HomeMy WebLinkAbout2017-12-18 - 1735 Ellington Road - Food Permit Application Higashi fiAO*" 84r4c Town of South Windsor — Health Department
o 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
30R•C�� 4`
Restaurant Establishment Information New Permit❑ Permit Renewal ❑
***(Please Print Clearly)***
Name of Establishment: �l
Manager's Name: V ^ ih L t n
t w►� `1ti'l �l
Street Address: ! 7 3 5 �,�t;,r,y�,1
City, State, Zip Code: ,So� f �/�Y a(S V,1 e !
Phone#: L0 V —7 29 Cell Phone#:
Fax#: v
E-Mail Address: %L�`u t! ytthoa Cco. Seating Capacity:
Please subtnit latest copy of the Qualified Food Opera tor/ServSafe certificates to the office.
YES® NO [-I (Required u Certificate#: Q
Qualified Food Operator: �.,�� $,4) 1.275 —
Name: '"onq S 'M;t,4 La U Date: a 2 12-. ;/0
Testing Organization: /;,; ;f:'.d ujv�sSiana( j-y�+Gt_ Phone#:
E-Mail Address: Alternate Phone#:
Designated Alternate 1: T1 n� tm i►+ L�n Designated Alternate2 : �; � yue i�iQ►n
Restaurant Owner Contact Information
Owner's Name: t4
Street Address: ( 7 3 (✓ <` nt
City, State, Zip Code: _Sr,;,itj?�i.n[ S�'Y Cl 0 (; o? �l
Phone#: 77$ Fax #:
E-Mail Address: `r/,,; { 'two roA00, cow Cell Phone#: W.10--926 gq j�
Renovations
Were there any renovations made last year? YES❑ NO jX Will there be any renovations? YES❑ NO LK
If Yes, please list all renovations
that were done/to be done:
Mailing Address to send Food License Renewal Permit to:
Name of Restaurant/Company: T'"A"i-e Res5L.41ya-.
Attention: J 711 n y. L r,A
Address: t 73.5' FLLi-,1t-11 k3d
City, State, Zip Code: _],.rihw i4 ser_ C j U
Phone#: An 14 — 7288
Restaurant Menu/List of All Items Served/Sold
Latest Menu Attached? YES P9 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.
Additional Information
Please check one only:
State Licenses: ❑ Bakery UQ Liquor Permit ❑ None
Water Supply: K Public _Private Well
Wastewater Disposal: -�_Public _On-Site _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. 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): �on ��ao`�1'Iv►'I licit
Applicant Signature: 6WL ,' Date: (,2
�� !
i
Office Use Only
Inspector Name (Print): Q j
Inspector Signature: D Date:
Food Class: 1 ❑ 2 ❑ 3 [�4 ❑ Expiration Date: I Z(31
Date Received: Date Approved:
' C",� A LZS `o`0-
I �
�ertified rofessionaa - food � anager
designa'tion has been conferred upon
TONY Sr=1AO MING LW
who has met all the professionarrequirements for certification.
Exam 1403 Recognized By Conference For Food Protection
�-- Certificate No: 1275825
Exam Date: 02/24/04
` Test Code: 6203301403
Dou is F. Campbell, CFSP Certificate expires no later than: 02/24/09
t
NI
APPETIZERS COMPLETE DINNERS FRIED RICE OR NOODLE
1. Age Tofu...........................................................................................5.25 Served with Miso Soup, Salad, Vegetables and White Rice 53. House Special Fried Rice...............................................................9.95
2. Yakitori.............................................................................................4.50 A. Tempura: 54. House Special Lo Mein.................................................................10.95
Grilled Skewered chicken in teriyaki sauce (Coated in lightly batter and gently deep fried)
1. Chicken Chicken Breast and Vegetables) 12.95 55. Fried Rice: (Chicken, Beef, Shrimp, Pork, or Vegs).....................8.00
3. Beef Negimaki.................................................................................7.25 ( 9 ).................................
2. Fish (Fish and Vegetables)................................................... 15.95 56. Lo Mein: (Chicken, Beef, Shrimp, Pork or Vegs)..........................9.00
4. Asparagus Beef Maki............................................... .......7.50 ....
••• •• 3. Jumbo Shrimp (Shrimp and vegetables) 57. Pad Thai w. Shrimp and Vegs. or Chicken or Beef......................9.95
Beef, asparagus, onion .................................15.95
5. Chicken negimaki. .........................................................................6.50 4. Seafood Combo..................,................................................17.95 58. Singapore Chow Fun w. Shrimp and Vegs or Chicken or Beef..9.95
Grilled Chicken and scallion roll in teriyaki sauce (Shrimp, Scallops, Fish and Vegetables) FROM SUSHI BAR
6. Tempura...........................................................................................7.25 B. Teriyaki:
(No Sushi or Sashimi Substitution w. Soup & Salad)
Lightly fried shrimp, chicken and vegetables (Grilled meat or seafood in teriyaki sauce) 59. Sushi Beginner..............................................................................13.95
....................................
7. Tatsuta Age............................
Deep fried chicken' Japanese Style 2. Beef.......................................................................................15.95
60. Sushi Dinner.................................................................................. 15.95
8. Edamame.........................................................................................4.25 3. Salmon or Red Snapple.......................................................15.95 (9 pieces sushi and 1 spicy crab roll)
Boiled green soybeans 4. Shrimp or Scallop................................................................16.95 61. Sashimi Dinner.............................................................................. 17.95
9. Gyoza or Vegetable Gyoza.............................................................4.95 5. Seafood Combo (Shrimp, Fish, Scallops)................................17.95 (an Assortment of sliced raw fish)
Pork and vegetable dumplings C. Nabeyaki Udon...............................................................................12.95 62. Deluxe Sashimi For 1 23.00
10. ...................................................................
Shrimp Shumai................................................................................5.25 Thick chewy wheat noodles simmered in broth with tempura shrimp, egg 63. Deluxe Sashimi For 2................................................,,,,•„......•......45.00
Steamed shrimp dumplings and traditional topping. (Choices of chicken tempura or shrimp tempura,
11. Wasabi Shumai ...............................................................................5.95 No Miso Soup & Rice). 64. Deluxe Sushi
Steam pork dumplings with wasabi D. Beef or Chicken Negimaki ............................................................15.95 For 1 (11 pieces, sushi and 1 spicy crab roll)..........................18.95
12. Green Mussels................................................................................6.95 (Grilled beef or chicken and scallion roll in teriyaki sauce) For 2 ( 22 pieces, sushi and 2 rolls).........................................37.00
Steamed pacific green mussels in house special sauce E. Asparagus Beef Maki....................................................................16.95 65. Roll Combo....................................................................................15.95
13. Kaki Fry............................................................................................7.50 (Beef, asparagus, onion) (1 rainbow roll, 1 California roll, 1 cucumber roll, 1 spicy crab hand roll)
Deep frier)breaded oysters F. Yakisoba: (fried soba noodle) 66. Spicy Roll Combo......................................................................... 16.95
14. Sushi Appetizers.............................................................................9.00 1. w. Chicken &Vegetables.....................................................11.95 (1 spicy tuna roll, 1 spicy salmon roll, 1 spicy crab roll,
3 pieces sushi and 1 California Roll 2. w. Shrimp or Beef&Vegetables.........................................13.95 1 spicy crab hand roll)
15. Sashimi Appetizers.........................................................................9.50 G. Yaki Udon: (fried thick chewy wheat noodle) 67 ....................................... 18.95
Assorted raw fish . Chirashi...................................................
1. w. Chicken and Vegetables ................................................11.95 (Assorted sliced raw fish and vegetables on a bed of rice)
16. Blacken Tuna...................................................................................7.50 2. w. Shrimp or Beef&Vegetables.........................................13.95 68. Una-J u B.B.Q eel served on a bed of rice 16.95
Lightly seared sliced tuna H. Sho a aki.......................................................................................14.95
17. Mixed Sunomono........ 7,50 g y 69. Sushi and Sashimi Combo...........................................................19.95
•••••••••••••••••••••••••~••••••••••••........................•••• (Sliced pork tenderloin sauteed with special ginger sauce) 70. Deluxe Sushi & Sashimi For 1 ...........24.95
..........................................
8. Wakame Salad.................................................................................4.95 I. Katsu (Breaded and deep fried to golden brown) 71. Deluxe Sushi & Sashimi For 2 49.95
.....................................................Spicy Seaweed salad 1. Chicken or Pork ..12.95 72. Tuna & Salmon Special ........23.00
.................................................................
6.95 ........................................................19. u a.................................................................................................. 2. Shrimp or Fish......................................................................13.95 (Sushi, Sashimi& a spicy salmon roll)
Seafood salad with miso dressing •••"""..................••
20. Soft Shell Crab J. Ginger Chicken..............................................................................14.95 73. Blacken Tuna Dinner Blacken tuna on a bed of rice ..................20.95
................................................................................7.25 (Slice Chicken in ginger sauce) ( )
Deep fried with teriyaki sauce
21. Volcano K. Spicy Seafood Udon Soup............................................................15.95 SUSHI A LA CARTE
..............................• ...........................7.50 (Scallop, shrimp, mussels, squid, crab stick, fish cake.
Salmon, white fish, scallop baked on scallop shell. No Miso Soup & Rice) (Sushi: Two Pieces Per Order)22. Vegetable Spring Roll.....................................................................4.95 SPECIAL-ASIAN & CHINESE Sushi Sashimii
74. Tuna (Maguro)......................................................................4.50 6.50
CUISINE ENTREES 75. White Tuna .........................................................................4.75 6.75
SOUP & SALAD Served with White Rice
23. Miso Soup........................................................................................1.50 76. Yellow Tail (Hamachi)...........................................................4.50 6.50
24. Clear Sou 35. Chicken w. Broccoli (or Mixed Vegetable).....................................9.95 77. Salmon Sake 4.50 6.50
p.......................................................................................1.50 36:'�Kung Pao Chicken ..........................................................................9.95 (Sake).....................................................................
25. House Special Seafood Soup (For 2)............................................7.25 78. White Fish (Hiromi)..............................................................4.50 6.50
26. 37. Cashew Nut Chicken.......................................................................9.95 ..................4.50 6.50
Garden Salad...................................................................................1.95 38:� 79. Squid (Ika).........................................................' Thai Curry Chicken..........................................................................9.95 80. Octopus tako 4.50 6.50
27. Avocado Salad..................................................... ....3.95 p ( ).....................................................................
••••••••••••••••••••••• 39. Basil Chicken ..........9.95
.........................................................................
28. Higashi Salad ..................................................................................5.25 40:46- 81. Shrimp (ebi).........................................................................4.50 6.50Chicken w. Garlic Sauce ................................................................9.95 82. Sweet Shrimp 4.50 6.50
House Salad with crab, tempura falke and masago p.....................................................................
41.`'�Hunan Chicken ................................................................................9.95 83. Surf Clam (Hokkigai) 4.50 6.50
29. Spicy Crab Salad.............. 6.25 42:0 General Tso's Chicken 11.50 """"""""""'""""""""""" ""
...............................................................
Cucumber, spicy crab, crunchy tempura flake and masa o """""""""""""""•"""""""""""""""""'
11.50 ( )........................................................
g 43. Sesame Chicken Crab- Stick Kanikama 3.25 5.25
30. Calamari Salad ............................................................................
...............................................................................7.25 44. Beef w. Garlic Sauce.................................................................... 11.50 85. Egg Omelette (Tamago)....................................................... 3.25 5.25
45. Hunan Beef.....................................................................................11.50 86. Tofu Skin (Inari)................................................................... 3.25
COMBINATION DINNER 46. Beef w. Broccoli ............................................................................11.50 87. Eel (Unagi)............................................................................4.50 6.50
(w. Miso Soup, Garden Salad, Fresh Fruit) 47. Beef w. Mixed Vegetables.............................................................11.50 88. Salmon Roe (ikura)..............................................................4.50 6.50
31. Chicken or Shrimp Tempura and Teriyaki Chicken 17.95 48. Jumbo Shrimp w. Vegetable.........................................................12.50 89. Flying Fish Roe (Tobiko).....................................................4.50 6.50
32. Chicken or Shrimp Tempura and Teriyaki Beef or Salmon.......18.95 49." Jumbo Shrimp w. Garlic Sauce....................................................12.50 90. Smelt Fish Roe...................................................................4.50 6.50
33. Chicken or Shrimp Tempura and Sushi or Sashimi ..................19.95 50. Happy Family.................................................................................15.50 91. Scallop................................................................................4.50 6.50
34. Teriyaki Chicken and Sushi or Sashimi......................................19.95 51.1 Hunan Shrimp................................................................................12.50 92. Sea Urchin (Uni)..................................................................5.50 8.00
52. Basil Shrimp...................................................................................12.50 93. Smoked Salmon.................................................................4.75 6.75
A LA CARTE ROLL AND HAND ROLL
Rice add $1 oo) � "!i Hand Roil
1. California Roll Crabstick,Avoca(Brown R
Avocado, Cucumber.......................4.25 3.75 /
2. Eel Roll Eel, Cucumber.........................................................4.75 3.95
� CompletecApunch
3. Tuna Roll ............................................................................4.25 3.95 Lunch Hours: 11:00 am-3:00 pm
4. Cucumber Roll...................................................................3.25 2.75 Exclude Sunday& Holiday
5. Yellow Tail Roll...................................................................4.25 3.95
6. Avocado Roll......................................................................3.75 2.95 Served with Miso Soup, Garden Salad,
7. Oshinko Roll......................................................................3.75 2.95 (Edamame or Fried Shumai or Fried Gyoza) &White Rice (,r
dwle�
8. Salmon Roll........................................................................4.25 3.75 (Vegetable Fried Rice, or Brown Rice add $1.00)
9. Peanut Avocado Roll.........................................................4.50 L 1. Chicken Teriyaki................................................................7.00 Since 1997
10. Mixed Vegetable Roll.........................................................4.25 L 2. Beef Teriyaki ...8.00
11. Salmon Skin Roll Salmon skin, avocado, cucumber..............4.75 3.95 """"""""""""""""""""""""' '"
12. Philadelphia Roll 5.50 4.25 L 3. Salmon or Shrimp Teriyaki................................................8.00
p ............................................................... . Beef Negimaki
Smoked salmon,cream cheese,avocado L 4 ..................................................................8.00
13. Spicy Roll Tuna, salmon, or crab...........................................4.75 3.95 L 5. Chicken Negimaki .........................7.50
14. Spicy Yellowtail or Spicy White Tuna Roll......................4.95 4.25 L 6. Nabe aki Udon No Miso sou ......7.50
15. Tuna Avocado(or Cucumber) Roll................................... 5.50 y ( p)
L7. Yaki Soba..........................................................................7.50
16. Alaskan Roll.......................................................................8.95
Inside:smoked salmon,cucumber outside:fresh salmon&avocado. L 8. Yaki Udon .........................................................................7.50
17. Rainbow roll.......................................................................8.95 L 9. Pork er Sauce .
Sho a aki Gin 7.50
Inside:crabstick,cucumber,outside:fresh salmon&avocado g y ( g )............
18. Tempura Roll...................................................................... 7.50 L9a. Ginger Chicken.................................................................7.50
19. Spider Roll ........ ........... ...... ........................................... 8.95 L10. Pork or Chicken Katsu......................................................7.50Je 4M
Soft shell crab,cucumber,avocado and roe L11. Tempura (Shrimp, Chicken and Vegs.) ....7.50
.........................
20. Higashi Roll........................................................................ 9.95 L12. Sushi Beginner (4 pieces cooked sushi and 1 California Roll)......9.00
Inside:tuna,salmon,white fish Outside:flying fish roe
21. Buckland Roll ....................................................................7.95 L13. Sushi (4 pieces sushi and 1 California Roll)................................9.00
inside:spicy crab,smelt fish roe outside:avocado L14. Roll Combo (Rainbow roll and cucumber roll) ..........9.00
22. Windsor Roll L14a. Spicy Roll Combo (Spicy tuna roll and spicy crab roll)..........9.50
.............................9.95
Inside:blackened tuna,salmon outside:avocado
23. Super Higashi Roll ...... .. .. .. .............................11.95 L15. Sashimi.............................................................................9.50
Inside:two shrimp tempura,surf clam,flying fish roe.
Outside:eel,avocado -
24. Lobster Roll Lobster meat, flying fish roe,lettuce..................11.95 Any Two Roll 9.50
25. Crazy Tuna Roll................................................................ 10.95 An Three Roll 12.50
Inside:spicy tuna outside:white tuna w.flying fish roe. y
26. Green Dragon Roll............................................................. 8.95 (Served with Soap atiu oa+ad)
Inside:cucumber,eel outside:avocado
27. Red Dragon Roll...........................................................
... 10.95 Sweet Potato & Onion Peanut Avocado Shrimp Tempura
Inside:spicy salmon outside:blackened tuna,smelt fish roe California Tuna Avocado Chicken Tempura
28. Dynamite Roll ....................................................................6.50 Philadelphia Tuna Cucumber Boston
Fully cooked in tempura style-salmon,white fish&avocado w.
spicy sauce&smelt fish roe. Mixed Vegetables Salmon Avocado Eel
29. Sweet Potatoes and Onion Roll....................................... 5.25 Tuna Salmon Cucumber Salmon Skin OPEN HOURS: Qi ,'�Q■
Tempura Style Vegetables Salmon Spicy Tuna Mango Avocado •�•
30. Boston Roll Shrimp, egg omelette, avocado&lettuce.............7.50 Mori. - Thurs.: 11:00 am - 9:30 pm •'�
31. Sic Shrimp Roll.............................................................. 7.50 Yellowtail Spicy Crab Oshinko Roll
Spicy p Friday: 11:00 am - 10:00 pm �-ti
32. Butterfly Roll...................................................................... 9.95 Avocado Spicy Salmon ram,■,-
Inside:Sweet potatoes outside:eel,avocado Cucumber Spicy w. Tuna Saturday: 12:00 noon - 10:00 pm .■ J
33. Orange Roll...................................................................... 10.95
Shrimp, Spicy crab,avocado wrapped with soy paper -_ - -_- _ _ _ - -._---_ Sunday: 12:00 noon - 9:00 pm
34. Christmas Roll...................abit.biko,................................. 10.95 SPECIAL ASIAN CUISINE: LUNCH SPECIAL
Tuna,salmon,blackened tuna,wasabi tobiko,avocado
wrapped w.cucumber Monday - Friday: 11:00 am - 3:00 pm.
35. Ever teen Roll.......tuna.....sabi.............voca....................... 10.95 Served with Vegetable Fried or White Rice and miso Sou Tel. :
(860) 644-7788
Spicy�almon,blackened tuna,wasabi, tobiko,avocado 9 p • •
wrapped w.cucumber S 1 Chicken or Beef with Broccoli 7.00
36. Tuna Amazing Roll ........withredt........spic....ayo................11.95 S 2. Chicken or Beef with Mixed Ve s. 7.00 www.higashi-restaurant.com
Spicy White Tuna inside topped with red tuna&spicy mayo. g """"""""""""""""""
37. Spicy Scallop Roll............................................................. 7.95 v ;. - I,u1 Iy a av %. [ i............................................................7.00
38. Mango Avocado Roll......................................................... 5.25 S 4. Cashew Nut Chicken ........................................................7.00 1735 Ellington Road
39. Fuji Roll..............................................................................9.95 S 4.-,%- Thai Curry Chicken...........................................................7.00
Tuna,mango inside,spicy crab&fried sweet potato on top.
40. Summer Roll ............11.95 S 5. Basil Chic
...................................................... ken or Beef .......................................................7.00 South Windsor (Town Center)
Shrimp tempura,mango avocado,inside wrapped with spicy tuna, S 6.^ft- Chicken or Beef with Garlic Sauce ...................................7.00
soy paper(no rice).
41. Fire Dragon Roll .............................................................. 10.95 S 7. Pad Thai (with Shrimp and Vegs.) .............................. .....7.00 If you have food allergy, please speak to the owner, manager, chef or your server.
Salmon,jaiapeno outside spicy tune S 8. Lo Mein (Chicken or Beef or Shrimp or Pork or Veg.) ......7.00 Consuming raw or undercooked meats, poultry, seafood, shellfish, or egg may increase
42. Angel Roll......................................................................... 10.95 S 9. "&- C,eneral iSO`s t.rllcrceti or Sesame Chicken......................7.00 your risk of Foodborne illness, especially if you have certain medical conditions.
Shrimp,avocado,cucumber inside,top with spicy tuna