HomeMy WebLinkAboutTemp Food Inspection 00 TEMPORARY FOOD SERVICE EVENT
COORDINATOR' S APPLICATION
This forin 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 foam is not a license.
TemporM-food events will not exceed of 1 to 5 days
Name of Event
Date(s) of Event
Hours of Event
Number of Food Vendors
Name of Event Coordinator—
Address of Event Coordinator _
500
Cell Phone#AOO S'.?361X0 Home Phone#�!D 630? /.fYfi Work Phone# ald0
E-Mail 114 5189 Pr�ISW_
Name of On— Site Coordinator f •�%
QFO (please check if On site coordinator is QFO and provide a copy of QFO certificate)
List of Vendors attending event
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5 6 ton ?-e e
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__
EI:\ppetrilloAvapping Fair\Temporary FoodCoordinatorApplication2007\TcmporaryFnodCoordinatorAuvlication2007.dnc