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Home My WebLink About2018-12-21 - 1739 Ellington Road - Food Permit Application Bento s°" SC4< Town of South Windsor — Health Department 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 �J,S0R atabllshrnent Information New Permit❑ Permit Renewal Type: Mobile/Itinerant Vendor❑ Temporary Event❑ Permanent Food Service Establishment I� ***(Please Print Clearly)*** CLASS:4 FEE DUE: 275 Name of Establishment: Bento Nouveau INC Name of Person in Charge: Sai Aye Establishment Street Address: 1739 Ellinton Road City, State, Zip Code: South Windsor, CT 06074 Phone#: (905)513-3860 Cell Phone#: (267)474-8220 Fax#: (905)513-9855 E-Mail Address: tdoctor@bentosushi.com Seating Capacity:0 Please submit latest copy of the Certified Food Protection Manager/ServSafe certificates to the office. Certified Food Protection Manager YES g NO ❑ Certificate#: 15109910 (CFPM) (Required for ALL Class 2,3&4) Name: Sai Aye Expiration Date: 05/10/2022 Testing Organization: ServSafe Phone#: (646) 359-3660 E-Mail Address: jcheung@bentosushi.COMAltemate Phone#: Alternate Person In Charge Aung Zaw Phone#: Restaurant O vner Contact Infori-nation Owners Name: Bento Nouveau Inc. Please check one of the following for ownership status: Mailing Address:25 Centurian Drive, Suite 208 Individual❑ Association ❑ City, State, Zip Code: Markham, ON L3R 5N8-Canada Corporation g Partnership❑ Other Legal Entity❑ Phone#: (905) 513-3860 Fax #: (905) 513-9855 E-Mail Address:tdoctor@bentosushi.com Cell Phone#: (267)474-8220 Renovations Were there any renovations made last year? YES❑ NO [a' Will there be any renovations? YES❑ NO [, If Yes, please list all renovations that were done/to be done: RECEIVED DEC 21 2018 SOUTH WINDSOR HEALTH DEPARTMENT aul64l AO*N sf'Q< Town of South Windsor — Health Department + � 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 80R Co November 30. 2018 Dear Food Service Operator. All food service permits expire in South Windsor on December 31. 2018. To renew your permit, pleasc: 1. Please complete the enclosed application and submit to the Health Department with a copy of your menu, CFPM certificate (Class 2-4 only), and permit payment. Your registration will be considered incomplete without all four of these items. You can mail, fax, hand deliver, or scan and email (heather.oatis'uisouthwindsor.ort:) the required documents by December 22, 2018. 2. You can also visit wv�,w.southwindsor.org/fsremistration to complete your registration by December 22, 2018. You will need an electronic copy of your menu and CFPM certificate (Class 2-4 only) to upload as part of the registration. Your registration will be considered incomplete without these items. You may then mail or hand deliver payment to the Health Department(addresses listed above). Please note, there are several changes to the process this year. 1. The application has been modified to reflect the requirements of the FDA Food Code that will be adopted no later than January 1, 2019. 2. The payment amount due can be found on the top of the first page and is based on your establishment class and seating capacity. The fee schedule has been included for your reference. Please contact the Health Department at (860) 337-6173 if you have any questions about this process or what your class is. >. Effective July 1, 2018, Qualified Food Operators (QFOs) are now known as Certified Food Protection Managers (CFPMs). CFPM are required to work in the establishment. Expiration dates on your training certificate will be enforced. If it has been more than five years since your certification (ex. ServSafe) you will be required to retake the exam and obtain a new certificate. A current and valid certificate is required to process your license application. Thank you, in advance, for quickly completing your registration for 2019. If you have any management or CFPM changes throughout the calendar year, the contact information can be updated using the same registration form or link. Sincerely. D P6 Heather Oatis, REFIS.. HHS Environmental Health Officer .� w AIN ServSafe" CERTIFICATION AI AYE far sumenfuly conV6tinq 4w sat 6th Via°4v&Sery a Food art Gerti�i Exan" w6ch is accredited by tha Anwic S Instive{,4N"SI Facx�Prdactican(CFPI. 109910 52 UMBER EXAM 5/10 5/10/202 GATE OF DATE Of EXPIRATIO, Lccd 6w s qrp .C ncy 6 recotmealenn roquirer #&. Now sa ausw �d.s►rs�, ` w «m .0 SIDES Japanese Chicken Dumpling (150 Cal) $4.99 Japanese Pork Dumpling (150 Cal) $4.99 MENU Seaweed Salad (110 Cal) $4.99 Shrimp Shumai (350 Cal) $4.99 Edamame (150 Cal) $2.99 PLATTERS, Sapporo (1240 Cal) 40 pieces of California,Spicy California, \ Cucumber & Avocado rolls $29.99 Kyoto (2050 Cal) 59 pieces of Orange, Red and Spicy California Rolls with Shrimp, BBQ Eel &Tuna Nigiri $39.99 Tokyo (2230 Cal) 52 pieces of California, Spicy e n o California, Veggie California, Alaska, Shrimp, Dynamite &Avocado Rolls $49.99 SUSHI Please order platters 24 hours in advance either in store or online at bentosushiusa.com • Plus applicable taxes • Product may contain raw seafood • All products are handmade in a location that also uses milk,sesame&sulphite ingredients •All items are served with ginger, wasabi and soy sauce unless otherwise noted FRESH SUSHI , • Please ask our chefs for custom orders as this is our standard menu • Some locations may not carry all items listed 2,000 calories a day is used for general nutrition advice, MADE DAILY but calorie needs vary, Additional nutrition information available uponrequest. SUSHI BOATS a FAMILY PACKS * COOKED * VEGGIE * RAW Assorted California Boat (600 Cal) $9.99 6 pieces of California, 6 pieces of Spicy • Mini Vegetable Roll (250 Cal) $4 99 California & 6 pieces of Veggie California Cucumber and Avocado rolls made mini California Family Pack (900 Cal) $13.99 • Veggie California Roll (260 Cal) $6.99 8 pieces of California, Spicy California Carrots, avocado & cucumber & Vegetable California Rolls topped with sesame Tuna Family Pack (720 Cal) $16.99 Veggie Spring Roll (300 Cal) $6.99 24 piece mix Mix of cucumber, avocado, carrot, red cabbage & mango in rice paper COMBOS FRAYS, e California Roll (280 Cal) $5.99 Crab stick, avocado & crisp cucumber Spicy Spring Roll & Sushi Combo (570 Cal) $7.99 Spicy California Spring Roll (380 Cal) $6.99 4 pieces Spicy California Rolls & Veggies & spicy crab, wrapped in rice paper 3 pieces Spicy California Spring Roll s Spicy California Roll (370 Cal) $5.99 Volcano Roll & Nigiri Combo (600 Cal) $12.99 Zesty crab mix fresh chili, Combination of Salmon Nigiri,ShrimpNigiri, cucumber & spicysauce Tuna Nigiri & Salmon Volcano Roll • Shrimp Tempura Roll (370 Cal) $8.99 Nigiri Combo (370 Cal) $11.99 Tempura Shrimp with cucumber 4 pieces Salmon Nigiri, & avocado, topped with teriyaki sauce 2 Shrimp Nigiri & 2 Tuna Nigiri * Green Dragon Roll (330 Cal) $7.99 Deluxe Combo (430 Cal) $12.99 California Roll topped with fresh avocado Combination of tuna hosomaki, salmon, Green Dragon Crunch Roll (300 Cal) $8.99 tuna &shrimp nigiri, masago &ikura gunkan • Green Dragon Roll topped Crazy Combo (820 Cal) $12.99 with seaweed salad & fried onions California roll topped with avocado, shrimp, masago, tobiko & spicysauce a Rainbow Roll (280 Cal) $10.99 California roll topped with salmon, tuna &shrimp California Roll & Nigiri Combo (820 Cal) $9.99 Combination of 6 California Rolls, 2 Salmon Tropical Tuna Crunch Roll (340 Cal) $9.99 Nigiri, 2 Shrimp Nigiri and 2 Tuna Nigiri California roll topped with tuna, teriyaki sauce, mayo, fried onions &mango California Samurai Combo (300 Cal) $8.99 Variety mix of Cali Roll, Tuna Nigiri, e Atlantic Salmon Avocado Roll (360 Cal) $7.99 Salmon Nigiri & Shrimp Nigiri Fresh Salmon and Avocado Salmon Lovers Combo (600 Cal) $12.99 * Spicy Atlantic Salmon Roll (390 Cal) $7.99 3 pieces of Spicy Salmon & Salmon Avocado Salmon, cucumber & green onion with spicy mayo Rolls, 4 Salmon Nigiri &8 Salmon Hosomaki Tuna Avocado Roll (310 Cal) $7.99 Salmon Avocado & Nigiri Combo (390 Cal) $9.99 Fresh tuna and avocado 3 pieces of Spicy Salmon&Salmon Avocado Rolls,4 Salmon Nigiri&8 Salmon Hosomaki a Spicy Tuna Roll (340 Cal) $7.99 Tuna, cucumber & green onion and spicy mayo ��f T � b ��i�� WRcaW)RoII &4 Tuna l g�t4i BOWLSTuna Shogun Combo (480 Cal) $13.99 A bit more than the samurai with spicytuna roll, salmon nigiri, tuna nigiri &shrimp nigiri Teriyaki Chicken Rice Bowl (510 Cal) $7.99 Beef Rice Bowl (480 Cal) $7.99 Tuna Sushi Combo (510 Cal) $13.99 A tuna filled mix of spicy tuna roll, tuna 2,000 calories a day is used for general nutrition avocado roll, tuna nigiri, &tuna hosomaki advice, but calorie needs vary. Additional nutrition information available upon request.