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Home My WebLink About494 Chapel Road (5) 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 It�SOR CVO Establishment Information New Permit❑ Permit Renewa 4 Type: Mobile/Itinerant Vendor❑ Temporary Event❑ Permanent Food Service Establishment ***(Please Print Clearly)*** CLASS: 4 FEE DUE: 275 Name of Establishment: Kinder Care Name of Person in Charge: We_4-)6\j ) C4 S Establishment Street Address: 494 Chapel Road City, State, Zip Code: South Windsor, CT 06074 Phone#: %coo Q�'D 1 5-7 9 Cell Phone#: % Fax#: Co Lo 10 `iOC15 E-Mail Address: c�k�n�e�c�r'�_c;,,� Seating Capacity: q c) Please submit latest copy of the Certified Food Protection Manager/ServSafe certificates to the office. Certified Food Protection Manager YES NO ❑ Certificate#: I ��--� (CFPM) (Required for ALL Class 2,3&4) Name: ( � Expiration Date: 9 1 � Testing Organization: Phone#: %&O %0 37 C1 E-Mail Address: Alternate Phone#: �L -�- CoLI U) Alternate Person In Charge LAD,-i �� 51�. Phone#: '%C00 D Restaurant Owner Contact Information Owner's Name: Please check one of the following for ownership status: Mailing Address: Individual ❑ Association ❑ Corporation ❑ Partnership❑ City, State, Zip Code: Other Legal Entity❑ Phone#: Fax #: E-Mail Address: Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO`�} Will there be any renovations? YES❑ NOV If Yes, please list all renovations that were done/to be done: RECEIVED JEC 2 F 2018 SCUTH WINDSOR HEALTH)U Ar2T v.ENT Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YE$2 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. Restaurant Food Prep (check all that apply) ❑Cook to order ONLY ❑Advanced catering for specific quantities ❑ Uses Time as a Public Health Control ❑Cooking/cooling/reheating/thawing/freezing/hot or cold holding ❑ Prepares food to serve at another site Prepares food for Highly Susceptible Population(preschoolers or the elderly) Prepackaged non TCS Food Only ❑ Non TCS Food only (food that does not require refrigeration) Additional Information Please check all that apply: State Licenses: ❑ Bakery ❑ Liquor Permit None Water Supply (check only one): Public _ Private Well Wastewater Disposal (check only one): ><— Public _Septic _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 and that I will comply with the ordinances and regulations of the Town of South Windsor and State of Connecticut. I also affirm to allow the Town of South Windsor Health Department access to the establishment as required. 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): Date of Birth: Applicant Address: �, Phone#: Applicant Signature: Date: Office Use Only Inspector Name (Print): Inspector Signature: Date: Food Class: Expiration Date: Date Received: Date Approved: �C\ k -:i� 1161 8 rq 2`�� rvSfe • 1`1 it ion;)l Re t Jur'll-it �'c"cfjf'01) lervsnfe CERTIFICATION DAWN MAHAN EY for successfully completing the standards set forth for the Se n Manager Certification Examination, which is accredited by the American National Standard "rence for food Protection (CFP). f R E 4/16/2018 4/16/2023 DATE OF EX DATE OF EXPIRATION Local laws apply.Cho for recertification requirements. CCREDITED PROGRAM ® Sher #0655 iation Solutions 0 'Q r• ' a . In accordance ServScr6 bgo are trademarks of the NRAEF.National Restaurant Association@ and the arc design Contact us with questions at 233 S.Wacker Drive,Suite 3600,Chicago,IL 60606-6383 or ServSafe@restaurant.org. serySafe e ry fe CERTIFICATION LORI SAZINSKI for successfully completing the standards set forth for the Se which is accredited by the American National Standard ante for Food Manager d rtcahon Examination, � Protection(CFP), r� E b` 4/16/2018 4/16/2023 DATE OF EX x_ Local laws apply.Ch DATE OF EXPIRATION Qy for recertification r � � equirements. Arnewan flat #0655 Sher ciaton Solutions In accordance wi Servs06 logo are eadenar6 of the NRW.Noh"Reshurom Association®and the arc design Contact us with questions of 233 S.Wacker Drive,Suite 3600,Chicago,IL 60606,6383 or Sery S<+te®reslaurantorg, CiRiPW HAPPY Whole-grain Granola English Muffin with Sun Butter Scrambled Eggs Kik Whole Grain Cereal Crispy Rice Cereal Peaches Applesauce Oranges Pears Fresh Bananas 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Chicken Beef Patty with Sliced Cheese Cheese Chicken Sliced Turkey and Cheese Whole-grain Pasta Whole-grain Bun Whole-grain Ravioli Rice Whole-grain Crackers Peas Baked Beans Fresh Garden Salad (Mixed Fresh Califlower Vegetable Soup Vegetables) Mandarian Oranges Applesauce Pears Peaches Pineapple 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Cheese Crackers Sun Butter&Jelly Fresh Cucumber Slices Whole Wheat Tortilla Cereal Mix 1% Unflavored Low-fat Milk Whole-grain Bread Saltine Crackers and Dip Sun Butter and Banana 1%Unflavored Low-fat Milk This Institution is an equal opportunity provider (Items listed in parentheses and italics indicate suggested age appropriate substitutions for 1-2 year olds.) 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 ages 12-24 months are served unflavored whole milk and 2+year olds are served unflavored 1%milk. Glt6W HAPPY • my-Al Whole-grain Toasty O's Whole-grain Bagel Whole-grain Pancakes Whole-grain Kix Cereal Whole-grain Chex Cereal Cereal Pears Fresh Orange Slices Mixed Berries Applesauce Fresh Bananas (Mandarin Oranges) (Finely Diced Mixed Berries) 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1 1 1 1 a Chickpeas Mozarella Cheese Beef Sliders Chicken Crumble Sun Butter&Jelly Whole-grain Pasta Whole Grain Pizza Whole-grain Bun Whole-grain Pasta with Whole-grain Bread Tomato Sauce Carrots Corn Green Beans Peas Tomato Soup Peaches Pears Applesauce Pineapple Mango 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Yogurt Cereal Mix cream cheese Cheddar Cheese Cubes (Cheese Slices) Whole-grain Cheese Crackers Whole-grain Granola 1% Unflavored Low-fat Milk Whole-grain Bagel Townhouse Crackers (Crispy Rice Cereal) (Whole-grain Biscuit) This Institution is an equal opportunity provider (Items listed in parentheses and italics indicate suggested age appropriate substitutions for 1-2 year olds.) 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 ages 12-24 months are served unflavored whole milk and 2+year olds are served unflavored 1%milk. lip 4 r GK6W HAPP*( -z- Y-AVM *n� 11 Whole-grain Chex Cereal English Muffin with Sun Butter Yogurt Whole-grain Biscuits Whole-grain Kix Cereal Fresh Orange Slices Peaches Blueberries Pears Fresh Bananas (Mandarin Oranges) 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Baked Beans Chicken Cheese Sauce Scrambled Eggs Tuna Whole-grain Pasta Whole-grain Rice Whole Grain Macaroni Whole-grain Tortilla Whole-grain Bread Corn Green Beans Fresh Green Salad Broccoli Vegetable Soup (mixed vegetables) (Finely Diced Steamed Broccoli) Peaches Applesauce Bananas Pears Pineapple 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Yogurt 1% Unflavored Low-fat Milk Cheese Sliced Turkey Cheese Whole-grain Granola Whole-grain Toasty O's Saltine Crackers Cucumber Slices Whole-grain Pita Bread (whole grain cheerios) Cereal This Institution is an equal opportunity provider (Items listed in parentheses and italics indicate suggested age appropriate substitutions for 1-2 year olds.) 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 ages 12-24 months are served unflavored whole milk and 2+year olds are served unflavored 1%milk. � r j P 6W HAPPY �x Lei 0 11 ' Crispy Rice Cereal Whole-grain Pancakes Whole-grain English Muffins Granola Whole-grain Toasty O's Cereal Pears Oranges Peaches Fresh Orange Slices Applesauce (Mandarin Oranges) 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk Chicken Shredded Cheese Diced Chicken Turkey Sausage Patty Sliced Cheese Whole Grain Pasta Whole Grain Tortilla Whole-grain Bun Whole Grain Bisquit Wheat Crackers Carrots Baked Beans Corn Peas Tomato Soup Pineapple Applesauce Mango Peaches Pears 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk 1% Unflavored Low-fat Milk cream cheese Sun Butter and Jelly Cottage Cheese Pretzels house crackers) (town 1% Unflavored Low-fat Milk Whole-grain Bagel Whole-grain Cheese Crackers Snack Mix (whole-grain Biscuit) (Whole-grain Toasty O's) Crackers Milk Kix&Chex Cereal,Pretzels,Raisins (Townhouse Crackers) This Institution is an equal opportunity provider (Items listed in parentheses and italics indicate suggested age appropriate substitutions for 1-2 year olds.) 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 ages 12-24 months are served unflavored whole milk and 2+year olds are served unflavored 1%milk. k