HomeMy WebLinkAboutApplication 291 Oakland Road Town of South Windsor - Health Department
r 1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074—Office Address
s ` Phone Number: (860) 337-6173 Fax: (860) 644-1930
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Restaurant Establishment Information New Permit❑ Permit Renewal
***(Please Print Clearly)***
Name of Establishment:
Manager's Name: /-jJ rct4 Pry) R C'� en
Street Address: 79 �_ �fl are 141"' 1
City, State, Zip Code: tom , (4)rr-i, � C7 O�j0�7�
Phone#: Cell Phone#:
Fax#:
E-Mail Address: NjosbO1 . Si.mw a qmd(SO'riSeating Capacity: 3
Please submit latest copy of the Oualified Food nnerator/,ervSafe certificates to the office.
Qualified Food Operator: YES d NO ❑ (Required for Certificate#:
l Class 3&4)
Name: RrN5 Chen Date: � ( -�t�, c�0/ 7
Testing Organization: /(��Q/)e A- j,Wn� � Phone#: (74a
E-Mail Address: Alternate Phone#:
Designated Alternate 1: Designated Alternate2
Restaurant Owner Contact Information
Owner's Name: w e( zkt o-) fl / t0
0 /11?-J ck e (Sfelk)
Street Address: /Q') 8f jd1Z GUG0 (1 goC'J
City, State, Zip Code: SC,�t A Lv ��o�vr� G-r 4�07�-
Phone#: 9'( _ A (4 - 94 2 Fax #:
E-Mail Address: 9FXk7o - tA�q/�7U;/C'Q7►� Cell Phone#: a
Renovations RECEIVE
Were there any renovations made last year? YES❑ NO &J//� Will there be any renovations? Y
If Yes, please list all renovations (
that were done/to be done: SOUTH WINDSO
HEALTH DEPT.
Mailing Address to send Food License Renewal Permit to:
Name of Restaurant/Company: �t.-(n SL(/7
Attention: clp- /
Address: .-9/ /r?/' l�►_h�ii( lQr7 cad
City, State, Zip Code:
Phone#: �- �14
Resta rant Menu/List of All Items Served/Sold
Latest Menu Attached? YES 7NO ❑ 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 Ni None
Water Supply: Public Private Well
Wastewater Disposal: Public 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 application may result in immediate shutdown or revocation of my Food
Service License for the Town of South Windsor.
Applicant Name (Print):
. 1 Fn C -�
Applicant Signature: Date: fl— —
Offim UM only
Inspector Name (Print):
Inspector Signature: Date: ILI
Food Class: 1 ❑ 2 ❑ 3 [R"4 ❑ Expiration Date: t1A 0[
Date Received: Date Approved: k-L t(c.t[(`j
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Wai Ang Chen
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Certified Professional Food Managerm
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Anthony W. Mitchell, Ph.D.
'President
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L l T>F CH SPECIAL PLATES
Served Monday - Sunday from 11:00 a.m. - 3:00 p.m.
All Dishes Served with Pork Fried Rice or Steamed White Rice
w. Brown Rice $1.00, Vegetable Fried Rice or Chicken Fried Rice $1.00, Shrimp Fried Rice $2.00
Fresh Salmon (Steamed or Fried) Served w. Broccoli ..............................7.50
L 1. Chow Mein (Chicken or Shrimp)..................................................................6.50 S U
L 2. Chicken with Broccoli ..................................................................................6.50 L 3. Shrimp with Broccoli 6.95 Chinese es 1+
, a.
L4. Beef with Broccoli.........................................................................................6.95
L 5. Pepper Steak with Onion..............................................................................6.95
Since 1988
L6. Moo Goo Gai Pan (Chicken).........................................................................6.50
L 7. Pork with Chinese Vegetables.....................................................................6.50
L 8. Shrimp with Lobster Sauce..........................................................................6.95 291 Oaklani , '.�Oad
L 9. Sweet & Sour (Chicken or Pork)..................................................................6.50
L 10. Spare Ribs (Boneless)..................................................................................6.95 South Windsor, CT 06074
L 11. Egg Foo Young (Chicken or Pork)....................... ...6.50 \ (860) -44-7'586
L 12. Buddha's Delight (Mixed Vegetables) 6.50
L 13.4 Broccoli with Garlic Sauce...........................................................................6.50 ;
L 14.4 Kung Po Chicken ....................................................................................6.50 (860) 644-2587
L 15.4 Chicken with Garlic Sauce...........................................................................6.50
II L 16.4 General Tso's Chicken ....... (Take Out or Eat In)
...6.95
L 17. Sesame Chicken ..................................................................... ,�
.............6.95
L 18.4 Chicken with Orange Sauce.........................................................................6.95
We will try our best to accommodate your food allergy
L 19. Shrimp & Chicken with Diced Vegetables..................................................6.95 needs. However, we do not Guarantee that it will be riskfree
L 20. Chicken with Cashew Nuts 6.50 to you. Please use your judgement in placing your order.
L 21.4 Pork with Garlic Sauce.................................................................................6.50 L 22. Lo Mein (Pork or Chicken) ...........................................................................6.50
L 23. Lo Mein (Beef or Shrimp).............................................................................6.95 � visA
L24. Chicken with Mushroom ..............................................................................6.50 •,
L 25. Chicken with Zucchini..................................................................................6.50
L 26. Green Bean with Chicken ............................................................................s.5o � � Olen 7 Days A Week
L27.4 Ginger Chicken .......................................................... ..................................6.95
L 28. , Mixed Vegetables with (Pork or Chicken) .::::::6.50 7 Mon. - Sat.: 11:00 am - 10:00 m
L 29. Beef with Mixed Vegetables................................................................... 6.95 Sunday: 12:00 noon - 10:00 pm
L 30. Shrimp with Mixed Vegetables 6.95
L 31. Eggplant with (Pork or Chicken) .................................................................6.95
L32. Beef with Eggplant........................................................................................7.50
L 33. Shrimp with Eggplant...................................................................................7.50
• Vegetable Oil Only14 .
OUR SPECIAL COOKING : Fresh Meats and Vegetables OUR SPECIAL COOKINGNatural Ingredients
• Low Oil Cooking Available ' • Vegetable Oil Only
m
• Fresh Meats and Vegetables
• All Natural Ingredients
• Low Oil Cooking Available
�&.I i OT & SPICY DISHES L _
All other orders made with mild sauce unless by request. si
Please note the Crispy fried noodles is 500perbag
Homemade sauce is available:Small for 25c,8oz for$2.00 PORK (with White Rice) Order S VLn I'.ET & SO '
(Duck sauce,mustard sauce,ginger sauce,hot chili oil,BBQ sauce,hoisin sauce) 42. Roast Pork with Broccoli.... _. 8.95 (with While Rice-Sauce on Side) Order
APPETIZERS 43. Roast Pork with Mixed Vegetable.........................................8.95 93 Sweet&Sour Pork ..8.95 CHEFS SPECIALTIES
1 Egg Roll(Pork)(1)......... ......................................................1.60 44. Roast Pork with Snow Peas _ . .._ 8.95 94 Sweet&Sour Chicken..........................................................8.95 (with While Rice)
2 Spring Roll(Shrimp)(1)....................................................... 1.60 45. Roast Pork with Mushroom.. .....................I..............8.95 95 Sweet&Sour Shrimp 11.95
,i Boneless Spare Ribs............................................................7.95 46.*Roast Pork with Garlic Sauce............................................. .8.95 S 1 A General Tso's Chicken ................10.50
4. Bone-In Spare Ribs.........................•..................................10.95 47.4Double Cooked Pork.. .8.95 Pad Thai (Shrimp &Chicken)............••••••10.50 Chunks of boneless chicken marinated andfried
5.A Fried Jumbo Shrimp(5)... 7.50 48. Roast Pork with Green Beans.. 8.95 until crispy in a spicy, tangy sauce and served
.................................................... ....................................... �. with broccoli.
r Hot •l' (Mild upon onl )
5.B Coconut Shrimp( )...............................................................7.50 CIIICKLN (wilhWhileRic,) Order ( g Shrimp
6. Fried Wonton Pork 8 .....4.00 In Flat Rice No. th only.)
and Chicken,
(Pork)( )"•""••'•"'••"""......•"•"••••"""•'•••" Egg, Garlic,Bean Sprouts, Chives,Lime,Hot Pepper and
7 Crab Rangoon 6 .5.25 49. Chicken with Broccoli............................................................8.95 S 2. Sesame Chicken .........10.50
••••••••••••••••••••••••••••••••••••••••••••••••••••••• Peanuts with special flavor blended Fish Sauce) """"""""'
8. Chicken Fingers....................................................................6.50 50. Moo Goo Gai Pan.....................,.....,.....................................8.95 Chunks of boneless chicken marinatedandfried
9. Chicken Wings(4)................................................................5.25 51. Chicken with Snow Peas......................................................8.95 until crispy in a tangy sauce, sesame seeds on
DI I �[' 'K S HEAVEN p.
10. Teri aki Beef Sticks(3).........................................................6.95 52.E Chicken with Curry Sauce .... .8.95 and served with broccoli.
to
•'••••'•' ••'••••••••" Our Special Steamed Cooking without Oil Served with While Rice and
11. Por Dumpling-Fried or Steamed(8)..................................5.95 53. Chicken with Green Beans ................................................ .8.95 Ginger Sauce on the Side
11.0 Chicken Dumpling-Fried or Steamed(8)............................5.95 54. Chicken with Mixed Vegetables......................,,....,...................8.95 S 3.4 Chicken with Orange Sauce . �0.50
11.V Vegetable Dumpling Steamed Only 8 .........5.95 Chunks of boneless• ''
55. Chicken with Cashew Nuts D 2 B Mixed Vegetable.................................................8.95� p g y ••-••••••••••••-••••• .... 8.95 D 1 Chicken w.
12. Cold Noodles w. Sesame Sauce 5.50 """""""""""""""""""""" crispy spicy g fl
until cris in a s i oran e nvored sauce and
•• 56. Chicken with Mushroom 8.95 Beef w. Mixed le etable . 10.50
13. Pu Pu Platter-(For 2).........................................................13.95 ....................................................: D 3 Shrimp w. Mixed g ...........................,......,............. served with broccoli.
57.4Kung Po Chicken 8.95 P d Vegetable................................. . .... 11.95
*(2 Eg,, Rolls. 2 Spare Ribs, 2 Chicken Wirr��s, 8 58.l�Chicken with Garlic Sauce ................................. 8.95 s �_•. .• G
SIDE ORDERS S 4.:..Bvc.f i�0h 1-) .,n�,,.Chicken Finger:c, 2 enyaki Beef No.Srrbstitrtttvns) 59.4Tai Chi Chicken...................................................................10.50 White Rice .............•................. Pint-1.50 Quart-3.00 11 ,
SOIL I S Chicken with Zucchini . .9.50 Brown Rice. ...................................... Pint-2.50 Quart-5.00 in a spicy orange flavored sauce and served
(with Crispy Noodles) Small Large ,4 Ginger Chicken.....................................................................9.50
with broccoli.
14. Wonton Soup(Pork) .......... .................. 225 4.00
15. Egg Drop Soup....... . ..................... ......................225 4.00 Chicken with Eggplant .................. .9.50 FA
�'f
15. Wonton&Egg Drop Mixed(Pork).........................2 50 4.00 Chicken with Teriyaki Sauce(No Vegetables) ..................10.95 COMBO MEALS . S5. Sesame Beef. .............................. 11.95
ishs Served with Pork Fried Rice&Egg Roll Tender chunks of breaded beef fried until crispy
17 Velvet Com with Minced Chicken........................ .2 50 5.00 BEEF (with While Rice) order in a tangy sauce with sesame seed and served
18. Chicken-with Rice or Noodles.............................250 5.00 (Served all day)
60 Beef with Broccoli...... ................. .............. 10.50 with broccoli.
19.4 Hot&Sour Soup(No Meat)............. 250 5.00 10.50 wn Rice$1.00, Chicken of Veg Fried Rice$ 1.00,
20.A House Special Sou 61 Pepper Steak with Onion.......................... Shrimp Fried Rice$2.00 1 9
p p......................... (One Size Only) 7.50 P
62 Beef with Green Beans...................... 10.50 C r
20.B Vegetable Soup._ ._. .... ......_. . .... (One Size Only) 6.50 ............................... ........... ...... .,.. 2. 5
64 Beef with Mushrooms ...................................................... 10.50 White chicken&jum �lmil wit l cn,i
*Dine - In served by bowl only* 65 Beef with Snow Peas....... ....10.50 C 1.4 General Tso's Chicken.................................8.95 water chestnuts, and green pepper in a spicy
. ............................................CHOW h en or IN 66 4Beef with Garlic Sauce.......................................................10.50 C 2. Chow Mein Chick Shrimp) 8.50 brown sauce.
(with White Rice R C5 isp�v Noodles) La ge 67 Beef with Mixed Vegetables.. .............................................10.50 ( p)
21. Chow Mein Beef or Chicken) 8.95 68 *Hunan Beef 11.95 S 7 Happy Fam ...............................12.95
23. Sun Sun Chow Mein h Iiiij•, ••••.•.•• 9.50 Beef with Teriyaki Sauce(No Vegetables)_........................11.95 C 3. Pepper Steak w.Onion.................................8.50 Jumbo shrimp, pork, beef,&crabmeat
Chow Mein(Pork or
(Pork, ! icken&Shrimp) ......... 9.50 with assorted vegetables in a brown sauce
CHOP SUEY SEAFOO (with While Rice) . ...__....... order C 4. Chicken with Broccoli..................................8.50
69. Shrimp with Broccoli ......I.......................... 11.95 S 8. Crispy Shrimp..............................12.95
(,with While Rice) order 70. Shrimp with Chinese Bok Choy .95 C 5. Moo Goo Gai Pan Chicken 8.50 Jumbo shrimp breaded and fried until golden
24. Chop Suey(Pork or Chicken)........................................... 8.95 71. Shrimpwith Lobster Sauce Ground Pork 95 (Chicken) crispy in a special tomato sauce, served with
25. Chop Suey(Beef or Shrimp)............................,... ............ 9.50 ( ) broccoli.
26. Veaetable Chnr Suev . 8.95 72. Shrimp with Snow Peas... ........................................... .95 C 6. Chicken with Snow Peas 8.50
............................... .............................
73.4Shrimp with Curry Sauce. ............................................ 95
EGG FOO YOUNGreenS 9. Seafood Combination..................12.95
75. Shrimp with Cashew Beans Nuts.. ........................................ 11.95
95 C 7. Sweet&Sour(Chicken or Pork) 8.50 Delightful fresh scallops, jumbo shrimp, &
/will,While Rice) Order
27. Egg Foo Young(Pork or Chicken) 8.95crabmeat with assorted vegetables in a special
28. Egg Foo Young(Beef or Shrimp). 9.50 76. Shrimp with Mushroom... ............................. ...11.95 C 8. Beef with Broccoli........................................8•95 white sauce.
29. Vegetables Egg Foo Young......... 8.95 77. Shrimp with Snow Peas& ,y Corn .................................11.95
FRIED E small Large 78. Shrimp&Chicken with Diced gel: ins........... ........... . .. 11.95 S10.4Tan erine Shrimp C 9. Pork with Mixed Vegetable ........................ 8.50 � p .......,............... 12.95
30. Fried Rice(Pork or Chicken)............................... .4.95 7.95 80.YaShrimp with Tomato Sauce 1.95 g crispy in a spicy orange sauce, served with
79.4Kun Po Shrimp...... ....................................... 9
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31. Fried Rice(Beef or Shrimp)................................. .5.50 8.95 81.3s hump with Garlic Sauce 1.95 C 10. Shrimpwith Mixed Vegetable broccoli.
32. Vegetable Fried Rice........................................... .4.95 7.95
33. Young Chow Fried Rice(Pork,Chicken&Shrimp).5.95 9.50 82•4Shrimp with Szechuan Style Sauce.................................... 1.95
83 Shrimp with Mixed Vegetables 1.95 C 11. Shrimp with Lobster Sauce.........................8.95 S11.�a•Shrimp and Scallops......... 2.95
.LO MEIN Fresh Salmon(Fried or Steamed)w. Broccoli.................... 3.95 hinibi, dirinip(Inrl fresh wl/ry+c wit)I eo
(Spaghetti Noodles-No Rice Served) Pint Offal l vegetables in a spicy garlic sauce.
VEGET AN C 12. Shrimp with Broccoli ...................................8.95 g P cy
35• Lo Mein Pork or .5.25 8.95
36. Lo Mein Beef or .5.95 9.50 (with While Rice-No Meat) Order C 13. Spare Ribs(with Bone or Boneless)..........8.95 S12. Lemon Chicken............................10.50
Vegetable37. 5.25 8.95 84.4Broecoli with Garlic S Sauce 8.95 Filet chicken breast breaded and fried, served
. ( p) 86 Buddha's n w - 8.95 with broccoli and special lemon sauce on the
o Mein......... . ...................:. ... . .......... Garlic auce•"`,`tables ...,............................. .8.95 C 14. Shrimp&Chicken with Diced Veg..............8.95 side.
�
38. Sun Sun Lo Mein Pork,Chicken&Shrim 6.50 9.50 85.S�Green Bean with
C or FUN 88. Tofu with Mir , )
(Broad Rice Noodles)
Chicken or Pork Chow Fun. . . 8,95 87 r Eggplant with Garlic Sauce.............................................. . 8.95
'' Ides..................... 9.95 C 15.i�Chicken with Garlic Sauce..........................8.50 S13 Chicken with Scallo s................ 12.95
Beef or Shrimp Chow Fun.............. .9.50 � ••••�••••••••••••••••••�• p
Vegetable Chow Fun.................. . . . . . . .8.95 .4Crispy Tofu(with Broccoli) .... ............. 9.95 Sliced white chicken fresh scallops sauteed
... . . . . . ........................ .. ... ce with au
House Special Chow Fun(Roast Pork,Shrimp&Chicken)....9.95 MOOS U DIS�1t S C 16. Chicken with Mixed Vegetables.... .............8.50 with assorted vegetables to a special brown
............. I sauce. I
IN FUN (Rice Vermicelli Noodles) (Served with 4 Pancakes) C 17. Egg Foo Young(Pork or Chicken). 8.50
Chicken or Pork Mein Fun ............................................... 8.95 Extra Pancakes$1 25(4 Pieces) order
Beef or Shrimp Mein Fun. .................................................9.50 89 Moo Shu Vegetable .8.95 C 18. Lo Mein (Pork or Chicken)...........................8.50
de Mein Fun .............................................. 8.95 90 Moo Shu Roast Pork.. ....................... ........................... .8.95
pecial Mein Lii,kkoast Pork,Shrimp&Chicken) 91 Moo Shu Chicken ....................................................... .8.95 i; L OT & SPICY DISHES
in Curry Sauce..................................... ......... 9.95 92 Moo Shu Beef or Shnmp 9.95 - '� All orders made with mild sauce unless by request.