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HomeMy WebLinkAboutLongHorn Steakhouse #5296 - 12/31/2021- 057,5 �k� 01 go- FOR BOARD OF HEALTH USE ONLY Permit # Issued FOOD ESTABLISHMENT PERMIT APPLICATION (Applicationon must be submitted at least 30 days before the planned opening date) Establishment Name LongHorn Steakhouse #5296 Establishment Address 390 West Street, Mansfield Establishment Mailing Address (if different) Attn: Licensing, PO Box 695016 Orlando FL 32869-5016 Establishment Telephone No 508-261-8810 Applicant Name & Title: RARE Hospitality International, Inc. Applicant Address 1000 Darden Center Drive, Orlando Fl 32837 Applicant Telephone No.: 407-245-6787 24 Hour Emergency No.: 800-248-4918 Applicant Email rhayward@darden.com Owner Name & Title (If different from applicant) Owner Address Owner telephone number Owner email: Establishment Owned By: if a corporation or partnership, give name, title, and home address of officers or H An Association partner. LXA Corporation Name Title Address H An Individual See attached List H A Partnership H Other legal Entity Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: Joellen Sasville, Managing Partner Address: 15 Cranberry Lane, Berldey MA 02779 Telephone No: 508-261-8810 24 Hour Emergency No: 508-513-7238 FAX: 407-872-370 E-mail: J5.5VIIllj Ce lo Alt E-Mail: District Or Regional Supervisor (if applicable) Name & Title: Robert Botelho, Director of Operations Address: 138 CHestnut St. Rehoboth, MA 02769 Telephone No:407-921-6192 24 Hour Emergency No. 407-921-6192 FAX: E-mail: RBotelho@LongHornsteakhouse.com Food Establishment Information WATER SOURCE: Town SEWAGE DISPOSAL: Town No. of Food Employees: 49 DEP Public Water Supply No: (If applicable) DAYS/HOURS: Sun-Thurs 11AM-10PM Fri -Sat I lAM-11PM Name of Persons) In Charge Certified in Food Protection Management: See attached certificates NaTee f rsh.n in ?,ticoYes Certified in Allergen Awareness Training Name of pest control company routinely inspecting the premises for evidence of pests Ecopest-1-800-325-1671 If there is seating for 25 people or more, a person trained in manual choke saving procedures will be onslte at all times food is being prepared. EX Yes Does this establishment require a FOG permit? Yes If yes, please attach the FOG permit application. Length of Permit: Establishment Type: Annual Q Retail Food $125.00 0 Mobile Food Consesslon 0 Temporary I] Food Service up to 100 INCLUDING NO PHF PREPARED ON SITE $100.00 Temporary Start Date: FOOD TRUCKS $175.00 ❑ Manufacture Frozen Dessertsllce Cream I_ $26.00/freezer [r.�Footl Service up to 101 -20D $250.00 Temporary End Date: Q Food Service up to 201 + $300.00 0 Pushcart $50.00 # of Pushcarts: Temporary Time: © Supermarkets $400 © Residential Kitchen $100.00 Rain Date: [¢�Milk 8 Cream $10.00 li] Caterer t?35.00 Food Operations: Definldons:AIF- �rdou�od�notimeRemporetralure controls rWmd) F'sennollyhazardmis regWred) (Check all that apply): NarPRTE -ready-MeatWilis(Ex.sandwiches,salads, morons wNch nsedno rerdierlumossing) [X Sale of Commercially Pre -Packaged Non-PHFs ffPHFCooked To Order I Hot PHF Cooked and Cooled or Hot Held ❑c Sale of Commercially Pre -Packaged PHFs Iff Preparation of PHFs For Hot And for More Than a Single Meal Service nu Delivery of Packaged PHFs Cold Holding For Single Meal Service PHF and RTE Foods Prepared For Highly Susceptible Population Facility Q Sale of Raw Animal Foods Intended [ Reheating of Commercially to be Prepared by Consumer Use of Process Requiring A Variance Processed Foods for Service Within 4 Hours I] Customer Self -Service and/or HACCP Plan (including bare hand © Customer Self -Service of Non PHF and Non. contact alternative, time as a public health Perishable Foods Onllyy Fr-1control lee Manufactured and Packaged for Foods ) r�Preparation of Non-PHFs Retail Sale (�Offers Raw Or Undercooked Food Of Juice Manufactured and Packaged for Animal Origin Other Food Operations Retail Sale 0 Vacuum Packaging / Cook Chill Ej Offers RTE PHF in Bulk Quantities Prepares Food/Single Meals for El Retail Sale of Salvage. Out -Of -Date Catered Events or Institutional Food Service or Reconditioned Food I, the undersigned, attest to the accuracy of the Information provided in this application and affirm that the food establishment operation gill comply vAth 105 CMR 590.000 and all other applicable law. I have been Instructed by the board of health on how Lain copies of 105 CMR 690.000 and the federal Food Code. Signature of Applica V Kita ria ar0. A enr Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I, to my best knovAedge and belief, have filed all state tax returns and paid state taxes required under law. Social Security Number or Federal ID: 58-1498312 Signature of Individual or Corporate Name: RARE Hospitality International Inc TAX CERTIFICATION FORM I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns, and paid all state taxes required under law. CoLyons, Asst Sec RARE Hospital ty aU Inc d lleen Hu ter Signature of Individual or Corporate Name B � orporate Offic (Mandatonj, i/Appiicabfe) 58-1498312 **Social security No, (Voluntary) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. C:tUu %Iulte\Desktopt5cmrs DoeumenMWood Esmhltshmmu-Temp\TAX CERTWICATION FORMAa The Commonwealth of Massachusetts Department of Industrial Accidents fu Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: RARE Hospitality International Inc dba LongHorn Steakhouse #5296 Address: 390 West Street City/State/Zip: Mansfield, MA 02048 Phone #: 508-261-8810 Are you an employer? Check the appropriate box: Business Type (required): 1. ® I am a employer with 49 employees (full and/ 5. ❑ Retail or part-time).* 6. ® Restaurant/Bar/Eating Establishment 2. ❑ I am a sole proprietor or partnership and have no 7, ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] g• ❑Non-profit 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** ILEJ Health Care 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp, insurance req.] 12.0 Other *Any applicant that checks box #1 must also GII out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #I. Iam an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy information. Insurance Company Name: XL Insurance America Inc Insurer's City/State/Zip: Stamford, CT 06902 Policy # or Self -ins. Lic. # RWD3001138-04 Expiration Date: 6/1/2021 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby cent f under he pains andpenalties ofer''my that the information provided above is true and correct. ARE HOSPITALITY INTERN4TIONAL, INC. Phone #: 800-248-4918 x6787 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/oia Ac"idy® CERTIFICATE OF LIABILITY INSURANCE ATE G0512112020Dmv THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA, Inc. 3031 N. Rock Point Drive West, Suite 700 Tampa, FL 33607 Attn: Tampa.certrequest@mamh.com CONTACT NAME' PHONE aC No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: ACE Property & Casualty Insurance Com an 20699 CN1 01 737850--GAWU-20-21 5296 LONG INSURED Darden Restaurants, Inc. GMRI, Inc. INSURER B: Greenwich Insurance Company 22322 INSURER C: XL insurance America Inc. 24554 INSURER D: XLSpecial I Insurance Com an 37885 1000 Darden Center Cr Orlando, FL 32837 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-004378780-12 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR ism POLICY NUMBER POLICYEFF MMIDDfYYYY POLICY EXP MMIDD LIMITS B X I COMMERCIAL GENERAL LIABILITY RGE3001137-04 0610112020 06/01/2021 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Eam,ournmca $ 1,000,000 X MED EXP(Any one parson) $ LIQUOR LIABILITY PERSONAL&ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 GEN'L X POLICY ❑ jEC LOC PRODUCTS-COMP/OP AGO $ 5,000,000 SIR $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY RAD943779604 06/0112020 0610712021 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IXX BODILY INJURY(Peraccidam) $ PROPERTY DAMAGE Per .odder $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLALIAB X OCCUR XOO G28123383005 06/0112020 06101/2021 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAR CLAIMS MADE DED I X I RETENTION 25000 $ C D D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICERIMEMB R EXCLUDEDIANYPROPRIETORIPARTNEWEXECUTIVE N (Mandatory in NH) MIA RWD3001138-04(ADS) RWR3001139-04 (WI) RWE9435480-04(OH) 06101/2020 06/01/2020 06NV2021 06101I2021 0610112021 XPER OTH- STATUTE ER E.I. EACH ACCIDENT $ 2,000,000 E.L. DISEASE -Eq EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below SIR: $1,000,000 (OH) DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: LongHorn #5296 - 390 West Street, Mansfield MA 02048 This certificate cancels and supersedes all previously issued certificates. CERTIFICATE HOLDER CANCELLATION Town of Mansfield SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board of Health THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 6 Park Row ACCORDANCE WITH THE POLICY PROVISIONS. Mansfield, MA 02048 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee - VsLau ee " .V-Ce-.r.0 byes 01988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD RARE HOSPITALITY INTERNATIONAL, INC. OFFICERS AND DIRECTORS Address all official correspondence to any of the Corporate Officers below to: P.O. Box 695016, Orlando, FL 32869.5016 Name Title Residence William R. White, III President, Treasurer 4035 Gilder Rose Place and Director Winter Park, FL 32792 Joseph G. Kern VP/Secretary 112 Kennison Drive Orlando, FL 32801 Colleen Hunter Lyons Assistant Secretary 11762 Aurelio Lane Orlando, FL 32827 (RARE Hospitality International, Inc. is a wholly owned subsidiary of GMRI, Inc., whic is wholly owned by Darden Restaurants, Inc., a publicly traded company) QkA Vj Town of Mansfield Health Department APPLICATION FOR FATS OILS and GREASE DISCHARGE PERMIT ASAO5 RESTAURANT & FOOD PREPARATION ESTABLISHMENTS Business/ Food Establishment Name: RARE. Hospitality. International Inc. dba LongHorn Steakhouse #5296 Address: 390 W. Street Mansfield MA 02048 Mailing Address_Attn: Licensing#5296 PO Box 695016 Orlando FL.32869-5016 Phone/Fax Number;r407-245-6787 fax 407-872-3768 Email: rhayward@darden.com Contact Person/Title for Grease Traps:-.SLM Michael Cooper 267-429-7431 Name of Company scheduled to .pump internal grease trap(s) monthly: W i ndriver Environmental Name of Company scheduled to pump external grease trap quarterly:. Windriver Environmental. Please attach the following documents to this application: Most recent waste hauler receipt or waste hauler manifest • Appropriate permit fee based on new fee schedule (Checks can be made out to the Town of Mansfield) ITHE UNDERSIGNED HAVE OBTAINED AND REVIEWED THE MANSFIELD BOARD OF HEALTH FATS, OILS, AND GREASE (FOG) REGULATIONS APPROVED AND ADOPTED ON OCTOBER 4, 2018. In consideration of the granting of the permit, the undersigned agrees to the conditions of the permit and ack ledges that the information submitted n these documents is true, accurate and complete. Signed_ _____ Date11/25/2020 Print Name Rita Hayward Agent Facility Operational Information Please answer all questions in this section. If an Item Is not applicable, indicate "N/A". Unless otherwise specified, please print or type. Seating Capacity (per Fire Department Regulation): Seating Capacity (Actual Count): Normal Hours of Food Preparation/Service: Monday 11AM-IOPM Thursday 11AM-10PM Sunday 11AM-10PM Tuesday IIAM-10PM Friday IIAM-11PM Wednesday LAM-IOPM Saturday 11AM-IIPM Please indicate the NUMBER of kitchen fixtures used In your establishment and if it is attached to a Grease Removal Units (GRU/trap) Number in establishment Attached to GRU 2 one of them i 3 compartment sink 6 no Handwashing sink Not including bathroom 1 yes Commercial Dishwasher 1 no Barsink 1 no Mop Sink 0 N/A Garbage Disposal 1 no Ice Making Machines I yes Fryolators 1 yes Grills or Ovens 2 yes Exhaust Hoods 22 Floor drains Other: How are hood vents cleaned? (i.e., in three (3) bay sink, off site by private company): Soaked for at least 7 hours then ran through the dish machine Is dinnerware pre -rinsed before being washed? X Yes If yes, at what station/sink? Dish area in bus bucket lon Grease Traps and Grease Removal Internal Grease Traps How many indoor Grease Removal Units (GRU/trap) are on site? Please list fixtures attached to each grease trap Grease Trap 1 Back of House 50 gal passive ( Under dishmachine under 3 bar sir Grease Trap 2 Back of House 50 gal passive Grease Trap 3 Grease Trap 4 Grease Trap 5 External Grease Traps Does this establishment have an outdoor Grease Removal Unit (GRU/Interceptor)? X Yes No Size 3500 gallons Where Is the existing outdoor GRU located? Dumister Corral If the owner is responsible for external trap pumping, provide the Name, Address and Telephone Number of the property owner below: Property Owner's Name: C'T emcn TT C; Property Owners Address: PO Box 521 Mansfield MA 02048 Property Owner's Telephone Number: 508-339-6316 Yellow Grease Waste Do you store yellow grease waste from fryolators? N/A Where is the grease storage unit located? Dumpster Corral How often is this grease storage unit emptied? 2 x's month Please list the vendor who removes the waste: Windriver Environmental i TOWN OF MANSFIELD LOCAL BYLAWS The following bylaws apply to all food establishments permitted by the Mansfield Health Department: Plastic Waste Reduction; Polystyrene Container Reduction; and Plastic Straw/Stirrer Reduction. A copy of each bylaw is included. It is the responsibility of the applicant to read and understand all bylaws. Please indicate by initialing the following statements that the permitted food establishment will adhere to all applicable bylaws. The applicant and associate corporation are subject to fines associated with violations. Plastic Waste Reduction No retail establishment in the Town of Mansfield shall provide thin-film, single -use plastic check-out bags to customers. I have received a copy of the Plastic Waste Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Polystyrene Container Reduction (effective January 1, 2021) Food establishments are prohibited from dispensing prepared food and drink in disposable food service containers made from expanded polystyrene. All food establishments are strongly encouraged to use reusable food service containers and cutlery, and when possible biodegradable, compostable alternatives. Compostable materials must meet ASTM (American Society of the International Association for Testing and Materials) Standards for compostability. I have received a copy of the Polystyrene Container Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Plastic Straw/Stirrer Reduction (effective January 1, 2021) Plastic beverage straws and plastic stirrers shall not be used or dispensed or sold except upon request in conjunction with the serving by business establishments or at any town -sponsored event of liquid, slurry, frozen, semi -frozen, or other forms of beverages to the public for consumption. I have received a copy of the Plastic Straw/Stirrer Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Applicant Signature Date:_ Applicant Name (please print clearly) NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONA CERTIFIES': JOELLEN E S4SVILLE HAS SUCCESSFULLY SATISFIED THE REQUIREMENT 5 O 1 THE. FOOD SAFETY MANAGER UNDER THE CONFERENCE FOR FOOD PROTECTION ST, N )ARDS PRESIDENT: ICH :AE L.AWRENCE J. L.Y ISSUE DATE: JU E 201; EXPIRATION DATE:JU. E 202 CERTIFICATE NOS 2 4 884: TEST FO,RM}1: XE7 e W U w w V z *-0 z .is V l z z 11 N�J I� W u�} WW m N N 2 Q e MO6Sfi 6751 Forum ➢AVe, Sul(020. bdando, 1102521 P (800) A46i0257 F (407) 352.36091Yww,NRFSP,com National Registry_ofFood safety pmfasstonals• . NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONAL CERTIFIES DANIEL J MARSHALL HAS SUCCESSFULLY SATISFIED THE REQUIREMEP FOOD SAFETY MANAGER UNDERTHE CONFERENCE FOR FOOD PROTECTION SI PRESIDENT: LAWRENCE J.L i ISSUE DATE: NOVEMI EXPIRATION DATE: NovEMI CERTIFICATE IN TEST THE 2018! 20231 k u the Ma vs o Safe company `�rv:ir'isfi't<ife�vf���%f<�ie+vsrrrtf�.:vrvilm?v�rrikrr ( �-. Dantei,Marshti �E, xa✓=narttx�r�t yr/�+-n,.�:llri/ lit. Alv/Oplood $af@ Cotppatty 'htlerg$n"Awaran$s3 EMPIOY , !Food Softly Online Coittto & Exam Patel 11f13/2019 (va!f 4 unfit 11/13J2022) Coarse reference; AA Learner: referencei 1OW6- IhhAtafnirq Ise fat IcoMtrnikv zdcquoi h" toeard V*ielua!w1110 a2&taKatk n applia ion for ACF nv &mloh yiY�iYirF k Nick OMtWood The Always Food Sale Company $1203 President e99 Montrea4 Cir€le, St. pant. MN b3102. Tho Aiways Food Sale Company www.atwaysfaod5afeCom t Congratulations! G ahead and frame the big copy- you've earned ill Keep in your wallet for anytime, anywhere proo you passed! For your manager to keep and admire ]� h x AtWays f , liiWC7}f� �r,�. F�3r$afe t"c�f��,Safe Denle! Matshalt f ,: DWW to " ,t xg 11rt ALravi toil Gvnpu�t' y��� s Aaaiw Awsteness Aaergen Auvenesa �. lry�yot,w6kNNwnm aNw a9krt+ � � <;«pWps twawwtounrewu+l9 saw ? AA rt++ lYnYalll h�rdlYW t4lYaat3t A++� 41nLbCti (xYM(ult lfaLJaY.'n ..,.._nt...... 91dai. m..,M. seas ' �li��lj'��yM�a�y�kripetKafojeArtS� (j/yr�+. nt kgpp9rcdN SiPnneiYq RaVpMda a. ..p»., MMIWObl1 i�YGt9uf111nLY1 K'Ot�lb "�Mi" r..n h04(NWfiiggfD6�iMRia2f9�t hY i rL'F tftlMar00 � a ACiaMm4a � ... NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONA JONATHAN D=WR HAS SUCCESSFULLY SATISFIED THE REQ FOOD SAFETY MANAGER UNDERTHE CONFERENCE FOR FOOD PROTECTION S7 PRESIDENT: LAWRENCE J. L ISSUE DATE: NOVEMI EXPIRATION DATE: NOVEMI CERTIFICATE N, TEST 41 2j 6� 0 W' d Prometric Score Report Congratulations! You passed the, Professional Food Manager exa Your Score is as follows: Score Status ain jDal 77 PASS 1 27111118 FRANCISCO RODRIGUEZ 83 PACIFIC ST CENTRAL FALLS, RI 02863 Tgi Fridays Massacheseffs. Tedeschi the; i t Always2.1,11 a S Safe ,4 r x ! company al. �ev�raa�ntd`i��uav ¢ dir. ' j Francisco Rodriguez: y .t, F�nve 41"C" (41ulCy, roort/tlef I he Always Food sale Company Allergen Awareness Apnro"t Emplol ee Food Safety Online Course & Exam Dates 10/30/2020 (V ilidt until 10/30/2023) .j Course reference: AA } ) Learner reference: 560138 This training Is-ap roved for I continuing education hour toward the initial or recertification apin : Icationfor ACFcertification . �. I i . Nick Eastwood The Always Food Safe Company 0�� i 0 President 899 Montreal Circle, St, Paul, MN 55102. - The Always Food Safe: Company www.alwaysfoodsofe.com Congratulationsl So ahead and frame the big copy-- you've earned it! j s Keep in your wallet for anytime, anywhere pri of you passedl For your manager to keep and a Jrr it I cq Always.zc s Always,} romdSafe 4E Faglm 116fe cornoopony ny 2 �, co 5.2X"C,,cr/r!,' 0,✓�41✓,v1° ,, r ./ ; rr,✓a ,r`I A. Francisco Rodriguez _ Francisco Rodriguez ��,G., tlµ uffYl r4 / fi •. m• AMwn roots soN ept000" ...d.,aw m.Aw p road sof. caroanr Allergen Awareness Allergen Awareness I Srnpb..wreodsM.MdMm e.ura.i s.em Err," Foos sagty 0.11" Caw{. Is room aru, 1013e'2020(vafidt wtd 10130O23) oa« 10r3UR020(vehdt unfit IOWA1023)._ CpN111afMM« AA CwMr Ml4fa[« AA t a nraiflM, ssol3a. UIIMfIH«an<« 660138 This:rainng is appoved f0r i continuing dduwtia / Ths usinlnp i9 approved rOrl<mtinuL19 Bd=6 farI A f hour toward the Oat of recxirtidauod application 1\ hour'. atlio NSUdl fraddn epphralib to xnts n.w! ACf CaNflcatiM MrdManradFfHoaa>a+Y ACF cpUfioarm .trod: Wd"11W. larAlHfPraodlrM1Cam.NY I is, MCJomI 119HpnI,W ChW.sL.Nd.MNr{to iMu«an/eed{aMCemprM Mw«"rtuyflaadwlruvn MWant .NMw1.JCv{u, q.aM MNI 1MNxvYl Yeetl Lla tompsrvj rw«..IMaY1MNW,<um I{{ L