HomeMy WebLinkAboutApplication 1739 Ellington Road �40w" Town of South Windsor — Health ue anlnic11L
1540 Sullivan Ave., South Windsor, CT 06074 —Mailing Address
5 i 530 Sullivan Avenue, y 860 33indsor, CT 06074 —7 6i73 Fax• (60) 644-1'930 ce Address
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Phone Number. ( )
bson•C��r
New.Permit Permit Renewal
Restaurant Establishment Information
❑
***(Please Print Clearly)***
Name of Establishment: �T>�(' t
rianayer'Z 1Aa1' W-
Street Address: .
City, State, Zip Code: -���'1n
Phone#: q-`6= -�UZ(� Cell Phone#:
Fax#:
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-Mail Address:S%.!sp—e, , ,<<,st-���.v ,,�:i� cu�c.( c-,
please submit latest copy of the Qualified Fodd operator/ServSa�ceficeteR to the office.
YES No El (Required for Certificate#: Z I I �Z°4
Qualified Food Operator: class 3&4)
Name: -Don�c►� Scan cljR 6o ��ti` z,t'� Date: 1�L?/I�
a�ai?;�I�J P, (r t,,IaS Phone#: :rC-0 LAYS Z{CSZ(v
Testing organization: Noltlom-A �'«jt'i r J of 'k cl,rr i� <<:'
E-Mail Address: s s i sib`-e ctL�Fi sfr�,r r�� '� Alternate Phone#:
Designated Alternate is ;i'-Ne `S��'-�',CL'i Designated Alternate2 :
Restaurant owner Contact Information
Owner's Name: The Stop&Shop Supermarket Company LLC
Street Address: Attn:Ashlye Brennan
City, State, Zip Code: 1385 Hancock StreetQuincy, MA 02169
Fax#;
Phone#: Phone:617-770-8708
E-Mall Address: Email:Ashlye.brennan@retaiIbusinessservices.com Cell Phone#:
Renovations
Were there any renovations made last year? YES❑ No WIII there be any renovations? YE5❑ NO
IF Yes, please list all renovations
that were done/to be done:
RECEIVED
DEC 13 2017
Mailing Address to send Food License Renewal Permit to: SOUTH WINDSOR
HEALTH DEPT.
Name of Restaurant/Company: The Stop&Shop Supermarket Company LLC
Attention: Attn:Ashlye Brennan
1385 Hancock Street
Address: Quincy, MA 02169
Phone:617-770-8708
City, State, Zip Code'
Email:Ashlye brennan@retailbusinessservices.com
Phone#: -
000-m Is3
vil,UOn J
NATIONAL REGISTRY OF
FOOD SAFES I`Y PROFESSIONALS®
CERTIFIES
D014NA M SCH U LTZMBOYI NGTO N
HAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR THE
CERTIFIED
R ROOD SAFETY MANAGER
UNDER THE
CONFERENCE FOR-FOOD PROTECTION STANDARDS
PRESIDENT:
LAWRENCE J.LYNcm,CAE
ISSUE DATE:JANUARY 27, 2016
a0656 ExPIRATION DATE:JANUARY 27, 2021
CERTIFICATE N0: 21 186204
Iniverset Blvd„Suite 550,Orlando,rL 32819 `PEST FORM: EZS130
146-0257 F(407)352-3603 www.NRFSP.com This certificate is not valid for more
I Registry of Food Safety Professionals@ than nve years from date orissne,
os�tu urr NoliU,r.II Itc;ci;l,y of Forut Sali:ty Prnt::4innnls r
:1i � C FAI"IFIED FOOL)SM:El'Y VIA1'ACila(
tification of Test Result
t: xxx_xx_ � DONNA M SCHULTZ-
led Test Score: 98 DOYYNGT'ON
)didate Status: Pass
t Date: January 27, 2016 7660 Univnrsal Olvd
„ulle 550
Orlando,Ft.JZUiU
Ton Fire("I)440-0).67
Pnnnr_(407)352.3810 Certificate No:21186204
re.(407)352-3603 Issue Date:January 27,ZQ16
w7w.NRF5r-.com Expiration Date:January 27,2021
,ratulationsl Attached is your certificate and wallet card.Plcase notify DONNA M SCHULTL-BOYINGI'ON
lational PLegistry of name or address changes at the address below, 101 WESTERLY ST
MANCHESTER, CT 06042
enling Contamination and Cross Contamination(Competent)
uing Personal Hygiene and Employee Health(Mastered)
,ely Managing Controls in a Food Eetabllahment(Mastered)
Itoring the Flow of Foods(Mastered)
,ring Product Time and Temperature(Mastered)
lucting Cleaning and Sanitizing(Mastered)
aging:Physical Facility Design&Maintenanee;Proventing&Controlling Pests(Mastered)
National Registry of Food Safely Professionals® 1 7690 Universal Blvd Ste 550 .1 Orinn(lo,PL 32819 1 fBone;407.352,0.10 l Fnx:407.352.3603
O&VOOb�, NATIONAL REGISTRY OF
FOOD SAFETY PROFESSIONALSO
U
G, Q CERTIFIES
MELISSA PIJAR
HAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR THE
CERTIPIED FOOD SAFETY MANAGER
UNDER THE
CONFERENCE FOR FOOD PROTECTION STANDARDS
P RESIDiwNT:
a—=—
LAWRENCE J,LYNCH,CAE
ISSUE DATE. OCTOBER 4, 2017
EXPIRATION DATE: OCTOBER 4, 2022
1:0656 CERTIFICATE NO: 21394422
Forum Drive,Suite 220.Orlando,FL32a21 TEST FORM: E,ZS36
Th6 certificate is not oalld far more
446.0257 F(407)352-3603 wivw,NRFSPx0rn than five years from date of Issue.
real Registry of Food Snfety PmfegalonaW
National kcKlsb y of Food Safely NI nfe%0rmo1s
ifiCation of Test Result ° CR1t'r'1FLt?U POOD SAIIET'Y AtANACER
XXX-XX- MELISSA PIJAR
ed Test Score: 91 L1x,,,ML)
dilate Status: Pass
We
Date: October 4, 2017 e751,FwA)a
t.WM.1:1 37671
"od11,o.t�ool.s6 a3) Certificate NO;21304,122
ts,°,t«v> «-,mo lasue Date:October 4,2017
I,-tW71 Uxpirailoii Daw October 4,2()22
rww NN,'tiV.mm
ratulationsl Attached is your certificate and wallet cart.Please notify MELISSA PIJAR
ational Registry of name or address changes tit t1w uddress below. 297 OAK ST
MANCIIESTER, CT 06040
rnting Contamination and Cross Contamination(Competent)
ring Personal Hygiene and Employee Health(Competent)
ply Managing Controls In a Food Establishment(Mastered)
oring the Flow of Foods(Mastered)
•ing Product Tlrne and Temperature(Mastered)
ucting Cleaning and Sanitizing (Mastered)
car Facility Design&Maintena nee:Preventing&Controlling Paste(Mastered)
National Itegictry of Foud Safety Professional5(M I 6751 Forum I)rivo tits:220 I 00nm1o,FI.32S21 I Phone;407,352.3N30 I Far;407.3s2.3603