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OWN OF YARMOUTH BOARD OF HEALTH
1 1146 ROUTE 28
FOOD ESTABLISHMENT INSPECTION REPORT SOUTH YARMOUTH, MA 02664
Item Code C -Critical Item
Name DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
1.„u Ke 'S ); • , Date Type of Operation(s) Type of Inspection No. Reference R -Red Item PLEASE PRINT CLEARLY Verified
fU Food Service Routine .
AddressSRcorE.. ,I
c �5 Retail U Re-inspection Z JG Com. 0 SI sins 0 C2
I
Telephone5-708w -776-- 5C500 j ❑ R: raIKitchen Pvious Inspection C C0
Date: NIC ,
Owner HACCP Y/N U Temporary LI Pre-operation
- U Suspect Illness ��
Time ❑ Caterer P
Person in Charge (PIC) I U General Complaint
��T..�S (� '
f �ca � )�" U Bed & Breakfast p
In: U HACCP
Inspector t ,
�„ Rezbe-4,nu Out: Permit No. U Other
I Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. .� C.. �- ' e.-
Violations belated to Foodborne Illness Interventions and Risk Factors Red Items) Non-compliance with: L.C.7�;ld
'Cj .r• i
( 1
Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate 590.009E O o 590.009 (F) U
corrective action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT ./alw.,..5?-'yltze-2-2,...„ eSenirear
0 12. Prevention of Contamination from Hands
724-• /7_72.4,- 5
La 1. 'PIC Assigned / Knowledgeable / Duties 0 13. Handwash Facilities f '
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i/ "" .�► E�.-"� .
❑ 2. Reporting of Diseases by Food Employee and PIC 0 14. Approved Food or Color Additives
0 3. Personnel with Infections Restricted/Excluded 0 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE S ..� 5
TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) c .,t
❑ 4. Food and Water from Approved Source 0 16. Cooking Temperatures (3' 40 C- 6) C , '-'''1 Ci _
❑ 5. Receiving/Condition ❑ 17. Reheating elece-N `Ci
0 . 6. Tags/Records/Accuracy.of Ingredient Statements 0 18. Cooling
0 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION O 20. Time as a Public Health Control ‘ '9e' .0,01, '
0 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) C /.--5- .....,,/71 '"jf‹:,,
0 9. Food Contact Surfaces Cleaningand Sanitizing 9 0 21 . Food and Food Preparation for HSP
0 10. Proper Adequate Handwashing CONSUMER. ADVISORY - CA
i La11 . Good Hygienic Practices1 t1rC.
0 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Items) Number of Violated Provisions ons Related to ,.�Critical(C)violations marked mustbe corrected immediately Foodborne .Illnesses Interventions and Risk 4 -c �► A44:64
or within 10 days as determined by the Board of Health. Factors (Red Items 1-22):
'1 ( ria rfvliet0 ot S --
Non-critical (N) violations must be corrected immediately
E or within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection -""'1+0 �" "�
today, r
C N the items checked indicate violations of 105 CMR 590.000/
federal Food Code. i
23. Management and Personnel (FC-2)(590.003) This report, when signed below by a
24. Food and Food Protection Board of Health member or its agent constitutes an order of
(FC-3)(590.004)
25. Equipment and Utensils the Board of Health. Violations not corrected are subject to
f (FC-4)(590.005) fines per Yarmouth Board of Health. If aggrieved .b. this
26. Water, Plumbingand Waste Y
(FC-5)(590.006) order, you have a right to a hearing. Your request.must be
27. Physical Facility (FC-6)(590.007) in.writing and submitted to the Board of Health at the above
28. Poisonous or Toxic Materialsaddress withinDiscussion with Person in Charge:
Correction Action Required: ❑ No 0 Yes
(FC-7)(590.00.6) 10 days of receipt of this order. g q
29. Special Requirements (590.009) - DATE OF RE-INSPECTION: 0 VoluntaryCompliance • U Employee Restriction /
30. Other
p Exclusion
ak
O Re-inspection Scheduled 0 Emergency Suspension
ilk I\
Inspe 77 • . 1.t - Print
l ,c) i O Embargo O :: nc01e
PIC's Signature Print Page _ of Pages ❑ Voluntary 0 r
t ki,„: Disposal
_.. _ _...aa...•ra.._.._ �...u___._. .� _--- - - -