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HomeMy WebLinkAbout2023 Licensing The Commonwealth of Massachusetts Fee Town of Yarmouth $30.00 Food Establishment License Number: BOHF-15-1033-08 Issue Date: 1/1/2023 Mailing Address: Location Address: ELDER SERVICES OF CAPE COD & ISLANDS, INC. 528 FOREST RD ELDER SERVICES YARMOUTH NUTRITION SITE SOUTH YARMOUTH, MA 02664 68 ROUTE 134 SOUTH DENNIS, MA 02660 IS HEREBY GRANTED A 2023 LICENSE TO OPERATE: Non-Profit; This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2023 unless sooner suspended or revoked and is not transferable. Conditions SEATING: 120- Congregate Dining Room Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T.Holway, Clerk Debra Bruinooge Health Eric Weston Bruce G: Murphy, H, CHO/James G. Gardiner Health Director/Assistant Health Director TOWN OF YARMOUTH BOARD OF HEALTH APPLICATION FOR LICENSE/PERMIT -2023 Please complete form and attach all necessary documents by December 18, 2022. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: L I L L Sc R. k Cc 5 TAX ID: -/ LOCATION ADDRESS: le Fon ' 1-. � S . Yak l�►oJih M A TEL.#: MAILING ADDRESS: 6pIf 13 -i S• Q�,v, M A Odd`0' E-MAIL ADDRESS: lows. Va.Va.3 CS Cc a ,s ots OWNER NAME: CORPORATION NAME (IF APPLICABLE): MANAGER'S NAME: Vc,I Du&;S TEL.#:C S)/()3'C/- MAILING ADDRESS: 6 V 13- S- De A)A) ti A Ina() POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. 2. Pool operators must list a minimum of two employees currently certified in standard First Aid and Community Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at all times. Please list the employees below and attach copies of their certifications to this form. The Health Department will not use past years records. You must provide new copies and maintain a file at your place of business. 1. 2. 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department will not use past years'records. You must provide new copies and maintain a file at your establishment. 1. Vc.. 1 DJ bn S 2. PERSON IN CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. VfA.1 IuboS 2. ALLERGEN CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who has Allergen certification, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.009(G)(3)(a). Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain a file at your establishment. 1. VJ c b 2. HEIMLICH CERTIFICATIONS: All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. 2. 3. 4. RESTAURANT SEATING: TOTAL # OFFICE USE ONLY LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 _CABIN $55 MOTEL_ $110 —INN $55 _CAMP $55 SWIMMING POOL$110ea. —LODGE $55 TRAILER PARK $105 _WHIRLPOOL $110ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LIC NSE REQUIRED FEE PERMIT# 0-100 SEATS $125 _CONTINENTAL $35 ION-PROFIT $30 —>100 SEATS $200 COMMON VIC. $60 WHOLESALE $80 RESID.KITCHEN $80 RETAIL SERVICE: LICENSE RE QUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# sq >25,000 sq.ft. $285 _VENDING-FOOD $25 —<25,000 sq.ft. $150 _FROZEN DESSERT $40 _TOBACCO $110 NAME CHANGE: $15 Amount Due= $ *****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM***** ADMINISTRATION Under Chapter 152,Section 25C,Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR . / CERT. OF INSURANCE ATTACHED v OR I WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must be paid pr. r to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: . YES NO MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere. Transient occupancy shall generally refer to continuous occupancy of not more than thirty(30)days,and an aggregate of not more than ninety(90)days within any six (6) month period. Use of a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient. POOLS POOL OPENING: All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. Contact the Health Department to schedule the inspection three (3) days prior to opening.PLEASE NOTE: People are NOT allowed to sit in the pool area until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, and submitted to the Health Department three(3)days prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three(3)days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the Health Department,or from the Town's website at www.varmouth.ma.us under Health Department, Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter,with sample results submitted to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFÉS: Outside cafes(i.e., outdoor seating with waiter/waitress service), must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking, preparation, or display of any food product by a retail or food service establishment is prohibited. TOBACCO PRODUCT PERMIT CAP & VIOLATION ASSESSMENT A tobacco permit holder who has failed to renew his or her permit within thirty (30) days of the previous year's permit expiration date is considered an expired license,and the tobacco license cap is reduced. Violations of 105 CMR 665.000,State minimum standards for retail sale tobacco,shall be assessed as follows: 1st Violation a fine of$1,000.00 shall be imposed,2°d Violation within 36 months of 1st violation,a fine of$2,000.00 shall be imposed and a prohibition on sale of tobacco products may be imposed for at least 1 day and up to 7 days, 3"Violation within 36 months of 1st violation or additional violations during that time period,a fine of$5,000.00 shall be imposed, and a prohibition on the sale of tobacco products may be imposed for at least 7 consecutive business days and up to 30 consecutive business days. NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S) BY DECEMBER 18, 2022. All renovations to any food establishment,motel or 0111 (i.e.,painting,new equipment,ect.), Must be reported to and approved by the Board of Health to commence tt. Reno tions may require a MA engineer site plan. DATE: i!AY/DU SIGNATURE: ', w PRINT NAME&TITLE: Lb i)t') ET0,(Z_S / /Q i I .G ti i1 o,,r4.41 CI N K P il... Rev. 10/11/2022 • ServSafe _.National Restaurant Association • ServSafe® CERTIFICATION VALERIE DUBOIS for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection (CFP). 20828309 5523 C ... CAT NUMBER EXAM FORM NUMBER 7/19/2021 7/19/2026 DATE OF EX MINATION DATE OF EXPIRATION Local laws apply.Check with your local regulatory cy for recertification requirements. ANSI j:. ACCREDITED PROGRAM American National Standards Institute and the Conference tor Food Protection ® "- Sherman rown #0655 40cutiye Vice President, National Restaurant Asfciation Solutions ■ ■ • In accordance wit40011111111tievention 2006,Resolution ADM N 068-2013(Regulation 3.2c Stands • l Restaurant AssocioAon Educotionol Foundation(NRAEF(.All rights rem v• the ServSafe logo are trademarks of the NRAEF.National Restaurant Association®and the arc design of the National Restaurant Association. This document cannot be reproduced or altered. 17110811 v.1711 Contact us with questions at 233 S.Wacker Drive,Suite 3600,Chicago,IL.60606-6383 or ServSafe@restaurant.org. / •ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �i. 11/03/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Cheryl Woodside HUB INTERNATIONAL NEW ENGLAND LLC (A/C.No•Extl: (978)661-6678 —7FAX (NC.No): E-MAIL ADDRESS: thewoodside I hubinternational.com rY• @ 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC# NORWELL MA 02061 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: _ ELDER SERVICES OF CAPE COD ANDTHE ISLANDS INC INSURERC: INSURER D: 68 RTE 134 INSURER E S DENNIS MA 02660 INSURERF: COVERAGES CERTIFICATE NUMBER: 831474 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCEDAMAGE TO $ CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT I LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ IDED RETENTION$ $ WORKERS COMPENSATION X STA UTE ERH AND EMPLOYERS'LIABILITY A OFFICER/MEMBER EXCLUDED?ECUTIVE E.L.EACH ACCIDENT $ 1,000,000 N/A N/A N/A 6560UB8H20309322 07/07/2022 07/07/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Brewster 2198 Main Street AUTHORIZED REPRESENTATIVE Brewster MA 02631 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD `,..-. '1 1 fle I.Uf fff[U1tWLUUIL Uf inussuCILUS iL5 Department of Industrial Accidents Office of Investigations WI% s 1 Congress Street, Suite 100 .. x Boston, MA 02114-2017 ' �'"r% www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Elder Services of Cape&the Islands Address: 68 Route 134 City/State/Zip:S.Dennis, MA 02660 Phone#: (508) 394-4630 Are you an employer? Check the appropriate box: Business Type(required): 1.❑� I am a employer with 1 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales (incl. real estate, auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, j 1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:HUB International New England LLC Insurer's Address:600 Longwater Dr. Norwell, MA City/State/Zip: Norwell, MA 02061 Policy#or Self-ins. Lic. # 6S6OUB8H20309322 Expiration Date:7/7/23 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of ei DIA for insurance coverage verification. I do hereby certi under the tins and penalties o perjury that the information provided above is true and correct~ Signature: ,,,,.A...„ n Is Date: 11/7/22 Phone#:(508) 394-4630 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone#: f H Food Establishment Inspection Report - Town of Yarmouth Yarmouth Board o thalth cp p 1146 Route.28,South Yarmouth,MA 02664 Establishment: Cr�� � J&iytJ,OfJ CJ-T ���-A-, Date: ..`, //o=wr.� Page 1 of a: Address: 5 ag" �j-t PO/ S� Time in: / Time out: Telephone: 1 Permit No.: Number of Violated Provisions Related to Foodbome Illness Risk Factors Owner: and Interventions(Items 1 through 29): Person-in-charge: Number of Repeat Violations Related Y 1\ Pn .'� to Foodborne Illness Risk Factors Inspector: t .�) and Interventions(Items 1 through 29): Type of Operation(s): Type,.�� of Inspection: Other Information: .Food Service Establishment ..Nehoutine O Retail Food Store O Re-inspection 0 Residential:Cottage Foods 0 Pre-operational 0 Residential;Bed& O Illness investigation Breakfast 0 General complaint O Mobile/Pushcart 0 HACCP �.•^ 0 Temporary Food Estab. 0 Other B'_�y7�j�� O Other t�J FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS 5 POINTS IN=in compliance OUT=out of compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation Compliance Status IN OUT N/A N/O COS R Compliance Status I IN IOUTI N/A I N/O I COS 1 R Supervision / Protection from Contamination 1 Person-in-charge present, demonstrates ✓ 15 Food separated and protected /4 knowledge, and performs duties 16 Food-contact surfaces; cleaned & :4,2 Certified Food Protection Manager / sanitized Employee Health Proper disposition of returned, /, Management, food employee and 17 previously served, reconditioned & v 3 conditional employee; knowledge, unsafe food responsibilities and reporting Time/Temperature Control for Safety 4 Proper use of restriction and exclusion t/J 18 Proper cooking time& temperatures Procedures for responding to vomiting , 19 Proper reheating procedures for hot 5 and diarrhea)events holding Good Hygienic Practices 20 Proper cooling time and temperature Proper eating, tasting, drinking, or / 21 Proper hot holding temperature t,� J 6 tobacco use 22 Proper cold holding temperature v 7 No discharge from eyes, nose, and it. 23 Proper date marking and disposition mouth e Preventing24 Time as a Public Health Control Contamination by Hands/ 8 Hands clean & properly washed ConsumerAdvlsory No bare hand contact with ready-to-eat 25 Consumer advisory provided for raw/ . 9 undercooked food food Adequate handwashing sinks properly ° Highly Susceptible Populations 10 supplied and accessible r 26 Pasteurized foods used; prohibited foodsif Approved Source not offered 11 Food obtained from approved source 1%/ Food/Color Additives and Toxic Substances 12 Food received at proper temperature ✓ 27 Food additives: approved & properly I sed 13 Food received in good condition, safe, & / 28 Toxic substances properly identified, 1 / unadulterated stored & used 14 Required records available: shellstock Conformance with Approved Procedures tags, parasite destruction 29 Compliance with variance /specialized process /HACCP Plan i GOOD RETAIL PRACTICES AND MASSACHUSETTS-ONLY SECTIONS 2 POINTS IN=in compliance OUT=out of compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection R=repeat violation Compliance Status I IN IOUTI N/A I N/O I COS l R Compliance Status jOUTlN/AINIOICOS R Safe Food and Water • 48 Warewashing facilities: installed, Pasteurized eggs used where maintained, & used; test strips 30 required 49 Non-food contact surfaces clean 31 Water & ice from approved source Physical Facilities :.,..„ Variance obtained for specialized Hot& cold water available; 32 processing methods 50 adequate pressure 4' Food Temperature Control 51 Plumbing installed; proper backflow Proper cooling methods used; devices 33 adequate equipment for 52 Sewage &waste water properly temperature control disposed 1. - 34 Plant food properly cooked for hot 53 Toilet features: properly holding constructed, supplied, & cleaned n 35 Approved thawing methods used 54 Garbage& refuse properly 36 Thermometers provided & accurate disposed; facilities maintained Food Identification 55 Physical facilities installed, / 37 'Food properly labeled; original ELMI maintained, &clean container 56 Adequate ventilation & lighting; Prevention of Food Contamination designated areas used 38 IInsects, rodents, & animals not Additional Requirements listed In 105 CMR 590.011 present M1 Anti-choking procedures in food Contamination prevented during service establishment 39 food preparation, storage and M2 Food allergy awareness display Review of Retail Operations listed in 105 CMR 590.010 40 Personal cleanliness M3 Caterer 41 Wiping cloths: properly used & M4 Mobile Food Operation stored M5 Temporary Food Establishment 42 Washing fruits & vegetables M6 Public Market; Farmers Market Proper Use of Utensils Residential Kitchen; Bed-and- 43 In-use utensils properly stored I • I M7 Breakfast Operation 44 Utensils, equipment& linens: M8 Residential Kitchen: Cottage Food properly stored, dried, & handled • Operation 45 Single-use/single-service articles: M9 School Kitchen; USDA Nutrition properly stored & used Program 46 Gloves used properly M10 Leased Commercial Kitchen If Utensils,Equipment and Vending M11 Innovative Operation r Jood & non-food contact surfaces Local Requirements leanable, properly designed, L1 Local law or regulation onstructed & used L2 Otff 1'U iii,, Official Order for Correction: Based on an inspection today,the items marked"OUT"indicated violations of 105 CMR 494.000 and applicable sections of the 2013 FDA Food Code. This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If you are subject to a notice of suspension, revocation, or non- renewal pursuant to 105 CMR 590.000 you may request a hearing before the board of health in accordance with 105 CMR 590.015(B). Date of Reinspection: Discussion with Person-in-Charge: / Signature of Person-In-Charge: L1 �'j,..,l,,,,? Date:5/ � I � R o Signature of��e ct}jr /e/� /y-,,�� ,. i/ic:f2-�.+ _,..,..,„(-7 "e-- MDPH report r002111111100 m-10/5/18 v .� 7) �L+I r�-�•--� Food Establishment Inspection Report - Town of Yarmouth Establishment: ._-i r,c- t S �j-� �-12 i-�•+� ,�. Date: `� �,�2s� Page of )fiti(.CQ . Temperature Observations Item I Location Temp(°F) Item I Location Temp(°F) Item 1 Location Temp(°F) Observations and/or Corrective Actions Violations cited in this report must be corrected within the time frames stated below or in Section 8-405.11 of the Food Code Item Section of Code Description of Violation Date to Correct By Number s� I� i cL ~ '41/ �� oduS c-' cs' W7/Crzs r A lC-vt �P 1"J4 (".{+ CT . c l Stu is ' .4,)/ fr.7 "//s_ .:al f / 5 ram, It-A4 46 c JS Nesa4 -;0 ?- r'/1pl t 5��y,-�,—?-Q 7� Signature of Person-in-Charge: Date: Signature of Inspector:/ , /,`/ /Date, MDPH report form-10/5/18 version