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Home My WebLink AboutDIas West Mansfield Variety - 4/16/2002TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 August 5, 2002 Mr. Rupal K. Patel Amrvta Corporation dba Dias West Mansfield Variety 428 Ehn Street Mansfield, MA 02048 Dear Mr. Patel, The Board of Health has received an Incident Report dated July, 31, 2002 regarding the free distribution of "gutkha", a tobacco product to minors. The Mansfield Board of Health "Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco' prohibits distribution to minors and free distribution of tobacco products (Article 5. Sale of Tobacco Products, Section 1. Retail sales: part A and Section 2. Free Distribution Coupons). A hearing regarding the suspension or revocation of your permit for the sale of tobacco products will be held on August 15, 2002 at 7:OOPM in meeting room 3A/B on the third floor of the Town Hall, 6 Park Row. If you have any questions regarding this matter, please do not hesitate to contact me at 508-261-7366. Yours M fiel B and of Health Scott eit ealth Agent CERTIFIED MAIL: 7099 3400 0008 9408 2908 TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 August 21, 2002 Ms. Rupal K. Patel Amrvta Corporation dba Dias West Mansfield Variety 428 Elm Street Mansfield, MA 02048 Dear Ms. Patel, The Board of Health held a hearing on August 20, 2002, regarding the suspension or revocation of your permit for the sale of tobacco products, which was attended by Kanaiyala N. Patel. Cause for the hearing were violations of the Mansfield Board of Health "Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. You received notice of the hearing on August 6, 2002 by way of certified mail. At the hearing, the Board heard from the Mansfield Police Department that "gutkha", a tobacco product, had been distributed to minors, for free, on several occasions. The Mansfield Board of Health "Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco' prohibits distribution to minors and free distribution of tobacco products (Article 5. Sale of Tobacco Products, Section 1. Retail sales: part A and Section 2. Free Distribution Coupons). The Board of Health found that these violations were serious and repeated over a period of time and therefore voted to revoke your permit for the sale of tobacco products until June 2, 2003. After that date, you may re -apply for a permit for the sale of tobacco products. Should you choose to apply for the permit you will be required to demonstrate that you are fully aware of the implications and laws governing the sale of tobacco. You are hereby ordered to remove all tobacco products from the Dias West Mansfield Variety located at 428 Elm Street within forty-eight (48) hours of receipt of this order. Tobacco products are: cigarettes, snuff, chewing tobacco, cigars and pipe tobacco. Patel August 21, 2002 Page 2 If you have any questions regarding this matter, please do not hesitate to contact me at 508-261-7366. Yours of Health Scott Le#e,'Iealth Agent Served personally by Scott Leite, Health Agent at the Dias West Mansfield Variety 428 Elm S et, Mansfield, Massachusetts By: On: r \� 2/dam At. - Certified Mail: 7099 340D 0008 9408 2922 to Rupal K. Patel 2 Kasena Drive, #9, Taunton, MA 02780 TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 September 9, 2002 Amina, Incorporated Mr. Syed A. Hussain, President 80 Wallnut Street Canton, MA 02021 Dear Mr. Hussain, Please be advised that at its September 5" meeting the Board of Health declined your request for a permit for a food establishment at 428 Elm Street. The permit was declined on the grounds you provided a false or misleading statement in that you have no tenancy at 428 Elm Street, according to the owner of the property. Therefore, you have no location to operate the establishment. You are entitled to a hearing. You must request the hearing in writing and file the request within ten (10) days of receipt of this notice with this office. A hearing will then be held not later than ten (10) days after the day on which the request was filed. Your check is returned to you in this mailing. If I can be of assistance, please do not hesitate to contact me at 508-261-7366. our Scott Leite, Health Agent CERTIFIED MAIL: 7099 3400 0008 9408 2892 TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 APPLICATION FOR THE SALE OF TOBACCO PRODUCTS I hereby make application for a permit to sell tobacco products in compliance with the Board of Health Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. This Permit expires on June I" of each year. Violation of this Regulation may result in fines, suspension or revocation of this permit. Name of Business: MC4 e� S ' ;t t -Y Location of sale of tobacco products: t-{-4 c�-- '_ j ro g' {- Telephone No. at location: s-I Owner of Business: r c( Si 1 q c 1 ice' Address of Business: s�L -4- gTyl ,s+ Telephone No of Owner: �, > � �, < ;� 1 . i ''� C,' L Ili - Fax No.: If a corporation or partnership, give name, title, and home address of officers or partner. S.S./FIBNo.: G- .,.-4-C_. "`19'1-- Permit No. t 2�f r Signature Date RAH.lthTat'a D=.0 aIMIHMT APPLICATIONSWLANK TOBACCO APPAc IN TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 APPLICATION FOR MILK & CREAM PERMIT 1 hereby make application for a MILK & CREAM PERMIT, which expires on June 1 of each year. Name of Business ' k g`. -r Address �4 Owner Telephone No._ Fax No. S.S./F4D No. C ( Lj " ' C . C `j � -,�t Fee $2.00 Permit No. y Signature Date �1�� f�/-�`z'C`�f �..�.� � �i ��j / ,,1� % ��tjj��' 1/lCIC`�/e;�G101%'—'. D':7Ly� � p�,�{/l" . �' i `--'��;1 �k'{. ,��, <��-.�tiL""Zt-LLILC ..�/i�L{�u��CL�" � i ` ! �Zfr �.-�GC-i�CL� �.-�7�t'/,:l<�%CGG�dI; G�LI,i%%1. .-lCd��ftEZG�K' �f GiLE'. a11_t'-' //�, r � C-L 17C... �J�LI%� t 1'(i��l��1��-:�f � /`�L-� .,L��l�tiL,L; �� f�� i _�i ��1, y jL�yL � ,. C. Hearing Procedure 1. Open hearing called by the Mansfield Board of Health. (State time and "on August 15th, 2002") 2. Purpose of the hearing is to give Mr. Rupert K. Patel President of the Amrvta Corporation doing business as Dias West Mansfield Variety an opportunity to be heard as to why its Permit for the Sale of Tobacco Products should not be suspended or revoked. 3. Summary of events leading to hearing presented by Mansfield Police Department Detective Robert Martin. 4. Hear the permit holder's rebuttal. 5. The Board will then hear comments from parties in favor of suspension or revocation of the Amrvta Corporation dba Dias West Mansfield Variety Permit for the Sale of Tobacco Products. 6. The Board will then hear comments from parties opposed to the Amrvta Corporation dba Dias West Mansfield Variety Permit for the Sale of Tobacco Products. 7. The Board may close the hearing. 8. The Board may make a decision or postpone the decision to a later time in the meeting or a later meeting. TOWN OF MANSFIELD, BOARD OF HEALTH SIX PARK ROW, MANSFIELD, MA 02048 PERMIT TO OPERATE A RETAIL FOOD ESTABLISHMENT In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws, a Permit is hereby granted to: Rupal K. Patel, President Whose Place of Business is: Amrvta Corp. dba Dias West Mansfield Variety 428 Elm St. Permit Expires June 1, 2003 License Number RF-44 Food Fee: $50.00 Milk & Cream: YES BOARD OF HEALTH Michelle Madan, Chairman PERMIT FOR THE SALE OF TOBACCO PRODUCTS Violation of REGULATION AFFECTING SMOKING AND THE SALE, VENDING, AND DISTRIBUTION OF TOBACCO may result in fines, suspension or revocation of this permit. Whose Place of Business is: Amrvta Corp, dba Dias West Mansfield Variety 428 Elm St. Permit Expires: June 1, 2003 License No: RF-44 BOARD OF HEALTH Michelle Madan, Chairman COMMONWEALTH OF MASSACHUSETTS TOWN OF MANSFIELD SIX PARK ROW LICENSE TO SELL MILK AND CREAM This is to certify that. Rupal K. Patel, President residing at: 428 Elm St., Mansfield MA 02048 and having a place of business at: Amrvta Corp. dba Dias West Mansfield Variety 428 Elm St. in the Town of Mansfield has been granted a license to sell MILK and CREAM and is subject to the Provisions of the Laws of the Commonwealth of Massachusetts, relating to the terms and conditions, and to the rules and regulations established by the Board of Health, of the Town of Mansfield goveming the sale of Milk and Cream and shall remain in force until June 1, 2003, unless previous to that time is suspended or revoked. Expires: June 1, 2003 License No.: RF-44 POST THIS LICENSE IN A CONSPICUOUS PLACE This license shall not be sold, assigned or transferred • 1 • ;Ij v j asivem� . . I herely make application for a MILK & CREAM PERMIT, which expires on June 1st of each year. Name of Business: Amrvta Corp. dba Dias West Mansfield Variety Address: 428 Elm St. Owner: Rupal K. Patel, President Telephone No.: 508-339-3151 Fax No.: S.S./FID No.: 04-3531086 Fee: $2.00 Permit No.: RF-44 Signature � � Ga=tt — Date U,!� .1 11 l naL TOWN OF MANSFIELD BOARD OF HEALTH SIX PARK ROW, MANSFIELD 02048 APPLICATION FOR THE SALE OF TOBACCO PRODUCTS I hereby make application for a permit to sell tobacco products in compliance with the Board of Health Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. This Regulation expires on June I" of each year. Violation of this Regulation may result in fines, suspension or revocation of this permit. Name of Business: Amrvta Corp. dba Dias West Mansfield Variety Location of sale of tobacco products: 428 Elm St. Telephone No. at location: 508-339-3151 Owner of Business: Rupal K. Patel, President Address of Business: 428 Elm St., Mansfield MA 02048 Telephone No of Owner: Fax No.: S.S./FID No.: Permit No. 04-3531086 119 grC! 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Alanpa0 paloulsalj 1! 4 aleldwoo os!y .£ pueZ 't wall swat! aleldwoo Date Received Date Inspected Approved By Permit # Issued FOOD ESTABLISHMENT PERMIT APPLICATION (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: rV1 • �, £ ,, 2) Establishment Address: 3) Establishment Mailing Address (if different) 4) Establishment Telephone No: y c r 3 i- ( 4 i_ .a 5) Applicant Name & Title: 6) Applicant Address: 7) Applicant Telephone No.: _ 24 Hour Emergency No.: � .x l ) :_ 8) Owner Name & Title (if different from applicant): S " t s� 7' 5 , P q j 9) Owner Address (if different from applicant): 10) Establishment Owned By: 11) If a corporation or partnership, give name, title, and home address of officers or partner. ❑ An Association- orporation ❑ An Individual>`'<-( d i v ❑ A Partnership ❑ Other legal entity �'� c r:� I )l%' Sr Cif t • �y�J 191 Ppr-4nn nirarJiv Raannnsihla Fnr nail. nnnrnfinnc lrlwnar narann in rharna 4mamianr KA— — et.. I Name & Title: Address: - t-4"') `37- eP Cl." C'i 4 i"d Telephone No: Fax: Emergency Telephone No: ;- 13 District Or Re Tonal SuDervillsor if a ficable Name & Title: Address: Telephone No: Fax: Food Establishment Information 14.) Water Source 15) Sewage Disposal DEP Public Water Supply No: (if applicable): 16) Days and Hours of Operation: C V"j Vi , �t )` ; 17) No. of Food Employees 18) Name of Person In Charge Certified in Food Protection Management: Required as of 101112001 In accordance with 105 CMR 590.003(A Please attach cn of ceftifrcato 19) Person Trained in Anti -Choking Procedures (if 25 seats or more): 20) Location: 22) Establishment Type: ❑ Caterer ED-Retail ( Sq. Ft) ❑ Food Delivery []_Food Food Service — ( ) Seats ❑ Residential Kitchen for Retail Sale ❑ Permanent ED-Food Service - Institution ❑ Residential Kitchen for Bed & Breakfast Home ❑ Mobile (Dates) ( Meals/Day) ❑ Residential Kitchen for Bed & Breakfast Establishment ❑ Frozen Dessert Manufacturer Other (Describe) 21) Length Of Permit: (check one) ❑ Annual ❑Seasonal/Dates ❑ Temporary/Dates/Times 23) Food Operations: Definitions: PHF— Potentially hazardous food (tima4emperature controls required) (check all that apply): Non-PHFs — non -potentially hazardous food (no fime/tempereture controls required) RTE— ready -to -eat foods Ex. Sandwiches, salads, muffins which need no further rocessin Sale of commercially Pre- ❑ PHFCooked To Order ❑ Hot PHF Cooked and Cooled or Hot Held for Packa ad Non-PHFs __ _ _ ____ More Than a Single Meal Service -- Sale of Commercially Pre Preparation Of PHFs For Hot And cold ❑ PHF and RTE Foods Prepared For Highly Packa ed PHFs Holding For Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs LT Sale of Raw Animal Foods Intended to El Vacuum Packaging/Cook Chill be Pre ared b Consumer Reheating of commercially ❑ Customer Self -Service ED Use of Process Requiring A Variance and/or Processed Foods For Service HACCP Plan (including bare hand contact Within 4 Hours. alternative time as a public health control Ll Customer Self -Service of Non ED Ice Manufactured and Packaged for Ll Offers Raw Or undercooked Food Of Animal PHF and Non -Perishable Foods Retail Sale Origin Only. Preparation of Non-PHFs 0 Juice Manufactured and packaged for E Prepares Food/Single Meals for Catered Retail Sale Events or institutional Food Service ❑ Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Other (Describe): ED Retail Sale of Salvage, Out -Of -Date or Total Permit Fee Reconditioned Food Payment is due with'application I, the undersigned, attest to the accuracy of the information provided in this application and 1 affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been Instructed by the board of health on how to obtain copies of 105 CMR 590.000 and the federal Food Code. I 24) Signature of Applicant: Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state returns and paid state taxes required under law. 25) Social Security Number or Federal ID: (, } 26 Signature of Individual or Corporate Name: BLANK FOOD PERMIT APPLICATION.doc 9 Date R elbed { APR "t 6 2002 Inspected Approved By u Permit # Issued Or- q y FOOD ESTABLISHMENT PERMIT APPLICATION (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: Amrvta Corp. dba Dias West Mansfield Variety 2) Establishment Address: 428 Elm St. 3) Establishment Mailing Address (if different) Same 4) Establishment Telephone No: 508-339-3151 5) Applicant Name & Title: Rupal K. Patel 6) Applicant Address: 428 Elm St., Mansfield MA 02048 7) Applicant Telephone No.: 508-339-3161 24 Hour Emergency No.: 508-238-4868 8) Owner Name & Title (if different from applicant): Rupal K. Patel, President 9) Owner Address (if different from applicant): 428 Elm St., Mansfield MA 02048 10) Establishment Owned By: 11) If a corporation or partnership, give name, title, and home address of officers or Dartner. A Corporation Rupal K. Patel, President 2 Kasena Dr., #9, Taunton 02780 ❑ An Association Kanaiyalal N. Patel, Manager, 2 Kasena Dr., Taunton ❑ A Corporation ❑ An Individual ❑ A Partnership ❑ Other legal entity 12) Person Directly Resnonsible For Daily oneratinns !Owner nercnn in rharna Ci incnticnr Hnmmncr otr I Name & Title: Kanny Patel Address: Telephone No: 508-339-3151 Fax: Emergency Telephone No: 508-238-4868 13 District Or Regional Supervisor if applicable) Name & Title: Address: Telephone No: Fax: r-ooci tstamisnmem InTormailon 14.) Water Source: 15) Sewage Disposal DEP Public Water Supply No: (if applicable): 16) Days and Hours of Operation: 17) No. of Food Employees 18) Name of Person In Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003 A Please attach copy of certificate 19) Person Trained in Anti -Choking Procedures (if 25 seats or more): 20) Location: 22) Establishment Type: ❑ Retail ( Sq. Ft) ❑ Caterer ❑ Permanent ❑ Food Service - ( ) Seats ❑ Food Delivery ❑ Mobile (Dates) ❑ Food Service - Institution ❑ Residential Kitchen for Retail Sale ( MealsiDay) ❑ Residential Kitchen for Bed & Breakfast Home Other (Describe) ❑ Residential Kitchen for Bed & Breakfast Establishment ❑ Frozen Dessert Manufacturer 21) Length Of Permit: 23) Food Operations: Definitions. PHF— Potentially hazardous food (time/temperature controls required) Non-PHF's — non -potentially hazardous food (no time/temperature controls required) check all that a I ): RTE — ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further processing) ❑ Sale of commercially Pre- PHFCooked To Order Hot PHF Cooked and Cooled or Hot Held Packaged Non-PHFs for More Than a Single Meal Service ❑ Sale of Commercially Pre- El Preparation Of PHFs For Hot And LJ PHF and RTE Foods Prepared For Highly Packaged PHFs cold Holding For Single Meal Susceptible Population Facility Service El Delivery of Packaged PHFs El Sale of Raw Animal Foods Intended Vacuum Packaging/Cook Chill to be Prepared by Consumer Reheating of commercially Customer Self -Service ❑ Use of Process Requiring A Variance Processed Foods For and/or HACCP Plan (including bare hand Service Within 4 Hours. contact alternative, time as a public health control ❑ Customer Self -Service of ❑ Ice Manufactured and Packaged for ❑ Offers Raw Or undercooked Food Of Non PHF and Non- Retail Sale Animal Origin Perishable Foods Only. El Preparation of Non-PHFs U Juice Manufactured and packaged Prepares Food/Single Meals for Catered for Retail Sale Events or institutional Food Service LJ Offers RTE PHF in Bulk Ouantittes Other (Describe): To be completed by the Board of Health El Retail Sale of Salvage, Out -Of -Date or Reconditioned Food Total Permit Fee: $50.00 Payment id due with application I, the undersigned, attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the board of health on how to obtain copies of 105 CMR 590.000 and the federal Food Code. 24) Signature of Applicant: % q Q l4l'Dr� tv Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 04-3531086 26) Signature of Individual or Corporate Name: