HomeMy WebLinkAbout1530 Sullivan Avenue (7) Town of South Windsor— Health Department
r-"^Suilivan Ave.,South Windsor,CT 06074—Mailing Address
Ilivan Avenue,South Windsor,CT 06074—Office Address
A N2hone Number:(860)337-6173 Fax:(860)644-1930
New Perm' ermit�
Type• obile/Itinerant Vendor Temporary Event Permanent Food Service Establishment
***(Please Print Clearly)*** CLASS: FEE DUE:
Name of Establishment:
Name of Person in Charge:
Establishment Street Address:
City,State,Zip Code: C% O(. o``#O
Phone#: Uj t Z., Cell Phone#:
Fax#: y 3 e-3 1 b
E-Mail Address: ""t hti "�`��� t'`a '47 P Seating Capacity:
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Certified Food Protection Manager(CFPM) YES O Certificate#:
Name: V U t _ Expiration Date: l� L4 J 'Zu Z i
Testing Organization: ����, Phone#:
E-Mail Address Alternate Phonme#:
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Alternate Person In Charge Phone#: } 1(_?_, �( j
Please check one of the following for ownership status:
Individual Association Ll--C -
Corporation Partnership Other Legal Entity F jOwner's Name: RECEIVED
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Mailing Address: --
City,State,Zip Code: SOUTH WINDSOR
HEALTH DEPARTMENT
Phone#: Fax#:
E-Mail Address: Cell PhoncA6 i3\ 3 y� 1 c a�
Were there anyrenovations made last year? YES fO''1 Will there be any renovations? YES CO—)f Yes,please list all renovations that ~
were donetto be done:
Latest Menu Attache 0- �E NO W ,,
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Please list all menu items in as much detail as possible a copy of a menu attached is applicable.
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Cook to order ONLY Advanced catering for speck quantities Uses Time as a Public Health
Control
Cookinglcoolingireheatinghhawing/freezing/hot or cold holding repass 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 Liquor Permit None�1
Water Supply(check only one-'Publi Private Well
Wastewater Disposal(check only one): Publi Septic Other(please use space below to explain)
By submitting this application,I affum 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: 1 (Z l( 7S t
Applicant Address: C � — �k" Phone#: L:3 0 _ �p7 -C
Applicant Signature: Date:
Inspector Name(Print):
Inspector Signature:Date:
Food Class: Expiration Date::
Date Received: Date Approved:
„_ r 7
Thomas' Smokey BBQ Soul Food
"A Family Tradition of BBQ"
Specials
"Pit"- Tato
Baked Potato, cheese sauce, sour cream, bacon bits, chives and choice of meat
Pulled Pork - $ 8.00 or Chopped Brisket - $10.00
Grilled Cheese Chopped Brisket or Pulled Pork Grilled Cheese Sandwich - $10.00
Sandwiches
• Pulled Pork with a side of Carolina Slaw— $8.00
• Chopped BBQ Brisket Sandwich with a side of Carolina Slaw — $10.00
• "Pit Bombs"
Pulled Pork, Mom's Mac & Cheese, Carolina Slaw, Bacon, & BBQ Sauce— $10.00
Beef Brisket, Mom's Mac & Cheese, Carolina Slaw, Bacon, & BBQ Sauce - $12.00
BBQ Baskets
(Served with one side of your choice and Carolina Slaw or Corn Bread)
• Pulled Pork - $10.00
• Jerk Chicken Wings -$10.00
• Chopped BBQ Brisket - $12.00
Sides
• Mom's Baked Mac & Cheese - $4.00
• Baked Beans - $4.00
• Collard Greens — $4.00
Jerk Chicken Wings 6 wings for$5.00 Add Celery and Ranch - $1.00
Please feel free to stop by the food truck to place your order or text your name and
order to 860-778-9012 and we will text you when your order is ready. We accept cash
and credit payments.
Thank you!— The Thomas Family