HomeMy WebLinkAbout950 Sullivan Avenue (3) Town of South Windsor — Health Department
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
aSoe•co
Restaurant Estab*ishment Information New Permit❑ Permit Renewal
***(Please Print Clearly)***
Name of Establishment: p041 G�.1, ;L -Wzw" `!61
Manager's Name: A-s.-LJG C* A
Street Address:
City, State, Zip Code: �.;�� � a CT 0 6�'
Phone#: 0 ���,�._��� Cell Phone#:
Fax#:
E-Mail Address: ig I Seating Capacity:
Please submit latest copy of the Qualified Food Operator/ServSafe certificates to the office.
Qualified Food Operator: YES E!( NO ❑ (Required for Certificate#: 10 �g04
Name: A1-I-, Fj (,�pCla� Date:
Testing Organization: � 5� Phone#:
E-Mail Address: Alternate Phone#:
Designated Alternate 1: Designated Alternate2
Restaurant Owner Contact Information
Owner's Name: ='i'� _ ) -oC C-40A
Street Address: C��o
City, State, Zip Code: Q n W�� So c, CA . Oct
Phone#: ,�[ Fax #:
E-Mail Address: / L Cell Phone#:
Renovations
Were there any renovations made last year? YES❑ NO Will there be any renovations? YES❑ NO
If Yes, please list all renovations RECE V
that were done/to be done: rr��
t,76% 2 "2017
SOUTH WINDSOR
Mailing Address to send Food License Renewal Permit to:
Name of Restaurant/Company:
Attention, `
Address: p
City, State, Zip Code:
Phone#: A 64+_ 66t�
Restaurant Menu/List of All Items Served/Sold
Latest Menu Attached? YES❑ 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 one
Water Supply: _�,Z 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): nn
— L^_ l-_
Applicant Signature: 0C Date: �� p
Office Use Only
Inspector Name (Print): �_p
Inspector Signature: Date:
I&A Ojg,<
Food Class: 1 ❑ 2 ❑ 3 Y4 ❑ Expiration Date:
Date Received: Date Approved:
��\ 41�22 S 7,0(3
EXAM FORM NO. 4895
CERTIFICATE NO. 10483906
e ry af 0
CERTIFICATION
MING FENG CHEN
for successfully completing the standards set forth for the ServSafe Food Protection Manager Certification Examination,
which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection(UP).
10/30/2013
DATE OF EXAMINATION
10/30/2018
DATE OF EXPIRATION
Local laws apply.Check with your local regulatory agency for recertification requirements.
Oak
I
Paul Hineman
® Executive Vice President,National Restauro;,- Association
#0655
02012 National Rc.;sirant Assacletion Educationai Foundation(NRAEF).All rights reserved ServSale is a regstered trad,n. of the NRAEF,used under license by National Restaurant Association Solutions,U.C.
The logo.i ppuanng next to ServSafe is a traderrurk of the National Restaurant Association.
This document cannot be reproduced or aliered.
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SOUP CHOW HO FUN(RICE NOODLE) ir •
(w. Fried Noodle) Pt. Qt f1r�i°f k, fc*� 52. *, Singapore Chow Mi Fun .........8.75 COMBINATION PLATES SINNER lio t CHEFS S 13ECIALI IES '
is� Served w Roast Pork Fried Rice or 0, ite Rice or ra 1. Wonton Soup
..............................2.15 3.95 X A ki k 1� 53. Roast Pork Chow Mi Fun........................8.25 (w White Rice) Order
� 16 i� 2. Egg Drop Soup...........................1.75 2.95 JE€ 0 + �•� 54. Chicken Chow Mi Fun.............................8.25 (Sub w. Vegetable Fried Rice add$1.00 or
6j 1f ;% 3.� Hot& Sour Soup................... .....2.35 4.15 fi + 4n 55. Beef or Shrimp Cnow Mi Fun..................8.75 Shrimp or Beef Fried Rice add$1.50) and Roll Order H 1. Happy Family.......................... 12.95
lily J& i* 4. Chicken Rice or Noodle Soup.....1.95 3.25 1E€ i7 1'n 56. Chicken Chow Ho Fun............................8.25 W k, C 1. Shrimp Chow Mein 8.55 T #x H 2.a, General Tso's Shrimp ............ 12.95
1l< it>tr 5. Wonton Egg Drop Soup..............1.95 3.95 fi %7 n 57. Shrimp or Beef Chow Ho Fun.................8.75 # ky C 2. Chicken Chow Mein...................8.45 It H 3. Sesame Chicken 9.95
+ ;13 6. Vegetable Soup... 4.25 SWEET & SOUR (w White Rice) Order
;� 7. House Special sou � #t �- C 3. Pepper Steak with Onion..........8.45 �� >� �i� H 4.� Orange Flavor Chicken............ 9.95
p p.....................:... 6.75 id A# � r�] 58. Sweet&Sour Chicken or Pork...............7.95 g C 4. Roast Pork E Foo Young r'.� � :a Egg g ......8.45 � T �iW H 5.� General Tso's Chicken............. 9.95
8. Seafood Soup..... 8.50 0 at Wa 59. Sweet&Sour Shrimp .9.95 p...Shri.............Por iR At �A C 5. Shrimp
(Lobster,Scallop&Shrimp) � � p with Lobster Sauce......8.85 � A H 6.� General Tso's Tofu.................... 9.25
APPETIZER - =- �� 60. Sweet&Sour Chicken, Shrimp and Pork 9:25 * M � C 6. Beef with Broccoli........... 8.95 q tl
EGG FOO YOUNG ""...... I it H 7.%� Szechuan Delicacy 9.95
i 9 Shanghai Spring Roll (2)...................... 2.75 (w White Rice) Order VatM. A#C 7. Sweet S Sour Pork or Chicken.8.45 01 A 4- H 8.%, Orange Flavor Beef.................11.95
tF- 10 Egg Roll(1)..... 1.50 At x C 8. Moo Goo Gai Pan...............
�Zt��,�[€a� 61. Roast Pork or Chicken Egg Foo Young..8.25 "......8.45 & � -7- �� H 9.� Chicken 8 Beef in Garlic Sauce. 9.25
*R 11 Shrimp Roll (1) 1.60 -t- th -* 62. Beef Egg Foo Young .................8.i5 X 1 6 X C 9. Roast Pork with Chinese Veg...8.45
ft 4 X 12. Fried Chicken Wings(4) 4.95 + ;k t 1 63. Vegetable Egg Foo Young 7.95 4# It C10. Spare Ribs..................................8.95 � JR -t H10. Sizzling Scallops & Beef.........11.95
kt k Wei 13. Fried Jumbo Shrimp(5) 6.75 #R t �* 64. Shrimp Egg Foo Young ........... R 75 = H11.�Beef, Chicken, Shrimpw. Broccoli
- ��;t����C11. Roast Pork or Chicken Lo Mein 8.45
ft -f- 9 14. Fried Scallop 4.25 it Wx t 1 65. Lobster Egg Foo Young..........................9.25 8r Garlic Sauce........................ 9.95
4, $A j- 15.E Hot&Spicy Chicken Wings(4)................5.75 Si At it C12. Chicken w. Broccoli...................8.45
CHICKEN (w White Rice) Pt Qt �# C13. Sesame Chicken 8.75�Ak��� 16. Steamed or Fried Dumplings 8 5.55 � ,,,,,,,,,,,,,,,,,,,,,,,, X 1i� + H12. Sesame Beef............................11.95
( )""""""' ;k it 66. Chicken w. Bean Sprout.. 8.25
K 17. Ve etable Dumplings 8 5.55 P ...• t T C14.� General Tso's Chicken..............8.75 -f- JR H13. Chicken w. Scallop11.75
9 ( )••••••••••••••••••••••••• A� � 67 Chicken w. Cashew Nuts ......... """""""""....... 8.95 ,
44 t 18. B.B.Q. Spare Ribs ......(Sm.)6.95(Lg.) 12.95 4"k 68. �Chicken w. Garlic Sauce, 8.95 A C15.A., Orange Flavor Chicken.............8.75 P, A H14.-4,Shrimp w. Scallop 12.75
f r 4 19. Crab Groon Wonton(10) ........................6.25 a 1 69. Chicken w. Snow Peas... 8.95 A q 44 A CI 6. Boneless Spare Ribs.................8.75 k fi it H15.i DaChian Chicken...................... 9.95
44 20. Boneless Spare Ribs .(Sm.)6.55(Lg.) 11.95 x Tg 70. Kung Pao Chicken . . . . ...895 Wx C17. Shrimp w. Broccoli....................8.95 )A ! §x H16x Cris Shrimp 12.95
�2 A 21. Roast Pork..................(Sm.)6.55(Lg.) 11.95 ;�� � �l€ 71. �► Hunan Chicken.............. 8.95 Crispy p""""""""""""'
q )II C18.i Chicken Szechuan Style..........8.45 -W H17. Shrimp w. pp ( )m ail t 4 22 Szechuan Wonton(10)...........................4.95 q �. a �� 72. Chicken w. String Bean.., 8.95 p Salt 8.Pepper 45 ..11.95
-k + 4A 23 Golden Chicken Fingers (Sm.)5.95(Lg.)8.75 , �o 73. Aw Chicken Eggplant in Garlic Sauce.. .8.95 ] C19. Beef Lo Mein..............................8.76 ugHappiness•��� H18 Four 9.95
� $ 24 Teriyaki Beef(4)............. 7.95 MI } $I€ C20.� Chicken w. Garlic Sauce...........8.45 ail � 74. �►.Chicken, Szechuan Style..... . ..... .. .. ...8.95 AL H79. Triple Crown....., .................. . 9.95
25 Teriyaki Chicken(4) 7.25 io 1k 75. Chicken w. Broccoli. . . . .. ..... 5.25 8.95 6 It C21. Chicken W. Chinese Veg............8.45
A f 26 Shrimp Toast(2) 3.25 41 A h 76. Moo Goo Gai Pan 5.25 8.95 (a �C22. Shrimp w. Chinese Vegetable � H2O. Tangy Lemon Chicken............. 9.95
�
q r; ro 27 Cold Noodle w. Sesame Sauce..............5.75 $ A A 77. Chicken w. Black Bean Sauce....5.25 8.95 fi. _ �c � 1 T H21. Shrimp&Chicken with
ft T 4 28 Fried Wonton(12).. 5.25 fi ;k . lk 78. Chicken w. Chinese Vegetables 5.25 8.95 1 $ C23. Chicken W. Snow Peas..............8.75
°h° � 79. �Cur Chicken 5.25 8.95 e Cashew Nuts........................... 9.95
s 91 C24.-%. Broccoli w. Garlic Sauce...........8.25
� � it29 Pu Pu Platter(for 2) 12.95 � � '�-•-••----••-•••••�-••
;Eh t# 30 Scallion Pancake...... 4.25 PORK(w White Rice) Pt. Qt X ►M C25. Roast Pork w. Broccoli..............8.45 4 H22. Subgum Wonton..................... 10.96
A A 31 Chicken Nuggets(12) 4.95 M, 80. IL,Pork w. Garlic Sauce............................ 8.95 * 0 C26. Chicken w. Cashewnuts............8.46 H23. Seafood Combination............ 13.95
FRIED RICE Pt. Qt ;'AA A M 81. �Double Cooked Pork...... ... ............... 8.95 It 0- *C27. Chicken Wings...........................8.45 '�' H24. Boneless Chicken .................,.. 9.95
rid] r,] >; 82. 1.Hunan Pork.... ................................ 8.95 A�5-T-0 C28X Chicken w Eggplant in Garlic Sc 8.45 ,
�i' K 32 Vegetable Fried Rice...................4.55 7.25 •���� � ° ggp #f, ''$ H26. Wor Shu Duck......................... 14.95
q ail M. 83. �Pork Szechuan Style........................... 8.95 $ i T C29. Teriyaki Beef
33 Roast Pork or Chicken Fried Rice.4.55 7.55 - Y •••••••9.95 A 1� �Z H27.�Dragon Phoenix.......................11.95
. M l; 84. Pork w. Scallion&Onion...................... 8.95 > C30. Teri aki Chicken...........................9.55
Wx H28.i Mongolian Beef......................... 9.95 4-*�K 34 Shrimp or Beef Fried Rice...........5.25 8.25 t� X 85. Pork w. Mushroom .5.25 8.95 y
* 4 *i K 35 House Special Fried Rice...........5.25 8.25 •� " �i H29.i General Tso's Duck.
�h k 86. Pork w. Broccoli..........................5.25 8.95 � T �•- ... 14.95
It, A k, ik 36 Lobster Fried Rice.......................5.95 9.50 2 Q �i X 87. Pork w. Snow Peas.....................5.25 8.95 SEAFOOD
4# W+l 0 #R 37 Young Chow Fried Rice..................... ....8.25 A 7 X 88. Pork w. Chinese Vegetable.........5.25 8.95 (w White Rice) Pt. Qt. 1L, Hot & Spicy
q )II W€R 106. IL,Shrimp, Szechuan Style....................... 10.25
LO MEIN Pt. Qt. BEEF (w White Rice) Pt Qt -15$-L*Ax 107. Shrimp w. Baby Corn&Snow Peas......10.25
38 Vegetable Lo Mein......................4.55 7.25 89. Beef, Szechuan Style..... ........................9.95 --f� Al Wfx 108. i,Shrimp w. Hot Spicy Sauce.................. 10.25
X 39 Roast Pork or Chicken Lo Mein..4.55 7.95 !S A -f- 90. Beef w, Snow Peas............................ 9.95 A * Jrx 109. Shrimp w. Cashew Nuts........................10.25 �
i 40 Shrimp or Beef Lo Mein..............5.25 8.25 v, q91. Beef w. Scallion.......................................9.95 2 A JR 110. Shrimp w. Snow Peas........................ 10.25 `
4,0 tt 41 House Special Lo Mein...............5.25 8.75 92. IL,Shredded Beef w. Hot Spicy Sauce........9.95
..., � #x 111. %.•Shrimp w. Garlic Sauce........................ 10.25 SPECIAL DIET MENU
it Jrx 4 42 Lobster Lo Mein..........................5.95 9.95 •.., J& 93. A�Beef w. Garlic Sauce........................ ... ..9.95 x 4* 9z 112 IL,Kung Pao Shrimp ................................ 10.25 (All Steamed)
C OW MEIN 4 s 94. Beef w. String Bean 9.95 *R 4=Tt`$X 113. Shrimp w. Mixed Veg.... . _. ... 10.25 1. Chicken or Pork,Mixed Vegetable.. 8.95
(w.White Rice) Pt Qt. A "�'a�4- 95. IL,Beef w. Eggplant in Garlic Sauce....... 9.95 m * s ir 114. Shrimp w. String Bean....................... 10.25 2. Beef, Mixed Vegetable ..... 9.55
k; it 43 Vegetable Chow Mein.................4.55 7.25 �• Beef w. Broccoli 5.95 9.95 Wtnx 115. Shrimp w. Chinese Vegetable 10.25 3. Mixed Vegetble .............. 7.2i)
(€ ;$@ 44 Chicken or Roast Pork Chow Mein.4.55 7.95 97. Pepper Steak..............................5.95 9.95 i 41 if! 116. Shrimp w. Mushroom..................6.25 10.25 Jrx 4. Shrimp Mixed Vegetable............... .......10.25
jr, 1 J@ 45 Shrimp or Beef Chow Mein.........5.25 8.55 41 98. Beef w. Mushroom .5.95 9.95 M JR 117. Shrimp w. Broccoli......................6.25 10.25
* ¢t ki A@ 46 House Speical Chow Mein..........5.25 8.55
no t 99. Beef w. Pepper&Tomato...........5.95 9.95 irk 1t A 118. Shrimp w. Lobster Sauce............6.25 10.25 .•..•..•..•..•..•..•..•..•..•..•..•..•..•..•..•..•..•..•.4.4..•.-4.
1t Wax k; A@ 47 Lobster Chow Mein.....................5.25 8.95 VEGETABLE A A 1z 119 %�Shrimp w Black Bean Sauce.. .. 6.25 10.25
C OP SUEY (w White Rice) Order °ho 9' 120. IL,Curry Shrimp.. ...... ... ........ ........6.25 10.25 SIDE ORDER
(w.White Rice) Pt. Qt 4t 0 100. Sauteed Mixed Vegetables.......... ..7.75
r� 4t � 48 Pork Chop Suey..........................4.55 7.95 � � s; Ys� 101. 'k, Broccoli w. Garlic Sauce •.7•75....... MOO SHU � �c 1. White Rice....................(Sm.) 1.50 (Lg.)2.75
(w White Rice and 4 Pancakes) Order 3 L 2. Soda.......................(Can) 1.00 (2 Liter)2.95
4t a$ 49 Beef Chop Suey .5.25 8.55 rul Ai 102. %w Bean Curd Szechuan Style......... 7.75
�
Wiz 4t 4 50 Shrimp Chop Suey .....................5.25 8.55 $ /�# 103. Bean Curd w. Mixed Vegetables.. ..7.75 121. Moo Shu Pork................. .8.25 3. Fortune Cookies(3)................................ .50
4. French Fries............................................3.50
k t} 4 51 Chicken Chop Suey....................4.55 7.95 t ;k 104. Sauteed Chinese Ve ..7.75 * 122. Moo Shu Chicken............ .8.25
g.""""""""' * �-�,�� 123. Moo Shu Beef or Shrimp. 8.95
FIOt Spicy A � 105. A.Eggplant w. Garlic Sauce......... . ..7 75 ;, p• � Hot & Spicy
p Y * , � � 124. Moo Shu Vegetable......... .7.95 p y
LUNCH SPEC
�r.
Served From 11:00 am-3:00 pm
(Served w. Roast Pork Fried Rice or ite Rice or Sub w.
(Vegetable Fried Rice add$1.00) or(Shrimp or Beef Fried Rice add$1.50) PARTY SPECIAL
and Choice of Soup: Wonton, Egg Drop or Hot Sour Soup or Egg Roll or Soda ` 3
:� It L 1. Mixed Vegetables................................ 5.65 f�
0 f0 L 2. Chicken w. Chinese Veg. . .... ............. 6.15 3 Qt.
s; PA -0 L 3. Chicken w. Broccoli.............. ... ...... ... 6.15 1. Happy Family............................................ 31.99 ', r
t€ ki' A@ L 4. Chicken Chow Mein............................ 6.15 Dou
�," r_ M 0 2. Chicken w. Broccoli................................. 29.99
a 1r ,, ,� L 5. Chicken w. �
� Snow Peas........................ 6.15
i U X L 6. Moo Goo Gai Pan ............ ...... ........ 6.15 A Wx 3. Shrimp w. Mixed Vegetables................... 31.99 tr r• \ l , •
^. 4 L 7. Golden Chicken Finger 6 15 1�E J vew ;�uimm r
Alt L 8. Chicken w. Cashew Nuts 6.15 Afi 4. Chicken Wings......................................... 13.29
g 1* 11 L 9.1L, Kung Po Chicken ................................ 6.15 fi A 4- 5. Sizzling Scallops & Beef......................... 31.99 Chinese Food To Take Out & Eat In
Q A L10. Chicken w. String Bean....................... 6.15
k it L11.iL, Orange Flavor Chicken....................... 6.35 = 4� 6.-%, Beef, Chicken, Shrimp w. Broccoli (No M.S.G. Added to Any Items)
T # L12.a. General Tso's Chicken ........................ 6.35 & Garlic Sauce........... 29.99 950 Sullivan Ave., South Windsor, C.T. 06074
� �wfL L13. Sesame Chicken................................. 6.35
a A L14.i Chicken w. Garlic Sauce..................... 6.15 4 7.'►. General Tso's Chicken 29.99
k� It L15. Fried Chicken Wings (4)...................... 6.15 4- 8. Beef with Broccoli.................................... 29.99 TEL: (860) 644-6683 C' 51 3
1i fio J-It L16.'#,, Chicken w. Eggplant in Garlic Sauce.. 6.15
3 X X L17. Roast Pork w. Broccoli........................6.15 0 9. Sesame Chicken ...... .. ....... . .. 29.99
x� e L18. Roast Pork Egg Foo Young.................6.15
- - � fkx + 10. Pepper Steak with Onion......................... 29.99 DELIVERY
X x&,- 0 X L19. Roast Pork w. Chinese Veg.................6.15
X 1 40 (Min.L20. Roast Pork Lo Mein . ...................... 6.15 Ot 11. Shrimp Lo Mein........................................ 29.99 $ 15.00)
44 L21. Boneless Spare Rib Tips.................... 6.35
s; P�9 4- L22. Beef with Broccoli............................... 6.35 r�i°ski+�n 12.E Singapore Chow Mi Fun.......................... 24.99
� & � L23. Pepper Steak..................................... 6.35 � � �� It13. Boneless Spare Ribs............................... 29.99 OPEN 7 DAYS A WEEK
�- 4 � L24.� Hot & Spicy Beef..... Mon.-Thur.: 11:OOam-10:30pm
;A 41 � L25.� Beef w. Hunan Style...................... . .. 6.35 Q s 14. Chicken w. String Beans......................... 24.99 Fri. & Sat.: 11:00 am - 11:00 pm
Q lil 4- L26.i Beef w. Szechuan Style ............... 6.35 ] 16. Teriyaki Beef 12 .. 22.99 Sunday: 12:00 noon - 10:00 pm
Wx t, L27. Shrimp Chow Mein............................. 6.35
s; PA L28.i Broccoli w. Garlic Sauce 5.65 � �� 17. Sweet& Sour Chicken............................. 21.99 We Accept: l VISA...............
W A L29. Shrimp with Lobster Sauce.......... ..... 6.75 X K 18. Roast Pork Fried Rice.............................. 18.99 (Min. $10.00) (No Checks)
s; PA Wx L30. Shrimp w. Broccoli........................ ...... 6.75
1 Wx 1-31.%� Hot & Spicy Shrimp...................... 6.35 - 19. Crab Rangoon (30)................................... 15.99 Purchase $30 or MoreGet 2 Liter of Soda
1i1 W L32. Shrimp w. Cashew Nuts............... 6.75 . At : , tz 20. Steamed or Fried Dumplings 24 14.99 1 FREE
g TX-, 93 L33.'►. Kung Po Shrimp........................... 6.75 Purchase $45 or More Get Double 2 Liter 1
AA Tt) #x L34.1►. Shrimp w. Hunan Style................. 6.75 1 $ 21. Teriyaki Chicken(12)................................ 20.99 1 of Soda FREE 1
Q lil Wx L35.i Shrimp w. Szechuan Style ........... 6.75 1 or 10% OFF 1
L36. Beef w. Garlic Sauce......................... 6.75 ��.
9j, L37.'►. Shrimp w. Garlic Sauce..................... 6.75 Baca
s Wx L38. Shrimp w. Snow Peas......................... 6.75 Graham Rd_
Cn
k A, #R L39. Fried Jumbo Shrimp (5) ...................... 7.85 a v 3
� Hot & Spicy o m
A L40. Fried Scallop........... ........................... 5. 5 o
If You Want Some Other Dishes, z m m v
You Can Order Some From the Other Side of the Menu Hill Side Rd ;v
"f ( &r� �� Route 5