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HomeMy WebLinkAboutTemp Food Inspection 151 Sand Hill Road VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor, CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date Name of Event Date of Event Time of Event Location of Event Event Coordinator _ -- 67 Event Coordinator Address_ J,!q Event Coordinator Phone# �'� � Event Coordinator E-Mail Address dr Event Coordinator Phone#(cell, work&home) Name of Applicant CZ� i?zkl Name of Applicants Business (please indicate if mobile vendor) S �,;,,�/ Applicants Address Applicants E-Mail Address /-1z — Applicants Phone#(cell, work&home) Set up time_ Please provide the following: (If any of the following does not apply to you put N/A) 2 1. List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. 2. Describe specifically howfozen, cold, and hot foods will be transported to the event. Na 3. List all places (name &address) where meats, poultry, seafood, shellfish, and ice will be purchased. IV/� - 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 2 6. Describe the number, location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8. Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. r 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11. Describe how colds foods will be kept cold(45 degrees and below). 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) ye-s- 3 r ATTACHMENT #1 LIST- OF INDIVIDUALS HANDLING FOOD NAME OF PHONE# ADDRESS SHIFT 2. 3. 4. 5. 6. 7. 8. 9. 10. 4 TEMPORARY FOOD SERVICE EVENT COORDINATOR' S APPLICATION This form must be filed 14 days prior to opening event.Application must be submitted to the Town of South Windsor Health Department at 1540 Sullivan Avenue, South Windsor,Connecticut 06074 Phone 860-644-2511 Extension 248 Fax 860-644-7280 This form is not a license. Temporary food events will not exceed of 1 to 5 days Name of Event r u,Yif Date(s)of Event Hours of Event /O%od �-I Number of Food Vendors ,�Ou/��/1i�,��T�2S_�C�'i��'iL`s/C�y�«�°de� Sw•2�i°l"���`�`s' r=oc�o Name of EvengCoordinator Address of Event Coordinator Leo Cell Phone J3 Home Phone#�� ���p�g,� Work Phone# E-mail Name of On-Sit+oordinator QFO (please check if On site coordinator is QFO and provide a copy of QFO certificate) List of Vendors attending event ze ;.1>O�iyJ9�acrr>� Each vendor must complete the Temporary Food Service Event Vendor Application. Application not received fourteen days prior to the event will not be accepted and the vendors will not be allowed to open for business. The Event coordinator must make arrangements 5 days in advance with the Town of South Windsor Health Department to determine the time of pre-will comply with the Connecticut Public Health Code and the Town of South Windsor Code of Ordinances. Signature of Event Coordinator Date �7 ('•\Tlnniimnnta an+l CattinrtelNrrh\AAv Tlnonm+*ntelRMacuhr+rry FnetlTrmnnranr Fn�+l C�rn•ii+iatnr Armlirati+m �11(1'7`inr. C� VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor,CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date A "7 1 Name of Event Date of Event Time of Event Location of Event Event Coordinator Event Coordinator Address g�D Event Coordinator Phone# o-06 O — Event Coordinator E-Mail Address 422�����G, Event Coordinator Phone#(cell, work&home) e::4�6.- V`f -3Z 7/ Name of Applicant _ Name of Applicants Business(please indicate if mobile vendor aJ�Z�j�, �u/w 7�, Applicants Address Applicants E-Mail Address �,�/�O� y�Aaz Jp Applicants Phone#(cell, work&home) Set up time �f��Q Please provide the following: (If any of the following does not apply to you put N/A) l.List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. ZeyJ�dd� /G� G�l�/`��•OGT IVd /$40.7' e L 3. List all places(name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. 4. List names, phone numbers, addresses,and shifts to be worked of all employees. See attachment#1. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 6. Describe the number,location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 2 8. Describe how wastewater will be collected, stored and disposed. -S 9. Describe the number and location of arbage containers. QGig�'/Uivg /�GILiGGS �erJ©o�l�- 10�iva�J is e"O", 6 Qy c�*JlZ 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). r 11. Describe how colds foods will be kept cold(45 de ees and below). ���i���>� �•Gr�Lem �C��/���G`�L'�Td�✓ T,LUce"O< 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no, where will foods be purchased?(enclose a copy of food license) 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. /70 G/s/Y'.G7ZlI/lr / G %,)" 2. 3. 6>01K— z 2lf�o �G y _�J�dO ✓�3 S�sr/��S�CC/.c� G/ 4. � � ST��� 6. 8. 9. 1 o, /Z/ 9'/ 4 • ATTACHMENT #2 avo lea D r t�a,vrsrS CHECKLIST FOR FOOD BOOTHNENDOR OPERATORS Metal probe thermometer(0—220 degrees F range) Thermometers for all refrigerators T/ Coolers and ice packs(if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil ✓ Extra utensils: tongs, spatulas, spoons, and knives -- Water source Buckets/tubs for washing, rinsing, sanitizing food equipment Bleach for sanitizing,test strips for checking Waste water disposal container Container(s)for grease collection Clean wiping cloths and a container to store them in Garbage containers and plastic bags Hats/hair restraints Crates, shelves to store food off of the ground Gloves for food handling Hand washing station R V VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor, CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date Name of Event i 0as o Q al�QQ� S Date of Event 9UM I v Time of Event 5 Location of Event 15 I N tOcl P1 I I 1i?4" S . W,f,ic(s Q Event Coordinator_ 0ji6 W RQU61i'CC n J16"r) Gmrn o[,uu' DI'C�l �jtit'I na 3d S-UlAdsQC Event Coordinator Address V6n5 I�oLl- Event Coordinator Phone# 94 o Cp q4 -3861 Event Coordinator E-Mail Address W%JW hi?r0 �ts� + 0 ri j Event Coordinator Phone# (cell,work&home) Name of Applicant TQ,tnG �pAZ[Qn Name of Applicants Business (please indicate if mobile vendor)_j&k etc V.A &-N Tomah Applicants Address oil Sat_ De. 61Usu-)-dd 6 - 6 6-3 C1 Applicants E-Mail Address ekows- Applicants Phone# (cell,work&home) 3W M10 ���v I N� 0 867 (3669LC Cat, Set up time 9 ,3 0-11M Please provide the following: (If any of the following does not apply to you put N/A) L Gam" 1. List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the event. 6Ac116PC61?0 - i rUPOLL d din jkun n C na�n d B64W Wab.4 Sa Ct- 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. �Icc,P.c'a n T�,� - Utj ,Co 3.List all places(name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. P�ck tb641 ed ro� Saes G - (,e� •nc ' 4.List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. `Zarv7a ZVoZfan Zl %"& DV- Ci ,s,W &c� Q'LA B u i2ns c2l S6& De-- g9csur3-ect 5.Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. r_ ;AtLS Yl a� CLaAA'9 KId +b�d T -& 2 6.Describe the number, location and set up of handwashing facilities to be used by employees. 0-�46& 03 6 M J&4ak47, 4-6n V- Pe- , US� (k1Q& anct cc S' -}fin L brew h WA to 7.Describe how and where utensil/equipment washing will take place.If no facilities are available, describe how alternate steps will be taken. 5 tan LW �ePC6f-0 K�rF 9, gam4i'ud I (A&Q 8.Describe how wastewater will be collected, stored and disposed. .P df dv, n k - Ue U me 'rc w 9.Describe the number and location of garbage containers. 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). fi 16 Q af Ce I N A-"Ve-d (! Q M ;J' 11.Describe how colds foods will be kept cold(45 degrees and below). -P� 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site?If no, where will foods be purchased?(enclose a copy of food license) pp a n - Pe- ♦Hack LA b�'s rkw 3 ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS SHIFT I. R,,,n AS-- 2. J,,j'� 3. 4. 5. 6. 7. 8. 9. 10. 4 ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS 016 Metal probe thermometer(0—220 degrees F range) AT Thermometers for all refrigerators +� Coolers and ice packs(if ice is to be used for cooling of foods, where is water to be drained) �1 Plastic wrap/Aluminum foil Extra utensils:tongs, spatulas, spoons, and knives !Se-6v p e! Water source - W+� �o p G� W�(s `( potabb {Yt d was % Buckets/tubs for washing, rinsing,sanitizing food equipment Bleach for sanitizing,test strips for checking _Waste water disposal container N Container(s) for grease collection Clean wiping cloths and a container to store them in Garbage containers and plastic bags Hats/hair restraints Crates, shelves to store food off of the ground TCt S Gloves for food handling _Hand washing station 5 VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor, CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date q-a&--(® Name of Event7c�,� Sl U�Q Date of Event j l Time of Event qa 0D Location of Event Event Coordinator Event Coordinator Address 0 s� �� , 45, /,�7c.Ycc(so,� Event Coordinator Phone# �cQC1—" p� -- M0 Event Coordinator E-Mail Address Event Coordinator Phone#(cell,work&home) Name of Applicant ! /f G� Name of Applicants Business (please indicate if mobile vendor) &N Applicants Address P�, 46X 660 Applicants E-Mail Address L6 c�Jc &9907_A 1%��44 Applicants Phone# (cell,work&home) Set up time �1;50 *-/11 Please provide the following: (If any of the following does not apply to you put N/A) �4 d4/ 6 2 1. List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. h Ysewgoeh 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 3.List all places (name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. / 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 2 J a ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1.3. 2. /"pooh' (4. tVu c s. 6. 7. 8. 9. 10. 4 6.Describe the number, location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8.Describe how wastewater will be collected, stored and disposed. 9.Describe the number and location of garbage containers. � ) �n � 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11. Describe how colds foods will be kept cold(45 degrees and below). 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site?If no,where will foods be purchased? (enclose a copy of food license) 3 . � � � ��_ �- �"°� F`.� �o� a R VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor, CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date 5-a6 - o to Name of Event 3b-7qw6er%rcu pt_osby8- Date of Event Jo ne !c Time of Event Q— 5PM Location of Event IM Sacd 14-7 IjRIA Event Coordinator SW e py 61%c a0 �i�J r) Ob m m I +ez Event Coordinator Address C Dewm& Lre. OY I V0e.. n d. ;Or- Event Coordinator Phone# &C>C) (D (4�- 3$(QCI Event Coordinator E-Mail Address Event Coordinator Phone#(cell,work&home) Name of Applicant C?r2Jt)P--- (d Name of Applicants Business (please indicate if mobile vendor) Applicants Address Ytt_t._� Iy J land C1 0(oOW Applicants E-Mail Address F('IS4US2aoZ.cOm Applicants Phone#(cell,work&home) &O R4,4 14 Set up time 2;45 Please provide the following: (If any of the following does not apply to you put N/A) 2 1. List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. _ c 1 NCN B AQS , 1, c keC?) 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 1-�J'4 3. List all places (name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. /N 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 5.Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. have 1A0+ been 3t5k! C 44, 2 6. Describe the number,location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8. Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). fOo 11. Describe how colds foods will be kept cold(45 degrees and below). Iv/A 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no,where will foods be purchased? (enclose a copy of food license) - (Pro8 urJ s sr-e, Re f.A& 28 3 ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS SHIFT Whom M- Dan r► 2. 3. 4. 5. 6. 7. 8. 9. 10. 4 ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS Metal probe thermometer(0—220 degrees F range) Thermometers for all refrigerators N/A—Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil /A Extra utensils: tongs, spatulas, spoons, and knives Water source k Buckets/tubs for washing, rinsing, sanitizing food equipment Bleach for sanitizing,test strips for checking Waste water disposal container k Container(s) for grease collection 14 Clean wiping cloths and a container to store them in r Garbage containers and plastic bags 1� Hats/hair restraints Crates, shelves to store food off of the ground Gloves for food handling in �4'a+ N Hand washing station 5 VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event.This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor,CT 06074. This application is not allicense.Temporary food permits will not exceed a period of 1 to 5 days. Today's Date • f r Name of Event �'d tJ-(h 11�I NG{Sd l'Z b�1/C� eSfi� G Date of Event Time of Event J 630 Location of Event A) C U 8n k 061 CL V k Event Coordinator 21 C V e Event Coordinator Address 8. Event Coordinator Phone# 2&6 ~ lo4 4—"-�qL Event Coordinator E-Mail Address Event Coordinator Phone# (cell,work&home) Name of Applicant wu -cLK Name of Applicants Business(please indicate if mobile vendor) (YW L Gt9_& Applicants Address d V 7 � �D l- � U 1 d a)Sk Applicants E-Mail Address K\U L 6-e— k8t S-bje,ie \]A A 00 ( d✓�'1 Applicants Phone#(cell,work&home) C)C)_� Set up time D A Y� Please provide the following: (If any of the following does not apply to you put N/A) 2 1. List all food and beverage items to be prepared and served(menu).Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. p u�,d A JJ tl-e-C-ro JdAA A-fa 2.Describe specifically how frozen,cold, and hot foods will be transported to the event. ce 3.List all places(name&address)where meats,poultry, seafood, shellfish,and ice will be purchased. 4. List names,phone numbers,addresses, and shifts to be worked of all employees. See attachment#1. L1 C o 5.Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 2UCo 040 6.Describe the number, location and set up of handwashing facilities to be used by employees. l -tJ D N g -VOA) 7.Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. U�`e PLAS+tc, cv 0U) )►v 8.Describe how wastewater will be collected,stored and disposed. !N i eV c k e. 4- 9.Describe the number and location of garbage containers. pLJ00 �j-2 S� �"h �ri e tom e p 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11.Describe how colds foods will be kept cold(45 degrees and below). D i c e lz-S 12.Describe how food temperatures are monitored. tt JJ -�b Iz o � d v + 0 � (�.� ' �r I+V -C --k 2 M d�-eg 13.Will foods be prepared on site?If no,where will foods be purchased? (enclose a copy of food license) 3 ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. spa- /,,1 L S6 ds 5a a-ca-Q-Q- 2 ly\, I+ J, o s)s r 3. 4. 5. 6. 7. 8. 9. 10. 4 A A-,o AA,�k"� --, /?o t./ VENDOR APPUCATION FOR TEMpORARY roOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event.This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor,CT 06074. This application is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date Name of Event �.r �6 -,r I �;�e7 �r- Date of Event Time of Event Location of Event Event Coordinator /LP , rYJ i Pe le / �/ —� r Event Coordinator Address 3O J�Pt ow.5 �>r, Event Coordinator Phone# -Fk::2 Event Coordinator E-Mail Address /V Event Coordinator Phone#(cell,work&home) Name of Applicant ! ho.4"S 4" h Name of Applicants Business(please indicate if mobile vendor)A///C �Pgr/Z' q�vC�S L� Applicants Address /j L / p 0 90 Applicants E-Mail Address i Pa Applicants Phone#(cell,work&home) ��Q-�a7-.S3DO Set up time Please provide the following:(If any of the following does not apply to you put N/A) 2 1. List all food and beverage items to be prepared and served(menu).Attach a separate sheet if necessary. NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the event. , die w;l� he iv,r11 Cv� ter•7�� 4 1�f ale l,-f� � ✓� ��gS rc Cfi�s w � Y'� �t� t,b, heeac� i n 4-P bKeqC/ 2. Describe specifically how frozen,cold,and hot foods will beLtrans/p��rted to the ev nt. /� A U r rr0'C��C T S R �E' > 5��/z°l�� v© T(�"S c�(� ( Q yc�9✓ S z'/y" 1 r P. O� grvc�r° i s c�� c� 6,f U/-���-r�►-�P �, s Puy h4 L �/� 9116 �t/P O r ✓r cKP 7` y 3.List all places(name&address)where meats,poultry, seafood,shellfish,and ice will be purchased. r� 4.List names,phone numbers, addresses,and shifts to be worked of all employees. See attachment#1. Mq5 // ,1/hw n S6O --3575306 /?Y,, 41141 ?-'-c- 36 73W5- 5.Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 2 6.Describe the number,location/and set up oo handwashing facilities to be US7 employees. 71 if hive 5;-o4 , f i 7.Describe how and where utensil/equipment washing will take place.If no facilities are available, describe how alternate steps will be taken. ;�� � U5 r7 0//r S -F//gin or�cl wto �'y�l n l 4Ao �� 5 e ve/ �crr� r S , (�/{ c!/5-0 w �l �evf q 5q" i //Zer o✓► s'/;le , 8.Describe how wastewater will be collected, stored and disposed. 9.Describe th/e number and location of garbage c/ontaine>rs. r/r7/ q.� 1 0� S 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). 7r---1gh1P 95 , 11.Describe how colds foods will be kept cold(45 degrees and below). lj/,4- 12.Describe how food emperatures are monitored. 1tr r rhon r' � 13. Will foods be prepared on site?If no,where will foods be purchased?(enclose a copy of food license) / U 3 ATTACHMENT #2 CHECKLIST FOR FOOD BOOTHIVENDOR OPERATORS Metal probe thermometer(0—220 degrees F range) Thermometers for all refrigerators Coolers and ice packs(if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil Extra utensils:tongs, spatulas, spoons,and knives Water source Buckets/tubs for washing,rinsing,sanitizing food equipment / Bleach for sanitizing,test strips for checking Waste water disposal container Container(s)for grease collection -i Clean wiping cloths and a container to store them in Garbage containers and plastic bags Hats/hair restraints '-� Crates, shelves to store food off of the ground Gloves for food handling y Hand washing station rej r i s `aDq �c�t v c I�e snre7P q vot v 5 ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS c-T IF SHT 1� �2S i'/ �9 �G' ��S3o� ?- /olY�rJS ✓r cfi` 2. 3. lC,r�r� q�h9r� ��� 3o S 35�C rfi� 4. 5. ��n eO 6. 7. 8. 9. 10. 4 VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event.This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue,South Windsor, CT 06074. This application is not a license.Temporary food permits will not exceed a period of 1 to 5 days. Today's Date �� ( -to Name of Event /Q( p Date of Event 1 Time of Event 17a 00 a Location of Event mL ges UG Event Coordinator (,, Event Coordinator Address % C��1 � 2 _ I�� St 4JG4,qdSC,1- Event Coordinator Phone# � Event Coordinator E-Mail Address Event Coordinator Phone#(cell,work&home) Name of Applicant ,) L, U,�T � Name of Applicants Business(please indicate if mobile vendor) N! Applicants Address Applicants E-Mail Address ,�.��� Applicants Phone#(cell, work&home) !=t5" Set up time "r.30 1 'dz t Please provide the following: (If any of the following does not apply to you put N/A) 2 1. List all food and beverage items to be prepared and served(menu).Attach a separate sheet if necessary. NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the event. ( ,{ yS� ©(S�� 2.Describe specifically how frozen,cold,and hot foods will be transported to the event. 3.List all places(name&address)where meats,poultry,seafood,shellfish, and ice will be purchased. ids / #Nt---PAr a-7L- 4.List names,phone numbers, addresses,and;shifls to be worked of all employees. See attachment#1. 5.Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 2 ATTACHMENT #1 LIST OF INDIVIDUALS HANDLING FOOD NAME OF EMPLOYEE PHONE# ADDRESS SHIFT vit -7'70 2. ),�UkAy 661 W644( R60 4. ML6&W 0 6q5'/7klJ Xfi 5. 6. 7. 8. 9. 10. 4 6.Describe the number, location and set up of handwashing facilities to be used by employees. J1,a�_ 7.Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8.Describe how wastewater will be collected, stored and disposed./ Of 9.Describe the number and location of garbage containers. 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11.Describe how colds foods will be kept cold(45 degrees and below). 12.Describe how food temperatures are monitored. 13. Will foods be prepared on site?If no,where will foods be purchased?(enclose a copy of food license) 3