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W •N = c c a c = � E Z �� o Q = `-° �v z� ri v �ci co � co oi o ; ,C O d Ci � N � C �� fC > �� U , N ni tV N N N N M «. oc E m ¢ w o o -p m �v � � m -p °' -v >o �o R . Z Q rn p � '�O, O� C�C > � V yW, N G� � O N cC��O ~ N .O � � � C C)� C V� p O� � L i C v '� O O:i. d � � � n. LL LL � H U W fA�LL � C� � t 'i.�. 2 v fn 5 O ar � c, m o d .. « � 0 J G t- «. ea ... � ,t d y � A a a 3 d w � °° `-° d O .- a cv ri � v �ri cc � � oo ai o � ea «•3 �•3 � i� �. � z a � o a ` w > '> c°� � O w OO � OOOO a OOOO > ti `oz° o v � °' TOWN OF YARMOUTH BOARD OF HEALTH 1146 ROUTE 28 FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 Name CJG �. �i,� S!/�� Date /! Type of Operation(s) Type of Inspection U Food Service U Routine Prig Address -T �� /� U Retail U Residential Kitchen U Re -inspection Previous Inspection Telephone- G- /� U Mobile U Temporary Date: U Pre-operation Owner HACCPY/N f c z rz, t U Caterer U Bed &Breakfast Permit No. U Suspect Illness U General Complaint J HACCP U Other_ __ Person in Charge (PIC) U LUL Time In: Out: Inspector �" p n�G 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) U 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 LI 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 U 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) CriticallC) 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. 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 U 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEM PERATU RE 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): 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: Inspect ' re Print C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified PIC'gnatur Prig U Other r Page -,-'O'f_./Pages l.% Item No. Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Disposal U Other r f c z rz, t t ^moirA _77 c C c- r k \<C� '- 5 CJK (-G� r i"i ; - t� �c✓i l Discussion with Person in Charge: Correction Action Required: ❑ No LJ Yes r-" C � � LJVolunta Compliance ❑ Employee Restriction Voluntary P Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension U Embargo ❑ Emergency Closure ❑ Voluntary Disposal U Other TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPFCTInN RFpnRT BOARD OF HEALTH 1146 ROUTE 28 4u luz Correction Action Required: ❑ No Signature� n PrintS Page J of ! Pages Name RLV C ` �\� £�O 'T' Date `7 4't Type of Operationfs) Type of Inspection Address 3 %!�✓�?© �KFood Service U Retail ❑ Residential Kitchen ❑ Mobile ❑Temporary ❑Caterer L�Routine U Re -inspection Previous Inspection Date: ❑Pre-operation U Suspect Illness Telephone ;-O2 _ / G �� LJ / Owner HACCP Y/N Person in Charge (PIC) Tlme In: ❑ Bed & Breakfast Permit U General Complaint ❑ HACCPOut: ,� Inspector /�,�� / J.j/ No. ❑ Other - ther yuuw ail WAPIdnduon on >;ne narrauve page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Non-compliance with: 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 (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 ❑ 12. Prevention of Contamination from Hands ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) Cl 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): Official Oider 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' • n4 qre�,PIC's Correction Action Required: ❑ No Signature� n PrintS Page J of ! Pages Item Code C -Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. I Reference I R - Red Item I PLEASE PRINT CLEARLY I Verified e_ Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion Cl Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal . ❑ Other