HomeMy WebLinkAboutFLI-05-2022-172070.TIF (e ) Application for Temporary Food Establishment Permit
(To be completed for each booth)
515 lee applies I Please make checks payable to Catawba County Environmental Health
c a t a w b a county Moil to:Catawba County Environmental Health, PO lox 389, Newton, NC 28658
public health
■*I!IG Iiviie SIMI "All parts of this application must be filled out before turning in"
Establishment Name eCC�t e.c_ �� Id /h i.�." ' Inn't P ��� - 7 �d
Operator/Owner Name C�, ICu1 n ; ()oit 731307
Mailing Address I )3 ICE ClCa l -0 '7 CY-le id C _ k- 3 3
Telephone (daytime) ( e9' or;Ike .3I) 1 (evening)
E-mail Address: C,177,1 .it-4 /Gz..t j 6U-' Clill i, C0.v.
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Name of Event/Festival/Carnival;etc. tf_'� a,c2,.% $M ia v O. I Ii 01 t-A;t t i\\CC t t CC(c(1:Uk.4
Dates 8 Times of Operation '")/ 5 3 -1 /„ (0 — (0 I/2-
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Event Location SILL Setup Completion Date 8 Tm iia in
Signature of applicant & Z "
Menu: Attachmenu or list oil food itemsto 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 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.
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Foods Prepared and Cooked Offsite:
Name of Permitted Establishment
NC DENR Establishment ID#
Establishment Owner/Manager
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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 C Q e
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Sources of all meat, poultry, seafood and shellfish:
Method of storing and disposing of wastewater:
Booth sketch:
Draw the food booth, identifying and describing all equipment, including handwoshing facilities, equipment washing
fedlities, 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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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/ehmain.asp.
A brochure explaining the rules and requirements in detail is available on the Catawba County
Environmental Health website at http://www.catawbacountync.gov/EnvlronmentalHealth/
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
CATAWBA COUNTY
H� y G 100A SOUTHWEST BLVD
1 NEWTON,NORTH CAROLINA 28658 RECEIPT
V log CD �� 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-40356242-23-05-2022
PAYMENT DATE: 05/23/2022
PAYMENT TYPE: Check 1024
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-22-406780 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-05-2022-172070
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 1960 HWY 70 SE,HICKORY NC 28602
Applicant CRAZY FRIED THINGS, 11310 OBT#177,ORLANDO,FL 3287
C:6092163121
Paid By RED CARPET AMUSEMENTS INC, 11310 S ORANGE BLOSOOM TRL SUITE 177,ORLANDO FL
328379421
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 05/23/2022 09:30 Page 1 of 1