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C� ~ {�• � W > � u`. fl � O t 7 u�. ODOO a 0000 > ti�z° `o t� c a TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name t 1. -, Date `��/// c�` / of Operation(g) a of Inspection \�,e Jam, Food Service Retail U R U Residential Kitchen U Mobile iJ Temporary U Caterer` J Bed &Breakfast Permit No. U Routine i J Re -inspection Inspection PreviDate: U Pre -operation U Suspect Illness U General Complaint J HACCP U Other_________ Address L�- % Telephone Owner HACCPY/N Person in PIC Charge 9 (PIC) Time In. Out: Inspector > _� L i Each violation checkeJ 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) J 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 ❑ 3. Personnel with Infections RestrictedlExcluded 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 0 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)(590.006) 29. Special Requirements (590.009) 30. Other ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIM E/TEMPERATU 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: Ins! re Printa f PIC's Signature Print Page of Pages Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date VerifiSd 25 Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ VoluntaryCompliance ❑ Employee Restriction / P 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 t a , _ + 0 Date Type of Operption(s) Type of Inspection X Food Service U Routine n/ Address �+ 4 5 1 P Q rl� 15 U Retail U Residential Kitchen U Mobile UOwner Temporary U Caterer U Bed & Breakfast W Re -inspection Previous Inspection Date:") i2_44 1, U Pre-operatidn. U Suspect Illness U General Complaint U HACCP Telephone cif`, r-i I f ._ fj7 ,�/ �1.i«. , , ,. 1 S HACCP Y/N Person in Charge (PIC) Time In: InspectoriF 1 -J r*r ^G �T9 Out: Permit No. U Other____ - 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 Foodbome 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) corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 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)(690.006) 27. Physical Facility (FC-6)(590.007) 28. Poisonous or Toxic Materials (FC-7)(590.008) 29. Special Requirements (590,009) 30. Other ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE 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 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: Inspec ILh Print T n PIC's Signature 4 \,) Print _ i Page �_ of _/. Pages Item No. Code Reference C- Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified n �'t S _- a c v Ct E-i,aS / 4 - ( `-> 27 r J Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes ❑ VoluntaryCompliance ❑ Employee Restriction / p Exclusion ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure U Voluntary Disposal U Other TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name ,!�!,�f'tj ` fs� ! Date :� /s Type of O er tion seof Inspection Food Service U Retail Residential Kitchen U U Mobile U ry Tem ora U Caterer U Bed &Breakfast Permit No; -Routine U Re -inspection Previous Inspection Date: U Pre -operation U Suspect Illness U Genera( Complaint J HACCP U Other___ __ {- Address ��'f�ze Telephone ( L - v`7" P/ J 10 Owner �"Mz HACCP Y/N Person in Charge PIC 9 (PIC) Time In. Out: Inspector !�/^i J(; �- 4 tGt �� 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) J corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 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)(590005) 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 (590009) 30. Other ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATURE CONTROLS (Potentially Hazardous Foods) ❑ 16. Cooking Temperatures O 17. Reheating O 18. Cooling O 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 HeatWmember 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 t(tis order. 'DATE OF RE -INSPECTION: i<L) t� Inspec el u �..7',!�('� "_�. Print PIC's Signature._ Print 4r7 /1�yU Page _ of Pages Item No. Code Reference C- Critical Item R - Red Item - DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified y^ WAIAK \ ei*^e yo t-I tP:_ t Z- c' - -, s� Ft �sN y Y r.. C(,c�. T r7 r it S •. ,r'^r ^.., M „e t Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Exclusion Restriction / O Re -inspection Scheduled U Emergency Suspension ❑ Embargo 0 Emergency Closure U Voluntary Disposal U Other r On TOWN OF i ARMOUTH BOARD OF HEALTH 1146 ROUTE 28 FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 Name iP '? S G,tc� �ZZCf Date ) -131� �� Type of Operation(sl Type of Inspection Food Service U Retail ❑ Residential Kitchen ❑ Mobile U Temporary ❑ Caterer U Bed & Breakfast Permit No. 'Routine Re -inspection Previous inspection DatelEllow-L ❑ Pre -operation~ ❑ Suspec¢t Illness U Genet`al Complaint ❑ HACCP ❑ Other Addre>;s LI� Telephone % %� _ I-r -7Q �+ r_- ( Owner 1\/UtJIG% HACCP Y/N Person in Charge (PIC) V G r S Time In: Out: Inspector h9 j( 1�, ��I%� 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) ❑ 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. 23. Managementand 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/TEMPERATURE 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 (Re 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: t 1� vvI/' 1 14 , �--- -.,, . Page _ of Pages Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified t _ U V7- 'V=' ram. \ �^ - S -t s c 4= Lev � rn Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction / ry P Exclusion ❑ Re -inspection Scheduled ❑ Emergency Suspension ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other Me TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name ��- �� (, p` �c Date j � i ';�� I a(slpe of Operation Type of Inspection jo, Food Service U Retail U Residential Kitchen U Mobile U Temporary U Routine -,6 Re -inspection Previous Inspection U Pre-o ratidn5 Address J- 9 P j_ - Al Telephone "7 % - 14 70 '-61 IS 1 e--b b 2 ?SSG/ -077 Owner HACCP Y/N J U Caterer U Bed &Breakfast U Suspect Illness HACCP U General Complaint J Person in Charge (PIC) Time In. Inspector rti1« n v Out: Permit No. U Other___.__ 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) J corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 0 1. PIC Assigned / Knowledgeable / Duties EMPLOYEE HEALTH 0 2. Reporting of Diseases by Food Employee and PIC 0 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE O 4. Food and Water from Approved Source O 5. Receiving/Condition 0 6. Tags/Records/Accuracy of Ingredient Statements 0 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION 0 8. Separation/Segregation/Protection O 9. Food Contact Surfaces Cleaning and Sanitizing 0 10. Proper Adequate Handwashing O 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) ❑ 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 0 22. Posting of Consumer Advisories Number of Violated Provisions Related to Foodborne Illnesses Interventions and Risk 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: Insp t natu e/ Print C1 rA ;n v� PIC's Signatge _✓r` i Print Page _ of EPages Item No. Code `"` Reference C- Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified - VL it Co r -7 f•�Y �� r-Jv - c Ili �=r ?V�,Y 0 tit ✓� E %%e�r� _ P\ S t-i-H_f Discussion with Person in Charge: a w7"d Correction Action Required: ❑ No ❑ Yes PG C U Voluntary Compliance U Exclusion Restriction / U Re -inspection Scheduled U Emergency Suspension U Embargo U Emergency Closure U Voluntary Disposal U Other iVf �% �; 1 l.7i'r'i l /✓� TOWN OF YARMOUTH FOOD ESTABLISHMENT INSPECTION REPORT BOARD OF HEALTH 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 Name /yi �r- < G Y� y t , f� 7� Date l/J� Type of Operation(s) Ty e of Inspection Food Service U Retail U Residential Kitchen U Mobile U Temporary U Caterer U Bed & Breakfast Permit No. 'A. Routine U Re -inspection Previous Inspection Date: U Pre -operation U Suspect Illness U General Complaint U HACCP U Other______ .__.. Address <' ��-G j , Telephone 7 f �- 5 f Owner HACCPWN Person in Charge (PIC) Time Inc Out: Inspector �t�f;, /� �G'Gr (� Each violation check d 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) J corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands 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)(590005) 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 ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIM E/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 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: Inspel6to is SY4 re { ) Print PIC's Signature Print Page V_ of A_ Pages Item No. Code Reference C- Critical Rem R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified W - f > a 71 M 2 t' (( S7°:_ c� < C C o L >" ( -4 T Discussion with Person in Charge: Correction Action Required: ❑ No ❑Yes Li Voluntary Compliance O Employee Restriction / P Exclusion U Re -inspection Scheduled U Emergency Suspension ❑ Embargo U Emergency Closure ❑ Voluntary Disposal ❑ Other TOWN OF I ARMOUTI I BOARD OF HEALTH 1146 ROUTE 28 FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664 Name tl, '. ' , l ( Date !� Type of Operation(s) Type of Inspection * Food Service U Routine Address ` F r � U Retail U Residential Kitchen *) Re -inspection Previous Inspection Telephone • t U Mobile U Temporary Date:/. _J Pre-operati n Owner HACCP YIN U Caterer U Bed & Breakfast U Suspect Illness U General Complaint U HACCP Person in Charge (PIC) / / Time In: Inspector f ; Out: Permit No. U Other_____ Each violation checked requires an explanation on the naftative 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 / 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)(690.003) ?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)(590.009) 29. Special Requirements (590009) 30. Other ❑ 13. Handwash Facilities PROTECTION FROM CHEMICALS ❑ 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals TIME/TEMPERATU R E 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: Inspector'sSignat re } y Print PIC's Signature N V J . -' Print Page I__ ofV_.._. Pages Item No. Code Reference C -Critical Item R - Red Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION PLEASE PRINT CLEARLY Date Verified Discussion with Person in Charge: Correction Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Exclusion Restriction / ❑ Re -inspection Scheduled U Emergency Suspension ❑ Embargo ❑ Emergency Closure U Voluntary Disposal ❑ Other