HomeMy WebLinkAboutItnerant Vendors Correspondence 953 Sull w
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
1540 SULLIVAN AVE,SOUTH WINDSOR, CONNECTICUT 06074
PHONE (860) 644-2511ext 248/FAX(860) 644-7280
PLAN REVIEW APPLICATION FOR MOBILE VENDOR FOOD SERVICE
I. Information
,•'" A full set of floor plans drawn to scale,the equipment list(including method of
installation),the menu and photo of the truck/cart.
+ All changes in plans must have health department approval before the permit is
approved.
• Definitions: "Commissary" A service room, catering establishment,restaurant or
any other place in which food, containers or supplies are processed,prepared,
handled,packed,transferred or stored and directly from which food is distributed to
a food vendor or from which any vehicle or pushcart offering food to the public is
supplied.
o "food". Any raw, cooked or processed edible substances,beverages,
ingredients, ice or water used or intended for use or for sale in whole or in
part for human consumption.
Business Name(Food service business name):
Name of Owner(s)of Business: V,0,/. 1+ 5
Mailing Address: 0
Address of Owner(if different from mailing address):
Telephone numbers for owner(s): home:g(QO`gff 4Af& cell: E-mai .G,�D"
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If your business has more than one vehicle or cart, each vendor must be identified below: -7
Name of Food Vendor:
Address of Food Vendor:
Mailing Address(if different from home address):
Telephone number home: E-mail:
Telephone number cell:
If the Mobile Vending Operation is a class 3 or 4 operation,the Operator of the Mobile Vending unit.is
require to be a Qualified Food Operator. Provide a copy of the current QFO certificate. If your bale N
of operation(commissary) is located outside OF THE Town of South Windsor, please provide a copy
of your current food service license issued by the local health department and your last sanitary food
service inspection.
Please list the location of all stops made throughout the Town of South Windsor- (Please be
detailed) and approximate time of day the stops are made:
II. Equipment List
Complete this equipment list or provide identical information on the specification sheet indicating
the equipment to be installed on the truck or cart.
Item# Item Manufacturer Model Number
Example Counter Top Gas Grill Hobart 270-EG-2481
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fII. Menu
Provide a detailed list of all foods that are to be sold on the mobile truck/pushcart.
Cold Foods List Preparation Steps
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Hot Foods List Preparation Steps
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1. Will food be made more than 4 hours in advance? Yes CNo
2. Where will the fio d items be prepared and cooked? Nk
NA
3. Identify the source(s) of the food to be dispensed:
4. How will hot food be maintWned at 140T or above on the mobile vending unit?
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5. How will cold food be maintained at 450F or below on the mobile vending unit?
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6. Will food items be reheated on.the mobile vending unit? YES No
If yes,describe how and where the food items will be re-heated:
7. Describe what is done with food items that are leftover at the end of the business day:
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8. If used,how are raw vegeta 1 washed?
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9.Where are extra food and paper products stored?
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IV. Plumbing and Disposal
10. Describe the hand washing facility(s) at the mobile vending unit and commissary:
11. Describe the location and method for cleaning and sanitizing utensils, containers, etc.used on
the mobile vending unit: ;
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12. Is the water supply for the mobile vending unit fro a PU LIC WATER SYSTE r a
PRIVATE WELL WATER SUPPLY? (Circle one) If your water source is from a private well,
please provide a water test from a Connecticut Certified Laboratory.
13. How are the water tanks filled on the mobile vending unit? Also describe how often the tank is
cleaned and what method is used?
14. Where is the Tastewater dispos
15. Where and how will garbage be disposed on the mobile vending unit and at the base of
operation?
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THE UNDERSIGNED AGREES TO COMPLY WITH ALL OF THE REGULATIONS AND ORDINANCES ENFORCED BY
THE TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. OUR
OFFICE MUST BE NOTIFIED IF THERE ARE CHANGES IN MENU,FACILITY,EQUIPMENT,OR THE ABOVE LISTED
INFORMATION.
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