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HomeMy WebLinkAboutEHPR-07-2016-24384.TIF Catawa Co�ty Pubic Heal h � CATAWBA www.catawbacountync.gov/environmentalhealth COUD'TY /' Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 North Carolina Phone (828) 465-8270. Fax(828) 465-8276 PLAN REVIEW APPLICATION FOR A MOBILE FOOD UNIT Submit application form, a complete proposed menu of food items for sale, and a scaled drawing to the Health Department for approval before beginning any construction or renovation. Applications must be reviewed and approved before we can look at your unit. Insufficient information will delay plan review. • Attach a proposed menu of food items for sale. • Attach a diagram of unit containing location of all equipment, storage areas, sinks, and tanks. • Does supporting restaurant or commissary have a well and septic system? If so, a tank check and water sample will be required. A "mobile food unit" means a vehicle-mounted food service establishment designed to be readily moved. All units must report daily to the restaurant or commissary for supplies, cleaning and servicing. Facilities shall be provided at the restaurant or commissary for all aspects of function of a mobile unit including food storage, dry storage, obtaining fresh water, sewage disposal and garbage disposal. An operator is not allowed to maintain foods and products sold in a mobile unit to be stored at their personal residences. If a permitted restaurant or food stand is not capable of handling the extra needs of a mobile food unit a permit will be denied. f� t , • Name of Business: C ra2� + `� `� �� cw-, �1 Owner & mailing address: 17 % 1.00o a\a a CSrfi C> o• e-f C J Telephone #(s): gad gay - S G=1 R Email Address: ©Cc ��, Sc„rc)C`� G Y''tc I • Cow` Restaurant or Commissary supportin• unit: UGCc r4. -5-Gt p an CSS P C>ce cps S State ID # of Restaurant or Commissar : Applicant Signature & Date: "Leading the Way to a Healthier Community" EHealth t ;} CHECK LIST FOR PERMITTING A MOBILE FOOD UNIT (MFU) (Please keep this check list and turn in the rest of this form) Submitted completed application form. Submitted menu. Submitted diagram of equipment layout. Permits and schedule notifications: L/ 1. Mobile food units (MFU) must work in conjunction with a permitted restaurant or commissary within Catawba County and you must report daily to the facility for supplies, cleaning and servicing. A ligAle& must be kept at the facilihich shows this. I/ 2. MFU permits shall be posted at all times. A copy of the last inspection shall also be kept on site and the grade card shall be posted and visible at all times rV 3. Operators must provide a list to the Health Department of all locations the MFU will operate on a routine basis. If the MFU travels to other counties, the operator mus- c - prior to operation. Such lists must be kept current ermit could be suspended! Stora 4. Storage of any and all extra supplies must be kept at the restaurant or commissary rather than your personal homes or vehicles. Adequate storage areas must be established and provided at the base commissary prior to permittin . Cle ng: 5. Cleaning of the unit and extra utensils, coolers, equipment must be done at the restaurant or commissary. The MFU must be kept clean. Wate upply: _units must have a potable water system under pressure with water heatin cilities. '—'- 7. Your unit's potable water tanks must be filled with a potable water hose at the restaurant or commissary at a clean and protected fresh water connection other than an exterior can/ mop wash facility. If the restaurant and/or commiss uses well water as its water source, a sample must be taken pri r t ssuance of permit. 8. The water inlet on the MFU should be located above the sewage outlet connection, have a different connection & size than the sewage disposal connection and it must be kept capped (covered) for protection unless being used. "Leading the Way to a Healthier Community" 00Health t - it Sewag isposal: 9. Your unit's sewage storage or gray water tanks must be 15 % larger than t otable water tanks. 10. The tank(s) must be emptied and thoroughly flushed at the restaurant or commis ry at an established dump station connected to a properly sized and approv on-site sewage system or public sewer system. 11 . All waste connections on the MFU for servicing the waste lines and tanks must be a different size or type than those used for the potable water and should blocated lower than the potable water taps on the unit. Gar ge Disposal: vs- 12. All garbage and other solid waste shall be stored and disposed of in an approve anner. Equip t and Interior: 13. All equipment and utensils must be NSF or other approved commer I equipment with the exception of toasters, mixers, microwave ovens, wat r eaters and hoods which can be residential type. 1 . II cooking equipment must be located within the enclosed unit. 15. All utensils, tables, sinks, cabinets and shelves must be clean and in good repair. All surfaces must be smooth, not readily corrodible and have no open cracks or joints that will collect food particles and slime. 16helves, tables and counters cannot be covered with paper, car ard, or other absorbent material. 17. Hot and cold holding as well as cooking equipment must be provided as need . 18. All floors, walls and ceilings shall be smooth, non-absorbant and easily cl able. Sind 19. At least a single-compartment commercial sink with (2) integral drainboards, rounded corners, backsplash protection and hot/ cold water is required for utensil washing (see attached picture). The sink must be of sufficient size to submerge, wash, and rinse your largest utensils or pots. Domestic sinks are n9t4pproved for this use. Two compartment sinks are recommended. \-/ 20. A separate hand wash sink with hot/ cold water, combination supply faucet, so , and single-service towels is required. Food P tection: 21 . Insect and dust protection must be provided as necessary at window , doors and equipment. 22. All foods shall be obtained from approved sources and handled in a sanitary manner. "Leading the Way to a Healthier Community" 81Health -- ,,., F' ` _ 23. Allotentiall hazardous foods must be maintained at or below 45°F, P Y or at or above 135°F. Cold temperatures shall be 41°F on or after January 1, 2019. 24. n-accurate metal stemmed thermometer that goes from 0°F -220°F (+/-2°F ust be provided to check food temperatures. / 25. Gloves must be worn when touching ready-to-eat food (RTE) or use another non direct food contact way to touch food. Empi ees: 26. Employees shall be clean and wear clean outer clothing and effective air restraints. No tobacco should be used in any form while in the foodservice area. 27. The person in charge (PIC) on-site must have completed a certified food safety protection class within 210 days of issuance of permit unless you already have one that is valid. Dise and Illness: 28. No person who has a communicable or infectious disease that can be transmitted by foods, or who is a carrier of organisms that cause such a disease, or who has a boil, infected wound, or an acute respiratory infection with cough and nasal discharge, shall work in a temporary food establishment in any capacity in which there is a likelihood of such person contaminating food or food- contact surfaces, with disease-causing organisms or transmitting the illness to other persons. An employee health policy agreement must be in place for all employees. "Leading the Way to a Healthier Community" ¢°Health - 1 `01, FOOD HANDLING PROCEDURES Explain the following with as much detail as possible. Provide descriptions of the specific areas of the kitchen and corresponding items on the plan where food will be handled. Explain the handling procedures for the following categories of food. Describe the process from receiving to service including: • How the food will arrive (frozen, fresh, packaged, etc.) • Where the food will be stored • Where (specific pieces of equipment with their corresponding equipment schedule numbers) and how the food will be handled (washed, cut, marinated, breaded, cooked, etc.) • When (time of day and frequency/day) food will be handled 1. READY-TO-EAT FOOD HANDLING (edible without additional preparation necessary, e.g., salads, cold sandwiches, raw molluscan shellfish) 2. PRODUCE HANDLING a. Will produce washed or rinsed prior to use? Yes No b. Is there an a oved location used for washing or rinsing produce? Yes No c. Will it be us for other operations? Yes No Please indicate location of produce washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the produce at this location: 1.1 w'Al be W c-s\n'k5 rnos\ of veS /erod uc of k\A-e_ �ra1/41e ✓ G n Ck •k w .A \ t. c. r OuM (). 1 CA.,-V\ • 3. POULTRY HANDLING a. Will poult a washed or rinsed prior to use? Yes No b. Is there a pproved location used for washing or rinsing poultry? Yes \ . No "Leading the Way to a Healthier Community" SlOC Pt 7 . ,ro. Health c. Will it be ed ed for other operations? Yes V No Please indicate location of poultry washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the poultry at this location: $ uu11 \,,c7._ .,..)aS\n ;n o n cl MCA‘C n 0,:\ e a4- Cow\ n, 7 S.. ..4ri (es\ u‘arp�") arounX rig§ e ( natty. i'rnt -1-v e See r,n'CM and re c&c\ r�r- 6e ick do, ✓I LS e- . 4. MEAT HANDLING a. Will pork apired meats be washed or rinsed prior to use? Yes V No b. Is there an a roved location used for washing or rinsing pork and red meats? Yes L ,No c. Will it be us for other operations? Yes No Please indicate location of seafood washing equipment and describe the procedures. Include time of day and frequency for washing or rinsing the seafood at this location: kece osw \e wiuc.t, care SeC -cooc\ ak\e_SS SQeic G\ arca( bLs A— I au 5k w`, \\ \oe a* Coyti,m:Sseci,1 o-reo as wc-\\ 5. SEAFOOD HANDLING 1 a. Will seafood be washe r rinsed prior to use? Yes No b. Is there an approved to ion used for washing or rinsing seafood? Yes No c. Will it be used for other erations? Yes No Please indicate location of wahDiaciwashing equipment and describe the procedures. Include timeofday and frequency for washing or rinsing the seafood at this location: y wt\\ NO t- 4-3C-S\: 13 an A Pr2¢in) \�A 0\eo.\ c. \- Cawm,SSG.. Grecti a\ .nU0," aenck ',- -Qr - - -e OS "Leading the Way to a Healthier Community" g8DHealth t I 6 ° i ; Mobile Food Unit Diagram 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 surfaces of the unit. 1t,.r4 coc,S\A S,n\-,.._ •t-n0ao\,J _ • ---- tee_- 1111111111111111111111.11111 CS.... WC)( � . Jr "Leading the Way to a Healthier Community" zpaa2oC p4 , gHealth "-- % 1 An example of a sink which complies with the requirement in 15A NCAC 18A, section .2672(e), Specific Requirements for Mobile Food Units which requires: (e) At least a one-compartment sink shall be provided. The sink shall be of sufficient size to submerge, wash, rinse, and sanitize utensils and shall have splashback protection. Drainboards shall be provided as specified in Section 4- 301.13 of the Food Code as amended by Rule .2654 to accommodate the drying of washed utensils. Splashback protection and drainboards must be an integral part of, and continuous with, the sink. These drainboards shall be of sufficient size to accommodate the drying of washed utensils. g ,, t i ,i i Fi l 'Leading the Way to a Healthier Community" 11zpuibIui t g�Heal$h .° 1 * Graz LzN1 , i \A M'. All Baguettes/Croissant come with : -pickled dycon and carrots, fresh cucumber, jaleponos, cilantro, pate, mayolbutter. Toasted. *LOADED=Add egg extra charge. *}sa ckaripak #1. Bork shoulder/belly. n-.,hc4 ; ; Ste, #2. Smoked Beef brisket. #3. RoastedlBbq chicken breast. #4. fried tofu. #5. fried Egg. Egg foils. l rE0-6/ C 4-ct) -- Garliclkimchee fries. Gtr lAcat-aA4nNhttt - Coconut steam rice. Ck `dn — Curry fried chicken. 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Z i; • ", ,c ‹, „, § 'a' ..„ ,.,..„ D�A Y y w, .rny Q � / # A CATAWBA COUNTY i 00 SOUTHWEST BLVD d mRV : H NEWTON,NORTH CAROLINA 28658 RECEIPT /Pe ' PHONE: 828.465.8399 V v^ �y of ¢ �C Thursday, July 28, 2016 1842 sM www.catawbacountync.gov PAYOR: Crazy Monkey Banh Mi Crazy Monkey Barth Mi (0, Sang) PAYMENTS TRANSACTION NUMBER: TRC-754720-28-07-2016 PAYMENT DATE : 07/28/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330992 FLI Mobile Food Unit/Push Cart $150.00 Plan Review Fee TOTAL PAYMENTS : S150.00 EHPR-07-2016-24384 CASE TYPE: Environmental Health Plan Review WORK CLASS: Other FLI SITE ADDRESS: 2321 N CENTER ST, HICKORY NC 28601 Applicant CRAZY MONKEY BANE MI, 1796 WOODLEAF CT,CONOVER NC 28613 C:8282345678 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/28/2016 10:24 Page I or 1 CATAWBA Catawba County Public Health www.catawbacountync.gov/environmentalhealth COUNTY Environmental Health —�� P.O.Box 389, 100-A South West Blvd.,Newton,NC 28658 NorthCarolina\ Phone (828) 465-8270.Fax (828)465-8276 Mobile Food Unit/Hot Dog Pushcart Compliance Agreement We. the undersigned parties, acknowledge by signature that the parties have read and understand the Rules Governing the Sanitation of Restaurants and Other Foodhandling Establishments, 15A NCAC 18A,section.2600,as pertains to the operation of a mobile food unit/pushcart and that the parties understand the responsibilities of each party as required in .2670 - .2672 of the rules and must meet requirements from the 2009 NC FDA Food Code Manual,which include: "Pushcarts or mobile food units shall operate in conjunction with a permitted restaurant or commissary and shall report at least daily to the restaurant or commissary for supplies,cleaning,and servicing. Facilities,in compliance with this section,shall be provided at the restaurant or commissary for storage of all supplies. The pushcart shall also be stored in an area that protects it from dirt, debris, vermin and other contamination. Water faucets used to supply water for pushcarts and mobile food units shall be protected to prevent contact with chemicals, splash and other sources of contamination. Solid waste storage and liquid waste disposal facilities must also be provided on the restaurant or commissary premises." This,the I a day of !Ltju S-4 20110 I, S iia l V VS, DA e V of Restaurant Owner or Mager) (Title) jr j r f-0 located at (Name of Establishment) 2_5 2 1 W `ier— c c. 0,e_ 7-g-6 o / ID# N c-DLIL S 0 SS 1 S'..S- (Address)(Address) 7—,01 S 01 k7certify that I have read and understand the above regulations and hereby authorize (IU v CD , Mobile Food Unit Operator (Name) to operate a push cart/mobile food unit in conjunction with my facility,as required by the rules. I certify that I am authorized to enter into this agreement on behalf of the above listed establishment. I understand that the rules require the unit to visit my establishment each day the mobile food unit operates or pushcart, for supplies,cleaning, and servicing, including replenishing of water and disposal of all solid and liquid waste. I agree to post and maintain a log to be signed and dated by the mobile food unit or pushcart operator upon each visit to my establishment, to produce the log upon request, and to accurately report its contents upon inquiry. I agree to allow all supplies for the unit to be stored in the above listed premises. I agree to provide access to my establishment by the mobile food unit operator or pushcart for these purposes. I understand that the area in my establishment used by the mobile food unit operator is subject to any inspection performed by the local environmental health it agree that if this approval is rescinded, the Catawba County Environmental Health Division♦011/0 Timmediately. N.% �� /A ` I a 7 Iv (Signature) qadififiePermitted Operator rotary (Signature) II V 4111Mobile Food UnidPushc t Operator pub1`G V (Signature) i j �-. �'-) On C Notary Seal :.(P,(Nei,— �� � • My commission expires i'" i �1 ‘� "Leading the Way to a Healthier Community" ��t llllltt�, rI P u i i c Amed.ted) ,leahh '88Healthn Cjç'1 '1\ çTT3j\. Catawba County Public Health www.catawbacountync.gov/environmentalhealth COUI�'TY'_.,---r Environmental Health P.O. Box 389, 100-A South West Blvd., Newton,NC 28658 North Carolina Phone (828) 465-8270. Fax (828)465-8276 Mobile Food Unit/Hot Dog Pushcart Compliance Agreement We. the undersigned parties, acknowledge by signature that the parties have read and understand the Rules Governing the Sanitation of Restaurants and Other Foodhandling Establishments, ISA NCAC ISA, section .2600,as pertains to the operation of a mobile food unit/pushcart and that the parties understand the responsibilities of each party as required in .2670 - .2672 of the rules and must meet requirements from the 2009 NC FDA Food Code Manual,which include: "Pushcarts or mobile food units shall operate in conjunction with a permitted restaurant or commissary and shall report at least daily to the restaurant or commissary for supplies, cleaning, and servicing. Facilities, in compliance with this section,shall be provided at the restaurant or commissary for storage of all supplies. The pushcart shall also be stored in an area that protects it from dirt, debris, vermin and other contamination. Water faucets used to supply water for pushcarts and mobile food units shall be protected to prevent contact with chemicals, splash and other sources of contamination. Solid waste storage and liquid waste disposal facilities must also be provided on the restaurant or commissary premises." This,the I a day of 4-7u 3-1 ,201 Cy I, 'S H6- r /VOlm�� , DWneir of (Restaurant Owner or M' ager) (Title) \I —1'1- located at (Name of Establishment) /' 2� 21 Al 0,07-0-- 41cc- (!�� zgr6o / ID# Nc-Dt4La30S3iS'S (Address) 2.-.°146010k7 certify that I have read and understand the above regulations and hereby authorize %i\(it C_CAinMobile Food Unit Operator J (Name) to operate a push cart/mobile food unit in conjunction with my facility,as required by the rules. I certify that I am authorized to enter into this agreement on behalf of the above listed establishment. I understand that the rules require the unit to visit my establishment each day the mobile food unit operates or pushcart, for supplies, cleaning, and servicing, including replenishing of water and disposal of all solid and liquid waste. I agree to post and maintain a log to be signed and dated by the mobile food unit or pushcart operator upon each visit to my establishment, to produce the log upon request, and to accurately report its contents upon inquiry. I agree to allow all supplies for the unit to be stored in the above listed premises. I agree to provide access to my establishment by the mobile food unit operator or pushcart for these purposes. I understand that the area in my establishment used by the mobile food unit operator is subject to any inspection performed by the local environmental healthl Mil agree that if this approval is rescinded, the Catawba County Environmental Health Division` lk egg rle, immediately. `. ��4 //id's;L (Signature) ��f Permitted Operator Q Wr Pe = �o y F (Signature) ` Mobile Food UniUPushc�t Operator a. p ,Ubkt0 V (Signature) M (C Notary Seal ��91f = 1 • My commission expires Q�►,pf��t�t `� "Leading the Way to a Healthier Community" 3oHeaIth t I `° °,