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HomeMy WebLinkAboutTemp Food Inspection 150 Nevers Road 07/09/2008 19:18 FAX 860 648 5048 SOUTH WINDSOR RECREATION �1001 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 SOMnL'r Cron 1 �i�r;�5 bate( )of Event s r Hours of Event Nurz>,ber of Food Vendors One- Name of Event Coordinator Sown 04 �, Address of Event Coordinator �Sb Navt* 0'Ay, 04 x -(r, 4ap7'1 Cell Phone#. Home Phone# Work Phone# E-Mail ("can �,,,,r ja c,�,ld��ary Name of On—Site Coordinator_quo e- or �� 3" OL"1 QFO (please check if On site coordinator is QFO and provide a copy of QFO certificate) List of Vendors attending event 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 �J bate -7h/D$ C:\Document5 and.Settin9s\r3ranzkane\Loca1 SettinsskTempomry Intemat Files\OLK4\Temporary Food Coordinator Application 2007.dou t VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS \\sthfile001\users\robertmdevito\Desktop\Temporary Food Vendor Application 2007.doc 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 (,D Location of EventU( V I� �j( �(�� Ic Event Coordinator Event Coordinator Address C S eV Y-f K Gk—YkI Event Coordinator Phone# Event Coordinator E-Mail Address (PC-'St U tZ , LOW) Event Coordinator Phone#(cell, work&home) PfiCf 1�61CD b— LA 3 Name of Applicant Name of Applicants Business (please indicate if mobile vendor) JAd� � ��/ ' Applicants Address I�Ul�j Ly Applicants E-Mail Address CA Yd V V_ MbLy Applicants Phone#(cell, work &home) Set up time Dyn Please provide the following: (If any of the following does not apply to you put N/A) I.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 V"- neA a 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. COK�a hcv� bf wad t ��\6UA CVAC-S " � S U� WK O-R-y v61-0 . U-) LL�' � ( l T-,P Vr` • ` 'e MON o 1 n n.Q�• 3. List all places (name& address)where meats, poultry, seafood, shellfish, and ice will be purchased. +kV eu ' I�PI�` s vCKCIDV � 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. kpt1'tO( bdbc' jili Toth to U(� _��b 5-�D w se attachment#2 in this packet to sketch a drawing showing the event area and where your peration will be., 6. Describe the number, location and set up of handwashing facilities to be used by employees. Co -Iftvft� �O/ [fVC1V ( (�Ab m to V nA CA �- t�i��l ���� l i e,Vffat� cr�- ro,NO Sri D � � S 7. Describe how and where utensil/equipment washing wil take place. If no facilities are available, describe how alternate steps will be taken. Pvt -"�pp �o �eC1 ova ta.-Dlf- 8. Describe how wastewater will b collected, stored and disposed. mop Y bV1 d cd UA 9. Describe the numberr and location of containers.b� S:,t�up w garbage �\ 6,.,V-C a ) 10. Describe wha heat source will b6 u ed to keep hot foods hot(140 degrees and above). �-'k I 11. Describe how colds foods will be kept colSt ees and below). 6K I�bl-c U b� _tc(' ko w A ; l ( to w-p S e d- 12. Describe how food tern eratures e In nitored cleaned an s ized. �t a. ,� � d tsc�vded ���VIRdseop MAKba V 11 ut ftt .% `QC�2 (.,� S Sty �I13ki11fooreparecT on site'?If no, where will lbods be purchased? (enclose copy of food license) 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. 2. sc 3. 4. 5. 6. 7. 8. 9. 10. ATTACHMENT #2 CHECKLIST FOR FOOD BOOTHNENDOR OPERATORS Metal probe thermometer(0 220 degrees F range) Thermometers for all refrigerators KDP acoolers and ice packs (if ice is to be used for cooling of foods,where is water to be drained) V-T Plastic wrap/Aluminum foil N I I i-� Extra utensils: tongs, spatulas, spoons, and knives �S 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 S Garbage containers and plastic bags 4 SHat air restraints Crates, shelves to store food off of the ground SGloves for food handling t-S Hand washing station 5 �ye�uU S S 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 i to 5 days Name of Eventtb vyfm> CAn w_+ Str i: &o& Date(s) of Event 7/3( ��-1 + �/I4 Hours of Event &:;51 t7Y14- 4 : �yyL Number of Food Vendors j Name of Event Coordinator 01MAX-4-0 M l l?_-4J / ( l0(,t, �r�,yt�Z{ S-,76L / g" Address of Event Coordinator. 1�1 I ��/�t�L( 1'(.�� �/�/�U 9 3 �OUM/L 642 0?T Cell Phone# 8.e0 q4b 457gHome Phone# Work Phone# E-Mail vv, Name of On-Site Coordinator 01 L16 U ( ,ylt"L W skli QFO (please check if On site coordinator is QFO and provide a copy of QFO certificate) List of Vendors attending event uk mn yt& CtY, v) 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 Hartford Municipal Code Signature of Event Coordinator. Date r'C—D \\sthfile001\users\robertmdevito\Desktop\Temporary Food Coordinator Application 2007.doc MAY-29-2008 04 :59 AM Sherrie and Mike Allen 1 860 923 2855 P. 03 itKri��i luutl/wtL !Z:�I YN MUM WALK FAX No, 860 432 3484 P. 002 VSNDOR APDucmox roR TxmipoRARY FOOD EVENT The VENDOR of tab temporary food Mat must oomplete Chia application and must be filed 14 days Prior to the operning VML This applioation must be submitted to the Town of South Windsor Health Dep+armo►evut, 1540 Sullivan Aveltim,South Windsor, CT 06074, Thls Aonllcatfon!4 not a_ ,Tmpormy food permits will not exceed a period of 1 to S days. Today's Date S -Z 1 ' 0 8 Name oPEvent �SU rnMP_(- &n Date of Event Avch 7 A ,j I D Time of,Event nn - CI .O© _•,,,,, Y.ocation of Event.,_�C y ere Event Coordinator Z. b e . Event Coordinator Address So i I've r aln Wo_ 5 v'r�Z. 5'03 So v+i,, Vj',Aka', c7. rmt Coordinator Phone# 60 Z ' 3 3 9 F Evleat Coordinator E-Mail Address_-Clyl V.e Q m I i 4 y/e o►'-, Event Coordinator Phone#(cell,work&home)_ 860) t1 ' 7 - 3317 Name of Applioant�„ �s�k� ���2•. Name of Applicants Busineas(please indicate if mobile vandor) �u k� + -I e ��� �✓ho�O l'(�� Applicants Address .5 0 6 kgxvt n a qy G r�s V 4-A0-1 e-. C.vr cS6 z Applicants E-Mail Address S 1,er-N,r kL_: y 0 eh v Applicants.Phone#(cell,work&home) - 0 Z3 - n ss Set up time S s 00 ,o,', Please provide the following:(If any of the following does not apply to you put N/A) 111st gA food and beverage items to be prepared and served(menu),Attach it separate sheet if necessary-, NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the Gwent, z - - - - - - - -- -- - - - ,�PY/'l8/2008/WE➢ 12: 1 PM EVERGREEN WALE FAX R�). 860 432 3484 2.Describe specifically bow frozen, cold,and hot foods will be transported to the event, �j j A I List all plw=(name&address)where meats,poultry,seafood,shellfish,and ice Urill be purchased, N1A 4. foist names,phone numbcrs, addresses,and shifts to be worked of all employees, See attachment#1. Dca.�rlQt� oP ero.-'�� 5.Use attachment 02 in this packet to sketch a drawing showing the event area and where your operation will be. b.Describe tho number,location and set up of hendwashing facilities to be used by employees. I- S f kv- �O o�'rw-a- (o✓15' W ov- irk n7t ,ner cv t� 5 P o u+- aid` Goes b U c,� w Z 0,,,- 1.r d\ -wL4 5C^P, 7.DescnU}sow and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. t�•.�2 I—v-a— o c.c e s s -� a. Lo r►�,ti.,c r�.ram( k ��.� 2 0 Jll Y-1 IL FAX No. 860 436^1 .3481 1AY/28,19.008AED 11':32 PM EVERGREEN WALK P. 0.04 S.Describe how wastewater will be collected, stored and disposed. e—o t t e-c4e� IYN c;-- by C,Ke-+ c,,S,� I t al, � 4---k-e-r\ V,,b vv,.P- eo-x-�, ni-gVN+ evvy�te,4\, 9.Describe the number and location of garbage containers. - 5"5 bE'VN:ZJ" 10.Describe what heat gource will be used to keep hot foods hot(140 degrees and above). N/ A 11.Describe how colds foods will be kept cold(45 degrees and below), N/ (a 12.Describe bow Food temperatures at monitored,cleaned and sanitizod. 0 / t4 13.Will foods be prepared on site?If no,where will foods be p=hwed?(enclose copy of food license) YV5 3 t . 10' Table for supplies (popcorn, sugar,oil and Propane tank salt. Handwash station. Rack to display bags of Propane packaged Kettle kettle corn Cooker 101 popcorn. Popcorn receiving bin Cashier's Table