COMMONWEALTH OF MASSACHUSETTS TH iW?l pig/V4 M57, Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name that assailants Mendelssohn j/ i: Food Servipe El Routine Address I Risk Hetall Ci Flo-inspection Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Ci Temporary Ci Pro-operation owner HACCP WN Caterer Suspect Illness Person In Charge I Time Bed Breakfast General Complaint .- . In: HACCP '?sp?ctor I L61 Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Fletated to Foodborne illness Interventions and Risk Factors iReg items: Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE Ci 4. Food and Water from Approved Source CI 5. Receiving Condition CI 6. Tags I Records I Accuracy of Ingredient Statements CI 7. Contormance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION 8. Ci 9. Food Contact Surfaces Cieaning and Sanitizing Ci 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board ct Health. Nonacritical (N) violations must be corrected immediately or within 90 days as determined by the Board Non~comp?ance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) Local Law Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) is. 17. Cl is. CI is. 20. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting otConsumerAdvisories Cooking Temperatures Reheating Cooling Hot and Cold Holding Time as a Public Health Controi Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Fied Items 1-22): Oltigial Qrder for Correction: Based On an inspection today, the items checked indicate violations of 105 CMR 'i gas 0f Heaith- 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23- Management and Personnel (FC-2ii590.003) order of the Board of Health. Failure to correct violations 24- Food and Food Protection (FC-3ii590-004i cited in this report may result in suspension or revocation of 025 EqUipment and Utensils (FC-4ii590.005) the food establishment permit and cessation of food at 26. Water. Plumbing and Waste (FG-SHSQODUBI establishment operations. it aggrieved by this order. you I 27- PhYSiCal Facility have a right to a hearing. Your request must be in writing 28- POISOHWS 0r TOXIC Materials and submitted to the Board of Health at the above address 29- SPBCIBI ReqUiremeniS (590-009) within 10 days of receipt of this order. 30- Other DATE FIE-Inspector Signature. ff. mix A Mi. 1? Print. PIC Signaturp. {LL/?nil Lt rjm? Print. 734A QIZOIOJ HOBBS 8r WARREN - BOSTON This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS .5. TOWN OR CITY OF Establishment Name: .- Date: gas r. Page: of Item: Codeirils?ii C-Criticalltem -5 g' Detail-=1- NOE Rate-rencg-i:fii Red "em PRINT Mari-?ed .- - .--: .- . :HrI--.-. .- . Discussion With Person in Charge: Corrective Action Required: No in j?es if, J. Employee Restriction] Exclusion x" VoluntaryCompliance Re?inspec? on Scheduled Emergency Suspension Emergency Closure 00000 El Embargo I3 Voluntary Disposal Other: Form 734 AM Sulkin 00.. Charlestown, MA THE COMMONWEALTH OF MASSACHUSETTS ??it/Vim or); (H) ESTABLISHMENT INSPECTION REPORT Board of Health Tel. ii at lgi-?i owl/? Name Dale Walton {12%;ny (O tip/{9 7 - RoodIService a Soultine I Address etai e- nspect on LeVel Residential Kitchen Previous inepection Te'epmne Ci Mobile Data: 321132?? Egii?ii'ii?ls Person In Charge (PIC) I El Bed 8. Breakfast Complaint Ins actor - - . in ma Lu i trail/int a Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne illness Interventions and Risk Factors (Red Items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. Pic Assigned/Knowledgeable!Duties EMPLOYEE HEALTH 2. RepOrling of Diseases by Food Employee and Pic 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source Ci 5. Receiving Condition 6. Tags/Records (Accuracy of ingredient Statements 7. Conformance with Approved Procedures Plans PROTECTION FROM CONTAMINATION 8. Separation I Segregation 1 Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing ti. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 28. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law (3 Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands {:63 Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or ColorAdditives Ci 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling ta Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red items 1-22): thiciai Qrder for Correction: Based on an inspection todayI the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF FIE-INSPECTION: Inspector?s Signature: 0 11/1 0,12; mm: to {tall/lace Signatu re: ?k in?i?ii \fixl muan \m?h A $4.6 01 Prim: Page og?j?agw FORM 734A QIZOIDJ HOBBS 8r WARREN - BOSTON This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN 0R CITY OF Establishment Narne: Page: 5:7?01? Item Code Critical Item Nm Redltem 3 0F r" PLEASE PRINT CLEARLY Date Verified I 1 s3) Discussion With Person in Charge: Corrective Action Required: No ?ri?es [3 El El 13 Voluntary Compliance Rea?inspection Scheduled Embargo Voluntary Disposal CIDEIEJEI Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other: Form 734 8 AM. Sulkin 00., Charlestown. MA THE COMMONWEALTH OF MASSACHUSETTS "Wm a: ll ix Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name . Date at 30 (f Food Service Routine Address 1' Rik Retail Fla-inspection Level El Residential Kitchen Previous inspection Telephone Mobile Data: Temporary El Pro-operation owner HACCP YIN Caterer Suspect Illness Person In Charge (PIC) Time 1: Bed Breakfast a General 00mplaint n, In: HACCP Inspecm" LU ?pug/WA. (1, Out: Permit No. Other Each violation checked redulres an explanationuo? the narrative pae(s) and a citation of specific provisionls) violated. Violations Related to Illness Interventions and Items) Violations marked may pose an imminent health hazard and require immediate corroctivc 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 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source Ci 5. Receiving Condition 6. Tags Records Accuracy of ingredient Statements 7. Conformance with Approved Procedures/ HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection Ci 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Eloiations Related to Good Retail Practices (Blue items) Critical (0) violationsmarked 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. 30. Other 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (500.009) Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law Allergen Awareness 590.009 (G) El 12. Prevention oi Contamination irom Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or CoiorAdditives is. Toxic Chemicals CONTROLS {Potentially Hazardous Foods) is. 17. CI is. Cooking Temperatures Rehea?ng Cooling is. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) [i 21. Food and Food Preparation for CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): erigtal Qrger tor Based on an Inspection today, the items checked indicate violations oi 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. QF Inspector?s Signalqu?u: . '3 ,l - Print: ?C?ss?gm?wif ill Print: Page . FORM 734A HOBBS a: WARREN - BOSTON This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY Iii" I Establishment Name: Lil-1" - Date: - -r Page: - of Ta. Item. 6: Crit'ca' ?em - DESCRIPTION OF Datsiiar No. Ri? Red lbem 3 - 2-: PLEASE p'RmT Veri?ed . Discussion With Person in Charge: Corrective Action Required: n?m El Yes if El Voluntary Compliance iEmployee Restriction 5 Exclusion Re?inspection Scheduled Emergency Suspension DUDE El El Embargo El Voluntary Disposal Other: Emergency Closure Form 734 AM. Sulkin Co.. Chariestown, MA THE COMMONWEALTH OF MASSACHUSETTS r/r'i 0P [tiger/r2; Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name .. '7 Date .. - Roommate} HEW (Lab set/"j (JD- Effect! Service Cl Fioutlne Address sf Risk Retail Re~lnspection Level Residential Kitchen Previous inspection Telephone [3 Mobile Date: Temporary Pro-operation HACCP YIN owner . CI Caterer CI Su5pect Illness Person In Charge (PIC) ?9 - if Time Bed 8: Breaklast General Complaint I i" If 3 in: El HACCP '1de Mira") elm/Ag Out: Permit No. Dlher Each violation checked req?uires an explanation 3n the narrative page(s) and a citation of specific provisionts) violated. Violations Related to Foodborne illness Interventions and Risk Factors lFted Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD pnorscnon MANAGEMENT 1. PIC Assigned Knowledgeabie Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving/Condition CI 6. Tags/ Records Accuracy of ingredient Statements El 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation Segregation Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good?etaii Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection . Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials CI 14. Approved Food or Color Additives Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law [3 Allergen Awareness 590.009 (G) Cl 12. Prevention of Contamination irom Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods20. Cooking Temperatures Reheatan Cooling Hot and Cold Holding Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Pied Items 1-22): Order Based on an inspection today. the items checked indicate violations of 105 CMR 590.000iFederai Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation oi food establishment Operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29. Special Requirements (590-009) within 10 days of receipt of this order. 30- Other DATE ill PrintPage ofT._Pages i' - it,? new FORM 73dA 9/20l0?t HOBBS 6t WARREN BOSTON This Form Approved by the Massachusetts Department of Public Health Establishment Name: THE COMMONWEALTH OF MASSACHUSETTS . 25?; in J. Date: IV TOWN 0R CITY Page: -I Alysia .5 of item No.1 7 Code Reference - Critical Item. .. DESCRIPTION OF VIOLATION PLAN OF CORRECTION PRINT CLEARLY Date . Veri?ed 14 reg-=1 17:4,? {1.5 I J. fl - Discussion With Person in Charge: Corrective Action Required: Basilio Yes El Voluntary Compliance (I . .v Re?inspection Scheduled Embargo El Voluntary Disposal El 0 Cl Employee Restriction Exclusion Emergency Suspension Emergency Closure Other: Fonn 734 8 AM. Sulkin 00., Chariestom, MA THE COMMONWEALTH OF MASSACHUSETTS 0F Kori/4030211. FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. Name I a . I Macedon Sis-y KM 4613/ IE1 :1 Service Routine Address FIEIHII Level Residential Kitchen Previous Inspection Tahiti")m3 Mobile Data: Ci Temporary CI Pro-operation 0 HACCP VIN wner Caterer El Suapect Illness Person In Charge (PIC) ?t lg) (0 Time Bed 8. Breakiast El General Complaint .1 In: El HACCP Inspect" Bin (Lt A 14-9 Ly 3% my Out: Other Each violation checked risquires an expianatidWon the narrative page(s) and a citation of specific provision(s) violated. ?otations Related to Foodborne Hinges Interventions an Hi It Factors Had It Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT Ci 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted I Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approvad Source 5. Receiving I Condition 8. Tags I Records I Accuracy of Ingredient Statements CI 7. Conformance with Approved Proceduresl HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation I Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing Ci 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non?critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements 30. Other ti-siisso.007) (590.009) Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) [Ii Local Law i] Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FFIOM CHEMICALS El 14. Approved Food or Color Additives Ci 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating i] 18. Cooling Cl is. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) i3 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting oi Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items Official rt Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DAEO -N I .. Inspector?s Si nature: Print: 3 I- Print: Sigltatilrevfw . {191 2w Page of Pages .. .4- FORM 734A 9r2010i HOBBS a WARREN . aosToN This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY 0F #23, .1: . Establishment Name: . - 3? - Date: f. r" 7 Page: Item *Cri?calltem . . DESCRIPTION GF-WULATIONIPLANOFCORRECHON . . Date 'IRef - . . . NO finance?? Radium CLEARLY .. Noi- El Yes up} 13 Discussion With Person in Charge: Corrective Action Required: Employee Restriction Exctusion f? J. - El Voluntary Compliance Cl Re?inspection Scheduled [2 Emergency Suspension El Emergency Closure Embargo El Voluntary Disposal Other. Form 73-4 AM. Sulkin 00.. Charlestown. MA THE COMMONWEALTH OF my (a )l tit/grin Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name .I I- Dale . Minimal] Hal-:4: 4746f Inl?iaood Service Routine Address Risk i Fietall Cl Flo-inspection Level Residential Kitchen Previous inspection Telephone El Mobile Date: Temporary Pro-operation owner ACCP YIN Caterer El Suspect Illness Person in Charge (PIC) il'lme Bed 8: Breakiast 322%: Complaint n: Inspecmr If? [11? If 1/ My? {j I Out: Permit No. Other Each violation checked req'ul'res an explanation ?an the narrative page(s) and a citation of specific provision(s) VIOIateq- Non-compiiance with: Violations Related to Illness egg Bisk Factors [Pied Items] Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT l. PIC Assigned Knowledgeabte Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted! Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source CI 5. Receiving/Condition 6. Tags Records fAccuracy of ingredient Statements [3 7. Conformance with Approved Procedures HACCP Pians PROTECTION FROM CONTAMINATION CI 8. Separation I Segregation Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Began Practices (Blue items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other i? "t 590.009 (E) El 590.009tF) CI Local Law Allergen Awareness 590.009 (G) El 12. Prevention of Centamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives CI 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Rehearing 18. Cooling Cl 19. Hot and Cold Holding Cl 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): tiic ai rd rt 'Based on an inspection today, the items checked indicate violations of 105 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE QE Inspector?s Signatur?axj ??fg?lw Print: i, fl?ltjm?df. [r . f? Page aim-(1 Pages FORM 734A (REV. 9/20i0i HOBBS ?t WARREN BOSTON PlC?s Signature: Alfalfa/Ff: Print: This Form by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY Establishment Name: 5- -. .. L: Date: Page: 0? Item owe- ?5 ?3 DESCRIPTION OF VIOLATION I PLAN OF. CORRECTION . "finaffi?E-ii} 1 No. Reference. 2' .: I. 1'35" gy?l?e?I'l' - I I: I. _l .r'll D: I .7, WK Discussion With Person in Charge: Corrective Action RequiredVoluntary Compliance El Employee Restriction! I 7' *1 H: .551. A 1 ,1 - 1.52.5111; Exclusion El Rue-inspection Scheduled in Emergency Suspension ,4 Embargo El Emergency Closure El Voluntary Disposal Other: Form 1?34 AM. Sulkin 00.. Charlestown. MA THE COMMONWEALTH OF MASSACHUSETTS Win/i will); j??j/l Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Dat . Type of?peralignial mm {ff/f] Zf/?l Food Service Routine Address Risk' CI Retail Flo-inspection Level Residential Kitchen Previous inspection Telephone Mobile Date: CI Temporary CI Pro-operation owner HACCP YIN CI Caterer El Suspect illness Person in Charge (PIC) Time Bed Breakiast General Complaint In: HACCP r. I l_ . I) Fir gm!? Out: Permit No. Other Each violation checlted requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT t. PIC Assigned I Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections Restricted Exaluded FOOD FROM APPROVED SOURCE C1 4. Food and Water from Approved Source [3 5. Receiving Condition [3 6. Tags/ Records (Accuracy of Ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation Protection Ci 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices 1'?ipLations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) LocaiLaw Allergen Awareness 590.009 12. Prevention oi Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMENEMPERATUFIE CONTROLS (Potentially Hazardous Foods) CI 16. Cooking Temperatures Cl 17. Reheating El 18. Cooling Ct 19. Hot and Cold Holding CI 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting otConsumerAdvisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Otticiai Order for Germ Based on an inspection today. the items checked indicate violations of 105 CMR 590.000/Federai Food Code. This repon, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE QF I Print: it till Win Wt Rim Page. Pages ?sent/Wail This Form Approved by Massachusetts Department of Public Health - TOWN OR CITY OF - A I ,2 Establishment NameDate: - Page: of Item Code - '3 ?rth-=3! Item - DESCRIPTION OF VIOLATION Data No; Reference -:Red_1tem' - - 5- PRINT CLEARLY if, . - .?Ileif fied Id?Discussion With Person in Charge: Corrective Action Required_M9I_untary Compliance El Employee Resin-idiom 2 - ?i .: I: 51/: av 32" Exclusion I: Re?inspection Scheduled El Emergency Suspension E2 Embargo Emergency Closure :1 Voluntary Disposal El Other: Form 734 AM. Squin Co.. Chadestown, MA THE COMMONWEALTH OF MASSACHUSETTS mm OF Lei/Weill rut FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. {Ii/.55? Name Date ai Wm A i 6/ and Service Routine Address Risk 1 [3 Retail CI Fla-inspection Level Residential Kitchen Previous inspection El Mobile Date: Temporary Pro-operation HACCP YIN owner CI Caterer CI Suspect Illness Person In Charge (PIC) Time Bed Breaklast IS General Complaint in: Ins actor i . . 1 I It?buymgw Out. PermItNo. Other Each violation checked tequires an explanation on the narrative page(s) and a citation of Specific provision(s) violated. Violations Related to illness Interventions and Risk Factors {Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT I3 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PK: CI 3. Personnel with infections Restricted I Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. Receiving I Condition El 6. Tags! Records Accuracy of Ingredient Statements 7. Conformance with Approved Procedures HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI t1. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Hams) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board oi Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous orToxic Materials Non-compilance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) El Local Law Allergen Awareness 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMENEMPERATURE CONTROLS (Potentially Hazardous Food) 16. Cooking Temperatures [j 17. Reheating 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) a 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22): Of?cial Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.000/Federai Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. it aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board oi Health at the above address 29. Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DATE OF lnspeior?shSIgnature: [lg/{r Prmt: {max Print: 'r Pagan ?hr?Pages FORM 734 HUVBSIE WARREN - BOSTON This Form Approved by the Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CNITY Establishment Name: z?n?v/ Date: '7 Page: :1 of A a. Item Cede C-Criticalltem DESCRIPTION OF OF CORRECTION - - Date No. Reference: R-Red Item - - PLEASE ?ll-rum? Z. . . :?Ve'ri?1.orII. LnCorrective Action Required: El Yes Discussion With Person in Charge: Qg?oluntary Compliance Employee Resirictionll Exclusmn Re?inspection Scheduled El Emergency Suspension Cl EI Embargo Emergency Closure El Voluntary Disposal Other: Form 734 8 AM. Sulkin 00., Charlestown, MA THE COMMONWEALTH OF MASSACHUSETTS rr 2/ Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name I ?Jl Date? . 11p at (?trike If and Service Routine Address alsk Fl Retail Re-inspectlon Level El Residential Kitchen Previoua Inspection Telephone Mobile Data: Temporary CI Pro-operation HACCP WN owner Caterer El Suspect Illness person ?n Charge (plc) [i I Time CI Bed Breakfast 3:21;: Complaint r" ?speck? f. )?jbir? Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provlslon(s) violated. Related to Fo?borne illness interventigns and Risk Factors (Red Items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC Cl 3. Personnel with infections Restricted I Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving I Condition 6. Tags I Records IAccuracy oi ingredient Statements 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation I Segregation I Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Nan-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) Local Law Allergen Awareness 590.009 (G) Cl Cl 12. Prevention of Contamination from Hands Cl 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or ColorAdditives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardoue Foods) CI 16. Cooking Temperatures [j 17. Rehearing 18. Cooling [1 is. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22Based on an inspection today. the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation oi the food establishment permit and cessation of food establishment operations. It aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days oi receipt of this order. Dgl? 0F I . - {Inf/"H r' r? 0 Inspector Signature. 1% :1 0 Print. Signature: Page of Ir Pages FORM 734A IREV. QIZOIOI HOBBS 8: ARREN - BOSTON infirm/frag This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS -. I .9 TQWN OR CITY OF =42 ?1 ?d I '1 ?ff?"HM Establishment Name: ?w .t a; A: xix-"u. Date: 43' Page: of x? ?Em CW8 DESCRIPTION OF VIOLATIDNIPLAN 0F -. tn 7h? 21-10? 1C pv'w x" I i (Lg: 1 x/ - Discussion With Person in Charge: Corrective Action Required: No 1035? El El Embargo El Voluntary Disposal El Voluntary Compliance Re?inspection Scheduled Employee R?striction 1' Exclusion Emergency Suspension Emergency Closure Other: Form 734 AM. Sulkin 00.. Charlestown. MA COMMONWEALTH OF MASSACHUSETTS MOP 6i); {/Ixr? i iiyii'CI/U FOOD ESTABLISHMENT INSPECTION REPORT Board of Health . . .a Tel. (OJ Mid (i (57 Name 1 .. a Date Wis) ItimLinsnachee J1 a" lri__ [El (Tod Service Routine Address Risk II stall CI Fla-Inspection Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pro-operation HACCP YIN owner Caterer El Suspect Illness Person In Charge (PIC) Time Bed 81 Breakiast General Complaint I35 in; El HACCP Ins actor i v- - . A Out. Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness interventions and Risk Factors (Red lternsi Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned i Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Feed Employee and PIC 3. Personnel with infections Restricted Excluded FOOD FROM APPROVED SOURCE Cl 4. Food and Water from Approved Source l3 5. Receiving Condition 6. Tags Records Accuracy of ingredient Statements CI 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION CI 8. Separation I Segregation Protection 9. Food Contact Surfaces Cleaning and Sanitizing CI to. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to good Betail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. 24. 25. J26. 27. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility Nan-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law [3 Allergen Awareness 590.009 (G) E) CI 12. Prevention oi Contamination from Hands 13, Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives CI 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. El 17. l] 18. Cooking Temperatures Reheating Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting ct ConsumerAdvisories Number of Violated Provisions Related To Foodborne illnesses interventions and Risk Factors (Red items 1-22): Mia] Order for Correction: Based On an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order oi the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order. you have a right to a hearing. Your request must be in writing t25- POISQHOUS 0r Toxic Materials and submitted to the Board of Health at the above address 29, Requirements (590.009) within 10 days of receipt of this order. 30- Other QATE QF RE-INEPEQ r1"! . - I. or Igna ure 1 he i (Lil/[A Print {141/ it 1U I i. Signature: Print: 1? FORM 734A (REV. QIZOIOI HOBBS 8: WARREN - BOSTON This Form Approved by the Massachusetts Department or Public Health TOWN OR CITY OF Establishment Name: THE COMMONWEALTH OF MASSACHUSETTS a Date: Page: - Code Referen Item No, .- ?see-1;: Date Verified . PLEASE PRINT CLEARLY oF. PLANOF comecrlou "iiLr'Discussion With Person in Charge: No (HF-s Corrective Action Required: Employee Restriction! Exclusion El Voluntary Compliance Re?inspection Scheduled Emergency Suspension Embargo Emergency Closure CI Other. Voluntary Disposal Form 734 AM. Sulkin 00.. Charlestown, MA THE COMMONWEALTH OF MASSACHUSETTS Erect/Jase mi in?) ii i0 -.J Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name a. - Dal erratum If) i -- nod Service Routine Add . I I Risk Hotel! El Pie-inspection fess LA) I Ii? I?t? (I 37.1 Level Fiesidentiai Kitchen Previous Inspection Telephone Mobile Date: Temporary Pro-operation owner HACCP WM Caterer Suspect illness Person in Charge (PIC) Time Bed a Breakfast General Complaint I (M, i In: HACCP m3)? (a Li 1 )q/Jf (H I), '1 Out: Permit No. CI Dihermm Each violation checked require's an explanation on the narrative pageis) and a citation of specific provision(s) violated. Violations Related to Foodborge Illness interventions and Risk Factors {Red items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. Pic Assigned Knowledgeable Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections Restricted Excluded FOOD FROM APPROVED SOURCE Ci 4. Food and Water from Approved Source 5. Receiving Condition [3 6. Tags Records/ Accuracy of ingredient Statements Ci 7. Conformance with Approved Proceduresri HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation Segregation I Protection 9. Food Contact Surfaces Cleaning and Sanitizing Ci 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violatiggs Fiei ed to Good Re rec it: (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements 30. Other (590.009) Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Ci Local Law [3 Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands Cl 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentiily Hazardous Foods) 16. i3 17. 18. Cooking Temperatures Reheating Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses interventions and Ftisk Factors (Pied Items 1-22): i I rt orr Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. it aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt oi this order. Dal OF Page of Pages Inspector?s Signatut?cig/Cyj Print: PIC ?gurative/'3 i Print: FORM 734A IREV. 9'20101 HOBBS Br WARREN - BOSTON This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY [fl-vii In; .?x?lrriruJ' if") I, i, I Establishment Name: 5?44 L/w M?Date: c" 9" Page: of (4?4 Date '33. Va ri?ed 57, mass Pam-r CLEARLY ?en Pm DESCRIPTION OFMIOLATIONIPLAN 3- Reference? - 15.3.: 55.Discussion With Person in Charge: Correc?veAction RequiredVoluntary Compliance Em?ployee Restriction Exclusion If, i/ Embargo Emergency Closure . A .x a raster-x Rea?inspection Scheduled CI Emergency Suspension BUD Voluntary Disposal Other. Form 734 AM. Sulkin 00., Charlestown, MA THE COMMONWEALTH OF MASSACHUSETTS My?; (it? .2 Board of Heal-the, FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name . e-c- . Dale museum ii) (151 .Ml?iictt/ MrirlLt-i' (.2 F3 2 9 Erased Service .t-?butine Address Ftislt 1' Flntall Flo-inspection Level Residential Kitchen Previous lnspectioo Telephone Ci Mobile Date: El Temporary Ci Pre~operetlon owner HACCP Caterer Ci Suspect Illness Person in Charge (PIC) Time Cl Bod Breakfast a General Complaint - In: "Speak" \in 9,1 its DUST/trd/l . Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board 01 Health. FOOD PROTECTION MANAGEMENT i] 1. PIC Assigned Knowledgeabie Duties EMPLOYEE HEALTH Cl 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with infections Restricted Excluded FOOD FROM APPROVED SOURCE Ci 4. Food and Water from Approved Source Ci 5. Receiving I Condition 6. Tags/Records/Accuracy of Ingredient Statements [3 7. Conformance with Approved Procedures! HACCP Plans PROTECTION FROM CONTAMINATION Ci 8. Separation I Segregation Protection Ci 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law [1 Allergen Awareness 590.009 (G) l: 12. Prevention of Contamination trom Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS Cl 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) [3 16. Cooking Temperatures El 17. Rehearing [j 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Illnesses Interventions and Risk Factors (Red items 1-22): OIficial Order Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result In suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE TI N: Print: (W ?I/lj/?iLAI/Zit/Z/yf ?mw?m?ss'm?s?t Page 1' of! Pages Signature: i FORM 734A IREV. HOBBS 8t WARREN - BOSTON Print: hr) This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS vl/L/ TOWN OR CITY OF Establishment Name: Date: ?13' I ?1 Page: 5/ of if 1' PLEASE PRINT CLEARLY item Codeg?.f C-Criticalltem - -DESCRIPHON CORRECTION: 225-531 I . :Datfa; :1 No- Reference?: RgRedltem . . Veri??.142 ya31511 . . . . 1 52glCL. i J14 3'7, ,a . .. $4.4 12/ i! uh 3 Discussion With Person in Charge: Corrective Action Required; No Yes El Voluntary Compliance Employee Restriction - E. L: i . . A: /lj\ Excluswn Re-inspection Scheduled Emergency Suspension Emergency Closure UUDUD Cl Embargo El Voluntary Disposal Other. Form 734 AM. Suikin 00.. Charlestown. MA THE COMMONWEALTH OF MASSACHUSETTS ms 14.141 {Mr 11231777 Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name (JO A y) I it?! - Wiesel 15mm A i - Food Service Routine Address I Retail Level Residential Kitchen Previoue Inspection Telephone Mobile Date: Temporary El Pro-operation owner HACCP WN El Caterer Suspect Illness Person In Charge (PIC) Time CI Bed Breaklast General Complaint In: HACCP 0 Lu )7 Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Vlglations Related to Foodborne Illness Interventions and RisLFaotors (Red Items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assignedr Knowledgeable Duties EMPLOYEE HEALTH Cl 2. Reporting oi Diseases by Food Employee and PIG 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water trom Approved Source i2] 5. Receiving 1 Condition El 6. Tags/ RecordslAccuracy of Ingredient Statements El 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION [j 8. Separation/ Segregation Protection El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials El 12. El 13. Non-compliance with: Anti-Choking Tobacco 590.009 (E) El 590.009 (F) Local Law Allergen Awreness 590.009 (G) Prevention of Contamination from Hands Handwash Facilities PROTECTION FROM CHEMICALS D14. D15. Approved Food or Color Additives Toxic Chemicals CONTROLS (Potentially Hazardous Foods20. Cooking Temperatures Reheating Cooling Hot and Cold Hoiding Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) El 21. Food and Food Preparation for CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses interventions and Risk Factors (Red Items 1-22): Official Qrger for Based on an inspection today, the items checked indicate violations of 105 CMR 590.000lFederal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order. you have a right to a hearing. Your request must be In writing and submitted to the Board of Health at the above address Ins actor?s Si naturew?f'?? . 1' 3.1/3? 29. Special Requirements (590-009) within 10 days of receipt of this order. 30- Other DATE QE Print: Print: Page of Pages Signature: iffy-?. a, .4 5. FORM 73dA HOBBS 6t WARREN - BOSTON This Form Approved by the Munsachuscus Department or Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY for? .3 I I fir?F..? Establishment Name: 5. m- Date: I- f- .74- 95? Page: of "emf 00"9.? f3? . DESCRIPTION OF. VIOLATIONIPLAN OF CORRECTION :7 I - - . . Dali?? No.2: Reference ?r??edgltem? . PLEASE PRINTCLEARLY '2 . E?llierl?ed s. Discussion With Person in Charge: Corrective Action Required: kw} El Yes If I 14,1 I El Voluntary Compliance El ?Employee Restriction! gab/Jr: _r Exclusion {l g} CI Re?inspection Scheduled El Emergency Suspension '1 El Embargo El Emergency Closure a Voluntary Disposal El Other. Form 734 A M. Sulan Co . Charlestown. MA THE COMMONWEALTH OF MASSACHUSETTS ?or? Mixer/{31! Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name Date 0 Minestrone (II ,o (I Service Cl Routine Address Ll Peiail Flo-Inspection Level Residential Kitcher Prevlous InSpectlon Telephone Mobile Data: El Temporary El Pro-operation owner HACCP Caterer El Suspect Illness I Ch (PIC) - Time Bed Breakiast General Complaint arson a 99 1 In: El HACCP Impactor (X .mp1 It:qu I Out: Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. 1 Violations Related to Foodborne Illness Interventions and Risk Factors {Red ltemsi Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE Cl 4. Food and Water from Approved Source 5. Receiving Condition Cl 6. Tags I Records lAccuracy of Ingredient Statements 7. Conformance with Approved Procedures I HACCP Plans PROTECTION FROM CONTAMINATION Cl 8. Separation Segregation Protection El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing Cl 11. Good Hygienic Practices Violatigns Related to Ggod Retail Praciiges (Blue Items) Critical (0) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous orToxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law [1 Allergen Awareness 590.009 (G) [j 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS [j 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Fieheating Cl 18. Cooling CI 19. Hot and Cold Holding Cl 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction; Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the lood establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE E-IN I N: Inspector?s Signaturej?g: will? Print Page 06 Pages sr i - gnature FORM 734A IREV. l?in'ms 81 WARREN - BOSTON i i' Prim' Kr f/l/r? IQ/llcr/ :?LLijiriJ This Form Approved by the Massachusetts Department of Public Henlth THE COMMONWEALTH OF MASSACHUSETTS . ?l n' - 1 TOWN OR CITY 'xAr'LJ'k QH Date: - r' . Establishment Name: Page: c: "of has Lu?a' Item Code _c {cri?ealltem No. Reference 1 Ree DES PTO VIOLATIONIPLANOF some now Date PLEASE PRINT CLEARLY - - . - :Ven?ed I?Discussion With Person in Charge: Corrective Action Required: El Yes Voluntary Compliance Employee Restriction Exclusion Emergency Suspension Re?inspec?on Scheduled Emergency Closure [3000 El E1 Embargo 0 Voluntary Disposal Other: Form 734 AM. Sulkin 00.. Charleston-m. MA COMMONWEALTH OF MASSACHUSETTS (Media Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name -- Dee WM Wheaties (M i 7 El Food Service CI Routine Address CI Retail Re-inspeotlon Level Residential Kitchen Previous Inspection Telephone El Mobile Data: CI Temporary Pro-operation owner HACCP YIN El Caterer Suspect Illness Person In Charge (PIC) Time [It Bed 3. Breakfast General Complaint (LII- Imk In: El HACCP leaped? (?61 i. M) Out: Permit No. Other Each violation checked i?qulres an explanation on the narrative page(s) and a citation of specific provision(s) violated. ?ctitious Related to Foodborne Illness Interventions and Risk Factors [Red Items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT CI 1. PIC Assigned Knowledgeable Dulles EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections Restricted Excluded FOOD FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. Receiving Condition CI 6. Tags Records /Accuracy of Ingredient Statements 7. Conformance with Approved Procedures i? HACCP Plans PROTECTION FROM CONTAMINATION 8. Separation l' Segregation I Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing Cl 11. Good Hygienic Practices Violations Related to Good Retail Practises (Blue Items) Critical (0) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. 24. 25. 26. 27. 28. 29. 30. Management and Personnel Food and Food Protection Equipment and Utensils Water. Plumbing and Waste Physical Facility Poisonous or Toxic Materials Special Requirements Other (590.009) Non-compliance with: Anti-Choking Tobacco 590.009 (F) El Local Law 1] Allergen Awareness 590.009 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPEFIATURE CONTROLS (Potentially Hazardous Foods) Ci 16. Cooking Temperatures 17?. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY CI 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22): Official Qrger [or Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/Fsderal Food Code. This report. when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. ELITE QF IL Inspector?s gig?f?KA Print: I- P105 n} (WP-C {in ?l?rlnt: Ll fed? Page I omega ?Jf FORM 734A (REV HOBBS WARREN - BOSTON This Form Approved by the Massachusetts Department of Public Health TOWN OR CITY OF Establishment Name: I I '1 THE COMMONWEALTH OF MASSACHUSETTS - .- lLti . Date: Page: Code Reference Item No.: -Cri1:il:al Item -Red_lt?rn DESCRIPTION or woodman PLAN PLEASE FRNT CLEARLY 1' Date 1_ Verified Discussion With Person in Charge: Corrective Action Required: Yes {a x-f Voluntary Compliance 1? CI Re-inspection Scheduled El Embargo 0 Voluntary Disposal Employee Restriction Exclusion Emergency Suspension Emergency Closure Other. Form 734 AM. Suan 00.. Chadestown. MA COMMONWEALTH OF MASSACHUSETTS ?Erin/fit 0F {lyricist/1:51 [my FOOD ESTABLISHMENT INSPECTION REPORT Board of Health Tel. Name Date .I Us.) Om um is Address Risk 1' Level Telephone Owner HACCP YIN Person in Charge (PIC) if Time In: Inspector Out: and Service El Residential Kitchen CI Mobile Temporary Caterer Bed Breakiast Permit No. Ftoutine CI Re-inspection Previous Inspection Date: Pro-operation Suspect Illness General Complaint HACCP CI Other .. ~s \Mm rr Lam/irer Each violation checked reduires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne illness interventions and Factors {Fied items} Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with Infections Restricted Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. Receiving Condition CI 6. Tags I Records Accuracy of Ingredient Statements 7. Conformance with Approved Procedures! HACCP Plans PROTECTION FROM CONTAMINATION El 8. Separation/ Segregation Protection CI 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing CI 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water. Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements 30. Other (590.009) 16. [117. 18. I3 19. El 20. Non-compliance with: Anti-Choking Tobacco 590.009 (E) 590.009 (F) El Local Law Allergen Awerenes 590.009 (G) 12. Prevention of Contamination from Hands CI 13. HandWash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hzardous Foods) Cooking Temperatures Reheating Cooling Hot and Cold Holding Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red items 1-22}: Wu; Based on an Inspection today, the items checked indicate violations of 105 CMFI 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board 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. aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. FRE-IN PE TI FORM 734A (REV. QIZOIOI HOBBS 8r WARREN - BOSTON Page of Pages Inspector?s Signalman; I Print: PIC sSIgnaturePrint: Luigi {Jeff/Ll This Form Approved by the Massachusetts Department of Public Health THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF 'l Establishment Name: - . r- Date: Page: g'of ML Code Refe- renoe Item No.- -..C - Critical Item . -Red [tel-11' DESCRIPTION OF2VIOLATION i PLAN UPCORRECEON PLEASE HINT CLEARLY Date Veri?ed .. Discussion With Person in Charge: Corrective Action RequiredVoluntary Compliance Re?inspection Scheduted Embargo Voluntary Disposal I Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other: Form 734,8 AM. Sulkin 00., Chanestown, MA