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HomeMy WebLinkAboutItnerant Vendors Inspection 0000 John Fi (2) EHS-1A,6$t' INSPECTION REPORT STATE OF CONNECTICUT W ROUTINE INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT 0 t O.n 5 3 2 0� CLASS STREET pp TOWN ADDRESS 7�T. C2>I/ �C fi A9ksNG- LoT) 50LiTo W_tN0 5b(7, OWNER or INSPECTION OPERATOR DATE and TIME a o� Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date specified below. SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS I VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2 nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1 2 Original container,properly labeled 1 23 A=rate thermometers provided,dish basket,if used insects/rodents 24 Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed, temperature requirements during storage, equipment clean constructed as required,good repair,clean preparattransportation display,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required transportation . equipment clean 9 q 1 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean 5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1 6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean not reserved 29 Water source adequate,safe 4 49 Walls,ceilings attached,equipment properly 1 7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation 2 provided as required surfaces as required. 8 Food containers stored off floor 50 Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 31 Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic items properly stored,labeled,used 14 51 Adequate lighting provided as required 1 PLUMBING 52 Room free of steam,smoke odors 1 PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as rent 12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 14 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1 13 Hand washing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean installed 14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING 55 Establishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles CONSTRUCTION &INSTALLATION 1 r Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry maintained,installed,located tissue waste receptacles provided 57 Clean/soiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGE/RUBBISH STORAGE&DISPOSAL I (except guide dogs) 18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1 19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— [Tindicatedooby ats 75 r more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean ns) sted at entrance(s),smoking area 1 sign(s) 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 4 3 _ 2 1 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 a62 Written documentation of training program 2 rso in harge TOTAL RATING Date Corrections Due Signature of P U SIGNED(In e DESCRIBE DEFICIE ON CONTINUATION SHEETS ZI jr a Beverages Beverages Celts- 1-1.50 16—$ZGO Coneea 12oz S1.� 160: Sports Bottled Water-20 oz$1.60 62�00 Orarpe Juice 61.26 i- Sports Bottled Wafer-20 or 61.60 SnPPe le 61.25 Orange Juice 0146 PP le Gatorade 61.26 - Sna67 Soda$1.00 Gatorade Soda j'k00 Breakfast (SERVED BETWEEN 7:00 AM AND 2:30 PM) _ Breakfast 3 Egg Sennb/e,Tout.Bacon d Sausage t1.00 (SERVED BETWEEN 7:00 AM AND 2:30 PM) Burnt w7Egg.Potato,Cheesed Sausage or Bacon or Hem 62.76 _ 3 Egg Sersnble,Toas4 Bacon d Sausage 61.00 BLT 6Z75 - Bunt6o w. gg,Polito,Cheese d Sousa"Bacon Egg d Cherie Sandwich SZ25 BLT 62.76 sags or Bacon or Ham 5Z76 Sausage Egg d Cheese Sandwich$126 - Ham Egg d Cheese Sandwich$126 Bacon Egg d Chewe Sandwich iZ26 Cheese Omlet w(Toaat 6Z26 4 Sausage Egg d Cheese Sandwich$225 Bagle 50.95 with Cream Choose$1.95 Ham Egg d Cheese Sandwich$126 Bacon 50.65 each Cheese Om/et w?osat jZ25 Sausage$0.46 each Bag/a$0.95 with Cream Cheese$1.95 each Luncheon Entrees Bacon 5OAS$DA5ea Sausage each a-� (SERVED BETWEEN 10:00 AM AND 2:30 PM) Luncheon Entrees Sausage Sandwich w/Peppers d Onions"00 (SERVED BETWEEN 10:00 AM AND 2.30 PM) Kielbasa w/Cheese$3.50 , Ham d Cheese$3.50 Sausage Sandwich w/Peppers d Onions$COO CheeseBurgerw/Letfuce d tomato$3.25 K/elbose w/Cheese$3.50 Hamburger w/Lettuce d tomato$2.99 Ham d Cheese$3.50 Grilled Cheese wham$Z75 CheeseaurgerW&ettuce d tomato$3.25 Chill Dog$Z65 Hamburger w/Lettuce d tomato$Z99 Hot Dog$2.26 Grilled Cheese wham 1275 Chips$0.75 Chili Dog$Z65 Hot Dog$126 i Chips$0.75 Page of �. u s INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION D.i o.C)CN's SOLI-A Wn d sb-C 9 INSPECTION FORM# REMARKS 3� o 4 Zc wQ)-1 ��- HW s),nk N0-re T c Q S 7"ENPs Co NoT� Uni i�Z.0 SCE Pf'm cWo c,^., LOk CIQ/G S Sce, cock ban In rc'CDZ , W. i� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) XU7 Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN TpV44 Fr«w -a"1b, DATE OF INSPECTION '*bIA.iJt.)4:s Savi1-i 1.J•�� `� I o jo9 INSPECTION FORM# REMARKS t-6T Fs d G LZ:A-t..i tINITIAL(INSPECTOR) INITIAL(PERSON IN CHARGEV 14 Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager I .. e 7Establishment: Date of Inspection: y +4v ss: h,t.r\J --r�..a ;3yv Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served - -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,.labeled properly,used properly Proper type/installation/backflow prevention device/air gapfor: i H equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Food � -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance-Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 21 vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored EEquipment&Utensils• Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 541 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesyrovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean 11 XRoutine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ture s' not rer sd r�! 1`Ca.-�A+ _ L� o� print name n ame i to yv.is►t X_VIT DATE CORRECTIONS phone number tit e j,It, Page 2 of 2 plus�_continuation pages Focused Inspection 1/2002 p � Establishment: Inspection Date: It Ltmn Time: ins REinsp Address/City: Health Dept: ",Z ,,n , „„A� class: 1 2 3 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C I N/0 I N/A DNC KIEY; C[complies] N/O[not observed] NIA[not applicable] 3 1 DNC[does not comply] 0[other] RTE[ready-to-eat] *. 2 q Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 001 A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe 11 B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature / D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140eF. (whole beef/pork roasts 1300'F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D I Proper sanitizin rocedure B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 ME tCloths and/or sponges in good repair and clean A Produce washed g cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands. C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 O1 1 *DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. -M: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET y 2—'1 ,{ Z 3 NAME OF ESTABLISHMENT TOWN %A I STbV DATE OF INSPECTION %ux, ..Ili k � INSPECTION REMARKS FORM# 1 S� ��r�A-mot (�Sv1'� vs, I)w.S T1' 4S 4. ,o. b s N �-..�� ,,,,,,�,.c,e, ®��� � � 'as1—se-x-�� �v� ►-fit �-�� � `►�a� Mom.. 1..� �'� Iw�+ +'���e-��.�.'�' INITIAL 7(INSPECTOR) ���_ INITIAL(PERSON IN CHARGE) P Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager 77 "EMEN, Establishment: '.J A'S Date of Inspection: ` 2 Address:5 E,.,., s? Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35Ldesnfed,' lities. Adequate,convenient,accessible, -Water quality in compliance-Monitoring in compliance properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 0 e penings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required located 6 Floor,wall juncture covered Nonf d-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean led,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils- Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stared properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 37 Proper toilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Routine Inspection OReinspection O Preoperational Inspection Ot rInspection: R: P N IN HAR E:.7Demerit Score: *Include demerits from page 1 A-z-t-c�IWAAOTKOIJ J%L 1 4 3 2 1 Total Rating signature T tur n(a ` J VZ print name p t nam n s (c '4q-2S I VCZ14 1 lv'erlioo�09' ... I/ phone numbe DATE CORRECTIONS DUE: 1 6 i Ll Page 2 of 2 plus__L_continuation pages Focused Inspection 1/2002 0"co3•� vz .. Establishment: Inspection Date: 2 S Time: t 2,4C3 Wkhijp9REinsp Address/City: o�.," Fa Lam, ��..Jt� �S �,.� Health Dept: ► w,sj4%. Class; 1 2 s Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/O N/A JDNCJ KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] } _W A Food workers have no exposed infected lesions/burns MIN 2 B Personnel with infection restricted ` m, NN % C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved a � ; B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use 000, E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140 F. (whose beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 45°F. B Wounds covered adequately ® C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 do Approved sanitizer available/adequate Bc n ationofsanitizer B Food-contact surfaces and utensils usdid for potentially hazardous food sanitized at least every 4 hours 1100 A Footlthermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp D Proper sanitizin procedure B Properfood thermometerfor product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 EM A No unnecessary han7777 th bare hands Soap/paper towels/ drying device available Dispenser(s)working: ❑Soap ❑Papertowel B Minimize food handith bare hand C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N ♦To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N fl�esi indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: 1 1 Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 �Dy!N Sf4 C %Wn olic slo� ?d&U&Ot s w� 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 SOR•CO TELEPHONE (860) 644-2511 MOBILE VENDOR CHECKLIST VENDOR NAME OWNER NAME LICENSE PLATE �1 TYPE OF VEHICLE FOOD CL SIFICATION OWNER ADDRESS 7 S p !-U/N,9S. 6 HOME PHONE_A�g� CELL PHONE 4j��— ��3 E-MAIL QFO NAME APPROVED BASE OF OPERATION 7ENU CLEARLYVISIBLEECURRENT MOTOR VEHICLE REGISTRATION(TEMPORARY REGISTRATION NOT ACCEPTABLE) _IZVEHICLE CLEAN AND FREE OF ODORS ,ALL EQUIPMENT CLEAN AND OPERABLE 6/GRILL(S)ENCLOSED AND PROPERLY VENTED PROTECTION FROM AIRBORNE CONTAMINATION AND INSECTS —L44OPER HAND WASHINGl APPROVED SANITARY GLOVES(If Applicable) VHOT&COLD WATER PROVIDED&WASTEWATER COLLECTION PROPER THERMAL EQUIPMENT TO HOT HOLD AND/OR COLD HOLD PROPER THERMOMETERS: TYPE&AMOUNT,ALCOHOL WIPES TRASH CONTAINER(S)WITH COVERS CLEANING&SANITIZING CHEMICAL PRESENT-PROPERLY STORAGE AD UATE UTENSILS PROVIDED(SPOONS,SCOOPS,LADLES,ETC) ADEQUATE SINGLE SERVICE STORAGE/DISPENSING Notes: SWNATUAE APPR6VMG AANDfARIAN * Prior to inspection, all mobile vendors shall complete the Mobile Vendor application. Once the application has been reviewed and approved, a scheduled Sanitary Food Service Inspection can be arranged. Upon satisfactory completion of a Sanitary Food Service Inspection,The Town of South Windsor Health Department will allow the sale of food products. Failure to complete these requirements may result in fines,fees and/or closure of the Mobile Vendor. \\sthfile001\users\robertmdevito\Desktop\Mobile Vendor Checklist.doc RECEIVED TM CHEMSTATION® ► 6 SEP,51 zooe Atlanta P . Baltimore Baton Roazge BIYn}tdpghadn ' Bo,tan Chattanooga Cldicago ct.inrzati Town of.South Windsor c=zeYelana South Windsor, CT 06074 C"olaunlaia C"oln,v&sCxA To Whom It May Concern cola mb.s nl-1 Y Covington Dallas This letter will serve as verification that the property to the south of 1496 John Fitch Dayton Blvd, Route 5, is owned by 1496 Realty Associates, of which I am sole owner. The parcel Denver extends about 880' beyond the building at 1496 JFB. and goes about 100' past the right De3Mo=nes of wayto the brick company. I am giving m permission to "Dianna's Catering" to DetYaa p Y g g Y p g El paso operate a food concession on my property. Dianna Kenny will provide all the necessary y,� Ezuart permits and insurance. d d'.I.andeyd.de G"'1 y Thank you. C�PLLrdS�0Y0 1-loaastoi= i'k Incliardapolis Tacksonville Bruce A. LeFebvre ICsrnaaoo Property Owner Kansas C'itg Kingq,,t Lansing Lima Longview Louisville Memphis . t'4'lilwaulcee r/ � I_ z�finneapolis ?vloble .�loarl ead L k- W/ 4us7 v311e v a oklahoma City 1'Iz l pbocn ra Phoenix Pittsbnrglz Portland �y Raleigh Ricl=nzond Yoj V� j l� k\ l PJt ^ St.Louis San Antonio Seattle �� ```•, , Springdale /� �3 ✓� Stockton ( a / /J 1a "nzpa [—�„�1+ 1496 John Fitch Blvd. ♦ South Windsor,CT 06074♦www.chemstation.com (860) 291-2863 6 (800) 273-8265 4 Fax(860) 291-2864 Page 1 of 1 Dianna Kenny<diannakennya yahoo.co,n> hide details 1:01 pm(5 minutes ago) reply-to diannakenny@yahoo.com to ton verraneault<ronwins@gmali date Sep 5,26081:01 PM subject Fw:van lettering signed-by yahoo.com mailed-by yahoo.com ---On Wed,9/3/08,Sharon Wayler<signs@rainbow.necoxma6l,com>wrote: From:Sharon Wayler<signs_@rainbow_necoxmail.com> Subject:van lettering To:diannakenn -@yahoo.com Date:Wednesday,September 3,2008, 12:12 PM SEE ATTACHED lot I HOC 0 209K View PDownload C)l Call Abood 0 http://mail.google.com/mail/?ui=1&il--b3da4715e0&view=cv&search=inbox&th=1... 9/5/2008 TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT 1540 SULLIVAN AVE,SOUTH WINDSOR,CONNECTICUT 06074 PHONE (860)644-2511ext 248/FAX(860) 644-7280 PLAN REVIEW APPLICATION FOR MOBILE VENDOR FOOD SERVICE I. Information • A full set of floor plans drawn to scale,the equipment list(including method of installation),the menu and photo of the truck/cart. • All changes in plans must have health department approval before the permit is approved. • Definitions: "Commissary" A service room, catering establishment,restaurant or any other place in which food, containers or supplies are processed,prepared, handled,packed, transferred or stored and directly from which food is distributed to a food vendor or from which any vehicle or pushcart offering food to the public is supplied. o "food". Any raw, cooked or processed edible substances,beverages, ingredients, ice or water used or intended for use or for sale in whole or in part for human consumption. B smess Name(Food service business name): Name of Owner(s)of Business: 1 bcina 1 el'n j Mailing Address: +n n Address of Owner(if different from mailing address): ) ��Q/Ylei�iCAN`o, Ap)Telephone numbers for owner(s):home 95y , �2y cell: N13 E-mail: k`QthtaU,Cbpj If your business has more than one vehicle or cart,each vendor must be identified below: Name of Food Vendor: Address of Food Vendor: Mailing Address(if different from home address): Telephone number home: E-mail: Telephone number cell: If the Mobile Vending Operation is a class 3 or 4 operation,the Operator of the Mobile Vending unit is required to be a Qualified Food Operator. Provide a copy of the current QFO certificate. If your base of operation(commissary) is located outside OF THE Town of South Windsor, please provide a copy of your current food service license issued by the local health department and your last sanitary food service inspection. Please list the location of all stops made throughout the Town of South Windsor- (Please be detailed) and approximate time of day the stops are made: d CT II. Equipment List Complete this equipment list or provide identical information on the specification sheet indicating the equipment to be installed on the truck or cart. Item# Item Manufacturer Model Number Example Counter Top Gas Grill Hobart 270-EG-2481 r-la� -, ' i r s rr ODD W) P _ Oboyll Cdlele- Ma6er Ti)n a 96 rOU)MI e- WNLROD l AS L1451 I III. Menu Provide a detailed list of all foods that are to be sold on the mobile truck/pushcart. Cold Foods List Preparation Steps 1 Q —r sh e 1 n erG r L Cb rd At 2 • I41 eraior 3 ash i 4 1 WN: r i h on - . 5 �-- ` 'd Lj n I 6 rn -, 1 — M 11 1 1� r 8 9 10 Hot Foods List Preparation Steps 1 © c� ° 2 166 a 4 e- F o of� 5 Zcrn '(�� ted fdrn Ft'° eo 54a4-c i 6 J S f'_ -E p 7 Cv ..e.n 5hr ld "in 8 F1 9 10 1. Will food be made more than 4 hours in advance? Yes No 2. �1 will the food items be prepared and cooked? �[ I i n► 3. Identify the source(s) of the food to be dispensed: X&U e�5 i cK.Q n 5 c5Du A w���� 'bra1� kcA �r-11 �Tl►I_;__ �, cl�b M ho r,c1-, 4. ow will hot foo be maintained at 140T or above on the mobile vending unit? t'p e (" 5. How ill cold food be maintained at 4S°F or Belo on the mobile vending unit? ' 0r 6. Will food items be reheated on the mobile vending unit? YES No If yes, describe how and where the food items will be re-heated: n VkS PC=s uSco 1-0 Oup ertxk 7. Describe what is done with food items that are leftover at the end of the business day: �Lf\- 9M bt GV601PAR8 � Cl 8. If used how are raw vegetables washed? n D(?)+n b1f Ij 9. Where are extra food and paper products stored? (!)C1 'On!L O,N r IV. Plumbing and Disposal 10. Describe the hand washing facility(s)at the mobile vending unit and�mmissar 11. Describe the location and method for cleaning and sanitizing utensils, containers, etc. used on the mobile vending unit: ®tZ"Itk n 6 R' 4� 1� ��s I f, \A s IA)a.-er4C(� wa-re� 90" i 12. Is the water supply for the mobile vending unit from a UBLIC WATER SYSTEM a PRIVATE WELL WATER SUPPLY? (Circle one) If your water source is om a private well, please provide a water test from a Connecticut Certified Laboratory. 13. How are the watertanks filled on the mobile vending unit? Also describe how often the tank is cleaned and what method is used? DUN, g- ' 10 0 A56.8' Am Lpbced - 14. Where is the Nvastewatpr disposed? a nr 15. Where and how will garbage be disposed on the mobile vending unit and at the base of operation? e G it[ e 544A-kjnn THE UNDERSIGNED AGREES TO COMPLY WITH ALL OF THE REGULATIONS AND ORDINANCES ENFORCED BY THE TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. OUR OFFICE MUST BE NOTIFIED IF THERE ARE CHANGES 1N MENU,FACILITY,EQUIPMENT,OR THE ABOVE LISTED INFORMATION. "D V\I�r)n I /Y pp scant ease pnnt pp scanMig nature Wat o� ooDs The National Registry Of Food Safety Professionals® ' .' Certifies DIANNA L KENNY jp,`. A:TIFI Has Successfully Satisfied the Requirements For �dy$FIFETPMMA 3 w{ra d `yM , The Food Safety Manager ,k hM ! p Certification Examination IN s �, f�Y � 95,; J i e l h �.• y...s� q,,..' / ry1u^+n+^ i ,fin,4*,y j•!I ri resi ew: = H � Issue Date: May 29,2008 Certificate No:ZS20264612 j ' Test Form:ZSD �d" „.`�"� ✓� This certificate is not valid for more f.r v—rrnm d«tr of:ccno ■ pan na s Call Ahead Orders 860=462=74 23 Beverages Coffees 12oz$1.50 16oz Sports Bottled Water- 20 oz Orange Juice Snapple Gatorade Soda Breakfast (SERVED BETWEEN 7:00 AM AND 2:30 PM) 3 Egg Scranble, Toast, Bacon & Sausage Burrito w/Egg, Potato, Cheese & Sausage or Bacon or Ham BLT Bacon Egg & Cheese-Sandwich Sausage Egg & Cheese Sandwich Ham Egg& Cheese Sandwich Cheese Omlet w/Tonst Bagle $0.95 with Cream Cheese Bacon each Sausage each Luncheon Entrees (SERVED BETWEEN 10:00 AM AND 2:30 PM) Sausage Sandwich wl Peppers & Onions Kielbase w/Cheese Ham & Cheese CheeseBurger wlLettuce & tomato Hamburger w/Lettuce & tomato Grilled Cheese w/Ham Chili Do Hot o D Chips Off-