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HomeMy WebLinkAboutApplication 494 Chapel Road (3) �1%0w" SC44 Town of South Windsor — Health Department o r 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 SnR•CO�• Restaurant Establishment Information New Permit❑ Permit Renewal ***(Please Print Clearly)*** Name of Establishment:fl Je,-C_, C),—(E- Manager's Name: � `� S Street Address: 1r.) CI L J City, State, Zip Code: C_ �oC> I Phone#: Cl Cell Phone#: Fax#: cK��_ U 10_UP� S E-Mail Address: ;�Cta4-ja U co�P.c,�^n Seating Capacity: G Please submit latest copy of the Quill?fled Food Operator/ServSafe certificates to the office. Qualified Food Operator: YES L. NO ❑ (Required fh, Certificate#: G Class 3&,':) V p G >0u Name: �a►yn m�i�G> Date: �I a lc Testing Organization: Phone#: �_a�s�_131 w uu , 3 E-Mail Address: '301b9L17 @ ��ca_,F),Coen Alternate Phone#: ,t� Designated Alternate 1: Designated Alternate2 Restaurant Owner Contact Information Owner's Name: Street Address: City, State, Zip Code: Phone#: Fax #: E-Mail Address: Cell Phone#: Renovations Were there any renovations made last year? YES ❑ NO 1%)` Will there be any renovations? YES❑ NO If Yes, please list all renovations RECEIVED that were done/to be done: N 0 V 3 02017 SOUTH WINDSOR HEALTH DEPT. Mailing Address to send Food License Renewal Permit to: Name of Restaurant/Company: L n C1e,- Cae- Le n-5 Attention: fie--) 61 lj Address: Ll 9 9 0}.-3)� ` �DC_k6 City, State, Zip Coder ����� � L� ��C)-j LI Phone#: C4_jD —O5ro-- 1 �,� MONDAY TUESDAYAL r - r r • L 406� Cereal served with English muffin toasted Yogurt served with Whole-grain bagel Cereal, served with BREAKFAST peaches and milk with sun butter, served p pears and milk with cream cheese, banana and milk with served with pineapple oranges and milk and milk LUNCH Pasta with Butter Tacos Baked Whole Grain Chicken and Rice Turkey and Cheese Ravioli Stackers Whole wheat Rotini Tortilla with shredded Ravioli and Tomato Diced chicken served Sliced Turkey and with butter and cheese with peas Sauce with mixed over Rice Pilaf with Cheese on wheat parmesan cheese applesauce and milk vegetable/salad, bak—beans,- crackers served with with green beans, banana and milk applesauce and milk veggie noodle soup, pears and milk oranges and milk VEGETARIAN OPTION Rice Bowl Cheese Stackers AFTERNOON SNACK Cheese crackers with Whole wheat crackers Cheerios and Banana Pears and Cottage Cereal Mix and Milk Milk topped with grape jelly Cheese rcordnnco wtlb Fetleral nml nghtc taro and U S Depart—t d Agriculture(USDA)ciml rlghL-regulnlions and pol¢les the USDA iL-Agenclea WB and employees endm,iullgnc pa,a«peang mar pd mlmpt g USDA programs ore prohlblted ham do blm hag based pn rwe cola,ne0oml ongln sex dlcnbdlty age«re reel or relalmbon f«prmr ilrlghtb rch ntym en y program o,acbmlyconducled or luntlntl by USDA Pcr:ons with di:obilibe;who require allnrnellva meenc.bf cam—n—bon for program lnl«mntlon(eq Brellle lerge print autltotepe A—r—n Sign Langu etc)should conlacl the Agency(St-or lael)where they oppll.d fa benefit.- Intlly-in who ere deef hard of hea,mg«have speech disobll4mc meyconlact USDA through the Federal Relay Service el(B00)B1)-933g Add(.—lly program inlormntionmaybemntlenvnilnhlein lnnguagpp other than English To rlenprogrnm comploml ddiscrimmallon complete the USDA PrWg Diccrlmmallpn Camplamt Form(AD-3021)frond online Dl'+ri • - and o1 enyUSDA�Hiceowrlt,q teller ddrep toUSDA pbd provide In theleher ell Dlthe lnf«m1—requestedlnthef«m TorequeatecopVdthe comploml form call(8M)632-0g02 Dub-1 your comDlbled lorm pr taller to USDA by (1)mall U S Dep«tment d Agriculture Onice of the Ac:l.lenl Secretory f«Civil Rlghlc 14001ndependence Avenue SW—hinglon D C 2 02 50-9410 (2)f,,(202)0g0-1442 ar(3)email program lnlekegQuctle gov Thm lnslpullon is pn equal opportunity Orovltler Water is available to children throughout the day and at all meals and snacks.If no beverage is specified the beverage offered will be water. Children(age 12.24 months)are served whole milk.After 24 months,all children are served 1%milk. www.GrowHappy.me 00000 . . SM F , inderC LEARNING CEN 16 OPS 1n1036 2016 KI ldur(Aie F.ducatlon L I C All nghL Iesel-d I / :r s • - . BREAKFAST Cereal, served with Pancakes served with English Muffins with Cereal served with Cereal, served with peaches and milk pineapple and milk Jelly with peaches pears and milk pineapple and milk and milk LUNCH Pasta with Butter Pizza Mini Sliders Egg Patty and Cheese Sun Butter& Jelly Sandwich Sandwich Whole wheat Rotini Miniature cheese lvtini Slider anztctTeese Egg Patty and cheese Sun butter and jelly with parmesan pizza with corn, on a whole wheat on english muffin with sandwich on whole- cheese and butter peaches and milk bun with green beans, peas, peaches and grain bread with with carrots, pears pears and milk milk tomato soup, oranges and milk. and milk VEGETARIAN OPTION Cheese Sandwich Cheese and English Muffin AFTERNOON SNACK Crackers and sliced Cereal Mix and Milk Cheese and tortillas Crackers and Cottage Peaches served with cheese Cheese yogurt nrdance wilh Federnl ciwl rights few and U S Deperlmnnl of AgriculWrn(USDA)- (USDA) nght,eg ulnhons and pckc the USDA,its Agencies offices and emplpyees and m shlu t,pnrllclpefing In or ed,,lt,ng USDA programs ere p hlbb.from dl bbbmlm booed on race cgla.nebonol on .sev.diceblllly.ape, repnsel pr releliellon fa poor uvh rights activelyin any p,og,em or acllvityconducteda funded by USDA Perconc with dicnblli—who reguee allernelwe moons pfcommunicouon for progrnm i,fa l—(eg Braille.Inrge pool e,d,,i.p,Ame nSign LenOuoge etc(should confect the Agency(Slelep,local)where lhey epphed for benefts Inds A-lbwha ore deaf,herd of hoaring a have speech d—bllihe may contact USDA through the Federal Raley Service W(900)0'/'/-0339 Additionally p gr_ for t—m ey be mode evnileble In languogac ohs,Ihnn Enghch To hle a program comploml of diccnmlo .complete the USDA Program Dis --lmn Cpmpleml F.—(AD-302])found online el hd,I`—escrusdo.0av/cpmpleinl hung oust hlml end of nny USDA otfice.o-Ite a I,—addressed to USDA end pro in the teller ell a the infprme reguesfed in the fam To request a copy bf the , ploinl form.cnll(3 )032-9992 5ubmd your compl,l,d from or Intl,,to USDA by (1)m 1 U S Depnrtmenl of Aqr,u1(u SIT,,d the Assistant Secretary fa Clvll Right 14001nde ,de ,Avenue.SW W eshmg D C 20250.9410:(2)fae(202)090-7442,or(3)smell program ml,Fe(Musde,,v Thlc inchtutmn is on a ,1 opp,n ity provider Water is available to children throughout the day and at all male and snacks-It no beverage is specified the beverage offered will be water. CM6at- 12-24 months)are servod whole milk.After 24 morphs,all children are served 1%milk • �I www.GrowHa .me 013 © 1� Kinde C ppy L LEARNING CEN IG OI'S 10 P"' 7016 KlndcrCaW Edl ll.allon LI C All I I u•sel n d * . Cereal, served with Whole-grain bagel Whole-grain Ceresserved with Cereal, served with BREAKFAST oranges and milk topped with Cream pancakes, served with banana and milk oranges and milk Cheese, with peaches applesauce and milk and milk LUNCH Pasta with Buffer Egg Patty Burrito Mac and Cheese Chicken and Rice Soup and Sandwich Whole wheat Rotini Egg Patty topped with Mac and Cheese with Diced chicken with Sliced cheese on with butter and cheese on a tortilla mixed Rice Pilaf and baked whole wheat with grated parmesan with corn, applesauce vegetable/salad, beans, pears and milk veggie noodle soup cheese with carrots, and milk pineapple and milk banana and milk pears and milk VEGETARIAN OPTION Cheese Burrito Rice Bowl Cereal Mix and Milk Pretzels and Cheese Banana's and Sun Bagel with Cream Pineapple and AFTERNOON SNACK (Townhouse for Butter(milk for younger Cheese Cottage Cheese younger children) children) rordp nee with Fetlrnl ci vil 1,11.and U S Depnrtmen(IN Agr-11 re(USDA)civil righls reguinlions and policies,the USDA,It,Agenciec office:Ind employees nntl lnsUtulipns pedicipating In or pits-In,'Ing USDA programs ere prahibited from discrlmineling based on rote cola,national In—-x disability age or reprisal or roloI.Obb for Inor bull nghls activity in any p rnm or echvlly contluctetl or hindrtl by USDA Persons with di-nbditie-who requae allernnhve means INcommunlcellon for pr.g liformnb-it,g Braille 1—,print,pudiolope Amencon Sign Language a lc)-hould contact the Agency(Slole or lccnl)where thoy epplietl for benehts Individual-who ere deaf,hard ofhenring I,have speech tllpebilllins m nycontocl USDA through the Federal Relay Service pt(800)912-13339 Atldilionolly pronrnm information mn y be mode av oilnble in language-other than English To hleaproprpm compininl of di-cnminolion c motels the USDA Progrnm Diccnmin Ilion Complaint Form(AD-3D2])frond online el htlp llwww pscra molelnl_fI1ni,cult hill,and Many USDA office write n teller oddrecsed to USDA and provide in the teller all of the information reque-letl in lM1e from To requecl acopY o! In,compininl fa call OGG)D32-g 2 Submit your completed form or letter to USDA by (1)mnil US Depodment IN Agrcullure Olfce pl hit Ac-istnnt Secretary for Clvll Itch1-14001ndependence Avenue SW Weshnplon DC 20250A410:(2)fev(202)M-1442 or(3)email progrom lnlakeLQusda Gov Thls inclitulipn is an equal opp,rl biypro d,r Water Is available to children throughout the day and at all meals and snacks.It no it—raga is specified the beverage offered will be water. Children(age 12.24 months)are served whole milk.Ahor 24 months,all chlld..ary served 1%milk. Kinderi E131 Car www.GrowHappy.me 00 © ® . 16 OPS 101035 i' 2016 KrnderCale Ldu ation l I C All I ghis le5er n_1d ts- ,�'� '`'Tat::. / �. •,..i^vr✓'-[^ �'r - l - + • Cereal, served with Bagels topped with Whole-grain Cereal served with Cereal, served with BREAKFAST peaches and milk cream cheese served pancakes, served with pears and milk peaches and milk with applesauce and pineapple and milk milk Homemade Baked Cheese Quesadillas Meatloaf Dinner Pasta and Chicken Cheese Stackers Cheesy Pasta Casserole Whole-grain rotini with Tortillas toasted with Beef patty with Rice Whole wheat pasta with Wheat Crackers with LUNCH mozzarella cheese and cheddar jack cheese, Pilaf, baked beans, diced chicken and sliced cheese with corn, pears and milk peas, oranges and milk peaches and milk carrots, applesauce and tomato soup, oranges milk and milk VEGETARIAN OPTION Rice and Beans Pasta with Butter Sauce Cottage Cheese and Cereal Mix and Milk Yogurt and pineapple CheAa.,�e_and Tortilla Cheese Crackers and Peaches Milk AFTERNOON SNACK cpl dance with Federal civil nghls Inw and U S Depnrlmenl of Agnoulture(USDA)clvlI nghl regulnllons and policies,the USDA ac Agenclec ofhces end employees and lncllluhons penc�ipnting in or pdminlstenng USDA pro bbin are pIh,b—from dlscn noting based on race color n net origin s x d—blllly age o reprisal o,ro 1n,hon for prior ci vil rights acllvdy in any prp nin or aohvily conducletl or lundrd by USDA Pemons wi lh dicnbhb-who repairs allernntive means al communicnlion tar program br—inion(eg Braille large pool audialnpe American Sign Language.etc).should contact the Agency(Slele or local)where they oppn.for bnn-- Inds viduels who ere deaf herd of hearing or hove speech disnbilihas may contact USDA lhrouph the Federal Raley Service nt(900)B'!'!-BO]g Adtlihonplly pr.qm mfpmalion may be matle pvnil nbla in lnngup other then English To file a program complmnl of dlscrimin0on complete the USDA Program Oi:cnminelion Complain)Form(AD-]02])found online el hnpI/—escr usdagpvlcompininl_filing_cust html end at any USDA ofhceo wale matter eddrbi,,d to USDA and provide in the latterrill of the lniormetion reguesled in the form To repuecla copy of the cnplaint form cal l(000)0]2-g0g2 Submit your completed form or lellnrto USDA by mail U S Depnrlmenl of Agriculture Of—of-AscislnnlSecrotary F,ClvilRighic 14001ndependence Avenue-SW Wghinglon D C 21)250-g410;(2)1..(202)000-7442:or(3)in-1 program g- This nsti.bon is an eg 1opportunity provider Water is available to children throughout the day and at all meals and snacks.If no beverage Is specified the beverage offered will be water. Children(age 12.24 months)are served whole milk.After 24 months,all children are served t%milk • • , • www.GrowHappy.me 00 ©� E91 16 OPS 10 10 35 2015 KnulelCWe.I:_d urallon i I C All nq)its reserved