HomeMy WebLinkAboutTemp Food 297 Oakland Road TOWN OF SOUTH WINDSOR
TEMPORARY FOOD EVENT INSPECTION SHEET
Event Name: '' Event Date:
Location of Event:
Applicant/Coord.:��1r,.. ��, nr�r` Ph.
Email Address: 2 Of Fax#
QFO Name: Ph.#
Email Address: Fax#
METHOD: On-Site inspection Kitchen inspection Interview
(Circle one)
Food/Water So�c e
\/ . Approved source of food, wholesome,free from spoilage
Water source potable, from approved supply, food grade hoses utilized
Temperature CWrol
NX"" Hot/cold holding equipment and temperatures adequate
Ort Food cooked/reheated to correct temperature
Metal probe food thermometer(0—220F range)available/sanitized between use
Accurate thermometers for all refrigerators
ICI Coolers(self draining) and ice packs/bags
Hygiene/H hing 7 ��� � 5 n11� i� V .i�-�✓w,
Hats or effective hair restrain for food workers
KHand washing station-warm water in jug w/spigot,liquid soap,paper towels
_____�� y Gloves for food handling, designated person to handle money
[Q Scoops to have handles
Records ` /''
V r Designated person in charge of food booth for each shift—logs kept
General Food Protection Y am,
cs�Nu� �.�-�C� ,' c
C/ No extensive food preparation/handling
t\JIA Food protected by wrapping, sneeze guards or other effective barriers
Condiments single service,pump dispensers or squeeze bottles/shakers
PHF hot held and not sold discarded daily or at end of event
Food and single service food containers stored off floor
rinks stored in ice must be stored in self-draining storage containers
Raw fruits and vegetables used in food prep to be washed in potable water
Toilet Facilities/Waste Disposal S� \� �
_Toilet facilities adequate, clean and conveniently located
n�k,. Waste water disposal container—disposed of properly
Container for grease collection—disposed of properly
Non-absorbent garbage containers, fly tight covers, Dumpsters must be covered
Garbage containers and plastic bags
Cleaning/Sanitizing �
Buckets"/ttu"b`ss Tor washing,rinsing, sanitizing food equipment(hot water)
Bleach/Quat. for sanitizing, appropriate concentration,test strips available
Utensils are to be sanitized every 4 hours or as needed
/—Moist wiping cloths to be stored in container with clean sanitizing solution
Storage/FB Construction
All utensils/equipment to be properly stored to protect from contamination
�—Chemicals to be stored separate from food products,bottles to be labeled
in J I A_ Food booths constructed properly to protect food, adequate lighting provided
COMMENTS:
h:
HEALTH INSPECTOR: S I
zgnature: Date.
EVENT COORDINATOR: 'A—
Suture: i a licable Date.
b' (.f PP I
"A temporary food service establishment serving food or drink shall comply with all provisions of Public
Health Code 19-13-B42 which are applicable to its operation."
April 2011
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 Health
Department, 1540 Sullivan Avenue, South Windsor, CT 06074.
This application is not a license. Temporary food events will not exceed a period of 1 to 5 days.
Today's Date May 10,2011
Name of Event Letting Go of Anger: Open Refreshment Caf6 beforehand
Date of Event May 13,2011
Time of Event 9am-lpm
Location of Event Odiyana Meditation Center,297 Oakland Road, South Windsor
Event Coordinator Ryan Cronin
Event Coordinator Address 92 Autumn Street, Manchester
Event Coordinator Phone# 860-874-1970
Event Coordinator E-Mail Address admire@odiyana.org
Event Coordinator Phone#(cell,work&home) same as above
Name of Applicant Ryan Cronin
Name of Applicants Business (please indicate if mobile vendor) Odiyana Meditation Center
Applicants Address see above
Applicants E-Mail Address see above
Applicants Phone#(cell, work&home) see above
Set up time Saturday,May 13, 8-9am
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.
- Fruit, Cheese. and Cracker Plate: Grapes, cut strawberries, assorted cheeses,and crackers.
All ingredients to be purchased at local grocery store. Fruit will be washed in sterilized rinse
bay of 3-bay sink with gloved hands. Crackers and cheese will be cuttarranged with gloved
hands.
- Assorted Pastries: To be purchased from Tray's Place Cafe in West Hartford, displayed in a
covered cake plate dish and self-served with tongs.
- Biscotti: Purchased at grocery store and individually wrapped.
- Tea: Loose tea purchased from Green Teahouse in West Hartford, stored in a re-sealable bag,
scooped for brewing with spoon, brewed in teapot and served.
- Saarkling Juice: Mix of cranberry juice and seltzer purchased from grocery store and self-
served from a pitcher.
2. Describe specifically how frozen, cold, and hot foods will be transported to the event.
- Items will be brought directly from store to event site and stored in our refrigerator or plated
immediately for serving.
3. List all places (name&address)where meats, poultry, seafood, shellfish, and ice will be purchased.
- N/A
4. List names, phone numbers, addresses, and shifts to be worked of all employees. See attachment#1.
Attachment#1
5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your
operation will be.
Attachment#2
6. Describe the number, location and set up of handwashing facilities to be used by employees.
- One handwashing sink near food prep area. Stocked with pump soap and paper towels.
7. Describe how and where utensil/equipment washing will take place. If no facilities are available,
describe how alternate steps will be taken.
- Dishes will be washed in 3 bay sink. One for wash, one rinse and one for sanitizing dishes.
Appropriate concentration of bleach to water will be used in sanitizing bay. Dishes will air dry on
drying racks.
8. Describe how wastewater will be collected, stored and disposed.
- N/A
9. Describe the number and location of garbage containers.
- 1 Garbage can located under countertop near bar
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
- N/A
11. Describe how cold foods will be kept cold(45 degrees and below).
- Refrigerator near food prep area. Most food will be served immediately.
12. Describe how food temperatures are monitored, cleaned and sanitized.
- Thermometer in refrigerator. All fruit will be prewashed with gloved hands in sterilized rinse
bay of 3-bay sink.
13. Will foods be prepared on site? If no,where will foods be purchased? (enclose copy of food license)
- On site preparation: cutting of fruits and cheese. All foods purchased at local grocery store
except for pastries (Tray's Place,West Hartford) and tea(Green Tea House,West Hartford)
ATTACHMENT #1
NAME OF EMPLOYEE PHONE# ADDRESS SHIFT
1. Mitch Stephenson 860-372-8774 7 Gretel Lane, Simsbury, CT full event
2. Alison Stephenson 860-372-8774 7 Gretel Lane, Simsbury, CT full event
3.
4.
5.
6.
7.
8.
9.
10.
ATTACHMENT #2
CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS
NA Metal probe thermometer(0—220 degrees F range)
YES Thermometers for all refrigerators
YES Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be
drained)
YES Plastic wrap/Aluminum foil
YES Extra utensils: tongs, spatulas, spoons, and knives
YES Water source
YES Buckets/tubs for washing,rinsing, sanitizing food equipment
YES Bleach for sanitizing, test strips for checking
NA Waste water disposal container
NA Container(s) for grease collection
YES Clean wiping cloths and a container to store them in
YES Garbage containers and plastic bags
YES Hats/hair restraints
YES Crates, shelves to store food off of the ground
YES Gloves for food handling
YES Hand washing station
Refrigerator
Handwashing
" t Food Prep
Dishwashing
Emergency
Exit and
Restrooms
Class Space
O
Trash
Seatin
Front Door
TOWN OF SOUTH WINDSOR
TEMPORARY FOOD EVENT INSPECTION SHEET
Event Name: '. Event Date: tom,;tot 1
Location of Event: '
Applicant/Coord.: '�,,,,,.,, Cs Ph.# ,o-Ss°-7y--U400
Email Address: �d -`� Fax#
QFO Name: Ste- goyny--A!, Ph.#
Email Address: Fax#
METHOD: On-Site inspection Kitchen inspection Interview
(Circle one) -K t.1
Food/Water urce
✓Approved source of food, wholesome, free from spoilage tocoj\ �§ocn s�-3
Water source potable, from approved supply, food grade hoses util'zed
C I
o. - �ks�c rA rc ,�1� t- c� l;r�ts-wt1,oc�_�•o p t��'
Temperature C trol S6_k-`
Hot/cold holding equipment and temperatures adequate Cr�c-�t•�,�t s
-� Food cooked/reheated to correct temperature
-)C Metal probe food thermometer(0-220F range)available/sanitized between use
Accurate thermometers for all refrigerators
Coolers(self draining) and ice packs/bags
Hygiene/Handw g
Hats or effective hair restraints for food workers
Hand washing station-warm water in jug w/spigot, liquid soap,paper towels
Gloves for food handling, designated person to handle money s ��
�-Scoops to have handles
Records
Designated person fi charge of food booth for each shift-logs kept
General Food Protection
No extensive food preparation/handling1; ^n
Food protected by wrapping,sneeze guards or other effective barriers
N�Condiments single service,pump dispensers or squeeze bottles/shakers
N ,PHF hot held and not sold discarded daily or at end of event
Food and single service food containers stored off floor
Drinks stored in ice must be stored in self-draining storage containers
Raw fruits and vegetables used in food prep to be washed in potable water
r
Toilet Facilities ste Disposal
,Toilet facilities adequate, clean and conveniently located
Waste water disposal container—disposed of properly
i'i IPr Container for grease collection—disposed of properly
h} Non-absorbent garbage containers, fly tight covers, Dumpsters must be covered
Garbage containers and plastic bags
Cleaning/Sanitizing '�� S:ri,
Buckets/tub washing,rinsing, sanitizing food equipment(hot water)
Bleach/Quat. for sanitizing, appropriate concentration,test strips available
Utensils are to be sanitized every 4 hours or as needed
Moist wiping cloths to be stored in container with clean sanitizing solution
Storage/FB Construction
N A All utensils/equipment to be properly stored to protect from contamination
Ot Chemicals to be stored separate from food products,bottles to be labeled
Pr Food booths constructed properly to protect food, adequate lighting provided
COMMENTS: `
rv� vr•o c7�r \"ty° 0Co.�ooV`C_. ;�_Cr�� �.r-0 \�,, -
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HEALTH INSPECTOR: Ls 0
Signature: Date.
EVENT COORDINATOR: �)
Signatur�f applicable) Date:
"A temporary food service establishment serving food or drink shall comply with all provisions of Public
Health Code 19-13-B42 which are applicable to its operation."
April 2011
VENDOR
APPLICATION
AND
GUIDELINES
FOR
TEMPORARY FOOD SERVICE EVENTS
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 events will not exceed a period of 1 to 5 days.
Today's Date April 29,2011
Name of Event Food for Thought: Meditation and Vegetarian Dinner
Date of Event May 6, 2011
Time of Event 6:30-8:30pm
Location of Event Odiyana Meditation Center,297 Oakland Road, South Windsor
Event Coordinator Ryan Cronin
Event Coordinator Address 92 Autumn Street,Manchester
Event Coordinator Phone# 860-874-1970
Event Coordinator E-Mail Address admin@odiyana.org
Event Coordinator Phone#(cell,work&home) same as above
Name of Applicant Ryan Cronin
Name of Applicants Business (please indicate if mobile vendor) Odiyana Meditation Center
Applicants Address see above
Applicants E-Mail Address see above
Applicants Phone#(cell, work&home) see above
Set up time Thursday,May 5: 7-9PM and Friday,May 6: 4-6:30PM
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.
- Vegetarian Gumbo (flour, oil,tomato, okra,peppers, onions, celery,vegetarian sausage,
parsley,Worchestershire sauce
- Fried Sweet Potato w/Sauce(sweet potato,breadcrumbs, olive oil, cumin, chili powder, garlic
powder, salt,pepper, bottled sauce
- Grilled Corn Muffins (store bought)
- Salad(red cabbage,carrots, scallions,baby spinach, bottled dressing)
- Coffee
- Tea
- Sparkling Juice
2. Describe specifically how frozen, cold, and hot foods will be transported to the event.
- Items will be brought directly from store to event site and stored in our refrigerator or a cooler
with ice.
3. List all places (name& address)where meats,poultry, seafood, shellfish, and ice will be purchased.
- N/A
4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1.
Attachment#1
5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your
operation will be.
Attachment#2
6. Describe the number,location and set up of handwashing facilities to be used by employees.
- One handwashing sink near food prep area. Stocked with pump soap and paper towels.
7. Describe how and where utensil/equipment washing will take place. If no facilities are available,
describe how alternate steps will be taken.
- Dishes will be washed in 3 bay sink. One for wash, one rinse and one for drying dishes.
. ' 8. Describe how wastewater will be collected, stored and disposed.
- N/A
9. Describe the number and location of garbage containers.
- 1 Garbage can located under countertop near bar
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
- Electric griddle to cook cornbread. Crockpots to cook gumbo and keep it warm.
11. Describe how cold foods will be kept cold(45 degrees and below).
- Refrigerator near food prep area. Coolers with ice used if extra space is needed.
12. Describe how food temperatures are monitored, cleaned and sanitized.
- Thermometer in refrigerator. All vegetables will be prewashed.
13. Will foods be prepared on site? If no, where will foods be purchased? (enclose copy of food license)
- On site preparation: salad, gumbo. All ingredients including pre-made cornbread to be
purchased at a local grocery store.
ATTACHMENT #1
NAME OF EMPLOYEE PHONE# ADDRESS SHIFT
1. Kaitlyn Brayton 203-435-3077 90 North Turnpike Rd.,Wallingford, CT full event
2. Thiemba Ferguson 860-798-7760 14 Cottage St.,Windsor, CT full event
3. Patrick Cronin 860-810-0863 92 Autumn St., Manchester, CT full event
4. Jackson Raymond 860-940-9943 28 Carlson St., 3rd Floor,New Britain, CT full event
5.
6.
7.
8.
9.
10.
ATTACHMENT #2
CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS
NA Metal probe thermometer(0—220 degrees F range)
YES Thermometers for all refrigerators
YES Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be
drained)
YES Plastic wrap/Aluminum foil
YES Extra utensils: tongs, spatulas, spoons, and knives
YES Water source
YES Buckets/tubs for washing,rinsing, sanitizing food equipment
YES Bleach for sanitizing,test strips for checking
NA Waste water disposal container
NA Container(s) for grease collection
YES Clean wiping cloths and a container to store them in
YES Garbage containers and plastic bags
YES Hats/hair restraints
YES Crates, shelves to store food off of the ground
YES Gloves for food handling
YES Hand washing station
• Refrigerator
* Handwashing
� Food Prep
Dishwashing
Emergency
Exit and
Restrooms
Class Space
O
Trash
Seatin
Front Door
----; Page of
Pw• }- 3.
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWNC DATE OF INSiPECrTION
IN PECTIO REMARKSFORM#
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FINITIAT(INSPECTOR) INITIAL(PERSON IN CHARGE)
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager
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 Health
Department, 1540 Sullivan Avenue, South Windsor, CT 06074.
This application is not a license. Temporary food events will not exceed a period of 1 to 5 days.
Today's Date April 1, 2011
Name of Event Peace and Pancakes: Meditation Class followed by brunch
Date of Event April 3,2011
Time of Event 10am-12:30pm
Location of Event Odiyana Meditation Center,297 Oakland Road,South Windsor
Event Coordinator Ryan Cronin
Event Coordinator Address 92 Autumn Street,Manchester
Event Coordinator Phone# 860-874-1970
Event Coordinator E-Mail Address admin@odiyana.org
Event Coordinator Phone#(cell,work&home) same as above
Name of Applicant Ryan Cronin
Name of Applicants Business (please indicate if mobile vendor) Odiyana Meditation Center
Applicants Address see above
Applicants E-Mail Address see above
Applicants Phone#(cell, work&home) see above
Set up time Saturday,April 2, 1-3pm and Sunday,April 3, 8-loam
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.
- Pancakes
- Waffles
- Toppings (fresh fruit, maple syrup,whipped cream,powdered sugar, cinnamon)
- Coffee
- Tea
- Sparkling Juice
2. Describe specifically how frozen, cold, and hot foods will be transported to the event.
- Ingredients for pancakes and waffles along with other items will be driven from preparer's
home,where all cold items will be refrigerated until the morning of the event.
3. List all places (name &address)where meats,poultry, seafood, shellfish, and ice will be purchased.
- N/A
4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1.
Attachment#1
5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your
operation will be.
Attachment#2
6. Describe the number, location and set up of handwashing facilities to be used by employees.
- One handwashing sink near food prep area. Stocked with soap and paper towels.
7. Describe how and where utensil/equipment washing will take place. If no facilities are available,
describe how alternate steps will be taken.
- Dishes will be washed in 3 bay sink. One for wash,one rinse and one for drying dishes.
8. Describe how wastewater will be collected, stored and disposed.
- N/A
9. Describe the number and location of garbage containers.
- 1 Garbage can located under countertop near bar
10. Describe what heat source will be used to keep hot foods hot(140 degrees and above).
- Electric griddle and waffle iron will be used to cook items to order. No need to keep hot.
11. Describe how cold foods will be kept cold(45 degrees and below).
- Refrigerator near food prep area.
12. Describe how food temperatures are monitored, cleaned and sanitized.
-N/A
13. Will foods be prepared on site?If no,where will foods be purchased? (enclose copy of food license)
- Yes. Some food purchased at East Hartford Shop Rite.
ATTACHMENT #1
NAME OF EMPLOYEE PHONE# ADDRESS SHIFT
1. Walt Butler 860-883-0676 5 Olde Flatbrook Road, East Hampton, CT full event
2. Mitch Stephenson 860-372-8774 7 Gretel Lane, Simsbury, CT full event
3. Alison Stephenson 860-372-8774 7 Gretel Lane, Simsbury, CT full event
4.
5.
6.
7.
8.
9.
10.
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
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
Refrigerator
Handwashing
t -- Food Prep
Dishwashing
Emergency
Exit and
Restrooms
Class Space
0
Trash
Seating--,
Front Door
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DATE: 12131/2009
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DATE: 12/31/2009
• Safety.Lisblag:No
• Sink Type:Self: ing
• Wfdth: 15i
4. Mr.coffee Coffee and Espresso Machine,lVio,lef#ECM21.Enjoy.goormat
Ofilee and espre in the.comfort of your own home with the Mr:Coffee Espresso- 14�achine."
)3Vraw Prepaies 2-.Cups
Frothing slid
• Variable Steam control . .
Atinovable Ddp tray
• Coffee prepares I-B Cups
+� Removable Water Rmcrvoir
BrcwIng Pause In Serve
+..Removable Cane Filter Basket :
• 1-4 Cup Small Qum ity Setting
• -Capacity: g CUPS
color:.
Black.
-. i1+lc�dell�Tv:: ECM21 _ .
Sipping Weigia(in pounds)`
Product in Inches(L x€W`x�: 1.5.15 x 13.09 x 14.27
Assembled in Country of Origin:
Origin of Conaponenis: bnported
Wal-Mart No.:: 001589395
S.P-ush Pump:Caraffes(for co 'ee service) Stainless steel(I.S fit tall)
6.Cooling Caraffes for.milhlcreamer)('!IOM08)
7.Electric Plugwln Not Water Boller(For.Tea)
8.Formica laminate countertop:fur.air dryg
9. Cabinets:Both gall.and base cabinets are`new stock cabinetsa'ront Hones depot.
They are white syathetic material with a smooth finish(almost l!!re formica).
Wan cabinets are 1 ft deep and base cabinets 0re'2 feet deep
I
Page 1 of 3
DeVito,Robert
From: Ryaq__Cronin@wbps.org
Sent: Thursday,January 21,20.10 9:48 AM
To: DeVito, Robert
Subject:Re: FW:Correct application
.Hi again,
Jam going;to fax you over the updated floor plans in a few minutes with everything we spoke about. Below i
answered each question that you asked in your first email.
Thanks again for all your support!
You can email me back with any further concerns or questions.-_I'll try to write back promptly.
Ryan
DeVRo,Robert"eRobed�eVlto@sou"nd9or.or9>
- To<ryan_cronin@whps.oig>
cc
07/20L2010.01:58 PM Subject Fw:'Correct application
From: DeVito, Robert
Sent: Wednesday,January 20:, 20iO 1:57 PM
To: 'Ryan Cronin' .
Subject:RE: Correct application
Ray,
What type of rough inspection are you speaking of?
I.appreciate all the information you have sent but there are some things that are missing.If you recall we spoke of
the following items that are necessary for this dept.to thoroughly review your activity and to ensure proper food
handling which will ultimately protect the health of the public:
1. A floor plan,nothing fancy, but it needs to show the layout of.the food prep area to include but not limited
to the location of the hand sinks, 3 bay sinks,garbage collection area,toilet area,coffee counter where your
coffee push pumps will be kept,where will your toxic chemicals be stored,and so on.
1l21.I2010
Page 2.of 3
See plan
2. The three bay-sink area needs an.area for air drying of the equipment that will be manually washed.
See plan
3. What will you use for a sanitizer?
Bleach
.4. What will you use for a test kit to check the concentration of the sanitizer?
Will order from website you mentioned.
5. You indicated that the interior garbage containers will be stored behind the counter under the back counter.
What it this area:constructed of.Typically the garbage collections.area are subject to abuse and the area
surrounding them must.be constructed of a material that is light in color and non-absorbent and easily cleanable.
See plan. Area around garbage can,wiil be.finished plywood or sheetrock. Finished smooth with_white or offwhite
paint.
6. Where will you store your pre packaged food?What will it be stored on?
See plan. All cabinetry is new,white and smooth finished surface.
7. Where will your cups, plates,-paper products,cleaned and air dried equip,etc be stored?
See plan. All cabinetry is new,white and smooth finished surface.
8. Do,you have a mop sink?
See plan. We have a mop sink in a separate closet. We will install a mop hanger.
9. Do you intend on sharing a dumpster with the rest of the plaza?There are.existing issues with dumpsters
at this site already and the nature of your business will increase the problem.This is only acceptable if your
frequency of pick up is more.than 1X per week or you obtain your own dumpster.
Checked with the Chinese Restaurant.It gets picked up 2X per week:
10. Your application indicates that the,cream&milk will be served to the customer by individual cups.How do
you intend to maintain the product temperature of 45 degrees or below at the counter?
We will use the thermos style pour containers to keep it cool and will not use the individual cups.
11. Your application..Indicates that the coffee will be offer to the customer in a Tupperware container. Is the
:coffee in an individual package or is it kept loose in the container?
We will make and serve the coffee.
12. Your application indicates that the tea will be offered to the customer in an air tight metal container. Is the
tea in individual wrapped containers?
We will make and serve the tea.
13. Your application indicates that the biscotti,chocolate covered pretzels,cookies,and cakes will be served
In a glass container.Will they be kept in their individual wrapped package?
1/21/20:1.0
Page 3 of 3
We will provide tongs for customers to take these items from containers.
14. Specification Sheets are needed for
a. The refer
b. The 3 bay sink
c.. The shelving used for air drying of the.equipment,
d.` : Push pumps
e. Ceiling tiles for.food prep area.
All included with the Fax
from: Ryan Cronin fmaiito:ryan.t.cronin@gmail.com]
Sent:Wednesday,January 20,201011:40 AM
-To: DeV!to, Robert
Subject: Re: Correct application
Hi Mr.Devito
I am faxing you our food service application now. Let me know if there's anything missing. I tried to
incorporate everything we spoke about We have a rough inspection scheduled for tomorrow that I will
be postponing until Monday. I think we.need.your approval to go ahead with that.
Thanks-so much
Ryan Cronin
860-874-1970
On Dec 31,`2009,at 12:59 PM, "DeVito,Robert"<Robert.DeVitoOsouthwindsor.org>wrote:
<Food-Class I Plan Review Application 2007.DOC>-
1/21/2010
Eaulpmenj: -
_1. Microtfridge Combination Appliance(Model 2.9IvY1+7TI)
- Fridge,freezer,microwave
- To stare creamer,milk and some water bottles to keep cold
Exterior Color:Black,White
Interior Color:Stay-Cool Glacier'White
Fridge Capacity:2.13 cu.-1L
Freezer Capacity:0.75 cu.fit.
Total Capacity:2.9 cu:ft.
Internal Safe PlugV Technology: Yes
Dual Outlet-Charging Station:Yes
Doors:2.
Defiost Type:.Refrigerator,Anto!
Freezer,.Manual
Freezer Type:0°la reezer
11vSicrowave`L?Vatts Output:700
Microwave Capacity..0.7 cu.it.
Height:44.13 In*
Width: 18.62 in
Depth. 20.12 in
WeighU 84 Ibs
Shipping 96 lba
An4*: 11
KWH Per Year:290
2. .$tainless Steel 3 bay sink.(Bays.are 2 ft deep and will accommodate_all equipment
to be wssbed)
Used NSF Carnes with 12"spout on faucet,adjustable legs, and optional lever actuated
drains. Tub dimensions are 1 S"X 18"X 14ri Deep.. Overall length is 901,X 24"Deep,
3.Handwashing sink
Elkay Dayton
• Assembled Depth(in Inches) : 15 in
Assembled Height(Ins Inches) . 5.125 in
• Assembled Weight(In LBS):4.50_yb
Assembled Width(In Inches) : 15 in
• Color/Finish :'Ultra radiant
lLnergy Star Compliant:No
• height: 5.125 in
Odlyana Meditation Center—Food ntabbshment Plan Review Application
Food:
Kottle Clips:assorted,individual packages(Sam's Club)
Biscotd:prepackaged,stored in glass display container(Sam's Club)
Chocolate Covered.P..retzels..prepackaged,.stored in glass display container.(Sam's Club)
Brownies:prepackaged,stored in eovered cake dish(Sam's Club)
Cookies-oatmeal,chocolate chip:prepackaged,stored in covered cake dish(Sam's Club)
Cakes-chocolate,coffee cake;prepackaged,stored in coveted cake dish(Sam'S'Club)
Tongs p roAded for all foods service items
All extra food will be stoned in cabbmu.behind main service countor.
Coffee:. flavors,stored r+Tupperware bins(Coffee Trader:Avon,CT) ed by staff
Tea: 10 flavors stored in airtight metal containers(Teavana)—served_by staff.
Juice—Apple,Orange,Pineapple:Tud victual bottles.(Sam's Club).
Water.Individual bottles(Sam's Club)
Creamer,b4i11c: (Sam's Club)to be served out of a thermos pour container to keep cold
Sugar,Splenda: Individual.packages(Sam's Club)
r5er intrware:
Mugs:Ceramics
Small Dessert Plates.Ceramic
Forks:Stainless Steel
Spoons:Stainless Steel
Sty:wow
Cups:Pape with plastic lids(to go)
Ceramic Tile throughout,with ceramic tile baseboard
-Con r
Formica and smled.wrood
COMB
Ceiling 13f high
waft
Sheetrvck painted with matte finish(offwhitefpcwh) .
UMIAK
In-ceiling can-lights
l
Page l of 2
DeVito, Robert
From: DeVito, Robert
Sent: Wednesday,January-20,20101:57 PM
To: 'Ryan Cronin'
Subject: RE:Correct application
Ray,
What type of rough inspection are you speaking of?
.I appreciate all the.information you have sent but there are some things that are missing. if you recall we spoke of
the following items*that are.necessary.for this dept.to thoroughly review your activity and to ensure properfood
handling which will ultimately protect the.health of the.public:
1. A floor plan,nothing fancy,but it needs to show the layout of the.food prep area to include but not limited to
the location of the hand sinks,-3 bay sinks,.garbage collection area;toilet area,coffee.counterwhere your
coffee push pumps will be:kept,where will your toxic chemicals be stored,and-so-on.
.2. The three bay sinkarea needs an area for air drying of the equipment that will be manually washed.
3. What will you use for a sanitizer?
4. What will you use for test kit to check the concentration of the sanitizer?
5. You indicated that the interior garbage containers will be stored behind the counter under the back counter.
What is this area constructed of.Typically the garbage collections area.are subject to abuse and the area
surrounding them must be constructed of a material that is light In color and non-absorbent and easily
cleanable.
6. Where will you store your pre packaged food?What will it be stored on?
7. Where will your cups,-plates,.paper products,cleaned and air dried equip,etc be stored?
8. Do you have a mop sink?
9. Do you intend-on sharing a dumpsterwith the rest of the.plaza?There are existing issues with dumpsters
at this site already and the nature of your-business will increase the problem.This is only acceptable if your.
frequency of pickup is more than 1X per week or you obtain your own:dumpster.
10. Your applicationindicates that the cream&.milk will be served to the customer by individuai.cups..How do.
you intend to maintain.the product temperature of 45 degrees or below at the counter?.
11.- Your.application indicates that the coffee will be offer to the customer in a Tupperware container. Is the
coffee in an individual-package or is It kept loose in the container?
12. Your application indicates that the tea.will be offered to the customer in an air tight metal container..is the
tea in individual wrapped containers?
i3. Your application indicates that the biscotti,chocolate covered pretzels,cookies,and cakes will be served in
a glass container.Will they be kept in their individual wrapped package?
14. Specification Sheets are needed for
a. The refer
b. The 3 bay sink
c. The shelving used for air drying of the equipment.
d. Push pumps
e. Ceiling tiles for food prep area.
From: Ryan Cronin[mailto:ryan.t.cronin@gmail.com]
Sent:Wednesday,January 20, 2010 11:40 AM
To: Devito, Robert .
Subject:Re: Correct application
Page 2 of 2
Hi Mr.Devito
I am faxing you our food service application now:. Let me know if there's anything missing. I tried to
incorporate everything we spoke about We have a rough-inspection scheduled for tomorrow that I will
be postponing until Monday. I think we need your approval to go ahead with.that..
Thanks so much
Ryan Cronin
860-874-1970
On Dec 3l;2009, at 12:59 PM, "DeVito,Robert"-<Robert.DeVito@southwindsor org>wrote:
<Food-Class I Plan Review Application 2007.DOC>
1/20/2010
Page 1 of 1
Devito, Robert
From: :Ryan Cronin[ryan.t.cionin@gmaii.com]
Sent: Wednesday,January 20,201011:40 AM
To: Devito, Robert
Subject: Re:Correct application
Hi Mr.Devito
I am faxing you our food service application now:.Let me know if there's anything missing :I tried.to
incorporate everythi.ng.we spoke about
po�tp<r ing Until Ma cias;I think wen r* u- o go ead with that.
Thanks so much
Ryan Cronin
860-874-1970
On Dec 31,2009,at 12.59 PM, Devito,Robert <Robert.DeVito&outhwindsar:org>wrote:
<Food-Class I Plan Review Application.2007.DOC>-
1/20/2010
I
Town ofSouth Windsor
1540 Sullivan Avenue So►rth Wier,CT 0604
860-644-2511 PHONE
960-644-7290 FAX
FOOD ESTABLISHMENT PLAN REVZW APPLICATION
for Class 1 Food Establishments
SOUTH WINDSOR HEALTH DEPARTMENT
ISO SULLIVAN AGUE
SOtTPH'VVoWsm,Cr 06074
ONEW (4EMODEL 0 ALTERNATION eCHA1V'GE OF OWNEYi.4DIP
Name of Es^tablislmaA;
ad; a no- i Ce.nk 7
Establishment's Address: 2 R. R.o
(AKIJorr .CT. 0Gc77
Phone if avail$ble : 60 S. (^. .d
Name of Owner or owner's 've: ah -+�i �"tit�i sir- ►•�-� �i
Owners Mailing Address: � � �`�`•",`,' �f'
M^�11.av 64c_, o c.1 o va
Applicant's Name and Relaflow1 ip to Owner(self,manager,eW.):
Applicants Mailing Address:
M av t. k_1i CT
Applicants Telephone Number. a., r67 L�
Garbage and Refuse
rnSJide
C. kf u•k Will ruse be stored inside? NO
If so,deserft where recepwies will.be located: .
Ontsfde
Will the area around premises be mabdained cleat of 'YEg NO
unnecessary brush,Titter boxes and ottw vermin hrbora
NO
Will a-dampster be.used?
Number { Size to F *. of i x e w
Where will the dumpster be located? -'r "14— n_L z.� � - a44 a
4+�r^--•.#-
Identify dw Waste Hauler that will be used:
Will the dumpster be cleaned by an off-site contracted cleaning scmce?
M YRS,please provide name.and address of the firm contacted for this service.
Will a compactor be used? N
Number _ Size —Frequency ofpichp
Contractor:
Where will tho compactor_be located?
Win the compactor be cleaned on site?
If the compactor is cleaned on site;the wastewater from the cleaning operation must
415(*aMe to the sanitary sewer a tem..
YES lY0
Will the compactor be cleaned 6 an off-site contracted Cleanin service?
If YES,please provide the name and address of the firm contracted for this seMoc.
6.6 f Describe tho surface and location where ft dUmpster/compactor/barrers W'U be stored:
The following information mast be weladed for review:
Locadon of to •toilet, t e k ia'•
Listing of food and beverages to be said. Attach additional pages if needed.
Location of all cleaning materials and toxic iteaits that will be used.at the.facility
C4 j s L.V V"L)
usrrrw.■�..■soarsss■snr.wf.rss.ray:�uuassas�rwwr■■.■rrs�swsaasu�urrwrrrr�w■.■a■rw.
�k*�rk�iilt
STATEhMNT:I hereby certify that the above i mm;tion is correct. I My understand tbot any deviation from the
above without prior approval from the South Windsor Health Deparm4ent.is prohibited.
owner(s)or Res • bk Representa6iwe(s)
Date: t 2--c) t o
■rrrarrwa.aa�■■■r■sass■■trss Now rani■rsssrrrrrwr MORE rawisr MEOW-MEN anon
rrususssas.r#sr
Approval of these plans and specifications by ilia South Wmdsor does not iudicate compliance with,any other code,
law or regulation fat may be required—federal,state,or local. It further does not constitute endorsement or
acceptance of the completed establiftwW(Wtwt m or equipment). (A pre-opening Impecdonof the
establishment with.equipment is place and operational will benecessary to determine if it complies with the
all laws governing food service estabUshments).
■.■■n■.Na■.a■Emilia a mono a min R■■r■r■■.■■a■■snag Masons s■aaonN.■■■■■■■.r■a■N■■■■a■arrrarrss■
3
Odlyana meditation Center—Food Establishment Plan Review Application
Food;
Kettle,Chipa:assorted,individual p w4ges.(Sam's Club)
Bisrotti:prepackaged,stored in glass display container(Sam's CM)'-
�b
�Chocolato Covered Pretzels:prepac mzA stored in glass display'.container(Saws Club)Brownies:prepackaged,stored in covered cake dish(Sam's Club)
Cookies-oatmeal,chocolate chip:prepackaged,stored in covered calm dish(Sam's Club)
\� �C, Cakes-chocolate,Coffee cake:AVFWkaged,stored in covered cake dish(Sam's Club)
`` All extra food will be stoned in cabinets behind main,servioe counter.
Drinks:
Coffee:3 flavors,stored in Tupperware bins(Coffee Trader:-Avon,CT)
Tea; 10 IUvors stored In airtight metal cordaaiaers(Teavana)
Juice-Apple,Orange,Pineapple;lndividual bales(Sarn's Chub)
Waiter:Individual bottles(Sam's Club)
Creamer,A+iikc:individualservingcups(Sam's Club)
Sugar,Sple nda:l'ndividud packsges(Sam's Club)
Servinmare;
Mugs:Ceramic
Small bessert Plate$:Ceramic
Forks:Stainless Steel
Spoons:Stainless Steel
Stirrers:Wood
Cups:Paper with plastic lids(to go)
Faniutiaent:
Microfridge Combination Appliance(Model 2.9MF 7TP)
Fridge,free ave
To creamer,nii& d some water bottles to keep cold
Exterior Color:Black VVIdte
In erior Color: Stay Cool Glacier Wbite
Fridge Capacity:2.13 cu.it
Freezer Capacity:0.75 cu.fl.
Total Capacity.2.9 cu.f#...:
internal Safe Piugg Technology:Yes
Dual Outlet Charging Station:Yes
Doors:2
Defrost Type:Refrigerator,Auto/
Freezer,Msnzal
Freezer Type:Ir Fromr
Microwave Watts Output:700
Microwave Capacity:0.7 m#t'.
Haight:44.13 i0
Widths 18.62 in
-Depth:20.12 in
Wi* t:84ft
Shipping Weight:96 s
,Amps:11
IMR Per Year.-290
Stainless Steel 3 bay dale(S"s are 2 ft deep and w01 accommodate all equipment to
be washed)
Handw hfug slnk
Mr.Coffee Coffee and Espresso Msehine,Model 0 ECNU1.Enjoy gourmet coffee
And espressos In the:comfort of your own home with the Mr.Coffee Espresso .
iVYachlae.. . .
Espresso Prepares 2.4 Cups .
• Frothing Aid
• Variable Steam Control
• Removable Drip tray
• Coffoo prepares 2-9 Cups
• R.emovable Water Reservoir
• Brewing Pause'n Serve
• Removable Cone Filter Basket
. 1-4 Cup Small Quantity Setting
• Capacity: 8:Cups
Color: . Black
Model No.: ECM21
Shipping Weight(in pounds): 11.5
Product in inches(L x W x I): 15.15 x 13.09.x.14:27
Assembled in Country of Origin: Imported
Origin of Components: Imported
Wal-Mart No.: 001589595
Push Pump Caraffes(for coffee service) Stainless stool(1.5 feet tall)
Electric Ping-In Hot Water Boiler(For Tea)
FiQ� -
Ceromic Tile tyro Wg out,with ceramic We baseboard
Counter
Formica and seated wood
Ceil"
Water resistant wougtical tiles
Shecawk painted with matte.finish(off WhWpow )
Lighting
Tn..ceiling can lights.
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