HomeMy WebLinkAboutMee L Yang App 11 01 09.TIF
Application for Temporary Food Establishment Permit
(To be completed for each booth)
v (NOTE: As of July 1, 2008 a $SUM Fee Applies)
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Establishment Name .:eP~
Operator Name L _ cu'i
Mailing Address ^ ~ E`}
Telephone (day loC 6- (after hours) ~~JCZ t'Yt~_
Event/Dates & Times of Operation Kh V. 22 -2-00c
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Please Indicate Setup Completion Time
Signature of applicant:
Menu: Attach menu or list all food items to be prepared or served.
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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 18A .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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RECEIVED
NOV o 2 2009
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Foods Prepared and Cooked Offsite:
Name of Permitted Establishment:
NC DENR Establishment ID#
Establishment Owner / Manager
Establishment Address
Establishment telephone #
In the table below list all foods prepared in the permitted establishment and check all procedures performed
there.
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Foods o o o
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List sources of all meat, Poultry, seafood and shellfish:
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State method of storing and disposing of wast water:
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Booth sketch:
Draw the food booth, 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 surfaces of the booth.
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BA CD CATAWBA COUNTY, NC
100-A South West Blvd
Newton, NC 28658- PERMIT RECEIPT
Phone: (828)465-8399 Monday, November 2, 2009
184 sM www.catawbacountync.gov
Permit Number: FLI-11-09-2298 Invoice Number: FLI-1 1-09-256877
Permit Type: Food & Lodging Institutions Receipt Number: RCPT-000407
Work Class: 73 - Temporary Food Establishment
Address: 1 127 US 70 HWY, Newton, NC
APPLICANT OWNER
MEE L. YANG AMERICAN LEGION POST 48
207 PO BOX 1844
HODGES HICKORY NC 28603
SPARTANBURG SC 29301-
MEE L. YANG
NC
FEE DESCRIPTION DATE FEE AMOUNT
Temporarv Food Establishment Fee 11/02/2009 $75.00
TOTAL FEES $75.00
Date Payment Type Check Number Amount Change
11/02/2009 Check 118 $75.00 $0.00
Memo:
Total Payment: $75.00
11crmilreccipt;fr198b3dI-cdto--loci-89b3-dac21aatib4,19: rpt 11/02/2009 17:18 Page 1 of 1