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O � z a � O a � R � � `o O � O � T � � ° � V � a �— � W '» � LL o W oa LL o00o a 000a > � ozo TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name Date Type of Operations) Type of Inspection U Food Service U Retail IJ Routine U Re -inspection Pi L Address ' J L__) i; �,� _Pages Page of4A d I U Residential Kitchen PrevPrevious Inspection Telephone U Mobile U Temporary U Pre-operation Owner HACCP Y/N U Caterer U Bed &Breakfast Permit No. U Suspect Illness U General Complaint U HACCP U Other_ Person in (PIC) Charge 9 ) Time In: , ;i; Out: Inspector ' .,„ ^• Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate 590.009 (E) ❑ 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 ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations 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. C N 23. Management and Personnel (FC -2)(590.003; 24. Food and Food Protection (FC -3)(590.004; 25. Equipment and Utensils (1=C-4)(590.005; 26. Water, Plumbing and Waste (FC -5)(500.006; 27. Physical Facility (FC -6)(590.007; 28. Poisonous or Toxic Materials (FC -7)(590.008. 29. Special Requirements (590.009) 30. Other ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIM E/TEMPERATURE 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) ❑ 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): s` 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. Violations not corrected are subject to fines per Yarmouth Board of Health. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Inspector's Signature C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Print PIC's SignatureT' Pi L Print _Pages Page of4A i! Item Code No. Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified .A cr Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ VoluntaryCompliance U Employee Restriction/ P Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo U Emergency Closure ❑ Voluntary Disposal - U Other TOWN OF YARMOUTH BOARD OF HEALTH 1146 ROUTE 28 FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 Name Date ac Type of Operations) Type of Inspection 'l� Food Service [Retail U Residential Kitchen U Mobile U Temporary ❑ Caterer ❑Bed &Breakfast Permit No. ?�" Routine ,A Re -inspection Previous Inspection Date: U Pre-operation U Suspect Illness U General Complaint U HACCP U Other Address +� TZ P' 3 ft') Telephone d 0 Owner HACCP Y/N Person in Charge (PIC) - L. Gr(i{'P�t t Time In: Out: Inspector ��- 41p WJ Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Non-compliance with: Factors (Red Items) C�') Anti -Choking Tobacco Violations marked may pose an imminent health hazard and require immediate 590.009 (E) U 590.009 (F) U corrective action as determined by the Board of Health. Page __ of Pages FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10 Proper Ade uate Handwashin q 9 ❑ 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. C N 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; 2/. Physical Facility (FC -6)(590.00r 28. Poisonous or Toxic Materials (FC -7)(590.008; 29. Special Requirements (590.009) 30. Other 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. Violations not corrected are subject to fines per Yarmouth Board of Health. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE -INSPECTION: Insp s atur Print C - Critical Item R - Red Item C�') t PIC's natur '- Prini Page __ of Pages Disposal ❑ Other Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date PLEASE PRINTCLEARLYVerified - > b Disposal ❑ Other - -k- S v S itC ^Jec1 t r > LG �^ 4 _0 Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes (7. o; � L1 Employee Restriction / ❑ Voluntary Compliance Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary , f � ' � � (0-,o n , 41ftV s ,).� " ( , , 9,eJol a, Disposal ❑ Other