HomeMy WebLinkAboutApplication 150 Nevers Road (6) 0
n � 8, TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT
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�O 1540 Sullivan Ave., South Windsor, CT 06074
Phone Number: (860) 644-2511 x250, Fax Number: (860) 644-7280
TEMPORARY/SPECIAL EVENT FOOD SERVICE LICENSE APPLICATION
***Must be submitted 2 weeks prior to event,No fees charged***
M ATIO N
Event Name: /(V1 cc / �S G-7t
Event Date(s):
Event '
EventLocation: 1��L
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PERSON IN CHARGE INFORMATION o ►'�-rr�-
Last Name: -N � First: Ckcic (, M.I.: f� Date: (v j
Street Address:�� h 2. � ( Apartment/Unit#: O iZ 4 �O 2
city: Looj( y�o Lx r I / ��- State: 7Jp: I _(a 7 6-/
Phone:PhoneA Cell _ / J s 3 Address lA I(Y)SiC �� 1 V e YJ x l S Vn✓� t
ORGANIZATION REPRESENTED (IF ANY) Q! w�Yrt
Representing:
Street Address: Apartment/Unit#:
City: /V State: Zap:
Phone: E-mail Address:
QUALIFIED FOOD OPERATOR (INCLUDE COPY OF CERTIFICATE) F] YES 1-1 NO ❑
Name:
Certificate#: Date:
ADDITIONAL INFORMATION /
Water Supply: YES 4✓Y NO ❑ Wastewater Disposal YES ✓ NO
Electrical: YES ❑ NO'T_ If other,please
MENU "(PLEASE LIST ALL MENU I IN AS MUCH DET�AS POSSIBLE)**
Se_& (c t 1 Cs A nIfLA hC) S I j-r_y, r 7 ar-
� e c h�Lfc�.1-tr.( 'cAv�✓� vc n� - m s^�' � out :nc�.� �s�(Z;.,-
****PLEASE DRAW A DETAIL DIAGRAM OF FOOD BOOTH ON THE BACK OF THIS FORM.
USING THE GRAPH PICTURE ON THE BACK OF THIS APPLICATION****
The food preparation and storage areas must be covered if event is outdoors. Be sure that the
te'AGnts used for overhead cover are fire-rated. Der the South Windsor Fire Marshal's office.
EMENT AND SIGNATURE
By submitting this application,I affirm that the facts set forth In it are true and complete.I understand that any false statements or other
misrepresentations made on this application may result in immediate shutdown or revocation of my temporary Food Service License for the Town
of South Windsor. Temporary Food Service License will be/issued after the Food Inspector has completed his/her inspection.
Applicant
(Please Print): 0A r
RECEIVED
Applicant Signature: /3 / J OCT 13 2016 Date: 10
SOUTH WINDSOR
HEALTH DEPT.
r•
OFFICE USE ONLY
Inspector Name:
(Please Print):
Inspector Date:
Signature:
Food Class: 1❑ 2❑ 3❑ 4❑ FEE: N/A
Temporary Food License*: Boration Date:
Notes: Date Received:
/^{owK NdKe- Town of South Windsor Health Department
l�N 6f�
`u Temporary Food Event Questionnaire Form
Please complete all questions and return to the Health Department with your application.
"lOR l �
1. What is the source of the food to be served/dispensed? (Please include name/address of source)
Foods must be from an approved source. Meat and dairy products must come from a government-inspected
source. If it is necessary to bring in foods that are prepared at a licensed facility other than the temporary site,you
must indicate how the food is protected during transport and how it is kept hot or cold as needed.
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2. How will the food items be kept cold/frozen?
Ice must be from an approved potable source. Frozen foods cannot be thawed at room temperature. Proper
thawing can
be done in a refrigerator, under cool running water,or as [. i t of the cooking process.
3. How will the food items be cooked and/or hot held?
A sanitized metal stemmed,calibrated probe thermometer to monitor food temperature is required. If thin patties
are being cooked,a thermocouple may be needed to accurately check temperatures.
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4. Please describe the type of hand washing facility to be used.
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S. How will the food be protected?
Food must be protected during storage, preparation, display,service and transportation. Cooking to order will
lessen the chance for bacterial growth,which may occur prior to service.
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6. How will the all utensils and food contact surfaces be washed,rinsed and sanitized?
7. Where will excess food(Potentially hazardous and non-potentially hazardous foods),dry goods,and single service
items be stored?
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S. Where will ware wash detergents and sanitizers be stored?
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9. How will co iments and single service items(cups,plates,utensils,etc.)be dispensed?
10. What method of garbage disposal will be used?
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Additional Information
❑ Contact the local Fire Marshal (860-282-0669)to ensure compliance with the Fire Code.
�Gle ic�ocl prep-ir.ition and storage areas must be covered if event is outdoors. Be sure that the
V tent" 111AId for ovorhead cover are fire-rated, per the South Windsor Fire Marshal's office.
�st.ewater must be disposed of in a sanitary sewer or other approved sewage disposal system.
l Equipment and tables must be clean, smooth, washable, durable, non-absorbent and in good
repair.
br Dust must be controlled (i.e.dry fields) by watering down.
❑ All workers at the food booth must sign a log sheet indicating the date,their name, address and
telephffl number nd the hours that they worked. Please retain the log sheet after the event.
t/�IT 0r i ti �
Vlf gloves are used, they must be a food grade quality glove and must be used for only one task
(such as working with ready-to-eat foods or with raw animal food). You must wash your hands
after removing the gloves and prior to putting on a new pair of gloves. Gloves must be discarded
when damaged or soiled, or when ' �erruptions to use occ�r. Li 'a h✓�v� ��
k �-r a v - zw�,L
ood employees may not wear nail polish or artificial nails unless wearing intact gloves in good
repair.
Page 1 of 2
Oatis, Heather
From: Oatis, Heather
Sent: Friday, October 14, 2016 9:54 AM
To: Oatis, Heather; 'whimsicalolivebranchoils@gmail.com'
Cc: Andy Paterna; Collelo, Diane
Subject: RE: SW Farmer's Market
Attachments: 2011-02 Farmers Mkts Poultry Statutes.pdf
apologize, please see the attached circular letter referenced in my previous email
Heather Oatis,REHS,HHS
Environmental Health Officer
Ph: 860-644-2511 ext.250
Fax: 860-644-7280
www.southwin(Isor.org
From: Oatis, Heather
Sent: Friday, October 14, 2016 9:52 AM
To: 'whimsicalolivebranchoils@gmail.com'
Cc: Andy Paterna; Collelo, Diane
Subject: SW Farmer's Market
Good Morning Cheryl,
I still need the same information that you did not provide for me at past markets. Where are you producing your
canned items? You again listed "a commercial kitchen/restaurant". Please give me the exact location you are
working out of and provide documentation that you are a farmer. Acidified food products have very specific
guidelines that must be adhered to. Only farmers have the exemption to produce these foods.
"Public Act 10-103 -An Act Concerning Farms, Food and Jobs
This Act: (1) allows the preparation and sale of acidified foods on residential farms. Previously, the law allowed
the sale of jams,jellies, or preserves on a residential farm that were prepared (a)with fruit grown on the farm and
(b) in a room on the farm that is used as living quarters. It exempts their preparation from any state or local
agency inspection. The law requires each jam,jelly, or preserves container offered for sale on the farm to have on
its label, in ten-point type: "Not prepared in a government inspected kitchen."The Act adds"acidified foods"to
this exemption and labeling requirement. It establishes specific preparation criteria acidified food must meet for
the exemption. The Act restricts those who can be in the kitchen where acidified food is prepared and recognizes
successful completion by a food preparer of a DCP-approved safe food processing course. The Act defines
"acidified food product"as a food item with a pH value of 4.6 or less upon completion of the recipe making the
product, including pickles, salsa, and hot sauce, produced on the premises of a residential farm. The food product
must not include food consisting in whole or in part of milk or milk products, eggs, meat, poultry, fish, shellfish,
edible crustacean ingredients or other ingredients, including synthetic ingredients, in a form capable of supporting
rapid and progressive growth of infectious or toxigenic microorganisms. The Act redefines jam,jelly, and
preserves to include products made with vegetables;..."
The CT Department of Public Health Circular Letter#2011-02 (attached) states:
"SUMMARY
Acidified foods, jams,jellies, and preserves made from vegetables, and poultry from small farmers processed in a
facility under inspection from the DoAg, are now exempt from regulation by state or local officials. Acidified foods
and jams,jellies, and preserves made with vegetables (in addition to the previously exempt jams,jellies, and
preserves made from sugar, and, maple syrup) may only be sold on the farm or at a certified farmers" market.
Exempt poultry may only be sold to household consumers and in restaurants, hotels, or boarding houses. EHS
Circular Letter#2011-02
There is a risk of foodborne disease associated with improperly canned foods. Home canning is recognized as
the leading cause of botulism cases in the United States. Although acidification is recognized as an effective
10/14/2016
Page 2 of 2
process to render a food non-potentially hazardous, it is more complex than is generally understood. There are
many factors that determine what makes a food non-potentially hazardous, and the variables associated with the
effectiveness of recognized methods (including acidification)to alter the status of a food are numerous. The
training that is required for processors of acidified foods and proposed in the compliance guide for small exempt
poultry producers is intended by the legislature to provide awareness of the associated risks of foodborne disease
and the safe practices for reducing the risk of illness."
I cannot provide any exceptions to these state statues. Please provide the proper documentation so that you can
participate in the South Windsor Farmer's Market.
Heather Oatis,REHS,HHS
Environmental Health Officer
Town of South Windsor
1540 Sullivan Avenue
South Windsor,CT 06074
Ph: 860-644-2511 ext.250
Fax: 860-644-7280
www.soulliwiiidsor.org
10/14/2016
' STATE OF CONNI,CTICUT
DEPARTMENT OF PUBLIC HEALTH
`•...,.,�' ENVIRONMENTAL HEALTH SECTION
EHS Circular Letter#2011-02
To Local Directors of Health
Chief Sanitarians
Certified Food Inspectors
From: Tracey Weeks, MS, RS; Food Protection Program
Date: July 8, 2011
Subject: Statute Changes Concerning Farmers' Markets:
1. Acidified Foods and Small Poultry Producers - Public Act 10-103 An Act
Concerning Farms, Food, and Jobs
2. Licensing of Farmers' Markets —Public Act 11-191 An Act Concerning
Farmers'Markets
During the last two legislative sessions a number of changes have been made to the statutes
related to Farmer's Markets. Public Act 10-103, An Act Concerning Farms, Food, and Jobs,
includes revisions to Connecticut General Statutes (CGS) § 22-6r and §21 a-24a that are related
to the definition of a farmers' market and exempt foods that can be sold at a farmers' market,
respectively. Also included is a new section, §22-326(t), concerning small poultry producers.
Public Act 11-191, An Act Concerning Farmers'Markets, includes revisions to CGS § 22-6r
related to farmers' markets and licensing. Following is an overview and interpretation of the
changes.
OVERVIEW OF CHANGES
PA-10-103
• Allows a farmers' market to operate for a single day or longer
• Adds acidified foods produced on a residential farm to the list of foods exempt from any
state or local inspection
• Modifies the definitions of jams,jellies, and preserves to include vegetables as an ingredient
• Designates poultry from small producers as originating from an approved source, and allows
the sale of such poultry to restaurants and hotels (and boarding houses)
PA-11-191
• Allows farmers at certified farmers' markets to operate food service operations at multiple
health jurisdictions with one 'portable' license
• Requires that farmers notify health jurisdictions at least 14 days in advance of operating in a
health jurisdiction other than the one where the license was obtained
3
4. During food product preparation and processing, the kitchen where the exempt food
product is prepared "is restricted from non-processing individuals, pets, children or any
other potential contaminants during such preparation".
5. The person preparing (processing) the food products has successfully completed either:
• an examination on safe food handling techniques administered by an
organization approved by DPH for qualified food operators (QFO) or
• an approved course on safe food processing techniques administered by an
organization approved by the Department of Consumer Protection (DCP)
6. Documentation of successful completion of the QFO exam or the food processor course
must be made available to the local health department or DCP upon request.
7. Each container of exempt food products—jams,jellies, preserves, acidified foods—must
have a label with the statement in 10 point type: "Not prepared in a government
inspected kitchen."
Local Health Department Role
Local health departments may encounter exempt food products during inspections of certified
farmers' markets. These specific food products -jams,jellies, preserves, acidified food
products, and maple syrup are the only products exempt from regulation, and they can only be
prepared in a residential kitchen that is located on the farm where the ingredients were grown
Additionally, products can only be sold directly to the consumer on the farm where they were
grown and produced, or at a kiosk at a certified farmers' market. CGS§22-6r(b) defines a
farmer's kiosk at a certified farmers' market as an extension of the farm.
Jams,jellies, preserves, acidified food products, and maple syrup are only exempt from
regulation when sold by farmers on the farm or at the certified farmers' market kiosk. These
food items cannot be sold at other locations such as food service establishments or retail stores
unless they comply with the state laws and regulations that pertain to commercial food product
preparation and processing. If these unregulated food products are found at regulated
establishments, the products would be considered as originating from an unapproved source
and should be disposed of properly (destroyed or embargoed).
Non-exempt food products sold by farmers at farmers' markets and any food sold by vendors
other than farmers are subject to all applicable laws and regulations.
To determine whether a farmers' market is certified, check the DoAg website to see if the
market is listed. http://www.ct.qov/doag/cwp/view.asp?a=3260&q=398996
or call 860-713-2503.
Exempt products must have the statement "Not produced in a government inspected kitchen" on
the label. It may be difficult for an inspector to distinguish from an exempt food product that is
not properly labeled from a food product that was produced in a regulated facility (and therefore,
does not require the label statement). If a container of jam,jelly, preserves, or an acidified food
product does not have the statement on the label, and there are concerns that it was not
produced in a regulated facility, the inspector should contact DCP (the agency that regulates
food processors) at 860-713-6160 for assistance. Note: DCP indicates that their agency has
other labeling requirements that include:
• Common name
• Net quantity in English or metric weight
• Declaration of the 8 major food allergens
• Declaration of responsibility
EFFECTIVE DATE: January 1, 2011
EHS Circular Letter#2011-02 5
• The FPP is aware that some health care facility kitchens may be interested in serving
exempt poultry as part of the 'Plow to Plate' program" once the DoAg implements its Poultry
Slaughter Facility Inspection Program. The new statutory language allows the sale of
exempt poultry to 'restaurants'. CGS §30-22(f) defines "restaurant". ""Restaurant"means
space, in a suitable and permanent building, kept, used, maintained, advertised and
held out to the public to be a place where hot meals are regularly served, but which
has no sleeping accommodations for the public and which shall be provided with an
adequate and sanitary kitchen and dining room and employs at all times an adequate
number of employees." As health care facilities do not meet the definition of a restaurant,
they would be prohibited from serving exempt poultry.
USDA requirements include that poultry produced under this exemption provision be labeled
with the statement"Exempt Poultry P.L. 90-492."The label must also include other pertinent
information such as name and address of producer/processor, establishment number, date, and
batch code. The FPP will provide local health departments with a list of approved exempt
poultry processing facilities that used together with the label information, should assist certified
food inspectors in determining if poultry in food establishments is from an approved source.
Poultry labeled as 'exempt' that is found in food establishments other than restaurants, hotels,
and boarding houses, should be considered as originating from an unapproved source and
disposed of in an appropriate manner. Additionally, poultry labeled 'Exempt' from other states is
not to be considered as an approved source. If it is unclear if the poultry is from an approved
source, the product should be embargoed until the restaurant or hotel can provide
documentation that the poultry is from a commercial processing plant under USDA inspection or
exempt as described above.
Questions concerning exempt poultry should be directed to the DoAg Bureau of Regulation and
Inspection at 860-713-2508.
EFFECTIVE DATE: June 2, 2010
2. PA-11-191 An Act Concerning Farmers' Markets
Section 1 of this act adds new statutory language that allows a farmer to obtain a food service
license or permit to operate in a certified farmers' market in one health jurisdiction and then use
that same license or permit to operate in other certified farmers' markets located in other health
jurisdictions with certain provisions.
This new language specifies that:
• The menu and operation have been approved in the licensing health jurisdiction.
• The menu and operation at each subsequent certified farmers' market where the farmer
operates is substantially the same as what was approved in the licensing health jurisdiction.
• The farmer notifies the subsequent health jurisdictions within 14 days before operating in a
certified farmers' market located in a health jurisdiction other than the one that issued the
license/permit.
• Each notice sent by the farmer must include a copy of the license/permit and the approved
food service menu and plan of operation for which the license/permit was issued.
• The license/permit is only valid for the calendar year in which it was issued.
• Any local director of health may take regulatory action against any farmer for non-
compliance with the Public Health Code.
• A farmer who has a license/permit and whose menu items and operation were approved in
another health jurisdiction cannot be required to obtain a license/permit in any other local
health jurisdiction or required to show ability to comply with a local ordinance.
EHS Circular Letter#2011-02 7
There is a risk of foodborne disease associated with improperly canned foods. Home canning is
recognized as the leading cause of botulism cases in the United States. Although acidification
is recognized as an effective process to render a food non-potentially hazardous, it is more
complex than is generally understood. There are many factors that determine what makes a
food non-potentially hazardous, and the variables associated with the effectiveness of
recognized methods (including acidification) to alter the status of a food are numerous. The
training that is required for processors of acidified foods and proposed in the compliance guide
for small exempt poultry producers is intended by the legislature to provide awareness of the
associated risks of foodborne disease and the safe practices for reducing the risk of illness.
The new licensing provisions for farmers operating at certified farmers' markets as a result of
the passage of PA 11-191 may impact local health departments financially, but the authority of
local directors of health has not been diminished.
The FPP advises local health departments to become familiar with these new provisions and
enforce them accordingly. Additional guidance and updates on the interpretation of PA 10-103
and PA 11-191 will be provided to local departments as needed. Should you have general
questions regarding the information contained herein, please contact Tracey Weeks or Christine
Applewhite of the FPP at (860) 509-7297.
*"Plow to Plate is a comprehensive initiative that combines hospital leadership and community-
based programs to promote the local foods and agriculture as a critical means to well-being and
disease prevention." from www.plowtoplate.orq
c: Suzanne Blancaflor, MS, MPH, Chief, Environmental Health Section, DPH
Ellen Blaschinski, R.S., M B.A., Chief, Regulatory Services Branch
Frank Greene, Director, Food&Standards Division, DCP
Bruce Sherman, Director, Bureau of Regulation&Inspection, DoAg
Wayne Kasacek,Asst. Director, Bureau of Regulation&Inspection, DoAg