The URL can be used to link to this page

Home My WebLink AboutTemp Food Correspondence 150 Never Rd 3p SOUTH WINDSOR HEALTH DEPARTMEN TEMPORARY FOOD PERMIT EVENT : EVENING IN THE PARK � LOCATION : NEVERS PARK APPLICANT : BOBBY T ' s F VALID : MAY 199 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 MCGANNQNVIRONMENTAL HEALTH OFFICER DATE SIGNED: THIS PERMIT MUST BE DISPLAYED IN AN AREA VISIBLE TO EVENT PATRONS AND IS NON TRANSFERABLE " PERMIT ONLY VALID IF SIGNED BY HEALTH OFFICIAL ifs-ice-Rev.t9ras INSPECTION REPORT STATE OF CONNECTICUT 0 ROUTINE INSPECTION O REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH kPREOPERATIONA o OTHER 410 Capitol Avenue,MS#11 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT t�dB� CLASS STREET ADDRESS !✓ >4 /'�a f�./ I7 �I� S' TOW G OWNER or OPERATOR V DATE and TIME - 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 EQUIPMIIENT&UTENSILS:CLEANLINESS I VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insectslrodents 2 nonaduharated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1 2 Original container,properly labeled 1 Accuratethennornetarsprovided,dishbasketifused inseetslrodants 2 nilization rinse(hot water-chemical) 2 FOOD PROTECTION Clean wiping cloths 1 FLOORS,WALLS&CEILINGS 3 Potentially hazardous food meets 4 28 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 transportation required equipment clean 1 46 floor,wall juncture covered 4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean tem erature,thermometers Provided 5 Potentially hazardous food properly thawed 2 4$ 1 Exterior walking,driving surfaces, 9 6 Unwrapped or Potentially hazardous food 4 WATER SUPPLY good repair,clean not re-served 29 Water source adequate,safe 4 49 Walls,callings 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. a Food containars stored off floor 50 Dustless cleaning methods used, 1 SEWAGE DISPOSAL cleaning equipment properly stored 9 Handling of food minimized 2 31 8swage disposal approved 4 10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION 11 Toxic Rams property stored,labeled,used 4 51 Adequata lighting provided as required 1 PLUMBING 52 Room free of steam,smoke odors 1 PERSONNEL 33 Location,installation,maintenance 1 63 Room&equipment hoods,ckols,varied asrequired 12 1 Personnel with infection restricted 4 34 Noam connection,back siphonage,bacldtow 4 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES FA I Rooms adequate,dean,adequate lockers 1 13 Handwashing belittles provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,f"lltlaa dean rsonnel hands washed clean installed 14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-dosing door 1 15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,dean HOUSEKEEPING 55 Establishment and premises fuse of litter,no 1 EQUIPMENT&UTENSIM DESIGN, NDWASHING FACILITIES insecdlrodent harborage,no unnecessary articles CONSTRUCTION&INSTALLATION suitable hand oleanerand unitary 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 Cleanlsoiled linens stored properly 1 17 Nonfood-contact surfaces designed, 1 t 5B No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL I(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,dean SMOKING PROHIBITED 20 Dishwashing facilities approved design,adequately 2 40 Storage areairooms,enclosures— 59 Smoking prohlbitsd,signs posted at saoh 3 constructed,maintained,installed,loaded properly constructed,clean entrance 1 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60' Qualified Food Operator 3 4 2 1 I RXSX FACTOR VIOLATIONS IN RED 61 Designated alternate 2 t 62 Written documentation of training program 2 Signature of Person in rg TOT AL RATING Date Corrections Due SIGNED(Inspector) UTSCRI13E DEFICIENCIES N CON UATION SHEETS DISTRIBUTION:1"-White—Health Department 2nd_yellow—Owner/Operator TO'd �Z:2T ZTOZ Z 19pW 88T�Zb9098:XP3 311 Hi-IH3H d31S3H0NHW Page-L Of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABUSHNdENTS TEffATfR+MEEN O PUBLIC TT�v�+l.��V .�r..HE H CONTINUATION SHEPT NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION 0 A&V I H IN5P REMARKS FFORM# Z Lf ' M Ove- S fve INITIAL(INSPECTOR) /2 INITIAL(PERSON 1N CHARGE) Distribution: 1st-White-Realth Department -2nd-Yellow-Owner/Manager ZO'd 2Z:2Z ZZOZ Z ReW 88T2)V9098:xp3 3Q Hi�H3H d3MH0NdW DOR 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 April 29, 2009 Name of Event Evening in the Park Date of Event May 16t`2009 Time of Event 5:00pm 9:00pm Location of Event Nevers park Sand hill rd South Windsor Ct 06074 Event Coordinator Kent Carlson Event Coordinator Address 970 Avery St South Windsor ct 06074 Event Coordinator Phone#860-250-6554 Event Coordinator E-Mail Address kcarlsonl2l@aol.com Event Coordinator Phone# (cell,work&home) 860-250--6554 C:::a:m:eo f Applicant an Macgregor ' Applicants Business(please indicate if mobile vendor)N.A. Applicants Address 18 Gordon aver Enfield ct 06082 Applicants E-Mail Address ianmac3 I @cox.net Applicants Phone# (cell,work&home) 860-604-9212 Set up time between 12:30pm and 1:30 0 Please provide the following: (If any of the following does not apply to you put N/A) l.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. Hotdogs, Hamburgers, Cheeseburgers, Potato chips, Soda, Water, Ice cream sold from Ice-cream truck on site 2. Describe specifically how frozen,cold, and hot foods will be transported to the event. Food will be transported in coolers,which will be iced down.No hot food to be transported an everything cooked to order. 3. List all places (name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. Cosco foods Enfield ct 06082 Sig Y supermarket Enfield ct 06082 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. On attachment#1 5. Use attachment#2 in this packet to sketch a drawing showing the event area and where your Operation will be. 6. Describe the number,location and set up of handwashing facilities to be used by employees. 1 hand washing station. Water cooler with hot water,hand soap with a bucket to collect wastewater And paper towels to dry hands 2 . Describe how and where utensil/equipment washing will take place. If no facilities are available, Describe how alternate steps will be taken. Utensils will be washed back at Eddies . Ice-cream facility in their dishwasher. During Event they will be wiped down with sanitizing wipes if needed 8. Describe how wastewater will be collected, stored and disposed. Wastewater will be collected in 5gallon buckets covered and brought back to Eddies Ice-cream to be disposed of properly 9. Describe the number and location of garbage containers. 2 cans one behind cooking area for cooks trash,one out front near condiment table for public use There will also be other cans available thru out the park during the event 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). Food will be cooked to order on an 8-burner gas grill 11. Describe how colds foods will be kept cold(45 degrees and below). Cold foods will be kept on ice in coolers.All raw food and cooked food will be stored in separate coolers with ice. 12. Describe how food temperatures are monitored. Food is cooked to order and will be checked with a metal probe thermometer. 13. Will foods be prepared on site?If no,where will foods be purchased? (Enclose a copy of food license) Food will be cooked to order on site. 3 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT l.Rallene Phillips 463-9265 Ellington ct All 2.Jerry Byers 749-9267 Enfield ct All 3. Steven Breault 798-8751 Ellington ct All 4. 5. 6. 7. 8. 9. 10. 4 ATTACHMENT ##2 6 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS x 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) x Plastic wrap/Aluminum foil x Extra utensils: tongs, spatulas, spoons, and knives -Water source x Buckets/tubs for washing,rinsing, sanitizing food equipment Bleach for sanitizing,test strips for checking x Waste water disposal container x Container(s) for grease collection x Clean wiping cloths and a container to store them in x Garbage containers and plastic bags Hats/hair restraints Crates, shelves to store food off of the ground x Gloves for food handling X Hand washing station MOBILE VENDOR CHECKLIST VENDOR NAME OWNER NAME LICENSE PLATE TYPE OF VEHICLE FOOD CLASSIFICATION OWNER ADDRESS HOME PHONE CELL PHONE E-MAIL QFO NAME APPROVED BASE OF OPERATION N/i MENU CLEARLY VISIBLE NL CURRENT MOTOR VEHICLE REGISTRATION(TEMPORARY REGISTRATION NOT ACCEPTABLE) NJIT VEHICLE CLEAN AND FREE OF ODORS J ALL EQUIPMENT CLEAN AND OPERABLE GRILL(S)ENCLOSED AND PROPERLY VENTED ? PROTECTION FROM AIRBORNE CONTAMINATION AND INSECTS PROPER HAND WASHING J APPROVED SANITARY GLOVES(If Applicable) J HOT&COLD WATER PROVIDED&WASTEWATER COLLECTION J PROPER THERMAL EQUIPMENT TO HOT HOLD AND/OR COLD HOLD PROPER THERMOMETERS: TYPE&AMOUNT,ALCOHOL WIPES J TRASH CONTAINER(S)WITH COVERS J CLEANING&SANITIZING CHEMICAL PRESENT-PROPERLY STORAGE ADEQUATE UTENSILS PROVIDED(SPOONS,SCOOPS,LADLES,ETC) J ADEQUATE SINGLE SERVICE STORAGE/DISPENSING Notes: /i(26 SIGNA ROVING SANITARIAN .•77 * Prior t inspection, all mobile vendors shall complete the Mobile Vendor application. Once the application has been reviewed and approved, a scheduled Sanitary Food Service Inspection can be arranged. Upon satisfactory completion of a Sanitary Food Service Inspection,The Town of South Windsor Health Department will allow the sale of food products. Failure to complete these requirements may result in fines,fees and/or closure of the Mobile Vendor. WAHealth Department 2008\Forms\Mobile Vendor Cheeklist.doc Page 3 of 7 VENDOR APPLICATION FOR TEMPORARY FOOD EVER ' 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 April8th 2010 Name of Event, Evening in the Park Date of Event May 15th 2010 Time of Event 5 PM to 9PM Location of Event Town Of South Windsor Nevers Park Event Coordinator Kent Carlson Event Coordinator Address 970 Avery Street South Windsor CT.06074 Event Coordinator Phone,#860-250-6554 Event Coordinator E-Mail Address kcarlsonl21@aol.com Event Coordinator Phone#(cell, work&home) N/A Name of Applicant Ian MacGregor Name of Applicants Business (please indicate if mobile vendor) N/A Applicants Address 18 Gordon Ave Enfield Ct Applicants E-Mail Address ianmac31@cox.net Applicants Phone#(cell,work&home) Cell 860-604-9212- Setup time Saturday Mayl5th 1 P1Vl 4/9/2010 Page 5 of 7 h_ Describe the number, location and set up of handw ca._hin facilities to he used by employees l Hand washing station next to the food prep area 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will betaken. Utensil washing will be done at Eddies Icecream EastWindsor Ct 8. Describe how wastewater will be collected, stored and disposed. All waste water will be collected in 5gallon buckets with lids and disposed at Eddies Icecream east in EastWindsor Ct 9..Describe the number and location of garbage containers. 3 cans for rubbish will be Distributed around or site for public and our use 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). All foods are cooked to order 11. Describe how cold foods will be kept cold(45 degrees and below) All foods will be kept in coolers covered with Ice 12. Describe how food temperatures are monitored,cleaned and sanitized: Food temps will be checked with metal food probe and wiped with sanitizing wipe 13.Will foods be prepared on site? If no, where will foods be purchased? (enclose copy of food license) Food will be prepared on site to order 4/9/2010 Page 7 of 7 ATTACHMENT A CL7MT;'NT #2 CHECKLIST FOR FOOD BOOTHNENDOR 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 4/9/2010 y Page 1 of 7 Lipe, Michele From: Ian MacGregor[ianmac31 @cox.net] •' Sent: Thursday,April 08, 2010 9:38 PM To: Lipe, Michele Subject: Temporary Food Vendor Application for May 15th 2010 Evening in the Park Attachments: header.htm VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS 4/9L2010 Page 1 of 1 Lipe, Michele From, Hall, Judith Sent: Thursday,April 01, 2010 8:34 AM To: Lipe, Michele Subject: FW:vendor application Director of Human Resources Town of South Windsor South Windsor, Connecticut Phone: 860.644.2511,Extension 201 E-mail:judith.Hall@southwindsor.org From. Ian MacGregor [mailto:ianmac3l@cox.net] Sent: Wednesday, March 31,2010 9:28 PM To: DeVito, Robert Subject: vendor application Hi Bob this is Ian MacGregor from the Town garage ,I am doing the Evening in the Park again this year May 15th . I tried to find the Application on line for temporay food service events but cant seem to find it on line;can you please send me the link so that I can fill it out on dine and send it to you, or you can just change the date from last years application, cause nothing is going to change( I know you cant do that) Thanks Ian MacGregor - 4/1/2010 Y * F*Y*rt*Y *1*Y *Yfi*Y YY*Y*Ya*Y *Yk* *Y*fi *fi* T*Y*fi T*Y*F T**fi T**fi*F T*Y** f * F +�fifi T*Yrt*Y*rt cT'f*-*T1 *T*T1 *T*TT*T*T*T * *"r* ,r * *"�* *"�*'f* *"�,t *"-*T 4 "A**-** The South Windsor Patriotic Commission Presents AN EVENING IN THE PARK 2011 A Celebration of Armed Forces Day Nevers Road Park Saturday May 21 2011 5:00 PM to Dusk Free Admission Armed Forces Displays and Equipment Veterans Groups Civic Organizations Patriotic Band Concert Activities for Kids Food Available for Purchase 5:00- Military & Community Displays 7:30 S.W. Community Band Concert busk Spectacular Fireworks bis Ia p Y MOM SOUTH WINDSOR HEALTH DHPARTIVIHN . b TEMPORARY FOOD PERMIT EVENT : PICICIIC IN THE PARK LOCATION : NEVERS PARK , S . WINDSOR APPLICANT : IAN MAcGREGOR VALID : MAY 219 2011 THE RECIPIENT OF THIS LICENSE ACCEPTS THE SAME WITH THE UNDERSTANDING THAT HE/SHE WILL OPERATE IN ACCORDANCE WITH THE ORDINANCES AND REGULATIONS OF THE SOUTH WINDSOR HEALTH DEPARTMENT AND THE CONNECTICUT PUBLIC HEALTH CODE. A SHERRY RO NVIRONDQTAL HEALTH OFFICER DATE SIGNED: THIS PERMIT MUST BE DISPLAYED IN AN AREA VISIBLE TO EVENT PATRONS AND IS NON-TRANSFERABLE ' PERMIT ONLY VALID IF SIGNED BY HEALTH OFFICIAL Page 3 of 8 s µ VENDOR APPLICATION FOR TEMPORARY FOOD EVER 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 6, 2011 Name of Event Picnic in the Park Date of Event May 21 st 2001 Time of Event 5 pm to 9 pm Location of Event Town of South Windsor @ Nevers Park Event Coordinator Kent Carlson Event Coordinator Address 970 Avery Street South Windsor Ct 06074 Event Coordinator Phone # 860-250-6554 Event Coordinator E-Mail Address kcarlson121@aol.com Event Coordinator Phone#(cell, work&home)N/A Name of Applicant Ian MacGregor Name of Applicants Business (please indicate if mobile vendor)N/A Applicants Address 18 Gordon Ave Enfield CT 06082 Applicants E-Mail Address iamnac31@cox.net Applicants Phone#(cell, work&home) 860-604-9212 Set up time May 21 st 1 pm to 2 pm 4/7/2011 Page 4of8 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. Hotdog,Hamburgers, Cheeseburgers,bagged chips, canned soda,bottled water and sealed Ice Cream from and Ice Cream truck. Condiments will be squeeze containers 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. Frozen food will be kept in ice chest — 5&(� Ckto'AY'A Y-'Q � All hot foods will be cooked to order; raw and cooked food will be kept in separate coolers packed with ice 3. List all places (name&address)where meats,poultry, seafood, shellfish, and ice will be purchased. Cosco, Enfield Ct 06082 BigY Enfield Ct 06082 4.. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 4/7/2011 Page 5 of 8 5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your Operation will be. Set up below Nevers Park upper lot next to walking path 6. Describe the number, location and set up of handwashing facilities to be used by employees. 1 hand washing station next to food prep 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 washing will be done at Eddies Ice-Cream East Windsor Ct 8. Describe how wastewater will be collected, stored and disposed All waste water will be collected in 5gallon buckets with lids and disposed at Eddies Ice-Cream in East Windsor ct 9. Describe the number and location of garbage containers. 3 cans will be distributed around our site for public use and ours 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). All foods cooked to order 11. Describe how cold foods will be kept cold(45 degrees and below). All foods will be kept in coolers covered with ice 12. Describe how food temperatures are monitored, cleaned and sanitized. Food temps will be checked with metal food probe and wiped with sanitizing wipe 13. Will foods be prepared on site? If no, where will foods be purchased?(Enclose copy of food license) 4/7/2011 Page 6of8 Food will be prepared on site to order 4/7/2011 Page 7 of 8 ATTACHMENT #1 NAME OF EMPLOYEE PHONE#ADDRESS SHIFT 1.Ralenne Phillips 860-463-9265 Ellington Ct All 2.Jerry Byers 860-749-9267 Enfield Ct All 3.Steve Breault 860-798-8751 Ellington Ct All 4. 5. 6. 7. 8. 9. 10. 4/7/2011 Page 8 of 8 J y � ' � y 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 4/7/2011 Town of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 TEMPORARY FOOD EVENT INSPECTION SHEET Event Name: U A-\. Q Event Date: , 54t 1 Z. Location of Event: 0N Applicant/Coord.:' "t`S -- Z6 b-'CZ,,rcAVe, Ph.# Email Address: Fax# QFO Name:— _ Ph.# Email Address: Fax# METHOD: On-Site inspection Kitchen inspection nterview (Circle one) Food/Water urce -Fucs� 1"' ws C�"�' Approved source of food,wholesome, free from spoilage Water source potable, from approved supply, food grade hoses utilized.4r Temperature ntrol Hot/cold holding equipment and temperatures adequate vi&,Food cooked/reheated to correct temperature 5'T rm —Metal probe food thermometer(0—220F range) available/sanitized between use Accurate thermometers for all refrigerators � � Coolers (self draining) and ice packs/bags Cso\c9_7yAw\�, �c�.6" Hygiene/Handwashing \/ Hats or effective hair restraints for food workers and washing station-warm water in jug w/spigot, liquid soap,paper towels Gloves for food handling, designated person to handle money Scoops to have handles Records Designated person in charge of food booth for each shift—logs kept General Food P tection No extensive food preparation/handling Food protected by wrapping, sneeze guards or other effective barriers _ ondiments 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 Drinks stored in ice must be stored in self-draining storage containers N��Raw fruits and vegetables used in food prep to be washed in potable water Toilet Facilitie aste Disposal Toilet facilities adequate, clean and conveniently a-a ve n aste water disposal container—disposed of properly S Gp-kw, — Container for grease collection—disposed of properly GJ f� on-absorbent garbage containers, fly tight covers, Dumpsters must be covered Garbage containers and plastic bags Cleaning/Sanitizin ckets/tubs for washing,rinsing, sanitizing food equipment(hot water) leach/Quat. for sanitizing, appropriate concentration,test strips available ensils are to be sanitized every 4 hours or as needed Moist wiping cloths to be stored in container with clean sanitizing solution Storage/FB Couction _ 11 utensils/equipment to be properly stored to protect from contamination Chemicals to be stored separate from food products,bottles to be labeled N Pr- Food booths constructed properly to protect food,adequate lighting provided COMMENTS: HEALTH INSPECTOR: Signature: ate; EVENT COORDINATOR: Signature:(if 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." 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 th mt This 2nnliy2tian must be submitted to the Tomm of Smith WA06mUmlib Department, 1540 Sullivan Avenue, South Windsor, CT 06074. CNED APR 23 2012 SOUTH WINI)SOR HEALTH®EpT. This application is not a license. Temporary food events will not exceed a period of 1 to 5 days. Today's Date 1 L Name of Event Evej_A Date of Event P%f r l 1 c/ 7 Time of Event '5_19"n nll Location of Event N@ yuC Al Event Coordinator Event Coordinator Address 9 Q Sy S Event Coordinator Phone#_ C) (a �( Event Coordinator E-Mail Address hoeMudlv LA a L Cc)ri Event Coordinator Phone#(cell,work&home) Name of Applicant CO b@ A, gco Name of Applicants Business (please indicate if mobile vendor) 1,) I 0 k ' 2 Applicants Address ( d � (0 7� ( aSC' ,..5/ /11 19A'C=- ss U Applicants Phone#(cell, work&home) C,y-a-) _` p 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 NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the event. TD C tkeSC' 0 v2 GCKs �Mudv) -C14 s - CfiA4vec) 56d19 ^ �d11/eJ wIlle' 7 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. coalelu JCL cfie4 D/Z Y : 3. List all places(name&address)where meats,poultry,seafood, shellfish, and ice will be purchased. �•q('tS GLc� r� 1� �'��'��5 sOt /Lr `✓C�� 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. 1 v la eTc�a tic `7-if W--7" 5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. 6. Describe the number,location and set up of handwashing facilities to be used by employees. s� 11>7WIT7evz LP�2-4/ 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. 8.Describe how wastewater will be collected, stored and disposed. 9. Describe the number and location of garbage containers. 10.Describe what heat source will be used to keep hot foods hot(140 degrees and above). G- CAA 11.Describe how cold foods will be kept cold(45 degrees and below). Wj /h`7i4-C. & (9 e /11«t moo,, Ie�L 12.Describe how food temperatures are monitored, cleaned and sanitized. /kele-t �1,eb be —Mel? 46C.>Ld C_ f& e. Wi,pCl-S 13.Will foods be prepared on site? If no,where will foods be purchased? (enclose copy of food license) ATTACHMENT #1 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT / 3. .4. 5. 6. 7. 8. 9. 10. I ATTACHMENT #2 CHECKLIST FOR FOOD BOOTHNENDOR OPERATORS Metal probe thermometer(0—220 degrees F range) Thermometers for all reT gaatm at;a L G tis 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 air restraints Crates, shelves to store food off of the ground —Gloves for food handling Hand washing station i � ..S _� � i'. ]a; a