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Z W ,�, a � � �s A ���� 0�� N N N N N M « � � C ` � C� > � U W � y � ~ � � .'T V C � O m .�t� � � � +"��j O � Q � 0 Qa O � f- � W � tL � � �_�= Z � 00 � � � � .� W � p � a cvEi p .r �rirdn� a aceic .� �3c= � � z �a� � o a 5 W y � � OwOOua. 00OOa000a ' tioz° ov � °' ; -- -- � TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name_ }7, !j r Date % rJ Type of Operations) Type of Inspection 7q Food Service U Retail U Residential Kitchen U Mobile U Temporary U Caterer U Bed & Breakfast Permit No.( 5'-02--3, Routine U Re -inspection Previous Inspection Date: U Pre-operation Suspect Illness u U General Complaint ! 1 HACCP U Other___ Address% Telephone L21d` .. Owner { ` 0 HACCP YIN Person in Charge (PIC) � yps Time In: Out: Inspector `,t% X Each violation chocked 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) J 590.009 (F) U corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned / Knowledneahle / Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC 0 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition 0 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) ?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 PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIMEITEMPER ATUR E CONTRO LS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures ❑ 17. Reheating ❑ 18. Cooling 0 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: in!V2Signature Print C -Critical Item R - Red Item Pies SJ'�natOi 's Print ./ � (11 Page �_ of �. Pages Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date PLEASE PRINT CLEARLY Verified I Z�LGr C7VP� �3PG c:;^ Ck -4r l J •_8. C" ice•'' .'G' �- ,U,-C•-'C�.- _-] I.�:. y� � 1 „G GsCc /116C17.r'l (,n f'- C�l•1 d=, O oil` Discussion with Person in Charge: Correction Action Required: ❑ No 11 Yes U Voluntary Compliance ❑ Employee Restriction / Exclusion ❑ Re -inspection Scheduled U Emergency Suspension U Embargo ❑ Emergency Closure U Voluntary Disposal 0 U� � fir--)•� Other