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HomeMy WebLinkAboutTemp Food Inspection 9999 r sw SOUTH YffINDSOR HEALTH DEPARTMEN MOBILE FOOD VENDOR PERMIT ,. , APPLICANT : RoSADO ' S TREATS & NOVELTIES VALID : MAY 149 2012 DEC . 319 2012 THE RECIPIENT OF THIS PERMIT SHALL OPERATE IN ACCORDANCE WITH THE REGULATIONS OF THE SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. SHERRY MCGANN,9VIRONMENTAL HEALTH OFFICER DATE ilGNEd. THIS PERMIT MUST BE DISPLAYED IN AN AREA VISIBLE TO CONSUMERS AND IS NON-TRANSFERABLE * PERMIT ONLY VALID IF SIGNED BY HEALTH OFFICIAL STATE OF C ONNECTICUT DEPARTMENT of REVENUE SERVICES Temporary Permit for Sales and Use Tax Do NOT marl to the Department of Revenue Services This temporary permit must be displayed for customers to see and Is not assignable or transferable. Confirmation 12W9900330027 Number*: Organization Aliases Rosado Name: Business Trade Ice cream Vendor Name: Bushes Address: 1 Thompson rd apt J Manchester,CT 06040 This temporary permit will expire on 0511112012. EHS-10&Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT ❑ 50AM INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH WPREOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT �c.� C1�S "��� CLASS STREET TOWN ADDRESS OWNER or (� INSPECTION OPERATOR1 e S DATE and TIME S114 1"L� Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date specified below. SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked F43 Presence of insects/rodents 2 nonadulterated 22 Wash water clean,proper temperature 1 Outer openings protected against entrance of 1 2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents 24 Sanitization rinse(hot water-chemical) 2 FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed, temperature requirements during storage, equipment clean constructed as required,good repair,clean preparation,display,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required transportation equipment clean 91 46 Floor,wall juncture covered Adequate facilities to maintain product L27 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean temperature,thermometers provided 11 5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1 6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean not reserved 29 Water source adequate,safe 4 49 Walls,ceilings attached,equipment properly 1 7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling display,service&transportation 2 provided as required surfaces as required. 8 Food containers stored off floor 50 Dustless cleaning methods used, 1 SEWAGE DISPOSAL I cleaning equipment properly stored 9 Handling of food minimized 2 31 Sewage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic items properly stored,labeled,used 4 51 Adequate lighting provided as required 1 PLUMBING 52 Room free of steam,smoke odors 1 PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required 12 1 Personnel with infection restricted 14 34 No cross connection,back siphonage,backflow 14 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1 13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean Personnel hands washed clean installed 14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING 55 Establishment and premises free of litter,no 1 EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles CONSTRUCTION&INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1 16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry maintained,installed,located tissue waste receptacles provided 57 Clean/soiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL 1(except guide dogs) 18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1 19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS 20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 59 Seats 75 or more:Nonsmoking area provided, 3 constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area 1 indicated by sign(s) 41 Garbage disposed of in an approved manner, at approved frequency J_jQUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 4ZYO 2 1 FRISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 62 Written documentation of training program 2 a Signature of Person in charge TOTAL RATING Date Corrections Due SIGNED(Insp1�� l� D SCRIBE DEFICIENCIES ON TINUATION SH S Page of INenmrT10N nEnnnT ISTAIR nTi' rnlUl�ITr'rTrrrTT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS 4 CN b IS r Aln INITIAL(INSPECTOR) i A INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager 0 �� aktan Mursaloglu `a (860)877.2515 Name: 0 4n�n�rr�przn�,t .Date: CITY DESCRIPTION PK PRICE TOTALCITY DESCRIPTION PK PRICE TOTAL 100 Firecracker Bullet 12 $8.25 46 HD Oran a Cream Bar 24 $9.25 10 Bomb Pop12 25 50 HD Fudge Bar 24 $9.25 12 Ton ue S lasher Bomb 12 $8.25 52 HD Ice Cream Bar 24 $9.2S 19 Tear Jerker Bomb Pop 12 $8.2S 213 Malt Crunch Bar 24 $14.25 8 Jolly Rancher Bomb Pop 12 $8.25 47 Blue Bunny Eclair 24 $14.25 14 Fudge Bomb Pop 12 $8.25 48 Blue Bunny Shortcake 24 $14.2S 15 Watermelon Bomb Pop 12 $8.25 183 Kem /Hood Eclair 24 $12.92 118 Lick a Color Sour 24 $12.S0 184 Kem /Hood Shortcake 24 $12.92 180 GH Jr Bomb Pop RWB 72 $19.25 27 Crunch Bar Vanilla 24 $14.25 18 Jr Bomb Pop RWB 24 $9.25 73 Lemon Chill Cup 12 $13.25 244 Jr Bomb Pop Cherry 24 $9.25 72 Cherry Chill Cup 12 $13.25 243 Jr Bomb Pop Sour 24 $9.25 70 Malt Cup Chocolate 12 $14.25 127 Hyper Stripe 24 $12.S0 7 Cookie n Cream Cup 12 $14.25 20 Big Dipper Vanilla 24 $17.2S 128 Looney Tunes Cup 12 $14.25 23 Big Dip Cookies N Cream 24 $17.25 84 GH Ice Cream Bar 24 $20.86 93 Big Dipper Choc Lovers 24 $17.25 90 Reeces IC Bar 24 $24.25 21 Big Dipper Strawberry 24 $17.25 41 GH Eclair 24 $21.86 275 King size Stawberry Cone 12 $19.5o 40 GH Candy Center Crunch 24 $21.86 194 King Size Brownie Cone 12 $19.50 43 GH Toasted Almond 24 $21.86 127 Bunny Tracks Cone 12 $21.00 28 Oreo Ice Cream Bar 24 $24.25 32 Nut Cone 24 $13.15 42 I IGH Shortcake 24 $21.86 833 Riches Cookie Cone 24 $13.60 136 KS Wells Shortcake 24 $19.75 276 King Kone 24 $25.25 137 KS Wells Eclair 24 $19.75 25 Choco Taco 24 $27.S0 138 KS Wells Candy Center 24 $19.75 279 Party Icecream Sandwich 24 $16.87 195 KS Cookie&Crm Bar 24 $19.75 510 36ct Washburn IC Sandwich 36 $16.87 270 Riches Big Banana Bar x $12.75 51 13 oz Hood Sandwich 24 $12.50 271 Riches Crazy Coconut x $12.75 511 3 oz GH Sandwich 24 $14.65 207 Froz Fruit-Banana N Cream 24 $17.00 207 6 oz Vanilla Sandwich 24 $17.50 229 Froz Fruit Lime 24 $17.00 37 Big Neo Sandwich 24 $17.50 145 Froz Fruit-Coconut 24 $17.00 305 6 oz Double Straw sandwich 24 $17.50 146 Froz Fruit-Strawberry 24 $17.00 31 6 oz Mississippi Sandwich 24 $17.50 248 Hot Fudge Premium 12 $18.00 139 Chips Galore 24 $24.50 269 Wells Turtle Sundae 12 $18.00 44 GH Premo Cookie Sand. 24 $24.50 210 Premo Raspberry Bar 12 $18.00 26 Cookies N Cream Sand 24 $24.S0 95 Dove Bar Choc Choc 12 $21.00 203 Oreo Ice Cream Sandwich 24 $28.60 89 Sponge Bob Bar 12 $9.25 2 Popsicle Shots Lime 12 $12.50 108 Dora The Explorer 12 $9.25 11 Popsicle Shots Fruity 12 $22.50 68 Spiderman 12 $9.25 3 Snickers 2oz 24 $21.50 278 Iron Man Face 12 $9.25 301 Snickers King Size 3.2oz 24 $27.50 62 Ninja Turtle 12 $9.25 280 GH Popsicle Scribblers 24 $11.00 263 Batman 12 $9.25 228 Sports Bar 24 $15.50 154 Pink Panther 12 $9.25 839 Sour Cherry Bar 24 $12.92 55 Bugs Bunny 12 $9.25 838 Sour Blue Rasp Bar 24 $12.92 174 Sonic Hedgehog 12_ $9.25 186 Klondike Original 24 $22.50 6 Power Puff Girls 12 $9.25 290 Jolly Rancher cool tube 24 $17.00 57 Tweety Bird 12 $9.2S. 29 Looney Push Up 24 $17.00 289 Scooby 000 face 12 $9.25 116 Hood Push Up 24 $13.00 216 Bloo face 12 $9.25 53 Hoodsie Cup 36 $15.50 87 Tear Jerker cup 12 $9.25 277 Van Choc cup washbum 24 $10.91 133 Jolly Rancher Cup Waterm 12 $9.50 250 Italian Ice Cherry 12 $7.50 220 Jolly Rancher Snow Cone 12 $9.50 251 Italian Ice Lemon 12 $7.50 221 Watermelon Snow cone 12 $9.50 252 Italian Ice Blue Rasp 12 $7.50 76 Tear Jerker Snow Cone 12 $9.50 253 Italian Ice Watermelon 12 $7.50 69 Bubbiegum Snow Cone 12 $9.50 186 Klondike Original 24 $22.40 81 Cry Baby Cherry 12 $9.50 170 Froz Fruit Pineapple 24 $17.00 35 Cry Baby Watermelon 12 $9.50 267 Froz Fruit Pomgranite 24 $17.00 111 Good Humor Snow Cone 24 $16.25 169 Cotton Candy Bar 12 $30.7S 292 Snickers cone 24 $28.25 214 Sour Wower Bl Rasp 24 $10.75 291 M&M sandwich 24 $28.25 65 Watermelon Whirl 24 $30.75 700 Shrek 12 $9.25 66 Bubble Gum Bar 24 $10.75 701 Brats 12 $9.25 67 Cherry Bannana Split 24 $10.75 702 Blue Bunny Chocolate Sundae Bar 24 $14.00 38 CherryTwo Ball Screw Ball 24 $13.75 703 1 Fat Frog 12 $9.25 156 Blue Two Ball Screwball 24 $13.75 704 Madagascar 12 $9.25 208 Klondike Crunch 24 $22.75 705 I Screamers Cookiedough Cup 12 $14.25 840 1 Wackey Watermelon pop 1241 $12.00 i South Windsor Police Department 151 Sand Hill Rd., South Windsor, CT 06074 (860) 644-2551 � � �.$� � •` � ��a ., "fix ��fi�� � ��� �- �- rt �k '� F�p �, -s�.- , �.-..:: .-.�4.a�a--�.��� ^La_,.-----_� _ s.�4..5- ._' �:.s�-�._n �•<# :f..,rts.— .r-: - �'�s,ti- -- .—� is�s�c���=F? A" ^'Z��,SP'Yl'ii'ks�DHQ s%�0��'�9:3•- -��1NSa. PERMIT #: 85 PERMIT TYPE: PEDDLER PERMITTEE'S NAME: ROSADO,ALIXES M ISSUED DATE: May 07,2012 9:28 VALID FROM DATE: May 07,2012 9:28 EXPIRATION: May 07, 2013 9:28 LOCATION: ORGANIZATION: CASE/CAD # PCAD2012015197 Ice Cream Truck i An application for this permit has been submited,reviewed and approved by the Chief of Police for the Town of South Windsor, Connecticut. This permit is valid only within the Town of South Windsor,CT and is subject to revocation at the discretion of the issuing authority. Issuance of this permit is not to be constued as an endorsement of the permittee or the permittee's business by the Town of South Windsor. This permit is valid only for the activity listed and for the dates listed. Any material changes to the data contained within this permit must be reported to the issuing authority immediately. This permit must be displayed or presented upon request in accordance with the laws,regulations or ordinance governing the issuance of this particular type of permit. Approved by: Matthew D. Reed Chief of Police South Windsor Police Department South Windsor Police Department Page 1 of 1 SOUTH WINDSOR, CONNECTICUT APPLICATION FOR PEDDLER'SUCENSE LICENSE NOT TRANSFERRABLE Initial Fee - $25.00 Annual Renewal Fee - $2.00 Name of Applicant Pk 1 txP� Home Address_ i T i�,nr�c�SO Pi A QV d Home Phone Work/Cell Phone%Q 90' 7-793 Date of Birth a/,acd-/yq Sex M_Height th�'8 i Weight alb Name&Address of Employer n) /b Brief description of nature of business and goods to be sold 1 f (e-s ; i 1 t he 0 0-- ro,-'ri up r),r�s_e_C-Y- kA I��1 �nrn��Ic�Pr�� �.n t r� cads o►nr1r�y� C { I�� Method of delivery_ nip �- Q c-v-,--c-),m v If vehicle is to be used, give registration# 79 J'j- C� _ �� T (Number)(State) ' Description of vehicle b©c�(at' (�r a m �/O►(� 1.�1n i� �OO� , (Make—Model—Color—Year) Have you ever been convicted of any crime, misdemeanor or violation of any municipal ordinance?Yes Noi If so, give details References—Give names of two (2) reliable people who can attest to your good character and business responsibility. - ■................................................ Present this application along with (Signature( Applicant) MAY Q : 1. Connecticut Sales and Use Tax Permit 2012 2. Proper Identification `J I SOUTH WINDSOR Date "Permit fee will be collected when permit is issued . POLICE DEPT. : Permit is issued to an individual, not a company Annual Licenses Only. Must be renewed each year upon expiration. ........... X....... ..............""" SWPS 3/2006 �(i/�77T vl Z 6 f5-/9� Rk t Yes ( ,05o dO t�ao aGY 1-793 - RiECErVIE D MAY 04 ?p�? R TOWN w SOUTHr AYf SOu�1w...- HEALTH DEPARTMENT ��ITF/CEP. 1540 SULLIVAN AVE,SOUTH WINDS014 CONNEMCUT 06074 PHONE(860)644-2511est 248/FAX(860)-644-7280 PLAN'REVIEW APPLICATION FOR MOBILE VENDOR FOOD SERVICE L Information • A full set of floor plans drawn to scale,the.equipment list(including method of installation),the menu and photo of the ftWWcart. All changes in plans must have health department approval before the permit is approved. • Definitions: "Commissar' 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 Pat.for human consumption. Business Name(Food service.business name). - face ccPram -rrtskl Name of Owner(s)of Business: N k-�Z r n RcxcxAo Mailing Address: , I I b n r n pn rA F1 P-V Md;nCh�Ske��� i Address of Owner(if different from mailing address): Telephone numbers for owner(s):home: cell:&0 -*3 77q�-mail: n,t_IxPgRq hJ �(alr,�t�. Born If your business has more than one vehicle or cart,each vendor must be identified below: , Name of Food Vendor. 'A 1 u xe s Qn5 QcA n Address of Food Vendor: tom s c� r A P M o�n he r� C T i 0(.6qo Mailing Address,(if different from home address): Telephone number home: E-mail: 0\1\)0e,5 Telephone number cell: ?(.O 9C,? 7793 t If the Mobile Vending Operation is a class 3 or 4 operation,the Operator of the Mobile Vending unit is r u' to be a Qualified Food Operator. Provide a copy of the current QFO certificate. If your base of operation(commissary)is located outside OF THE To iJf Your adiinf 1561smce license issued by the local health department and your last sanitary food service inspection. Please list the location of an stops made throughout the Town of South Windsor-(Please be detailed)and approximate time of day the stops are made: �-o s k on K� SEopiS b„2c��1 8�1 �c�S�ome,r' IL 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-E(I-2481 Vc-e z e(- a f III.Menu Provide a deta ed list of all foods that are to be sold on the mobile truck/pushcart. Cold Foods List Prepa eo, s O s 2 3 4 5 6 7 . 8 9 10 Foods List Preparation Steps 1 2 Ser v 3 4 s 6 7 8 9 10 1. Will food be made more than 4 hours in advance? Yes No 2. Where will the food items be prepared and cooked? N/ A -- A 11 J'o Qc\ t lc m s w i t\ be j2 o,r \C 0%2fA nbrA r in k a rl� 3. Identify the source(s) of the food to be dispensed: j 4.How will hot food be maintained at 1401F or above on the mobile vending unit? N / A 5.How will cold food be maintained at 45°F or below on the mobile vending unit? �hl� �7 i 11 done hrovcaah 11-z us 6'C Creezfrs 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: Tlr,e 7 AL k r ca c ca s w�A Leh CS,c-P 5kn -e A kn A be 8. If used,how are raw vegetables washed? 9. Where are extra food and paper products stored?_ CA� pncc be Skored or ca shelyt na t k J IV, Plumbing and Disposal 10.Describe the hand washing facility(s)at the mobile vending unit and commissary: t�� sink r� ►Qf-rs(7-n C c \1 o is QC1C CA , 1-,®-\,.-vcr ho,QC� san1A j: f r an-A .1 n is X ni�vc5 carr in A-he- Van 11. Describe the location and method for cleaning and sanitizing utensils, containers, etc.used on the mobile vending unit: r 12. Is the water supply for the mobile vending unit from a PUBLIC WATER SYSTEM or 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? N /A 14. Where is the wastewater disposed? 15.Where and haw will garbage be disposed on the mobile vending unit and at the base of operation? bage- cxc� anCkusca�- c OL �hr enA aj;P CvCc-u IIS4 THE UNDERSIGNED AGREES TO COMPLY WITH ALL OF THE REGULATIONS AND ORDINANCES ENFORCED BY THE TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUr PUBLIC HEALTH CODE, OUR OFFICE MUST BE NOTIFIED IF THERE ARE CHANGES IN MENU,FACILITY,EQUIPMENT,OR THE ABOVE LISTED INFORMATION A'pltcant ease print Applicant's signature `' ate SO Wv_W. --w a,w qSM.Wo&WO—w—Ew——KAM wow w__ X­ ­­ camp jQj My s NIPS rnwl 11 T­­­ - 0 A -JI MAI oil Tj SM IQMWASWAP�i ­'1!t.,, ini. I j %­ M! gua El squvy—MMA—f W.mw A NUM. wy"ARM! _rw mum PR mm"UMMM!" OAK— 0 RIO Ws YM awnqj!"", iw� ",_t fly lot AMWAY 11114 , " 0 - " - - - LOA ow" M � �*'0,W-0 0 1 n gist too ,old A R 11 bw A-0vyy"_ "NARY", !ION ASK: ERIC �!T oil Big 1 - - jS 1 W ky� " A, TOP A q "I"." "silk Q nkhPTQj[ ,;IA Oslo! 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