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N N N N M� N � . � W �i � « � p � p Q �'Q -',� �"� " � � � f- 2S u 3 � � � $ ��► a �� p � 0 LL � r � � '� � U��s � �i , �i� y � � « � " � � � � � � p � o ` p .: Q, c�i ri � � �rs �i ti p a� oi o � �; c�3 w b �"" t� _ ~ a t w > c°> � O u�i DO � O � OQ a� ODO > vazo � � a TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name` 2ik Date i1 %,LI af fib Type of Operation(s) Type of Inspection Food Service Retail U Residential Kitchen rU Mobile U Temporary U Caterer U Bed &Breakfast Permit No. Routine ARe-inspection Previous Inspection Date: ofy��ltp U Pre -o eratio U Suspect Illness U General Complaint U HACCP U Other__` _ Address Telephone > _� r Owner HACCP YIN Person in Charge (PIC) 7: 01) 0 ( t Time In: Out: Inspector Each violation checiled 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) U 590.009 (F) U corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT A-2. Prevention of Contamination from Hands Ll1. PIC Assigned / Knowledgeable / Duties ❑ 13. Handwash Facilities 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. SeparationlSegregation/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)(590.009) 29. Special Requirements (590.009) 30. Other PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures O 17. Reheating ❑ 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Heafth Control REOUIREMENTS 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 I Factors (Red Items 1-22): Official Orderfor 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 's naturd" / n ' I Print PIC's Signature Print Page J_ of _�_._ Pages Item Code C - Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R - Red Item PLEASE PRINT CLEARLY Verified G 'c lv ! e,� � nen �� ' t • f? i E �V= ru i=-�� Discussion with Person in Charge: Correction Action Required: ❑ No 11 Yes ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name�-2 Item Code Reference Date Type of Orations) Iype of Inspection °Food Service :*�Routine Ir �Adg>o Address !�i p7 /� U Retail U Residential Kitchen U Re -inspection Previous Inspection Date: Telephone QQ Tele P _790 G' /10 ! ; U Mobile U Temporary U Pre-operation Owner HACCP WN JK.') t- tQ U Caterer U Bed & Breakfast Permit No. U Suspect Illness U General Complaint U HACCP U Other____ _ Person in Charge (PIC) -1 vi , &11-C`I-ttwo ; Time In: 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) a 590.009 (F) I corrective action as determined by the Board of Health. 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 Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions Related to Critical (C) violations marked must be corrected immediately Foodborne Illnesses Interventions and Risk i or within 10 days as determined by the Board of Health. Factors (Red Items 1-22): Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Official Orderfor Correction: Based on an inspection today, C N the items checked indicate violations of 105 CMR 590.000/ 23. Management and Personnel (FC -2)(590.003) federal Food Code. This report, when signed below by a 24. Food and Food Protection (FC -3)(590.004) Board of Health member or its agent constitutes an order of the Board of Health. Violations not corrected are subject to 25. Equipment and Utensils (FC -4)(590.005) fines per Yarmouth Board of Health. If aggrieved by this 26. Water, Plumbing and Waste (FC -5)(590.006) order, you have a right to a hearing. Your request must be 27. Physical Facility (FC -6)(590.007) in writing and submitted to the Board of Health at the above 28. Poisonous or Toxic Materials (FC -7)(590.008) address within 10 days of receipt of this order. 29. Special Requirements (590.009) DATE OF RE -INSPECTION: 30. I-1 er _\O�, a Ins p 't r 'g to TG�� Item Code Reference C - Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date PLEASE PRINT CLEARLY Verified rNo. A55 P. fl/ C Ir �Adg>o t ci /10 ! ; JK.') t- tQ Ins p 't r 'g to TG�� Print - ❑ No PIC's Signature f� -�1 Print Page _L of Pages I 1\ a7 I F" t o I EO, I n cep i; „� +,'r �� � .c�>1 -� _ bp PZP 1 Discussion with Person in Charge:p Correction Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction! ry P Exclusion Suspension ❑ Re in ioIT) ❑ Emba r Closure U Volunt ❑ Other P. � lV ��_ , , s _ Cc,