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Home My WebLink About2019-2-1 - 1735 Ellington Road - Food Permit Application Emeralds °"'" Se'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 s Phone Number: (860) 337-6173 Fax: (860) 644-1930 �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: 250 Name of Establishment: Emeralds Eatery Name of Person in Charge: :77#�EOF_ &UAY Establishment Street Address: 1735 Ellington Rd City, State, Zip Code: South Windsor, CT 06074 Phone#: @60 Cell Phone#: _ Fax#: E-Mail Address: �l( f.G' iG'Pr � Seating Capacity: J'r0 Please submit!atest copy of the Certified Food Protection M.anager'ServSafe certificates to the office. Certified Food Protection Manager YES X NO ❑ Certificate#: /4/ ,sf5?S3y (CFPM) (Required for ALL Class 2,3&4) Name: TRJWEd;&41( Expiration Date: Testing Organization: v ( S'�� Phone#: (544)) 41 yy /1Ff E-Mail Address: �,��¢ �� Alternate Phone#: Alternate Person In Charge Kl Phone#: Restaurant Owner Contact Information Owners Name: �.N0,l,Eit) JAu�� Please check one of the following for ownership 3 /� '� status: Mailing Address: /;'///It %Gsv' � Individual ® Association❑ f Corporation ❑ Partnership ElCity, State, Zip Code: f,Q�iKt�Sv4, QT" 0�7y Other Legal Entity❑ Phone#: � J (Plv Fax #: E-Mail Address: C_4q=ric.,,r vo- i > Ae Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO [5 Will there be any renovations? YES❑ NO If Yes, please list all renovations that were done/to be done: B �ourii wrnlpso„ HEALTH DEPikRTMEN+ a Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES X1 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 El 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): Y Public _ Private Well Wastewater Disposal (check only one): X 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): ��,��VF r!—�c Date of Birth: - Applicant Address: 7 do, J d& - 7 Phone#: j Applicant Signature: Date:_- y Office Use Only Inspector Name (Print): Inspector Signature: Date: Food Class: Expiration Date: Date Received: Date Approved: 1,6�;L j L Y 0 -4 '4 TEL 860-644r-51'7Y Daily Special RAL E M E i EATERY D' BREAKFAST SERVED ALL DAY FROM THE GRIDDLE NEW Monte Emerald.....................................$9.95 2 Pancakes or French Toast.............,...............$4.95 French Toast topped with cheese, ham and egg with Bacon, Sausage or Ham.........................$7.50 served with home fries ...$6.75 Emeralds Special...........................................$9.95 3 Pancakes or French Toast with Bacon, Sausage or Ham.........................$9.25 2 Eggs, 2 Sausage, 2 Bacon, 2 French Toast 2 Eggs& 2 Pancakes........................................$7.25 and Home Fries 1 Fluffy Waffle ..................................................$6.95 Ruby Special................................................$11.25 3 Eggs, 3 Sausage, 3 Bacon,Toast and Home Fries Pure Maple Syrup (3 oz.) ••• ••. ......••• •.••. • .$1 75 Sapphire Special -„ $ Waffle, Pancakes or French Toast pP p � ............................... ......... 9.95 with Fruit add $2.75 2 Eggs any style on Hash,Toast and Home Fries Strawberries, Peaches, Blueberries, Apples EGGS SIDE ORDERS 1 Egg, Home Fries, Toast.....................................$4.25 Assorted Cereal.....................................................$1.95 with Bacon, Sausage or Ham.............................$6.25 Hot Oatmeal ..........................................................$3.25 2 Eggs, Home Fries, Toast....................................$5.75 English Muffin........................................................$1.50 with Bacon, Sausage or Ham.............................$7.75 Hard Roll ...............................................................$1.50 2 Eggs, Home Fries, Toast, and Creton................$6.95 Muffins...................................................................$2.50 EggSandwich .......................................................$3.50 Bagel.....................................................................$1.50 with Cheese........................................................$3.95 with Cream Cheese............................................$1.95 Egg Sandwich with Meat and Cheese...................$4.75 Bacon, Sausage, or Ham......................................$3.25 WesternSandwich ................................................$6.25 Home Fries............................................................$2.50 withCheese........................................................$6.75 Single Egg.............................................................$1.75 SubstRute English Muffin or Bagel add $.65 Toast......................................................................$1.35 Mushrooms, Onions or Peppers$.75 extra Corn Beef Hash.....................................................$4.95 Cretan....................................................................$2.00 OMELETTES All Omelettes are 3 Eggs and served with Home Fries &Toast Kid'5 Corner Cheese..................................................................$6.95 r (served with Milk or Juice) " Bacon & Cheese ...................................................$7.95 Mickey Pancake.................................$4.50 or Ham or Sausages $7.95 Mushroom & Cheese.............................................$8.25 1! 1 Egg, Horne Fries,Toast..................34.50 Western with Cheese ..............$8.50 1 Egg, Home Fries, Toast..................35.50 Broccoli or Spinach $8.50 with a pieces 30con or Sausage Veggie....................................................•----..........$9.50 (8 and under) NEW Meat Lovers...............................................$10.95 _ Ham, Bacon and Sausages BEVERAGES N Juice........................................................ Regular$2.25 NEW Phc $10.95 y ............................................... Peppers, Onion and Cheddar Cheese (Orange, Ruby Red Grapefruit,V-8,Apple, Cranberry) Milk........................................................................$2.25 Substitute English Muffin or Bagel add $.65 Chocolate Milk.......................................................$2.50 Mushrooms, Onions or Peppers $.75 extra Coffee, Decaf, Tea................................................$2.50 Egg white omelets$1.75 extra Hot Chocolate........................................................$2.50 Coke, Diet Coke, Ginger Ale, Lemonade and Root Beer ......$2.50 ........................................................ IceTea ..................................................................$2.50 11 Tov OCACf'lnn CUM I MQU 4. Gnr_c❑cni W-Fc TW:aicu nF Fnnn RnMNIP 11 1 tiFcc EMERALDS EATERY LUNCH TE L 860-644-51 cl if (starting at 11:30 am) APPETIZERS BURGER CORNER Soup of the Day..................................Cup$2.95 Bowl$3.95 All burgers served with French Fries and a pickle Cream Soups .....................................Cup$3.50 Bow!$4.50 Emeralds Burger............................................................$9.25 Small Tossed Salad.......................................................$4.49 lettuce,tomato,cheese,mayo,mushroom,onion&peppers withEntree......------•..............................................•-...$2.99 American Burger,Lettuce,tomato,cheese&mayo..................$8.25 Potato Skins w/Cheese..................................................$4.50 with/Bacon &Cheese................................................$6.75 Mushroom Burger, mushrooms, onions&cheese..............$8.50 French Fries............................ $2.50 Dijon Burger,dijon mustard,onions&cheese.........................$8.50 with/Cheese...............................................................$3.25 Veggie Burger,lettuce&tomato..........................................$7.50 OnionRings....................................................................$5.25 Patty Melt.......................................................................$8.25 All burgers cooked medium-well to well. SALADS HOT OPEN PLATTERS All salads served with hot rolls&butter All platters served with choice of mashed potato or French Fries House Salad...................................................................$7 50 and hot veggie or lettuce,tomato. green leaf lettuce,tomato,onions,carrots, Hot Chicken....................................................................$8.95 cucumbers,sliced egg&croutons Hot Open Turkey............................................................$9.95 Chicken Caesar Salad....................................................$9.50 Hot Open Roast Beef.....................................................$9.95 sliced grilled chicken, lettuce,croutons, HamburgerSteak...........................................................$9.95 Romano& Provolone cheese Spinach Salad, spinach, mushrooms&eggs.....................$8.95 Cajun Grilled Chicken Salad..........................................$9.50 Chefs Salad,turkey, ham&provolone cheese..................$9.50 SPECIAL T'S Tuna Salad, chunk white tuna...........................................$8.25 The Gobbler.............................................................$9.50 Crispy Chicken Salad,with Honey Mustard...................$9.50 This tasty tidbit is sure to leave you gobbling for more! Raspberry Chicken Waldorf.........................................$10.50 The Gobbler comes with bacon,turkey,cheese,lettuce, lettuce, raisins,apples,carrots, tomato,and a spread of cranberry sauce served on walnuts,grilled chicken in a raspberry dressing grilled thick Texas white bread with French Fries. Cobb Salad..... Miss Piggy................................................................$9.25 ..........•----...............................................$10.50 lettuce,bacon bits,crushed egg,diced tomatoes, A delicious combination of ham,bacon,cheese,lettuce, grilled chicken and chunky blue cheese dressing tomato on grilled rye bread served with French Fries. Mr. Moo Moo............................................................$9.50 This sandwich is sure to stop anyone's mooing!Comes CLUB SANDWICHES with roast beef,lettuce,tomato and cheese.Served on All clubs are served with lettuce,tomato, grilled rye bread with French Fries. mayo,bacon, French Fries,and a pickle Philly Steak..............................................................$9.25 Hamburger Club.............. $8.95 Steak,peppers,onion,and cheddar cheese served on a Cheeseburger Club........................................................$9.50 roll with French Fries. Ruben.......................................................................$9.25 Turkey Club....................................................................$9.75 Rye Bread grilled with Swiss cheese,comed beef, Ham Club with Cheese...................................................$8.95 sauerkraut,and 1000 Island Dressing with French Fries. Roast Beef Club ............................................................$9.50 Buffalo Chicken Breast Sandwich.........................$9.25 Tuna Club.......................................................................$8.25 Served on a roll and topped with Blue Cheese, served with French Fries. SANDWICHES i F n All sandwiches served with lettuce,tomato,and v pickle,your choice of hard roll,wheat, rye,or white. ��^ ' Kid 5 Corner Ham & Cheese.....................................................$6.50 H (8 and under,served with fountain drink) RoastBeef............................................................$7.95 Turkey Breast with Cranberry Dog with French Fries 35-a5 t4k` Tuna Salad...................................................... ....$6.50 Chicken Nuggets with French Fries 35.25 Egg Salad.............................................................$5.50 i Gritted Cheese with French Fries$4.75 Chicken Salad......................................................$7.50 v Peanut Butter 8,Jelly$3.75 BLT.......................................................................$6.95 National Restaurant •ServSafe ciation TM ry f e CERTIFICATION IRENE GUAY for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute(ANS[Konference for Food Protection (CFP). 5343 ER EXAM FORM NUMBER 3/1/2018 3/1/2023 a0655 DATE OF EX DATE OF EXPIRATION ASTME2659 c..n6cere,v. Local laws apply.Ch cYfor recertification requirements. Sher ciation Solutions � 0 0 In accordance wi e ServSofe logo 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@restourant.org.