GY Greenfield Health Department 14 Court Square ~ Greenfield, MA 01301 pee Phone 413-772-1404 Fax 413-772-2038 FOOD ESTABLISHMENT RE-INSPECTION REPORT mer eal Wy se 2" Retail Aasress 2ST) Wyn St cyl {F Restdentat Kitchen Nero soorected Telephone (f>- US 23257 By Nompocory v Owner tl HaccP YT) Caterer D1 avictations not Person in Charge (IC) (oem my FT ef h Santen | come ‘Out 5 Permit No. details inspector YT tala oto. Tnspector’s Signature, | 7] ~ [Pein FO (elo PICs Signature: Oka Print CY ara JL Page_| of| Pages £1 iA aes Oc fy occas A pr DASEUaAFOOD ESTABLISHMENT INSPECTION REPORT. Greenfield Health Department 14 Court Square — Phone 413-772-1404 Greenfield, MA 01301 Fax 413-772-2238 mre WCU ef poate Boa) | eee | Aro ee = x 7 Seer) | Retain | Fen erin Bam AA LOE A see (Serre Person in Charge PION Wy (Li /~ 7 cenN 0) Bed Breatiast | F) General Complain wnepestor ELV tw: £3 | permit No. Omer unruly Each viol Violations Related to Foodborne iliness Interventions and Ri action as determined by the Board of Health. Mark items below as IN / OUT /N.O. /N.A. (IN compliance, OUT of c ‘To the right of each item mark with an “X" for Corrected on Site fn noted requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations marked may pose an imminent health hazard and require immediate corrective ‘Non-compliance wit isk Factors (Red items) ‘AntChoking 590.009 (€) Tobacco $90.009(F) [) ‘Allergen Awareness 590.009 (6) C) -ompliance, Not Observed during inspection, or Not Applicable) FOOD PROTECTION MANAGEMENT. (COS) R. [Gap our 1 PIC Assigned Krowiedgeable Duties es EMPLOYEE HEALTH 7h) out 2 Reporting of Diseases by Food Employee, PIC AY our 2 Personnel wih Infections Restrictediexcluded ‘our # Food and Water from Approved Source ‘our & Recewing/Conaition BY Or &.TagsiRecords/ Accuracy of Ingredient Statements [BS OUT. Conforms with Approved Procedures/HACCP Plan LILI | "PROTECTION FROM CONTAMINATION INCU 6. Separation! Segregation! Protection oo Ww a ‘Food Contact Surfaces Cleaning and Sanitizing ¥ a Gs 00F 70, Proper and Adequate Handwashing (COS}.ar Repeat Violations (R) CoRR DUT 12, Prevention of Contamination fom Hands 1s 13. Handwash Faciilies, ‘PROTECTION FROM CHEMICALS. [our 14 Approved Food or Golor Addiives CJT | i) ovr 15. Toxic Chemicals “TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) | 1S Big 16. Cooking Temperatures oo [1 Gee IT. Reheating aT | “Jour 18. Cooling 1 QU 19. Hot and Cold Holding wo [Bxgir 20 Time asaPubicHearn conv COLT "REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS [HSP) [disgut 21 Food and Food Preparation for HSP oo ‘CONSUMER ADVISORY, ogqd Oo oO 7 OUT 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-crtical (N) Violations must be corrected immediately or within 80 days as determined by the Board of Health. Mark items below as IN or OUT BuOUr | c 23. Management and Personnel (FC-2)'90.003) t 24. Food and Food Protection (FC-3X500.004) 25. Equipment and Utensils __(FC-4)(690.005) 26. Water, Plumbing and Waste (FC-5X590.008) 27. Physical Facility (C-6)'90.007) 28. Poisonous or Toxic Materials (FC-7)580.008) 29. Special Requirements (690.009) 30. Other [aor 22 Posing ofconsumerAavsores CITT | ‘Number of Violated Provisions Related To Foodborne Ilinesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items marked “OUT” 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, Failure to correct violations cited in this report may result in suspension or revocation ofthe food establishment permit and cessation of food establishment operations. f ‘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 ofthis order. DATE OF RE-INSPECTION: jg] 4 Tnspector’s Signature: ye TO Fm (IO Print: PIC Signatares Oh an 2 SE DiQe Chonda Van Page| of Pages9 ‘THE COMMONWEALTH OF MASSACHUSETTS eset TOWN OR CITY OF Orenfad Establishment Name:_ LCL BL Wotwle Date: AIT Page: F_ of B ay ee g aa DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Afal Merry secon aS “Cou Loie SAL ISI > Bae Ct yantsine caxcned Vioded by WA- WDA "He Bl 7 GONE mide a eed Oey [CLAS on |a1ae Curyig “YCLUe = SE YOUAS — NS fete eTo.2 193 eau Caneel alee (Oa Wt San aioe ee waste SOS athe Sa Ce eer SS, \ast SU que 2\\ : & We oe SND Co ' pa ud, Broce in OM ea SOM |S eae eo Cen pak XG COLES TANS Mut Ts Ci a © Reinspection Scheduled a Embargo 2 Emergency Ciosure a Prin Voluntary Disposal Other: This form is approved by the Massachusetts Departms