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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,