HomeMy WebLinkAboutPop's Old Company Store & Tavern TFE App 03 15 16.TIF BA c Application Temporary " '�' '�
�G� A lication for Tem orar Food Esta 1>s 1 rm t
H (To be completed for each booth)
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`C S75.00 Fee Applies
�� � Please make check payable to Catawba County Environmental Health
j8 42 SM Mail to Catawba County Environmental Health,PO Box 389, Newton,NC 28658
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Establishment Name • p O 1110 0.1 _or [ • 0 17-2 G b.it a , e r 11 .
Operator Name Lt ��PP A l... , 1-- Tilt-
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Mailing Address , se . Q 1 ft e • \_
Telephone (day #) 302 7 3 : ...6 n (after r'hours) 30 -7 j 3 " 0-47 R.
Location of event I U ) K3 . NA& n �7- - ( ih &i"1 K C oi, kiO i
Name of Event/Festival/Carnival; etc.0 R Lo C3 A eR1 UpIx f P�I '- /+Cl A s 1 cciu)54
Dates &Times of Operation Gat v�( 4 A.2c.k 1 e f ��1 L9
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Please Indicate Setup Co)/61///_- 4_..Time C i ( A ¶1,00 pen N\Q-cd i O��
Signature of applicant: �� ✓
Menu: Attach menu or list all foofl items to be preparedorerved.
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All foods sold at this Temporary Food Establishment must be prepared and cooked at the permitted site except
foods prepared in another establishment permitted under 15A NCAC I 8A .2602.
Food Prepared and Cooked On-Site
In the table below, check the procedures for each food which will performed on site in the Temporary Food
Establishment.
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Foods 3 " , ct = =
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Foods Prepared and Cooked Offsite:
Name of Permitted Establishment:
NC DENR Establishment ID#
Establishment Owner/ Manager //uAinee
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Establishment Address Atibu
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Establishment telephone# C. 202-753 - ?
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In the table below list all foods prepared in the permitted establishment and check all procedures performed
there.
Foods - Ct
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List sources of all meat, poultry, seafood and shellfish:
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State method of storing and disposing of wastewater:
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All booths must comply with the requirements listed in ISA NCAC I8a .2635. A copy of this document is
available at http://www.deh.enr.state.nc.us/ehs/26.htm.
A brochure explaining the rules and requirements in detail is available on the Catawba County Environmental
Health website. It is available in English. Spanish and Hmon2.
This application must be completed and returned to the Catawba County Environmental Health Department no
less than one week before the date of the event. Vendors arriving at the festival without having submitted an
application will be inspected by the Environmental Health Division after all other vendors have been inspected
and permitted and this application has been completed. All vendors must comply with all applicable rules
before a permit will be issued.
Catawba County Public Health Department
Environmental Health Division
100-A Southwest Boulevard
P.O. Box 389
Newton, NC 28658
(828)465-8270
(828)465-8276 (fax)
(828)465-8200 (TDD)
11?,A, ea, CATAWBA COUNTY
100A SOUTHWEST BLVD
F-4 frikaa a NEWTON,NORTH CAROLINA 28658 RECEIPT
h.
O ®� PHONE: 828.465.8399
ab Tuesday, March 15, 2016
/842 sm www.catawbacountync.gov
PAYOR: Pops Old Company Store
Pops Old Company Store (HYATT, WAYNE)
PAYMENTS
TRANSACTION NUMBER: TRC-637903-15-03-2016
PAYMENT DATE: 03/15/2016
PAYMENT TYPE: Credit Card
INVOICE NUMBER FEE NAME FEE AMOUNT
03-16-326153 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS : $75.00
FLI-03-2016-070075
CASE TYPE: Food& Lodging Institutions WORK CLASS: 90 -Temporary Food Stands
SITE ADDRESS: 101 N MAIN ST, CATAWBA NC 28609
Applicant POPS OLD COMPANY STORE, 101 N MAIN ST, CATAWBA NC 28609
B:8282414011C:3027532670 WAH45 @AOL.COM
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 03/15/2016 12:18 Page I of 1
Temporary Food Establishment
Draw to scale, identifying and describing all equipment,including handwash facilities,equipment,
washing facilities,cooking equipment, refrigeration,worktables,storage, hot and cold holding units,
water source and storage. Describe the floor,wall and ceiling surfac• • • •
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