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Home My WebLink About2011-6-12 - 1060 Main Street - Temporary Food Inspection and ApplicationAntiquc AP'waisalsz‘l 1:00 am-4-zOO Pm éouth Windsor Antique APPraisal Dag C 5un&a5,Junc IZ,2.01 l WHERE: 5outh WinJsor Rehab an&Nursing Ccnt¢r . 1 060 Main 5trcct $5outl1 WimJsor,Ct 0607+ .QWWK M E; TOWN OF SOUTH WINDSOR METHOD:On-Site inspection Kitchen inspection mm (Circle one) Food/Water urce Approved source of food,wholesome,free from spoilage N or Water source potable,from approved supply,food grade hoses utilized Temperature Control "Hot/cold holding equipment and temperatures adequate Cy Nuke Ciao-Wk *0 OI"6’L{" VFood cooked/reheated to correct temperature wan &r.w- Metal probe food thermometer (0 —22OF range)available/sanitized between use N W ”Accurate thermometers for all refrigerators Coolers (self draining)and ice packs/bags Hygiene/Handwa ing x,Hats or effective hair restraints for food workers and washing station —warm water in jug w/spigot,liquid soap,paper towels Gloves for food handling,designated person to handle money Wl if?Scoops to have handles Records Designated person in charge of food booth for each shift logs kept General Food Protection \/o extensive food preparation/handling ,ood protected by wrapping,sneeze guards or other e tive barriers ondiments single service,pump dispensers o w /shakers ,‘HF hot held and not sold discarded daily or at end of event V/60d and single service food containers stored off floor ‘Drinks stored in ice must be stored in self-draining storage containers N)W Raw fruits and vegetables used in food prep to be washed in potable water AQQ (M w~\\BN \Event Name $\,x z Event Date:IL '\ Locatlon of Event s wt mkhw Mb a NMMA (3g ww'.“Ss\~p.w 5c-\ Appllcant/Coord.:($n‘ovx Khucwok.Ph.# Email Address:vwwrL .bmA O‘M 273 (Awkw-Fax # QFOName:'wq\£(ALW Lr Ph.#‘1D 3 *-'”7 CL:K07 O 5‘5 Emall Address.Fax # Toilet Facilities raste Disposal Tn Qb’wA L; 'Toilet facilities adequate,clean”nveniently located Waste water disposal container —disposed ofproperly ontainer for grease collection disposed ofproperly Non absorbent garbage containers fly tlght covers Dumpsters must be covered Garbage contalners and plastic bags Cleaning/Sanitizing Ni ry Buckets/tubs for washing,rinsing,sanitizing food equipment (hot water)mwWhM x/l ”Bleach/Quat.for sanitizing,appropriate concentration,test strips available Utensils are to be sanitized every 4 hours or as needed Moist wiping cloths to be stored in container with clean sanitizing solution Storage/FB Construction ~All utensils/equipment to be properly stored to protect &om contamination Chemicals to be stored separate hem food products,bottles to be labeled N l 1%Food booths constructed properly to protect food,adequate lighting provided COMMENTS QDM Wr \N rbad ox mmwtk Wkwm Cn-R/MewrK“‘5 HEALTH INSPECTOR:W/L l?)uV/Dale: EVENT COORDINATOR:/\/MSignature/(ifapplicable)Date: Signature “A temporary food service establishment serving food 0r drink shall comply with all provisions 0f PublicHealthCode19-13-B42 which are applicable to its operation.” April 2011 Toilet Facilities aste Disposal TA $v¥lw$ Toilet facilities adequate,clean\nveniently located Waste water disposal container —disposed of properlyContainerforgreasecollection—disposed ofproperly Non-absorbent garbage containers,fly tight covers,Dumpsters must be coveredvGarbagecontainersandplasticbags Cleaning/Sanitizing pr Buckets/tubs for washing,rinsing,sanitizing food equipment (hot water)mwvVv‘W x/Bleach/Quat.for sanitizing,appropriate concentration,test strips available Utensils are to be sanitized every 4 hours or as needed Moist Wiping cloths to be stored in container with clean sanitizing solution Storage/FB Construction All utensils/equipment to be properly stored to protect nom contamination Chemicals to be stored separate &om food products,bottles to be labeledNPrFoodboothsconstructedproperlytoprotectfood,adequate lighting provided COMMENTS:\x “m'\c is o\(lei Qac/Qiku,\ Wk $uoek aWI .pwvih Wb-lccoklcu‘Hv?"ia/Ucos/\‘ ,Mm NV'R/IAEH-‘al HEALTH INSPECTOR:/L I?)uv/D&e: EVENT COORDINATOR:NM Signature/(ifapplicable)Date: Signature:K) “A temporary food service establishment serving food or drink shall comply with all provisions of PublicHealthCodel9-13—B42 which are applicable to its operation.” April 2011 VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS C:\D0cuments and Settings\SherryLROy\Local Scttings\Tcmporary Internet FiIeS\OLK50\Temporary Food Vendor Application 2011 Appraisal Day June152011forSowthWindsorHistoricalSociety(2)4doc VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event.This application must be submitted to the Town of South Windsor Health Department,1540 Sullivan Avenue,South Windsor,CT 06074. This apglication is not a license.Temporary food permits will not exceed a period of 1 to 5 days. Today’s Date May 30,201 1 Name of Event Appraisal Day at South Windsor Rehab and Nursing Date of Event:June 15,2011 Time of Event 11am—4pm Location of Event Old Main Street @ Rehab Center Event Coordinator E—Mail Address rivard.brian07 l @gmail.com Event Coordinator Phone #(cell,work &home) Name of Applicant The South Windsor Historical Society Name of Applicants Business (please indicate if mobile vendor) Applicants Address PO box 216 South Windsor CT f.‘a f.”1 5w ,‘1‘}a: Please provide the following:(If any of the following does not apply to you put N/A) 1.List all food and beverage items to be prepared and served (menu).Attach a separate sheet if necessary. NOTE:Any changes to the menu must be submitted to the Health Department 10 days prior to the event. Event Coordinator Brian Rivard Event Coordinator Address Foster Rd Extension Event Coordinator Phone #860.678.4273 Applicants E-Mail Address NA Applicants Phone #(cell,work &home)NA Set up time 9:30 am gm“y%!\it‘'1’“i“a kt. Hot Dogs,Hamburg6rs,Cheese burgers,Bagged Chips,Soda,Water 2.Describe specifically how frozen,cold,and hot foods will be transported to the event. Ice Chest for cold transport. 3.List all places (name &address)where meats,poultry,seafood,shellfish,and ice will be purchased. Sams’club,Bogners for meat,Ice is currently unknown.Will provide info onsite. 4.List names,phone numbers,addresses,and shifts to be worked of all employees.See attachment'#1. South Windsor Historical society members and volunteers,will provide a sign-up sheet on site to the inspector. 5.Use attachment #2 in this packet to sketch a drawing showing the event area and where your operation will be. 6.Describe the number,location and set up of handwashing facilities to be used by employees. 1 hand washing station behind food tent and 1 dish washing station behind food tent. 7.Describe how and where utensil/equipment washing will take place.If no facilities are available, describe how alternate steps will be taken. Will switch out every 2 hours with fresh utensils as well as dish washing station onsite.Commercial Kitchen onsite. 8.Describe how wastewater will be collected,stored and disposed. Buckets to be disposed of in porta—potty or commercial kitchen. 9.Describe the number and location of garbage containers. At least 4 containers dispersed throughout the grounds. 10.Describe what heat source will be used to keep hot foods hot (140 degrees and above). Holding table/chafers ll.Describe how colds foods will be kept cold (45 degrees and below). Coolers 12.Describe how food temperatures are monitored. Probe thermometer. 13.Will foods be prepared on site?If no,where will foods be purchased?(enclose a copy of food license) Foods prepared onsite. NAME OF EMPLOYEE PHONE #ADDRESS SHIFT 1.Brandy Feldmeier (860)33 1—9892 10. F00d Service Area Hand and dish washing station Cold Prep,paper goods table buns /rolls cheese Steam Table/Chafers Hotdog,Burgers Burger,hot dog grill ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS Metal probe thermometer (0 220 degrees F range) Thermometers for all refrigerators Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil Extra utensils:tongs,spatulas,spoons,and knives Water source Buckets/tubs for washing,rinsing,sanitizing food equipment Bleach for sanitizing,test strips for checking Waste water disposal container Container(s)for grease collection Clean wiping cloths and a container to store them in Garbage containers and plastic bags Hats/hair restraints Crates,shelves to store food off ofthe ground Gloves for food handling Hand washing station