HomeMy WebLinkAboutTemp Food Inspection 500 Evergreen Walk 27. 2009 01:215AM
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VENDOR
APPLICATION
AND
GUIDELINES
i FOR
1
TEMPORARY FOOD SERVICE EVENTS
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�:V]ycumcnr�MJ Sottings�jux,>n?Lacel Rntfings??Empurar7 Intett�Ct Filcsll orttcut(yutlt�ukl5?1 Yt?7Na1'f tmp,lrtuy Nod!Vrn9ur Applicuhoti 2007 dui
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Siti'd 08zLbt�9��1 0z�8b1�9098 MS WdH:wOJA VR:ST 6002-82—AUW
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Ve'"oR A►PPLIcAlriox Fo,
�'EMPollARY F'ooD EVENT
The �'Lthf;0 of caoh teinlIorary.food ovent mustcornplete this a lac
prior . L opening el�eflt, This spplicfltioll pjtt8t he submitted cv th Plic tic?" and must Eye til�:t1 14 c9a}:s
health Depaxtment, 1540 Sullivan Aveilue,%Uth Windsor, CT 06074.. Otii] Wind.sm
TL's a Iics�ttoh is xno a lilikt ft' I einpor:�ry food jzerrnits will n.ut ex��ed a pert-Od of l fo 5 do
ys-
Todey's Date _ �a-11 _
Nance Of lvi,nt�"�1
Da.tc of.Event 1 , ty �I l�. LI C —
Tii=of Event —— —-
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!1o(:&ti.un of E?vant�(��L1��
Event Courdinator
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L*"cnt Cbot-diliatcr Addres t �j b
1?vent eoordinator'Phone#
l;verat Coordinator E.M;ril Address
1=-vcnt. Coordinator #(cc Jl, work
Niantc of Applicant ftttty
Name of A 1'
PP lcar�ts 13usincss (1�1c;tsC iir(licate if Mobile vendor) J-
Applicant;Address ��%C, Y�lg:, _s_� May rf+
A licants F� —...—
J?p Mail Addre�t;.�[�ldL.1'. •� �l(\�YlC,� ���[. ��1��/_��� ���`
Appli4atits Phone #(ce)l, work &hotiia)— �,��_'?
dot up tirUC—�/�
Please provide the following... (If any nfthe f011o%.vitig does not apply to rota put MIA)
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l.I 8t.�11#:c►nd and btweragc�items to be prepared artd served(menu), Atrieh a separ;rtr sh;ct If
neccssrriy,
NOTR:Ally chariges to tho mom.,rtttlst be submitted to the Health Dep�trttnent 1(1 flays prior to[li��
cvcnt. p
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0821t7t19:01 OaMt+9098 MS WdH:wO AJ VR:ST 6002-82-AdW
v1:-Y, 9 ZI 26AM
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2.Desca-lbe speoilkally ljoW
POUR,Cold GAI and hot fhodH will be transpol led to the e-vent.FvO2-Cyj by Q- tdS �k-- voonfl IYI
'V-CCZUS UV LOCACV, Uyit'\I
IX �VW'kui(j �Vuo flyxyl Tt'\ Wk \ k.
h(Al 16 b U Yd PtAt I VY'.)(Y)TIC-111MILi uaci Irb
Lckk'v'�' 6v
k-i S tvtcd 1H ( CNvtvCj Md(kl
bv hO bU(' S ( i2Z�.�)
3- List all places(naim,&address)where meats,polliji-y%Sejjl'(.)t)kj, -5hollfish, and im will be-PtIrchaml.
4. List "allies 111ionv numbers, addrw,ses, and shifts to bc workcdu r all eqllp]Oye-es" Set.CtS.-Jomucilt*1
U-'k) b-C -NUOYVIG
bL:C. V a C)c o Ick
Tun Mcllb
n&- -0;)A)v1Cv- �) q�1 - 2)W0
5, Use attaclunent 42 in thLs packet to sketch ti drawing shovving the event are, jjjjL j where yo,jr
operalim will be, j
6. Duscijbe.thu miml-ior, location and set )c � f handwashing facilitics to tie. u!5ej by ejjjljjOyeL..s Uvl t ) hm-AAKYG\1� sul
-Z tht qvtll ":A I' vinc Avak
7. Describe how and whore utensilkquipmentwayhing will IA'e-place. If do faciiiii"are availabic,
deNe-rlhe how altornato .3teps will be.tak n.
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082L-"9:01 0228H79098 MS WdH:wOJJ i72:ST 6002-e2-AUW
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g. 1)escri(Ie JWW wastewater will be collected, 'sirs cd and d-spored.
k�Cr'�t ��( Cou-c� , 711C� 1 C�UIYI.�CI Ir1 �,�.,�,��I � SIr��L �` t►- r��
9. Uautribe,the number and location of gartlage cc► diners.
oat���cr
1 MtnI C)vffl � �
1(.l,Ua Bribe what heat smir'cc will be used t ke,;p hot foods hot (140 degree;;Wid above)
�V1aff'I�\9
11.- Uescribe.hovt col.d,�;tDods will be kdpi.cold (45 degrees and below).
1 C-. (-VCaryl CGk v 1"
.ACV ,C 1-A-C.. d aN IC.
12. DEfribeiOw�foY ljn �crt �s arc monito ed.
� '/13. Will foods be prepared can fiite'! Uno,where will #bock tie uzch��sr ���i `�� ry)��S
licarise) 1' ell(r.nalose a ccspy r7t f�,��d
I c� epy y I .
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Si�'d 082L-M79:01 0228t+9098 MS WdH:wOJA b2:ST 6002-82-AUW
MRY-28-2009 15:34 From:HPM SW 8606448320 To:6447280 P.5/5
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