HomeMy WebLinkAboutTemp Food Inspection 150 Nevers Road (8) VENDOR APPLICATION FOR TEMPORARY FOOD EVENT
The VENDOR of each temporary food event must complete this application and must be fled 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 5" 02-7 b q
Name of Event &W 11 'S
Date of Event
Time of Event
Location of Event 9 664 i 1_L6 134-NIK- IM4-Y_
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Event Coordinator if_0 Lb 6 rul Gl`7j's zp—w ASV I
Event Coordinator Address 60 t EVt�cl V-c<X (AJ"I 't,(j je 60 3 .St f k [,J i Yf dP l/
Event Coordinator Phone# �U C
Event Coordinator E-Mail Address h 4 K.1 d�-�l1�Yj- h J- SlU j ti. �G' -
Event Coordinator Phone#(cell,work&home) tLA-t.f (moo) �b 2-S-t Gj 'j
Name of Applicant
Name of Applicants Business (please indicate if mobile vendor) GlApplicants Address Address WD 1 &L�(A Y o/" w( � c� z DU t U& 01 rd kK
Applicants E-Mail Address
Applicants Phone#(cell, work&home) W8&_
Set up timeO_ IF
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.
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2. Describe specifically how frozen, cold, and hot foods will be transported to the event.
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3.List all places (name&address) where meats,poultry, seafood,shellfish,and ice will be purchased.
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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.
6. Describe the number,location and set up of handwashing facilities to be used by employees.
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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.
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8.Describe how wastewater will be collected, stored and disposed.
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9. Describe the number and location of garbage containers.
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
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11.Describe how colds foods will be kept cold (45 degrees and beI w).
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12. Describe how food temperatures are monitored, cleaned and sanitized.
13. Will foods be prepared on site? 1f no,where will foods be purchased? (enclose copy of food license)1
3
NAME OF EMPLOYEE PHONE# ADDRESS SHIFT
1.
2.
3.
4.
S.
6.
7,
8.
9.
10.
ATTACHMENT #2
CHECKLIST FOR FOOD BOOTHNENDOR 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
>�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
4
Hats/hair restraints
Crates,shelves to store food off of the ground
Gloves for food handling
Hand washing station
12
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5
VENDOR APPL=CAT=ON 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 z O
Name of Event � ��/,/ GUi,� -55r
Date of Event �/da�� f�� Z Oa
Time of Event
Location of Event ct�if� Gvi.�os /�o�if,�y,�f dog ivc�
Event Coordinator �/�/g y
Event Coordinator Address
Event Coordinator Phone#
Event Coordinator E-Mail Address �j,�C,2/ yd'� e e, 4fa e
Event Coordinator Phone#(cell, work&home) 7/
Name of Applicant �i�B�/1T .�id.Gad�
Name of Applicants Business (please indicate if mobile vendor).S 64J
Applicants Address J 4 �.
Applicants E-Mail Address
Applicants Phone#(cell, work&home)
Set up time 9 :o o
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.
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2
2. Describe specifically how frozen,cold, and hot foods will be transported to the event.
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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.
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.
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9. Describe the number and location of garbage containers.
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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.��r'7�itla�lG71�
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
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ATTACHMENT #2
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CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS
t, /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
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
r/ Crates, shelves to store food off of the ground
Gloves for food handling
Hand washing station
8