HomeMy WebLinkAbout2008 Jan 04 - Fax from MA DPH Re: Inspection and ViolationsJAN-04-2008 13:07 FROM:DPH FDDD PRDTECTIDN 617 983 6770
TD:50e7603472 P.1/13
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305 South Street
Jamaica Plain, MA 02130
Phone: 617 983-6100
FAX; 617 983-6770
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NOTICE: The pages comprising this facsimile transmission contain confidential
information from the Department of Public Health. This information is intended only for
the use by the recipient listed above. If you are not the intended recipient or the employee
or agent of the intended recipient responsible for the delivery of this information, you are
hereby notified that the disclosure, copying, use or distribution of this information is
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07/21/2006 15:16 50e4321553
PAGE 02
Mid -Cape Seafood Products
28 Huntington Avenue
South Yarmouth, MA 02664
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_ -- The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Food Protection Program
305 South Street, Jamaica Plain. MA 02130-3597
617-983-6712 617-983-6770 - Fax
NOTICE OF VIOLATIONS/ORDER TO CORRECT
dd DATE:
TO: /y�i f "� /iy jv' G
ut r
The attached inspection form constitutes a Notice of Violations/Order to Correct issued pursuant to
Department of Public Health regulations. Within 10 calendar days of the date of this Order, you are
required to submit, in writing, to the Food Protection Program a Plan of Correction (POC).
Each Plan of Correction shall include:
1. The name of the facility;
2. A reference to each violation or deficiency cited on the inspection form and for each violation
indicate:
a) The action taken and the date the work was completed; and/or
b) Where corrective action has not been completed, a detailed explanation as to why the
violation was not corrected, and a timeline for completion.
3. A Correction Plan submitted on either the form provided at the tine of the inspection or on
company letterhead.
4. The date and the signature of the responsible person, sworn to under the pains and penalties of
perjury,
5. Forward the Plan of Correction by mail or fax to the address or fax number listed above.
Please note that failure to comply with any time limits for correction or the false certification
of corrections may result in denial, suspension or revocation of the facility license or permit
and/or where permitted, the assessment of administrative penalties as defined in 105 CMR
500.017. The Department reserves the right to commence legal action at any time.
-DaUJ Ti r-(!n )-/19 CA N,
Name of Responsible Person (Pr t) Name of Agent o e Commissioner (Print)
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Signature ofResponsib erson signature# Agent
drder to C orTm 17J14105
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DISCUSSION WITB MANAGEMENT
Indicate the name and title of individual(s) with whom this inspection was conducted and dieeussed-
R,ecord ary recommendations and/or warnings as wellas management's responses. List all violations
with the item number first and then a full description of the violation.
All-
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Food Vulnerability Assessment was conducted
,Signature of Inepec v.
Signature of Plant Official Who Received Copy:
FP&WDgmp.doc 3128105
Yes O No L7�lbl'r
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Date: TT
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Time In: ,
Time Out:
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OF MANUFACTURING PROCEDURES AND CONTROLS
Obtain from mariagem.ent the names and locations (city/state) of the firm's primary suppliers,
customers, and a list of the most common products manufactured and provide a brief description of
the •manufacturing processes and controls for the produet(s) inspected. 'Where appropriate, report
times, temperatures, and other critical processing steps. If microbiologica] or any other type of
contamination is suspected or encountered. fully describe the relattonship between the routes of
contamination and the process. Use flow cbarta where appropriate, If more space is needed, use the
narrative section.
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FOOD PROTECTION PROGRAM
FOOD PROCESSING UNIT
BASELINE INFORMATION & INSPECTION REPORT COVER SHEET
Establishment Type: �c!dpv�4a-A6/ Establishment Code: Establishment Number:
License or Permit Number: Expiration Date:
Establishment Name "I W
O BA:
Address (including Zip code) gZK h�
S..
D 2CG
Owner / Manager Name 8 Title: yl_;;e 6, �,•2z�il%,�iiG��� " dl.�l? t'i
Telephone Number: (9V) 3 a' -- 2 Gf 3 2 Date of Inspection: G Inspector: 11"r
FAX Number: ( }� In, l( Email address:_ ii1"nn JL s -2COVA R+7 GD 141
Reason for Inspection : ( ) New ( einspection ( ) Complaint ( ) Investigation ( ) Routine ( ) FDA
( ) Ownership Change ( ) Out of Business ( ) Change in type of Operation
Classification: (- Food Processor ( ) Food Warehouse ( ) Salvage ( ) Bottled Water ( ) Other
Inspection Time: Travel Time: ( ) Address Change ( ) No Access
Number of floors: r Square footage footage or size ('10
!! //S1W Years in business e�
Building construction:/Number of Employees:
Days and hours of operation P ff
Product testing ( yes I no) A If yes what type of testing
Records kept Labels
Sanitation /cleaning schedule
Water Supply Source: City / Town system: Private Well:
Test dates & AnaWis: ( if not Public water supply )
Sewage disposal
Name of pest control company d) 6A(A41'4&4 is Frequency
Obemicals used
ACTION: ( ) ReinspecWn
Voluntary Disposal: Number of
Months ( ) Warning Letter ( ) Meeting ( ) Ordered Closed ( ) Voluntary Closure
pounds Value $
( ) Embargo & #
( ) No Action upervisors Initials Number of Samples: Sample Numbers:
NEW: Approved for Licensure: Hold Llcensure until Reinspection:
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