Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978?446-7103 Name Date Type 'Operationfs} Ty Inspection r4 414 a. 9,017/4? ood Service Routine Address Risk Retail Re-inspection /7 Liam r_ 371' Level Residential Kitchen Previous Inspection Telephone . . Mobile Date: stevsv . .. AC CP YIN Temporary El Pre operation Owner El Caterer Suspect Illness rson-in-Char PIC Time Bed Breakfast General Complaint 9 rm In; HACCP Inspector Jim I Out' Permit No. Other Each violation checked requires an explanation on {Wrrative page(s) and a citation of specific provision(s) violated. Water Temp m?gp? Serve- Safe Cert Number Expiration Number ?7 I I arty/dag Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - servsafe 590003 (A) (Red Items) Pest Control 590.007 - - - - . - - Anti-Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC [j 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating I: 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21, Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 -I..I- 29- Special Requirements (590-009 within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: 590InspectForm6- 14 doc f? I Inspector?s Emmy-(Wig Print: JIM 4 FIGS Signatur%M Print: TOM Page_ of_ Pages I Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Cawf/ City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name . Date of Operation(s) Type of Inspection r61! EFZoodlService E) Routine Address Ri It I etai e?inspection I 7 0? mm?: 41 Lat IL 51? Level Residential Kitchen Previous Inspection Telephone? Mob'l Date: 72r?33g9a3 .e . AC CP YIN Temporary Pre operation Owner WXRM j, (W Caterer Suspect Illness - Bed Breakfast El General Complaint Person?in?Charge (PIC) 4 Erne HACCP Inspector r. Out: Permit No. Other Each violation checked requires xpla Water Temp (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 El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements T. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION CI 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 S: doc on on the narrative page(s) and a citation of specific provision(s) violated. Serve-Safe Cert Number Expiration Number cf - Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - /)J-SeWSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) [j 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?sW_ C/l/Mf Print: . ?0536?? Pm? I some COINFQW Page_ of_ Pages City Hall 375 Merrimack Street Lowell, MA Lowell Board of Health 7 4/ Tet; 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978-446-7103 Name . Date Ty of Operation(s) Ty Sow {33:00:} Service Routine Address {7 .1L 3L Risk? Retail CIRe-inspection a. a; Level El Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner A HACCP YIN El Caterer Suspect Illness PIC [1 Bed Breakfast General Complaint Person In arge( El HACCP Inspector . j; 144 Out: Permit No. Other Each violation checked requires an explanation oWative page(s) and a citation of specific provision(s) violated. ?9 Water Temp L. Serve-Safe Cert Number Expiration Number 195:7 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - servSafe 599.003 (A) (Red Items) Pest Control 590.007 . . . . . . . Anti-Choking 590.009 (E) Violations marked may pose an Imminent health hazard and reqwre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy Statements I: 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing I: 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 Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 28- POISQHOUS Materials and submitted to the Board of Health at the above address 29- SpeCIal Reqwrements (590.009) within 10 days of receipt of this order. 30. Other DA TE 0F RE-INSPECTION: Inspector?s Signature: Print: ??mm/g 1? - Latent (02?1er ages PICS Si natur Print: wait Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT A/wl/ rt: City Hall [g 5:6 375 Merrimack Street a?wh Lowell, MA M94 Tel.: 978-674-4144 Fax: 978-446-7103 Name - j? Date Ty of Operationfs) gm! f/e/f/ 7/?9 Eplfood Service Routine Address . Risk El Retail Re-inspection I) 67 In} CM I 57L Level [3 Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary I: Pre-operation Owner 1 HACCP YIN Caterer El Person-in-Charw - Time El Bed Breakfast General Complaint - .. poll El HAccp Inspector trot-1AA r, I cut PermItNo. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp (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. 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 I: 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 Serve-Safe Cert Number ML Expiration Number ML Violations Related to Foodborne Illness Interventions and Risk Factors - Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling El 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature: 8: 590lnspechann6?14.dac . Print: PICS Signatumv APR {7 Print: BI. Page__ of_ Pages {?0496 rile THE COMMONWEALTH OF MASSACHUSETTS Citv OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health Establishment Name: Def 5L/t 5/4 56 AW As; Date: :7 Page: 2' of Item Code - Critical Item DESCRIPTION OF VIOLATION i PLAN OF CORRECTION Date No. Reference - Red Item PRINT mam-rm Verified d3; 2163. ?ex: 2C. Hf; iC/La?z?? Discussion With Person in Charge: Corrective Action Required: Cl No. Was 9' Voluntary Compliance Cl Employee Restriction/ Exclusion Emergency Suspension Re-inspection Scheduled Embargo Emergency Closure El Voluntary Disposal Other FORM 734B 7/2000) This Form Approved by the Department of Public Health Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT ?9 . City Hall ?me 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Ty Operation(s) Ty Inspection Bil/?f 2443/ C6 140? 5/9? 7 Epgd Service fauna Address . Risk II Retail Rea-inspection I7 UNAM . 3 1? Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary El Pre-operation Owner HACCP YIN Caterer El Suspect Illness - - Bed Breakfast General Complaint Person-In-Charge (PIC) Time El @1141: {Li @Y?l 0 In: HACCP Inspector MW 5 Out: Permit No. Other Each violation cheglted requires an explanation on narrative page(s) and a citation of specific provision(s) violated. Water Temp (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. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (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 Serve?Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors Non-compliance with: 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) I:l 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of ConSUmer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE OF RE-INSPECTION: /7 . ff- Inspector? Signatur: Print: Print: WTIQ Page_ of_ Pages 1U V?s-7w Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 ems/- Name Date Operation(s) Type of Inspection Buff/er" Sa?m/ ab//lg? rig/Eco; Service outine Address Risk Retail Re-inspection 60/4447 ?31- Level Residential Kitchen Previous Inspection eep one Mobile Date: 0 3 45?. Tag/% HACCP YIN Temporary Pre-operation wner Caterer Suspect Illness Person-i har PIC T'm El Bed&Breakfast General Complaint 1.3.. 1:932. 6 HACCP Inspector 2.1533197? Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citaiion provision(s) violated. Water Temp (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 I: 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH I: 2. Reporting of Diseases by Food Employee and PIC I:l 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Serve?Safe Cert Numberm?xpiration Number Violations Related to Foodborne Illness Interventions and Risk Factors- Non-compiiance with: ServSafe 590.003 (A) El Pest Control 590,007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling Cl 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) I: 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 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 5: 590lnspachon-n6?14 doc order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s 5 Print: L193 ignaturIu; "r I ?2 5% PICs Signature: 5, I (39W- Pm? 831mm may PageL of? Pages 0 .. Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA 978 674 4144 Tel.. - - MM Fax: 978-446-7103 Bat/?lair 551m We? (jam/94M It] . Telephone la 5:33 Owner Person- AM ?Aug, Inspector 11,5? 6mm rv I yoe Type of Inspection 110d Sawice Wutine Risk Ij Retail Re-inspectirm Level Residential Kitchen Previous Inspection El Mobile Date: Temporary Pre-operation HACCP YIN Caterer Ij Time Bed Breakfast General Complaint In: HACCP Out: Permit Filo. Other Each viola?on checked requires an explanation on the narrative pageis) and a citation?- 0 specific pIoirisionfs) violated. Water Temp it; Serve-Safe Cert Number Mjf?l/ Expiration Number.__ Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC AssignedlKnowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 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 S: 5901nspechonn6?14 doc nce with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Officiai Order for Corr action: Based on an inspection today, the items checked indicate violations of 105 CIVIR 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. DA TE OF Page 7L Pages Inspector?s SignaW Print; . PICS Si nature: Print: - 1. er City Hall 375 Merrimack Street Lowell, MA LOWGII Board Of Health (7 . Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT (57% In? Fax: 978-446-7103 Name Datv ofbperationfs) of inspection EMA. 3 (410:) I (Kile/[1? Food Service ??utine Add RT: Retail Re-inspection ress (7th 3 ?Sm El Residential Kitchen Previous Inspection Telephone I Mobile Date: aw 67?" AC CP I:l Temporary El Pre-operation Owner I El Caterer Suspect Illness -Ch a PIC Bed Breakfast General Complaint Person in rge( LS 1' A NAI OSV InI:ne El HACCP Inspector 5m Out: Permit No. Other Each violatlrorT E'hecked requires an explanation on the narrative page(s) and a cita on 0 specific provision(s) violated. Water Temp Serve-Safe Cert Number (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 El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 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 8: 590lnspechorrn6-14.d00 Expiration Number $2445 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling El 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s Sign .: Print: 5m Printz?dl?ma 056/? Page 7! 0f Pages PICs Signature: 3;:41 0 2 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT [Jr ewe/2g! City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446?7103 Name Typ? perationrs) Type of Inspection [?qu 3410: I I mile Address Ri'skd?7 El Retail Re-inspection [/45 60/ MM Level El Residential Kitchen Previous inspection Telephone Mobile Date: I 3" 9346? A CP YIN [1 Temporary Pre-operation Owner I:l Caterer El Suspect Illness -Ch Pic Bed Breakfast General Complaint 3'9 S55 2. meme. (Es-er? [i HACCP inspector Out: Permit No. Other Expiration Number Non-compliance With: Each violation checked Fequires an explanation on the narrative page(s) and a citat' of specific provision(s) violated. Water Temp A Serve- Safe Cert Numberm Violations Related to Foodborne illness lnterventeoltj??n? 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/Knowiedgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of ingredient Statements T. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) [1 Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) I: 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/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. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: 590lnspectForrn6-14.doc Inspector?s Sig rc: Print: PICS Signature: SJ Print: 5? (v #95 I'\j Qr? Page of 4 Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Name 06173390 City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 of Operationrs} Breed Service Ty of Inspection IEpReoutine Address Risk Retail [3 Re-inspection (Q I O?f Level Residential Kitchen Previous Inspection Telephone Mobile Date: 0 a @l/4 HACCP YIN El Temporary El Pre-operation wner Caterer Person-in-Char PIC Time Bed Breakfast El General Complaint 9 U): IV um ek?aclds I: HACCP Inspector LISA. 5m Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specIftc pr Water Temp Serve-Safe Cert Number 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. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 (FC- -3 (590.004) 25. Equipment and Utensils (FC- -4 (590.005) 26. Water, Plumbing and Waste (590.006) 27. Physical Facility (FC- -6 (590.007) (-FC -5) 28. Poisonous or Toxic Materials 7) 590.008 OVISIZHIZI Eiolated. Expiration Number on- compliance with: 0/ 590.003 (A) ?39 9/56 Pest Control 590.007 Anti- -Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands I: 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Rehearing 18. Cooling El 19. Hot and Cold Holding I: 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 29- Special Requirements 590.009 within 10 days of receipt of this order. 30. Other DA TE OF S: A Inspector?s Signet Print. SM PICS Signature: Print: Page of Pages pat/(IA Vatican/43 Lowell Board of Health FOOD ESTABLISHMENT INSPECTEON REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 WM Fax: 978-446-7103 Name a ype of Opera tion(s) Type of Inspection I Cir/23 Food Service outine Address El etail Re?inspection I RI Levei n. WKitchen Previous inspection eep one Mobile Date: 4.46 E) Temporary E) Pre-operation Owner HACCP YIN Caterer ESuspect illness - E) Bed Breakfast General Complaint Person In Charge (PIC) . El 5 I Erna HACCP Inspector Ll?? 631? out Permit No. Other Each violation checked requires an explanation on the narrative page(e) and ac ciatio at specific piovision(s) violated. Water Temp Jag; Serve? Safe Cert Number Jim Expiiation Number J90 Nonmompiiancav with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) (Red Pest Control 590.007 Anti-Choking 590.009 (E) El Violations marked may pose an imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowiedgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 8: 14 doc Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEHEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction. Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. UATE OF Inspector?s Signatur - PICS Signature: 3 age/__ 0 ages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Comp; Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name 3a Type Operationi?s) Type of Inspection [1 cod Service outine Address 3 Rl's'k Retail Re-inspection Clark-f Level Residential Kitchen Previous Inspection Telephone mg Mobile Date: Ell-{4" AC CP YIN Temporary Pre-operation Owner Caterer Suspect Illness Person-in-Charge (PIC) Ha V) Time Bed 8? Breakfast 3:73;: Complaint In: inspector IW Out: Permit No. Other Water Temp Each violation checkzd requires an explanation on the narrative page(s) and Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeabie/Duties EMPLOYEE HEALTH E) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 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 8, Serve~Safe Cert Number priration Number a cita ion 0 specific provision(s) violated. 30 Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 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) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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 food establishment permit and cessation of food establishment operations. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Print: 5m Page A of Pages Inspector??nature' PICS Signature: zi?M/V? i" City Hall 375 Merrimack Street Lowell. MA Tel.: 978-674-4144 Fax: 978?446-7103 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT O?m jig/y Name Da . Type wbperationfs) Type I. I I9 WService Wine . Address a I Risk Retail Re-inspection Level Residential Kitchen Previous Inspection Telephone 1 owp-wg- #0013 YIN Temporary Pre operation Owner Caterer Suspect Illness Person-in-Charge PIC) - Time El Bed Breakfast General Complaint I I imam In: El HACCP Inspector Out: Permit No. Other Expiration Number Each violation chegked requires an explanation on the narrative page(s) and a cita ion of pacific provision(s) violated. {4 egg Water Temp Serve-Safe Cert Number Hm Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors ServSafe 590.003 (A) (Red Items) Pest Control 590.007 iAnti-Choking 590.009 (E) El Violations marked may pose an imminent health hazard and reqwre Immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 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 El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy ofIngredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE 0F S: 590lnspeciFaim6-14.dac Inspector?s Signature: a. PM AW 99717 PICS Signature: UMJA Pm? GENT Bax-mix] Page A Mi Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name CJnar-Lr 3:;th Address .306 Gal/km 2 Telephone 73?8?39?3- 0290 Owner mm ()2th Cl? Operation(s) of Inspection Food Service IB/Raoutine 'Rtisk I Retail El Re-inspection Level [3 Residential Kitchen Previous Inspection Mobile DElate: Temporary Pre-operation HACCP YIN Caterer Suspect Illness Time Bed Breakfast El General Complaint In: HACCP Out: Permit No. Other Inspector Each violation chec?lgted requires an explanation on the narrative page(s) and a cita ?on fspecific provision(s) violated. 6:2 6 (2 52 Water Tomp Serve?Safe Cert Number 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/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC I: 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements I: 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 (FC-4 (590.005) Expiration Number Non-compilance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (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) El 16. Cooking Temperatures 17. Reheating 18. Cooling CI 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 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 food establishment permit and cessation of food I 26' Water, Plumbing and Waste establishment operations. If aggrieved by this order, you 27' Phys?caI FaC'I'ty . have a right to a hearing. Your request must be in writing 28- Materials and submitted to the Board of Health at the above address 29- SpeCIal Reqwrements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF 590lnspechorm6-l4.doc Inspector?s Sig Print: SM 4 . PICS Signaturwl I Print: 3?4 (11W 0 301/4 d. Page A of Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTBON REPORT City Hall 375 Merrimack Street Lowell MA Tel.: 978? 674- 4144 Fax: 978 446 7103 Name Dat Type of Opsration{s) Type 0 inspection Service toutine Address Risk Retail Fae?inspection ?13}:th Level Residential Kitchen Previous Inspection Telephone 890 Mobile Date: . 69% (3:23?19 HACCP YIN Temporary Pre-operation Owner El Caterer Suspect Illness Person-in-Char a Time Bed Breakfast General Complaint CL In: HACCP Inspector I 579. (WU Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a cit/0:71? specific plovision(s) violated. Water Temp (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 El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 8: Serve?Safe Cert Number J??l?f Expiration Number (9 Violations Related to Foodborne Illness Interventions and Risk Factors - Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating I3 18. Cooling El 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 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 Cerrection: 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. Dir-I TE OF WON: Print: Inspector?s Signa tref? A PICS Si nature: - . sum I aim? at 4. Print: 52w row ()ch Page *4 Pages t? II. Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Fax: 978-446-7103 Gambia Name Date ype Operation(s) Type of inspection 30h C501 35,9! I i wISewice Routine Address Ris etai e-inSpection 3-06: x. m0?) 8} Level El Residential Kitchen Previous inspection Telephone Mob'le Date: 00:99 seam . 0 . AC CP YIN El Temporary Pre operation wner Caterer Suspect Illness rs -Char PIC . . Time Bed&Breakfast El General Complaint "1 9 (1mm OZQi-ldt In. HACCP Inspector pr Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citatio of specific provision(s) violated. oz 2 Water Temp Serve-Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors- (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy ofingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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) Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding [3 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-3USCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE OF RE-INSPECTION: 30. Other Print: S: 590lnspecIFonn6?14.doc Inspector?s 2 2 OZCL in a; Page A 01% Pages e/T PICsSignatu ("Da?mmJl?J Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date - Woperation?) Type spection 63.1 (f 1331:) cod Service outine Address Qt: Risk El Retail CI Rainspecticn I Level Residential Kitchen Previous Inspection Telephone CI Mobile Date: 0907) A CP YIN Temporary Pre?operation Owner El Caterer Suspect Illness . - Bed Breakfast General Com Iaint Person-In-Charge il'Ime A CP n: Inspector 51:73? Out: Permit No. El Other Each vic?tion checked requires an explanation on the narrative page(s) and a ci?at'fn 5f specific provision(s) violated. Water Temp 420: Serve-Safe Cert Number priration Number 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. Reporting of Diseases by Food Employee and PIC I: 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 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: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) Cl 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) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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/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. DA TE OF Inspector?s Sign; S: 590lnspechonn6?14.dac Pm" 929?57577 PICS Signature: Page of TIL Pages LS ?23..?ch OJEAQ um Gist-12141.. 0 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Cam/5m Name Dat Type parationi?s) 71%? memes [B?gd?tine Address Ris'k 1' Retail Re-inspection 4' Level Residential Kitchen Previous Inspection Telephone CI Mobile Date: El Temporary Pre-operation Owner HACCP YIN El Caterer Suspect Illness Person-in-Char PIC - Time Bed Breakfast El General Complaint 9 I I lit/J41 /0M?j In: HACCP Inspector Al?? 557,) Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/RecordslAccuracy ofingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 S: 590inspechorm?-14 doc Serve-Safe Cert Number A Expiration Number Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awarenesa 590.000 (G) El El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating CI 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s Signm\t Print: 5i 5M Print: Page 7L 02L Pages PICS Si natu Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674?4144 Fax: 978?446?7103 :24 23:55 aavi?t??wm Muscles?7c: ma pa Inspection ne of 0peration(s) outine Food Service . .caII Re-Inspection Residential Kitchen Previous Inspection Mobile Date: Temporary Pre-operation ?Ihi Calais) (yrcup Pm Person- i-n-Chal'ge (PIC) Inspector 5AM I HACCP WN El Caterer Time Bed a Breakfast General Complaint In: HACCP out: Permit No. Other Each violation checked requires an explanation on the narrative page(s and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number Expiration Number ma ?11 Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 S: 590lnspecIFom16-t?4 doc Non-compliant: with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): @?iciai Grater far 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be In writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE 0F Inspector?s SEW Pm? L1 5m PICS Signature: Print: Page 7L 0f4ll Pages 62214: 220 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA 70 Tel.: 978-674-4144 Fax: 978-446?7103 "me One lactic Ar (teem Telephone ?ag QS4-c9-g7'o Owner ?51! Person-ih-ChargetP'CI ??SIJ/mlzo Inspector 1..ng Type Operationfs) Type of Inspection 77.3! ood Service IE?Rbutine 'Risk Retail Re-inspection Level I: Residential Kitchen Previous Inspection Mobile Date: Temporary Pre-operation HACCP YIN El Caterer Suspect Illness Time Bed Breakfast General Complaint In: HACCP Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific pro isionIs) violated. Water Temp Serve-Safe Cert Number Expiration Number I083 693 .. Non tmii'ipli/1 ith: Violations Related to Foodborne illness Interventions and Risk Factors - sewsafe 590_ 003 (A) E, (Red Items) Pest Control 590.007 - - - - - - - Anti-Choking 590.009 (E) El Violations marked may pose an imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH I:l 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives I: 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling CI 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27' Physical Facility have a right to a hearing. Your request must be in writing 28- Materials and submitted to the Board of Health at the above address 29. Special Reqwrements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: 590lnspachonn6?14.doc m. Inspector?s Signaeig: "r Print: Z), SH, 5m PICS Signature: Print. 1&7? 6a 2224/) age_'[ Of?l?L Pages M'n? City Hall 375 Merrimack Street Lowell, MA Lowell Board of Health Tel; 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT a) Fax: 978-446-7103 Name Type! Operationis) Type Inspection CWJ (Saga/22.? after MI Elael in i9 and Service outine Address Risk El Retail El Re-inspection Level Residential Kitchen Previous Inspection Telep one 9 8" Mobile Date: 0 ?29 ACCP YIN Temporary Pre?operation wner Caterer Suspect Illness Person-in-Charge (PIC) I Ef?e Bed Breakfast Complaint Inspector 1 Out' Permit No Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 11gb; Serve- Safe Cert Number Expiration Number A Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) El (Red Items) Pest Control 590.007 Anti-Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) correCtive action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Waterfrom Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 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 Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands I:l 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY I:l 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DA TE OF Inspector?s Signatur . (PC) 3 Print: AZW PICS Signatuif. Print: WA {De/r10 Z- Page; Pages I shun- -: Lowell Board of Health arm FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA {writ/agar Tel.: 978-674-4144 Fax: 978?446-7103 Name Type of Operation(s) Type of lnSpection Oil/I I i? [740/ 27?; 101] I ll El? Food Service El?outine Address Retail Re-inspection I I. 17477] [7.131 IL Level Residential Kitchen Previous Inspection eep one Mobile Date: 0 (7jo Shafts- ACCP YIN Temporary El Pre-operation wner El Caterer El Suspect Illness Person- in-Charge (PIC) Time Bed Breakfast ?zgecrag Complaint In: Inspector A Out: PermItNo. Other Each violation checked requires an explanation on the narrative page(s) and .9 Ci tion of specific provision(s) violated. Water Tem (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/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 S: 590lnspechorm6?14.dac Serve-Safe Cert Numberm Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - .20 2, Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 CI Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector? sSignaturYIjJJ/m Pm" {15% W171 of_ Pages PICsSignatur' {uh ?'??imoj (bu: ICIDCL r1 6? Page? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 WIQUW Name Type of Operation(s) Type of Inspection 00 CI Food Service ?ne Address 3 VJ . Risk Retail El Re-inspection I W) Level Residential Kitchen Previous Inspection Te epho i - .1 Mobile Date: 0 7} 7? c! X5 HACCP YIN Temporary Pre-operation wner Caterer [j SUSpect Illness Person-in-Charge (PIC) Time Bed 8? Breakfast Complaint In: Inspector II film 14.52 Out' PermIt No. Other Each violation checked reqmres an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 4,66)? Serve- Safe Cert Number Expiration Number ml 1 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/KnowledgeabIe/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 Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 8' doc Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): 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 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. DA TE OF RE-INSPECTION: Inspector?s Signat?r? Print: "Elm/6 WWI Pm" I16 an Iii/1m Page_ Pages PICS [m II-W Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT CM (7/9ch City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operation(s) Type of spection 0?01 0M: Am L, 5 4 Food Service W1: Address .- Risk El Retail Re-inspection gum Level El Residential Kitchen Previous Inspection Telephone . Mobile DateHACCP YIN Temporary Pre-operation wner El Caterer Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast El 322%? Complaint A A In: Inspector i ,1 Mam Out: Permit No. [3 Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 0 Serve-Safe Cert Number Expiration Number 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. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Vioiations Reiated 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 S: 590lnspechonn6?14 doc 2&22. Non-compliance with: ServSafe 590.003 (A) 1] Pest Control 590.007 CI Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 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 CI 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF qt n' Inspector?s Print: ?Taxi/?. Page_ of_ Pages 1C5 Pm? "If T?t'iiCOLtifCJ?Qi Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Con/1W City Hall 375 Merrimack Street Lowell MA la; 64 Tel.: 978- 674-4144 Fax: 978- 446- 7103 Name Danie . Type of 0peration(s) Type of Inspection I?at?m (MI) Gig I El and Service El cutine Address Ri Retail Re-inspection J56 M31 12.? Level Residential Kitchen Previous Inspection Telephone (. 5Z7 gr ?7 a 0L cf 81'? Mobile Date: 0 ACCP YIN Temporary Pre-operation wner Caterer Suspect Illness Perso n- -Char PIC Time Bed Breakfast General Complaint I )1 In. HACCP Inspector I ?w Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. h-g :215?2/1, Water Temp Serve-Safe Cert Number/ 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/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 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 590lnspechonn6?14.doc Expiration Number Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE 0F Inspector?s Signature? KI ?in? Ann: II Mb?. I Page_ of_ Pages PICsSignature: ?1,-ij (our)? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operation(s) Type of Inspection aM/cm El Food Service ERoutine Address Risk Retail El Re-inspection (K 3 1 7" Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pro-operation Owner A HACCP YIN Caterer Suspect Illness Pers 413% {row/M Time El Bed Breakfast General Complaint In. El HACCP Inspector UM Out- Permit No Other Each violatiorI checked requires an explanation on a narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number (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/KnowledgeabIe/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. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 >275 7Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - 5 I lSeWSafe Non- -compliancs with: 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27' Facility . have a right to a hearing. Your request must be in writing 28- P0lsonous or Materlals 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 DA TE OF RE-INSPECTION: S: 590lnspachaml6-14.dac Inspector?s Signaturc// Print: ?m/w?l ,5 FIGS Signature. Print: 1 Page_ Pages /\Dm\k/2J A Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Cg eM/Ezz/ City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978?446-7103 Name Date of Operation(s) Ty of Inspection FWA 4mm, ,4 an 0/6,va ca/xm//3? Food Service Egoutine Address Risk. Retail [1 Re-inspection ?3 g; Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pr'e-operation Owner HACCP YIN Caterer El Suspect Illness -Char PIC - Bed Breakfast General Complaint 93? HACCP Inspector M4 4- Out- Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number MI Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility Poisonous or Toxic Materials 23. 24. 25. 26. 27. 28. gr/yef/M Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS CI 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF RE-INSPECTION: S: 590lnspectFonn6-14.doc Inspector?s Signature: Print: JW PICS Signatur ?it . vi Pm" MICK. the atrium Page_ of_ Pages 375 Merrimack Street Lowell, MA LOWGII Board Of Health Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978?446-7103 Name Date of Operation(s) Type of Inspection 5W Elli/7 g/Emd Service outine Address - isk Retail Re-inspection 3 re?w? 3; Level El Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer ESuspect Illness - Bed Breakfast General Complaint Person In Charge (PIC) . (mag/a ?(an Erne HACCP Inspector Out' Permit N0. C) Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number Expiration Number WW l' ith on-comp lance 3?72 fSewS Violations Related to Foodborne Illness Interventions and Risk Factors - ate 590.003 (A) (Red Items) Pest Control 590.007 . . . . - Anti-Choking 590.009 (E) Violations marked may pose an Immlnent health hazard and reqUIre Immediate Tobacco 590-009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH E) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing E) 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 S: 590lnspacIFonn6-14.dac Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling )3 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPEC Inspector?s Signature: 7 Print: Wm er/ minimal/2401a r00 Illa/t Page??Jag? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Tel.: meta/W Lowell, MA 978-674-4144 Fax: 978-446-7103 Name Type of Operation(s) Type of inspection UL) MU WOW m/ 4 74/7,? Ei?mFem utme AddressI Risk Retai e-inspection I K751 CWIUJ Level Residential Kitchen Previous Inspection Te eP one Mobile Date: 4/7, 5/7 2" If Temporary El Pre-operation Owner HACCP YIN [j Caterer Suspect Illness Person- -in-Charge (PIC) Time El Bed Breakfast Complaint In: . Inspector Kill/I43; kip) Out: Permit No. Other Each violation checked requires an explanation, on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 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 AssignedlKnowIedgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/RecordslAccuracy Statements El 7. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 (FC 24. Food and Food Protection (FC- 25. Equipment and Utensils (FC 26. Water, Plumbing and Waste (FC 27. Physical Facility (FC 28. Poisonous or Toxic Materials (FC 29. Special Requirements (590.009) 30. Other S: 590lnspechorm6-14. doc Serve-Safe Cert Number Expiration Number M2 80/ Non- c-ompliance with: ServSafe 590.003 (A) Pest Control 590.00? Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) I: 16. Cooking Temperatures El 17. Reheating El 18; Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 590.000lfederal 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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature: {/11 ?Ma (IO KI Pm? Stir/UM I i/Zm. Print: 39m Page_ of_ Pages PICs Signature: =421w! I I 0 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA COW -. Tel.: 978-674-4144 MI Fax: 978-446-7103 Name Type of Operation(s) Type of Inspection GEN A 10! I 160m Jaw/M ?it-x I EEj?EowIService We Address 3k etai e-inspec ion K76, 7] 3 WW6 Level El Residential Kitchen Previous Inspection Telephone 7/ El Mobile Date: 7 5 "26752 A CP YIN Temporary Pre-operation Owner Caterer Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast ?zgecrg Complaint Inspector I W44 Permit No. Other Each violation chepked requires an explanation on the narrative pagets) and a citation of specific provision(s) violated Water Temp ?1 Serve-Safe Cert Number W?xpimtion Number #1 ?6 13 Non~compliance with: VIolatIons Related to Foodborne illness interventions and Risk Factors- sewsafe 590. 003 (A) .3 (Red Items) Pest Control 590.007 - - - - - - - Anti-Choking 590.009 (E) El VIolatIons marked may pose an ImmInent health hazard and reqUIre ImmedIate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non?critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 8: 590lnspechomI6-14. doc Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling [3 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 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 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 orderInspector?s Signature: PICs Signature 01 ?p Page_ of_ Pages ?mm 19mm Ie( Witt? dropping-,4 43} ?x?iwv? in Clicki- (50:11 201"? City Hall 375 Merrimack Street Lowell, MA Board Of Health Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978-446-7103 Name gs Type 1? Operation(s) Type 0 Inspection Mu r7712 F5712 (m (Mlle/IL, 2.01/4} gm?! Service outine Address 45 RIsk Retail Re-inspection IV 5 I0 IQ Level Residential Kitchen Previous Inspection Telephone 47/]ng 9V a? fed/M MobIIe Date: . ACCP Temporary Pre?operation wner Caterer Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast General Complaint in: HACCP Inspector Mam Out' Permit No. Other Each violation checkedTeruires an explanatio on the narrative page(s) and a citation of specific provision(s) violated. a Water Temp 410? Serve- Safe Cert NumberM/ixpiration Number 2'0 0213 Non- -compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) El (Red Items) Pest Control 590.007 . . . . - - - Anti-Choking 590.009 (E) El VIolatIons marked may pose an Imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) 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 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 (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 590lnspechorm6?14.doc Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY I: 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 food establishment permit and cessation of food establishment operations. lf aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF . Inspector?s Signature/J PIIW Print IZI (LIE. f2? PICsSigntitu?/L/ Print: ny/ #WF?/fip/ Page_of_LPages COW City Hall 6267M 0?4 375 Merrimack Street II, MA Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978?446-7103 Name eofOperationfs} Type of inspection 61 11./dis l1 EM CW Dat inL/lc? Food Service Routine Address y/ Risk Retail Re-inspection 1'7 75 i/i?i Level Residential Kitchen Previous inspection Telephone 3 Mobile Date: 0 #055 3 ?2 HACCP YIN Temporary Pre-operation wner Caterer Suspect Illness Bed Breakfast I: General Complaint Person-in-Charge (PIC) Time ACCP In: Inspector CW Mm Out- Permit No Other I Each violation checked requires an explanation on the narrative page(s) and a citatien of specific provision(s) violated. Water Temp 0 Serve? Safe Cert Number Expiration Number 3'3 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors- ServSafe 590.003 (A) El (Red Items) Pest Control 590.007 iAnti-Choking 590.009 (E) El Violations marked may pose an imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowiedgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC [j 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE I: 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 0 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 2 . Water, Plumbing and Waste ., Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other 8: 590lnspaciFami6-14 doc Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federai Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. 67 DA TE OF RE-INSPECTION: 9 Inspector?s Signatur LLUL HA liq/ML PICS Signature: if Pei/H raj-Ma sags??Use THE COMMONWEALTH OF MASSACHUSETTS City OF Lowell ohn Street 2nd floor Lowell, MA 01852 Board of Health - Establishment Name: it?? L00 Date: 9?7 ?37 Page: 2" of 2? 1' Item Code 6- Critical ItemM DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference R- Red Item PLEASE CLEARLY Veri?ed 2?7 from am Ht. Coolm?. mm pmpmir ?Ull?j/ J??j Jig. 27? WW7 Shinto Exp/we?, Discussion With Person in Charge: COrrective? Action Required: CI No mes Exclusion Fla-inspection Scheduled CI Embargo DUB Voluntary Disposal Other Cl Voluntary Compliance CI Employee Restriction Emergency Suspension Emergency Closure FGRM 734B (REV. 7/2000) I.-. aL- u- rn I -- l_l City Hall 375 Merrimack Street If . Lowell, MA LOWOII Board Of Health 0009 Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978?446-7103 Nam Date Type of Operation(s) Type of Inspection @dej W/?l I?d} Food Service E?Rou?ie Add Risk Retail Re-inspection I75) Level Residential Kitchen Previous Inspection eep one - . Mobile Date: 0 ?13 6: 2 HACCP YIN Temporary [3 Pre-operation wner Caterer Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast I:l General Complaint A x: In: El HACCP Inspector .U {i (I 1: WM Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number I 51/79 Expiration Number 3 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - Sewsafe 590.003 (A) '3 (Red Items) Pest Control 590.007 lAnti-Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH I:l 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. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Item) 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 S: 590lnspechonn6?14doc Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s SigltatuWU%l Eat; WM Print: 54" mil tame. at? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT 0 City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978?446-7103 ?lm/(I Dat'e Name Type of Operation(s) Type of Inspection 6F?l? Ah at. 3123/? FoodService Routine Address Risk I Retail Re-inspection II {on (7 Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary El Pre-operation Owner HACCP YIN Caterer El Suspect Illness rson-?n-Char PIC Time Bed&Breakfast General Complaint 9 9? EIHACCP Inspector Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 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. 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 El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. (3 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 S: 590lnspectFom16-14 doc _Ll?a_ Serve-Safe Cert Number 1% $95 ?(Expiration Number LI {id Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (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) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding [3 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Print Inspector?s SignalurW/EW: 257/.? mmu Print PICs Signature: ?3:13 A IS Page? of_ Pages Euotgd to 9 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA 5: Tel.: 978-674-4144 Fax: 978-446-7103 Name Date of Operation(s) Gram. (?qu 51!, 5? Service E/Reo?tine Address Retail Re-inspection I ?7 1? 5" Level CI Residential Kitchen Previous Inspection Telephone Mobile Date: 53 5 by? 61? HACCP YIN El Temporary Pre-operation Owner Caterer I: Suspect Illness Person-in-Chal?ge (PIC) I Time EI Bed 8? Breakfast 3:290? Complalnt AM In: Inspector .m Out' Permit No. El Other Each violation checked requires an ex?anation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 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 El 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 S: 590lnspectFam16?14. doc iff- 57,42,551: Non- c-ompliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature: (W Print: lbw/??7? PICs 5 [guanine I: Print: Paguw of_ Pages Zuni Fr) Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tei.: 978-674-4144 Fax: 978?446-7103 new . Name ate Ty of Operation(s) Ty of Inspection 6 Agar Magood Service EPRBoutine Address I L, I: 5; Risk Retail Re-inspection ?7 #:1014145 Level Residential Kitchen Previous inspection Telephone Mobile DDate: Temporary Pre-operation Owner HACCP YIN Caterer Suspectliiness n-?n-Char PIC I 3 Time Bed Breakfast General Complaint erso I I 5E In: HACCP inspector J'm Out: Permit No. Other Each violation checked requires an expla/nation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve?Safe Cert Number M?Expiration Number 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/Knowledgeabie/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 3: 590inspecIFonn6-1?4 doc Non-compliance with: {Ia/?/J?ervSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address Within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s Signature: Print: Prinl??-?jZA-?g' U: I .160 M55- Page__ 0f_ Pages ?g PICS Signature??61 Out' Permit No. El Other Water Temp (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 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 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 3: 5901n5pschorm6-14. doc Each violation checked requires an explanation on the narrative page(s) and a citation of ecific provision(s) violated. Serve-Safe Cert Number/M Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - 49.11 Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 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 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 590.000lfederal 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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE 0F RE-INSPECTION: Inspector? M1314 at a .. PICS Signature. WE 44.1?? rim: of_ Pages Waging I?m? .a Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT 0001000, City Hall 375 Merrimack Street Lowell MA Tel. 978- 674- 4144 Fax: 978- 446- 7103 Name Date Type of Operation(s) Type of Inspection 7&1 nfain 501mg S/rali 7 Iail/Food Service Escutine Address .. Rilsk Retail Re-inspection 50A hp lij/U/U, {(716 Level Residential Kitchen Previous Inspection Telephone 2 Mobile DateTemporary Pre-operation wner ACCP El Caterer El Suspect Illness Person-in-Charge (PIC) Time El 38d Breakfast El complaint I Inspector LU I gut' Permit No. Other Each violatioz checked requires" an explanation he narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy ofingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 3: 5901n5pachonn6?14.doc 35*;0 .11 Non?compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives CI 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling El 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector? sSignatuI-e: W26 1a (84K Print 7531100741 Ki 0am PICs Signature: CALL t: .. - H?n A rm Page_ 0f_ Pages City Hall ?LWwe 375 Merrimack Street . - Lowell, MA Lowell Boa rd of Health at Caron, in Tel. 978-574-4144 FOOD ESTABLISHMENT INSPECTION REPORT 34. 5mm (?fag Fax: 978-446-7103 Name a Type of Operation(s) Type of Inspection 1 0 JM 0 OZ (gfi ?ll 9 Food Service Routine Add - Retail Re-inspection ress ?00 {fl/d I L59) [i Residential Kitchen Previous Inspection Telephone 07 Mobile Date: 0 . A CP YIN Temporary Pre-operation wner Caterer ESuspect Illness - Bed Breakfast General Complaint Person in Charge (PIC) Line i: HACCP Inspector U1 Kl Valli Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a gitatIon of specific provision{s) violated. Water Temp Serve-Safe Cert Number [513?5357; Expiration Number ?12? 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/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected Immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. 24. 25. 26. 27. 28. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other S: 590lnspechorm6?14.doo Non- c-ornpliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE- POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of 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 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 orderInspectorss Signaturezuw Print: 4 If R1 PICs Signature: 644mm 1: Print: jg?wx mitt-?g. 5ml-?1?Ii? DA TE OF RE-INSPECTION: Page_ of__ Pages THE COMMONWEALTH OF MASSACHUSETTS City Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health . 1 Establishment Name: 5 Date: q?I(o (7 Page: of Item Code C?Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date . Reference R- Red Item PLEASE mm am? Verified 27 R. m; 90+ +0 Vague (300/0105 MC l?I do: reload r/I Hmr/ F0002 0 2.. :97 0?05? c? It {jar Aojam- if? 0 4/0007 Kiowa/1 balm/1e. '6 Em: ?1 M0 nth/brawn? raga/Me lime/La ?47730 dud {90*005? UOCI system Mal/L +0 I10 Islam/0M opt/1.: 2? I4 pi pl: reinsuml'im Gui/I Hm millage/10,0 Timon/.10. Li {If} Discussion With Person in Charge: Corrective Action Required: CI No *5er35 Voluntary Compliance Employee Restriction/ Exclusion Cl Re?inspection Scheduled CI Emergency Suspension . Cl Embargo CI Emergency Closure Cl Voluntary Disposal Cl Other 7I9?nn Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street iOJl/Cx. Tel.: Lowell, MA 978-674?4144 Fax: 978-446-7103 Name IDat Type of Operation(s) Type of Inspection CO I Food Service Routine Address CI Retail El Re-inspection 36 0 Chi: I I 9 Level El Residential Kitchen Previous Inspection Telephone 29 [3 Mobile DateTemporary Pre?operation Owner Caterer Cl Suspect Illness Person-in-Charge (PIC) Time El Bed 8? Breakfast 322%: Complaint In: Inspector VWQ Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of 33:? Erovision(s) violated. Water Temp/L Serve-Safe Cert Numbe {Sig OLExpiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/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 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing Cl 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be Corrected immediately or within 90 days as determined by the Board of Health. 23. 24. 25. 26. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 27- Fac'l'ty have a right to a hearing. Your request must be in writing 28- POIsonous or Toxic Materials and submitted to the Board of Health at the above address 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: doc Print: Inspector?s Signature. jg} Zak PICs Signature: J1 Print.(2lm ?153 Page_ of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Lax/4 City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Operation(s) Ty of inspection bout (a [aft IQ/lgoid Service E) Routine Address Risk Retail Re-inspection 5? 3:7 Mic/#16 53% 5; Level Residential Kitchen Previous Inspection Telephone 0) UFO .14 8-13 CI Mobile Date: 0 AC CP YIN Temporary Pro-operation wner Caterer El Suspect Illness - Bed Breakfast General Complaint Person In Charge (PIC) CO 0, U\\g?lo Erna HACCP Inspector I Out: Permit No. Other r/ Water Temp (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. 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. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non?critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Serve-Safe Cert Number Expiration Number Jig/i Violations Related to Foodborne Illness Interventions and Risk Factors - Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures CI 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspeCtion today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DA TE OF S: I Inspector?s Signature: Print: Jim 14 PICs Signature Print: 1. . I - Page_ of_ Pages erQabmW Mum? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Cay/M City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674?4144 Fax: 978-446?7103 [?ame . Date Type-of Operation(s) Ty of Inspection 69W l/ qul Czar/aw (lg/Mgr Food Service Routine Address he? Risk El Retail CI Re-inspection Alike/{MIA- J'g? 37.21 Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer El Suspect Illness 3 i" - Bed Breakfast General Com laint Person in Charge (PIC) L?/Lt?tbf?Ma Lime HACCP Inspector . 914/: 4 Permit No. Other Each violation checked requires ait exp?fanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements CI 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 (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 Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 29- Special Requirements (590.009) within 10 days of receipt of this order. 30- Other DA TE OF RE-INSPECTION: S: 590lnspechorm6-14.doc .- ..- - . Inspector . ?12351" rint 191/? 4H1) PICs Sign?gttwuf'W? Print: I I {9?15th of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Qi?er City Hall 375 Merrimack Street Lowell. MA Tel.: 978?674-4144 Fax: 978-446?7103 Name - . - ateV 0peralion(s) of Inspection L0 H13 (j ??ma?j?p 642, A). E/Igotod Service Routine Address . Risk Retail Re-inspection 5'3 3) Level El Residential Kitchen Previous Inspection Telephone Mobile Date: El Temporary Pre-operation Owner HACCP YIN El Caterer El Suspect Illness rson-in-Char PIC .- Bed Breakfast [3 General Complaint 9? I UL or Lat-I21:? "31m HACCP Inspector \j?f?ll 0 Out: Permit No. Other (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. 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. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices, (Blue Items} Critical 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 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors- Non-compliance with: ServSafe 590.003 (A) Pest Control 590.00? Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DA TE OF RE-INSPECTION: S: 590lnspechon116?14.doc r: Inspector?s Signature: . -- Print: Print PICs Signature: WW L.) (J Page__ of_ Pages Hbi 30?? Mar (9k 45'" Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name . Date ?7 of Operationfs) of inspection Q/Ai?hci? gar/4? 4; /Jr7 B/Igood Service meoutine Address - 1 Risk Retail Re?inspection [93> Level Residential Kitchen Previous Inspection Te 99 one . Mobile DateTemporary Pre-operation Owner HACCP YIN El Caterer Suspect Illness Person-in-Char plc) Time Bed Breakfast General Complaint 9 IQD I ?pbA Viol/x In: HACCP Inspector I Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number 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/Knowledgsable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 3: 5 901nsp echon'n?- 14 doc Expiration Number Non-compliance with: ServSafe 590.003 (A) Pest Control 590.00? Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal 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. DA TE OF /7 Inspector?s SignM% Page_ 0f_ Pages A 5 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT ?aw/I City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operation(s) Type of Inspection [dwel/ 5:1501 302/]? If] Food Service Routine Address Risk Retail Re?inspection Y0 air 5} 141 A [b Level Residential Kitchen Previous Inspection Telephone Mobile Date: 4 El Temporary El Pre?operation Owner HACCP YIN Caterer El Suspect Illness Person- in-Char IC El Bed Breakfast General Complaint 9 05,) 01/) All 'fne E1 HACCP Inspector ?gzm Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 4/39? Serve- Safe Cert Number )5 T5 307! Expiration Number 7 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 E) 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 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing [j 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 (FC 2)(590. 003) 24. Food and Food Protection (FC- -3 )(.590 004) 25. Equipment and Utensils (FC 4)(590 005) 26. Water, Plumbing and Waste (FC- 5)(590 006) 27. Physical Facility (FC- 6)(590. 007) 28. Poisonous or Toxic Materials (FC- 7)(590 008) 29. Special Requirements (590 009) 30. Other 5: 590lnspechonn6- 44 doc Non-compliance with: I bl, iv? 2 r)ServSafe 590003 (A) El Pest Control 590.007 [1 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (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) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 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. DA TE OF Inspector?s SignatW . 7' Punt?? gd? Print: K7621 Page_ of_ Pages PICS . mew 375 Merrimack Street rr cL/?c/J? Lowell, MA LOWBII Board Of Health ?w Mfg}? Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978 --446 7103 Name .V Type of Operation(s) Type of Inspection (9A Service ?Routine Address Risk El Retail Re- i-nspection I F0 F4: Mv. Use/[Ae? Level Residential Kitchen Previous Inspection Te ephone Mobile Date: 973 0 27 ?965 AC Temporary Pre-operation Owner CP YIN Ell gaff; kf . Person-in-Charge (PIC) Time a rea as enera omp aInt Lei-Fr? I . El HACCP Inspector I 144 ?by gut. Permit No Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp L. Serve- Safe Cert Number Ar) 35-39 Expiration Number 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 El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 31/ Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 CI Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling El 19. Hot and Cold Holding [3 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing 28' Poisonous Materials and submitted to the Board of Health at the above address 29- SpeCIal Reqwrements (590.009) within 10 days of receipt of this order. 30. Other DATE OF S: 590lnspecIForm6a14 doc I Inspector?s Signatur 9: Print: HJ Lu PICS. 51({rurui WJKM Print: Ufa? I IQ Vol v, Page(__ ofig Pages THE COMMONWEALTH OF MASSACHUSETTS Citv OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health Establishment Name: .jL 6:4. r45 Date: :71 page: ,1 of ?71 item :Code C-Critical item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference Fl ?=Fled item PLEASE PRINT CLEARLY Verified ?6 Ewe/(lame c2 4 m. Esamaa lap/#CKW Lao: ?r I i 9/0 7 Discussion With Person in Charge: Corrective Action Required: No Wes G, Voluntary Compliance Pie-inspection Scheduled Cl Embargo Voluntary Disposal Cl Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other 734B (REV. 7/2000) This Form Approved by the Department of Public Health Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT WM City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446?7103 Name . Dat of Operation(s) Type of Inspection (47 [Mfg A 5:7 Service moutine Address a. . 1. Risk El Retail El Re-inspection @117 [?11 [Muir Mn? Jf/i?l [if/Vt?! Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer El Suspect illness -Cha PI T'me Bed Breakfast General Complaint Per? In 30 HACCP Inspector . 4? Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 1L Serve- Safe Cert Number 33' 53? H3 0? Expiration Number 3? Non- -compliance with: 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. 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 [3 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) E) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Grater 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 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 Page_ of? Pages 29- Special Requirements (590-009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: 590lnspachonn6-14 doc I -- Inspector?s Signature: Print: lot?1? PICs Signature Puma Lowell Board of Health City Hall 375 Merrimack Street Lowell, MA . Tel.: 978-674-4144 ??aw/ga/ Fax: 978-446-7103 FOOD ESTABLISHMENT INSPECTION REPORT Name ?at Type of Operation(s) Ty of Inspection /7l 5 6?4 74: Food Service Routine Address . Risk Retail Re-inspection 90 [31/ Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre?operation Owner HACCP YIN CI Caterer Suspect Illness Person-in-Charge (PIC) Em] ?47 Time Bed 8? Breakfast 322%? Complaint In: Inspector JM M2 Out' Permit No. Other Each violati?n requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Serve- Safe Cert Number Expiration Numbers Water Temp 5/7/ 2 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors- ServSafe 590.003 (A) I: (Red Items) Pest Control 590.007 . . . . . . . Anti-Choking 590.009 (E) VIolatIons marked may pose an ImmInent health hazard and reqUIre ImmedIate Tobacco 590.009 (F) I: corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/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 [3 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 S: 1'4.doc Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating I: 18. Cooling El 19. Hot and Cold Holding I: 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE 0F RE-INSPECTION: Inspector?s 3%an I 1 Print: A wg/(El i tinny/aka ?1712/39? 5710 pugc_ 0f_ Pages PICS Signature: g! @j a I Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA 978-674-4144 (em/e/ Fax: 978-446-7103 Name Date Ty of Operationrs) Erfae?of Inspection Mg. A4, Sly/M 6/5/46? Eglfood Service Routine Address Risk CI Retail Re-inspection 570 ?115 Si! Level Residential Kitchen Previous Inspection Telephone Mobile DateTemporary I: Pre-operation Owner Caterer Suspect Illness son-' -Char PIC T'me El Bed Breakfast General Complaint er In gel ml: HACCP Inspector W1 4 Out: Permit No. Other Each violation checked requires an eipianation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 72L Serve?Safe Cert Number Expiration Number Non-compliance with: 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. 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. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El 11. Good Hygienic Practices F/zz?ervSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) I:l 16. Cooking Temperatures El 17. Reheating I: 18. Cooling I: 19. Hot and Cold Holding I:l 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories 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 Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection 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 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 29- Special Requirements (590.009) within 10 days of receipt of this order. 30- Other DA TE OF S: 590lnspechorm6?14. doc . ,e Inspector?s Signatu e: Print: PICS Signatu Prim 42:47 tee/me Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978 Fax: 978- -674-41 44 446-7103 I Name . . . Date Ty eof Operation(s} Ty of inspection 4: 4o. (LR. 5 3; 7 Food Service 1EJJReoutine Address :7 3 . isk [3 Retail Re-inspection 5 7C 92?. Level Residential Kitchen Previous Inspection Telephone El Mobile Date: El Temporary El Pre-operation Owner HACCP YIN Caterer El Suspect illness 'n-Char PIC Bed Breakfast General Complaint 99? pa- 1 We} Ir/am HACCP Inspector WW Out: Permit No. Other Each violation checked requires arI explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp jigg? Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeabie/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility Serve-Safe Cert Number Expiration Number I Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing 28' POISCIHOUS 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 DATE OF FIE-INSPECTION: S: 590inspacharm6?14 doc I I Print: Inspector?s Signature. PICs SignatW 412/, "mt/Dr. a ,m 0f_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Cur ?a Lowell. MA Tel.: 978?674-4144 ll ?19? Fax: 978-446-7103 Name 55-4917/ Da i?r Operationrs) Haiti Service Address .. Risk Retail EIRe-inspection $7 0 51L Level [3 Residential Kitchen Previous Inspection Telephone [3 Mobile Date: CI Temporary El Pre-operation Owner HACCP YIN Caterer Suspect Illness Person-in-Char PIC Bed Breakfast General Complaint 9 I )Quzwrt? Magda/t mine HACCP Inspector Erin Out: Permit No. Other of inspection [a?ecutine Each violation checked requires an explartation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Violations Related to Foodborne Illness Interventions and Risk Factors- Serve?Safe Cert Number Expiration Number ServSafe f/yvh Non-compliance with: 590.003 (A) E: (Red Items) Pest Control 590.007 Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and requrre immediate Tobacco 590-009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 S: 590lnspechorrn6?14.doc .Tff Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating I3 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE or: RE-INSPECTION: Inspector?s Signati Print: llirLr?\/ Pr intIOc' A Him/17,4351 Page_ of__ Pages PICS Stgriaturfi?rf Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name . ate? Ty Operation(s) Type of inspection NC 7? ma Service outine Address ?Ri?k El Retail Rue-inspection 8% Level Residential Kitchen Previous inspection Telephone Mobile Date: Temporary Pre?operation Owner HACCP YIN Caterer Suspe'ct Illness rson- -Char Bed& Breakfast General Complaint 9 ID Icon ml!? DHACCP inspector \Jf ?ww Out' Permit No. El Other Each violation checked requirf? al?explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 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/KnowiedgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC [j 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 8: 590lnspachonn6?14.doc Expiration Number -22 ?411 Serve-Safe Cert Number {575 3 47 A12) Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands CI 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal 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. DA TE OF RE-INSPECTION: {i Inspector?s Signature: Print: H. Printzor?or?i/ git/gluon) I?:Ige_ of_ Pages FIGS Signature: ??L?41dim Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT d?w City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operationfs) of Inspection . VI 94- Food Service [E?R?outine Address - Risk Retail Re?inspection A) HOW ?if; 9E: Level Residential Kitchen Previous Inspection Telep one Mobile DateHACCP YIN Temporary Pre-operation wner El Caterer Suspect Illness son-' -Char PIC T'me Bed 8: Breakfast El General Complaint er 9? I 69 rm 3 ?ns/(imam /7 HACCP Inspector 4 Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve?Safe Cert Number 355:2? Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC I: 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 fr- 0 Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (6) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF S: 590lnspecIFann6-14.dac Inspector?W Print: I?rin?qL new? .. of_ Pages PICss?aturW L/(f t? I: Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT waf?/ City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Fax: 978-446-7103 Name . Date Type Operation(s) of Inspection IV ?t?/kue (S 67 El RootilService K??flfoutine Address - RIsk etai e-inspec ion [4 Mir-41.x 71% Level El Residential Kitchen Previous Inspection Telephone b?le DateTeamI orary Pre?operation Owner I HACCP YIN Cateprer El Suspect Illness Person-in-Char PIC (I 1 Time El Bed Breakfast El General Complaint 9 I I firm In; HACCP Inspector 14.. m. .11 Out' Permit No. Other Each violation checked requires an explefnation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve?Safe Cert Number 15% Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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. 26. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other S: 590lnspech0rrn6-14.doc ff? 3/;Lf/ 32; Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Cl Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS I:l 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature. Print: I Page_ of_ Pages ?enema/107737 fat/Idem Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street ffifr Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name MC ?phg/ Ty of Operation(s) 2241//?7 ?ood Service ?dress Risk? El Retail Re-inspection 3/ New, Level Residential Kitchen Previous Inspection Telephone El Mobile Date: El Temporary El Pre-operation Owner HACCP Y, Caterer I: Suspect Illness Perso -Char PIC i Bed&Breakfast GeneraiCompiaint I )J?ann r" ?ns am ln'zne El HACCP Inspector VA 254 M4 Out: Permit No. Other of Inspection Routine Water Temp LL Serve- Safe Cert Numberm Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors- Each violation checked requires an explar?tion on the narrative page(s) and a citat on of specific provision(s) violated. . Non-compliance with: ?//l//?298erv8afe 590.003 (A) (Red Items) Pest Control 590.007 . . . . . . . Anti-Choking 590.009 (E) Violations marked may pose an Imminent health hazard and reqUIre ImmedIate Tobacco 590-009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION 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 El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/RecordslAccuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 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 (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 Allergen Awareness 590.000 (6) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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/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. DA TE OF RE-INSPECTION: S: 590lnspecIForm6-14doc fir?_ Inspector?s SignaturQ: Q: Print: 4; PICS SignatuW/ Print?j?tggai? NP Ilo'jp/f/xe eK/f Pagei 0f_2?Pages (ii/W 505.4 Establishment Name: MC Al/ have: 5611157? Citv OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health Date: Ci: Page: 9 of ?am No. Code Reference Critical Item - Red Item DESCRIPTION OF PLAN OF CORRECTION Date Veri?ed 97 F: a J. PLEASE PHIHT CLEARLY car-9% 0/955 Leaf been {5 If? :5 $41.36: I?d-f, Fc: - a; ?.74 ?5 /'7fn.wn'/ Cchf-e?im I'Lr-r 5, VJ x7 F- a? m?eae sir mwo? v.5 rte-6? i [Lac/{I ?/pl 9"-Wp; erbr?? ?E?l Yes Discussion With Person in Charge: Corrective Action Required: No Voluntary Compliance CI Exclusion Pie?inspection Scheduled CI Embargo Cl Voluntary Disposal Other Employee Restriction I Emergency SUSpension Emergency Closure FORM 734E (REV. 7/2000l This Form Approved by the Department of Public Health Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT 5., City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978?446-7103 Name Date . of Operation(s) Type of ln5pection HC 41 dd 5mg? 957/57 E/Food Service utine Address 5k Retail e-inspection 0/ a. Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer El Suspect Illness -Ch T'me Bed 8 Breakfast General Complaint Person- -in arg? 77X HACCP Inspector JIM VQ Out- Permit No. Other Each violation checked requires an explaZrttion on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 1L Serve- Safe Cert Number 5 3 Expiration Number Jr )0 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 5.90.003 (A) El (Red Items) Pest Control 590.007 IAnti?Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 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 El 5. Receiving/Condition CI 6. Tags/Records/Accuracy of Ingredient Statements Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF RE-INSPECTION: S: 590lnspectFonn6?14. doc ?air 4? Inspector?s Sigrw: I Print: J): Wow/? PICs Prim??/r?r??/OJI //Vl Page_ of__ Pages 1? Lowell Board of Health City Hall 375 Merrimack Street Lowell, MA (Or/i 9/ Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT ,9 Fax: 978-446-7103 Name Date Type of Operation(s) Type of Inspection Me 4 [i ca 3 {2 7/67 IE Food Service Routine Address - Risk Retail Re-inspection 3 gr {Mr/1 3 7L Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer El Suspect illness Person-in-Charge (PIC) Time Bed Breakfast El General Complaint In. HACCP Inspector 4/?1 3' Out- Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. [.100 Water Temp 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/KnowiedgeabielDuties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition E) 6. Tags/RecordslAccuracy of ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 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. Serve- Safe Cert Number $33 a {all Expiration Number 0? LI /0 2 Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) Ci 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 23, Management and Personnel (F0 by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC- order-of the Board of Health. FaIiure to correct VIoiatIons 25_ Equipment and Utensils (F0 Cited In this report may result In suspenSIon or revocation of . the food establishment permit and cessatIon of food 26' Water, Plumbing and Waste (FC $590006) establishment operations. if aggrieved by this order, you 27- PhySIcai Facniity have a right to a hearing. Your request must be in writing 28- or Tom; Mater '3'5 ?(590008) and submitted to the Board of Health at the above address 29- Requwements (590-009) within 10 days of receipt of this order. 30. Other DATE OF 3:5901nspechorm6-14 doc Inspector?s Signature:/ Print: :m PICs Signature: ?/Ly/A/fz/ Wm. P'm? Lanna/? ?9 rib/?96$ of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978?446-7103 Name . Date Type of Operation(s) Type of Inspection a [a ?7 3? Food Service Routine Address . Risk Retail Re?inspection A) 5?4 - 5 7/ Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner ,1 HACCP YIN Caterer Perso -'n-Char PIC Time Bed&Breakfast General Complaint 9 I I MW M/m In: HACCP Inspector M. Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number HI 3 5 Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 8: 590InspacIFonn6-14.doc ZUUH Non-compliance with: 2ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s SignatuWMf Print: m/f?V/rr PICS Signature: Mm? 1% Print" J) Page_ of_ Pages Lowell Board of Health City Hall 375 Merrimack Street Lowell, Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT Fax: 978?446-7103 Name A Date Type of Operation(s) Type of Inspection .gc ?b 7/20/l? FoodlService goutine Address - ., . Risk Retai e-inspection II t2 S, Said I Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer El Suspect Illness Person- in-Char PIC Time Bed Breakfast General Complaint 9 I I $529,342. ?B/?iw In. HACCP Inspector Out' Permit No Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 4L Serve-Safe Cert Number 5? 5-71 Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing II 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 S: 590lnspachonn6?14.doc IDIIJ 0 Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: P?nt Inspector?s Signature MM PICS Signature: Print: Page_ of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA [29m [0/92 Tel.: 978-674-4144 Fax: 978-446-7103 Name te Type of Operation(s) Type of Inspection $14 g/io/l? IE4 Food Service [ERoutine Address . - 7 Risk Retail Re-inspection /0 5 ?4174 7( Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness Person-in-Char PIC . Time Bed &Breakfast General Complaint HACCP Inspector (- Out: Permit No. Other Each violation checked requires arI explanation on the narrative page(s) and a citation 2f fpecific provision(s) violated. 0 Water Temp Serve-Safe Cert Number Expiration Number 70 [0 [2 2 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) (Red Items) Pest Control 590.007 Anti-Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 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. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 S: 14. doc Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY I:l 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Mm aw PICs Signature: A0 PrintLEO/t/?/? D05 P:ige_ Pages City Hall 375 Merrimack Street Lowell, MA Lowell Board of Health CI Ta; 978-574-4144 FOOD ESTABLISHMENT INSPECTION REPORT I Fax: 978-446-7103 Name (I I Dat Ty of Operation(s) Type inspection __Moo AA Ir a) Food Service W?ne Address isk Retail Re-inspeciion I Level Residential Kitchen Previous Inspection 9P one '4 S. Mobile Date: 0 q. tag-?2} 32*? El Temporary Pre-operation wner AC I Caterer ESuspect Illness - Bed Breakfast General Complaint Person- -in Charge H4 Quads Erna HACCP Inspector 63m Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citatio of ecific provision(s) violated. Water Temp Serve?Safe Cert Number xpiration Number cur?L. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) El (Red Items) Pest Control 590.007 iAnti-Choking 590.009 (E) El Violations marked may pose an imminent health hazard and reqUire Immediate Tobacco 590_009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeabie/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 El 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 S: Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s SigW PICs Signature: {71% "mt 5m Pagei of Pages Lowell Board of Heaith FOOD ESTABLISHMENT REPORT new City Hall 375 Merrimack Street Lowell, MA Fax 978 446 7103 Tel.: 978-674?4144 Name Iypn' . Cia ball ?it Service Address Ris?? Retail TI mere 8" Leveg Residential Kitchen Telephone 7643 Tgmpirary Owner HACCP YIN Caterer Person-in- -Charge (PIC) A10 #4 We 3 Time Bed 8: Breakfast I 2 in: Inspector I I514 Out' Psrmitiio. Type of Inspection Mutine Re-inspection Previous inspection Date: E) Pre-operation Suspect Illness General Complaint HACCP Other Each violation checked requires an explanation on the narrative pageis) )and a cii Water Temp Serve-Safe Cert Number 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 El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 8: 5901nspecIFomI?-i4 doc A at'o specific provision(s) violated. Expiration Number Non-compiiance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) [j 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) El 16. Cooking Temperatures El 17. Reheating CI 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (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 9; tier 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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF REINSPECTION: Inspector?s SignIIturci? $12 5 a 2 Print: Print: A (LU (AL Page 7; of 47 Pages PICs Signature: i It! 1 I rues Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Fax: 978-446-7103 Name . Da Type Operation(s) of inspection (?490m RoodIService g?goutine Address Ri ai e-inspection I593 - cm 5 Level Residential Kitchen Previous Inspection Telephone 957) El Mobile Date: ?ta-:99 q. AC CP YIN Temporary Pre-operation Owner El Caterer El Suspect illness Person-in-Char PIC Time Bed Breakfast General Complaint gl Jammy?an 47 In: DHACCP Inspector Out: Permit No. Other Each violation checlfed requires an explanation on the narrative page(s) and a cit tio of specific provision Expiration Number .50: Serve?Safe Cert Number Violations Related to Foodborne Illness Interventions and Risk Factors - Water Temp (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/Knowledgeabie/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 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 S: 590lnspechonn6-14 doc violated. Non-compliance with: ServSafe El Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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/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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s 8%an Print: PICS Signature: 2: . .. Print: Page #1 of (Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell MA Tel. 978- 674-4144 Fax: 978-446- 7103 Name peretionfs} Wspection 0.5274! I, if: El macadIService El IFqioutine Address um ai e-inspection 66 Level Residential Kitchen Previous Inspection Telephone 98" Mobile Date: (i .35 HA CP YIN Temporary Pre?operation Owner 15:? 53/ (a El Caterer El Suspect Illness in? 5? Person-in-Charge (PIC) Time El Bed Breakfast General Complaint In. HACCP Inspector i ,r Out: Permit No. [3 Other Each violation checked requires an explanation on the Water Temp Serve-Safe Cert NurnberEZ?f?r??i?i Violations Related to Foodborne lnterggri?g'??t?isk 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 El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 (FC- 25. Equipment and Utensils 26. Water, Plumbing and Waste (FC- 590.006) 27. Physical Facility (FC- 28. Poisonous or Toxic Materials (FC- 29. Special Requirements (590.009) 30 Other S: 590lnspechonn6?14doc A tive page(s) and a citati 0 specific provision(s) violated. Expiration Number Non-compliance with: 7 :26 ServSafe 590.003lA) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspectorss SignatuW PICS Signature: (?fe-W 6 I Page 7L Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Ch Iii/M Tel.: 978?674-4144 Fax: 978-446-7103 Name Typeof 0peration(s) Type of Inspection WI 2 I ?7 Er?Food Service EI'Rbutine Address 3 fr Tn, - Risk I Retail Re-inspection I I) dik . Level El Residential Kitchen Previous Inspection eep one .h Mobile DateTemporary El Pre?operation Owner HACCP YIN Caterer El Suspect Illness Person-in-Charge (PIC) Time Bed 8? Breakfast ?gg?g complaint In: . '"SPem/14 cut: Perm" Other Each violation checked requires an explanation on the narrative page(s) and a cgation; of specific provision(s) violated. Water Temp ?9 Serve- Safe Cert Number Expiration Number 2?0 I . Non- -compliance with: ViolatIons Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) (Red Hams) Pest Control 590.007 . . . . - - - - Anti-Choking 590.009 (E) E1 Violations marked may pose an Imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 3: 5901nspechann6-14 doc Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: f-I . .. Inspector?s Signature: fi??uj {k I ?39411.01"? :1 K3 WC PICs Signature: f?/L Prin?o I :3 C: II (436?- Page_ of_ Pages n? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA C510 Wot/1% Tel.: 978-674-4144 Fax: 978-446-7103 Name emj Dat Type of Operation(s) Type of Inspection IM I Jig/:5 I IX E?F'ood Service Routi??e" Address .. El Retail El Re?inspection I 1590 Uh? Level Residential Kitchen Previous Inspection ep one Mobile DateTemporary Pre-operation wner A GP El Caterer E) Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast General Complaint A . In. HACCP Inspector I7 009361 Out: Permit No. DOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp #49; Serve?Safe Cert Number 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. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements I: 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing I:I11.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. 24. 25. 26. 27. 28. Management and Personnel (FC-2) (590003) Food and Food Protection (FC Equipment and Utensils (FC- Water, Plumbing and Waste Physical Facility Poisonous or Toxic Materials Expiration Number ., 21- 20!? Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590-009 within 10 days of receipt of this order. 30. Other DA TE OF RE-INSPECTION: S: 5901n5pectFonn6-14 doc Inspector?s Signatulg?M?/wb PICS Signature: Page_ 0f_ Pages 1, 'Mmjy ({va Pm? ma (6 Iran 107V Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell. MA Tel.: 979674-4144 978-446-7103 Name qDate Type of Operation(s) Type of Inspection 0 fut/I WW) I 87!! 2,1117; EongService Ha :oqtine t. Address sk an e-Inspec Ion I 30 WWIUIIZI: Level El Residential Kitchen Previous inspection Telephone Mobile Date: (I Hf 9L AC YIN Temporary Pre-operation Owner Caterer Suspect Illness Person-in-Charge IPICIA Time Bed Breakfast ?ggegzgl Complaint In: . Inspector 1 J) p? lug/60? Out' Permit No. CI Other Serve- Safe Cert Number Expiration Number 4? ?zu/g Each violatio checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated Water Temp 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. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition CI 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 590InspechamI6-14. doc Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities 147512,: PROTECTION FROM CHEMICALS I 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 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. DA TE OF RE-INSPECTION: Inspector?s Signatule: .Qu?u wW/gjk? I Print: PICs Signature: Print: I -. 2450,11 I/m Page_ of _Pages MAM Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall . 375 Merrimack Street C0 Lowell, MA cm. I 5" Tel.: 978-674-4144 fig, Fax: 978?446?7103 Name 0 te f/ Type of Operation(s) finspection \/f;IfI 0A1 0 I El Food Service g?tine Address Risk El Retail Re?inspection I 2 OJ Oil/I10 MW Level Residential Kitchen Previous Inspection Tele . on $7 g1?) 4?5 I in?gntigirary DElatlgre-operation HACCP YIN Owner Caterer Suspect Illness Person-in-Charge Time Bed Breakfast ?zge?gl Complaint In: Inspector WWL g! Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provi?i0n(s) violated. 0 Water Temp #40? Serve-Safe Cert Number ?g 5/ Expiration Number Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - Servsafe 590,003 (A) i: (Red Items) Pest Control 590.007 . . . . . . - Anti-Choking 590.009 (E) J: Violations marked may pose an Imminent health hazard and reqUIre immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH 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 I: 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 4. 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 S. 590lnspectFoim6?14.doc Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal 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 orderInspector? Signatufo]. Vd? Prin are 5m i7 Page??Jag? Cs Signature: 4( ?g 9 I 4w; awl?rintf THE COMMONWEALTH OF MASSACHUSETTS Citv OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Establishment Name: ?310sz Date: Board of Health .. 0 Page: 2, 2 of item No. Code Reterence - Critical Item Hegltern PLEASE mm CLEARLY DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Verified MIL-903 In war?Ine. I . {Le 69mm - ?4 )0er 90,5me {Drive/M3,? Md AM IILLIJI .OFU M554 (WM 0 Cam pan/LII? pamm' r: Cam ~71) cab: i- ?xx EM Whisk FIAOW Discussion With Person in Charge: Corrective Action Req uire'd: Cl El CI Cl Voluntary Compliance Re-inspection Scheduled Embargo Voluntary Disposal Employee Restriction Exclusion Emergency Suspension Emergency Closure Other FORM 734B (REV. 7/2000) This Form Approved by the Department of Public Health Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT CEWML City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446?7103 Name Date Type of Operation(s) Type of Inspection I IIOM MI 0 II 0 It Food Service ou ine Address Riska Retail Re-inspection I 3 I?iflI/L Level Residential Kitchen Previous Inspection Telephone 97 qu 2: 77 Mobile Date: AC CP YIN El Temporary El Pre-operation Owner Caterer El Suspect Illness Person-in-Charge (PIC) Time Bed Breakfast El General Complaint . In: El HACCP Inspector ?1116/5? K1 W?k Out' Permit No. Other Each violation cheacked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp JL Serve Safe Cert Numbef?m Expiration Number mid Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC AssignedlKnowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/RecordslAccuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 Non compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 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 29- Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF S. 590lnspectFonn6?14 doc If] Pm" Jitter 54L Var/2i Inspector?s SignatureW?n?k {1 Print. Pages DIME PICS Signature: AU sneiipieemwr? Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT M/rb/ City Hall 375 Merrimack Street Lowell, MA 978?674-4144 Fax: 978-446-7103 Name Date Ty of Operation(s) Type of Inspection ur/z /4 27/ 17/57! 3' Food Service EE/Ftoutine Address . Risk El Retail Re-inspection 6 M5 3/ Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness Person-' -Cha 9 PI Time Bed Breakfast General Complaint r9 I %M5Ma?f Joy/c354 In. HACCP Inspector ??44 Mk7, Out: Permit No. Other Each violation checked requires an explanation on ?7the narrative page(s) and a citation of specific provision(s) violated. Water Temp LIL Serve-Safe Cert Number Expiration Number 25? 59? Non-campiiance with: Violations Related to Foodborne Illness Interventions and Risk Factors- W??/J?5m3aie 500.003 (A) I: (Red Items) Pest Control 590.007 - - - - - - - Anti-Choking 590.009 (E) VIolatIons marked may pose an Imminent health hazard and reqUIre ImmedIate Tobacco 590.309 (F) 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 El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 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 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 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 29. Requirements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF RE-INSPECTION: S: 590inspechoIm6-14.doc Inspector?s Signature: 4 fag/5?7: Print: hwy/? PICS Signmurwl/Q/l?f?x Avid/C Print: Pages 19/ 77/50) 7 9/694? Page_ of Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT mew 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name . - Date Type of Operation(s) Type of Inspection 1 LI /4 "7 Food Service Routine Address - Risk Retail El Re-inspection ?3 go Level Residential Kitchen Previous Inspection Telephone El Mobile Date: Temporary Pre-operation Owner HACCP YIN El Caterer El Suspect Illness - Bed Breakfast CI General Complaint Person In Charge (PIC) Wm (Zap k?fk A HACCP Inspector 4 If i cut Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp LL Serve- Safe Cert Number wj?xpiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/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 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El 11. Good Hygienic Practices )4 .1 Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories 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. Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection 23. 24. 25. 26. 27. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility 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 28. Pctsonous OT-TOXIC Materials and submitted to the Board of Health at the above address 29. SpeCIal Reqwrements (590.009) within 10 days of receipt of this order. 30. Other DA TE OF S: arr??x I Inspector?s Signature: Print: ['14 PICs Signaturelefj Print: Page_ of__ Pages it Matti/z? Egg/632:, Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Inf/i5 5c A4710 Address - . 'j Retail El Re-inspection 3 Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness Person- n- Char PIC Bed Breakfast CI General Complaint I I ?aw HACCP ln5pector I Out' Permit No. Other of Dperation(s) ?gs of Inspection Q/lgood Service Routine Each violation checked requires an expiahation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve- Safe Cert Number Expiration Number We} Non-compliance with: 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. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 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 ServSafe 590.003 (A) El Pest Control 590.00? Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of. Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing 28- Poisenous 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 DA TE OF RE-INSPECTION: S: 590lnspectFonn5?14.doc . i . Inspector?s Signature: If:- Print: A. (Mm/4' PICS dig Page of 421%ch THE COMMONWEALTH OF MASSACHUSETTS City OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health Establishment Name: ?rfw #mnct/ 32%!44? Date: f6 Pageitem Code C?Crltical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date No. Reference Fl Fled Item PLEASE P?ir?' Verified 32 Fc?rc" Dan-1 ?3 a; (six {fl/11" L-riri Illa-?1- 214.46 d'sz - lag-Ar? i? If Discussion With Person in Charge: Corrective Action Required: No Was Voluntary Compliance El Employee Restriction/ Exclusion CI Fla-inspection Scheduled CI Emergency Suspension Embargo CI Emergency Closure Cl Voluntary Disposal CI Other 7345 (REV. 7/2000) This Form Approved by the nf pnhlin ?pollh Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street (MM Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name - Date Ty of Operation(s) Type of Inspection Myr? k/q A 0/ 5; ?711 Food Service Routine Address .. . Ri?sk Retail Re-inspection ?3 5/ 41 0/ ?ne? 5' 3) Level Residential Kitchen Previous Inspection Telephone Mobile Date: El Temporary Pre?Operation Owner HACCP YIN Caterer El Suspect Illness Person-in-Charge (PIC) I (M f& 7mer OSIQ Time El Bed 8? Breakfast El Complaint . I In: Inspector Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve-Safe Cert Number 7 50 F5 3" Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors- (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC AssignedlKnowledgeable/Duties EMPLOYEE HEALTH El 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 El 5. Receiving/Condition 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Pr0per 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. 24. 25. 26. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste [g 5* [g .2. Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) Cl 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27- FaC'I'ty . have a right to a hearing. Your request must be in writing 28. POISOHOUS or TOXIC Materials and submitted to the Board of Health at the above address 29- Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S: 5901nspectFann6-t4.doc ?xer?j) ?eff Jet" IHSPeCtor?s Signature: Print: PICS mm% ?mi/XI We? (2w (est, 0f_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT (from 0/ City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name - . a Date Type of Operation(s) Type of Inspection Arr?'7? Mr/la/IW/ '3 [121/ I8 IX) Food Service IE Routine Address .z . Risk Retail Re?inspection 3 Level El Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness -Char PIC) Bed Breakfast General Complaint erson- -in 9 Ir:rne HACCP Inspector I Cut Permit No Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. [?00 Water Temp 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 El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Waterfrom Approved Source I: 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 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 (590.008) 29. Special Requirements 30. Other S: 590lnspecIFarm6- t4 doc FC-T) 590.009 Serve-Safe Cert Number Expiration Number 57/33/21 I Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) E) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating 18. Cooling II 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s SignaturV/? ?3 Print: fir-f If?! 5' PICs Signature: Print: MOI F0 I Z95 Page_ of 0' J: Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 d? Name Add Address Telephone "9,72 44/ _3 7 Sf Owner Person-in-Charge (PIC) Main)? ?11m Inspector Date of Operationis) Ty of Inspection 4?7 12193 bed Service ?El?tecutine Ri?k Retail El Re-inspection Level Residential Kitchen Previous Inspection El Mobile DEIate: Temporary Pre?operation HACCP YIN Caterer El Suspect Illness Time Bed Breakfast General Complaint In: HACCP Out. Permit No. Other Each violation checked requires art explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve? Safe Cert Number Expiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 (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. 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 S: 590InspaciForm6-14 doc (FC (-FC (FC (FC (FC (590.009) "ff? 6/3/ Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands I:l 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE OF RE-INSPECTION: Inspector?s Signature: Print: 1 PICs A Print: Mfza My 51> Page_ of_ Pages Lx? 17/ I 0m 5 CityHaII . 375 Merrimack Street a Lowell MA ff; 1 Lowell Board Of Health ?1.04? LEM MM Tel_; 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT J46 J4f? Fax: 978-446-7103 Name Date of Operation(s) Ty of Inspection L.) A N/Mrm/ 50/90721/ (1 If//?j Service #outine Address Risk Retail Re-inspectlon (19 (J ?f Level El Residential Kitchen Previous Inspection Te eF? one Mobile Date: Temporary Pre?operation Owner HACCP YIN El Caterer - Bed Breakfast General Complaint Person in Charge (PIC) Mal?- EFL {6 /y 7,ch Erne I HACCP Inspector a til-1W I Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 5 Serve-Safe Cert Number Expiration Number Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) I: (Red Items) Pest Control 590.007 Violatibns marked may pose an imminent health hazard and require immediate ?ziggkm 23333: :3 a corrective action as determined by the Board of Health. Allergen Awareness 590:000 (G) ,3 FOOD PROTECTION MANAGEMENT El 12. Prevention of Contamination from Hands 1. PIC ASSIgned/Knowledgeable/DutIes El 13. Han dwa sh Facilities anszo?EE lil'tl'EALTlle' I PIC PROTECTION FROM CHEMICALS ep? 'Seases 0? mp and [i 14. Approved Food or Color Additives . t' El 3 ersonne WIth ec Ions RestrIcted/Excluded El 15- Toxic Chemicals FOOD FROM APPROVED SOURCE El 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. CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP El 10. Proper Adequate HandwashIng CONSUMER ADVISORY 11. Good Hygienic Practices El 22. Posting of Consumer Advisories 9. Food Contact Surfaces Cleaning and Sanitizing 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 Official Order for Based on an of Health. today, the items checked indicate violations of 105 CMR 590.000/federal Food Code. This report, when signed below Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): 23_ Management and Personnel 503590003) by a Board of Health member or its agent constitutes an 24_ Food and Food protection order-of the Board of Health. Failure to correct violations 25' Equipment and Utensils CIted In We report may result In suspenSIon or revocatIon of 26. Water, Plumbing and Waste the food estabIIshment permIt and cessatIon of food establIshment operatIons. If agngeved by thIs order, you 27' Fac'l'ty have a right to a hearing. Your request must be in writing 28' MaterIals and submitted to the Board of Health at the above address 29- SpeCIal ReqUIrements (590-009) within 10 days of receipt of this order. 30. Other DA TE OF S: 590lnspactFonn6?14.doc I Inspector? Signature: Print: by 4 PICs SignutWA A Print: MU r( go I 7/ 1013 Page__ 0f__ Pages THE COMMONWEALTH OF MASSACHUSETTS Citv OF Lowell 35 John Street 2nd floor Lowell, MA 01852 Board of Health Establishment Name: eke/P is jaw Date: 6? Page: of 2 Item Code C?Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date No. Reference Red Item PLEASE Pam-r CLEARLY Verified 27 0' 4L [Ci?z? 531;;er Sr?tr?cr'?r Lea-A 21 KL Discussion With Person in Charge: Corrective Action Required: El No Mes if; Voluntary Corn Iiance I t' t? 1% if ?an ?"13 A col/Jr? . Eggs/:2: esncron Re-inspection Scheduled CI Embargo BUD CI Voluntary Disposal Other Emergency Suspension Emergency Closure 7345 (REV. 7/2000) Thic- uni-r11 Annrnilnr. -r Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT We/ City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Fax: 978-446-7103 Name Operationi?sl Ty of Inspection [?aw/b Marv/12? Service Routine Address R?iskr Retail El Re-inspection C7) 5? ?4 Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN El Caterer Suspect Illness Person-in-Char PIC . Time El Bed Breakfast General Complaint 9 I Mo: rm QDI In: HACCP Inspector km 4 Out- Permit No. Other Each violation checked reqUIres an explanation/gnhk the narrative page(s) and a citation of specific provision{s) violated. Water Temp Serve- Safe Cert Number Expiration Number if ?33 f/ Non-compiiance with: Violations Related to Foodborne Illness Interventions and Risk Factors - 2? ServSafe 590003.100 CI (Red Items) Pest Control 590.007 El Violations marked may pose an imminent health hazard and require immediate 223:2?? 233333 E: corrective action as determined by the Board of Health. Allergen Awareness 590:000 (G) FOOD PROTECTION MANAGEMENT 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH [j 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address 29- Special Requirements (590.009) within 10 days of receipt of this order. 30- Other - . 9? DATE OF RE-INSPECTION: S: 590lnspachonn6?14 doc Inspector?s Signature: Print: HM- PICS 5%an 9,47 Print: .7195 Pagc_ of _Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Fax: 978-446-7103 Rail/u 5:545 Address . J7 - 7Q9k I Telephone - - I I Owner Inspector 5m Da Operation(s) Type of ln5pection E14355 Service me RI's'k 5? Retail El Re-inspection Level Residential Kitchen Previous inspection Mobile (Dine: Temporary Pre-operation HACCP YIN Caterer Suspect illness Time Bed Breakfast General Complaint In. HACCP Out: Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citati of Specific provision(s) violated. Water Temp Serve-Safe Cert Number Expiration Number [9 ?31 Violations Related to Foodborne Illness Interventions and Risk Factors- (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC CI 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 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 005) 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials (FC-T 590.008 29. Special Requirements 590.009 30. Other S: 590lnspechonn6-14.doc Non-complicit ce with: ServSafe 590.003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding I:l 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. if aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signatuhm 24 Page of Pages - Print: 6W PICs Signature: Print: u. {j 1 Lowell Board of Heaith FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowe Tel.: WQ4 II, MA 978?674-4144 978?446?71 03 3mm ??35 I15 IRA). Telephone 5' m_ 0937- 11?0335? Person- -in-Clharge (PIC) Inspector Fax: Dat Type sf Operationfs) l5: Food Service Ris'tt Level L, Henri-"Had Kitchen Mobile El Temporary HACCP YIN Caterer Time Bed 81 Breakfast In: Out: Permit N0. Type of Inspection outine El Re-inspection Previous Inspection Date: Pre?operation Suspect Illness El General Complaint HACCP El Other [Each violation checked requires an explanation on the nairative page(s) and I citat on W?piration Number Lam?.17 Violations Related to Foodbarne Illness Interventions and Risk Factors - Water Temp Serve-Safe Cert Number (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 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items). Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 3: 590lnspechon'i16-1 4 duo 0 speci?c piovision(s) violated. Nonicompliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) II 21. Food and Food Preparation fo CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodbarne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Cor eCIion: 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. DA TE OF RE-INSPECTION: Inspector?s Sir, Print: . 6m PICS Signature: g3 Print: Pagel Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Comic [2924/ Name . Type 0 Operation(s) Type of inSpection REA IIUI 80:461.? I 2 Daf/?l/lqr Service outine Address .- 6'71 QI RI ?k Retail Re-inspection 1 Level Residential Kitchen Previous Inspection Telep on 9} bile Date: ?W?b Ct +9.35 '3 . ACCP YIN El Temporary Pre operation Owner El Caterer Suspect Illness Person-in-Charge PIC) Time Bed Breakfast General Complaint I If, Land. (K I In: HACCP Inspector 4153/9 SM Out: Permit No. Other Water Temp Serve-Safe Cert Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/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 El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 (FC- 5)(590. 006) 27. Physical Facility (FC- 6)(590 007) 28. Poisonous or Toxic Materials (FC- 7)(590. 008) 29. Special Requirements (590. 009) 30. Other S: 590lnspachom16-14 doc Each violation checked requires an explanation on the narrative page(s) and a citati of specific provision(s) violated. Expiration Number (011 l?k Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature: Pm? Am?? 5472? Pm? Kiri/27L? ft? -A Page i of Pages . . 3'42!" 1? I .- zafm, f?e-cg Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name a . perstionfs} pe of Inspection Karl/u go?m/ ?if?/M and Service gramme Address R?Isk Retail Re-inspection M?xgidl E6274 Level Residential Kitchen Previous Inspection Telep one 98" Mobile Date: 0 9 -16? AC CP YIN Ij Temporary Pre-operation wner - .., El Caterer El Suspect Illness -Ch PIC I I Bed Breakfast General Complaint erson in arge( A?/thi; Ir:ne HACCP Inspector I Out: Permit No. Other Each violation c'h?cked requires an?explanation on the narrative page(s) and a citati of pacific provision(s) violated. Water Temp 4&1. Serve-Safe Cert Number 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 I:l 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 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 (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 S: 590lnspecl'FormG?14 doc Expiration Number Non-compliance with: ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating El 18. CoOIing El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE OF RE-INSPECTION: ,Print Inspector?s Sign re' 377722 PICS Signature? fat/{TC Print: Page 1d Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA i 39W Tel.: 978-674-4144 Fax 978 446 7103 Name Operationfs) Wpec?on itmolgi Sims-0 I mibo?? Food Service outine Address Riel-<7 Retail Re?inspection Level Residential Kitchen Previous inspection 9P one Mobile Date: a 955?? Temporary Pre-operation Owner HACCP YIN Caterer Suspect illness Person-in-Char PIC Time El Bed Breakfast General complaint 9 3 ?0 MW In: HACCP Inspector I 614*? Sm Out: Permit No. I:l Other Serve-Safe Cert Number Each violation {:th requires an explanation on the narrative page(s) and Mxpiration Number MI Water Temp Violations Related to Foodborne Illness interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/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 5. Receiving/Condition 6. Tags/Records/Accuracy Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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. a citat?on of specific provision(s) violated. ServSafe Pest Control Anti-Choking Tobacco Allergen Awareness I: 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals Non-compliance with: 590.003 (A) 590.007 590.009 (E) :1 590.009 (F) I: 590.000 (G) I: CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 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 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements 30. Other 8: 590inspeciFonn6-14.doc 26. Water, Plumbing and Waste i (590.009) have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF TION: Inspector?s Sign urc' 5m PICs Signature. MM Page 7L of_ Pages 7249qu I/M?ina?d 5* City Hall 375 Merrimack Street Lowell, MA Board Of Health Tel.: 978-674-4144 FOOD ESTABLISHMENT INSPECTION REPORT ?a Fax: 978?446-7103 Name Da?e I Type - paraiionfs) Type ofi spection I Cj/i pod Sewice Emmi; Address RIsk El Retail Re-inspection I 37) Levei El Residential Kitchen Previous Inspection 6P 009 I: Mobile Date: 0 qa?b 456% CCP YIN Temporary )3 Pre-operation wner A Caterer Suspect Illness -Ch PIC [1 Bed Breakfast General Complaint erson in arge( EDI, Wu? Z0 anti-Hie El HACCP Inspector 1?45? Sm Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a cit specific provision(s) violated. Water Temp 4% Serve-Safe Cert Number Expiration Number ?/ijn Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) (Red tems) Pest Control 590.007 El Violations marked may pose an imminent health hazard and require immediate 333333 :3 a corrective action as determined by the Board of Health. Allergen Awareness 590:000 (G) FOOD PROTECTION MANAGEMENT 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 El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 S: 590lnspacIFarm6-t 4 doc El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures I: 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): - Official Order for Correction: Based on an inspection today, the Items checked indicate violations of 105 CMR 590.000/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. DA TE 0F Inspector?sSignaturK CH3) r/?f REL Print: AW 5% Page of Pages PICS Signature: KW I {?124ou $71 Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 WA Fax: 978?446-7103 Name Type parationfs) Type of inspection Mg?ervice outine Address 8L Risk? Retail Re-inspection urn Level El Residential Kitchen Previous Inspection Te ephone p_ Mobile Date: 0 a 7.7 I I HACCP YIN El Temporary Pre-operation wner El Caterer El Suspect Illness Person- in-Char PIC Time Bed Breakfast General Complaint 9 I I Na II 01/ 751' 3210?, HACCP Inspector -L 357;" Out: Permit No. Other Water Temp (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 E) 1. PIC Assigned/KnowledgeabIe/Duties EMPLOYEE HEALTH CI 2. Reporting of Diseases by Food Employee and PIC E) 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source E) 5. Receiving/Condition El 6. Tags/Records/Accuracy ofIngredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 Each violation checked requires an explanation on the narrative page(s) and a cit tiona ecific provision(s) violated. I 27?} 2 I Serve-Safe Cert Number Mxpiration Number Violations Related to Foodborne Illness Interventions and Risk Factors - Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling I: 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPEC S: 590InapecIForm6-1 4.01m Ir? 5 Inspector?s 81 FIGS Signature: atur 21% am Page of Pages Print: ?a ?ag, ?m Lowell Board of Health City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Wm 7% Fax: 978-446-7103 Ty Operation(s) Type of Inspection FOOD ESTABLISHMENT INSPECTION REPORT Name eVIWId/df} ?fX/{7 Food Service outine Address Retail Re-inspection I I1 Level Residential Kitchen Previous Inspection Te 9P 011%, El Mobile Date: 4M- (I Temporary Pre-operation Owner HACCP YIN Caterer ESuspect Illness - Bed Breakfast General Complaint Person In Charge (PIC) Buy/n a? I Lime HACCP Inspector Permit No. Other 6 Water Temp HLZL Serve?Safe Cert Number Expiration Number Each violation checked requires an explanation on the narrative page(s) and a citat'En oEspecific 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/KnowledgeabIe/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition El 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 (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 S: Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.00? Anti-Choking 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures El 17. Reheating 18. Cooling 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 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s Signature. i i' Print: PICs Signature: a 9W, Print: Page of Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operation(s) Type of Inspection 0 ram Sc LUV, 3 2 Hi? El Food Service LEI Routine Address Risk Retail El Re-inspection /0 If Level Residential Kitchen Previous Inspection Telephone Mobile Date: [3 Temporary Pre-operation Owner HACCP YIN Caterer El Suspect Illness Person-in-Charge Wt?QlLb?p?n? Time El Bed 8? Breakfast 322%: Complaint In: Inspector [?lly/m Out' PermIt No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Serve-Safe Cert Number Expiration Number ?1 2 1 Water Temp :1 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. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition II 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (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 8: 590lnspeciForm6? 1'4 doc Non- -compliance with: g/ly/Jo ServSafe 590,003 (A) Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) Cl 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/federal 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. DA TE 0F Inspector?s SignaM Print. PICS Signature: xg?xx 1km.) Print: ?b?exh?c gawk.) IRAQ Page_ of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT Canny/M City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Date Type of Operation(s) of inspection 5.9M Luau-J Food Service gowns Address Risk Retail e-inspection Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary El Pro-operation Owner HACCP YIN Caterer Suspect Illness son- -Char PIC Time Bed Breakfast General Complaint er I jB?C-Ns?s- HR El HACCP Inspector M, Out' Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp .9 Serve- Safe Cert Number 03 [9?19? Expiration Number I 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/KnowledgeabIe/Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue NEWS) 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 8. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other S. 590lnspechonn6-14 doc Non-compliance with: E's/x 9/ ServSafe 590.003 (A) Pest Control 590.007 Anti-Choking 590.009 (E) Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating El 18. Cooling 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RE-INSPECTION: Inspector?s Signature: if Print: . 1. PICs .1. Eng h? . that? Page_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT City Hall 375 Merrimack Street Lowell, MA Tel.: 978?674-4144 Ci?u? ,w Fax: 978-446-7103 Name . Date Type of Operation(s) Type of Inspection [0 5391504 5 a/w?r Wood Service g/Routine Address 5 8 Risk Retail Re?inspection I gr: i? 3" Level Residential Kitchen Previous Inspection Telephone Mobile Date: Temporary Pre-operation Owner HACCP YIN Caterer Suspect Illness son- -Char PIC T'me El Bed Breakfast General Complaint er I C\n this t??thNm m: HACCP Inspector JQ Out- Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp 21% Serve? Safe Cert Number A 7Expiration Number W21. 377?), -. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) El (Red Items) Pest Control 590.007 . . . . . . . Anti?Choking 590.009 (E) El Vlolatlons marked may pose an Imminent health hazard and reqUIre Immediate Tobacco 590.009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC AssignedlKnowIedgeable/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 El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements El 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION I:l 8. 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (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 8: 590lnspechonn6?14.doc Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling El 19. Hot and Cold Holding 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) El 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF RIF-INSPECTION: Inspector?s Signature: Print: AM PICS SignatureK mk-Q-l Lug". ?was? 9?5? Page? of_ Pages Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT f5 Mde City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674?4144 Fax: 978-446-7103 Name . . Operation(s) Inspection "?iv-S?m Sax Food Service outine Address 57/ Risk Retail Re-inspe?tion '4 Level Residential Kitchen Previous inspection Telephone El Mobile Date: Temporary El Pre-operation Owner HACCP YIN El Caterer El Suspect Illness Person-in-Char PIC Time Bed Breakfast General complaint 9i Roam mm Inspector me Out- Permit No. Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Water Temp Serve?Safe Cert Number W357 Expiration Number 112- Non- -compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors - ServSafe 590.003 (A) (Red Items) Pest Control 590.007 iAnti-Choking 590.009 (E) El Violations marked may pose an Imminent health hazard and reqUIre immediate Tobacco 590-009 (F) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC El 3. Personnel with infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source El 5. Receiving/Condition 6. Tags/Records/Accuracy of Ingredient Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION El 8. 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 8: 590lrispachon116?t4.doc Allergen Awareness 590.000 (G) El I: 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures El 17. Reheating 18. Cooling El 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) [j 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): Of?cial 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 food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Inspector?s Signature: MH/f/f Print: JIM [g "inky?bl" (L L1 Page 0f_"_2Pages PICS SignatuWM h??Ql} lag/k THE COMMONWEALTH OF MASSACHUSETTS Citv OF Lowell . 35 J0 Street 2nd floor Lowell, MA 01852 Board of Health ??au?iQL?h/ Date: Page: of 1? Establishment Name: item Code Critical Item 1 DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Reference Red Item PLEASE PRINT CLEARLY Verified N0 27 F06 It? 7:3? Amer 47 3 44;, 5224 Discussion With Person in Charge: Corrective Action Required: No mes Voluntary Compliance Cl Employee Restriction! Exclusion Emergency Suspension Re?inspection Scheduled El Embargo Emergency Closure ODD Cl Voluntary Disposal Other 7345 (REV. 7/2000) Lowell Board of Health FOOD ESTABLISHMENT INSPECTION REPORT W?wf City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446?7103 Name Dat of Opsration(s) Type (.5 $14? (37.1.5 g" E/g'cod Service wtine Address I (Q- Risk Retail Re-inspection . Level Residential Kitchen Previous Inspection Te eP one That-- Mobile Date: 0! 35' - 010?? El Temporary El Pre?operation 2mm HACCP YIN El Caterer Suspect illness Person-in-Charge (PIC) Time Cl Bed Breakfast Sig? Complaint In: Inspector Sm Out: Permit No. Other Each violation Ehecked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Expiration Number Water Temp Serve-Safe Cert Number 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/KnowledgeablelDuties EMPLOYEE HEALTH I: 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 Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. 9. Food Contact Surfaces Cleaning and Sanitizing 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to 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 5: A Non-compiiance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) El El 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) El 16. Cooking Temperatures 17. Reheating El 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY-SUSCEPTIBLE-POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DA TE OF Print: 5m,? Ant-mars, ?g Page i of?erages Inspector?s Sign ure: m? It'll Lowell Board of Heaith FOOD ESTABLISHMENT INSPECTION REPORT WW City Hall 375 Merrimack Street Lowell, MA Tel.: 978-674-4144 Fax: 978-446-7103 Name Dar 7 Type peT?atioMs) pe 1'15 $1702?! Gig/Ag Service outine Address 17?; 1 Risk LI Retail Re-inspection . Level Residential Kitchen Previous Inspection Telephone 29% El Mobile Date: 9 .. HABCP [3 Temporary I:l Pre-operation Owner Caterer Suspect illness Person-'n har PIC Time Bed Breakfast General Complaint '70. 5? in. DHACCP Inspector 1% Sam Out: Permit No. El Other d! Each violation checked requires an explanation on the narrative page(s) and a cite/?out of specific provision(s) violated. Water Temp Serve-Safe Cert Number Violations Related to Foodborne Illness Interventions and Risk Factors - (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 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 El 5. Receiving/Condition El 6. Tags/Records/Accuracy Statements 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 8. El 9. Food Contact Surfaces Cleaning and Sanitizing I:l 10. Proper Adequate Handwashing El 11. Good Hygienic Practices Violations Related to Good Retail Practices_ (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 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 3: 590lnspactForm6-14 doc/x Expiration Number 43. Non-compliance with: ServSafe 590.003 (A) El Pest Control 590.007 El Anti-Choking 590.009 (E) El Tobacco 590.009 (F) El Allergen Awareness 590.000 (G) l] El 12. Prevention of Contamination from Hands El 13. Handwash Facilities PROTECTION FROM CHEMICALS El 14. Approved Food or Color Additives El 15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time as a Public Health Control REQUIREMENTS FOR (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): . Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000/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. DA TE OF Print: pay 5m Print: Qwe?p Page 7! of Pages Inspector?s mature? PICS Signatuk I 61? Wk at; ?s