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Temp Food Inspection 00 Evergreen Walk
COOK - At church kitchen, DRIVER (pickup spuds from FLOATER - Meet driver, clean,bake,wrap potatoes; church,bring to fair,buy ice at GREETER -Greet people at CASHIER - at Fair, take CHEFS - at Fair (take slips take potatoes to tent,assess heat sauces, prep food for Sam's,replenish drinks and tent,clean tables,assist taking orders,make change,give slips from cashier,prepare potatoes supply needs,bring passes to Times tent. ingredients) orders. to chefs. to order,give to customers) workers, fill in where needed. SATURDAY, SEPTEMBER 11, 2010 10:00 a.m. To 11:00 p.m. 1. Josh Sheffel ** 8:00-9:00 2. Nick Crawford First shift arrives 1 hour early to put drinks on ice, setup prep station 1. Josh Sheffel ** 1. Cindy Marlin 1. Bill Neal 1. Gay Foster ** 9:00-noon 2. Nick jCrawford Dick Brown Kim Welch 2. Katie Marlin 2. Fran Neal 2. Brian Welch 1. Roland Schneider * 1. Jeanne Ewing 1. Ted Gozdeck 1. Gay Foster ** 'noon-3:00 2. Mark Williams June Brady Kathleen King 2. Joyce Vallez 2. Nancy Gozdeck 2. Bruce King 1. Josh Sheffel ** 1. Dan Kellner 1. Donna Williams 1. Gay Foster ** 3:00-6:00 2. Nick Crawford Liza Love Pauline Kavanagh 2. Nancy Kellner 2. Debbie Spieker 2. Carol Grein 1. Josh Sheffel ** 1. Nancy Fulton 1. Jim Fulton 1. Gay Foster ** 6:00-9:00 2. Nick Crawford Joyce Cyr Pat Stebbins 2. Sandra Richmond 2. Patty Albrecht 2. Ken Johnson Last shift cleans up and puts down sides of tent 1. Josh Sheffel ** 1. Darby Long 1. Geri Coligan 9:00-11:00 2. Nick Crawford Al Arnett Pat Anderson 2. Nancy Basselaskes 2. Caroline King Jon Hale ** SUNDAY, SEPTEMBER 12 - 10:00 a.m. To 6:00 p.m. 1. Josh Sheffel ** 8:00-9:00 2. Nick Crawford First shift arrives 1 hour early to put drinks on ice, setup prep station 1. Josh Sheffel ** � �da,�-� 1. Nancy Norman I. Ted Gozdeck 9:00-noon 2. Nick Crawford Roy Norman 2. Nancy Gozdeck 2. Chuck Oakes(10-12) Gay Foster ** 1. Dave Panagrosso * 1. Jan Tarr 1. Barb Gelinas 1. Sherm Tarr 1. Gay Foster ** noon-3:00 2. Ellen Panagrosso Dee Hawver 2. Alberta Mirer 2. Rob Mirer 2. Gail Snow 2. Judy Foster 1. Josh Sheffel ** 1. Dee Baker 1. Bill Baker 1. Pat Anderson ** 3:00-6:00 2. Nick Crawford Al Arnett Matt Desy 2. Jennifer Rho 2. Christine Carlson 2. Craig Rho 6:00- ?? clean up: take down tent,tables, chairs, pack up coolers, tools, etc. Ken Johnson, John Drake, ** indicates person in charge WAPPING FAIR BAKED POTATO BOOTH - September 9 - 12, 2010 COOK - At church kitchen, DRIVER (pickup potatoes CHEFS - at Fair (take slips FLOATER - Meet driver, clean,bake,wrap potatoes, from church, bring to fair, GREETER - Greet people at CASHIER - At Fair, take from cashier, prepare take potatoes to tent,assess heat sauces,prep food for buy ice at Sam's, replenish tent, clean tables, assist orders, give slips to chefs, potatoes to order,give to supply needs,bring passes to Times tent. drinks and ingredients) taking orders. make change. customers) workers, fill in where needed. THURSDAY, SEPTEMBER 09, 2010 6:00 - 10:00 P.M. 1:00-4:00 Set up tent,refrigerator, tables and chairs Bill Sawyer, Ken Johnson, John Drake, David Foster 1:00-4:00 Set up ingredients for food inspection at 4:00 p.m. m Gay Foster 3.00-5:00 Pat Anderson,Ann Drake Bake 40 potatoes at 3:00 First shift arrives 1 hour early to put drinks on ice, set up prep station 1. Pat Anderson 1. Haley Delgreco 1. Cindy Miller 1. Mark Burnham 5:00-8:00 2. Ann Drake Chris Kabrick 2. Carol Grein 2. Darby Long 2. Lois Snelgrove Pat Stebbins ** Last shift cleans up and puts down sides of tent 1. Greg Rowe 1. Dee Baker 1. Diane Rosfjord 8:00-10:00 2. George Gates * Pat Anderson Bill Baker (8:30-10:00) 2. Cindy Miller 2. Tom Rosfjord Donna Wnuck FRIDAY, SEPTEMBER 10, 2010 6:00 - 10:00 p.m. 1. George Gates 3:00-5:00 2. Pat Anderson First shift arrives 1 hour early to put drinks on ice, setup prep station 1. Dee Hawver * 5-6 Pat Anderson 1. Alice Walls 1. Dabble Spieker 5:00-8:00 2. Ellen Panagrosso 6-8 Wayne Wnuck Sue Lingua 2. Dave Walls 2. Pat Anderson Gay Foster ** Last shift cleans up and puts down sides of tent 1. Rob Elliott/Jason 1. Mark Ruegg 1. Nancy Calabrese 1. Sam Usifer 8:00-10:00 2. Jon Hale Rick Usifer Matt Desy 2. Pat Anderson 2. Leslie Perrone 2. Karen Ruegg ** indicates person in charge Vendor Address City, State&Zip Phone E-Mail Description Contact /r. asy's Ice Cream 8 High Ledge Rd Bloomfield, CT 96992 860-243-0738 Ice Cream Truck Elba Schulman fi oecialty Beverage 18 Deepwood Dr Madison, CT 06443 203-887-5990 1023bobc@gmi Coffee, Smoothies Bob Cohen urnpions pizza 465 Buckland Road South Windsor, CT 06074 860-648-9523 campion.giann€cheesey breadstix Campion Gianelli Ari Jochine Pavilion Resl 1180 Chapel Street New Haven, CT 06511 203-865-5033 indochinepavilic sesame chicken,pe Niapapron Kiangr acks Fried 7940 W. Silverleaf Larn Dunnellon, FL 34433 352-212-6655 jacksfries1962(Fries Judy Piche/Gary I /Vinci Concessions 20 Clover Hill Place Berlin, CT 06037 860-965-2995 kvinci@comcas Fried Dough Ben Vinci ,�t bc.� SW Democractic Town 89 Heritage Drive South Windsor, CT 06074 860-644-0 90 erm999@aol.cc Pulled pork �1izllcGuire/Joan \KA (OppInghUrch'; 1790 Ellington Road South Windsor, CT 06074 860-644-5020 gay.foster@gm;Baked Potatoes Gay Foster Catfe�Allez 726 Avery Street South Windsor, CT 06074 860-922-5442 daniel_gasparir crepes Daniel Gaspanno rapd is M ills.Me6441164 Ninth District Road Somers, CT 06071 860-749-5548 dboucher96@y,Meatball Grinders Darlene Boucher ✓ astifly :3trudel House 400 Chapel Road Suite South Windsor, CT 06074 860-436-4852 pastrystrudelho cookies, brownies Doaa �onathon's 17 Deepwood Road Enfield, CT 06082 860-930-1405 Kettle Corn David Thorensen S t/Wappin g Fair PO Box 486 South Windsor, CT 06074 Hot dogs, burgers Mark Schneider co, ,4 � Vol �V.AJVA 1% VEND09 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 07/28/2010 Name of Event Wapping Fair Date of Event Sept. 9t1i 12'2010 Time of Event 9/9 6 p.m.-10 p.m.; 9/10 6 p.m. — 11 p.m. 9/11; 10 a.m. -11 p.m.; 9/12 10 a.m. —6 p.m. Location of Event Evergreen Walk (behind LA Fitness) Event Coordinator Paul Petrillo Event Coordinator Address PO Box 486 South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address wappingfair@aol.com Event Coordinator Phone#_(cell,work& home)_(C)860-573-6780(H) 860-632-1.544 Name of Applicant Anthony Tufano Name of Applicants Business(please indicate if mobile vendor)_Tufano Amusement Applicants Address 1695 Reinhard Road Cheshire, CT 06410 Applicants E-Mail Address dtufano@aol.com Applicants Phone# (cell, work& home)._203-271-2294 Set up time 2 hours prior to fair hours of operation each day Please provide the following: (If any of the following does not apply to you put N/A) 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. Popcorn, cotton candy, carmel and candy apples, and sno-cones CTDOCS:25996.1 7 2. Describe specifically how frozen, cold, and]lot foods will be transported to the event. Ice individually bagged 3. List all places (name& address) where meats, poultry, seafood, shellfish, and ice will be purchased.. A&B Ice, Asylum Street, Bridgeport, CT 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. Anthony Tufano 5. Use attachment #2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide layout the week of the fair. 6. Describe the number, location and set up of handwashing facilities to be used by employees. A three bay sink with hot and cold running water 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. In one bay of sink with bleach and water solution. 8. Describe how wastewater will be collected; stored and disposed. Holding tank in trailer. 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers.located in area surrounding food areas 10. Describe what heat source 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 how food temperatures are monitored, cleaned and sanitized. Everything is cleaned and sanitized with bleach and water. CTDOCs:25986.1 2 s n 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose copy of food license) yes NAME OF EMPLOYEE PHONE# ADDRESS SHIFT T.Anthony Tufano 203-271.2294 1695 Reinhard Rd Cheshire, CT all 2. 3. 4. 5. 6 7. 8. 9. 10. ATTACHMENT #2 CTD005:25986.1 , AUG. 24. 2010 4: 21 PM `RWELLS FARGO ADVISOR N0, 019 P. 2 d 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 Departments 1540 Sullivan Avenue,South Windsor,CT 06074. This awlication is not a license.Temporary food permits will not exceed a period of 1 to 5 days. Today's Date Name of Event-Wapping Fair Date of Event Sept 9—12,2010 'nme of Event 919 6 p.m.—10 pm.;9/10 6 p.m.—I I p.m.;9/11 10 a.m.-11 p.m;9/1210 a.zn_—6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator_South Windsor Jaycees/Paul Petrillo Event Coordinator Address_,PO Box 486,South Windsor,CT 06074 Event Coordinator Phone#�860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.co (2_ waj j Event Coordinator Phone#(C)860-573-6780; (H) 860-632-1544 Narne of Applicant Name of Applicants Business (please indicate if mobile vendor) ,---� Applicants Address -if? '9r) (60CLVI .Applicants E-Mail Address Applicants Phone#(cell,work 8t home) Setup tirne 15 ewv Please provide the following: (If any of the following does not apply to you put N/A) l.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 AUG. 24, 2010 4; 21 PM WELLS FARGO ADVISOR N0, 019 P. 3 2.Describe specifically how frozen,cold, and hot foods will be transported to the event. J� amp s U44-, LALZ 000 E;ol �O " Ca- Co►� a� a- r-� 46 \�L 3.List all places(name&.address)where meats,poultry,seafood,shellfish, and ice will be purchased. = .s Cab 4 List names,phone numbers, addresses, and shifts to be worked of all e�oployees. See attachment M. 'il� �M SUL LAq? 1 , 0 wLa P4CU S.Use attachment 02 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair b.Describe the numbs ,location and set up of haywashing, ZV Z- 'lities to be used by employees. k t p VA Lac kaxx OL-) Pa,/VL 00.5" 7.Describe how and where utensil/equipment washing will tape place, If no facilities are available, describe how alternate steps wiu be taken. � C � AUG, 24, 2010 4: 21PM WELLS FARGO ADVISOR NO. 019 P, 4 8.Describe how wastewater will be collected,stored d disposed. :74 Cz eo1 (JA- 0.- 1oGl r� � WckQo�� � w rm o u,, 9. escbe the number and 1 anon of garbage containers. p , Wapping Fair wvi11 have garbage containers throughout the fair grounds 10.Describe what heat ource will be used to keep hot foods hot(140 degrees and above). \JAA!5Q_"-4A (200"a - ti'L' VtQ:. 11.Describe h w colds foods will be kept cold(45 degrees and below). 12. Describe how food temperatures are monitored. - �pttxQ- $ �Ckk �,� zAt)S �► a 7.10 . 13,Will foods be prepared on site?If no,where will foods be purchased?(enclose a copy of food license) 3 AUG, 24. 2010 4: 21PM WELLS FARGO ADVISOR NO, 019 P. 5 NA1 M OF EMPLO)TE I # �DpZ2FS� SHHVC 2. 3. 4. s_ s. 7. s, 9. M 4, AUG. 24. 2010 4:21PM WELLS fARGO ADVISOR N0. 019 P. 6 42 El 1� 6 AUG- 24- 2010 4; 21 PM WELLS FARGO ADVISOR NO. 019 P, 7 / CHECKLIST FOR FOOD EOOTE!'V' MOR OPERATORS `' Metal probe thermometer(0—220 degrees F range) Thermometers for all refrigerators ✓ Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil ZExtra utensils:tongs,spatulas,spoons,and knives '.Water source ✓ Buckets/tabs for mashing,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 +Garbage containers and plastic bags �/ Hats/hair restraints _L—Crates,shelves to store food off of the ground Gloves for food handling and washing station 8 AUG. 24, 2010 4: 24PM 'jZ,�WELLS FARGO ADVISOR NO, 020 P. 2 VENDOR APPLICATION roR TEMPORARY FOOD EVEN' 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 Wapping Fair Date of Event Sept 9— 12,2010 Time of Event—9/9 6 p.m.— 10 pm.;9/10 6 p.m.—11 p.m.;9/11 10 a-m:11 p.m; 9/1210 a.m.—6 p.m. Location of Event evergreen Walk(Behind LA 7Fitness) Event Coordinator South Windsor Jaycees/Paul Petrillo Event Coordinator Address___P0 Box 486,South Windsor,CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address WappingF'air@aol.co �. Event Coordinator Phone#(C)860-573-6780; (H) 860-632-1544 Name of Applicant Name of Applicants Business(please indicate if mobile vendor) Applicants Address Applicants E-Mail Address Applicants Phone#(cell,work&home) Wa 0- k' Set up time V,,, Please provide the following. (If any of the following does not apply to you put N/A) 1.List all food and beverage items to be prepared and served(mouu).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. B o , SOLXX- CAAZX1rV-% CLC�0�I 06 rev J- (DVVU^, L43 ..- W t 3 04A,, kA`. 2 AUG, 24. 2010 4: 24PM WELLS FARGO ADVISOR N0, 020 P. 1 ME Address Branch Tel Branch Fax City State Zip Fax Date: 8/24/2010 To: Robert DeVito Company: Dept of Health, South Windsor Fax: 860-644-7280 Pages: �fi" C From: Gay Foster Regarding: Vendor License for Wapping Fair name of Wapping Community Church CONFIDENTIALITY NOTICE This message is intended only for the named recipient and it may contain information that is confidential and/or subject to Firm privileges. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by return facsimile or phone call and destroy this message at once. Wells Fargo Advisors,LLC, Member SIAC. 584422 Page 1 of 1 AUG. 24, 2010 4; 21 PM WELLS FARGO ADVISOR NO, 019 P. 1 MM Address Branch Tel Branch Fax City state Zip Fax Date: 8/24/2010 To: Robert DeVito Company: Dept of Health, South Windsor Fax: 860-644-7280 Pages: 7 From: Gay Foster Regarding: Vendor License for Wapping Fair name of Wapping Community Church f, CONFIDENTIALITY NOTICE This message is intended only for the named recipient and it may contain information that is conweritial and/or subject to Firm privileges. If the reader of this message Is not the Intended recipient, you are hereby notrfied that any dissemination, distribution or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by return facsimile or phone call and destroy this message at once. Wells Fargo Advisors,11C,Member S1PC. 58 22 Page 1 of 1 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 / i Name of Event—Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event—9/9 6 p.m. — 10 pm.; 9/10 6 p.m.— 11 p.m.; 9/11 10 a.m.-II p.m; 9/12 10 a.m.—6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator—South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486,South Windsor, CT 06074 Event Coordinator Phone#_860-573-6780 Event Coordinator E-Mail Address WappingFair_@aol.com Event Coordinator Phone#(C )860-573-6780; (H) 860-632-1544 Name of Applicant � ✓ e.t, Name of Applicants Business (pleas indicate if mobile vendor) �- R,� Applicants Address n a� Applicants E-Mail Address Applicants Phone# (cell, work&home)_qL G �-167 3'j Set up time Please provide the following: (If any of the following does not apply to you put N/A) 1.List all food d beverage items to be prepared and served (menu). Attach a separate sheet if necessary. ,R_ NOTE: Any hanges to the menu must be submitted to the Health Department 10 days prior to the event. h f 2 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 4 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 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. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number, location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 2 8. Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). 11. Describe how colds foods will be kept cold (45 degrees and below). 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food -- license)..------- --- -------- 3 • VENDOR APPLICATION FOR TEMPORARY FOOD EVENT d 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 13--)b It Name of Event Wapping Fair Date of Event Sept 9— 12,2010 Time of Event_9/9 6 p.m.— 10 pm.; 9/10 6 p.m.— 11 p.m.;9/11 10 a.m.-11 p.m;9/12 10 a.m.—6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator_South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486,South Windsor,CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone(C)860-55,7`3-67 (H) 860-632-1544 Name of Applicant / # �" � Name of Applicants Business(please indicate if mobile vendor) Applicants Address l Y ��'�,��-✓� �'� �1ST �� � '� �� Applicants E-Mail Address _ Applicants Phone#(cell,work&home) ®� ` v d ` S Set up time� `�✓S _ Please provide the following: (If any of the following does not apply to you put N/A) 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. z 2.Describe specifically how frozen,cold,and hot foods will be transported to the event. Y-- 3. List all places(name&address)where meats,poultry, seafood, shellfish,and ice will be purchased. Avrq i I 4. List names,phone numbers,addresses, and shifts to be worked of all employees. See attachment#1. /d"//l P- 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number,location and set up of handwashing facilities to be used by employees. �lI 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. L'-"04 A A I. /'L, 5ctn� 2 8.Describe how wastewater will be collected,stored and disposed. K'e�� _.,— kc�- 9.Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). Describe how colds foods will be kept cold(45 degrees and below). �)r 12. Describe how food temperatures are monitored. P) e- 13.Will foods be prepared on site?If no,where will foods be purchased?(enclose a copy of food license) (ja 3 • 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 07/28/2010 Name of Event Wapping Fair Date of Event Sept. 0 i 12'2010 Time of Event 9/9 6 p.m.-10 p.m.; 9/10 6 p.m. — 11 p.m. 9/11; 10 a.m. -11 p.m.; 9/12 10 a.m. —6 p.m. Location of Event Evergreen Walk (behind LA Fitness) Event Coordinator Paul Petrillo Event Coordinator Address PO Box 486 South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address wappingfair@aol.com Event Coordinator Phone#(cell, work& home)_(C) 860-573-6780 (H) 860-632-1544 Name of Applicant Campion Giannelli Name of Applicants Business(please indicate if mobile vendor)_Campion's Pizza Applicants Address 465 Buckland Road, South Windsor Applicants E-Mail Address—campion.giannelli@gmail.com Applicants Phone# (cell, work&home)_860-648-9523 Set up time-2 hours prior to fair hours of operation each day Please provide the following: (If any of the following does not apply to you put N/A) 1.List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. Pizza, Mozzerella sticks, boneless buffalo chicken NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. CTDOCS:25986.1 2 2.Describe specifically how fro n,cold,and hot foods will be tr4psported_rto e��e`v/eent. r ". zi$f✓ D ` l.+( 6ro-t5Z 4 (y�(r l� �uT �.�r/lV'ctCS ba I List all places(name&address)where meats,poultry,seafood,shellfish,and ice will be purchased. (2'e It' SPA 4. List names,phone numbers,addresses, and shifts to be worked of all employees.See attachment#1. sec- 5. Use attachment#in this packet to sketch a drawing showing the event area and ,mere vour operation will be. Wapping Fair will provide week of fair 6.Describe the number,location and set up of handwashing facilities to be used by employees. et 4--r C 7. Describe how and where utensilfeauipment washing will take place. if no facilities are available, describe how alternate steps will be take /' � 2 ATTACHMENT #2 �a N pool. l 1 aS 0 go c) 7 6 8.Describe how wastewater will be collected,stored and disposed. 34,r,tj T'-q J�N 0--C. " 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11.Describe how colds foods will be kept cold(45 degrees and below). -_- (-,(,eLezer- 12.Describe how food temperatures are monitored. -t RAP- "�rrat V t"< e-tT_r3 " sig I- ----- wieci�will YiFis:1 a :'s_iii.itnfirts% ir`_.i ei,iii P_.n t: e t j VVU license) 3 NAME OF EMPLOYEE t PHONE# ADDRESS SHIFT U•- t��n„c,.et�� �4�60��1(�'3067 ll�= ©—G z. TI Xo 4. gj 5, fAf-he Ir,,' CFI —C — 6. 7. 8. 9. 10. 4 ' VENDOR APPLICATION FOR TEMPORARY FOOD EVENT Tht 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 Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event_9/9 6 p.m.— 10 pm.; 9/10 6 p.m.— I I p.m.; 9/11 10 a.m.-11 p.m; 9/12 10 a.m.—6 p.m. Location of Event Evergreen Walk(Behind LA Fitness) Event Coordinator—South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486, South Windsor,CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(CL),86600-573-678p0; (H) 860-632-1544 Name of Applicant NY ��t`�JN MoftO KL Name of Applicants Business (please indicate if mobile vendor) h@X & fA\J A UAMT Applicants Address c � Applicants E-Mail Address Y W Applicants Phone (cell work&home)_ S� Set up time 0 7`�® Please provide the following: (If any of the following does not apply to you put N/A) 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. l e w" 2 2.Describe specifically how frozen, cold, and hot foods will be transported to the event. C-e LP R O D TWA5 Mt, U- S W© 3Nf COLW6- 0027 v-rit- Ya +PA-ev— ro ISO TA% A N "MWL o 1) VE�kf&OA-TU 9f s F ®X OCLP W M 0 W Too TT61k5 9wnw6- TkAN sP -� G 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. NOW" V-AfWM 51 V"4F -)N 14L VWAV6N Chi 06TI'f W.V3olvvyl F�L�� ��-� �W��� ST N���V•6rJ C�dd�I� cr� �3 ) $'SO 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number,location and set up of handwashing facilities to be used by employees. NOTA-AM j &Atm. Mr-k 5 CAW 0 W f,'�'Te& kCen& C&JTA-WG P, �NDwAW"6- "CI LM-5 geTWec-N 600Wl RREA . 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. U AIL M� tC, Sao t ,dt '1�Q o-� P@b D RNP &WW Na) o R- )N #, E'PN`YRT NeV, BF WME 2 I ""Nef 1 h MftjN V&VC-D K N f(-,Mi sI-4E0- 01 A- LG�S`i (L�o O� AND I1 A-VvA'16L ` tCI^A"A4Aj j# bjLA* " ),L444, No ��esc,� S AJ1 lA$I,E ��;\� N6- �'EU�PAL UTENJ IL Arv� �62)n� bpeK `I0 Vv4 td /� �'�-r`►:�Mi 8. Describe how wastewater will be collected, stored and disposed. Sktp�u,UT D �UlAPLOO W P Re6WTPkGE OP- 90C DWN U b I,lfe` N 6 F WA4IE W'fl t Q 6�t N ILC'f rp 9. Describe the number and location of garbage containers. A PP(V Y S&)j6p— Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). \-%tT vJ� 'u f &N &P&OAK LC 11. Describe how colds foods will be kept cold(45 degrees and below). 12.Describe how food temperatures are monitored.,V#pCS~? P �6T �0 VCLL PLAB' 0� ST&j 1 TPt8 ,c '� P TUL@ I0 F eb L'� Fdo kme N ��- o F Ply- 6&)OVj. 13.Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) 3 .r NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 2. pal � 3. 4. 5. 6. 7. 8. 9. 10. 4 ice �.ice�c�e Department of Health New Haven, ConnecticutIN 4 s- ENE;RAVILI � --_._---- ------ 4. (Trade Name OPN KLAN N[ AP GMANE. . _-- APicen'seei ------ Restaurant�Fu�l Sev_ is hereby licensed to operate a 06511 1180 LAPEL ST, NEW_HAV -— (Address) — r` I' in accordance with City Ordinances, " license to expire May 1st,2010 Lic Nbr: 0041 Class: 4 ---------"- _ Fee $275 CT: 007 Direea r of Health Dated City of New Haven,CT This license not transferable 5113/2009 ertmed Professionai rood anager desi�nation has been conj�rred upon KL A,N(r,l AN E NIPAPORN "(.4)ho has errsq 47gEfi.c�•�«�rzy��,y,�•z�»tal.'requiretne-,nt,s for certz zratr.'ovr Fxam 140I Recognized B . Y Conference.For Food Protection / f Training Provided B C�x)o .." C"as (acil, C" 'Sp American Food Safety Institute 800-723-3873 Certifleate Issueds5/5/03 Tectcode: 620306 1401 an: J 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 1,�g 44 Name of Event—Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event—9/9 6 p.m. — 10 pm.; 9/10 6 p.m.— 11 p.m.; 9/11 10 a.m.-11 p.m; 9/12 10 a.m.—6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator—South Windsor Jaycees/Paul Petrillo Event Coordinator Address—PO Box 486, South Windsor, CT 06074 Event Coordinator Phone#_860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(C)860-573-6780; (H) 860-632-1544 Name of ApplicantT�ITj Name of Applicants Business (please indicate if mobile vendor) Applicants Address?qykj, i 2 ff&We,&w� L�may.yrp Applicants E-Mail Address t p Applicants Phone#(cell, work&home) Set up time Please provide the following: (If any of the following does not apply to you put N/A) 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. rR OUCH CH ro 'rC T P o / / �V W 7� 1�o �s coXAv PoGs G6/ 7"46X 2 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 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#l. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number, location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. -51'PkS 2 8. Describe how wastewater will be collected, stored and disposed. I- -Di NG-- '171VK.5 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). T L4 HIP5 X- co P-N D aG5 11. Describe how colds foods will be kept cold(45 degrees and below). fu//-/k 12. Describe how food temperatures are monitored. T# 6, n 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) 1 �� 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. 2. lc 3. 4. 5. 6. 7. 8. 9. 10. 4 VENDOR APPLICATION FOR TEMPORARY FOOD EXTENT 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_Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event_9/9 6 p.m.— 10 pm.; 9/10 6 p.m.— 11 p.m.; 9/11 10 a.m.-II p.m; 9/12 10 a.m. —6 p.m. Location of Event Evergreen Walk(Behind LA Fitness) Event Coordinator_South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone#_860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(C )860-5 3-6780; (H) 860-632-1544 o r Name of Applicant f Name of Applicants Business (please indicate if mobile vendor) l �C fl C�6rt C6ssiol4f, Applicants Address Applicants E-Mail Address Applicants Phone#(cell, work&home) Set up time Please provide the following: (If any of the following does not apply to you put N/A) 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. �=d Doc�nk ) I t 5(5!�3'-J:4- 2 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 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#l. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number, location and set up of handwashing facilities to be used by employees. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8. Describe how wastewater will be collected, stored and disposed. l 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). C60�ICO Pce Ofw(f-tz 11. Describe how colds foods will be kept cold (45 degrees and below). 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. ( Ke V1,r4 C 2. L()LA, VI 3. `- --�-�, r4 4. 5. 6. 7. 8. 9. 10. 4 ATTACHMENT #2 --J'E!Pe4pl Aug 2510 01:42p Pastry Strudel House 860-436-4551 p.4 i i 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 Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event 9/9 6 p.m.— 10 pm.; 9/10 6 p.m. — 11 p.m.; 9/11 10 a.m.-11 p.m; 9/12 10 am. —6 p.m. Location of Event Evergreen Walk(Behind LA Fitness) Event Coordinator South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone 4 (C)860-573-6780; (H) 860-632-1544 Name of Applicant 8 8 A(U m aiz. Name of Applicants Business (please indicate if mobile vendor)__af t" Cal Hc)u&, Applicants Address in 5U)1h 1 , Applicants E-Mail Address QQ6'jr\JCy�r[jdd ho( :)L 6P Q Mai Applicants Phone At (cell,work&home) &DID Set up time /.2- h Y bf r<, Please provide the following: (If any of the following does not apply to you put N/A) Aug 2510 01:43p Pastry Strudel House 860-436-4551 p.5 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. �5�� COL'he (by-ov n ieb) Ccdno-6) Vir5pi 'Treoi ce 2. Describe specifically homer frozen, cold, and hot foods will be transported to the event. Ali Items Will bc trU f+(fd in a coojer wl ice. paces. -M- vv l l as,-)o have, o, re-fri q3t r a r G-f the, t-h 3. List all places (name & address)where meats,poultry, seafood, shellfish, and ice will be purchased. Not I'e.ablt 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 6CZ OWjIMCf& 5. Use attachment 42 in this packet to sketch a drawing showing the event area and.where your operation will be. Wapping Fair will provide week of fair 2 Aug 2610 01:43p Pastry Strudel House 860-436-4551 p.6 6. Describe the number,location and set up ofhandwashing facilities to be used by'employees. AI bring W Mbro I�Or c. ec. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. F,x-tTO- UteOit>11s WI11 �-- . 8. Describe how wastewater will be collected, stored and disposed. � & t1 te, 4. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds, 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). r\lof aW 11'eIf 11. Describe how colds foods will be kept cold(45 degrees and below). r 12. Describe how food temperatures are monitored. 13. Will foods be No on site? If no, where will foods be purchased? (enclose,,a copy of food y license) 1 o )Nl r� �- �e t cl o—i b.7 ne,5 5 01C6re-JS 3 Aug 2610 01:43p Pastry Strudel House 860-436-4551 p.7 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT L cutentri CT UlOD39 2. 3. Chnsh`nc brut ner- -StD "` 'n is-k 4. ,505 S. 6. 7. 8. 9. 10. 4 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 Wapping Fair Date of Event Sept 9- 12,2010 Time of Event-9/9 6 p.m.- 10 pm.; 9/10 6 p.m.- 11 p.m.; 9/11 10 a.m.-11 p.m; 9/12 10 a.m. -6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator-South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486,South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(C )860-573-667�80; (H) 860-632-1544 Name of Applicant !JIO�12,� S t rti l7 Name of Applicants Business (please indicate if mobile vendor) Applicants Address bV�-�r� n�4Y C-T-c)('OV Applicants E-Mail Address 02:1� +zZ s, ;, UO•GO(`c� Applicants Phone#(cell, work&home) Set up time Please provide the following: (If any of the following does not apply to you put N/A) 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. $ vv-� -+c,�--��.e ► 1 �'- ��-°-��. r l,Ja� 2 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 3. List all places (name&address) where meats,poultry, seafood, shellfish, and ice will be purchased. cub - 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#l. 78 c�)9ZZ- 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number,location and set up of handwashing facilities to be used by employees. A �9--n 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8. Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). ill be A Told (45 degrees and below). 11. Describe how colds foods w 12. Describe how food temperatures are monitored. 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT' I. ass�t�dl� Q-el A �-- l?�s- c- 3. �kj � ��s 7g9 4. s. 6. 7. s. 9. 10. 4 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 Wapping Fair Date of Event Sept 9- 12, 2010 Time of Event-9/9 6 p.m. - 10 pm.; 9/10 6 p.m.- 11 p.m.; 9/11 10 a.m.-II p.m; 9/12 10 a.m. -6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator-South Windsor Jaycees/Paul Petrillo Event Coordinator Address —PO Box 486, South Windsor, CT 06074 Event Coordinator Phone#_.860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(C )860-573-6780; (H) 860-632-1544 Name of Applicant�Q Name of Applicants Business (please indicate if mobile vendor) Uc21 Applicants Address Lo 4 N 44{-1 J i 34-n C j_ K o� - S o y rer-s Q.- o(n&7 1 Applicants E-Mail Address O rn Applicants Phone#(cell, work&home) �L - 7 - 5 f j (H) 'EW Setup time ` Please provide the following: (If any of the following does not apply to you put N/A) 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. me-04 bcI-11 1 S r(nrlc+'S, Locu er bo44-1-e� , Ca n neck.. SooLct- Small bcL�s o Ps 2 6. Describe the number,location and set up of handwashing facilities to be used by employees. �i Y1 lcr ►'1'Z-)i Gi e_ Se t P Con 46-A ri e:A. +v-o. r UD 144, 7. Describe how,and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. he'c" -C-al— 8. Describe how wastewater will be collected, stored and disposed. 14c) i n I 4-0x\k.. k d.e - c-c,. �-e�r- e� �1�, o wA sad e 9. Describe the number and location of garbage containers. cA. t l ha.►J er c�a -C be, c,c���, r1 exS 5 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). G l�G+c e, C,c-0 C.k. po 11. Describe how cold foods will be kept cold(45 degrees and below). 'e`e C�{-Y' C- U'k-vf . GLn Ok- I'C Z, 0-0 O 2XS e 12. Describe how food temperatures are monitored, cleaned and sanitized. 13. Will foods be prepared on site? If no,where will foods be purchased? (enclose copy of food license) ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS ✓ Metal probe thermometer(0—220 degrees F range). Thermometers for all refrigerators Coolers and ice packs(if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil J Extra utensils: tongs, spatulas, spoons, and knives 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 ✓ Garbage containers and plastic bags Hats/hair restraints ,/ Crates, shelves to store food off of the ground. _ Gloves for food handling ✓ Hand washing station 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—Wapping Fair Date of Event Sept 9— 12, 2010 Time of Event—9/9 6 p.m. — 10 pm.; 9/10 6 p.m.— 11 p.m.; 9/11 10 a.m.-11 p.m; 9/12 10 a.m. —6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator—South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone#_860-573-6780 Event Coordinator E-Mail Address WappingFair@aol.com Event Coordinator Phone#(C)860-573-6780; (H) 860-632-1544 Name of Applicant 5imrhzV1 �G��Sd� i Name of Applicants Business (please indicate if mobile vendor) Applicants Address �//�/�061e Applicants E-Mail Address Applicants Phone#(cell, work&home) 0&26 Set up time `7 Yq� Please provide the following: (If any of the following does not apply to you put N/A) 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. 2 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 3. List all places (name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. 8Y �UV510w) 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#l. 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide week of fair 6. Describe the number, location and set up of handwashing facilities to be used by employees. QA 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 4o 8. Describe how wastewater will be collected, stored and disposed. Vv , 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). 11. Describe how colds foods will be kept cold(45 degrees and below). NIA 12./Describe how food temperatures are monitored. n' �P S' MkCLt- 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) O, en 3 Rental Agreement Vendor Layout and Product Information Please complete the layout of your booth, so that we may best position you in our commercial section Rear S pr v Front Items to be sold, displayed or given away. Limit three(3)food items. No exceptions. All items must be listed. Beverages may not include anything containing alcohol, fresh squeezed lemonade or smoothies THIS FORM MUST BE RETURNED WITH YOUR RENTAL AGREEMENT APPLICATION Application Submission checklist: Rental Agreement Vendor Layout Town of South Windsor Temporary Food Vendor Application Deposit(50% due with application; after August 13th payment in full) Certificate of Insurance naming Wapping Fair as additionally insured. (If you do not have insurance it must be purchased through the Wapping Fair insurance company. Contact us for more info) NAME OF EMPLOYEE PHONE# ADDRESS SHIFT All 2. /��✓ems lei' ` 4. 64 - 5. B7 6 8. Yzu Ge" s37� l �f2; 9. 7f177 c�&2 4 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 mast be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue,South Windsor,CT 06074. This aunlication is not a license. Temporary food permits will not exceed a period of 1 to 5 days. Today's Date I`C 4_2Uf 0 Name of Event—Wapping Fair _-- Date of Event Sept 9— 112010_ Time of Event—9/9 6 p.m. — 10 pin..; 9/10 6 p.m.— 11 p.m.; 9/11 10 a.m.-II p.m; 9/12 10 a.m. —6 p.m. Location of Event_Evergreen Walk(Behind LA Fitness) Event Coordinator—South Windsor Jaycees/Paul Petrillo Event Coordinator Address PO Box 486,South Windsor, CT 06074 Event Coordinator Phone It_860-573-6780 Event Coordinator E-Mail Address WappingFairC aol.com Event Coordinator Pho )860-573-6780; (H) 860-632-1544_ Name of Applicant Name of Applicants Business { lease indicate if mobile vendor) t Applicants Address Applicants E-Mail Address flfl Applicants Phone#(cell,work&home) 060 ?3,0146,5'rE` 0 Set up time_ _ 'ZQ 10 Please provide the following: (If any of the following does not apply to you put N/A) 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. 2 2. Describe specifically how frozen,cold,and hot foods will be transported to the event. 3. List all places(name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. 4. names,phone numbers,addresses, and shifts to be worked of all employees. See attachment#1. eG,,, - /86 0 7 gs 7786 OJJ -;U, oi� a 5. Use"attachment#2 fhis�paet to sketch a drawing sho ing the event area and where your operation will be. Wapping Fair will provide week of fair 6.Describe the number,location and set up of handwashing ffa�cilities to be used by employees. ��w � �c12iQ� --t�— 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. Cx 1 w -- 8. Describe how wastewater will be collected.stored and disposed. 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers throughout the fair grounds 10.Describe what heat source will be used to keep hot foods hot (140 degrees and above). `Tro(0ct-w-e. 6 11. Describe how colds foods will be kept cold(45 degrees and below). 12.Describe how food temperatures are monitored. 13.Will foods be prepared on site`?If no,where will foods be purchased? (enclose a copy of food license) � 4 3 Rental Agreement Vendor Layout and Product Inform . Please complete the layout of your booth, so that we may best p ion y940o' -� < ercial section Rear 001 TZ — Nlc o t / Front t 3 o v Items to be sold, displayed or given away. Limit three (3) food items.No exceptions. All items must be listed. Beverages may not include anything containing alcohol, fresh squeezed lemonade or smoothies u THIS FORM MUST BE RETURNED WITH YO ENTAL AGREEMENT APPLICATION Application Submission checklist: Rental Agreement Vendor Layout Town of South Windsor Temporary Food Vendor Application Deposit (50% due with application; after August 13'h payment in full) Certificate of Insurance naming Wapping Fair as additionally insured. (If you do not have insurance it must be purchased through the Wapping Fair insurance company. Contact us for more info) NAME OF EMPLOYEE PHONE# ADDRESS SHIFT , yibtQ4f-� (560 4136140�- 17 peep woo 0 2. 4. 5. 6. 7. 8. 9. 10. 4 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 I to 5 days. Today's Date 07/28/2010 Name of Event Wapping Fair Date of Event Sept. 9" 12'r' 2010 Time of Event 9/9 6 p.m.-10 p.m.; 9/10 6 p.m. — 11 p.m. 9/11; 10 a.m. -11 p.m.; 9/12 10 a.m. —6 p.m. Location of Event Evergreen Walk (behind LA Fitness) Event Coordinator Paul Petrillo Event Coordinator Address PO Box 486 South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E=Mail Address wappingfair@aol.com Event Coordinator Phone#(cell, work & home)_(C) 860-573-6780 (H) 860=632-1544_ Name of Applicant Mark Schneider Name of Applicants Business(please indicate if mobile vendor)_South Windsor Jaycees Applicants Address 242 Talcottville Rd 4408, Vernon, CT 06066 Applicants E-Mail Address_marks79@comcast.net .Applicants Phone # (cell, work & home)_860-305-8325 Set up time-2 hours prior to fair hours of operation each day Please provide the following: (If any of the following does not apply to you put N/A) 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. CTDOCS:25986.i • Hamburgers • Cheeseburgers • Hot Dogs • Chili • Pickles • Potato Chips • Bottled Soda • Bottled Water • Juice Boxes 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. Cold foods (e.g. hamburger patties, hot dogs and cheese)will be delivered by an outside vendor in their refrigerated truck. Items will them by placed directly into the on site refrigerator/freezer. No hot foods will be transported to the event. All foods will be cooked /prepared on-site. 3. List all places (name& address)where meats, poultry, seafood, shellfish, and ice will be purchased. Ice—Dee Zee Ice, 350 Chapel Road, South Windsor, CT, 860-528-3500 Hot dogs, hamburgers,—HPC Food Service, South Windsor CT 06074 4. Li.st names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. The South Windsor Jaycees will employ a volunteer sign in sheet to track all volunteers who work at the South Windsor Jaycee food booth. 5. Use attachment #2 in this packet to sketch a drawing showing the event area and where your operation will be. Wapping Fair will provide layout the week of the fair. 6. Describe the number, location and set up.of handwashing facilities to be used by employees. The Wapping Fair will provide hand washing station in the area surrounding the food area. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. Utensil /equipment washing will not take place on-site, rather the food booth will utilize several sets of utensils throughout the day. An individual set will be used for no longer than two hours (or earlier if it becomes soiled)before it is replaced with a clean set. At the days end all utensil sets will be removed from the premises and appropriately cleaned and disinfected. CTDOCS:25986.1 2 S. Describe how wastewater will be collected, stored and disposed. The food booth will not generate waste water. 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers located in area surrounding food areas 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). Food will be cooked to-order on a 6 foot propane powered grill. 11. Describe how colds foods will be kept cold (45 degrees and below). Perishable foods will be stored in a freezer prior to cooking. 12. Describe how food temperatures are monitored, cleaned and sanitized. The food booth will maintain several metal probe food thermometers to monitor the temperature of cooked items. An individual thermometer will be used for no longer than two hours (or earlier if it becomes soiled) before it is replaced with a one. At the days end all thermometers will be removed from the premises and appropriately cleaned and disinfected. 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose copy.of food license) All foods will be prepared on site, with the exception of pre-packaged drinks and snacks (e.g. potato chips and soda). crpocS:25996.1 Wapping Community Church Volunteers at Wapping Fair Name Address Home Phone Mark Albrecht 41 Devonshire, SW 644-8773 Patty Albrecht 41 Devonshire, SW 644-8773 Pat Anderson 99 Tumblebrook Dr, SW 644 2741 Dot Armstrong 522 Foster St, SW 644-0628 Bill Baker 83 Eagle Run, SW 6442227 Dee Baker 83 Eagle Run, SW 644-2227 Bob Benson 128 Kelly Rd, SW 644-4696 Nancy Benson 128 Kelly Rd, SW 644-4696 Gretchen Bickford 53 Clinton Dr, SW 644-1422 Lance Blackwell 441 Main St, East Hartford 263-8133 Wayne Botha H-5 St. Marc Circle, SW 436-9865 June Brady 80 West Rd, SW 289-8174 Sam Brady 80 West Rd, SW 289-8174 Mark Burnham 15 Chapman St, East Hartford 436-0731 Nancy Calabrese 19 Andreis Trail, SW 644-9789 Geri Coli an 2299 Ellington Rd, SW 644-4420 Joanne Collins 31 Homestead, SW 648-4611 Nick Crawford 1002 Falls View Rd 236-7524 Jo ce Cyr 63 Blue Ridge Dr, Manchester 646-8346 Matt Desy 15 Newmarker, SW 648-1431 Ann Drake 29 Graham Rd, Broad Brook 623-1864 .Nancy Dunn 83 Homestead, SW 644-3057 Heather Eaton 655 Talcottville Rd,Vernon 256-7102 Megan Emmettee 128 Kelly Rd, SW 644-4696 Jeanne Ewing 25 Summerwood, SW 436-2271 Kevin Flanigan 97 Christine Dr, East Hartford 528-0204 Gay Foster 20 Berle,SW 644-5020 Judy Foster 120 Foster St, SW 644-1874 Jim Fulton 5 Grace Rd, SW 644-9002 Nancy Fulton 5 Grace Rd, SW 644-9002 Rich Gacek 23 Kent Lane, SW 644-8702 Carol Grein 6 Porter Green, SW 432-3999 David Grein 6 Porter Green,SW 432-3999 Jon Hale 54 Orchard Hill Dr., SW 644-8080 Carole Halpin 130 Country View, SW 644-0130 Sarah Hamilton 55 Berry Patch, SW 648-0085 Ernie Hintz 11 Aroda Dr, SW 644-1982 Marion Hintz 11 Aroda Dr, SW 644=1982 Barb Johnston 80 Jacques Lane, SW 528-6852 Pauline Kavanagh 146 Beelzebub, SW 644-4034 Dan Kellner 34 Gail Lane, SW 436-4717 Nancy Kellner 34 Gail Lane, SW 436-4717 Tim Kiessling 11 Barbara's Way, Ellington 871-2930 Caroline King 100 Farmstead, SW 648-1214 Diane Lazinsk 96 Farmbrook Lane, SW 644-3636 Jill Limberger 48 Wapping Ave., SW 508-2629 Darby Long 15 Strong Rd., SW 282-0288 Nick Mader 316 Rye St, Broad Brook 758-7693 Sarah Mader 316 Rye St, Broad Brook 758-7693 Larry Marciano 85 Spring St, New Britain 826-8772 Stacy Mike 188 Morgan Farms Dr, SW 644-6932 Cindy Miller 21 LeFoll Blvd, SW 528-0001 Nancy Normen 158 Homestead Dr., SW 644-9029 Lauren Oates 935 Main St., SW 528-8220 Paul Oates 935 Main St., SW 528-8220 Tracy Oates 935 Main St., SW 528-8220 Nancy Oltheten 9 Birch View Dr, Ellington 872-2825 Wapping Community Church Volunteers at Wapping Fair Name Address Home Phone Becky Person 16 Niederwerfer Rd, Broad Brook 872-2847 Ross Person 16 Niederwerfer Rd, Broad Brook 872-2847 Diane Rosfjord 175 Orchard Hill Dr, SW 644-3157 Tom Rosford 175 Orchard Hill Dr, SW 644-3157 Karen Ruegg 157 Natsisk Farm, SW 644-3553 Mark Rueg 157 Natsisky Farm, SW 644-3553 Roland Schneider 80 Judy Lane, SW 291-1176 Josh Sheffei 1002 Falls View Rd 236-7524 Gail Snow 1041 Strong, SW 644-2659 Tom Spitler 25 Case Hill Circle, SW 290-8833 Pat Stebbins 711 Misty Meadow, SW 644-9287 Jan Tarr 180 Mohegan Trail 644-9738 Sherm Tarr 180 Mohe an Trail 644-9738 Gerry Tavernier 73 Wood Pond Rd., SW 644-1209 Robby Tavernier 73 Wood Pond Rd., SW 644-1209 Rick Usifer 115 Greenfield Dr, SW 644-2578 Paul Vasseur 403 Summit St, Manchester 649-9956 Alice Walls 18 Birch Hill Dr, SW 644-1279 Dave Walls 18 Birch Hill Dr, SW 644-1279 Jamie Wells 785 Foster Rd Ext, SW 989-1247 Jay Wells 785 Foster Rd Ext, SW 989-1247 Donna Williams 103 Cliffwood Dr SW 644-1161