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OOOO > tioz° o C� n a TOWN OF YARMOUTH BOAR1 O ROUTE 2s imon ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 Name % �T.00d Date �J/�j f' Tvae of Ooeration(s) Type of Inspection Service U Retail U Residential Kitchen U Mobile U Temporary U Caterer U Bed 8 Breakfast Permit No. �� outine -CJ' -Re-inspection Previous Inspection Date: U Pre-operation U Suspect Illness u General Complaint J HACCP U Other___ Address CY' - Telephone Owner HACCPY/N a PIC - c,`^f� Person in Charge (PIC)�n ` Time In: Out: Inspector it%; i ` " 1 ii . 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 Foodbonne 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) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH C1,° 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 O 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) ?4. 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/TEM PERATU RE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating O 18. Cooling ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Heahh 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 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: Ins�rSi�are J Print ,` ; Q C - Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date R - Red Item PLEASE PRINT CLEARLY Verified PIC's Print (� Disposal Page _ of�.. !,� 1t m CZ L Item No. Code Reference C - Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date R - Red Item PLEASE PRINT CLEARLY Verified Disposal [] Other CZ L -TCM `4CPF -'a-� S 1 arm e, cz, I-Twet -rot . r"L--G I 4- 1le"i.t Vl c'ct Ns S -t M /-' o -Te,-36 5j r �, t. S 2. - NAG « 4/4 _5 rf l 7 0/- r-, ,-,ti I rf:01t - ba �F - ,L I've 0-147 Mirl �.. fv0 Ox> Discussion with Person in Charge: Correction Action Required: O No ❑Yes r y ❑ Volunta Com Bance ❑ Employee Restriction ry p Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo U Emergency Closure ❑ Voluntary Disposal [] Other