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Temp Food Inspection 00 Evergreen Walk (3)
WAPPING COMMUNITY CHURCH - WAPPING FAIR BAKED POTATO VOLUNTEER LIST September 9-12, 2010 A B C D E 1 NAIVIL ADDRESS HOME PRONE CELL PHONE E-MAIL ADDRESS 2 Albrecht, Patty 41 Devonshire Drive, SW 860-644-8773 3 Anderson, Pat 99 Tumblebrook Drive, SW 860-644-2741 860-614-7587 cpatander cox.net 4 lArnett, Al 2807 Ellington Road, SW 860-644-5166 860-324-8798 5 jBaker, Bill 83 Eagle Run, SW 860-644-2227 6 Baker, Dee 83 Eagle Run, SW 860-644-2227 7 Bassilakis, Nancy 220 Laurel Street, SW 860-644-7176 nancyb7176@yahoo.com 8 Brady, June 80 West Road, SW 860-289-8174 860-796-2310 (Sam) 9 Brown, Dick 148 Oak Street, SW 860-644-8017 860-794-3239 10 Burnham, Mark 15 Chapman, Rm. 25, E. Hartford 860-436-0731 11 Calabrese, Nancy 19 Andreis Trail, SW 860-644-9789 860-558-8830 ncc19@sbcglobal.net 12 Carlson, Christine 15 Ferndale Drive, Manchester 860-643-8875 860-221-9174 christinedc@hotmaii.com hotmail.com 13 Coligan, Geri 2299 Ellington Road, SW 860-644-4420 860-690-2208 coliganraymond@sbcglobal.net 14 Crawford, Nick 19 Cliffside Drive, SW 860-281-9076 nickcrawford@gmail.com 15 Cyr, Joyce 63 Blue ridge Drive, Manchester 860-646-8346 860-944-8423 jcyr121@cox.net 16 Delgreco, Haley 15 Strong Road, SW 860-282-0288 17 Desy, Matt 15 Newmarker Road, SW 860-648-1431 860-281-4411 mdm@ghberlin.com 18 Drake, Ann 29 Graham Road, Broad Brook 860-623-1864 anniohnd@yahoo.com 19 Drake, John 29 Graham Road, Broad Brook 860-623-1864 860-836-4973 anniohnd@yahoo.com 20 Edson, Lynn 11 Kingsley Drive, SW 860-644-0712 860-573-9404 21 Elliott, Jason 1 Eastwood Drive, Broad Brook 860-654-1719 22 Elliott, Rob 1 Eastwood Drive, Broad Brook 860-654-1719 860-214-1168 rob.elliott@cox.net 23 Ewing, Jeanne 25 Summerwood Lane, SW 860-436-2271 860-881-9131 pewing@cox.net 24 Foster, David 20 Berle Road, SW 860-644-5020 25 Foster, Gay 20 Berle Road, SW 860-644-5020 860-798-5100 gay.foster@gmail.com 26 Foster, Judy 12 Foster Street, SW 860-644-1874 860-995-5422 cowfoster@gmail.com 27 Fulton, Jim 5 Grace Road, SW 860-644-9002 860-970-5153 ifulton@snet.net 28 Fulton, Nancy 5 Grace Road, SW 860-644-9002 29 Gates, George 2308 Mill Pond Drive, SW 860-644-9366 860-550-2259 gwg222@cox.net 30 Gelinas, Barb 285 Graham Road, SW 860-644-2059 860-995-2830 gelinasl2@cox.net 31 Gozdeck, Ted 136 Homestead Drive, SW 860-644-9816 32 Gozdeck, Nancy 136 Homestead Drive, SW 860-644-9816 33 lGrein, Carol 9 Porter Green, SW 860-432-3999 dcgreinl@cox.net WAPPING COMMUNITY CHURCH - WAPPING FAIR BAKED POTATO VOLUNTEER LIST September 9-12, 2010 A B C D E 67 Rowe, Greg 198 Norton Lane, SW 860-644-1013 860-268-5239 growe@cox.net 68 Ruegg, Karen 157 Natsisky Farm Road, SW 860-644-3553 69 Ruegg, Mark 157 Natsisky Farm Road, SW 860-644-3553 860-748-8278 riieggm@aol.com 70 lSawyer, Bill 43 1/2 Wapping Wood Road, Ellington 860-871-1406 71 Schneider, Roland 9 Karen Way, SW 860-291-1176 72 Sheffel, Josh 19 Cliffside Drive, SW 612-236-7524 oshsheffel@hotmail.com 73 Snelgrove, Lois 85 Valley View, SW 860-644-8342 860-930-3028 loal54@cox.net 74 Snow, Gail 130 Winding Lane, E. Hartford 06118 ' 860-462-0070 gsnow5213@vahoo.com 75 Spieker, Debbie 365 Barber Hill Road, SW 860-644-1866 860-214-8664 mustanemama652aol.com 76 Stebbins, Pat 711 Misty Meadow Drive, SW 860-644-9287 860-559-5132 pes355@aol.com 77 Tarr, Jan 180 Mohegan Trail, SW 860-644-9738 860-202-8036 jbtarr@aol.com 78 Tarr, Sherm 180 Mohegan Trail, SW 860-644-9738 79 Usifer, Rick 115 Greenfield Drive, SW 860-644-2578 860-967-9827 RU507@cox.net 80 Usifer, Sam 115 Greenfield Drive, SW 860-644-2578 81 Vallez, Joyce 105 Judy Lane, SW 860-289-3603 860-874-1760 stewart720@aol.com 82 Walls, Dave 18 Birch Hill Drive, SW 860-644-1279 83 Walls, Alice 18 Birch Hill Drive, SW 860-644-1279 84 Welch, Brian 51 Vernon Road, Bolton 860-645-9971 85 Welch, Kim 51 Vernon Road, Bolton 860-645-9971 860-202-3111 kimw9@sbcglobal.net 86 Williams, Donna 103 Cliffwood Drive, SW 860-644-1161 860-305-4264 87 Williams, Mark 103 Cliffwood Drive, SW 860-644-1161 860-305-4264 mfwill@cox.net 88 Wnuck, Donna 30 Spinner Road, SW 860-644-6059 860-970-7120 89 Wnuck, Wayne 130 Spinner Road, SW 860-644-6059 860-989-5542 wayne.wnuck@utc.com Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event - Food Inspection Name of Organization:_ZY/0 642"- Phone No.: Cell No.: Person-in-charge (PRINT): Name &Address of Event: Date(s)of Event: Hours of Operation: -/a ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(450F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation:Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: s: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates & Times Worked)Keep for 90 days ♦ Other: CORRECTIONS DUE IMMEDIATELY Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The V ENT)OR of each temporary food event must complete this application and mast 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 O Name of Event Wapping Fait Date of Event _Sept 10- 13 Time of Event 9/10 (6 p.m. -10 p.m.); 9/1 1 (6 p.m. — 11 p.m.); 9/12 (10 a.m. — 11 p.m.); 9/13 (10 a.m. -6 P.m.) Location of Event _Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address Wappingfair@aol.coin Event Coordinator Phone # (cell,work& home) (C) 573-6780; (H) 632-1544 (W) 236-5901 Name of Applicant C� ,►V � � Name of Applicants Business (please indicate if mobile vendor) Mkt- f aj Applicants Address W � Af'�1,5� 1JJ" 6A -&a 0-0 b ' 7d Applicants E-Mail Address TZ�y\Ab C &V\- Applicants Phone # (cell, work & home) ��3 � Lk ` 'D I LECI Set up time PNIA OL �D 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. P"jAt4 N-" Nofdq 6* t w, M� 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. SAM I etub Wew-OAvenf Cr 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. 5. Use attachment 42 in this packet to sketch a drawing showing the event area and where your operation will be. —To be provided by Wapping Fair prior to event 6. Describe the number, location and set up of handwashing facilities to be used by employees. we-"\* oNe W'911J'fl8tf3NCr ]A i 6 WD"Alvni iCU- 64C JoCA & C-'VLv�MS C&9K3NG NW �� ffrf W-atcJ Tf t& . 7. Describe how and where utensil./equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. NMI* M 5"o&C- 3T� N® W-1 lj t." 49" AVA ZAA6 jive-kxv6N C)qe,+ S: Describe how wastewater will be collected, stored and disposedURPTC 9. Describe the number and location of garbage containers. To be pi-ovided by Wapping Fair 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. �' 109 b*✓ w PrW7-W btu- (Afn MOST W vomow wide meoltm€ 706tAwtees, f Will foods be prepared on site? 1f no, where will foods be purchased? (enclose a copy of food license) ko � Poo We f ugC' Kep FOOD PLOM , 12-651VAAA",17- per• NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 6. 7 s. 9. 10. �1- 4M 11"'ltuel-F4 NAlid)B);ai 6,*,t sslvl(;S3i 1i1100148fz • aa, i FR Training Provided By American Food Safety IMgtitute 8W723-3873 Certuieate Ivied: 2/27/00 Tes[cock: b2(13 -1 i0[ll Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: Phone No.: Cell No.: Person-in-charge(PRINT): Name &Address of Event: i Date(s) of Event: *__/0-0 Hours of Operation:- ----------------------- ------------------------------- -------------------------------- ♦ Hand Washing Setup: 0 tz ♦ Waste Water/Garbage Disposal: J e,C /J An;dP Uj' 40/z- * Approved Food&Water Source: V " ♦ Personal Hygiene: L ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): l� ♦ Coolers: ' I ♦ Hot Temps(140°F or hotter): /V s ♦ Internal Cooldng Temps: u d KI Ce1,,-e CHECK FOOD TEMPERATURES THROUGH-OUT THE AY♦U YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/ Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizes/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: DIE- * Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: L ♦ Workers Log(Name,Address, Phone#, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: ( Q� Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: IV VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The N-'ENDOR 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 (S Name of Event Wapping Fair Date of Event _Sept 10- 13 Time of Event 9/10 (6 p.m. -10 p.m.); 9/11 (6 p.m. — 1 I p.m.); 9/12 (10 a.m. — 11 p.m.); 9/13 (10 a.m. -6 p.m.) Location of Event_Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address W"appingfair@aol.com Event Coordinator Phone# (cell, work.& home) (C) 573-6780; (H) 632-1544 (W) 236-5901 Name of applicant vb,nz Name of Applicants Business (please indicate if mobile vendor) —Uk�Y-w_t �M-e1# Inc Applicants Address Q Applicants E-Mail Address Applicants Phone # (cell, work & home) _ oa- �� - —� C� aQ -(QC�� 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. h . 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. 1 3. List all places (name & address) where meats, poultry; seafood, shellfish, and ice will be purchased. o�c�1 Grocej Ste- — -T-f-e- 4. List names, phone numbers,addresses, and shifts fto 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. — To be provided by Wapping Fair prior to event 6. Describe the number, location and set up of handwashing facilities to be used by employees. �C 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. CO 4 VA �O Ic 1� s�(� `csrJ 3 { v S. Describe how wastewater will be collected, stored and disposed. -(:]n 110 IAi vyvikvuk U A&V -+VC .t' k_vl' 9. Describe the number and location of garbage containers. To be provided by Wapping Fair 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). g 14 11. Describe how colds foods will be kept cold (45 degrees and below). �t 12. Describe how food temperatures are monitored. R� H 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) 4 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT �. C.k�s�►(Y�, Cr o� c(rd 4. 5. 6. 7. s. 9. l o. Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization:S'0j • t.Gp /G Phone No.: Cell No.: Person-in-charge (PRINT): Name &Address of Event: Date(s)of Event: Hours of Operation: �a --------------- ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/ Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/ Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name, Address, Phone#, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side 1 have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 1.4 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. Temporai-y- food permits will not exceed a period of 1 to 5 days. Today's Date Name of Event Wapping Fair Date of Event _Sept 10- 13 Time ofEvent 9/10 (6 p.m. -10 p.m.); 9/11 (6 p.m. - I I p.m.); 9/12 (10 a.m. - 11 p.m.); 9/1U (10 a.m. -6 p.m.) Location of Event_Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address—PO Box 486, South Windsor, CT 06074 Event Coordinator Phone # 860-573-6780 Event CoordinatorE-Mail Address Wappingfair@aol.coin Event Coordinator Phone # (cell, work& home) (C) 573-6780; (H) 632-1544 (W) 236-5901 Name of Applicant 9 o"Lo, C,�,r. ``e�L.�, Name of Applicants Business (please indicate if mobile vendor) �e- c Applicants Address � �� Applicants E-Mail Address_ C"\c s-V-C -<) c,-- :applicants Phone# (cell, work& home) Set up time -Vass Please provide the following: (If any of the following does not apply to you put N/A) [.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. 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. S N�1S C-\v11--. 4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. vu-J-4z- L'�-U r`-s 5. Use attachment #2 in this packet to sketch a drawing showing the event area and where your operation will be. — To be provided by Wapping Fair prior to event 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, S. Describe how wastewater will be collected, stored and disposed. vs"') 5►-�'\ S 9. Describe the number and location of garbage containers. To be provided by Wapping Fair 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). �`���.. G r-��� � �2�1c,� "C✓r CCQ� �s�2/' CW�.�2�� (�rrs{lc�2 G✓�/ 6r-! �Cs (lam°�Ze-Q' &t dL� 11. Describe how colds foods will be kept cold (45 degrees and below). Co-�2.rS c„-,1-10— L C"4-2 I I 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) C � 1 c,✓ k NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. J. 4. J. 6. 7. s. 9. M a. i3 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event— Food Inspection Name of Organization: ajam)(l f-i ►-(lam- Phone No.: Cell No.: Person-in-charge (PRIN—T)::U Name &Address of Event: L Date(s)of Event: 9/b D Hours of Operation: - I a ------- --------------- + Hand Washing Setup: ♦ Waste Water/Garbage Disposal:-, co ♦ Approved Food& Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): N , ♦ Coolers: i� ♦ Hot Temps(140°F or hotter): ♦ Internal Cooldng Temps: D/G CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination:__ Utensil Washing: ♦ Sanitizer/Wiping Cloths: r7 L ♦ Food/Equipment/Single-Use Protection: nty ♦ Self-Serve food/ Utensils Protected: [) ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone #, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: VENDOR APPLICATION rOft TEMPORARY OD r E 0 . -VENT The 'VEND zl! porar food&ent .prior to the opel-1111-o.event, This application must-1-16 sUbilulted to the Tovvi-I I-lealtiv Depa, runent, 1 i40 Sull' ivan Ax-t-l-Ille, South IkVilldsor. CT 06074 Thi-s applirgil)'II is a licr$js t mceed a vlvf iod of 1 tO i Today's Date Nl,alve.of Event wa-ITIll" . CO3 Daie of[-.'veflt pt 10- 13 Tinle 0J.'EVC1,11 9Y 10(6 ;Lfb: -C. 1-001 lon of Event EvOgre h W, lk bel ind LA Fitness EvOlt Coordinator Soulb willd'sor j,I\Cees, Event C001-dimator Addi-c-s N.) Box 486, Souti-I WindOr- CT 061074 73�-6 780 Event Phone # Event Coordinator E-N-lail Address Wap if, P fir ir�aacil.l~irtt`r_ hme 4 'citq vvor k 0 0- 5 4_1 COV) 2 Name of Appli)COint Name (yr Applicinto Busilleas fpl&,,jse i Id cLite if mobile vinad or) Applicants Address Aj:)plwants FNlail Ai di-es I'llione # fCcIt work:& ljonie) please provide Ille follov"im- (11'am. of fhc foljoiN-ing does tl0t APP.IN00you put N/♦N) _L.Is,.t All 10od and bever.age ilenis to be prep-ared and, icl ved f -jemt), Aft! c-i j N-OTE.-Any changeS to if v menu must be Submitted to the Fleattl Departin clFtvs pj to the 1 flit. C_ *49e=9�06&'` R. Dekrlbe specifically, ht)y" frOlzen-coU and hot fbods-will uls� d.to the 6e.ijj, be t, Im-te 3, List till places tname Id s's),where,rijed-ts� poultry, sejfi(,I_. shelfri-sh and ice.Avill I AUM ne jji_jf,(f�,i-%4 4 Lisi names, phorie IlUmbers,. Ladd resics, and shifts to be worked of all emploYees: See attachinent 4, AI-5 �Zolcl. /C7� D� Q'A/Al 61 dY C, IP:Pl F1, S. I JS '2 ' this Imicket to qketch A:drawing,-sh.oxving t4e,:eveiit:jj d:vvjjejt,- V()Lll-- T e.attachment 4 ill rea Ari operation will 1)&, -To be provid d b 'W i Y app.m.- Fair prior to-event 6,.Desc.r.i.be thc:numhcr,.loQation and set up of bandwashing,facilities tc�t.-)c tjge d by elliployets,. D �,c Ib le tupment-v.,a e lace, Jf I-10 radfit, S re Vail ble. es r' e1low and wheye utelis7ij., (I -vvill 1---ik pI it deescribehow ahernate:stepsq xvill be taken- 8 Describe:how wastow mterwiMbc cotlected st(.)j-ed and dispOsed, Ib I'kll De -ib-e tbe-num-ber and 4.)cATIon of garbag( contamej-,g, To be provided by Wapping Fair 1), Del llc-d b.0wilat I'l—waf sou rce wi 11 be used it) keep hot foods hot 140 degrec.,z, and a bove�. 1. YJ(If T Opf S. F /t. C-lel Des-cribe lik-t-vv colds:foods Nvill I'('Rept cold 0i dcgj-oc�al Id 60,011,11,L Describe:how floOld IC-1111)eratures are rtionitored. 13. will foodi he Prepared On site? If nog X.N.-here will food,, be (enchw to Copy Of fo(�-Id llcens.c) JE Sll 1 T 3 -- W: 1 { 4- 51 6. 7 10, Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization:9 1/m,�► � ��S/Dh< Phone No.: Cell No.: Person-in-charge (PRINT): Name&Address of Event: n / Date(s)of Event: >D—b Hours of Operation: 7d -------------------- ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: SlVaJd ,'—) Ll&IV4 -5j JIL ♦ Approved Food&Water Source: ♦ Personal Hygiene: /) 4 ♦ Thermometers/Alcohol Swabs: Cold Temps(45°F or colder): (� Al 4 � S ♦ Coolers: ow ♦ Hot Temps(140°F or hotter): i C) ♦ Internal Cooking Temps: 10 CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: �,6 mljtam - tZcf tozf- ND VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event mast complete this application and must he 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 , ( J CJ l , Name of Event Wapping Fair, ` Date of Event —Sept 10- 13 Time of Event 9/10 (6 p.m. -10 p.m.),- 9/11 (6 p.m. — 11 p.m.); 9/12 (10 a.m. — 11 p.m.); 9/13 (1.0 a.m.. -6 p.m.) Location of Event—Evergreen Walk beirind LA Fitness Event Coordinator—South Windsor Jaycees Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone # 860-573-6780 Event Coordinator E-Mail Address Wappitngfair@aol.com Event Coordinator Ph 1e # ({cell, wort£ home) (C) 573-6780; (H) 633-1544 (W) 236-5901 Name of Applicant o*--eGI Name of Applicants Business (please indicate if mobile vendor) Applicants Address p;)o Applicants E,Mail Address Applicants Phone# 'cell, work& home) _ CC�� Set up time Please provide the following: (If any of the following does not apply to you put N/A) 1.List all: food anev " ms`t e prepared and s rved (menu). Attach a separate sheet if necessary. � Qt� � aONOTE: Any chanu must be mitt o the Health Department 10 days prior to the event. Z. Describe specifically how frozen, cold, and hot foods will be transported to the event. l 3. List all places (name& address) where meats, poultry, seafood, shellfish, and ice will be purchased. 4. List names, phone numbers, addresses, and shims to be worked of all employees. See attachment #1. 21 S. Use attachment 42 in this pacicet to sketch a drawing showing the event area and where your operation will be. —To be provided by Wapping Fair prior to event 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. 5(; S. Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. To be provided by Napping Fair 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). (::�O � per. op- t 1. 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) ATTACHMENT #2 6 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: l.f? /b- Al ZZ-A Phone No.: Cell No.: Person-in-charge(PRINT): Name &Address of Event: / Date(s)of Event: 47w d Hours of Operation: ♦ Hand Washing Setup: k_ ♦ Waste Water/Garbage Disposal: u 7- ♦ Approved Food&Water Source: V Qcj ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: y J ♦ Cold Temps(45°F or colder): ♦ Coolers: /� b Ct U ♦ Hot Temps(140°F or hotter): 1 7- f ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY♦USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name, Address, Phone#, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (sign): Date: Inspector: Date: r 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 Wap ins , it Date of Event Sept.'&h Time of Event 9/Av 6 p.m.-10 p.m.- 94 6 p.m. - 11 p.m. 9/i Z 10 a.m. -11 p.m., 91AS10 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 4 860-573-6780 Event Coordinator E-Mail Address wappingfair@aol.com Event Coordinator Phone# (cell, work & home) _(C) 860-573-6780 (-FI) 860-632-1544 Name of Applicant /� - Poe- Name of Applicants Business (please indicate if mobile vendor} ? ,- Applicants Address _ l 6( OL&CU"J KJ 9 r(d t4,j f1(' �f! 07, Applicants E-Mail Address Cr,44 )y4, r("Ale.41( (� 4.Ct)/-i Applicants Phone 4 (cell, work& home) Set up time K ob aM a�- 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 �✓ S I _ 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. l vl.7�hl f--� ee- &,.e o��d�1 �1ti o- rvy j �MPc.1 S r � Mc✓q� � �lAayttiS�ko/r1w I Ot� C-�00 jZL0. tr"' gdo G, jrf N-j n.coL< eq',r4. l( o /VaT ;--if? t� ,(4- 0veN tL0 -� �►vy ts�� r �'v tir 1, ,.rs wf�c ,..e c�a,�— 5 L�( ti.. -� O-e A<S c k-d ed 3. List all places (nam & address) where meats, poultry, seafood, shellfish, and ice will be purchased. S� V ter lf'm evi �„4 1 3-C-e tin✓C air u c e ' o+�r d�.(.,.. -�( c c �-,r� c 1�i L -V-1 S t1G— q. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. D..tiict SO h (_24-'0 - �Gc�- q2& `f6Li7�=(� I'. ec� 'Q� — �6v-zed 116-v'ad�,c� S4-, (-(4�� ✓'o(C7. Ca^^A^ G-�.. At,�ti `f,2 J- �60 qC<�c(e �G� ta . Cf C)6u?�� ct r;`; ;" Sus g -�. e6d- TV- �zU 63 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 fail'. 6. Describe the number, location and and set{p of handwashing facilities to be used rr by em loyees.j vaSLlctiS C�T�tid^ +v� E1. Cd IA"O' s rit,n/�II.S lafcl'tl '�i�aC.rL ✓i4� S�1in Q_A, et- cctk , b,.tc 0 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. w �t� be eL ati� a cO;,k�tr '� Sir� ('�( � LA� ,s i �'1-c� v t(� b� 7 t', Gar k 8. Describe how wastewater will be collected, stored and disposed. Cv �I{ CW U-S'4s s �� � Oc,c et-,3 �, e did lt-L, v r��<< �U CC(,—PL A r �J� O(I SPV a3-' 9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers located in area surrounding food areas Gtwe- q 4-- It-0- 3 Oev-43 rc-ceP/1c ('wr Ok.P l.LJ< +LI� 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). (�V �Sc•►.S �/vc�✓� Cp oJ��S �o v 11. Describe how colds foods will be kept cold (45 degrees and below). 12. Describe chow_food temperatures are monitored; cleaned and sanitized. r,i ��N\�cit-ca'V �iCCr� lvlat`�'t� }TCSfi S�`✓��S/Ivt �.� !� q 'bv 11-ve- ��//"O'U I �$ 15. Will foods be prepared on site? If no, where will foods be purchased? (enclose cony of food license) Iza.Ods w I'I C—C'A.'e fi/ur,-► (;Y5Co �r ()p6::, NAME OF EMPLOYEE PHONE# —ADDRESS r SHIFT �>�,,,,�,,,�� CAldk•t' ddl gtv3,067 a. 1. � 6 71( _ 17u,v�tl ��v pi- N15tit -y—cil�,'/sal- 0„(,�( a-t e�4-fin( 4. ��r���� Scr�9 '�-��� "-G S-Cj7-7067 ..� �.� v d,.�,o<�I��( Pr,� - o-c 6. 7, s. a to, ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS Metal prove 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 toil 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 4 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization:u,�i-joP/uk cLy k Phone No.: Cell No.: Person-in-charge (PRINT): _ Name &Address of Event: / * Date(s) of Event: /p —D`j Hours of Operation: ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooldng Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: Download the original attachment C",k. VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS 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 t 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 o� Q Q i Name of Event Wapping Fair Date of Event Sept. 4'h— 7th Time of Event 9/4—6 p.m.-10 p.m.; 9/5 6 p.m. — 11 p.m. 9/6; 10 a.m. -11 p.m.; 9/7 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 T 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 Name of Applicants Business(please indicate if mobile vendor) Applicants Address Applicants E-Mail Address r Applicants Phone#(cell,work&home) &10 o/yy 1570a a i 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 ev nt. ` �p 't Z�Z r 2. Describe specifically how,' frozen, cold,and hot foods ll be 4-anspto�rt�ed to the event.�45-A n FAO l J—k Gl'✓I wQxow Q V ` 40+ u vv, o, �. 3. List all places(name&address)where meats,poultry,seafood, shellfish,and ice will be purchased. 1(� r ✓�� V� 4. List names,phone numbers,addresses,and shifts to be worked of all employees. See attachment#1. < '(Qo _&I t-S-oc_;,0 a4 40 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. 7. Describe how and where utensil/ uipment washing will take place. If no facilities are available, �QQ ��wA u-x-& describe how alternate steps will be taken. Oj 8. Describe how wastewater will be collected, stored and disposed. 9. Describe the nwriber and location of garbage containers. �° -3 cl- ,t&'VI ► � Wapping Fair will have e contamers loca&!area surrounding food PP g g � g areas 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). n p_ �• �� `,,i„. (o 0 11. Describe how colds foods will be kept cold(45 degrees and below). 00-v 12. Describe how fold tempera es are monitored,cleaned and zed. 13.Will foods be prepared on site?If no,where will foods be purchased?(enclose copy of food license) no `<P Wo-DPP � NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. 2. 3. Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization:6 fi'�OMi9- k! JS ��hone No.: Cell No.: Person-in-charge (PRINT): ' Name &Address of Event: Date(s) of Event: '7/D-D 7 Hours of Operation: /0 ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hy 'ene: ♦ Thermometers/Alcohol Swabs: t ¢ti J Cold Temps(45°F or colder): ♦ Coolers: ) ♦ Hot Temps(140°F or hotter): ( tow ♦ Internal Cooling Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissa /Licensed Kitchen: ♦ Cross-Contamination: (� Utensil Washing: ♦ Sanitizerl Wiping Cloths: ♦ food/Equipment/Single-Use Protection: IL- * Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: v ♦ Workers Log (Name, Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 1.4 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 z j— 0 Naive of Event _Napping Fair__ Date of Event _Sept 10- 13 Time of Event 9/10 (6 p.m. -10 p.m.); 9/11 (6 p.m. — 11 p.m.); 9/12 (10 a.m. — 11 p.m.); 9/13 (10 a.m. -6 p.m.") Location of Event_Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address—PO Box 486, South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address VVappingfair@aol.com Event Coordinator Phone# (cell, work& home) (C) 573-6780; (H) 632-1544 (W) 236-5901 Name of Applicant 4 c o!r L anch . P-6A�,� Al Name of Applicants Business (please indicate if mobile vendor) kfvt 4elf Applicants Address 4f rj y f.�h�y,e� i, a/ -7 Applicants >;Mail Address � ��/ J �o �'a,�a Applicants Phone# (cell, VmC& home) l�0- 30?-.-5W/ 7 Setup titne__ 5f 10"-, _gip Please provide the following: (If any of the following does not apply to you put N/A) 1.Li.st 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. g9 p Ffye5 c0`h ddys � hfc fiewcf ers 2. Describe specifically how frozen, cold, and�l's will be transported to the event. ReAcr Ttac `C I List all places (name & address) where meats, poultry, seafood, shellfish, and ice will be purchased. Th u r S /-Oy Fir o/x 4. List names, phone numbers, addresses, and shins to be worked of all employees. See attachment #1. h it9,e6 4 e6ofl-aI4 5. Use attachment #2 in this packet to sketch a drawing showing the event area and where your operation will be. — To be provided by Wapping Fair prior to event 6. Describe the number, location and set up of handwashing facilities to be used by employees. .L A/ /A e aiK/ 7. Describe how and where utensil./equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. S. Describe how wastewater will be collected, stored and disposed. ho1�1,4 f -gay/ � Sesvev fIke t� ?. Describe the number and location of garbage containers. To be provided by Wapping Fair- 10. Describe what heat source will be used to keep hot foods hot (140 degrees and above). s�(-6a� �/4G 1. 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) �e S NAME OF EMPLOYEE PHONE# ADDRESS SHIFT Dclopa�r i4 x� � �6 �� y�" T�do� A�(/ 2. ✓ef 4. ;. 6. T s. 9. 10. 4 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: Phone No.: Cell No.: Person-in-charge (PRINT): Name&Address of Event: Date(s)of Event: "9�(�—� Hours of Operation: -------------- ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: A0 4-7 ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ ThOrinometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooling Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/ Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/ Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: ENDOR 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 08/18/2008 Name of Event Wapping Fair Date of Event Sept. 10"' 13th Time of Event 9/10 6 p.m.-10 p.m.; 9/11 6 p.m. — 11 p.m. 9/12; 10 a.m. -11 p.m.; 9/13 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 Caroline Winter Name of Applicants Business (please indicate if mobile vendor)_South Windsor Jaycees Applicants Address 299 Buckland Hills Dr 19223, Manchester, CT 06040 Applicants E-Mail Address wintercl@gmail.com Applicants Phone# (cell, work&home) _919-862-6956 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. CTDOC&25986.1 2 1p • 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. List 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. CTD005:25986.1 2 14 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). CTDOCS:25986.1 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: S. LO . be*rVQ tt Phone No.: Cell No.: Person-in-charge(PRINT): Name &Address of Event: LU 1119170 n c FZ7 t IZ Date(s) of Event: 2—/D 0 J Hours of Operation: G ----------------------------------------- Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/ Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY Other: Food Safety Information on Reverse Side have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: 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"--4 Wapping Fair Date of Event Sept. 4tn-7th Time of Event 9/4-6 p.m.-10 p.m.; 9/5 6 p.m.- 11 p.m. 9/6; 10 a.m. -11 p.m.; 9/7 10 a.m.-6 p.m. %& X c� Location of Events Evergreen Walk(behind LA Fitness) Event Coordinators Paul Petrillo Event Coordinator Address PO Box 486 South Windsor, CT 06074 Event Coordinator Phone#v 860-573-6780 Event Coordinator E-Mail Address t wappingfair@aol.com Event Coordinator Phone# (cell, work&home)_(C) 860-573-6780 (H) 860-632-1544_ � ,^ i N Name of Applicant 'sC>t 1 W 1 Oot'Y\Ui. ( izzb Name of Applicants Business (please indicate if mobile vendor) Applicants Address Rxe Applicants E-Mail Address Applicants Phone# (cell, work&home) (%b-(.QL-L4-(_)(9 q0 0VLC K6 d- 61 tb_�*_(o 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. 2 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 2. G�C 3. �A � ��� - ���--� Dada- � 4. 5. 6. 9. �f3o - ado -�ta < &e� rye, Lei�vt� ATTACHMENT #2 CHECKLIST FOR FOOD BOOTHNENDOR OPERATORS \ Metal probe thermometer(0—220 degrees F range) !r 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 4 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. e Ao we 0-1 3. List all places (name & address)where meats, poultry, seafood, shellfish, and ice will be purchased. B i- -S CS-t,,-6--W ) cx-M's � 1� YO-ut cb 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 layout the week of the fair. 6. Describe the number, location and set up of handwashing facilities to be used by employees. TOI N 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. VN eox v 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). VD�IN 11. Describe how colds foods will be kept cold(45 degrees and below). 12. Describe how food temperatures are monitored, cleaned and sanitized. C Lu j fin' "4-��evx\,ko`(V-o-t. -Q-�r 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose copy of food license) 3 y Garbage containers and plastic bags Hats/hair restraints Crates, shelves to store food off of the ground Gloves for food handling Hand washing station 5 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: ] 2 Phone No.: Cell No.: Person-in-charge(PRIN ): Name &Address of Event: / Date(s)of Event: /a D Hours of Operation: —/d ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: r ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/ Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitized Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates & Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: Inspector: Date: ,VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be tiled 1.4 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 clays. Today's Date !!�[ l / Name of Event Wapping Fair__ Date of Event _Sept 10- 13 Time of Event 9/10 (6 p.m. -10 p.m.); 9/1 1 (6 p.m. - 11 p.m.): 9/12 (10 a.m. - 11 p.m.): 9/13 (10 a.m. -6 j P.m.) Location of Event_Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address PO Box 486, South Windsor, CT 06074 Event Coordinator Phone # 860-573-6780 Event Coordinator E-Mail Address Wappingfair@aol.coin Event Coordinator Phone # (cell, work& home) (C) 573-6780; (H) 632-1544 (W) 236-)%1 Name of Applicant 9 06 60 4e''> Name of Applicants Business (please indicate if mobile vendor) .6Gtt Applicants Address l L®v vim? b r C7— 04�y.3 Applicants E-Mail Address Applicants Phone # (cell, work & home) _Q�d ���� -- S9 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. mo o 4-A OU Pef-/r4��<) 66Cewl S. Describe how.wastewater will be collected; stored and disposed. 9. Describe the number and location of garbage containers. To be provided by Wapping Fain 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). PA - 12. Describe how food temperatures are monitored. Ni-B- 13. Will foods be prepared on site? If no, where will foods be purchased? (enclose a copy of food license) Ll 1 4 Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization: a—o #M 5 Phone No.: Cell No.: Person-in-charge (PRINT): Name &Address of Event: Date(s) of Event: Hours of Operation: /0 -------------------------------------------------------------------------- ♦ Hand Washing Setup: Q �-- ♦ Waste Water/Garbage Disposal: ®d Pb ' ♦ Approved Food&Water Source: ♦ Personal Hygiene: b ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooldng Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON IN CHARGE (Sign): Date: ..... .- . .. _ Inspector: Date: YSNDOR 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. ,Aoday's Date ri ,/Name of Event Wapping Fair ;/Date of Event Sept./O 41th ,/Time of Event 91AO 6 p.m.-10 p.m.; 9/86 p.m. - 11 p.m. 9/Q10 a.m. -11 p.m.; 91A?10 a.m. - 6 p.m. ,Location of Event Evergreen Walk(behind LA Fitness) /Event Coordinator Paul Petrillo r/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_ ✓Dame of Applicant ✓Name of Applicants Business (please indicate if mobile vendor) ® nQYA&,y 'S .✓Applicants Address 17 U.9 pD C-f ©lo�j8 applicants E-Mail Address borne i - g 60 - '7 Applicants Phone# (cell, work&home) eY 0 - I -&(v0 , q30 , Setup time o C_ Plea e provide the following: (If any of the following does not apply to you put N/A) 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. �71� prn ® /l Sl y 1va Gh�SS'�� 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. Q� List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. 1-7-1)-e,f UV-edl 7 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. i/6. Describe the number, location and set up of handwashing facilities to be used by employees. h Qn s h - l.C�Q'( �-Pr sda pl fafm J-e W�e (l ��ind Sa n it ,�el- V/7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. �M j-wo,f,gr rsoop) ri os e ho-f Wafar 6afit'f11zed S � ►�`�� 2 Describe how w stewater will be collected, stored and disposed. }� cv041--1 GQC�-- . � /9. Describe the number and location of garbage containers. Wapping Fair will have garbage containers located in area surrounding food areas ADescribe what heat source will be used to keep hot foods hot(140 degrees and above). 00, /11. Describe how colds foods will be kept cold (45 dxgrieesO d below). .4. Describe how food temperatures are monitored, cleaned and sanitized. C h-ees e 13. Will foods be prepared on siIf no, where will foods be purchased? (enclose copy of food license) 'Yes a,o� 11 Rental Agreement Vendor Layout and Product Information complete the lie Data of v offal it that vac max lit pasitiwi%on in our cat mnicrcial sediun @ Rear .14 rs 1 � From I a� Items to be sold. _ ri44nzaaN- Please be stue to iea en gu-xlnct restrictions listed on the rites K regulations shed Food endors ue tin-cited to t? three fokA items and bmerages c cqx lemonade_ All items must be listed- THIS FORM MUST BE RETURNED WITH YOUR RENTAL AGREEMENT APPLICATION Complete this form and send to Wapping Fain~ i Town of South Windsor Health Department Telephone(860) 644-2511 Extension 248 Temporary Event — Food Inspection Name of Organization:��Cff;ll � Phone No.: Cell No.: Person-in-charge (PRINT): Name &Address of Event: i Date(s)of Event: U 0 Hours of Operation: --� -------------------- ♦ Hand Washing Setup: ♦ Waste Water/Garbage Disposal: ♦ Approved Food&Water Source: ♦ Personal Hygiene: ♦ Thermometers/Alcohol Swabs: ♦ Cold Temps(45°F or colder): ♦ Coolers: ♦ Hot Temps(140°F or hotter): ♦ Internal Cooking Temps: CHECK FOOD TEMPERATURES THROUGH-OUT THE DAY*USE YOUR PROBE THERMOMETER ♦ Off-Site Preparation: Approved Commissary/ Licensed Kitchen: ♦ Cross-Contamination: Utensil Washing: ♦ Sanitizer/Wiping Cloths: ♦ Food/Equipment/Single-Use Protection: ♦ Self-Serve Food/Utensils Protected: ♦ Proper Construction/Smooth Cleanable Surfaces: ♦ Workers Log (Name,Address, Phone#, Dates &Times Worked) Keep for 90 days CORRECTIONS DUE IMMEDIATELY ♦ Other: Food Safety Information on Reverse Side I have read and hereby agree to follow the Food Safety Information listed on the reverse side of this form. PERSON 1N CHARGE (Sign): Date: Inspector: Date: VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event inust complete this application and must be tiled 14 days prior to the opening event. This application mint 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 10- 13 Time of Event 9/10 (6 p.m. -.10 p.m.); 9/1 1 (6 p.m. — 1 l p.m.); 9/12 (10 a.m. — I p.m.); 9/1" (10 a,ni. -6 P.M.) Location of Event_Evergreen Walk behind LA Fitness Event Coordinator_South Windsor Jaycees Event Coordinator Address—PO Box 486, South Windsor, CT 06074 Event Coordinator Phone# 860-573-6780 Event Coordinator E-Mail Address Wappingfair a.aol.coin Event Coordinator Phone # (cell, work& home) (C) 573-6780, (H) 6�2-1544 (W) 2'36-5901 Name of Applicant v v v Name of Applicants Business (please indicate if mobile vendor) Applicants Address ' 0 & L l © G Q b:_p Applicants E-Mail Address Applicants Phone # (cell, work & home) q 60 X. 3 0 7 3 Set LIP 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 ubmitted to the Health Department 10 days prior to the event. �� — I NAME OF EMPLOYEE PHONE# ADDRESS SHIFT I. a,^y C-r-on `� 2. 4. 0 -73 � h. 7 s. 9. 40. a 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. �. List all places (name & address) where meats, poultry, seafood, shellfish, and ice will be purchased. q. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment #1. 5. Use attachment 42 in this packet to sketch a drawing showing the event area and where your operation will be. —To be provided by Wapping Fain prior to event 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. S. Describe how wastewater wilVe collected; stored and disposed. 11 9. Describe the number and location of garbage containers. To be provided by Wapping Fair 10. Describe what heat source ill be used to keep hot foods hot (140 degrees and above). 11. Describe how colds foods will be kept cold (45 degrees and below). ��'W,�°G'�;-/ 4 1 e�r- 12. Describe how food temperatures are monitored. T��r/yi0me�er A 7 13. Will foods be prepared on site? If no, where will foods be purchased? (en(-lose a copy of food license) . e