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Home My WebLink AboutFLI-05-2022-172073.TIF °AN catawba county public health AUTHORIZATION OF REFUND Date: 6/7/2022 Case#: FLI-05-2022-172073. 172074 Applicant: Red Carpet Amusements Inc Refund Amount: $150.00 Refund Reason: 2 TFE establishments serving exempt items only Authorizing Signature: 1 1'-P/ �� , 11 --k -V .3./1 Received By Staff: 4U/t/C likCIL�. , i Date: /7/)) catawbacountync.gov Environmental Health Cctcwbo County Government (enter 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. Catawba County, North Carolina - Disbursement Voucher Vendor No. Date: 6/7/2022 Make Payment To: �� Co(„, Voucher No(s) Red Carpet Amusements Ee 11310 Orange Blossom Trail Suite 177 Q 114 �� Orlando, FL 32837-9421 v �� 18 42 ATTACHMENT Prepared by: Julia English Description Amount 2 TFE establishments serving exempt items only. Permit not needed $150.00 Sub-Total Food Tax Sales Tax Total $ 150.00 For Accounting Use Fund Cost Center Object Project Amount Only 110 580200 663000 Total The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) Cps CATAWBA COUNTY �" I00A SOUTHWEST BLVD ` NEWTON,NORTH CAROI,INA 28658 RECEIPT u`,` 0 ,� PHONE:828.465.8399 \\� Tuesday,June 7,2022 1 g 4 2 sti+ www.catawbacountync.gov PAYOR: Red Carpet Amusements Inc Red Carpet Amusements Inc PAYMENTS TRANSACTION NUMBER: 'FRC-41228467-07-06-2022 PAYMENT DATE: 06/07/2022 PAYMENT TYPE: DV INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-22-406783 110-580200-663000 Temporary Food Establishment ($75.00) Fee TOTAL PAYMENTS: ($75.00) FLI-05-2022-172073 CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen SITE ADDRESS: 1960 HWY 70 SE,HICKORY NC 28602 Applicant ICEE STAND IANNI, 11310 S ORANGE BLOSSOM TRAIL,ORLANDO FL 328379421 Paid By RED CARPET AMUSEMENTS INC, 11310 S ORANGE BLOSOOM TRL SUITE 177,ORLANDO FL 328379421 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 06/07/2022 10:20 Page 1 of 1 I 1( ) Application for Temporary Food Establishment Permit (To be completed for each booth) 575 fee applies I Please make checks payable to Catawba County Environmental Health c a t a w b a county Mail to:Cotawbo County Environmental Health, PO lox 389, Newton, NC 28658 public health RUING LIV,N6 ri11[r. "All parts of this application must be filled out before turning in" rLI -0S-)OP> /7)o73 i ,ems► -7- Establishment Name it. �� it __L-Lf€ - b'ii -. 10(1( ► Operator/Owner Name C); rvo, _Llkdlt'1 : I I) (2d 1TC7313 Dq Mailing Address ‘ ( 3 I Ci 1',q T 1' 1-11 c( d 0 t V (-- S?&3 1 Telephone (daytime) IVQG' () ICtr- 0 ( (evening) E-moil Address: CXi4 ? --rl--cA -VA( V? )) 99g 1) 1 CRJ , C.S.j,r-v•_ Name of Event/Festival/Carnival; etc.' LS2 ;, -,Q \J(1(4. L�' . '�l S l L (Cc ailfeL_.Q Dates& Times of Operation r 4 S--(2 43 -tot 1,1 16/(,;(:; u 3 1-ic,L,y ic, r3 -c(49 Event Location V eii 9 ;IFetup Completion Date & Time ``f► Lu /1 Signature of applicant //1A Li jOvti Menu: Attach menu or list all food items to be prepared or served. (6 t (.%-w f rc1 r ."Q-t"? c s. t ai,;c1,i, j 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 1SA NCAC 18A .2659. 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. Foods % 3 e — ! 0o 0 o \ N o o •C .. •t -r I I `�' co - o ..., o 0 00 m •0 0 o a � v Q V V V = OC = _ 0. 0. .� N i r e-+- .s ❑ ❑ El Li ❑ ( F ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CC cw ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 El ❑ 0 ❑ ❑ ❑ 0 s Foods Prepared and Cooked Offsite: Name of Permitted Establishment NC DENR Establishment ID# Establishment Owner/Manager Li) \\ ' *- Establishment Address 4 1 Establishment telephone # In the table below list all foods prepared in the permitted establishment and check all procedures performed there. Foods 3 3 c = v, :.o . ivVVC Zit ►-. ` Q Z Ct = Z a. ,—. - — — . --01101.1. 4 F - •—.- Sources of all meat, poultry, seafood and shellfish: &Ivy Ul Method of storing and disposing of wastewater: r Booth sketch: Draw the food booth, identifying and describing all equipment, including handwashing facilities, equipment washing facilities, cooking equipment, refrigeration, worktables, storage, hot and cold holding units, water source and storage. Describe the floor, ll and ceiling surfaces of the booth. Ttetz-€1 ,S bt,u L-2-;°1%r i \ N cd -> ":" .._.D __ All booths must comply with the requirements listed in 15A NCAC 18a .2665-.2669. A copy of this document is available at http://www.catawbacountync.gov/phealth/ehmafn.asp. A brochure explaining the rules and requirements in detail is available on the Catawba County Environmental Health website at http://www.catawbacountync.gov/EnvironmentalHealth/ TempFood.asp. It is available in English, Spanish and Hmong. 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 ENVIRONMENTAL HEALTH Catawba County Government Center 125 Government Drive I P.O.Box 389 Newton,NC 28658 Phone:(828)465-8270 I Fax:(828)465-8276 ismail. E:H Admit,; CatawbaCountyNC.yor. VAA CATAWBA COUNTY �" '{� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT C.�1 � PHONE:828.465.8399 Monday,May 23,2022 I842 SM www.catawbacountync.gov PAYOR: Red Carpet Amusements Inc Red Carpet Amusements Inc PAYMENTS TRANSACTION NUMBER: TRC-40356245-23-05-2022 PAYMENT DATE: 05/23/2022 PAYMENT TYPE: Check 1024 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-22-406783 110-580200-663000 Temporary Food Establishment $75.00 Fee TOTAL PAYMENTS: $75.00 FLI-05-2022-172073 CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen SITE ADDRESS: 1960 HWY 70 SE,HICKORY NC 28602 Applicant ICEE STAND IANNI, 11310 S ORANGE BLOSSOM TRAIL,ORLANDO FL 328379421 Paid By RED CARPET AMUSEMENTS INC, 11310 S ORANGE BLOSOOM TRL SUITE 177,ORLANDO FL 328379421 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 05/23/2022 09:38 Page 1 of I