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HomeMy WebLinkAboutGetty Mart 561 Sullivan Ave v EHS-106-Rev.06/01 INSPECTION REPORT STATE OF CONNECTICUT Mt 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 �J' ,`-� 1�41IZ.- CLASS STREET qi /� A r?� J t I 1 uwi) v E'� TOWN ADDRESS SOLI'CH WS N pSU2 OWNER or INSPECTION OPERATOR DATE and TIME O eA 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 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 Accurate 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 preparation,display,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required transportation equipment clean 9 1 46 Floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipmentlutensils,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 adequate,safe 29 Water source ade q 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 provided as required surfaces as required. 2 8 Food containers stored off floor 50 1 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 1 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic items properly stored,labeled,used 4 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 required 12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 4 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1 13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean _.personnel hands washed.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 7approved uitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 hand drying devices provided, and laundry maintained,installed,located ssue 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/RLIBBISH STORAGE&DISPOSAL (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- 59 1 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area 1 indicated by 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 X _ 62 Written documentation of training program 2 Signature of PersQp in charge P TOTAL RATING Date Corrections Due /]- t 0 ,.,0 _ SIGNED(Insp /J DESCRIBE DEFICIE I N CONTINUATION SHEETS r Page of 1 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF OF ESTABLISHMEENNT TOWN DATE OF INSPECTION I ' ►Inc ' �d� y W1njsv( 6)J01 INSPECTION FORM# REMARKS NdrE}- LL U`p�aT1��5 c` -}'I'Ni�, o� �Pi l� �,� j�•r INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) 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 N OF ES LISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS G a INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: 4,4 Inspection Date: Time: R0[nsp RE[nsp ddress/City: Health Dept: Class: 1�3 4 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 IDNC KEY: C[complies] N/0[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 ` Pr + tel'watli''iri#ectaonr'estr"ice"tad' 61' Ds signatedi4lerrie` ,"rr 2 _ NtA 4 62 Written documentation of training program . 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 100 7 Approved source,-wholesome,nonadrtiterated C NFO N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handwast�ing facltdes provided,handswastd,than C NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nOnadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms or 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 07 E Handwashing at appropriate times F4- W gyre � �t o 15'food Ftrgre>rii� raci'ces C N/b'"NfE1 2 A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating Of0 E Proper internal cooking I consumer advisory posted t � r 0 A Approved sanitizeravailable/adequate concentration of sanitizer s 1 � B Food-contact surfaces and utensils used for potentially rtpf hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 �,` MY sglvr+ ail tr#�rs Oran,,ft A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods O C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards I sneeze guard g Single use gloves changed when soiled E No unauthorized personnel VC Food--contact surfaces clean F44o pooling of eggs not cooked immediately 8 ood containers stored off the floor 00,Je 0 * Sit rn%n n�ec° 71 _t NZA` Z A No unnecessary handling RTE and/or cooked foods with bare hands 000, A Soap I 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 00, 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] 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 at 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 re a food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? *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 ge barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: 0/D *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate io 4swered 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 Sling 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 ♦Desc' what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page f of 2 REstablishment: Date of Inspection: C� ddress: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4: 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required -Potentially hazardous foods not re-served 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 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 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 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floorcovering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 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 481 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 2 rate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean nfood-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 wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) ,/<36 Yet rooms enclosed with self-closing door -31 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,cl an ❑Routine Inspection 1UReinspection ❑ Preoperational Inspection Other Inspection: E P ININ CHARGE: Demerit Score: *Include demerits from page 1 CQ�-q— 4 3 2 1 Total IRating ure � � signature Z'Z lfrini-nam print name 2s-1 A S,- phone number tide DATE CORRECTIONS DUE: e ins ,er , Page 2 of 2 plus continuation pages Focused Inspectlonll22 Sp-NN Sfq x S-� V&U&Ot a ` s � w� 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 Sox.co�' TELEPHONE (860) 644-2511 February 5,2009 Azkar Chaudhry Getty Mart 561 Sullivan Avenue South Windsor,CT 06074 Re: Food Service inspection for The Getty Mart located at 561 Sullivan Avenue, South Windsor, Connecticut Dear Mr. Chaudhry: On February 5, 2009 a food service inspection was conducted at The Getty Mart located at 561 Sullivan Avenue, South Windsor,Connecticut. At the time of the inspection,the rating score was 84 with One(1)4-demerit point item in violation. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO 4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511 ext.248. Sincerely, Robert De Vito,R.S. Environmental Health Officer Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TO N DATE OF INSPECTION ll S LJ �1 s� S -7 INSPECTION FORM# REMARKS Lei- y CA,` O 47 _sa� (G ��7z� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager �� a. EZ Establishment: Date of Inspection:FY Address: _ 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 g 11 Toxic chemicals. 34 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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food:Original container,properly labeled 40 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 2 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 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, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good re air,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 0 stless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 1 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 531 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 premisesfreeof lifter,noinsect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 koilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean JJRRoutIne Inspection ❑Reinspection ❑ Preoperational Inspection I T PERSON IN CHARGE: Ot Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating atu si ature r print name print name 2� 1 DAT CORRECTIONS D E: 11 K/ VV phone number title G 107 /�.{,� Page 2 of 2 plus continuation pages Focused Inspection I/2002 Establishment: Inspection Date: Time: ROinsp REinsp ddress/City: Health Dept: ' class: 10 3 4 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 C KEY: C[complies] N/O[not observed] NIA[not applicable] DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Aerhatc` 12�;P i drr iel vdt ifdJiWdA"efttk16t9d� C WA 4' 62 Written documentation of training program 2 A Food workers have no exposed infected lesions I burns B Personnel with infection restricted 1 Approved source,witotesome,nonadalterated C Pt/0 N/A C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultryUSDA approved drryashin`g facilities provided,hands washed,clean C p}{ B Food cans in good Condition(not dented,rusty,bloated,leaking) 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 E 0 Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure E Handwashing at appropriate times e Q R T cil ttjg[e is pradfices C WO N/A 2" A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 F.) ❑ No eating El smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling Proper sink used for handwashing D Proper re-heating E Proper internal cooking/consumer advisory posted _ 0 proved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially k hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp L Proper sanitizin rocedure B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units dip aY+Al eiw�ce lart!tia�isSctrEation Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 V - t 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 I 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 8 tood containers stored off the floor (10 III IS son w f mg.:���:: ., A No unnecessary handling RTE andlorcooked 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 0 111111111110 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food], FB[foodborne] PHFs are hot held at: IF. 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 poll tyres the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to . 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 Ty!1`017A nguage barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: ♦Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monit of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW •Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N cribe what is washed and inspection: —i where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Page_of_ R-c INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION impection Form M 1 t r N zt&= i INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager c:kat\smfmm2.cn Establishment: Inspection Date: Time: RO[nsp Einsp Address/City: Health Dept: s .��,lJ, dL�2' Class; 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/0 N/A jDNV KEY: C[complies] NIO[not observed] N/A[not applicable] �0113 DNC[does not comply] 0[other] RTE[ready-to-eat] a t In tc" Of, of It"Ilttt� g�rc�grl�t y A Food workers have no exposed infected lesions/burns 62 B Personnel with infection restricted Qpp iV�tl'$b E Y1f<itD7850 ' adt ittfai6d C=PO WA 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA a roved '13 Ha rtdi+vasihing fecilities provided,binds;;iiW,dean G'..]�UO° NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe 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 0 D Personnel hands washed,clean/Proper handwash procedure - E Handwashing at appropriate times ol NON 0 WN��._ , 'X W�"' 2" A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 13o°E) A_ ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately 011 C Proper cooling V1C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted SEMEN 0 A Approved sanitizeravailable/adequate concentration ofsanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Foodthermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food O 0 A Cloths and/or sponges in good repair and clean A Produce washed ' B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard "Sine ves changed when soiled E No unauthorized personnel surfaces clean o pooling of eggs not cooked immediatelyood containers stored off the floor g A Soap/paper towels/Ydrying device available A No unnecessary handling RTE and/or cooked foods with bare hands 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 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. 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 ea th department? Roasts Other Describe re-heating procedures: Is there a written ill at requires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? Y N an a 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 Is there a languag er between inspector&QFO? Y N ff-ps 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 questio�fhheQrFoplr-e ( rint): Indicate the title of above person(circle al QFO DA Mgr Cook Owner FW Is cooling monitored for time&te. Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received sib ties 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 �. Establishment: Date of Inspection: ddress: AA Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] LZI 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 74 No cross connections,back siphonage,backflow 11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap : -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks , -No unnecessary toxics on the premises -Chemical dispensers -Ice machines s -Pesticides/rodenticides properly dispensed r ' Proper drain fors 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 storagearealrooms,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 43 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, 45 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 8 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing 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 7 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premisesfree of litter,no insect/rodent harborage, 8 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 6 filet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovfided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent pro f,clean ❑Routine Inspection I EkReinspection D Preoperational Inspection IN R: PERSON IN CHARGE: Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating s' to signature l Z print name mt na M / _Lllar phone number 1 title C�.a DATE CORRECTIONS DUE: " Q Page 2 of 2 plus continuation pages Focused Inspection 1/2002 • MUM t DATE OF INSPECTION M0.4911 _ _- �ME. _ -Z WHOM r/� ►Ui , wri , �� - - v MA - Liilri . . � ! & , INITIAL •. , / (PERSONINITIAL y , 7ah Date of Inspection. 7 f Owner or Operator: ADDITIONAL FOUR POINT ITEMS 6 Foods not re-served. KEY: DNC [DOES NOT COMPLY] y 4-Unwrapped foods not re-served 31 Sewage disposal approved.-Operating as required 4 -Potentially hazardous foods not re-served 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 -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed 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 designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 1 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/moms,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 43,Outer openings protected against entrance of insects/rodents 4 Floors: Floorcovering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,walljuncture covered 7 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 481 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 501 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils• Cleanliness 5 11 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash waterclean,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 7 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of lifter,noinsect/rodentharborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 561 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly MEN 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean Rkutine Inspection ❑Reinspection ❑ Preoperational Inspection T PERSON IN CHARGE: Othe nspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating vL / pri t name ri t na e tf7HA TO DATE CORRECTIONS DU : phone number title Page 2 of 2 plus continuation pages Focused Inspection 112112 i Establishment: Inspection Date: - -6 Y Time:t ROinsp REinsp Address,City: Health Dept: S, &A ,VJ,Q ®v class: G)3 4 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 JDNCKEY: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 e tdr iri# Eaa7" tic " i `N/A 4' A Food workers ve no exposed infected lesions/burns 5527, °Wen tl6tipthettioa tng prtgrn ha2 B Personnel with infection restricted ApptOi►BdsQ Ce,wttolBSdpie,rton3tEUl efatt El C N/0 /A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 13 Handmshilag facilities provided,hands washed,clean CVol NIA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe 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 1400F. (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 00, D Proper re-heating 0 E Proper internal cooking/consumer advisory posted .,. 0 Approved sanitizeravailableladequate concentration ofsanitizer 01 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 L Proper sanitizin B Properfood thermometer for product procedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods 0 C Food covered properly MEWS 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 ood containers stored off the floor z 0 n A Soap I paper towels I drying device available A No unnecessary handling RTE and/or cooked foods with bare hands B Dispensers)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands I VV I Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 O •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. -KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. 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 ♦ d sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is a Ian u etween inspector&QFO? Y N 1Lyes indicate language spoken List products cooled: A: *Can the CFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered t ove questions: Name(print): Is coolingmonitored for time&tern Y N Is them Indicate the title of above person(ct II that apply):QFO DA Mgr Cook Owner FW p• g of cooling recorded? Y N .Obtain signature of the person who receive FO responsibilities information at the time of the Is there a produce washing policy? Y ♦Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 ••• NUVIOU • I • IMMMIM NAIgE OF i DATEOF • /l �J it YAM i MTN :1_�r. Xi Establishment: GeTt'i AJ\e-t,, _Z E XP2ze-,S Date of Inspection: -IT-L- ddress: Owner or Operator:`tjik,iA M 1 z FA a-0a � ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 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 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 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 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 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 8 Exterior walking,driving surfaces,good repair,clean 1Ingle service articles,storage,dispensing 19 No reuse of single service article Ils,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 2 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of wastewater 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 PropertoiletfixturesprovIded,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean JoRoutine Inspection ❑Reinspection ❑ Preoperational Inspection X., INSPECTOR: PERSON IN CHARGE: Other inspection: � � Demerit Score: *Include demerits from page 1 4� 4 3 2 1 Total Rating signature signature print name print name — phone number title DATE CORRECTIONS DUE: 2 t 2 �} CQSH;F Page 2 of 2 plus 1 continuation pages Focused Inspection l@002 Page of .,>� INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET CLAS NAME OF ESTABLISHMENT TOWN 5(p` SQLi-W ' ,3 DATE OF INSPECTION Zx)S (T)(Pe ,;5 C„siA�¢r Sc�11-1 w ,�,pSa2 2 INSPECTION FORM# REMARKS wv- PPeb 0(z uc� s��+p sT22�QS 2-7 o�F- 63-z) TD rs f C LEaw&, Zy 2 .jASu- a+wcA - sAW«IX C&ZF r Pbr" OC,-S- 1 Lr T'O B-cS 2,PLAc.,st AS ►vvxt,6 C:.oetse. 350 F INITIAL(INSPECTOR) /L� INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager i Establishment: ZNS oEXPeZ< , ��' MA-e Inspection Date: 3 ,z I c g Time: I Ii REinsp Address/City: 5101 SoLL vs�yo A.t Health Dept: clas 2 3 4 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 WO NIA tPNC I KEY: C[complies] N/0[not observed] NIA[not applicable] i 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12 ` hersadi el sirs rife x i est c# d C N/0'NfA 4 tit Designated Attesaate � 2 q Food workers have no exposed infected lesions/burns 62 Writtep documentation of training program:. 2 B Personnel with infection restricted 1 Approved source,wholesome,nattad�lterated C N/0 N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 131 HandwashhV facilities provided,hands washed,dm C N/0 N/A 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A I Handwash facilities in all food prep/dispensing&warewash areas VIL C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) VC Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 an washing at appropriate times 0 aceaad e f 15 G©od' iy j ii"d pfiac#Ices C PO NIA 2 A Hot holding greater than or equal to 140oF. (whole beef/pork roasts 130e F.) A KNo eating No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately 70 C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted f 0 A Approved sanitizeravailableladequate concentration ofsanitizer air at[es;#q€ rdaiak prods # Cayq � ,' B Food contact surfaces and utensils used for potentially erare; ©tteters�Poan f hazardous food sanitized at least every 4 hours _ � �= , A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food r a fp A Cloths and/orsponges in ood re air and clean dtispiay,service arld transportation9 p 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 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 'C" CiNA2, -O. ,3:' .,� � . .... _. .,. i-R, A No unnecessary handling RTE and/or cooked foods with bare hands Soap/paper towels I 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 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: IF. 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 If yes 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 9 TOWN OF SOUTH WINDSOR STAFF SITE CHANGE FOR SITE & SUBDIVISION GENERAL: ! CHANGE ORDER CONTACT PERSON SSG T_S�t° s Phone No. s Ott Address_ f, ty}y.i�t� Q �SCo sv/l/ V av,, AU Site Name 6,E' ''-i c,r- ' P&Z No. Owner cf, ry Phone No.'b7"4 Contractor (e(Al c r(A+0 Signature of Owner Date: Signature of Design Engr. Date: CHANGE: (Describe location and nature of change. Include Four (4) copies of plan/profile of Change. ) R 00 P�74 Z �t� S S , Ac, �A� cA Reason for Change: (Why is change required) APPROVALS: (As Required) ASfDir. Of Planning .l Date: 3 C Town Engineer Date: Dir. of Public Works Date: Other: Date: STAFF COMMENTS: White - Town Engineer Yellow - Applicant Pink - Director of Planning Goldenrod - Engineering Department t i t s , ._._:— _ ..._ ___.--_._ _.. ._ ._ _-•,._may - -s 01I07/2008 �. 77 2't, � et 2,21 01/07/2008 LIMIT OF 80' \\ \ \ UPLAND REVIEW AREA \\ EXIST, GRAVEL \ / / PARKING LOT \ / 7 TFI74.3•H / AP ROX.030ATES CARS XISTI TR INE �\ IN 6 TR ER SEWER AS—�pWILTS ♦ t / \ 1 12" TRqZE SNET#2518 B FLAG PO \ 8 JH AEl W/LA SC LAND PE \ 7 \\ A BO 3 81 R C TE DUM R / CONVERT EXISI7 \ do E LOSU CB TO SMH SEE AIL E T TO CLOSE TOP Dpp�, / ® DUMPSTER \ C.B. �0 pAD �i 0 BE RELOCATL EXIST. LAV�� � ; DI,SCCHARGE 0 SA . SEWER R OCAT 500 ON ROPA TAN I 12' APLE I TOI E REMO \\ \ � \ I 2 V I 1 \\ EXIST. BUILDING 75, GRAVEL t 7 STRONG ROAD )C 0 ' 7779 S.F. / NEW BIT. UR /^ L 3H: W i N A C \ ' f M.H. \V \ J L �\ ROP E ONS VAII \-' ss PHASE 2 CDN\` Q FUTURE EXPA SIGN W PROPAA TANK DC. . ASE NT 1 5 A 'i � ((500 GA N 4048 S.F. � / � \TO BE Rt FF:78.50 \ T R \\� / 4 9 S. o _urv' o / 1 CAl ° / •../ PHASE 7 / 5 I 3 27 S.F. / /a PROP'.•AADppITION I SEE R 1 OW- 6 DP / 7ASH BAY FF:78.>3" ••.,• I \ FO P S " — 51AIF1 EXIS G T LINE E k 6 \ -7 5 S SEPARAM PROP. YET7T LSE BIT. PAVEMENT j j t C OFF \ YPE LLW oy C / i / BU PR P SED RAP AK /� / r J 1 // EXIST. BUILDING 17 y 5,000 S.F. EDP Of- SIN BUS PARKING BUSES)