HomeMy WebLinkAbout976 Sullivan Avenue (3) °*" Sf 4� Town of South Windsor — Health Department
Lo 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
s' 4 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address
Phone Number: (860) 337-6173 Fax: (860) 644-1930
11�SOR•CO•
Establishment Information New Permit❑ Permit Renewal
Type: Mobile/Itinerant Vendor❑ Temporary Event❑ Permanent Food Service Establishment❑
***(Please Print Clearly)*** CLASS: 3 FEE DUE: 100
Name of Establishment: Munch Bus
Name of Person in Charge: "U( pir) e
Establishment Street Address: 976 Sullivan Ave
City, State, Zip Code: South Windsor, CT 06074
Phone#: �� - t(y Cell Phone#:
Fax#: '
E-Mail Address: — ry9 Seating Capacity:
P9ease sutrnit latest cosy of the Certified rood Protection Manager/ServSafe certificates to the office.
Certified Food Protection Manager YES I NO ❑ Certificate#: „ )
(CFPM) (Required for ALL Class 2,3&4) a, L/q V / J
Name: �( •� d_ Expiration Date: P al A.9
t
Testing Organization. AA-t,,6r)x, A�y,y$j fz� Phone#:
E-Mail Address:-1'r),fv ( "'An r1 Alter ate Phone#:
Alternate Person In Charge Phone#:
Restaurant Owner Contact Information
Owner's Name: `44 U�� � � �� Please check one of the following for ownership
! j status:
Mailing Address: q�b O UL�_\/jjn AVrnU , Individual R Association ❑
], 11,_�,' ,/0 /_ Corporation ❑ Partnership❑
City, State, Zip Code: � _ Other Legal Entity❑ _
Phone#: _ b 0 0 `7 3 q (t d(� Fax #:
E-Mail Address: -� 10 �J� C Q�C� fAco Cell Phone#:
0
Renovations
Were there any renovations made last year? YES[Y NO ❑ Will there be any renovations? YES❑ lK ❑
If Yes, please list all renovations _
that were done/to be done:
RECEIVED
On
5'QTH WINDSOR
i-iEAt.t'H' EFARTMENT
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.
Re taurant 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 ❑ quor Permit 1 } None
Water Supply (check only one): �Publl _ 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): v f+1 1 !0 Date of Birth:
Applicant Address: 'C�� M Wl-hd , 6 7 hone#: U q-
Applicant Signature: Date: — p
Office Use Only
Inspector Name (Print):
Inspector Signature: Date:
Food Class: Expiration Date:
Date Received: Date Approved:
1�ti a` CKr-- %
2018-12-15 12:04 RED CABIN 8604329588» P 1/3
°w" 5'r,44 Town of South Windsor — Health Department
1640 Sullivan Ave., South Windsor, CT 06074- Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074-Office Address
Phone Number: (860) 337-6173 Fax: (860) $44-1930
Establishment Information New Permit❑ Permit Renewal
Type: Mobile/Itinerant Vendor❑ Temporary Event❑ Permanent Food Service Establishment❑
***(Please Print Clearly)*** CLASS: 3 FEE DUE: 100
Name of Establishment; Munch Bus
Name of Person in Charge: I U U N 101 nLpe
Establishment Street Address: 976 Sullivan Ave
City, State, Zip Code: South Windsor, CT 06074
Phone#: �VU (-f - N/ Cell Phone#:
Fax#:
E-Mail Address: —")""rJ:y N�►�b,�..�{r' Seating Capacity:
n!ca;c scrsma Cates:copy of the Certmea rood Protection Manager/ServSafe certificates to the office.
Certified Food Protection Manager YES NO ❑ Certificate#: , J D t
(CFPM) (Required for ALL Class 2,3&4) /L
Name: �( Expiration Date: �� �� ) ,
Testing Organization: 114-vena1 jj�L,3Q j j ;�J 1•tf(lt/ Phone#: 4v_ 414 j-7j4 0
E-Mail Address: j'�r t'� n r7 Alte ate Phone*,
Alternate Person In Charge Phone#:
Restaurant Owner Contact Information
Owner's Name: U�� 2 h Please check one of the following for ownership
Status:
Mailing Address: qj(f 6 LjL Giv)jn Individual g Association❑
Corporation❑ Partnership ElCity, State, Zip Code: SU(/tiL J� ki r-,djo ` f_ U6 01 y Other Legal Entity[IPhone#: 6 O u - 3 - q q y J Fax #:
E-Mail Address; —f �tn /I ` off, �' Cell Phone#:
Renovations C l
Were there any renovations made last year? YES[ No ❑ Will there be any renovations? YES❑ IK ❑
If Yes, please list all renovations
that were done/to be done:
RECEIVED
DEC "I 8 2018
SOUTH WINDSOR
HEALTH DEPARTMENT
2018-12-15 12:04 RED CABIN 8604329588» P 2/3
Latest Menu Attached? YES LA NO U
Please list all menu items in as much detail as possible -:: a copy of a menu attached is applicable.
. f
Cook to order ONLY ❑Advanced catering for specific quantities ❑Uses Time as a Public Health Control
`] Cookinglcooling/reheatinglthawingifreezingi 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)
Please check all that apply:
State Licenses: ❑ Bakery C_i Liquor Permit Ll None
Water Supply (r--heck only one): Public _ Private Well
Wastewater Disposal (check only one): Public _Septic _Other(please use space below to explain)
By submitting this application, I affirm that the, fects set forth in it are true and complete and that I will Comply with the
ordinances and regulation5 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
misrepresentatians made on this application may result in immediate shutdown or revocation of my Food Service License for
+iyr the Town of South Windsor,
Applicant flame (Print): ���� / � U { Date of Birth:
_
Applicant Address:_.....'-
Applicant Signature; Date: c!
Inspector Name(Print):
Inspector Signature: Date,.
Food Class: Expiration Date: 4
Date Received: Date Approved: I
3018-17-15 12:04 RED CABIN 8604329588 » P 3/3
THE RED CABrN
976 5ull ivan Avenue
South Windsor, CT 06074
Cell (860) 995-3560
Meatloaf Melt - our meatloaf layered on Texas Toast and melted
cheese 10.00
Turkey Dinner Wrap - sliced turkey, stuffing, and cranberry aioli all
wrapped up in a grilled tortilla shell 10.00
The God Father - breaded and fried chicken served on a roll layered
with lettuce, tomato, basil pesto, and mozzarella 10.00
Classic Reuben - grilled corned beef topped with sauerkraut, melted
Swiss cheese, and our thousand island dressing on served on grilled rye
bread 10.00
Philly Steak Wrap - tortilla shell filled with shaved steak, peppers,
onions, mushrooms, and melted cheddar cheese 10.00
Todd's Funky Grinder - sausage, kielbasa fried onions, peppers, nacho
sauce all topped with shredded mozzarella 10.00
*all sandwiches come with chips and pickles, cash only please