HomeMy WebLinkAboutTemp Food Inspection 1175 Ellington Road (6) e
Oy Scout irro_ 642
Pasta Dinner
Id
All Proceeds to Benefit Local Human Services Holiday Needs
Noveniber Ist
Two Seatinas: 5plin 6pin
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South Windsor Tickets ,fox sale
Fire House #1 at door. E-rail
reservations ,to:
1175 Ellington Rd pastadinner@troop62sworg
$6*00 - Adults $100a Seniors/Children 10 and under
For more information, visit: tfoopQsworg
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 Event �S & z-
Dates)of Event
Hours of Event
Number of Food Vendors �" Q
Name of Event Coordinator
Address of Event Coordinator 1 q' 41,)n 00
" (Aj(k-
Cell Phone# 9-60-&3-oo5lP Home Phone# 70 -/9 0 9 Work Phone#
E-Mail
Name of On—Site Coordinator Tva"t- �
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 snake c`ltTangerlments 5 days In advance
Department to determine the time of pre-will comply with the Connecticut Public Health Code and the Tovvn of
South Windsor Code of Ordinances.
Signature of Event Coordinator v
Date / °( Z 7 Z J SC
C-UlmsbwnaXAppDataUAcal%TempWempl a 2008 10 25.OpXTempmwy Food Coudindw Application 2007.doe
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VENDOR AFFUCAYION rOR TEMPORARY rOOD EV ENT
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.
Th_ts anollication is not a license.Temporary food permits will not exceed a period of I to 5 days.
Today's Date b $
Name of Event 79' ,p Z pQS Qi��rt.C�✓'
Date of Event K a i . l Z oo N
Time of Event S r -7 ro nti
Location of Event Fi r-c- AOL,
Event Coordinator k" FV
Event Coordinator Address ►
Event Coordinator Phone# $b c --2-.2 Z -l 9 0
Event Coordinator E-Mail Address # -L J-L Po T S 6<_ 1-o a tiL. � ,�r T-
Event Coordinator Phone#(cell,work&home) o-?$ - D v S'Cp
Name of Applicant c pct�-e.r
Name of Applicants Business(please indicate if mobile vendor) -
Applicants Address 9 'Ft-VLK_
Applicants E-Mail Address
Applicants Phone#(cell,work&home)
Set up time v - 41 = 3 o �a•x A_J,rr
Please provide the following: (If any of the following does not apply to you put N/A)
r ,
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.
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d
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2. Describe specifically how frozen,cold,and hot foods will be/transported to the event.
C o o -v
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.
To �-e v
_T c wtr ...21n this packet to sketch a drawing showing the event area and where your
-ration will be.
Describe l x?2�32 ber, 1oea.go__,._n_ cat 4? r�? t?tliva �?t�i�# 14�t4s's tt? h i3 f'_ !4l P_.t�4fiplo- ees.
.5 O P
7. Describe how and where utensil/equipment washing will take place.If no facilities are available,
describe how alternate steps will be taken.
40
19
8.Describe how wastewater will be collected,stored and disposed.
S u& �ell-- S
9.Describe the number and 1 on of garbage containers.
/ / 04, &=
Z► rJ
:;.Describe what'peat source will be used to keep hot foods hat(140 degrees and above'%
C) ✓c°!J l G/LO kl/�
1.4 d S. Describe how LVt4�i.�?i\TV11s�?vYddi DC KC l COW iYJ 4leg11010 ad34�3. 17��iYV 1'v j.
iL.i.;escribe haw ILWU teiT'i rues arc mini` "ei►.
13. Will foods be prepared on site?If no,where.x,ial foods be
License,