HomeMy WebLinkAboutTemp Food Inspection 150 Nevers Road (9) 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 1 to 5 days
Name of Event Awme&i r,_Ss 7D��j
Date(s) of Event LQ I Z� at
Hours of Event /z) --
Number of Food Vendors � t�1c,�)
Name of Event Coordinator j `R WA3 60A PL0gFF
Address of Event Coordinator Q��A. 4dc, �CY S0502 IC4S
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Cell Phone # Home Phone# Work Phone# (eq&—(oJ// 6ef 331
E-Mail JtX.c Vl�. �lUric�v / SOO-thW 6n&W—,Orz�
Name of On—Site Coordinator � t�
QFO (please check if On site coordinator is QFO an provide a copy of QFO certificate)
List of Vendors attending event
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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
C:\Documents and Settings\dennisdsheridan\Local Settings\Temporary Internet Files\OLKI\Temporary Food Coordinator Application 2007.doc
€6p 23 08 12: 52p Leukemia-Lymphoma Societj (203) 379-0451 p. 1
FACSIMILE TRANSMITTAL SHEET The Leukemia&Lymphoma SdC%rys
Fighting Blood Cancers
TO: FRO
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COMPANY: DATE:
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PAX NUMEER. TOTAL NO.O PAGES INCLUDING COVER:
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C7 URGENT 11 FOR REVIEW PLEASE COMMENT CI PLEASE REPLY ❑PLEASE RECYCLE
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THE LEUKEMIA & LYMPHOMA SOCIETY
300 RESEARCH PARKWAY,SUITE 310
MERIDEN,CT 06450
TEL 203.379-0445 FAX 203.379.0451
TOLL FREE 888.282.9465
Sep 2.3 08 12: 53p Leukemia-Lymphoma Society (203) 379-0451 p. 2
VENDOR
APPLICATION
AND
GUIDELINES
FOR
TEMPORARY FOOD SERVICE EVENTS
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Sep 33 08 12: 53p Leukemia-Lymphoma Society (203) 379-0451 p, 3
VENDOR APPLICATION YOR TEMPORARY FOOD
EVENT
The VENDOR of each temporary food event must complete this application and must be filed I
prior to the opening event. This application must be submitted to the Town of South Windsor 4 days
Health Department, 1540 Sullivan Avenue, South Windsor, CT Q6 e T
4.
This apalieation is not a license.Temporary food permits will not exceed a period of I to 5 days,
Today's Date
Name of Event L t /.
Date of Event ei�
Time of Event 5 . 3 - 9
Location of Event_ -flu
Event Coordinator` � � ,
Event Coordinator Address
Event Coordinator Phone# v, ��?(Ion
Event Coordinator E-Mail Address��
-2 (a), �1
Event Coordinator Phone# cell work&home l
Name ofAppIican(- b Ud
Name of Applicants Business(please indicate if mobile vendor)
AppIicatits Address
Applicants E Mail Address
Applicants Phone#(cell, work&home)
Setup time s02
Please provide the following: (If any of the following does not apply to you put N/A)
Uist 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
Sep 2-3 08 12: 53p Leukemia-LBmphoma Societ8 (203) 379-0451 p. 4
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 wiI1 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 ofhandwashing facilities to be used by employees.
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LA_)a '- w � 12e �� � cif t V(—
'7.Describe how and where,u ens Uecluipment washingw' --
describe how alternate steps will be taken. will take place.if no facilities are available,
OU
2
Sep 2a 08 12: 53p Leukemia-LSmphoma SocietS (203) 379-0451 p. 5
8. Describe how wastewater will be collected, stored and disposed.
;CSC, ED I UL UA
9.Describe the number and location of garbage containers.
.5
Off d'6
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
(Q1
11.Describe how colds foods will be kept cold(45 degrees and below).
12. Describe how food temperatures are monitored,cleaned and sanitized.
13. Will foods be prepared on site? If no,where will d
foos be purchased?(enclose co
� py of food license)
S
J
3
Sep 2,3 08 12: 54p Leukemia-Lymphoma Society (2031 379-0451 p. 6
.NAME OF EMPLOY13B pHpNE#
DD ESs SHIFT
koov 2. ,_�Ch� ��C�C..�-. � �
a S/0
3. � �
4.
5.
6.
7.
8.
9.
10.
ATTACHUV.NT jY
CHECKLIST FOR FOOD BOOTEVVENDOR 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
Colltainer(s)for grease collection
Clean wiping cloths and a container to store them in
Garbage containers and plastic bags
4
09/23/2008 TUE 13:17 FAX 860 644 7280 South Windsor Town Hall 12001
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,pax coVEN SHEET
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CONNECTICUT -06074-2786
TELEPHONE: 860 644-2511 FAX: 860 644-7280
DATE:
PLEASE DELIVER THE FOLLOWING PAGES TO:
NAME: - CUFF/DEE
COMPANY:. ALL AMERICAN WASTE
FAX # 291-9062
FROM:
NAME: Bernie Russo, 644-2511, Ext. 249
TITLE:
MESSAGE:
Scrap MPf.a1 -Pie-kill) or•