HomeMy WebLinkAboutTemp Food Inspection 150 Nevers Road (6) 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 10/7/08
Name of Event Oktoberfest
Date of Event 10/17/08
Time of Event 11AM
Location of Event_South Windsor Senior Center, 150 Nevers Rd, SW
Event Coordinator_Mickey Kozikowski, Senior Programmer
Event Coordinator Address_SW Human Services, 150 Nevers Rd., SW
Event Coordinator Phone#_648-6361, Ext.339
Event Coordinator E-Mail Address_Wladyslawa.Kozikowski@southwindsor.org_
Event Coordinator Phone # (cell, work&home) See above
Name of Applicant_South Windsor Senior Center
Name of Applicants Business (please indicate if mobile vendor)
Applicants Address_150 Nevers Rd., SW
Applicants E-Mail Address
Applicants Phone # (cell, work& home)
Set up time_10:30AM_
Please provide the following: (If any of the following do s&rzUR— C&fvk ,
1.List all food and beverage items to be prepared and se
necessary.
NOTE: Any changes to the menu must be submitted to
event. -+! �
Sausage,potatoes, cake, cabbage, onions � "'O°A<<�
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2. Describe specifically how frozen, cold, and hot foods will be transported to the event.
By staff,utilizing food business packaging in whatever form it comes
3. List all places (name & address) where meats, poultry, seafood, shellfish, and ice will be purchased.
Food items purchased from following:
Adolf s, New Britain Ave.,Hartford—sausage
Sam's, Manchester- potatoes, cake
Harken's Market, East Windsor- cabbage, onions
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. See previously submitted map
6. Describe the number, location and set up of handwashing facilities to be used by employees.
See map
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7. Describe how and where utensil/equipment washing will take place. If no facilities are available,
describe how alternate steps will be taken.
Kitchen has adequate washing facilities
8. Describe how wastewater will be collected, stored and disposed.
9. Describe the number and location of garbage containers.
See kitchen map previously forwarded
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
Ovens
11. Describe how colds foods will be kept cold(45 degrees and below).
Refrigerator/freezer
12. Describe how food temperatures are monitored.
Probe thermometer
13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food
license)
Yes
All items listed as purchased will be prepared on site by kitchen staff using our kitchen which, as
you know, has ovens, refrigeration, freezer,wash sinks and trash disposing receptacles.
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NAME OF EMPLOYEE PHONE# ADDRESS SHIFT
1. Mickey Kozikowski 648-6361 X339 150 Nevers Rd. 10:30AM-End
2. Other Human Services Staff as needed
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10.
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• CHECKLIST FOR FOOD BOOTHNENDOR OPERATORS
_X Metal probe thermometer(0—220 degrees F range)
_X Thermometers for all refrigerators
Coolers and ice packs (if ice is to be used for cooling of foods, where is water to be drained)
N Plastic wrap/Aluminum foil
_X Extra utensils: tongs, spatulas, spoons, and knives
—X Water source
_X Buckets/tubs for washing,rinsing, sanitizing food equipment
X Bleach for sanitizing, test strips for checking
Waste water disposal container
X Container(s) for grease collection
X Clean wiping cloths and a container to store them in
X Garbage containers and plastic bags
Hats/hair restraints
_X Crates, shelves to store food off of the ground
_X Gloves for food handling
_X Hand washing station
CQ-
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