Equipment and Vendin M11 Innovative Operation Food non-food contact surfaces l3: 47 cleanable, properly designed, - constructed used . Local Requirements L1 Local law or regulation \l?K L2 Other Type of Inspection: 91- Routine Re-inspection El Pre-operational El Illness investigation El General complaint Type of 0peration(s): 00d Service Establishment El Retail Food Store Residential: Cottage Foods El Residential; Bed Breakfast El Mobile/PushcaIt [1 Er Temporary Food Estab. ?Elplher 3 LIME u) ELOther it? Other Information: fl. Signature of Person- -in~0h@ fate MDPH report Iorm? 1005.115 version ?r?I/g 4 Food Establishment Inspection Report City/Town of 6303M. [Establishment Sndo, I Date: i/K/(7 Pageiofil Observations Item I Location Tem Item I Location Observations andlor Corrective Actions cited in must be corrected within the time frames stated or Item Section of Code Description of Violation c. 5 I. I. I Item I Location 6?41 05. 1 of Date to Correct 5 )3 A Signature of Person-in-ChargW I: . A 11 off?! 5 Signature of Inspector: a Vii/z MDPH report form - 1015;15 versmn Food Establishment Inspection Report City/Town of ad?? Establishment: