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HomeMy WebLinkAboutFood Service Establishment Inspection 99 (4) y RE�E�yEp MAR 2 6 20 14 HsgCTUrH W DEPr iNpgoR goo FIRST CONGREGATIONAL CHURCH UNITED CHURCH OF CHRIST 993 MAIN STREET, P.O. Box 165 SOUTH WINDSOR, CT 06074 South Windsor Health Department March 20, 2014 1540 Sullivan Avenue South Windsor Ct.06074 Attention:Sherry McGann, Environmental Health Officer The congregation of the First Church of South Windsor desires to expand its service to and on behalf of the less fortunate people of our community by hosting periodic food events open to the public at our church home on 993 Main Street in South Windsor. The enclosed license application for our-kitchen--- facility is a critical step towards that goal. Our plan is to select varied menus that are nutritious,appropriate to the season and within our capacity to prepare. Starting slowly we hope to eventually expand our efforts to one meal per month as more of our members become trained in proper food preparation and sanitation. All food will be either purchased from other licensed sources or prepared on site. Any food remaining at the end of a meal will be disposed of immediately. Nothing will be retained for reheating and serving at a later time. Please contact our certified food handler Ms.Judith Borre with any questions and to schedule an inspection of our facilities.She can be reached by phone at(860)644-4397 or by email at Borre@cox.net.We are very appreciative of the interest and support that you have already given to this project and look forward to working with you in the future. Sincerely Q� Rachel Anderson, hairman Board of Trustees Rev. Sarah Courtney 860-528-7992 website: www.. irstchurchszv.org email:firstchurchsw993@.sbcglobal.net EXAM FORM NO. 4900 CERTIFICATE NO. 10537359 ServSafe National Restaurant Association S ry af CERTIFICATION TO J DIT W HAB ORR for successfully completing the standards se °Food Protection Manager Certification Examination, which is ac 'redited by the American Nati (ANSI)-Conference for Food Protection(CFP). i 4 h i' 'Syr n i tZM DATE O 11/18/2Auwa DATE OF EX41 I Local laws apply.Ch or recertification requirements. ....`ry �I ACCREDITED American National Standards Institute and the Conference for Food Protection ® ant Association #0655 ©2012 National Resta mark of the NRAEF,used under license by National Restaurant Association Solutions,I.I.C. The logo Peceiveo r. R Town of South Windsor - Health Department MAR 262014 1540 Sullivan Avenue, South Windsor, CT 06074 yUTNWi, z Phone: 860-644-2511 ext.248 Fax: 860-644-7280 �fTH p OR ti ► c c18 FOOD ESTABLISHMENT PLAN REVIEW APPLICATION *for Class 3 or 4 establishments NEW REMODEL - Z—CONVERSION CHANGE OF OWNERSHIP Name of Establishment: Fv y-e_ Gtt, ,vet J �j/ "<A 0 �,tiJ �N�Spy Category:Restaurant ,Institution 1 ,Daycare ,Retail Market ,Other ch LO-C Address: 7st 93 Ai iN YT J-o 67Z ldr i✓®Sd Phone(if available): E 016 �j 2 8 W9 2-- Name of Owner: MaiImg dress. �) l3LL �sVd�D 1✓ 06 Telephone: a �'o Applicant's Name: ka( �PJ f�y✓lJ e Yv?S� Title(owner,manager, architect,etc.): ?0_41nd 07' l�C�/ems Mailing _,L / Address: y 9-0-)( Z/ �47� ii�/ �d}' / 6-d 74 pp-, Telephone: Hours of Operation: �� Mon Tues Wed Thurs Fri Sat Sun kob M (!A as/�y � Number of Seats: Number of Staff. (Maximum per shift) Total Square Feet of Facility: Number of Floors on which operations are conducted Maximum Meals to be Served:(approx.#) Breakfast Lunch Dinner '7-8 d I Wl;kw e -- /oe-- Yne es-1. Projected Start Date of Project: ,QVcC Projected Completion Date of Project: C- 201, Type of Service: Sit Down Meals-Take Out Caterer Mobile Vendor Other - 1 - FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods(PHF's)to be handled,prepared and served. CATEGORY* ( LEJS NO 1. Thin meats,poultry,fish,eggs (hamburger; sliced meats; fillets) ( ) ( ) 2. Thick meats,whole poultry(roast beef; whole turkey,chickens,hams) ( ) ( ) 3. Cold processed foods(salads, sandwiches,vegetables) ( ) ( ) 4. Hot processed foods (soups, stews,rice/noodles, gravy,chowders, casseroles) ( ) ( ) 5. Bakery goods (pies, custards,cream fillings &toppings) ( ) ( ) 6. Other / l y t _YAy *A generic HACCP plan for each category of food may be available from the regulatory authority for reference. PLEASE CIRCLEIANSWER THE FOLLOWING QUESTIONS: FOOD SUPPLIES: -:tire-a}rfood-supplies-from-inspected-and-approved-sources: S/N�OJ - 2.What are the projected frequencies of deliveries for Frozen foo s--(+�,�� `' Refrigerated food *ef� ,and Dry goods QS -f 3.Provide information on grount of space(in cubic feet)allocated for: n 3 Dry storage Refrigerated Storage_ 7`' ,and Frozen storage 4.How will dry goods be stored off the floor? �/jJ (2a A,,,Ale�S COLD STORAGE: 1. Is adequate and ap ved freezer and refrigeration available to store frozen foods,and refrigerated foods at 45°F and below?/NO Provide the metho used to calculate cold storage requirements. Qs k 2. Will raw eats,poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods? ri/NO If yes,how will cross--con nation be prevented? 3.Does each refrigerator/freezer have a thermometer`?/NO 4. #of refrigeration units: / #of freezer units:_L Bulk Ice Machine?YES NO -2- THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: Please indicate by checking the appropriate boxes how frozen Potentially Hazardous Foods (PHF's)in each category will be thawed. More than one method may apply. Also,indicate where thawing will take place. Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS 1 Refrigeration y Running Water Less than 70°F Microwave (as part of cooking process) Cooked from Frozen state 1 Other(describe) *Frozen foods: approximately one inch or less=thin, and more than an inch=thick. COOKING: 1.Will food thermometers be used to measure final cookingtreheating temperatures of PHF's? S NO What type of temperature measuring device: Gam- i 1S O e� 2.List types of cooking equipment. �a /2 6A, 2 UG 'AS �'1! E? WIcI-O U'l yic HOT/COLD HOLDING: 1.How will hot PHF's be maintained at 140T or above during holding for service?Indicate type and number of hot holding units. 574a,, A-�/P5S ��Peo— A01AL Glut.✓t'' ( , � 2.How will cold PHF's be maintained at 45°F or below during holding for service?Indicate type and number of cold holding units. 11 -3 - COOLING: Please indicate by checking the appropriate boxes how PBF's will be cooled to 45°F within 6 hours(140°F to 70°F in 2 hours,and 70°F to 45°F in 4 hours).Also,indicate where the cooling will take place. COOLING THICK THIN THIN THICK RICE/ � METHOD MEATS i MEATS t SOUPS/ it SOUPS/ ► NOODLES GRAVY I GRAVY Shallow Pans Ice Baths I j Reduce Volume or Size Rapid Chill Other(describe) REHEATING: 1.How will PBFs that are cooked,cooled,and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds.Indicate type and number of units used for reheating foods. 4) 2.How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? 4- PREPARATION: 1.Please list categories of foods prepared more than 12 hours in advance of service. 2.Will food employees be trained in good food sanitation practices?&NO Method of training: Number(s)of employees: ® Dates of completion: 3.Will osable gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to-eat foods?Qy/NO s there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? QT ' /NO S t-oC C_-�5 Please describe briefly_ n1v nt7_44/ al� :5-u4A &�&0114e L?/sp-eg- Will employ have paid sick leave?YES/NO 5.How will cooking equipment,cutting boards,counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? v�"" V Chemical Type: X Concentration: Test Kit:YES/6 6.Will ingredients for cold ready-to-eat foods suc na,mayonnaise and eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled. YES O If not,how will ready-to-eat foods be cooled to 41°F? 7.Will all produce be washed on-site prior to use?(YES (NO Is there a planned location/designated sink used for washing produce?YES/NO °t Describe -5 - If not,describe the procedure for cleaning and sanitizing multiple use sinks between uses. 8.Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone(45°F- 140°F)during preparation. J 9.Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared on- site or otherwise required by the regulatory authority. AI 10.Will the facility be serving food to a highly susceptible population?YES/V If yes,how will the temperature of foods be maintained while being transferred between the kitchen and service area? A.FINISH SCHEDULE Applicant must indicate which materials(quarry tile,stainless steel,4"plastic coved molding,etc.)will be used in the following areas. FLOOR COVING WALLS CEILING i Kitchen/Bar P L&', i i Food Storage 1 i I Other Storage 1' i i Toilet Rooms � 6lti✓� 1. a -6- Dressing Rooms 3 J r A Garbage & All I Refuse Storage 1 i __. — Mop Service �,kY bAc Ce, Basin Area � ; �u�h e Warewashing 1jiJ So/ r� rGt ijd Per /r /`� 1 yt3G j�� f / i Area Walk-in A 1 Refrigerators � t � anc Freezers- -� --- - -i- - --- -- YES No NA B INSECT CONTROL (Please check appropriate boxes) , AND R DENT 1.Will all outside doors be self-closing ands proof? n doors provided on all entrances left open to the outside? 2. Are scree ( ) ( ) #16 mesh screening? 3.Do all openable windows have a minimum ( ) ( ) r 4.Is the placement of electrocution devices identified on the ation systems exhaust and ( ( ) ( ) 5.Will all pipes&electrical conduit chases be sealed;ventilation intakes protected? Is area around building clear of unnecessary brush,litter,boxes and other X' 6. harborage? ( ) ( ) 7.Will air curtains be used?If yes,where? C.GARBAGE AND RE JSE ( ) ( ) Inside 8.Do all containers have lids? ( ) ( ) 9.Will refuse be stored inside? { If so,where? far garbage can or floor mat cleaning? 10 .Is there an area designated -7 - 0 Outside 11.Will a dumpster be used. YE /NO Number Size Contractor .54J .r/ Frequency of pickup �� � 12.Will a compactor be used? YE /0, Number Size Frequency of pick up Contractor 13.Will garbage cans be stored outside? YES/00 14. Describe surface and location where dumpster/compactor/garbage cans are to be stored 01 15.Describe location of grease storage receptacle 16.Is there an area to store recycled containers? /NO(list location) 0 Indicate what materials are required to be recycled; gj Glass (,°Metal (Paper (l Cardboard SV Plastic 17. Is there any area to store returnable damaged goods? YES/NO I 4 D.PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18.Toilet 1 /) j19.Urinals I - 8 - 120. J Dishwasher 21. Garbage I A Grinder 22.Ice machines I 23.Ice storage bin /v„ A 24.Sinks a.Mop b.Janitor-- - - -- - - - - - --- - c.Handwash d.3Compartment e.2 Compartment I L 1Compartment i g.Water Station ; 25.Steam i tables AIA I 26.Dipper wells � �( f� i i 27. { Refrigeration i condensate/ drain lines 28.Hose � �( I connection f� I i I 29.Potato /4/A peeler I -9- { 30.Beverage Dispenser w/carbonator a 131. Other 32.Are floor drains provided&easily cleanable,if so,indicate location: E.WATER SUPPLY 33.Is water supply public or private( ) ? 34.If private,has source been approved?YES ( )NO( )PENDING( ) AI Please attach copy of written approval and/or permit. 35.Is ice made on premises( )or purchased commercially 00 ? If made on premise,are specifications for the ice machine provided?YES ( )NO( ) //IW Describe provision for ice scoop storage: A-4 Provide location of ice maker or bagging operation "tl" 36. at is the c acity of the hot ter enerator? a 1 . 37.Is the hot water generator sufficient for the needs of the establishment?YES j NO( ) 38.Is there a water treatment device?YES( )NO S-r If yes,how will the device be inspected&serviced? �4 39.How are backflow prevention devices inspected&serviced? -,t//�' F.SEWAGE DISPOSAL 40.Is building connected to a municipal sewer?YES�vNO( ) - 10- 41. If no,is private disposal system approved?YES O NO( )PENDING O x1A *Please attach copy of written approval and/or permit. 42.Are grease traps provided?YES( )NO f If so,where? ,v Provide schedule for cleaning&maintenance G.DRESSING ROOMS 43.Are dressing rooms provided?YES( )NO 44.Describe storage facilities for employees'personal belongings(i.e.,purse,coats,boots,umbrellas,etc.) H.GENERAL 45.Are insecticides/rodenticides stored separately from cleaning&sanitizing agents?YES4 NO( ) Indicate location: &)04"Yq' � BY2YdDWt/ 46.Are all toxics for use on the premise or for retail sale(this includes personal medications), stored away from food preparation and storage areas?YES(V NO( ) 47.Are all containers of toxics including sanitizing spray bottles clearly labeled?YESAA NO( ) 48.Will linens be laundered on site?YES( )NO(14 If yes,what will be laundered and where? If no,how will linens be cleaned? 49.Is a laundry dryer available?YES( )NO 50.Location of clean linen storage: Z"t" /,"" /" 51.Location of dirty linen storage: 52.Are containers constructed of safe materials to store bulk food products?YES NO( ) Indicate type: - 11 - I�453.Indicate all areas where exhaust hoods are installed: A LOCATION FILTERS SQUARE FIRE AIR AIR I WOR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM J DEVICES II I , 1 I 1 1 i I I i i t i i 1 54. How is each listed ventilation hood system cleaned? I.SINKS 55.Is a mop sink present?YES eNO( ) If no,please describe facility for cleaning of mops and other equipment: 56. If the menu dictates,is a food preparation sink present?YES NO( ) J.DISHWASHING FACILITIES 57.Will sinks or a dishwasher be used for warewashing? Dishwasher,XTwo compartment sink(k)Three compartment sink( ) 58.Dishwasher: Type of sanitiza on used: Hot water(temp. provided) Ip O Booster heater Chemical type Is ventilation provided?YES( )NO(� It - 12- 59.Do all dish machines have templates with operating instructions?YES,( NO( ) 60.Do all dish machines have temperature/pressure gauges as required that are accurately working?YES* NO( ) 61.Does the largest pot and pan fit into each compartment of the pot sink?YES,f�NO( ) If no,what is the procedure for manual cleaning and sanitizing? 62.Are there drain boards on both ends of the pot sink? YES'11*�NO( ) 63.What type of sanitizer is used?(circle one) Chlorine Quaternary Ammonium Hot Water Iodine 64.Are test papers and/or kits available for checking sanitizer concentration?YES'�NO( ) K.HANDWASHING/TOILET FACILITIES 65.Is there a handwashing sink in each food preparation and warewashing area?YES NO( ) 66.D_o all handwashing sinks,including those in the restrooms,_have a mixing valve or combination_fauce�? YES n'NO( ) 67.Do self-closing metering faucets provide flow of water for at least 15 seconds without the need to reactivate the faucet?YES( )NO( ) A 68. Is hand cleanser available at all handwashing sinks?YES T NO( ) 69.Are hand drying facilities(paper towel dispensers,etc.)available at all handwashing sinks?YES j NO( ) 70.Are covered waste receptacles available in each restroom?YES KNO( ) <-- 71.Is hot and cold running water under pressure available at each handwashing sink?YES(,,'f NO( ) 72.Are all toilet room doors self-closing?YESK NO( ) 73.Are all toilet rooms equipped with adequate ventilation?YES-V NO( ) 74.If required,is a handwashing sign posted in each employee restroom?YES ( ?j NO( ) L.SMALL EQUIPMENT REQUIREMENTS 75.Please specify the number,location,and types of each of the following: /� 1 Slicers © Cutting bo P.� Can openers_�`�1 �,,' �� s/G� ixers AO Floor mats) ';V&4A �_�;y&� Other e,/61,t,4-' ' - 13 - STATEMENT: I hereby certify that the above information is correct,and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. J Signature: (Owner or responsible representative) Print Q Name: � �a ;_h CJ) AffS6Y1 Date: Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code,law or regulation that may be required--federal,state,or local.It further does not constitute endorsement or acceptance of the completed establishment(structure or equipment).A preopening inspection of the establishment with equipment in place&operational will be necessary to determine if it complies with the local and state laws governing food service establishments. - 14- �O-qJ N 8,t C J T-Own O-P Soadt Vi�� we 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 r�dsox•co� TELEPHONE (860) 644-2511 March 27,2014 First Congregational Church United Church of Christ Rachel Anderson Chairman,Board of Trustees 993 Main Street P.O.Box 165 South Windsor,CT 06074 Subject: Plan Review Application First Congregational Church United Church of Christ,993 Main Street, South Windsor,CT Dear Ms.Anderson: On March 26, 2014, thLS department received a plan review application and food service plan for the above referenced food service establishment. The plan was approved with the following conditions: 1. The handwash sink needs a splashguard to separate the handwash sink from the food prep sink. Sinks are to be designated for handwashing and food prep only. 2. Test strips are needed for sanitizer used at 3 bay.sink and in sanitizing buckets. 3. Alcohol wipes (>70%alcohol) are needed for cleaning food thermometer. 4. Covered garbage container needed in women's bathroom. 5. Stove does not have a hood/ansul system; cooking foods that emit grease laden vapors should be avoided. Per the Fire Marshal a Class-K Fire Extinguisher must be available. 6. At the two bay sink a sanitizing bin must be used in lieu of 3rd bay for washing equipment that does not fit in the dishmachine. Please contact this department to schedule a pre-operational inspection. If you have any questions or need any additional information,you may reach me at 860-644-2511,ext.248. Sincerely, Sherry M ann,BsREHs,HHs Environmental Health Officer Page 1 of 1 Good Morning Carroll, 1 have attached some documents to give you an idea of what would be required to become a certified kitchen.The regulations regarding public food service establishments are attached (specifically 19-13-B42). I would be more than happy to meet with you and conduct a walkthrough of the church kitchen to let you know what you would need to meet the requirements of the public health code. If you are interested in meeting,give me a call at 860-644-2511 ext.248.1 look forward to hearing from you! Sherry McGann,as xses wu Environmental Health Officer Town of South Windsor 1540 Sullivan Avenue South Windsor,CT 06074 (860)-644-2511 ext.248 www.southwindsor.org From:Carroll Steams[mailto:fidelco5@aol.com] Sent:Wednesday,March 27,2013 10:13 AM To:McGann,Sherry Subject:kitchen facilities at first church Hello-My name is Carroll Steams. I am contacting you on behalf of First Church located at 993 Main Street in South Windsor. Our congregation has expressed an interest in serving meals open to the public as part of our community outreach program which is something that has not happened in my memory. The reason given for not doing so is"because we can't"although no one knows why that is. My goal is understand what is required,if and how we are currently deficient and and what it would take to meet requirements from a health department prospective.That information combined with that from other regulatory agencies such as the Fire Marshal to create a fesablility plan which we can cost out.Although the church has expressed a willingness to invest in our kitchen in order to make this possible they may ultimately decide to invest our limited resources in other forms of outreach. Towards that end I am asking if you would meet me at the church for a walk through of our facilities. I am looking only for feedback on the acceptability of our space and equipment so that I can begin to frame out the plan. I am not looking for a formal inspection at this time. We would of course meet all health regulations before actually beginning to serve the public. Thank you for your assistance. I can be reached by phone at(860)432-4111 and am available most every week day. South Windsor Food Service Est.Plan Review Application.pdf(123KB) if South Windsor Food Establishment Plan Review Gu!delines.pdf(42KB) 19-13-1340-19-13-1342 Foods,fairgrounds,ice trucks,trailers.pdf(204KB) http://sthearch001:8 000/cgi-mod/openwebmail/openwebmail-read.pl?user=cn%3 Dmcgann... 4/3 0/2013 EH3-106-Rev.01i/01 INSPECTION REPORT STATE OF CONNECTICUT ❑ R E INSPECTION ❑ REINSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH REOPERATIONAL ❑ OTHER 410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134 NAME OF ESTABLISHMENT ESTABLISHMENT ��- Cn a � � � � � ��..�$Ot' CLASS L4 STREET h S TOWN ' a A ADDRESS �"rv\ OWNER or INSPECTION OPERATOR 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 EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL 1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2 nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1 22 Original container,properly labeled 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 4 Adequate facilities to maintain product 2 28 1 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean temperature,thermometers provided 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 q 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 1 Dustless cleaning methods used, 1 SEWAGE DISPOSAL 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 1 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required 12 1 Personnel with infection restricted 14 34 1 No cross connection,back siphonage,backftow 4 DRESSING ROOMS&LOCKERS CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 1 Rooms adequate,clean,adequate lockers 1 13 Hand washing facilities provided, 4 ±37Proper quate,convenient,accessible,designed, 4 provided,facilities clean ersonnel hands washed clean alled 14 Clean outer clothes,effective hair restraints 1 et rooms enclosed with self-closing door 1 15 Good hygienic practices,smoking restricted 2 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 property 1 17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1 constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL I(except guide dogs) (DI 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 b sign s 41 Garbage disposed of in an approved manner, at approved frequency QUALIFIED FOOD OPERATOR DEMERIT SCORE 60 Qualified Food Operator 3 3 d 2 3 1 1 RISK FACTOR VIOLATIONS IN RED 61 Designated alternate 2 d 0 r ` 62 Written documentation of training program 2 4Pb Si ature of Person in ar r TOTAL RATING Date Corrections Due ED(I p ctor) cam" f1 DESCRIBE DEFICIENCIES IQJN CONTINUATION SHEETS w I am Page ; of-7 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION FORM# REMARKS o � On L a5 G �: . 0 con, A c b r5 r• i n yv QJA.01 for fbod'- S\xfxu aciv on INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: Ist-White-Health Department 2nd-Yellow-Own r/M nager