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HomeMy WebLinkAboutFSE Application 569 Griffin Road Town of South Windsor - Health Department O.NN SC4 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 'IU,Sgk•Coc Restaurant Establishment Information New Permit❑ Permit Renewal X❑ ***(Please Print Clearly)*** Name of Establishment: South Windsor Public Schools— Eli Terry Manager's Name: Laurie Cloutier Street Address: 569 Griffin Rd City, State, Zip Code: South Windsor, CT 06074 Phone#: 860-648-5721 Cell Phone#: Fax#: E-Mail Address: Eliterry.fs@yahoo.com Seating Capacity: 168 Please submit latest copy of the Qualified Food Operator/ServSafe certificates to the office. YES X❑ NO ❑ (Required Certificate#: Qualified Food Operator: for 8845234 Class 3&4) Name: Salvatore Rizzo Date: 02/23/2012 Testing Organization: Servsafe Phone#: 860-648-5721 E-Mail Address: Alternate Phone#: Designated Alternate 1: Laurie Cloutier Designated Alternate2 : Greg King Restaurant Owner Contact Information Owner's Name: Greg King —Chartwell's Dining Street Address: 161 Nevers Road City, State, Zip Code: South Windsor, CT 06074 Phone#: 860-474-1440 Fax #: E-Mail Address: Gregory.king@compass-usa.com Cell Phone#: Renovations Were there any renovations made last year? YES X❑ NO ❑ Will there be any renovations? YES❑ NO ❑ If Yes, please list all renovations New Cold Well For Fresh Fruit&Vegetable that were done/to be done: RECEIVED JAN 03 2017 SOUTH WINDSOR Mailing Address to send Food License Renewal Permit to: HEALTH DEPT. Name of Restaurant/Company: Charlwell's Dining Attention: Greg King Address: 161 Nevers Rd Town of South Windsor - Health Department 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address t0'$M S`+< 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 L I/J.",R-01� City, State, Zip Code: South Windsor, CT 06074 Phone#: 860-474-1440 Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES X❑ NO ❑ NOTE"'(Must have latest copy on file) Please list all menu items in as much detail as possible or a copy of a menu attached is applicable. Additional Information Please check one only: State Licenses: ❑ Bakery ❑ Liquor Permit I_ I None Water Supply: XPublic Private Well Wastewater Disposal: XPublic On-Site _Other (please use space below to explain) Agreement 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 plication may result in immediate shutdown or revocation of my Food Service License for the Town of South Windsor. Applicant Name (Print): V// Gregory King Applicant Signature: Date: 2•W-IL Office Use Only Inspector Name (Print): Az Inspector Signature;-- Date: Food Class: 1 ❑ 3 21 4 ❑ Expiratio Date: Town of South Windsor - Health Department 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 Date Received: Date Approved: 12/13/2016 Print Menus December 2016 Eli Terry School Breakfast MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Main Entrees Main Entrees • Whole Grain French Toast Honey Granola Sticks Cinnamon Toast Crunch • Cinnamon Toast Crunch Cheerios • Cheerios Frosted Corn Flakes • Frosted Corn Flakes Yogurt,Vanilla,Danimals, • Strawberry Banana Yogurt Crush Cup,4 oz Fruit&Vegetable Bar Strawberry Yogurt • Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Bagel Blueberry Banana Smoothie Egg&Cheese Sandwich Whole Grain Blueberry Muffin Scooby Doo Graham Crackers • Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch • Cheerios Cheerios Cheerios Cheerios Cheerios • Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes • Cream Cheese,Light,1 oz Honey Granola Vanilla Yogurt Strawberry Banana Yogurt Strawberry Banana Yogurt • Strawberry Yogurt Strawberry Banana Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Strawberry Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Chilled Fruit Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Chilled Fruit - Fresh Whole Fruit Fresh Whole Fruit Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Assorted Fruit Juice Fresh Whole Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Apple Cinnamon Nutrigrain Berry Patch Smoothie Egg&Cheese Sandwich Whole Grain French Toast Honey Granola Bar Cinnamon Toast Crunch Cinnamon Toast Crunch Sticks Cinnamon Toast Crunch • Cinnamon Toast Crunch Cheerios Cheerios Cinnamon Toast Crunch Cheerios • Cheerios Frosted Corn Flakes Frosted Corn Flakes Cheerios Frosted Corn Flakes • Frosted Corn Flakes Honey Granola Vanilla Yogurt Frosted Corn Flakes Yogurt,Vanilla,Danimals, • Low Fat Mozzarella String Strawberry Banana Yogurt Fruit&Vegetable Bar Strawberry Banana Yogurt Crush Cup,4 oz Cheese Fruit&Vegetable Bar Assorted Chilled Fruit Fruit&Vegetable Bar Strawberry Yogurt • Strawberry Yogurt Fresh Whole Fruit Fresh Whole Fruit Fresh Whole Fruit Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Fruit Juice Assorted Fruit Juice Assorted Chilled Fruit • Assorted Chilled Fruit Fresh Whole Fruit • Fresh Whole Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Bagel Blueberry Banana Smoothie Egg&Cheese Sandwich Whole Grain Blueberry Muffin Scooby Doo Graham Crackers • Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch • Cheerios Cheerios Cheerios Cheerios Cheerios • Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes • Cream Cheese,Light,1 oz Honey Granola Vanilla Yogurt Strawberry Banana Yogurt Strawberry Banana Yogurt • Strawberry Yogurt Strawberry Banana Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Strawberry Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Chilled Fruit Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Chilled Fruit Fresh Whole Fruit Fresh Whole Fruit Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Assorted Fruit Juice Fresh Whole Fruit i No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation Milk&Condiments:1%Low-fat Milk,Chocolate Fat Free Milk Menus Subject to Change We try our best to serve our menus as posted;however,sometimes last minute changes occur.Please check with the cafe manager prior to the meal if you have any concerns. More Details:http://southwindsor.nutrislice.com/menu/eli-terry-school/breakfastl This Institution is an equal opportunity provider. Layout,design&code©Nutrislice,Inc.Private and non-commercial uses permitted. https://southwindsor.nutrislice.com/menLdeli-terry-school/breakfasttprint-menu/ 1/1 12/13/2016 Print Menus December 2016 Eli Terry School Lunch MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Main Entrees Main Entrees • Chicken Taco Meat Classic Cheese Pizza • Baked Tortilla Scoops Colorful Tossed Salad • Baked Tortilla Scoops Nachos Fun Lunch • Seasoned Black Beans Corn&Black Bean Salad with • Nachos Fun Lunch Salsa • Corn&Black Bean Salad with Classic American Salsa Cheeseburger • Deli Turkey Fruit&Vegetable Bar • American Cheese Fresh Baby Carrots • Soft Flour Tortilla Power Peas • Salsa Fresh Pear Fruit&Vegetable Bar Assorted Chilled Fruit Garbanzo Beans Sliced Cucumbers Fresh Pear Assorted Chilled Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Chicken Nuggets Whole Grain French Toast Cheese Stuffed Breadsticks California Chicken Cheese Classic Pepperoni Pizza • Fresh Baked Whole Grain Sticks Marinara Sauce Wrap Colorful Tossed Salad Biscuit Scrambled Eggs Seasoned Broccoli Broccoli Florets Crispy Chicken Caesar Salad • Seasoned Corn Tater Tots PBU Fun Lunch PBU Fun Lunch Whole Grain Breadstick • PBU Fun Lunch Warm Baked Apple Slices Classic American Honey Ham PBU Fun Lunch • Classic American PBU Fun Lunch Cheeseburger American Cheese Classic American Cheeseburger Honey Ham Fruit&Vegetable Bar Soft Flour Tortilla Cheeseburger Fruit&Vegetable Bar American Cheese Fresh Broccoli Florets Fruit&Vegetable Bar Fruit&Vegetable Bar • Fresh Baby Carrots Soft Flour Tortilla Fresh Baby Carrots Garbanzo Beans Fresh Baby Carrots • Sweet Corn Salad w/Ranch Fruit&Vegetable Bar Fresh Whole Fruit Sliced Cucumbers Power Peas Dressing Fresh Celery Sticks Fresh Orange Wedges Fresh Whole Fruit Fresh Whole Fruit • Fresh Whole Fruit Garbanzo Beans Fresh Orange Wedges Fresh Orange Wedges • Fresh Orange Wedges Fresh Whole Fruit • Fresh Orange Wedges 0 W Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Meatballs in Zesty Marinara - Teriyaki Chicken Cheese Stuffed Breadsticks Chicken Bacon Cheddar Melt Classic Cheese Pizza • Whole Grain Rotini Asian Brown Rice Marinara Sauce Orange Glazed Carrots Colorful Tossed Salad • Marinara Sauce Seasoned Broccoli Seasoned Corn Bagel with Yogurt and String Chicken and Cheese Chef • Savory Green Beans Bagel with Yogurt and String Bagel with Yogurt and String Cheese Salad • Bagel with Yogurt and String Cheese Cheese Deli Turkey Whole Grain Breadstick Cheese Deli Turkey Crispy Chicken Patty American Cheese Bagel with Yogurt and String • Crispy Chicken Patty American Cheese Sandwich Soft Flour Tortilla Cheese Sandwich Soft Flour Tortilla Fruit&Vegetable Bar Fruit&Vegetable Bar Crispy Chicken Patty Fruit&Vegetable Bar Fruit&Vegetable Bar Fresh Broccoli Florets Corn&Black Bean Salad with Sandwich • Fresh Baby Carrots Fresh Celery Sticks Fresh Baby Carrots Salsa Fruit&Vegetable Bar • Sweet Corn Salad w/Ranch Garbanzo Beans Fresh Whole Fruit Sliced Cucumbers Fresh Baby Carrots Dressing Fresh Whole Fruit Fresh Cinnamon Orange Fresh Whole Fruit Power Peas • Fresh Whole Fruit Fresh Cinnamon Orange Smiles Fresh Cinnamon Orange Fresh Whole Fruit • Fresh Cinnamon Orange Smiles Smiles Fresh Cinnamon Orange Smiles Smiles LU r Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Chicken Nuggets Whole Grain Pancakes Cheese Stuffed Breadsticks General Tso's Chicken Classic Pepperoni Pizza • Roasted Carrot"Fries" Turkey Sausage Patties Marinara Sauce Broccoli&Cauliflower Florets Colorful Tossed Salad • Whole Grain Pretzel Warm Baked Fresh Apple Colorful Tossed Salad Asian Brown Rice Chicken Caesar Salad • PBU Fun Lunch Slices PBU Fun Lunch PBU Fun Lunch Whole Grain Breadstick • Classic American PBU Fun Lunch Classic American Honey Ham PBU Fun Lunch Cheeseburger Honey Ham Cheeseburger American Cheese Classic American Fruit&Vegetable Bar American Cheese Fruit&Vegetable Bar Soft Flour Tortilla Cheeseburger • Fresh Baby Carrots Soft Flour Tortilla Fresh Broccoli Florets Fruit&Vegetable Bar Fruit&Vegetable Bar • Sweet Corn Salad w/Ranch Breakfast Syrup Fresh Baby Carrots Citrus Kidney and Garbanzo Fresh Baby Carrots Dressing Fruit&Vegetable Bar Fresh Whole Fruit Bean Salad Power Peas • Fresh Whole Fruit Fresh Celery Sticks Cranberry Pear Fruit Salad Sliced Cucumbers Fresh Whole Fruit • Cranberry Pear Fruit Salad Citrus Kidney and Garbanzo Fresh Whole Fruit Cranberry Pear Fruit Salad Bean Salad Cranberry Pear Fruit Salad • Fresh Whole Fruit • Cranberry Pear Fruit Salad https://southwindsor.nutrislice.com/menLdeli-terry-schoolAuncWprint-menu/ 1/2 12/13/2016 Print Menus La U EJ LA No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation Milk&Condiments:Chocolate Fat Free Milk,1%Low-fat Milk,Skim Milk,Strawberry Skim Milk,Ketchup,Yellow Mustard,Mayo,Fat Free Ranch Dressing Menus Subject to Change We try our best to serve our menus as posted;however,sometimes last minute changes occur.Please check with the cafe manager prior to the meal if you have any concerns. More Details:http://southwindsor.nutrislice.com/menu/eli-terry-schoolAunch/ This Institution is an equal opportunity provider. Layout,design&code©Nutrislice,Inc.Private and non-commercial uses permitted https://southwindsor.nutrislice.com/menLdeli-terry-schoolAunctdprint-menu/ 2/2