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Home My WebLink AboutFLI-08-2016-075763.TIF �A 1`'� ("/,::,, Application for Temporary Food Establishment Permit �' (To be completed for each booth) U • $75.00 Fee Applies �� Please make check payable to Catawba County Environmental Health /g 41, sM Mail to Catawba County Environmental Health, PO Box 389,Newton,NC 28658 Establishment Name C rant 1 M, r d D-Aj c i, 1 E0 - O -, DILe-075 263 Operator Name Tucker [ h. Ir1 Q — - it) ao1713oeng --- Mailing Address PO g0}( ',9v. .icir , ivc?0,4,66 Telephone (day #) $?-,F, — 3(0 —;401-1-2, (after hours) Location of event bobori-tJf j I4 k y Name of Event/Festival/Carnival; etc. b2r fey - Dates & Times of Operation Q C f o b g( 7 -- Please Indicate Setup Completion Time 9 +he 7 Signature of applicant: 4goor, --"'i Menu: Attach menu r ist all food items to be prepared or served. - - d1P 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. Ai-i-otheA I 1 Foods 3 3 E -x -� .- o ct U U U ° ECE1vE. H c) < = a. cc,-?1 . AUG 15 2016 — — CATAWBA CO U. iv•i 1 --- — .ENVIRONMENTAL t-c%,,.'aTH-i Foods Prepared and Cooked Offsite: Name of Permitted Establishment: �'I fliflfl06 Contry Ki t- hen NC DENR Establishment ID# _ ( \®\ 9.Q\ 03 7 7 Establishment Owner/ Manager Kcr± Cob Establishment Address 3L1'1-1-g Miller Brid3e r Cohnelll Sprf'06q A/C �5)61,2, Establishment telephone# 2 - 347 --3500 In the table below list all foods prepared in the permitted establishment and check all procedures performed there. cu Foods 3 3 -� .� o to c‘t v ¢ 0 0 U c a, a. Ac List sources of all meat, poultry, seafood and shellfish: State method of storing and disposing of wastewater: mcfied ",th a n or) 5 i 4-e +on ie Tfe Food List.xlsx Page 1 of 1 How is food handled?cooked? Food/Menu Item Food supplier Thawing Cut,washed,assembled where? Where? Where is item held? Catfish,Pork chops, Reinheart food Taken straight from freezer to Country fried Steak Service no held in freezer in original packagin fryer Under a Heat lamp Fried green tomatoes,Mac N cheese nuggets,corn nuggets,french fries. Reinheart food Taken straight from freezer to Fried pickles service no held in freezer in original packagin fryer Under a Heat lamp Pinto Beans and Collard Greens in Purchased cans from IFH no Shelf to hot plate hot plate to steam table steam table Frozen Biscuit pucks Reinheart no held in freezer in original package freezer to convection oven Bread Warmer Hamburgers,Hotdogs IFH, Bologna,Livermush, Reinheart,May Sausage s Meats no Held in freezer/refrigerator Fryer/Grill Heat Lamp Strawberry Shortcake IFH no held in Refrigerator dip and serve Refrigerator White pepper gravy Reinheart food in bag Service no add dry mix to boiling water steam table Prep at Cole Slaw Restaurant no held in Refrigerator dip and serve Refrigerator Prep at Reheated and held on steam Chicken Dumplings Restaurant no held in Refrigerator table steam table Cinnamon Roll Opened and placed in waffle Waffles IFH no held in Refrigerator iron Refrigerator Lettuce,Tomato, washed and cut at prep sink Onion,Pickles, IFH no andheld in Refrigerator held over ice on a sandwich unit Refrigerator heated on stove top and held Chili IFH no held in Refrigerator on the steam table steam table Fried green Hand breaded and dropped into tomatoes IFH no Washed and cut at prep sink a deep fryer heat lamp https://us2-excel.officeapps.live.corn/x/_layouts/xlprintview.aspx?&NoAuth=1&sessionld... 8/12/2016 ran s COUNTRY KITCHEN The Taste That Takes You Back! POTENTIAL MENU ITEMS Entrees: Homemade Chicken N' Dumplins in a Bread Bowl Famous Country Fried Steak with Old fashion White Pepper Gravy Country Fried Chicken with White Pepper Gravy Homemade Pork BBQ Fried Catfish Filets with Tartar Sauce Virginia Smoked Ham Fried Pork Chops Fried Chicken Tenders Homemade Chili Homemade Chicken Pot Pie Smoked Chicken Fried Chicken Livers Country Sides: Fried Green Tomatoes Fried Pickles Corn Nuggets Fried Mac N Cheese Cole Slaw French Fries Pinto Beans Collard Greens Sandwiches: Thick Sliced Fried Bologna Moonshine injected Bratwurst Pimento Cheese & Fried Green Tomato Chicken Sandwich Fried Catfish Filet Thick Sliced Livermush Pork Chop Hamburgers Hot Dogs Breakfast Biscuits: (Served in the Mornings) Gravy Biscuit Sausage Bologna Livermush Country Ham Dessert: Strawberry Shortcake Banana Puddin' Cinnamon Roll Waffle (Seen on Food Network/Cooking Channel) Beverages: Sweet Tea Lemonade Sweetened with Splenda Bottled Soft Drinks and Bottled Water Inside trailer layout.xlsx Page 1 of 1 2 steam wells Heat plate Char-Grill 2 Deep Fryers Freezer Refrigerator Bread warmer Convection bellow heat oven bellow plate grill Window Door Counter top Three Compartment sink Dry rack Counter top Hand sink window https://us2-excel.officeapps.live.com/x/ layouts/xlprintview.aspx?&NoAuth=1&sessionld... 8/12/2016 Festival source menu.xlsx Page 1 of 1 Type of food Source(where it was purchased) Entrees:Country fried steak,country fried chicken,Fried catfish fillets,fried porkchops,fried chicken tenders, Chopped BBQ Reinheart Food Service/Mays Meats Sides: Fried Green Tomatoes, Fried Pickles, Fried Mac N Cheese, French Fries, pintos, Collard Greens. Reinheart food service Sandwiches: Moonshine injected Bratwurst, Pork chops, Hamburgers, Hotdogs,Bologna, chicken Reinheart Food Service/Mays Meats Breakfast biscuits: Gravy, Sausage Reinheart Food Service https://us2-excel.officeapps.live.com/x/_layouts/xlprintview.aspx?&NoAuth=1&sessionld... 8/12/2016 4'A C CATAWBA COUNTY 7"' OC, 100A SOUTHWEST BLVD fy 6711 y �' -,1, ,,,,,,, NEW T ON,NO RTH CAROLINA A 2865 8 RECEIPT-' , H PHONE: 828.465.8399 V � " Tuesday,August 16, 2016 18 42 srn www.catawbacountync.gov PAYOR: Grannys Country Kitchen Grannys Country Kitchen PAYMENTS TRANSACTION NUMBER: TRC-784615-16-08-2016 PAYMENT DATE: 08/16/2016 PAYMENT TYPE: Check 14962 received by mail INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331643 Temporary Food Establishment $75.00 Fee TOTAL PAYMENTS : $75.00 FLI-08-2016-075763 CASE TYPE: Food& Lodging Institutions WORK CLASS: 73 -Temporary Food Establishi SITE ADDRESS: UNION SQUARE, HICKORY NC 28602 Applicant GRANNYS COUNTRY KITCHEN, PO BOX 1194, ICARD NC 28666 B:8283973588C:8283102642 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/16/2016 10:16 Page 1 of I