HomeMy WebLinkAboutApplication 770 Sullivan Avenue (2) 1d=IUH.L]V3H �v f• ,rr /w�
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(i) ASSESS THE POTENTIAL FOR FOODBORNE ILLNESS IN A FOOD SERVICE ESTABLISHMENT-
PERFORM OPERATIONAL FOOD SAFETY ASSESSMENT; RECOGNIZE AND DEVELOP STANDARDS,
POLICIES AND PROCEDURES, SELECT AND TRAIN EMPLOYEES; IMPLEMENT SELF AUDIT/
INSPECTION PROGRAM; REVISE POLICY AND PROCEDURE (FEEDBACK LOOP); IMPLEMENT CRISIS
MANAGEMENT PROGRAM.
(ii) ASSESS AND MANAGE THE PROCESS FLOW-IDENTIFY APPROVED SOURCE; IMPLEMENT AND
MAINTAIN A RECEIVING PROGRAM; IMPLEMENT AND MAINTAIN STORAGE PROCEDURES;
IMPLEMENT AND MAINTAIN PREPARATION PROCEDURES; IMPLEMENT AND MAINTAIN
HOLDING/SERVICE/DISPLAY PROCEDURES; IMPLEMENT AND MAINTAIN COOLING AND POST
PREPARATION STORAGE PROCEDURES; IMPLEMENT AND MAINTAIN RE-SERVICE PROCEDURES;
IMPLEMENT AND MAINTAIN TRANSPORTATION PROCEDURES.
QUALIFIED FOOD OPERATOR
DEMONSTRATED KNOWLEDGE STATEMENT
I ��V"1 ►� u2� attest that
(Print name of Owner or Operator) (Print name of Qualified Food
Operator)
is employed in a full-time supervisory position and has demonstrated to me the elements of
knowledge and demonstrable elements of competency as described in A and B, as listed above.
Signature and Title Date'� 3 ( 1
(S ed by Owner/ p rator of the Establishment)
Signature and Dateg 3
(Signed by Qualified Food Operator)
Nam f Establish t
i
Address of Establishment
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RECEIVED
** Please attach corresponding certificate of completion for approved training course."" 0 3 2017
SOUTH WINDSOR
HEALTH DEPT.
Mobile Food Vendor Application Sect. 4.1.1
Address of Proposed Food Cart/Truck 70 1 V d h G ver w— i ijs o rd
Size (Max. 8'x 221 one
1. Name of Applicant Z �- Z
Address
rI lone I��.mbCr J477
2. Starting Date
Ending Date /I
I A plot plan must be submitted with the application showing the proposed location of the
food cart/truck along with any signage related to it. Food cart/truck must be a minimum
of 20 feet from a street line.
4. A safe pull off and parking area must be provided. The food cart/truck and parking
shall be located to not pose a safety hazard or obscure sight lines.
5. Temporary signage related to the food cart/truck is to be kept to a minimum. Sign(s)
are to be located on the property where the food cart/truck is located and must be behind
the property line of 10 feet from the road, whichever is farther. Max. of 12 sq ft of
signage allowed.
6. The food cart/truck, trash container (required), and all the temporary signage for the
food cartitruck are to be removed at the end of each workday or by 9:00pm (whichever is
earlier).
7. This application must be renewed on an annual basis.
I, the undersigned, acknowledge that the above information is true to the best of my
knowledge and that I agree ide by the above requirements. RECEIVED
Applicant Signatur JUN 032017
a Owner's Name SOUTH Wf .')*oR
Property rty / HEALTH EPT'
Property Owner's Signature vv
.................................................................................
Reviewed and approved by: j � �c� L� ��- Date G
11
zoning Enforcement Officer